CDC on Vaccines and Children's Health: United States 1900–98

During the twentieth century, the health and life expectancy of persons residing in the United States—as in most other countries of the globe—have improved greatly. (For a discussion of some aspects of that improvement, see the article in this issue by Kevin White assessing the effects of changes in cardiovascular and tuberculosis mortality in the United States since 1900.) A considerable share of this change is attributable to advances in public health. To highlight these advances the Morbidity and Mortality Weekly Report (MMWR) of the Centers for Disease Control and Prevention (an agency of the US Department of Health and Human Services) is issuing a series of reports profiling ten great public health achievements in the United States during the present century. The first of these reports discusses vaccination: “Impact of vaccines universally recommended for children—United States, 1900–1998,” MMWR 48 (12), 2 April 1999. It is reproduced below in full. The improvements chronicled in the report are especially great with respect to morbidity. In many developing countries mortality resulting from vaccine-preventable causes is, however, still very high. Recent international initiatives, involving UN agencies, bilateral aid agencies, foundations, and the vaccine industry, aim at accelerating the outreach of immunization in developing countries. A meeting discussing an expanded program of vaccination (Bellagio, March 1999) estimated that global immunization, at a cost of approximately $3 billion per year, could save some 40 million lives over the next ten years.     

Systematic review on the cost and cost-effectiveness of mHealth interventions supporting women during pregnancy

ObjectivesThe increased integration of digital health into maternity care—alongside growing use of, and access to, personal digital technology among pregnant women—warrants an investigation of the cost-effectiveness of mHealth interventions used by women during pregnancy and the methodological quality of the cost-effectiveness studies.MethodsA systematic search was conducted to identify peer-reviewed studies published in the last ten years (2011–2021) reporting on the costs or cost-effectiveness of mHealth interventions used by women during pregnancy. Available data related to program costs, total incremental costs and incremental cost-effectiveness ratios (ICERs) were reported in 2020 United States Dollars. The quality of cost-effectiveness studies was assessed using the Consolidated Health Economic Evaluation Reporting Standards (CHEERS).FindingsNine articles reporting on eight studies met the inclusion criteria. Direct intervention costs ranged from $7.04 to $86 per woman, total program costs ranged from $241,341 to $331,136 and total incremental costs ranged from -$21.16 to $1.12 million per woman. The following ICERs were reported: $2168 per DALY averted, $203.44 per woman ceasing smoking, and $3475 per QALY gained. The full economic evaluation studies (n = 4) were moderate to high in quality and all reported the mHealth intervention as cost-effective. Other studies (n = 4) were low to moderate in quality and reported low costs or cost savings associated with the implementation of the mHealth intervention.Conclusions for practicePreliminary evidence suggests mHealth interventions may be cost-effective and “low-cost” but more evidence is needed to ascertain the cost-effectiveness of mHealth interventions regarding positive maternal and child health outcomes and longer-term health service utilisation.     

The potential of child care tax credits to reduce poverty and welfare recipiency

As more and more mothers of young children enter the work force, interest in government financing of child care grows. The chief government subsidy for child care is the child care credit in the federal Internal Revenue Code. This is a nonrefundable credit and therefore provides benefits only to those with incomes high enough to require them to pay income tax. Yet of the $ 5.5 billion spent by the federal government on child care in 1986, this program accounted for $ 3.5 billion.This paper simulates the effects of expanding the child care tax credit by (1) doubling the reimbursement rates of the current credit; (2) making the credit refundable; and (3) both making the credit refundable and increasing its value for all families with income below $ 32,000.Results suggest that these changes will have modest effects on the income and earnings of mothers, and on the poverty gap and welfare recipiency. Costs, however, differ substantially. Doubling the value of the credit is far more expensive than either making the credit refundable or making it both refundable and more generous at the bottom of the income distribution. Making the credit refundable may cost taxpayers very little by leading to increases in hours worked and concomitant reductions in welfare payments.     

Gay male, lesbian and bisexual health-related research funded by the National Institutes of Health between 1974 and 1992

Health-related problems among lesbians, bisexuals, and gay men require research before solutions to them can be identified. This paper describes NIH sponsored research listing homosexuality as a primary or secondary issue between 1974 and 1992. Homosexual projects unrelated to HIV and excluding capitol funding averaged only $532,000 per year compared to about $20 million per year since 1982 for HIV projects. Considering the range of health threats to these communities and the amounts needed to deal with HIV alone, current funding is clearly inadequate. Community members, scientists, experts, and others need to take action if appropriate research is to be done and the health needs of these groups are to be addressed.     

