---------------------- Forwarded by Dennis Raphael/Atkinson on 03/06/2002 12:27
PM ---------------------------
Nancy Krieger <[log in to unmask]> on 03/06/2002 11:41:21 AM
To: Spirit of 1848 <[log in to unmask]>
cc: nancy krieger <[log in to unmask]>(bcc:
Dennis Raphael/Atkinson)
Subject: [spiritof1848] Health Affairs issue on social
disparites in health
fyi ...
EFFECTS OF HEALTH ON WEALTH ARE STRONG; BUT CAUSAL MECHANISMS, POLICY
IMPLICATIONS ARE COMPLEX & CONTROVERSIAL
Special Issue Explores Nonmedical Factors In Depth
The percentage of women with diabetes who have not completed high school
is more than twice the percentage who have, the Centers for Disease
Control and Prevention reported in February. Women with diabetes are twice
as likely to live in households with annual incomes below $25,000 a year
than in households above that level. In general, death rates from chronic
disease among high school graduates are less than half what they are among
non-graduates.
In many estimates, socioeconomic, behavioral, and environmental
factors far outweigh access to medical services in explaining variations
in population health. But there is little agreement among researchers
about how these factors work. Even more controversial are the policy
questions raised by nonmedical determinants of health
The March/April issue of the policy journal Health Affairs
features fifteen articles by a distinguished lineup of scholars, who
tackle "the policy implications of the gradient," or the tendency for
health status to decline with income, from a variety of angles. The papers
include objective analysis of what we know about the "powerful yet
mysterious" mechanisms by which nonmedical factors influence health
status; theoretical discussion of how far redistributive strategies and
other policy options might go toward reducing disparities; detailed
treatments of the economics of tobacco, alcohol, and illegal drug
regulation; and other papers on the effects of obesity, parenting issues,
and tobacco advertising.
Health and Wealth
"Poorer people die younger and are sicker than richer people," Princeton
University's Angus Deaton writes in the volume's opening paper. But the
question of whether health policy should therefore focus on equalizing
incomes remains complex because of the intervening effects of other
factors such as behavior, education and social "rank"; and the reciprocal
influence of health on income. "The existence of the gradient strengthens
the case for income redistribution," Deaton concludes, but an exclusive
focus on inequality "would not be sound policy."
The British epidemiologist Sir Michael Marmot draws on a large body of
research in the United Kingdom for his discussion of nuances in the
relation between health and wealth. "Once education is included in the
model, the effect of income on mortality is markedly reduced," Marmot
notes. Status and social support systems also matter. "Important as money
might be, we need to go beyond absolute measures of income to understand
the relation between social position and health."
Both of these papers are available free to the public on the
journal's Web site, www.HealthAffairs.org.
Disparities
David Mechanic, of Rutgers University, finds similarly that
abundant evidence of a correlation between disparities in health and
wealth does not yield clear-cut policy implications. "Initiatives intended
to improve population health also may increase disparities," Mechanic
finds, citing large reductions in black infant mortality in the U.S. after
1950 that nevertheless did not close the gap with whites. Poor countries
with relatively healthy populations display an "emphasis on educational
attainment; empowerment of women; and well-organized primary medical
care," he points out.
Nancy Adler and Katherine Newman, of the University of California
at San Francisco and Harvard, respectively, map the relevant components of
socioeconomic status (SES) education, income, and occupation and explain
how SES interacts with factors such as environment and behavior to
influence health status. Policymakers need to recognize the multiple
pathways created by these interactions and tailor interventions
accordingly with multiple approaches.
Policymaking, Regulation and Economics
Michael McGinnis and colleagues at the R.W. Johnson Foundation
tour the wide universe of health determinants genetics, social status,
environment, behavior, and access to care and outline the complex
challenge of selecting interventions within realistic resource
constraints. The difficulties include assessing the effectiveness of
measures taken and assigning political accountability for the choices.
Leadership, incentives, and research emerge as critical factors.
Nicole Lurie of RAND examines the policy options in greater
detail and suggests a robust agenda. Leadership from CDC, the Surgeon
General's office and other federal agencies will set the pace. Cooperation
between disparate government departments is essential, and federal
agencies can exert leverage by "management of the informational
environment." Obstacles, as well as opportunities, are considered.
Additional perspectives are offered by John Lavis and Leonard Syme and
colleagues.
Three papers explore the economic dimension of policymaking in
some of the most developed and familiar areas of nonmedical but
health-related legislation and regulation tobacco, alcohol, and illegal
drug use. Authors include Philip Cook, Jonathan Gruber, Michael Grossman,
and Frank Chaloupka.
An interview with outgoing CDC director Jeffery Koplan rounds out the
volume, along with shorter papers on "Parental Behavior and Child Health,"
"The Effects of Obesity, Smoking, and Problem Drinking on Chronic Medical
Problems and Health Care Costs," and "Youth Targeting by Tobacco
Manufacturers: Magazine Advertising Since the Master Settlement Agreement."
Health Affairs, published by Project HOPE, is a bimonthly multidisciplinary
journal devoted to publishing the leading edge in health policy thought and
research.
All articles from the March/April issue are available to subscribers on
the journal's Web site, www.healthaffairs.org.
The special issue was published with the generous support of the Robert
Wood Johnson Foundation.
We welcome posting on social justice & public health that provide:
a) information (e.g. about conferences or job announcements or
publications relevant to social justice & public health), and
b) substantive queries or comments directly addressing issues
relevant to social justice and public health.
Please do NOT post petitions on the bulletin board, as they clog up
the works; instead, if you have a petition you want to circulate,
please post a notice about the petition and provide your email
address so people can email you to get a copy of the petition. Also,
to limit e-mail volume, please do not send posts directed toward a
single individual to the list at large. Instead of hitting 'reply',
cut and paste the person's address into the 'to' field, and send your
message directly to the her/him.
Community email addresses:
Post message: [log in to unmask]
Subscribe: [log in to unmask]
Unsubscribe: [log in to unmask]
List owner: [log in to unmask]
Web page: www.progressivehn.org
To subscribe or un-subscribe send an e-mail to the address
specified above with the word "subscribe" or "unsubscribe"
in the subject line.
Your use of Yahoo! Groups is subject to http://docs.yahoo.com/info/terms/
Send one line: unsubscribe click4hp to: [log in to unmask] to unsubscribe
See: http://listserv.yorku.ca/archives/click4hp.html to alter your subscription
|
