Fatal Flows—Doctors on the Move

Fatal Flows—Doctors on the Move
New England Journal of Medicine October 27, Volume 353, Number 17.

Chen, L.C. & Boufford, J.I.

The movement of physicians from poor to rich countries is a growing obstacle to global health. Ghana, with 0.09 physician per thousand population, sends doctors to the United Kingdom, which has 18 times as many physicians per capita. The United States, with 5 percent of the world's population, employs 11 percent of the globe's physicians, and its demand is growing.1 As underscored in the article by Mullan in this issue of the Journal,2 today, 25 percent of U.S. physicians are international medical graduates, and the number is even higher in the United Kingdom, Canada, and Australia.

Validation of Spanish and English Versions of the Asthma Portion of the Brief Pediatric Asthma Screen Plus (BPAS ) Among Hispanics

Validation of Spanish and English Versions of the Asthma Portion of the Brief Pediatric Asthma Screen Plus (BPAS ) Among Hispanics
Annals of Allergy, Asthma, & Immunology, 95, pg. 53-60, July,

Berry, C., Quinn, K., Wolf, R., Mosnaim, G. & Shalowitz, M.

Background: The health and health care needs of non-English-speaking Hispanic families with children are poorly understood, in part because they are often excluded from research owing to language barriers. Instruments that are valid in English and Spanish are necessary to accurately evaluate the magnitude of asthma prevalence and morbidity among Hispanics.

Objective: To establish the sensitivity and specificity of the English and Spanish versions of the asthma portion of the Brief Pediatric Asthma Screen Plus (BPAS ) in a low-income Hispanic population.

Methods: The validation sample consisted of 145 children whose parents completed the BPAS in Spanish and 78 whose parents completed it in English. Bilingual clinicians conducted the examinations on which the clinical assessments were based. We compared the BPAS results with the clinical assessment findings to determine the sensitivity and specificity of the BPAS among Hispanics in terms of identifying children who warrant further medical evaluation for asthma.

Results: The sensitivity and specificity of the asthma portion of the Spanish BPAS were 74% and 86%, respectively. The sensitivity and specificity of the asthma portion of the English BPAS were 61% and 83%, respectively.

Conclusions: The asthma portion of the BPAS , a valid screen for identifying children who are in need of further evaluation for potentially undiagnosed asthma, is valid for low-income Hispanics in Spanish and English. As the Hispanic population continues to grow, it is imperative that researchers have English and Spanish instruments that are valid for this population.

The Economics of Microfinance

The Economics of Microfinance
Harvard University. MIT Press: Cambridge,

Morduch, J. & Armendariz de Aghion, B.

The microfinance revolution, begun with independent initiatives in Latin America and South Asia starting in the 1970s, has so far allowed 65 million poor people around the world to receive small loans without collateral, build up assets, and buy insurance. This comprehensive survey of microfinance seeks to bridge the gap in the existing literature on microfinance between academic economists and practitioners. Both authors have pursued the subject not only in academia but in the field; Beatriz Armendáriz de Aghion founded a microfinance bank in Chiapas, Mexico, and Jonathan Morduch has done fieldwork in Bangladesh, China, and Indonesia. The authors move beyond the usual theoretical focus in the microfinance literature and draw on new developments in theories of contracts and incentives. They challenge conventional assumptions about how poor households save and build assets and how institutions can overcome market failures. The book provides an overview of microfinance by addressing a range of issues, including lessons from informal markets, savings and insurance, the role of women, the place of subsidies, impact measurement, and management incentives. It integrates theory with empirical data, citing studies from Asia, Africa, and Latin America and introducing ideas about asymmetric information, principal-agent theory, and household decision making in the context of microfinance. The Economics of Microfinance can be used by students in economics, public policy, and development studies. Mathematical notation is used to clarify some arguments, but the main points can be grasped without the math. Each chapter ends with analytically challenging exercises for advanced economics students.

Facing the Futures: Building Robust Nonprofits in the Pittsburgh Region

Facing the Futures: Building Robust Nonprofits in the Pittsburgh Region
The Forbes Funds,

Light, P.C.

The Pittsburgh region faces tough questions as it faces the futures ahead. Will it, for example, find a way to stop its young people from leaving or slip further into the profile of a “weak market” city, with all that means for the erosion of jobs and talent? Will it close the gaps between its citizens on education, health, earnings, and poverty, or will it continue to be listed as a city of disadvantage for African Americans? And will it play an aggressive role in helping Pennsylvania rebuild its aging economy or eventually eclipse North Dakota and West Virginia as the state with the slowest growing economy in the nation?

