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Backhaus I, Hoven H, Kawachi I. Far-right political ideology and COVID-19 vaccine hesitancy: Multilevel analysis of 21 European countries. Soc Sci Med 2023; 335:116227. [PMID: 37722145 DOI: 10.1016/j.socscimed.2023.116227] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2023] [Revised: 05/24/2023] [Accepted: 09/05/2023] [Indexed: 09/20/2023]
Abstract
BACKGROUND Far-right political parties across the EU have downplayed the risk of COVID-19 and have expressed skepticism toward the safety of the COVID-19 vaccine. This may affect the risk perception of people who support far-right parties and may be associated with an elevated risk of vaccine hesitancy. We aimed to explore if voting far-right is associated with COVID-19 vaccine hesitancy and if the association varies by individual and country-level factors. METHODS We used cross-sectional data from 28,057 individuals nested in 21 countries who participated in the tenth round of the European Social Survey (ESS). COVID-19 vaccine hesitancy was assessed by asking respondents whether they will get vaccinated against COVID-19. Voting behavior was measured by asking respondents which party they voted for in the last election. To test the association between far-right voting and COVID-19 hesitancy, we applied a series of multilevel regression models. We additionally ran models including interaction terms to test if the association differs by sociodemographic characteristics (e.g., institutional trust) or contextual factors (e.g., income inequality). RESULTS We found that far-right voters were 2.7 times more likely to be COVID-19 vaccine hesitant compared to center voters (PR: 2.69, 95% CI: 1.46-4.94). The association persisted even after controlling for institutional trust and social participation (adjusted PR: 2.15, 95% CI: 1.35-3.42). None of the tested interaction terms were significant suggesting that the association between political ideology and COVID-19 vaccine hesitancy does not differ by sociodemographic characteristics or contextual factors. CONCLUSION Voting for far-right parties is associated with COVID-19 vaccine hesitancy. The association is similar among European countries, regardless of how stringent the public health measures were and magnitude of income inequality in each country. Our findings call for a more in-depth investigation of why, how and under which conditions political ideology affects vaccination behavior.
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Affiliation(s)
- Insa Backhaus
- Department of Social & Behavioral Sciences, Harvard T.H. Chan School of Public Health, Boston, MA, USA; Institute of Medical Sociology, Centre for Health and Society, Medical Faculty and University Hospital, Heinrich Heine University Düsseldorf, Düsseldorf, Germany.
| | - Hanno Hoven
- Department of Social & Behavioral Sciences, Harvard T.H. Chan School of Public Health, Boston, MA, USA; Institute for Occupational and Maritime Medicine, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Ichiro Kawachi
- Department of Social & Behavioral Sciences, Harvard T.H. Chan School of Public Health, Boston, MA, USA
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Fisher MP. Politicized disease surveillance: A theoretical lens for understanding sociopolitical influence on the monitoring of disease epidemics. Soc Sci Med 2021; 291:114500. [PMID: 34757240 DOI: 10.1016/j.socscimed.2021.114500] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2021] [Revised: 08/16/2021] [Accepted: 10/19/2021] [Indexed: 10/20/2022]
Abstract
Sociopolitical forces commonly influence the collection, analysis, dissemination, and general perceptions of epidemiological information. Yet few theoretical lenses provide insight into the mechanisms through which such influence occurs. In this article, I draw and expand upon empirical findings to propose a novel theoretical lens, politicized disease surveillance, which I define as extreme or undue sociopolitical influence on public health surveillance systems or processes in ways that impact disease incidences and prevalences, or estimates or perceptions thereof. This lens foregrounds disease incidence and prevalence as objects of contestation and policy influence and articulates how certain facets of sociopolitical forces shape disease incidences and prevalences-especially amid an epidemic-through one or more channels: (1) the diagnostic construct; (2) screening tools, procedures, or systems; or (3) the behaviors of individuals who are living with or at risk for a certain disease. I provide several contemporary illustrations of politicized disease surveillance and discuss its theoretical and practical implications.
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Affiliation(s)
- Michael P Fisher
- Towson University, Department of Health Sciences, 8000 York Road, Linthicum Hall, #121L, Towson, MD, 21252, USA.
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3
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Simpson J, Albani V, Bell Z, Bambra C, Brown H. Effects of social security policy reforms on mental health and inequalities: A systematic review of observational studies in high-income countries. Soc Sci Med 2021; 272:113717. [PMID: 33545493 DOI: 10.1016/j.socscimed.2021.113717] [Citation(s) in RCA: 35] [Impact Index Per Article: 11.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Revised: 01/18/2021] [Accepted: 01/22/2021] [Indexed: 11/17/2022]
Abstract
Evidence increasingly shows that changes to social security policies can affect population mental health. Thus, in the context of rising burden of mental illness, it is of major importance to better understand how expansions and contractions to the social security system may impact on mental health of both adults and children. The aim of this systematic review is to provide a synthesis of observational literature on the effects on mental health and inequalities in mental health of social security reforms. We conducted a systematic review of quantitative observational studies of specific national and regional social security policy changes in high-income countries and summarised the mental health effects of these policies. We searched seven electronic databases, including Medline, PsychInfo, Embase, CINAHL, ASSIA (Proquest), Scopus and Research Papers in Economics from January 1979 to June 2020. We included both objective and subjective mental health and wellbeing measures. The study quality was assessed using the Validity Assessment tool for econometric studies. We identified 13,403 original records, thirty-eight of which were included in the final review. Twenty-one studies evaluated expansionary social security policies and seventeen studies evaluated contractionary policies. Overall, we found that policies that improve social security benefit eligibility/generosity are associated with improvements in mental health, as reported by fourteen of the included studies. Social security policies that reduce eligibility/generosity were related to worse mental health, as reported by eleven studies. Ten studies found no effect for either policies contracting or expanding welfare support. Fourteen studies also evaluated the impact on mental health inequalities and found that contractionary policies tend to increase inequalities whereas expansionary policies have the opposite effect. Changes in social security policies can have significant effects on mental health and health inequalities across different recipient groups. Such health effects should be taken into account when designing future social policy reforms.
