Universal Policy Research Articles

Conflicts of interest and the risk of bias are inevitable in urolithiasis research.

This review examines data from stone conferences and research journals to assess whether justifiable concerns exist about possible bias in urolithiasis research and if so, how they can be minimized. Conflict of interest (COI) policies of two major urological congresses and three symposia dedicated to stone research were reviewed. Disclosure slides were viewed in webcasts and were evaluated for robustness and speaker compliance with respect to policy. Additionally, disclosure and COI policies of ten Science Citation Index (SCI)-approved journals were assessed and compared with actual declarations in published papers on urolithiasis. It was observed that disclosure and conflict declarations are frequently conflated in congresses and journals. Differences between the two ideologies appear to be ignored or unappreciated. Disclosures in the major urological meetings revealed a high percentage of financial relationships with industry. In dedicated stone conferences, more than two-thirds of speakers failed to display a declaration slide. Both scenarios generate questions about objectivity. Disclosure and COI statements in journals varied widely in format, detail and content. It is concluded that there exists a misinformed and incorrect perception in urolithiasis research that disclosure of potential COIs somehow validates a study as being objective and unbiased. Current policies and practices at conferences and in published papers create a setting in which concerns of bias prevail. Changes, including the establishment of a universal policy, insistence of independent and explicit declarations of disclosures and conflicts, implementation of sanctions for transgression and the introduction of intensive scrutiny by reviewers are required to minimize doubts.

Nordic paradox in action: The complicated relation between social mobility and health inequalities in an international comparative study.

Socio-economic inequalities originate from several channels, one of which is family origins, with clear effects on people's health. This paper aims to evaluate the role played by social mobility in determining health inequalities, relying on Blau and Duncan's status attainment model and focusing specifically on two moments of social reproduction of inequalities: one inter-generational, based on the transmission of resources from the family of origin, the other intra-generational, related to the capitalisation of economic resources to maximise well-being. Multi-group models of structural equations were used to examine the direct and indirect effects of parental cultural background, education and economic conditions of respondents on self-perceived health in 28 countries, relying on the European Social Survey (N=38,879). Overall, the results confirmed the presence of an inter-generational transmission of social and health status. Different models of transmission of health inequalities emerged among the countries considered. Countries characterised by a social democratic welfare regime showed higher social mobility and fewer health inequalities, although in correspondence with a prominent role of economic factors in determining health conditions. On the other hand, in countries where social mobility is lower, health inequalities are more pronounced, yet driven by factors others than economics, such as socio-cultural origins. The presence of a higher economic-health gradient in social democratic countries - notwithstanding their egalitarian and universal welfare policies - provides support for the existence of a Nordic paradox in relation to health inequalities.

How social policies shape the health and well-being of sexual- and gender-minority youth: Pathways of influence, social side effects and implications for life course trajectories

Recent research has documented the harmful health consequences of structural-level stigma that targets sexual and gender minority (SGM) individuals. In the case of sexual and gender minority youth (SGMY), life trajectories are shaped not only by targeted, SGM-focused policies, but also by social policies more broadly which may have unique impacts on SGMY given their social position. However, little work has explored the pathways that connect both targeted and universal social policies and the health and well-being of SGMY. In this study, we conducted 68 qualitative interviews with SGMY in New York City (n = 30) and community stakeholders across the US (n = 38) and used the constant comparative method to identify the pathways through which social policies affect SGMY health and well-being. We propose three pathways that are shaped by specific inter-related social policies in ways that contribute to health inequities among SGMY: 1) access to social inclusion in educational settings; 2) housing-related regulations and subsequent (in)stability; and 3) access to material resources through labor market participation. We also highlight ways that SGMY, and organizations that support them, engage in agency and resistance to promote inclusion and wellbeing. Drawing on ecosocial theory, we demonstrate how policies work across multiple domains and levels to influence cycles of vulnerability and risk for SGMY. We close by discussing the implications of our findings for future research and policy.

Challenges associated with implementing anti-doping policy and programs in Africa.

