Socio-economic inequalities in health among older adults in two rural sub-districts in India and Bangladesh: a comparative cross-sectional study

Health inequalities have been observed among older people in many developing countries, particularly among those with least social protection and low socio-economic (SES) status. This study attempted to examine effects of SES on the health of older adults, and related gender differences, in two rural sub-districts - Matlab, Bangladesh and Vadu, India. The study utilised the WHO SAGE-INDEPTH Wave 1, 2007 Matlab, Bangladesh and Vadu, Pune District, India datasets. Both gender and SES indicators were strongly associated with all health indicators of older adults in the Bangladesh site, whereas in India, education and asset quintiles were not consistently associated with self-rated health, quality of life and functional ability score but gender was consistently associated with all health indicators except the quality of life score. The SES-health gradient was noticeably higher amongst older adults in Matlab, Bangladesh than in Vadu, India. Education was also found to be an important predictor of health outcome in both sites.     

Health hazards and socio-economic status: a neighbourhood cohort approach, Vancouver, 1976–2001

This paper lays the foundation for a research program concerned with the geographical patterning of environmental and population health at the urban neighbourhood scale. Based on the Vancouver metropolitan region, the aim is to better understand the role of neighbourhoods as epidemiological spaces where environmental and social characteristics combine as health processes and outcomes at the community and individual levels. With respect to procedure, this paper builds a cohort of commensurate neighbourhoods across all six census periods from 1976 to 2001, assembles neighbourhood air pollution (total particles) data, and provides an initial analysis to demonstrate how air pollution systematically and consistently maps onto neighbourhood socio-economic markers, specifically education and family status. We conclude with a discussion of how the neighbourhood cohort can be further developed to address emergent priorities in the population and environmental health literatures, namely the need for temporally matched data, a life-course approach and analyses that control for spatial scale effects.     

Foreclosure Risk and Community Health: Does Social Capital Have a Protective Effect?

This study draws upon the social determinants of health framework to model and test the extent to which a community’s social capital is health protective in the face of a substantial economic shock, namely the recent foreclosure crisis. U.S. county–level data are used to analyze potential moderating effects of social capital on health given a community’s foreclosure risk. We rely upon established social capital measures for U.S counties and merge them with county level foreclosure risk scores constructed by the U.S. Department of Housing and Urban Development (HUD). While theorists suggest that social capital’s effect on health and other outcomes may be durable over time there have been few empirical tests of this. We interact established social capital indicators measured at two points in time with foreclosure risk to predict overall self-reported health. Our results provide strong support suggesting that high levels of social capital are health protective. Communities with high levels of social capital that are facing high foreclosure risks report significantly better aggregate health outcomes than comparable communities facing the same level of foreclosure risk, but lower levels of social capital.     

Geographic accessibility to primary care providers: Comparing rural and urban areas in Southwestern Ontario

This research examines geographical accessibility to primary care providers (PCPs) across urban and rural areas of Southwestern Ontario and examines variations in the distribution of PCPs in relation to the senior population (aged 65 years and older). Information about PCP practices was provided by the HealthForceOntario Marketing and Recruitment Agency. Population data were obtained from the 2016 Census of Canada. To calculate scores for accessibility to PCPs (i.e., PCPs/10,000 population), we applied the enhanced 2-step floating catchment area method with distance decay effect within a global service catchment of 30-minute drive time. A geospatial mapping approach revealed disparities in the distribution of PCPs with a pattern of higher spatial accessibility in or around major urban areas in Southwestern Ontario. Comparative analyses were performed in association with the seniors’ population to identify how accessibility scores were mismatched with the population needs. The outcome of this study will assist researchers and health service planners to better understand the distribution of existing PCPs to address inequalities, particularly in rural areas.     

Spatial/temporal mismatch: a conflation protocol for Canada Census spatial files

The Canada census is one of the chief sources of demographic and socio-economic data for researchers in this country. Census variables are linked to geography files that allow researchers using geographic information systems (GIS) to view and analyze spatial data. Some of the most useful analysis, however, is based on changes in attribute values over time and space. Analysis of spatio- temporal events such as shifting migration patterns or changes in the distribution of health status permits a more dimensioned perspective than the viewing of static spatial phenomena. The analysis of spatio-temporal phenomena is limited by major changes in the spatial framework (e.g., location of road networks and other spatial entities) between national censuses. This paper addresses this limitation by (i) illustrating the extent of spatial mismatch between the 1996 and the 2001 census; (ii) examining attempts to rectify this problem in other jurisdictions and (iii) presenting a 'made-in-Canada' solution for conflation of census geometries. We believe that this solution will enhance the ability of Canadian researchers to describe and analyze socio-economic, health and demographic shifts across time and space. The research is supported by an ftp site for downloading the census geography rectification software presented in this paper.     

