Were the mental health benefits of a housing mobility intervention larger for adolescents in higher socioeconomic status families?

Moving to Opportunity (MTO) was a social experiment to test how relocation to lower poverty neighborhoods influences low-income families. Using adolescent data from 4 to 7 year evaluations (aged 12–19, n=2829), we applied gender-stratified intent-to-treat and adherence-adjusted linear regression models, to test effect modification of MTO intervention effects on adolescent mental health. Low parental education, welfare receipt, unemployment and never-married status were not significant effect modifiers. Tailoring mobility interventions by these characteristics may not be necessary to alter impact on adolescent mental health. Because parental enrollment in school and teen parent status adversely modified MTO intervention effects on youth mental health, post-move services that increase guidance and supervision of adolescents may help support post-move adjustment.     

Do interventions to increase income improve the health of the poor in developed economies and are such policies cost effective?

Health policy has shifted towards placing a greater emphasis on the role of lifestyle and life circumstances in improving health. The factors that are associated with poor health status are known, but the comparative effectiveness of specific policy interventions in improving health and reducing inequalities in health is unclear. For example, there is little evidence that specific policies aimed at providing income support or poverty eradication have any measurable impact on health. Two previous reviews have addressed the evidence in this area but in a fairly restrictive way. One considered only randomised trials and the other excluded non-cash benefits. This article builds on the previous reviews in three ways: a broader scope of study designs and types of intervention is considered; more recent literature is reviewed; and it considers the extent to which an economic evaluation framework has been applied. A systematic search of electronic databases was carried out for literature published since 1980 and in the English language. Each study was appraised in terms of its relevance to the question of interest, and the quality of the study design was appraised in terms of its capacity to provide robust answers. Few studies were found with health outcomes as their main focus. Most of the studies that used secondary data sources or survey data were of poor quality. Where economic evaluations were reported, these tended to be restricted to financial assessments. Different types of interventions were evaluated. In studies of cash benefits, there was limited evidence that they had a positive effect on some health domains, mainly psychosocial. Studies in welfare-to-work interventions produced mixed results in terms of impact on either income or health; there was no consistent relationship between income gains and health improvements. Five welfare-to-work studies included 'benefit-cost analysis', but these were essentially financial assessments. Studies of benefits in kind did not meet the quality criteria for inclusion in this article. Overall, we found no evidence of the potential cost effectiveness of income support or anti-poverty initiatives in improving health, nor is there a strong effectiveness literature on which to build such analysis. However, the hypothesis that increased income may improve health cannot be said to have been properly tested. Studies generally analyse the incremental effect of changes to the welfare system and do not estimate the health effects of current provisions. The production function for good health is complex. Increasing income may be a necessary, but not a sufficient, condition for the creation of better health in those with low incomes.     

Preventing long-term welfare receipt: the theoretical relationship between health and poverty over the early life course

Largely absent in the congressional debate regarding U.S. welfare reform reauthorization are policy discussions aimed at preventing long-term welfare use for families at risk. This study examines three social science perspectives explaining the relationship between early poverty and health as a means to understand long-term welfare receipt. Using longitudinal data collected for more than 30 years from a cohort of African Americans living in inner-city Chicago, we examined whether a social causation, health selection, or bio-social perspective best characterized the route to long-term welfare receipt. Results indicated that a bio-social perspective provided the best explanation for how early life course factors relate to long-term welfare use later in adulthood. Thus, this theory merits further study as an explanation for the relationship between health status and income. These findings point to the vulnerability of those who are both poor and in ill health, and should direct our policies regarding how to best prevent long term welfare receipt in future generations.     

Welfare Receipt Trajectories of African-American Women Followed for 30 Years

Although there has been much discussion about the persistence of poverty and welfare receipt among child-rearing women in the US, little is known about long-term patterns of poverty and welfare receipt or what differentiates those who remain on welfare from those who do not. Furthermore, are there distinctions between child-rearing women who are poor but not on welfare from those who do receive welfare? This study examined trajectories of welfare receipt and poverty among African-American women (n = 680) followed from 1966 to 1997. A semiparametric group-based approach revealed four trajectories of welfare receipt: no welfare (64.2%), early leavers (12.7%), late leavers (10.1%), and persistent welfare recipients (10.1%). The “no welfare” group was further divided into a poverty group and a not poverty group to distinguish predictors of welfare from predictors of poverty. Multivariate analyses revealed differences in predictors of trajectory groups in terms of education, physical and psychological health, and social integration. In addition, earlier chronic illness and social integration were important predictors to differentiate between long-term users (i.e., late leavers, persistent recipients) and short-term users (i.e., early leavers). Trajectories did not differ in teenage motherhood, substance use, or family history of welfare receipt. Implications for public policy are discussed.     