Compensation for Occupational Risk and Valuation of Statistical Life

This paper uses information on a sample of 430 blue collar workers from different manufacturing industries of Ahmedabad, India to examine the influence of worker’s compensation on their wage and mortality rates. This relation has a direct impact on the value of statistical life (VSL) estimates which is used to evaluate various health and safety policies. The compensation benefit plays a significant role in worker’s compensation package however it has not received much attention in previous Indian studies. Inclusion of the compensation variable not only raises the co-efficient of risk variables but also increases the value of statistical life and value of statistical injury (VSI) estimates. The result of this study indicates that trade-off between worker’s wage and compensation benefit exists for the workers in the sample. The estimated VSL that captures the effect of compensation benefit ranges between INR 30.27 million ($0.46 million) and INR 72.11 million ($1.10 million) while the estimated VSI ranges between INR 1.94 million ($0.029 million) and INR 2.82 million ($0.043 million). Besides, this paper goes further to study the rate of substitution between worker’s compensation benefit and their wage and finds that the benefit levels are sub-optimal.

     

Mobile Money and School Participation: Evidence from Africa

This paper shows that mobile money technology—an electronic wallet service that allows users to deposit, transfer, and receive money using their mobile phones—is positively correlated with increased school participation of children in school age. By using data from 4 African countries, we argue that, by reducing transaction costs, and by making it easier and less expensive to receive remittances, mobile money reduces the need for coping strategies that are detrimental to child development, such as withdrawing children from school and sending them to work. We find that mobile money increases the chances of children attending school. This finding is robust to different empirical models. In a nutshell, our results show that 1 million children could start attending school in low-income countries if mobile money was available to all.

     

Life Satisfaction as a Distinguishing Indicator of College Student Functioning: Further Validation of the Two-Continua Model of Mental Health

The two-continua model of mental health contends that both psychological distress and psychological well-being make related-yet-distinct contributions to our understanding of human health and its relations with other quality of life outcomes. Using self-reported somatization, depression, and anxiety symptoms as indicators of psychological distress and self-reported life satisfaction as an indicator of psychological well-being, the present study classified participants into one of four mental-health-status groups—mentally healthy, mentally unhealthy, symptomatic yet content, or asymptomatic yet discontent—and investigated between-group differences across three key indicators of college student functioning: academic achievement, interpersonal connectedness, and physical health. Findings provide further validation for the two-continua model of mental health among college students, showing that, when considered in conjunction with clinical symptoms, life satisfaction serves as a distinguishing indicator of college students functioning across academic, social, and physical health domains—as well as a strong predictor of the absence or presence of clinical symptoms and comorbidity. Implications for theory, practice, and future research are discussed.     

R. F. Harrod on Reviving the Birth Rate

Continuing below‐replacement fertility and projected declines in population size are demographic features of many European countries and Japan. They are variously met with complacent acceptance, calls for higher rates of immigration, or—often last and least—proposals for increasing the birth rate. Fertility was also low in the 1930s, and some of the policy debate from that period resonates today. In England and Wales, fertility then had been declining for half a century. Over the decade 1931–40, it averaged 1.8 children per woman—moreover, with net emigration. Worries over this situation and its likely consequences led to the setting up in 1944 of a Royal Commission on Population, charged with considering “what measures, if any, should be taken in the national interest to influence the future trend in population.” In a memorandum submitted to the Commission in that year, the economist R. F. Harrod set out a detailed proposal to encourage childbearing through a scheme of family endowments. Part of the introductory section of Harrod's submission, arguing the case for state intervention and for material rather than ‘spiritual’ measures, is reproduced below. An evident problem in offering economic incentives for childbearing is that, to induce a given behavioral change, well‐off families would require much larger incentives than the poor. Hence child endowments that aspire to effectiveness across the income distribution have to be skewed toward the upper end. Harrod argues that this is as it should be, that policy should establish neutrality between large and small family sizes, and that this is a conceptually separate issue from poverty alleviation. ‘We should seek a re‐distribution of national income favourable to the parents of larger families and the plan should be put into effect whether or not another re‐distribution as between rich and poor is proceeding at the same time.’ He remarks on the implausibility of the government's being able to ‘talk up’ fertility— thereby generating some kind of costless ideational change, a ‘spiritual aufklärung.’ Later pans of the submission not reprinted here cover the specific details of the proposal. The proposed annual benefit per child (intended for every child after the second, with half‐rates payable for the second child) is paid for 18 years. It is substantial and increases with the child's age—at ages 13–18, for most of the income range it amounts to 20–30 percent of the father's income (or mother's, if hers is higher). Harrod also discusses further the rationale for making the endowments (and the compulsory contributions—a flat 5 percent of income—that finance them) proportional to income. To make his case Harrod draws on the dysgenic and population‐quality arguments popular at the time: worry about ‘race decline’ and ‘a general lowering of standards and of efficiency if the parents who are best equipped in experience, knowledge and culture are relatively infertile.’ In the event, the Commission recommended a flat schedule of family allowances, together with tax exemptions for dependent children calculated to provide some income‐based benefit. These were justified on population as well as equity and welfare grounds, ‘since the handicaps of parenthood have played a large part in the fall of average family size below replacement level.‘ Population quality issues—the subject of several other submissions—were sidestepped by calling for further research. By the time the Commission's report was finally published, in 1949, the baby boom was well underway: average fertility over 1946–50 was 2.4. Roy Forbes Harrod (1900–78) was one of the foremost economists of his day. His career was largely spent at Christ Church College, Oxford. A student and sometime colleague of Keynes, his best‐known early work was centered on identifying a dynamic equilibrium growth path for the economy—building on Keynes's static equilibrium analysis. As stylized (by others), this came to be called the Harrod‐Domar growth model, a formulation basic to growth theory. Harrod was editor of the Economic Journal for the period 1945–66. He was active in politics and as an economic adviser to both Labour and Conservative governments. He was knighted in 1959. The extract is reprinted from volume 5 of the Papers of the Royal Commission on Population (London: His Majesty's Stationery Office, 1950), pp. 80–85.     

