Unsafe Housing Research Articles

Stigmata: A Memoir of Pain and Resistance

Feminist Studies 45, no. 1. © 2019 by Feminist Studies, Inc. 235 Vivyan Adair Stigmata: A Memoir of Pain and Resistance For some of us poverty is not experienced from a distance or from the position of an audience member or critic, but as the most pressing truth of our existence, past or present and our core sense of identity. —Roxanne Rimstead, Remnants of Nation: On Poverty Narratives by Women Shame My own mother—with four children under the age of seven by the time she was twenty five—taught, nurtured, and loved us ferociously but struggled and utterly failed to keep us fed, sheltered, and safe. We clung desperately to her fragile dignity, grace, and laughter, against all the forces of a cruel and indifferent world. Yet, in the end she was crushed by the weight of our shame and our raw, unrelenting pain as my brothers and sister and I were bent and broken and taken from her; with scars that never faded; injuries, infections, and ailments for which we found neither respite nor repair; with feet mangled by cheap, used Salvation Army shoes; the gnawing void of hunger and insecurity clawing at our tender backs; public indignities and humiliations for which I still can find no words. With access to neither medical insurance nor care, when my already fragile, toddling sister’s forehead was split open by a car door slammed in frustration, my brother and I had to pin her tiny body to the ground as 236 Vivyan Adair my mother sewed the angry gash together with needle and thread, practicing the meticulous dressmaker’s stitches for which she had received a modicum of acclaim, but so little reward. My sister somehow endured, but registered the pain, the terror, and the trauma with a brand, a stigmata , an angry and frightening scar as an indelible sign of our poverty, visually cleaving her very forehead in two, for the remainder of her life. In our school cafeteria “free lunchers” were reminded with a large and colorful sign to “line up last.” In that auditorium each fall we were coerced up onto a makeshift stage, with the promise of first dibs on free milk. There, our pristine school nurse sat upright and sucked air through her teeth as she donned surgical gloves to cautiously check only the hair of poor hungry children, one by one, for lice. I burned and choked and raged with shame, as our far more decent working-class colleagues and friends, in color-coordinated Sears sweater sets and matching tartan knee high socks, averted their eyes from our reluctant genuflections , while silently spooning their mac and cheese and sipping their Tree Top from tiny Dixie cups. In dilapidated and unsafe housing often without heat, hot water, or lights and with access to only public bathrooms, I developed a stubborn case of ringworm, scabies, and a series of painful urinary tract infections . When my second grade teacher would not excuse me every hour or so—because, as she said I was “willful”—I could not help but wet my pants in class. My schoolmates guffawed at my flea bitten legs, my ducttaped shoes, my crooked and ill-serviced teeth, and the way my siblings and I stank. Kids, teachers, and strangers stepped away from us intuitively and then, with great shows of distress, feigned concern and then outrage and disgust. Regularly our teachers excoriated us for our inability to concentrate in school and our refusal to come to class with proper school supplies , calling us out as greedy when we tried to take more than our share of free lunch. Whenever backpacks or library books came up missing, we were publicly interrogated and sent home to think about our offenses, often accompanied by notes that reminded my bewildered mother that she should be working twice as hard to make up for the discipline and order that had supposedly walked out the door with my father. And when occasionally we cried foul and lashed out, our behavior was used to justify even more elaborate punishment that exacerbated the effect of our growing anomie. Vivyan Adair 237 Guilt As children, our disheveled and unkempt bodies were produced as...

No Hothouse Flower.

