Health and Wellbeing
Elizabeth Armstrong • Jeanne Brooks-Gunn • Anne C. Case • Dalton Conley • Noreen Goldman • Bryan Grenfell • Douglas S. Massey • Sara F. McLanahan • C. Jessica E. Metcalf • Daniel Notterman • Charles F. Westoff • Yu Xie
Elizabeth Armstrong continues her work on a book manuscript titled, How We Begin: The Origins of Fetal Personhood. The book explores the evolution of the belief that the fetus is a person in medicine, law and popular culture. Armstrong is also interested in cultural attitudes and beliefs about risk during pregnancy and childbirth and policies related to maternity care in the United States. She is conducting research on medical professional attitudes towards home birth in the U.S. and on popular practices around childbirth. She has also investigated popular cultural practices regarding the placenta and is currently analyzing medical and scientific texts on placental form and function.
João Biehl’s main research centers on medical anthropology, the social studies of science and religion, global health, subjectivity, ethnography, social and critical theory (with a regional focus on Latin America and Brazil). His present research explores the social impact of large-scale treatment programs in resource-poor settings and the role of the judiciary in administering public health in Brazil.
Unfinished. The Anthropology of Becoming was edited by João Biehl and Peter Locke (Northwestern University). This original, field-changing collection explores the plasticity and unfinishedness of human subjects and lifeworlds, advancing the conceptual terrain of an anthropology of becoming. The becomings of people trouble and exceed ways of knowing and acting, producing new possibilities for research, methodology, and writing. The contributors creatively bridge ethnography and critical theory in a range of worlds on the edge, from war and its aftermath, economic transformation, racial inequality, and gun violence to religiosity, therapeutic markets, animal rights activism, and abrupt environmental change. Defying totalizing analytical schemes, these visionary essays articulate a human science of the uncertain and unknown and restore a sense of movement and possibility to ethics and political practice. Unfinished invites readers to consider the array of affects, ideas, forces, and objects that shape contemporary modes of existence and future horizons, opening new channels for critical thought and creative expression.
João Biehl’s chapter entitled, “Ethnography Prosecuted: Facing the Fabulation of Power,” was published in the book, If Truth Be Told. The Politics of Public Ethnography, Edited by Didier Fassin. The objects arousing emotional responses vary across countries, as Biehl realized when he carried out his collective project on the judicialization of health in Brazil. While the country was praised worldwide for its management of the HIV epidemic, the multiplication of lawsuits by patients suffering from a wide range of health conditions and unable to access treatment amid precarious infrastructures raised concerns among public authorities. By contesting, on the basis of their empirical data, the official discourse that discredited those who used this alternate path to access medicines, Biehl uncovered the failure of the state to fulfill its obligations and the falsehood of its arguments against those who tried to unveil it. In response he was confronted with the criticisms of his Brazilian collaborators regarding the validity of his findings and the reliability of his method.
Anne Case and Ta-Nehisi Coates (National Correspondent, The Atlantic) co-authored the first chapter in Knowledge to Action, Accelerating Progress in Health, Well-Being, and Equity, entitled, “Fear and Despair: Consequences of Inequity” – Together they present a stark portrait of the fear and despair that take over when equity is absent and present a distinct and compelling argument for attending to equity now. Coates offers a powerful personal narrative to recreate the fears of a black child who comes to realize that his personal safety is always at risk and that he is on his own – the helping institutions protect some people from harm, but he is not among them. Case’s provocative analysis points to alarming increases in “diseases and deaths of despair” among middle-aged white adults. Believing that life will not improve for them, their mortality rates are rising, reflecting drug overdoses, suicide, and deaths from alcohol abuse.
Anne Case and Angus Deaton co-authored, “Suicide, Age, and Wellbeing: An Empirical Investigation,” chapter 10 in Insights in the Economics of Aging. They find that suicide rates, life evaluation, and measures of affect are all plausible measures of the mental health and wellbeing of populations. Yet in the settings examined, correlations between suicide and measured wellbeing are at best inconsistent. Differences in suicides between men and women, between Hispanics, blacks, and whites, between age groups for men, between countries or U.S. states, between calendar years, and between days of the week, do not match differences in life evaluation. By contrast, reports of physical pain are strongly predictive of suicide in many contexts. The prevalence of pain is increasing among middle-aged Americans and is accompanied by a substantial increase in suicides and deaths from drug and alcohol poisoning. Our measure of pain is now highest in middle age—when life evaluation and positive affect are at a minimum. In the absence of the pain epidemic, suicide and life evaluation are likely unrelated, leaving unresolved whether either one is a useful overall measure of population wellbeing.
Anne Case and Angus Deaton published, “Mortality and Morbidity in the 21st Century,” which was published in the Brookings Papers on Economic Activity. Building on their earlier research (Case and Deaton 2015), they find that mortality and morbidity among white non-Hispanic Americans in midlife since the turn of the century continued to climb through 2015. Additional increases in drug overdoses, suicides, and alcohol-related liver mortality— particularly among those with a high school degree or less—are responsible for an overall increase in all-cause mortality among whites. They find marked differences in mortality by race and education, with mortality among white non-Hispanics (males and females) rising for those without a college degree, and falling for those with a college degree. In contrast, mortality rates among blacks and Hispanics have continued to fall, irrespective of educational attainment. Mortality rates in comparably rich countries have continued their premillennial fall at the rates that used to characterize the United States. Contemporaneous levels of resources—particularly slowly growing, stagnant, and even declining incomes—cannot provide a comprehensive explanation for poor mortality outcomes. They propose a preliminary but plausible story in which cumulative disadvantage from one birth cohort to the next—in the labor market, in marriage and child outcomes, and in health—is triggered by progressively worsening labor market opportunities at the time of entry for whites with low levels of education. This account, which fits much of the data, has the profoundly negative implication that policies—even ones that successfully improve earnings and jobs, or redistribute income—will take many years to reverse the increase in mortality and morbidity, and that those in midlife now are likely to do worse in old age than the current elderly. This is in contrast to accounts in which resources affect health contemporaneously, so that those in midlife now can expect to do better in old age as they receive Social Security and Medicare. None of this, however, implies that there are no policy levers to be pulled. For instance, reducing the over prescription of opioids should be an obvious target for policymakers.
Dalton Conley’s paper, “Malaria Ecology, Child Mortality and Fertility,” was published in Economics and Human Biology and written with Gordon C. McCord (University of California, San Diego) and J. Sachs (Columbia University). The authors state that the broad determinants of fertility are thought to be reasonably well identified by demographers, though the detailed quantitative drivers of fertility levels and changes are less well understood. This paper uses a novel ecological index of malaria transmission to study the effect of child mortality on fertility. They find that temporal variation in the ecology of the disease is well-correlated to mortality, and pernicious malaria conditions lead to higher fertility rates. They then argue that most of this effect occurs through child mortality, and estimate the effect of child mortality changes on fertility. Their findings add to the literature on disease and fertility, and contribute to the suggestive evidence that child mortality reductions have a causal effect on fertility changes.
