Health Equity: 09/25/12

Tuesday, September 25, 2012

[EQ] Neighborhood Effects on the Long-Term Well-Being of Low-Income Adults

Neighborhood Effects on the Long-Term Well-Being of Low-Income Adults

Jens Ludwig1,2,*, Greg J. Duncan 3, Lisa A. Gennetian 4, Lawrence F. Katz 2,5, Ronald C. Kessle r6,
Jeffrey R. Kling 2,7, Lisa Sanbonmatsu 2

1 Harris School of Public Policy, University of Chicago, USA.

2 National Bureau of Economic Research, USA.

3 School of Education, University of California, USA.

4 The Brookings Institution, Washington, DC, USA.

5 Department of Economics, Harvard University, Cambridge, USA.

6 Department of Health Care Policy, Harvard Medical School, USA.

7 Congressional Budget Office, Washington, DC USA.

Science 21 September 2012: Vol. 337 no. 6101 pp. 1505-1510

Website:

“…….Nearly 9 million Americans live in extreme-poverty neighborhoods, places that also tend to be racially segregated and dangerous. Yet, the effects on the well-being of residents of moving out of such communities into less distressed areas remain uncertain.

Using data from Moving to Opportunity, a unique randomized housing mobility experiment, we found that moving from a high-poverty to lower-poverty neighborhood leads to long-term (10- to 15-year) improvements in adult physical and mental health and subjective well-being, despite not affecting economic self-sufficiency

A 1–standard deviation decline in neighborhood poverty (13 percentage points) increases subjective well-being by an amount equal to the gap in subjective well-being between people whose annual incomes differ by $13,000—a large amount given that the average control group income is $20,000.

Subjective well-being is more strongly affected by changes in neighborhood economic disadvantage than racial segregation, which is important because racial segregation has been declining since 1970, but income segregation has been increasing….”

Moving and the Neighborhood Glass Ceiling.

Robert J. Sampson. Science 21 September 2012: 1464-1465.

http://bit.ly/VEnhEx

KMC/2012/SDE
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[EQ] The fiendish puzzle of health inequities

The fiendish puzzle of health inequities

Wayne Kondro
CMAJ September 18, 2012 184:1456-1457; doi:10.1503/cmaj.109-4271
Prof Sir Michael Marmot, UCL Institute of Health Equity, UCL Department of Epidemiology and Public Health, UCL, London, UK
Website: http://bit.ly/Swx0hj

“…….Medieval cartographers once depicted monsters and bogs on the borders of their maps, as if foraying into uncharted territories put one at risk of unimaginable and unpredictable consequences.

It might be said that Canada’s physicians find themselves in a bit of that predicament after embracing the notion that they have a major role to play in addressing health inequities and the social determinants of health, such as housing, education and poverty.

As they discovered during sessions of the Canadian Medical Association’s 145th annual general meeting, held in Yellowknife, Northwest Territories, the solutions aren’t readily identifiable, and definitely not easily achieved. Broad policy solutions, like ones offered in a keynote lecture by internationally renowned epidemiologist Sir Michael Marmot, are not generally palatable to governments or consistent with prevailing political winds, while more local action, and even measures taken at the physician–patient level, can quickly devolve into classic conundrums. …”

Presentation: http://bit.ly/UEETSA

WHO European review of social determinants of health and the health divide

Prof Sir Michael Marmot FRCP a , Jessica Allen PhD a, Ruth Bell PhD a, Ellen Bloomer MSc a, Peter Goldblatt PhD a,
on behalf of the Consortium for the European Review of Social Determinants of Health and the Health Divide.
Prof Sir Michael Marmot, UCL Institute of Health Equity, UCL Department of Epidemiology and Public Health, UCL, London, UK
The Lancet, Volume 380, Issue 9846, Pages 1011 - 1029, 15 September 2012

Website: http://bit.ly/U8o2HE

“…….The European region has seen remarkable heath gains in those populations that have experienced progressive improvements in the conditions in which people are born, grow, live, and work. However, inequities, both between and within countries, persist.

The review reported here, of inequities in health between and within countries across the 53 Member States of the WHO European region, was commissioned to support the development of the new health policy framework for Europe: Health 2020. Much more is understood now about the extent, and social causes, of these inequities, particularly since the publication in 2008 of the report of the Commission on Social Determinants of Health

The European review builds on the global evidence and recommends policies to ensure that progress can be made in reducing health inequities and the health divide across all countries, including those with low incomes. Action is needed—on the social determinants of health, across the life course, and in wider social and economic spheres—to achieve greater health equity and protect future generations….”

