Search

Nearly 100 years ago, the philosopher and mathematician Bertrand Russell warned of the social dangers of widespread envy. One view of modern society is that it is systematically developing a set of institutions -- such as social media and new forms of advertising -- that make people feel inadequate and envious of others. If so, how might that be influencing the psychological health of our citizens? This paper reports the first large-scale longitudinal research into envy and its possible repercussions. The paper studies 18,000 randomly selected individuals over the years 2005, 2009, and 2013. Using measures of SF-36 mental health and psychological well-being, four main conclusions emerge. First, the young are especially susceptible. Levels of envy fall as people grow older. This longitudinal finding is consistent with a cross-sectional pattern noted recently by Nicole E. Henniger and Christine R. Harris, and with the theory of socioemotional regulation suggested by scholars such as Laura L. Carstensen. Second, using fixed-effects equations and prospective analysis, the analysis reveals that envy today is a powerful predictor of worse SF-36 mental health and well-being in the future. A change from the lowest to the highest level of envy, for example, is associated with a worsening of SF-36 mental health by approximately half a standard deviation (p < .001). Third, no evidence is found for the idea that envy acts as a useful motivator. Greater envy is associated with slower -- not higher -- growth of psychological well-being in the future. Nor is envy a predictor of later economic success. Fourth, the longitudinal decline of envy leaves unaltered a U-shaped age pattern of well-being from age 20 to age 70. These results are consistent with the idea that society should be concerned about institutions that stimulate large-scale envy. [ABSTRACT FROM AUTHOR]

Neighborhood socioeconomic status (SES) and greenspace can affect respiratory health. However, it is unclear whether effects of neighborhood SES and greenspace on respiratory health still exist regardless of temperature variations. This paper conducted a two-stage, age-stratified case time-series study. The first goal is to examine the associations between two temperature metrics (daily mean temperature [DMT] and diurnal temperature range [DTR]) and respiratory emergency department (ED) visits among four age groups in New York City. The second goal is to evaluate whether neighborhood SES and greenspace would be determinants of respiratory ED visits independent from temperature varying factors. A distributed lag nonlinear model was applied on ED data from 135 zip codes (October 2016 - February 2020). Our first-stage analysis indicated that older adults aged 65+ had higher risk of ED visits (RR=2.78, 95% eCI: 2.41, 3.22; with 7 days of lag) on days with low DMT (-10 °C), followed by adults aged 18-64 (RR=2.48, 95% eCI: 2.32, 2.65), children and youth aged 5-17 (RR=1.38, 95% eCI: 1.24, 1.53), and young children aged 0-4 (RR=1.04, 95% eCI: 0.96, 1.13). However, no excess respiratory ED visits were observed on days with high DMT (30 °C). Higher DTR was associated with higher risk, with children and youth more susceptible when DTR was high (DTR 20 °C; RR=5.70, 95% eCI: 3.42, 9.49; with 7 days of lag). The second-stage analysis indicated neighborhood SES and greenspace had significant associations with respiratory ED visits regardless of temperature variations. Specifically, Higher income and greenspace exposure were negatively associated with ED visits among all age groups. Neighborhood SES and greenspace could affect respiratory morbidity regardless of weather conditions. Daily temperature variations accelerated the short-term risk among population subgroups under different weather conditions (e.g., higher risk of days with low DMT among older adults, higher risk of days with high DTR among children and youth aged 5-17), which could create co-effects with neighborhood SES and greenspace on respiratory health. • Respiratory ED visit was significantly associated with both DMT and DTR. • Older adults more vulnerable to low DMT (RR=2.78, 95% eCI: 2.41, 3.22). • Youth aged 5-17 more vulnerable to high DTR (RR=5.70, 95% eCI: 3.42, 9.49). • SES and greenspace associated with respiratory ED visit regardless of temperature. • Intracity examination of impacts of DMT and DTR on health allows local actions. [ABSTRACT FROM AUTHOR]

Census-based deprivation indices have been widely used in Aotearoa/New Zealand, Canada and UK to measure area-based socio-economic inequalities. This paper examines the indicators used in census-based area deprivation indices using a political ecology approach. We question whether the current indicators of deprivation derived from census data are meaningful for the all age groups and minority groups in the population, with a particular focus on deprivation indicators used in New Zealand, Canada and the United Kingdom. We comparatively reviewed methodological papers and reports that describe the indicators of deprivation in Aotearoa/New Zealand, Canada and the UK from 1975 to 2014. We consider the relationship between the notion of standards of living and measurements of deprivation and explore how hegemonic cultural constructs are implicit in measures of deprivation that privilege a Eurocentric, ageist and gender normative construction of statistics. We argue for more political ecological analyses to studying the relationship between social inequalities, geographies, health inequities and political economy to transform structures of oppression and inequality. This requires turning the analytical gaze on the wealthy and privileged instead of defaulting into deficit models to account for inequality. Studies of deprivation and inequality would benefit from understanding the processes and operations of power in the (re)production of socio-economic and health inequities to inform holistic strategies for social justice. [ABSTRACT FROM AUTHOR]