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Affiliation(s)
- Julija Simpson
- Population Health Sciences Institute, Newcastle University, Newcastle Upon Tyne, NE1 4LP, UK.
| | - Viviana Albani
- Population Health Sciences Institute, Newcastle University, Newcastle Upon Tyne, NE1 4LP, UK
| | - Zoe Bell
- Population Health Sciences Institute, Newcastle University, Newcastle Upon Tyne, NE1 4LP, UK
| | - Clare Bambra
- Population Health Sciences Institute, Newcastle University, Newcastle Upon Tyne, NE1 4LP, UK
| | - Heather Brown
- Population Health Sciences Institute, Newcastle University, Newcastle Upon Tyne, NE1 4LP, UK
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Is there a relationship between welfare-state policies and suicide rates? Evidence from the U.S. states, 2000–2015. Soc Sci Med 2020; 246:112778. [DOI: 10.1016/j.socscimed.2019.112778] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2019] [Revised: 12/18/2019] [Accepted: 12/20/2019] [Indexed: 11/19/2022]
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5
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Yao Q, Li X, Luo F, Yang L, Liu C, Sun J. The historical roots and seminal research on health equity: a referenced publication year spectroscopy (RPYS) analysis. Int J Equity Health 2019; 18:152. [PMID: 31615528 PMCID: PMC6792226 DOI: 10.1186/s12939-019-1058-3] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2019] [Accepted: 09/23/2019] [Indexed: 12/03/2022] Open
Abstract
BACKGROUND Health equity is a multidimensional concept that has been internationally considered as an essential element for health system development. However, our understanding about the root causes of health equity is limited. In this study, we investigated the historical roots and seminal works of research on health equity. METHODS Health equity-related publications were identified and downloaded from the Web of Science database (n = 67,739, up to 31 October 2018). Their cited references (n = 2,521,782) were analyzed through Reference Publication Year Spectroscopy (RPYS), which detected the historical roots and important works on health equity and quantified their impact in terms of referencing frequency. RESULTS A total of 17 pronounced peaks and 31 seminal works were identified. The first publication on health equity appeared in 1966. But the first cited reference can be traced back to 1801. Most seminal works were conducted by researchers from the US (19, 61.3%), the UK (7, 22.6%) and the Netherlands (3, 9.7%). Research on health equity experienced three important historical stages: origins (1800-1965), formative (1966-1991) and development and expansion (1991-2018). The ideology of health equity was endorsed by the international society through the World Health Organization (1946) declaration based on the foundational works of Chadwick (1842), Engels (1945), Durkheim (1897) and Du Bois (1899). The concept of health equity originated from the disciplines of public health, sociology and political economics and has been a major research area of social epidemiology since the early nineteenth century. Studies on health equity evolved from evidence gathering to the identification of cost-effective policies and governmental interventions. CONCLUSION The development of research on health equity is shaped by multiple disciplines, which has contributed to the emergence of a new stream of social epidemiology and political epidemiology. Past studies must be interpreted in light of their historical contexts. Further studies are needed to explore the causal pathways between the social determinants of health and health inequalities.
