The application of quantitative indices for health planning to regional health service areas in vermont

Health System Agencies (HSAs) are expected to collect and analyze data on the health care delivery systems in their respective geographic areas for the purpose of preventing unnecessary dupplication of health resources and promoting the development of manpower and facilities which meet identified needs and reduce documented inefficiencies. The purpose of this paper is to present the results of a feasibility study of health services in Vermont using a profile system of individual manpower and facility types and summary indices of adequacy and efficiency. The profile system and indices make use of data already available in most health service areas. Profile and the values of summary indices are presented for each of the service areas of Vermont, using state provider/population and facility/population ratios as norms. Profiles and indices based on national norms are also presented for certain types of health professionals. Caveats are given in the interpretation of the results of applying the profile system and indices by health planners.     

National indicators for health for all

This paper examines available international data relevant to the World Health Organization model of health status. It explores the possibility of constructing useful measures of health status, health policy, social and economic status, and provision of health care based on these data. A five-factor model is developed and tested empirically using World Bank statistical data from 123 countries. Two factors representing dimensions of country affluence and population density are found to explain 78 percent of the variations in the health status indicator. The countries with health status indicator levels worse than those predicted by the model are predominantly third-world countries; a majority are African. Countries with health status indicator levels better than predicted are mainly in Asia, Latin America, and Europe. Some generally accepted causal relationships were not supported by the findings in this analysis.     

Impact of health and fitness-related behavior on quality of life

While the relationships between (a) health behavior and health status and (b) health status and perceived quality of life (QOL) have received some attention, the association between health behaviors and QOL has not been determined. The primary objective of this study was to assess the effects of health behaviors on QOL that are independent of the effects of health status. A sample of approximately 5 000 randomly selected U.S. Navy personnel was split into halves and analyses performed on each to establish the replicability of the findings. At step one of a multiple regression procedure, health status variables were forced into the equation; next, health behavior variables were entered. As expected, the block of health status variables was significantly related to QOL: self-assessed health and fitness status and lower reporting of physical symptoms accounted for 16% and 18% of the variance in QOL for the two subsamples. After controlling for health status, two behavioral measures made unique contributions to the prediction of QOL: behaviors related to avoiding unnecessary risks as a driver or pedestrain and avoiding or minimizing accidents. Wellness maintenance behaviors also were associated with QOL in one subsample. After controlling for health status, health behavior measures contributed an additional 11% and 6% of the explained variance in QOL for the two subsamples. Results indicate that health behaviors influence QOL independently of health status.     

Population aging, health care, and growth

This paper constructs a small open two-sector (health care and non-health care) overlapping generations model and investigates how changes in the demand for health care induced by population aging influence the economy’s employment structure and per capita income growth rate. We show that population aging induces a shift in labor from the non-health care sector to the health care sector and lowers the per capita income growth rate. This paper also investigates public policy for child care and demonstrates the existence of an intergenerational conflict between current and future generations concerning public policy on child care.     

Life change,health status and life satisfaction: A reconsideration

Recent research has suggested that life changes may be unrelated to health status indices and to overall satisfaction with life. Yet research has also reported that life changes appear to be related to measures of psychological distress. To attend further to clarification of the role of life change as a predictor of health status and life satisfaction, this paper examines the relationship between negative life change self-reports and indices of health status and life satisfaction. The data come from a survey of 1423 Northwestern Wisconsinites interviewed in 1974 by the Wisconsin Survey Research Laboratory. The findings indicate that self-reports of negative life changes were related to overall life satisfaction, controlling for health status, feelings of alienation/attachment, and personal disruption. Implications of the findings are discussed in conclusion.     

Heat and adult health in China

Given projected increases in the frequency of precipitation and temperature extremes in China, we examine the extent adults may be vulnerable to climate anomalies. We link nutrition, health, and economic data from the China Health and Nutrition Survey (1989–2011) to gridded climate data to identify which socioeconomic outcomes are particularly susceptible, including adult underweight incidence, body mass index, dietary intake, physical activity, illness, income, and food prices. We find warm temperatures augment the probability of being underweight among adults, with a particularly large impact for the elderly (ages >?60). Extremely dry and warm conditions produce a 3.3-percentage point increase in underweight status for this group. Consequences on nutrition coincide with changes in illness rather than dietary, income, or purchasing power shifts. Social protection targeting areas prone to excessive heat may consider supplementing bundles of goods with a suite of health care provisions catering to the elderly.     

