Elias Nosrati, Michael Ash, Michael Marmot, Martin McKee and Lawrence P King
Health inequalities are on the rise in the United States: the gap in life expectancy between those at the top and the bottom of the income spectrum has increased rapidly since the dawn of the century, to the point where the lives of the poor are cut short by up to a decade and a half compared with those of the wealthy. Moreover, while the rich tend to live longer everywhere, life expectancy among the poor varies significantly by geographical region.
In our article recently published in the IJE, we show that these patterns of health are the product of powerful political and economic forces. Over the past few decades, neoliberal politics, the decline of unions and economic globalisation have resulted in rapid industrial restructuring and economic dislocation in the US. Organised labour has been eroded in the industrial heartland, and manufacturing operations have been shifted to the non-unionised south and to foreign countries.
Eleonora Uphoff, Neil Small, Rosie McEachan and Kate Pickett
For some years, our research has been based in the city of Bradford in northern England. We are often asked to justify our research setting. There seems to be a concern that a cohort population that is not representative of the nation as a whole or of the ‘average person’ cannot produce valuable insights beyond its local setting.
While such concerns are not new, they now seem more present, perhaps due to the rise of Big Data or the increased sharing of and access to data from national surveys and cohorts. Do these reservations represent a push for representativeness and generalisability in epidemiology? If so, this might come at the expense of research aiming to paint a more detailed picture of population health.
Rheumatic Heart Disease (RHD) is caused by a bacterial (streptococcal) throat infection acquired in childhood. Although this type of infection is common and widespread, a small proportion of children so affected go on to develop an inflammatory condition that leads to scarring and narrowing of the heart valves and, in time, heart failure. Early on in the course of the disease the joints may be affected – hence the term “rheumatic”.
Still an important disease At one time Rheumatic Heart Disease was common throughout the UK, Europe and the US; it was the most important cause of heart disease among young adults in Victorian Britain and probably caused the death of Mozart. Although rare now in most developed countries, it remains an important public health problem in many low and middle income countries. The disease is widespread in the Middle East and Asia, and the the poor indigenous populations of some wealthy countries, for example among Australian Aboriginees and New Zealand Maoris. It is particularly prevalent in sub-Saharan Africa, where it is one of the commonest causes of heart disease, typically affecting children or young adults. There it carries a grim prognosis because of the lack of specialised treatment. Continue reading “Smoke exposure in early life and Rheumatic Heart Disease”→
Some previous epidemiologic studies have suggested that having Parkinson’s disease decreases your risk of developing cancer, and vice versa. If true, this finding could provide insight into underlying biologic mechanisms for the two diseases.
How we set out to answer the question In a study published in the International Journal of Epidemiology we used data from Medicare, a U.S. federal health insurance programme for those aged ≥65 years, linked to U.S. cancer registry data to examine the relationship between Parkinson’s disease and cancer. Because we used Medicare data, we were limited to people aged 65 years and older. However, as the Medicare database is very large, we were able to examine relationships in whites and non-whites, in men and women, and in different age groups (all above 65 years).
It’s over seven years since the onset of the 2008 Global Financial Crisis and we’re beginning to get a clear idea of its impact on mental health and suicide.
In keeping with previous economic recessions, the 2008 financial crisis was followed by rises in suicide deaths in many affected countries. As documented in an article published in the British Medical Journal in 2013, younger men appear to have been particularly badly affected.
Joan Benach, Alejandra Vives, Gemma Tarafa, Carlos Delclós and Carles Muntaner
João was 14 when he got his first job at a Brazilian bank. By the time he was 19, he was working part-time as an assistant to the board of directors of a multinational bank while working on a technical degree in foreign trade. He was earning about US$150 a month when he applied for a full-time position in the trade sector, but his application was denied because he was seen as too valuable in the position he held at the time. He then began to work on getting a university degree, but monthly payments cost more than what he was earning per month. When he saw his next transfer application for a different position in the trade sector denied, he left the university and decided to move to Canada. He felt that learning English would be a good way to improve his employment prospects.
Once there, he realised everything was more expensive than he had originally anticipated. Despite having only a tourist visa, João got a series of short-term jobs to support his English training. He worked brief stints as a carpet installer, an office assistant and, finally, as a bricklayer. It was in this final position that he earned CDN$29 an hour, over three times more than the minimum wage he’d earned in his previous jobs. Yet, as an undocumented worker, he was denied political, health and educational rights, and was constantly exposed to abuse by his employers and severe income insecurity. Moreover, the overlong work shifts, the exhausting nature of his tasks and a constant exposure to toxins took a substantial toll on his body.