What predicts the quality of life in Turkey: The results of a country representative study

Quality of life is a multidimensional, sophisticated, comprehensive and abstract concept that reflects life conditions, health and social welfare status, perception of life and psychology of individuals. It is affected by health problem and disease existence as well as individual, demographic, economic and social characteristics such as gender, education, marital status and income level. The objective of this study is to determine the more likely predictors of the quality of life in Turkey. 2016 Turkey Health Survey that is a large and nationally representative survey was used to reach study objective. The results indicated that individual and demographic characteristic as well as self‐rated health status and disease existence were the main predictors of quality of life. Based on the findings, it can be recommended that appropriate interventions might improve quality of life which is tend to be lower among aged, female, less educated and widow/separated individuals. It is also recommended in improving health status of individuals and improving accessibility, and quality of the health services for people with a disease will increase the quality of life of individuals.     

Capability Development among the Ultra-poor in Bangladesh: A Case Study

Microcredit is advocated as a development tool that has the potential to reduce poverty, empower participants, and improve health. Results of several studies have shown that the extreme poor, or the ultra-poor, often are unable to benefit from traditional microcredit programmes and can, as a result of taking a loan they cannot repay, sink deeper into economic and social poverty. This case study describes an intervention directed at enabling the ultra-poor rural populations to pull themselves out of poverty. The intervention integrates multiple components, including asset grants for income generation, skills training, a time-bound monthly stipend for subsistence, social development and mobilization of local elite, and health support. Results of an evaluation showed that, after 18 months, the programme positively impacted livelihood, economic, social and health status to the extent that 63% of households (n=5,000) maintained asset growth and joined (or intended to join) a regular microcredit programme. Impacts included improved income, improved food security, and improved health knowledge and behaviour. Applying a social exclusion framework to the intervention helps identify the different dynamic forces that can exclude or include the ultra-poor in Bangladesh in development interventions such as microcredit.Key words: Capacity-building, Economic assistance, Poverty, Ultra-poor, Bangladesh     

Meeting the challenge of epidemic infectious disease outbreaks: an agenda for research

Challenges arising from epidemic infectious disease outbreaks can be more effectively met if traditional public health is enhanced by sociology. The focus is normally on biomedical aspects, the surveillance and sentinel systems for infectious diseases, and what needs to be done to bring outbreaks under control quickly. Social factors associated with infectious disease outbreaks are often neglected and the aftermath is ignored. These factors can affect outbreak severity, its rate and extent of spread, influencing the welfare of victims, their families, and their communities. We propose an agenda for research to meet the challenges of infectious disease outbreaks. What social factors led to the outbreak? What social factors affected its severity and rate and extent of spread? How did individuals, social groups, and the state react to it? What are the short- and long-term effects on individuals, social groups, and the larger society? What programs can be put in place to help victims, their families, and affected communities to cope with the consequences--impaired mental and physical health, economic losses, and disrupted communities? Although current research on infectious disease outbreaks pays attention to social factors related to causation, severity, rate and extent of spread, those dealing with the "social chaos" arising from outbreaks are usually neglected. Inclusion, by combining traditional public health with sociological analysis, will enrich public health theory and understanding of infectious disease outbreaks. Our approach will help develop better programs to combat outbreaks and equally important, to help survivors, their families, and their communities cope better with the aftermath.     

Teen births, income inequality, and social capital: developing an understanding of the causal pathway

Many studies have demonstrated a relationship between income inequality and poor health, but how does income inequality impact health? One possible explanation is that greater income inequality undermines social capital (social cohesion, civic engagement, and mutual trust in a community). We conducted path analyses of the relationship between income inequality, poverty, and teen birth rate, testing for the mediating effect of social capital in 39 US states. Birth rate was affected by both poverty and income inequality, though income inequality appeared to affect teen birth rate primarily through its impact on social capital.     

Transformations and continuities in Canadian social welfare programs

Poor mothers and their families constitute a core dilemma for a social welfare system that aims primarily to encourage and keep workers in the labor force. Public income transfers to these and other marginalized groups may be viewed as disincentives to seek paid work and have been characterized in Canada by stinginess and contradictions since the beginning of the XX century. This paper discusses recent transformations in these programs and their effects on families and individuals. Focusing specifically on poor mothers raising children alone, it argues that many gradual cuts and reshaping these programs have changed the character of the social welfare state in Canada, blocking escape routes from poverty for marginalized groups.     