No Hothouse Flower Marguerite Barnett To be a woman is a rich and dangerous job. I experienced this in my mother's womb, she who created me out of hope and love, which transcended betrayal and racism. I sensed this as I watched my adoptive mother subsume her identity to a soul-sucking concept formed at the confluence of culture and religion. But I didn't really learn it until I began the path that led to my current identity as a surgeon. I should not have survived any of this, and I say that with a sense of wonder and gratitude. I was born to a Japanese woman in postwar Japan, who met my father, a US military doctor, at a USO dance. He did not wear a wedding band, but he did not try to hide her. He took her to "nice" restaurants where Japanese women were not usually taken, so, at nineteen, she thought they were having a grand love affair. She did not realize he already had a wife and child back in the States. She was so naïve she did not know she was pregnant. She had morning sickness, and he smuggled her into the base hospital for testing. She found out when he sat her in the office chair and said, "I have a Japanese doctor friend who can fix this." The way that he said it made her realize "this" meant she was pregnant, "fix" meant an abortion. Something was wrong—he should be happy they were having a child! I do not know why she didn't have an abortion. Abortion was not frowned upon in Japan, but having a mixed blood, unwanted child certainly was. Most unusually, she kept me without any support. The combination of youth, poverty, and lack of support left her vulnerable, and she lost custody of me when I was trafficked by a babysitter at age one. Ultimately, I was adopted by an Army chaplain and his wife, who provided a stable upbringing despite the constant movement of military life. This conservative and fundamental religious upbringing primed me for marriage and a life of being a "helpmate" to a husband. There were some warning signs that I might not take the expected path. I knew I wanted to be a doctor even though, at that time, I knew nothing about my natural father other than his nationality. I did not want to be a nurse. I thought it was because I was a failure to thrive, which, in retrospect, I think was because of my refusal to eat when separated from my mother. But the fact that I had a heart murmur and got ill very easily led the doctors to conclude that I had a bad heart and would not make it past my fifth birthday. It was so bad my adoptive mother said she could not hang white sheets on the clothesline lest I thought it was the doctor coming to give me a shot! The warning signs became red flags, and I ultimately hit a brick wall when I chose to attend an Ivy League Medical School to be with my then fiancé. I did not realize how a liberal "heathen" institution such as the one I attended in the 1970s could destroy me. This was the time of widespread student protests against the war, Timothy Leary was urging everyone to "drop out and drop acid," and Patty Hearst had been kidnapped and brainwashed into a gun-toting radical. For my crimes, I was disowned by my parents, and the shock of losing their support was compounded when my minister molested me. I do not know how I survived those dark days. My fledgling marriage fell apart under the pressure, and I was abandoned in the cold north in a program not known for its supportive nature. Desperate, I joined the military scholarship program, but it only paid for books and tuition. The financial aid package provided by the school did not cover living expenses. It should not have been a surprise that the final injury—caused by my lack of financial security, expressed in such seemingly minor things as unsafe housing and...

Book Review Symposium: Is Racism an Environmental Threat? With a response from Ghassan Hage

Hage’s book tells us that inequality is an insufficient explanation for the question of how the Grenfell Tower residents came to be living in what is now alleged to have been criminally unsafe housing while their neighbours lived in safety and luxury. He writes that ‘what is elided in the question “why do we live and they die?” is the question that in a way already contains the answer, which is “why do they die so that we may live?”’ (p. 53). The Grenfell Tower residents did not just happen to live in less secure circumstances than their wealthy neighbours. Their neighbours’ wealth was based upon their exploitation. Many of the residents of the Grenfell Tower were immigrants and refugees from the former British Empire and from conflict zones around the post-9/11 globe. They had escaped from the necropolitics of Syria, of Iraq, of Afghanistan to participate in the biopolitical life of London as students, teaching and health care assistants, artists and musicians. But necropolitics caught up with them in Grenfell Tower and utterly exterminated them.

Child welfare involvement and academic difficulties: Characteristics of children, families, and households involved with child welfare and experiencing academic difficulties

Children involved in child welfare experience academic difficulties more than any other functioning concern. This study used data from OIS-2013, a large representative sample of child welfare investigations (n = 4033), involving children aged 4–15. The following research questions were answered: 1) Do children with maltreatment histories and academic difficulties differ from those with maltreatment histories but no academic difficulties; and 2) Does the presence of academic difficulties influence ongoing child welfare services. Frequencies, cross-tabulations, and Chi-square tests assessed the relationships between academic difficulties and child characteristics, caregiver functioning concerns household characteristics, and maltreatment. Transfer to ongoing child welfare services was the outcome variable in a multiple logistic regression analysis. Being an adolescent, male, Indigenous, and having additional child functioning issues, notably externalizing behaviour, suicidal thoughts, and self-harm were each related to academic difficulties. Academic difficulties were significantly related to households where a caregiver had a cognitive impairment or low social supports, that were overcrowded, unsafe, or of lower income. Children who have academic difficulties are more likely to have recurrent involvement in child welfare, significant risk of future maltreatment, to experience physical harm, and to be placed in out of home care. Unsafe housing was the most significant predictor of a decision to transfer a case to child welfare services, followed by caregiver functioning, maltreatment type, then academic difficulties, when controlling for child gender, age, and ethnicity. Difficulties are likely to compound over time, and ultimately increase cost and frustration across systems.

