Political gender inequality and infant mortality in the United States, 1990-2012

Male twinning after the 2008 Obama election: A test of symbolic empowerment

On November 4, 2008, Barack Obama was elected the first Black President of the United States. His campaign and electoral win served as a symbol of hope for a more just future, fostering an "Obama effect" that appears associated with improved well-being among non-Hispanic (NH) Black communities. Situating the Obama election within the symbolic empowerment framework, we consider the potentially protective role of the Obama election on NH Black fetal death, an important but understudied measure of perinatal health that has stark racial disparities. Using restricted-use natality files from the National Center for Health Statistics, we proxy fetal death using the male twin rate (number of twins per 1000 male live births). Male twins have a relatively high risk of in utero selection that is sensitive to maternal and environmental stressors, making the twin rate an important marker of fetal death. We then estimate interrupted time-series models to assess the relation between the Obama election and male twin rates among NH Black births across monthly conception cohorts (February 2003-October 2008). Greater-than-expected male twin rates signal less susceptibility to fetal loss. Results indicate a 4.5% higher male twin rate among all NH Black cohorts exposed in utero to the Obama election, after accounting for historical and NH white trends (p < 0.005). The greater-than-expected rates concentrated among births conceived in the months preceding Obama's nomination at the Democratic National Convention and Obama's presidential win. These results suggest a salutary perinatal response to election events that likely reduced NH Black fetal loss. They also indicate the possibility that sociopolitical shifts can mitigate persisting NH Black-NH white disparities in perinatal health.

Gender(ed) science: How the institutionalization of gender continues to shape the conduct and content of women's health research

Gender refers to the socially constructed roles, behaviors, and attributes that a particular society considers appropriate for men and women based on assumptions about biological sex. It also operates as a major social organizing principle that confers unequal power, status, and resources to men and women, with direct consequences for health. Historic patriarchal and misogynistic beliefs and values are reinforced through social institutions, including health science, which reify gender inequities. This commentary examines two key domains in which the social organization and institutionalization of gender in scientific research affect the conduct of women's health research and, by extension, women's health outcomes. These domains are: 1) decisions about which topics are prioritized, researched, and funded and 2) the dissemination of research findings. Using the National Institutes of Health (NIH) as a case study to illustrate broader patterns in scientific research, we present evidence of gender-based inequities in what is prioritized, deemed fundable, and disseminated, and how this affects knowledge production and attention to women's health. We highlight efforts and progress made by the NIH and call for additional attention to further address gender-based inequities and their impact on women's health research. We conclude with a call for critical social science analyses-ideally supported by the NIH-of the social organization of health science research to identify points of intervention for redressing deep-seated obstacles to advancing research on women's health.

Structural heteropatriarchy and maternal cardiovascular morbidities

The United States has some of the poorest maternal health outcomes of any developed nation. Existing research on maternal cardiovascular morbidities has focused predominantly on individual- and clinic-level drivers, but we know little about community- and structural-level factors that shape these outcomes. We use a composite measure of "structural heteropatriarchy" which includes measures of structural sexism and structural LGB-stigma to examine the relationship between structural heteropatriarchy and three cardiovascular-related maternal morbidities using the National Longitudinal Study of Adolescent to Adult Health (n = 3928). Results using multivariate regressions show that structural heteropatriarchy is associated with increased risk of reporting maternal morbidities. Our findings provide further evidence that sexuality- and gender-based stigma operate together to shape health disparities, including maternal health.

Political Ideology Direction of Policy Agendas and Maternal Mortality Outcomes in the U.S., 1915-2007

OBJECTIVES

The causes for persistently high and increasing maternal mortality rates in the United States have been elusive.

METHODS

We use the shift in the ideological direction of the Republican and the Democratic parties in the 1960s, to test the hypothesis that fluctuations in overall and race-specific maternal mortality rates (MMR) follow the power shifts between the parties before and after the Political Realignment (PR) of the 1960s.

RESULTS

Using time-series data analysis methods, we find that, net of trend, overall and race-specific MMRs were higher under Democratic administrations than Republican ones before the PR (1915-1965)-i.e., when the Democratic Party was a protector of the Jim Crow system. This pattern, however, changed after the PR (1966-2007), with Republican administrations underperforming Democratic ones-i.e., during the period when the Republican Party shifted toward a more economically and socially conservative agenda. The pre-post PR partisan shifts in MMRs were larger for Black (9.5%, p < . 01 ) relative to White mothers (7.4%, p < . 05 ) during the study period.

