Barney Cohen

Critical Perspectives on Racial and Ethnic Differences in Health in Late Life

In their later years, Americans of different racial and ethnic backgrounds are not in equally good--or equally poor--health. There is wide variation, but on average older Whites are healthier than older Blacks and tend to outlive them. But Whites tend to be in poorer health than Hispanics and Asian Americans. This volume documents the differentials and considers possible explanations. Selection processes play a role: selective migration, for instance, or selective survival to advanced ages. Health differentials originate early in life, possibly even before birth, and are affected by events and experiences throughout the life course. Differences in socioeconomic status, risk behavior, social relations, and health care all play a role. Separate chapters consider the contribution of such factors and the biopsychosocial mechanisms that link them to health. This volume provides the empirical evidence for the research agenda provided in the separate report of the Panel on Race, Ethnicity, and Health in Later Life.

Social Dynamics of Adolescent Fertility in Sub-Saharan Africa

Adolescent fertility tends to be valued and sanctioned in the countries of sub-Saharan Africa when parents have had adequate ritual or training preparation for adulthood and the child has a recognized father. Young women and adolescents who conceive and bear children within this context are widely accepted by society; those who conceive outside of marriage however are strongly condemned by society. Over the past 2-3 decades most African countries have successfully raised their levels of education. Girls and women are increasingly privy to formal school education and training in trade apprenticeships domestic service and ritual initiation which had otherwise been denied in the past. These factors combined with declining menarche in a few areas and changing economic opportunities law and religion make it more difficult to define the exact date of entry into marriage. Many girls are taking advantage of these changing circumstances and their opportunities to obtain educations and resist early marriage and cildbearing. While defying the traditional entry into early marriage many young women do not however refrain from engaging in sexual activities. Pregnancies to unwed mothers are thereby on the rise and may constitute the most profound change observed in the social context of adolescent fertility on the continent. Once pregnant many women find themselves shut out by family planning programs and prenatal clinics which serve only married women. This paper ultimately concludes that the social context of adolescent childbearing has an effect on the outcome for mother and child which is as important as the physiological maturity of the mother.

Explaining Divergent Levels of Longevity in High-Income Countries

During the last 25 years, life expectancy at age 50 in the United States has been rising, but at a slower pace than in many other high-income countries, such as Japan and Australia. This difference is particularly notable given that the United States spends more on health care than any other nation. Concerned about this divergence, the National Institute on Aging asked the National Research Council to examine evidence on its possible causes. According to Explaining Divergent Levels of Longevity in High-Income Countries, the nations history of heavy smoking is a major reason why lifespans in the United States fall short of those in many other high-income nations. Evidence suggests that current obesity levels play a substantial part as well. The book reports that lack of universal access to health care in the U.S. also has increased mortality and reduced life expectancy, though this is a less significant factor for those over age 65 because of Medicare access. For the main causes of death at older ages -- cancer and cardiovascular disease -- available indicators do not suggest that the U.S. health care system is failing to prevent deaths that would be averted elsewhere. In fact, cancer detection and survival appear to be better in the U.S. than in most other high-income nations, and survival rates following a heart attack also are favorable. Explaining Divergent Levels of Longevity in High-Income Countries identifies many gaps in research. For instance, while lung cancer deaths are a reliable marker of the damage from smoking, no clear-cut marker exists for obesity, physical inactivity, social integration, or other risks considered in this book. Moreover, evaluation of these risk factors is based on observational studies, which -- unlike randomized controlled trials -- are subject to many biases.

Preventing and Mitigating AIDS in Sub-Saharan Africa

The AIDS epidemic in Sub-Saharan Africa continues to affect all facets of life throughout the subcontinent. Deaths related to AIDS have driven down the life expectancy rate of residents in Zambia, Kenya, and Uganda with far-reaching implications. This book details the current state of the AIDS epidemic in Africa and what is known about the behaviors that contribute to the transmission of the HIV infection. It lays out what research is needed and what is necessary to design more effective prevention programs.

Family planning programs socioeconomic characteristics and contraceptive use in Malawi.