Disability and Dissent in Ann Petry's The Street.

I argue that Ann Petry in her novel The Street (1946) portrays chronic illness, disfigurement, and disability as embodied effects of racism resulting from labor exploitation, crowded and unsafe housing conditions, and lack of access to nourishing food and respectful, thorough, and effective health care. Further, Petry conveys that Western medicine (as practiced in the United States) reproduces and maintains white supremacy through mechanisms including how treatment resources are allocated, how medical institutions collaborate with law enforcement officials and institutions, and how medical professionals and spaces authorize the objectification of Black bodies. Some of the conditions Petry portrays as disabling are not recognized by Western medicine or measured in health disparities research; other conditions, Petry shows, are misrecognized by those discourses. Thus, Petry's novel challenges the medical model of disability while also urging a more expansive understanding of what should be recognized as an embodied effect of racism.

Contrast effect in spatial context: Robustness and practical significance.

Contrary to lay conceptions, unattractive locations can under certain circumstances increase the perceived value of neighboring areas. This phenomenon is akin to a contrast effect. However, extant research on this type of contrast suffers from two limitations. First, the use of repeated measures may inflate the likelihood of observing a contrast effect. Second, there is a lack of meaningful comparisons for gauging the size of the effect. We designed three experiments to address these issues. In each, we assessed how much participants valued places located increasingly far from an unsafe housing block. Participants either rated several target locations or just a single one at a time. We also assessed whether the positiveness of the contrast effect due to the unsafe housing block would be able to compete with the positive effect of a nearby park. The results replicate past findings of a contrast effect in spatial context; they show that the effect generalizes to a different design; and they demonstrate that a contrast effect due to an unattractive location can indeed be as "beneficial" for some neighboring areas as the effect of a genuinely attractive location. (PsycINFO Database Record

Circus and zoo animal welfare in Sweden: an epidemiological analysis of data from regulatory inspections by the official competent authorities

AbstractGood animal welfare is crucial for the success of circuses and zoos. Epidemiological studies of animal welfare that investigate associations between animal-based measures (ABMs) and resource- and management-based measures are needed. However, due to the relatively low numbers of animals within each species kept at individual facilities, such investigations can be difficult to carry out. In this paper, we report the analysis of a multi-facility epidemiological study using data from all regulatory inspections of circus and zoo animals in Sweden for 2010 to 2014. Information from 42 inspections of 38 circuses, and 318 inspections of 179 zoos was analysed. For ABMs assessed during routine inspections of circuses (n = 14) and zoos (n = 61), 9.1 and 14.3% did not comply with requirements for general care of hooves/claws and coat, 10.0 and 8.6% for body condition, and 0 and 1.7% for animal cleanliness, respectively. In addition, the zoo checklist assessed whether animals were kept in appropriate groups, finding non-compliance in 17.0% of inspections. The most frequent non-compliant resource- and management-based measures at routine inspections of circuses were for space (41.7%) and exercise requirements (38.5%). For zoos, 29.4% did not comply with space followed by 28.8% for enrichment requirements. In multivariable logistic regression analyses, zoos that had inadequate or unsafe housing and space design, inadequate bedding, or failed to meet nutritional requirements, were more likely to be non-compliant with at least one ABM. The checklists should be improved to better assess welfare status by including more ABMs; benchmarking of risks and trends over time is also recommended.

