Poverty

Who Is Accountable for Racial Equity in Health Care?

Who Is Accountable for Racial Equity in Health Care?
Journal of the American Medical Association. Vol. 299 No.7, February 20: 814-816.

Blustein, J.
02/20/2008

Racial disparities are a ubiquitous feature of the US medical landscape, with health care delivery substantially segregated by race/ethnicity. Recent evidence from hospitals,1-3 nursing homes,4-5 and physicians' offices6 suggests that those caring for minority patients do not perform as well as those who care for nonminority patients, on average. This evidence is troubling but hardly surprising because the limited resources of those who care for the poor have helped to create and sustain racial disparities. As the United States enters an era of accountability in health care, it is time to consider these familiar circumstances from a new perspective.

IESP Brief: Public Funding for After-School Programs 1998-2008

IESP Brief: Public Funding for After-School Programs 1998-2008

Weinstein, M., Calabrese, T.
01/01/2008

The authors of this policy brief document that in the decade since the Open Society Institute awarded a challenge grant to TASC to encourage the creation of sustainable public funding streams for after-school programs, every level of government has dramatically increased public funding for comprehensive after-school programs in New York City.
The authors note that the City of New York has contributed an increasingly larger share of public support since the city launched its Out-of-School Time Initiative to provide kids with academic, cultural and recreational activities after school and during summers. The authors estimate that eight times more kids in kindergarten through high school attend after-school programs today than in 1998. "Over the past ten years in New York City," they conclude, "public support for after-school programs has become one of the foundations of service for children and youth."

Reversal of Fortunes: Low Income Neighborhoods in the 1990s

Reversal of Fortunes: Low Income Neighborhoods in the 1990s
Urban Studies, 45: 845-869.

O'Regan, K. & Ellen, I.G.
01/01/2008

This paper offers new empirical evidence about the prospects of lower-income, US urban neighbourhoods during the 1990s. Using the Neighborhood Change Database, which offers a balanced panel of census tracts with consistent boundaries from 1970 to 2000 for all metropolitan areas in the US, evidence is found of a significant shift in the fortunes of lower-income, urban neighbourhoods during the 1990s. There was a notable increase in the 1990s in the proportion of lower-income and poor neighbourhoods experiencing a gain in economic status. Secondly, in terms of geographical patterns, it is found that this upgrading occurred throughout the country, not just in selected regions or cities. Finally, it is found that the determinants of changes in lower-income, urban neighbourhoods shifted during the 1990s. In contrast to earlier decades, both the share of Blacks and the poverty rate were positively related to subsequent economic gain in these neighbourhoods during the 1990s.

The Intergenerational Transmission of Context

The Intergenerational Transmission of Context
American Journal of Sociology, Jan 2008, Vol. 113 Issue 4, p931-969, 39p.

Sharkey, P.
01/01/2008

This article draws on the extensive literature on economic and social mobility in America to examine intergenerational contextual mobility, defined as the degree to which inequalities in neighborhood environments persist across generations. PSID data are analyzed to reveal remarkable continuity in neighborhood economic status from one generation to the next. The primary consequence of persistent neighborhood stratification is that the racial inequality in America's neighborhoods that existed a generation ago has been transmitted, for the most part unchanged, to the current generation. More than 70% of black children who grow up in the poorest quarter of American neighborhoods remain in the poorest quarter of neighborhoods as adults, compared to 40% of whites. The results suggest that racial inequality in neighborhood economic status is substantially underestimated with short-term measures of neighborhood income or poverty and, second, that the steps taken to end racial discrimination in the housing and lending markets have not enabled black Americans to advance out of America's poorest neighborhoods.

From districts to schools: The distribution of resources across schools in big city school districts

From districts to schools: The distribution of resources across schools in big city school districts
Economics of Education Review Oct 2007, Vol. 26 Issue 5, p532-545, 14p

Rubenstein, R. & Schwartz, A.E., Stiefel, L., Bel Hadj Amor, H.
10/01/2007

While the distribution of resources across school districts is well studied, relatively little attention has been paid to how resources are allocated to individual schools inside those districts. This paper explores the determinants of resource allocation across schools in large districts based on factors that reflect differential school costs or factors that may, in practice, be related to the distribution of resources. Using detailed data on school resources and student and school characteristics in New York City, Cleveland and Columbus, Ohio, we find that schools with higher percentages of poor pupils often receive more money and have more teachers per pupil, but the teachers tend to be less educated and less well paid, with a particularly consistent pattern in New York City schools. We conclude with implications for policy and further research.

