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PubMed2004

Poverty and obesity: the role of energy density and energy costs.

Many health disparities in the United States are linked to inequalities in education and income. This review focuses on the relation between obesity and diet quality, dietary energy density, and energy costs. Evidence is provided to support the following points. First, the highest rates of obesity occur among population groups with the highest poverty rates and the least education. Second, there is an inverse relation between energy density (MJ/kg) and energy cost (US dollars/MJ), such that energy-dense foods composed of refined grains, added sugars, or fats may represent the lowest-cost option to the consumer. Third, the high energy density and palatability of sweets and fats are associated with higher energy intakes, at least in clinical and laboratory studies. Fourth, poverty and food insecurity are associated with lower food expenditures, low fruit and vegetable consumption, and lower-quality diets. A reduction in diet costs in linear programming models leads to high-fat, energy-dense diets that are similar in composition to those consumed by low-income groups. Such diets are more affordable than are prudent diets based on lean meats, fish, fresh vegetables, and fruit. The association between poverty and obesity may be mediated, in part, by the low cost of energy-dense foods and may be reinforced by the high palatability of sugar and fat. This economic framework provides an explanation for the observed links between socioeconomic variables and obesity when taste, dietary energy density, and diet costs are used as intervening variables. More and more Americans are becoming overweight and obese while consuming more added sugars and fats and spending a lower percentage of their disposable income on food.

Adult↗

PubMed2005

Widow(er) poverty and out-of-pocket medical expenditures near the end of life.

OBJECTIVES: Elderly widows are three times as likely to live in poverty as older married people. This study investigates the gap in poverty, income, and wealth between these groups. Focus is placed on the role played by out-of-pocket medical expenditures spent on dying spouses. METHODS: A national panel survey of people age 70 and older in 1993 was used. Income, poverty, wealth, and out-of-pocket expenditures were examined before and after widowhood, with comparisons made with couples not experiencing a death. RESULTS: Forty-four percent of the difference in economic status between widow(er)s and married elderly persons was due to disparities in economic status that existed prior to widowhood. The remaining 56% was due to factors more directly related to the death of a spouse, including the loss of income and expenses associated with dying. On average, out-of-pocket medical expenditures in the final 2 years of life were equal to 30% of the couple's annual income. For couples in the bottom quarter of the income distribution, these expenditures were 70% of their income. DISCUSSION: As policy makers continue to debate expansions and reforms of Medicare, the potential effects of these reforms on economic well-being, particularly among widows, should be considered.

Adaptation, Psychological↗

PubMed1993

Poverty among older Americans: the plight of nonmetropolitan elders.

Elderly persons in nonmetropolitan areas are more likely to be poor than their metropolitan counterparts, and the gap between them increases with age. This study provides a comprehensive empirical comparison of the nature of income poverty among metropolitan (metro) and nonmetropolitan (nonmetro) elders. Drawing on the 1990 Current Population Survey, we document differences in poverty by age and for various demographic subgroups of the elderly population. These analyses show that poverty rates are higher among nonmetro elders for virtually all demographic subgroups. We estimate logistic regression models to predict the likelihood that elders are poor to separate the effects of population composition from those of nonmetro residence. We find that even after controlling for age, sex, race, marital status, and living arrangements, nonmetro elders are more likely to be poor than those in metro areas.

Adolescent↗

PubMed1992

Urbanisation, poverty and employment: the large metropolis in the third world.

"The main purpose of this paper is to provide an overall review of the chief analytical as well as economic policy issues in relation to Third World cities in the light of the available theoretical and empirical studies on urbanisation, poverty and employment in the developing countries.... Part I...provides basic information on urbanisation in the Third World...[and] outlines the nature and extent of urban poverty in these large cities and considers the impact of the world economic crisis on the urban poor. Part II of the paper discusses the most important structural features of urbanisation in relation to economic development....Finally, Part III briefly examines policy issues in relation to urbanisation and poverty in the Third World's large cities."

Demography↗

PubMedDate not supplied

Family poverty, welfare reform, and child development.

