Associate Professor of Public Health Policy and Management
- Professional overview
Dr. Diana Silver's research explores the impact of variation in the implementation, adoption and repeal of state and local public health policies on health outcomes, particularly alcohol consumption, motor vehicle crashes, tobacco use, and food safety. Some of her other work has examined variation in access to publicly funded services such as clinics, after-school programs, parks and playgrounds. Her work has been funded by the National Institutes of Health, the Robert Wood Johnson Foundation, the New York City Department of Health and Mental Hygiene, and several other funders.
Dr. Silver's work has been published in a variety of prominent journals, including the American Journal of Public Health, the American Journal of Health Promotion, Public Health, Tobacco Control, Journal of Safety Research, Social Science and Medicine, the American Journal of Evaluation, PLoS One, Journal of Community Health, Journal of Immigrant and Minority Health, International Journal of Equity in Health, Globalization and Health, Youth and Society, Public Administration Review and Policy Studies Journal. She is an associate editor for the American Journal of Health Promotion, and serves on the New York City Department of Health’s Health Advisory Committee. She began her career focused on the developing policies and programs that could address the epidemics of AIDS, substance abuse and violence in New York City, in such settings as schools, workplaces, jails, and homeless shelters.
Dr. Silver teaches undergraduate and master’s level courses at the College of Global Health, and trains doctoral students. In 2015, Dr. Silver received NYU’s Distinguished Teaching Award, the university’s highest honor for teaching excellence.
BA, History, Bates College, Lewiston, MEMPH, Health Education, Hunter College, New York City, NYPhD, Public Administration, New York University, New York City, NY
- Honors and awards
Distinguished Teaching Award, New York University (2015)Steinhardt Goddard Award (2011)Annual Award for Outstanding Evaluation, American Evaluation Association (2010)Public Affairs Resident Scholar, The Rockefeller Foundation (2007)
- Areas of research and study
Access to HealthcareAlcohol, Tobacco and Driving PoliciesFood Safety PoliciesImplementation and Impact of Public Health RegulationsInjury PreventionNew York Department of Health and Mental HygienePublic Health LawPublic Health Policy
Planned parenthood is health care, and health care must defend it: A call to actionSilver, D., & Kapadia, F.
Journal titleAmerican Journal of Public Health
Changes in health care inequity in Brazil between 2008 and 2013Mullachery, P., Silver, D., & Macinko, J.
Journal titleInternational Journal for Equity in Health
Background: Brazil has made progress towards a more equitable distribution of health care, but gains may be threatened by economic instability resulting from the 2008 global financial crisis. This study measured predictors of health care utilization and changes in horizontal inequity between 2008 and 2013. Method: Data were from two nationally representative surveys that measured a variety of sociodemographic, health behaviors and health care indicators. We used Poisson regression models to estimate adjusted prevalence ratios and the Horizontal Equity Index (HEI) standardized by health needs to measure inequity in the utilization of doctor and dentist visits, hospitalizations and reporting of a usual source of care (USC) for those 18 and older. To estimate the HEI, we ranked the population from the poorest to the richest using a wealth index. We also decomposed the HEI into its different components and assessed changes from 2008 to 2013. Results: The population proportion with doctor and dentist visits in the past year and a USC increased between 2008 and 2013, while hospitalizations declined. In 2013, pro-rich inequity in doctor visits increased significantly while the distribution of hospitalizations shifted from pro-rich in 2008 to neutral in 2013. Dentist visits were highly pro-rich and USC was slightly pro-rich; the distribution of dentist visits and USC did not change over time. Health need was a strong predictor of health care utilization regardless of the type of coverage (public or private). Education, wealth, and private health plans were associated with the pro-rich orientation of doctor and dentist visits. Private health plans contributed to the pro-rich orientation of all outcomes, while the Family Health Strategy contributed to the pro-poor orientation of all outcomes. Conclusion: The results of this study support the claim that Brazil's population continued to see absolute gains in access to care despite recent economic crises. However, gains in equity have slowed and may even decline if investments are not maintained as the country enters deeper financial and political crises.
