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I Would if I Could: Bike Share

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                    [post_content] => Bike share programs are booming. Present in over 100 cities across the US, bike sharing is an inexpensive form of transportation that can save time during a commute, while also offering numerous health benefits.

However, a disproportionate amount of city residents who participate are White and high-income. But it’s not a lack of interest keeping lower-income residents and people of color from participating. Rather, several barriers block access for underserved and underrepresented groups, including cost, lack of bike stations in low-income neighborhoods, lack of bank accounts, and lack of familiarity with bike share.

In 2015, Better Bike Share Partnership (BBSP) provided funding to six cities in efforts to increase access to bike share in low-income and underserved communities. They went on to co-fund a study with the National Institute for Transportation and Communities at Portland State University to research how BBSP interventions impacted bike share use in Chicago, Philadelphia, and Brooklyn. The study measured ongoing barriers by collecting user and non-user perceptions towards bike share in BBSP target neighborhoods.
The team collected 1,885 responses and compared the results of four demographic groups: higher-income people of color, lower-income people of color, higher-income white, and lower-income white residents.  
English and Spanish surveys were sent out to communities in Chicago, Philadelphia, and Brooklyn. Race/ethnicity was self-reported; individuals were divided into higher- and lower-income categories based on their household income (either over or under 150% of the poverty level). The team collected 1,885 responses and compared the results of four demographic groups: higher-income people of color, lower-income people of color, higher-income white, and lower-income white residents. Reported barriers are represented in the word-cloud graphic above; the bolder the font, the more often it was reported. The cost of a membership was a barrier for almost half of the lower-income residents of color. Over 50% of lower-income residents of color were concerned about damaging the bike and being held liable. Having to use a credit card was a barrier for over a quarter of lower-income residents of color (37%), as was unfamiliarity with the system (34%). The most common barrier reported by lower- and higher-income white residents was a preference for riding their own bike (45%). Lower-income white residents also cited cost and availability as barriers to using bike share. People’s enthusiasm for bike share, however, was not lost in the face of these barriers. The majority of residents expressed a liking for the system, and strong interest to utilize it. Even though almost all of the survey residents reported seeing a bike share in their neighborhood, unfamiliarity with using the bike share was found to be an overall barrier. Two-thirds of the surveyed respondents reported that they would be more likely to use bike share if discounted membership rates were available. Bike share programs in all three cities have cash-payment or reduced-fee options to help make it more affordable. If bike share programs could implement strategies to spread awareness of the affordability and simplicity of use, there’s a good chance more people would use them. Image from "Breaking Barriers to Bike Share: Insights from Residents of Traditionally Underserved Neighbourhoods" Natham McNeil, Jennifer Dill, John MacArthur, Joseph Broach, Steven Howland. NITC-RR-884b. Portland, OR: Transportation Research and Education Center (TREC), 2017. doi: 10.15760/trec.176 [post_title] => I Would if I Could: Bike Share [post_excerpt] => Better Bike Share Partnership increased access to bike share programs in low-income and underserved communities in six cities. This study assessed ongoing barriers to use in Chicago, Philadelphia, and Brooklyn. [post_status] => publish [comment_status] => closed [ping_status] => closed [post_password] => [post_name] => i-would-if-i-could-bike-share [to_ping] => [pinged] => [post_modified] => 2019-02-14 22:31:41 [post_modified_gmt] => 2019-02-15 03:31:41 [post_content_filtered] => [post_parent] => 0 [guid] => https://www.publichealthpost.org/?post_type=bu_databyte&p=6304 [menu_order] => 0 [post_type] => bu_databyte [post_mime_type] => [comment_count] => 0 [filter] => raw ) [extra_args] => Array ( ) [owner] => BUPHP_Post Object *RECURSION* [_trigger_error:WPLib_Base:private] => 1 ) [view] => BUPHP_Post_View Object ( [multipage] => [extra_args] => Array ( ) [owner] => BUPHP_Post Object *RECURSION* [_trigger_error:WPLib_Base:private] => 1 ) [extra_args] => Array ( ) [owner] => [_trigger_error:WPLib_Base:private] => 1 )

Better Bike Share Partnership increased access to bike share programs in low-income and underserved communities in six cities. This study assessed ongoing barriers to use in Chicago, Philadelphia, and Brooklyn.