Our review of research suggests that family poverty has selective effects on child development. Most important for policy are indications that deep or persistent poverty early in childhood affects adversely the ability and achievement of children. Although the 1996 welfare reforms have spurred many welfare-to-work transitions, their time limits and, especially, sanctions are likely to deepen poverty among some families. We suggest ways policies might be aimed at preventing either economic deprivation itself or its effects.

Aid to Families with Dependent Children↗

PubMedDate not supplied

The home environments of children in the United States part I: variations by age, ethnicity, and poverty status.

Although measures of the home environment have gained wide acceptance in the child development literature, what constitutes the "average" or 'typical" home environment in the United States, and how this differs across ethnic groups and poverty status is not known. Item-level data from the National Longitudinal Survey of Youth on four age-related versions of the Home Observation for Measurement of the Environment-Short Form (HOME-SF) from five biennial assessments (1986-1994) were analyzed for the total sample and for four major ethnic groups: European Americans, Asian Americans, African Americans, and Hispanic Americans. The percentages of homes receiving credit on each item of all four versions of the HOME-SF are described. For the majority of items at all four age levels differences between poor and nonpoor families were noted. Differences were also obtained among African American, European American, and Hispanic American families, but the magnitude of the effect for poverty status was greater than for ethnicity, and usually absorbed most of the ethnic group effects on HOME-SF items. For every item at every age, the effects of poverty were proportional across European American, African American, and Hispanic American groups.

Adolescent↗

PubMed1989

Indian student doctors' attitudes towards primary health care, poverty and related issues.

An attempt is made to study the attitudes of student physicians towards primary health care, poverty, and related social issues in India. The sample consisted of 464 men and 228 women final-year medical students (a total of 692) from 11 medical colleges in India. An open-ended questionnaire was used. Content analysis was performed on the responses. There were no statistically significant differences between the responses of the students belonging to different socio-economic groups. There were some differences in the responses of the men and women students, especially on the question of poverty and related social issues. The data presented here show that the student physicians do not have a clear understanding of the primary health care approach, or about the social issues that influence health. This study underlines the need for exposing student physicians to the essential aspects of poverty and its impact on health and the importance of the primary health care approach for providing health care to disadvantaged groups.

Attitude of Health Personnel↗

PubMed2005

Poverty and inequality: challenges for the IAB: IAB presidential address.

This paper focuses on poverty and inequality in the world today. First, it points out how this topic is a main concern for the IAB. Second, it proposes 'new' theoretical tools in order to analyze global justice and our obligations towards the needy. I present John Rawls's denial that the egalitarian principle can be applied to the global sphere, his proposed weak duty of assistance, and his consideration of endemic poverty as essentially homegrown. In opposition, I focus on Thomas Pogge as representative of a cosmopolitan view who also holds a critical position towards the international systems which allow and cause poverty. I endorse the general normative proposal that defends every human being as an ultimate unit of moral concern, as well as the strategy of moving away from the charity model of bilateral aid to the realm of rights and duties. These ideas should redesign and broaden the normative and practical roles of institutions, and should also help provide a new approach on bioethical issues such as drug patenting or the imbalance in global research and neglected diseases.

Bioethical Issues↗

PubMed2005

The effect of income question design in health surveys on family income, poverty and eligibility estimates.

OBJECTIVE: To compare systematic differences between an "omnibus" income measure that asks for total family income amounts with a central survey item and an aggregated income measure that sums specific amounts of income obtained from multiple income sources from everyone within a family. DATA SOURCE: The 2001 Current Population Survey-Demographic Supplement (CPS-DS). Data were collected from 78,000 households from February through April 2001. STUDY DESIGN: First, we compare the omnibus family income to the aggregated family income amounts for each family. Second, we use the various aggregated family income sources to predict whether there is a mismatch between the omnibus and aggregated family income amounts. Finally, we assign a new aggregated amount of income that is restricted to be within the range of the omnibus amount to observe differences in poverty rates. DATA COLLECTION: Data were extracted from University of Michigan's ICPSR website. PRINCIPAL FINDINGS: There is a great deal of variation between the omnibus family income measure and the aggregated family income measure, with the omnibus amount generally being lower than the aggregated. As a result, the percent of people estimated to be in poverty is higher using the omnibus income item. CONCLUSIONS: Health surveys generally rely on an omnibus income measure and analysts should be aware that the income estimates derived from it are limited with respect to poverty determination, and the related concept of eligibility estimation. Analysts of health surveys should also consider matching respondents or multiple imputation to improve the usability of the data.

