Thursday, November 9, 2023

Social Vulnerability, Climate Change and Health: Scoping review.

 Very happy to see this new scoping review published in The Lancet Plenatary Health.

The recent IPCC assessment report argued that lack of ability to identify social vulnerability at a local and urban level was a critical barrier to climate adaptation planning.

We conducted a scoping review of 230 studies that examined social vulnerability to the health effects of climate change in order to understand the main foci of the literature and potential gaps.

We found that the main share of the research focused on high-income settings – the United States, Western Europe, Australia, Japan etc. China was the exception to that rule being the most researched country after the United States. The most vulnerable countries are lest studied. This is an issue for climate justice.

We found that most research focuses on a narrow set of socio-demographic variables. Age, sex, ethnicity, education, income being amongst the most used indicators of social vulnerability.

We found a relative paucity in the number of studies that address or measure broader structural dimensions of social vulnerability – issues of housing, access to community facilities beyond health services, governance are less researched.

We argued that a lot of the research is very descriptive rather than explanatory. Drawing on more social science understandings of vulnerability and a broader range of indicators could help explain how group membership/social category translates to vulnerability and help identify leverage points for interventions.

Here is the abstract for the paper

The need to assess and measure how social vulnerability influences the health impacts of climate change has resulted in a rapidly growing body of research literature. To date, there has been no overarching, systematic examination of where this evidence is concentrated and what inferences can be made. This scoping review provides an overview of studies published between 2012 and 2022 on social vulnerability to the negative health effects of climate change. Of the 2115 studies identified from four bibliographic databases (Scopus, Web of Science, PubMed, and CAB Direct), 230 that considered indicators of social vulnerability to climate change impacts on health outcomes were selected for review. Frequency and thematic analyses were conducted to establish the scope of the social vulnerability indicators, climate change impacts, and health conditions studied, and the substantive themes and findings of this research. 113 indicators of social vulnerability covering 15 themes were identified, with a small set of indicators receiving most of the research attention, including age, sex, ethnicity, education, income, poverty, unemployment, access to green and blue spaces, access to health services, social isolation, and population density. The results reveal an undertheorisation and few indicators that conceptualise and operationalise social vulnerability beyond individual sociodemographic characteristics by identifying structural and institutional dimensions of vulnerability, and a preponderance of social vulnerability research in high-income countries. This Review highlights the need for future research, data infrastructure, and policy attention to address structural, institutional, and sociopolitical conditions, which will better support climate resilience and adaptation planning.  

Thursday, June 30, 2022

Do Vaccine Mandates on Childcare Services Work?

Here is the latest paper I have published with Ang Li that provides an evaluation of No Jab No Play policies that have been enacted in a series of Australian states.  Here is the title and abstract: 

 Title:  
Vaccine mandates on childcare entry without conscientious objection exemptions: A quasi-experimental panel study

 Abstract

Objectives

Examine the effect of No Jab No Play policies, which linked vaccine status to childcare service entry without allowing for personal belief exemptions, on immunisation coverage.

Study design

Immunisation coverage rates from the Australian Immunisation Register were linked to regional level covariates from the Australian Bureau of Statistics between January 2016 and December 2019. Differential timings of policy rollouts across states were used to assess changes in coverage with the implementation of policies with generalised linear models. Quantile regression and subgroup analysis were also conducted to explore the variation in policy responses.

Results

Baseline mean vaccination rates in 2016 were 93.4% for one-year-olds, 91.2% for two-year-olds and 93.2% for five-year-olds. Increases in coverage post-policy were significant but small, at around 1% across age groups, with larger increases in two and five-year-olds. Accounting for aggregate time trends and regional characteristics, implementation of the policies was associated with improved full immunisation coverage rates for age one (post-year 1: 0.15% [95 %CI–0.23; 0.52]; post-year 2: 0.56% [95 %CI 0.05; 1.07]), age two (post-year 1: 0.49 [95 %CI: 0.00; 0.97]; post-year 2: 1.15% [95 %CI: 0.53; 1.77], and age five (post-year 1: 0.38% [95 %CI 0.08; 0.67]; post-year 2: 0.71% [95 %CI 0.25; 1.16]. The policy effect was dispersed and insignificant at the lowest quantiles of the distribution of immunisation coverage, and smaller and insignificant in the highest socioeconomic areas.