Income inequality, social cohesion and the health status of populations: the role of neo-liberalism

There has been a recent upsurge of interest in the relationship between income inequality and health within nations and between nations. On the latter topic Wilkinson and others believe that, in the advanced capitalist countries, higher income inequality leads to lowered social cohesion which in turn produces poorer health status. I argue that, despite a by-now voluminous literature, not enough attention has been paid to the social context of income inequality--health relationships or to the causes of income inequality itself. In this paper I contend that there is a particular affinity between neo-liberal (market-oriented) political doctrines, income inequality and lowered social cohesion. Neo-liberalism, it is argued, produces both higher income inequality and lowered social cohesion. Part of the negative effect of neo-liberalism on health status is due to its undermining of the welfare state. The welfare state may have direct effects on health as well as being one of the underlying structural causes of social cohesion. The rise of neo-liberalism and the decline of the welfare state are themselves tied to globalization and the changing class structures of the advanced capitalist societies. More attention should be paid to understanding the causes of income inequalities and not just to its effects because income inequalities are neither necessary nor inevitable. Moreover, understanding the contextual causes of inequality may also influence our notion of the causal pathways involved in inequality-health status relationships (and vice versa).     

Social determinants of tuberculosis case rates in the United States

BACKGROUND: Social capital has been related to a number of important public health variables such as overall mortality, health status, and sexually transmitted infections (including AIDS case rates). However, the relationship of social capital to tuberculosis has received little attention. Because social capital may be related to the constructs of poverty and income inequality, any exploration of the correlation between social capital and tuberculosis should include examination of the interrelationships with poverty and income inequality as well. OBJECTIVE: This study examined the state-level relationship between social capital, poverty, income inequality, and tuberculosis case rates. METHODS: The design was state-level, correlational analysis (including bivariate linear correlational analysis, and multivariate linear stepwise regression analysis). Main outcome measures were 1999 state-level case rates of tuberculosis. RESULTS: In bivariate analyses, poverty, income inequality, and social capital were all significantly correlated with tuberculosis case rates. In stepwise multiple regression analyses predicting tuberculosis case rates from this set of three predictor variables, social capital and income inequality entered the regression equation (with social capital being the strongest predictor variable). CONCLUSIONS: These results suggest that social capital is highly predictive of tuberculosis at the state level. The results indicate the need for further research into this potentially causal relationship, including the examination of structural interventions designed to increase social capital.     

Putting policy into practice? Poverty and people with serious mental illness

This paper addresses the effects of chronic poverty on people with serious mental illness. More specifically, we are concerned with the extent to which welfare restructuring, by deepening the poverty facing people with serious mental illness, undermines the expressed intent of mental health policy to improve the quality of life (QOL) of this population. The province of Ontario in Canada forms the setting for the study. The paper first examines recent trends in mental health care and social assistance policy in Ontario. While income support is consistently recognized as a core element of mental health care, welfare restructuring has led to a significant decline in the real value of income supports received by people with serious mental illness. The paper then examines the implications of this trend for the QOL of residential care facility tenants in Hamilton, Ontario. Here, the case study is explicitly connected to QOL scholarship. In addition, the study is grounded in an analysis of the broader transformation of the welfare state in Ontario. Interview data suggest that tenants experience chronic poverty that has a deleterious impact on multiple life domains including basic needs, family, social relations, leisure and self-esteem. Implications for research and policy are discussed.     

Infrastructure and resources of social, educational and health support in rare diseases

Rare diseases (RD) pose a great challenge to our society in different fields: health, social and educational. This means that multidisciplinary interventions are required that deal with the negative impact of these diseases on the people affected and their families. In order to minimise the repercussion of these problems there are a series of support resources in the different fields referred to (social, educational and health) that provide welfare, favour social integration and improve the quality of life of the people affected and their families. With respect to the educational field we present an analysis of the forms of schooling and types of curricular adaptation as well as Hospital Classrooms. With respect to the social field we consider the importance of the associative movement, the types of support it provides, the Law of Promotion of Personal Autonomy and the map of services. Finally, with respect to the health field, we discuss genetic counselling. As a conclusion, we set out some of the challenges and expectations in each of these fields, bearing in mind that a global approach to intervention can be an optimum solution facing this challenge.     