Financial Performance and Outreach: A Global Analysis of Leading Microbanks

Financial Performance and Outreach: A Global Analysis of Leading Microbanks
Economic Journal, February 2007, Vol. 117, Issue 517, pp. F107-F133

Morduch, J., Cull, R. & Demirguc-Kunt, A.
02/01/2007

Microfinance promises to reduce poverty by employing profit-making banking practices in low-income communities. Many microfinance institutions have secured high loan repayment rates but, so far, relatively few earn profits. We examine why this promise remains unmet. We explore patterns of profitability, loan repayment, and cost reduction with unusually high-quality data on 124 institutions in 49 countries. The evidence shows the possibility of earning profits while serving the poor, but a trade-off emerges between profitability and serving the poorest. Raising fees to very high levels does not ensure greater profitability and the benefits of cost-cutting diminish when serving better-off customers.

Can Public Schools Close the Race Gap? Probing the Evidence in a Large Urban School District

Can Public Schools Close the Race Gap? Probing the Evidence in a Large Urban School District
Journal of Policy Analysis and Management, 26(1): 7-30.

Stiefel, L., Schwartz, A.E., Gould & I.E.
01/01/2007

We examine the size and distribution of the gap in test scores across races within New York City public schools and the factors that explain these gaps. While gaps are partially explained by differences in student characteristics, such as poverty, differences in schools attended are also important. At the same time, substantial within-school gaps remain and are only partly explained by differences in academic preparation across students from different race groups. Controlling for differences in classrooms attended explains little of the remaining gap, suggesting little role for within-school inequities in resources. There is some evidence that school characteristics matter. Race gaps are negatively correlated with school size - implying small schools may be helpful. In addition, the trade-off between the size and experience of the teaching staff in urban schools may carry unintended consequences for within-school race gaps.

Disentangling the Racial Test Score Gap: Probing the Evidence in a Large Urban School District

Disentangling the Racial Test Score Gap: Probing the Evidence in a Large Urban School District
Journal of Policy Analysis & Management, Winter 2007, Vol. 26 Issue 1, p7-30, 24p.

Stiefel, L., Schwartz, A.E. & Ellen, I.G.
01/01/2007

We examine the size and distribution of the gap in test scores across races within New York City public schools and the factors that explain these gaps. While gaps are partially explained by differences in student characteristics, such as poverty, differences in schools attended are also important. At the same time, substantial within-school gaps remain and are only partly explained by differences in academic preparation across students from different race groups. Controlling for differences in classrooms attended explains little of the remaining gap, suggesting little role for within-school inequities in resources. There is some evidence that school characteristics matter. Race gaps are negatively correlated with school size-implying small schools may be helpful. In addition, the trade-off between the size and experience of the teaching staff in urban schools may carry unintended consequences for within-school race gaps. © 2006 by the Association for Public Policy Analysis and Management.

From Districts to Schools: The Distribution of Resources across Schools in Big City School Districts

From Districts to Schools: The Distribution of Resources across Schools in Big City School Districts
Economics of Education Review, 26: 532-545.

Rubenstein, R. & Schwartz, A.E., Stiefel, L.
01/01/2007

This paper explores the determinants of resource allocation across schools in large districts and examines options for improving resource distribution patterns. Previous research on intra-district allocations consistently reveals resource disparities across schools within districts, particularly in the distribution of teachers. While overall expenditures are sometimes related to the characteristics of students in schools, the ratio of teachers per pupil is consistently larger in high-poverty, high-minority and low-performing schools. These teachers, though, generally have lower experience and education levels - and consequently, lower salaries - as compared to teachers in more advantaged schools. We explore these patterns in New York City,  Cleveland and Columbus, Ohio by estimating de facto expenditure equations relating resource measures to school and student characteristics. Consistent with previous research, we find schools that have higher percentages
of poor pupils receive more money and have more teachers per pupil, but the teachers tend to be less educated and less well paid, with a particularly consistent pattern in New York City schools. The paper concludes with policy options for changing intradistrict resource distributions in order to promote more efficient, more equitable or more effective use of resources. These options include allocating dollars rather than teacher positions to schools, providing teacher pay differentials in hard-to-staff schools and subjects, and adapting current district-based funding formulas to the school (and student) level.

Race, Segregation, and Physicians' Participation in Medicaid

Race, Segregation, and Physicians' Participation in Medicaid
The Milbank Quarterly Vol. 84, Iss. 2, June

Greene, J., Blustein, J. & Weitzman, B.C.
06/01/2006

Many studies have explored the extent to which physicians’ characteristics and Medicaid program factors influence physicians’ decisions to accept Medicaid patients. In this article, we turn to patient race/ethnicity and residential segregation as potential influences. Using the 2000/2001 Community Tracking Study and other sources we show that physicians are significantly less likely to participate in Medicaid in areas where the poor are nonwhite and in areas that are racially segregated. Surprisingly—and contrary to the prevailing Medicaid participation theory—we find no link between poverty segregation and Medicaid participation when controlling for these racial factors. Accordingly, this study contributes to an accumulating body of circumstantial evidence that patient race influences physicians’ choices, which in turn may contribute to racial disparities in access to health care.

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