Evidence into Policy and Practice? Measuring the Progress of U.S. and U.K. Policies to Tackle Disparities and Inequalities in U.S. and U.K. Health and Health Care

Health policy in both the United States and the United Kingdom has recently shifted toward a much greater concern with disparities and inequalities in health and health care. As evidence for these disparities and inequalities mounts, the different approaches in each country present specific challenges for policy and practice. These differences are most apparent in the mechanisms by which the progress of such policies is measured. This article compares the United States' and United Kingdom's strategies to gauge the challenges for policymakers in order to inform policy and practice. A cross-national comparison of selected measurement mechanisms identifies lessons for policy and practice in both countries.     

Is Income Inequality a Determinant of Population Health? Part 2. U.S. National and Regional Trends in Income Inequality and Age- and Cause-Specific Mortality

This article describes U.S. income inequality and 100-year national and 30-year regional trends in age- and cause-specific mortality. There is little congruence between national trends in income inequality and age- or cause-specific mortality except perhaps for suicide and homicide. The variable trends in some causes of mortality may be associated regionally with income inequality. However, between 1978 and 2000 those regions experiencing the largest increases in income inequality had the largest declines in mortality (r= 0.81, p < 0.001). Understanding the social determinants of population health requires appreciating how broad indicators of social and economic conditions are related, at different times and places, to the levels and social distribution of major risk factors for particular health outcomes.     

Trends in U.S. hospitalizations and inpatient deaths from pneumonia and influenza, 1996–2011

BackgroundTo reduce excess morbidity and mortality of pneumonia and influenza (PI), the Advisory Committee on Immunization Practices has recommended the use of 7-valent pneumococcal conjugate vaccine (PCV7), and incrementally expanded the target group for annual influenza vaccination of healthy persons, to ultimately include all persons ≥6 months of age without contraindications as of the 2010–2011 influenza season. We aimed to capture broader epidemiologic changes by looking at PI collectively.MethodsUsing interrupted time series, we evaluated the changes in the rates of PI hospitalization and inpatient death across three periods defined according to the changes in vaccination policy. We assessed linear trends adjusting for seasonality, sex, and age group, allowing for differential impact across age groups. PI hospitalizations were defined as a principal diagnosis of PI, or a principal diagnosis of sepsis or respiratory failure, accompanied by a secondary diagnosis of PI.ResultsOverall annual rates of PI hospitalizations and inpatient deaths declined by 95 per 100,000 (95% CI: 45–145) and by 4.4 per 100,000 (95% CI: 0.9–7.8), respectively. This translates to 295,000 fewer PI hospitalizations and 13,600 fewer PI inpatient deaths than expected based on the average rates from 1996 through 1999. PI hospitalizations dropped the most among seniors aged 65+ by 487 per 100,000, followed by children aged <2, by 228 per 100,000. PI inpatient deaths declined most among seniors aged 65+, by 25.3 per 100,000.ConclusionsIn this nationally representative study, PI hospitalizations and inpatient deaths decreased in U.S. between 1996 and 2011. There is a temporal association with the introduction and widespread use of pneumococcal conjugate vaccines, and the expansion of the target group for annual influenza vaccination to include all persons ≥6 months of age, while it is difficult to attribute these changes directly to specific vaccines used in this era.     

The Household Food Insecurity and Health Outcomes of U.S.–Mexico Border Migrant and Seasonal Farmworkers

Emerging evidence suggests chronic household food insecurity has an adverse effect on health. This study examined the prevalence, predictors and health outcomes associated with food insecurity in 100 migrant and seasonal farmworker (MSFW) households living on the U.S.–Mexico border. Data were collected using the U.S. Food Security Scale, California Agricultural Worker’s Health Survey, and objective anthropometric, clinical and biochemical indicators. Food insecurity affected 82% of households; 49% also had hunger. Household food insecurity was predicted by the presence of minor children in the home and low maternal education. Food insecure households were more likely to have at least one member affected by symptoms of depression (deprimido), nervios (an ethnospecific condition), learning disorders, and symptoms suggestive of gastrointestinal infection. Although not directly associated with food insecurity, adult obesity, central body adiposity, elevated blood pressure, and blood lipid and glucose disturbances were common. These findings highlight the significant food security and health challenges faced by border area MSFW families.