Income inequality and self-rated health status: Evidence from the european community household panel

We examine the effect of income inequality on individualś self-rated health status in a pooled sample of 11 countries, using longitudinal data from the European Community Household Panel survey. Taking advantage of the longitudinal and cross-national nature of our data, and carefully modeling the self-reported health information, we avoid several of the pitfalls suffered by earlier studies on this topic. We calculate income inequality indices measured at two standard levels of geography (NUTS-0 and NUTS-1) and find consistent evidence that income inequality is negatively related to self-rated health status in the European Union for both men and women, particularly when measured at national level. However, despite its statistical significance, the magnitude of the impact of inequality on health is very small.     

An epidemiological model for health policy analysis

Health programs needing health and other related data have failed in their solutions because they have lacked a rational framework for analysis. A cursory analysis of present disease patterns reveals chronic conditions for which the present system of organized health care has no immediate cures. On the other hand, infectious diseases of decades past have been all but eliminated by vaccines and antibiotics. Before we are able either to prevent or to arrest current disease processes, we must dissect the health field into more manageable elements that reflect a creative area for epidemiological models. An epidemiological model that supports health policy analysis and decisiveness must be broad, comprehensive, and must include all matters affecting health. Consequently, four primary divisions have been identified: (1) System of Health Care Organization; (2) Life Style (self-created risks); (3) Environment; and (4) Human Biology. An application of the epidemiological model involves four steps: (1) the selection of diseases that are of high risk and that contribute substantially to the overall morbidity and mortality; (2) to proportionately allocate the contributing factors of the disease to the four elements of the epidemiological model; (3) to proportionately allocate total health expenditures to the four elements of the epidemiological model; and (4) to determine the difference in proportions between (2) and (3) above. Five tables illustrate how the epidemiological model is applied, showing the diseases selected for analysis; the contributing factors of each disease to the four components of the epidemiological model; the distribution of Federal outlays for medical and health-related activities by category; the distribution of Federal outlays of health expenditures by category; and a comparison of Federal health expenditures to the allocation of mortality in accordance with the epidemiological model. The conclusion to be drawn from this study is that, based on current procedures for reducing mortality and morbidity, little or no change in our present disease patterns will be accomplished unless we dramatically shift our health policy.     

Taking charge of self: breast health practices of older rural women

The purpose of this grounded theory study was to explore breast health practices of older Vermont women residing in rural communities. Although the three components of breast health-mammography, clinical breast exam, and self-breast exam-are recommended for women 40 years and over, minimal research has empirically analyzed the breast health practices of healthy women to ascertain if, in fact, these procedures are followed, and if so, what the motivation is for doing so. Twelve women, 50-64 years, participated in face-to-face, audiotaped interviews. Data analysis, including line-by-line and constant comparative approaches, occurred concurrently with data collection. Taking Charge of Self, the generated theory, describes participants' engagement in a process of learning how to take charge of their lives. The analysis indicates that health care providers have a powerful role in the lives of women in this age group. With an increasing emphasis on health promotion and disease prevention, health care providers are positioned to cultivate and support women's development of the personal or internal motivation for health and well-being.     

