Deprived Households Research Articles

Maternal Mental Health Spillovers From Child Illness and Disability: A Dynamic Panel Analysis

ObjectivesThere is growing recognition of the consequences of a person’s health and illness experience for the health and wider welfare of those close to them. However, estimation of these health spillovers is challenging. This study adopts a longitudinal approach to examine maternal mental health spillovers associated with various forms of child illness and disability. MethodsDynamic panel models are used in estimating maternal mental health spillovers related to 7 subcategories of chronic child illness and disability. In particular, we use longitudinal data from the Growing Up in Ireland study and a system generalized method of moments approach. We also consider heterogeneity in these spillovers by the severity of the child’s illness/disability and by household deprivation. ResultsWe find that a child’s experience of chronic nervous system conditions and chronic mental and behavioral disorders are associated with 10.8 and 5.1 percentage point increases in the probability of maternal depression, respectively. Similar associations were not observed for other health conditions. Spillover magnitude is also found to be strongly related to illness/disability severity. Finally, subsample analyses reveal a larger association between severe child illness and maternal depression among deprived households. ConclusionsThis analysis, in observing health spillovers related to certain disease categories but not others, draws further attention to their context specificity. Our findings also further corroborate calls for inclusion of caregiver and family member outcomes in the economic evaluation of child health services and support consensus guidelines for collection of these outcomes alongside patient outcomes in clinical trials.

The impact of unconditional cash transfers on enhancing household wellbeing in Pakistan: evidence from a quasi-experimental design

Cash transfer programs have emerged as potent tools for alleviating poverty and enhancing the living conditions of the most deprived households in developing nations. Such initiatives have now become integral components of social protection systems in many developing countries, including Pakistan. Evaluating the efficacy of these safety nets is crucial to comprehend their value in terms of public expenditure. This research employed a well-being index to gauge the impact of unconditional cash transfers on the socioeconomics of recipients. By employing three rounds of the BISP impact assessment survey conducted in 2011, 2016, and 2019. The study measured the overall impact of cash transfers on well-being by utilizing Principal Component Analysis in conjunction with a Difference-in-Differences Quasi-Experimental design over the years. The findings of the study indicate that between 2011 and 2016, the socioeconomic status declined for both treatment and control groups, but the reduction was less pronounced among those who received treatment compared to the control group with insignificant. From 2016 to 2019, there was a marginal positive increase in socioeconomic status, although it was of insignificance. Overall, the well-being of both the control and treatment groups decreased from 2011 to 2019, with a slightly more pronounced improvement observed in the treatment group. This trend suggests that the impact of the BISP unconditional cash transfer program had a limited effect on altering the well-being of the beneficiaries. The lack of substantial impact from the BISP’s cash transfers on household well-being can be attributed to factors such as inflation, unemployment, economic slowdown, payment challenges, insufficient funding, and gaps between installments. The government of Pakistan should reconsider the substantial investment in BISP within the context of value for money. It is advisable for the government and policymakers to channel this substantial investment into income generation, capital asset development, microbusinesses, climate-resilient agriculture, and livestock in order to stimulate the real economy sectors.

Assessing access to safe drinking water in flood-affected areas of District Nowshera, Pakistan: A case study towards achieving sustainable development goal 6.1

Access to safe drinking water is one of the most vital targets of sustainable development goal (6.1). However, climate change has become a significant challenge to safe water access. Climate-induced changes in rainfall patterns create many hydro-meteorological hazards such as drought, floods, and desertification. These hazards pose a major risk to the water supply system, particularly in areas vulnerable to climate change's impacts. The onset of these hazards may damage the hydro-ecological system and water supply infrastructure, cause an interruption in water supply, and pollute water resources. Therefore, assessing access to safe potable water after the onset of any hazard is crucial to ensure sustainable management. For this purpose, the current investigation aims to assess access to safe, potable water in flood-affected neighborhood councils of district Nowshera. The sample sites were purposively selected based on specific criteria, and 2 % (564) of households were surveyed using the Kobo collect tool. The six parameters, accessibility, availability, affordability, acceptability, water quality, and equity, were assessed for access to safe potable water using WHO and UNICEF standard procedures. The estimated results classified the study area access into safely managed (49.5 % to 51.77 %), primary (17.59 % to 47.92 %), limited (3 % to 94.67 %), unimproved (1.82 % to 41.46 %) water facilities. The current results provide the status of access to safe potable water and visualize the deprived households for priority action. This study indicates that recent flooding has significantly affected access to safe potable water. The methods and techniques utilized in current research can be used to monitor sustainable development goals. The present study highlights the need for a climate change perspective in addressing access to clean water in flood-prone areas. It identifies key factors for future research and policy action.