In this paper, micro-level data from a survey of 4,849 women in Malawi are linked to information from a service availability questionnaire to assess the relative importance of socioeconomic background and various aspects of family planning provision on contraceptive use in one country in sub-Saharan Africa. Maximum-likelihood probit is used to assess the independent influence of four distinct dimensions of family planning effort on contraceptive use: mass media exposure, i.e., promotion of family planning through radio and print messages; contraceptive choice; accessibility of contraceptive services; and service quality. Results indicate that all four components of family planning effort contribute to the use of modern contraceptives in Malawi, although their relative importance varies significantly across different segments of the population.

International Differences in Mortality at Older Ages

Among industrialized countries, the United States ranks near the bottom on life expectancy at birth. In 2006, the average American man and woman could expect to live 75 and 80 years, respectively, while the average Western European man and woman could expect to live 77 and 83 years, respectively (World Health Organization, 2009; World Health Organization Regional Office for Europe, 2010). Although the extent to which this is attributable to differences in the health care system is unknown, the United States spends two to three times more than other industrialized countries on medical care (Anderson and Hussey, 2001; Organisation for Economic Co-operation and Development, 2006). This suggests that at least part of the causes of the U.S. disadvantage might lie elsewhere. A plausible hypothesis is that disparities in mortality in the United States are larger than in other high-income countries, particularly in Western Europe. This implies that U.S. excess mortality might be attributable to higher excess mortality in those with low levels of education, while mortality levels for those with secondary or higher education might be comparable in Europe and the United States. Population composition is more diverse in the United States in terms of geography, race, and ethnicity, which may translate into larger health disparities than in Europe. Health care and social policies also differ dramatically between Europe and the United States. Most noticeably, while access to health care is nearly universal in Western Europe, about 41 million Americans remain uninsured (Adams, Dey, and Vickerie, 2007). In addition, compared with European countries, the United States has lower provision of social transfers (e.g., social retirement benefits, unemployment compensation, sick pay) and fewer redistributive policies, resulting in substantially larger income and wealth inequalities (Organisation for Economic Co-operation and Development, 2008; Wolf, 1996). Whether the less generous U.S. policies translate into larger mortality inequalities has not yet been established. The overall excess mortality in the United States compared with Western Europe is well documented (Organisation for Economic Co-operation and Development, 2006; World Health Organization, 2009). However, whether Americans of all education levels have higher mortality than comparable Europeans is yet unknown. Earlier mortality studies have focused only on the strength of education effects, yielding mixed results (Dahl et al., 2006; Kunst and Mackenbach, 1994; Mackenbach et al., 1999). Two recent studies suggest that although older Americans of all education, wealth, and income levels report poorer health than equivalent Europeans, the U.S. health disadvantage is largest among the poor and less educated (Avendano et al., 2009; Banks et al., 2006). Although based on cross-sectional and self-reported data, these findings support the hypothesis that larger health disparities in the United States partly explain the overall U.S. health disadvantage. A competing hypothesis is that Americans of all education levels experience higher mortality than equivalent Europeans. If true, one would expect U.S. residents of all education levels to have higher mortality rates than comparable Europeans. In this study, we examined cross-national differences in mortality by education level in the United States and 14 European countries in the 1990s and compared the magnitude of the disparities in mortality by education among these populations.

Aging in Sub-Saharan Africa

No wonder you activities are, reading will be always needed. It is not only to fulfil the duties that you need to finish in deadline time. Reading will encourage your mind and thoughts. Of course, reading will greatly develop your experiences about everything. Reading aging in sub saharan africa is also a way as one of the collective books that gives many advantages. The advantages are not only for you, but for the other peoples with those meaningful benefits.This paper analyses labour market behaviour of the elderly in South Africa, focusing on the Black/African population group. The analysis uses data from the 2001 census and 1996 census, the Labour Force Surveys for September 2000 and 2001, and the Income and Expenditure Survey for 2000. Findings show that participation rates fall fairly rapidly after age 45, with particularly sharp declines in both participation and work at the age of eligibility for the old-age pension. Measures of unused productive capacity demonstrate that South Africas age profile of labour force withdrawal compares favourably with some OECD countries. The hazard rate indicates that the age of pension eligibility is associated with increased rates of retirement. The paper also examines major determinants of elderly labour supply, including household structure and marital status, public and private pensions and schooling and, finally, calculates probit regressions to gain a clearer picture of the variables affecting the work activity of the elderly.