Matthew Desmond contributed to the Stanford Center on Poverty & Inequality’s publication, State of the Union 2017, with his “Housing” chapter. Housing is a fundamental human need, necessary to promote family, economic, and community stability. The lack of stable, affordable housing is a wellspring for multiple kinds of social maladies, from homelessness and material hardship to school instability and health disparities. Unequal access to affordable, stable, and owner-occupied housing remains a prime driver of racial and ethnic inequality in America.
The key findings in Desmond’s chapter on housing are: Racial and ethnic gaps in homeownership, housing wealth, and tax expenditures on housing are still very wide. Whereas 71% of white families live in owner-occupied housing, only 41% of black families and 45% of Hispanic families do.; Many nonwhite families were excluded from social programs that facilitated dramatic growth in homeownership in the mid-20th century.; The ownership gap is related to an affordability gap. Black and Hispanic families are approximately twice as likely as white families to experience “extreme housing costs,” defined as spending at least 50% of income on housing.
Megan Sandel (Boston Medical Center) and Matthew Desmond published, “Investing in Housing for Health Improves Both Mission and Margin,” in JAMA. During the last 20 years, low-income families have had their incomes plateau or decline as their housing costs soared. Public aid has not been expanded to meet the growing need: only one in four households that qualify for housing assistance receives it. As a result, today most renting households below the federal poverty line spend more than half of their income on housing costs, and one in four spends more than 70% of its income on rent and utility costs alone. Rent-burdened families not only have less money to spend on wellness and health care but also regularly face eviction and homelessness, which further threatens their health. According to recent estimates, 2.8 million renting households are at risk of eviction and more than 500,000 people are homeless on any single night.
Medical researchers and clinicians are increasingly recognizing the importance of the social determinants of health, which include stable, decent, affordable housing. Housing problems have been associated with a wide array of health complications, including lead exposure and toxic effects, asthma, and depression. In the United Kingdom, a study of more than 4000 adults found that childhood housing conditions, such as poor ventilation, were associated with an increased risk of mortality. In the United States, data from the Third National Health and Nutrition Examination Survey estimated that 40% of asthma cases in children were related to the children’s home environment. Moreover, the lack of stable housing compromises the ability of clinicians to treat low-income patients with medical complexity, not only because eviction and residential insecurity thwart treatments and continuous care, but also because families are often forced to choose between medication costs or rent.
Acute residential insecurity among low-income households contributes to making the U.S. health care system both ineffective and inefficient. The top 5% of hospital users—overwhelmingly poor and housing insecure—are estimated to consume 50% of health care costs. Patients living in poverty in the United States are often the most expensive to treat, in part because of their lack of a stable home. If nothing changes, many individuals with unstable housing will continue to develop difficult-to-treat illnesses and will continue to account for substantial health care costs.
Matthew Desmond’s chapter, “How Housing Dynamics Shape Neighborhood Perceptions,” was published in Evidence and Innovation in Housing Law and Policy, edited by Lee Fennell (University of Chicago Law School) and Benjamin Keys (Wharton School, University of Pennsylvania). This chapter investigates how three housing dynamics – (1) residents’ reasons for moving; (2) their strategies for finding housing; and (3) the quality of their dwelling – influence neighborhood perceptions. Drawing on a novel survey of renters in Milwaukee, it finds that city dwellers who relocated to their neighborhood after an eviction, who found their apartment through a nonprofit or government agency, and who experienced long-lasting housing problems harbored lower evaluations of their neighborhoods. These findings indicate that any theory of the neighborhood will be incomplete without accounting for the influence of housing dynamics.
Matthew Desmond’s article, “House Rules,” published in The New York Times Magazine looks at social policy in America’s housing, namely how it continues to give the most help to those who least needed it – affluent homeowners – while providing nothing to most rent-burdened tenants. The article states that homeownership was once the cornerstone of the American Dream. Thanks in part to the Federal Tax Code, it’s now the cornerstone of American Inequality.
Susan Fiske published, “Going in Many Right Directions, All at Once,” in Perspectives on Psychological Science. When asked whether the field is going in the right direction, her answer is “yes, mostly.” Policymakers’ respect and the public’s interest put us in the spotlight for our intrinsic strengths—but they also draw attention to our weaknesses as reflected by the replication crisis, about which reasonable opinions differ. Among other concerns, civility and mutual tolerance have sometimes been an issue in these debates. As an example of a constructive debate, the Fiske lab’s recent experience with mutually respectful engagement has advanced solving one scientific puzzle. Principles facilitating this adversarial collaboration include using their respective tribes as secure bases for exploration, sharing agreed-upon rigorous standards, and establishing mutual trust. Finally, Fiske’s own career path has perhaps oriented her to rely on perseverance, flexibility, tolerance, and optimism for the field.
Margaret Frye continues to work on her third research project which examines the relationship between perceived attractiveness and AIDS in Malawi. Using ethnographic data, Frye shows that attractive women are locally perceived to be more likely to be infected, and beautiful women are even blamed for the epidemic. Yet, survey data shows that women who are perceived as less attractive are more likely to be infected. This work is a collaboration with Nina Gheihman (Harvard University, Sociology Department) and Sophia Chae (Guttmacher Institute).
“Physical Attractiveness and Women’s HIV Risk in Rural Malawi,” published in Demographic Research is Margaret Frye’s collaboration with Sophia Chae (Guttmacher Institute). This paper won an Editor’s Choice award. Qualitative evidence from sub-Saharan Africa, where a generalized AIDS epidemic exists, suggests that attractiveness may play a role in shaping individual-level HIV risk. Attractive women, who are often blamed for the epidemic and stigmatized, are believed to pose a higher HIV risk because they are viewed as having more and riskier partners. The authors examine the association between perceived attractiveness and HIV infection and risk in rural Malawi in the midst of the country’s severe AIDS epidemic. They use interviewers’ ratings of respondents’ attractiveness, along with HIV test results and women’s assessments of their own likelihood of infection, to estimate the association between perceived attractiveness and HIV infection and risk for a random sample of 961 women aged 15–35.