Social class, smartphone advertising exposure, self‐esteem, and materialism: The case of children in Lebanon

AbstractThe current compounded economic crisis in Lebanon has increased poverty rates and widened the gap between families of different socioeconomic classes. Little is known about the impact of advertising, particularly smartphone advertising, on the self‐esteem and materialism levels of children in developing countries like Lebanon. This study aimed to measure the differences among children coming from lower and upper socioeconomic classes in the following: smartphone advertising exposure, materialism and self‐esteem, vulnerability to the effects of smartphone advertising exposure on materialism, and vulnerability to the effects of materialism on self‐esteem. It was found that advertising affected negatively the self‐esteem of the children coming from lower social classes, including the “newly poor,” because in the current economic situation, children who are more exposed to advertising are more likely to believe in advertising, have lower self‐satisfaction, and believe themselves to be inferior for not owning the various products that are advertised, which lead them to become more materialistic than children from wealthier families. On the other hand, advertising had a reinforcing effect on materialism among more affluent children. In addition, and contrary to the expected, children from higher social classes, and not children from deprived households, were more susceptible to the impact of advertising on materialism. These findings enlighten us on the significant role that today's advertising plays in societies with wide socioeconomic disparities.

Factors associated with parental human papillomavirus vaccination intentions among adolescents from socioeconomically advantaged versus deprived households: a nationwide, cross-sectional survey

In the USA, HPV vaccine coverage is substantially lower among adolescents from high-income households compared to their low-income counterparts. We examined and compared the factors associated with parental HPV vaccination intentions between socioeconomically divergent groups. Data from unvaccinated and not fully HPV-vaccinated adolescents from the 2017-2021 National Immunization Survey (NIS)-Teen were analyzed. Socioeconomically advantaged vs. deprived groups were identified based on dichotomized income (material capital) and education (social capital). Parental intent to initiate and complete the HPV vaccine series was compared using bivariable analysis and the factors associated with lacking intent were identified. The 2017-2021 NIS-Teen included a total of 212,643 participants; the final analytical sample consisted of 105,958 adolescents (an estimated 10.3 million adolescents) who were unvaccinated or not fully vaccinated. In the advantaged group, 64.7% of parents of unvaccinated adolescents (equating to 2.4 million US adolescents) had no intention to initiate the HPV vaccine compared to 40.9% of parents in the deprived group (equating to 0.2 million adolescents) (P<0.0001; S>13.29). The most frequent reason for lacking intent in the advantaged group was 'safety concerns' (25.5%). In the deprived group, 'lack of knowledge', 'not recommended', and 'not needed' were common reasons (nearly 15% each). Lack of intent to complete the HPV vaccine series was higher in the advantaged group (43.9%; 1.1 million adolescents) compared to the deprived group (25.2%; 0.08 million adolescents) (P<0.0001; S>13.29). More than half in the advantaged group (58.4%) and over a third (37.1%) in the deprived group cited 'already up to date' as the main reason for not completing the HPV vaccine series. Lack of intent to initiate and complete the HPV vaccination series, particularly among socioeconomically advantaged parents is a significant barrier to achieving the national goal in the USA. The US National Institute on Minority Health and Health Disparities, the National Center for Advancing Translational Sciences, MUSC Hollings Cancer Center Seed funding, and the US National Cancer Institutes.

A composite index; socioeconomic deprivation and coverage of reproductive and maternal health interventions.