Concerns regarding the capability of the International Olympic Committee to address doping in sport catalyzed the formation of the World Anti-Doping Agency (WADA) in 1999. In its establishment phase, WADA sought geopolitical legitimacy and support from governments (including non-Western states) for financing and acceptance. Africa was not considered during WADA's creation, relegating African states to a passive role in the global anti-doping program, and yet is still subject to the strict compliance requirements for WADA's global policy. African countries face challenges establishing anti-doping support structures and implementing the universal policy, including competing macro-level policy demands that favor addressing legacies of colonialism and human capacity development. To develop robust anti-doping support structures, African nations must spearhead anti-doping initiatives by leveraging existing infrastructure and encouraging collaborations between NADOs such that capacity can be built for policy implementation.

Implementation Of Universal Precaution Policy On Class I Nurses In Hospital X

Universal precaution is a strategy to protect health care workers to prevent the transmission of infectious diseases in all health facilities. The latest data on HAIs at Hospital X shows that the highest number of HAIs occurs in class I inpatient rooms at 3.8%. This study aims to describe the implementation of the universal precaution policy on class I inpatient nurses at Hospital X. Informants consisted of nurses from Hospital X including IPCN, class I inpatient nurses, IPCLN ICU rooms, and room leader of class I inpatient rooms. The result of this study is that all informants have understood the purpose of the universal precaution policy at Hospital X, but cannot mention the full policy objectives. Human resources, funds, and facilities at Hospital X have fulfilled the need for implementing universal precaution policies. Communication between implementing parties is good, but there are no sanctions and rewards. The available competencies are sufficient. Supervision in the implementation of this policy is carried out by the KPPI (Infection Prevention and Control Committee) and tiered supervision that has been running well. Class I inpatient nurse at Hospital X has good cognition on universal precaution points. KPPI Hospital X needs to conduct upgrading to refresh the cognition of officers regarding the universal precaution policy. It is necessary to have a separate budget post for KPPI, as well as periodic awards for employees of Hospital X.

Technical and vocational education provision in Zimbabwe: leveraging institutional support for learners with special educational needs

ABSTRACT The benefits of equal opportunity and inclusivity to access education of choice are very crucial to people in situations of deep scarcity and need. This study sought to analyse and evaluate how the universal policy of inclusive education was applied in technical and vocational education and training to enable learners with special educational needs to navigate their skills-based learning experiences. The study, using an inclusive education outcome framework, further interrogated the institutional support strategies put in place to normalise and ameliorate the plight of affected learners. A qualitative research approach in the interpretivist paradigm was used to capture the perceptions of the affected learners and their immediate associates in two colleges of technical and vocational education in Zimbabwe. The participants generally applauded the national stance to adopt inclusive vocational and technical education, but contended that the application of the policy at institutional level lacked seriousness and needed due improvement. Institutional support was linked to, and dependent on, home, community and national support. The study concludes that the inadequate institutional support for SEN learners requires more inter-personal approaches towards sustainable improvement.

Lifting Universal Masking in Schools — Covid-19 Incidence among Students and Staff

BackgroundIn February 2022, Massachusetts rescinded a statewide universal masking policy in public schools, and many Massachusetts school districts lifted masking requirements during the subsequent weeks. In the greater Boston area, only two school districts — the Boston and neighboring Chelsea districts — sustained masking requirements through June 2022. The staggered lifting of masking requirements provided an opportunity to examine the effect of universal masking policies on the incidence of coronavirus disease 2019 (Covid-19) in schools.MethodsWe used a difference-in-differences analysis for staggered policy implementation to compare the incidence of Covid-19 among students and staff in school districts in the greater Boston area that lifted masking requirements with the incidence in districts that sustained masking requirements during the 2021–2022 school year. Characteristics of the school districts were also compared.ResultsBefore the statewide masking policy was rescinded, trends in the incidence of Covid-19 were similar across school districts. During the 15 weeks after the statewide masking policy was rescinded, the lifting of masking requirements was associated with an additional 44.9 cases per 1000 students and staff (95% confidence interval, 32.6 to 57.1), which corresponded to an estimated 11,901 cases and to 29.4% of the cases in all districts during that time. Districts that chose to sustain masking requirements longer tended to have school buildings that were older and in worse condition and to have more students per classroom than districts that chose to lift masking requirements earlier. In addition, these districts had higher percentages of low-income students, students with disabilities, and students who were English-language learners, as well as higher percentages of Black and Latinx students and staff. Our results support universal masking as an important strategy for reducing Covid-19 incidence in schools and loss of in-person school days. As such, we believe that universal masking may be especially useful for mitigating effects of structural racism in schools, including potential deepening of educational inequities.ConclusionsAmong school districts in the greater Boston area, the lifting of masking requirements was associated with an additional 44.9 Covid-19 cases per 1000 students and staff during the 15 weeks after the statewide masking policy was rescinded.

