Inequalities in health and health care across sub-national territories have received far less attention in Europe than have socioeconomic inequalities in health. Yet the (increasingly) regionalized nature of many European healthcare systems, and the increasing fiscal strains caused by rising health care expenditures, suggest that territorial inequalities may be worthy of more attention than they have previously been paid. This book project examines the relationship between territorial and socioeconomic inequalities, and explores the trajectories of health politics in polities characterized by different forms of territorial organization.

Papers:
"The Politics of Territorial Health Inequalities in Europe." Presented at the Annual Meeting of the American Political Science Association, Boston (August 2008).

Chapter 4 Appendix: Mapping Territorial Inequalities in Mortality

Neither health nor health care is distributed equally in America. Normative work on justice and health ethics suggests that the public should be concerned with some (though perhaps not all) inequalities in health and health care, and that public policies should be constructed to minimize those inequalities that the public finds objectionable. Yet we know very little about how mass publics actually view disparities in health care. This research seeks to understand public attitudes towards health care inequalities. Which inequalities seem natural, or unproblematic, and which seem profoundly unjust? Why? How does this compare to our beliefs about justice in other domains, such as income or education? And what are the implications for public policy of the structure of public attitudes towards health inequalities?

I am currently analyzing data from a nationally representative survey (thanks to generous funding from the University Research Fund of the University of Pennsylvania and an Investigator Award in Health Policy Research from the Robert Wood Johnson Foundation). Look for more papers soon!

A related TESS module, co-authored with Elizabeth Rigby, is currently under analysis.

Papers:
"Playing Fair: How Fairness Beliefs Influence Health Reform Policy Preferences in the United States" (with Sarah Gollust), May 2009.

"What's Fair in Health Care?" Presented at the Annual Meeting of the American Political Science Association, Washington DC (August 2005).

In 2008, mortgage foreclosure filings were reported on 2.3 million properties nationwide. In Philadelphia, 15,659 properties received foreclosure filing notices, almost double the number in 2007. Foreclosure affects populations already vulnerable to health problems, but the health impacts of this housing crisis remain largely unknown. We hypothesize that mortgage foreclosure affects health not only by imposing financial and physiological stress on individuals who are threatened with loss of their homes, but also by disrupting social and civic networks in communities affected by foreclosure, and by decreasing tax revenues and social spending in municipalities and states heavily affected by the crisis.

In 2008, we partnered with Consumer Credit Counseling Services of Delaware Valley (CCCS), a community-based mortgage counseling service, to recruit individuals undergoing foreclosure into a longitudinal study of the health effects of foreclosure. The first results of this pilot study were published in the American Journal of Public Health in August 2008, and received nationwide media attention.

We are currently analyzing data from a follow-on study linking foreclosure data to medical records, which allows us to directly compare health conditions and health care utilization in the same individual (and his or her family members) before and after foreclosure.

Research support provided by a Pilot Grant from the Leonard Davis Institute for Health Economics, U Penn.

Papers:
"The Health Status of People Undergoing Foreclosure in the Philadelphia Region" with Craig Pollack, American Journal of Public Health (October 2009) 99:10, pp. 1833-1839.

Media Coverage:
The Wall Street Journal
The Washington Post
US News and World Report
Time Magazine

How does the private provision of social welfare functions affect citizen attitudes towards the state? In this paper we use a multilevel model and simulations to test whether private provision of social services undermines citizen confidence in state institutions by "hollowing out" the moral legitimacy of the state, or boosts trust in government by producing more satisfied citizens who benefit from more effectively delivered services. We find that ceteris paribus, private provision and financing of health services are both associated with less trust in government among intensive users of the healthcare systems in both Western and Eastern European countries. In Western Europe, however, more intensive users of healthcare are less negatively affected by private provision. Our findings lend support to the "hollowing out" thesis, but also suggest that where private services offer greater real or perceived efficiency for a vocal minority of users, they may act as a political counterweight to the equity concerns of the majority.

Research support provided by Penn’s Browne Center for International Politics and Brown University’s Department of Political Science.

Papers:
"Does Non-State Provision of Social Services Promote or Undermine Citizen Trust in Government? The Case of Health Care in Europe," with Melani Cammett, January 2009.

"Providers and Politics: The Effect of Private Healthcare on Citizen Trust in Government in Western and Eastern Europe," with Melani Cammett. Presented at the Annual Meeting of the American Political Science Association, Boston (August 2008)