Inequality

Above Board: Raising the Standards for Passenger Service Workers at the Nation's Busiest Airports

Above Board: Raising the Standards for Passenger Service Workers at the Nation's Busiest Airports

Mason, C. Nicole & Garcia, Lisette
02/01/2012

I n the fall of 2011, the Women of Color Policy Network at New York University's Robert F. Wagner Graduate School of Public Service conducted a survey of over 300 passenger service workers at the region's three major airports: LaGuardia, Kennedy International and Newark Liberty International.
Only workers contracted by the airlines were surveyed. This report focuses on the impact of the low-bid
contracting system on passenger service workers at the airports. It also proposes ways forward and concrete recommendations to raise job quality and performance standards for companies contracted directly with airlines.

Access to, use of and satisfaction with health services among adults enrolled in Brazil’s Family Health Strategy: evidence from the 2008 National Household Survey

Access to, use of and satisfaction with health services among adults enrolled in Brazil’s Family Health Strategy: evidence from the 2008 National Household Survey
Tropical Medicine & International Health, Vol. 17, no. 1, pp. 36-42. 10.1111/j.1365-3156.2011.02866.x

Macinko, J., and M.F. Lima Costa
01/01/2012

Objective  To assess the effects of participation in Brazil’s primary healthcare programme (the Family Health Strategy or FHS) on access, use and satisfaction with health services among adults.

Methods  Data are from the 2008 National Household Survey (PNAD) on 264 754 adults. This cross-sectional analysis compares FHS enrollees to both non-enrollees and those with private health plans. We calculated predicted probabilities of each outcome stratified by household wealth quintile, rural/urban location and sex using robust Poisson regression. We performed propensity score analysis to assess the differences in access among FHS enrollees and the rest of the population, once relevant socio-demographic characteristics and other determinants of access were balanced.

Results  Compared to families with neither FHS enrolment nor private health plans, adult FHS enrollees were generally more likely to have a usual source of care, to have visited a doctor or dentist in the past 12 months, to have access to needed medications and to be satisfied with the care they received. The FHS effect was largest among urban dwellers and the poorest.

Conclusions  The FHS appears to be associated with enhanced access to and utilization of health services in Brazil. However, it has not yet been able to match levels of access experienced by those with private health plans, perhaps because the population served by the FHS is among the poorest, most rural and least healthy in the country.

Demographics, clinical characteristics and outcomes of neonates diagnosed with fetomaternal haemorrhage.

Demographics, clinical characteristics and outcomes of neonates diagnosed with fetomaternal haemorrhage.
Arch Dis Child Fetal Neonatal Ed. 2012 Feb 28. [Epub ahead of print]

Stroustrup, Annemarie and Leonardo Trasande
01/01/2012

OBJECTIVE:

To determine clinical characteristics, demographics and short-term outcomes of neonates diagnosed with fetomaternal haemorrhage (FMH).

DESIGN:

The authors analysed the Nationwide Inpatient Sample, 1993 to 2008. Singleton births diagnosed with FMH were identified by International Classification of Diseases (ICD-9) code 762.3. Descriptive, univariate and multivariable regression analyses were performed to determine the national annual incidence of FMH over time as well as demographics and clinical characteristics of neonates with FMH.

RESULTS:

FMH was identified in 12 116 singleton births. Newborns with FMH required high intensity of care: 26.3% received mechanical ventilation, 22.4% received blood product transfusion and 27.8% underwent central line placement. Preterm birth (OR 3.7), placental abruption (OR 9.8) and umbilical cord anomaly (OR 11.4) were risk factors for FMH. Higher patient income was associated with increased likelihood of FMH diagnosis (OR 1.2), and Whites were more likely to be diagnosed than ethnic minorities (OR 1.9). There was reduced frequency of diagnosis in the Southern USA (OR 0.8 vs the Northeastern USA).

CONCLUSIONS:

Diagnosis of FMH is associated with significant morbidity as well as regional, socioeconomic and racial disparity. Further study is needed to distinguish between diagnostic coding bias and true epidemiology of the disease. This is the first report of socioeconomic and racial/ethnic disparities in FMH, which may represent disparities in detection that require national attention.