CONCLUSIONS FOR PRACTICE

These findings imply that parties and the ideological direction of their agendas substantively affect the social determinants of maternal health and produce politized health outcomes.

Understanding the Relationship Between Gender Representation in County Government and Perinatal Outcomes to Black, White, and Hispanic Birthing People in Georgia

Objective

To characterize the association between percent of county-level elected officials who were female-presenting and perinatal outcomes in Georgia and variation by individual race, 2020-2021.

Materials and Methods

We gathered data on the gender composition of county-level elected officials for all Georgia counties (n = 159) in 2022 and calculated the percent of female elected officials (percent female, 0-100). We linked this to data from 2020 to 2021 birth certificates (n = 238,795) to identify preterm birth (PTB, <37 weeks), low birthweight (LBW, <2500 grams), hypertensive disorders of pregnancy, and cesarean delivery. We fit multilevel log binomial models with generalized estimating equations, with percent female as the primary independent variable. We adjusted for individual and county-level potential confounders and individual race/ethnicity as an effect modifier.

Results

County median percent female elected officials was 22.2% (interquartile range: 15.5). Overall, 14.6% of births were PTB and 10.1% LBW. A 15 percentage point increase in percent female elected officials was associated with lower risk of hypertensive disorders of pregnancy for white (adjusted risk ratio [RR]: 0.94, 95% confidence interval [CI]: 0.88-0.99), and possibly Hispanic (adjusted RR: 0.95, 95% CI: 0.89-1.0) and non-Hispanic other (adjusted RR: 0.94 (0.87-1.01), but not black birthing people (adjusted RR: 1.0, 95% CI: 0.95-1.05). There was not a clear pattern for PTB, birthweight, or cesarean delivery.

Conclusion

Greater female representation in county government was associated with improved maternal health for some racial/ethnic groups in Georgia.

Long-run intergenerational health benefits of women empowerment: Evidence from suffrage movements in the US

An ongoing body of research documents that women empowerment is associated with improved outcomes for children. However, little is known about the long-run effects on health outcomes. This paper adds to this literature and studies the association between maternal exposure to suffrage reforms and children's old-age longevity. We utilize changes in suffrage laws across US states and over time as a source of incentivizing maternal investment in children's health and education. Using the universe of death records in the US over the years 1979-2020 and implementing a difference-in-difference econometric framework, we find that cohorts exposed to suffrage throughout their childhood live 0.6 years longer than unexposed cohorts. Furthermore, we show that these effects are not driven by preexisting trends in longevity, endogenous migration, selective fertility, and changes in the demographic composition of the sample. Additional analysis reveals that improvements in education and income are candidate mechanisms. Moreover, we find substantial improvements in early-adulthood socioeconomic standing, height, and height-for-age outcomes due to childhood exposure to suffrage movements. A series of state-level analyses suggest reductions in infant and child mortality following suffrage law change. We also find evidence that counties in states that passed the law experienced new openings of County Health Departments and increases in physicians per capita.

Income Support Policy Packages and Birth Outcomes in U.S. States: An Ecological Analysis

Research suggests that generous social welfare programs play a role in maternal and child health. However, most studies examine a single policy in isolation. Drawing from research documenting low-income families 'packaging' of social policies, we create a novel measure summarizing the value of a collection of income support policies for the working poor. This collection includes: the Supplemental Nutrition Assistance Program (SNAP), the Earned Income Tax Credit (EITC), the minimum wage, and the unemployment insurance (UI) program. Using U.S. state-level administrative data from 1996 to 2014, we estimate fixed effects regression models to examine the relationship between birth outcomes and income support policies (individually and combined). We find that increases in the combined value of the four income supports are significantly associated with reductions in preterm births and low birthweight births, but not infant mortality rates. States with the highest observed levels of combined income support had 14% fewer PTBs and 7% fewer LBWs than states with the lowest levels of income support. Of the four individual income support policies, only unemployment insurance has no significant independent effects. SNAP benefits have the largest and most consistent effects, reducing poor birth outcomes across all three indicators. An annual increase of $1000 in SNAP benefits is associated with a 3% decline in infant deaths, 5% decline in preterm births, and 2% decline in low birthweight births. These results suggest that increasing the generosity of income support policies may be a promising strategy for improving birth outcomes in the United States.

Association between gender social norms and cardiovascular disease mortality and life expectancy: an ecological study

OBJECTIVE

Examine the association between country-level gender social norms and (1) cardiovascular disease mortality rates; (2) female to male cardiovascular disease mortality ratios; and (3) life expectancy.