In the context of the escalating burden of diabetes in low and middle-income countries (LMICs), there is a pressing concern about the widening disparities in care and outcomes across socioeconomic groups. This paper estimates health poverty measures among individuals with type 2 diabetes mellitus (T2DM) in Malaysia. Using data from the National Diabetes Registry between 2009 and 2018, the study linked 932,855 people with T2DM aged 40–75 to death records. Cox proportional hazards models were used to estimate the 5-year survival probabilities for each patient, stratified by age and sex, while controlling for comorbidities and area-based indicators of socio-economic status (SES), such as district-level asset-based indices and night-time luminosity. Measures of health poverty, based on the Foster-Greer-Thorbecke (FGT) measures, were employed to capture excessive risk of premature mortality. Two poverty line thresholds were used, namely a 5% and 10% reduction in survival probability compared to age and sex-adjusted survival probability of the general population. Counterfactual simulations estimated the extent to which comorbidities contribute to health poverty. 43.5% of the sample experienced health poverty using the 5% threshold, and 8.9% were health poor using the 10% threshold. Comorbidities contribute 2.9% for males and 5.4% for females, at the 5% threshold. At the 10% threshold, they contribute 7.4% for males and 3.4% for females. If all patients lived in areas of highest night-light intensity, poverty would fall by 5.8% for males and 4.6% for females at the 5% threshold, and 4.1% for males and 0.8% for females at the 10% threshold. In Malaysia, there is a high incidence of health poverty among people with diabetes, and it is strongly associated with comorbidities and area-based measures of SES. Expanding the application of health poverty measurement, through a combination of clinical registries and open spatial data, can facilitate simulations for health poverty alleviation. • Novel health poverty measures applied to T2DM in Malaysia using early mortality risk. • Administrative dataset comprising 1M adults combined with death records and SES. • Male gender, older age and area deprivation drive health poverty. • Nighttime luminosity reveals regional patterns in health poverty. • Combining luminosity data and medical datasets enhances risk stratification in LMICs. [ABSTRACT FROM AUTHOR]

The last two decades have seen growing unease regarding the negative health consequences of increasing levels of physical inactivity, both in the UK and further afield. Public health initiatives and interventions aimed at increasing levels of physical activity have, therefore, become somewhat commonplace. Within the current context of demographic change, with growing numbers of older adults and evidence that inactivity increases with age, these initiatives hold particular relevance to mid and later-life adults. Yet despite their prevalence, the policy gains from such promotional efforts have typically been modest at best, demonstrating the limits to decontextualized health messages that encourage people to 'sit less', 'move more' or 'move faster'. In this paper, we draw on the concept of rhythm, to provide an original contribution in response to recent calls to rethink existing approaches to physical activity in mid-life and beyond. We draw from three qualitative data sets from separate studies exploring health, wellbeing and ageing (two in the context of chronic health conditions and sensory impairments). Inspired by facet methodology, we advance knowledge by providing 'flashes of insight' into the subtle patterns and tempos that frame physical activity in mid and later life. In doing so, we offer alternative insight into how people avail themselves to, and experience motion and stillness during these life stages. That alternative, as we also note, has an important role to play in the development of appropriate, relatable health messages regarding movement that recognises 'expertise by experience'. • Instructions to simply 'move more' can overlook the impact of context on PA. • Experiences of physical activity are shaped by numerous rhythmic flows. • Rhythm provides new ways of understanding PA in mid-later life. [ABSTRACT FROM AUTHOR]

Abstract Previous research findings across a variety of nations show that affiliation with the conservative party is associated with greater longevity; however, it is thus far unclear what characteristics contribute to this relationship. We examine the political party/mortality relationship in the United States context. The goal of this paper is two-fold: first, we seek to replicate the mortality difference between Republicans and Democrats in two samples, controlling for demographic confounders. Second, we attempt to isolate and test two potential contributors to the relationship between political party affiliation and mortality: (1) socioeconomic status and (2) dispositional traits reflecting a personal responsibility ethos, as described by the Republican party. Graduate and sibling cohorts from the Wisconsin Longitudinal Study were used to estimate mortality risk from 2004 to 2014. In separate Cox proportional hazards models controlling for age and sex, we adjusted first for markers of socioeconomic status (such as wealth and education), then for dispositional traits (such as conscientiousness and active coping), and finally for both socioeconomic status and dispositional traits together. Clogg's method was used to test the statistical significance of attenuation in hazard ratios for each model. In both cohorts, Republicans exhibited lower mortality risk compared to Democrats (Hazard Ratios = 0.79 and 0.73 in graduate and sibling cohorts, respectively [p < 0.05]). This relationship was explained, in part, by socioeconomic status and traits reflecting personal responsibility. Together, socioeconomic factors and dispositional traits account for about 52% (graduates) and 44% (siblings) of Republicans' survival advantage. This study suggests that mortality differences between political parties in the US may be linked to structural and individual determinants of health. These findings highlight the need for better understanding of political party divides in mortality rates. Highlights • Republicans have greater longevity compared to Democrats, adjusting for demographics. • This relationship is partly explained by Republican's higher socioeconomic status. • This relationship is partly explained by Republican's personal responsibility ethos. [ABSTRACT FROM AUTHOR]

