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PubMed2004

Explaining the differences in income-related health inequalities across European countries.

This paper provides new evidence on the sources of differences in the degree of income-related inequalities in self-assessed health in 13 European Union member states. It goes beyond earlier work by measuring health using an interval regression approach to compute concentration indices and by decomposing inequality into its determining factors. New and more comparable data were used, taken from the 1996 wave of the European Community Household Panel. Significant inequalities in health (utility) favouring the higher income groups emerge in all countries, but are particularly high in Portugal and - to a lesser extent - in the UK and in Denmark. By contrast, relatively low health inequality is observed in the Netherlands and Germany, and also in Italy, Belgium, Spain Austria and Ireland. There is a positive correlation with income inequality per se but the relationship is weaker than in previous research. Health inequality is not merely a reflection of income inequality. A decomposition analysis shows that the (partial) income elasticities of the explanatory variables are generally more important than their unequal distribution by income in explaining the cross-country differences in income-related health inequality. Especially the relative health and income position of non-working Europeans like the retired and disabled explains a great deal of 'excess inequality'. We also find a substantial contribution of regional health disparities to socio-economic inequalities, primarily in the Southern European countries.

Europe↗
PubMed1997

Demographic change and income inequality in the United States, 1976-1989.

"The U.S. economy experienced significant increases in the degree of income inequality over the past two decades.... In this paper we consider the effects of race, age, female headship, and college education on the distribution of family income by developing a multivariate methodology that allows us to gauge the influence of one factor while holding other determinants of family incomes constant. Over the period studied we find that race had only a minor effect on the overall size distribution of income. Age had a somewhat greater effect than race. In contrast, the impact of female heads and college education were quite substantial. The multivariate estimates reveal that the effects of female heads and college education both increase the Gini to a much greater extent than the progressivity of federal income taxes decreases it. The effects of college education and female headed families on inequality have grown larger across time, while the influence of age has declined. We find that the effects of race on inequality have changed little over the 1976 to 1989 period."

Age Factors↗
PubMed2002

The distribution problem in economic evaluation: income and the valuation of costs and consequences of health care programmes.

To date, a common view in the health economics literature is that the applicability of cost-benefit analysis (CBA) is limited, due to the distribution problem which underlies its main method of valuation (e.g. willingness to pay). One view is that cost effectiveness analysis (CEA) overcomes these problems. We show that the same distributional concerns apply to non-monetary valuations of health consequences, to measurement of costs and to the decision rules of CEA. Hence adopting CEA over CBA cannot be justified on the basis of "avoiding" distributional considerations. The implications of our results are discussed, including alternative strategies for the use of "income-based" research findings in social decision-making.

Consumer Behavior↗
PubMed2001

Inequality in the geographical distribution of general practitioners in England and Wales 1974-1995.

OBJECTIVES: To compare geographical inequality in the distribution of general practitioners (GPs), other resources and mortality around 1995 in England and Wales; to measure trends between 1974 and 1995 in inequality of GP distribution; to examine the implications of different need adjustments and inequality measures on the degree of geographic inequality; and to analyse the impact of policies (increased supply, area inducements and entry regulation) on inequality. METHODS: Measurement of relative inequality (decile ratio, Gini coefficient, Atkinson index) and absolute inequality (standard deviation) in the ratio of GPs to need-adjusted population in former Family Practitioner Committee/Family Health Services Authority areas each year from 1974 to 1995; and relative inequality across areas in the distributions of income, other resources and standardised mortality ratios (SMRs) around 1995. Regression of 1995 GP/population ratios on 1974 ratios. Application of equalising net advantages location model to GP distribution. RESULTS: Inequality in the distribution of GPs in 1995 was less than inequality in other primary care resources, but greater than inequalities in disposable income, SMRs, primary school expenditure, and hospital and community health services expenditure. The decile ratio shows little change between 1974 and 1995. Gini and Atkinson inequality indices indicate some reduction in inequality between 1974 and 1980, but little change thereafter. The standard deviation of need-adjusted provision increased over the period. Areas that had the lowest GP provision in 1974 tended to have the lowest in 1995. CONCLUSIONS: The choice between relative and absolute inequality measures and, to a lesser extent, the method of adjusting for need affect conclusions about the trend in inequality. Both types of measure and most need adjustments suggest that the policies adopted did not lead to a reduction in inequality over the period. Interactions between policies may reduce their overall effectiveness.

