Wealthy Areas Research Articles

Still the Linchpin: Segregation and Stratification in the USA

High levels of black residential segregation emerged over the course of the twentieth century as the black population urbanized. Segregation was achieved by means of different mechanisms at different times and places, beginning with targeted violence directed at African Americans followed later by discrimination in real estate and banking using devices such as deed restrictions, restrictive covenants, and racial redlining, practices that were institutionalized in federal policies during the New Deal. By 1977, however, discrimination had been outlawed in most US markets and average black segregation began to decline. The declines, however, were inversely proportional to the size of the black community. As Latinos grew in number after the 1970s, levels of racial isolation within Hispanic neighborhoods also rose. At the same time, class segregation increased, especially among families with children, and inequalities of wealth and income grew to create a polarized urban geography. High concentrations of affluence now prevail for affluent whites and Asians living in wealthy post-industrial coastal areas, with high concentrations of poverty prevailing for poor blacks and Hispanics in older, declining industrial areas in the Midwest and the South, which also contain pockets of white and Asian poverty. The new political geography of race and class effectively denies blacks and Hispanics their access to quality education and undermines their lifetime earning prospects to create self-perpetuating system of social and economic stratification.

New Digital Safety Net or Just More ‘Friendfunding’? Institutional Analysis of Medical Crowdfunding in the United States

Crowdfunding is becoming a popular way of financing healthcare. Some commentators suggest that crowdfunding could serve as a new institution that fills gaps in conventional safety nets. Others suggest that crowdfunding is simply another way of obtaining help from family, friends, and local associations, and has little transformative potential. We provide one of the first quantitative analyses of medical crowdfunding, and the first to model the broader societal context in which campaigns are situated. We scraped data on US medical campaigns from the leading platform, and combined them with county-level socioeconomic data to model predictors of campaign frequency and success. Our findings suggest that many seek help from crowdfunding when both formal and informal conventional safety nets fail them. Significantly more campaigns are initiated in US counties with poorer private insurance coverage, lower social security provision, fewer social associations, and weaker cultures of giving. However, campaigns are least likely to reach their goals where most needed. Campaigns are more likely to be successful in counties that are wealthier and healthier, and have more social associations. Crowdfunding is not merely ‘friendfunding’: fundraisers can increase their chances of success by having their appeals widely shared on social media. However, the returns to sharing are greater for campaigns initiated in wealthier areas. Overall, our findings suggest that medical crowdfunding is an entrepreneurial safety net: one where protection is not afforded universally or on the basis of need, but on the basis of one’s ability to appeal to the audience and out- compete rivaling needfuls.

Vernacular Wisdom as a Path Towards Ecologically Sustainable Housing and Settlements: Participatory Design and Building to Rehabilitate Local Adobe Brick Constructions in El Salvador

Globalized cultures, imaginaries, and economies are often matched to the standardization of building approaches. However, solutions that are not tailored for a specific context tend to entail environmental, economic, and social issues. Throughout human history, vernacular wisdom has produced interesting low-energy and climate-responsive architectures all around the globe: These can be seen as interesting examples in an era of global warming and overall uncertainty; at the same time, they represent accessible sustainable solutions in deprived areas of the world as well as in wealthier areas. The experience of participatory design and building process is here presented, carried on in a rural area of El Salvador, Central America. A sanitary facility for a school is designed and realized after the collectively desired recovery and improvement of one of the fruits of local vernacular wisdom in building design, i.e., the adobe earth brick. Some potentials and limits of such experience as well as of the used technology are reviewed in the perspective of affordable and ecologically sustainable housing and settlements in the area.

Maybe It's Time to Rethink Freestanding Emergency Departments.

Maybe It's Time to Rethink Freestanding Emergency Departments.

Neighborhood Poverty and Sex Differences in Live Donor Kidney Transplant Outcomes in the United States.

