Inequality

Primary Care, Social Inequalities, and All-Cause, Heart Disease, and Cancer Mortality in U.S. Counties, 1990.

Primary Care, Social Inequalities, and All-Cause, Heart Disease, and Cancer Mortality in U.S. Counties, 1990.
American Journal of Public Health.

Shi, L., Macinko, J. Starfield, B. Politzer, R., Wulu, J. & J. Xu.
03/01/2005

We tested the association between the availability of primary care and income inequality on several categories of mortality in US counties. Methods. We used cross-sectional analysis of data from counties (n=3081) in 1990, including analysis of variance and multivariate ordinary least squares regression. Independent variables included primary care resources, income inequality, and sociodemographics. Results. Counties with higher availability of primary care resources experienced between 2% and 3% lower mortality than counties with less primary care. Counties with high income inequality experienced between 11% and 13% higher mortality than counties with less inequality. Conclusions. Primary care resources may partially moderate the effects of income inequality on health outcomes at the county level.

School Finance Court Cases and Disparate Racial Impact: The Contribution of Statistical Analysis in New York

School Finance Court Cases and Disparate Racial Impact: The Contribution of Statistical Analysis in New York
Education and Urban Society, February 2005, Vol. 37, No. 2, pp 151-173.

Stiefel, L., Schwartz, A.E., Berne, R. & Chellman, C.
02/01/2005

Although analyses of state school finance systems rarely focus on the distribution of funds to students of different races, the advent of racial discrimination as an issue in school finance court cases may change that situation. In this article, we describe the background, analyses, and results of plaintiffs' testimony regarding racial discrimination in Campaign for Fiscal Equity Inc. v. State of New York. Plaintiffs employed multiple regression and public finance literature to show that New York State's school finance system had a disparate racial impact on New York City students. We review the legal basis for disparate racial impact claims, with particular emphasis on the role of quantitative statistical work, and then describe the model we developed and estimated for the court case. Finally, we discuss the defendants' rebuttal, the Court's decision, and conclude with observations about the role of analysis in judicial decision making in school finance.

Primary care, race and mortality in the United States

Primary care, race and mortality in the United States
Social Science & Medicine Volume 61 Number 1, pages 65-75.

Shi, L., Macinko, J., Starfield, B., Politzer, R. & J. Xu.
01/01/2005

This study used US state-level data from 1985 to 1995 to examine the relationship of primary care resources and income inequality with all-cause mortality within the entire population, and in black and white populations. The study is a pooled ecological design with repeated measures using 11 years of state-level data (n=549). Analyses controlled for socioeconomic and demographic characteristics. Contemporaneous and time-lagged covariates were modeled, and all analyses were stratified by race/ethnicity. In all models, primary care was associated with lower mortality. An increase of one primary care doctor per 10,000 population was associated with a reduction of 14.4 deaths per 100,000. The magnitude of primary care coefficients was higher for black mortality than for white mortality. Income inequality was not associated with mortality after controlling for state-level sociodemographic covariates. The study provides evidence that primary care resources are associated with population health and could aid in reducing socioeconomic disparities in health.

The Effects of Specialist Supply on Population Health: Assessing the Evidence

The Effects of Specialist Supply on Population Health: Assessing the Evidence
Health Affairs Volume 5, pages 97-107.

Starfield, B., Shi, L., Grover, A. & Macinko, J.
01/01/2005

Analyses at the county level show lower mortality rates where there are more primary care physicians, but this is not the case for specialist supply. These findings confirm those of previous studies at the state and other levels. Increasing the supply of specialists will not improve the United States' position in population health relative to other industrialized countries, and it is likely to lead to greater disparities in health status and outcomes. Adverse effects from inappropriate or unnecessary specialist use may be responsible for the absence of relationship between specialist supply and mortality.

Immigrants and the Distribution of Resources within an Urban School District

Immigrants and the Distribution of Resources within an Urban School District
Educational Evaluation and Policy Analysis, Winter 2004, Vol. 26, No. 4. pp- 303-328.

Stiefel, L. & Schwartz, A.E.
12/01/2004

In New York City, where almost 14 percent of elementary school pupils are foreign-born and roughly half of these are "recent immigrants," the impact of immigrant students on school resources may be important. While immigrant advocates worry about inequitable treatment of immigrant students, others worry that immigrants drain resources from native-born students. In this article, we explore the variation in school resources and the relationship to the representation of immigrant students. To what extent are variations in school resources explained by the presence of immigrants per se rather than by differences in student educational needs, such as poverty or language skills, or differences in other characteristics, such as race? Our results indicate that, while schools resources decrease with the representation of immigrants, this relationship largely reflects differences in the educational needs of immigrant students. Although analyses that link resources to the representation of foreign-born students in 12 geographic regions of origin find some disparities, these are again largely driven by differences in educational need. Finally, we find that some resources increase over time when there are large increases in the percentage of immigrants in a school, but these results are less precisely estimated. Thus, elementary schools appear not to be biased either against or for immigrants per se, although differences in the needs of particular groups of immigrant students may lead to more (or fewer) school resources.

Experiences of and Responses to Discrimination Among Asian and Pacific Islander Gay Men: Their Relationship to HIV Risk

Experiences of and Responses to Discrimination Among Asian and Pacific Islander Gay Men: Their Relationship to HIV Risk
AIDS Education and Prevention,Volume 16, pp. 65-83.

