SEARCH · Search PubMed
Search indexed PubMed citations on genomics, clinical trials, systematic reviews and public health. Explore titles, authors and supplied subject terms, then open the PubMed record.
Quote a phrase for an exact phrase match. Source license links do not imply unrestricted reuse.
Physicians prefer simplicity and would prefer to work out their differences among themselves. However, when money and personal time are at stake, a more sophisticated income distribution formula--one that prevents problems--is an excellent trade off.
This paper is the first to present a Chinese general fertility model that simultaneously controls for the endogeneity of infant mortality and per capita income determination at county level. Using the 1982 Chinese population census data, comprising 2305 observational units, this analysis improves on existing studies in several ways. First, since all the underlying variables are measured at the Chinese county level, we treat both the per capita income and infant mortality rates as endogenous, as opposed to exogenous as assumed in most previous studies on Chinese fertility. Our testing results strongly reject the null hypothesis of the exogeneity of both infant mortality and income determination within our model. Secondly, concerning the hypothesis of nonlinear income effect on fertility behavior, we examine both the variable income-elasticity and constant income-elasticity models. Strong evidence is obtained in support of the variable income elasticity model, predicting a U-shaped income effect on Chinese general fertility. This suggests that a more equitable income distribution leads to a reduction in the Chinese fertility rates. Thirdly, employing the two stage least squares procedure, we find a much stronger positive replacement effect on infant mortality when the endogeneity of infant mortality and income are both controlled for simultaneously. Our results indicate that Chinese general fertility may well be shaped by optimizing behavior.
OBJECTIVE: To examine the extent to which good primary-care experience attenuates the adverse association of income inequality with self-reported health. DATA SOURCES: Data for the study were drawn from the Robert Wood Johnson Foundation sponsored 1996-1997 Community Tracking Study (CTS) Household Survey and state indicators of income inequality and primary care. STUDY DESIGN: Cross-sectional, mixed-level analysis on individuals with a primary-care physician as their usual source of care. The analyses were weighted to represent the civilian noninstitutionalized population of the continental United States. DATA COLLECTION/EXTRACTION METHODS: Principal component factor analysis was used to explore the stricture of the primary-care indicators and examine their construct validity. Income inequality for the state in which the community is located was measured by the Gini coefficient, calculated using income distribution data from the 1996 current population survey. Stratified analyses compared proportion of individuals reporting had health and feeling depressed with those with good and bad primary-care experiences for each of the four income-inequality strata. A set of logistic regressions were performed to examine the relation between primary-care experience, income inequality, and self-rated health. PRINCIPAL FINDINGS: Good primary-care experience, in particular enhanced accessibility and continuity, was associated with better self-reported health both generally and mentally. Good primary-care experience was able to reduce the adverse association of income inequality with general health although not with mental health, and was especially beneficial in areas with highest income inequality. Socioeconomic status attenuated, but did not eliminate, the effect of primary-care experience on health. In conclusion, good primary-care experience is associated not only with improved self-rated overall and mental health but also with reductions in disparities between more- and less-disadvantaged communities in ratings of overall health.
The effects of social capital, income inequality, and absolute per capita income were investigated in an ecological analysis of 23 rich and poor countries. Trust was chosen as an indicator of social capital, and GNP (gross national product) per capita and Gini index measured absolute and relative income, respectively. These independent variables were analyzed in a linear regression model with the dependent variables adult mortality rate (25-64 years), life expectancy, and infant mortality rate (IMR). Separate analyses were performed for poor and rich countries as well as all countries combined. Social capital (trust) showed no significant association with the three health outcomes. A particularly strong relationship was found between Gini index and IMR for rich countries, and GNP per capita and life expectancy for all countries. In the group of poor countries, GNP per capita and Gini index in the same model were associated with IMR. The results contradict the suggested impact of social capital on health, and instead support the notion that economic factors such as absolute income and relative income distribution are of importance.
