The Great Recession has brought income inequality to the forefront of the American psyche. Parallels have been made between the Great Depression and the Great Recession, and as such, economic history can act as a powerful analytical tool in directing policy. The first essay in Income Inequality during the Great Depression is a qualitative analysis of income transitions from 1929 to 1933 using 33 representative cities as surveyed by the Civil Works Administration. The second essay investigates the welfare effects of income inequality on infant mortality during the Depression. And the third essay on noninfant mortality gives context to the analysis of infant mortality and stillbirths.

O desenvolvimento pode ser estudado sob diversas perspectivas. Dentre estas, destaca-se a de Amartya Sen, na qual o objetivo maior de uma política de desenvolvimento é o de expandir a liberdade de escolha dos indivíduos. Partindo da ideia de ampliação das capabilities, define-se uma das dimensões consideradas como essenciais, a saúde, mais especificamente a mortalidade infantil, como objeto de estudo. Um dos papéis do Estado deve ser o de garantir a provisão de serviços de saúde para todos os indivíduos, já que ela pode ser classificada como um bem meritório. Em busca dos determinantes do padrão regional recente da mortalidade infantil no Brasil, utiliza-se o modelo de determinantes proximais proposto por Mosley e Chen (1984), no qual os fatores socioeconômicos influenciam indiretamente o resultado observado da variável de interesse. No Brasil, houve uma redução expressiva dos níveis de mortalidade infantil nas últimas décadas, mas ainda assim persiste uma intensa desigualdade regional. Com o objetivo de comparar os resultados alcançados localmente no país, é necessário incluir a dimensão espacial em um modelo econométrico para que os problemas decorrentes da dependência espacial possam ser evitados. Após utilizar o filtro espacial para tanto, estimando cross-sections para 1980, 1991 e 2000, o trabalho conclui que a infraestrutura de saúde, enquanto medida pelo número de leitos e de estabelecimentos perdeu importância na explicação do padrão da mortalidade infantil ao longo do tempo. Em contrapartida, as variáveis socioeconômicas tornaram-se mais relevantes e significativas. A implicação mais direta disso é que futuras políticas devem buscar melhorar o acesso das famílias aos serviços públicos de saneamento, reduzir a pobreza e a desigualdade e aumentar o nível educacional da população. Ou seja, o estímulo à prevenção familiar contra problemas que possam ocasionar a morte prematura torna-se cada vez mais essencial. / Development can be understood from many perspectives. Among those, the one proposed by Amartya Sen states that a development policy should aim at expanding the freedom of individuals, and this goal can be achieved by the expansion of capabilities. With this conceptual framework in mind, health, more specifically infant mortality, is chosen as a measure of development and as the object of study. The Government should guarantee the provision of health services, as they consist in meritory goods. Mosley and Chen (1984) propose a theoretical framework to study infant mortality based on the proximal determinants, in which the socioeconomic factors affect the result observed indirectly. In Brazil there has been a substantial reduction of the average levels of infant mortality rates in the last decades. However, there is still a significant regional inequality. Econometric models for 1980, 1991 and 2000 are estimated including a spatial filter in order to account for the spatial dependency observed in the data. The study concludes that health infrastructure lost its explanative power for the differences in infant mortality rate among the localities. On the other hand, socioeconomic variables have become more relevant and significant. It means that future public policies must try to improve the access of the families to public facilities, reduce poverty and inequality and improve educational levels. Therefore, the family-based prevention against health problems should be stimulated, helping to avoid premature death

