Missed policy opportunities to advance health equity by recording demographic data in electronic health records.

The science of eliminating health disparities is complex and dependent on demographic data. The Health Information Technology for Economic and Clinical Health Act (HITECH) encourages the adoption of electronic health records and requires basic demographic data collection; however, current data generated are insufficient to address known health disparities in vulnerable populations, including individuals from diverse racial and ethnic backgrounds, with disabilities, and with diverse sexual identities. We conducted an administrative history of HITECH and identified gaps between the policy objective and required measure. We identified 20 opportunities for change and 5 changes, 2 of which required the collection of less data. Until health care demographic data collection requirements are consistent with public health requirements, the national goal of eliminating health disparities cannot be realized.

How the government intervention affects the distribution of physicians in Turkey between 1965 and 2000.

INTRODUCTION: One of the main weaknesses of the health system in Turkey is the uneven distribution of physicians. The diversity among geographical districts was huge in the beginning of the 1960s. After the 1980s, the implementation of a two-year compulsory service for newly graduated physicians is an interesting and specific experience for all countries. The aim of this study is to analyse the distribution of physicians, GPs and specialists between the years 1965-2000 and the efficiency of the strict 15 year government intervention (1981-1995). METHODS: The data used in this study includes the published data by the Ministry of Health and The State Institute of Statistics between the years 1965-2000. Covering 35 years for total physicians, GPs and specialists, Gini coefficients are calculated so as to observe the change in the distribution. In order to measure the efficiency of government intervention, Gini index belonging to the previous 15 years (first period-1965 to 1980) and the last 15 years (second period) of 1981 when the compulsory service was enacted is also analysed including the statistical tests. RESULTS: In 1965, the Gini for total physician is quite high (0.47), and in 2000 it decreases considerably (0.20). In 1965, the Gini for GPs and the Gini for specialists is 0.44 and 0.52, respectively and in 2000 these values decrease to 0.13 and 0.28, respectively. It is observed that, with this government intervention, the level of diversity has decreased dramatically up to 2000. Regarding to regression, the rate of decrease in Gini index in the second period is higher for the GPs than that of the specialists. CONCLUSION: The inequalities in the distribution between GPs and specialists are significantly different; inequality of specialist distribution is higher than the GP. The improvement of the inequality in the physician distribution produced by the market mechanism shows a long period when it is left to its own devices. It is seen that the compulsory service policy is efficient since the physician distribution has improved significantly. The government intervention provides a faster improvement in the GP distribution.

Human smuggling in Austria: a comparative analysis of data on smuggled migrants from former Yugoslavia and the Russian Federation.

This article provides a summary of the author's research on human smuggling in Austria comparing migrants from Former Yugoslavia and the Russian Federation. The project's primary intent was to collect more detailed information on migrants seeking asylum in Austria and their use of smuggling services to leave their home countries, including detailed information on demographics, force or threat of force by smugglers, routes and methods of transportation, costs of smuggling, payment methods, and deeper perceptual questions regarding the flight. Another central premise of the article discusses how current distinctions between human smuggling and human trafficking are arbitrary in many regards.

Exposure to international migration and its effect on childbearing in Turkey.

International migration alters social norms, family structures, and population development in sending regions. Each of these factors affects fertility, making the impact of international migration on childbearing an increasingly important area of study. In many sending regions, the Demographic and Health Surveys (DHS) provide a promising, but underutilized, source of data for understanding the relationship between international migration and childbearing. Using the household and individual questionnaires in the 2003 Turkish DHS, we develop a multi-layered approach for measuring international migration. We then use these measures to examine differences in childbearing among women in migrant and non-migrant households, assessing the effects of migrant selection and migration-related roles and attitudes on the number of children born. After adjusting for selection characteristics, we find return female migrants and migrant wives are not significantly different from women in non-migrant households; role and attitude differences have only modest impacts on the association between women's exposure to migration and childbearing.

Enduring pictures in our heads: the continuance of authoritarianism and racial stereotyping.

This study highlights the importance of examining the influence of personality measures, specifically authoritarianism, on negative racial stereotyping, even in an era of alleged color blindness. The authors examine the relationship of various demographic variables and authoritarianism with negative racial stereotyping in a sample of White urban respondents. Current literature suggests that age, sex, marital status, religious identification, religious service attendance, education level, income, political affiliation, level of authoritarianism, and the demographic composition in an individual's local population all affect racial stereotyping. The evidence presented, using path analysis, suggests that some demographic characteristics influence the level of negative racial stereotyping. While the effects of most included demographic characteristics were statistically significant, others, which continually resurface in the literature, remained insignificant (such as the demographic composition of the respondent's area). The results of this study challenge the loss of traditional prejudice with color blindness and point to the importance of authoritarianism as a mediating factor in negative racial stereotyping. The authors conclude the greatest indicators of negative racial stereotyping included in this study are authoritarianism, education, and income, while many other demographics - such as marital status, religious identification and attendance, and political affiliation - have indirect influences through authoritarianism.