Conclusion

Findings suggest that No Jab No Play policies had a small positive impact on immunisation coverage. This policy effect varied according to prior distribution of coverage and socio-economic status. Childcare access equity and unresponsiveness in high socioeconomic areas remain concerns.

 

Tuesday, February 15, 2022

What are the mental health benefits of stable housing for private renters?

New paper by Ang Li, Emma Baker, and Rebecca Bentley has been published in Social Science and Medicine, looking at how stable and secure tenancy affects the mental health and level of psychological distress of private renters compared to home owners. The results suggest that stability helps to close the mental health gap between those two groups by increasing renters well being at a faster rate overtime. This is interesting to me for two reasons: 1) it suggests that ontological security is more important than tenure type. It isn't necessarily homeownership that is protective of mental health. 2) it underscores the relationship between housing and mental health, and that the rights of tenants should be considered a public health issue. 

Here is the abstract for 'Understanding the mental health effects of instability in the private rental sector: A longitudinal analysis of a national cohort': 

Using a population-based longitudinal dataset in Australia over nearly 20 years, this study examines the impact of tenure instability on mental health and psychological distress among a low-income working-age population. The analysis compares private renters (who are notable for their relative tenure insecurity in the Australian context) and homeowners with similar sociodemographic characteristics. To enhance group comparability and address the presence of time-varying covariates that confound and mediate the relationship between tenure exposure and mental health, marginal structural models were used applying weights estimated cumulatively over time. The results show that while private rental tenants report worse mental health than homeowners initially (mental health difference: Beta = −5.29, 95%CI −7.61 to −2.97; psychological distress difference: Beta = 1.77, 95%CI 0.55 to 2.99), this difference diminishes to become statistically indistinguishable by 5–6 years of occupancy (mental health difference at year 6: Beta = −2.09, 95%CI −4.31 to 0.13, predicted mental health increases: from 65.06 to 69.83 for private renters and from 70.46 to 72.02 for homeowners; psychological distress difference at year 5: Beta = 0.81, 95%CI −0.09 to 1.71, predicted psychological distress decreases: from 19.85 to 18.04 for private renters and from 17.95 to 17.10 for homeowners). Residential stability is particularly beneficial for private renters in early middle adulthood (35–44 years), with each additional year of stable occupancy for private renters correlated with a 0.99 (95%CI 0.46 to 1.53) increase in mental health and a −0.47 (95%CI −0.69 to −0.24) decrease in psychological distress. The findings provide evidence that stable and secure rental tenure is protective of mental health, and the mental health of stable renters becomes comparable to that of homeowners over time. This adds support for housing policies that promote and improve the stability and security of rental tenure.

This demonstrates another dimension to how the housing system effects our life chances and health outcomes

Saturday, October 2, 2021

Do house price increases negatively affect fertility intentions and fertility?

New paper by Ang Li (and co-authors Kadir Atalay & Stephen Whelan from the University of Sydney) looks at the effect of house price increases on renters and homeowners fertility intentions and fertility outcomes in Australia.  Housing affordability has been a big issue in Australia for some time and the impact of decreasing affordability has been linked to declining fertility rates. Atalay, Li and Whelan using data from the HILDA survey find that increasing house prices have different effects for homeowners and renters. Here is the abstract: 

There is increasing evidence that housing and housing markets impact a variety of behaviors and outcomes. Using a rich panel of Australian microlevel data, we estimated the effect of housing price changes on both fertility intentions and fertility outcomes. The analysis indicates that the likelihood of having a child among homeowners is positively related to an increase in housing wealth. The positive housing wealth effect has the greatest impact on the fertility and fertility intentions of Australian homeowners who are young and mortgage holders. In comparison, there is evidence that increases in housing prices decrease the fertility intentions of private renters with children.

The full paper can be viewed here: https://doi.org/10.1016/j.jhe.2021.101787

This paper is based on a chapter of Ang Li's PhD thesis which can be found here: http://hdl.handle.net/2123/18877

Thursday, August 12, 2021

Blur under the Sandridge bridge

I recently starting posting to my Flickr account, which I've had for the longest time but never really used. Above is something I posted.

Tuesday, January 19, 2021

'Removing conscientious objection: the impact of ‘no jab no pay’ and ‘no jab no play’ vaccine policies in australia': New Paper


I have a new paper with Ang Li (reseachgate here) just published in Preventive Medicine on the impact of No Jab, No Pay  and No Jab, No Play on vaccine coverage rates.

