Suchergebnisse

Health inequalities are the most important inequalities of all. In the US and the UK these inequalities have now reached an extent not seen for over a century. Most people's health is much better now than then, but the gaps in life expectancy between regions, between cities, and between neighbourhoods within cities now surpass the worst measures over the last hundred years. In almost all other affluent countries, inequalities in health are lower and people live longer. In his new book, academic and writer Danny Dorling describes the current extent of inequalities in health as the scandal of our times. He provides nine new chapters and updates a wide selection of his highly influential writings on health, including international-peer reviewed studies, annotated lectures, newspaper articles, and interview transcripts, to create an accessible collection that is both contemporary and authoritative. As a whole the book shows conclusively that inequalities in health are the scandal of our times in the most unequal of rich nations and calls for immediate action to reduce these inequalities in the near future

Income is robustly associated with health status. Higher income is associated with lower mortality and morbidity, both cross‐nationally and within societies. This relationship is not just confined to low levels of income, but extends well beyond median levels of income in society with diminishing marginal returns to health status with additional increments in income. Drawing upon the absolute and relative interpretations of income and conceptualising them simul‐taneously at the individual and community level, we develop a typology of income–health relationships and discuss the distinctiveness of, and connections between, each type. We conclude that a multilevel conceptual and methodological framework is most appropriate to understand the income–health relationship.

While a growing body of literature has investigated the health impact of intimate partner violence (IPV), less has been written on the social determinants of IPV. The authors use multilevel modeling methods to analyze data from a sample of 83,627 women in India to examine the socioeconomic and demographic patterning of the state‐ and neighborhood‐level variation in, and the state‐ and/or neighborhood‐level characteristics related to, IPV. This study finds social gradients in IPV in which women who are uneducated, from marginalized castes, and living in poor households have higher likelihood of reporting IPV than those living in advantaged circumstances. The results also show differences in IPV between neighborhoods and between states that are partially explained by state levels of gender inequality. The results suggest that changing cultural norms to promote the status of women and increasing the educational and economic opportunities for all people could decrease the prevalence of IPV.

BACKGROUND: This study examines the geographic variation and the magnitude of wealth inequities in birth registration in India between 2005 and 2015. METHODS: Data came from India's 2005 (n = 51,940) and 2015 (n = 250,194) Demographic Health Surveys. We estimated absolute wealth inequities at the national and state-level and specified three-level logistic regression models (children, communities, and states) to calculate the variance partitioning coefficient attributable to each level to examine the variation in birth registration at each time point. RESULTS: National birth registration coverage was 41.2% in 2005 and improved to 79.6% in 2015. Between 2005 and 2015, coverage among children in the poorest quintile (Q1) improved from 23.9% to 63.8% while coverage among the wealthiest children (Q5) improved from 72.4% to 92.8%. Although the absolute wealth inequity decreased from 48.6%-points to 29.1%-points, children in Q1 still had levels of coverage in 2015 that were lower than children in Q5 in 2005. Between 2005 and 2015, birth registration improved in every state and coverage was higher than 90% in 13 states. Wealth inequities decreased in 21 states and increased in 8 states. In adjusted multi-level models the proportion of total variation in birth registration attributable to states (35.7% 2005 and 29% in 2015) was larger than the variation attributable to communities (15% in 2005 and 13.7% in 2015). CONCLUSION: Birth registration is essential for ensuring inclusive population counts of birth and mortality rates. Efforts to reach universal birth registration in India will require a commitment to reducing wealth inequities within states.

Objectives. To determine the extent to which opioid prescribing rates vary across US congressional districts. Methods. In an observational cross-sectional framework using secondary data, we constructed 2016 congressional district–level opioid prescribing rate estimates using a population-weighted methodology. Results. High prescribing rate districts were concentrated in the South, Appalachia, and the rural West. Low-rate districts were concentrated in urban centers. Conclusions. In the midst of an opioid overdose crisis, we identified congressional districts of particular concern for opioid prescription saturation. Public Health Implications. The congressional district geography represents a policy-relevant boundary and a politically important level at which to monitor the crisis and determine program funding. Furthermore, in the context of the opioid crisis, knowing how congressional districts rank across the country and in states is useful in the creation of policies targeted to areas in need.