Social Capital and Self Perceived Health Among European Older Adults

There is increasing interest among researchers in the effects of social capital on the health of older adults. One of the key policy question for an ageing population concerns how do we identify the factors that influence health. Very recently, an increasing interest on social capital as a key determinant for health has developed and, surprisingly, not much is known for the European population. This paper analyzes the association between social capital and self-perceived health among older adults in Europe using a mixed effects logistic model. Social capital is considered in its two components—bonding and bridging—in order to understand if the relations inside or outside an individual inner circle have a different association with health. Our results give empirical support to the role of individual social capital in preventing a poor self-perceived health. This means that social capital, especially the bridging component of it, can be one of the key factors of ageing in good health and should be fostered by policy makers in order to give an answer to one of the most compelling challenge of our century: population ageing.     

Measuring Community Economic Resilience in Australia: Estimates of Recent Levels and Trends

We measure changes in community economic resilience (CER) across geo-locations in Australia between 2006 and 2011, a time span characterised by major natural and economic shocks. We build an index of potential CER that captures communities’ stocks of human, social, natural, physical and financial capitals, levels of economic diversity and accessibility to service centres. Using Census data and the ARIA index, we resort to principal component analysis to generate CER indexes at statistical area level 1, which is our community proxy. Our analysis of index values provides a number of useful insights. First, there was a statistically significant improvement over time in the overall CER index in all states and regions. Second, our CER measures improved at a different pace across regions and states while their rank remained mostly unchanged. Third, CER improved over time in social and physical capital and accessibility terms, but declined in human, natural, financial capital and diversity terms. Fourth, communities with a high economic diversity level reported higher capital stock except for natural capital, and communities with a low accessibility level had lower capital stock except for social and natural capital. Finally, CER has a long-term positive association with household income.     

The impact of immigration on the Social Security System

In 1992, the estimated deficit of the entire Social Security System attributable to the foreign born was $2.7 billion (i.e., payments the foreign born payed to and received from the system). Also in 1992, there was an estimated surplus of $19.0 billion for the native born population. During the 1993–2002 decade, the $2.7 billion annual deficit attributable to the current stock of immigrants is projected to grow by about one percent annually in present value terms, reaching $2.98 billion yearly in 2002.The ten-year deficit for the 1993–2002 decade would amount to nearly $30.0 billion in 1993 dollars. In policy terms, the addition of large numbers of less skilled foreign workers to the labor force (which will occur if there is no change in immigration law or enforcement policy) in the hope of bolstering the solvency of the Social Security System would in fact have the opposite effect.     