We found that these policies, which removed non-medical exemptions from government benefits and childcare enrolments, were occasioned by an increase in vaccination coverage across states between 2-4% for one-year olds, 1-1.5% for two-year olds, and 1-3.5% for five-year-olds.


We also found that the effect of the policy differed significantly depending on characteristics of the area.

Areas that were characterised by either: lower socio-economic status, lower median income, more Family Tax Benefit recipients, or higher pre-intervention coverage had greater responsiveness to the policy changes.

Variation in response to the policy changes across areas suggest the effect was largely led by lower-socioeconomic status parents who were nudged towards full vaccination, while more affluent parents were relatively unaffected.

Title: Removing conscientious objection: The impact of ‘No Jab NoPay’and ‘No Jab No Play’vaccine policies in Australia

Hightlights: 

  • Removing conscientious objection increased overall childhood vaccination coverage.
  • The policy responses were heterogeneous.
  • Socioeconomically advantaged areas were less responsive to policy changes.
  • Benefit-dependent and lower-income areas were more responsive to policy changes.
  • Areas with pre-existing low coverage were more persistent and less responsive.

Abstract: Vaccine refusal and hesitancy pose a significant public health threat to communities. Public health authorities have been developing a range of strategies to improve childhood vaccination coverage. This study examines the effect of removing conscientious objection on immunisation coverage for one, two and five year olds in Australia. Conscientious objection was removed from immunisation requirement exemptions for receipt of family assistance payments (national No Jab No Pay) and enrolment in childcare (state No Jab No Play). The impact of these national and state-level policies is evaluated using quarterly coverage data from the Australian Immunisation Register linked with regional data from the Australian Bureau of Statistics at the statistical area level between 2014 and 2018. Results suggest that there have been overall improvements in coverage associated with No Jab No Pay, and states that implemented additional No Jab No Play and tightened documentation requirement policies tended to show more significant increases. However, policy responses were heterogeneous. The improvement in coverage was largest in areas with greater socioeconomic disadvantage, lower median income, more benefit dependency, and higher pre-policy baseline coverage. Overall, while immunisation coverage has increased post removal of conscientious objection, the policies have disproportionally affected lower income families whereas socioeconomically advantaged areas with lower baseline coverage were less responsive. More effective strategies require investigation of differential policy effects on vaccine hesitancy, refusal and access barriers, and diagnosis of causes for unresponsiveness and under-vaccination in areas with persistently low coverage, to better address areas with persistent non-compliance with accordant interventions.

 

Here is link for access: https://doi.org/10.1016/j.ypmed.2020.106406.  

Thursday, January 14, 2021

Effects of Graduating during Economic Downturns on Mental Health: New paper

I have a new paper with Ang Li (reseachgate here) just published in Annals of Epidemiology looking at the effects of graduating during economic downturns on mental health.

We found that graduating during a time of increased unemployment is not good for either short-term mental health or long-term mental health. The scarring effect is particularly pronounced for men, people who don't receive government payments, and people with only vocational or secondary qualification.

People with higher education seem to do better and graduating during downturns had less of a lasting effect.


Abstract

Purpose

This study examined the effects of economic downturns at the time of graduation on short-term and long-term mental health of graduates.

Methods

Using a large longitudinal dataset whose respondents graduated from their highest level of education between 2001 and 2018 in Australia, the study investigated the effects of initial labor market conditions on psychological distress measures, quality-of-life mental health scales, and diagnoses of depression or anxiety since graduation.

Results

Evidence suggests the presence of a scarring effect of graduating during a recession on the mental health of young adults, particularly significant and persistent for men. Higher unemployment rates at graduation were associated with increased risks of high psychological distress and diagnoses of depression or anxiety, and lower levels of social functioning and mental well-being among men lasting over a decade. The psychological effect was largely driven by young adults with vocational or secondary qualifications or receiving no government allowance at graduation.

Conclusions

Policies should consider the psychological effect of graduating during recessions and focus particularly on vulnerable groups who are susceptible to adverse labor market conditions, such as graduates who are in cyclically sensitive occupations and have less or no work benefits and social protection. 

The full article can be found herehttps://authors.elsevier.com/a/1cOsO3k7xFjOxS