Results show that women who are rated by interviewers as ‘much less’ or ‘less’ attractive than other women their age are 9% more likely to test positive for HIV. They also find that attractiveness is associated with women’s own assessments of their HIV risk: Among women who tested negative, those perceived as ‘much less’ or ‘less’ attractive than average report themselves to be at greater risk of HIV infection. The results suggest that attractiveness is negatively associated with HIV risk in Malawi, countering local beliefs that hold attractive women responsible for perpetuating the epidemic. This study highlights the need to consider perceived physical attractiveness, and sexual desirability more broadly, as an under-examined axis of inequality in HIV risk in high-prevalence settings.
Margaret Frye and Lauren Bachan (Pennsylvania State University) co-authored, “The Demography of Words: An Assessment of the Global Decline in Non-Numeric Fertility Preferences,” in Population Studies. This paper examines the decline in non-numeric responses to questions about fertility preferences among women in the developing world. These types of responses—such as “don’t know” or “it’s up to God”—have often been interpreted through the lens of fertility transition theory as an indication that reproduction has not yet entered women’s “calculus of conscious choice” (Coale 1973, p. 65), but have yet to be investigated cross-nationally and over time. Using 19 years of data from 32 countries, they find that non-numeric fertility preferences appear to decline most substantially in the early stages of a country’s fertility transition. Using country-specific and multilevel models, they explore the individual- and contextual-level characteristics that are associated with women’s likelihood of providing non-numeric responses to questions about their fertility preferences. Non-numeric fertility preferences are influenced by a host of social factors, with educational attainment and knowledge of contraception being the most robust and consistent predictors.
Noreen Goldman, Dana A. Glei (Georgetown University), and Maxine Weinstein (Georgetown University) published, “The Best Predictors of Survival: Do They Vary by Age, Sex, and Race?” in Population and Development Review. This paper considers a broad set of variables used by social scientists and clinicians to identify the leading predictors of five-year survival among American adults. Together they address a question not considered in earlier research: Do the strongest predictors of survival vary by age, sex or race/ethnicity? The analysis uses hazard models with 30 well-established predictors to examine five-year survival in the National Health and Nutrition Examination Survey. They found that the simple measure of self-assessed health and self-reported measures of functional ability and disability are the strongest predictors in all demographic groups, and are generally ranked considerably higher than biomarkers. Among the biomarkers, serum albumin is highly ranked in most demographic groups, whereas clinical measures of cardiovascular and metabolic function are consistently among the weakest predictors. Despite these similarities, there is substantial variation in the leading predictors across demographic groups, most notably by race and ethnicity.
“Suburbanization and Segregation in the United States: 1970-2010” was written by Douglas Massey and Jonathan Tannen (Facebook) and published in Ethnic and Racial Studies. Analysis of trends in the suburbanization of whites, blacks, Asians, and Hispanics reveal that all groups are becoming more suburbanized, though the gap between whites and minorities remains large. Although central cities have made the transition to a majority-minority configuration, suburbs are still overwhelmingly white. Levels of minority-white segregation are nonetheless lower in suburbs than in cities. Blacks remain the most segregated group at both locations. Black segregation and isolation levels are declining in cities and suburbs; however, while Hispanic and Asian segregation levels have remained stable, spatial isolation levels have risen. Multivariate analyses suggest that Hispanics achieve desegregation indirectly by using socio-economic achievements to gain access to less-segregated suburban communities and directly by translating their status attainments into residence in white neighborhoods. Blacks do not achieve desegregation indirectly through suburbanization and they are much less able than Hispanics to use their socio-economic attainments directly to enter white neighborhoods.
Douglas Massey published, “Why Death Haunts Black Lives,” in Proceedings of the National Academy of Sciences. In their 2017 Proceedings of the National Academy of Sciences article, “Death of Family Members as an Overlooked Source of Racial Disadvantage in the United States,” Umberson et al. demonstrate that African Americans are much more likely than whites to experience deaths in their immediate family circle and that this elevated exposure to death occurs at virtually all stages of the life cycle. Differential exposure to bereavement by race is likely to contribute to long-standing black-white differentials with respect to health and socioeconomic status more generally. As the authors note, human well-being across a range of dimensions is well known to be adversely affected by exposure to the stress of bereavement.
The Big Picture: Confederate Revisionist History,” written by Douglas Massey, is the 23rd installment of The Big Picture, a public symposium on what’s at stake in Trump’s American, co-organized by Public Books and NYU’s Institute for Public Knowledge. Donald Trump was elected on a wave of unrestrained white nationalism that promised to “take back our country,” and in so doing “make America great again.” His pandering to white racial resentment throughout the campaign was open and unapologetic. To whites who felt that their social status had been reduced by the advances in racial equity achieved through decades of Civil Rights struggles; to those whom Republicans since Richard Nixon’s “southern strategy” had pandered to with so-called “dog whistle politics”; to those who could not reconcile themselves to Obama’s election as president—that is, to the election of an African American to the nation’s highest office—Trump spoke their language of racial fury and overt prejudice.
The plain truth is that the Confederate states launched an unconstitutional armed insurrection against the legitimate government of the United States that resulted in the death of more than 700,000 Americans, more than in all other American wars combined. A revolt to preserve slavery is not something Americans should honor with stately monuments or florid displays of the Confederate Battle Flag. In reality, these symbols are tokens of a bloody war fought in defense of a dehumanizing institution, whose only purpose was to enrich a class of wealthy property owners while giving otherwise oppressed poor white Southerners someone even lower on the totem pole to look down upon. It is not a pretty picture.
Colter Mitchell (University of Michigan), Sara McLanahan, Lisa Schneper, Irwin Garfinkel (Columbia University), Jeanne Brooks-Gunn (Columbia University), and Daniel Notterman published, “Father Loss and Children’s Telomere Length,” in Pediatrics. These researchers examined how father loss (due to separation/divorce, death, or incarceration) is associated with cellular function as estimated by telomere length and how this association differs by genetic sensitivity. Father loss has a significant association with children’s sTL, with the death of a father showing the largest effect. Income loss explains most of the association between child sTL and separation and/or divorce but much less of the association with incarceration or death. Effects are 40% greater for boys and 90% greater for children with the most reactive alleles of the serotonin transporter genes when compared with those with the least reactive alleles. No differences were found by age at father loss or a child’s race/ethnicity.
Sarah James, Sara McLanahan, Jeanne Brooks-Gunn (Columbia University), Colter Mitchell (University of Michigan), Lisa Schneper, Brandon Wagner (University of Texas), and Daniel Notterman published, “Sleep Duration and Telomere Length in Children,” in The Journal of Pediatrics. These researchers tested the association between sleep duration and telomere length in a pediatric population by analyzing cross-sectional data for 1567 children from the age 9 study wave of the Fragile Families and Child Wellbeing Study. They found that children with shorter sleep durations have shorter telomeres than children with longer sleep durations. Each hour less of nightly sleep duration is associated with having telomeres that are 0.015 log-kilobases per chromosome shorter (P?<?.05). They found no difference in this association by race, sex, or socioeconomic status. This finding is consistent with a broader literature indicating that suboptimal sleep duration is a risk for increased physiological stress and impaired health.
