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

Emerging Tools to Control Feral Horse Populations in the Western USA

The U.S. Geological Survey (USGS) has been conducting research to support the Bureau of Land Management (BLM) Wild Horse and Burro Program since 1996 and is currently engaged in testing additional tools to curb high population growth of feral horses. Horses are protected by the Wild and Free-Roaming Horses and Burros Act of 1971 and are managed to maintain populations at appropriate management level (AML). With no natural predators, many populations double in 4-5 years. Population size is controlled primarily with “gathers” in which horses are rounded up and made available for adoption by the public. This is a costly enterprise in which animals are housed in holding facilities while they await potential adoption and many horses are never adopted. Today ~48,000 horses remain in holding facilities across the USA, and facilities are now full. There are approximately 72,000 horses on public lands across the west, which is almost 3 times range wide AML. Horses have profound impacts on habitat and other wildlife, and the situation is becoming critical on western landscapes. With holding facilities at capacity, BLM is forced to leave excess animals on public lands, leading to rangeland degradation and impacts to sage grouse and other wildlife. Solutions are needed quickly to address exponential population growth of horses. USGS partnered with Oklahoma State University (OSU) and Colorado State University (CSU), respectively, to conduct studies testing the efficacy of intrauterine devices (IUD) for horses, and gelding a proportion of males in a population. The IUD study was conducted on 20 domestic mares that were housed with stallions at OSU. Fifteen mares retained IUDs for the 18-month duration of the trial before IUDs were removed. Mares who received progesterone at the time of IUD insertion retained their IUDs, and no mares with an IUD became pregnant. Next we will test IUDs in free-roaming mares. In the gelding study with CSU, there were no differences in individual behavior or movement rates between gelded and non-gelded harem stallions or bachelors after the first breeding season. Gelded harem stallions did not lose their mares at a higher rate than intact stallions, and mares joined gelded harem stallions as often as they joined intact stallions. Preliminary results indicate little if any change to social structure or individual behavior of stallions or mares compared to controls. We will determine after the summer 2019 birthing season if gelding males affects population growth rate. USGS proposed a field study to determine behavior and population growth reduction of sterilizing mares but the study was litigated and postponed. Modeling by USGS indicates sterilization is the most effective and promising tool to reduce herds to AML and would potentially save BLM \u3e$1 billion annually in direct operational costs. The environmental cost to habitat and other wildlife associated with keeping excess horses on the range, as well as direct economic costs, have not yet been calculated for comparison

A Dynamic Process Model of Private Politics: Activist Targeting and Corporate Receptivity to Social Challenges

This project explores whether and how corporations become more receptive to social activist challenges over time. Drawing from social movement theory, we suggest a dynamic process through which contentious interactions lead to increased receptivity. We argue that when firms are chronically targeted by social activists, they respond defensively by adopting strategic management devices that help them better manage social issues and demonstrate their normative appropriateness. These defensive devices have the incidental effect of empowering independent monitors and increasing corporate accountability, which in turn increase a firm’s receptivity to future activist challenges. We test our theory using a unique longitudinal dataset that tracks contentious attacks and the adoption of social management devices among a population of 300 large firms from 1993 to 2009

Is the perception of time pressure a barrier to healthy eating and physical activity among women?

Objectives To describe the proportion of women reporting time is a barrier to healthy eating and physical activity, the characteristics of these women and the perceived causes of time pressure, and to examine associations between perceptions of time as a barrier and consumption of fruit, vegetables and fast food, and physical activity.Design A cross-sectional survey of food intake, physical activity and perceived causes of time pressure.Setting A randomly selected community sample.Subjects A sample of 1580 women self-reported their food intake and their perceptions of the causes of time pressure in relation to healthy eating. An additional 1521 women self-reported their leisure-time physical activity and their perceptions of the causes of time pressure in relation to physical activity.Results Time pressure was reported as a barrier to healthy eating by 41 % of the women and as a barrier to physical activity by 73 %. Those who reported time pressure as a barrier to healthy eating were significantly less likely to meet fruit, vegetable and physical activity recommendations, and more likely to eat fast food more frequently.Conclusions Women reporting time pressure as a barrier to healthy eating and physical activity are less likely to meet recommendations than are women who do not see time pressure as a barrier. Further research is required to understand the perception of time pressure issues among women and devise strategies to improve women’s food and physical activity behaviours

Mathematical modelling of tissue-engineering angiogenesis

We present a mathematical model for the vascularisation of a porous scaffold following implantation in vivo. The model is given as a set of coupled non-linear ordinary differential equations (ODEs) which describe the evolution in time of the amounts of the different tissue constituents inside the scaffold. Bifurcation analyses reveal how the extent of scaffold vascularisation changes as a function of the parameter values. For example, it is shown how the loss of seeded cells arising from slow infiltration of vascular tissue can be overcome using a prevascularisation strategy consisting of seeding the scaffold with vascular cells. Using certain assumptions it is shown how the system can be simplified to one which is partially tractable and for which some analysis is given. Limited comparison is also given of the model solutions with experimental data from the chick chorioallantoic membrane (CAM) assay

