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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.
As colleges and universities extend academic programs abroad, develop internationally mixed research teams and create international curricular initiatives, it is essential to ensure that access to a high quality education remains a key component of the research and policy agenda transnationally.
The reduction of inequalities within and between countries stands as a policy goal, and deserves to take centre stage in the design of the Sustainable Development Goals agreed during the Rio+20 Summit in 2012.The 2013 edition of A Planet for Life represents a unique international initiative grounded on conceptual and strategic thinking, and – most importantly – empirical experiments, conducted on five continents and touching on multiple realities. This unprecedented collection of works proposes a solid empirical approach, rather than an ideological one, to inform future debate.The case studies collected in this volume demonstrate the complexity of the new systems required to accommodate each country's specific economic, political and cultural realities. These systems combine technical, financial, legal, fiscal and organizational elements with a great deal of applied expertise, and are articulated within a clear, well-understood, growth- and job-generating development strategy.Inequality reduction does not occur by decree; neither does it automatically arise through economic growth, nor through policies that equalize incomes downward via ill conceived fiscal policies. Inequality reduction involves a collaborative effort that must motivate all concerned parties, one that constitutes a genuine political and social innovation, and one that often runs counter to prevailing political and economic forces.
Major epidemics of the last two decades (SARS, H1N1, MERS, Ebola and Zika) have been followed by increases in inequality (Furceri, Loungani, Ostry and Pizzuto, 2020). In this paper, we show that the extent of fiscal consolidation in the years following the onset of these pandemics has played an important role in determining the extent of the increase in inequality. Episodes marked by extreme austerity—measured using either the government’s fiscal balance, health expenditures or redistribution—have been associated with an increase in the Gini measure of inequality three times as large as in episodes where fiscal policy has been more supportive. We survey the evidence thus far on the distributional impacts of the COVID-19 pandemic, which suggests that inequality is likely to increase in the absence of strong policy actions. We review the case made by many observers (IMF 2020; Stiglitz 2020; Sandbu 2020b) that fiscal support should not be withdrawn prematurely despite understandable concerns about high public debt-to-GDP ratios.
This report provides new evidence on social mobility in the context of increased inequalities of income and opportunities in OECD and selected emerging economies. It covers the aspects of both, social mobility between parents and children and of personal income mobility over the life course, ...
This paper analyzes the extent of income inequality from a global perspective, its drivers, and what to do about it. The drivers of inequality vary widely amongst countries, with some common drivers being the skill premium associated with technical change and globalization, weakening protection for labor, and lack of financial inclusion in developing countries. We find that increasing the income share of the poor and the middle class actually increases growth while a rising income share of the top 20 percent results in lower growth—that is, when the rich get richer, benefits do not trickle down. This suggests that policies need to be country specific but should focus on raising the income share of the poor, and ensuring there is no hollowing out of the middle class. To tackle inequality, financial inclusion is imperative in emerging and developing countries while in advanced economies, policies should focus on raising human capital and skills and making tax systems more progressive.
We posit that the relationship between income inequality and economic growth is mediated by the level of equality of opportunity, which we identify with intergenerational mobility. In economies characterized by intergenerational rigidities, an increase in income inequality has persistent effects—for example by hindering human capital accumulation— thereby retarding future growth disproportionately. We use several recently developed internationally comparable measures of intergenerational mobility to confirm that the negative impact of income inequality on growth is higher the lower is intergenerational mobility. Our results suggest that omitting intergenerational mobility leads to misspecification, shedding light on why the empirical literature on income inequality and growth has been so inconclusive.
During the last 25 years, life expectancy at age 50 in the United States has been rising, but at a slower pace than in many other high-income countries, such as Japan and Australia. This difference is particularly notable given that the United States spends more on health care than any other nation. Concerned about this divergence, the National Institute on Aging asked the National Research Council to examine evidence on its possible causes. According to Explaining Divergent Levels of Longevity in High-Income Countries, the nation's history of heavy smoking is a major reason why lifespans in the United States fall short of those in many other high-income nations. Evidence suggests that current obesity levels play a substantial part as well. The book reports that lack of universal access to health care in the U.S. also has increased mortality and reduced life expectancy, though this is a less significant factor for those over age 65 because of Medicare access. For the main causes of death at older ages-cancer and cardiovascular disease-available indicators do not suggest that the U.S. health care system is failing to prevent deaths that would be averted elsewhere. In fact, cancer detection and survival appear to be better in the U.S. than in most other high-income nations, and survival rates following a heart attack also are favorable. Explaining Divergent Levels of Longevity in High-Income Countries identifies many gaps in research. For instance, while lung cancer deaths are a reliable marker of the damage from smoking, no clear-cut marker exists for obesity, physical inactivity, social integration, or other risks considered in this book. Moreover, evaluation of these risk factors is based on observational studies, which-unlike randomized controlled trials-are subject to many biases.
Evidence indicates that actions within four main themes (early child development fair employment and decent work social protection and the living environment) are likely to have the greatest impact on the social determinants of health and health inequities. A systematic search and analysis of recommendations and policy guidelines from intergovernmental organizations and international bodies identified practical policy options for action on social determinants within these four themes. Policy options focused on early childhood education and care; child poverty; investment strategies for an inclusive economy; active labour market programmes; working conditions; social cash transfers; affordable housing; and planning and regulatory mechanisms to improve air quality and mitigate climate change. Applying combinations of these policy options alongside effective governance for health equity should enable WHO European Region Member States to reduce health inequities and synergize efforts to achieve the United Nations Sustainable Development Goals.
America's cities have symbolized the nation's prosperity, dynamism, and innovation. Even with the trend toward suburbanization, many central cities attract substantial new investment and employment. Within this profile of health, however, many urban areas are beset by problems of economic disparity, physical deterioration, and social distress. This volume addresses the condition of the city from the perspective of the larger metropolitan region. It offers important, thought-provoking perspectives on the structure of metropolitan-level decisionmaking, the disadvantages faced by cities and city residents, and expanding economic opportunity to all residents in a metropolitan area. The book provides data, real-world examples, and analyses in key areas: Distribution of metropolitan populations and what this means for city dwellers, suburbanites, whites, and minorities. How quality of life depends on the spatial structure of a community and how problems are based on inequalities in spatial opportunityâ€"with a focus on the relationship between taxes and services. The role of the central city today, the rationale for revitalizing central cities, and city-suburban interdependence. The book includes papers that provide in-depth examinations of zoning policy in relation to patterns of suburban development; regionalism in transportation and air quality; the geography of economic and social opportunity; social stratification in metropolitan areas; and fiscal and service disparities within metropolitan areas.