To examine inequalities in the coverage of reproductive and maternal health interventions in low- and middle-income countries and territories using a composite index of socioeconomic deprivation status. We obtained data on education and living standards from national household surveys conducted between 2015 and 2019 to calculate socioeconomic deprivation status. We assessed the coverage of reproductive and maternal health interventions, using three indicators: (i)demand for family planning satisfied with modern methods; (ii)women who received antenatal care in at least four visits; and (iii)the presence of a skilled attendant at delivery. Absolute and relative inequalities were evaluated both directly and using the slope index of inequality and the concentration index. In the 73 countries and territories with available data, the median proportions of deprivation were 41% in the low-income category, 11% in the lower-middle-income category and less than 1% in the upper-middle-income category. The coverage analysis, conducted for 48 countries with sufficient data, showed consistently lower median coverage among deprived households across all health indicators. The coverage of skilled attendant at delivery showed the largest inequalities, where coverage among the socioeconomically deprived was substantially lower in almost all countries. Antenatal care visits and demand for family planning satisfied with modern methods also showed significant disparities, favouring the less deprived population. The findings highlight persistent disparities in the coverage of reproductive and maternal health interventions, requiring efforts to reduce those disparities and improve coverage, particularly for skilled attendant at delivery.

Ageing, sport and physical activity participation in Scotland.

As sport and physical activity are vital to support extended health spans, this study aimed to analyse the current trends in sports participation and physical activity rates among individuals aged 65 years and older in Scotland. Data were compared with the Chief Medical Officer (CMO) guidelines and analysed the influence of key factors on participation rates. The study used data from the Scottish Health Survey and the Scottish Household Survey (2019) to investigate self-reported participation in physical activity and sports across different age groups. Descriptive statistics and cross-tabulations were used to analyse the relationships between participation rates and influencing factors. Participation data for Parkrun events in Scotland were also analysed for the years 2008-2018. The study found a clear decline in sports participation with age, with a steep decline after the age of 65, particularly in women. The majority of participation among individuals aged 65+ was in walking, with a sport participation rate of only 31.2% when walking was excluded. Physical activity and sport participation was lower in women across all age ranges but particularly so in the 75+ age group. The most popular sporting activities in the older age group were keep fit/aerobics, swimming and golf. Additionally, the study found that social deprivation had a major impact on sports participation rates, with the most deprived households exhibiting the lowest participation levels irrespective of age. The prevalence of loneliness was lower among individuals who participated in sports or adhered to the CMO guidelines for moderate/vigorous physical activity and strength-building exercises. The findings of this study have implications for promoting physical activity and sports participation among older adults, particularly in deprived communities. This study highlights the importance of balance exercises within sport and the need for more targeted efforts to increase participation rates among older adults. The study also emphasizes the positive impact of sports participation on reducing loneliness among older adults. Overall, the findings suggest the need for ongoing efforts to promote physical activity and sports participation among older adults to improve their overall health and well-being.

Prevalence and correlates of multidimensional child poverty in India during 2015-2021: A multilevel analysis.

Despite increasing research and programs to eradicate poverty, poverty still exists and is a far greater concern for children than adults, leading child poverty to become a political, economic, and social issue worldwide and in India. The current study aims to find variations in the prevalence of child poverty and associated factors in India during 2015-21. In the current study, we used two consecutive rounds of the National Family Health Survey (NFHS-4, 2015-16 & NFHS-5, 2019-21) to estimate child poverty (aged 0-59 months) using the Alkire-Foster method. The multilevel logistic regression analyses were performed to find the important cofounder and cluster level variation in child poverty. The results show that about 38 percent of children were multidimensionally poor in 2015-16, which reduced to 27 percent in 2019-21. The decomposition analysis suggests that contribution of nutrition domain to child poverty increases over time, whereas the standard of living substantially declines from NFHS-4 to NFHS-5. The multilevel analysis results show that the age and sex of the child, age and years of schooling of the mother, children ever born, religion, caste, wealth quintile and central, northeast, north and west regions are significantly associated with child poverty over time. Further, the variance participation coefficient statistics show that about 12 percent of the variation in the prevalence of child poverty could be attributed to differences at the community level. The prevalence of child poverty significantly declines over time, and the community-level variation is higher than the district-level in both surveys. However, the community-level variation shows increases over time. The finding suggests a need to improve the nutritional status and standard of living of most deprived households by promoting a child-centric and dimension-specific approach with more focus on PSU-level intervension should adopt in order to lessen child poverty in India.

