Inequalities in US Life Expectancy by Area Unemployment Level, 1990-2010

This study examined the association between unemployment and life expectancy in the United States during 1990-2010. 

Census-based unemployment rates were linked to US county-level mortality data. Life expectancies were calculated by age, sex, race, and unemployment level during 1990-2010. Differences in life expectancy were decomposed by age and cause of death. 

Life expectancy was consistently lower in areas with higher unemployment rates. In 2006-2010, those in areas with high unemployment rates (≥9%) had a life expectancy of 76.9 years, compared with 80.7 years for those in areas with low unemployment rates (<3%). The association between unemployment and life expectancy was stronger for men than for women. 

Life expectancy ranged from 69.9 years among black men in high unemployment areas to 90.0 years among Asian/Pacific Islander women in low unemployment areas. Disparities persisted over time. In 1990-1992, life expectancy was 4.7 years shorter in high unemployment than in low unemployment areas. In 2006-2010, the life expectancy difference between the lowest and highest unemployment areas decreased to 3.8 years. Heart disease, cancer, homicide, unintentional injuries, diabetes, HIV/AIDS, and liver cirrhosis contributed most to the lower life expectancy in high unemployment areas. High unemployment areas recorded larger gains in life expectancy than low unemployment areas, contributing to the narrowing gap during 1990-2010.

Below:  Life expectancy at birth by sex and area unemployment level, United States, 1990–2010

Below:  Survivorship by age, race, and unemployment level, United States, 1990–2010

Below:  Conditional probability of survival between ages of 25 and 64 years by unemployment level, United States, 1990–2010

Full article at:   http://goo.gl/FI27Gt

By:  Singh GK1, Siahpush M2.

• 1US Department of Health and Human Services, 5600 Fishers Lane, Rockville, MD 20857, USA.
• 2Department of Health Promotion, Social and Behavioral Health, University of Nebraska Medical Center, College of Public Health, Omaha, NE 68198-4365, USA.
• Scientifica (Cairo). 2016;2016:8290435. doi: 10.1155/2016/8290435. Epub 2016 Mar 17. 

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The Use of Cash Transfers for HIV Prevention - Are We There Yet?

Poverty and social inequality are significant drivers of the HIV epidemic and are risk factors for acquiring HIV. As such, many individuals worldwide are at risk for new HIV infection, especially young women in East and Southern Africa. By addressing these drivers, social protection programmes may mitigate the impact of poverty and social inequality on HIV risk. 

There is reason to believe that social protection can be used successfully for HIV prevention; social protection programmes, including cash transfers, have led to positive health outcomes and behaviour in other contexts, and they have been used successfully to promote education and increased income and employment opportunities. 

Furthermore, cash transfers have influenced sexual behaviour of young women and girls, thereby decreasing sexual risk factors for HIV infection. When HIV outcomes have been measured, several randomised controlled trials have shown that indirectly, cash transfers have led to reduced HIV prevalence and incidence. 

In these studies, school attendance and safer sexual health were directly incentivised through the cash transfer, yet there was a positive effect on HIV outcomes. In this review, we discuss the growth of social protection programmes, their benefits and impact on health, education and economic potential, and how these outcomes may affect HIV risk. 

We also review the studies that have shown that cash transfers can lead to reduced HIV infection, including study limitations and what questions still remain with regard to using cash transfers for HIV prevention.

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By:  Taaffe J1, Cheikh N1, Wilson D1.

• 1 The World Bank Group , Washington , DC , USA. 
• Afr J AIDS Res. 2016 Mar;15(1):17-25. doi: 10.2989/16085906.2015.1135296.

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Foreclosure and Health in Southern Europe: Results from the Platform for People Affected by Mortgages

Housing instability has been shown to be related to poorer health outcomes in various studies, mainly in the USA and UK. Affected individuals are more prone to psychiatric (e.g., major depression, anxiety) and physical disorders (e.g., hypertension). This situation has deteriorated with the onset of the economic crisis. One of the most affected countries is Spain, which has high rates of foreclosure and eviction that continue to rise. In response, a civil movement, The Platform for People Affected by Mortgages (PAH), works to provide solutions to its members affected by foreclosure and advocates for the right to decent housing. 

The aims of this study ware to describe and compare the health status of PAH members from Catalonia to a sample of the general population and to analyze the association between health status and mortgage status, foreclosure stage, and other socioeconomic variables, among members of the PAH. We conducted a cross-sectional study using a self-administered online questionnaire (2014) administered to 905 PAH members in Catalonia (>18 years; 559 women and 346 men). Results were compared with health indicators from The Health Survey of Catalonia 2013 (n = 4830). The dependent variables were poor mental health (GHQ 12 ≥ 3), and poor self-reported health (fair or poor). All analyses were stratified by sex. We computed age-standardized prevalence and prevalence ratios of poor mental and self-reported health in both samples. We also analyzed health outcomes among PAH members according to mortgage status (mortgage holders or guarantors), stage of foreclosure, and other socioeconomic variables by computing prevalence ratios from robust Poisson regression models. 