Exploring the associations between cooling centre accessibility and marginalization in Montreal,Toronto, and Vancouver,Canada

Cooling centres provide respite, safety, and social support during extreme heat events for populations that do not have the resources to own or operate in-home air conditioning. The objective of this study was to measure the spatial accessibility of cooling centres and analyze the associations between cooling centre access and marginalization in Montreal, Toronto, and Vancouver, Canada. The potential spatial accessibility of cooling centres within a 15-minute walk was measured at the dissemination area scale using the two-step floating catchment area method. A two-stage modelling approach was used to analyze the associations between cooling centre access and marginalization. Approximately 62%, 58%, and 54% of the populations in Montreal, Toronto, and Vancouver had access to at least one cooling centre. In Montreal and Vancouver, high marginalization areas were more likely to have cooling centre access than low marginalization areas. Of the areas with cooling centre access, smaller access scores were observed in areas with high residential instability. Approximately one-fifth of the areas in each city had no cooling centre access and high marginalization, and may be considered for future cooling centres or programs that improve accessibility to existing centres.     

The Index of Economic Disparity: Measuring trends in economic disparity across Canadian Census Subdivisions and rural and urban communities

Territorial inequalities have long been a subject of study and concern in Canada. In the face of large structural changes such as industrial shifts and the decarbonization of our economies, there is an urgency to understand such inequalities and design effective policy interventions for those places facing persistent economic decline. This paper shares a novel composite index that measures economic disparity across Canadian Census Subdivisions (CSDs) using Census data from 2001 through 2016 and the 2011 National Household Survey. Named the “Index of Economic Disparity,” it is comprised of an equally weighted average of four sub-indices that assign percentile rankings for all CSDs based on whether they experience persistent and substantial decline in key economic areas: population, labour force outcomes, working-age share of population, and industrial diversity. The variation of outcomes across geographies—urban and rural—highlights the importance of place-based policies.     

BAYESIAN SMOOTHING OF RATES IN SMALL GEOGRAPHIC AREAS*

ABSTRACT. An enormous amount of socio-economic and public-health data come as rates (e.g., unemployment, per capita income, mortality rates, census undercount) reported in small geographic areas. The U.S. Census Bureau regularly publishes data series at the county level, although the county is often a small area chosen for administrative convenience rather than by design. The reported rates can be regarded as a noisy representation of the true geographic distribution of rates over the small areas. This article presents a Bayesian statistical method of smoothing raw rates. In order to illustrate the important features of the method, a data set on undercoverage in the 1980 U.S. Census will be used.     

The role of housing and neighbourhood in the re-settlement process: a case study of refugee households in Winnipeg

Access to adequate, affordable housing is an essential first step in the re-settlement process for immigrants and refugees. It is the basis from which newcomers look for jobs, language training and other services. Without such housing, newcomers may have limited security of tenure, compromised health, jeopardized education and employment opportunities and impaired social and family life. Refugees generally face the greatest challenges of all newcomers and find their housing choices constrained by many factors. This article presents the results of a study of refugee housing circumstances in Winnipeg. Key socio-economic, housing and neighbourhood characteristics important to successful re-settlement are documented and analyzed. The longitudinal nature of the study facilitates exploration of trajectories in a variety of indicators over time. The picture that emerges is one of the improving trajectories in many key indicators but also of very difficult circumstances that negatively affect the re-settlement process and the effective integration of refugee households. The article ends with suggestions for policy and program changes that would improve the housing circumstances of newly arrived refugee households.     

Identifying Functional Regions in Australia Using Hierarchical Aggregation Techniques

This paper continues our work focused on developing a new socio-economic geography for Australia such that the chosen spatial aggregation of data is based on an analysis of economic behaviour. The underlying hypothesis is that the development of a geographical classification based on underlying economic behaviour will provide new insights into critical issues of regional performance, including unemployment differentials, the impact of industry, infrastructure and changes in local public expenditure on local labour markets. As a precursor to detailed work on the 2006 Census of Population and Housing data, we establish the proof of concept in this paper of the Intramax methodology using 2001 Journey-to-Work data from the Australian Bureau of Statistics (ABS) for the state of New South Wales. The functional regionalisation generated by the Intramax method is then tested using ABS labour force data. We compare 2001 ABS Census of Population and Housing data aggregated by the ABS labour force regions to the same data aggregated using our functional regions. The results demonstrate the potential value of this technique for the development of a new geography.     