Detecting causality in policy diffusion processesGrabow, C., Macinko, J., Silver, D., & Porfiri, M.
A universal question in network science entails learning about the topology of interaction from collective dynamics. Here, we address this question by examining diffusion of laws across US states. We propose two complementary techniques to unravel determinants of this diffusion process: information-theoretic union transfer entropy and event synchronization. In order to systematically investigate their performance on law activity data, we establish a new stochastic model to generate synthetic law activity data based on plausible networks of interactions. Through extensive parametric studies, we demonstrate the ability of these methods to reconstruct networks, varying in size, link density, and degree heterogeneity. Our results suggest that union transfer entropy should be preferred for slowly varying processes, which may be associated with policies attending to specific local problems that occur only rarely or with policies facing high levels of opposition. In contrast, event synchronization is effective for faster enactment rates, which may be related to policies involving Federal mandates or incentives. This study puts forward a data-driven toolbox to explain the determinants of legal activity applicable to political science, across dynamical systems, information theory, and complex networks.
That's not how the learning works - the paradox of Reverse Innovation: A qualitative studyHarris, M., Weisberger, E., Silver, D., Dadwal, V., & Macinko, J.
Journal titleGlobalization and Health
Background: There are significant differences in the meaning and use of the term 'Reverse Innovation' between industry circles, where the term originated, and health policy circles where the term has gained traction. It is often conflated with other popularized terms such as Frugal Innovation, Co-development and Trickle-up Innovation. Compared to its use in the industrial sector, this conceptualization of Reverse Innovation describes a more complex, fragmented process, and one with no particular institution in charge. It follows that the way in which the term 'Reverse Innovation', specifically, is understood and used in the healthcare space is worthy of examination. Methods: Between September and December 2014, we conducted eleven in-depth face-to-face or telephone interviews with key informants from innovation, health and social policy circles, experts in international comparative policy research and leaders in the Reverse Innovation space in the United States. Interviews were open-ended with guiding probes into the barriers and enablers to Reverse Innovation in the US context, specifically also informants' experience and understanding of the term Reverse Innovation. Interviews were recorded, transcribed and analyzed thematically using the process of constant comparison. Results: We describe three main themes derived from the interviews. First, 'Reverse Innovation,' the term, has marketing currency to convince policy-makers that may be wary of learning from or adopting innovations from unexpected sources, in this case Low-Income Countries. Second, the term can have the opposite effect - by connoting frugality, or innovation arising from necessity as opposed to good leadership, the proposed innovation may be associated with poor quality, undermining potential translation into other contexts. Finally, the term 'Reverse Innovation' is a paradox - it breaks down preconceptions of the directionality of knowledge and learning, whilst simultaneously reinforcing it. Conclusions: We conclude that this term means different things to different people and should be used strategically, and with some caution, depending on the audience.
Understanding policy diffusion in the U.S.: An information-theoretical approach to unveil connectivity structures in slowly evolving complex systemsAnderson, R.P., Jimenez, G., Bae, J.Y., Silver, D., Macinko, J., & Porfiri, M.
Journal titleSIAM Journal on Applied Dynamical Systems
Detecting and explaining the relationships among interacting components has long been a focal point of dynamical systems research. In this paper, we extend these types of data-driven analyses to the realm of public policy, whereby individual legislative entities interact to produce changes in their legal and political environments. We focus on the U.S. public health policy landscape, whose complexity determines our capacity as a society to effectively tackle pressing health issues. It has long been thought that some U.S. states innovate and enact new policies, while others mimic successful or competing states. However, the extent to which states learn from others, and the state characteristics that lead two states to influence one another, are not fully understood. Here, we propose a model-free, information-theoretical method to measure the existence and direction of influence of one state's policy or legal activity on others. Specifically, we tailor a popular notion of causality to handle the slow time scale of policy adoption dynamics and unravel relationships among states from their recent law enactment histories. The method is validated using surrogate data generated from a new stochastic model of policy activity. Through the analysis of real data in alcohol, driving safety, and impaired driving policy, we provide evidence for the role of geography, political ideology, risk factors, and demographic and economic indicators on a state's tendency to learn from others when shaping its approach to public health regulation. Our method offers a new model-free approach to uncover interactions and establish cause and effect in slowly evolving complex dynamical systems.