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Affiliation(s)
- Qiang Yao
- School of Political Science and Public Administration, Wuhan University, Wuhan, 430072 Hubei China
- School of Psychology and Public Health, La Trobe University, Melbourne, VIC 3086 Australia
| | - Xin Li
- School of Information Management, Wuhan University, Wuhan, 430072 Hubei China
| | - Fei Luo
- Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430022 Hubei China
| | - Lianping Yang
- School of Public Heath, Sun Yat-sen University, Guangzhou, 510275 Guangdong China
| | - Chaojie Liu
- School of Psychology and Public Health, La Trobe University, Melbourne, VIC 3086 Australia
| | - Ju Sun
- School of Political Science and Public Administration, Wuhan University, Wuhan, 430072 Hubei China
- Institute of Health, Wuhan University, Wuhan, 430071 Hubei China
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6
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Quesnel-Vallée A, Taylor M, Hadfield K. Postpartum Depression: Balancing Continuity and Change in Designing Interventions. Am J Public Health 2019; 109:S154-S155. [PMID: 31242009 DOI: 10.2105/ajph.2018.304756] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Affiliation(s)
- Amélie Quesnel-Vallée
- Amélie Quesnel-Vallée is with the departments of Sociology and Epidemiology, Biostatistics and Occupational Health, and the McGill Observatory on Health and Social Services Reforms, McGill University, Montréal, Canada. Miles Taylor is with the Department of Sociology and the Pepper Institute for Aging and Public Policy, Florida State University, Tallahassee. Kristin Hadfield is with the Department of Biological and Experimental Psychology, Queen Mary University, London, UK
| | - Miles Taylor
- Amélie Quesnel-Vallée is with the departments of Sociology and Epidemiology, Biostatistics and Occupational Health, and the McGill Observatory on Health and Social Services Reforms, McGill University, Montréal, Canada. Miles Taylor is with the Department of Sociology and the Pepper Institute for Aging and Public Policy, Florida State University, Tallahassee. Kristin Hadfield is with the Department of Biological and Experimental Psychology, Queen Mary University, London, UK
| | - Kristin Hadfield
- Amélie Quesnel-Vallée is with the departments of Sociology and Epidemiology, Biostatistics and Occupational Health, and the McGill Observatory on Health and Social Services Reforms, McGill University, Montréal, Canada. Miles Taylor is with the Department of Sociology and the Pepper Institute for Aging and Public Policy, Florida State University, Tallahassee. Kristin Hadfield is with the Department of Biological and Experimental Psychology, Queen Mary University, London, UK
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Prussing E. Critical epidemiology in action: Research for and by indigenous peoples. SSM Popul Health 2018; 6:98-106. [PMID: 30246140 PMCID: PMC6146565 DOI: 10.1016/j.ssmph.2018.09.003] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2018] [Revised: 08/08/2018] [Accepted: 09/07/2018] [Indexed: 11/02/2022] Open
Abstract
Global social justice movements, including transnational activism for indigenous rights, are working to promote health equity by transforming public health research and policy. Yet little social scientific research has examined how professional epidemiologists are figuring within such efforts. Discussions are unfolding, however, in critical sectors of epidemiology about how to improve the profession's input into advocacy. Findings from a multi-sited ethnographic study of epidemiological research for and by indigenous peoples in three settings (Aotearoa/New Zealand, the continental U.S., and Hawai'i) demonstrate how researchers/practitioners connect epidemiology and advocacy by: (1) linking the better-known legitimacy of quantitative methods to a lesser-known causal framework that positions colonialism as a sociopolitical determinant of health, (2) producing technical critiques that aim to improve the accuracy and accessibility of indigenous population health statistics, and (3) adopting a pragmatic flexibility in response to the shifting political conditions that shape when, whether and how epidemiological findings support advocacy for indigenous health equity. Attending closely to the credibility tactics at hand in this work, and to the skills and sensibilities of its practitioners, charts new directions for future research about epidemiology's contributions to advocacy for health equity.
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Affiliation(s)
- Erica Prussing
- Department of Anthropology and Department of Community & Behavioral Health, 114 MH, University of Iowa, Iowa City, IA 52242-1322, USA
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Østebø MT, Cogburn MD, Mandani AS. The silencing of political context in health research in Ethiopia: why it should be a concern. Health Policy Plan 2018; 33:258-270. [PMID: 29165682 DOI: 10.1093/heapol/czx150] [Citation(s) in RCA: 33] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/07/2017] [Indexed: 11/12/2022] Open
Abstract
In 2004, the Ethiopian government launched what has been called an innovative and groundbreaking solution to the country's public health challenges; the Health Extension Programme (HEP). The positive public health outcomes that have been reported following the implementation of the HEP have led researchers and global health actors to propose it as a model for other countries to emulate. In this systematic review, we point to a potential weakness and methodological bias in the existing research. Despite being implemented within a context of an increasingly authoritarian regime, research conducted following the implementation of HEP reflects a limited discussion of the political context. Following a discussion of why political context is marginalized we provide arguments for why a focus on political context is important: first, political context has an impact on health systems and actualizes questions related to good governance and ethics. While some of the studies we reviewed acknowledge the importance of political factors we contend that the one-sided focus on the positive relationship between political will, political commitment and political leadership on the one hand, and key public health outcomes on the other, reflects a narrow engagement with health system governance frameworks. This leads to a silencing of issues actualized by the authoritarian nature of the Ethiopian regime. Secondly, the political context has methodological implications. More specifically, we contend that the current political situation increases the probability of social desirability bias. In order to balance the overarching positive literature on Ethiopia's health system, research that takes the political context into account is much needed.