DESIGN

Ecological study with the country as the unit of analysis.

SETTING

Global, country-level data.

PARTICIPANTS

Global population of countries with data available on gender social norms as measured by the Gender Social Norms Index (developed by the United Nations Development Programme).

MAIN OUTCOME MEASURES

Country-level female and male age-standardised cardiovascular disease mortality rates, population age-standardised cardiovascular disease mortality rates, female to male cardiovascular disease mortality ratios, female and male life expectancy at birth. Outcome measure data were retrieved from the WHO and the Institute for Health Metrics and Evaluation. Multivariable linear regression models were fitted to explore the relationship between gender social norms and the outcome variables.

RESULTS

Higher levels of biased gender social norms, as measured by the Gender Social Norms Index, were associated with higher female, male and population cardiovascular disease mortality rates in the multivariable models (β 4.86, 95% CIs 3.18 to 6.54; β 5.28, 95% CIs 3.42 to 7.15; β 4.89, 95% CIs 3.18 to 6.60), and lower female and male life expectancy (β -0.07, 95% CIs -0.11 to -0.03; β -0.05, 95% CIs -0.10 to -0.01). These results included adjustment within the models for potentially confounding country-level factors including gross domestic product per capita, population mean years of schooling, physicians per 1000 population, year of Gender Social Norms Index data collection and maternal mortality ratio.

CONCLUSIONS

Our analysis suggests that higher levels of biased gender social norms are associated with higher rates of population cardiovascular disease mortality and lower life expectancy for both sexes. Future research should explore this relationship further, to define its causal role and promote public health action.

The Future of Social Determinants of Health: Looking Upstream to Structural Drivers

Policy Points Policies that redress oppressive social, economic, and political conditions are essential for improving population health and achieving health equity. Efforts to remedy structural oppression and its deleterious effects should account for its multilevel, multifaceted, interconnected, systemic, and intersectional nature. The U.S. Department of Health and Human Services should facilitate the creation and maintenance of a national publicly available, user-friendly data infrastructure on contextual measures of structural oppression. Publicly funded research on social determinants of health should be mandated to (a) analyze health inequities in relation to relevant data on structural conditions and (b) deposit the data in the publicly available data repository.

Macro-level gender equality and women's depressive symptoms in South Korea: a longitudinal study

PURPOSE

In 2014, the Korean Government passed the Gender Equality Act, which was accompanied by policies to increase women's participation in the labour force and representation in positions of power in the public and private sectors. While Korea has witnessed modest progress in macro-level gender equality, little is known about the effects of these changes on mental health outcomes. Our study investigated the relationship between regional-level gender equality (as measured by women's economic and political power) and women's depressive symptoms from 2013-18, and whether the effects differed across women from different socioeconomic positions.

METHODS

To examine how change over time in political and economic power influences the severity of depressive symptoms, we applied a fixed-effect regression, using a nationally representative sample for women aged 19-64 (n = 9,589) from the Korean Longitudinal Survey of Women and Families (2013-2018, wave 4 to 6) residing across the 16 regions of South Korea.

RESULTS

Our study found that increases in women's political and economic power led to moderate reductions in depressive symptoms (-0.25 and -0.23 points in CESD respectively). Sensitivity analyses indicate that economic power is more consistently associated with subsequent reductions in CESD. The effect of economic and political power on depressive symptoms did not differ by women's socioeconomic positions.

CONCLUSIONS

Our findings suggest that even modest improvements in gender equality were associated with increases in women's mental health. Further progress to ensure gender equality, such as the anti-discrimination legislation, may lead to greater improvements in public mental health.

Adverse childhood experiences growing up in East or West Germany or abroad

Background

Adverse childhood experiences (ACEs) are potentially traumatic events that occur before the age of 18. The term encompasses various adverse childhood experiences, e.g., physical, psychological, and sexual abuse, physical and psychological neglect, and family dysfunction. Prevalence estimates for a broad spectrum of ACEs against the background of where childhood and adolescence were spent are scarcely available in Germany. This study examines the frequencies of adverse childhood experiences, considering growing up in East or West Germany or abroad and interacting with different age cohorts and gender.

Methods

A total of 5,018 individuals (51.4% female) aged 14 years and older were retrospectively assessed on adverse childhood experiences using questionnaires "adverse childhood experiences" (ACE). Logistic regression models were used to analyze the association between birth cohort, gender, and where a person grew up. Descriptive statistics and univariate analyses were used to calculate frequencies, proportions, and unadjusted associations for each variable.