Understanding links between adolescent health and educational attainment

The educational and economic consequences of poor health during childhood and adolescence have become increasingly clear, with a resurgence of evidence leading researchers to reconsider the potentially significant contribution of early-life health to population welfare both within and across generations. Meaningful relationships between early-life health and educational attainment raise important questions about how health may influence educational success in young adulthood and beyond, as well as for whom its influence is strongest. Using data from the National Longitudinal Survey of Youth 1997, I examine how adolescents’ health and social status act together to create educational disparities in young adulthood, focusing on two questions in particular. First, does the link between adolescent health and educational attainment vary across socioeconomic and racial/ethnic groups? Second, what academic factors explain the connection between adolescent health and educational attainment? The findings suggest that poorer health in adolescence is strongly negatively related to educational attainment, net of both observed confounders and unobserved, time-invariant characteristics within households. The reduction in attainment is particularly large for non-Hispanic white adolescents, suggesting that the negative educational consequences of poor health are not limited to only the most socially disadvantaged adolescents. Finally, I find that the link between adolescent health and educational attainment is explained by academic factors related to educational participation and, most importantly, academic performance, rather than by reduced educational expectations. These findings add complexity to our understanding of how the educational consequences of poor health apply across the social hierarchy, as well as why poor health may lead adolescents to complete less schooling.In a presidential address to the Population Association of America, Palloni (2006) emphasized the need for research on early-life health as a mechanism in the intergenerational transmission of socioeconomic status. Although poor health is well known as a consequence of childhood and family socioeconomic conditions, it is also clear that illness during childhood and adolescence has lasting educational and socioeconomic effects (Case, Fertig, and Paxson 2005; Conley and Bennett 2000; Smith 2005). What remains less clear is how health early in life influences educational success in young adulthood and beyond. Do those with a health disadvantage graduate from high school at lower rates, for example, because they perform poorly in school or because they and their families develop reduced expectations for the future? In addition, how do race/ethnicity and socioeconomic status complicate these relationships? Our understanding of how health’s influence on educational attainment differs across groups is unclear.This article considers these complexities by asking several questions. It confirms that health during adolescence is strongly negatively associated with educational attainment and then examines this relationship in greater depth than is typical. First, I examine variation in the link between health and educational attainment along socioeconomic and racial/ethnic lines. Are the families of adolescents in poorer health better able to mitigate the negative educational consequences of a condition if they are socially and/or economically advantaged? Or do youths in these families suffer an equal or greater disadvantage? Second, I evaluate the role of academic factors—specifically, educational participation, performance, and expectations—that may explain the connection between adolescents’ health and educational attainment. I examine these questions with data from the National Longitudinal Survey of Youth 1997 (NLSY97), with an overall goal of understanding the ways in which health and social status act together to create educational disparities in the early life course.     

Elderly parent health and the migration decisions of adult children: Evidence from rural China

Recent research has shown that participation in migrant labor markets has led to substantial increases in income for families in rural China. This article addresses the question of how participation is affected by elderly parent health. We find that younger adults are less likely to work as migrants when a parent is ill. Poor health of an elderly parent has less impact on the probability of employment as a migrant when an adult child has siblings who may be available to provide care. We also highlight the potential importance of including information on nonresident family members when studying how parent illness and elder care requirements influence the labor supply decisions of adult children.     

Simultaneity in the use of maternal-child health care and contraceptives: evidence from developing countries

This study examined the relationship between the use of maternal-child health (MCH) care and the use of contraceptives. The high correlation between the two may be due to the independent effect of one on the other or to an association of both with the same or similar background factors. We used structural equation models to examine the relationship between these two interventions. The data were derived from six Demographic and Health Surveys: Zimbabwe from Sub-Saharan Africa, Thailand from Asia, Egypt and Tunisia from North Africa, and Guatemala and Colombia from Latin America. The results show that in all six countries, the use of contraceptives and MCH care are significantly associated, independent of intervening factors; this finding suggests that families develop a joint demand for better-quality health and limited family size and translate these demands into action by using health services for mothers and for children and by voluntarily regulating fertility.     

Does Multiracial Matter? A Study of Racial Disparities in Self-Rated Health

How do self-identified multiracial adults fit into documented patterns of racial health disparities? We assess whether the health status of adults who view themselves as multiracial is distinctive from that of adults who maintain a single-race identity, by using a seven-year (2001–2007) pooled sample of the Behavioral Risk Factor Surveillance System (BRFSS). We explore racial differences in self-rated health between whites and several single and multiracial adults with binary logistic regression analyses and investigate whether placing these groups into a self-reported “best race” category alters patterns of health disparities. We propose four hypotheses that predict how the self-rated health status of specific multiracial groups compares with their respective component single-race counterparts, and we find substantial complexity in that no one explanatory model applies to all multiracial combinations. We also find that placing multiracial groups into a single “best race” category likely obscures the pattern of health disparities for selected groups because some multiracial adults (e.g., American Indians) tend to identify with single-race groups whose health experience they do not share.     

Socioeconomic Inequalities in Infant Mortality in Egypt: Analyzing Trends Between 1995 and 2014