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Affiliation(s)
- Marit Tolo Østebø
- Department of Anthropology, University of Florida, 1112 Turlington Hall, PO Box 117305, Gainesville, FL, USA
| | - Megan D Cogburn
- Department of Anthropology, University of Florida, 1112 Turlington Hall, PO Box 117305, Gainesville, FL, USA
| | - Anjum Shams Mandani
- Department of Anthropology, University of Florida, 1112 Turlington Hall, PO Box 117305, Gainesville, FL, USA
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9
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Filippidis FT, Girvalaki C, Mechili EA, Vardavas CI. Are political views related to smoking and support for tobacco control policies? A survey across 28 European countries. Tob Induc Dis 2017; 15:45. [PMID: 29234245 PMCID: PMC5723047 DOI: 10.1186/s12971-017-0151-x] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2017] [Accepted: 12/05/2017] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND General political views are rarely considered when discussing public support for tobacco control policies and tobacco use. The aim of this study was to explore potential associations between political views, smoking and support for tobacco control policies. METHODS We analysed responses from 22,313 individuals aged ≥15 years from 28 European Union (EU) member states, who self-reported their political views (far-left [1-2 on a scale 1-10]; centre-left (3-4); centre (5-6); centre-right (7-8); and far-right (9-10) in wave 82.4 of the Eurobarometer survey in 2014. We ran multi-level logistic regression models to explore associations between political views and smoking, as well as support for tobacco control policies, adjusting for socio-demographic factors. RESULTS Compared to those placing themselves at the political centre, people with far-left political views were more likely to be current smokers (Odds Ratio [OR] = 1.13; 95% Confidence Interval [CI]: 1.01-1.26), while those in the centre-right were the least likely to smoke (OR = 0.84; 95% CI: 0.76-0.93). Similar associations were found for having ever been a smoker. Respondents on the left side of the political spectrum were more likely to support tobacco control policies and those on the centre-right were less likely to support them, as compared to those at the political centre, after controlling for smoking status. CONCLUSIONS General political views may be associated not only with support for tobacco control policies, but even with smoking behaviours, which should be taken into account when discussing these issues at a population level. Further research is needed to explore the implications of these findings.
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Affiliation(s)
- Filippos T. Filippidis
- Department of Primary Care and Public Health, School of Public Health, Imperial College, 310 Reynolds Building, St. Dunstan’s Road, W6 8RP, London, UK
- Center for Health Services Research, School of Medicine, National and Kapodistrian University of Athens, Athens, Greece
| | - Charis Girvalaki
- Laboratory of Toxicology, Medical School, University of Crete, Rethimno, Greece
| | | | - Constantine I. Vardavas
- Laboratory of Toxicology, Medical School, University of Crete, Rethimno, Greece
- Institute of Public Health, American College of Greece, Athens, Greece
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10
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Menec VH. Conceptualizing Social Connectivity in the Context of Age-Friendly Communities. ACTA ACUST UNITED AC 2017. [DOI: 10.1080/02763893.2017.1309926] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Affiliation(s)
- Verena H. Menec
- Department of Community Health Sciences, The University of Manitoba, Winnipeg, Manitoba, Canada
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11
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Fox AM, Feng W, Yumkham R. State political ideology, policies and health behaviors: The case of tobacco. Soc Sci Med 2017; 181:139-147. [PMID: 28395251 DOI: 10.1016/j.socscimed.2017.03.056] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2015] [Revised: 03/11/2017] [Accepted: 03/26/2017] [Indexed: 11/22/2022]
Abstract
Anti-smoking campaigns are widely viewed as a success case in public health policy. However, smoking rates continue to vary widely across U.S. states and the success of anti-smoking campaigns is contingent upon states' adoption of anti-smoking policies. Though state anti-smoking policy is a product of a political process, studies of the effect of policies on smoking prevalence have largely ignored how politics shapes policy adoption, which, in turn, impact state health outcomes. Policies may also have different effects in different political contexts. This study tests how state politics affects smoking prevalence both through the policies that states adopt (with policies playing a mediating role on health outcomes) or as an effect modifier of behavior (tobacco control policies may work differently in states in which the public is more or less receptive to them). The study uses publicly available data to construct a time-series cross-section dataset of state smoking prevalence, state political context, cigarette excise taxes, indoor smoking policies, and demographic characteristics from 1995 to 2013. Political ideology is measured using a validated indicator of the ideology of state legislatures and of the citizens of a state. We assess the relationship between state political context and state smoking prevalence rates adjusting for demographic characteristics and accounting for the mediating/moderating role of state policies with time and state fixed effects. We find that more liberal state ideology predicts lower adult smoking rates, but that the relationship between state ideology and adult smoking prevalence is only partly explained by state anti-smoking policies.
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Affiliation(s)
- Ashley M Fox
- Department of Public Administration and Policy, University at Albany, State University of New York, Albany, NY, USA.
| | - Wenhui Feng
- Department of Public Administration and Policy, University at Albany, State University of New York, Albany, NY, USA.
| | - Rakesh Yumkham
- Department of Public Administration and Policy, University at Albany, State University of New York, Albany, NY, USA.
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12
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Rasanathan K, Diaz T. Research on health equity in the SDG era: the urgent need for greater focus on implementation. Int J Equity Health 2016; 15:202. [PMID: 27938374 PMCID: PMC5148849 DOI: 10.1186/s12939-016-0493-7] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2016] [Accepted: 12/06/2016] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND The tremendous increase in knowledge on inequities in health and their drivers in recent decades has not been matched by improvements in health inequities themselves, or by systematic evidence of what works to reduce health inequities. Within health equity research there is a skew towards diagnostic studies in comparison to intervention studies showing evidence of how interventions can reduce disparities. MAIN TEXT The lack of sufficient specific evidence on how to implement specific policies and interventions in specific contexts to reduce health inequities creates policy confusion and partly explains the lack of progress on health inequities. In the field of research on equity in health, the time has come to stop focusing so much energy on prevalence and pathways, and instead shift to proposing and testing solutions. Four promising approaches to do so are implementation research, natural experimental policy studies, research on buy-in by policy-makers to action on health inequities, and geospatial analysis. CONCLUSION The case for action on social determinants and health inequities has well and truly been made. The community of researchers on health equity now need to turn their attention to supporting implementation efforts towards achievements of the Sustainable Development Goals and substantive reductions in health inequities.
