Measurement Of Socioeconomic Status In Health Disparities Research: Fill & Download for Free

People with the lowest incomes may have mortality rates that are double or more those of people at the upper end of the income distribution.The table below shows the results from a study that compared the risk of death among U.S. adults age 45 through 64 at varying levels of household Income. The risk of dying was 2.4 times higher in those averaging less than $15,000 a year compared to those making more than $70,000 (even after adjusting for the effects of education and disability).[Source: Income dynamics and adult mortality in the United States, 1972 through 1989, P McDonough, G J Duncan, D Williams, and J House, Am J Public Health (1997)]One of the most significant things these data reveal is a gradient: the higher the income, the lower the mortality. Experts once assumed that higher rates of illness and death among the poor arose from simple deprivation, that is, things like overcrowding, lack of medical care, and inadequate food. This assumption implied that there must be a threshold at which further increases in income or socioeconomic status have no effect on health.That view was shattered by the Whitehall Study, a decades-long survey started in the 1960s that compared the health and life spans of men employed in the British civil service. It found that not only did those at the bottom of the scale have higher mortality than those above them, but also gains in health and longevity at each step up in job status all the way to the top of the ladder. There was no threshold at which the link between higher social status and better average health stopped.[source: The Influence Of Income On Health: Views Of An Epidemiologist, Michael Marmot, Health Affairs (2002)]The Whitehall study, and others that followed, refuted the assumption that material deprivation alone was the cause of social class differences in health and longevity. And it fueled a debate that continues to this day about what we should be doing to improve the health of disadvantaged populations.Sociologists and public health researchers in recent years have learned much from studying the so-called “social determinants” of health, that is, how limited income, lack of education, and the characteristics of neighborhoods and social networks can harm health through complex pathways.Much of the research suggests that policies not normally considered health interventions may be the most effective way to reduce health disparities if they reduce resource inequalities. This could include, for example, minimum wage and parenting leave laws, head-start programs, housing for homeless and low-income people, college-admission policies, regulation of lending practices, and so on.This scatter plot shows the association between premature mortality and median household income for U.S. counties. Income ranges from $9,333 to $82,929. Death rates range from 144 to 1,146 deaths per 100,000 people in the population. The two vertical lines mark the 25th ($29,361) and 75th ($39,401) percentiles of median household income.[Source: Cheng ER, Kindig DA. Disparities in premature mortality between high- and low-income US counties. Prev Chronic Dis (2012)]Death rate per 100,000 population in Scotland, 2001, by deprivation category of their neighborhood of residence. The DepCat scale combines measures of overcrowding, unemployment, car ownership, and the proportion of low-income households.[Source: Equally Well: Report of the Ministerial Task Force on Health Inequalities - Volume 2 (2008)]

