Building for the future: influence of housing on intelligence quotients of children in an urban slum.
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INTRODUCTION: Interventions on behalf of the marginalized in society can assume many formats. In an urban slum the Government of Delhi built one-room houses for some of the residents in what is termed a 'plot area'. Not all residents could be accommodated in the project and the remainder continued to live next door in shanty houses of the slum. Nineteen years later, young children who had migrated with their parents, have grown up and have children of their own. We looked at the development of the children living in the two types of accommodation. METHODS: A total of 373 children were studied. All children (n = 200) between the ages of 3.5 and 5.5 years in a cluster of five residential blocks in the plot area were studied. As a control, children in two large clusters of shanty houses (n = 173) were also studied. For development assessment the Central Institute of Education (CIE) Test was performed. This is an Indian adaptation of the Standford-Binet Test. Multiple regression analysis was utilized to determine the factors that influenced IQ most. RESULTS: The mean IQ of the children in the plot area was 92.5 (s.d. 13.38) and in the shanty houses 89.5 (s.d. 12.9) (p = 0.05). Analysis showed that the most significant factors affecting IQ were malnutrition in the first 6 months of life and attendance of the child at pre-school. For nutrition in the first 6 months, there was no difference between the groups. For attendance at pre-school, 110 of 200 in the plot area and 47 of 173 in the shanty houses were attending pre-school (p < 0.01). CONCLUSION: We find that children living in the permanent houses had a significantly better IQ than those in shanty houses. A review of the literature did not reveal a comparable study. (+info)
Geographic patterns of deprivation in South Africa: informing health equity analyses and public resource allocation strategies.
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There is a growing interest in the use of small area analyses in investigating the relationship between socioeconomic status and health, and in informing resource allocation decision-making. However, few such studies have been undertaken in low- and middle-income countries (LMICs). This paper reports on such a study undertaken in South Africa. It both looked at the feasibility of developing a broad-based area deprivation index in a data scarce context and considered the implications of such an index for geographic resource allocations. Despite certain data problems, it was possible to construct and compare three different indices: a general index of deprivation (GID), compiled from census data using principal component analysis; a policy-perspective index of deprivation (PID), based on groups identified as priorities within policy documents; and a single indicator of deprivation (SID), selected for relevance and feasibility of use. The findings demonstrate clearly that in South Africa deprivation is multi-faceted, is concentrated in specific areas within the country and is correlated with ill-health. However, the formula currently used by the National Treasury to allocate resources between geographic areas, biases these allocations towards less deprived areas within the country. The inclusion of the GID within this formula would dramatically alter allocations towards those areas suffering from human development deficits. The area in which analysis was undertaken was not, however, sufficiently small to identify pockets of deprivation within the less deprived metropolitan areas. These findings suggest that it is feasible to conduct small area analyses in LMICs but that specific attention needs to be given to the size of the geographic unit used in analysis. In addition, they highlight the importance of considering deprivation in resource allocation mechanisms if vertical equity goals are to be promoted through resource allocation, particularly within decentralized health systems. (+info)
Area deprivation and widening inequalities in US mortality, 1969-1998.
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OBJECTIVES: This study examined age-, sex-, and race-specific gradients in US mortality by area deprivation between 1969 and 1998. METHODS: A census-based area deprivation index was linked to county mortality data. RESULTS: Area deprivation gradients in US mortality increased substantially during 1969 through 1998. The gradients were steepest for men and women aged 25 to 44 years and those younger than 25 years, with higher mortality rates observed in more deprived areas. Although area gradients were less pronounced for women in each age group, they rose sharply for women aged 25 to 44 and 45 to 64 years. CONCLUSIONS: Areal inequalities in mortality widened because of slower mortality declines in more deprived areas. Future research needs to examine population-level social, behavioral, and medical care factors that may account for the increasing gradient. (+info)
Psychiatric deinstitutionalization and its cultural insensitivity: consequences and recommendations for the future.
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Despite the plethora of models and strategies for addressing issues that surround the chronically mentally ill, there remains a paucity of literature that addresses the specific implications of deinstitutionalization on racial minorities. Racial minorities comprise a significant number of the homeless, jailed, and geriatric mentally ill. History and current reality suggest the reasons why some chronically mentally ill blacks and their families have feared the impact of deinstitutionalization. This article examines the Ohio State Department of Mental Health's response to these issues as a possible prototype for statewide coordination for deinstitutionalization. (+info)
Provision of, and patient satisfaction with, primary care services in a relatively affluent area and a relatively deprived area of Glasgow.
