The public health implications of maternal care trade-offs

A bioeconomic approach to marriage and the sexual division of labor

Children may be viewed as public goods whereby both parents receive equal genetic benefits yet one parent often invests more heavily than the other. We introduce a microeconomic framework for understanding household investment decisions to address questions concerning conflicts of interest over types and amount of work effort among married men and women. Although gains and costs of marriage may not be spread equally among marriage partners, marriage is still a favorable, efficient outcome under a wide range of conditions. This bioeconomic framework subsumes both cooperative and conflictive views on the sexual division of labor. We test hypotheses concerning marriage markets, assortative mating, and men’s labor motivations among Tsimane forager-horticulturalists of Bolivia and find that: (1) men and women both value work effort in marital partners, (2) marital labor contributions are complementary, (3) work effort is correlated between spouses, (4) total production is correlated with total reproduction, and (5) better hunters have higher fitness gains within marital unions.

Poverty related risk for potentially preventable hospitalisations among children in Taiwan

BACKGROUND

This study investigated the incidence of potentially preventable hospitalisations in the first two years of life among children in the National Health Insurance (NHI) system of Taiwan. It also examined income disparities in potentially preventable hospitalisations across four economic categories: below a government-established poverty line and low-, middle-, and upper-income. Five major diseases causing potentially preventable hospitalisations were investigated: gastroenteritis and dehydration, asthma and chronic bronchitis, acute upper respiratory infections, lower respiratory infections, and acute injuries and poisonings.

METHODS

NHI data on enrolee registrations and use of ambulatory and hospital care by all children born between July 1, 2003 and June 30, 2004 (n = 218,158) was used for the study. The negative binomial regression method was used to identify factors associated with total inpatient care and the severity level for various types of potentially preventable hospitalisations during the first two years of life.

RESULTS

This study found high inpatient expenses for lower respiratory infections for children in all income categories. Furthermore, results from the multivariate analysis indicate that children in the lowest economic category used inpatient care to a much greater extent than better-off children for problems considered potentially avoidable through primary prevention or through timely outpatient care. This was especially true for acute injuries and poisonings and for lower respiratory infections. On average, and controlling for other variables, a child in poverty spent 6.1 times more days in inpatient care for acute injuries and poisonings (p < 0.01) and 2.7 times more days for lower respiratory infections (p < 0.01) before age two, compared with a similarly-aged high-income child. The results also suggest a connection between economic status and the severity of a condition causing a potentially avoidable hospital admission. On average, length of stay for each admission for gastroenteritis and dehydration for children in poverty was 1.3 times that for high-income children (p < 0.01). Both the ratios for lower respiratory infections and for acute upper respiratory infections were 1.2 (p < 0.01 for both).

CONCLUSIONS

There were high hospital admission rates and lengths of stays for lower respiratory infections among young children in all income categories. Hospital care use of young children in the poorest category was significantly higher for acute injuries and poisonings as well as for lower respiratory infections, compared with those of better-off children. The findings suggest the need for increased attention to these two disease types. It particularly calls for more research on the causes of high hospital care use for lower respiratory infections and on the reasons for large economic disparities in hospital care use for acute injuries and poisonings.

Why do men hunt? A reevaluation of "man the hunter" and the sexual division of labor

The role of men in hunter-gatherer societies has been subject to vigorous debate over the past 15 years. The proposal that men hunt wild game as a form of status signaling or "showing off" to provide reproductive benefits to the hunter challenges the traditional view that men hunt to provision their families. Two broad assumptions underlie the signaling view: (1) hunting is a poor means of obtaining food, and (2) hunted game is a public good shared widely with others and without expectation of future reciprocation. If hunters lack the ability to direct food shares and obtain subsequent benefits contingent on redistribution, then the ubiquitous observations of male hunting and universal pair-bonding cannot be explained from a perspective that emphasizes kin provisioning and a division of labor. Here we show that there is little empirical support for the view that men hunt for signaling benefits alone. The ethnographic record depicts a more complex relationship between food sharing patterns, subsistence strategies, mating, and the sexual division of labor. We present a framework incorporating trade-offs between mating and subsistence strategies in an economic bargaining context that contributes to understanding men's and women's roles in hunter-gatherer societies.