BIRTH ATTENDANT UTILIZATION IN THE INDONESIAN MEGA-URBAN REGIONS OF JABODETABEK,BANDUNG AND SURABAYA

Indonesia's rapidly growing mega-urban regions of Jabodetabek (Jakarta Extended Metropolitan Region), Bandung and Surabaya each have a large and socio-economically heterogeneous population. The 2000 Census presents evidence that substantial spatial and socio-economic inequalities in under-five mortality risk exist in these mega-urban regions. Differences in patterns of birth attendant utilization likely contribute to these inequalities. Multilevel multinomial logistic regression of data primarily from the National Socio-economic Survey (SUSENAS) reveals that use of a skilled birth attendant is highly associated with mother's education. Highly skilled assistance is more related to the enabling factor of household expenditure quintile. The findings provide evidence for efforts to help reduce inequalities in early age mortality risk through improved access to trained birth assistance, in addition to other interventions.     

SMOKING AND HEALTH IN INDONESIA

Indonesia is one of the top five tobacco-consuming countries in the world (Ng et al. 2006). Most Indonesians consider cigarette-smoking socially acceptable (Aditama 2002). This study seeks to determine the extent to which the three theoretical debates identified by Pampel and Rogers (2004) are applicable in Indonesia. The empirical work of this study will be based on the 2000 Indonesian Family and Life Survey (2000 IFLS). The main conclusion from the regression analyses is that the effect of smoking on health is similar across all the socio-economic characteristics at the individual, household and community levels. Overall, multivariate analyses suggest that an additive relationship between socio-economic status and health, and the health impact of smoking in Indonesia, reflect neither the forces of the Blaxter nor social vulnerability hypotheses. The analyses of 2000 IFLS also suggest that marriage has beneficial effects on health and smoking-related morbidity.     

Ideological Warriors and Constituent Servants: Understanding the Determinants of Participation on Health Care Legislation in the Polarized Senate

Recent scholarship on the Senate indicates that partisanship and polarization have fundamentally changed the dynamics and the nature of policy making in the institution. To understand how senators balance their roles as constituent servants and partisan warriors, we examine senators’ participation in floor amending on major health legislation over a 10-year period (2000–2010). Health care is central to the ideological divide over the nature of the welfare state and has a significant impact on constituents. Unlike previous studies, we develop a fuller picture of the factors that motivate senators to participate by analyzing both amendments filed to a bill and amendments considered on the floor. We find that minority party status and ideology, both the liberal-conservative dimension and ideological extremism, are important indicators of participation. Furthermore, senators elevate ideology in comparison to constituent need when an issue is a presidential priority. Finally, the influence of constituency factors varies by party. For Democrats, their ideological commitment to the social welfare state makes them more likely to participate on health issues regardless of constituent need. However, Republican senators become more likely to sponsor amendments as the level of observable constituent factors increases.     

BIOARCHAEOLOGICAL ANALYSIS OF SUBSISTENCE AND HEALTH AT THE LAKE GEORGE SITE,MISSISSIPPI (22YZ557)

Abstract

Bioarchaeological investigations of subsistence and health were conducted on a skeletal population from the Lake George site (22YZ557), a large prehistoric settlement in the lower Yazoo basin of west-central Mississippi. Subsistence is inferred from oral health indicators (including dental caries, calculus, periodontal disease, abscesses, antemortem tooth loss, and macrowear) and stable carbon and nitrogen isotope ratios from bone collagen and apatite. Health is inferred from nonspecific indicators (including cranial porous lesions, enamel hypoplasias, and Harris lines). The sample includes 25 adults and 25 subadults, all of which date to the Coles Creek period (A.D. 700–1200). Frequencies of all pathological conditions are reported for the entire sample and divided by sex and age for adults. Results indicate a heavy pathology load at Lake George, but one that is not dissimilar to other Coles Creek populations. Isotope values indicate a diet that included primarily C3 plants (δ¹³C_Col = ?21.03‰, δ¹³C_Ap-Diet = ?22.06) and terrestrial protein (δ¹⁵N = 9.72‰). The sources of nonspecific pathologies are attributed to stressors associated with increasing population density and cultural complexity that occurred during the Coles Creek period.     

