CONSTRUCTING A HEALTH AND SOCIAL INDICATOR FRAMEWORK FOR INDIGENOUS COMMUNITY HEALTH RESEARCH

Health and social indicators that capture the distinct historical, social, and cultural contexts of Indigenous communities can play an important role in informing the planning and delivery of community interventions. There is currently considerable interest in cataloguing and vetting meaningful community-level health and social indicators that could be applied to research and health promotion activities in Indigenous communities in Australia, Canada, and New Zealand, inclusive of conventional indicators as well as measures developed specifically for use in or with Indigenous communities. To avoid haphazard selection of indicators, and to assure the comprehensiveness and relevance of any given set of indicators, a framework that can accommodate and conceptually classify indicators representing a full range of domains is required. We report here on the development of a conceptual framework, by which Indigenous community indicators, and more general community-level social indicators, can be sorted, catalogued, and systematically classified within four hierarchical levels. The indicator framework was developed across Canada, Australia and New Zealand in consultation with academic researchers and Indigenous community stakeholders, building from established health and social indicator systems. The Indigenous indicator framework permits Indigenous communities, public health researchers, and funding agencies to compare and select the most appropriate indicators for application in specific contexts from the multitude of existing indicators.     

DETERMINANTS AND INDICATORS OF HEALTH AND WELL-BEING: TOOLS FOR EDUCATING SOCIETY

Over the last 50 years, industrial countries have seen dramatic increases in the health and well being of their citizens. Life expectancy, infant and maternal mortality, key measures of population health, have shown continuous improvements since the turn of the century. Yet changes in the economic and social fabric such as increasing income disparity, psychological stressors such as high unemployment levels, and health care reforms with reductions in service provisions that are currently being experienced in industrialized countries, are threatening the sustainability of human health and well-being. With government resources dwindling for health services, expectations are increasing for communities to take charge of their own health and well-being. This paper presents some of the issues and dilemmas surrounding the sustainability of human health, and identifies the importance of developing educated and mobilized communities. By highlighting examples from the Community Health and Well-being in Southwestern Ontario: A Resource for Planning report, it suggests that the provision of key local health and well-being indicators is an important first step to community education and mobilization.     

Measuring Health Inequality in US: A Composite Index Approach

Social Indicators Research - In this paper, we use the standardized mortality rates for 21 mutual exclusive causes of death to propose a composite index of US county-level health performances in...     

Kuznets Curve for the US: A Reconsideration Using Cosummability

Social Indicators Research - The relationship between income inequality and long-run economic growth has gained a growing attention in economic research for over decades. This study employed...     

Convergence of Health Care Expenditures Across the US States: A Reconsideration

Current evidence on the convergence of health care expenditures across the US states into a single convergence club is non-existent. Against this backdrop, we use a modified panel unit root test that accounts for smooth structural changes, spanning the period of 1966–2009. The results illustrate that the ratio of the individual health care expenditures relative to the cross-sectional average is broken trend-stationary, not only in the aggregate panel, but also across all 50 US states. The findings also document that the evidence of convergence is possibly due to the convergence of personal disposable income across the US states.     

Sub‐Saharan Africa's Future: A US National Intelligence Council Conference Report

The US National Intelligence Council's 2020 Report, Mapping the Global Future, was issued in December 2004. It presented an assessment of geopolitical trends and set out some speculative scenarios for global development over the next 15 years. Excerpts were carried in the Documents section of PDR 31, no. 1. A follow‐up conference in 2005 brought together a group of US experts on Africa to explore likely trends and drivers of change in sub‐Saharan Africa over the same period, partly in the light of the Report's treatment of that region. Part of the NIC's summary of the conference discussions is reproduced below. (Omitted sections discuss globalization, terrorism, democratization, foreign influences, and religion. The full summary is available at http://www.odci.gov/nic/confreports_africa_future.html .) It is notable that the topic of population, which once would have figured heavily in such prognostications, nowhere appears in the conference deliberations. Yet the region's population growth is still rapid—and is plausibly a major driver of change. In the UN's medium projections, sub‐Saharan Africa's population, estimated at 906 million in 2005, will more than double by 2050, its share of world population rising from 12 percent to 19 percent. In the 15‐year time frame of the NIC it will likely grow by 200 million. Those numbers are of course tenuous, contingent on the expectations they embody about the timing of the region's transition to low death and birth rates (and specifically in their assessment of the future course of the AIDS epidemic)—which in turn will be influenced by many of the factors that the NIC conferees considered.     