Evaluation of the Impacts of Radio-Marking Devices on Feral Horses and Burros in a Captive Setting

Radio-collars and other radio-marking devices have been invaluable tools for wildlife managers for \u3e40 years. These marking devices have improved our understanding of wildlife spatial ecology and demographic parameters and provided new data facilitating model development for species conservation and management. Although these tools have been used on virtually all North American ungulates, their deployment on feral horses (Equus ferus caballus) or burros (E. asinus) has been limited. To determine if radio-collars and radio-tags could be safely deployed on feral equids, we conducted a 1-year observational study in 2015 to investigate fit and wear of radio-collars on feral horses and burros kept in pastures/pens at the Bureau of Land Management contracted adoption facility in Pauls Valley, Oklahoma, USA. We assessed the impact of radio-collars and transmitter tags on individual behavior, body condition, and evaluated neck surface for effects. We tested 2 radio-collar shapes (teardrop and oval) and a radio-tag (i.e., avian backpack) braided into the mane and tail of horses. Behavior of mares did not differ between radio-collared (n = 12) and control (uncollared; n = 12) individuals. Despite the small sample size, collared burro jennies (n = 4) spent more time standing than controls (n = 4). Stallions wearing radio-collars (n = 9) fed less, moved less, and stood more than controls (n = 8). During the study, we did not detect injuries to the necks of mares or burro jennies, but stallions developed small sores (that healed while still wearing radio-collars and re-haired within 3 months). Two radio-collars occasionally flipped forward over the ears onto the foreheads of stallions. Although our study confirmed that radio-collars could be safely deployed on captive mares and jennies, stallions proved challenging for a variety of reasons. While our conclusions were optimistic, longer studies will be required to ensure radio-collar safety on free-ranging feral horses and burros

Research and Analysis of Fisheries in Illinois F-69-R (32) Final Performance Report July 1, 2018 – June 30, 2019

Fisheries managers are charged with understanding the interaction between sport fish populations and anglers to inform resource management decision making that supports and promotes healthy fisheries. Fundamental to this mission is easy access to long-term fisheries data, analytical tools and metrics that offer insight into the quality of a fishery, and an understanding of the factors that influence fish population dynamics. Equally important is the need to communicate this scientific knowledge and promote angling opportunities to the public. Project F-69-R has four overall goals: (1) conduct a variety of surveys and investigations that elucidate patterns of variation in sport fish populations and the mechanisms that drive those patterns, (2) evaluation methodologies used to collect fisheries data and inform sampling strategies; (3) communicate research findings and basic assessments of sport fish populations to the angling public, and (4) organize, manage, analyze and deliver sport fisheries data to researchers, sport fish managers, and the angling public. Basic and applied research studies, public outreach efforts, and data management activities all work in concert to create a better understanding of the restoration and conservation needs of sport fish populations in Illinois. Surveys and investigations completed in Segment 32 were executed under Study 1, Study 2, and Study 3. Summarized below, these studies were focused on three areas of sport fish restoration and management. First, a series of six experiments investigating the status and trends of Ancient Sport Fishes (Gars, and Bowfin) were conducted statewide, detailing age and growth methodology; spatial ecology and genetic relatedness; population vital rates; and bowfishing tournament harvest. Second, one experiment investigating the influence of on the heritability of lure avoidance were conducted, providing further evidence of the role angling vulnerability plays in fishing quality. Third, an evaluation of patterns in age and growth of walleye, sauger and their hybrids was initiated on several impoundments in east central Illinois. Evaluation of sampling methods initiated under Study 4 focuses on an evaluation of incorporating a fixed/random sample design into fisheries assessments in Illinois impoundments. Specifically, habitat and bathymetric assessments of study lakes were initiated, to be followed by data simulations utilizing sport fish data sets managed under Study 5. Sport fish data sets are the building blocks that support research studies and outreach activities within Project F-69-R, making the collaborative collection, organization, analysis, and dissemination of sport fish information a critical component of the overall goals of this project. In Study 5, project personnel collaborated with the Illinois Department of Natural Resources to efficiently collect and manage data that reflects the status and trends in sport fish populations in Illinois and organizes that information in such a way that the needs of all data users can be more efficiently met. An online permit application system for fishing tournaments throughout Illinois 6 has been met with great success regarding its ease of use and generation of important data for researchers and managers. A new online data portal accessible by IDNR Division of Fisheries that integrates the Hatchery Information Management System (HIMS) and the assessment data system METRICS has been developed. Informed by repeated consultations with system users in the last segment, the new I Fish Data Portal is scheduled for launch in the first quarter of Segment 33. Achieving this significant landmark supports a transition toward placing more data management responsibility with the IDNR Division of Fisheries, while maintaining collaborative access to data for use in Project surveys and investigations. Outreach activities under Study 6 primarily consist of the maintenance of the website www.ifishillinois.org. The website is a heavily visited, popular resource for anglers seeking information about sport fishing opportunities in Illinois. The site provides basic information about access, as well as science-based assessments about the quality of sport fishing in Illinois waters. Through Study 6 we are able to communicate the results of sport fish research and analysis, delivering state-of-the-art information to researchers, managers, and the angling public. Social media will continue to be utilized to promote and share information about sport fishing opportunities throughout Illinois. The website, social media, and public outreach activities are essential to sharing public data and information about sport fish populations and management in Illinois. The importance and value of Project F-69-R lies in the ability to be responsive to emerging sport fish management issues through research studies utilizing long-term sport fish data sets, followed by compelling and salient communications of those findings to the angling public. The Executive Summary provides a brief overview of the accomplishments of each job within the project, followed by a more detailed reporting of the specific procedures, findings and recommendations for future activities under this project.Illinois Department of Natural Resources, Federal Aid in Fisheries Restoration F-69-R (32)unpublishednot peer reviewedOpe