The Delta-Omicron wave of the COVID-19 pandemic (Wave 4) in the United States occurred in Fall of 2021 through Spring of 2022. Although vaccinations were widely available, this was the deadliest period to date in the U.S., and the toll was especially high in rural areas, exacerbating an existing rural mortality penalty. This paper uses county-level multilevel regression models and publicly available data for 47 U.S. states and the District of Columbia. We describe differences in COVID-19 case and mortality rates across the rural-urban continuum during Wave 4 of the COVID-19 pandemic. Using a progressive modeling approach, we evaluate the relative contribution of a range of explanatory factors for the rural disadvantage we observe, including: pre-pandemic population health composition, vaccination rates, political partisanship, socioeconomic composition, access to broadband internet rate, and primary care physicians per capita. Results show that rural counties had higher observed burdens of cases and deaths in Wave 4 compared to more urban counties. The most remote rural counties had Wave 4 COVID-19 mortality rates 52% higher than the most urban counties. Older age composition, worse pre-pandemic population health, lower vaccination rates, higher share of votes cast for Donald Trump in the 2020 Presidential election, and lower socioeconomic composition completely explained the rural disadvantage in reported COVID-19 case rates in Wave 4, and accounting for these factors reversed the observed rural disadvantage in COVID-19 mortality. In models of mortality rate, Trump vote share had the largest effect size, followed by the percentage of the population age 50 or older, the poverty rate, the pre-pandemic mortality rate, the share of residents with a 4-year college degree, and the vaccination rate. These findings add to a growing literature describing the disproportionate toll of the COVID-19 pandemic on rural America, highlighting the combined effect of multiple sources of rural disadvantage. • Rural counties had higher case and death rates in the Delta-Omicron wave. • Rural counties had up to 51% more deaths per capita than the most urban counties. • Age, health, and SES composition partially explained the rural disadvantage. • Vaccination and Trump vote share were separate factors in the rural disadvantage. • Multiple sources of disadvantage combined in rural areas to produce poor outcomes. [ABSTRACT FROM AUTHOR]

This paper uses a survival analysis technique to examine socio-economic and demographic factors that influence under-five mortality for rural and urban Ghana. The paper employs the Breslow Method for Ties for survival probability and uses data for the 2014 Ghana Demographic and Health Survey (GDHS). Data on some 5884 children was also generated through the interview of 4086 women aged 15–49. They indicated the birth histories of the children under five years. The study finds the most significant socio-economic determinants of a child survival in Ghana to be maternal age, mother's education, household wealth index quintile, place of delivery and birth order. The influence of these determinants on child survival differ from urban to rural. The survival probabilities of these explanatory variables are different in the rural area from the urban area. Therefore, it is imperative to scale up efforts in the rural area to ensure children live up to age five. • The determining factors of under-five mortality are maternal age, mother's education and wealth. • Other factors of child survival are place of delivery and birth order. • The child survival probabilities are different from rural to urban Ghana. • Immunization, Breastfeeding, Gender, and Birth weight were not statistically significant. • The study is limited by the lack of information about unwanted children. [ABSTRACT FROM AUTHOR]

Abstract This paper seeks to extend prior research by exploring whether family structure transition is associated with an increase in early alcohol consumption and whether this association is mediated by; children's socio-emotional problems, providing information on whether the effects of the transition; differ according to the number of changes, the family's initial status, or the time of exposure. The; data have been drawn from the UK Millennium Cohort Study to explore associations framed with; a life-course approach. Our findings suggest that types of family transitions (such as distinguishing; parental exits from and parental entrances to the family) are more important than the number of; family changes during childhood. The results show that moving from a two-parent household to a single-parent household directly increased the probability of being a frequent alcohol consumer among early adolescent boys, whereas the indirect effect on girls was found via socio-emotional difficulties. Our findings also show an increase in socio-emotional and behavioural difficulties in boys due to the entrance of a step-parent only if the transition occurred in the earliest childhood. Indeed, a sensitivity analysis of the time to which the children were exposed to the transition to a new family structure showed stronger effects for those who experienced a family structure change in the early life course, consistent with the cumulative disadvantage process. Highlights • Types are more important than the number of family changes during childhood. • Moving into a single-parent household is directly associated with boys'drinking. • Moving into a single-parent family is associated with girls' drinking via SDQ. • Moving into a stepfamily in the earliest childhood increased SDQ in boys. [ABSTRACT FROM AUTHOR]

A source of debate in the health care priority setting literature is whether to weight health gains to account for equity considerations, such as concern for those with very short life expectancy. This paper reviews the empirical evidence in the published social sciences literature relevant to the following research question: do members of the public wish to place greater weight on a unit of health gain for end-of-life patients than on that for other types of patients? An electronic search of the Social Sciences Citation Index for articles published until October 2017 was conducted, with follow-up of references to obtain additional data. Hierarchical criteria were applied to select empirical studies reporting stated preferences relating to hypothetical health care priority setting contexts. Twenty-three studies met the inclusion criteria and were included in the review. Choice exercises were the most common method used to elicit preferences; other approaches included budget allocation, person trade-off and willingness-to-pay. Some studies found that observed preferences regarding end-of-life patients are influenced by information about the patients' ages. Overall, the evidence is mixed, with eight studies that report evidence consistent with a ‘premium’ for end-of-life treatments and 11 studies that do not. Methodological and design aspects that appear to influence the findings of end-of-life-related preference studies are identified and discussed. The findings of the UK studies have particular relevance for assessing the legitimacy of the National Institute for Health and Care Excellence's policy for appraising life-extending end-of-life treatments. [ABSTRACT FROM AUTHOR]