Invasive Aggregatibacter infection: shedding light on a rare pathogen in a retrospective cohort analysis.

Introduction. Aggregatibacter are Gram-negative, facultatively anaerobic rods or coccobacilli that are infrequently encountered as pathogens causing infection.Hypothesis/Gap Statement. The range of invasive infection that Aggregatibacter cause is poorly described. The pathogenicity of species such as Aggregatibacter segnis is debated.Aim. To identify invasive infection due to Aggregatibacter species in a large healthcare organization and to characterize clinical syndromes, co-morbidities and risk factors.Methodology. All microbiological samples positive for Aggregatibacter species were identified by conventional culture or 16S rRNA PCR between October 2017 and March 2021. Electronic records for all patients with positive samples were reviewed and the infection syndrome classified for patients with invasive disease.Results. Twenty-seven patients with invasive infection were identified, with a statistically significant difference in species-specific patterns of invasive infection (P=0.02) and a statistically significant association with residence in the 30 % most deprived households in the UK by postcode (P<0.01). The three most common co-morbidities were periodontitis or recent dental work (29.6%), cardiovascular disease (25.9%) and diabetes (18.5 %).Conclusion. We describe a novel association of Aggregatibacter segnis with skin and soft tissue infection. The propensity of the Aggregatibacter species to cause invasive infection at different body sites and be associated with deprivation is reported. Aggregatibacter actinomycetemcomitans bacteraemia was associated with infective endocarditis, and Aggregatibacter aphrophilus was implicated in severe appendicitis and noted to cause brain abscess. Areas warranting future research include exploring the risk-factors required for invasive infection and those that may determine the species-specific differences in patterns of invasive disease.

Socioeconomic Deprivation, Genetics and Risk of Dementia

AbstractBackgroundThe risk of Alzheimer’s disease and other subtypes of dementia is determined by multiple pathways including genetic, environmental and lifestyle factors. With higher risk in socioeconomically deprived individuals, it remains unclear whether associations of genetic risk with dementia incidence may be modified by individual‐ or area‐level socioeconomic deprivation.MethodParticipants of the UK Biobank study attended baseline assessments at 22 assessment centers between 2006 and 2010 and were followed‐up until 2016 or 2017. Cox proportional‐hazards regressions with area‐level socioeconomic deprivation based on the Townsend Deprivation Index and individual‐level socioeconomic deprivation based on car and home ownership, housing type, and income were run. A comprehensive polygenic risk score was employed and potential mediation through lifestyle and depressive symptoms was assessed. In an imaging substudy, associations of socioeconomic deprivation with six imaging‐derived phenotypes including white matter hyperintensities were examined.Result196,368 participants (mean [standard deviation] age, 64.1 [2.9] years, 52.7% female) aged 60 years and older, of European ancestry, without dementia diagnosis or cognitive impairment at baseline were followed‐up for 1,545,316 person‐years (median [interquartile range] follow‐up, 8.0 [7.4‐8.6] years). In high genetic risk and high area‐level deprivation 1.71% (95% confidence interval, 1.44% to 2.01%) developed dementia compared to 0.56% (95% confidence interval, 0.48% to 0.65%) in low genetic risk and low‐to‐moderate area‐level deprivation (hazard ratio, 2.31; 95% confidence interval, 1.84 to 2.91). In high genetic risk and high individual‐level deprivation 1.78% (95% confidence interval, 1.50% to 2.09%) developed dementia compared to 0.31% (95% confidence interval, 0.20% to 0.45%) in low genetic risk and low individual‐level deprivation (hazard ratio, 4.06; 95% confidence interval, 2.63 to 6.26). There was no significant interaction between genetic risk and area‐level (P =.77) or individual‐level (P =.07) deprivation. An imaging substudy including 11,083 participants found greater burden of white matter hyperintensities associated with higher socioeconomic deprivation.ConclusionIn older adults without dementia area‐level and individual‐level socioeconomic deprivation and genetic risk were significantly and independently associated with a higher risk of dementia. Dementia prevention interventions may be particularly effective if targeted to people living in deprived households and areas, regardless of genetic vulnerability.