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Rural Living and Dying

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                    [post_content] => For the past few decades, nonmetropolitan areas have been facing a phenomenon called the “rural mortality penalty.” This penalty was once associated with cities, as crowding and poor sanitation helped contagious diseases spread quickly in urban environments. But this burden has shifted to rural areas over the last 40 years. The difference between urban and rural excess deaths, or the number of deaths that exceed the predicted amount each year, grew almost ten-fold from the 1980s to the early 2000s. Further, the death rate in the US in 2014 was the lowest in the country’s history, yet rural deaths by cancer and heart-disease between 1999 and 2014 declined at a slower rate than those in urban areas.

A new report in the American Journal of Public Health highlights changes in death rates in the United States between 1970 and 2016. The researchers consistently found poverty, education, race, and income to be associated with deaths by all causes over the 47-year study period.

The breakdown of mortality by poverty levels in urban and rural areas is depicted in the figure above. Rural high poverty areas had the highest mortality rates in 2016, at 900 deaths for every 100,000 people, and urban low poverty areas had the lowest rates, at 700 deaths for every 100,000 people. This gap in 2016 between the two areas is the widest since 1970. Looking specifically within rural areas, the gap between high and low poverty areas is also the widest it has been since 1970, with a difference of around 150 deaths per 100,000 people.

The rural mortality penalty that first became evident in the 1980s continues to exist, and seems to impact high-poverty rural areas the most. Rural America may be at particular risk because healthcare is more limited than in urban America.

Graph: Figure 4—Trends in Age-Adjusted All-Cause Mortality Rates for Rural, High-Poverty Counties; Rural, Low-Poverty Counties; Urban, High-Poverty Counties; and Urban, Low-Poverty Counties: United States, Centers for Disease Control and Prevention WONDER, 1970–2016, American Journal of Public Health. 2019;109:155–162. doi:10.2105/AJPH.2018.304787
                    [post_title] => Rural Living and Dying
                    [post_excerpt] => There is a widening gap in US rural and urban death rates. Researchers report that these changes are not sudden and have been happening since 1970.
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There is a widening gap in US rural and urban death rates. Researchers report that these changes are not sudden and have been happening since 1970.

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The Unexpected: Less Lead in New Orleans

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                    [post_content] => After Hurricane Katrina researchers feared that storm surge flooding would cause heavy metal contaminants in soil to increase. Instead, they found that that lead levels dropped. This was good news for Dr. Mielke at Tulane University, who has committed his career to mitigating lead poisoning in children. For over two decades, Dr. Mielke and his students have collected soil samples in New Orleans to measure how lead in soil corresponds to blood lead in children. Researching soil lead levels before and after Katrina has given Dr. Mielke insight as to why lead concentrations in soil have dropped.

The maps above represent pre- and post-Katrina soil lead levels across 172 New Orleans census tracts. Tracts with darker red represent higher levels of contamination, concentrated in areas of high-industrialization along the river. After the Hurricane, soil lead concentration dropped by a factor of 2. Mielke and his team found that this corresponded with a drop in reported children’s blood lead levels by a factor of 2.5. Something had caused lead levels to drop over time.

Post-Katrina urban redevelopment may have helped to dilute and bury lead deeper below the surface as new soil was dumped for new houses. However, more recent findings from Mielke indicate that lead levels dropped ubiquitously between areas that did and did not undergo flooding and redevelopment. He suggests that the phasing out of tetraethyl lead from gasoline in 1970s and 80s may have had the most impact in reducing lead levels in soil and children. The removal of lead from gasoline was accomplished in the wake of the Clean Air Act signed into law in 1970.

Although dangerous levels of legacy lead are still concentrated in high-density traffic areas of the city, Mielke’s results are indicative of the positive change that can come about when public health policy prevails. Although long-term, daily exposure to low amounts of lead can still cause developmental harm, the levels that are present in New Orleans today present a much lower risk.

Map from "Soil Lead and Children’s Blood Lead Disparities in Pre- and Post-Hurricane Katrina New Orleans (USA)," International Journal of Environmental Research and Public Health. 2017 Apr;14(4):407. doi: 10.3390/ijerph14040407
                    [post_title] => The Unexpected: Less Lead in New Orleans
                    [post_excerpt] => After Hurricane Katrina, researchers found that storm surge flooding did not increase heavy metal contaminants in soil. Instead, lead levels dropped. 
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After Hurricane Katrina, researchers found that storm surge flooding did not increase heavy metal contaminants in soil. Instead, lead levels dropped.