Background: Studies on political ideology and health have found associations between individual ideology and health as well as between ecological measures of political ideology and health. Individual ideology and aggregate measures such as political regimes, however, were never examined simultaneously. Methodology/Principal Findings: Using adjusted logistic multilevel models to analyze data on individuals from 29 European countries and Israel, we found that individual ideology and political regime are independently associated with self-rated health. Individuals with rightwing ideologies report better health than leftwing individuals. Respondents from Eastern Europe and former Soviet republics report poorer health than individuals from social democratic, liberal, Christian conservative, and former Mediterranean dictatorship countries. In contrast to individual ideology and political regimes, country level aggregations of individual ideology are not related to reporting poor health. Conclusions/Significance: This study shows that although both individual political ideology and contextual political regime are independently associated with individuals' self-rated health, individual political ideology appears to be more strongly associated with self-rated health than political regime.

Studies have largely examined the association between political ideology and health at the aggregate/ ecological level. Using individual-level data from 29 European countries, we investigated whether self-reports of political ideology and health are associated. In adjusted models, we found an inverse association between political ideology and self-rated poor health; for a unit increase in the political ideology scale (towards right) the odds ratio (OR) for reporting poor health decreased (OR 0.95, 95% confidence interval 0.94–0.96). Although political ideology per se is unlikely to have a causal link to health, it could be a marker for health-promoting latent attitudes, values and beliefs.

Social Capital and Health discusses social capital—a concept that originated in the social sciences—and its application to the field of public health. The editors take care to define the concept of social capital, describe its theoretical origins, and discuss the controversies and debates surrounding the use of the concept in public health research and practice. The book provides a comprehensive 'tool kit' of current approaches to measure social capital. Further, the book surveys the empirical evidence linking social capital to physical and mental health outcomes, health-related behaviors (like smoking), and aging-related outcomes.

The chapters in this dissertation provide insights into different aspects of the SDG research agenda. The chapters also both incorporate publicly available secondary data sources as well as newly collected survey data. Depending on the chapter, analyses were done either for a pooled sample or a single country. Chapters II-V address questions around SDGs #2 Zero Hunger and #3 Good Health and Well-Being, by incorporating secondary data from between 56-61 different low- and middle-income countries in pooled analyses. Chapter VI addresses the interface of SDGs #1 No poverty and #3 Good Health a...

The chapters in this dissertation provide insights into different aspects of the SDG research agenda. The chapters also both incorporate publicly available secondary data sources as well as newly collected survey data. Depending on the chapter, analyses were done either for a pooled sample or a single country. Chapters II-V address questions around SDGs #2 Zero Hunger and #3 Good Health and Well-Being, by incorporating secondary data from between 56-61 different low- and middle-income countries in pooled analyses. Chapter VI addresses the interface of SDGs #1 No poverty and #3 Good Health a...

With the launch of the Swachh Bharat Mission (SBM), India accelerated access to improved sanitation in a 'mass movement' emphasising people's participation and political leadership. However, SBM continues to be implemented at the administrative unit of districts, disassociated from the political and electoral units of Parliamentary Constituencies (PC). We provide estimates of India's 543 PCs by their performance on three important Water Sanitation and Hygiene (WASH) indicators: unsafe disposal of child stool, unimproved drinking water supply, and unimproved sanitary facilities. We used multilevel modelling to generate precision-weighted estimates of each indicator at PC-level, based on recently developed methodologies linking cluster GPS data from the National Family Health Survey (NFHS), 2016 to potential PCs. We found very high heterogeneity across PCs ranging from 0.95 per cent–95.85 per cent for unsafe stool disposal, 0.35 per cent–64.17 per cent for unimproved drinking water source, and 0.19 per cent–90.69 per cent for unimproved sanitation facility. Unsafe child stool disposal and unimproved sanitary facility were strongly correlated ( r = 0.85, Pearson and r = 0.83, Spearman). Monitoring of SBM data at the PC level will allow parliamentarians to effectively improve WASH conditions in their constituencies, while accounting for critical between-PC variability that may be obfuscated in an approach focussed on state or district means.

In 2017, the Joint Monitoring Programme estimated that 520 million people in India were defecating in the open every day. This is despite efforts made by the government, Non-Governmental Organizations (NGOs), and multilaterals to improve latrine coverage throughout India. We hypothesize that this might be because current interventions focus mostly on individual-level determinants, such as attitudes and beliefs, instead of considering all possible social determinants of latrine ownership. Given this, we ask two questions: what is the association between the amount of dwelling space owned by households in rural India and their likelihood of toilet ownership and what proportion of the variation in household latrine ownership is attributable to villages and states? We used multilevel modeling and found significant associations between the amount of household dwelling space and the likelihood of latrine ownership. Furthermore, considerable variation in latrine ownership is attributable to villages and states, suggesting that additional research is required to elucidate the contextual effects of villages and states on household latrine ownership. Thus, sanitation interventions should consider household dwelling space and village and state context as important social determinants of latrine ownership in rural India. Doing so could bolster progress towards Sustainable Development Goal (SDG) 6.