Understanding income inequalities in health among men and women in Britain and Finland.

The aims of this study were to investigate whether the relationship between income and self-perceived health is similar for men and women in two contrasting welfare states, Britain and Finland; whether the relationship between income and health is accounted for by employment status, education, and occupational social class; and whether the association differs when using alternative ways of measuring income: gross individual and net household equivalent income. Among British and Finnish men, low household and low individual income were related to poor health, even after adjusting for employment status, education, and social class. The adjusted relationship between individual income and health was stronger for British than Finnish men. Among British and Finnish women, net household equivalent income was strongly related to health, but after adjusting for employment status, education, and social class this relationship became weaker for British women and practically disappeared for Finnish women. For British women the association between income and health differed strongly depending on the income measure used; gross individual income had almost no effect on health. These results indicate that the association between health and income has no threshold in the sense that only people in poverty have poorer health than others. In further studies of income and health, household equivalent income should be used as the principal measure of income with adjustments for employment status, and men and women should be studied separately.     

Effects of combining public assistance and employment on mothers and their young children

One goal of recent welfare reform legislation is to move welfare-dependent mothers with young children into the paid labor force. However, prior to the new legislation, many welfare-dependent women were already engaged in employment activities. In this paper we examine whether child or maternal well-being is influenced by a mother's strategy of combining work and public assistance receipt in the late 1980s. Measures of well-being include children's cognitive test scores and behavior problems, parenting behavior, and maternal mental health, social support, and coping strategies collected when children were 2 1/2 to 3 years of age. Data from the Infant Health and Development Program (a sample of low birthweight, premature infants born in 8 sites in 1985) were used to identify low-income families (incomes under 200% of the poverty threshold; N = 525). Comparisons were made among mothers in the following groups: (a) Work Only, (b) Some Work-Some Welfare, (c) Some Work-No Welfare, (d) No Work-No Welfare, and (e) Welfare Only. Mothers in the Some Work-Some Welfare group had children with cognitive and behavioral scores similar to children whose mothers were in the Work Only group; these two groups also had similar mental health, social support, and coping scores. However, not working and receiving welfare (Welfare Only) was associated with negative cognitive and behavioral outcomes for children, with less stimulating home learning environments, lower maternal mental health, less social support, and more avoidant coping strategies. We discuss the proposition that welfare and work may be complementary rather than opposing strategies, in terms of putting together a family income package.     

Links Between Maternal Breast-Feeding Duration and Québec Infants’ Health: A Population-Based Study. Are the Effects Different for Poor Children?

OBJECTIVES: To determine whether the relationship between breastfeeding duration and the health status of 5-month-old Quebec infants differs by poverty status. METHODS: Cross-sectional study of Quebec Longitudinal Study of Child Development data of a sample of 2223 infants who were 5 months old. Two infant health indicators were considered: presence of chronic diseases and hospitalization for at least one night since birth. Differences in the associations between infant health and breastfeeding duration according to poverty status were explored using a logistic regression model and controlling for children's and mothers' characteristics. RESULTS: Infants of low-income mothers were breastfed less often and for shorter periods of time. At five months, they had poorer health compared with children from families with adequate income. However, a positive association between breastfeeding duration and these health indicators was observed and was independent of poverty level. There was no interaction between poverty level and breastfeeding duration for the two health indicators studied. CONCLUSIONS: The associations between maternal breastfeeding for 4 months or more and both hospitalizations before 5 months of age and chronic diseases are independent of family income level. However, low-income mothers breastfeed less often and for shorter periods of time. Interventions intended to promote and support breastfeeding should especially target mothers living in poverty conditions.     

Monitoring poverty and social exclusion 2003

The New Policy Institute has produced its sixth annual report of indicators of poverty and social exclusion. This year's report focuses on regional variations across England, Scotland and Wales. With 5 years of data now available to measure progress since Labour came to office in 1997, it is becoming much clearer where the Government's strategy for combating poverty and social exclusion is being successful – and where it is not. With the number of people living in low‐income households now on a steady downward trend, the latest figures (for 2001/2002) passed the notable milestone of taking income poverty lower than at any time in the 1990s. The main reason why the number of people in low‐income households fell in the 5 years to 2001/2002 is that there were fewer people in workless households. But, over the same period, the number of people in low‐income, working households did not fall. Out‐of‐work benefits to both working‐age families with dependent children and to pensioners have risen by around 30% in real terms since 1998, faster than earnings. This, plus the rise in tax credits, will have had a significant impact on the severity of poverty suffered by some low‐income households even when it has not taken them above the low‐income threshold. In education, earlier progress in increasing the numbers of those with an adequate minimum level of qualification has stalled, with no further advance since 2000, compared with rapid progress during the second half of the 1990s. Around a quarter of young people at each of the ages of 11, 16 and 19 are still failing to reach a basic level of attainment. There is no sign of any reduction since 1997 in the health inequalities which leave people with low incomes more likely to suffer serious health‐related problems. Across the range of indicators, problems of poverty and social exclusion are generally more prevalent in the North‐east than in other areas of the country. London has particular problems centred on low income and work and Scotland has particular problems centred on health.     

