Greater Poverty Research Articles

Temperature, Myocardial Infarction, and Mortality: Effect Modification by Individual and Area-Level Characteristics

Background—While several studies have examined associations between temperature and cardiovascular-disease-related mortality, fewer have investigated the association between temperature and the development of acute myocardial infarction (MI). Moreover, little is known about who is most susceptible to the effects of temperature. Methods—We analyzed data from the Worcester Heart Attack Study, a community-wide investigation of acute MI in residents of the Worcester (MA) metropolitan area. We used a casecrossover approach to examine the association of apparent temperature with acute MI occurrence and with all-cause in-hospital and post-discharge mortality. We examined effect modification by sociodemographic characteristics, medical history, clinical complications, and physical environment. Results—A decrease in an interquartile range (IQR) in apparent temperature was associated with an increased risk of acute MI on the same day (hazard ratio=1.15 [95% confidence interval= 1.01– 1.31]). Extreme cold during the 2 days prior was associated with an increased risk of acute MI (1.36 [1.07–1.74]). Extreme heat during the two days prior was also associated with an increased risk of mortality (1.44 [1.06–1.96]). Persons living in areas with greater poverty were more susceptible to heat.

Social Determinants of Mental Health Treatment among Haitian, African American, and White Youth in Community Health Centers

We examine adequate mental health treatment, emergency room (ER) use, and early treatment dropout for Haitian, African American and White youth with a psychiatric diagnosis treated in community health centers in the United States. We present associations with possible socioeconomic determinants of care. Adequate treatment was less likely among Haitian youth from areas with greater poverty and among all youth from areas with more female-headed households. Medicaid-insured youth had more ER visits, especially African Americans. The relative impact of poverty on adequate care was higher for Haitians than Whites, and the relative impact of Medicaid coverage on ER use was higher for African Americans than for Whites. Early dropout was more likely among youth who were uninsured or from areas with more female-headed households. Socioeconomic factors and insurance status were significant determinants of care. Haitians living in poverty in the U.S. may face barriers to mental health services relative to other racial/ethnic groups.

Freedom and poverty in the fishery commons

In fisheries, alleviating poverty sometimes requires strategies that are inherently in conflict. When aiming to develop a fishery as a means to reduce poverty, its common pool resource basis might be undermined, resulting in greater poverty. But poverty in fisheries is also linked to, or a part of deeper social issues and processes, for instance, the marginalization and exclusion of certain communities. Poverty also has many factors— income, health, literacy, gender, power, security, etc.—all of which make poverty alleviation a particularly “wicked problem” that would require a broad process of political, social and institutional reform. In other words, poverty alleviation is not only an issue of sustainable resource management but also one of societal governance. Drawing from research in small-scale fisheries communities in Nicaragua, Tanzania, and Bangladesh, this paper describes how fishing people cope with poverty. The paper discusses what the governance implications are for alleviating poverty at individual, household and community levels, and argue that both the definition of poverty and poverty alleviation in small-scale fisheries must be rooted in real life experiences.

Freedom and poverty in the fishery commons

In fisheries, alleviating poverty sometimes requires strategies that are inherently in conflict. When aiming to develop a fishery as a means to reduce poverty, its common pool resource basis might be undermined, resulting in greater poverty. But poverty in fisheries is also linked to, or a part of deeper social issues and processes, for instance, the marginalization and exclusion of certain communities. Poverty also has many factors— income, health, literacy, gender, power, security, etc.—all of which make poverty alleviation a particularly “wicked problem” that would require a broad process of political, social and institutional reform. In other words, poverty alleviation is not only an issue of sustainable resource management but also one of societal governance. Drawing from research in small-scale fisheries communities in Nicaragua, Tanzania, and Bangladesh, this paper describes how fishing people cope with poverty. The paper discusses what the governance implications are for alleviating poverty at individual, household and community levels, and argue that both the definition of poverty and poverty alleviation in small-scale fisheries must be rooted in real life experiences.