C. Jessica Metcalf, Bryan Grenfell, M.S. Lau, B.D. Dalziel (Oregon State University), S. Funk (Centre for the Mathematical Modelling of Infectious Diseases, London School of Hygiene and Tropical Medicine, U.K.), A. McClelland (International Federation of Red Cross and Red Crescent Societies), et al. published, “Spatial and Temporal Dynamics of Superspreading Events in the 2014-2015 West Africa Ebola Epidemic,” in Proc Natl Acad USA. The unprecedented scale of the Ebola outbreak in Western Africa (2014-2015) has prompted an explosion of efforts to understand the transmission dynamics of the virus and to analyze the performance of possible containment strategies. Models have focused primarily on the reproductive numbers of the disease that represent the average number of secondary infections produced by a random infectious individual. However, these population-level estimates may conflate important systematic variation in the number of cases generated by infected individuals, particularly found in spatially localized transmission and superspreading events. Although superspreading features prominently in first-hand narratives of Ebola transmission, its dynamics have not been systematically characterized, hindering refinements of future epidemic predictions and explorations of targeted interventions. They used Bayesian model inference to integrate individual-level spatial information with other epidemiological data of community-based (undetected within clinical-care systems) cases and to explicitly infer distribution of the cases generated by each infected individual.
Their results show that superspreaders play a key role in sustaining onward transmission of the epidemic, and they are responsible for a significant proportion ([Formula: see text] 61%) of the infections. Their results also suggest age as a key demographic predictor for superspreading. They also show that community-based cases may have progressed more rapidly than those notified within clinical-care systems, and most transmission events occurred in a relatively short distance (with median value of 2.51 km). Their results stress the importance of characterizing superspreading of Ebola, enhance our current understanding of its spatiotemporal dynamics, and highlight the potential importance of targeted control measures showcases the unprecendented scale of the Ebola outbreak in Western Africa that prompted an explosion of efforts to understand the transmission dynamics of the virus and analyze the performance of possible containment strategies. Their results show that superspreaders play a key role in sustaining onward transmission of the epidemic and they are responsible for a significant proportion of the infections.
Caroline O. Buckee (Harvard University), Andrew J. Tatem (University of Southampton, U.K., Flowminder Foundation, Sweden), and C. Jessica Metcalf published, “Seasonal Population Movements and the Surveillance and Control of Infectious Diseases,” in Trends Parasitol. National policies designed to control infectious diseases should allocate resources for interventions based on regional estimates of disease burden from surveillance systems. For many infectious diseases, however, there is pronounced seasonal variation in incidence. Policy-makers must routinely manage a public health response to these seasonal fluctuations with limited understanding of their underlying causes. Two complementary and poorly described drivers of seasonal disease incidence are the mobility and aggregation of human populations, which spark outbreaks and sustain transmission, respectively, and may both exhibit distinct seasonal variations. Here they highlight the key challenges that seasonal migration creates when monitoring and controlling infectious diseases. They discuss the potential of new data sources in accounting for seasonal population movements in dynamic risk mapping strategies.
C. Jessica Metcalf, Cara E. Brook. Ying Bai (Division of Vector-Borne Diseases, Centers for Disease Control and Prevention), Emily O. Yu, Hafaliana C. Ranaivoson (Virology Unit, Institut Pasteur de Madagascar, Antananarivo, Madagascar, University of antananarivo, Madascar), Haewon Shin (University of Buffalo, State University of New York), et al. published, “Elucidating Transmission Dynamics and Host-Parasite-Vector Relationships for Rodent-Borne Bartonella spp. in Madagascar,” in Epidemics. Bartonella spp. are erythrocytic bacteria transmitted via arthropod vectors, which infect a broad range of vertebrate hosts, including humans. They investigated transmission dynamics and host-parasite-vector relationships for potentially zoonotic Bartonella spp. in invasive Rattus rattus hosts and associated arthropod ectoparasites in Madagascar. The authors identified five distinct species of Bartonella (B. elizabethae 1, B. elizabethae 2, B. phoceensis 1, B. rattimassiliensis 1, and B. tribocorum 1) infecting R. rattus rodents and their ectoparasites. They fit standard epidemiological models to species-specific age-prevalence data for the four Bartonella spp. with sufficient data, thus quantifying age-structured force of infection. Known zoonotic agents, B. elizabethae 1 and 2, were best described by models exhibiting high forces of infection in early age class individuals and allowing for recovery from infection, while B. phoceensis 1 and B. rattimassiliensis 1 were best fit by models of lifelong infection without recovery and substantially lower forces of infection. Nested sequences of B. elizabethae 1 and 2 were recovered from rodent hosts and their Synopsyllus fonquerniei and Xenopsylla cheopsis fleas, with a particularly high prevalence in the outdoor-dwelling, highland-endemic S. fonquerniei. These findings expand on force of infection analyses to elucidate the ecological niche of the zoonotic Bartonella elizabethae complex in Madagascar, hinting at a potential vector role for S. fonquerniei. Their analyses underscore the uniqueness of such ecologies for Bartonella species, which pose a variable range of potential zoonotic threats.
C. Jessica Metcalf, K.S. Walter (Johns Hopkins Bloomberg School of Public Health, Johns Hopkins University), Amy Wesolowski (Johns Hopkins Bloomberg School of Public Health, Johns Hopkins University), Caroline O. Buckee (Harvard T.H. Chan School of Public Health), E. Shevliakova (NOAA/GFDL, Princeton, NJ), Andrew J. Tatem (University of Southampton, U.K., Flowminder Foundation, Sweden), et al. published, “Identifying Climate Drivers of Infectious Disease Dynamics: Recent Advances and Challenges Ahead,” in Proc Biol Sci. Climate change is likely to profoundly modulate the burden of infectious diseases. However, attributing health impacts to a changing climate requires being able to associate changes in infectious disease incidence with the potentially complex influences of climate. This aim is further complicated by nonlinear feedbacks inherent in the dynamics of many infections, driven by the processes of immunity and transmission. Here, the authors detail the mechanisms by which climate drivers can shape infectious disease incidence, from direct effects on vector life history to indirect effects on human susceptibility, and detail the scope of variation available with which to probe these mechanisms. They review approaches used to evaluate and quantify associations between climate and infectious disease incidence, discuss the array of data available to tackle this question, and detail remaining challenges in understanding the implications of climate change for infectious disease incidence. The authors point to areas where synthesis between approaches used in climate science and infectious disease biology provide potential for progress.