Thesis advisor: Claudia Olivetti / This dissertation tracks a particular public health program and examines the economic causes and consequences of the institution of public health. I follow the United States rollout of county-level health departments (CHDs) over 1908 to 1933 and track the short-run benefits, the long-run benefits, and the factors that led to adoption. At the turn of the twentieth century, rural areas lagged behind urban centers in access to public health services, despite the fact that there had been convergence in urban-rural mortality. With 60 percent of the US population living in rural areas, this lack of public health was a population-wide problem. By 1908 the rural health problem drew national attention from the United States Public Health Service (USPHS) and health-interested private organizations. These organizations targeted rural health conditions by opening local public health departments that were operated by the existing county government. This revolutionary approach initiated the first nationwide rural public health program in United States history. The rollout of health infrastructure improved sanitation and provided access to child health services in under-served areas throughout the US. The sanitation improvements included inspections, hygiene training, and installation of toilets, wells, and drainage. Health services appeared in the form of exams, nutritional consults, immunizations, and midwife hygiene training. Local tax dollars provided the majority of funding for this program, although supplemental support arrived from outside organizations including the USPHS, state governments, the Rockefeller Sanitary Commission (RSC), and the Sheppard-Towner Act. In the first chapter, Taxation, Inequality, and the Provision of Local Public Health, I consider the factors that shaped the appropriation of rural public health. Using digitized county-level records on property values and taxation, I argue that adopting regions had local governments centered around the county as compared to the town or township. Within state, specific counties that adopted this program had more active local governments, as measured by county taxation, county debt, and measured property values. Next, because CHDs provided a bridge between the rural and urban areas of the county, I consider whether the CHDs were redistributive in nature. I find that CHDs operated in areas with higher levels of land and income inequality, which is distinct from what related literature has established with education spending. These results suggest that public programs based on local revenue may help to mitigate disparities within the region of jurisdiction but may exacerbate inequalities between adopting and non-adopting areas. External funding from higher levels of government as well as private donors helped to randomize the effort and spread the health services more evenly between counties. In the second chapter, Explaining Declines in US Rural Mortality, 1910-1933: The Role of County Health Departments, I assess the short-run impact of CHDs in terms of aggregate county-level mortality. Using two novel datasets--CHD administrative records and US county-level rural mortality--I track the rollout of CHDs throughout the United States and use variation in when and where CHDs operated to identify the mortality benefits. With an event study design, I establish that CHD entry led to a decline in infant mortality, but provided little advantage to overall population health. For infants, CHDs prevented two deaths per 1,000 births, which accounts for 8-10% of the period-specific mortality decline. The effect is most substantial in rural-only counties, as well as in the Midwestern region of the United States. In these areas, infant mortality declined by three to four deaths per 1,000 births. In the final chapter, The Long-term Impact of Public Health Measures Targeting Children, I examine whether the public health initiative was effective at improving adult human capital. While previous studies have established the lasting detrimental effect of poor child health, fewer studies have evaluated whether public health programs can mitigate these adverse effects. To address this question, I estimate whether childhood exposure to a public health intervention affects adult income, education, and health. The historical vantage point of the CHD program allows me to follow exposed children through adulthood and observe the life-cycle benefits, including the total lifespan. To estimate the long-term benefits, I use linked census data, World War II enlistment records, and Social Security death records and exploit variation in the timing, location, and age of CHD exposure. Based on this methodology, I find that children treated under the age of five show later-life earnings improvements of three to four percent. I investigate the mechanisms underlying the effect and demonstrate that higher earnings emerge from better adult health, measured by cognition, body mass index, and the probability of living past age 80. / Thesis (PhD) — Boston College, 2018. / Submitted to: Boston College. Graduate School of Arts and Sciences. / Discipline: Economics.