This paper analyses the trend of the socioeconomic inequalities in infant mortality rates in Egypt over the period 1995–2014, using repeated cross-sectional data from the National Demographic and Health Survey. A multivariate logistic regression and concentration indices are used to examine the demographic and socioeconomic correlates of infant mortality, and how the degree of socioeconomic disparities in child mortality rates has evolved over time. We find a significant drop in infant mortality rates from 63 deaths per 1000 live births in 1995 to 22 deaths per 1000 live births in 2014. However, analyzing trends over the study period reveals no corresponding progress in narrowing the socioeconomic disparities in childhood mortality. Infant mortality rates remain higher in rural areas and among low-income families than the national average. Results show an inverse association between infant mortality rates and living standard measures, with the poor bearing the largest burden of early child mortality. Though the estimated concentration indices show a decline in the degree of socioeconomic inequality in child mortality rates over time, infant mortality rate among the poor remains twice the rate of the richest wealth quintile. Nonetheless, this decline in the degree of socioeconomic inequality in child mortality is not supported by the results of the multivariate logistic regression model. Results of the logistic model show higher odds of infant mortality among rural households, children who are twins, households with risky birth intervals. We find no statistically significant association between infant mortality and child’s sex, access to safe water, mothers’ work, and mothers’ nutritional status. Infant mortality is negatively associated with household wealth and regular health care during pregnancy. Concerted effort and targeting intervention measures are still needed to reduce the degree of socioeconomic and regional inequalities in child health, including infant mortality, in Egypt.     

Does Women’s Empowerment in Agriculture Matter for Children’s Health Status? Insights from Northern Ghana

Given that women in rural communities in developing countries are responsible for the nutrition and health-related decisions affecting children in their care, their empowerment may influence the health status of their children. The association between women’s empowerment, measured by using a recently developed Women’s Empowerment in Agriculture Index, and children’s health status is examined for a sample of households in Northern Ghana applying a Multiple Indicators Multiple Causes (MIMIC) model. The MIMIC approach is used to link multiple indicator variables with multiple independent variables through a “single underlying” latent variable. Height-for-age and weight-for-height z-scores are used as indicators of the underlying children’s health status and women’s empowerment in agriculture and control variables are used as the multiple independent variables. Our results show that neither the composite empowerment score used to capture women’s empowerment in agriculture nor its decomposed components are statistically significant in their association with the latent children’s health status. However, the associations between children’s health status and control variables such as mother’s education, child’s age, household’s hunger scale and residence locale are statistically significant. Results also confirm the existence of the ‘single underlying’ common latent variable. Of the two health status indicators, height-for-age scores and weight-for- height scores, the former exhibited a relatively stronger association with the latent health status. While promoting women’s empowerment to enhance their ability to make strategic life choices, it is important to carefully consider how the achievement of these objectives will impact the women’s well-being and the well-being of the children in their care.     

The political economy of rationing in social health insurance

Due to the rapid progress in medical technology social insurance systems will soon no longer be able to grant health services without limits but must employ non-price rationing devices. This raises the question how these limits will be determined. Here we consider a direct democracy where the size of the social health insurance plan is determined in a popular referendum using simple majority rule. Moreover, two different kinds of rationing are distinguished according to whether additional private purchases of health care are allowed. For both systems we examine the size of the social insurance system in a political equilibrium, and we compare the results in particular with respect to their distributional effects.Funding for this research from the Norwegian Research Council under the Ruhrgas Scholarship Scheme and valuable comments by two anonymous referees are gratefully acknowledged.     

Gender differences in the link between childhood socioeconomic conditions and heart attack risk in adulthood

A growing body of evidence shows that childhood socioeconomic status (SES) is predictive of disease risk in later life, with those from the most disadvantaged backgrounds more likely to experience poor adult-health outcomes. Most of these studies, however are based on middle-aged male populations and pay insufficient attention to the pathways between childhood risks and specific adult disorders. This article examines gender differences in the link between childhood SES and heart attack risk trajectories and the mechanisms by which early environments affect future disease risk. By using methods that model both latent and path-specific influences, we identify heterogeneity in early life conditions and human, social, and health capital in adulthood that contribute to diverse heart attack risk trajectories between and among men and women as they age into their 60s and 70s. We find that key risk factors for heart attack operate differently for men and women. For men, childhood SES does not differentiate those at low, increasing, and high risk for heart attack. In contrast, women who grew up without a father and/or under adverse economic conditions are the most likely to experience elevated risk for heart attack, even after we adjust for the unequal distribution of working and living conditions, social relationships, access to health care, and adult lifestyle behaviors that influence health outcomes.     

Older women and the health care system: a time for change

In spite of women's active involvement in a woman's health care movement, the mainline health care system continues to hold tight to its androcentric focus. If women are to be subjected to a health care system that employs sexist and ageist practices, the quality of life in their later years will continue to be jeopardized. The purpose of this paper is to first, recognize the existing health care practices which limit the health care opportunities and choices of older women; and secondly, to discuss how such basic feminist principles as education, egalitarianism, empowerment, and inclusion can be used to improve an older woman's experience.