“Opportunities and Challenges in Modeling Emerging Infectious Diseases” in Science by C. Jessica Metcalf and Justin Lessler (Johns Hopkins Bloomberg School of Public Health, Johns Hopkins University). The term "pathogen emergence" encompasses everything from previously unidentified viruses entering the human population to established pathogens invading new populations and the evolution of drug resistance. Mathematical models of emergent pathogens allow forecasts of case numbers, investigation of transmission mechanisms, and evaluation of control options. Yet, there are numerous limitations and pitfalls to their use, often driven by data scarcity. Growing availability of data on pathogen genetics and human ecology, coupled with computational and methodological innovations, is amplifying the power of models to inform the public health response to emergence events. Tighter integration of infectious disease models with public health practice and development of resources at the ready has the potential to increase the timeliness and quality of responses.
Saki Takahashi, C. Jessica Metcalf, Matthew J. Ferrari (The Pennsylvania State University), Andrew J. Tatem (University of Southampton, U.K., Flowminder Foundation, Sweden), and Justin Lessler ( Johns Hopkins Bloomberg School of Public Health, Johns Hopkins University) published, “The Geography of Measles Vaccination in the African Great Lakes Region,” in Nature Communications. Expanded access to measles vaccination was among the most successful public health interventions of recent decades. All WHO regions currently target measles elimination by 2020, yet continued measles circulation makes that goal seem elusive. Using Demographic and Health Surveys with generalized additive models, they quantify spatial patterns of measles vaccination in ten contiguous countries in the African Great Lakes region between 2009–2014. Seven countries have ‘coldspots’ where vaccine coverage is below the WHO target of 80%. Over 14 million children under 5 years of age live in coldspots across the region, and a total of 8–12 million children are unvaccinated. Spatial patterns of vaccination do not map directly onto sub-national administrative units and transnational coldspots exist. Clustering of low vaccination areas may allow for pockets of susceptibility that sustain circulation despite high overall coverage. Targeting at-risk areas and transnational coordination are likely required to eliminate measles in the region.
C. Jessica Metcalf, Keitly Mensah, Amy P. Wesolowski (Johns Hopkins Bloomberg School of Public Health, Johns Hopkins University), Amy K. Winter, B. Ramamonjiharisoa (Virology Unit and National Influenza Center, Institut Pasteur de Madagascar), Saki Takahashi, et al. published, “Seasonal Determinants of Access to Care: Implications for Measles Outbreak Risk in Madagascar,” in The Lancet. Measles containing vaccine was introduced to Madagascar in 1985. Since 2007, intensification of efforts has bought Madagascar closer to the goal of elimination. Nevertheless, recent data also indicate that population immunity might be eroding in the face of high birth rates and barriers to vaccine delivery. Despite evidence that many factors likely to shape vaccination programme effectiveness are seasonal (including transmission, which responds to seasonal human behaviour, and birth rates), how seasonal fluctuations in vaccination shape outbreak risk and timeliness of vaccination is rarely considered. The authors aimed to evaluate this here.
They obtained data from the national passive surveillance system for fever and rash in Madagascar from 2004 to 2015 and combined them cross-sectional data for children's vaccination status from the 2008 Demographic Health Survey to characterize seasonality in childhood-infection transmission, access to vaccination, and births, and the signature of extreme climatic events (e.g., cyclones). Measles incidence is too low for direct inference into seasonality in transmission, but they leveraged data for rubella, which is likely to have similar drivers. They integrated these data with mathematical models to assess the effect of seasonality in vaccination on outbreak risk and also timeliness of vaccination—e.g., the degree to which children obtain vaccination at the appropriate age. They additionally assessed barriers to vaccination that shape seasonal uptake by pairing this analysis with a detailed case study on vaccination access in a focal region of Madagascar.
Seasonal fluctuations in vaccination coverage can affect measles outbreak risk and interact with seasonality in births to affect the timeliness. While the theoretical optimal seasonal timing of vaccination can be identified, understanding barriers to access to health centers, their staffing, and vaccine supply is essential to strengthening health system functioning, and developing robust responses to extreme climatic events. Small changes in the timing of vaccination are relatively straightforward to implement and have the potential to strengthen vaccination programmes.
“A Signature of Tree Health? Shifts in the Microbiome and the Ecological Drivers of Horse Chestnut Bleeding Canker Disease,” published in New Phytol was written by B. Koskella (University of California, Berkeley, Centre for Ecology and Conservation, University of Exeter, U.K.), S. Meaden (Centre for Ecology and Conservation, University of Exeter, U.K.), W.J. Crowther (The University of Warwick, U.K.), R. Leimu (Oxford University, U.K.), and C. Jessica Metcalf. Host susceptibility to pathogens can be shaped by genetic, ecological, and evolutionary factors. The ability to predict the spread of disease therefore requires an integrated understanding of these factors, including effects of pests on pathogen growth and competition between pathogens and commensal microbiota for host resources. The researchers examined interactions between the leaf-mining moth Cameraria ohridella, the bacterial causal agent of bleeding canker disease Pseudomonas syringae pv aesculi, and the bark-associated microbiota of horse chestnut (Aesculus hippocastanum) trees. Through surveys of > 900 trees from 60 sites in the U.K., they tested for ecological or life history predictors of leaf miner infestation, bleeding canker, or coinfection. Using culture-independent sequencing, the researchers then compared the bark microbiomes from 46 trees to measure the association between microbiome composition and key ecological variables, including the severity of disease. Both pest and pathogen were found to respond to tree characteristics, but neither explained damage inflicted by the other. However, they found a clear loss of microbial diversity and associated shift in microbiome composition of trees as a function of disease. These results show a link between bark-associated microbiota and tree health that introduces the intriguing possibility that tree microbiota play key roles in the spread of disease.
J.M. Prada, C. Jessica Metcalf, S. Takahashi, Justin Lessler (Johns Hopkins Bloomberg School of Public Health, Johns Hopkins University), Andrew J. Tatem (University of Southampton, U.K., Flowminder Foundation, Sweden) et al. published, “Demographics, Epidemiology and the Impact of Vaccination Campaigns in a Measles-Free World – Can Elimination be Maintained?” in Vaccine. All six WHO regions currently have goals for measles elimination by 2020. Measles vaccination is delivered via routine immunization programmes, which in most sub-Saharan African countries reach children around 9 months of age, and supplementary immunization activities (SIAs), which target a wider age range at multi-annual intervals. In the absence of endemic measles circulation, the proportion of individuals susceptible to measles will gradually increase through accumulation of new unvaccinated individuals in each birth cohort, increasing the risk of an epidemic. The impact of SIAs and the financial investment they require, depend on coverage and target age range. They evaluated the impact of target population age range for periodic SIAs, evaluating outcomes for two different levels of coverage, using a demographic and epidemiological model adapted to reflect populations in four sub-Saharan African countries.