Economic and Accounting Interpretative Approach on Income Disparity: Evidence from China

In this paper, we analyse the current China urban and rural income disparity. Our analysis demonstrates that the Economic and Policy reforms instituted by the Chinese government over the past decade or so have had two primary aims: Firstly, to maintain political stability at all costs and secondly to transform China into a modern industrial state. To ensure political stability, it has eschewed the current Russian model for a unique Chinese model where state owned enterprises co-exist with market driven businesses. This all began in 1978, after two disastrous near revolutions where the hard-line Marxist-Socialists had to concede that all was not well for the future of China, in a modern world. Beginning with the rural sector, where the pool of greatest poverty existed and improving in that sector firstly, allowed the market-oriented to greatly improve their incomes, thus changing the disparities between urban and rural economics. The period of 1985 to 2005 was a period of almost exponential growth, and the raising of millions out of poverty was only part of the positive results, but the greatest social negative was that inequality became worse, as is found in most Capitalist societies. There seems to be an initial jump in the incomes of rural China to jump out of poverty, but the effects have slowed, and it is now up to government agencies to aid the remaining impoverished to escape the traps of poverty through education and relocation incentives for industry, domestic and foreign. This does not mean throwing money at the problem, it means preventing destitution, as destitution adds to crime and other anti-social events and greatly increases instability, the anti-thesis of current Chinese policy. Perhaps the question ought to be a rethink of agricultural policies, to generate corporate farming, as opposed to collective farming, all in order to reduce rural poverty and make rural businesses into a proper and profitable sector of employment

Poverty, Tobacco, and Health: An Indian Scenario

Poverty and health have a two-way relationship. Poverty increases the vulnerability of people to disease, and sickness affects their income leading to poverty. Tobacco has been identified as a major avoidable cause of illness and premature death. In India, more than half of men and one-tenth of women use one or more forms of tobacco. Tobacco-use shows a clear and continual increase with decreasing wealth quintiles. Poor smokers, who are at a greater risk of illness, are also at a greater risk of not being treated or of falling into greater poverty if they seek treatment. Poor people spend money on tobacco that could be spent on food, shelter, education, and healthcare. These decisions can entrench families in an ongoing cycle of poverty and ill-health. The direct and indirect costs of tobacco-use are immense for national economy. This has positioned control of tobacco relevant in India's per suite to achieve the goals of poverty eradication and health for all.

Monitoring Adherence to the International Code of Conduct: Highly Hazardous Pesticides in Central Andean Agriculture and Farmers' Rights to Health

The WHO has advocated monitoring adherence to the Food and Agriculture Organization's Code of Conduct to reduce use of highly hazardous pesticides in lower and middle income countries. We re-framed Code articles in terms of farmers' rights and drew on survey data, farmer focus group results, and direct observations of agrochemical stores in Ecuador and Peru to construct indicators reflecting respect for such rights. Use of highly (Ia and Ib) and moderately (II) hazardous pesticides was common. Worse indicators were observed in places with lower education, greater poverty, and more use of indigenous languages. Limited government enforcement capacity, social irresponsibility of the pesticide industry, and lack of farmers' knowledge of the Code were all factors impeding respect for farmers' rights. Addressing the power imbalance among social actors requires informed farmer and farmworker participation in monitoring adherence and active involvement of non-governmental organizations and municipal governments.

The Plight of Rural Child Welfare: Meeting Standards Without Services

ABSTRACT While poverty and substance abuse are two critical predictors of entry in the child welfare system, rural families have at least as frequent mental health and substance abuse treatment needs as their urban counterparts, greater poverty, and less access to services. A content analysis of final reports for Round One of the Child and Family Services Reviews (CFSRs) found rural comments related to 26 of the 45 items reviewed, and particularly related to adequate services (“service array”) available to rural children. Rural comments also noted creative methodologies for overcoming resource shortages and achieving positive outcomes. The article highlights the Administration for Children and Family (ACF) findings that adequate services were related to capacities to provide for children's needs, and to permanency and stability in living situations. While the CFSRs were not designed to determine rural versus urban differences, these findings raise questions about states' differential provision of protection to rural versus urban children. The study highlights the need for national data systems to define and collect data related to the welfare of rural children, for increased research related to rural child welfare, and for an examination of justice issues related to rural families, caregivers and child welfare workers who are held to the same standard of care without the same support as their urban counterparts.

Quick Fixes and Student Potential

I’m living through educational quick fixes in my home town of New York City at a rate that surpasses anything I’ve ever experienced. But that doesn’t mean that what happened before should be viewed as the good old times. Many of the Klein-­Bloomberg fixes (Joel Klein is the schools’ chancellor, Michael Bloomberg the mayor) are merely new versions of old ones, intensified to meet the intensified demand for quick solutions. What’s new is the possibility of giving up on public schooling for one ver-­ sion or another of privatization. None of us who are contributing to this issue of Profession are satisfied with what education in America has achieved, above all for those kids who start at the bottom. Given the fairly stagnant rate of social mobility in our nation, they are likely to remain at the bottom unless dramatic change takes place both in their schooling and in the economy. In a society where schooling credentials are increasingly a stand-­in for all forms of merit, staying at the bottom may lead them into greater poverty, while climbing slightly up the schooling ladder may not put them much further ahead. We can devise a system that is fairer and offer kids access to their power as citizens, which in turn might help them find ways to make America more equitable and fairer. But tackling this job will require us to reframe what the purpose of public education is, so that all kids may par-­