Neighborhood poverty has been associated with worse outcomes after live donor kidney transplantation (LDKT), and prior work suggests that women with kidney disease may be more susceptible to the negative influence of poverty than men. As such, our goal was to examine whether poverty differentially affects women in influencing LDKT outcomes. Using data from the Scientific Registry of Transplant Recipients and US Census, we performed multivariable Cox regression to compare outcomes among 18 955 women and 30 887 men who received a first LDKT in 2005-2014 with follow-up through December 31, 2016. Women living in poor (adjusted hazard ratio [aHR], 1.30; 95% confidence interval [CI], 1.13-1.50) and middle-income (aHR, 1.26; 95% CI, 1.14-1.40) neighborhoods had higher risk of graft loss than men, but there were no differences in wealthy areas (aHR, 1.07; 95% CI, 0.88-1.29). Women living in wealthy (aHR, 0.71; 95% CI, 0.59-0.87) and middle-income (aHR, 0.82; 95% CI, 0.74-0.92) neighborhoods incurred a survival advantage over men, but there were no statistically significant differences in mortality in poor areas (aHR, 0.85; 95% CI, 0.72-1.01). Given our findings that poverty is more strongly associated with graft loss in women, targeted efforts are needed to specifically address mechanisms driving these disparities in LDKT outcomes.

The Internet and Drug Abuse: Evidence from Craigslist

The United States is in the midst of a drug overdose epidemic. While the online availability of drugs has been a growing concern with considerable speculation that digital platforms are contributing to this epidemic, empirical assessments have been lacking. To quantify this impact, we rely on the phased rollout of Craigslist, a major online platform, as an experimental setup. Applying a difference-in-differences approach on a national panel data set for all counties in the United States from 1997 to 2008, we find a 14.9% increase in drug abuse treatment admissions, a 5.7% increase in drug abuse violations, and a 6.0% increase in drug overdose deaths after Craigslist's entry. The impacts of Craigslist entry are larger among women, whites, Asians, and the more educated. Further, the unintended consequences of Craigslist are more likely to accrue in larger, wealthier areas with initially low levels of drug abuse. These findings raise the possibility that the marked growth in the U.S. drug abuse may have partially stemmed from the wider availability of illicit drugs online at the very beginning of its evolution.

Self-rated health among elders in different outmigration areas\u2014a case study of rural Anhui, China

China has been a rapid growing economy in recent decades. Part of its economic development engine comes from internal rural-urban migration. The decades-long rural-urban migration is the result of China’s long-lasting uneven development between its urban and rural areas and its income and resource distribution inequality. Rural Anhui is one of the most affected outmigration regions of China. The absence of young and middle-aged villagers changed its natural villages’ demographics. It broke the self-sufficient rural family structure and their traditional lifestyle with no societal infrastructure to replace family support. Meanwhile, it created aging communities—particularly in relatively poorer villages. This study investigates rural elder villagers’ perception of their physical health in the context of rural-urban migration. It explores the reality of the left-behind rural aging population—their real life challenges and regional disparities reflected in their self-rated health status: those who are living in a relatively poorer region (county) tend to have significantly lower self-rated health (SRH) scores than their counterparts in wealthier areas. Women tend to have lower SRH scores than men, and living alone elders tend to perceive their own physical health to be poorer than others. These findings also show that regional economic condition affect individual lives, women are more vulnerable, and healthy personal interaction is an essential element for wellbeing.

Evaluating Project Safe Neighborhoods in Connecticut: a Youth Opportunity Initiative

Despite containing numerous wealthy geographic areas, the state of Connecticut continues to struggle with social and economic distress, along with gun-related crime. Problem analysis in urban areas revealed a critical need for services aimed at deterring violent and gun-related crime in two target populations: serious juvenile offenders, aged 14–17 years, and at-risk youth, aged 11–13 years. Using a quasi-experimental design, this study aimed to evaluate the effect of Project Safe Neighborhoods (PSN) on youth in two cities in Connecticut. Implementation resulted in 133 young people receiving a variety of services in New Haven and Bridgeport. Evaluation research assessed intervention efforts designed to (1) build on the strengths and address the challenges of each juvenile offender, (2) expand community outreach and education efforts to reinforce and reward positive attitudes and behaviors surrounding “no-gun policies,” and (3) utilize data-driven decision-making to guide program implementation and evaluate the results. Our findings suggest that youth who participated in Connecticut’s PSN Youth initiative benefited from the services provided and exhibited a decreased involvement in the juvenile justice system following enrollment.