'They hear "Africa" and they think that there can't be any good services' - perceived context in cross-national learning: A qualitative study of the barriers to Reverse InnovationHarris, M., Weisberger, E., Silver, D., & Macinko, J.
Journal titleGlobalization and Health
Background: Country-of-origin of a product can negatively influence its rating, particularly if the product is from a low-income country. It follows that how non-traditional sources of innovation, such as low-income countries, are perceived is likely to be an important part of a diffusion process, particularly given the strong social and cognitive boundaries associated with the healthcare professions. Methods: Between September and December 2014, we conducted eleven in-depth face-to-face or telephone interviews with key informants from innovation, health and social policy circles, experts in international comparative policy research and leaders in Reverse Innovation in the United States. Interviews were open-ended with guiding probes into the barriers and enablers to Reverse Innovation in the US context, specifically also to understand whether, in their experience translating or attempting to translate innovations from low-income contexts into the US, the source of the innovation matters in the adopter context. Interviews were recorded, transcribed and analyzed thematically using the process of constant comparison. Results: Our findings show that innovations from low-income countries tend to be discounted early on because of prior assumptions about the potential for these contexts to offer solutions to healthcare problems in the US. Judgments are made about the similarity of low-income contexts with the US, even though this is based oftentimes on flimsy perceptions only. Mixing levels of analysis, local and national, leads to country-level stereotyping and missed opportunities to learn from low-income countries. Conclusions: Our research highlights that prior expectations, invoked by the Low-income country cue, are interfering with a transparent and objective learning process. There may be merit in adopting some techniques from the cognitive psychology and marketing literatures to understand better the relative importance of source in healthcare research and innovation diffusion. Counter-stereotyping techniques and decision-making tools may be useful to help decision-makers evaluate the generalizability of research findings objectively and transparently. We suggest that those interested in Reverse Innovation should reflect carefully on the value of disclosing the source of the innovation that is being proposed, if doing so is likely to invoke negative stereotypes.
Age, period, and cohort effects in motor vehicle mortality in the United States, 1980-2010: The role of sex, alcohol involvement, and position in vehicleMacinko, J., Silver, D., & Bae, J.Y.
Journal titleJournal of Safety Research
Introduction Although substantive declines in motor vehicle fatalities in 1980-2010 have been observed, declines by position in the vehicle and alcohol involvement have not been well elucidated. Method Analyses of FARS data use the Intrinsic Estimator (IE) to produce estimates of all age, period, and cohort effects simultaneously by position in the car and by alcohol involvement. Results Declines in MVC deaths by position in the car vary for men and women by age and cohort over time. Cohorts born before 1970 had higher risks than those born later. Analyses using proxy indicators of alcohol involvement found the highest risks for those aged 16-24. By period, these risks declined more rapidly than non- alcohol related traffic fatalities. Conclusion Changes in risk patterns are consistent with evidence regarding the contributions of new technologies and public policy efforts to reduce fatalities, but gains have not been shared evenly by sex or position in the car. Practical applications Greater attention is needed in reducing deaths among older drivers and pedestrians. Gender differences should be addressed in prevention efforts aimed at reducing MVCs due to alcohol involvement.
Compliance with minimum price and legal age for cigarette purchase laws: Evidence from NYC in advance of raising purchase age to 21Silver, D., Bae, J.Y., Jimenez, G., & Macinko, J.
