Inequality

Transportation to Clinic: Findings from a Pilot Clinic-Based Survey of Low-Income Suburbanites

Transportation to Clinic: Findings from a Pilot Clinic-Based Survey of Low-Income Suburbanites
Journal of Immigrant and Minority Health 2010.  DOI: 10.1007/s10903-010-9410-0

Silver D, J Blustein, BC Weitzman.
01/01/2010

Health care policymakers have cited transportation barriers as key obstacles to providing health care to low-income suburbanites, particularly because suburbs have become home to a growing number of recent immigrants who are less likely to own cars than their neighbors. In a suburb of New York City, we conducted a pilot survey of low income, largely immigrant clients in four public clinics, to find out how much transportation difficulties limit their access to primary care. Clients were receptive to the opportunity to participate in the survey (response rate = 94%). Nearly one-quarter reported having transportation problems that had caused them to miss or reschedule a clinic appointment in the past. Difficulties included limited and unreliable local bus service, and a tenuous connection to a car. Our pilot work suggests that this population is willing to participate in a survey on this topic. Further, since even among those attending clinic there was significant evidence of past transportation problems, it suggests that a population based survey would yield information about substantial transportation barriers to health care.

The High Cost of Segregation: The Relationship Between Racial Segregation and Subprime Lending

The High Cost of Segregation: The Relationship Between Racial Segregation and Subprime Lending
November 2009

Furman Center for Real Estate & Urban Policy
11/18/2009

This study examines whether the likelihood that borrowers of different races received a subprime loan varied depending on the level of racial segregation where they live. It looks both at the role of racial segregation in metropolitan areas across the country and at the role that neighborhood demographics within communities in New York City played.

Stirring up the Mud: Using a Community-Based Participatory Approach to Address Health Disparities through a Faith-Based Initiative

Stirring up the Mud: Using a Community-Based Participatory Approach to Address Health Disparities through a Faith-Based Initiative
Journal of Health Care for the Poor and Underserved. Vol. 20.4

Kaplan, S.A.
11/01/2009

The paper provides a mid-course assessment of the Bronx Health REACH faith-based initiative four years into its implementation.

Calorie Labeling And Food Choices: A First Look At The Effects On Low-Income People In New York City

Calorie Labeling And Food Choices: A First Look At The Effects On Low-Income People In New York City
Health Affairs (Millwood). 2009;28(6):w1110-21 (published online October 6; 10.1377/ hlthaff.28.6.w1110)

Elbel, B., Kersh, R., Brescoll, V.L. & Dixon, L.B.
10/06/2009

We examined the influence of menu calorie labels on fast food choices in the wake of New York City's labeling mandate. Receipts and survey responses were collected from 1,156 adults at fast-food restaurants in low-income, minority New York communities. These were compared to a sample in Newark, New Jersey, a city that had not introduced menu labeling. We found that 27.7 percent who saw calorie labeling in New York said the information influenced their choices. However, we did not detect a change in calories purchased after the introduction of calorie labeling. We encourage more research on menu labeling and greater attention to evaluating and implementing other obesity-related policies.

 

Black–White Differences in Avoidable Mortality in the USA, 1980–2005

Black–White Differences in Avoidable Mortality in the USA, 1980–2005
Journal of Epidemiology and Community Health, Vol. 63 no. 9, pp. 715-721. 10.1136/jech.2008.081141

Macinko, J., and I.T. Elo
09/01/2009

Background: Avoidable Mortality (AM) describes causes of death that should not occur in the presence of highquality and timely medical treatment and from causes that can be influenced at least in part by public policy/ behaviour. This study analyses black–white disparities in AM.

Methods: Mortality under age 65 was analysed from: (1) conditions amenable to medical care; (2) those sensitive to public policy and/or behaviour change; (3) ischaemic heart disease; (4) HIV/AIDS; and (5) the remaining causes of death. Age-standardised death rates (ASDRs) were constructed for each race and sex group using vital statistics and census data from 1980–2005. Absolute rate differences and the proportionate contribution of each cause of death group to all-cause black–white mortality disparities are calculated based on the ASDRs. Negative binomial regression was used to model relative risks of death.

Results: In 2005, medical care amenable mortality was the largest source of absolute black–white mortality disparity, contributing 30% of the black–white difference in all-cause mortality among men and 42% among women; mortality subject to policy/behaviour interventions contributed 20% of the black–white difference for men and 4% for women. Although absolute black–white differences for most conditions diminished over time, relative disparities as measured by rate ratios showed little change, except for HIV/AIDS for which relative risks increased substantially for black men and women.

Conclusions: There is considerable potential for narrowing of the black–white difference in AM, especially from causes amenable to medical care and (for men) policy/behaviour interventions.

Race, Gender and the Recession: Job Creation and Employment

Race, Gender and the Recession: Job Creation and Employment

C. Nicole Mason, Ph.D
05/01/2009

This report focuses on the effect of the recession and the American Recovery and Reinvestment Act (ARRA) on economically marginalized communities. The Network highlights four key areas of impact for women of color and their families: job creation and employment, housing and social services, education, and tax cuts to individuals.

The Impact of Primary Healthcare on Population Health in Low‐ and Middle‐Income Countries

The Impact of Primary Healthcare on Population Health in Low‐ and Middle‐Income Countries
Journal of Ambulatory Care Management, Vo. 32 no. 2, pp. 150-171. 10.1097/JAC.0b013e3181994221

Macinko, J., B. Starfield, and T. Erinosho
04/01/2009

This article assesses 36 peer-reviewed studies of the impact of primary healthcare (PHC) on health outcomes in low- and middle-income countries. Studies were abstracted and assessed according to where they took place, the research design used, target population, primary care measures, and overall conclusions. Results indicate that the bulk of evidence for PHC effectiveness is focused on infant and child health, but there is also evidence of the positive role PHC has on population health over time. Although the peer-reviewed literature is lacking in rigorous experimental studies, a small number of relatively well-designed observational studies and the consistency of findings generally support the contention that an integrated approach to primary care can improve health. A few large-scale experiences also help identify elements of good practice. The review concludes with several recommendations for future studies, including a focus on better conceptualizing and measuring PHC, further investigation into the advantages of comprehensive over selective PHC, need for experimental or quasi-experimental research designs that allow testing of the independent effect of primary care on outcomes over time, and a more detailed conceptual framework guiding overall evaluation design that places limits on the parameters under consideration and describes relationships among different levels and types of data likely to be collected in the evaluation process.

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