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Databyte

The 2 Degree Solution

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                    [post_content] => Our globe is on a fast-track to exceed 2˚C in warming by 2050, leading to more extreme weather events. So what, specifically, would it take for us not to surpass a 2˚C increase in global temperature in the next 30 years? An energy policy firm, Energy Innovation, chose to tackle that question head-on, by modeling how current energy policies will impact future emissions.

To have a 50% chance of not overshooting 2˚C by 2050, we must reduce our carbon emissions by 1156 gigatons, or 41%, from we might expect to produce over the next 30 years. This is achievable if the top 20 greenhouse gas emitting countries (with China and the US in the lead) reduce their emissions collectively. The figure above illustrates the cumulative emissions that need to (and can) be reduced across five sectors of the economy, and land use, in order to remain below the most dangerous levels in 2050.

Industry has the greatest potential for cutting back on global emissions through policies focused on more efficient energy production and stricter emissions standards (such as regulating oil and gas leaks). Power sector (electricity) emissions would decline with renewable energy incentives and improving the grid’s capability to accommodate multiple energy sources. Transportation sector emissions would drop with stricter fuel economy standards and more green urban transportation systems (improved public transportation, bike lanes, and sidewalks). A buildings’ energy consumption could decrease with more efficient building codes and appliance standards (such as improved insulation and energy-saving electronics). Carbon Pricing is a cross-sectional policy that would create carbon taxes and caps, while land use emissions could be reduced through policies aimed at reducing deforestation and forest degradation.

The Paris Agreement provides targets for reducing emissions, but it’s policy implementation that will allow for those targets to be met. This is the first time we have access to clear guidelines for what we need to do in order to curb our emissions for a safer future. How to make the necessary changes is less clear, but will certainly be impossible without focused and concerted international effort.

Graphic from Energy Innovation, How to Prioritize Policies for Emissions Reduction
                    [post_title] => The 2 Degree Solution
                    [post_excerpt] => What would it take for us to avoid a 2˚C increase in global temperature in the next 30 years? An energy policy firm tackles the question, modeling how current energy policies will impact future emissions.
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What would it take for us to avoid a 2˚C increase in global temperature in the next 30 years? An energy policy firm tackles the question, modeling how current energy policies will impact future emissions.

...more
Databyte

Immigrants and Private Insurance: Pay More, Use Less

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                    [post_content] => Between 2002 and 2009, immigrants paid an estimated $115.2 billion more into Medicare than they used. However, half of immigrants are covered by private insurance so it is important to understand contributions and expenditures in that type of insurance as well.

A study published in Health Affairs used data from the Medical Expenditure Panel Survey (MEPS) to measure both premiums and expenditures from private health insurance. Data from the Medical Expenditure Panel Survey and the National Health Interview Surveys were linked for this study.

The graph above shows the premiums, expenditures, and net contributions of all documented and undocumented immigrants and US natives. Both groups of immigrants had positive net contributions, meaning they paid more toward their private insurance coverage than they spent in receiving health services. Undocumented immigrants had an even higher net contribution (Yes, undocumented immigrants get paychecks and these paychecks have deductions). US natives had a negative net contribution, meaning that, per capita, their expenditures on health care were greater than their premiums.

These findings upend the common belief that immigrants are a drain on the US health care system. Indeed, the opposite is true. Immigrants who contribute to Medicare and to private health insurers are subsidizing the health care of US citizens.

Graph from "Immigrants Pay More In Private Insurance Premiums Than They Receive In Benefits," Leah Zallman, Steffie Woolhandler, Sharon Touw, David U. Himmelstein, and Karen E. Finnegan, HEALTH AFFAIRS 37, NO. 10 (2018): 1663–1668, doi: 10.1377/hlthaff.2018.0309
                    [post_title] => Immigrants and Private Insurance: Pay More, Use Less
                    [post_excerpt] => New research in Health Affairs upends the belief that immigrants are a drain on the US health care system. 
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New research in Health Affairs upends the belief that immigrants are a drain on the US health care system.

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Databyte

Not Just Dads Getting that Bread

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                    [post_content] => As definitions and expectations of genders continue to evolve, so do family, work, and home lives. Earlier this year, the Pew Research Center examined changes in American parenthood in terms of employment, participation in household duties, and opinions on parent roles over the past half-century. The findings on fatherhood indicate a rise in stay-at-home fathers and single fathers over the past few decades. The time dads spend on child care has increased from 2.5 in 1965 to 8 hours per week in 2016, compared to moms at 10 to 14 hours per week. Paid work for dads has decreased from 46 to 43 hours per week.