Two areas, containing a total of over 160,000 people, were examined for mortality rates; one area was directly under incoming flights, near Los Angeles International Airport (LAX). The other was removed from the LAX flight patterns so that jet noise was not dominant. The two areas were chosen so that they were as nearly alike as possible in age, racial distribution, income and in other relevant factors with the sole major difference of jet noise in one of them. It was found that there was a substantial increase in mortality rates in the area under the jets where there was large noise radiation. In particular, by a most conservative statistical treatment there was in the jet noise area: a 15% increase in deaths due to strokes (cerebro-vascular disease) which accounted for 39 deaths in the two-year period of the study--presumably attributable to the excessive jet noise. Further, in the noise-radiated area there was a 100% increase in deaths due to cirrhosis of the liver (primarily attributed to alcoholism)--amounting to 24 extra deaths in the two years, due to jet noise. One of the disturbing side results of this study was that in these relatively poor regions it appears that there should be about 50% more deaths than were reported and recorded by Los Angeles County. These losses were perhaps due to a concentration of bad, given addresses in the areas in question; this serious loss casts grave doubt on previous studies of eath rates for minority peoples (e.g. blacks), suggesting that the rates may be considerably higher than those previously reported.
This paper examines the socio-economic variation in height and weight using data from the German Socio-Economic Panel. Results reinforce previous research insofar as height is associated with socio-economic differences. For example, a low maternal schooling level or a lower position in the income distribution is negatively correlated with the height of West Germans. Furthermore, there is a west-east and a north-south gradient in height in Germany. BMI is also determined by individuals' characteristics with similar underlying patterns. That is, in both West and East Germany, women with low income and low education have a higher BMI whereas the better educated women weigh less.
BACKGROUND: It has been hypothesized that areas with an unequal income distribution are less likely to invest in health and more likely to have a social environment that influences the development of ischaemic heart disease (IHD) METHODS: We used pooled data from two cohort studies conducted in Copenhagen to analyse the association between area income inequality and first admission to hospital or death from IHD in women and men while controlling for individual income and other IHD risk factors. A total of 11 685 women and 10 036 men, with initial health examinations between 1964 and 1992, were followed for a median of 13.8 years. Information on median income share at parish and municipality levels was obtained from population registers. RESULTS: During follow-up 1700 men and 1204 women experienced an IHD event. At parish level income share was inversely associated with an increased risk of IHD in men (hazard ratio [HR](most versus least equal quartile) = 0.85 (95% CI: 0.73-0.98). Among women there was no relation between parish income inequality and IHD. Subject's household income was inversely related to IHD, and when this variable was controlled for, the association between income inequality at parish level and IHD in men attenuated slightly. When behavioural and biological risk factors were entered into the Cox model this relation attenuated further. However, some of these risk factors might mediate rather than confound the effect of income inequality. The association between income inequality at municipality level and IHD was insignificant for men, while in women the relation had a curved shape with those living in the least equal areas having the lowest risk. CONCLUSIONS: This study provides no clear evidence for an association between income inequality measured at parish or municipality level and IHD in Danish adults. The associations were weak and varied between different strata and geographical levels.
We use cross-national data to examine the impact of both public spending on health and non-health factors (economic, educational, cultural) in determining child (under-5) and infant mortality. There are two striking findings. First, the impact of public spending on health is quite small, with a coefficient that is typically both numerically small and statistically insignificant at conventional levels. Independent variation in public spending explains less than one-seventh of 1% of the observed differences in mortality across countries. The estimates imply that for a developing country at average income levels the actual public spending per child death averted is $50,000-100,000. This stands in marked contrast to the typical range of estimates of the cost effectiveness of medical interventions to avert the largest causes of child mortality in developing countries, which is $10-4000. We outline three possible explanations for this divergence of the actual and apparent potential of public spending. Second, whereas health spending is not a powerful determinant of mortality, 95% of cross-national variation in mortality can be explained by a country's income per capita, inequality of income distribution, extent of female education, level of ethnic fragmentation, and predominant religion.
OBJECTIVES: To examine the association between tooth decay and dental treatment needs in 5-12-year-old schoolchildren in São Paulo with area-level indicators of social development. METHODS: The present study refers to a representative sample of children from the city of São Paulo, Brazil, comprising 2491 girls and boys attending public and private schools in different areas of the city. The assessment of caries and treatment needs followed the international methodological standards prescribed by the World Health Organization. We used spatial data analysis to describe epidemiological measures distributed by small areas, and to explore hypotheses of ecological association between caries indexes and indicators of social development. RESULTS: Schoolchildren in central districts were less affected by tooth decay and presented fewer dental treatment needs when compared to those in peripheral deprived areas. At the spatial level, average family income, unemployment rate, household overcrowding, and an index of inequality of income distribution were significantly correlated with variables measuring children's caries experience. CONCLUSIONS: The heterogeneous distribution of caries indexes by areas of the city indicates higher levels of dental decay in areas of social deprivation. The delimitation of areas with increased risk of caries and greater dental treatment needs should be helpful to public health services for the formulation of policies and the targeting of resources to address these problems.