Aggregation and the measurement of income inequality: effects on morbidity

This is a cross-sectional study using records from the National Health Interview Survey linked to Census geography. The sample is restricted to white males ages 25-64 in the United States from three years (1989-1991) of the National Health Interview Survey. Perceived health is used to measure morbidity. Individual covariates include income-to-needs ratio, education and occupation. Contextual level measures of income inequality, median household income and percent in poverty are constructed at the US census county and tract level. The association between inequality and morbidity is examined using logistic regression models. Income inequality is found to exert an independent adverse effect on self-rated health at the county level, controlling for individual socioeconomic status and median income or percent poverty in the county. This corresponding effect at the tract level is reduced. Median income or percent poverty and individual socioeconomic status are the dominant correlates of perceived health status at the tract level. These results suggest that the level of geographic aggregation influences the pathways through which income inequality is actualized into an individuals' morbidity risk. At higher levels of aggregation there are independent effects of income inequality, while at lower levels of aggregation, income inequality is mediated by the neighborhood consequences of income inequality and individual processes.     

Effects of Combining Public Assistance and Employment on Mothers and Their Young Children

SUMMARY

One goal of recent welfare reform legislation is to move welfare-dependent mothers with young children into the paid labor force. However, prior to the new legislation, many welfare-dependent women were already engaged in employment activities. In this paper we examine whether child or maternal well-being is influenced by a mother's strategy of combining work and public assistance receipt in the late 1980s. Measures of well-being include children's cognitive test scores and behavior problems, parenting behavior, and maternal mental health, social support, and coping strategies collected when children were 2 ½ to 3 years of age. Data from the Infant Health and Development Program (a sample of low birthweight, premature infants born in 8 sites in 1985) were used to identify low-income families (incomes under 200% of the poverty threshold; N = 525). Comparisons were made among mothers in the following groups: (a) Work Only, (b) Some Work-Some Welfare, (c) Some Work-No Welfare, (d) No Work-No Welfare, and (e) Welfare Only. Mothers in the Some Work-Some Welfare group had children with cognitive and behavioral scores similar to children whose mothers were in the Work Only group; these two groups also had similar mental health, social support, and coping scores. However, not working and receiving welfare (Welfare Only) was associated with negative cognitive and behavioral outcomes for children, with less stimulating home learning environments, lower maternal mental health, less social support, and more avoidant coping strategies. We discuss the proposition that welfare and work may be complementary rather than opposing strategies, in terms of putting together a family income package.     

Women's status and health of two ethnic groups inhabiting a periurban habitat of Kolkata City, India: a micro-level study

We studied the interrelationship of women's status in terms of socioeconomic inequality and its effect on women's health at micro level between two ethnic groups in a periurban area of Kolkata City, India. One-hundred twenty-seven women who belong to a tribal population (Munda) and 174 women who belong to a caste population (Poundrakshatriya) participated in this study. We found significant differences between various (socioeconomic, demographic, diet intake, and body mass index [BMI] factors among the two ethnic groups that indicated a better situation for the Pod women. The number of live births, dietary intake and BMI of the women of the two ethnic groups varied differentially among socioeconomic factors, such as women's education and working pattern and poverty level of the household, which are the most recognized measures of women's status. Thus, the diverse socioeconomic status in various cultural groups in traditional Indian societies reflects a more complex situation of women's status and their health. Different factors were responsible for the differential health status of women, which is culture and location specific. Women who are more educated and employed are not necessarily more healthy, since poverty remains an integral factor, base on which literacy and employment status of women in India is determined. Furthermore, suppression of women is rooted in the very fabric of the Indian society, in tradition, in religious doctrine and practices, within the educational systems, and within the families. Along with education, therefore, income-generating schemes for the women of the economically deprived population should be strengthened to bring equality in overall health status of a region that consists of diverse cultural populations with vast economic disparity.