Public Support for Emergency Shelter Housing Interventions Concerning Stigmatized Populations

Research SummaryWe examine citizen decision‐making in the context of providing access to safe housing to different noncriminal and criminal populations. More than 4,000 national online survey respondents considered different “emergency housing policy” scenarios that would affect the housing conditions of one of five randomly assigned populations of varying stigma (three noncriminal, two criminal). We find that the criminal populations had the least support for helpful housing policies and the most support for harmful housing policies. Furthermore, compared with a “no cost” policy, average support levels decreased when it increased taxes for the respondent.Policy ImplicationsCitizens seem more willing to subject criminal populations to poor and unsafe housing conditions compared with noncriminal populations. Thus, citizen support may be higher when policies are pitched in ways that do not imply specifically helping ex‐offenders, when they do not involve a personal sacrifice through increased taxes, and when they do not involve “in‐my‐backyard” proposals. For example, a housing policy pitched as aiding the area's homeless (ex‐offenders included) would likely see more support than one that identifies ex‐offenders (and particularly sex offenders) as the population being targeted for help, or that identifies a specific neighborhood as a potential housing facility location.

On the Combined Influence of Attractive and Unattractive Locations on the Surroundings

Living near an unsafe housing block or a landfill is unattractive because of their negative influence on the environment. The question we ask is “Would a nearby attractive location cancel out this negative influence?” In two studies, participants were shown fictitious neighborhoods that contained an unattractive location (an unsafe housing block or a landfill) located close to an attractive location (one’s own home or a park). The participants were asked to evaluate how pleasant it would feel to live at increasing distances from these locations. The results showed that positively evaluated locations can mitigate but not entirely neutralize the effects of negatively evaluated locations. The present research elucidates how people combine the effects of sources of positive and negative influence.

Evicted: Poverty and Profit in the American City. By Matthew Desmond. New York: Crown Publishers, 2016. Pp. xi+420. $28.00.

Book Reviews that loosely weaves together ideas of relational subjectivity with the systems theory of Niklas Luhmann—I gave up. The world is in flames. We need good, clear, accurate, and powerful ex- planations for what’s happening so that we can figure out how to smartly move forward. Maybe a sociologist will read some critical realism and get inspired to produce a brilliant explanation she or he wouldn’t have other- wise. I hope so. But neither of these two books makes a convincing case that critical realism is the royal road to sociological truth. Evicted: Poverty and Profit in the American City. By Matthew Desmond. New York: Crown Publishers, 2016. Pp. xi1420. $28.00. David J. Harding University of California, Berkeley Matthew Desmond’s Evicted is first and foremost an ethnography about the daily experiences of poverty with a unique focus on the causes and con- sequences of housing instability and housing quality. Unlike prior poverty ethnographies that focus on a particular neighborhood, this book shadows eight poor families, both black and white, and two landlords who rent apartments, houses, or trailer homes to the poor. Following the experiences of these research subjects over multiple years in Milwaukee reveals in painstaking detail the central importance of eviction to the contemporary experience of being poor. These arguments are buttressed by other data sources as well, including surveys of renters and administrative records from housing court. In short, one cannot read Evicted without coming to the conclusion that eviction and its consequences play a central role in trap- ping individuals and families in poverty. Despite the focus on public housing and housing vouchers in public and academic discussions of housing and poverty, Evicted points out that most of the poor are on their own in the private rental market, one in which there is surprisingly little variation in rents across neighborhoods and almost no options that are anywhere near affordable for a family trying to get by on low-wage work or public assistance. Landlords who rent to such families can rarely count on consistently receiving the full payment of rent, and, as a result, the apartments, houses, and trailers available to such families are typically in chronic disrepair, including broken plumbing, inoperable appliances and furnaces, and broken doors and windows. The state is ab- sent from the market in many ways, with minimal proactive enforcement of building code violations, few resources devoted to affordable housing, and little regulation of rents. Yet when the state does play a role, it is over- whelmingly arrayed against the tenant. Nuisance complaints recorded by the police motivate evictions, sheriff’s deputies execute evictions, child wel- fare agencies take children away when families become homeless or live in unsafe housing, and the complexities of housing courts favor the landlord This content downloaded from 169.229.151.152 on June 30, 2017 10:30:27 AM All use subject to University of Chicago Press Terms and Conditions (http://www.journals.uchicago.edu/t-and-c).