Results

37.4% (N = 1,878) of respondents reported experiencing at least one form of ACE. Individuals who grew up abroad report significantly more adverse childhood experiences than individuals in East or West Germany. Men and women who grew up in East Germany reported a lower rate of ACEs. We found significant effects for all predictors: Where childhood and adolescence were predominantly spent, year of birth, and gender. Significant differences in the prevalence of adverse childhood experiences within the gender groups were only found for sexual and physical abuse and substance dependence in the household.

Conclusion

The results suggest that the socio-political context plays an essential role in the experience of adverse childhood experiences, both in frequency and risk. Thus, child abuse and neglect studies should increasingly focus on societal risk and protection mechanisms.

Female political representation and the gender health gap: a cross-national analysis of 49 European countries

Background

Does increased female participation in the social and political life of a country improve health? Social participation may improve health because it ensures that the concerns of all people are heard by key decision-makers. More specifically, when women’s social participation increases this may lead to health gains because women are more likely to vote for leaders and lobby for policies that will enhance the health of everyone. This article tries to examine whether female participation is correlated with measures of health inequality.

Methods

We draw on data from the World Health Organization Health Equity Status Report initiative and the Varieties of Democracy project to assess whether health is better and health inequalities are smaller in countries where female political representation is greater.

Results

We find consistent evidence that greater female political representation is associated with lower geographical inequalities in infant mortality, smaller inequalities in self-reported health (for both women and men) and fewer disability-adjusted life-years lost for women and men. Finally, we find that greater female political representation is not only correlated with better health for men and women but is also correlated with a smaller gap between men and women because men seem to experience better health in such contexts.

Conclusions

Greater female political representation is associated with better health for everyone and smaller inequalities.

The Power of Women: Does increasing women's parliamentary representation reduce intake of sugar-sweetened beverages among children and adolescents?

OBJECTIVE

Consumption of sugar-sweetened beverages (SSBs) is associated with overweight and obesity in children and adolescents. Although existing research confirms the significance of economic and social factors as determinants of SSB intake, comparative studies on political factors and cross-national analyses are lacking. Research indicates that including women in the process of political decision-making promotes healthcare and child protection. This study examined how women's parliamentary representation influences children's and adolescents' SSB intake compared to adults.

DESIGN

The study used cross-national food and beverage intake data from the Global Dietary Database. The outcome measurement was SSB consumption (g/day) for different population groups. We modeled SSB intake as a function of age groups, women's parliamentary representation at the national level (the independent variable), regime types (the contextual factor), and import tariffs on SSBs (the mediator) using country and time fixed effects regression models.

SETTING

185 countries across three waves from 2005 to 2015.

PARTICIPANTS

Different population groups.

RESULTS

The impact of female representation on reducing SSB consumption is more prevalent in children and adolescents than in adults. Furthermore, the effect of women's parliamentary representation on SSB consumption among children and adolescents is conditional on a country's democratic status. Finally, the marginal effect decreases when import tariffs on SSBs are considered a link in a causal chain. No changes in adult SSB intake are statistically significant.

CONCLUSIONS

The findings suggest that the presence of women in the legislature can have a substantial impact on child and adolescent health.

State-Level Sexism and Gender Disparities in Health Care Access and Quality in the United States

In this investigation, we examined the associations between state-level structural sexism-a multidimensional index of gender inequities across economic, political, and cultural domains of the gender system-and health care access and quality among women and men in the United States. We linked administrative data gauging state-level gender gaps in pay, employment, poverty, political representation, and policy protections to individual-level data on health care availability, affordability, and quality from the national Consumer Survey of Health Care Access (2014-2019; N = 24,250). Results show that higher state-level sexism is associated with greater inability to access needed health care and more barriers to affording care for women but not for men. Furthermore, contrary to our hypothesis, women residing in states with higher state-level sexism report better quality of care than women in states with lower levels of sexism. These findings implicate state-level sexism in perpetuating gender disparities in health care.

The relationship between global gender equality with maternal and neonatal health indicators: an ecological study

PURPOSE

Achieving the millennium development goals (MDGs) and sustainable development goals (SDGs) including gender equality, reducing maternal, neonatal, and under 5 mortality rates are still considered a major global challenge. This study was performed with the aim of investigating the relationship between global gender equality and maternal as well as neonatal, and under 5 children health indicators.