The study of spatial accessibility to healthcare services is key to health policy (Pförtner et al., 2019; Vergier et al., 2017). Terms such as 'rurality' or 'medical desertification' were employed to stress the relevance of the topic. Within the existing literature, there is little (if any) concern with the legitimacy of the existing ways to measure inequality. Expert systems were assumed to be in place, and discrepancies or consistency with existing regulations or to views of relevant stakeholders were not considered. This paper discusses spatial accessibility of medical services in three distinct approaches: normative, that is following what national regulations consider as standard; relative, that is what statistical approaches reveal; consensual, which adjusts the indexes based on representations of stakeholders. The three approaches are compared for the case of Romania, an EU country with low population density, ideal to inspect geographical discrepancies. For the relative and the consensual approach, population is adjusted according to different demand expressed by age groups, and also including population and providers from the nearby localities. The normative approach follows official regulations. The refinements in the consensual model are based on survey data from stakeholders and consider distances to neighbouring localities and adjustments according to the age structure of the population in the catchment area. The results reveal high consistency between the consensual and the relative approach. Both are more permissive with respect to detecting medical desertification as compared to the normative approach but prove to be more effective in directing policy when resources are scarce. The normative approach, however, is relevant in depicting the state of the system as contrasted to a desired standard. The relative approach also overlaps with the consensual one. Therefore, to fully characterize spatial accessibility to general practitioners (GPs) and pharmacies, one needs to consider at least the normative and the relative approaches. • Different measurements of spatial access to healthcare overlap only partly. • The relative approach proves its legitimacy. • Relative and consensual approaches better grasp areas under risk. • Normative approaches are more effective to compare to a desired standard. • A multifaceted approach to spatial accessibility is recommended. [ABSTRACT FROM AUTHOR]

Self-rated health (SRH) is arguably the most widely used generic health measurement in survey research. However, SRH remains a black box for researchers. In our paper, we want to gain a better understanding of SRH by identifying its determinants, quantifying the contribution of different health domains to explain SRH, and by exploring the moderating role of gender, age groups, and the country of residence. Using data from 61,365 participants of the fifth wave (2013) of the Survey of Health, Ageing and Retirement in Europe (SHARE) living in fifteen European countries, we explain SRH via linear regression models. The independent variables are grouped into five health domains: functioning, diseases, pain, mental health, and behavior. Via dominance analysis, we focus on their individual contribution to explaining SRH and compare these contributions across gender, three age groups, and fifteen European countries. Our model explains SRH rather well (R2 =.51 for females/.48 for males) with functioning contributing most to the appraisal (.20/.18). Diseases were the second most relevant health dimension (.14/.16) followed by pain (.08/.07) and mental health (.07/.06). Health behavior (.02/.01) was less relevant for health ratings. This ranking held true for almost all countries with only little variance overall. A comparison of age groups indicated that the contribution of diseases and behavior to SRH decreased over the life-course while the contribution of functioning to R2 increased. Our paper demonstrates that SRH is largely based on diverse health information with functioning and diseases being most important. However, there is still room for idiosyncrasies or even bias. • Self-rated health (SRH) is explained via five dimensions of health information. • Amount of explained variance by dimension is compared by gender, age group, and country. • Functioning and diseases were the most important dimensions. • Only minor differences in importance were found by gender and country. • Importance of diseases/behavior decreased with age, increased for functioning. [ABSTRACT FROM AUTHOR]

This paper uses techniques of binary logistic regression to identify the spatial determinants of the last national epidemic of smallpox to spread in England and Wales, the variola minor epidemic of 1921–34. Adjusting for age and county-level variations in vaccination coverage in infancy, the analysis identifies a dose-response gradient with increasing odds of elevated smallpox rates in local government areas with (i) medium (odds ratio [ OR ] = 5.32, 95% Confidence Interval [95% CI] 1.96–14.41) and high ( OR = 11.32, 95% CI 4.20–31.59) coal mining occupation rates and (ii) medium ( OR = 16.74, 95% CI 2.24–125.21) and high ( OR = 63.43, 95% CI 7.82–497.21) levels of residential density. The results imply that the spatial transmission of variola virus was facilitated by the close spatial packing of individuals, with a heightened transmission risk in coal mining areas of the country. A syndemic interaction between common respiratory conditions arising from exposure to coal dust and smallpox virus transmission is postulated to have contributed to the findings. We suggest that further studies of the geographical intersection of coal mining and acute infections that are transmitted via respiratory secretions are warranted. [ABSTRACT FROM AUTHOR]

