The role of public health improvements in health advances: The twentieth-century United States

Mortality rates in the United States fell more rapidly during the late nineteenth and early twentieth centuries than in any other period in American history. This decline coincided with an epidemiological transition and the disappearance of a mortality "penalty" associated with living in urban areas. There is little empirical evidence and much unresolved debate about what caused these improvements, however. In this article, we report the causal influence of clean water technologies--filtration and chlorination--on mortality in major cities during the early twentieth century. Plausibly exogenous variation in the timing and location of technology adoption was used to identify these effects, and the validity of this identifying assumption is examined in detail. We found that clean water was responsible for nearly half the total mortality reduction in major cities, three quarters of the infant mortality reduction, and nearly two thirds of the child mortality reduction. Rough calculations suggest that the social rate of return to these technologies was greater than 23 to 1, with a cost per person-year saved by clean water of about dollar 500 in 2003 dollars. Implications for developing countries are briefly considered.     

Environmental Effects on Family Size Preferences and Subsequent Reproductive Behavior in Nepal

This study investigates the relationship between environmental degradation and men and womens family size preferences and subsequent reproductive behaviors in Nepal. We draw on unique environmental data at the local level, household and individual-level survey data and individuals reproductive behavior over a 3 year time period in Western Chitwan Valley, Nepal. Results from Ordinary Least Squares (OLS) and logistic regression models show that poorer environmental quality and greater reliance on publicly owned natural resources are associated with higher family size preferences and higher rates of pregnancy. The analyses provide support for the vicious circle argument that environmental degradation can lead to rising population growth via positive effects on fertility. As environmental conditions decline and when households rely on public lands for natural resources, men and women desire larger family sizes and women are more likely to get pregnant in the near future.     

The Divergent Meanings of Life Satisfaction: Item Response Modeling of the Satisfaction with Life Scale in Greenland and Norway

Cultural differences in response to the Satisfaction With Life Scale (SWLS) items is investigated. Data were fit to a mixed Rasch model in order to identify latent classes of participants in a combined sample of Norwegians (N = 461) and Greenlanders (N = 180). Initial analyses showed no mean difference in life satisfaction between the two subsamples. After transforming the ordinal raw scores into interval scales while simultaneously controlling for response bias, different results appeared. First, approximately 80% of the participants in the Greenlandic subsample fit a latent class with a large degree of random responding to the SWLS. Second, relative to the Norwegians, more Greenlanders were using extreme categories in responding to the SWLS. After statistically controlling for this tendency, Norwegians were in general more satisfied with their lives than Greenlanders. Third, Greenlanders who belonged to one specific latent class were more satisfied than their Norwegian counterparts. A salient feature of this class was the relative unwillingness of respondents to change the circumstances of their lives if they were given such an opportunity. The above results are a reminder of the care that must be used in analyzing survey data across cultures. The analytical strategy applied in the article offers an improved approach to handling such data.     

Structural Analysis of a Consumption-Based Stratification Indicator: Relational Proximity of Household Expenditures

This paper proposes a new analysis of consumption inequality using relational methods, derived from network images of social structure. We combine structural analysis with theoretical concerns in consumer research to propose a relational theory of consumption space, to construct a stratification indicator, and to demonstrate its analytical efficacy with aggregate consumption data. This allows us to emphasize the multi-dimensionality of the relationship between social groups and consumption patterns in the context of a stratification perspective. We utilize the concept of structural equivalence, derived from network models of social structure, to recover relational proximity between social groups and between consumption categories. Additionally, we use relational proximity to construct a new indicator of consumption hierarchy and we test its predictive ability in estimating consumption behavior. We discuss the theoretical implications of our findings for a spatial theory of stratification, as well as possible directions for future research.     

Demographers’ Involvement in Twentieth-Century Population Policy: Continuity or Discontinuity?

The second half of the twentieth century witnessed the development of a crusading spirit and massive technical aid aimed at reducing fertility levels and rates of population growth in developing countries, and also the involvement of demographers in these events. The demographers at Princeton University’s Office of Population Research, Frank Notestein and his colleagues, have been singled out by recent authors as playing a unique role in bringing about these changes, and they have been criticized for encouraging demographers to become involved, so eroding their scientific objectivity. This paper examines the development of relevant population thought and theory in the English-language literature over the first half of the twentieth century. It concludes that in the circumstances of the second half of the twentieth century, it was inevitable that developed countries and their demographers would become involved in controlling fertility levels in developing countries. The OPR story should be seen largely in terms of how the world’s leading demographic center and its demographic transition theory were swept along by global changes. As those developments started, attitudes to population change in densely settled Asia became Malthusian, even as population growth accompanied by mortality decline in Asia demonstrated that, at least in the short term, the positive checks were disappearing.     