Mitigating welfare-related prejudice and partisanship among U.S. conservatives with moral reframing of a universal basic income policy

Inequality and deep poverty have risen sharply in the US since the 1990s. Simultaneously, cash-based welfare policies have frayed, support for public assistance has fallen on the political right, and prejudice against recipients of welfare has remained high. Yet, in recent years Universal Basic Income (UBI) has gained traction, a policy proposing to give all citizens cash sufficient to meet basic needs with no strings attached. We hypothesized that UBI can mitigate the partisanship and prejudice that define the existing welfare paradigm in the US but that this potential depends critically on the narratives attached to it. Indeed, across three online experiments with US adults (total N = 1888), we found that communicating the novel policy features of UBI alone were not sufficient to achieve bipartisan support for UBI or overcome negative stereotyping of its recipients. However, when UBI was described as advancing the more conservative value of financial freedom, conservatives perceived the policy to be more aligned with their values and were less opposed to the policy (meta-analytic effect on policy support: d = 0.36 [95% CI: 0.27 to 0.46]). Extending the literatures on moral reframing and cultural match, we further find that this values-aligned policy narrative mitigated prejudice among conservatives, reducing negative welfare-related stereotyping of policy recipients (meta-analytic effect d = −0.27 [95% CI: −0.38 to −0.16]), while increasing affiliation with them. Together, these findings point to moral reframing as a promising means by which institutional narratives can be used to bridge partisan divides and reduce prejudice.

Development of Evaluation Indicators for Sports Facilities for People with Disabilities Considering the Universal Design: Focusing on the Republic of Korea.

We developed evaluation indicators for sports facilities for people with disabilities and adopted the universal design to conduct Delphi surveys on sports facilities and sports experts. First, the range of universal design element reflection and the method of deriving the evaluation indicators were established through a literature review. Second, 21 experts conducted the first Delphi survey to select the important features of the seven principles of universal design and describe the necessary sub-factors to consider when designing sports facilities. The described elements were divided into 15 categories, and 49 sub-factors were extracted. Third, based on the evaluation of the indicators' content, acceptance was investigated, and the survey data were analyzed through indicators of reliability and validity of the sub-factors and categories. Fourth, we discussed whether to accept the standard value on the basis of the evaluation index through an expert meeting. Subsequently, the final evaluation index was obtained. The developed evaluation index should be applied by the operators and users of public sports facilities, and validation work is needed. Guidelines for applying the universal design to various sports facilities for people with disabilities should be developed. The financing of sports facilities applying the universal design and related policies should be discussed.

Comparison of Germline Genetic Testing Before and After a Medical Policy Covering Universal Testing Among Patients With Colorectal Cancer

In 2020, some health insurance plans updated their medical policy to cover germline genetic testing for all patients diagnosed with colorectal cancer (CRC). Guidelines for universal tumor screening via microsatellite instability and/or immunohistochemistry (MSI/IHC) for mismatch repair protein expression for patients with CRC have been in place since 2009. To examine whether uptake of MSI/IHC screening and germline genetic testing in patients with CRC has improved under these policies and to identify actionable findings and management implications for patients referred for germline genetic testing. The multicenter, retrospective cohort study comprised 2 analyses of patients 18 years or older who were diagnosed with CRC between January 1, 2017, and December 31, 2020. The first analysis used an insurance claims data set to examine use of MSI/IHC screening and germline genetic testing for patients diagnosed with CRC between 2017 and 2020 and treated with systemic therapy. The second comprised patients with CRC who had germline genetic testing performed in 2020 that was billed under a universal testing policy. Patient demographic characteristics, clinical information, and use of MSI/IHC screening and germline genetic testing were analyzed. For 9066 patients with newly diagnosed CRC (mean [SD] age, 64.2 [12.7] years; 4964 [54.8%] male), administrative claims data indicated that MSI/IHC was performed in 6645 eligible patients (73.3%) during the study period, with 2288 (25.2%) not receiving MSI/IHC despite being eligible for coverage. Analysis of a second cohort of 55 595 patients with CRC diagnosed in 2020 and covered by insurance found that only 1675 (3.0%) received germline genetic testing. In a subset of patients for whom germline genetic testing results were available, 1 in 6 patients had pathogenic or likely pathogenic variants, with most of these patients having variants with established clinical actionability. This nationwide cohort study found suboptimal rates of MSI/IHC screening and germline genetic testing uptake, resulting in clinically actionable genetic data being unavailable to patients diagnosed with CRC, despite universal eligibility. Effective strategies are required to address barriers to implementation of evidence-based universal testing policies that support precision treatment and optimal care management for patients with CRC.