Wilson, P.A. & Yoshikawa, H.
01/01/2004

As the HIV/AIDS epidemic enters its third decade, rates of infection continue to rise in ethnic minority populations. Though the prevalence of HIV among Asian and Pacific Islander (A&PI) gay men remains to be clearly documented, research has shown that these men engage in relatively high rates of HIV risk behavior. The social discrimination that minority gay men experience may impact their HIV risk behavior and mental health (Diaz & Ayala, 2001). This article examines the experiences of and response to social discrimination among A&PI gay men, and their links to HIV risk behaviors. The study analyzes 166 narrative episodes of discrimination, as well as data on HIV risk obtained from in-depth interviews with 23 A&PI gay men. Results showed that A&PI gay men experience types of discrimination across a variety of contexts. Homophobia and anti-immigrant discrimination were linked to confrontation and social network-based responses whereas discrimination based in stereotypes of passivity / submission were linked with self-attribution. A&PI gay men who used confrontational, social network-based or avoidance response types showed less HIV risk than those who did not. Conversely, A&PI gay men who responded to discrimination with self-attribution showed greater HIV risk behaviors. These findings indicate that experiences of social discrimination and responses to discrimination may impact A&PI gay men's well-being and health.

Gender and the Treatment of Heart Disease in Older Persons in the United States, France and England: A Comparative, Population-Based View of a Clinical Phenomenon

Gender and the Treatment of Heart Disease in Older Persons in the United States, France and England: A Comparative, Population-Based View of a Clinical Phenomenon
Gender Medicine, Vol 1, No. 1.

Weisz, D., Rodwin, V.G. & Gusmano, M.K.
01/01/2004

Background: Gender disparities in the treatment of coronary artery disease (CAD) have been extensively documented in studies from the United States. However, they have been less well studied in other countries and, to our knowledge, have not been investigated at the more disaggregated spatial level of cities.

Objective: This study tests the hypothesis that there is a common international pattern of gender disparity in the treatment of CAD in persons aged > 65 years by analyzing data from the United States, France, England and from their largest cities - New York City and its outer boroughs, Paris and its First Right, and Great London.

Conclusions: A consistent pattern of gender disparity in the interventional treatment of CAD was seen across 3 national health systems with known differences in patterns of medical practice. This finding is consistent with the results of clinical studies suggesting that gender disparities in the treatment of CAD are due at least in part to the underdiagnosis of CAD in women.

Reconsidering Risk: Biosocial Interactions and their Implications for Health Policy: The Case of Low Birth Weight.

Reconsidering Risk: Biosocial Interactions and their Implications for Health Policy: The Case of Low Birth Weight.
Journal of Health Politics, Policy and Law,

Strully, K. & Conley, D.
01/01/2004

According to recent research, interactions between infant health and environment can play crucial roles in clustering health and economic disadvantage among certain families. Researchers have provided a clear example of such intergenerational biosocial cycles when they document that interactions between parental low birth weight status and prenatal environment are associated with the risk of a low birth weight, and that interactions between a child's birth weight status and early childhood environment are associated with adult socioeconomic outcomes. In this article, we consider how existing policies may be revised to more effectively address such interactions between social and biological risk categories. We are particularly concerned in this discussion with revising risk categories so they can encompass biological risk, social risk, and developmental frameworks. A framework of biosocial risk is quite flexible and may be applied to a variety of issues and programs; however, in this article we focus on the single case of low birth weight to illustrate our argument. In considering specific applications, we further explore how attention to biosocial interactions may reshape Medicaid, special education, the Earned Income Tax Credit, and Temporary Assistance for Needy Families.

The Price of Female Headship: Gender, Inheritance, and Wealth Accumulation in the United States

The Price of Female Headship: Gender, Inheritance, and Wealth Accumulation in the United States
Journal of Income Distribution, Fall2004/Winter2005, Vol. 13 Issue 3/4, p41-56, 16p.

Conley, D. & Ryvicker, M.
01/01/2004

Female-headed households in the United States suffer from lower levels of asset ownership than their male-headed counterparts. This gap remains after controlling for the lower incomes of female heads. What, then, produces the gender discrepancy in net worth? Using longitudinal, intergenerational data from the Panel Study of Income Dynamics, we ask whether differential patterns of inheritance, savings rates, or investment yield this female-male asset gap. Results demonstrate that differential savings rates between female- and male-headed households account for the gender gap in net worth. We speculate on the financial constraints within female-headed households that account for the savings rate differential.

Wage inequality, health care, and infant mortality in 19 industrialized countries

Wage inequality, health care, and infant mortality in 19 industrialized countries
Social Science & Medicine Volume 58 Number 2, pages 279-292.

Macinko, J., Shi, L. & Starfield, B.
01/01/2004

This pooled, cross-sectional, time-series study assesses the impact of health system variables on the relationship between wage inequality and infant mortality in 19 OECD countries over the period 1970-1996. Data are derived from the OECD, World Value Surveys, Luxembourg Income Study, and political economy databases. Analyses include Pearson correlation and fixed-effects multivariate regression. In year-specific and time-series analyses, the Theil measure of wage inequality (based on industrial sector wages) is positively and statistically significantly associated with infant mortality rates--even while controlling for GDP per capita. Health system variables--in particular the method of healthcare financing and the supply of physicians--significantly attenuated the effect of wage inequality on infant mortality. In fixed effects multivariate regression models controlling for GDP per capita and wage inequality, variables generally associated with better health include income per capita, the method of healthcare financing, and physicians per 1000 population. Alcohol consumption, the proportion of the population in unions, and government expenditures on health were associated with poorer health outcomes. Ambiguous effects were seen for the consumer price index, unemployment rates, the openness of the economy, and voting rates. This study provides international evidence for the impact of wage inequalities on infant mortality. Results suggest that improving aspects of the healthcare system may be one way to partially compensate for the negative effects of social inequalities on population health.

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