The absence of a correlation between age-adjusted death rates and the average income levels of economically developed countries has led researchers to conclude that income does not affect the mortality levels of economically developed countries. The mortality experiences of the former Soviet Union and some of the eastern European countries have further brought into question the importance of income's distribution in determining mortality among economically developed countries; prior to its breakup, the income distribution of the Soviet Union was as equal as that of Sweden, yet the life expectancy of the Soviets has been dramatically shorter than that of the Swedes. Using insights from a longitudinal microanalysis of U.S. mortality, this study presents evidence that, even for economically developed countries, the income distribution of a nation is an important determinant of its mortality. The results of this study also suggest that the relatively unequal income distribution of the United States is an important contributing factor to its low life expectancy relative to other high-income countries.
Traditionally, poverty was linked to an individual's family phase. This article examines to what extent poverty cycles are still apparent in OECD countries. By combining data on social policy programs and data on income distribution, the authors compare trends between nations. The main question is, how successful have various sociopolitical solutions been in eliminating poverty? Here the focus is on family policy and pensions. Improvements in social policies have impacts on poverty cycles in all countries. In most countries poverty among the elderly has declined, and the young have replaced the old as the lowest income group. In many countries the poverty cycles have flattened out, and life phase is no longer as important as it used to be. Some differences between nations remain, however. High poverty rates among families continue to be an Anglo-American problem, and improvements in this area have been only marginal. Social policy provisions are important for explaining both cross-national variation in poverty and changes over time. The impact is clearest among pensioners. Family-related poverty is lowest in countries that have combined cash benefits with public child-care services that facilitate parents' participation in the labor market.
BACKGROUND: People who have periods of low family income are at risk for increased health problems in the future, even if they present a similar clinical picture before the reduction in family income. The association between low income and health status was studied in residents of an area with relatively low-average family income and with a historically unstable economy. METHODS: We surveyed a stratified, clustered sample of residents of Johnson County, Tennessee, using a structured interview. The responses were analyzed in conjunction with national and regional data (National Health Interview Survey). RESULTS: Residents of the geographic area under study had a markedly higher prevalence of self-reported health problems than either the national average or rural areas in the southeast United States. The higher prevalence was accounted for by the combination of age and family income, which had equal effects on health status, but not by age differences alone. CONCLUSIONS: Family income and economic development are critically important to improving community health. Sensible capitation rates in managed care arrangements can be obtained only if the income distribution of an insured population is considered along with their age, sex, and physical health status.
Factors affecting rural-urban migration in India are explored. "The study, based on the sample of 205 migrant households, conducted in the hill region of Uttar Pradesh, attempts to highlight the characteristics of migration and its effects on the pattern of income distribution among the households....[It is found that] migration...is primarily motivated by...socioeconomic condition of households, development of road transport and communication sources, level of education...and various geographical and physical conditions."
This exploratory study examines the relationship between state-level public policy and individual and family well-being and factors that affect it. The inquiry, based on exchange and choice theories, assumes that state-level public policy reflects states' awareness of the needs of individuals and families, their ability to predict the future in failing to meet them, and the extent to which the norm of reciprocity prevails in the 50 states. Measures of states' collective choices were states' per capita expenditures for public welfare, education, and health, and per capita taxes in 1980; measures of states' individual and well- or ill-being, or social malaise, were states' teenage birthrates, infant death rates, and suicide rates. Taken into account as antecedent and intervening variables were age, gender, and racial composition, income distribution, marital, socioeconomic, and employment status of states' populations, and attitudes toward public spending. The findings show that higher state expenditures for public welfare and for education indeed contribute to individual and family well-being as measured by lower state rates of suicide and teenage births. States per capita spending for education, which together with state per capita spending for public welfare was a positive predictor of school completion rates and positively associated with states' income level, accounted for almost all of the variance in states' per capita taxes. State spending for public welfare was not a predictor of state per capita taxes. These findings are cause for considerable concern given the reduced role of the federal government in human affairs, particularly in states whose choices violate the assumptions underlying exchange and choice theories and the norm of reciprocity which says that people should help, not hurt, others.
