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

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

Diagnosis and Treatment of Sylvia Plath and Virginia Woolf

Previous research indicates a correlation between creativity and psychopathology, particularly among female authors and poets, possibly heightening this group’s risk for suicide. This article aims to provide a psychohistory containing psychological evaluations and hypothetical treatments plans for two prominent female writers, Sylvia Plath and Virginia Woolf both of whom completed suicide. Primary source material such as Plath’s journals, Woolf’s diaries, and related autobiographies were used as supplemental data for the clinical assessment. Plath is argued to have hypothetically met today’s DSM-5 criteria for Major Depressive Disorder, and Woolf for Bipolar I Disorder in addition to trauma-related difficulties

Focusing on Friendship: Online Supported Activities for Adolescents on the Autism Spectrum

A core feature of Autism Spectrum Disorder (ASD) is social skills differences. Social skills groups have received support as an intervention that fosters social skills of those with ASD. However, there is limited information about the use of telehealth-based social skills groups. The proposed ASD adolescent social group design is formatted for telehealth services, and has been conducted virtually since 2020. This ASD social group program features unique virtual teaching and recreational activity curriculum as well as some program evaluation data methods and responses from participants

REDI for Binned Data: A Random Empirical Distribution Imputation Method for Estimating Continuous Incomes

Researchers often need to work with categorical income data. The typical nonparametric (including midpoint) and parametric estimation methods used to estimate summary statistics both have advantages, but they carry assumptions that cause them to deviate in important ways from real-world income distributions. The method introduced here, random empirical distribution imputation (REDI), imputes discrete observations using binned income data, while also calculating summary statistics. REDI achieves this through random cold-deck imputation from a real-world reference data set (demonstrated here using the Current Population Survey Annual Social and Economic Supplement). This method can be used to reconcile bins between data sets or across years and handle top incomes. REDI has other advantages for computing values of an income distribution that is nonparametric, bin consistent, area and variance preserving, continuous, and computationally fast. The author provides proof of concept using two years of the American Community Survey. The method is available as the redi command for Stata

The Undergraduate RA: Benefits and Challenges for Sociology Faculty and Research Assistants

Reprinted with permission

The Pandemic Penalty: The Gendered Effects of COVID-19 on Scientific Productivity

Academia serves as a valuable case for studying the effects of social forces on workplace productivity, using a concrete measure of output: scholarly papers. Many academics, especially women, have experienced unprecedented challenges to scholarly productivity during the coronavirus disease 2019 (COVID-19) pandemic. The authors analyze the gender composition of more than 450,000 authorships in the arXiv and bioRxiv scholarly preprint repositories from before and during the COVID-19 pandemic. This analysis reveals that the underrepresentation of women scientists in the last authorship position necessary for retention and promotion in the sciences is growing more inequitable. The authors find differences between the arXiv and bioRxiv repositories in how gender affects first, middle, and sole authorship submission rates before and during the pandemic. A review of existing research and theory outlines potential mechanisms underlying this widening gender gap in productivity during COVID-19. The authors aggregate recommendations for institutional change that could ameliorate challenges to women’s productivity during the pandemic and beyond

Sociophonetic Markers Facilitate Translation Priming: Maori English GOAT – A Different Kind of Animal

This study investigates whether socio-indexical labelling operates under a shared or a separate system across the two languages of a bilingual talker-listener. We argue for a shared system, showing that L1 indexical labels interact with L2 indexical labels during speech perception. In particular, we investigate the effect of ethnic dialect on bilingual speech processing by using a novel cross-language/cross-dialect auditory priming paradigm in the New Zealand context, where Maori (TR) and English are both official languages, and English has two main ethnic varieties: Maori English (ME) and Pakeha English (PE). Fifty-four English-Maori bilinguals participated in a short-term auditory primed lexical decision task, where bilingual prime and target pairs were made up of English-to-Maori and Maori-to-English translation equivalents. Half of the English words were pronounced by a PE speaker, and half by a ME speaker, creating four test conditions: TR-ME, TR-PE, ME-TR, PE-TR. The results reveal a significantly larger priming effect between ME and TR than between PE and TR. We argue for a direct activation link between the Maori indexical labels within the English language set of representations and the Maori indexical labels within the Maori language set of representations. The results suggest that socio-indexical labels can facilitate translation priming. In particular, recent, more innovative variants appear to be processed as special in short-term memory