Evidence from the 2001 English Census on the contribution of employment status to the social gradient in self-rated health

Background Unemployment and economic inactivity are associated with poor health. There are social gradients in unemployment and economic inactivity, so it was hypothesised that they may contribute to the social gradient in self-rated health. Methods Data on employment status, socio-economic position (SEP) and self-rated heath were obtained for people of working age (25–59) who had ever worked from a 3% sample of the 2001 English census. The age-adjusted prevalence differences in poor general health for four separate measures of SEP were compared with the prevalence differences obtained after additional adjustment for employment status. Results Prevalence differences for poor health were reduced by 50% or over when adjusting for employment status (for men ranging from 57% to 81%, for women 50% to 74%). Discussion The social gradient in employment status contributes greatly to the social gradient in self-reported health. Understanding why this is the case could be important for tackling social inequalities in health

Visualising and quantifying 'excess deaths' in Scotland compared with the rest of the UK and the rest of Western Europe

BACKGROUND: Scotland has higher mortality rates than the rest of Western Europe (rWE), with more cardiovascular disease and cancer among older adults; and alcohol-related and drug-related deaths, suicide and violence among younger adults. METHODS: We obtained sex, age-specific and year-specific all-cause mortality rates for Scotland and other populations, and explored differences in mortality both visually and numerically. RESULTS: Scotland's age-specific mortality was higher than the rest of the UK (rUK) since 1950, and has increased. Between the 1950s and 2000s, 'excess deaths' by age 80 per 100 000 population associated with living in Scotland grew from 4341 to 7203 compared with rUK, and from 4132 to 8828 compared with rWE. UK-wide mortality risk compared with rWE also increased, from 240 'excess deaths' in the 1950s to 2320 in the 2000s. Cohorts born in the 1940s and 1950s throughout the UK including Scotland had lower mortality risk than comparable rWE populations, especially for males. Mortality rates were higher in Scotland than rUK and rWE among younger adults from the 1990s onwards suggesting an age-period interaction. CONCLUSIONS: Worsening mortality among young adults in the past 30 years reversed a relative advantage evident for those born between 1950 and 1960. Compared with rWE, Scotland and rUK have followed similar trends but Scotland has started from a worse position and had worse working age-period effects in the 1990s and 2000s

To What Extent Do Financial Strain and Labour Force Status Explain Social Class Inequalities in Self-Rated Health? Analysis of 20 Countries in the European Social Survey

Introduction: Nordic countries do not have the smallest health inequalities despite egalitarian social policies. A possible explanation for this is that drivers of class differences in health such as financial strain and labour force status remain socially patterned in Nordic countries. Methods: Our analyses used data for working age (25?59) men (n=48,249) and women (n=52,654) for 20 countries from five rounds (2002?2010) of the European Social Survey. The outcome was self-rated health in 5 categories. Stratified by gender we used fixed effects linear regression models and marginal standardisation to instigate how countries varied in the degree to which class inequalities were attenuated by financial strain and labour force status. Results and Discussion: Before adjustment, Nordic countries had large inequalities in self-rated health relative to other European countries. For example the regression coefficient for the difference in health between working class and professional men living in Norway was 0.34 (95% CI 0.26 to 0.42), while the comparable figure for Spain was 0.15 (95% CI 0.08 to 0.22). Adjusting for financial strain and labour force status led to attenuation of health inequalities in all countries. However, unlike some countries such as Spain, where after adjustment the regression coefficient for working class men was only 0.02 (95% CI 2 0.05 to 0.10), health inequalities persisted after adjustment for Nordic countries. For Norway the adjusted coefficient was 0.17 (95% CI 0.10 to 0.25). Results for women and men were similar. However, in comparison to men, class inequalities tended to be stronger for women and more persistent after adjustment. Conclusions: Adjusting for financial security and labour force status attenuates a high proportion of health inequalities in some counties, particularly Southern European countries, but attenuation in Nordic countries was modest and did not improve their relative position