They found that a single SIA can maintain elimination over short time-scales, even with low routine coverage. However, maintaining elimination for more than a few years is difficult, even with large (high coverage/wide age range) recurrent SIAs, due to the build-up of susceptible individuals. Across the demographic and vaccination contexts investigated, expanding SIAs to target individuals over 10 years did not significantly reduce outbreak risk.
Elimination was not maintained in the contexts they evaluated without a second opportunity for vaccination. In the absence of an expanded routine program, SIAs provide a powerful option for providing this second dose. They show that a single high coverage SIA can deliver most key benefits in terms of maintaining elimination, with follow-up campaigns potentially requiring smaller investments. This makes post-campaign evaluation of coverage increasingly relevant to correctly assess future outbreak risk.
C. Jessica Metcalf’s paper, “Multinational Patterns of Seasonal Asymmetry in Human Movement Influence Infectious Disease Dynamics,” written with Amy Wesolowski (Johns Hopkins Bloomberg School of Public Health), Elisabeth zu Erbach-Schoenberg (University of Southampton, U.K.), Andrew J. Tatem (University of Southampton, U.K., Flowminder Foundation, Sweden), Christopher Lourenço (University of Southampton, U.K.), Cecil Viboud (Fogarty International Center, National Institutes of Health), et al. and published in Nature Communications. Seasonal variation in human mobility is globally ubiquitous and affects the spatial spread of infectious diseases, but the ability to measure seasonality in human movement has been limited by data availability. Here, the authors use mobile phone data to quantify seasonal travel and directional asymmetries in Kenya, Namibia, and Pakistan, across a spectrum from rural nomadic populations to highly urbanized communities. They then model how the geographic spread of several acute pathogens with varying life histories could depend on country-wide connectivity fluctuations through the year. In all three countries, major national holidays are associated with shifts in the scope of travel. Within this broader pattern, the relative importance of particular routes also fluctuates over the course of the year, with increased travel from rural to urban communities after national holidays, for example. These changes in travel impact how fast communities are likely to be reached by an introduced pathogen.
Ayesha Mahmud, Nur Haque Alam (International Centre for Diarrhoeal Disease Research, Bangladesh), and C. Jessica Metcalf published, “Drivers of Measles Mortality: The Historic Fatality Burden of Famine in Bangladesh,” in Epidemiology & Infection. Measles is a major cause of childhood morbidity and mortality in many parts of the world. Estimates of the case-fatality rate (CFR) of measles have varied widely from place to place, as well as in the same location over time. Amongst populations that have experienced famine or armed conflict, measles CFR can be especially high, although past work has mostly focused on refugee populations. Here, the authors estimate measles CFR between 1970 and 1991 in a rural region of Bangladesh, which experienced civil war and famine in the 1970s. They use historical measles mortality data and a mechanistic model of measles transmission to estimate the CFR of measles. They first demonstrate the ability of this model to recover the CFR in the absence of incidence data, using simulated mortality data. Their method produces CFR estimates that correspond closely to independent estimates from surveillance data and we can capture both the magnitude and the change in CFR suggested by these previous estimates. They use this method to quantify the sharp increase in CFR that resulted in a large number of deaths during a measles outbreak in the region in 1976. Most of the children who died during this outbreak were born during a famine in 1974, or in the 2 years preceding the famine. Their results suggest that the period of turmoil during and after the 1971 war and the sustained effects of the famine, is likely to have contributed to the high fatality burden of the 1976 measles outbreak in Matlab.
Britt Koskella (University of California, Berkeley), Lindsay J. Hall (The Gut Health and Food Safety Programme, Quadram Institute, Norwich, U.K.) and C. Jessica Metcalf published,”The Microbiome Beyond the Horizon of Ecological and Evolutionary Theory,” in Nature Ecology and Evolution. The ecological and evolutionary study of community formation, diversity, and stability is rooted in general theory and reinforced by decades of system-specific empirical work. Deploying these ideas to study the assembly, complexity, and dynamics of microbial communities living in and on eukaryotes has proved seductive, but challenging. The success of this research endeavor depends on our capacity to observe and characterize the distributions, abundances, and functional traits of microbiota, representing an array of technical and analytical challenges. Furthermore, a number of unique characteristics of microbial species, such as horizontal gene transfer, the production of public goods, toxin and antibiotic production, rapid evolution, and feedbacks between the microbiome and its host, are not easily accommodated by current ecological and evolutionary theory. Here they highlight potential pitfalls in the application of existing theoretical tools without careful consideration of the unique complexities of the microbiome, focusing particularly on the issue of human health, and anchoring our discussion in existing empirical evidence.
C. Jessica Metcalf, Ann T. Tate (Vanderbilt University), and Andrea L. Graham published, “Demographically Framing Trade-offs Between Sensitivity and Specificity Illuminates Selection on Immunity, in Nature Ecology & Evolution. A fundamental challenge faced by the immune system is to discriminate contexts meriting activation from contexts in which activation would be harmful. Selection pressures on this ability are likely to be acute: the penalty of misidentification of pathogens (therefore failure to attack them) is mortality or morbidity linked to infectious disease, which could reduce fitness by reducing lifespan or fertility; the penalty associated with misidentification of host (therefore self-attack) is immunopathology, whose fitness costs can also be extreme. Here the researchers use classic epidemiological tools to frame this trade-off between sensitivity and specificity of immune activation, exploring implications for evolution of immune discrimination. They capture the expected increase in the evolutionarily optimal sensitivity under higher pathogen mortality risk, and a decrease in sensitivity with increased immunopathology mortality risk; but a number of non-intuitive predictions also emerge. All else being equal, optimal sensitivity decreases with increasing lifespan; and, where sensitivity can vary over age, decreases at late ages not solely attributable to immunosenescence are predicted. These results both enrich and challenge previous predictions concerning the relationship between life expectancy and optimal evolved defenses, highlighting the need to account for epidemiological setting, life stage-specific immune priorities, and immune discrimination in future investigations.
Elizabeth Paluck’s research is motivated by two basic ideas. The first idea is that social psychological theory offers potentially useful tools for changing society in constructive ways. The second idea is that studying attempts to change society is one of the most fruitful ways to develop and assess social psychological theory. Much of her work has focused on prejudice and intergroup conflict reduction, using large-scale field experiments to test theoretically driven interventions.
