Public housing,health, and health behaviors: Is there a connection?

This paper explores the relationship between public housing, health outcomes, and health behaviors among low-income housing residents. While public housing can be a dangerous and unhealthy environment in which to live, the subsidized rent may free up resources for nutritious food and health care. In addition, public housing may be of higher quality than the available alternatives, it may provide easier access to health clinics willing to serve the poor, and it may link residents to social support networks, which can improve mental health and the ability to access higher-quality grocery stores. To test whether there is a "back-door" health benefit to the public housing program, we analyze data from the Fragile Families and Child Wellbeing Study. We minimize the effects of selection into public housing with controls and instrumental variables estimation and find that the results are somewhat sensitive to the instrumental variable used, and thus, we conclude that we are unable to detect a robust health benefit from public housing for our measures of health. However, we do find some evidence that public housing residency has mixed effects on domestic violence, increases obesity, and worsens mothers' overall health status.     

Mental health and substance abuse insurance parity for federal employees: How did health plans respond?

A fundamental concern with competitive health insurance markets is that they will not supply efficient levels of coverage for treatment of costly, chronic, and predictable illnesses, such as mental illness. Since the inception of employer-based health insurance, coverage for mental health services has been offered on a more limited basis than coverage for general medical services. While mental health advocates view insurance limits as evidence of discrimination, adverse selection and moral hazard can also explain these differences in coverage. The intent of parity regulation is to equalize private insurance coverage for mental and physical illness (an equity concern) and to eliminate wasteful forms of competition due to adverse selection (an efficiency concern). In 2001, a presidential directive requiring comprehensive parity was implemented in the Federal Employees Health Benefits (FEHB) Program. In this study, we examine how health plans responded to the parity directive. Results show that in comparison with a set of unaffected health plans, federal employee plans were significantly more likely to augment managed care through contracts with managed behavioral health "carve-out" firms after parity. This finding helps to explain the absence of an effect of the FEHB Program directive on total spending, and is relevant to the policy debate in Congress over federal parity.     

Personalizing solidarity? The role of self-tracking in health insurance pricing

Can data-driven innovations, working across an internet of connected things, personalize health insurance prices? The emergence of self-tracking technologies and their adoption and promotion in health insurance products has been characterized as a threat to solidaristic models of healthcare provision. If individual behaviour rather than group membership were to become the basis of risk assessment, the social, economic and political consequences would be far-reaching. It would disrupt the distributive, solidaristic character that is expressed within all health insurance schemes, even in those nominally designated as private or commercial. Personalized risk pricing is at odds with the infrastructures that presently define, regulate and deliver health insurance. Self-tracking can be readily imagined as an element in an ongoing bio-political redistribution of the burden of responsibility from the state to citizens but it is not clear that such a scenario could be delivered within existing individual private health insurance operational and regulatory infrastructures. In what can be gleaned from publicly available sources discussing pricing experience in the individual markets established by the Patient Protection and Affordable Care Act 2010 (ACA), widely known as ‘Obamacare’, it appears unlikely that it can provide the means to personalize price. Using the case of Oscar Health, a technology driven start-up trading in the ACA marketplaces, I explore the concepts, politics and infrastructures at work in health insurance markets.     

Malnourished children? Child health disparities and its causes in Eastern India

The disparity in child health outcomes across Indian districts, particularly in Eastern India, is alarming. Approximately half of the districts in this region exhibit very poor child health outcomes, evidenced by alarmingly high neonatal, infant, and under-five mortality rates. This study analyses the existing levels and patterns of child health outcomes across 112 districts of Eastern India, a region known for its low levels of child health status. To do this, we have constructed a composite child health index (CHI) using nationally representative data from the National Family Health Survey (NFHS-5). Using Principal Component Analysis, the study uses the CHI values to categorize the districts into high, moderate, and low-performing districts. The results show a significant variation in CHI outcomes across the districts, with striking regional disparities. Notably, all high-performing districts were located only in the state of Odisha. In contrast, a substantial proportion of the low-performing districts were in the state of Bihar, suggesting systemic healthcare deficiencies. Using discriminant function analysis, we obtain the critical determinants of CHI to be sanitation facilities, mother's education, marriage before 18 years, and low body mass index of the mother. Our findings confirm that improvements in these areas are crucial for enhancing child health outcomes and ending intergenerational transmission of poor health outcomes. The implications of this study extend beyond eastern India, offering valuable insights into similar challenges in global low- and middle-income regions.     