Vulnerability to motor fuel price increases: Socio-spatial patterns in England

In high-motorisation, car-dependent countries, transport affordability is intimately linked to the price of oil derived motor fuels, which may become increasingly volatile in the future due to global oil price movements and environmental taxation. The negative impacts of fuel price spikes in terms of increased household expenditure and economic stress are unevenly spatially and socially distributed. Previous research has found that vulnerability to fuel price increases is higher in peripheral, peri-urban and rural areas, and that low income tends to be co-located with high car dependence and low vehicle fuel efficiency, with a compounding effect on vulnerability. The goal of this article is to test these hypotheses for England, providing new evidence on spatial patterns of vulnerability to fuel price increases at the small-area level. We propose a composite vulnerability indicator combining data on income, accessibility, vehicle inspection and vehicle registration for 2011. Within English city-regions, we find little evidence of the socially regressive patterns previously identified in the literature. This is explained by the persistent concentration of poverty in urban cores, as well as by the poor fuel economy of the vehicle fleet in wealthier areas, due to the prevalence of powerful vehicles there. On the other hand, our analysis suggests that the impacts of fuel price increases would be very unequal between city-regions, as the least sensitive metropolitan area (Greater London) is also characterised by high levels of adaptive capacity. We conclude by setting out an agenda for future research on spatial vulnerability to fuel price increases.

Introduction pathways and socio‐economic variables drive the distribution of alien amphibians and reptiles in a megadiverse country

AbstractAimsWe identify alien reptiles and amphibians, invaders or not, in Brazil and evaluate the following: (a) which alien species are found in the country; (b) where they originate from; (c) how they are distributed; (d) why and how they were introduced; and (e) which factors affect the record incidences and local richness of these species.LocationBrazil.MethodsWe conduct a comprehensive survey of different data sources to collect records of alien amphibians and reptiles. We then use a causal model approach to evaluate the influence of space, climate, anthropogenic predictors, and introduction pathways on alien richness and number of records.ResultsWe find a total of 2,292 records of 136 species of alien reptiles and amphibians. Although species from many regions of the world can be found, most are snakes, lizards and anurans originating in the Americas. Although records of alien amphibians and reptiles are found throughout Brazil, they are concentrated in more economically developed areas. Socio‐economic measures have both a direct and indirect causal relationship over the distribution of alien species and affect all introduction pathways, which are key factors explaining the alien species’ distribution. Pet trade was directly related to alien diversity, while all the three introduction pathways contributed to explain the number of records.Main ConclusionsWe reveal a high diversity of alien amphibians and reptiles widespread in an already megadiverse country. The finding that alien richness occurs in highly populated and wealthy areas and that it is linked to the pet trade helps to direct efforts towards the surveillance and prevention of the spread of alien species in Brazil. A higher record incidence is associated with species introduced accidentally or for human consumption, mainly represented by a few already invasive widespread species, impairing management measures.

Drug Abuse and the Internet: Evidence from Craigslist

The United States is in the midst of a drug overdose epidemic. Although the online availability of drugs has been a growing concern with considerable speculation that digital platforms are contributing to this epidemic, empirical assessments have been lacking. To quantify this impact, we rely on the phased rollout of Craigslist, a major online platform, as an experimental setup. Applying a difference-in-differences approach on a national panel data set for all counties in the United States from 1997 to 2008, we find a 14.9% increase in drug abuse treatment admissions, a 5.7% increase in drug abuse violations, and a 6.0% increase in drug overdose deaths after Craigslist’s entry. The impacts of Craigslist’s entry are larger among women, whites, Asians, and the more educated. Further, the unintended consequences of Craigslist are more likely to accrue in larger, wealthier areas with initially low levels of drug abuse. These findings raise the possibility that the marked growth in U.S. drug abuse may have partially stemmed from the wider availability of illicit drugs online at the very beginning of its evolution. This paper was accepted by David Simchi-Levi, information systems.

The Italian Regional Dualism: A MARS and Panel Data Analysis

The income gap between the richest and the poorest areas in Italy has increased in the last decades. We study the sources of regional wealth that can explain the differences in income and compare rich and poor areas to provide suggestions on how to bridge the gap. A multivariate adaptive regression splines (MARS) analysis is used to detect the relevant GDP determinants, and a fixed effects model is used to investigate the regional characteristics. The effects of the 2007 crisis are evident in all regions, and some structural weaknesses in the less wealthy areas limit the opportunities to exit the recession and close many socioeconomic gaps with the wealthiest regions.