Disabled Laborers And The Equal Employment Opportunity Commission’s (EEOCs) Nightmare

In 2012, EEOC v. Henry’s Turkey Service was one of the largest disability settlements in American history. Henry’s Turkey Service was ordered to pay $240 million for paying mentally disabled workers with I.Q.s estimated in the 60-70 range, 41 cents per hour and housing them in unsafe housing and health conditions (Hsieh, 2013). Over forty years, Henry’s Turkey Service relocated hundreds of mentally disabled workers from Texas to Iowa where they were subjected to horrendous living conditions with unlawful, minimal pay—about $65.00 per month, while they worked at a local turkey processing factory in West Liberty, Iowa. The actual case shows a pattern of violations of the Fair Labor Standards Act of 1938 and Americans with Disability Act, 1990. After a raid of the bright blue, florescent colored, century old school house in Atalissa, Iowa, these employers were brought to justice. This case study is about one of the largest EEOC settlements in the history of the United States; yet due to federal damage caps was cut to $1.6 million for all of the men and their estates. The graphic account of the inhumane treatment and degradation of the labors presented in this study is not provided for gratuitous or salacious purposes; rather, it places into context what can occur when governmental regulations and laws go unheeded, unenforced and when authorities are apprised of wrongdoing possibilities stand idly by and in this case, do nothing for 35 years.

Bridging Health Disparity Gaps through the Use of Medical Legal Partnerships in Patient Care: A Systematic Review.

Over the past two decades, we have seen an increase in the use of medical-legal partnerships (MLPs) in health-care and/or legal settings to address health disparities affecting vulnerable populations. MLPs increase medical teams' capacity to address social and environmental threats to patients' health, such as unsafe housing conditions, through partnership with legal professionals. Following the Preferred Reporting Items for Systematic Review and Meta-Analyses guidelines, we systematically reviewed observational studies published from January 1993-January 2016 to investigate the capacity of MLPs to address legal and health disparities. We identified 13 articles for qualitative analysis from an initial pool of 355 records. The resulting pool of 13 articles revealed more information regarding the capacity of MLPs to address legal outcomes than their capacity to address health outcomes; only 4 studies directly addressed the impact of MLP intervention on patient wellbeing and/or patient utilization of healthcare services. We call for further evaluation/longitudinal studies that specifically address MLPs' short and long term effects upon patient health disparities. Finally, given the demonstrated capacity of MLPs to address unmet legal needs, and their evident potential in regards to improving health outcomes, we present the MLP model as a framework to address HIV-related legal and health disparities.

Evaluation of a Home-Based Environmental and Educational Intervention to Improve Health in Vulnerable Households: Southeastern Pennsylvania Lead and Healthy Homes Program.

This evaluation examined whether participation in a home-based environmental educational intervention would reduce exposure to health and safety hazards and asthma-related medical visits. The home intervention program focused on vulnerable, low-income households, where children had asthma, were at risk for lead poisoning, or faced multiple unsafe housing conditions. Home visitors conducted two home visits, two months apart, consisting of an environmental home assessment, Healthy Homes education, and distribution of Healthy Homes supplies. Measured outcomes included changes in participant knowledge and awareness of environmental home-based hazards, rate of children’s asthma-related medical use, and the presence of asthma triggers and safety hazards. Analysis of 2013–2014 baseline and post-intervention program data for a cohort of 150 families revealed a significantly lower three-month rate (p < 0.05) of children’s asthma-related doctor visits and hospital admissions at program completion. In addition, there were significantly reduced reports of the presence of home-based hazards, including basement or roof leaks (p = 0.011), plumbing leaks (p = 0.019), and use of an oven to heat the home (p < 0.001). Participants’ pre- and post- test scores showed significant improvement (p < 0.05) in knowledge and awareness of home hazards. Comprehensive home interventions may effectively reduce environmental home hazards and improve the health of asthmatic children in the short term.

Multidimensional poverty measure and analysis: a case study from Hechi City, China.