Marrying in the city in times of rapid urbanization.

Economic, social, political, and demographic processes changed Western European cities strongly during the nineteenth century. Especially during this time, the northern part of Belgium (Flanders) became highly urbanized. Investigating the long-term development of the marriage pattern in the cities of Antwerp, Aalst, and Ghent gives a detailed picture of the evolution of the urban marriage pattern. In this article, specific emphasis is on gender, social, and migration distinctions. The results confirm that there is a male-female difference and variation among various social and migrant groups in the age at first marriage during the period 1800-1906. Moreover, regional differences are also visible. In the port city of Antwerp, massive immigration caused a unique evolution in the age at first marriage during the last decades of the nineteenth century, which did not appear in the textile cities of Aalst and Ghent during this time.

Nineteenth-century urbanization as sacred process: insights from German Strasbourg.

This article examines a crucial site for modernity's encounter with religion during the long nineteenth century, albeit one largely ignored both by religious and urban historians: the modern big city. Drawing on evidence from Strasbourg, which joined the ranks of Germany's big cities soon after the Franco-Prussian War, it points out first, that urbanization had a significant urban dimension. It altered the absolute and relative size of the city's faith communities, affected the confessional composition of urban neighborhoods, and prompted faith communities to mark additional parts of the urban landscape as sacred. Second, while urban growth­both demographic and physical­frequently challenged traditional understandings of religious community, it also facilitated the construction of new understandings of piety and community, especially via voluntary organizations and the religious media. Thereby, urbanization emerged as a key force behind sacralization in city and countryside as the nineteenth century ended and the twentieth began.

Deinstitutionalization reconsidered: geographic and demographic changes in mental health care in British Columbia and Alberta, 1950-1980.

Using demographics on admission to, and discharge from, mental hospitals in Alberta and British Columbia, this paper analyzes the social process commonly framed as deinstitutionalization between 1950 and 1980. A focus on the two most western Canadian provinces permits an exploration of these changes in these regional contexts. Pressured by new funding arrangements, a shift towards community care, and growing criticism of the alleged oppressive nature of large institutions, the three main mental hospitals scaled down as of the 1950s. This trend did not mean, however, that the overall number of hospitalized patients decreased during this time period. The total number of hospitalizations, particularly short-term admissions, actually expanded, while trans-institutionalization also occurred. This case study mirrors larger trends of postwar mental health care, illustrating the social, political, and cultural challenges experienced in the reconstruction of institutional care.

More than just nickels and dimes: a cross-national analysis of working poverty in affluent democracies.

Despite its centrality to contemporary inequality, working poverty is often popularly discussed but rarely studied by sociologists. Using the Luxembourg Income Study (2009), we analyze whether an individual is working poor across 18 affluent democracies circa 2000. We demonstrate that working poverty does not simply mirror overall poverty and that there is greater cross-national variation in working than overall poverty. We then examine four explanations for working poverty: demographic characteristics, economic performance, unified theory, and welfare generosity. We utilize Heckman probit models to jointly model the likelihood of employment and poverty among the employed. Our analyses provide the least support for the economic performance explanation. There is modest support for unified theory as unionization reduces working poverty in some models. However, most of these effects appear to be mediated by welfare generosity. More substantial evidence exists for the demographic characteristics and welfare generosity explanations. An individual's likelihood of being working poor can be explained by (a) a lack of multiple earners or other adults in one's household, low education, single motherhood, having children and youth; and (b) the generosity of the welfare state in which he or she resides. Also, welfare generosity does not undermine employment and reduces working poverty even among demographically vulnerable groups. Ultimately, we encourage a greater role for the welfare state in debates about working poverty.

UK: the reality behind the "knife crime" debate.

This study of teenage violent crime in Britain in 2008, extracted from a longer briefing paper published by the Institute of Race Relations, aims to provide a description of who was killed, by whom and in what circumstances ­ a factual description which has been largely missing from much media and political evaluation.

Registrations of Assistance Dogs in California for Identification Tags: 1999-2012.