Reducing Racial and Ethnic Disparities: The Action Plan from the Department of Health and Human Services

Reducing Racial and Ethnic Disparities: The Action Plan from the Department of Health and Human Services
Health Affairs, 2011. Volume 30 / Issue 10 / October 2011, pp 1822-1829, Published online

Howard K. Koh, Garth Graham and Sherry Glied
10/12/2011

The Department of Health and Human Services (HHS) recently unveiled the most comprehensive federal commitment yet to reducing racial and ethnic health disparities. The 2011 HHS Action Plan to Reduce Racial and Ethnic Health Disparities not only responds to advice previously offered by stakeholders around the nation, but it also capitalizes on new and unprecedented opportunities in the Affordable Care Act of 2010 to benefit diverse communities. The Action Plan advances five major goals: transforming health care; strengthening the infrastructure and workforce of the nation’s health and human services; advancing Americans’ health and well-being; promoting scientific knowledge and innovation; and upholding the accountability of HHS for making demonstrable progress. By mobilizing HHS around these goals, the Action Plan moves the country closer to realizing the vision of a nation free of disparities in health and health care.

Converging Evidence for Neighborhood Effects on Children’s Test Scores: An Experimental, Quasi-Experimental, and Observational Comparison

Converging Evidence for Neighborhood Effects on Children’s Test Scores: An Experimental, Quasi-Experimental, and Observational Comparison
Whither Opportunity? Rising Inequality, Schools, and Children’s Life Chances, G. Duncan and R. Murnane, eds. New York: Russell Sage.

Burdick-Will, J., J. Ludwig, S. Raudenbush, R. Sampson, L. Sanbonmatsu, and P. Sharkey
09/01/2011

Rising income inequality has been found to be associated with rising segregation at the neighborhood level, generating concern about whether neighborhood environments themselves may influence children’s life chances, independent of other individual child and family characteristics. Because poor and minority Americans are overrepresented in our most disadvantaged neighborhoods, any “neighborhood effects” on children may contribute to persistent disparities in overall schooling outcomes across race and class lines in the United States.

A large body of nonexperimental research dating back to the Coleman Report in 1966 has produced evidence consistent with the idea of large neighborhood effects on children’s schooling outcomes. However, drawing causal inferences from these studies is complicated by the fact that the attributes of a neighborhood in which a family lives is likely correlated with characteristics of the family that predict schooling outcomes. These studies are therefore vulnerable to selection bias. The one formal randomized experiment in this literature is the five-city Moving to Opportunity (MTO) experiment, data from which suggests no statistically significant impacts, on average, on reading or math test scores for children in MTO measured four to seven years after baseline. How one should weight the findings from the MTO experiment versus the larger body of nonexperimental research remains the topic of ongoing debate within the research and policy communities.

In this chapter, we try to reconcile the experimental, quasi-experimental, and observational research literature regarding neighborhood effects on children, and we argue that the available findings are more convergent than many people believe. Drawing on a number of recent and unusually high-quality quasi-experimental and observational studies, together with a reexamination of MTO findings across the individual MTO demonstration sites, we believe that the available - 3 - evidence allows us to reject the null hypothesis that neighborhood environments never matter for children’s outcomes. Yet at the same time, the data also do not support the hypothesis that neighborhoods always matter.

In our view, the key question for research and public policy is to learn more about the conditions under which neighborhoods matter for children’s academic outcomes and why. Our ability to answer this question in the present chapter is restricted by the limited number of studies that have employed sufficiently strong research designs to support inferences about neighborhood effects on children’s outcomes, and by the fact that a disproportionate share of the studies that meet this research-design threshold have been carried out in a single city (Chicago).

With these important qualifications in mind, we believe that there is at least a suggestive case to be made that children’s test scores may be most strongly affected by community violence or may respond nonlinearly to concentrated neighborhood disadvantage or community violence. Put differently, what may matter most for children’s cognitive development is to avoid living in the most severely economically distressed or dangerous neighborhoods in the country, neighborhoods that are found in cities like Baltimore and Chicago but, surprisingly, are less prevalent even in other major urban areas such as Boston, Los Angeles, and New York. Given the limitations of the available evidence, we offer these as hypotheses to be tested further rather than as strong conclusions.