The characteristics of social contact intensity, contact frequency and contact structure in Hungary in 2006 and 2015

The study aims at comparing the Hungarian results of the questions on the frequency of personal and distance contact with relatives and friends in the 2006 and 2015 ad hoc modules of EU-SILC. According to our results, in line with the findings of previous Hungarian research, compared to 2006, there were fewer contacts in Hungary in 2015. Relations with friends, especially those held in person, were less exposed to weakening compared to relations with relatives. Among the different social groups, the already disadvantaged were typically negatively affected by either the change in intensity or the structure of relationships. However, the situation of the elderly and the inhabitants of deprived households deteriorated in all three dimensions examined: their re­lations weakened more strongly, and those related to relatives and personal ones further narro­wed by 2015. This result indicates that the social disintegration of these groups has accelerated particularly between the two years, which poses a serious social policy challenge.

Catastrophic health spending among older adults in India: Role of multiple deprivation

BackgroundPrevious studies have assessed catastrophic health spending (CHS) is high among households with older member, but no studies have examined its association with multiple deprivation. The purpose of this study is to compare the incidence and determinants of CHS between multiple deprived and non-deprived households in India. MethodsData for this paper was obtained from the 75th round of the National Sample Survey (NSS), a cross-sectional household survey conducted in 2017-18. The multiple deprivation index was estimated using Alkire and Foster method while CHS was estimated using the capacity to pay approach. Logistic regression analysis was used to identify the determinants of CHS in both types of households. ResultsThe study found 43% of households with an older member were deprived in multiple dimensions. We found the incidence of CHS was 19% among households with an older adults; 22% among multiple deprived and 16% among the multiple non-deprived older adult households. Regression analysis result suggest that the odds ratio of incurring CHS was 1.84 (p < 0.001) for the deprived older adult households than that of non-deprived households. Apart from multiple deprivation, any member being hospitalized or any member suffering from chronic diseases significantly associated with CHS in both type of households. ConclusionThis study established the higher financial catastrophes among the deprived older adult households. Therefore, there is an utmost need for the government and policymakers to focus on multiple aspects of geriatric wellbeing at one hand and improving financial mechanisms to reduce the CHS at other hand.

A national data linkage study to determine the association of congenital anomalies with standardised education outcomes.

ObjectivesEducation outcomes predict life chances; however disabilities and concurrent learning difficulties are often barriers to school performance. Low educational achievement is also linked with socio-economic deprivation. We aimed to quantify the association of these factors with education outcomes by ages 12 and 17 for children in Wales (UK). ApproachWe linked health, socio-economic and education data for children born after 1997 in Wales, registered with any one of 17 isolated congenital anomalies. Children were included if they had known education outcomes at ages 12 (n=9,223) and 17 (n=4524). A reference population comprised children born similarly but without anomalies, also having education records at 12 (n=261,827) and 17 (n=4,524). Multinomial logistic regressions determined the likelihood of attainment in compulsory subjects by age 12 and of attaining five GCSE qualifications by age 17. We adjusted for socio-economic status by using free school meal eligibility (household deprivation) and area-based indices of deprivation. ResultsWe identified 14 and 11 isolated anomalies that reduced the likelihood of achieving educational standards by ages 12 and 17 respectively. Educational achievements were lower for children with Down syndrome, Turner syndrome, hydrocephalus and limb reduction defects, particularly at age 12, indicating that children with anomalies may catch-up with their peers. While children with anomalies were less likely to achieve five GCSEs by age 17, there was no difference in the grades of those who did so. Deprivation, particularly at household level, further reduced the likelihood of education success. At age 17, household deprivation reduced 3-fold the odds of achieving any five GCSEs grades A*-C. ConclusionsChildren with congenital anomalies from the most deprived communities and households are at particular risk of low education achievement. To realise their potential, these children should be identified from medical records at an early age and offered targeted educational support as soon as possible and at every opportunity.

Twenty-year observational study of paediatric tonsillitis and tonsillectomy

IntroductionTonsillectomy is now only indicated in the UK when specific criteria are met, as outlined by the Scottish Intercollegiate Guidelines Network (SIGN) and The National Institute for Health and Care...