While the overall impact of the COVID-19 pandemic on U.S. population health has been devastating, it has not affected everyone equally. The risks of hospitalization and death from the disease are relatively low for the population as a whole, but much higher for specific subpopulations defined by age, health status, and race or ethnicity. The extent to which Americans perceive these disparities is an open question, with potentially important political implications. Recognition of unequal impacts may prime concerns about justice and fairness, making Americans more concerned and willing to support government intervention. On the other hand, belief that the pandemic primarily threatens "other people" or out-groups may reduce, rather than increase, a person's concern. Partisanship and media consumption habits are also likely to play a role in these perceptions, as they do in most issues related to COVID-19. In this paper, we use original survey data from the Cooperative Election Study (N = 1000) to explore Americans' perceptions of which groups are most harmed by the pandemic, the demographic and political determinants of these perceptions, and the relationship of these perceptions with their opinions about COVID-related mitigation policy. We find that, on average, people perceived accurately that certain groups (e.g., Black Americans, older people) were more affected, but these group perceptions varied by demographic and political characteristics of respondents. We find, in contrast with recent experimental evidence, that the perception that populations of color were harmed was associated with more support for pandemic mitigation strategies. More research should investigate the relationships among pandemic politics and the racial dynamics of the target populations most affected. • In fall 2020, survey participants recognized groups harmed by COVID based on age. • They had lower recognition of racial groups harmed, lowest for Native Americans. • Perceptions of groups harmed varies by information exposure and politics. • Perceiving group disparities was associated with more support for pandemic policy. • The racial dynamics surrounding the politics of COVID-19 requires more attention. [ABSTRACT FROM AUTHOR]

Primary medical prevention of cardiovascular disease (CVD) has received low priority in Tanzania, despite evidence of the rising prevalence of CVD risk factors. Different guidelines have been proposed for medical CVD prevention, including the European Society of Cardiology (ESC) and the World Health Organization (WHO) guidelines, which recommend medical prevention for all individuals based on the consideration of single CVD risk thresholds. A third alternative is differentiated risk thresholds according to age. This paper compares the WHO and the differentiated risk threshold by age approaches against a baseline of no medical CVD prevention and a best scenario identical to the ESC approach in Tanzania. Assuming fixed budgets, we evaluate the guidelines according to three outcome measures, namely: efficiency, inequality and the combination of efficiency and inequality. We ran a Markov analysis for an estimated Tanzanian population at risk of CVD employing a 40 years time horizon to estimate the total expected costs and CVD deaths associated with provision of the different guidelines. The results were then used to calculate three outcomes: life expectancy at age 40 as a proxy for efficiency, the Gini coefficient (a measure of inequality), and the achievement index (which combines concerns of efficiency and inequality). Our results suggest that higher life expectancy (28.3 vs. 26.6 years) and more equally distributed health (Gini coefficient of 0.22 vs. 0.24) could be attained if medical CVD prevention was based on the differentiated risk threshold approach compared to the WHO single risk threshold, when the total cost of these approaches is the same. Preventing CVD based on differentiating risk thresholds by age seems to be the better alternative when concerns of both efficiency and inequality are considered important. However, further research on the country-specific distribution of CVD risk levels and budget impact analysis are important to assess the feasibility of its implementation. [ABSTRACT FROM AUTHOR]

Measures of health-related quality of life are important in health technology assessments, and useful when analysing health inequalities across population sub-groups. This paper provides population norms on health and wellbeing in Norway based on two waves of a comprehensive health survey: Wave 6 of The Tromsø Study conducted in 2007/08 (N = 12,981) and Wave 7 conducted in 2015/16 (N = 21,083). By use of these data, the paper aims to provide new insight on how different measures of health and wellbeing, and different indicators for socio-economic position, will affect the magnitude of a reported social gradient in health. We apply validated multi-item instruments for measuring health and subjective well-being; the health state utility instrument EQ-5D, and the satisfaction with life scale, as well as a direct valuation of health on a visual analogue scale. We apply three indicators for socio-economic position; education, occupation and household income, each measured along four levels. After descriptive statistics, regression analyses are performed separately for men and women, adjusted for age, to explain the magnitude of the social gradient along each socio-economic indicator. The social gradient in health showed a consistent positive trend, along all three socio-economic indicators; it was strongest with income, and weakest with education. When health had been valued directly on a visual analogue scale, the gradient was steeper than when valued indirectly via the EQ-5D descriptive system. The social gradient in subjective well-being also showed consistent positive trends, except with education as the socio-economic indicator. We have shown that the magnitude of the social gradient critically depends on which socio-economic indicator is used, and whether health is being measured indirectly via the EQ-5D descriptive system or directly on a visual analogue scale. The strongest gradient in subjective well-being was observed with income as the socio-economic indicator. • Inequalities in health are larger by income than by education and occupation. • Inequalities by income are larger in subjective well-being than in health. • Inequalities in health and wellbeing are slightly larger among women than men. [ABSTRACT FROM AUTHOR]

While the economic consequences of IMF programs have been extensively analyzed in the literature, much less is known about how key welfare indicators, including suicide-mortality rates, correlate with countries' participation in such programs. This paper examines the impact of IMF lending on suicide mortality, using data from 30 developing and transition countries that received non-concessionary IMF loans during 1991–2008. Our results support the hypothesis of a positive causal relationship between suicide mortality and participation in IMF programs but reveal no systematic suicide-increasing effect from the size of IMF loans. This holds after accounting for self-selection into programs, resulting from the endogeneity of a country's decision to resort to the IMF for funding, and after controlling for standard socio-economic influences on suicidal behaviour. In particular, we find a positive aggregate suicide-mortality differential due to IMF-program participation of between 4 and 14 percentage points. We also find that the positive association between suicides and program participation is stronger and more robust among males. Comparing age groups, individuals belonging to the age group 45-to-64 exhibit the highest increase in suicide due to program-participation, which amounts to over 18 percentage points. Overall, our results imply that when countries are exposed to IMF programs in an attempt to resolve their economic problems, social-safety nets need to be designed to protect the adversely-affected part of the population. [ABSTRACT FROM AUTHOR]