2011 Federal Policy Review

2011 Federal Policy Review
Published by the Women of Color Policy Network, August 2011.

Women of Color Policy Network
08/01/2011

This summary of legislative action pertinent to the Network's federal policy priorities assesses how noteworthy acts and trends in Congress affect the lives of women of color, their families, and communities. Covering the areas of economic security, social equity, and immigration, the brief provides updates on the status of reproductive rights, job creation, safety net programs, and the DREAM Act, among other topics. The Network's assessment of the policy implications indicates that although the federal legislative landscape offers some progressive opportunities for women of color, obstacles to their advancement loom large amongst ongoing budget and deficit reduction negotiations.

Resetting our priorities in environmental health: An example from the south-north partnership in Lake Chapala, Mexico

Resetting our priorities in environmental health: An example from the south-north partnership in Lake Chapala, Mexico
Environ Res. 2011 Aug;111(6):877-80.

Cifuentes E, Lozano Kasten F, Trasande L, Goldman RH.
08/01/2011

Lake Chapala is a major source of water for crop irrigation and subsistence fishing for a population of 300,000 people in central Mexico. Economic activities have created increasing pollution and pressure on the whole watershed resources. Previous reports of mercury concentrations detected in fish caught in Lake Chapala have raised concerns about health risks to local families who rely on fish for both their livelihood and traditional diet. Our own data has indicated that 27% of women of childbearing age have elevated hair mercury levels, and multivariable analysis indicated that frequent consumption of carp (i.e., once a week or more) was associated with significantly higher hair mercury concentrations. In this paper we describe a range of environmental health research projects. Our main priorities are to build the necessary capacities to identify sources of water pollution, enhance early detection of environmental hazardous exposures, and deliver feasible health protection measures targeting children and pregnant women. Our projects are led by the Children's Environmental Health Specialty Unit nested in the University of Guadalajara, in collaboration with the Department of Environmental Health of Harvard School of Public Health and Department of Pediatrics of the New York School of Medicine. Our partnership focuses on translation of knowledge, building capacity, advocacy and accountability. Communication will be enhanced among women's advocacy coalitions and the Ministries of Environment and Health. We see this initiative as an important pilot program with potential to be strengthened and replicated regionally and internationally.

Microfinance and Social Investment

Microfinance and Social Investment
Annual Review of Financial Economics, vol. 3, ed. Robert Merton and Andrew Lo. 2011: 407-434.

Conning, J. & Morduch, J.
04/08/2011

This paper puts a corporate finance lens on microfinance.  Microfinance aims to democratize global financial markets through new contracts, organizations, and technology. We explain the roles that government agencies and socially-minded investors play in supporting the entry and expansion of private intermediaries in the sector, and we disentangle debates about competing social and commercial firm goals. We frame the analysis with theory that explains why microfinance institutions serving lower-income communities charge high interest rates, face high costs, monitor customers relatively intensively, and have limited ability to lever assets. The analysis blurs traditional dividing lines between non-profits and for-profits and places focus on the relationship between target market, ownership rights and access to external capital.

Massachusetts Links Pay for Performance to the Reduction of Racial and Ethnic Disparities

Massachusetts Links Pay for Performance to the Reduction of Racial and Ethnic Disparities
Health Affairs. 30(6):1165-1175.

Blustein, Jan, Joel Weissman, Andrew M Ryan, Tim Doran and Romana Hasnain-Wynia.
04/01/2011

The Institute of Medicaid has identified equity as a key dimension of quality. Recently, Massachusetts’ Medicaid program (MassHealth) took the unusual step of linking pay-for-performance (P4P) to the reduction of racial/ethnic disparities for hospital care.  We report on early experience with the program, describing the challenges of implementing an ambitious program in a short time frame, with limited resources.  Our findings raise questions about whether P4P as currently constituted is a suitable tool for addressing disparities in hospital care.

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