Social redistribution in federalised Belgium

The federalisation of Belgium has led to a fragmentation of competences in the field of social policy. Only social security has remained an exclusive federal responsibility. However, there have been calls for further federalisation in this policy area. The prominence of interregional financial transfers fuels such calls, while its opponents point out that, among other things, federalisation would result in greater poverty and inequality in Wallonia, a Region that is already disadvantaged in economic terms. In this contribution we first outline the territorial organisation of social policy in a federalised Belgium. We then analyse social transfers between Flanders and Wallonia, focusing on their size and determinants. We demonstrate that these transfers have a considerable equalising and anti-poverty effect. Next, we explore the theoretical arguments for and against federalising social policy, supplemented with examples from the Belgian case. We conclude with an overview of the discussion and indicate some future policy directions.

Peace, Conflict and Development: A Macro Sociological Perspective

It is significant that we are in an era when development as a process of socioeconomic change is widely conceptualised in direct reference to peace and conflict. Development-assistance agencies, such as the World Bank, have shown an increasing tendency to view development as a pro cess with peace and conflict implications. In other words, the widely held view today is that development could help avoid or reduce conflict. It is not difficult to understand why development practitioners are concerned about the 'conflict potential' of development. According to 2000/2001 World Development Report, 80 percent of the incidents of civil war and strife during the period 1990-95 were concentrated in deve loping countries (World Bank 2001: 50). It is also significant that a large proportion of these conflicts have taken place in sub-Saharan Africa that has one of the world's highest concentrations of abject poverty. What is noted here, by implication, is that there is a symbiotic relationship between the level of development and conflict: 'poor countries produce more conflict, and widespread conflicts, in turn, produce greater poverty and deprivation'. What is peculiar about the above analysis is that it is contextualised in an extremely ahistorical manner. In other words, the contextualisation is largely independent of time and space. On the other hand, a broader conceptual framework would indicate that development is a process that has often involved both structural and symbolic violence. It is a pheno menon with a long history, spanning over several centuries (cf. Baeck 1993). Moreover, deprivation and poverty in much of the developing world cannot be discussed without reference to growth and affluence elsewhere (cf. Rifkin 1981). '9/11' (11 September 2002), which many people routinely refer to when they, talk about the present global condition, has persuaded the world leaders to explicitly recognise the connection between develop ment and security. While some commentators would like to see the nexus as one connected with conflicting value systems or worldviews (Huntington 1991), others see a structural link between material and symbolic violence, on the one hand, and growing terrorism, on the other.

Poverty-related stressors and HIV/AIDS transmission risks in two South African communities.

Community stress associated with poverty is related to health risks and poor health outcomes. Perceived community stress is specifically related to HIV transmission risk behaviors in the United States, but research has not examined these relationships in southern Africa, the region of the world with the highest rates of HIV infection and among the greatest poverty. Men (N=464) and women (N=531) living in impoverished adjacent communities distinguished by race (e.g., indigenous African and Coloured) completed anonymous surveys of perceptions of 10 poverty-related community stressors and measures of HIV risk-related behaviors. Indigenous African and Coloured communities differed in their perceptions of stressors, with Africans consistently viewing the 10 community stressors as more serious problems. In addition, perceived seriousness of lacking basic living resources was related to higher risk for HIV among Africans. Perceived community stress was also related to alcohol and drug use, but substance use did not mediate the association between perceived community stress and HIV risks. In the Coloured community, perceived community stressors were related to drug use, but perceived community stressors were not associated with HIV risks. These findings extend the findings of previous research to show that poverty-related stressors are associated with HIV transmission risks in some poverty-stricken communities and that these associations are not mediated by substance use.