“Being black and feeling blue”: the mental health consequences of racial discrimination

The association between racial discrimination and mental health was examined using Wave 2 (1987–1988) and Wave 3 (1988–1989) panel data from the National Survey of Black Americans (NSBA). Mental health status was assessed by psychological distress and depression. In cross-sectional analyses, the perception of racial discrimination was related to high levels of psychological distress at Waves 2 and 3. Experiencing racial discrimination was marginally related to a high likelihood of depression at Wave 2. In longitudinal analyses, reports of racial discrimination at Wave 2 were associated with high levels of psychological distress at Wave 3. High psychological distress or depression at Wave 2 was not associated with reports of racial discrimination at Wave 3—indicating that poor mental health did not predict subjective reports (perceptions) of discrimination. The Discussion focused on possible directions for a more comprehensive program of research on mental health, stress, and experiences of racially based discrimination.     

Avian influenza, ‘viral sovereignty’, and the politics of health security in Indonesia

Abstract

In December 2006, Indonesian Health Minister, Siti Fadilah Supari, shocked the world when announcing her government would no longer be sharing samples of the H5N1 avian flu virus, collected from Indonesian patients, with the World Health Organization, at a time when global fears of a deadly influenza pandemic were running high. For observers of Southeast Asian politics, the decision reinforced the view of the region as made up of states determined to protect their national sovereignty, at almost all costs. This established view of the region, however, generally neglects the variable and selective manner in which sovereignty has been invoked by Southeast Asian governments, or parts thereof, and fails to identify the conditions shaping the deployment of sovereignty. In this paper, it is argued that Siti's action was designed to harness claims of sovereignty to a domestic political struggle. It was a response to the growing fragmentation and, in some cases, denationalisation of the governance apparatus dealing with public health in Indonesia, along with the ‘securitisation’ of H5N1 internationally. The examination of the virus-sharing dispute demonstrates that in Southeast Asia sovereignty is not so much the ends of government action, but the means utilised by government actors for advancing particular political goals.     

The politics of scarcity: Social welfare and health care cutbacks in Finland, 1991–1995

This article analyses cutbacks in Finnish social and health care programmes. Eight hypotheses were formulated and then tested with empirical cutback data from 1991–95. The analysis showed that strictly administrative programmes and those focused on marginal groups were more likely to be cut more than other programs. These results partially endorse to the ‘vote‐maximising politician’ and the ‘blame‐avoidance’ hypotheses. Political decision‐makers try to distribute the cuts so that harm to the vast majority of voters is minimised. In addition to this, it seems to be easier for politicians to pass the blame for unpleasant cuts to others. The empirical analysis did not corroborate the ‘bureaucratic politics’ theory according to which bureaucrats are in such an important position in the budgetary process that they can protect themselves from cuts. The analysis showed that the administration was hit by cuts significantly harder than other programmes, nor was the impact of powerful interest groups significant in the analysis.     

Programmatic action in Chinese health policy—The making and design of “Healthy China 2030”

The Programmatic Action Framework (PAF) is a powerful analytical perspective to advance our understanding of policy change by stressing the role of programmatic groups and how they promote their preferred policy programs. While the PAF has been applied successfully to European countries and the US, a considerable research gap remains regarding its explanatory power in other regions and political settings. To step into this research gap, we apply the PAF to authoritarian China through a qualitative case study of the making of “Healthy China 2030”, a national health policy program. We explore two research questions: firstly, to what extent can the PAF be operationalized in a nondemocracy to identify programmatic groups and evaluate policy design, and second, what are the limitations and challenges facing the application of the PAF to nondemocracies? Our empirical analysis shows that the design of this policy program involves actors from different policy areas, despite the top-down political structure. With regards to the transfer of PAF hypotheses, we show that the framework is a helpful lens to identify programmatic groups and to evaluate policy programs' potential for success based on coherence, responsiveness, and program fit. Meanwhile, the research process of our study revealed the challenges of applying policy process theories to China, including hard-to-reach political actors for data collection, lack of transparency regarding collaboration processes between actors, and a lack of publicly available program-related information.     

Public health as an agent of internal colonialism in interwar Czechoslovakia: shaping the discourse about the nation’s children

Shmidt’s text discusses the specifics of internal colonialism in the discourses and practices of the dominant group (Czechs) concerning Slovaks and Rusyns, ethnic groups from the peripheral, eastern areas of interwar Czechoslovakia. By targeting the reproductive patterns of these groups, seen as undesirable by the authorities, internal colonialism shaped the discourse about children by consistently opposing the normalized childhood inside the nation to the supposedly abnormal child development outside the civilizing process. Shmidt focuses on three interwar projects aimed at introducing new public health practices as an ‘infrastructure of dependence’ with regard to the peripheral groups. Being directly supported by the Rockefeller Foundation, these projects contributed to building the new Czechoslovak nation and securing its international legitimacy.