Health Inequality

There are many reasons why poverty matters, but it is especially troubling that it affects such fundamental outcomes as health and access to health care. If poverty did not bring about all manner of health risks, we would likely be somewhat less troubled by it. But of course poverty and other forms of social and economic disadvantage do often translate into deficits in health and health care. The purpose of this brief is to examine long-term trends in American health and to lay out the current state of evidence on the extent to which health and health care are unequally distributed. We also note how the recent economic downturn affected these trends and disparities. The key backdrop to this assessment is the tripling of U.S. health expenditures since the 1960s. In 2012, per capita expenditures on health were $8,915, more than double those from 1995, though growth has slowed in the past 4 years.1 Some of this rise is attributable to population aging. Costs associated with Medicare, a program established in 1965 to subsidize health care for those aged 65 and older, have grown as the elderly population constitutes an ever-larger portion of the U.S. population. Still, overall U.S. health expenditures have increased faster than the growth of the elderly population and faster than health expenditures in other OECD countries.2 It is possible that such rising costs have led to a more unequal distribution of health and health care. At the same time, health inequalities may also be affected by the economy (e.g., recessions), changes in how insurance is provided, and any number of other factors. In this brief, our objective is not to attempt to tease out the causes of any possible changes in health inequalities, but rather to provide a descriptive summary of the current evidence on trends in (a) health, (b) foregone health care and insurance coverage, and (c) health risk factors. To preview our results, we find first that some health indicators, such as life expectancy, show an overall improvement. But not all indicators are improving. For example, an increasing number of Americans report delaying or foregoing health care, particularly during the recent economic recession. Second, economic and racial disparities in health indicators are often substantial, and when changes in these disparities are observed, they usually take the form of an increase in absolute size. Third, a large proportion of Americans still remain uninsured in 2012 (i.e., 15 percent), although the proportion of children who are uninsured declined by nearly 2 percentage points between the late 1990s and 2012

State of the States’ Health

Inequalities in access to health and health care are especially important forms of inequality because they speak to who lives long and who lives well. It is well known that, even though the United States spends more on health care per capita than any other country, it has some of the worst access and outcome results among wealthy nations.1 While important, such cross-country comparisons hide substantial health inequality within the United States. Even a cursory inspection of the data suggests that some states are indeed better performers on key health measures. For example, only one in ten adults in Utah smoke, whereas more than one in four do so in West Virginia. The purpose of this brief is to examine whether state differences of this magnitude are commonly found across various other health measures. We focus not just on average levels of health access, behaviors, and outcomes, but also on how unequally they are distributed. Although everyone would presumably prefer a state with high average health scores, it also matters whether the health disparities between the poor and relatively well-off are very large. If a state has a high mean level of health but also subjects its poor residents to a large “health penalty,” then anyone who is at risk of being poor would presumably want to avoid that state (at least insofar as the penalty is large enough to render them worse off than their counterparts in other states). Therefore, we examine two important features of a state’s health profile: the average level of health, behavioral, or access problems in the state; and the variation in the distribution of these outcomes by income

‘The fight on educating the public to equal treatment for all will have to come later’: Jewish Refugee Activism and Anti-Immigration Sentiment in Immediate Post-War Canada

Canadian immigration policy of the 1930s and 1940s was the most restrictive and selective in the country’s history, making it one of the countries to take the smallest number of Jewish refugees fleeing the Nazi persecution. After the war, Canada slowly opened its borders, but only through small token gestures in 1947 and 1948. This article explores how the main Canadian Jewish organization lobbied for the welcoming of more Jewish refugees and migrants in the immediate aftermath of the war. It examines how their perception of the public’s anti-Jewish immigrant sentiment and of the Canadian immigration policy’s discriminatory mechanisms informed their strategies. During that period, the Canadian Jewish Congress prioritized constant and subtle action with the government instead of trying to set up mass mobilization campaigns. This strategic shift is an overshadowed but essential chapter of both Jewish and human rights histories in Canada. This article invites a re-evaluation of Jewish activism’s role in ending ethnic selection in the Canadian immigration policy and promoting refugee rights. It contributes to broadening our understanding of how minority groups lobbied and worked with hostile media and authorities