Chronologic History of Occupational Medicine

To provide a chronologic review of growing knowledge in occupational medicine relating work and work hazards to health, and to provide a perspective on the lessons learned from the frequent inattention or misrepresentation of hazards. Many books on the social and medical history of work including epidemiology and toxicology were reviewed, as well as published papers and interviews. Throughout history workplace hazards and occupational medicine have been shaped by the forces that shape work itself, social evolution, changing modes of production, shifting economic powers, and demographic changes in the workforce. Lest we think these changes are unique to the present time, this paper emphasizes the long-term and inevitable relationship between social structure and worker health. Hippocrates emphasized the relation between environment (air and water) and health, although he has less to say about the non-military work environment, perhaps because of the denigration of manual labor in Greece. The impact of work on health can be traced to the Edwin Smith Surgical Papyrus, written approximately 1700 BC. The earliest occupational physicians served military forces, and Galen was physician to Roman gladiators. Finger and wrist guards worn by Bronze Age archers represent early personal protective equipment. Writers of the classic period mention diseases and hazards of miners, and Pliny (1st century AD) mentions veils to cover the face. In the Middle East Rhazes included occupation in his case studies (9th century). Paracelsus, and Agricola were prominent, figures in the 15th century, with an emphasis on mining and health. Ramazzini's (c1700) work was widely translated in ensuing decades and is now well-known to all, but its influence between about 1800 and 1940 is inapparent. The emergence of a public health movement in the mid-1800s focused attention on the abominable conditions of many factories and on the living conditions, poor nutrition, high stress, poverty and ill health of the new factory working class, while paying scant attention to specific workplace hazards. The recognition of occupational diseases in the United States has often lagged by a generation behind the recognition of the same diseases in Europe. We are now into a second industrial revolution led by multinational corporations and information technology, shifting production facilities, and jobs moving around the world in search of cheap labor in the countries with the fastest growing population and the greatest poverty. Occupational medicine must be alert to the new challenges imposed by this revolution.

Active Tuberculosis Case Finding Among Immigrants in Barcelona

To assess the prevalence of tuberculous infection and disease in recent economic immigrants in Barcelona. Examination and testing of immigrants. Tuberculin tests (TTs) were given and the presence of scars from tuberculosis vaccinations were noted. Thresholds of 5 and 15 mm were established for positivity in unvaccinated and vaccinated individuals, respectively. A total of 3651 persons were examined, but only 3151 completed the study. Eighteen were diagnosed with tuberculosis (571.2 per 100,000) and 50.6% were classified as positive TT reactors, 34.4% because of infection and 16.3% possibly because of tuberculosis vaccination. The percentage of reactors was significantly higher in the sample of economic immigrants than in the local population. Age, male sex, place of origin, greater poverty, and higher prevalence of disease in the country of origin were associated with tuberculous infection in the sample. Active case finding proved efficient. Interference from tuberculosis vaccination greatly affects the findings, depending on the positivity threshold that is established. We recommend that chest radiographs be used in addition to TTs. Immigration will change the nature of endemic tuberculosis in Spain, and strategies should be specifically designed to deal with the new challenges that will appear.

Beyond the income inequality hypothesis: class, neo-liberalism, and health inequalities

This paper describes and critiques the income inequality approach to health inequalities. It then presents an alternative class-based model through a focus on the causes and not only the consequences of income inequalities. In this model, the relationship between income inequality and health appears as a special case within a broader causal chain. It is argued that global and national socio-political-economic trends have increased the power of business classes and lowered that of working classes. The neo-liberal policies accompanying these trends led to increased income inequality but also poverty and unequal access to many other health-relevant resources. But international pressures towards neo-liberal doctrines and policies are differentially resisted by various nations because of historically embedded variation in class and institutional structures. Data presented indicates that neo-liberalism is associated with greater poverty and income inequalities, and greater health inequalities within nations. Furthermore, countries with Social Democratic forms of welfare regimes (i.e., those that are less neo-liberal) have better health than do those that are more neo-liberal. The paper concludes with discussion of what further steps are needed to ‘go beyond’ the income inequality hypothesis towards consideration of a broader set of the social determinants of health.

The Limits of Housing Reform: British Social Rented Housing in a European Context

The British social rented sector has been characterised as operating like a socialist `command' system. It places a much greater emphasis on housing very poor households than its counterparts in other European countries, most of it is still owned and managed by the (local) state and pricing policies are not sensitive to demand. Consequently, allocation decisions rely on bureaucratic processes. Some other European countries have more socially diverse social rented sectors and make much greater use of price signals. These systems have been characterised as 'social markets'. It has been suggested that Britain could adopt some of the organisational structures and practices used elsewhere and move away from the present `command' system towards a 'social market'. Comparative evidence confirms that the British social rented sector does contain much greater concentrations of poor households and that this does not simply arise from the types of household housed in the sector. But further analysis of the distribution of income and work suggests that the divisions in the housing sector may primarily reflect these broader contextual divisions. Greater poverty and inequality imply a greater need for the housing system to provide a safety-net and make the introduction of market and quasi-market mechanisms problematic. This is illustrated with reference to allocations and pricing reforms currently under consideration. It is concluded that, given the socioeconomic context in which housing policy is formulated, it might be best to concentrate on providing an effective and high-quality safety-net.