Accessibility across transport modes and residential developments in Nairobi

A key goal of urban transportation planning is to provide people with access to a greater number of opportunities for interaction with people and places. Measures of accessibility are gaining attention globally for use in planning, yet few studies measure accessibility in cities in low-income countries, and even fewer incorporate semi-formal bus systems, also called paratransit. Drawing on rich datasets available for Nairobi, Kenya this analysis quantifies place-based accessibility for walking, paratransit, and driving using three different measures: a mobility measure quantifying how many other locations in Nairobi can be reached in 60 min, a contour measure quantifying the number of health facilities that can be reached in 60 min, and a gravity measure quantifying the number of health facilities weighted by a time-decay function. Health facilities are used because they are an essential service that people need physical access to and as a representation of the spatial distribution of activities more broadly. The findings show that place-based accessibility is highest for driving, then paratransit, then walking, and that there are high levels of access to health facilities near the Central Business District (CBD) for all modes. Additionally, paratransit accessibility is comparatively better in the contour and gravity measures, which may mean that paratransit is efficiently providing access based on the spatial distribution of services. The contour measure results are also compared across different residential levels, which are grouped based on neighborhood characteristics and ordered by income. Counterintuitively, the wealthiest areas have very low levels of place-based accessibility for all modes, while poor areas have comparatively better walking access to health facilities. Interestingly, the medium low residential level, characterized in part by tenement apartment buildings, has significantly higher accessibility than other residential types. One way to reduce inequality in access across income groups is to increase spatial accessibility for the modes used by low- and middle-income households, for example with policies that prioritize public transport and non-motorized travel, integrate paratransit with land use development, and provide safe, efficient, and affordable options.

Palliative Care Practice Patterns among Patients with Lung Cancer Metastatic to the Brain

This study aims to estimate palliative care utilization rates among lung cancer patients with brain metastases, a population for whom improvements in quality of life with early integration of palliative care have been consistently demonstrated. This analysis measured rates of palliative-directed therapy among patients with non-small cell lung cancer (NSCLC) and small cell lung cancer (SCLC) metastatic to the brain at time of diagnosis from 2010-2014 in the National Cancer Database (NCDB). Palliative-directed therapy is defined in the NCDB as any care with palliative intent including surgical, radiation, medical or pain management interventions. Multivariable logistic regression was used to produce adjusted odds ratios (OR) for factors potentially associated with incorporation of palliative-directed therapy. After propensity score matching, 15,078 patients with and without incorporation of palliative-directed therapy were selected for survival analysis. A total of 67,634 cases met inclusion criteria (80.1% NSCLC, 51.8% male; median age 65 years). At least one palliative-directed therapy was incorporated into the treatment of 22,766 (33.7%) patients, cancer-directed treatment without incorporation of palliative-directed therapy was received by 38,020 (56.2%) patients, and the remaining 6848 (10.1%) patients received no codified treatment. On multivariate analysis, odds of receiving palliative-directed therapy were lower with non-white or black race (OR 0.84; 95% CI 0.77-0.92), absence of comorbidities (OR 0.93; 95% CI 0.88-0.98), and increasing income in a step-wise fashion (reference <$38K: $38K-<48K OR 0.85, 95% CI 0.80-0.89; $48K-<63K OR 0.81, 95% CI 0.77-0.86; ≥$63K OR 0.76, 95% CI 0.71-0.81). Odds of receiving palliative-directed therapy were higher among those living in more educated areas in a step-wise fashion (area residents without high school diploma, reference ≥20%: 13-20% OR 1.19, 95% CI 1.13-1.25; 7-<13% OR 1.33, 95% CI 1.26-1.41; <7% OR 1.36, 95% CI 1.27-1.46). Among only those receiving some codified treatment (n=60,786), incorporation of any palliative-directed therapy had a similar significant inverse correlation with living in wealthier areas and direct correlation with living in more educated areas, as did receipt of palliative-intent radiation. The median survival in months for patients receiving incorporation of palliative-directed therapy versus cancer-directed therapy only was 4.8 (IQR 4.7-5.0) versus 6.8 (IQR 6.6-7.0), respectively. A surprising majority of patients receiving cancer-directed treatment for lung cancer metastatic to the brain have no incorporation of palliative-intent care as codified in the NCDB. This was particularly common for patients living in wealthier and/or less educated areas. This poses an important question of how we are framing our treatment recommendations across various populations.