MATERIALS AND METHODS

The present study is an ecological study performed through credible secondary data published in 2017 for each country. Then, the Gender Equality Index along with its four areas, maternal mortality, neonatal mortality, and under 5 mortality rates were extracted. Data analysis was performed by SPSS 24 via descriptive-analytical statistics and linear regression.

RESULTS

There was a significant and direct correlation between all of the three variables of maternal mortality, neonatal, as well as under 5 mortality and Gender Equality Index. Correlation analysis between the above-mentioned indicators and the areas of Gender Equality Index showed that there is no significant correlation between the "economic opportunities and participation" index and none of the maternal, neonatal, and under 5 mortality indicators. The "educational attainment" index had an inverse significant correlation with the above-mentioned variables. The "survival and health" index had only an inverse significant correlation with neonatal mortality, and "political empowerment" had such a correlation with neonatal and under 5 mortality rates.

CONCLUSIONS

Panning and policymaking for reducing gender equality barriers should be among the top priorities of primary healthcare in order to achieve maternal, neonatal, and under 5 health universally.

A gender-focused multilevel analysis of how country, regional and individual level factors relate to harm from others' drinking

BACKGROUND

The aim of this study was to examine how gender, age and education, regional prevalence of male and female risky drinking and country-level economic gender equality are associated with harms from other people's drinking.

METHODS

24,823 adults in ten countries were surveyed about harms from drinking by people they know and strangers. Country-level economic gender equality and regional prevalence of risky drinking along with age and gender were entered as independent variables into three-level random intercept models predicting alcohol-related harm.

FINDINGS

At the individual level, younger respondents were consistently more likely to report harms from others' drinking, while, for women, higher education was associated with lower risk of harms from known drinkers but higher risk of harms from strangers. Regional rate of men's risky drinking was associated with known and stranger harm, while regional-level women's risky drinking was associated with harm from strangers. Gender equality was only associated with harms in models in models that did not include risky drinking.

CONCLUSIONS

Youth and regional levels of men's drinking was consistently associated with harm from others attributable to alcohol. Policies that decrease the risky drinking of men would be likely to reduce harms attributable to the drinking of others.

Cervical cancer prevention in Africa: A policy analysis

BACKGROUND

Cervical cancer is a major public health challenge in Africa. We analyzed the presence and content of policies for the primary, secondary and tertiary prevention of cervical cancer in Africa, to identify areas of opportunity for policy strengthening in the region most affected by cervical cancer globally.

METHODS

We searched for publicly-available policy documents among countries in Africa. Using a data extraction form, we gathered data from these policies about key elements of primary, secondary and tertiary prevention approaches and activities based on World Health Organization (WHO) guidelines. We also contacted key stakeholders in each country to confirm these details. We summarized each country's policy details (summed score for each prevention stage and overall), and compared these scores across individual countries and groups of countries based on economic, policy and public health characteristics.

RESULTS

Most countries had at least one policy addressing some aspect of cervical cancer prevention. Primary and secondary prevention were more commonly addressed, and certain details like age of vaccination, screening age/interval and method, were frequently mentioned in these policies.

CONCLUSION

Countries with high HIV burden and relatively more donor financing for health had more comprehensive cervical cancer policies; there was no apparent association with cervical cancer mortality, female representation in government, or economic indicators (poverty prevalence or income inequality).

POLICY SUMMARY

There is room to improve cervical cancer policy comprehensiveness in Africa, and to bring these policies in line with evidence and expert recommendations. This analysis is timely given upcoming monitoring of the WHO Global Strategy to Accelerate the Elimination of Cervical Cancer as a Public Health Problem. These findings suggest some improvements in African cervical cancer policy, including increased inclusion of vaccination, but many topics remain under-specified. The influence of internal and external factors on policymaking should also be considered.

Structural Heteropatriarchy and Birth Outcomes in the United States

Emerging evidence links structural sexism and structural discrimination against lesbian, gay, and bisexual (LGB) populations to poor health outcomes, but studies have yet to examine the combined effects of these mutually reinforcing systems of inequality. Therefore, we developed a composite measure of structural heteropatriarchy-which includes state-level LGB policies, family planning policies, and indicators of structural sexism (e.g., women's political and economic position relative to men)-and examined its relationship to birth outcomes using data from Waves I to V of the National Longitudinal Study of Adolescent to Adult Health. Multivariate regression analyses demonstrated that higher levels of heteropatriarchy were associated with an increased risk of preterm birth and decreased birth weight, net of important covariates. There was no association between clinical low birth weight and heteropatriarchy, or interactions between heteropatriarchy and individuals' race, ethnicity or sexual identity, suggesting a negative effect of heteropatriarchy on birth outcomes for all pregnant people. This study demonstrates the importance of considering gender and sexuality as mutually reinforcing systems of oppression that impact population health. Future research should examine the impact of heteropatriarchy on additional health outcomes and in conjunction with other structural inequalities such as racism and transgender oppression.

