Disease Prevention as Social Change: Toward a Theory of Public Health
Constance A. Nathanson, Professor, Department of Population Dynamics, School of Hygiene and Public Health, Johns Hopkins University This article argues that public health policies are critical to the prevention and control of disease. However, public health policies are not adopted and implemented in a vacuum: they are the outcome of social and political change. The forces of change need to be understood in order for them to be harnessed in the interest of public health. The article proposes a conceptual framework to account for variation in the initiation and implementation of public health policies directed at reducing levels of mortality. This framework incorporates three sets of variables: pertaining to states, to social movements, and to constructions of risk. The framework’s usefulness for analytic purposes is tested in two case studies describing public health policymaking in France and the United States. Applicability of the framework in other settings is briefly discussed. [22, no. 4 (Dec 96) 609-637]
Social Interactions and Contemporary Fertility Transitions
John Bongaarts, Vice President, Research Division, the Population Council
Susan Cotts Watkins, Professor of Sociology and member of the Population Studies Center, University of Pennsylvania An analysis of fertility transitions in 69 developing countries since 1960 finds that the relationship between development and pretransitional fertility, the timing of the onset of transitions, and the pace of fertility decline after transition onset deviate substantially from what would be the case if fertility and development, as measured by the Human Development Index, were closely linked. A few noteworthy empirical regularities are identified, including a shifting threshold of development necessary for the onset of transition. This implies that, once a few countries in a region enter the transition, other countries follow sooner than expected. Also, the pace of fertility decline is not related to the pace of development, as might be expected, but rather to the level of development when the transition began. To explain these findings, the authors propose a key role for social interaction. Social interaction, they suggest, operates at three levels of aggregation. Personal networks connect individuals; national channels of social interaction such as migration and language connect social and territorial communities within a country; and global channels such as trade and international organizations connect nations within the global society. Through these channels, actors at all three levels exchange and evaluate information and ideas, and exert and receive social influence, thus affecting reproductive behavior. Development is important in understanding the timing and pace of fertility change, but social interaction is likely to have an independent influence on fertility. Given current levels of development and the proliferation of channels of social interaction, it is likely that few countries will fail to experience a fertility transition over the coming three decades. [22, no. 4 (Dec 96) 639-682]
Post-Cairo Population Policy: Does Promoting Girls’ Schooling Miss the Mark?
John Knodel, Professor of Sociology, University of Michigan, Ann Arbor
Gavin W. Jones, Professor of Demography, Australian National University, Canberra One emphasis of the new population paradigm that emerged at the 1994 International Conference on Population and Development in Cairo concerns gender inequality in education and the need to promote girls’ schooling at the secondary level, both as a goal of human development and as a means to encourage lower fertility in developing countries. A critical weakness of this approach to population and development policy is that it fails to address the socioeconomic inequality that deprives both boys and girls of adequate schooling. Such unbalanced attention to one dimension of inequality detracts from the attention accorded to other dimensions. Moreover, while female disadvantage remains an important feature of educational access in some regions, there are numerous countries, even within the developing world, where the gender gap in education is absent or modest, and in almost all countries it has been diminishing substantially over the last few decades. By contrast, the authors contend, inequality in education based on socioeconomic background is nearly universal and, in most cases, more pronounced than gender inequality. Data from various developing countries, especially Thailand and Vietnam, document this situation. [22, no. 4 (Dec 96) 683-702]
Forecasting US Age Structure and the Future of Social Security: The Impact of Adjustments to Official Mortality Schedules
Neil G. Bennett, Director of Demographic Research and Analysis, National Center for Children in Poverty, Columbia University
S. Jay Olshansky, Research Associate, Department of Medicine, University of Chicago The level of future expenditures on such old-age entitlement programs in the United States as Social Security and Medicare, and the development of public policy to fund these programs, are dependent on accurate estimates of the current and future size of the beneficiary population. Since most persons who will be eligible to draw benefits from these programs over the next 65 years have already been born, the critical demographic factor for projecting the size and age structure of the beneficiary population is mortality. Recent studies question the validity of old-age mortality rates in the United States, in large part because of problems with age misstatement and because of what appear to be unusually low death rates in North America relative to other low-mortality populations with reliable data. The authors examine the consequences of adjusting old-age mortality rates for observed and forecasted life expectancies, for forecasts of the size of the older population, and for the projected funding of selected age-entitlement programs in the United States. Forecasts made using adjusted mortality schedules lead to estimates of life expectancy at birth and at older ages that, over the next 60 years, are lower than those published by the Census Bureau and the Social Security Administration. [22, no. 4 (Dec 96) 703-727]
Notes and Commentary Fertility, Family, and Social Policy in Contemporary Western Europe
Jean-Claude Chesnais, Senior Research Fellow, Institut National d’Etudes Démographiques, Paris Period total fertility rates are below replacement level in all Western European countries. Mediterranean countries, commonly labeled traditional, Catholic, and family oriented, exhibit the lowest fertility levels, whereas Sweden--the cradle of the modern liberal welfare state and the country in which empowerment of women is most fully realized--has the highest fertility in Western Europe. In seeking an explanation for the fertility differential, this note compares the status of women in Italy and Sweden and contrasts attitudes and policies toward the family in Italy and Germany with those in Britain and Sweden. The evidence suggests that in advanced industrial societies, higher status of women may be a precondition for raising fertility to replacement level. [22, no. 4 (Dec 96) 729-739]
Data and Perspectives Immigration, Domestic Migration, and Demographic Balkanization in America: New Evidence for the 1990s
William H. Frey, Research Scientist, Population Studies Center, University of Michigan, Ann Arbor The recent scrutiny given to the impact of post-1965 immigration to the United States has largely overlooked an important long-term consequence: social and demographic divisions, across regions, that are being created by distinctly different migration patterns of immigrants and domestic, mostly native-born migrants. Evidence for 1990-95 shows a continuation of: highly focused destinations among immigrants whose race-ethnic and skill-level profiles differ from those of the rest of the population; migration patterns among domestic migrants favoring areas that are not attracting immigrants; and accentuated domestic outmigration away from high immigration areas that is most evident for less educated and lower-income long-term residents. These separate migration patterns are leading to widening divisions by race-ethnicity and population growth across broad regions of the country. These patterns are likely to make immigrant assimilation more difficult and social and political cleavages more pronounced. [22, no. 4 (Dec 96) 741-763]
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