A questão da mortalidade Infantil continua sendo um dos mais graves problemas sociais. A demonstração do Interesse por esse tipo de estudo não se limita ao âmbito do debate acadêmico, está presente no cotidiano daqueles que atuam no Interior das intituições governamentais voltadas para o planejamento e para a avaliação de prioridades no conjunto das políticas públicas. Embora os progressos na área de stlúde tenham contribuído pera uma redução importante nos riscos de morte de crianças menores de um ano em São Paulo, sua incidência ainda continua elevada em relação aos países que alcançaram níveis mais favoráveis. Além disso, o processo desigual da redução da mortalidade, que determina um avanço mais rápido em alguns setores da sociedade e um maior atraso em outros, reproduz a existência de importantes diferenciais sócio-econômicos da mortalidade infantil. A inclusão de uma histórla de nascimentos na Pesquisa Nacional por Amostra de Domicílios de 1984 propiciou a análise das probabilidades de morte infantil definidas no tempo e detalhadas por idade, segundo um conjunto de variáveis sócio-econômicas e demográficas. Este trabalho tem por base empírica este conjunto de informações e representa um esforço no sentido de analisar e discutir aspectos significativos dos padrões e diferenciais de mortalidade infantil, estimados diretamente a partir da história de nascimentos. Com isto, avençamos na compreensão da influência de fatores sócio-econômicos e demográficos nos níveis e tendências da mortalidade Infantil no Estado de São Paulo. A análise foi dividida em três capítulos principais: a influência de fatores sócio-econômicos sobre a mortalidade infantil, a influência de fatores demográficos e os efeitos da queda da fecundidade sobre a mortalidade infanlil em São Paulo. Primeiramente, são analisados os efeitos da instrução materna e da renda familiar. Em seguida, são abordados os efeitos do saneamento básico através da análise do tipo de abastecimento de água, com ou sem cananalização interna e do tipo de esgotamento sanitário controlando-se o uso da instalação sanitária. A partir daí, desenvolve-se uma análise da innuência simultânea da instrução, renda e saneamento. A variável cor materna é analisada individualmente e em conjunto com as demais variáveis sócio-econômicas. Por último, exploram-se as informações sobre aleitamento materno, procurando-se analisar as mudanças de frequência e a influência sobre a mortalidade infantil. O tema seguinte aborda a influência das variáveis demográficas: idade materna, ordem de nascimento, intervalo intergenésico e sexo. As variáveis são analisadas isoladamente e, em seguida, reunidas em um modelo multivariado para a análise simultânea dos efeitos. Finalmente, são analisados os efeitos recentes da queda da fecundidade sobre a mortalidade infantil, discutindo-se as tendências temporais da estrutura dos nascimentos segundo a ordem de nascimento, idade da mãe e intervalo intergenésico e suas influências sobre a mortalidade infantil. Os resultados obtidos salientam os efeitos diferenciados de algumas destas variáveis sobre o fenômeno estudado. / Infant mortality has remained as one of the most dramatic social problems and, therefore, has emerged as a rising point of analysis not only in the ambit of intrinsec academia interest but also as a concern for the govemment\'s future development goals. In fact, mortality studies have been more and more demanded by govemmental institutions which deal with planning and evaluation of the priorities in terms of pubfic policies to be put into effect. Despite some improvement in health, which has lead to a reduction in the risk of infant deaths in São Paulo, the levet of infant mortallity is still considerably higher than that estimated for developed countries. Moreover, the inequality of the process of mortality decline, which determines a more dramatic pace of improvement in some sectors than in others; reflects the existence of important socioeconomic differentials in infant mortality. The inclusion of a birth history in the 1984 National Household Survey (PNAD-84) gives rise to a possibility of analysing probabilities of infant deaths defined in a time scale and detailed by age, according to a set of socioeconomic and demographic variables. This study is undertaken on the basis of these empirical information, and represents an effort to discuss some significant aspects of patterns and differentials of infant mortality directly estimated from birth histories. With this, we bring forward the comprehension of the influence of socioeconomic and demographic factors on the levels and trends of infanl mortality in the State of Sao Paulo. The analysis of the determinants of infant mortalily is divided in three chapters. The first is concerned with socio-economic factors. The efects of maternal education and family income are studied. Subsequently the analysis turns to a discussion of the effects of basic sanitation, considering the sources of water supply - houses with or without piped water - and the kind of sewerage disposal. Education, income and sanitation are incorporated next in the anlysis, in order to obtain a better understanding of their simultaneous effects on infant mortality. The effect of mother\'s color studied both in itself and in conjunction with the other socio-economic variables. Information on breastfeeding is also included with the aim of analysing the pattern of breastfeeding behavior and its influence on infant mortality. The second chapter deals with the following demographic variables: maternal age, birth order, birth interval and sex of infant. These variables are first considered separately and then included in a multivariate model in order to understand their simultaneous effects on infant mortality. Finally, the third chapter studies the effects of fertility decline on infant mortality. The trends in birth composition according to birth order, mother\'s age and birth interval and their influence on infant mortality are analysed. The results shows that some of the studied variables have a diferentiated effect on infant mortalily.