The epidemiology of aseptic meningitis in New Zealand children from 1991 to 2020.

Aseptic meningitis, including culture negative and viral meningitis, contributes a significant health-care burden, including unnecessary antibiotic use and hospitalisation to treat possible bacterial meningitis. This study analysed aseptic meningitis hospitalisations in New Zealand (NZ) children over 29 years. In this population-based study, aseptic meningitis hospitalisations in NZ children <15 years old were analysed from 1991 to 2020. Incident rate ratios were calculated using Poisson regression models. Variations in hospitalisations by age, year, sex, ethnicity, geographical region and socio-economic deprivation were analysed. There were 5142 paediatric aseptic meningitis hospitalisations from 1991 to 2020. Most were unspecified viral meningitis (64%), followed by enterovirus (29%). Hospitalisation rates varied annually with a median of 18.4/100 000 children including a peak in 2001 of 56.4/100 000 (51.7-61.6). From 2002 to 2019, rates increased by 8.4%/year (7.2-9.5%) in infants <90 days old but decreased in all other age groups. In 2020, a reduction in hospitalisations to 9.6/100 000 (7.9-11.8) occurred, and in infants <90 days old were 0.37 times expected. Hospitalisations were 1.50 times (1.49-1.68) higher in males than females; higher in children of Māori (P< 0.001) and Pacific (P< 0.001) versus European ethnicity; and higher for children living in the most (2.44 times, (2.16-2.75)) versus least deprived households; and in northern versus southern NZ. Aseptic meningitis hospitalisations increased in young infants during 29 years of surveillance, apart from 2020 when admissions reduced during the COVID-19 pandemic. In contrast, hospitalisations decreased in children aged >1year. Further investigation into reasons for higher admissions by ethnic group, geographical location and increased deprivation are required.

Arterial and Venous Thromboembolism in Critically Ill, COVID-19 Positive Patients Admitted to Intensive Care Unit

Arterial and Venous Thromboembolism in Critically Ill, COVID-19 Positive Patients Admitted to Intensive Care Unit

The greener, the happier? The effects of greenspace on residents' happiness in contemporary urban China.

In recent years, research has begun to touch upon the associations between the natural environment and individuals' subjective wellbeing; however, whether such associations would vary among different groups of people remains under-studied. Using four waves (2010-2013) of data from the Chinese General Social Survey, we investigate the group-specific correlation between environment-specifically, greenspace exposure-and individuals' happiness in contemporary urban China. For this study, the normalized difference vegetation indexat the county level is a proxy for greenspace exposure. The results from the ordered logit model indicate that county-level green vegetation is associated with individuals' happiness level, but such effects vary with a household's relative deprivation. While greenspace exposure is positively associated with happiness among individuals from less deprived families, it is negatively associated with happiness among those from deprived households. These findings contribute to the body of knowledge of the heterogeneous effect of greenspace on residents' subjective well-being.

The COVID-19 alcohol paradox: British household purchases during 2020 compared with 2015-2019.

British supermarket-panel data suggest no increases in overall sales and purchases of alcohol following COVID-19 lockdowns, yet survey and mortality data suggest otherwise. This paper attempts to unravel the paradox. Based on purchase data of 79,417 British households from Kantar Worldpanel, we undertake controlled interrupted time series analysis of the impact of COVID-19 confinement introduced on 23rd March 2020, and variably applied during 2020, compared to purchases during 2015 to 2019 as controls. We also undertook Poisson regression analyses to estimate if changes in purchases differed by household socio-demographic and economic factors. Excess off-trade household alcohol purchases (expressed as grams of ethanol) following the introduction of confinement, were 29.2% higher (95% CI = 25.8% to 32.5%) for the post-confinement months of 2020, being larger until mid-July 2020 (37.5%, 95%CI = 33.9 to 41.26%) when pubs re-opened with restrictions, and smaller (24.6%, 95%CI = 21.6 to 27.7) thereafter. During the time of complete pub closures, and fully adjusting for no on-trade purchases, household purchases of alcohol did not change when compared with the same time period during 2015–2019 (coefficient = -0.9%, 95%CI = -5.6 to 3.8). Excess purchases from 23rd March to 31st December 2020 varied by region of Great Britain, being higher in the north of England, and lower in Scotland and Wales. Excess purchases were greater in the most deprived households, compared with the least deprived households. Excess purchases increased substantially as the amount of alcohol normally purchased by a household increased, with the top one fifth of households that normally bought the most alcohol increasing their purchases more than 17 times than the bottom one fifth of households that bought the least alcohol. That the heaviest buyers of alcohol increased their purchases the most, with some independent impact of socio-economic disadvantage, might explain why reported alcohol problems and recent alcohol-related death rates might have increased. A conclusion of this is that alcohol policy to reduce high consumption of alcohol, and the availability of help and treatment to reduce alcohol consumption become more important during extraordinary times, such as COVID lockdowns.