While China's economy has grown rapidly in recent decades, urban-rural inequalities in mental health have persisted, and depression is more prevalent among rural women. Using a nationally-representative survey data in China, this paper investigates the impact of women's off-farm employment on their depressive symptoms. Results from instrumental variable and individual fixed effects estimation show that women's participation in off-farm employment leads to a significant reduction in depressive symptoms. We further take into account the confounding effects of working conditions, and the main results are robust. Moreover, off-farm employment enhances women's mental health mainly through pathways including increased absolute income, higher self-perceived relative income, more frequent healthy behaviors, increased likelihood of health investment, and obtaining more formal social support. Further evidence suggests that the depression-reducing effect of off-farm employment is more effective for those with more severe depressive symptoms, middle-aged and elderly persons, and women with lower body mass index. The findings have important implications for preventing depressive disorders and improving mental health in China and other developing countries. • We investigate the impact of women's off-farm employment on their depressive symptoms in rural China. • Women's participation in off-farm employment leads to a significant reduction in depressive symptoms. • Formal social supports derived from workplace are important mechanisms by which employment affects depressive symptoms. • The depression-reducing effect is more effective for women with more severe symptoms and middle-aged and elderly persons. [ABSTRACT FROM AUTHOR]

Introduction Much of the work within economics attempting to understand the relationship between age and well-being has focused on the U-shape, whether it exists and, more recently, potential reasons for its existence. This paper focuses on one part of the lifecycle rather than the whole: young people. This focus offers a better understanding of the age-well-being relationship for young people, and helps with increasing general understanding regarding the U-shape itself. Method The empirical estimations employ both static and dynamic panel estimations, with the latter preferred for several reasons. Results and conclusion The empirical results are in line with the U-shape, and the results from the dynamic analysis indicate that this result is a lifecycle effect. [ABSTRACT FROM AUTHOR]

The unbalanced distribution of general practitioners (GPs) across geographic areas has been acknowledged as a problem in many countries around the world. Quantitative information regarding GPs' location decision over their lifecycle is essential in developing effective initiatives to address the unbalanced distribution and retention of GPs. This paper describes the age profile of GPs' location decision and relates it to individual characteristics. I use the Medicine in Australia: Balancing Employment and Life (MABEL) survey of doctors (2008–2012) with a sample size of 5810 male and 5797 female GPs. I employ a mixed logit model to estimate GPs' location decision. The results suggest that younger GPs are more prepared to go to rural and remote areas but they tend to migrate back to urban areas as they age. Coming from a rural background increases the likelihood of choosing rural areas, but with heterogeneity: While male GPs from a rural background tend to stay in rural and remote areas regardless of age, female GPs from a rural background are willing to migrate to urban areas as they age. GPs who obtain basic medical degrees overseas are likely to move back to urban areas in the later stage of their careers. Completing a basic medical degree at an older age increases the likelihood of working outside major cities. I also examine factors influencing GPs' location transition patterns and the results further confirm the association of individual characteristics and GPs' location–age profile. The findings can help target GPs who are most likely to practise and remain in rural and remote areas, and tailor policy initiatives to address the undesirable distribution and movement of GPs according to the identified heterogeneous age profile of their location decisions. [ABSTRACT FROM AUTHOR]

Evidence on provider payment systems that incorporate patient outcomes is limited for mental health care. In England, funding for mental health care services is changing to a prospective payment system with a future objective of linking some part of provider payment to outcomes. This research examines performance of mental health providers offering hospital and community services, in order to investigate if some are delivering better outcomes. Outcomes are measured using the Health of the Nation Outcome Scales (HoNOS) – a clinician-rated routine outcome measure (CROM) mandated for national use. We use data from the Mental Health Minimum Data Set (MHMDS) – a dataset on specialist mental health care with national coverage – for the years 2011/12 and 2012/13 with a final estimation sample of 305,960 observations with follow-up HoNOS scores. A hierarchical ordered probit model is used and outcomes are risk adjusted with independent variables reflecting demographic, need, severity and social indicators. A hierarchical linear model is also estimated with the follow-up total HoNOS score as the dependent variable and the baseline total HoNOS score included as a risk-adjuster. Provider performance is captured by a random effect that is quantified using Empirical Bayes methods. We find that worse outcomes are associated with severity and better outcomes with older age and social support. After adjusting outcomes for various risk factors, variations in performance are still evident across providers. This suggests that if the intention to link some element of provider payment to outcomes becomes a reality, some providers may gain financially whilst others may lose. The paper contributes to the limited literature on risk adjustment of outcomes and performance assessment of providers in mental health in the context of prospective activity-based payment systems. [ABSTRACT FROM AUTHOR]