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Affiliation(s)
| | - Theresa Diaz
- Health Section, UNICEF, 3 UN Plaza, New York, NY, 10017, USA
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13
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Pega F. Invited Commentary: Using Financial Credits as Instrumental Variables for Estimating the Causal Relationship Between Income and Health. Am J Epidemiol 2016; 183:785-9. [PMID: 27056959 DOI: 10.1093/aje/kwv312] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2015] [Accepted: 10/05/2015] [Indexed: 01/03/2023] Open
Abstract
Social epidemiologists are interested in determining the causal relationship between income and health. Natural experiments in which individuals or groups receive income randomly or quasi-randomly from financial credits (e.g., tax credits or cash transfers) are increasingly being analyzed using instrumental variable analysis. For example, in this issue of the Journal, Hamad and Rehkopf (Am J Epidemiol. 2016;183(9):775-784) used an in-work tax credit called the Earned Income Tax Credit as an instrument to estimate the association between income and child development. However, under certain conditions, the use of financial credits as instruments could violate 2 key instrumental variable analytic assumptions. First, some financial credits may directly influence health, for example, through increasing a psychological sense of welfare security. Second, financial credits and health may have several unmeasured common causes, such as politics, other social policies, and the motivation to maximize the credit. If epidemiologists pursue such instrumental variable analyses, using the amount of an unconditional, universal credit that an individual or group has received as the instrument may produce the most conceptually convincing and generalizable evidence. However, other natural income experiments (e.g., lottery winnings) and other methods that allow better adjustment for confounding might be more promising approaches for estimating the causal relationship between income and health.
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14
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Ladin K, Wang R, Fleishman A, Boger M, Rodrigue JR. Does Social Capital Explain Community-Level Differences in Organ Donor Designation? Milbank Q 2015; 93:609-41. [PMID: 26350932 DOI: 10.1111/1468-0009.12139] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/29/2015] [Indexed: 11/29/2022] Open
Abstract
POLICY POINTS The growing shortage of life-saving organs has reached unprecedented levels, with more than 120,000 Americans waiting for them. Despite national attempts to increase organ donation and federal laws mandating the equitable allocation of organs, geographic disparities remain. A better understanding of the contextual determinants of organ donor designation, including social capital, may enhance efforts to increase organ donation by raising the probability of collective action and fostering norms of reciprocity and cooperation while increasing costs to defectors. Because community-level factors, including social capital, predict more than half the variation in donor designation, future interventions should tailor strategies to specific communities as the unit of intervention. CONTEXT The growing shortage of organs has reached unprecedented levels. Despite national attempts to increase donation and federal laws mandating the equitable allocation of organs, their availability and waiting times vary significantly nationwide. Organ donor designation is a collective action problem in public health, in which the regional organ supply and average waiting times are determined by the willingness of individuals to be listed as organ donors. Social capital increases the probability of collective action by fostering norms of reciprocity and cooperation while increasing costs to defectors. We examine whether social capital and other community-level factors explain geographic variation in organ donor designation rates in Massachusetts. METHODS We obtained a sample of 3,281,532 registered drivers in 2010 from the Massachusetts Department of Transportation Registry of Motor Vehicles (MassDOT RMV). We then geocoded the registry data, matched them to 4,466 census blocks, and linked them to the 2010 US Census, the American Community Survey (ACS), and other sources to obtain community-level sociodemographic, social capital (residential segregation, voter registration and participation, residential mobility, violent-death rate), and religious characteristics. We used spatial modeling, including lagged variables to account for the effect of adjacent block groups, and multivariate regression analysis to examine the relationship of social capital and community-level characteristics with organ donor designation rates. FINDINGS Block groups with higher levels of social capital, racial homogeneity, income, workforce participation, owner-occupied housing, native-born residents, and white residents had higher rates of organ donor designation (p < 0.001). These factors remained significant in the multivariate model, which explained more than half the geographic variance in organ donor designation (R(2) = 0.52). CONCLUSIONS The findings suggest that community-level factors, including social capital, predict more than half the variation in donor designation. Future interventions should target the community as the unit of intervention and should tailor messaging for areas with low social capital.