Musculoskeletal impairments after critical illness: a protocol for a qualitative study of the experiences of patients, family and health care professionals

Background: Survivors of critical care are at risk of long-term disability from musculoskeletal (MSK) impairments. These can have a biopsychosocial impact on the patient and their families with a reduction in health-related quality of life, increased health care utilization, caregiving roles and associated psychological distress. Aims: To understand the experiences of patients living with MSK impairments following critical illness, and family and health care professionals supporting them, to inform the development of a future intervention to improve MSK health following critical illness. Study Design: A four-site qualitative case study approach will be taken, with each of the four hospital sites and associated community services representing a case site. We will conduct semi-structured interviews with 10–15 patients/family members and 10–15 health care professionals about their experiences of MSK impairment following critical illness. Interviews will be audio recorded, transcribed verbatim and analysed using reflexive thematic analysis within a descriptive phenomenological approach. Alongside interview data, analysis of publicly available policy documentation, patient-facing materials and information from service leads at the four sites will be conducted. Discourse analysis will be used for this case study documentation. Results: This protocol describes a qualitative study exploring the experiences of patients living with MSK impairments following critical illness, and the family and health care professionals supporting them. Relevance to Clinical Practice: Data analysis will illuminate their experiences and enable data richness to contribute to the qualitative body of evidence of intensive care unit (ICU) survivors. These findings will inform the development of a complex intervention for MSK rehabilitation after critical illness

Does probiotic consumption reduce antibiotic utilization for common acute infections? A systematic review and meta-analysis.

BackgroundOverall reduction of antibiotic use is a widely adopted public health goal. Given evidence that consuming probiotics reduce the incidence, duration and/or severity of certain types of common acute infections, we hypothesized that probiotics are associated with reduced antibiotic use. This systematic review of randomized controlled trials (RCTs) assessed the impact of probiotic supplementation (any strain, dose or duration), compared to placebo, on antibiotic utilization for common, acute infections in otherwise healthy people of all ages.MethodsWe searched 13 electronic databases including MEDLINE, Embase and CENTRAL from inception to 17th January 2017. Backward and forward citation searches were also conducted. Two reviewers independently selected studies for inclusion and extracted study data. We assessed risk of bias for individual studies using criteria adapted from the Centre for Reviews and Dissemination, and the quality of evidence for each outcome was assessed using the GRADE system. Studies that evaluated similar outcomes were pooled statistically in meta-analyses using a random-effects model.ResultsWe screened 1533 citations, and of these, 17 RCTs met our predefined inclusion criteria. All 17 were conducted in infants and/or children with a primary aim of preventing acute respiratory tract infections, acute lower digestive tract infections or acute otitis media. Included studies used 13 probiotic formulations, all comprising single or combination Lactobacillus and Bifidobacterium delivered in a range of food or supplement products. Mean duration of probiotic supplementation ranged from 4 days to 9 months. Trial quality was variable. Meta-analysis demonstrated that infants and children who received probiotics to prevent acute illnesses had a lower risk of being prescribed antibiotics, relative to those who received placebo (Pooled Relative Risk = 0.71, 95% CI: 0.54-0.94). When restricted to five studies with a low risk of bias, the pooled relative risk was 0.46 (95% CI: 0.23-0.97). Significant statistical heterogeneity was present in effect size estimates, which appeared to be due to one trial which could partly be considered as an outlier.ConclusionsProbiotics, provided to reduce the risk for common acute infections, may be associated with reduced antibiotic use in infants and children. Additional well-designed studies are needed to substantiate these findings in children and explore similar findings in other population groups