Paid Sick Leave and Sickness Benefits for employees’ economic and job security: A Scoping Review

Abstract In health emergencies, such as in the COVID-19 pandemic, the need to expand or introduce the Paid sick leave(PSL) and Sickness benefits(SB) increases. They are key components of the universal health coverage(UHC) and active labor market policies(ALMPs) that enable workers to take care of their health and guarantee return-to-work after recovery. This study examines effects those policies in achieving economic stability and job security of covered workers through a scoping review. Studies were selected using the search terms ‘paid sick leave', ‘sickness benefits', ‘paid sick day', and ‘earned sick leave’ in PubMed and Web of Science. Our search conducted on 6th April 2021 yielded 1,030 articles, of which 22 articles were included in the review. All articles were analyzed by the 4 sub-groups(employees, families, employers, and government) and we investigated indicators of socio-economic impacts on their lives. Articles are largely PSL(90.9%)-focused. PSL guarantees not only workers’ job security by securing employment agreement, but also their income security by promising part of wages enough to afford healthcare and living expenses during the medical treatment and recovery. Additionally, PSL attenuates employers’ financial risk, as it reduces presenteeism while increasing the return-to-work rate. Moreover, PSL and SB reduce the total healthcare and social security expenditures of the government. To sum up, PSL and SB guarantee health and labor rights by ensuring income and job security to employees while assuring financial stability to both employers, and the government. However, as the previous studies paid less attention on the equity of these impacts at the system levels, future research should more focus on the dimension. Key messages • PSL and SB guarantee health and labour rights by ensuring income and job security for employees, while assuring financial stability for both employers and the government. • The previous studies that examined the effects of PSL and SB paid less attention on the equity of ensuring income and employment security, therefore future studies should focus more on this dimension.

Harassment and abuse in sports: evidence-based guidelines for adherence to policy

ABSTRACT Rationale/purpose While the International Olympic Committee has issued several guidelines and recommendations on the protection of athletes from harassment and abuse in sports, there exists very little research which documents the extent to which these recommendations are actually implemented in sports organizations across Europe and most importantly, the efficacy of such measures. Findings Based on the results, a set of evidence-based guidelines for promoting compliance with the existing policies and measures of harassment and abuse are recommended, which include an Observatory of Harassment and Abuse in Sports, the ISO accreditation for all sports organizations, and a European Mobile phone application. Practical implications With these findings, this study offers a standardized method of implementation of policies, which will enable future pan-European assessments of efficacy, thus narrowing the current gap in knowledge. Research contribution This is the first study to recommend a remedy to the obstacles – identified in previous research – which hamper the implementation of Universal policies on harassment and abuse in sports.

Managing the Unpredictable: Recommendations to Improve Trainee Safety During Global Health Away Electives

Background:For institutions offering global health programs, the safety of trainees during clinical rotations at international sites is paramount. Current guidelines for global health electives recommend pre-departure training and safety-net resources, yet their advice on managing unanticipated problems is limited.Objective:This report illustrates critical safety considerations requiring additional guidance for programs and students and highlights approaches that may improve trainee safety while abroad.Methods:We present a series of five cases adapted from the experiences of students traveling to and from the Yale School of Medicine between the years of 2011–2021. These cases include instances of personal injury, mental health challenges following trauma, sexual harassment, political instability, and natural disaster. For each case, we recommend ways in which programs and their participants may approach the challenges and we highlight issues requiring additional analysis.Findings:We categorized the types of trainee safety issues into three groups: personal health emergencies, individual-level stressors, and large-scale crises.Conclusion:Ultimately, we recommend that rather than solely emphasizing a universal policy, programs and trainees should also be educated on the tools and resources available for addressing unexpected emergencies.