The energy austerity pitfall: Linking hidden energy poverty with self-restriction in household use in Austria

This paper investigates whether energy poor households may be overlooked because they self-restrict their residential heating to underconsumption. Energy poverty definitions predominantly focus on energy expenses relative to household income or theoretically estimated energy needs. Deprived households may accept colder room temperatures to avoid excessive energy bills, but this austerity reaction may backfire if they are no longer classified as energy poor. We thus propose a complementary perspective, highlighting hidden energy poverty emerging from residents’ reactions to their impaired situation. Drawing on survey data of predominantly low-income residents in energy inefficient housing in the cities of Vienna (N = 220) and Graz (N = 433), Austria, latent class analysis identifies two distinct classes of self-restricting and non-restricting households. Cross-tabulating these classes with current poverty definitions indicates a blind spot: about a third of those not considered income poor or energy poor cope by self-imposed restriction in energy use. This blind spot applies across a range of common income poverty and energy poverty definitions, and is replicated in both the Vienna and Graz samples reflecting different housing contexts. Self-restriction blurs the lines of current classifications, as some deprived households may not be recognized in poverty statistics or eligibility criteria of welfare and housing policies. Thus, we propose to consider self-restriction in energy use complementary to the energy poverty triad of high energy expenditures, low income and poor housing conditions in order to avoid misidentification.

Trends in, projections of, and inequalities in reproductive, maternal, newborn and child health service coverage in Vietnam 2000-2030: A Bayesian analysis at national and sub-national levels.

SummaryBackgroundTo assess the reproductive, maternal, newborn and child health (RMNCH) service coverage in Vietnam with trends in 2000−2014, projections and probability of achieving targets in 2030 at national and sub-national levels; and to analyze the socioeconomic, regional and urban-rural inequalities in RMNCH service indicators.MethodsWe used national population-based datasets of 44,624 households in Vietnam from 2000 to 2014. We applied Bayesian regression models to estimate the trends in and projections of RMNCH indicators and the probabilities of achieving the 2030 targets. Using the relative index, slope index, and concentration index of inequality, we examined the patterns and trends in RMNCH coverage inequality.FindingsWe projected that 9 out of 17 health service indicators (53%) would likely achieve the 2030 targets at the national level, including at least one and four ANC visits, BCG immunization, access to improved water and adequate sanitation, institutional delivery, skilled birth attendance, care-seeking for pneumonia, and ARI treatment. We observed very low coverages and zero chance of achieving the 2030 targets at national and sub-national levels in early initiation and exclusive breastfeeding, family planning needs satisfied, and oral rehydration therapy. The most deprived households living in rural areas and the Northwest, Northeast, North Central, Central Highlands, and Mekong River Delta regions would not reach the 80% immunization coverage of DPT3, Polio3, Measles and full immunization. We found socioeconomic, regional, and urban-rural inequalities in all RMNCH indicators in 2014 and no change in inequalities over 15 years in the lowest-coverage indicators.InterpretationVietnam has made substantial progress toward UHC. By improving the government's health system reform efforts, re-allocating resources focusing on people in the most impoverished rural regions, and restructuring and enhancing current health programs, Vietnam can achieve the UHC targets and other health-related SDGs.FundingThe authors did not receive any funds for conducting this study.