England↗
PubMed2000

Women's health in relation with their family and work roles: France in the early 1990s.

In this paper, the health of women aged 30 to 49 years is analyzed according to the family and work roles which they exercise, based on the 1991-1992 French national health survey. Households are classified based on the amount of their material resources, and a variety of measures of health and of health-related behaviors are considered. Looking at each role separately, the 'healthy married', 'healthy mother' and 'healthy worker' effects are very obvious for almost all health measures, and higher household income per unit of consumption is clearly associated with better health of women. The role patterns of women are not evenly distributed across income levels: housewives and lone mothers are more common at the bottom and middle of the income scale than at the top, while working women without children, married or not, are much more common at the top. In health terms, more heterogeneity is attached to role patterns in the middle of the income scale than at either extreme. In the middle stratum, two groups of women stand out as being clearly disadvantaged in comparison with that of married women with children and a job: (1) lone mothers, particularly in terms of mental health conditions, malaise symptoms and health-related behaviour, and (2) housewives, particularly in terms of physical health conditions. At the bottom of the income scale, no significant disadvantage is found for housewives compared to married working mothers, yet their overall health pattern is somewhat negative. At the top of the income scale, married working women without children, as well as single women do feel more often than married working mothers that they suffer from handicap or discomfort. The findings are discussed in terms of role enhancement and role strain, health selection, the nature of the health disadvantage associated with specific role patterns, and the importance of the structural context in the role framework.

Adult↗
PubMedDate not supplied

Working together for health and human rights.

The right to a standard of living adequate for health and well-being is being denied to vast numbers of people all over the world through increasing disparities in income and in wealth. In the name of economic development, a number of international and national policies have increased the grossly uneven distribution of income, with ever-growing numbers of people living in poverty as well as in increasing depths of poverty. Globalization, crippling levels of external debt, and the 'structural adjustment' policies of international agencies have expanded the numbers and the suffering of people living in poverty and have resulted in the neglect of government-funded social programs, of regulations protecting the environment, and of human development. Access to medical care, an essential element in the protection of health, is difficult for many, including the 44 million people in the United States who lack insurance coverage for the cost of medical care services. Working together for health and human rights also requires promotion of the right to peace. The right to life and health is threatened not only by the existence and active deployment of weapons of mass destruction, including nuclear, chemical and biological weapons and anti-personnel landmines, but also other weapons. The twentieth century has been the bloodiest in human history, with an estimated 250 wars, more than 110 million people killed, countless people wounded and at the least 50 million refugees. Health workers must work together with people in our communities for the promotion of health and human rights, which, in Sandwell and elsewhere, are inextricably intertwined.

Health↗
PubMed1997

[Income, percent of women living in rural areas, parity, and breast cancer mortality in Spain, 1975-1991].

BACKGROUND: The aim of the present study was to analyze breast cancer mortality by provinces in Spain during the period 1975-91, and to assess the relationship with the geographical distribution of income level, percent of women living in rural areas and average parity of women in each province. SUBJECTS AND METHODS: Data were obtained from national statistical sources. Standardized mortality ratios (SMR) for breast cancer were estimated by provinces for the periods 1975-1980, 1981-1986 and 1987-1991, and for the whole period 1975-1991. Poisson regression analysis was used to explore the association between breast cancer mortality and the above mentioned variables. Provinces were categorized according to the quintile distribution of independent variables, and ecological relative risks were estimated for each category. RESULTS: Higher SMR were observed in island provinces (Canary and Balearic island), Catalonia, Basque Country, Navarre and the provinces of Saragosa, Seville and Valencia. Lowest SMR were observed in the inner provinces of Spain and the east part of Andalusian region. This pattern has remained very similar along the study period: income level showed a positive association with mortality from breast cancer. On the contrary, percent of women living in rural areas and parity were negatively associated to breast cancer mortality. The relative risk estimated for each child of parity adjusted by the other factors was 0.92 (95% confidence interval: 0.89-0.94). CONCLUSIONS: The highest mortality from breast cancer in Spain has been observed in those provinces with the highest income level, the lowest percent of women living in rural areas and the lowest parity. These findings at the ecological (provinces) level are in concordance with results from other studies at the individual level, and further supports the hypothesis that for the etiology of breast cancer, environmental factors could play a dominant role.