Through field experiments in Central and Horn of Africa and in the United States, Paluck has examined the impact of the mass media and interpersonal communication on tolerant and cooperative behaviors. She has found support for a behavioral change model based on social norms and group influence. To change behavior, she suggests, it may be more fruitful to target citizens’ perceptions of typical or desirable behaviors (i.e. social norms) than their knowledge or beliefs. How do social norms and behaviors shift in real world settings? Some initial suggestions from this research include peer or role model endorsement, narrative communication, and group discussion. Paluck’s work in post-conflict countries has led to related research on political cultural change and on civic education. Paluck is also interested in social scientific methodology—particularly causal inference and behavioral measurement.
Most recently, Paluck has examined the role of institutions in shaping behavior and attitudes. She and colleagues found that after the 2015 Supreme Court ruling in favor of same-sex marriage, there was an increase in perceived social norms supporting gay marriage across the ideological spectrum.
Paluck will continue developing behavioral science projects that engage with real-world problems. She hopes to train a next generation of students who want to do this type of research, which is not part of our mainstream training in psychology. She is thinking about more ways to involve the public in her research.
“Confronting Hate Collectively” by Michael Chwe (University of California, Los Angeles) and Elizabeth Paluck in Political Science and Politics reveal intimidation and harassment have spiked throughout the United States since the recent presidential election. Women, people of color, immigrants, Muslims, Jews, and LGBTQ people--including many of our own students--report palpable fear. In the 10 days after Election Day, the Southern Poverty Law Center collected 867 reports of hateful intimidation and harassment (Southern Poverty Law Center 2016). These studies, set in disparate contexts, imply that potential perpetrators of hate crimes in the present-day United States are not necessarily “learning” hatred from Trump’s dehumanizing statements, including those about Mexican Americans (“They’re bringing drugs, they’re bringing crime, they’re rapists”), Muslim Americans (“There were people that were cheering on the other side of New Jersey where you have large Arab populations.... They were cheering as the World Trade Center came down”), disabled people (physically mocking disabled reporter Serge Kovaleski), and women (“Grab them by the p—y, you can do anything”) (Burns 2015; Fahrenthold 2016; Haberman 2015; Kessler 2015). Rather, potential perpetrators are encouraged to act by the fact that Trump garnered votes and now holds the highest office. They infer from this that they have a better chance of escaping social and legal sanction than before his election. According to this model of hate-crime motivations, prevention efforts must focus on convincing potential perpetrators that those in their community are opposed to this behavior.
Laboratory experiments on social confrontations of prejudice support the idea that hateful actions are socially mediated. Moreover, Czopp, Monteith, and Mark (2006) found that being confronted by others does seem to change a person’s behavior. In their experiments, when white American students were confronted about answering questions in a racially stereotypical way, they responded with anger and irritation toward the person confronting them and negative affect (such as anger, disappointment, and guilt) toward themselves. However, following the confrontation, they were less likely to engage in stereotypes and report prejudiced attitudes. Confrontations that did not explicitly label the person’s behavior as racist (by saying that they should be “more fair” as opposed to “less prejudiced”) provoked less hostility in the study participants. However, both types of confrontation were effective for reducing subsequent stereotyping and prejudiced attitudinal reports. Czopp, Monteith, and Mark (2006) wrote that “potential confronters may be willing to endure unpleasant interpersonal reactions if the confrontation will be ultimately successful in changing future behavior.”
Elizabeth Paluck, Eldar Shafir, and Sherry Wu co-authored, “Ignoring Alarming News Brings Indifference” published in Cognition. The broadcast of media reports about moral crises such as famine can subtly depress rather than activate moral concern. Whereas much research has examined the effects of media reports that people attend to, social psychological analysis suggests that what goes unattended can also have an impact. The idea is tested that when vivid news accounts of human suffering are broadcast in the background but ignored, people infer from their choice to ignore these accounts that they care less about the issue, compared to those who pay attention and even to those who were not exposed. Consistent with research on self-perception and attribution, three experiments demonstrate that participants who were nudged to distract themselves in front of a television news program about famine in Niger (Study 1), or to skip an online promotional video for the Niger famine program (Study 2), or who chose to ignore the famine in Niger television program in more naturalistic settings (Study 3) all assigned lower importance to poverty and to hunger reduction compared to participants who watched with no distraction or opportunity to skip the program, or to those who did not watch at all.
Elizabeth Paluck and Eldar Shafir contributed a chapter entitled, “The Psychology of Construal in the Design of Field Experiments” in the Handbook of Field Experiments published by Elsevier. In their chapter, the authors argue that good experimental design and analysis accounts for the notion of construal, a person's subjective interpretation of a stimulus, a situation, or an experimental intervention. Researchers have long been aware of motivations, such as self-presentation, profit seeking, or distrust, that can influence experimental participants' behavior. Other drivers of behavior include consistency, identity, social norms, perceptions of justice, and fairness—all factors that shape individuals' construal of the immediate situation. Experimental tools and interventions are similarly “construed” in ways that shape what participants are responding to. The logic is reviewed and findings around the notion of construal and the ways in which considerations of construal should affect how experiments are designed and deployed so as to achieve a shared construal between participants and investigators. These considerations also apply to the replication and scale-up of experimental studies. Discussion takes place on how construals of the experimental hypotheses can influence investigators' construal of the data.
Margaret Tankard (RAND Corporation) and Elizabeth Paluck published, “The Effect of a Supreme Court Decision Regarding Gay Marriage on Social Norms and Personal Attitudes,” in Psychological Science. The authors propose that institutions such as the U.S. Supreme Court can lead individuals to update their perceptions of social norms, in contrast to the mixed evidence on whether institutions shape individuals’ personal opinions. They studied reactions to the June 2015 U.S. Supreme Court ruling in favor of same-sex marriage. In a controlled experimental setting, found that a favorable ruling, when presented as likely, shifted perceived norms and personal attitudes toward increased support for gay marriage and gay people. Next, a five-wave longitudinal time-series study using a sample of 1,063 people found an increase in perceived social norms supporting gay marriage after the ruling but no change in personal attitudes. This pattern was replicated in a separate between-subjects data set. These findings provide the first experimental evidence that an institutional decision can change perceptions of social norms, which have been shown to guide behavior, even when individual opinions are unchanged.
In an ongoing study that involves 25,000 New Jersey high schoolers, Elizabeth Paluck identified students with high visibility within the school through data about whom they spent their time with in person and online. She and her research team found that by targeting these students for anti-prejudice interventions, a message of tolerance spread throughout the school more effectively than when it was delivered by adults. These measures have resulted in steep declines in harassment and bullying within the targeted schools.