No one knows yet just how these futures will play out. It could be that the Pittsburgh area is on the cusp of a great revival as it continues to make the turn from an industrial-age economy to an “eds and meds” future. It could also be that the area has reached the maximum range of its geographic spread, thereby signaling an end to the hollowing-out of its inner city. It could even be that the area’s young people are starting to see the vibrant opportunities embedded in urban renewal and a low-cost of living, not to mention an expanding arts community, access to some of the nation’s greatest educational institutions, and the chance to revel in the return of the Pittsburgh Steelers and the yellow towel industry that goes with it.

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.

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.

Human Resources for Health: Overcoming the Crisis

Human Resources for Health: Overcoming the Crisis
The Lancet, Vol. 364, Issue 9449, 27 November 2004-3 December 2004, Pgs 1984-1990

Chen, L.C., Evans, T., Anand, S., Boufford, J.I., Brown, H., Chowdhury, M. & Michael, S.

In this analysis of the global workforce, the Joint Learning Initiative—a consortium of more than 100 health leaders—proposes that mobilisation and strengthening of human resources for health, neglected yet critical, is central to combating health crises in some of the world's poorest countries and for building sustainable health systems in all countries. Nearly all countries are challenged by worker shortage, skill mix imbalance, maldistribution, negative work environment, and weak knowledge base. Especially in the poorest countries, the workforce is under assault by HIV/AIDS, out-migration, and inadequate investment. Effective country strategies should be backed by international reinforcement. Ultimately, the crisis in human resources is a shared problem requiring shared responsibility for cooperative action. Alliances for action are recommended to strengthen the performance of all existing actors while expanding space and energy for fresh actors.

Children Facing Economic Hardship in the United States: Differentials and Changes in the 1990's

Children Facing Economic Hardship in the United States: Differentials and Changes in the 1990's
Demographic Review, June 2004, Vol 10, Article 11.

Lu, H.H., Palmer, J., Song, Y., Lennon, M.C. & Aber, J.L.

This paper helps document significant improvements in the child low-income rate as well as the significant decrease in the proportion of children who relied on public assistance in the United States during the 1990s. Many disadvantaged groups of children were less likely to live in poor or low-income families in the late 1990s than such children a decade earlier. The improvement in the child low-income rates of these disadvantaged groups was accompanied by a substantial increase in parental employment. However, parental employment appears to do less to protect children from economic hardship than it did a decade earlier. This paper shows that working families� children in many disadvantaged social groups, especially groups in medium risk ranks�children in families with parents between ages 25 to 29, with parents who only had a high-school diploma, and in father-only families�suffered the largest increase in economic hardship. Our results indicate that the increased odds of falling below low income lines among children in working families facing multiple disadvantaged characteristics and the increased proportion of these children in various subgroups of working families in the 1990s can help explain the increased economic hardship among subgroups in the medium risk ranks listed above. Finally, the paper also notes that the official measure of poverty tends to underestimate low-income rates.

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
Symposium on Education Finance and Organization Structure in NYS Schools, Albany, NY, March

Schwartz, A.E., Stiefel, L. & Rubenstein, R.

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.

A Comparison of Ground-Level Air Quality Data with New York State Department of Environmental Conservation Monitoring Stations Data in South Bronx, New York

A Comparison of Ground-Level Air Quality Data with New York State Department of Environmental Conservation Monitoring Stations Data in South Bronx, New York
Atmospheric Environment, Vol. 38, pp. 5295-5304.

Restrepo, C., Zimmerman, R., Thurston, G., Clemente, J., Gorczynski, J., Zhong, M., Blaustin, M. & Chen, L.C.

The South Bronx is a low-income, minority community in New York City. It has one of the highest asthma rates in
the country, which community residents feel is related to poor air quality. Community residents also feel that the air quality data provided by the New York State Department of Environmental Conservation (DEC) through its network
of monitoring stations do not reflect the poor quality of the air they breathe. This is due to the fact that these
monitoring stations are located 15m above ground. In the year 2001 this project collected air quality data at three
locations in the study area. They were collected close to ground-level at a height of 4m by a mobile laboratory placed in a van as part of the South Bronx Environmental Health and Policy Study. This paper compares data collected by the project with data from DEC's monitoring stations in Bronx County during the same periods. The goal of the comparison is to gain a better understanding of differences in measured air quality concentrations at these different heights. Although there is good agreement in the data among DEC stations there are some important differences between ground-level measurements and DEC data. For PM2.5 the measured concentrations by the van were similar to those recorded by DEC stations. In the case of ozone, the concentrations recorded at ground level were similar or lower than those recorded by DEC stations. For NO2, however, the concentrations recorded at ground level were over twice as high as those recorded by DEC. In the case of SO2, ground level measurements were substantially higher in August but very similar in the other two periods. CO concentrations measured at ground-level tend to be 60-90% higher than those recorded by DEC monitoring stations. Despite these differences, van measurements of SO2 and CO concentrations were well below EPA standards.


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