Breast Neoplasms↗
PubMed1985

Sharing increasing costs on declining income: the visible dilemma of the invisible aged.

The federal government considers all persons aged 65 and over a single beneficiary group, and data collectors consider them a single cohort. As a result, the very old (80 years and over) are virtually invisible; little is known about their specific income benefits and economic resources. Costs for the very old--a more economically diverse group than the nonaged--are likely to grow disproportionately. Recent proposals to share costs will affect the distribution of income and assets among the aged and between generations.

Aged↗
PubMed2002

[Pension insurance and intergenerational justice following pension reform].

Against the background of the demographic development, the question is whether an old age income security system which is based on the pay-as-you-go principle is still in accordance with the principle of intergenerational solidarity. The article examines significant dimensions of a fair distribution of income between different generations and asks for the respective implications of the German pension reform 2001. The article finishes by concluding that even an old age income security system on a private basis which is based on the capital stock system cannot prevent future cohorts of younger generations from having a higher burden.

Aged↗
PubMed2001

Shoot structure and photosynthetic efficiency along the light gradient in a Scots pine canopy.

We examined the effects of structural and physiological acclimation on the photosynthetic efficiency of Scots pine (Pinus sylvestris L.) shoots. We estimated daily light interception (DLI) and photosynthesis (DPHOT) of a number of sample shoots situated at different positions in the canopy. Photosynthetic efficiency (epsilon) was defined as the ratio of DPHOT to the potential daily light interception (DLI(ref)) defined as the photosynthetically active radiation (PAR) intercepted per unit area of a sphere at the shoot location. To calculate DLI(ref), DLI and DPHOT, the radiation field surrounding a shoot in the canopy was first modeled using simulated directional distributions of incoming PAR on a clear and an overcast day, and estimates of canopy gap fraction in different directions provided by hemispherical photographs. A model of shoot geometry and measured data on shoot structure and photosynthetic parameters were used to simulate the distribution of PAR irradiance on the needle surface area of the shoot. Photosynthetic efficiency (epsilon) was separated into light-interception efficiency (epsilon(I) = DLI/DLI(ref)) and conversion efficiency (epsilon(PHOT) = DPHOT/DLI). This allowed us to quantify separately the effect of structural acclimation on the efficiency of photosynthetic light capture (epsilon(l)), and the effect of physiological acclimation on conversion efficiency (epsilon(PHOT)). The value of epsilon increased from the top to the bottom of the canopy. The increase was largely explained by structural acclimation (higher epsilon(I)) of the shade shoots. The value of epsilon(PHOT) of shade foliage was similar to that of sun foliage. Given these efficiencies, the clear-day value of DPHOT for a sun shoot transferred to shade was only half that of a shade shoot at its original position. The method presented here provides a tool for quantitatively estimating the role of acclimation in total canopy photosynthesis.

Light↗
PubMedDate not supplied

Predicting tobacco sales in community pharmacies using population demographics and pharmacy type.

OBJECTIVE: To determine whether the population demographics of the location of pharmacies were associated with tobacco sales in pharmacies, when controlling for pharmacy type. DESIGN: Retrospective analysis. SETTING: Iowa. PARTICIPANTS: All retailers in Iowa that obtained tobacco licenses and all pharmacies registered with the Iowa Board of Pharmacy in 2003. MAIN OUTCOME MEASURE AND INTERVENTIONS: Percentage of pharmacies selling tobacco (examined by pharmacy type using chi-square analysis); median income and distribution of race/ethnicity in the county for pharmacies that did or did not sell tobacco (t tests); predictors of whether a pharmacy sold tobacco (logistic regression using the independent variables county-level demographic variables and pharmacy characteristics). RESULTS: County gender composition, race/ethnicity make-up, and income levels were different for tobacco-selling and -nonselling pharmacies. Logistic regression showed that whether a pharmacy sold tobacco was strongly dependent on the type of pharmacy; compared with independent pharmacies (of which only 5% sold tobacco products), chain pharmacies were 34 times more likely to sell tobacco products, mass merchandiser outlets were 47 times more likely to stock these goods, and grocery stores were 378 times more likely to do so. Pharmacies selling tobacco were more likely to be located in counties with significantly higher numbers of multiracial groups. CONCLUSION: The best predictor of whether an Iowa pharmacy sells tobacco products is type of pharmacy. In multivariable analyses, population demographics of the county in which pharmacies were located were generally not predictive of whether a pharmacy sold tobacco.