Dogs are filling a growing number of roles supporting people with various disabilities, leading to a chaotic situation in the U.S. Although the federal laws allow public access with working dogs only for people with disabilities, no governmental enforcement or management system for such dogs exists. Furthermore, there is no substantive way to confirm whether the dog is an adequately trained assistance dog or not, as neither the handlers nor the dogs are required to carry any particular certification or identification. Therefore, unqualified assistance dogs and incidents such as dog bites by assistance dogs sometimes are problems in the U.S. A governmental oversight system could reduce problems, but no information is available about the current uses of assistance dogs in the U.S. We aimed to investigate the current demographics of registered assistance dogs and the evolving patterns in uses of dogs during 1999-2012 in California. We acquired data on assistance dogs registered by animal control facilities throughout California. We used descriptive statistics to describe the uses of these assistance dogs. The number of assistance dogs sharply increased, especially service dogs, in the past decade. Dogs with small body sizes, and new types of service dogs, such as service dogs for psychiatric and medical assistance, strongly contributed to the increase. The Assistance Dog Identification tags sometimes were mistakenly issued to dogs not fitting the definition of assistance dogs under the law, such as emotional support animals and some cats; this reveals errors in the California governmental registering system. Seemingly inappropriate dogs also were registered, such as those registered for the first time at older than 10 years of age. This study reveals a prevalence of misuse and misunderstanding of regulations and legislation on assistance dogs in California.

A demographic explanation for the recent rise in European fertility.

Between 1998 and 2008 European countries experienced the first continent-wide increase in the period total fertility rate (TFR) since the 1960s. After discussing period and cohort influences on fertility trends, we examine the role of tempo distortions of period fertility and different methods for removing them. We highlight the usefulness of a new indicator: the tempo- and parity-adjusted total fertility rate (TFRp*). This variant of the adjusted total fertility rate proposed by Bongaarts and Feeney also controls for the parity composition of the female population and provides more stable values than the indicators proposed in the past. Finally, we estimate levels and trends in tempo and parity distribution distortions in selected countries in Europe. Our analysis of period and cohort fertility indicators in the Czech Republic, Netherlands, Spain, and Sweden shows that the new adjusted measure gives a remarkable fit with the completed fertility of women in prime childbearing years in a given period, which suggests that it provides an accurate adjustment for tempo and parity composition distortions. Using an expanded dataset for ten countries, we demonstrate that adjusted fertility as measured by TFRp* remained nearly stable since the late 1990s. This finding implies that the recent upturns in the period TFR in Europe are largely explained by a decline in the pace of fertility postponement. Other tempo-adjusted fertility indicators have not indicated such a large role for the diminishing tempo effect in these TFR upturns. As countries proceed through their postponement transitions, tempo effects will decline further and eventually disappear, thus putting continued upward pressure on period fertility. However, such an upward trend may be obscured for a few years by the effects of economic recession.

Population momentum across the demographic transition.

Population momentum is the main driver of global population growth today, and this makes an appreciation of momentum critical to understanding contemporary worldwide growth dynamics. This article traces population momentum along with two recently defined measures of momentum decomposed­stable and nonstable momentum­across the demographic transition. We use historical data and population projections from 16 countries to illustrate some previously ignored empirical regularities of the demographic transition in both the developed and the developing world. We also demonstrate the dynamic nature of stable and nonstable momentum, as changes in stable momentum lead to predictable changes in current and future nonstable momentum. These results suggest that momentum, which by definition is measured at a point in time, can also be considered as a process that unfolds over time.

Effects of demographic and retirement-age policies on future pension deficits, with an application to China.

A simple method is proposed for projecting future deficits in a defined benefit or defined contribution pension scheme. The annual pension deficit rate is expressed in terms of the elderly dependency ratio (determined by demographic factors), the average retirement age, and a few parameters describing the scheme. An illustrative application to China demonstrates that if the average age at retirement gradually increases from the current low level to age 65 for both men and women in 2050, the annual pension deficit rate would be greatly reduced or even eliminated under various plausible demographic regimes over this period. With all else equal, a transition to a two-child policy (assuming this would raise fertility) would also lower the deficit rate in comparison to keeping the current fertility policy unchanged, although the effect would be seen only after 2030. The effect of potentially faster mortality decline in raising future deficits is appreciable and starts earlier than the effects of fertility change. The proposed method may also be used to gauge the magnitudes and timing of impacts on future pension deficits of alternative assumptions regarding levels and age/sex composition of international migration.

Measuring irregular migration and population flows ­ what available data can tell.