Aiming at the anti-poverty outline of China and the human–environment sustainable development, we propose a multidimensional poverty measure and analysis methodology for measuring the poverty-stricken counties and their contributing factors. We build a set of multidimensional poverty indicators with Chinese characteristics, integrating A–F double cutoffs, dimensional aggregation and decomposition approach, and GIS spatial analysis to evaluate the poor’s multidimensional poverty characteristics under different geographic and socioeconomic conditions. The case study from 11 counties of Hechi City shows that, firstly, each county existed at least four respects of poverty, and overall the poverty level showed the spatial pattern of surrounding higher versus middle lower. Secondly, three main poverty contributing factors were unsafe housing, family health and adults’ illiteracy, while the secondary factors include fuel type and children enrollment rate, etc., generally demonstrating strong autocorrelation; in terms of poverty degree, the western of the research area shows a significant aggregation effect, whereas the central and the eastern represent significant spatial heterogeneous distribution. Thirdly, under three kinds of socioeconomic classifications, the intra-classification diversities of H, A, and MPI are greater than their inter-classification ones, while each of the three indexes has a positive correlation with both the rocky desertification degree and topographic fragmentation degree, respectively. This study could help policymakers better understand the local poverty by identifying the poor, locating them and describing their characteristics, so as to take differentiated poverty alleviation measures according to specific conditions of each county.

Substantiated Reports of Child Maltreatment From the Canadian Incidence Study of Reported Child Abuse and Neglect 2008: Examining Child and Household Characteristics and Child Functional Impairment.

Identifying child and household characteristics that are associated with specific child maltreatment types and child functional impairment are important for informing prevention and intervention efforts. Our objectives were to examine the distribution of several child and household characteristics among substantiated child maltreatment types in Canada; to determine if a specific child maltreatment type relative to all other types was associated with increased odds of child functional impairment; and to determine which child and household characteristics were associated with child functional impairment. Data were from the Canadian Incidence Study of Reported Child Abuse and Neglect (collection 2008) from 112 child welfare sites across Canada (n = 6163 children). Physical abuse, sexual abuse, and emotional maltreatment were highly prevalent among children aged 10 to 15 years. For single types of child maltreatment, the highest prevalence of single-parent homes (50.6%), social assistance (43.0%), running out of money regularly (30.7%), and unsafe housing (30.9%) were reported for substantiated cases of neglect. Being male, older age, living in a single-parent home, household running out of money, moving 2 or more times in the past year, and household overcrowding were associated with increased odds of child functional impairment. More work is warranted to determine if providing particular resources for single-parent families, financial counselling, and facilitating adequate and stable housing for families with child maltreatment histories or at risk for child maltreatment could be effective for improving child functional outcomes.

House to house, shelter to shelter: experiences of black women seeking housing after leaving abusive relationships.

Locating safe and affordable housing is a vital step for women who decide to leave their abuser. Without housing, many women, particularly those who live in poverty, are forced to remain in abusive relationships, accept inadequate or unsafe housing, or become homeless (Menard, 2001; Moses, 2010). Women who choose to leave their abusers are faced with multiple barriers in establishing their independence such as limited financial resources, mental illness, and the lack of affordable housing (Botein & Hetling, 2010), putting them at risk of revictimization. This pilot study explores the narratives of Black mothers currently residing at an emergency intimate partner violence shelter to discover their experiences in seeking housing after leaving abusive relationships with a focus on housing instability and mental health. Utilizing a qualitative descriptive design, four major themes emerged: (a) unstable/insecure housing over time, (b) limited support,

Engineering Relief for Haiti

In January of 2010, Haiti suffered a 7.0-magnitude earthquake that killed 220,000 people, injured 300,000, and left over 1.5 million homeless. Recognized as the poorest country in the western hemisphere, the country has limited resources to rebuild the cities and villages damaged by the natural disaster. Since the earthquake, thousands of Haitians have continued to live in unsafe housing. A team of eight undergraduate students from the Rose-Hulman Institute of Technology (RHIT) Summer 2014 Grand Challenge Program team developed a project that addressed this housing crisis: plastic lumber. The Grand Challenge course is a teamtaught multidisciplinary design, build, and document class, with professors from the Mechanical Engineering, Physics and Optics, and Humanities and Social Sciences departments. While the three professors presented the students with the task of developing and designing a project for Haiti disaster relief, the concepts, solutions, ideas, and designs originated with the student team in just nine weeks.