Social factors and public policies associated with state infant mortality rates

Despite mounting evidence that social factors and public policies affect state infant mortality rates (IMRs), few researchers have examined variation in IMRs associated with those factors and policies. We quantified disparities in infant mortality by state social factors and public policy characteristics. We hypothesized that some social factors and public policies would be more strongly associated with infant mortality than others, and that states with similar factors and policies would form clusters with varying levels of infant mortality. We examined associations of women's economic empowerment, health and well-being, political participation, reproductive rights, and work and family-related policies with state IMRs in 2012 and 2015, using indicators created by the Institute for Women's Policy Research. Methods included generalized linear models, principal component analysis, and cluster analysis. Health and well-being predicted IMRs (2012, 2015, both p < .05), as did poverty and opportunity, and reproductive rights (2012, p < .10). Consistent with our hypothesis, states formed clusters, with the states in each cluster having similar social factors and public policies, and similar IMRs. Women's health status and insurance coverage were more predictive of state IMRs than other social factors. Improving health and insurance coverage may be an effective way to reduce state IMRs.

Women's Political Leadership and Adult Health: Evidence from Rural and Urban China

This study examined the role of women's political leadership at the community level in China, a context that has experienced recent political and socioeconomic change and has a distinctive rural-urban divide. Drawing on longitudinal data from the China Family Panel Studies (N range = 40,918-52,406 person-year observations), we found that female community directors outnumbered male directors in urban China but were much less common in rural areas. Female community directors had higher levels of human capital regardless of rural or urban location. Residents living in female-directed communities reported better mental health but not physical health or life satisfaction compared to those living in male-directed communities, and this association was most robust among rural women. For rural women, the mental health benefit of living in female-directed communities was partially explained by reduced personal experience of gender discrimination, suggesting that female leadership fosters ideational change toward women that lowers discriminatory behaviors among constituents.

Risk and protective factors for child maltreatment: A review

PURPOSE OF REVIEW

The purpose of this review was to synthesize the empirical literature regarding key risk and protective factors for child maltreatment at each level of the socioecological model and to identify directions for future research and practice.

RECENT FINDINGS

Prior research has largely focused on risk and protective factors at the individual and interpersonal levels of the socioecological model. More recently, research has begun to examine risk and protective factors at the community and societal levels, with results suggesting that programmatic and policy interventions that reduce risk and enhance protection at these levels are promising primary prevention strategies for child maltreatment.

SUMMARY

Future research should continue to focus on risk and protective factors at the community and societal levels with the aim of building the evidence base for population-wide prevention strategies. Such strategies have the potential to create contexts in which families and children thrive.

Organized Labor and Depression in Europe: Making Power Explicit in the Political Economy of Health

Despite engagement with the construct of power relations, research on the political economy of health has largely overlooked organized labor as a determinant of well-being. Grounded in the theory of power resources, our study aims to fill this gap by investigating the link between country-level union density and mental health while accounting for the compositional effects of individual-level union membership. We use three waves of the European Social Survey (N = 52,737) and a variation on traditional random-effects models to estimate both the contextual and change effects of labor unions on depressive symptoms. We find that country-level union density is associated with fewer depressive symptoms and that this is true irrespective of union membership. We discuss our findings vis-à-vis the literatures on the political economy of health, power resources, and fundamental causes of disease.

Increases In Women's Political Representation Associated With Reductions In Child Mortality In Brazil

We assessed the effects of female political representation on mortality among children younger than age five in Brazil and the extent to which this effect operates through coverage with conditional cash transfers and primary care services. We combined data on under-five mortality rates with data on women elected as mayors or representatives in state and federal legislatures for 3,167 municipalities during 2000–15. Results from fixed-effects regression models suggest that the election of a female mayor and increases in the shares of women elected to state legislatures and to the federal Chamber of Deputies to 20 percent or more were significantly associated with declines in under-five mortality. Increasing the political representation of women was likely associated with beneficial effects on child mortality through pathways that expanded access to primary health care and conditional cash transfer programs.

