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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.
Provides wide-ranging anaylses and reviews of the UK's experiences of health inequalities research and policy to date, and reflects on the lessons that have been learnt from these experiences, both within the UK and internationally.
We discuss regional disparities in economic performance and living standards. We first set out some key facts, and provide a conceptual framework to help analyze whether such disparities are efficient, or instead reflect market and/or policy failures. We examine whether policy attempts to reduce regional disparities necessarily involve a trade-off between equity and efficiency. We then investigate whether policymakers should focus on boosting the economic performance of lagging regions—or, conversely, accept the presence of regional disparities, and instead assist households in lagging regions through transfer payments, investments in education, health, and other basic services, and by facilitating out-migration.
The story of a kind of poverty in America so deep that we, as a country, don't even think exists--from a leading national poverty expert who "defies convention" (New York Times)
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.
This volume examines existing research documenting racial disproportionality and disparities in child welfare systems, the underlying factors that contribute to these phenomena and the harms that result at both the individual and community levels. It reviews multiple forms of interventions designed to prevent and reduce disproportionality, particularly in states and jurisdictions that have seen meaningful change. With contributions from authorities and leaders in the field, this volume serves as the authoritative volume on the complex issue of child maltreatment and child welfare. It offers a central source of information for students and practitioners who are seeking understanding on how structural and institutional racism can be addressed in public systems.
In early 2007, the Institute of Medicine convened the Roundtable on Health Disparities to increase the visibility of racial and ethnic health disparities as a national problem, to further the development of programs and strategies to reduce disparities, to foster the emergence of leadership on this issue, and to track promising activities and developments in health care that could lead to dramatically reducing or eliminating disparities. The Roundtable's first workshop, Challenges and Successes in Reducing Health Disparities, was held in St. Louis, Missouri, on July 31, 2007, and examined (1) the importance of differences in life expectancy within the United States, (2) the reasons for those differences, and (3) the implications of this information for programs and policy makers.
Exploring the consequences of federal devolution on state budgets, this work deals with three major areas of concern: the effect of moving large numbers of welfare recipients into labour markets; the planned federal reforms in the health care field; and trends in federal aid.
It's hard to imagine discussing welfare policy without discussing race, yet all too often this uncomfortable factor is avoided or simply ignored. Sometimes the relationship between welfare and race is treated as so self-evident as to need no further attention; equally often, race in the context of welfare is glossed over, lest it raise hard questions about racism in American society as a whole. Either way, ducking the issue misrepresents the facts and misleads the public and policy-makers alike. Many scholars have addressed specific aspects of this subject, but until now there has been no single integrated overview. Race and the Politics of Welfare Reform is designed to fill this need and provide a forum for a range of voices and perspectives that reaffirm the key role race has played--and continues to play--in our approach to poverty. The essays collected here offer a systematic, step-by-step approach to the issue. Part 1 traces the evolution of welfare from the 1930s to the sweeping Clinton-era reforms, providing a historical context within which to consider today's attitudes and strategies. Part 2 looks at media representation and public perception, observing, for instance, that although blacks accounted for only about one-third of America's poor from 1967 to 1992, they featured in nearly two-thirds of news stories on poverty, a bias inevitably reflected in public attitudes. Part 3 discusses public discourse, asking questions like "Whose voices get heard and why?" and "What does 'race' mean to different constituencies?" For although "old-fashioned" racism has been replaced by euphemism, many of the same underlying prejudices still drive welfare debates--and indeed are all the more pernicious for being unspoken. Part 4 examines policy choices and implementation, showing how even the best-intentioned reform often simply displaces institutional inequities to the individual level--bias exercised case by case but no less discriminatory in effect. Part 5 explores the effects of welfare reform and the implications of transferring policy-making to the states, where local politics and increasing use of referendum balloting introduce new, often unpredictable concerns. Finally, Frances Fox Piven's concluding commentary, "Why Welfare Is Racist," offers a provocative response to the views expressed in the pages that have gone before--intended not as a "last word" but rather as the opening argument in an ongoing, necessary, and newly envisioned national debate. Sanford Schram is Visiting Professor of Social Work and Social Research, Bryn Mawr Graduate School of Social Work and Social Research. Joe Soss teaches in the Department of Government at the Graduate school of Public Affairs, American University, Washington, D.C. Richard Fording is Associate Professor in the Department of Political Science, University of Kentucky.
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.