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In the United States, some populations suffer from far greater disparities in health than others. Those disparities are caused not only by fundamental differences in health status across segments of the population, but also because of inequities in factors that impact health status, so-called determinants of health. Only part of an individual's health status depends on his or her behavior and choice; community-wide problems like poverty, unemployment, poor education, inadequate housing, poor public transportation, interpersonal violence, and decaying neighborhoods also contribute to health inequities, as well as the historic and ongoing interplay of structures, policies, and norms that shape lives. When these factors are not optimal in a community, it does not mean they are intractable: such inequities can be mitigated by social policies that can shape health in powerful ways. Communities in Action: Pathways to Health Equity seeks to delineate the causes of and the solutions to health inequities in the United States. This report focuses on what communities can do to promote health equity, what actions are needed by the many and varied stakeholders that are part of communities or support them, as well as the root causes and structural barriers that need to be overcome.
Poverty among the elderly is sharply gendered—women over sixty-five are twice as likely as men to live below the poverty line. Older women receive smaller Social Security payments and are less likely to have private pensions. They are twice as likely as men to need a caregiver and twice as likely as men to be a caregiver. Recent efforts of some in Washington to reduce and privatize social welfare programs threaten to exacerbate existing gender disparities among older Americans. They also threaten to exacerbate inequality among women by race, class, and marital status. Madonna Harrington Meyer and Pamela Herd explain these disparities and assess how proposed policy reforms would affect inequality among the aged. Market Friendly or Family Friendly? documents the cumulative disadvantages that make it so difficult for women to achieve economic and health security when they retire. Wage discrimination and occupational segregation reduce women's lifetime earnings, depressing their savings and Social Security benefits. While more women are employed today than a generation ago, they continue to shoulder a greater share of the care burden for children, the disabled, and the elderly. Moreover, as marriage rates have declined, more working mothers are raising children single-handedly. Women face higher rates of health problems due to their lower earnings and the high demands associated with unpaid care work. There are also financial consequences to these family and work patterns. Harrington Meyer and Herd contrast the impact of market friendly programs that maximize individual choice, risk, and responsibility with family friendly programs aimed at redistributing risks and resources. They evaluate popular policies on the current agenda, considering the implications for inequality. But they also evaluate less discussed policy proposals. In particular, minimum benefits for Social Security, as well as credits for raising children, would improve economic security for all, regardless of marital status. National health insurance would also reduce inequality, as would reforms to Medicare, particularly increased coverage of long term care. Just as important are policies such as universal preschool and paid family leave aimed at reducing the disadvantages women face during their working years. The gender gaps that women experience during their work and family lives culminate in income and health disparities between men and women during retirement, but the problem has received scant attention. Market Friendly or Family Friendly? is a comprehensive introduction to this issue, and a significant contribution to the debate over the future of America's entitlement programs. A Volume in the American Sociological Association's Rose Series in Sociology
Aging populations are creating tremendous pressures on social security systems throughout the world, lifting the need for reform to the top of policy agendas. Proposed reforms often have different implications for men and women. At the same time, traditional family and gender roles are changing with the decline in fertility rates and the rapid rise in women's participation in the paid labor force.While trying to adapt social security systems to the fiscal demands of aging societies, policymakers face the compelling challenge of how to design pension reforms that achieve fair outcomes for women. Gender and Social Security Reform examines how different countries are attempting to meet this challenge. Drawing on comparative studies of European and Latin American countries along with a series of case studies of individual countries, the book provides insights into the gender dimensions of alternative designs for reform. All of the countries studied have recently reformed or are about to reform their pension systems, with a clear trend towards tightening the link between contributions and benefits in order to secure the long-term sustainability of pensions. The book also alerts policymakers to other issues: Should pension systems be gender-neutral or compensate for inequalities in paid and unpaid labor? Does compensation preserve gender discrimination? Are unisex life tables a reliable or fair redistributive tool for women? Or should annuities be linked directly to life expectancy, differentiated by sex and potentially other factors? Does a minimum pension guarantee risk compromising the principle of individual responsibility and work? How can recognition for caring work be balanced with work incentives? What can be done to help social security systems preserve freedom of choice in terms of work-family balance for women, men or the modem family unit as a whole?In analyzing the gender implications of recent social security policies and practices