Infant Mortality Rates for Farming and Unemployed Households in the Japanese Prefectures: An Ecological Time Trend Analysis, 1999-2017

Background

Recent research suggests that Japanese inter-prefecture inequality in the risk of death before reaching 5 years old has increased since the 2000s. Despite this, there have been no studies examining recent trends in inequality in the infant mortality rate (IMR) with associated socioeconomic characteristics. This study specifically focused on household occupation, environment, and support systems for perinatal parents.

Methods

Using national vital statistics by household occupation aggregated in 47 prefectures from 1999 through 2017, we conducted multilevel negative binomial regression analysis to evaluate occupation/IMR associations and joinpoint analysis to observe temporal trends. We also created thematic maps to depict the geographical distribution of the IMR.

Results

Compared to the most privileged occupations (ie, type II regular workers; including employees in companies with over 100 employees), IMR ratios were 1.26 for type I regular workers (including employees in companies with less than 100 employees), 1.41 for the self-employed, 1.96 for those engaged in farming, and 6.48 for unemployed workers. The IMR ratio among farming households was 1.75 in the prefectures with the highest population density (vs the lowest) and 1.41 in prefectures with the highest number of farming households per 100 households (vs the lowest). Joinpoint regression showed a yearly monotonic increase in the differences and ratios of IMRs among farming households compared to type II regular worker households. For unemployed workers, differences in IMRs increased sharply from 2009 while ratios increased from 2012.

Conclusions

Inter-occupational IMR inequality increased from 1999 through 2017 in Japan. Further studies using individual-level data are warranted to better understand the mechanisms that contributed to this increase.

Gender Equality, Drinking Cultures and Second-Hand Harms from Alcohol in the 50 US States

BACKGROUND

Gender inequality and cultures of binge drinking may increase the risk of second-hand harms from alcohol.

METHODS

Using the 2014-2015 National Alcohol Survey and 2015 National Alcohol's Harm to Others Survey (N = 7792), we examine associations of state-level gender equality measures (contraceptive access, abortion rights, women's economic equality) and binge drinking cultures (rates of men's and women's binge drinking) with individual-level indicators of second-hand harms by drinking strangers and partners/spouses.

RESULTS

In main effects models, only male binge drinking was associated with greater odds of harms from drinking strangers. There were significant interactions of gender equality with male binge drinking: High male binge drinking rates were more strongly associated with stranger-perpetrated harms in states low on contraceptive access or abortion rights compared to states high on these measures. Conversely, male binge drinking was more strongly associated with spouse/partner-perpetrated second-hand harms in states with more economic equality, compared to states lower on this measure.

CONCLUSIONS

Detrimental effects of high male binge drinking rates may be modified by gender equality. Targeted interventions may reduce alcohol-related harms experienced by women in states with high rates of male binge drinking. Restrictions in access to contraception and abortion may exacerbate harms due to men's drinking.

Current Crises and Potential Conflicts in Asia and the Pacific: Challenges Facing Global Health or Global Public Health by a Different Name

Since 1945, the reasons for major crises and how the world responds to them have changed every 10-15 years or sooner. Whereas these crises vary greatly across global regions, their economic, environmental, ecological, social, and disease aspects are increasingly under the influence of widely integrated global changes and forces arising primarily from: climate extremes; rapid unsustainable urbanization; critical biodiversity losses; and emergencies of scarcity in water, food, and energy. These slow-moving but increasingly severe crises affect larger populations across many borders and lead to the emergence of increasing population-based, preventable public health emergencies related to water, sanitation, food, shelter, energy, and related health illnesses, and ultimately global health security. This report explores the impact of these crises on Asia and the Pacific region, and their potential for regional conflict.

Global nurse/midwife workforce and reproductive health through social ecology lens

OBJECTIVE

To explore how community social ecology factors may be associated with country registered nurse/registered midwife (RN/RM) workforce supply and reproductive health globally.

DESIGN

A cross-sectional design using a social ecology framework was employed.

SAMPLE

Data were retrieved from publicly available websites for 107 countries.

MEASUREMENTS

Dependent variables included RN/RM density, maternal mortality ratios (MMR), and adolescent birth rates (ABR). Independent variables included gender inequality, region, country income classification, education, gross domestic product per capita, government expenditure of spending on education and health, life expectancy, percent of female seats in legislature, and labor force participation factors.

RESULTS

The best fit multivariable model of RN/RM density showed that after adjustment for region, country income and the GII, the percent of females with some secondary education explained most of variation in RN/RM density. The best fit models of MMR and ABR showed that gender inequality explained most of the variation. Other factors in the models were the percent of female seats in legislatures, region, country income class, and mean years of schooling.