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Affiliation(s)
- Keren Ladin
- Tufts University.,Tufts University Medical School
| | | | | | | | - James R Rodrigue
- Harvard Medical School.,Transplant Institute, Beth Israel Deaconess Medical Center
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Seniori Costantini A, Gallo F, Pega F, Saracci R, Veerus P, West R. Population health and status of epidemiology in Western European, Balkan and Baltic countries. Int J Epidemiol 2015; 44:300-23. [PMID: 25713311 DOI: 10.1093/ije/dyu256] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022] Open
Abstract
BACKGROUND This article is part of a series commissioned by the International Epidemiological Association, aimed at describing population health and epidemiological resources in the six World Health Organization (WHO) regions. It covers 32 of the 53 WHO European countries, namely the Western European countries, the Balkan countries and the Baltic countries. METHODS The burdens of mortality and morbidity and the patterns of risk factors and inequalities have been reviewed in order to identify health priorities and challenges. Literature and internet searches were conducted to stock-take epidemiological teaching, research activities, funding and scientific productivity. FINDINGS These countries have among the highest life expectancies worldwide. However, within- and between-country inequalities persist, which are largely due to inequalities in distribution of main health determinants. There is a long tradition of epidemiological research and teaching in most countries, in particular in the Western European countries. Cross-national networks and collaborations are increasing through the support of the European Union which fosters procedures to standardize educational systems across Europe and provides funding for epidemiological research through framework programmes. The number of Medline-indexed epidemiological research publications per year led by Western European countries has been increasing. The countries accounts for nearly a third of the global epidemiological publication. CONCLUSIONS Although population health has improved considerably overall, persistent within- and between-country inequalities continue to challenge national and European health institutions. More research, policy and action on the social determinants of health are required in the region. Epidemiological training, research and workforce in the Baltic and Balkan countries should be strengthened. European epidemiologists can play pivotal roles and must influence legislation concerning production and access to high-quality data.
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Affiliation(s)
- Adele Seniori Costantini
- Cancer Prevention and Research Institute (ISPO), Florence, Italy, Centre for Cancer Epidemiology and Prevention, AOU City of Health and Science, Turin, Italy, Burden of Disease Epidemiology, Equity and Cost-Effectiveness Programme and Health Inequalities Research Programme, University of Otago, Wellington, New Zealand, Department of Social and Behavioral Sciences, Harvard School of Public Health, Boston, MA, USA, Institute of Clinical Physiology (IFC), National Research Council, Pisa, Italy, National Institute for Health Development, Tallinn, Estonia and Wales Heart Research Institute, Cardiff University, Cardiff, UK
| | - Federica Gallo
- Cancer Prevention and Research Institute (ISPO), Florence, Italy, Centre for Cancer Epidemiology and Prevention, AOU City of Health and Science, Turin, Italy, Burden of Disease Epidemiology, Equity and Cost-Effectiveness Programme and Health Inequalities Research Programme, University of Otago, Wellington, New Zealand, Department of Social and Behavioral Sciences, Harvard School of Public Health, Boston, MA, USA, Institute of Clinical Physiology (IFC), National Research Council, Pisa, Italy, National Institute for Health Development, Tallinn, Estonia and Wales Heart Research Institute, Cardiff University, Cardiff, UK
| | - Frank Pega
- Cancer Prevention and Research Institute (ISPO), Florence, Italy, Centre for Cancer Epidemiology and Prevention, AOU City of Health and Science, Turin, Italy, Burden of Disease Epidemiology, Equity and Cost-Effectiveness Programme and Health Inequalities Research Programme, University of Otago, Wellington, New Zealand, Department of Social and Behavioral Sciences, Harvard School of Public Health, Boston, MA, USA, Institute of Clinical Physiology (IFC), National Research Council, Pisa, Italy, National Institute for Health Development, Tallinn, Estonia and Wales Heart Research Institute, Cardiff University, Cardiff, UK Cancer Prevention and Research Institute (ISPO), Florence, Italy, Centre for Cancer Epidemiology and Prevention, AOU City of Health and Science, Turin, Italy, Burden of Disease Epidemiology, Equity and Cost-Effectiveness Programme and Health Inequalities Research Programme, University of Otago, Wellington, New Zealand, Department of Social and Behavioral Sciences, Harvard School of Public Health, Boston, MA, USA, Institute of Clinical Physiology (IFC), National Research Council, Pisa, Italy, National Institute for Health Development, Tallinn, Estonia and Wales Heart Research Institute, Cardiff University, Cardiff, UK Cancer Prevention and Research Institute (ISPO), Florence, Italy, Centre for Cancer Epidemiology and Prevention, AOU City of Health and Science, Turin, Italy, Burden of Disease Epidemiology, Equity and Cost-Effectiveness Programme and Health Inequalities Research Programme, University of Otago, Wellington, New Zealand, Department of Social and Behavioral Sciences, Harvard School of Public Health, Boston, MA, USA, Institute of Clinical Physiology (IFC), National Research Council, Pisa, Italy, National Institute for Health Development, Tallinn, Estonia and Wales Heart Research Institute, Cardiff University, Cardiff, UK
| | - Rodolfo Saracci
- Cancer Prevention and Research Institute (ISPO), Florence, Italy, Centre for Cancer Epidemiology and Prevention, AOU City of Health and Science, Turin, Italy, Burden of Disease Epidemiology, Equity and Cost-Effectiveness Programme and Health Inequalities Research Programme, University of Otago, Wellington, New Zealand, Department of Social and Behavioral Sciences, Harvard School of Public Health, Boston, MA, USA, Institute of Clinical Physiology (IFC), National Research Council, Pisa, Italy, National Institute for Health Development, Tallinn, Estonia and Wales Heart Research Institute, Cardiff University, Cardiff, UK
| | - Piret Veerus