Capacitor performance limitations in high power converter applications

Background: Over the last 80 years the association between social class and obesity has changed. In the 1930s obesity rates were low and wealthy people tended to have a higher risk of obesity than poor people. However, rising affluence and industrialisation has lead to both rising rates of obesity and an obesogenic environment in which socioeconomically disadvantaged people have the highest risk of obesity. This study investigates the magnitude of these changes by modelling trajectories of adiposity by social class and cohort using the Twenty-07 study. Methods: The Twenty-07 study contains three cohorts of people (n = 4510), born in Glasgow in the 1930s, 1950s and 1970s. Two measures of adiposity, BMI and Waist to Height Ratio (WHtR), were recorded at baseline in 1987/8 when study participants were aged 15, 35 or 55, and again on 4 further occasions over 20 years. Parental social class (manual/non-manual) was collected at baseline. For each gender, we apply multilevel models to identify trajectories of adiposity by cohort and social class. Results: The trajectories indicated that adiposity increased with age and rates of increase varied by cohort, social class and gender. For any given age the youngest cohort had the fastest rate of increase and the highest predicted adiposity. For example, at age 35 for non-manual men, BMI was 24.2 (95% CI 23.7, 24.8) for the 1950s cohort and 27.2 (26.8, 27.5) for the 1970s cohort. By the end of the study respondents in more recent cohorts had BMI values approximately equivalent to those of people aged 20 years older in an earlier cohort. Cohort variation was much greater than socioeconomic variation. The smallest cohort difference in BMI was 2.10 (0.94, 3.26), a comparison of the 1950 and 1930s cohorts for non-manual men at age 55. In contrast, the largest social class difference in BMI, a comparison of manual and non manual women at age 64, was only 1.18 (0.37, 1.98). Socioeconomic inequalities tended to be smaller for men than women, particularly for the 1930s cohort where there was no evidence of a socioeconomic gradient for men unlike for women. The main difference between WHtR and BMI was that increases in WHtR accelerated with age whilst increases in BMI slowed with age. Conclusion: Increases in adiposity for younger cohorts across all socioeconomic groups dwarf any socioeconomic inequalities in adiposity. This highlights the damaging impact for the whole population of living in an obesogenic environment

Defining health and health inequalities

Objectives: To examine existing definitions of health and health inequalities and to synthesise the most useful of these using explicit rationale and the most parsimonious text. Study design: Literature review and synthesis. Methods: Existing definitions of health and health inequalities were identified, and their normative properties were extracted and then critically appraised. Using explicit reasoning, new definitions, synthesising the most useful aspects of existing definitions, were created. Results: A definition of health as a structural, functional and emotional state that is compatible with effective life as an individual and as a member of society and a definition of health inequalities as the systematic, avoidable and unfair differences in health outcomes that can be observed between populations, between social groups within the same population or as a gradient across a population ranked by social position are proposed. Population health is a less commonly used term but can usefully be defined to encompass the average, distribution and inequalities in health within a society. Conclusions: Clarifying what is meant by the terms health and health inequalities, and the assumptions, emphasis and values that different definitions contain, is important for public health research, practice and policy