Policies to Promote Child Health: Introducing the Issue

A large volume of high-quality research shows that unhealthy children grow up to be unhealthy adults, that poor health and low income go hand in hand, and that the consequences of both poverty and poor health make large demands on public coffers. Thus promoting children's health is essential for improving the population's health; policies to prevent children's health problems can be wise investments; and policy makers should implement carefully designed policies and programs to promote child health. According to the World Health Organization, health is a state of complete physical, mental, and social wellbeing, and not merely the absence of disease or infirmity. We view health in this broad sense, encompassing both physical and mental health indicators. And because some children's health problems may go undiagnosed or take years to become apparent, we also consider conditions that predict poor child health (such as low birth weight) and behaviors that affect health (such as substance use). We view policies in a broad sense as well. Because an array of physical and social factors--including unsafe housing, pollution, food insecurity, and maltreatment, all of which are related to poverty--can adversely affect health, many types of policies are important for child health. Thus we consider the effects of policies that don't specifically focus on health (such as cash or in-kind assistance, or parenting education programs) in addition to policies that focus on access to health care or the direct provision of medical services. Relevant policies come in many shapes and sizes, ranging from large federal programs such as Head Start and the Supplemental Nutrition Assistance Program (SNAP) to more modest local public health initiatives. U.S. child health policy is thus a patchwork of efforts at the federal, state, and local levels. Many policies aim specifically to improve child health, while others have different goals but could indirectly affect the health of children. Some health-related policies target children directly, attempting to treat health problems once they occur or to prevent them from occurring, while others target women during or before pregnancy with the goal of improving the health of newborns. Some policies target low-income children, while others are more universal. For this issue of The Future of Children, we commissioned a group of experts to review research on how effectively U.S. policies promote child health. The articles, based on the strongest evidence to date, assess how best to promote child health and, more specifically, what interventions and strategies work best at various stages of children's development. In the lead article, Sara Rosenbaum and Robert Blum paint a portrait of child health in the United States today, setting it in its historical, national, and international context. Maya Rossin-Slater reviews programs to promote child health at birth and in the early childhood years. Craig Gundersen, Ingrid Gould Ellen and Sherry Glied, and Lindsey Leininger and Helen Levy review policies that provide food, housing, and access to health care, respectively, examining how those policies impact child health. Lawrence Berger and Sarah Font consider policies that focus on families, viewed through a child health lens. Alison Cuellar focuses on children's mental health and reviews policies in that important area. Finally, Clare Huntington and Elizabeth Scott provide important context vis-a-vis the legal framework that both shapes and constrains U.S. policies to promote child health. Themes of the Issue Five broad, overlapping themes emerge from this issue: * A wide range of policies are important for promoting child health; * Responsibility for promoting child health is fragmented, with a lack of consensus about government's appropriate role; * We have a crisis response mentality that doesn't focus on prevention and often precludes implementing policies in ways that would let us thoughtfully evaluate their efficacy; * Information about cost-effectiveness is severely lacking; and * Poor and minority children typically face the greatest health risks. …

Teaching students to work with vulnerable populations through a patient advocacy course.

Nursing students need an in-depth understanding of how social determinants, such as poverty, unsafe housing, and illiteracy, impact the health of patients. The authors describe how a patient advocacy service-learning course increased students' awareness and proficiency in working with the challenges low-income, vulnerable individuals face as they attempt to improve their lives and health. Course learning objectives, essential requirements, and student reflections are presented.

Health and health care disparities: the effect of social and environmental factors on individual and population health.

Recently the existence and prevalence of health and health care disparities has increased with accompanying research showing that minorities (African Americans, Hispanics/Latinos, Native Americans, and Pacific Islanders) are disproportionately affected resulting in poorer health outcomes compared to non-minority populations (whites). This is due to multiple factors including and most importantly the social determinants of health which includes lower levels of education, overall lower socioeconomic status, inadequate and unsafe housing, and living in close proximity to environmental hazards; all contributing to poor health. Given the ever widening gap in health and health care disparities, the growing number of individuals living at or below the poverty level, the low number of college graduates and the growing shortage of health care professionals (especially minority) the goals of this paper are to: (1) Define diversity and inclusion as interdependent entities. (2) Review the health care system as it relates to barriers/problems within the system resulting in the unequal distribution of quality health care. (3) Examine institutional and global benefits of increasing diversity in research. (4) Provide recommendations on institutional culture change and developing a diverse culturally competent healthcare workforce.