Inequality

Major Expansion of Primary Care in Brazil Linked to Decline in Unnecessary Hospitalization

Major Expansion of Primary Care in Brazil Linked to Decline in Unnecessary Hospitalization
Health Affairs, Vol. 29, no. 12, pp. 2149-2160. 10.1377/hlthaff.2010.0251

Macinko, J., I. Dourado, R. Aquino, et al
12/01/2010

In 1994 Brazil launched what has since become the world’s largest community-based primary health care program. Under the Family Health Program, teams consisting of at least one physician, one nurse, a medical assistant, and four to six trained community health agents deliver most of their services at community-based clinics. They also make regular home visits and conduct neighborhood health promotion activities. This study finds that during 1999–2007, hospitalizations in Brazil for ambulatory care–sensitive chronic diseases, including cardiovascular disease, stroke, and asthma, fell at a rate that was statistically significant and almost twice the rate of decline in hospitalizations for all other causes. In municipalities with high Family Health Program enrollment, chronic disease hospitalization rates were 13 percent lower than in municipalities with low enrollment, when other factors were held constant. These results suggest that the Family Health Program has improved health system performance in Brazil by reducing the number of potentially avoidable hospitalizations.

Intraurban Differences in the Use of Ambulatory Health Services in a Large Brazilian City

Intraurban Differences in the Use of Ambulatory Health Services in a Large Brazilian City
Journal of Urban Health, Vol. 87 no. 6, pp. 994-1006. 10.1007/s11524-010-9499-4

Turci, M.A., M.F. Lima-Costa, F.A. Proietti, C.C. Cesar, and J. Macinko
12/01/2010

A major goal of health systems is to reduce inequities in access to services, that is, to ensure that health care is provided based on health needs rather than social or economic factors. This study aims to identify the determinants of health services utilization among adults in a large Brazilian city and intraurban disparities in health care use. We combine household survey data with census-derived classification of social vulnerability of each household’s census tract. The dependent variable was utilization of physician services in the prior 12 months, and the independent variables included predisposing factors, health needs, enabling factors, and context. Prevalence ratios and 95% confidence intervals were estimated by the Hurdle regression model, which combined Poisson regression analysis of factors associated with any doctor visits (dichotomous variable) and zero-truncated negative binomial regression for the analysis of factors associated with the number of visits among those who had at least one. Results indicate that the use of health services was greater among women and increased with age, and was determined primarily by health needs and whether the individual had a regular doctor, even among those living in areas of the city with the worst socio-environmental indicators. The experience of Belo Horizonte may have implications for other world cities, particularly in the development and use of a comprehensive index to identify populations at risk and in order to guide expansion of primary health care services as a means of enhancing equity in health.

Hidden Talent: Tacit Skill Formation and Labor Market Incorporation of Latino Immigrants in the United States

Hidden Talent: Tacit Skill Formation and Labor Market Incorporation of Latino Immigrants in the United States
Journal of Planning Education and Research December 2010 vol. 30 no. 2 132-146

Iskander, Natasha and Nichola Lowe
09/17/2010

This article examines informal training and skill development pathways of Latino immigrant construction workers in two different urban labor markets: Philadelphia, Pennsylvania, and Raleigh-Durham, North Carolina. We find that institutional differences across local labor markets not only shape how immigrants develop skills in specific places but also determine the localized obstacles they face in demonstrating and harnessing these skills for employment. To explain the role of local institutions in shaping differences in skill development experience and opportunities, we draw on the concept of tacit skill, a term that is rarely incorporated into studies of the labor market participation of less educated immigrants. We argue that innovative pathways that Latino immigrant workers have created to develop tacit skill can strengthen advocacy planning efforts aimed at improving employment opportunities and working conditions for marginalized workers, immigrant and nonimmigrant alike.

Income and Poverty in Communities of Color

Income and Poverty in Communities of Color

Women of Color Policy Network
09/01/2010

The U.S. Census Bureau’s recent statistics on income highlight the need for increased social supports for working families, the allocation of additional funds to create quality jobs with good wages, and the development of bold and targeted policies to help individuals and groups disproportionately impacted by the recession recover.

The Rise and Fall of a Micro-Learning Region: Mexican Immigrants and Construction in Center-South Philadelphia

The Rise and Fall of a Micro-Learning Region: Mexican Immigrants and Construction in Center-South Philadelphia
2010. Environment and Planning A, Volume 42, Number 7

Iskander, Natasha, Nichola Lowe, and Christine Riordan
07/01/2010

This paper documents the rise and fall of a micro-learning region in Philadelphia. The central actors in this region are undocumented Mexican immigrants who until recently were able to draw on the intensity of their workplace interactions and their heterodox knowledge to produce new and innovative building techniques in the city's residential construction. The new knowledge they developed was primarily tacit. More significantly, the learning practices through which immigrant workers developed skill and innovated new techniques were also heavily tacit. Because these practices were never made formal and were never made explicit, they remained invisible and difficult to defend. With the housing market collapse and subsequent decline in housing renovation in south-center region of Philadelphia, this tacit knowledge and the practices that gave it shape and significance, are no longer easily accessible. We draw on this case to demonstrate the importance of access to the political and economic resources to turn learning practices into visible structured institutions that protect knowledge and skill. Whether or not the practices that support knowledge development are themselves made explicit can determine whether the knowledge they produce becomes an innovation that is recognized and adopted or whether it remains confined to a set of ephemeral practices that exist only so long as they are being enacted.