Adolescent↗

PubMed1991

Poverty, primary care and age-specific mortality.

An important area of concern among rural health researchers and policy analysts is the social and ecological correlates of mortality levels. This research is concerned with the empirical relationship between the prevalence of poverty and the mortality experience of different age groups within the population. Poverty is viewed as a characteristic of the social organization of local areas and operationalized by employing several indicators, including a measure of rurality. The empirical results indicate that the magnitude of the association between the prevalence of poverty and mortality varies among different age groups. The impact of rurality, while being consistently positive, is shown to be statistically nonsignificant. The research also shows that the availability of primary care is associated with lower mortality.

Female↗

PubMed2002

The health effects of rural-urban residence and concentrated poverty.

This research quantifies the extent to which excess morbidity in rural areas is associated with individual characteristics, county income, and neighborhood poverty. Census geographic codes were assigned to people 25 to 64 years old (n = 176,930) from the National Health Interview Survey, 1989 to 1991, in order to link individuals to the U.S. Department of Agriculture's county urban-rural classification scheme and to 1990 county per capita income and poverty concentration in Census tracts. General health status and limitation of activity were analyzed in logistic and multinomial logit models. Residents of rural counties were at greater risk for health problems compared to residents of metropolitan and central core counties. In adjusted models, the health disadvantage of rural areas was partly explained by differences in population composition. The residual rural disadvantage was concentrated in people with less than a high school education. Tract poverty and county per capita income were also important independent predictors of morbidity. The results of this study suggest that special attention should be paid to improving education in disadvantaged places and to better understanding the ways in which economic growth and its benefits are distributed.

Activities of Daily Living↗

PubMed2004

Biodiversity conservation and the eradication of poverty.

It is widely accepted that biodiversity loss and poverty are linked problems and that conservation and poverty reduction should be tackled together. However, success with integrated strategies is elusive. There is sharp debate about the social impacts of conservation programs and the success of community-based approaches to conservation. Clear conceptual frameworks are needed if policies in these two areas are to be combined. We review the links between poverty alleviation and biodiversity conservation and present a conceptual typology of these relationships.

Animals↗

PubMed2000

Race, sex, poverty, and the medical treatment of acute myocardial infarction in the elderly.

BACKGROUND: Race, sex, and poverty are associated with the use of diagnostic cardiac catheterization and coronary revascularization during treatment of acute myocardial infarction (AMI). However, the association of sociodemographic characteristics with the use of less costly, more readily available medical therapies remains poorly characterized. METHODS AND RESULTS: We evaluated 169 079 Medicare beneficiaries >/=65 years of age treated for AMI between January 1994 and February 1996 to determine the association of patient race, sex, and poverty with the use of medical therapy. Multivariable regression models were constructed to evaluate the unadjusted and adjusted influence of sociodemographic characteristics on the use of 2 admission (aspirin, reperfusion) and 2 discharge therapies (aspirin, beta-blockers) indicated during the treatment of AMI. Therapy use varied by patient race, sex, and poverty status. Black patients were less likely to undergo reperfusion (RR 0.84, 95% CI 0. 78, 0.91) or receive aspirin on admission (RR 0.97, 95% CI 0.96, 0. 99) and beta-blockers (RR 0.94, 95% CI 0.88, 1.00) at discharge. Female patients were less likely to receive aspirin on admission (RR 0.98, 95% CI 0.97, 0.99) and discharge (RR 0.98, 95% CI 0.96, 0.99). Poor patients were less likely to receive aspirin (RR 0.97, 95% CI 0. 96, 0.98) or reperfusion (RR 0.97, 95% CI 0.93, 1.00) on admission and aspirin (RR 0.98, 95% CI 0.96, 1.00), or beta-blockers (RR 0.95, 95% CI 0.91, 0.99) on discharge. CONCLUSIONS: Medical therapies are currently underused in the treatment of black, female, and poor patients with AMI.