Journal titleTobacco Control
Background New York City (NYC) raised the minimum purchase age for cigarettes from 18 to 21 on 1 August 2014. The new law is intended to decrease current smoking rates and smoking initiation among the city's youth. Assessment of compliance with existing cigarette sales and tax laws could aid in determining what may be needed for successful implementation of the city's new law. Purpose To assess compliance with minimum sales price and purchase age laws in NYC, before change in law. Methods Ten trained field investigators purchased cigarettes from different types of retailers throughout all five NYC boroughs, resulting in 421 purchases. Investigators noted whether they were asked for identification and the price of their purchase. Multivariable logistic and Ordinary Least Squares regression techniques were used to assess predictors of retailer compliance with sales price and minimum purchase age laws. Results In 29% of purchases, investigators did not have to produce identification (p<0.05) to purchase cigarettes. Only 3.1% of sales were at prices lower than the minimum sales price. City borough was significantly associated with purchase without identification (p<0.001) and mean sales price (p<0.024). Vendor type (independent vs chain) was significantly related to investigators being able to purchase cigarettes without identification (p<0.001). Conclusions Variation in compliance with existing laws suggests that more active monitoring of compliance with the new minimum legal purchase age will be required in order to realise the new law's public health potential.
Diffusion of impaired driving laws among US statesMacinko, J., & Silver, D.
Journal titleAmerican Journal of Public Health
Objectives. We examined internal and external determinants of state's adoption of impaired driving laws. Methods. Data included 7 state-level, evidence-based public health laws collected from 1980 to 2010. We used event history analyses to identify predictors of first-time law adoption and subsequent adoption between state pairs. The independent variables were internal state factors, including the political environment, legislative professionalism, government capacity, state resources, legislative history, and policy-specific risk factors. The external factors were neighboring states' history of law adoption and changes in federal law. Results. We found a strong secular trend toward an increased number of laws over time. The proportion of younger drivers and the presence of a neighboring state with similar laws were the strongest predictors of first-time law adoption. The predictors of subsequent law adoption included neighbor state adoption and previous legislative action. Alcohol laws were negatively associated with first-time adoption of impaired driving laws, suggesting substitution effects among policy choices. Conclusions. Organizations seeking to stimulate state policy changes may need to craft strategies that engage external actors, such as neighboring states, in addition to mobilizing within-state constituencies.
Over-the-counter sales of out-of-state and counterfeit tax stamp cigarettes in New York CitySilver, D., Giorgio, M.M., Bae, J.Y., Jimenez, G., & Macinko, J.
Journal titleTobacco Control
Background New York City (NYC) has strict minimum cigarette price and tax stamp laws, but evidence regarding the extent of evasion of such laws in over-the-counter sales is scarce. Methods 830 packs were purchased at licensed tobacco retailers at 92 randomly selected neighbourhoods in NYC in spring and fall 2014, following the establishment of NYC's minimum price law. The Χ2 analyses of illegal tax stamps on pack, by retailer type and data collection period, are presented. Results Over 15% of packs purchased had out-of-state (4.5%) or counterfeit tax stamps (10.6%). Purchases resulted in at least one illegal pack obtained in 70% of neighbourhoods, largely from independent stores. In 21.5% of sampled neighbourhoods, it was possible to purchase an illegal pack each collection period. Conclusions Enhanced enforcement of retail sales of cigarettes is needed to ensure the full benefit of existing tobacco control laws in NYC.
Patterns of alcohol consumption and related behaviors in Brazil: Evidence from the 2013 National Health Survey (PNS 2013)Macinko, J., Mullachery, P., Silver, D., Jimenez, G., & Neto, O.L.M.
Journal titlePLoS One
This study uses data from a nationally representative household survey (the 2013 National Health Survey, n = 62,986) to describe patterns of alcohol consumption and related behaviors among Brazilian adults. Analyses include descriptive and multivariable Poisson regression for self-reports in the past 30 days of: drinking any alcohol, binge drinking, binge drinking 4 or more times, and driving after drinking (DD); as well as age of alcohol consumption initiation. Results show that current drinking prevalence was 26%, with an average age of initiation of 18.7 years. Binge drinking was reported by 51% of drinkers, 43% of whom reported binge drinking 4 or more times. Drinking and driving was reported by nearly one quarter of those who drive a car/motorcycle. Current drinking was more likely among males, ages 25-34, single, urban, and those with more education. Binge drinking was more likely among males, older age groups, and people who started drinking before 18. Drinking and driving was higher among males, those with more education, and rural residents. Those who binge-drink were nearly 70% more likely to report DD. All behaviors varied significantly among Brazilian states. Given their potential health consequences, the levels of injurious alcohol behaviors observed here warrant increased attention from Brazilian policymakers and civil society.