Disabling Travel: Quantifying the Harm of Inaccessible Hotels to Disabled People

During its 2023–2024 term, the U.S. Supreme Court will decide a case with significant implications for the future of the Americans with Disabilities Act (ADA). In Acheson Hotels v. Laufer, the Court will determine whether a civil rights “tester” plaintiff has Article III standing to sue a hotel for failing to provide information about the hotel’s accessibility online — in violation of Department of Justice (DOJ) regulations applying the ADA’s requirement of “reasonable modifications in policies, practices, or procedures” — when the plaintiff did not intend to book a hotel reservation. Plaintiff-Respondent Deborah Laufer has not only challenged the failure of Acheson Hotels to provide required information, but has also filed over 600 similar lawsuits, showcasing system-wide violations of the ADA’s “Reservation Rule.” The Reservation Rule (“the Rule”), promulgated in 2010, requires hotels to make accessibility information available “through [their] reservations service[s] in enough detail to reasonably permit individuals with disabilities to assess independently whether a given hotel or guest room meets his or her accessibility needs.” The Rule also requires hotels to deliver accessible rooms in the same manner and during the same hours as inaccessible rooms, to hold accessible rooms for individuals with disabilities, and to guarantee that an accessible room reservation is held for the reserving customer. Among the motivations for the Rule’s passage were widespread complaints related to accessibility in the hotel reservation process. During the Rule’s notice and comment period, which began in 2008, industry representatives advocated for language that required hotels to treat disabled individuals in “a substantially similar manner” to nondisabled guests; the Department did not accept this suggested language, and the Rule instead requires hotels to treat disabled individuals “in the same manner” as nondisabled individuals. Hotels had an 18-month transition period to implement the changes. The American Society of Travel Agents, Inc. (at the time “the world’s largest association of professional travel agencies”) filed a comment with the DOJ in support of “parity in reservations policies” and explained that, to achieve that goal, hotels are best positioned to provide accurate accessibility information. Hotels’ noncompliance with Title III of the ADA, and with the Reservation Rule in particular, is pervasive, and tester plaintiffs play a key role in enforcing the law. The ADA’s enforcement scheme depends in large part on private lawsuits to compensate for the limited resources of its designated enforcement agency, the DOJ. The burdens of filing suit and obtaining injunctive relief, however, are significant for the individuals on whom the ADA relies, the very same individuals who rely on the Act for the opportunity to, as Jacobus tenBroek famously put it, “live in the world.” Because damages are unavailable for violations of the Rule, suits for injunctive relief need to be filed before a problem arises: Injunctive relief is relatively useless for those who are denied accessibility information about public accommodations. Any injunction would take effect long after the disabled traveler needed the accessibility information. These obstacles undermine the affirmative duty that the Reservation Rule places on businesses to acknowledge and account for disabled individuals before those individuals need to book their reservations. Tester litigation helps to secure the services proposed by the Reservation Rule and to deliver on the regulation’s promise of equal efficiency, immediacy, and convenience

Neutrino transport in accretion disks

We test approximate approaches to solving a neutrino transport problem that presents itself in the analysis of some accretion-disk models. Approximation #1 consists of replacing the full, angular- dependent, distribution function by a two-stream simulation, where the streams are respectively outwardly and inwardly directed, with angles $\cos \theta=\pm 1/\sqrt{3}$ to the vertical. In this approximation the full energy dependence of the distribution function is retained, as are the energy and temperature dependences of the scattering rates. Approximation #2, used in recent works on the subject, replaces the distribution function by an intensity function and the scattering rates by temperature-energy-averaged quantities. We compare the approximations to the results of solving the full Boltzmann equation. Under some interesting conditions, approximation #1 passes the test; approximation #2 does not. We utilize the results of our analysis to construct a toy model of a disc at a temperature and density such that relativistic particles are more abundant than nucleons, and dominate both the opacity and pressure. The nucleons will still provide most of the energy density. In the toy model we take the rate of heat generation (which drives the radiative transfer problem) to be proportional to the nucleon density. The model allows the simultaneous solution of the neutrino transport and hydrostatic equilibrium problems in a disk in which the nucleon density decreases approximately linearly as one moves from the median plane of the disk upwards, reaching zero on the upper boundary.Comment: 8 pages, 5 figures Parentheses added in eqs. 10-1

High efficiency of soft X-ray radiation reprocessing in supersoft X-ray sources due to multiple scattering

Detailed analysis of the lightcurve of CAL 87 clearly has shown that the high optical luminosity comes from the accretion disc rim and can only be explained by a severe thickening of the disc rim near the location where the accretion stream impinges. This area is irradiated by the X-rays where it faces the white dwarf. Only if the reprocessing rate of X-rays to optical light is high a luminosity as high as observed can be understood. But a recent detailed study of the soft X-ray radiation reprocessing in supersoft X-ray sources has shown that the efficiency is not high enough. We here propose a solution for this problem. As already discussed in the earlier lightcurve analysis the impact of the accretion stream at the outer disc rim produces a ``spray'', consisting of a large number of individual gas blobs imbedded in a surrounding corona. For the high mass flow rate this constitutes an optically thick vertically extended screen at the rim of the accretion disc. We analyse the optical properties of this irradiated spray and find that the multiple scattering between these gas blobs leads to an effective reprocessing of soft X-rays to optical light as required by the observations.Comment: 7 pages, 6 figures, accepted for publication in A&