- Cancer Prevention and Research Institute (ISPO), Florence, Italy, Centre for Cancer Epidemiology and Prevention, AOU City of Health and Science, Turin, Italy, Burden of Disease Epidemiology, Equity and Cost-Effectiveness Programme and Health Inequalities Research Programme, University of Otago, Wellington, New Zealand, Department of Social and Behavioral Sciences, Harvard School of Public Health, Boston, MA, USA, Institute of Clinical Physiology (IFC), National Research Council, Pisa, Italy, National Institute for Health Development, Tallinn, Estonia and Wales Heart Research Institute, Cardiff University, Cardiff, UK
| | - Robert West
- Cancer Prevention and Research Institute (ISPO), Florence, Italy, Centre for Cancer Epidemiology and Prevention, AOU City of Health and Science, Turin, Italy, Burden of Disease Epidemiology, Equity and Cost-Effectiveness Programme and Health Inequalities Research Programme, University of Otago, Wellington, New Zealand, Department of Social and Behavioral Sciences, Harvard School of Public Health, Boston, MA, USA, Institute of Clinical Physiology (IFC), National Research Council, Pisa, Italy, National Institute for Health Development, Tallinn, Estonia and Wales Heart Research Institute, Cardiff University, Cardiff, UK
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16
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Reeves A, Karanikolos M, Mackenbach J, McKee M, Stuckler D. Do employment protection policies reduce the relative disadvantage in the labour market experienced by unhealthy people? A natural experiment created by the Great Recession in Europe. Soc Sci Med 2014; 121:98-108. [PMID: 25442371 DOI: 10.1016/j.socscimed.2014.09.034] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2014] [Revised: 09/16/2014] [Accepted: 09/18/2014] [Indexed: 10/24/2022]
Abstract
Unhealthy persons are more likely to lose their jobs than those who are healthy but whether this is affected by recession is unclear. We asked how healthy and unhealthy persons fared in labour markets during Europe's 2008-2010 recessions and whether national differences in employment protection helped mitigate any relative disadvantage experienced by those in poor health. Two retrospective cohorts of persons employed at baseline were constructed from the European Statistics of Income and Living Conditions in 26 EU countries. The first comprised individuals followed between 2006 and 2008, n = 46,085 (pre-recession) and the second between 2008 and 2010, n = 85,786 (during recession). We used multi-level (individual- and country-fixed effects) logistic regression models to assess the relationship (overall and disaggregated by gender) between recessions, unemployment, and health status, as well as any modifying effect of OECD employment protection indices measuring the strength of policies against dismissal and redundancy. Those with chronic illnesses and health limitations were disproportionately affected by the recession, respectively with a 1.5- and 2.5-fold greater risk of unemployment than healthy people during 2008-2010. During severe recessions (>7% fall in GDP), employment protections did not mitigate the risk of job loss (OR = 1.06, 95% CI: 0.94-1.21). However, in countries experiencing milder recessions (<7% fall in GDP), each additional unit of employment protection reduced job loss risk (OR = 0.72, 95% CI: 0.58-0.90). Before the recession, women with severe health limitations especially benefited, with additional reductions of 22% for each unit of employment protection (AORfemale = 0.78, 95% CI: 0.62-0.97), such that at high levels the difference in the risk of job loss between healthy and unhealthy women disappeared. Employment protection policies may counteract labour market inequalities between healthy and unhealthy people, but additional programmes are likely needed to protect vulnerable groups during severe recessions.
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Affiliation(s)
- Aaron Reeves
- Department of Sociology, University of Oxford, United Kingdom.
| | - Marina Karanikolos
- European Centre on Health of Societies in Transition (ECOHOST), London School of Hygiene and Tropical Medicine, United Kingdom; European Observatory on Health Systems and Policies, London School of Hygiene and Tropical Medicine, United Kingdom
| | - Johan Mackenbach
- Department of Public Health, Erasmus MC, University Medical Centre Rotterdam, The Netherlands
| | - Martin McKee
- European Centre on Health of Societies in Transition (ECOHOST), London School of Hygiene and Tropical Medicine, United Kingdom; European Observatory on Health Systems and Policies, London School of Hygiene and Tropical Medicine, United Kingdom
| | - David Stuckler
- Department of Sociology, University of Oxford, United Kingdom; European Observatory on Health Systems and Policies, London School of Hygiene and Tropical Medicine, United Kingdom
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17
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Welfare states and population health: The role of minimum income benefits for mortality. Soc Sci Med 2014; 112:63-71. [DOI: 10.1016/j.socscimed.2014.04.029] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2013] [Revised: 04/16/2014] [Accepted: 04/20/2014] [Indexed: 01/16/2023]
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18
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Ferrarini T, Nelson K, Sjöberg O. Unemployment insurance and deteriorating self-rated health in 23 European countries. J Epidemiol Community Health 2014; 68:657-62. [PMID: 24616353 PMCID: PMC4112438 DOI: 10.1136/jech-2013-203721] [Citation(s) in RCA: 47] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2013] [Revised: 02/15/2014] [Accepted: 02/18/2014] [Indexed: 11/22/2022]
Abstract
BACKGROUND The global financial crisis of 2008 is likely to have repercussions on public health in Europe, not least through escalating mass unemployment, fiscal austerity measures and inadequate social protection systems. The purpose of this study is to analyse the role of unemployment insurance for deteriorating self-rated health in the working age population at the onset of the fiscal crisis in Europe. METHODS Multilevel logistic conditional change models linking institutional-level data on coverage and income replacement in unemployment insurance to individual-level panel data on self-rated health in 23 European countries at two repeated occasions, 2006 and 2009. RESULTS Unemployment insurance significantly reduces transitions into self-rated ill-health and, particularly, programme coverage is important in this respect. Unemployment insurance is also of relevance for the socioeconomic gradients of health at individual level, where programme coverage significantly reduces health risks attached to educational attainment. CONCLUSIONS Unemployment insurance mitigated adverse health effects both at individual and country-level during the financial crisis. Due to the centrality of programme coverage, reforms to unemployment insurance should focus on extending the number of insured people in the labour force.