Utilization of Infertility Treatments: The Effects of Insurance Mandates

Over the last several decades, both delay of childbearing and fertility problems have become increasingly common among women in developed countries. At the same time, technological changes have made many more options available to individuals experiencing fertility problems. However, these technologies are expensive, and only 25% of health insurance plans in the United States cover infertility treatment. As a result of these high costs, legislation has been passed in 15 states that mandates insurance coverage of infertility treatment in private insurance plans. In this article, we examine whether mandated insurance coverage for infertility treatment affects utilization. We allow utilization effects to differ by age and education, since previous research suggests that older, more-educated women should be more likely to be directly affected by the mandates than younger women and less-educated women, both because they are at higher risk of fertility problems and because they are more likely to have private health insurance, which is subject to the mandate. We find robust evidence that the mandates do have a significant effect on utilization for older, more-educated women that is larger than the effects found for other groups. These effects are largest for the use of ovulation-inducing drugs and artificial insemination.     

Fiscal externalities of becoming a parent

Theoretical and empirical results suggest that there are externalities to childbearing, but those results usually assume that these externalities accrue uniformly within a homogeneous population. We advance this argument by developing separate estimates of the fiscal externalities associated with parents—those who devote time or material resources to minor children—and nonparents. Our analysis uses data from the US Panel Study of income Dynamics on the age profiles of taxes paid and publicly funded benefits consumed by parents and nonparents, together with a previously developed intertemporal economic-demographic accounting model. The accounting framework takes into account the net fiscal impacts of future generations as well as the present population. Our findings indicate that, with a 3 percent discount rate, parents produce a substantial net fiscal externality, about $217,000 in 2009 dollars. This is equivalent to a lifetime annuity of nearly $8,100 per year beginning at age 18. The results are sensitive to both the discount rate used and the proportion of parents within the cohort.     

How We Fall Apart: Similarities of Human Aging in 10 European Countries

We analyze human aging—understood as health deficit accumulation—for a panel of European individuals, using four waves of the Survey of Health, Aging and Retirement in Europe (SHARE data set) and constructing a health deficit index. Results from log-linear regressions suggest that, on average, elderly European men and women develop approximately 2.5 % more health deficits from one birthday to the next. In nonlinear regressions (akin to the Gompertz-Makeham model), however, we find much greater rates of aging and large differences between men and women as well as between countries. Interestingly, these differences follow a particular regularity (akin to the compensation effect of mortality) and suggest an age at which average health deficits converge for men and women and across countries. This age, which may be associated with human life span, is estimated as 102 ± 2.6 years.     

Does Religion Make You Healthier and Longer Lived? Evidence for Germany

Researchers in the US have consistently reported substantial—not just statistically significant—links between religious belief and practice, and improved health and longevity. In this paper we report evidence for Germany, using data from the long-running, nationally representative German Socio-Economic Panel (SOEP 1984). The SOEP dataset includes multiple measures of health, plus many ‘controls’ which it is appropriate to use in assessing links between religious practice, health and longevity. These controls include personality traits known to be associated with better health (notably conscientiousness), and also the age of death of parents of the survey respondents. Initial results suggested that religious practice (church attendance) may be linked only to subjective (self-rated) measures of health, not to more objective measures. It seemed possible that results in some previous research could be due to what may be termed satisfaction bias or positivity bias; the known tendency of religious people to report higher than average satisfaction with almost all aspects of life. Further investigation indicated that relationships between church attendance and subjective measures of health were weaker, when a control for satisfaction bias was in place. However, there was countervailing evidence that the subjective measures in SOEP may actually be more not less valid than the objective measures; they are better not worse predictors of mortality. It was also clear that religious belief and church attendance are associated with health-protective behaviors and attitudes, including taking more exercise, not smoking and higher life satisfaction. At the end of the paper we estimate a structural equation model which maps links between religious practice, these protective behaviors and attitudes, and improved health outcomes.     

Health Selection,Migration, and HIV Infection in Malawi

Despite its importance in studies of migrant health, selectivity of migrants—also known as migration health selection—has seldom been examined in sub-Saharan Africa (SSA). This neglect is problematic because several features of the context in which migration occurs in SSA—very high levels of HIV, in particular—differ from contextual features in regions that have been studied more thoroughly. To address this important gap, we use longitudinal panel data from Malawi to examine whether migrants differ from nonmigrants in pre-migration health, assessed via SF-12 measures of mental and physical health. In addition to overall health selection, we focus on three more-specific factors that may affect the relationship between migration and health: (1) whether migration health selection differs by destination (rural-rural, rural-town, and rural-urban), (2) whether HIV infection moderates the relationship between migration and health, and (3) whether circular migrants differ in pre-migration health status. We find evidence of the healthy migrant phenomenon in Malawi, where physically healthier individuals are more likely to move. This relationship varies by migration destination, with healthier rural migrants moving to urban and other rural areas. We also find interactions between HIV-infected status and health: HIV-infected women moving to cities are physically healthier than their nonmigrant counterparts.     