Retailer compliance with tobacco control laws in New York City before and after raising the minimum legal purchase age to 21Silver, D., Macinko, J., Giorgio, M., Bae, J.Y., & Jimenez, G.
Journal titleTobacco Control
Objectives New York City (NYC) is the first large city to increase the legal minimum age for possessing tobacco products from 18 to 21 (Tobacco 21) and establish a minimum price law to reduce smoking rates among youth. However, retailer compliance with these regulations is unknown. Methods Youthful investigators purchased cigarettes pre and post-Tobacco 21 implementation in 92 NYC neighbourhoods. Investigators recorded whether their ID was checked, the pack's purchase price, and observed compliance with additional regulations. Multivariable OLS and Poisson regression models assess pre and post Tobacco 21 compliance with ID checks and purchase prices, controlling for retailer type, location and compliance with other laws. Results Retailer compliance with ID checks declined from 71% to 62% (p
Temporal trends in motor vehicle fatalities in the United States, 1968 to 2010: A joinpoint regression analysisBandi, P., Porfiri, M., Silver, D., & Macinko, T.
Journal titleInjury Epidemiology
The effect of geography and citizen behavior on motor vehicle deaths in the United StatesAbaid, N., Macinko, J., Silver, D., & Porfiri, M.
Journal titlePLoS One
Death due to motor vehicle collisions (MVCs) remains a leading cause of death in the US and alcohol plays a prominent role in a large proportion of these fatalities nationwide. Rates for these incidents vary widely among states and over time. Here, we explore the extent to which driving volume, alcohol consumption, legislation, political ideology, and geographical factors influence MVC deaths across states and time. We specify structural equation models for extracting associations between the factors and outcomes for MVC deaths and compute correlation functions of states' relative geographic and political positions to elucidate the relative contribution of these factors. We find evidence that state-level variation in MVC deaths is associated with time-varying driving volume, alcohol consumption, and legislation. These relationships are modulated by state spatial proximity, whereby neighboring states are found to share similar MVC death rates over the thirty-year observation period. These results support the hypothesis that neighboring states exhibit similar risk and protective characteristics, despite differences in political ideology.
The geometry of motor vehicle deaths in the United StatesAbaid, N., Porfiri, M., Silver, D., & Mancinko, J.
Journal titlePLoS One
Child passenger safety laws in the United States, 1978-2010: Policy diffusion in the absence of strong federal interventionBae, J.Y., Anderson, E., Silver, D., & Macinko, J.
Journal titleSocial Science and Medicine
This article examines the diffusion of U.S. state child passenger safety laws, analyzing over-time changes and inter-state differences in all identifiable features of laws that plausibly influence crash-related morbidity and mortality. The observed trend shows many states' continuing efforts to update their laws to be consistent with latest motor vehicle safety recommendations, with each state modifying their laws on average 6 times over the 30-year period. However, there has been a considerable time lag in knowledge diffusion and policy adoption. Even though empirical evidence supporting the protective effect of child restraint devices was available in the early 1970s, laws requiring their use were not adopted by all 50 states until 1986. For laws requiring minors to be seated in rear seats, the first state law adoption did not occur until two decades after the evidence became publicly available. As of 2010, only 12 states explicitly required the use of booster seats, 9 for infant seats and 6 for toddler seats. There is also great variation among states in defining the child population to be covered by the laws, the vehicle operators subject to compliance, and the penalties resulting from non-compliance. Some states cover only up to 4-year-olds while others cover children up to age 17. As of 2010, states have as many as 14 exemptions, such as those for non-residents, non-parents, commercial vehicles, large vehicles, or vehicles without seatbelts. Factors such as the complexity of the state of the science, the changing nature of guidelines (from age to height/weight-related criteria), and the absence of coordinated federal actions are potential explanations for the observed patterns. The resulting uneven policy landscape among states suggests a strong need for improved communication among state legislators, public health researchers, advocates and concerned citizen groups to promote more efficient and effective policymaking.