Abigail Aiken (University of Texas, Austin), Catherine Aiken (University of Cambridge) and James Trussell’s research entitled, “In the Midst of Zika Pregnancy Advisories, Termination of Pregnancy is the Elephant in the Room,” was published in An International Journal of Obstetrics & Gynaecology. To date, the majority of research and reporting devoted to Zika virus has focused on its potential negative impact on fetal neurological development, in particular the risk of microcephaly. By contrast, relatively little attention has been paid to the impacts of Zika and its associated public health response on women, particularly regarding their ability to terminate pregnancies. While Zika exposure is clearly not the only reason why women in Latin America and the United States require access to termination of pregnancy (TOP), it brings the issue of reproductive rights in the midst of a public health crisis sharply into focus. Experiences in Latin-American countries have shown that there is both a need for clear information and a demand for TOP that is not currently met by healthcare systems. Their recent study indicates that requests for medical TOP through Women on Web, an online telemedicine service providing mifepristone and misoprostol to women in countries where safe, legal, TOP is not available, have increased by 36–108% since the Pan-American Health Organization (PAHO) issued an epidemiological alert regarding Zika virus. Many of the women seeking help were terrified of the risks Zika virus might pose, yet had no ability to pay for testing and no safe, legal option for ending their pregnancy through their own healthcare systems. The lesson from Latin America is clear: issuing to women advice that they cannot implement is not only unjust but also precipitates fear and anxiety.
“Contraceptive Method Preferences and Provision After Termination of Pregnancy: A Population-Based Analysis of Women Obtaining Care with the British Pregnancy Advisory Service,” written by Abigail Aiken (University of Texas, Austin), PA Lohr (British Pregnancy Advisory Service), Catherine Aiken (University of Cambridge), T. Forsyth (University of Edinburgh) and James Trussell, and published in An International Journal of Obstetrics & Gynaecology investigates clinical interactions before and after termination of pregnancy (TOP). This presents a dual opportunity to discuss contraceptive options and to access methods. Little is known about the contraceptive methods women choose during routine TOP care, however, or the extent to which their preferences are fulfilled. In light of guidance from the Royal College of Obstetricians and Gynaecologists (RCOG), which recommends that all women should receive the contraceptive method of their choice following TOP, these understudied clinical outcomes are important benchmarks for measuring and improving service provision and for ensuring high-quality care. They conclude that the standards set for patient-centered TOP care should emphasize the need for full range of contraceptive options to be offered and provided post-TOP.
“Similarities and Differences in Contraceptive Use Reported by Women and Men in the National Surveys of Family Growth,” published in Contraception was written by Abigail Aiken (University of Texas, Austin), Yu Wang (University of Wisconsin, Madison), Jenny Higgins (University of Wisconsin, Madison), and James Trussell. The objection: To compare use of contraceptive methods at last heterosexual intercourse among 15–44 year-old women and men at risk of unintended pregnancy in the United States. The conclusion: Estimates of men’s contraceptive use may be subject to underreporting of their partners’ method use, particularly when their female partner is sterilized. Neither older age nor married and cohabiting relationship status accounted for the observed differences. Further research is needed to explore the factors underlying reporting differences between women and men with respect to female sterilization and use of no method.
Also in Contraception, “‘I Don’t Know What I Would Have Done.’ Women’s Experiences Acquiring Ulipristal Acetate Emergency Contraception Online from 2011-2015,” was witten by Nicole Smith, Kelly Cleland, Brandon Wagner (University of Texas), and James Trussell. This study describes women's reasons for seeking ulipristal acetate (UPA) for emergency contraception (EC) through the only authorized online retailer for UPA EC in the US. Concluding, the importance of providing confidential services for acquiring EC online. Benefits of online access include convenience, less embarrassment, avoiding situations in which a provider might refuse to provide EC because of their own ideological belief, and more reliable availability for this time-sensitive contraceptive.
An International Journal of Obstetrics & Gynaecology article entitled, “Experiences and Characteristics of Women Seeking and Completing At-Home Medical Termination of Pregnancy through Online Telemedicine in Ireland and Northern Ireland: A Population-Based Analysis,” was written by Abigail Aiken (University of Texas, Austin), Rebecca Gomperts (Women on Web, Amsterdam, The Netherlands) and James Trussell. The study of women completing at-home medical termination of pregnancy (TOP) using online telemedicine. The findings: The vast majority of women who completed at-home medical TOP through Women on Web (WoW) had a positive experience. These demonstrated benefits to health and wellbeing contribute new evidence to the debate surrounding abortion laws in Ireland and Northern Ireland.
In “Medical Eligibility Criteria on both sides of the Atlantic Ocean” published in Contraception, Sarah Millar (Chalmers Sexual Health Service, Edinburgh, Scotland) and James Trussell research the topic. Separated by 4000 miles of ocean, the U.S. and the U.K. are two well-developed countries that share many similarities but also have significant differences. Forty-five percent of pregnancies are not planned in both countries, suggesting there are similar challenges in the delivery of effective contraception. On the other hand, healthcare systems and population characteristics are notably different. How do the medical eligibility criteria (MEC) for contraceptive use in the U.S. and U.K. compare? How are decisions about the categorization of conditions made? And as a result, are there any significant disparities? This commentary explores variations in the MECs from both sides of the Atlantic and consider the reasons for them.
Charles Westoff published, a Department of Health Services (DHS) Further Analysis Report No. 107 entitled, “Trends in reproductive behavior in Rwanda.” This report, based largely on the 2014-15 national survey in Rwanda, focuses on changes and trends in reproductive behavior since 2010. In the 4-5 years after the 2010 survey, fertility continued its decline to 4.2 births per woman as contraceptive prevalence increased slightly. However, the earlier downward trend in number of children desired appears stalled. This is clearly evident from an increase in the proportions of married women and men who say they want more children. Child mortality has significantly declined and remains strongly related to fertility; while age at marriage has continued to increase. The demographic goals specified in the 1998-99 plan for development, Rwanda Vision 2020, appear on track, but the annual rate of population growth remains high, currently 2.5%, because fertility is high. Furthermore, large numbers of young people are now entering their child-bearing years. Although most trends seem encouraging, especially compared with other countries in sub-Saharan Africa, significant population growth is expected in Rwanda, from 12 to 16 million people by 2030, and to 22 million people by midcentury, even with assumed reductions of fertility.
Yu Xie and Yongai Jin (Renmin University of China) published, “Social Determinants of Household Wealth and Income in Urban China,” in Chinese Journal of Sociology. Using data from a nationwide household survey—the China Family Panel Studies—they study how social determinants—political and market factors—are associated with wealth and income among urban households in China. Results indicate that both political and market factors contribute significantly to a household’s economic wellbeing, but the political premium is substantially greater in wealth than in income. Further, political capital has a larger effect on the accumulation of housing assets, while market factors are more influential on the accumulation of non-housing assets.