An Equal Start: Improving outcomes in Children's Centres

Improving outcomes in Children's Centres Executive Summary http://bit.ly/S3skua

An Evidence Review http://bit.ly/QSFDP4

The Institute of Health Equity was commissioned by 4Children to identify the most important outcomes Children’s Centres should be striving for in order to give all children positive early-years experiences.

The IHE have published both an executive summary (which includes the outcomes framework), and a full evidence review, which call for a renewed focus on supporting good parenting and the environment in which parents live and work.

The work builds on existing frameworks and draws together the best available evidence of what is important in early years, the views of practitioners and parents, and the work that government continues to take forward around the early years.

Moving on, the Institute will be involved in further work with Children’s Centres to help ensure that the outcomes framework becomes a useful tool which also identifies how best to measures these outcomes….”

KMC/2012/HSS
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* * *
This message from the Pan American Health Organization, PAHO/WHO, is part of an effort to disseminate
information Related to: Equity; Health inequality; Socioeconomic inequality in health; Socioeconomic
health differentials; Gender; Violence; Poverty; Health Economics; Health Legislation; Ethnicity; Ethics;
Information Technology - Virtual libraries; Research & Science issues. [DD/ KMC Area]
Washington DC USA

Thank you.

[EQ] Large-System Transformation in Health Care: A Realist Review

Large-System Transformation in Health Care: A Realist Review

Allan Best, 1 Trisha Greenhalgh, 2 Steven Lewis,3 Jessie e. Saul,4 Simon Carroll,5 and Jennifer Bitz1

1InSource Research Group; -2Barts and the London School of Medicine and Dentistry; -3Access Consulting Ltd.; -4North American Research and Analysis Inc.;
5University of Victoria

The Milbank Quarterly, September 2012 - Volume 90, Number 3 - (pp. 421–456)

Available online at: http://bit.ly/VySity

“……An evidence base that addresses issues of complexity and context is urgently needed for large-system transformation (LST) and health care reform. Fundamental conceptual and methodological challenges also must be addressed. The Saskatchewan Ministry of Health in Canada requested a six-month synthesis project to guide four major policy development and strategy initiatives focused on patient- and family-centered care, primary health care renewal, quality improvement, and surgical wait lists.

The aims of the review were to analyze examples of successful and less successful transformation initiatives, to synthesize knowledge of the underlying mechanisms, to clarify the role of government, and to outline options for evaluation….”

Methods:
We used realist review, whose working assumption is that a particular intervention triggers particular mechanisms of change. Mechanisms may be more or less effective in producing their intended outcomes, depending on their interaction with various contextual factors. We explain the variations in outcome as the interplay between context and mechanisms. We nested this analytic approach in a macro framing of complex adaptive systems (CAS).

Findings:
Our rapid realist review identified five “simple rules” of large-system transformation LST that were likely to enhance the success of the target initiatives:
(1) blend designated leadership with distributed leadership;
(2) establish feedback loops;
(3) attend to history;
(4) engage physicians; and
(5) include patients and families.
These principles play out differently in different contexts affecting human behavior (and thereby contributing to change) through a wide range of different mechanisms.

Conclusions:
Realist review methodology can be applied in combination with a complex system lens on published literature to produce a knowledge synthesis that informs a prospective change effort in large-system transformation.
A collaborative process engaging both research producers and research users contributes to local applications of universal principles and mid-range theories, as well as to a more robust knowledge base for applied research. We conclude with suggestions for the future development of synthesis and evaluation methods….”

Related material:

"If We Build It, Will It Stay?" A Case Study of the Sustainability of Whole-System Change in London (pages 516–547)

Trisha Greenhalgh, Fraser Macfarlane, Catherine Barton-Sweeney, and Fran Woodard

DOI: 10.1111/j.1468-0009.2012.00673.x at: http://bit.ly/ReE0NK

KMC/2012/HSS
Twitter http://twitter.com/eqpaho

* * *
This message from the Pan American Health Organization, PAHO/WHO, is part of an effort to disseminate
information Related to: Equity; Health inequality; Socioeconomic inequality in health; Socioeconomic
health differentials; Gender; Violence; Poverty; Health Economics; Health Legislation; Ethnicity; Ethics;
Information Technology - Virtual libraries; Research & Science issues. [DD/ KMC Area]
Washington DC USA

Thank you.