The Covid-19 pandemic has affected countries and regions to varying degrees. In this paper, I examine the socioeconomic determinants of Covid-19 mortality and study whether vaccinations have affected the relationship between those determinants and Covid-19 mortality rates across local areas in England. I use monthly data for 6791 Middle Layer Super Output Areas for the period from March 2020 to April 2021 and estimate a spatial correlations model with local authority and time fixed effects. To study whether vaccinations have affected the relationship between socioeconomic determinants and Covid-19 mortality, I extend the model to include interactions between socioeconomic variables and the lagged cumulative vaccination rate. I find that Covid-19 mortality is higher in areas that have an older population, a larger share of Asian population, higher population density, lower income, poorer pre-existing health and a larger share of employment in health and social care occupations. Vaccinations have weakened the links between mortality and these socioeconomic characteristics. These findings highlight the importance of making vaccines widely available and encouraging take-up, to reduce inequality in Covid-19 mortality across socioeconomic groups. • Covid-19 mortality is higher in areas of England with an older population. • Mortality is higher in areas with a larger share of Asian population. • Mortality is higher in areas with higher population density and lower income. • Mortality is higher in areas with poorer health and more health workers. • Vaccines weaken the links between mortality and socioeconomic characteristics. [ABSTRACT FROM AUTHOR]

This study examined the context and drivers of HIV risk and vulnerability among male partners of female sex workers in Kampala, Uganda, using an "intersectional risk environment" framework. This research reports on findings from an ethnographic study (2016–2019) of men in one informal settlement in Kabalagala Parish in Kampala. This research included long-term participant observation in and around the study community. Thematic analysis was used to assess aspects of the risk environment and how it influences HIV/AIDS among male partners of female sex workers. The informal settlement context where sex work takes place is conceptualized here as a "risk environment," or a social-physical space in which risk and harm are produced (Rhodes, 2002). Risk is situated within a broader social and political structure that constrains choices and facilitates HIV risk, particularly for young, low-income men facing matrices of domination on the basis of age, gender, residence, and income. These intersectionalities guide experiences of HIV vulnerability in the risk environment, including physical, social, economic, and policy risks. This includes physical risks (population density, bar density), social risks (sex work, bar groups), economic risks (informal and low wage work), and political risks (anti-poverty laws and legislation, urban policy). These findings highlight how an intersectional risk environment is differentially experienced by young, low-income men to produce unequal HIV/AIDS outcomes. This research fills a gap in the literature on the context of HIV/AIDS among men, particularly high-risk men like male partners of female sex workers. Using this framework will improve understandings of HIV outcomes among male partners of female sex workers and will facilitate context-specific and adapted structural interventions for HIV/AIDS prevention and treatment. • Male partners of female sex workers are key in Uganda's HIV epidemic. • This paper uses an intersectional risk environment to understand HIV risk. • The risk environment includes intimate partnerships and men's bar groups. • Young men face additional risks due to unemployment and alcohol use. • Young men face higher rates of arrest due to over-policing in the community. [ABSTRACT FROM AUTHOR]

This paper examines the interrelationship between suicide, health, socioeconomic, and psychosocial factors in contributing to suicide in older adults in rural Australia. Drawing on a coronial dataset of suicide cases and a mixed methods sociological autopsy approach, our study integrated a quantitative analysis of 792 suicide cases with a qualitative analysis of medico-legal reports from 30 cases. The sociological autopsy provided novel insights into the entanglement of policy and service provision at the state-level with individual end-of-life decisions. Particular attention is drawn to age and gendered dimensions of suicide, especially in relation to health and social issues. The study showed a continuity between suicide and the patterning of an individual's life course, including experiences and consequences of inequality and marginality; a desire to meet culturally–normative ideals of autonomy; and a fragmented, under-funded, and intimidating social care system that offered limited options. • Sociological autopsy applied to unique coronial dataset of older adult suicide. • Combines quantitative and qualitative analyses of data from medico-legal reports. • Age and gendered differences in health and social issues related to suicide. • State-level policies and practices intersect with individual end-of-life decisions. • Imperative of prevention creates harmful environments and consequences. [ABSTRACT FROM AUTHOR]

Female sex workers bear a disproportionate burden of HIV and other poor sexual and reproductive health (SRH) outcomes which has led to the tailoring of SRH interventions to mitigate risk. Understanding of the SRH vulnerabilities of young women who sell sex (YWSS) (16–24 years) in Southern Africa is under-represented in research which may result in a mismatch in current SRH interventions and service design. This paper is based on a sub-analysis of a qualitative study investigating the SRH of young women who sell sex (16–24 years) in Zimbabwe. We explored the differences in dynamics of SRH vulnerability amongst YWSS within the 16–24 year age band. In-depth interviews (IDIs) were conducted amongst key informants (n = 4), health care providers (n = 5), and peer educators (n = 16). Amongst YWSS, we conducted IDIs (n = 42) and focus group discussions (n = 30). Transcripts were inductively coded for emergent themes and categories. Age and life stage determinants led to key differences in SRH vulnerabilities between younger (16–19 years) and older YWSS (20–24 years). These determinants emerged in the following ways: 1) distancing of younger participants from a "sex worker" identity leading to difficulties in identification and limiting intervention reach, 2) inexperience in dealing with clients and immature cognitive development leading to greater exposure to risk, and 3) the subordinate social position and exploitation of young participants within sex worker hierarchies or networks and lack of protective networks. We highlight the presence of a diverse group of vulnerable young women who may be missed by sex worker programme responses. In future intervention planning, there is need to consider the age-related needs and vulnerabilities within a spectrum of young women involved in a wide range of transactional relationships to ensure that services reach those most vulnerable to poor SRH outcomes. • Young women who sell sex have unique sexual and reproductive health needs. • Elusive identities within the economies of sex pose a challenge to related interventions. • Substance use as a coping mechanism amongst young women who sell sex. • Subordinate social status of young women who sell sex in sex worker hierarchies. • Younger and older sex workers differ in characteristics and vulnerability. [ABSTRACT FROM AUTHOR]