The objective of this study was to explore a possible association between infant mortality rate (IMR) and Medicaid dental benefit payouts per state, as well as propose an expansion of the dental benefits provided through Medicaid. Data was obtained from the Vital Statistics report 2012 and the Center for Medicare & Medicaid Services (CMS) Medicaid coverage database for fiscal year 2011. Population and demographic data was also collected for further comparison. The states observed were Alabama, Georgia, Kentucky, Louisiana, North Carolina, South Carolina, and Tennessee. The IMR data was ranked in ascending order and then the dental payments were compared between the seven southern states. There did not appear to be an association between the two variables. It was hypothesized that the state with the highest IMR would have the least amount of Medicaid dental payments; possibly indicating limited benefits and a need for expansion. The data did not support the hypothesis. Although Mississippi had the highest IMR at 9.9 per 1,000 live births, the amount dental benefits paid through Medicaid was not the lowest. Kentucky had the lowest IMR at 6.9 per 1,000 live births, and North Carolina had the highest amount of dental payments with $352,602 being paid by the state. However, the comparing variable in each state did not reflect an association. Limitations of the study were addressed and suggested improvements were made for future studies that would possibly yield significant findings. In conclusion, the data collected and observed did not provide evidence that the expansion of Medicaid dental benefits would combat infant mortality rates across the country.

No presente estudo, realizado em trÃs municÃpios do interior do Cearà com boa cobertura de serviÃos de AtenÃÃo PrimÃria à SaÃde (APS), foram investigados atravÃs de um instrumento epidemiolÃgico denominado AutÃpsia Verbal (AV), 215 Ãbitos de crianÃas menores de um ano de idade, representando 90% do total identificado num perÃodo de dois anos - 1993/1994. Foram averiguadas as caracterÃsticas sÃcio-econÃmicas, cuidados e higiene, estado nutricional, o processo de doenÃa-assistÃncia-morte, a causa bÃsica do Ãbito, o funcionamento do Sistema de InformaÃÃo sobre Mortalidade e do Sistema de InformaÃÃo dos Agentes de SaÃde (AS). Dentre os Ãbitos investigados, 39,1% tiveram como causa bÃsica diarrÃia, seguida da Prematuridade que representou 17,2% dos casos e InfecÃÃo RespiratÃria Aguda (IRA) - 10,2%. Quanto ao processo doenÃa-assistÃncia-morte, destaca-se que 49,5% das crianÃas morreram no domicÃlio, embora 79% das famÃlias tenham procurado os serviÃos de saÃde no decorrer da doenÃa fatal, sugerindo uma baixa efetividade na identificaÃÃo e no tratamento de lactentes com doenÃas graves. Em 84% dos casos, a famÃlia procurou a rezadeira. Os AS foram procurados em 29% dos casos, embora tenham notificado 78% dos Ãbitos investigados, chamando atenÃÃo para a necessidade destes profissionais serem melhor treinados para intervir nestes casos. A concordÃncia estatÃstica do diagnÃstico dos AS para causa bÃsica do Ãbito em relaÃÃo ao da AV foi boa para diarrÃia, regular para outras causas, e fraca para IRA. Na discussÃo sÃo relatadas iniciativas tomadas pelas equipes de saÃde dos trÃs municÃpios com base nas informaÃÃes obtidas pelas AV com o objetivo de evitar novas mortes. O Estudo conclui que a investigaÃÃo de Ãbitos com instrumento de AV pode ser incorporada à rotina dos serviÃos de APS do Estado, propiciando informaÃÃes valiosas para as equipes locais de saÃde e gerando uma consciÃncia crÃtica que favorece a reduÃÃo da mortalidade infantil. / This study, was done in three municipalities of Cearà with Primary Health services funcioning at least four years. It was investigated with an epidemiological instrument, the verbal autopsy (VA), 215 deaths of children less one year of age, 90% of total identificated deaths from january, 1993 to dezember 1994. It was investigated social and economicas caratheristics, care with the children, nutricional status, basic cause of death. It was investigated too, the funcioning of Mortality Information Sistem (SIM), the Information Sistem of Comunitary Health Workers (CHW) Sistem and the sickness-assistance and death process. The basic cause of the investigated deaths by the VA was diarrhoea (39,1%), prematurity (17,2%) and acute respiratory infection (ARI), 10,2%. About the sickness-assistance and death process, 49,5% of the children died at home, however 79% of the families have had search for health services during the children sickness. This indicates low efectivity in identification and treatment of sick infants. The families search for popular healers in 84% of cases. The CHW was searched for 29% families, however have had notificated 78% of investigated deaths, showing the necessity of better training. The statistical concordance between information of CHW and VA about basic cause of death was good to diarrhoea, regular to other cases, and low to ARI. In the discussion is related actions of health workers of three municipalities based on the information of VA to reduce infant mortality. The study concluded that the investigation of infant deaths with an instrument of VA can be incorporated to the routine of Health Primary Services of CearÃ.