I have written answers to support both sides of this argument in the past. It is important that I do so, since I have an ethical responsibility as a medical practitioner to support patients regardless of my own position on any matter. In all honesty, my views regarding the termination of pregnancy are complex (as they ought to be), but in this instance I want to speak in terms of ideals. I feel compelled to.Former CEO of Westmead Children’s Hospital Prof Kim Oates spoke for me and so many others when he said ‘I am deeply uncomfortable with abortion being the solution to anything’. Kim is not only a decorated paediatrician but a nearby local parishioner. He is a man that understands the depth of the issues involved here, and that single straightforward answers are effectively guaranteed to be errant in some way. In order to assess abortion as a society we must understand what it is and why it happens.Most terminations of pregnancy occur without our knowledge. In fact, in the modern era the ‘Biochemical Pregnancy’ - a phenomenon arising from increased intervention and test sensitivity - has presented a definitive challenge. Many people and peak bodies have proposed means to decide what constitutes a human. Personally, I refer to our National Statement on Ethical Conduct in Human Research (2007) - Updated 2018, but the problem here is never a material one - it is always a matter of the Philosophy of mind practiced by a community. It is this that I wish to speak to - the importance of other people.In my opinion, the ‘battle lines’ with respect to abortion are very poorly drawn. They appear to arise from misunderstandings and contradictions. To better grasp what these are, we must again turn to natural processes to consider what promotes healthy pregnancies and deliveries. Such factors are increasingly well-understood. The Spectrum model represents a statistical means of demonstrating the effects of family planning and other factors on fertility, abortion, miscarriage, and stillbirths, whereas Factors Contributing to Maternal and Child Mortality Reductions are invariably those that reduce environmental stressors on families and the mother-child dyads that may come to exist in them.When we come to examine measures of such stressors, especially infant mortality, we see something striking:According to this year’s America’s Health Ranking Annual Report, the U.S. infant mortality rate is 5.9 deaths per 1,000 live infant births, while the average rate of infant mortality among the OECD countries is 3.9 deaths per 1,000 live births. Compared with other OECD countries, the U.S. ranks No. 33 out of 36 countries. Iceland is ranked No. 1 and has the lowest rate with 0.7 deaths per 1,000 live births. Mexico is ranked last with 12.1 deaths per 1,000 live births. New Hampshire and Vermont are tied for the top state in the U.S. with 3.9 deaths per 1,000 live births. These two neighboring states have achieved an infant mortality rate equal to the OECD average. As the bottom-ranked state, however, Mississippi has an infant mortality rate more than twice that of the OECD average at 8.9 deaths per 1,000 live births and internationally ranks below all but two of the OECD countries. Over the past 50 years, the decline in the U.S. infant mortality rate has not kept pace with that in other OECD countries. When examining sex- and age-adjusted infant mortality rates from 2001 to 2010, the U.S. rate was 75 percent higher than the average rate in 20 OECD comparable countries.Findings International Comparison | 2018 Annual ReportWhy would the country with the Top Economy in the World have such paediatric outcomes? Well, these statistics are inextricably linked to the affordability of healthcare.In a review published in March 2018 in the Journal of the American Medical Association, researchers found that the US spent about twice as much on healthcare as other high-income countries…and yet, higher spending didn't translate to better outcomes, nor is healthcare used more frequently in the US.The average cost of healthcare in 21 different countriesHence, it becomes apparent that even though abortion is a medical procedure it represents a small short-term cost in comparison to the cost of child-bearing and child-rearing - things that are taken into account not only in terms of maternal finances but in terms of maternal physiology.How much do women around the world pay to give birth? The answer is ‘much less than the USA’.Total costs for vaginal deliveries in a US hospital routinely amount to $30,000. Costs of care elsewhere in the world are significantly reduced compared to the USA, and such inflated financial obstacles in America correspond to a more pronounced expression of the Inverse care law.What becomes clear in health data is that abortions are a secondary measure of hardship. This is true physiologically and financially. The enduring fact of maternal-foetal medicine is this:On inspection of abortions per capita around the world this pattern is ever more apparent. Lesser disparity in terms of resources amounts to greater maintenance of child and family health.These data do not correlate with reduced conservatism as a political position or reduced religiosity, rather the opposite. Abortions are lowest per capita in North America, but this is not because of the influence of the USA primarily, it is due to Canada. There are relatively fewer pregnancies on the North American continent.The Canadian abortion rate effectively occupies the international average at 15.2/1000 women aged 15–44. The USA is the 11th highest in the world (according to reported statistics, which are not universally available) at 20.8/1000. Austria reports 1.3/1000 - almost twenty times less than the USA.Contrary to what some might suppose, Abortion in Austria has been fully legalised since 1975. Abortion on a woman’s request without a medical reason is legal in Austria if it is performed before the 16th week of pregnancy (within 3 months after implantation), in consultation with a physician / health care professional. (Legal regulation of abortion in Austria).Hence, there is a contradiction in terms of the impact on abortions imposed by legislation. Outlawing abortion does not impact maternal-foetal health, and in societies such as the USA such legislation has a disproportional impact on the population already most at risk of abortion.Unintended pregnancy and abortion by income, region, and the legal status of abortion: estimates from a comprehensive model for 1990–2019“Between 1990–94 and 2015–19, the global unintended pregnancy rate has declined, whereas the proportion of unintended pregnancies ending in abortion has increased. As a result, the global average abortion rate in 2015–19 was roughly equal to the estimates for 1990–94. Our findings suggest that people in high-income countries have better access to sexual and reproductive health care than those in low-income countries. Our findings indicate that individuals seek abortion even in settings where it is restricted. These findings emphasise the importance of ensuring access to the full spectrum of sexual and reproductive health services, including contraception and abortion care, and for additional investment towards equity in health-care services.”As a Christian, I publicly admit that I feel a compulsion to defend the rights of the unborn. However, as a result of that I feel compelled to make it clear that imposition of prohibitory legislation regarding termination of pregnancy is not associated with improved outcomes. In contrast, evidence at almost every level of health services indicates that equity in those health-care services and reduction in socioeconomic stressors provide the greatest hope for the healthy progress of even unintended pregnancies.If the goal of some society is to reduce intrauterine deaths - regardless of whether they are due to intervention or not! - the right response of that society must be to make the lives of mothers more conducive to supporting any possible child. In contrast to some misguided suggestions, the ideal paths to those outcomes involve women’s rights, reduction of wealth inequality, and increased access to equitable healthcare.Our CEO of Gidget Foundation Australia, Arabella Gibson, opening the Dubbo centre. As a member of the clinical governance committee for Gidget House I am very proud of the way that Arabella and the Gidget team seek to make a difference to families in real life, not in cold law.

I think (could be wrong) that you’re basically right: a decent medical education nowadays tends to counteract a belief in racial supremacy.Now, there’s a lot of caveats to add to that. First, science besmirched itself through the 1800’s and 1900’s with bogus “research” claiming the racial supremacy of — surprisingly — Caucasians. Scientific racism - Wikipedia. Some of these ideas trickled down through the years, including sociologist Charles Murray today Charles Murray. So so-called scientific racism is still with us, and a good education does not necessarily inoculate someone against racial supremacism.Second, by “racism” I think you mean a conscious belief in racial supremacy. There’s another sense of the word, which is more subtle but equally impactful: racial bias. Bias is unconscious or conscious, accidental or deliberate. Either way, bias causes discrimination, which in health care can even kill patients. Health outcomes can be measured, and show a widespread racial disparity in treatment outcomes, even when controlling for socioeconomic status. (www. nap.edu/catalog/10260,html) Example: Doctors send injured black football players back out to play again sooner than they do white players. Racial Bias in Perceptions of Others’ Pain. Of course, those doctors don’t know they’re doing this. This happens because white medical professionals can unknowingly assume that blacks feel less pain than whites. This is the “racial empathy gap”. Why White People Don’t Feel Black People’s Pain: This article also links to studies showing that U.S. blacks are given less analgesia for terminal cancer, migraines and back pain, orthopedic fractures in children, and in many other situations. (One good accidental outcome is that blacks did not get addicted to opioids as frequently as whites).You can also Google “racial disparities in health care” for a lot more information.I emphasize unconscious racial bias — which you didn’t really ask about — because it is arguably as deadly and damaging to people as is conscious racial supremacy, if only because it’s more common and harder to detect.By the way, doctors also have to deal with racist patients. After Charlottesville, A Doctor Reflects On Hateful Patients And His Own Biases. And doctors also work very hard to offset their biases and to treat every patient equally.So in the main, I think you’re correct. AND, black people still get hurt by unconscious bias in the health care system, stories of unequal medical treatment get passed down within black families, and people’s trust level with health care workers suffers as a result.