EFFECT OF LIVING ARRANGEMENT ON THE HEALTH STATUS OF ELDERLY IN INDIA

Epidemiological studies show strong association between lack/inadequate family support with increased mortality and poor health among the elderly. This study examined the effect of living arrangement on elderly health status by analysing the data of 39,694 persons aged 60 and above included in India's second National Family Health Survey conducted in 1998–1999. Results indicate that elderly who are living alone are likely to suffer more from both chronic illnesses, such as asthma and tuberculosis, and acute illnesses, such as malaria and jaundice, than those elderly who are living with their family, even after controlling for the effects of a number of socio-economic, demographic, environmental and behavioural confounders. The findings have important programme and policy implications for countries such as India, which has the second largest elderly population in the world. There is a strong need for the implementation of specific public support systems and health care strategies focused on the elderly population in general and elderly living alone in particular.     

‘Astronaut families’: transnational lives of middle-class Taiwanese married women in Canada

Despite increasing interest in the study of Taiwanese migrants, the underlying concept and methodology remain gender-blind. Invisible from the Census are the women who emigrated with their husbands, leaving behind their adopted country to make a living elsewhere. Most of the ‘astronaut wives’ studied in this research are middle-class women who had careers in Taiwan prior to emigration, but became full-time home-makers upon arrival in Canada, the host country. The major questions raised for this research are: (1) What are the circumstances of migration for Taiwanese families? (2) How do Taiwanese ‘dan qi ma ma’/‘astronaut wives’ cope with the challenges of the new environment? (3) How do they relate to their husbands, children, and the Taiwanese community during the process of adaptation? Thirty women from ‘astronaut’ families were interviewed in Toronto and Vancouver in 2005 and 2006, using a semi-structured questionnaire, ethnographic interviews, and participant observation methods. It was found that migration has not liberated them from the traditional familial roles in Taiwan, but has however enabled them to build new social networks that play an important role in their new lives.     

Microfinance and poverty reduction: evidence from a village study in Bangladesh

To evaluate the competing claims on the impact of microfinance programs on multidimensional poverty, a village study in Bangladesh was conducted where three microfinance programs had been operating for more than five years. The study found that microfinance has resulted in a moderate reduction in the poverty of borrowers, as measured by a variety of socio-economic indicators, but has not reached many of the poorest in the village. To make microfinance a more effective means of poverty reduction other services such as skills training, technological support, education and health related strategies should be included with microfinance.     

A spatial analysis of crime in Vancouver, British Columbia: a synthesis of social disorganization and routine activity theory

This article investigates the spatial dimension of automotive theft, break and enter, and violent crime in Vancouver, British Columbia in 1996. The article uses and synthesizes social disorganization theory and routine activity theory as a theoretical backcloth and employs a spatial autoregressive regression procedure that accounts for spatial autocorrelation between crime rates and socio-economic characteristics at the census tract level. Strong support is found for synthesizing these two most common spatial theories of crime. In particular, high unemployment (social disorganization theory) and the presence of young populations (routine activity theory) are the strongest predictors of criminal activity.     

Using General Estimating Equations to Analyze Oral Health in the Moche Valley of Perú

This study introduces a new method for analyzing oral health indicators and thus reconstructing diet. To this end, we examined the dental remains of 173 individuals recovered from the site of Cerro Oreja in the Moche Valley of Perú, who lived during the Salinar (400–1 BC) or Gallinazo (AD 1–200) phases. The infectious and degenerative conditions analyzed include: dental caries, dental wear, dental abscess, antemortem tooth loss and dental calculus, all of which have been used to track dietary and thus subsistence‐related economic and sociopolitical changes. Data were analyzed using generalized estimating equations, an extension of generalized linear models. Significant changes in the frequency of occurrence of most dental conditions suggest that during the period of study, there was an increase in the consumption of agricultural products. However, these changes in oral health did not equally affect females and males. By the end of the Gallinazo phase, significant sex differences developed, with females more often affected by dental caries and males displaying greater mean molar wear scores. Copyright © 2011 John Wiley & Sons, Ltd.     

An analysis of population and social change in London wards in the 1980s

"This paper discusses the estimation and projection of small area populations in London, [England] and considers trends in intercensal social and demographic indices which can be calculated using these estimates. Information available annually on vital statistics and electorates is combined with detailed data from the Census Small Area Statistics to derive demographic component based population estimates for London's electoral wards over five year periods. The availability of age disaggregated population estimates permits derivation of small area social indicators for intercensal years, for example, of unemployment and mortality. Trends in spatial inequality of such indicators during the 1980s are analysed and point to continuing wide differentials. A typology of population and social indicators gives an indication of the small area distribution of the recent population turnaround in inner London, and of its association with other social processes such as gentrification and ethnic concentration."