Intertemporal Material Deprivation

Individual well-being is multidimensional and various aspects of the quality of life need to be jointly considered in its measurement. The axiomatic literature on the subject has proposed many indices of multidimensional poverty and deprivation and explored the properties that are at the basis of these measures. The purpose of this chapter is to add intertemporal considerations to the analysis of material deprivation. We employ the EU-SILC panel data set, which includes information on different aspects of well-being over time. EU countries are compared based on measures that take this additional intertemporal information into consideration. Journal of Economic Literature Classi cation No.: D63.

Multidimensional Poverty and Material Deprivation

We examine the measurement of multidimensional poverty and material deprivation following the counting approach. In contrast to earlier contributions, dimensions of well-being are not forced to be equally important but different weights can be assigned to different dimensions. We characterize a class of individual measures reflecting this feature. In addition, we axiomatize an aggregation procedure to obtain a class of indices for entire societies allowing for different degrees of inequality aversion in poverty. We apply the proposed measures to European Union member states where the concept of material deprivation was initiated.

Monetary poverty, material deprivation and consistent poverty in Portugal

In this paper we use the Portuguese component of the European Union Statistics on Income and Living Conditions {EU-SILC) to develop a measure of consistent poverty in Portugal. It is widely agreed that being poor does not simply mean not having enough monetary resources. It also reflects a lack of access to the resources required to enjoy a minimum standard of living and participation in the society one belor]gs to. The coexistence of material deprivation and monetary poverty leads to the con'cept of consistent poverty. The assessment of material deprivation and the identification of the households and individuals living in consistent poverty could become essential parts of the national anti-poverty strategy and crucial instruments in the definition of the target groups in social policy.

Area deprivation and mortality in the provincial capital cities of Andalusia and Catalonia (Spain)

Objective: To study the linkage between material deprivation and mortality from all causes, for men and women separately, in the capital cities of the provinces in Andalusia and Catalonia (Spain). Methods: A small-area ecological study was devised using the census section as the unit for analysis. 188 983 Deaths occurring in the capital cities of the Andalusian provinces and 109 478 deaths recorded in the Catalan capital cities were examined. Principal components factorial analysis was used to devise a material deprivation index comprising the percentage of manual labourers, unemployment and illiteracy. A hierarchical Bayesian model was used to study the relationship between mortality and area deprivation. Main results: In most cities, results show an increased male mortality risk in the most deprived areas in relation to the least depressed. In Andalusia, the relative risks between the highest and lowest deprivation decile ranged from 1.24 (Malaga) to 1.40 (Granada), with 95% credibility intervals showing a significant excess risk. In Catalonia, relative risks ranged between 1.08 (Girona) and 1.50 (Tarragona). No evidence was found for an excess of female mortality in most deprived areas in either of the autonomous communities. Conclusions: Within cities, gender-related differences were revealed when deprivation was correlated geographically with mortality rates. These differences were found from an ecological perspective. Further research is needed in order to validate these results from an individual approach. The idea to be analysed is to identify those factors that explain these differences at an individual level.

Detecting and measuring deprivation in primary care: development, validity and reliability of a self-reported questionnaire - the DiPCare-Q

Background: General practitioners play a central role in taking deprivation into consideration when caring for patients in primary care. Validated questions to identify deprivation in primary-care practices are still lacking. For both clinical and research purposes, this study therefore aims to develop and validate a standardized instrument measuring both material and social deprivation at an individual level. Methods: The Deprivation in Primary Care Questionnaire (DiPCare-Q) was developed using qualitative and quantitative approaches between 2008 and 2011. A systematic review identified 199 questions related to deprivation. Using judgmental item quality, these were reduced to 38 questions. Two focus groups (primary-care physicians, and primary-care researchers), structured interviews (10 laymen), and think aloud interviews (eight cleaning staff) assured face validity. Item response theory analysis was then used to derive the DiPCare-Q index using data obtained from a random sample of 200 patients who were to complete the questionnaire a second time over the phone. For construct and criterion validity, the final 16 questions were administered to a random sample of 1,898 patients attending one of 47 different private primary-care practices in western Switzerland (validation set) along with questions on subjective social status (subjective SES ladder), education, source of income, welfare status, and subjective poverty. Results: Deprivation was defined in three distinct dimensions (table); material deprivation (eight items), social deprivation (five items) and health deprivation (three items). Item consistency was high in both the derivation (KR20 = 0.827) and the validation set (KR20 = 0.778). The DiPCare-Q index was reliable (ICC = 0.847). For construct validity, we showed the DiPCare-Q index to be correlated to patients' estimation of their position on the subjective SES ladder (rs = 0.539). This position was correlated to both material and social deprivation independently suggesting two separate mechanisms enhancing the feeling of deprivation. Conclusion: The DiPCare-Q is a rapid, reliable and validated instrument useful for measuring both material and social deprivation in primary care. Questions from the DiPCare-Q are easy to use when investigating patients' social history and could improve clinicians' ability to detect underlying social distress related to deprivation.