Although these changes are small, especially considering the 50-year timeline, the research suggests a substantial drop in families in which fathers are the only employed adult. As of 2016, within heterosexual couples fathers alone worked in only 27% of families that had at least one child under 18 years; most families with children are dual income. The proportion of couples with mothers as the sole breadwinner rose very little since 1970.

Pew also found that 63% of dads in the United States believe they spend too little time caring for their children. Most adults who think it is ideal for one parent to stay home for child-rearing prefer that one parent to be the mother; 75% think that having more working women makes child-rearing more difficult. Gender roles have shifted over the past five decades, but women in the work force has remained steady for the last three.

Graph from Pew Research Center, "7 facts about American dads," by Kim Parker and Gretchen Livingston, June 13, 2018
                    [post_title] => Not Just Dads Getting that Bread
                    [post_excerpt] => Research on fatherhood indicates a rise in stay-at-home fathers and single fathers over the past few decades. 
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Research on fatherhood indicates a rise in stay-at-home fathers and single fathers over the past few decades.

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Databyte

Title X Funding Improves Family Planning

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                    [post_content] => Health centers are legally required to feature voluntary family planning among their services, and have the option to apply for Title X grants to improve the quality of their care. The Title X program is a federal grant focused on family planning, and allows participating clinics to access greater resources and contraception services. Many women in underserved communities look to local community health centers for reproductive health care.

The Kaiser Family Foundation recently conducted a survey of community health centers and the breadth of their family planning services. Administered from May to July 2017, the survey captures information on 546 health centers in the 50 states and the District of Columbia.

Compared to non-Title X centers, more Title X-participating centers consistently offer more effective and high-quality family planning services, as the above Figure depicts. Health centers are considered to exhibit the highest level of performance if they provide all of the seven most effective family planning methods onsite or by prescription, adhere to all three best practice methods related to contraceptives, and allow new patients to set up family planning appointments on a same-day or walk-in basis. The three contraceptive best practices are: not requiring a pelvic exam to prescribe oral contraceptives, using the “quick start” method, and dispensing one-year supplies of contraceptives so return visits are unnecessary. Only 2% of non-Title X sites are considered optimal by these criteria, compared to 17% of Title X sites.

Although very few health centers perform at the highest level, the superiority of Title X centers compared to non-Title X centers remains clear across all measures of quality. Recent proposed changes by the current Health and Human Services leadership regarding requirements for Title X funding to community health centers threaten the quality and effectiveness of family planning services provided in the United States.

Graphic: Figure 6 from the report Community Health Centers and Family Planning in an Era of Policy Uncertainty, Susan F. Wood, Julia Strasser, Jessica Sharac, Janelle Wylie, Thao-Chi Tran, Sara Rosenbaum, Caroline Rosenzweig, Laurie Sobel, and Alina Salganicoff. 
                    [post_title] => Title X Funding Improves Family Planning
                    [post_excerpt] => Title X-participating centers consistently offer more effective and high-quality family planning services than non-Title X health centers.
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Title X-participating centers consistently offer more effective and high-quality family planning services than non-Title X health centers.

...more
Databyte

Childhood Poverty in Philadelphia

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                    [post_content] => About 21% of children in the United States, 15 million, live below the federal poverty line. Some researchers suggest that the federal poverty threshold—a household income measure used to determine eligibility to a variety of government support programs—is set too low and that families actually need about twice that income to cover basic expenses. Using this revised measure, over 40% of children in the United States live in low-income families.

Childhood poverty is not distributed evenly either across the country or within cities. The percentage of children living in poverty in Philadelphia is higher than the US national average. Nearly one-third of Philadelphia’s infants and toddlers live in poverty.

The map above shows the percentage of children under age five living in poverty in Philadelphia by zip code. The darker the color, the higher the proportion of children living in poverty. The disparities are large. Some areas of the city (like in the Northwest region) have less than 10% of children living in poverty, while others (like the Central part of the city) have up to 79% of children living in poverty.

Experiencing poverty during childhood is associated with a host of negative health outcomes. Poor children are more likely to develop asthma, become obese, and experience violence. They are also more likely to be exposed to lead, which can impair cognitive development.

There is work being done to alleviate childhood poverty in the city. Public Citizens for Children and Youth, for instance, is advocating for “increased investment and access to services” through policies such as the Earned Income Tax Credit and the Child Tax Credit.