The World Health Organization (WHO) found that 6.6 million children under five died in 2012 (WHO 2013). Almost half of all of these child deaths take place in the first month of life, and 75% of all under five deaths occur within the child's first year of life (WHO 2013). The aim of this study is to compare the most influential factors that decrease infant and neonatal mortality in order to find where policy makers, governments, and international organizations need to focus their efforts in order to get all countries on track for Millennium Development Goal 4 to reduce child mortality. Mosley and Chen (1984) suggest that infant mortality should be studied more as a process with multifactorial origins opposed to an acute, single phenomenon. To study the multifaceted nature of infant mortality they suggest grouping select variables into broad categories. This paper uses this model to test the contribution of the following four types of factors: 1) healthcare system 2) social determinants 3) reproductive behavior and 4) national context in order to understand which category impacts infant mortality most significantly. This study utilizes the Demographic and Health Surveys and was estimated using a discrete time hazard model. Results suggest that social determinants reduce infant mortality most significantly over the other three factors and that maternal education is the key to reaching Millennium Development Goal 4. This research suggests that healthcare interventions, although important, are not a substitute for mother's education. The combination of prenatal care and maternal education will ensure the safest first year for a child.

Diss. (sammanfattning) Stockholm : Karolinska institutet, 2009. / Härtill 5 uppsatser.

This report explores issues surrounding health concerns in the State of Louisiana in the context of environmental justice. It provides a history of Cancer Alley, an area along the Mississippi River with disproportionately high cancer rates. It discusses case studies of environmental justice issues within the state. The researcher provides a geographical analysis and statistical analysis to estimate whether there is a relationship between the presence of industrial plants and health indicators, specifically cancer and infant mortality. Using cancer and infant mortality as health indicators for a population, the evidence supports a correlation between the presence of industrial pollution and waste with cancer rates and infant mortality rates across the State of Louisiana. Given that these populations are predominantly minority and low-income, these results reflect an environmental injustice. / text

Infant health is an important comprehensive measure of the health in a society. Experiences during infancy can create durable and heritable patterns of social deprivation and illness ultimately producing health disparities in a population. This thesis sought to determine the relationship between maternal circumstances and infant mortality, morbidity and congenital anomaly rates in Winnipeg, Manitoba, Canada. Using logistic regression models the study explored provincial program screening data and administrative data held. The study found higher rates of congenital anomalies within two parent families and male infants. There was a relationship between hospital readmission rates and social and economic factors. Newborn hospital readmissions were associated with social support factors, while post-neonatal hospital readmissions were associated with contextual factors. Understanding the odds of infant mortality, morbidity and congenital anomaly in relation to different maternal socioeconomic factors may contribute to future health planning and the development of interventions that can improve health equity. / October 2015