Improving model-satellite comparisons of sea ice melt onset with a satellite simulator

Seasonal transitions in Arctic sea ice, such as the melt onset, have been found to be useful metrics for evaluating sea ice in climate models against observations. However, comparisons of melt onset dates between climate models and satellite observations are indirect. Satellite data products of melt onset rely on observed brightness temperatures, while climate models do not currently simulate brightness temperatures, and must therefore define melt onset with other modeled variables. Here we adapt a passive microwave sea ice satellite simulator, the Arctic Ocean Observation Operator (ARC3O), to produce simulated brightness temperatures that can be used to diagnose the timing of the earliest snowmelt in climate models, as we show here using Community Earth System Model version 2 (CESM2) ocean-ice hindcasts. By producing simulated brightness temperatures and earliest snowmelt estimation dates using CESM2 and ARC3O, we facilitate new and previously impossible comparisons between the model and satellite observations by removing the uncertainty that arises due to definition differences. Direct comparisons between the model and satellite data allow us to identify an early bias across large areas of the Arctic at the beginning of the CESM2 ocean-ice hindcast melt season, as well as improve our understanding of the physical processes underlying seasonal changes in brightness temperatures. In particular, the ARC3O allows us to show that satellite algorithm-based melt onset dates likely occur after significant snowmelt has already taken place. © 2022 Author

The Influence of Veteran Status, Psychiatric Diagnosis, and Traumatic Brain Injury on Inadequate Sleep

Adequate sleep is essential for health, social participation, and wellbeing. We use 2010 and 2011 Behavioral Risk Factor Surveillance System data (N = 35,602) to examine differences in sleep adequacy between: non-veterans; non-combat veterans with no psychiatric diagnosis or traumatic brain injury (TBI); combat veterans with no psychiatric diagnosis or TBI; and veterans (non-combat and combat combined) with a psychiatric diagnosis and/or TBI. On average, respondents reported 9.28 days of inadequate sleep; veterans with a psychiatric diagnosis and/or TBI reported the most—12.25 days. Multivariate analyses indicated that veterans with a psychiatric diagnosis and/or TBI had significantly more days of inadequate sleep than all other groups. Findings contribute to a growing literature on the relevance of the military service–psychiatric diagnosis–TBI nexus for sleep problems by using population-representative data and non-veteran and healthy veteran comparison groups. This research underscores the importance of screening and treating veterans for sleep problems, and can be used by social workers and health professionals to advocate for increased education and research about sleep problems among veterans with mental health problems and/or TBI

Investigation of the factors causing the complexity of the ongoing West African Ebola virus epidemic

Ebola virus disease is a hemorrhagic fever characterized by flu-like symptoms, internal and external bleeding, and quick onset of death in many victims. It was first identified in simultaneous outbreaks in Sudan and Zaire in 1976, and since then it has caused numerous small outbreaks and a few large ones. The largest outbreak to ever occur is still ongoing, with over 26,000 cases and over 11,000 deaths observed in the West African countries of Guinea, Liberia, and Sierra Leone. No previous outbreak has ever been so large, prompting many to question what exactly has caused this outbreak to become so large and complex. Because it is currently assumed that genetic changes in the strain causing this outbreak are not the cause of the size of the outbreak, the public health responses to each outbreak, cultural differences in each location, and the characteristics of the physical location of each outbreak were researched in order to determine if any difference in one of these variables could be behind the complexity of the current outbreak. Evidence indicates that poor public health infrastructure and spending, an inadequate initial international response, a lack of familiarity with Ebola in West Africa, and the proximity of the initial outbreak location to multiple capital cities allowed the virus to spread to and throughout numerous large cities while going undetected for almost three months, causing the outbreak to explode before officials had the chance to control it