Identifying optimal vaccination scenarios to reduce varicella zoster virus transmission and reactivation

BackgroundVaricella zoster virus (VZV) is one of the eight known human herpesviruses. Initial VZV infection results in chickenpox, while viral reactivation following a period of latency manifests as shingles. Separate vaccines exist to protect against both initial infection and subsequent reactivation. Controversy regarding chickenpox vaccination is contentious with most countries not including the vaccine in their childhood immunization schedule due to the hypothesized negative impact on immune-boosting, where VZV reactivation is suppressed through exogenous boosting of VZV antibodies from exposure to natural chickenpox infections.MethodsPopulation-level chickenpox and shingles notifications from Thailand, a country that does not vaccinate against either disease, were previously fitted with mathematical models to estimate rates of VZV transmission and reactivation. Here, multiple chickenpox and shingles vaccination scenarios were simulated and compared to a model lacking any vaccination to analyze the long-term impacts of VZV vaccination.ResultsAs expected, simulations suggested that an introduction of the chickenpox vaccine, at any coverage level, would reduce chickenpox incidence. However, chickenpox vaccine coverage levels above 35% would increase shingles incidence under realistic estimates of shingles coverage with the current length of protective immunity from the vaccine. A trade-off between chickenpox and shingles vaccination coverage was discovered, where mid-level chickenpox coverage levels were identified as the optimal target to minimize total zoster burden. Only in scenarios where shingles vaccine provided lifelong immunity or coverage exceeded current levels could large reductions in both chickenpox and shingles be achieved.ConclusionsThe complicated nature of VZV makes it impossible to select a single vaccination scenario as universal policy. Strategies focused on reducing both chickenpox and shingles incidence, but prioritizing the latter should maximize efforts towards shingles vaccination, while slowly incorporating chickenpox vaccination. Alternatively, countries may wish to minimize VZV complications of both chickenpox and shingles, which would lead to maximizing vaccine coverage levels across both diseases. Balancing the consequences of vaccination to overall health impacts, including understanding the impact of an altered mean age of infection for both chickenpox and shingles, would need to be considered prior to any vaccine introduction.

Editorial

Abstract This distinctive issue of Management & Marketing. Challenges for the Knowledge Society focusses on “Higher Education, Social Change and Impact”, emerging from the COST programme SHIINE “Multi-disciplinary innovation for social change”. The ideas presented in the papers are from various lenses reflecting an international perspective. There are significant and important insights which may be gained from this issue. International dialogue and the adoption of a multi-disciplinary approach to social problems can assist in the advancement of universal public policy. This will be to everyone’s gain.

Army of Hellenistic Egypt: organizational and historical-philosophical aspect

This article is devoted to the analysis of the formation and transformation of the organization of the army of the Ptolemaic power. The authors consider the mechanisms of the evolution of the army of Hellenistic Egypt and show the main directions of this process, its ideological justification – philosophical concepts that developed in the era of Hellenism. Rejecting the excessively strict classical assessments given to the military art of Hellenistic Egypt, the authors turn not only to historical but also to historical and philosophical argumentation. The conclusion is made about the sufficient effect of the army organization throughout the greater length of the history of the Ptolemaic state when the army acted as one of the main pillars of the Ptolemaic rule and a universal foreign policy tool. The decline of military affairs in Egypt, which occurred in the second half of the II – first half of the I century BC, was mainly caused by the changes that occurred in the system of international relations in the Mediterranean region and in the general crisis of the Ptolemaic dynasty and state. Despite all the shortcomings of the army of Egypt during the Hellenistic period, the army was one of the most stable institutions that slowed down the process of state collapse. The article is prepared based on materials announced during the round table “The Ancient World in the history of mankind”, dedicated to the memory of Candidate of Historical Sciences, Associate Professor Vyacheslav Gorovoy (1954–2020).

Responsible Governance in Containing the Spread of COVID-19 in a Developing State

Aim. The study aims to evaluate the government policy implementation in tackling the global pandemic and framing universal policies for responsible governance. It also measures the impact of training interventions and non-training implications in containing the spread of COVID-19 at the grassroots level.
 Methods. The samples were drawn empirically from pathological tests conducted over 23 weeks to precisely examine the success of the State Government's approach in lowering COVID-19 mortality and spread. Through trend analysis, the outcome has been predicted. The study establishes a link between acknowledged ideas and government practices, providing insight into how relevant the implementation of planned state-craft programs is.
 Results. The findings indicated that government-imposed policies account for timely pandemic containment, and even a tiny developing state lacking advanced medical facilities and technology can set an example in combating the epidemic.
 Conclusions. The temporal analysis is based on the inputs acquired from government publications and other sources, allowing us to assess policy initiatives that encompass training interventions and non-training implications as prioritized by the State Government. The paper shows that a good emergency preparedness and response system is needed to prevent huge losses in any sector. This includes the already-struggling health sector, which India needs to put first to avoid more tragedies.