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This paper presents the results of a survey of the structure of general practice in two contrasting areas within Greater Glasgow health board: the south west area had a more deprived social profile at the 1981 census and higher than average all cause and selected major cause standardized mortality ratios than the health board as a whole while the north west area had a more affluent social profile at the 1981 census and lower than average all cause and selected major cause standardized mortality ratios. The general practice survey data gathered in 1989 were supplemented with data from a survey of residents of the localities in three age cohorts carried out in 1987-88, which provided information on use of services, as well as perceived accessibility of and satisfaction with them. Despite the more deprived social and mortality profile of the south west area, and greater use of services, few systematic differences in the structure of general practices were found in the two areas. These findings support other studies which suggest that the stereotype of poorly resourced, low quality primary care in inner city areas may apply in London, but not elsewhere. Respondents in both areas were equally satisfied with services and found them accessible. (+info)
Are socioeconomic inequalities in mortality decreasing or increasing within some British regions? An observational study, 1990-1998.
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BACKGROUND: This paper evaluates claims in a recent study that inequalities in small area mortality rates have lessened. We examine the effect of differently estimated populations on time trends in age-specific mortality rates for Yorkshire and the Humber and East of England. METHODS: Populations were estimated for wards using four methods that introduce increasing amounts of information. Age-specific mortality rates for age-groups 45-54, 55-64, 65-74 and 75-84 for both sexes were calculated for population-weighted deprivation quintiles. Inequality was tracked using ratios of rates in the most deprived quintile divided bythose in the least. RESULTS: When constant 1991 populations are used, rate ratios decrease for all age-sex groups, indicating shrinking inequality. When a method adjusting small area populations to official district estimates is used, both decreases and increases are observed in the mortality rate ratios. These results differ from Trent region findings of decreases in inequality. When small area populations are cohort-survived and adjusted to district populations, most differences in rate ratios indicate increasing inequality. When a method is used that includes information on migration and special populations, then seven out of eight age-sex groups exhibit increasing inequality. CONCLUSIONS: A judgement about trends in mortality inequality is highly dependent upon the denominator population used. Simpler estimation methods result in convergence of rate ratios, whereas more sophisticated methods result in increasing inequalities in most age-sex groups. (+info)
Social deprivation and breast cancer.
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BACKGROUND: This cross-sectional study was carried out in a population-based setting in Worcestershire to investigate the relationship between social deprivation and other potential prognostic factors. METHODS: A total of 762 female patients diagnosed with primary breast cancer between 1 January 1998 and 31 December 1999 were selected. Breast cancer included all new cases of primary invasive breast cancer and ductal carcinoma in situ. A total of 753 patients were matched by their postcode of residence to enumeration district Townsend score and then divided into three groups based on Townsend quintiles (affluent n = 478; middle n = 157; deprived n = 118). Main outcome measures were relationships between social deprivation and tumour type, stage at presentation, oestrogen receptor status, tumour grade and treatment type. RESULTS: Compared with the most deprived women, affluent women were less likely to present with invasive ductal tumours (70.8 per cent versus 85.9 per cent, chi2 linear trend = 6.757, p = 0.009), tumours of higher grade (36.0 per cent versus 44.7 per cent, chi2 linear trend = 4.201, p = 0.040), and oestrogen receptor negative tumours (22.4 per cent versus 33.3 per cent, chi2 linear trend = 3.501, p = 0.061). There was no significant difference in stage or tumour size at presentation between deprivation groups. More deprived women with invasive tumours of less than 20 mm maximum diameter were significantly more likely to have mastectomies than affluent women (47.8 per cent versus 32.1 per cent, chi2 linear trend = 4.091, p = 0.043). CONCLUSIONS: This study suggests that level of social deprivation is associated with tumour type, grade and oestrogen receptor status. There was also a suggestion that increased level of deprivation was associated with increased risk of potentially unnecessary mastectomies. (+info)
The Index of Multiple Deprivation 2000 and accessibility effects on health.
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STUDY OBJECTIVE: To investigate whether the Index of Multiple Deprivation 2000 (IMD) is more strongly related to inequalities in health in rural areas than traditional deprivation indices. To explore the contribution of the IMD domain "geographical access to services" to understanding rural health variations. DESIGN: A geographically based cross sectional study. SETTING: Nine counties in the south west region of England. PARTICIPANTS: All those aged below 65 who reported a limiting long term illness in the 1991 census, and all those who died during 1991-96, aged less than 65 years. MAIN RESULTS: The IMD is comparable with the Townsend score in its overall correlation with premature mortality (r(2) = 0.44 v 0.53) and morbidity (r(2) = 0.79 v 0.76). Correlation between the Townsend score and population health is weak in rural areas but the IMD maintains a strong correlation with rates of morbidity (r(2) = 0.70). The "geographical access to services" domain of the IMD is not strongly correlated with rates of morbidity in rural areas (r(2) = 0.04), and in urban areas displays a negative correlation (r(2) = -0.47). CONCLUSIONS: The IMD has a strong relation with health in both rural and urban areas. This is likely to be the result of the inclusion of data in the IMD on the numbers of people claiming benefits related to ill health and disability. The domain "geographical access to services" is not associated with health in rural areas, although it displays some association in urban areas. This domain is potentially important but, as yet, inadequately specified in the IMD for the purposes of health research. (+info)