Smoking and Variation in the Hispanic Paradox: A Comparison of Low Birthweight Across 33 US States

The Hispanic Paradox in birth outcomes is well documented for the US as a whole, but little work has considered geographic variation underlying the national pattern. This inquiry is important given the rapid growth of the Hispanic population and its geographic dispersion. Using birth records data from 2014 through 2016, we document state variation in birthweight differentials between US-born white women and the three Hispanic populations with the largest numbers of births: US-born Mexican women, foreign-born Mexican women, and foreign-born Central and South American women. Our analyses reveal substantial geographic variation in Hispanic immigrant–white low-birthweight disparities. For example, Hispanic immigrants in Southeastern states and in some states from other regions have reduced risk of low birthweight relative to whites, consistent with a “Hispanic Paradox.” A significant portion of Hispanic immigrants’ birthweight advantage in these states is explained by lower rates of smoking relative to whites. However, Hispanic immigrants have higher rates of low birthweight in California and several other Western states. The different state patterns are largely driven by geographic variation in smoking among whites, rather than geographic differences in Hispanic immigrants’ birthweights. In contrast, US-born Mexicans generally have similar or slightly higher odds of low birthweight than whites across the US. Overall, we show that the Hispanic Paradox in birthweight varies quite dramatically by state, driven by geographic variation in low birthweight among whites associated with white smoking disparities across states.     

MAXIMUM PRINCIPLE FOR AGE AND DURATION STRUCTURED SYSTEMS: A TOOL FOR OPTIMAL PREVENTION AND TREATMENT OF HIV

Age and duration since infection are considered in a model of optimal control of the spread of Human Immunodeficiency Virus (HIV) in countries with high prevalence. Prevention and medical treatment are selected so as to maximize an economic objective function.The model extends the classical McKendrick equation. Necessary optimality conditions in the form of Pontryagin's global maximum principle and numerical solution based on them are presented. “Critical” initial prevalence is established numerically for which there are two optimal medical treatments: one intense and another less demanding. It is shown that treatment alone can be counterproductive: increase in treatment must be accompanied by increase in prevention.     

Fertility decline in a US population favoring large families: A hazard-model analysis of the effect of sib death on Amish fertility

This paper uses proportional hazards techniques and population data from a directory of the Old Order Amish of the Lancaster, PA settlement. It examines the effect of death of the immediately prior sibling on the risk of childbearing for up to 11 children. Prior research typically has pooled data for maternal cohorts. In contrast, separate models are estimated for each maternal cohort. The results are based on all reported first marriages of Amish women born between 1884–1973 (N = 4066). Hazard models run separately for children of each birth order reveal that net of maternal age and length of the prior birth interval (and other statistical and design controls), the death of the prior sib significantly increases the risk of a subsequent birth for the lower birth orders. Separate models by maternal cohort show that sib death increases the risk primarily for later cohorts. The pattern of effects from child mortality and other variables suggests changes in fertility behavior among the Amish, who have strong, traditional norms opposing contraception and favoring large families.     

Neighbourhood Ethnic Density Effects on Behavioural and Cognitive Problems Among Young Racial/Ethnic Minority Children in the US and England: A Cross-National Comparison

Studies on adult racial/ethnic minority populations show that the increased concentration of racial/ethnic minorities in a neighbourhood—a so-called ethnic density effect—is associated with improved health of racial/ethnic minority residents when adjusting for area deprivation. However, this literature has focused mainly on adult populations, individual racial/ethnic groups, and single countries, with no studies focusing on children of different racial/ethnic groups or comparing across nations. This study aims to compare neighbourhood ethnic density effects on young children’s cognitive and behavioural outcomes in the US and in England. We used data from two nationally representative birth cohort studies, the US Early Childhood Longitudinal Study-Birth Cohort and the UK Millennium Cohort Study, to estimate the association between own ethnic density and behavioural and cognitive development at 5 years of age. Findings show substantial heterogeneity in ethnic density effects on child outcomes within and between the two countries, suggesting that ethnic density effects may reflect the wider social and economic context. We argue that researchers should take area deprivation into account when estimating ethnic density effects and when developing policy initiatives targeted at strengthening and improving the health and development of racial and ethnic minority children.