Notes on Competition and Justum Pretium Theory and Practice in Medieval Italy

Medieval Italian Comuni are often considered as one of the cradles of the modern capitalist spirit. Comuni introduced economic legislation in an attempt to counteract restrictions to competition on the one hand and to control the price of certain goods and services on the other. Price control of basic commodities was often motivated by reasons of public order – such as preventing commoners’ riots. Despite some loose analogies with the modern European Union competition law approach to pricing – namely in the area of excessive pricing – the Italian medieval Comuni pricing theory and practice substantially differed from the modern European Union one. Medieval theory struggled in reconciling market mechanisms with costs analysis and missed the distinction between efficiency and distribution. Moreover, medieval Comuni market variables were substantially divergent from the modern European ones. Despite Comuni being the wealthiest areas in Europe in those days, their consumers had significantly lower buying power, they were affected by different cognitive biases than modern consumers and they were highly segmented from a gender perspective. Medieval producers, that is artisans, did not enjoy the degree of market power that characterizes modern oligopolists. Artisans produced goods for merchants who were the main promoters of trade and economic development. Merchants often succeeded in squeezing artisans’ profits, granting consumers lower prices for manufactured goods, at times also thanks to free trade policies pursued by Comuni administrations.

Farm succession at a crossroads: The interaction among farm characteristics, labour market conditions, and gender and birth order effects

Farm succession is a relevant issue, as it is related to rural and youth migration, sustainability and the ageing of the agricultural sector. Understanding the factors behind the willingness of potential successors to take over the family business is crucial for farm continuity. We examine the factors affecting children's likelihood of carrying on the family business in a sample of 216 potential heirs of Italian horticultural farms. Using local labour market conditions (income gap and employment rate) and surrounding context variables (population density), we plug the farm labour migration/occupational choice theory into farm succession analysis. This approach allows us to treat child succession as the opposite of the choice to migrate out of the farm sector. While farm labour migration theory predicts linear negative effects of labour market/contextual variables on farm transfer, we find that the income gap, employment rates and population density exert both negative and positive effects on child succession, according to their intensity. The pro-succession effects we find suggest that, despite potential threats, the proximity to wealthy areas may represent an opportunity for farm continuity and thriving. We also examine explicitly the effect of child characteristics (gender and birth order), finding that male and first-born potential successors are more likely to take over the family farm, in accordance with results from previous firm succession studies. This finding suggests a persistence of traditional normative beliefs in the agricultural sector.

Domestic Flying Geese: Industrial Transfer and Delayed Policy Diffusion in China

AbstractThis study illuminates the important yet under-studied phenomenon of industrial transfer in China: the migration of capital and investment from wealthy coastal areas into poorer central and western provinces, beginning in the 2000s. By 2015, the value of domestic investment in five central provinces alone was 2.5 times that of foreign investment throughout China. Compared to the original “flying geese” model of tiered production in Asia, China's experience is distinct in three ways: (1) industrial transfer occurred domestically, rather than across nations; (2) sub-national transfer followed cross-national transfer; and (3) industrial migration is accompanied by a delayed replication of government policies and practices. While coastal locales today resolve to expel low-end industries, inland governments cannot afford to be selective and have only recently adopted the aggressive investment promotion tactics that coastal cities abandoned years ago. Policy diffusion is delayed as policy adoption depends on economic conditions, which vary widely across China and change over time.

Discussion

Discussion

Neighbourhood incidence rate of paediatric dental extractions under general anaesthetic in South West England.

Introduction Extraction of decayed teeth is the most common reason for UK children aged 5-9 years to receive a general anaesthetic. Inequalities in oral health are well recognised, but is under-explored in dental general anaesthesia (DGA).Methods Secondary analysis of routinely collected data from three local authorities in South West England was used to assess: 1) dental activities recorded for children <18 years attending NHS general dental practitioners (GDP); 2) the incidence rate of DGA and disease severity among <16-year-olds; and 3) individual and neighbourhood factors associated with higher rates of child DGA, and greater severity of disease.Results Among 208,533 GDP appointments, rates of preventive action were low where 1/7 included fluoride varnish but 1/5 included permanent fillings. The incidence rate of DGA was 6.6 admissions for every 1,000 children, rising to 12.4/1,000 among 5-9-year-olds. A total of 86 (7.6%) children had previously received a DGA at the same hospital. Area deprivation was strongly associated with higher rates of DGA, but rates of DGA remained high in less deprived areas. No associations were observed between number of teeth removed and socio-economic status.Conclusion Too many children are receiving DGA, and too few preventive actions are recorded by GDPs. Area-based inequalities in DGA were apparent, but wealthy areas also experienced substantial childhood dental decay.

Against the tide in an ocean of opioids

Taking on the multibillion-dollar drugs industry to stem the US opioid epidemic has made Andrew Kolodny both a hero and a hate figure