The influence of income on health: views of an epidemiologist.
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Income is related to health in three ways: through the gross national product of countries, the income of individuals, and the income inequalities among rich nations and among geographic areas. A central question is the degree to which these associations reflect a causal association. If so, redistribution of income would improve health. This paper discusses two ways in which income could be causally related to health: through a direct effect on the material conditions necessary for biological survival, and through an effect on social participation and opportunity to control life circumstances. The fewer goods and services are provided publicly by the community, the more important individual income is for health. Under present U.S. circumstances, a policy of counteracting growing income inequalities through the tax and benefit system and of public provision appears justified. (+info)
Inflicted burns and scalds in children.
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Ten children who had been burnt and six who had been scalded by parents or those caring for them were seen over three years. In no case did the thermal injury affect more than 5% of the body surface and there were no deaths. In seven the perineum or buttocks were in the burnt area. In 12 children there was evidence of other inflicted injury including six recent fractures. Staff caring for burnt children should be aware of this type of inflicted injury. X-ray skeletal surveys should be carried out in doubtful cases and a case conference initiated with the appropriate social work services to consider supervising the family after the child's discharge or taking legal care proceedings. (+info)
Rethinking McKeown: the relationship between public health and social change.
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Thomas McKeown was a rhetorically powerful critic, from the inside, of the medical profession's mid-20th-century love affair with curative and scientific medicine. He emphasized instead the importance of economic growth, rising living standards, and improved nutrition as the primary sources of most historical improvements in the health of developed nations. This interpretation failed to emphasize the simultaneous historical importance of an accompanying redistributive social philosophy and practical politics, which has characterized the public health movement from its 19th-century origins. Consequently, the current generation of public health practitioners are having to reconstruct such a politics and practice following its virtual dismantlement during the last 2 decades of the 20th century. (+info)
The McKeown thesis: a historical controversy and its enduring influence.
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The historical analyses of Thomas McKeown attributed the modern rise in the world population from the 1700s to the present to broad economic and social changes rather than to targeted public health or medical interventions. His work generated considerable controversy in the 1970s and 1980s, and it continues to stimulate support, criticism, and commentary to the present day, in spite of his conclusions' having been largely discredited by subsequent research. The ongoing resonance of his work is due primarily to the importance of the question that underlay it: Are public health ends better served by targeted interventions or by broad-based efforts to redistribute the social, political, and economic resources that determine the health of populations? (+info)
McKeown and the idea that social conditions are fundamental causes of disease.
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In an accompanying commentary, Colgrove indicates that McKeown's thesis-that dramatic reductions in mortality over the past 2 centuries were due to improved socioeconomic conditions rather than to medical or public health interventions-has been "overturned" and his theory "discredited." McKeown sought to explain a very prominent trend in population health and did so with a strong emphasis on the importance of basic social and economic conditions. If Colgrove is right about the McKeown thesis, social epidemiology is left with a gaping hole in its explanatory repertoire and a challenge to a cherished principle about the importance of social factors in health. We return to the trend McKeown focused upon-post-McKeown and post-Colgrove-to indicate how and why social conditions must continue to be seen as fundamental causes of disease. (+info)
Home is where the harm is: inadequate housing as a public health crisis.
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Overcrowding and poor-quality housing have a direct relationship to poor mental health, developmental delay, heart disease, and even short stature. (+info)
Lead awareness: North Philly Style.
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Lead poisoning in children has been associated with reduced intelligence, shortened memory, slowed reaction times, poor hand-eye coordination, and antisocial behavior. The cost to society includes not only medical treatment and special education but also higher high-school drop-out rates, which are associated with crime and low earning potential. (+info)
Urban homelessness and poverty during economic prosperity and welfare reform: changes in self-reported comorbidities, insurance, and sources for usual care, 1995-1997.
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Little is known of how homeless and other urban poor populations have fared during the robust economy and within structural changes in health care delivery and entitlement programs of the 1990s. This is important in determining the need for population-specific services during a vigorous economy with low unemployment and increasing Medicaid managed-care penetration. This study compared health insurance status and availability of a source for usual medical care, psychiatric and substance abuse comorbidities, and perceived causes of homelessness in homeless adults surveyed in 1995 and 1997. Cross-sectional, community-based surveys were conducted in 1995 and 1997 at sites frequented by urban homeless adults residing in Pittsburgh, Pennsylvania. Self-reported medical, mental health, and substance abuse comorbidities, health insurance, and source for usual care were measured. Compared to the 388 individuals surveyed in 1995, the 267 homeless adults surveyed in 1997 had more medical comorbidity (56.6% vs. 30.2%, P <.001) and mental health comorbidity (44.9% vs. 36.9%, P =.04) and required more chronic medication (52.1% vs. 30.3%, P <.001). More respondents in 1997 than 1995 reported having no health insurance (41.4% vs. 29.4%, P <.001). While there was no difference in the overall proportion reporting a source for usual care (78.3% in 1997 vs. 80.2% in 1995, P =.55), fewer persons reported use of the emergency department and more persons reported using a shelterbased clinic for usual care in 1997 compared with 1995. These findings suggest more need for medical care among homeless and urban poor persons in 1997 compared with 1995 and support the continued need for outreach and support services despite a vigorous economy. (+info)