Black or African American↗

PubMed1995

Partnerships for people with serious mental illness who live below the poverty line.

Fifty-four persons with serious mental illness who were living below the poverty line were randomly divided into two groups. Members of one group received allowances and forgivable loans to raise them above the poverty line for one year. The others received some funds, but not enough to raise them above the poverty line. All participants selected one staff member from a consortium of supporting agencies to serve as a sponsor and another person to serve as an adviser to help them function better. For both groups hospitalization rates were significantly reduced, and quality of life in some domains improved.

Adult↗

PubMed2006

Does caregiving increase poverty among women in later life? Evidence from the Health and Retirement survey.

Given the rapid aging of the U.S. population and reductions in federal funding, elder care has become a major issue for many families. This paper focuses on a long-term consequence of elder care by asking how caring for elderly parents affects women's subsequent risks of living in poverty. Using longitudinal data from the Health and Retirement Study, we examine whether and how caregiving for parents in 1991 increases women's risks of living in households with incomes less than the poverty threshold, receiving public assistance, and receiving Medicaid in 1999. Our findings illustrate that caregiving in earlier life raises women's poverty risks in later life by intensifying the negative effects of stopping work and declining health on women's economic well-being.

Aged↗

PubMed1999

Health-promoting lifestyles and exercise: a comparison of older African American women above and below poverty level.

The purpose of this study was to compare the health-promoting behaviors and exercise behaviors of older African American women above and below poverty level. Fifty-eight African American women completed a demographic form and the Health Promoting Lifestyle Profile (HPLP). Results indicated that African American women living above the poverty level had higher overall scores on the total HPLP and higher scores on the exercise subscale of the HPLP than women living below poverty level. Implications include teaching culturally specific, practical, and inexpensive exercise activities in primary care and community settings.

Black or African American↗

PubMed2004

Understanding the risks of child neglect: an exploration of poverty and parenting characteristics.

A strong association between poverty and child neglect has been established, but the mechanisms that explain this relationship have not been clearly articulated. This research takes advantage of survey and child maltreatment administrative data about families with young children and assesses the influence of poverty and parenting characteristics on subsequent child neglect. The authors find that indicators of poverty, such as perceived material hardship and infrequent employment, and parenting characteristics, such as low parental warmth, use of physical discipline, and allowing a child to engage in frequent television viewing, are predictive of child neglect. Parenting characteristics do not appear to mediate the link between perceived hardship and neglect, although they suppress the link between employment and neglect. Results from this study provide information that is highly relevant to the approach and design of child maltreatment prevention and intervention strategies.

Attitude↗

PubMed1998

Poverty, psychological disorder and disability in primary care attenders in Goa, India.

BACKGROUND: This study examined the association of common mental disorders in primary health clinic attenders with indicators of poverty and disability in Goa, India. METHOD: Adult attenders (n = 303) in two primary health clinics were recruited. RESULTS: There were 141 (46.5%) cases of common mental disorder. The following were associated with common mental disorder: female gender; inability to buy food due to lack of money; and being in debt. Cases scored significantly higher on all measures of disability. Primary health clinic staff recognised a third of the morbidity but used multiple oral drugs, injectable vitamins and benzodiazepines to treat common mental disorders. CONCLUSIONS: Poverty is closely associated with common mental disorder which in turn is associated with deprivation and despair. Primary mental health care priorities in low-income countries need to shift from psychotic disorders which often need specialist care to common mental disorders. Health policy and development agencies need to acknowledge the intimate association of female gender and poverty with these disorders.

Adolescent↗