Pension Participation: Do Parents Transmit Time Preference?

Pension Participation: Do Parents Transmit Time Preference?
Journal of Family and Economic Issues, Vol. 31, no. 2 (Jun 2010), pp. 138-150. doi: 10.1007/s10834-010-9181-8

Gouskova, E., N. Chiteji, and F. Stafford
06/01/2010

A wide range of economic and health behaviors are influenced by individuals’ attitudes toward the future—including investments in human capital, health capital and financial capital. Intergenerational correlations in such behaviors suggest an important role the family may play in transmitting time preferences to children. This article presents a model of parental investment in future-oriented capital, where parents shape their children’s time preference rates. The research identifies a dual role for a parent’s time preference rate in the process of shaping the offspring’s attitude toward the future, and discusses paths through which parents may socialize children to be patient. The model’s implications are studied by investigating the parent–child correlation in pension participation using data from the Panel Study of Income Dynamics

How to House the Homeless

How to House the Homeless
Russell Sage Foundation Press

Ellen, I.G. & O'Flaherty, B. (eds.).
06/01/2010

How to House the Homeless, editors Ingrid Gould Ellen and Brendan O’Flaherty propose that the answers entail rethinking how housing markets operate and developing more efficient interventions in existing service programs. The book critically reassesses where we are now, analyzes the most promising policies and programs going forward, and offers a new agenda for future research. How to House the Homeless makes clear the inextricable link between homelessness and housing policy. Contributor Jill Khadduri reviews the current residential services system and housing subsidy programs. For the chronically homeless, she argues, a combination of assisted housing approaches can reach the greatest number of people and, specifically, an expanded Housing Choice Voucher system structured by location, income, and housing type can more efficiently reach people at-risk of becoming homeless and reduce time spent homeless. Robert Rosenheck examines the options available to homeless people with mental health problems and reviews the cost-effectiveness of five service models: system integration, supported housing, clinical case management, benefits outreach, and supported employment. He finds that only programs that subsidize housing make a noticeable dent in homelessness, and that no one program shows significant benefits in multiple domains of life. Contributor Sam Tsemberis assesses the development and cost-effectiveness of the Housing First program, which serves mentally ill homeless people in more than four hundred cities. He asserts that the program’s high housing retention rate and general effectiveness make it a viable candidate for replication across the country. Steven Raphael makes the case for a strong link between homelessness and local housing market regulations—which affect housing affordability—and shows that the problem is more prevalent in markets with stricter zoning laws. Finally, Brendan O’Flaherty bridges the theoretical gap between the worlds of public health and housing research, evaluating the pros and cons of subsidized housing programs and the economics at work in the rental housing market and home ownership. Ultimately, he suggests, the most viable strategies will serve as safety nets—“social insurance”—to reach people who are homeless now and to prevent homelessness in the future. It is crucial that the links between effective policy and the whole cycle of homelessness—life conditions, service systems, and housing markets—be made clear now. With a keen eye on the big picture of housing policy, How to House the Homeless shows what works and what doesn’t in reducing the numbers of homeless and reaching those most at risk.

Neighborhoods and Obesity in New York City

Neighborhoods and Obesity in New York City
Health & Place, Vol. 16, no. 3, pp. 489-499. 10.1016/j.healthplace.2009.12.007

Black, J.L., J. Macinko, L.B. Dixon, and G.E. Fryer, Jr.
05/01/2010

Recent studies reveal disparities in neighborhood access to food and fitness facilities, particularly in US cities; but few studies assess the effects of multiple neighborhood factors on obesity. This study measured the multilevel relations between neighborhood food availability, opportunities and barriers for physical activity, income and racial composition with obesity (BMI≥30 kg/m2) in New York City, controlling for individual-level factors. Obesity rates varied widely between neighborhoods, ranging from 6.8% to 31.7%. Obesity was significantly (p<0.01) associated with neighborhood-level factors, particularly the availability of supermarkets and food stores, fitness facilities, percent of commercial land use and area income. These findings are consistent with the growing literature showing that area income and availability of food and physical activity resources are related to obesity.

Time-preference, Non-cognitive Skills and Well-being across the Life Course: Do Non-cognitive Skills Encourage Healthy Behavior?

Time-preference, Non-cognitive Skills and Well-being across the Life Course: Do Non-cognitive Skills Encourage Healthy Behavior?
American Economic Review, May, Volume 100(2): 200-204

Chiteji, N.
05/01/2010

No abstract available.

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