Study of distribution and factors affecting syphilis epidemic among inner-city minorities of Baltimore.

Disparities in health and medical conditions among ethnic and racial groups have been repeatedly documented. These inequalities, which have been noted in the recent past, include health outcomes such as quality of life and mortality, process, accessibility and appropriateness of care, and the prevalence of certain degenerative conditions and infectious diseases. Syphilis, a sexually transmitted disease (STD) which seemed to have disappeared or had been controlled over the years, has now re-emerged as a major public health problem in many rural, urban and suburban communities. Progression of the current rate of syphilis, which erupted in Baltimore during the later part of 1994, has continued unabated, most especially among the ethnic minorities, despite efforts of the Baltimore City Health Department and Maryland Department of Health and Mental Hygiene to control the epidemic. With the current incidence rates of 270 per 100 000 live births for congenital syphilis and 99.3 per 100 000 population for primary, secondary and latent syphilis (96% of the cases being in the non-white population), Baltimore becomes the city with the highest number of syphilis cases in the nation, surpassing the national average of 2.6 cases per 100 000 population. This study, which utilizes a combination of retrospective and questionnaire-oriented approach, was designed to assess factors that influenced the high incidence of syphilis among Baltimore inner-city dwellers between 1994 and 1998. Data for the study included syphilis reports from private physicians, the Baltimore City Health Department, STD clinics, the Center for Disease Control (CDC), and ethnographic interviews. Factors favoring the distribution and infectivity of the disease among the inner-city dwellers include greater poverty, high level of communication gaps between providers and a cross-section of minority inner-city dwellers, exchange of sex for crack cocaine, lower educational background, and inadequate and inappropriate health education/health promotion programs for the ethnic minorities.The paper calls for, among other things, culturally-sensitive and competent syphilis elimination/prevention health education and health promotion programs for the ethnic minority inner-city dwellers of Baltimore.

Correcting cross-cultural stereotypes: aging in Shanghai and Canada.

This paper challenges common belief that the aging experience is primarily different for seniors in Asia and those in western cultures. The examination reveals that there are many differences in the life situation of seniors living in mainland China and those living in Canada, with Shanghais seniors living in much greater poverty, with much less education and typically not alone when compared to Canadian seniors whether they be of Chinese origin or not. The Shanghais are also in worse health and perceive themselves to be in worse health. However, when examining the predictors of subjective quality of life, life satisfaction, in both cultures it is social support and health that predict life satisfaction. The form that social support takes (the importance of sons is clearly evident in Shanghai, whereas spouses are more important in Canada) and the particular physical health problems that one might suffer from differ across cultures but it is social support and health that appear to be universal in their affects on our subjective quality of life. Similarly when examining caregivers there are many differences evident across the cultures but when examining subjective burden in both cultures it is the deteriorated health of the care receiver that is the major predictor of burden. The data suggest that there are cross-cultural universals, with particularistic forms.

Some Theoretical Thoughts on Constructing a Poverty-Eliminating Social Accounts Bill of Goods

It is unnecessary for us to point out that there has emerged a new type of warfare that is employed by terrorist organizations and that the continued and even greater poverty conditions of many regions of the world contribute to the growth of the terrorists' activities. This negative outcome has suggested to us the importance of eliminating as much as possible the extent of poverty among these regions, and ideally of course to eliminate all poverty.

Social Policy and Rights in AfricaFrom Social Contract to Loss of Self-determination

Summaries The agenda for social development in Africa, and therefore the framework in which social policy is defined, has undergone major shifts over the last forty years. This has partly been the result of the ability of post‐colonial governments to depoliticise poverty and demobilise the movements that brought them to power. But the major reason has been the current phase of the globalisation of capital, which has demanded a major restructuring of the world economy to suit its needs. The primary instruments used in effecting those changes were structural adjustment programmes and associated policies. These have resulted in the few accumulating (on a global as well as national level) immense wealth while the majority were condemned to greater poverty, and a reversal of the social gains of independence. In effect, there has been an increasing disenfranchisement of the majority in determining the goals of social development. With the rise of globalisation, the agenda for social development is being set, largely unilaterally, by undemocratic institutions of globalisation in the interests of multinational corporations.