Map from Child Trends June 2018 Report, The Status of Infants and Toddlers in Philadelphia, David Murphey, Dale Epstein, Sara Shaw, Tyler McDaniel, and Kathryn Steber, Figure 10. Percent of Children Under Age 5 in Poverty, by Zip Code. 2016. 
                    [post_title] => Childhood Poverty in Philadelphia
                    [post_excerpt] => Childhood poverty is not distributed evenly either across the country or within cities. Nearly one-third of Philadelphia’s infants and toddlers live in poverty.
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Childhood poverty is not distributed evenly either across the country or within cities. Nearly one-third of Philadelphia’s infants and toddlers live in poverty.

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Databyte

High Pay Gets Higher, Low Pay Gets Lower

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                    [post_content] => An employed person in the United States is healthier than an unemployed person, and a highly-paid employee is more likely to have better health. The federal minimum wage in the United States is currently set at $7.25 per hour. Workers who receive tips are required to receive a minimum of $2.13 per hour. These minimums have not been changed since 2009 and 1996, respectively.

An October health policy brief in Health Affairs highlights fluctuations in wages and how population health reflects these changes. J. Paul Leigh and Juan Du emphasize that the labor market does not strictly follow basic economic assumptions. In particular, they explain that an increase in wages may not reduce quality of work, as an economist critiquing minimum wage hikes might expect. Instead, they argue increased wages can improve productivity by boosting morale.

The wages between 1979 and 2013 only rose notably for those with already very high pay. As the image above depicts, people in the middle wage group have not seen much of an increase in pay over the years, barely reaching a 10% increase in 2009.

Those with very low wages have almost exclusively seen drops in their pay over the decades. Low-wage workers make up 29% of the United States workforce. This means there are 47 million people who are paid poorly for their work.

The authors also explain how increases in the minimum wage can positively impact health, citing prior research on the connections to lower smoking, fewer missed work days, and improved birthweight. While many states are looking to raise their minimum wages in 2019, the authors recommend that those still caught in the debate should approach the decision from both a health and economic perspective.

Graph from “Effects Of Minimum Wages On Population Health, " Health Affairs Health Policy Brief, October 4, 2018. Exhibit 1. DOI: 10.1377/hpb20180622.107025
                    [post_title] => High Pay Gets Higher, Low Pay Gets Lower
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Middle-wage earners have not seen much of an increase in pay, and low-wage earners have almost exclusively seen drops in their pay over the decades.

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Databyte

The Green Ceiling

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                    [post_content] => Climate change disproportionally damages low-income communities and communities of color. Although higher percentages of Americans of color, particularly African Americans, support green climate actions than White Americans, the majority of positions in environmental organizations are held by White individuals, usually White men.

Although environmental organizations have strived to become more diverse over the past five decades, their efforts have been primarily successful targeting White women. They still have a long way to go to diversify across ethnicities.

People of color comprise more than a quarter of the US population (around 38%). Yet, the percentage of paid positions held in environmental institutions by people of color is low. A Green 2.0 report, conducted by Dorceta Taylor from the University of Washington, reviewed diversity among environmental organizations, and the state of current initiatives in place to increase racial diversity in the workplace.

As seen in the chart above, people of color comprise a little over one third of all intern positions across three categories of environmental institutions (NGOs, Government Agencies, and Environmental Foundations). The percentage of ethnic minorities declines by more than half as volunteers move into paid positions; minorities comprise no more than one fifth of all hired staff and leadership positions. Environmental foundations have the highest number of people color on their boards, with the lowest number of board positions reported among environmental NGOs at less than 5%. African American Women are the most underrepresented.

Dorecta Taylor reviews the whiteness of the environmental movement, explaining that since the 1960s, ethnic minorities have been shunned, misunderstood, and marginalized from joining. It took several decades of activists, urging collaboration and drawing parallels across social justice and environmental issues, before the movement opened up to incorporate issues pertaining to poverty and racism. It wasn’t until 1990, when organizations such as the Wilderness Society and the Sierra Club were accused of racist hiring practices, did they publicly step forward to admit that they “had done a miserable job of reaching out to minorities.” Yet workplace diversity is still an ongoing struggle.

Feature image from The Challenge - Green 2.0, graphic titled Unconscious Bias, Discrimination, and Insular Recruiting. 
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                    [post_excerpt] => Climate change disproportionally damages low-income communities and communities of color. Yet, the majority of positions in environmental organizations are held by White individuals. 
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Climate change disproportionally damages low-income communities and communities of color. Yet, the majority of positions in environmental organizations are held by White individuals.

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