With global improvements in life expectancy, one important concern is to understand whether there is reduction in inequalities or greater cross-country convergence in expected length of life at various age thresholds. Insights on convergence patterns can help governments and other stakeholders decide upon health investments across age groups. This paper applies a novel econometric approach to test convergence and identify convergent clubs in life expectancy at various age groups for 201 countries/areas between 1950 and 2015. Life expectancy estimates for 201 countries/areas (1950 and 2015) from United Nations Department of Economic and Social Affairs (UNDESA) World Population Prospects (2015 Revision) are used for the analysis. We find global convergence in life expectancy at birth, but do not observe grand convergence for any other age groups. In the case of life expectancy at younger ages, most countries are moving in the same direction, but significant cross-country variations and convergence clubs are noted for older adults and elderly. Most of the better performing countries/areas are from Western Europe, Northern Europe and North America, the average performers are from South America, Eastern Europe, Southern Europe, South Asia, Central Asia, Eastern Africa, Central Africa, and the Caribbean Islands whereas the poor-performing ones are mainly Western Africa, Southern African and Oceania. In addition, we observe increasing between-country variance in life expectancy for older adults and elderly. The analysis reveals increasing global heterogeneity in the survival experience of older adults and the elderly population which has remained a neglected aspect in the discussions on global life expectancy improvements. Data, research and policy focus on life-expectancy at older ages is therefore critical to accelerate survival gains among older adults and elderly, particularly from the developing world. • Country explains 34% of the variability in life expectancy improvement. • At older ages, there are three life expectancy trajectories a country can be in. • Studying variability is a better metric for capturing life expectancy inequities. [ABSTRACT FROM AUTHOR]

There is broad agreement in the international literature that there are significant barriers to the use of long-term care services (LTCS) by older migrants in various contexts. However, there is a lack of comprehensive study in this area, and particularly concerning the diversity of migrants from different sending countries and the heterogeneity of their migration trajectories concerning the age at migration. Barriers to the use of care might be intensified for persons migrating at an older age, resulting in lower use of care. However, it is still unknown whether late-in-life migrants are underrepresented as users of LTCS in comparison to Swedish born and migrants arriving at younger ages. We study the likelihood of using any (1) LTCS, (2) residential care, and (3) personal and domestic care among older foreign-born, compared to Swedish-born older persons. Secondly, we study the likelihood of care across different birth countries compared to older persons born in Sweden. Thirdly, we investigate the likelihood of LTCS among migrants arriving at different ages. The total population of all persons 65 years and over in Sweden, is studied using register data with almost two million observations. The central findings of this study show that there is substantial heterogeneity across and within different birth countries regarding utilization of LTCS, residential care and personal and domestic care. The results from this study also suggest that late in life migration does not have to imply lower utilization of LTCS, residential care and personal, and domestic care. However, results show a slight over-representation of personal and domestic care among those who have migrated later in life. Further, there is an under-representation of residential care among late-in-life migrants. Our findings thus suggest that caution is needed when generalizing about levels of formal care use in migrant populations. • Heterogeneity exist in likelihood for the use of LTCS between countries. • Personal and domestic care are higher among migrants arriving after age 65. • Residential care is lower among late life migrants. • Hanna Mac Innes is the sole author of this paper. [ABSTRACT FROM AUTHOR]

An emphasis on individual intervention and psychological complexity has characterised research on bereavement following an experience of life-limiting illness. Exploration of "structural vulnerability" as a positionality produced by social and structural inequity could provide insights into areas of practice and policy in need of development. This scoping review sought to summarise published research on experiences of social and structural inequities in the context of bereavement due to life-limiting illness. Underpinned by recognised methodological frameworks, systematic searches were conducted of four electronic databases. Eligible studies attended to bereavement experience following the death of an adult due to life-limiting illness, included consideration of social and structural inequities, and were undertaken in high income countries between 1990 and 2018. Following thematic analysis, a conceptual framework was developed. Of 322 records, 62 full text articles were retrieved and 15 papers met inclusion criteria. Studies highlighted unequal social status in bereavement related to gender, class, sexuality, ethnicity and age, with structural inequity experienced in interactions with institutions and social networks. Studies also identified that the experience of bereavement itself may be accompanied by exposure to disenfranchising systems and processes. Structural vulnerability appeared to be associated with outcomes including psychological distress, social disenfranchisement and practical concerns such as financial strain, housing insecurity and employment issues. Social and structural inequities potentially contribute to layered and patterned experiences of disadvantage and disenfranchisement following expected death, with implications for individual agency. Findings point to the need for consideration of socio-ecological approaches within and beyond specialist palliative care, involving development of more responsive social policy, coordinated advocacy, and systemic capacity building regarding experiences of grief, to better support populations positioned as structurally vulnerable in bereavement. • Structural vulnerability may contribute to disadvantage in bereavement. • Social inequity was related to gender, class, sexual identity and ethnicity. • Structural inequity was experienced in interactions with institutions and networks. • Psychological distress, practical complexity and disenfranchisement were evident. [ABSTRACT FROM AUTHOR]