Wild assumptions, estimates and number games are made in regard to irregular migration flows. While the numbers cited are, in fact, often dated and of unclear origin, reports use such numbers to suggest a rise in irregular migration; they also usually assume that irregular entry and, to some extent, overstaying are the only significant pathways into irregularity. To properly account for irregular migration flows, however, both in- and outflows, as well as the complex ways of becoming (or ceasing to be) an "irregular migrant", have to be included. Thus, apart from irregular migration flows in the narrow sense, like unlawful entry and emigration of persons (unrecorded returns, registered voluntary returns and deportations), other flows ­ notably status-related inflows (overstaying, withdrawal of residence status, rejection of asylum claims), status-related outflows (regularisation, ex lege changes of the legal status of irregular migrants, etc.) and flows related to vital events (births and deaths), must be considered. The article provides a critical appraisal of available data sources, indicators, estimates and methods to estimate irregular migration flows. In the context of a case study, we then analyse statistics of apprehensions at the EUROPEAN UNION's external borders in Eastern Europe as indicators of geographical flows -- migration flows in the narrow sense -- arguing that despite the many limitations of the available data, the data can nevertheless be used as indicators of certain trends.

Toward a comprehensive demography: rethinking the research agenda on change and response.

This essay drafts a new interdisciplinary agenda for research on population and development. Starting from Kingsley Davis's 1963 formulation of change and response, Davis's analytical categories are broadened to include inertia as well as change and to encompass both demographic and non-demographic responses at the micro, meso, and macro levels. On that basis the essay proposes what can be called a comprehensive demography, an approach drawing principally on micro-level methodologies like those employed in anthropological demography. Like anthropological demography, comprehensive demography questions the rationality of actors, emphasizes cultural infuences, and stops short of the postmodernist extremes of anthropology. But it also takes explicit account of higher-level social, economic, and political factors bearing on demographic behavior and outcomes. The conclusion raises some epistemological issues. Illustrative examples are offered throughout to demonstrate the feasibility of the approach, mainly referring to sub-Saharan africa and the Caribbean and often drawn from the authors' own fieldwork.

A global perspective on happiness and fertility.

The literature on fertility and happiness has neglected comparative analysis. We investigate the fertility/happiness association using data from the world values surveys for 86 countries. We find that, globally, happiness decreases with the number of children. This association, however, is strongly modified by individual and contextual factors. Most importantly, we find that the association between happiness and fertility evolves from negative to neutral to positive above age 40, and is strongest among those who are likely to benefit most from upward intergenerational transfers. In addition, analyses by welfare regime show that the negative fertility/ happiness association for younger adults is weakest in countries with high public support for families, and the positive association above age 40 is strongest in countries where old-age support depends mostly on the family. Overall these results suggest that children are a long-term investment in well-being, and highlight the importance of the life-cycle stage and contextual factors in explaining the happiness/fertility association.

The size of the irregular migrant population in the European Union ­ counting the uncountable?

It is difficult to estimate the size of the irregular migrant population in a specific city or country, and even more difficult to arrive at estimates at the European level. A review of past attempts at European-level estimates reveals that they rely on rough and outdated rules-of-thumb. In this paper, we present our own European level estimates for 2002, 2005, and 2008. We aggregate country-specific information, aiming at approximate comparability by consistent use of minimum and maximum estimates and by adjusting for obvious differences in definition and timescale. While the aggregated estimates are not considered highly reliable, they do -- for the first time -- provide transparency. The provision of more systematic medium quality estimates is shown to be the most promising way for improvement. The presented estimate indicates a minimum of 1.9 million and a maximum of 3.8 million irregular foreign residents in the 27 member states of the European Union (2008). Unlike rules-of-thumb, the aggregated EU estimates indicate a decline in the number of irregular foreign residents between 2002 and 2008. This decline has been influenced by the EU enlargement and legalisation programmes.

A perfect storm? Welfare, care, gender and generations in Uruguay.

This article claims that welfare states modelled on a contributory basis and with a system of entitlements that assumes stable two-parent families, a traditional breadwinner model, full formal employment and a relatively young age structure are profoundly flawed in the context of present-day challenges. While this is true for affluent countries modelled on the Bismarckian type of welfare system, the costs of the status quo are even more devastating in middle-income economies with high levels of inequality. A gendered approach to welfare reform that introduces the political economy and the economy of care and unpaid work is becoming critical to confront what may very well become a perfect storm for the welfare of these nations and their peoples. Through an in-depth study of the Uruguayan case, the authors show how the decoupling of risk and protection has torn asunder the efficacy of welfare devices in the country. An ageing society that has seen a radical transformation of its family and labour market landscapes, Uruguay maintained during the 1980s and 1990s a welfare state that was essentially contributory, elderly and male-oriented, and centred on cash entitlements. This contributed to the infantilization of poverty, increased the vulnerability of women and exacerbated fiscal stress for the system as a whole. Furthermore, because of high levels of income and asset inequality, the redistribution of risk between upper- and lower-income groups presented a deeply regressive pattern. The political economy of care and welfare has begun to change in the last decade or so, bringing about mild reforms in the right direction; but these might prove to be too little and too late.