Fifty-state survey of child passenger safety laws in the US, 1978-2010: A public health approach to analyzing legal intrumentsBae, J., Anderson, E., Silver, D., & Macinko, J.
Journal titleSocial Science and Medicine
Utilization patterns and perceptions of playground users in New York CitySilver, D., Giorgio, M., & Mijanovich, T.
Journal titleJournal of Community Health
Playgrounds are assumed to be an important resource for physical activity. This study investigates seasonal utilization, user preferences, and perceptions of safety and upkeep of public playgrounds in New York City. A cross-sectional survey was conducted from May 2010 to January 2011 across 10 playgrounds in low/middle income neighborhoods in each of the five boroughs in New York City. A total of 1,396 adults accompanying children were surveyed. Outcomes included playground as main place of outdoor play, and perceptions of playground upkeep and safety. Covariates included socio-demographics and other characteristics of playground users. Multivariable logistic regression with playground/season fixed effects were used. Utilization varied substantially across the four seasons. Blacks had higher odds of reporting the playground as the main place of outdoor play (AOR 1.78, 95 % CI 1.13-2.80, p <.05). High income users had lower odds of reporting the playground as the main place of outdoor play (60-80,000: AOR 0.47, 95 % CI 0.29-0.76, p <.01, 80,000+: AOR 0.47, 95 % CI 0.28-0.79, p <.01). Racial differences in perceived upkeep and safety were not significant once playground/season fixed effects were included, highlighting the importance of neighborhood conditions. Women were more likely to report feeling unsafe within playgrounds (AOR 1.51, 95 % CI 1.12-2.02, p <.01). While some playground utilization is driven by individual characteristics, perceptions of public resources influences utilization and cannot be separated from neighborhood conditions. Increasing access to opportunities for physical activity for children requires new strategies beyond playground improvements.
Good Evaluation Measures: More Than Their Psychometric PropertiesWeitzman, B., & Silver, D.
Journal titleAmerican Journal of Evaluation
In this commentary, we examine Braverman's insights into the trade-offs between feasibility and rigor in evaluation measures and reject his assessment of the trade-off as a zero-sum game. We, argue that feasibility and policy salience are, like reliability and validity, intrinsic to the definition of a good measure. To reduce the tension between feasibility and measurement rigor, we argue that evaluators should make greater use of existing data, identify ways in which improved measurement will result in improved program management, and "thickly" invest measurement resources in areas where questions are most important and evaluation is most needed.
The effects of state regulations and alcohol consumption on traffic fatalities 1980-2010Silver, D., Bae, J., Jimenez, G., Paul, M., & Mancinko, J.
Journal titlePublic Health
Variation in U.S. traffic safety policy environments and motor vehicle fatalities 1980-2010Silver, D., Macinko, J., Bae, J.Y., Jimenez, G., & Paul, M.
Journal titlePublic Health
Objective: To examine the impact of variation in state laws governing traffic safety on motor vehicle fatalities. Study design: Repeated cross sectional time series design. Methods: Fixed effects regression models estimate the relationship between state motor vehicle fatality rates and the strength of the state law environment for 50 states, 1980-2010. The strength of the state policy environment is measured by calculating the proportion of a set of 27 evidence-based laws in place each year. The effect of alcohol consumption on motor vehicle fatalities is estimated using a subset of alcohol laws as instrumental variables. Results: Once other risk factors are controlled in statistical models, states with stronger regulation of safer driving and driver/passenger protections had significantly lower motor vehicle fatality rates for all ages. Alcohol consumption was strongly associated with higher MVC death rates, as were state unemployment rates. Conclusions: Encouraging laggard states to adopt the full range of available laws could significantly reduce preventable traffic-related deaths in the U.S. - especially those among younger individuals. Estimating the relationship between different policy environments and health outcomes can quantify the result of policy gaps.