Health Benefits and Health Cost Savings Due to Pets: Preliminary Estimates from an Australian National Survey

American, Australian and British studies have shown that pet dogs and cats confer health benefits on their owners. This paper reports results from the first national survey (N = 1011) estimating the magnitude of these benefits. The survey showed that dog and cat owners make fewer annual doctor visits and are less likely to be on medication for heart problems and sleeping difficulties than non-owners. An important public policy implication is that pet ownership probably reduces national health expenditure. By linking sample survey results to data on health expenditure, the paper proposes a method of estimating savings. A preliminary estimate of savings of $988 million is given for Australia for financial year 1994--95.     

Development of Indicators for Family Well-Being in Malaysia

This study was carried out to develop a set of indicators for measuring and reporting the state of family well-being in Malaysia, and subsequently, to produce an Index of Family Well-Being. To build the set of indicators, domains of family well-being and relevant indicators were identified from past studies. Focus group discussions with families, professional groups and NGOs helped to refine the indicators prior to the main study. Using a stratified random sampling design, 2,808 households were identified (a parent and a child aged at least 13 years), making a total sample of 5,616 respondents. Results indicated ten key indicators that can predict family well-being—resiliency, safety, savings, healthy lifestyle, time with family, work-family balance, importance of religion, number of bedrooms at home, debt and child care—supporting the notion of family well-being being multi-dimensional and interconnected. On the basis of the results, a model of family well-being was hypothesized. This model was used to guide the development of the Index of Family Well-being. Confirmatory factor analysis (CFA) was carried out to determine the fit of the model to data. Five domains of family well-being were identified—family relationships, economic situation, health and safety, community relationship and religion/spirituality. The Index of Family Well-Being was calculated using the equal weighting strategy to each of these five domains. This index showed that the current family well-being of Malaysians is relatively high at 7.95 (SD = 1.38) on a 0–10 Likert response format. The findings suggest that family well-being is multifaceted, made up not only of the immediate family relationships and health and safety of its members, but include having adequate income to meet the demands of a minimum standard of living. Currently, the Index that is developed is only in the form of a numerical value reflecting the state of family well-being, but in future, it can be used to track changes in the family from time to time.     

Invariance Testing of the SF-36 Health Survey in Women Breast Cancer Survivors: Do Personal and Cancer-related Variables Influence the Meaning of Quality of Life Items?

Quality of life (QoL) is affected by issues specific to illness trajectory and thus, may differ, and potentially take on different meanings, at different stages in the cancer process. A widely used measure of QoL is the SF-36 Health Survey (SF-36; Ware 1993); therefore, support for its appropriateness in a given population is imperative. The current study aimed to examine the conceptual (measurement) model of the SF-36, as well as closely related models, and test the measurement invariance of the SF-36 to determine if meaningful comparisons could be made among three groups of breast cancer survivors (N = 358 [data collected in 2007–2008]; divided on time since treatment, type of treatment, and age). Good model fit was found for one of three models based on the original design of this instrument—the items to subscales model. Two models were considered for measurement invariance testing: (a) items to physical health/mental health and (b) items to subscales. Strong invariance was found for time since treatment and type of treatment for both models. Weak invariance was found for age in the first model, while strict invariance was confirmed for the subscales model. Group comparisons in QoL were made where justified. Significant differences were found only on age for physical functioning, role limitations due to emotional problems, vitality, mental health, and social functioning. Overall, results suggest that while the SF-36 can be used to examine differences in QoL for various breast cancer survivors, some conceptual issues with this instrument need to be further examined.     

PrEP Whores and HIV Prevention: The Queer Communication of HIV Pre-Exposure Prophylaxis (PrEP)

ABSTRACT

HIV pre-exposure prophylaxis (PrEP) has been introduced as another biomedical tool in HIV prevention. Whereas other such tools—including post-exposure prophylaxis (PEP) and interruption of perinatal transmission—have been embraced by those impacted by HIV, PrEP has been met with more conflict, especially within the gay community and HIV organizations. The “PrEP whore” has come to designate the social value and personal practices of those taking PrEP. This study examines the “PrEP whore” discourse by using queer theory and quare theory. Within these theoretical vantage points, the study explicates four discursive areas: slut shaming, dirty/clean binaries, mourning the loss of condoms, and reclaiming the inner whore. The study illuminates possible discursive strategies that lie outside of the domains of public health and within the individual and community.