Dimensions Of Well-Being And Their Measurement: The Spf-Il Scale

What are the dimensions of well-being? That is, what universal goals need to be realized by individuals in order to enhance their well-being? Social production function (SPF) theory asserts that the universal goals affection, behavioral confirmation, status, comfort and stimulation are the relevant dimensions of subjective well-being. Realization of these substantive goals and the perspective on opportunities to realize these goals in the future contributes to the affective and cognitive component of well-being. The theoretical elaboration of this theory has been published elsewhere. This paper provides a measurement instrument for the dimensions of well-being. To measure levels of affection, behavioral confirmation, status, comfort and stimulation and empirically validate the dimensions of well-being, the SPF-IL scale was developed. This paper presents findings from a pilot study (n=145), the main study (n=1094), a test–retest examination (n=163), and a validation study (n=725). The measurement model was tested by means of structural equation modeling. Confirmatory factor analysis supported the dimensional structure of well-being indicating construct validity. The overall fit of the model was sufficient, in spite of the somewhat problematic measurement of status, and the test–retest study showed an acceptable level of stability. As for the content validity of the dimensions and their measurement, various sub-studies showed that the SPF-IL scale is a valid instrument, doing at least as well as popular measures of overall well-being but also specifying its dimensions.     

Structural Analyses Of The Quality Of Life Of Children At Risk

Quality of life (QOL) is usually assessed in terms of levels. This paper, in contrast, examines the structure of the quality of life of its subjects: two groups of children at risk, children who were kept at home and those who were removed from home. The social workers who made the decisions were asked to assess the children’s quality of life using Shye’s Systemic Quality of Life Model. The study’s main finding is that the QOL structure of the two groups of children differs both from the theoretical “ideal” (or “healthy” structure) and from each other. The QOL structure of the children who were kept at home was closer to the ideal than that of the children who were removed. The difference from the ideal in both groups is consistent with the fact that both groups of children at risk, whose QOL is compromised by definition. The greater proximity to the “ideal” of the QOL structure of the children who were kept at home suggests that the social workers who made the decisions viewed these children as having a healthier QOL than the children who were removed from home.     

Rurality Index for Small Areas in Spain

An operational definition for “rural area” is pivotal if proposals, policies and decisions aimed at optimising the distribution of resources, closing the gap on inequity between areas and raising standards of living for the least advantaged populations are to be put in place. The concept of rurality, however, is often based on alternative and conflicting definitions, requiring clarification of the underlying theoretical model. Traditionally a geographical area has been classified as rural by taking into account either the number of inhabitants or population density. Two kinds of problem are raised with this approach, however, namely: it is inherently difficult to describe such a complex concept as rurality with a single variable; and reducing the concept down to a rural/urban dichotomy by setting a non-universal cut-off point does not usually provide an accurate account of reality. Within the context of the rural–urban continuum, this paper has devised a rurality index for Spanish municipalities based on the 1991 Population, Housing and Household Survey. The index was built on a principal components factor analysis, giving rise to a single factor that is correlated to the aging of the population, economic dependency, farming, livestock or fishing-related employment, habitability of housing and population density. A score to each municipality was allocated. This index can be regularly updated thus enabling the progress of the concept of rurality to be monitored in our setting over time and then compared with other countries using the same methods.     

Global QUALITY OF LIFE (QOL), health and ability are primarily determined by our consciousness. Research findings from Denmark 1991–2004

Objective: To explain the global quality of life (QOL) from 2000 indicators representing all aspects of life. Design and setting: Two cross sectional population studies, one prospective cohort study and one retrospective cohort study. Participants: (1) Representative sample of 2500 Danes (18–88 years), (2) 7222 members of the Copenhagen Perinatal Birth Cohort 1959–1961 (31–33 years), (3) 9.006 mothers and their 8820 children born in Copenhagen 1959–1961, (4) 746 Danes (55–66 years). Main outcome measures: Global QOL measured by SEQOL (self evaluation of QOL) containing eight global QOL measures: Well-being, life-satisfaction, happiness, fulfilment of needs, experience of temporal and spatial domains, expression of lifes potentials and objective factors. Results: 2000 associations; strongest between QOL and health, ability, the personal philosophy of life, the relationships to oneself, the partner and friends; weakest between QOL and 1000 early life factors, 1000 life events and 100 objective factors like income. Conclusions: Quality of life is associated with personal health and attitude towards life, rather than objective factors, life style, or life events. We conclude that QOL can be developed independently and thus be used as medicine.     

Feeding the Illusion of Growth and Happiness: A Reply to Hagerty and Veenhoven

In a rebuttal of Easterlin (1995), Hagerty and Veenhoven (2003) analyze data for 21 countries and conclude that “growing national income does go with greater happiness.” But the U.S. experience does not support this conclusion, which they obtain only by mixing together two sets of noncomparable surverys. Moreover, the result of studies of European countries and the U.S. by other scholars do not support their claim either. Furthermore, the experience of 6 out of 7 of their non-European countries fail to support their claim. Finally, if countries in their analysis with quite similar growth rates are grouped, one finds quite disparate trends in happiness, suggesting that factors other than growth in income are responsible for the differential trends in happiness. Instead of straining to feed the illusion that a focus on economic growth will create happiness, an approach is needed that explores the impact on national trends in life satisfaction, not just of material goods, but also of family life, health, work utility, and the like.