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Affiliation(s)
- Tommy Ferrarini
- Swedish Institute for Social Research, Stockholm University, Stockholm, Sweden
| | - Kenneth Nelson
- Swedish Institute for Social Research, Stockholm University, Stockholm, Sweden
| | - Ola Sjöberg
- Swedish Institute for Social Research, Stockholm University, Stockholm, Sweden
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19
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Rodriguez JM, Bound J, Geronimus AT. US infant mortality and the President's party. Int J Epidemiol 2014; 43:818-26. [PMID: 24381011 PMCID: PMC4052132 DOI: 10.1093/ije/dyt252] [Citation(s) in RCA: 37] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/13/2013] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND Infant mortality rates in the US exceed those in all other developed countries and in many less developed countries, suggesting political factors may contribute. METHODS Annual time series on overall, White and Black infant mortality rates in the US were analysed over the 1965-2010 time period to ascertain whether infant mortality rates varied across presidential administrations. Data were de-trended using cubic splines and analysed using both graphical and time series regression methods. RESULTS Across all nine presidential administrations, infant mortality rates were below trend when the President was a Democrat and above trend when the President was a Republican. This was true for overall, neonatal and postneonatal mortality. Regression estimates show that, relative to trend, Republican administrations were characterized by infant mortality rates that were, on average, 3% higher than Democratic administrations. In proportional terms, effect size is similar for US Whites and Blacks. US Black rates are more than twice as high as White, implying substantially larger absolute effects for Blacks. CONCLUSIONS We found a robust, quantitatively important association between net of trend US infant mortality rates and the party affiliation of the president. There may be overlooked ways by which macro-dynamics of policy impact microdynamics of physiology, suggesting the political system is a component of the underlying mechanism generating health inequality in the USA.
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Affiliation(s)
- Javier M Rodriguez
- Population Studies Center, Institute for Social Research, Department of Economics and Department of Health Behavior and Health Education, School of Public Health, University of Michigan, Ann Arbor, MI, USA
| | - John Bound
- Population Studies Center, Institute for Social Research, Department of Economics and Department of Health Behavior and Health Education, School of Public Health, University of Michigan, Ann Arbor, MI, USAPopulation Studies Center, Institute for Social Research, Department of Economics and Department of Health Behavior and Health Education, School of Public Health, University of Michigan, Ann Arbor, MI, USA
| | - Arline T Geronimus
- Population Studies Center, Institute for Social Research, Department of Economics and Department of Health Behavior and Health Education, School of Public Health, University of Michigan, Ann Arbor, MI, USAPopulation Studies Center, Institute for Social Research, Department of Economics and Department of Health Behavior and Health Education, School of Public Health, University of Michigan, Ann Arbor, MI, USA
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20
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Pega F, Carter K, Kawachi I, Davis P, Blakely T. The impact of an unconditional tax credit for families on self-rated health in adults: Further evidence from the cohort study of 6900 New Zealanders. Soc Sci Med 2014; 108:115-9. [DOI: 10.1016/j.socscimed.2014.03.002] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2013] [Revised: 02/18/2014] [Accepted: 03/02/2014] [Indexed: 10/25/2022]
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21
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From a conservative to a liberal welfare state: Decomposing changes in income-related health inequalities in Germany, 1994–2011. Soc Sci Med 2014; 108:10-9. [DOI: 10.1016/j.socscimed.2014.02.022] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2013] [Revised: 01/14/2014] [Accepted: 02/09/2014] [Indexed: 11/18/2022]
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22
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Herian MN, Tay L, Hamm JA, Diener E. Social capital, ideology, and health in the United States. Soc Sci Med 2014; 105:30-7. [PMID: 24606794 DOI: 10.1016/j.socscimed.2014.01.003] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2013] [Revised: 12/10/2013] [Accepted: 01/03/2014] [Indexed: 12/01/2022]
Abstract
Research from across disciplines has demonstrated that social and political contextual factors at the national and subnational levels can impact the health and health behavior risks of individuals. This paper examines the impact of state-level social capital and ideology on individual-level health outcomes in the U.S. Leveraging the variation that exists across states in the U.S., the results reveal that individuals report better health in states with higher levels of governmental liberalism and in states with higher levels of social capital. Critically, however, the effect of social capital was moderated by liberalism such that social capital was a stronger predictor of health in states with low levels of liberalism. We interpret this finding to mean that social capital within a political unit-as indicated by measures of interpersonal trust-can serve as a substitute for the beneficial impacts that might result from an active governmental structure.
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Affiliation(s)
| | - Louis Tay
- Purdue University, Department of Psychological Sciences, USA
| | | | - Ed Diener
- University of Illinois, Department of Psychology, USA
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