The prevalence of poor mental health among PAH members was 90.6 % in women and 84.4 % in men, and 15.5 and 10.2 % in the general population, respectively. The prevalence of poor self-reported health was 55.6 % in women and 39.4 % in men from the PAH, and 19.2 and 16.1 % in the general population, respectively. These health inequalities were independent of socioeconomic status. The prevalence of poor mental health was higher among individuals in the non-payment stage of foreclosure than among those who were up to date with their payments. 

In contrast, self-reported poor health was more prominent in later stages of foreclosure, such as in post-eviction without dation in payment stage in men. 

We observed a considerably higher prevalence of poor mental and self-reported health among male and female PAH members than in the general population. Public policies that tackle housing instability and its consequences are urgently needed in Spain.

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By:  Vásquez-Vera H1,2,3, Rodríguez-Sanz M1,2,4,5, Palència L2,4, Borrell C6,7,8,9,10.

• 1Department of Experimental and Health Sciences, Universitat Pompeu Fabra, Barcelona, Spain.
• 2Agència de Salut Pública de Barcelona, Barcelona, Spain.
• 3Centro de Estudios para la Equidad en Salud, Universidad de La Frontera, Temuco, Chile.
• 4CIBER de Epidemiología y Salud pública (CIBERESP), Madrid, Spain.
• 5Institute of Biomedical Research (IIB-Sant Pau), Barcelona, Spain.
• 6Department of Experimental and Health Sciences, Universitat Pompeu Fabra, Barcelona, Spain. cborrell@aspb.cat.
• 7Agència de Salut Pública de Barcelona, Barcelona, Spain. cborrell@aspb.cat.
• 8CIBER de Epidemiología y Salud pública (CIBERESP), Madrid, Spain. cborrell@aspb.cat.
• 9Institute of Biomedical Research (IIB-Sant Pau), Barcelona, Spain. cborrell@aspb.cat.
• 10Agència de Salut Pública de Barcelona, Avinguda Lesseps 1, ES-08023, Barcelona, Spain. cborrell@aspb.cat. 
• J Urban Health. 2016 Mar 3.

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LBGTQ Populations and the Health Care System

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Access to Healthcare for Long-Term Conditions in Women Involved in Street-Based Prostitution: A Qualitative Study

Background

Women involved in street-based prostitution (SBP) have well-documented health problems specific to their occupation, but access to care for other chronic health problems has not been explored. Primary care is seen as the optimal context to deliver care for people with long-term conditions because it is accessible, efficient, and can tackle inequalities related to socioeconomic deprivation. We aimed to explore the perspectives of women involved in SBP about access to health care for their long-term conditions.

Methods

This was a qualitative study with women accessing a third sector organization in North West England. Semi-structured interviews were conducted with sixteen women involved in SBP and accessing support. Data were analysed using the principles of constant comparison and a framework approach.

Results

Women described how they were living with ill health, which they found difficult to manage, and often impacted on their work. Women reported poor access to care and viewed any ensuing consultations in primary care as unsatisfactory.

Conclusion

This study highlights the unmet health needs of women who work in SBP, not just related to their occupation, but due to their co-morbid long-term conditions. Access to primary care was reported to be problematic and interactions with general practitioners not fulfilling their expectations, which impacted on future consultation behaviour. Understanding the health-seeking behaviours and self-management strategies of women involved in SBP with chronic health problems is essential in the design and commissioning of services and may reduce unscheduled care in this under-served group.

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Spatial analysis of infection by the human immunodeficiency virus among pregnant women

Below:  Spatial analysis of HIV detection rate in pregnant women between 2001 and 2011, Recife, PE, Brazil. A) Spatial distribution with Moran Index; B) BoxMap; C) LisaMap; D) t 

The presence of spatial self-correlation was verified. Moran's Index was significant for the distribution. Clusters were identified, considered as high-risk areas, located in grouped neighborhoods, with equally high infection rates among pregnant women. A neighborhood located in the Northwest of the city was distinguished, considered in an epidemiological transition phase.

Precarious living conditions, as evidenced by the indicators illiteracy, absence of prenatal care and poverty, were relevant for the risk of vertical HIV transmission, converging to the grouping of cases among disadvantaged regions.

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