The 1973 CPS-IRS-SSA Exact Match Study--a joint undertaking of the Social Security Administration and the Bureau of the Census--links survey records for persons in the March 1973 Current Population Survey to their respective earnings and benefit information in SSA administrative records and to selected items from their 1972 Internal Revenue Service individual income tax returns. The resulting set of files provides a very broad base for cross-section and longitudinal analyses of income-distribution questions. This article attempts to provide an overview of the techniques employed in the study. Among the topics discussed are the confidentiality requirements in force during the project. The original study goals are also described and a list of some of the completed research is provided.
Around 30% of the deaths due to violent causes in Brazil result from homicides. Violence has traditionally been related to larger social problems, such as poverty. Recently, however, a positive correlation has been observed between higher incomes and an increase in the homicide rate, so that some researchers have begun to consider inequality, rather than poverty, as an explanation for the epidemic of violence. The objective of this study was to investigate the correlation between urbanization, poverty, and economic inequality and homicide rates in the state of São Paulo, Brazil, in 1996. Information regarding population size, average monthly income of household heads, income distribution, and Gini index was obtained for each municipality, based on the demographic census. Homicide rates were calculated based on official data. Data were analyzed in terms of correlation and relative risk with 95% confidence intervals. Homicide rates rose in direct proportion to city population and ranged from 6.96 (per 100,000 inhabitants) in municipalities with a population smaller than 10,000 inhabitants, to 55.54 in municipalities with more than 1 million inhabitants. Relative risk ranged from 1.35 to 7.98. A significant correlation with population size was found only for incomes above 3.11 times the minimum wage and a Gini index greater than 0.50. There was a strong, direct, and significant correlation between homicide rates and the income ratio between the ninetieth and the twentieth percentiles of the population. It is necessary to probe more deeply into the macrosocial determinants of homicide rates in order to identify indicators of inequality that can generate meaningful data for developing public health strategies.
This paper reviews relevant literature on the sustainability indicators theoretically proposed and practically applied by scholars over the past 15 years. Although progress is being made in the development and critical analysis of sustainability indicators, in many cases existing or proposed indicators are not the most sensitive or useful measures in developing countries. Indicator selection needs to meet the following criteria: relative availability of data representing the indicators, sensitivity to stresses on the system, existence of threshold values and guidelines, predictivity, integratability and known response to disturbances, anthropogenic stresses, and changes over time. Based on these criteria, this paper proposes a set of operational indicators for measuring agricultural sustainability in developing countries. These indicators include ecological indicators involving amounts of fertilizers and pesticides used, irrigation water used, soil nutrient content, depth to the groundwater table, water use efficiency, quality of groundwater for irrigation, and nitrate content of both groundwater and crops. Economic indicators include crop productivity, net farm income, benefit-cost ratio of production, and per capita food grain production. Social indicators encompass food self-sufficiency, equality in food and income distribution among farmers, access to resources and support services, and farmers' knowledge and awareness of resource conservation. This article suggests that the selection of indicators representing each aspect of sustainability should be prioritized according to spatial and temporal characteristics under consideration.
Statistical evidence suggests that social cohesion provides the link between income inequality and health, but it is not clear how it might do so. The vagueness of the concept of cohesion and the difficulty of seeing how something so apparently ephemeral could exert a major influence on health has led to skepticism about its role in the relation between income distribution and mortality. The author suggests that social cohesion is indicative of underlying psychosocial risk factors that are known to be closely associated with health. Attention is drawn to the strong inverse relationships between measures of social inequality and measures of the quality of social relations in numerous different data sets. Given that social status and social affiliations, in terms of population-attributable risks, are among the most powerful influences on population health in the developed world, this is a potentially potent mixture for health. An antipathy between hierarchical relations across inequalities of power, income, and status on the one hand, and supportive social relations between equals on the other, is likely to exert a powerful influence on health.