Non-Compliance with Universal Masking Policy by Patients During Covid-19 Pandemic: A Major Threat to Health Care Worker in Pakistan

Objective: To determine the frequency of patient compliance with universal face mask policy during COVID-19 pandemic using simple observable criteria. Study Design: Cross sectional study Place and Duration of Study: Pakistan Railway Hospital, Rawalpindi during the third wave of COVID-19 pandemic over a period of one month from 15 March 2021 to 15 April 2021. Materials and Methods: A total of 266 patients were recruited from the general population of patients visiting our hospital after undergoing screening for COVID-19 at the filter clinic. Face mask compliance was defined as the wearing of a disposable surgical mask while employing correct techniques as per the World Health Organization and National Institute of Health guidelines for hospital settings. Results: Majority of the patients (79.9%) wore a surgical face mask as recommended for hospital settings. However, only 41% employed the correct mask wearing technique. Patients under strict supervision in outdoor clinics were more likely to wear mask as compared to their indoor counterparts (76.79% vs 51.76%). Correlation was significant at a level of 0.492. One third (34.2%) of the patients did not cover their face, nose, and chin completely. An overwhelming majority (129/183 or 70.49%) admitted reusing the mask multiple times. Conclusion: The study findings indicate that while majority of the general population of patients visiting our hospital wore a face mask, compliance with correct mask wearing technique as per recommended guidelines was poor. Our results support strict implementation of universal masking policies for hospitals in Pakistan as part of a multifaceted strategy to minimize transmission of infection in health care settings.

Spurious early ecological association suggesting BCG vaccination effectiveness for COVID-19.

Several ecologic studies have suggested that the bacillus Calmette-Guérin (BCG) vaccine may be protective against SARS-CoV-2 infection including a highly-cited published pre-print by Miller et al., finding that middle/high- and high-income countries that never had a universal BCG policy experienced higher COVID-19 burden compared to countries that currently have universal BCG vaccination policies. We provide a case study of the limitations of ecologic analyses by evaluating whether these early ecologic findings persisted as the pandemic progressed. Similar to Miller et al., we employed Wilcoxon Rank Sum Tests to compare population medians in COVID-19 mortality, incidence, and mortality-to-incidence ratio between countries with universal BCG policies compared to those that never had such policies. We then computed Pearson's r correlations to evaluate the association between year of BCG vaccination policy implementation and COVID-19 outcomes. We repeated these analyses for every month in 2020 subsequent to Miller et al.'s March 2020 analysis. We found that the differences in COVID-19 burden associated with BCG vaccination policies in March 2020 generally diminished in magnitude and usually lost statistical significance as the pandemic progressed. While six of nine analyses were statistically significant in March, only two were significant by the end of 2020. These results underscore the need for caution in interpreting ecologic studies, given their inherent methodological limitations, which can be magnified in the context of a rapidly evolving pandemic in which there is measurement error of both exposure and outcome status.

The Effects of Residential Segregation on Black and White Mortality in the United States

Higher rates of black mortality compared to whites in the United States are longstanding and well documented. Wide variation across racial and socioeconomic groups suggests that many deaths may be preventable. We hypothesize that higher mortality for African Americans is due to the fundamental causes of structural racism and poverty. We developed a new index, the Racial Isolation of Poverty (RIP), to examine how the race/class nexus of disadvantage is associated with higher rates of mortality for African Americans. A wide range of policies has isolated black people into areas with poorer-quality schools and fewer jobs, where over-policing substitutes for community resources. Geographic isolation by race and income has enabled sub-standard resource distribution to African Americans. Geographic isolation also allowed us to measure the effects of racism in US counties. Two main effects, Racial Isolation (RI), and the interaction of RI with economic deprivation, or RIP, were tested in a cross-sectional fixed-effects model. Both RIP and RI increased mortality for blacks while only RIP increased mortality for whites. Universal policies to promote economic security for all and reparations especially designed to promote economic security and wealth for African Americans are proposed.