CONCLUSIONS

Employing a social ecology model can useful in RN/RM workforce planning and development as countries seek multisectoral strategies for increasing the RN/RM supply and improving reproductive health outcomes.

[Gender equality and the gender gap in life expectancy in Germany]

BACKGROUND

The gender gap in life expectancy is documented worldwide with lower life expectancy in male new-borns. International studies have shown that the gender gap in life expectancy varies markedly with gender inequality.

OBJECTIVES

The paper addresses the questions: (1) whether there are life-expectancy differences between the federal states and whether the extent of gender equality at federal level is associated with (2) gender differences in life expectancy and (3) the life expectancy of women and men.

MATERIALS AND METHODS

The Gender Inequality Index (GII) developed by the United Nations Development Project was calculated using data from the federal states. Using linear regressions, GII was associated with the gender gap in life expectancy as well as with life expectancy in males and females.

RESULTS

The GII varies between 0.065 (Bavaria) and 0.117 (Mecklenburg-Vorpommern) and the gender gap in life expectancy differs by almost two years within Germany. We found a correlation between the gender difference in life expectancy and GII (R² linear = 0.848) as well as between GII and life expectancy of male (R² linear = 0.700), but not female newborns (R² linear = 0.102). The association remains if GDP is taken into account as an indicator of economic power.

CONCLUSIONS

Gender equality seems to be positively related to the life expectancy of men. This can be explained by the reduced importance of male gender stereotypes and associated risk behaviors. The requirements for gender-differentiated interventions formulated in the Prevention Act (Präventionsgesetz) are highly significant.

The effect of women in government on population health: An ecological analysis among Canadian provinces, 1976-2009

Previous research finds connections between women in government, promotion of women’s issues, and government spending. However, the connection between female politicians and population health warrants more significant attention. This study takes advantage of differences among Canadian provinces to evaluate the effect of women in government on age-standardized all-cause mortality rates, to assess the potential mediating role of government spending, and to determine the role played by political partisanship. Time-series cross-sectional data are retrieved from the Canadian Socio-Economic Information Management System II Tables for 1976–2009 (10 provinces and 34 years = 340 cases). Cumulative women in government is measured as the cumulative seats held by female politicians as a percentage of provincial seats since 1960. Political partisanship is measured as the cumulative seats held by female politicians in left-wing, centre, and right-wing parties as a percentage of provincial seats since 1960. Government spending is measured as the average of standard scores of four provincial expenditures: medical care, preventive care, other social services, and post-secondary education. Health is measured as total, male and female age-standardized mortality rates per 1000 population (all causes of death). Estimation techniques include the Prais-Winsten regressions with panel-corrected SEs, a first-order autocorrelation correction model, and fixed-unit effects, adjusted for alternative factors. We find that as the cumulative average percentage of women in government has historically risen, total, male, and female mortality rates tend to be lower, net of alternative explanations. Government spending partially mediates the effect of women in government on mortality rates. Moreover, increases in female politicians from left-wing, centre, and right-wing parties are all significantly associated with decreases in mortality rates. Women in government can bring about desirable changes in population health. Our work encourages more debate and research about quotas and other measures designed to level the political playing field for women.

Gender and the Politics of Death: Female Representation, Political and Developmental Context, and Population Health in a Cross-National Panel

There is considerable speculation that female political empowerment could improve population health. Yet, evidence to date is limited, and explanations for why political empowerment would matter and the conditions under which this might be enhanced or muted are not well understood. In this article, we draw on theoretical work on the politics of representation to frame an investigation of whether increases in the percentage of females in a country's parliament influence mortality rates. We further examine whether the relationship is conditioned by extent of democracy and economic and social development. Through multivariate longitudinal regression, we analyze four indicators of mortality in 155 countries spanning 1990 to 2014 with controls for initial country conditions, time-stable structural predispositions to higher mortality, and a number of time-varying potential confounders. Results indicate that a high level of female representation-30 % or greater in our models-has large negative associations with mortality, that these are particularly strong in lesser developed and weak democratic contexts, that high female political representation effectively offsets liabilities associated with low development, and that the relationships are robust to various operationalizations of social development. In the end, our research provides a particularly thorough accounting of the relationship between female political representation and population health, particularly by specifying the conditions under which female representation is most salient. In doing so, the research suggests important links between issues of female empowerment, political context, and developmental trajectories of countries more generally.