How residential mobility and school choice challenge assumptions of neighborhood place-based interventionsSilver, D., Weitzman, B., Mijanovich, T., & Holleman, M.
Journal titleAmerican Journal of Health Promotion
Purpose: Explore the importance of residential mobility and use of services outside neighborhoods when interventions targeting low-income families are planned and implemented. Design: Analysis of cross-sectional telephone household survey data on childhood mobility and school enrollment in four large distressed cities. Setting: Baltimore, Maryland; Detroit, Michigan; Philadelphia, Pennsylvania; and Richmond, Virginia. Subjects: Total of 1723 teens aged 10 to 18 years and their parents. Measures: Continuous self-report of the number of years parents lived in the neighborhood of residence and city; self-report of whether the child attends school in their neighborhood; and categorical self report of parents' marital status, mother's education, parent race, family income, child's age, and child's sex. Analysis: Chi-square and multivariate logistic regression. Results: In this sample, 85.2% of teens reported living in the city where they were born. However, only 44.4% of black teens lived in neighborhoods where they were born, compared with 59.2% of white teens. Although 50.3% of black teens attended schools outside of their current neighborhoods, only 31.4% of whites did. Residential mobility was more common among black than white children (odds ratio = 1.82; p <.001), and black teens had 43% lesser odds of attending school in their home communities. Conclusions: Mobility among low-income and minority families challenges some assumptions of neighborhood interventions premised on years of exposure to enriched services and changes in the built environment.
Improving state health policy assessment: An agenda for measurement and analysisMacinko, J., & Silver, D.
Journal titleAmerican Journal of Public Health
We examine the scope of inquiry into the measurement and assessment of the state public health policy environment. We argue that there are gains to be made by looking systematically at policies both within and across health domains. We draw from the public health and public policy literature to develop the concepts of interdomain and intradomain policy comprehensiveness and illustrate how these concepts can be used to enhance surveillance of the current public health policy environment, improve understanding of the adoption of new policies, and enhance evaluations of the impact of such policies on health outcomes.
Transportation to clinic: Findings from a pilot clinic-based survey of low-income suburbanitesSilver, D., Blustein, J., & Weitzman, B.
Journal titleJournal of Immigrant and Minority Health
Health care policymakers have cited transportation barriers as key obstacles to providing health care to low-income suburbanites, particularly because suburbs have become home to a growing number of recent immigrants who are less likely to own cars than their neighbors. In a suburb of New York City,we conducted a pilot survey of low income, largely immigrant clients in four public clinics, to find out how much transportation difficulties limit their access to primary care. Clients were receptive to the opportunity to participate in the survey (response rate = 94%). Nearly one-quarter reported having transportation problems that had caused them to miss or reschedule a clinic appointment in the past. Difficulties included limited and unreliable local bus service, and a tenuous connection to a car. Our pilot work suggests that this population is willing to participate in a survey on this topic. Further, since even among those attending clinic there was significant evidence of past transportation problems, it suggests that a populationbased survey would yield information about substantial transportation barriers to health care.
Lifting boatswithout closing gaps: Child health outcomes in distressed us cities from 1992-2002Silver, D., Mijanovich, T., Uyei, J., Kapadia, F., & Weitzman, B.
Journal titleAmerican Journal of Public Health
Objectives. We compared cause-specific mortality and birth rates for children and youths aged younger than 18 years in 100 US cities from 1992 through 2002. Methods. We used 5 census indicators to categorize the 100 most populous US cities in 1990 as economically distressed or nondistressed. We used Poisson regression to calculate rate ratios for cause-specific mortality and birth rates, comparing distressed cities to nondistressed cities overall and by race/ethnicity from 1992 through 2002. We also calculated rates of change in these variables within each city over this period. Results. Despite improvements in health for the study population in all cities, disparities between city groups held steady or widened over the study period. Gaps in outcomes between Whites and Blacks persisted across all cities. Living in a distressed city compounded the disparities in poor outcomes for Black children and youths. Conclusions. A strong national economy during the study period may have facilitated improvements in health outcomes for children and youths in US cities, but these benefits did not close gaps between distressed and nondistressed cities.