Commerce↗
PubMed2006

What explains the association between neighborhood-level income inequality and the risk of fatal overdose in New York City?

Accidental drug overdose is a substantial cause of mortality for drug users. Using a multilevel case-control study we previously have shown that neighborhood-level income inequality may be an important determinant of overdose death independent of individual-level factors. Here we hypothesized that the level of environmental disorder, the level of police activity, and the quality of the built environment in a neighborhood mediate this association. Data from the New York City (NYC) Mayor's Management Report, the NYC Police Department, and the NYC Housing and Vacancy Survey were used to define constructs for the level of environmental disorder, the level of police activity and the quality of the built environment, respectively. In multivariable models the odds of death due to drug overdose in neighborhoods in the top decile of income inequality compared to the most equitable neighborhoods decreased from 1.63 to 1.12 when adjusting for the three potential mediators. Path analyses show that the association between income inequality and the rate of drug overdose mortality was primarily explained by an indirect effect through the level of environmental disorder and the quality of the built environment in a neighborhood. Implications of these findings for the reduction of drug overdose mortality associated with the distribution of income are discussed.

Adolescent↗
PubMed1996

Diversity in South African dental schools.

The present paper investigates the demographic distribution of incoming undergraduate dental students in 5 South African dental schools. Biographical data was acquired in 1992 using a questionnaire administered to students in each of the dental schools. Data for 1994 was obtained from the Department of Health. The students were categorized in terms of population group and gender. Frequency distributions for these categories were computed. The results indicate that there are wide discrepancies with regard to population groups in all schools suggesting a lack of representativeness in terms of the wider population. A number of recommendations are made to redress these imbalances.

Adolescent↗
PubMed2006

Hong Kong men with low incomes have worse health-related quality of life as judged by SF-36 scores.

OBJECTIVE: To analyse the association between income and health-related quality of life using the Medical Outcome Study Short Form 36 (SF-36) Chinese version in Hong Kong Chinese working population. DESIGN: Cross-sectional observation study. SETTING: A commercial company in Hong Kong. PARTICIPANTS: All clerical and administrative staff of a commercial company was invited to participate; 876 of the 1003 staff agreed. The subjects were categorised into three income groups according to monthly income in Hong Kong dollars (low, < or =10,000; middle, >10,000-25,000; high, >25,000). The mean age of the 288 men and 588 women was 34.9 (standard deviation, 7.9; median, 34.0; range, 18-71) years. MAIN OUTCOME MEASURES: SF-36 scores on health-related quality of life. RESULTS: The distribution of income was 30% in high-, 54.8% in middle-, and 15.2% in low-income groups. Women had similar SF-36 scores among different income groups. In men, for most variables there was a significant positive linear correlation between income and SF-36 scores. CONCLUSION: Low income is associated with a worse health-related quality of life in Hong Kong Chinese men.

Adolescent↗
PubMed2001

Links between social class and common mental disorders in Northeast Brazil.

BACKGROUND: Social class is an important aspect of all societies. Social class differences in the prevalence of common mental disorder are likely to vary according to time, culture and stage of economic development. The present study aimed to investigate the intermediaries between social class and common mental disorder in a deprived area of Northeast Brazil. The Self Reporting Questionnaire (SRQ) was used to estimate the prevalence of common mental disorder. METHOD: A cross-sectional survey was conducted of 683 adults, aged 15 years and over, living in a random sample of private households in area II of Olinda, Recife Metropolitan Region, Pernambuco, Brazil. RESULTS: Poor education (odds ratio, OR 2.5, 95% CI 1.2-5.2; <5 years vs > or =11 years education) and low income (OR 2.4, 95% CI 1.0-5.6; < or =1/4 minimum wage vs >1 minimum wage) were independently associated with the prevalence of common mental disorder. Univariate associations with occupation, housing conditions and possession of household appliances could be understood in part by their association with poor education. CONCLUSIONS: Brazil has the second most unequal distribution of income in the world. Disparity in educational attainment could be one of the most important factors perpetuating social inequalities in psychiatric disorder in the country.

Adolescent↗