Le médecin face aux inégalités sociales de santé: quel pouvoir d'action [General practitioners facing social inequalities in health: which power to act?].

The link between social inequalities and health has been known for many years, as attested by Villermé's work on the "mental and physical status of the working class" (1840). We have more and more insight into the nature of this relationship, which embraces not only material deprivation, but also psychological mechanisms related to social and interpersonal problems. Defining our possible role as physicians to fight against these inequalities has become a public health priority. Instruments and leads, which are now available to help us in our daily practice, are presented here.

Les déterminants de l’utilisation des services en santé mentale dans le sud-ouest de Montréal

Objectif : L’objectif principal de cette thèse est d’examiner les déterminants de l’utilisation des services de soins pour des raisons de santé mentale dans le sud-ouest de Montréal. Données et méthodes : L’étude utilise les données de la première phase du projet portant sur « le développement d’une zone circonscrite d’études épidémiologiques en psychiatrie dans le sud-ouest de Montréal ». Les données ont été collectées entre mai 2007 et août 2008 auprès d’un échantillon de 2434 personnes sélectionnées au hasard dans tout le territoire de l’étude. De cet échantillon, nous avons sélectionné un sous-échantillon de personnes ayant eu au moins un diagnostic de santé mentale au cours de la dernière année. 423 personnes ont rencontrées ce critère et constituent l’échantillon pour les analyses de la présente thèse. Le modèle comportemental d’Andersen a servi de cadre pour le choix des variables à analyser. Parce que l’approche socio-spatiale a été privilégiée pour modéliser les déterminants de l’utilisation des services, les analyses ont été effectuées à l’aide de quatre logiciels distincts à savoir : SPSS, AMOS, ArcGIS et MlWin. Résultats : Les résultats montrent que 53,66% de notre échantillon ont utilisés au moins un service de santé pour des raisons de santé mentale. On constate néanmoins que les déterminants de l’utilisation des services en santé mentale sont à la fois complexes et spatialement inégalement réparties. En ce qui concerne les caractéristiques sociodémographiques et cliniques, les femmes et ceux qui perçoivent la stigmatisation envers les personnes ayant un problème de santé mentale utilisent plus les services. Le nombre de diagnostics de santé mentale est aussi associé à l’utilisation des services. L’augmentation du nombre de diagnostics entraîne une augmentation de l’utilisation des services (=0,38; p<0,001). D’autres variables comme l’âge, le statut matrimonial, la taille du ménage, le soutien social et la qualité de vie influencent indirectement l’utilisation des services. À titre illustratif toute augmentation de l’âge entraîne une augmentation du soutien social de (=0,69; p<0,001) qui à son tour fait diminuer la détresse psychiatrique (= -0,09 (p<0,05). Or, toute augmentation d’une unité de détresse psychiatrique entraîne une augmentation de l’utilisation des services (=0,58 (p<0,001). Sur le plan spatiale, il existe une corrélation positive entre l’utilisation des services et la défavorisation matérielle, la défavorisation sociale et le nombre d’immigrants récents sur un territoire. Par contre, la corrélation entre la prévalence de la santé mentale et l’utilisation des services est négative. Les analyses plus poussées indiquent que le contexte de résidence explique 12,26 % (p<0,05) de la variation totale de l’utilisation des services. De plus, lorsqu’on contrôle pour les caractéristiques individuelles, vivre dans un environnement stable augmente l’utilisation des services (O.R=1,24; p<0,05) tandis que les contextes défavorisés du point de vue socioéconomique ont un effet néfaste sur l’utilisation (O.R=0,71; p<0,05). Conclusion : Les résultats de l’étude suggèrent que si on veut optimiser l’utilisation des services en santé mentale, il est important d’agir prioritairement au niveau de la collectivité. Plus spécifiquement, il faudrait mener des campagnes de sensibilisation auprès de la population pour combattre la stigmatisation des personnes ayant un problème de santé mentale. Sur le plan de la planification des soins de santé, on devrait augmenter l’offre des services dans les territoires défavorisés pour en faciliter l’accès aux habitants.

Équité d’utilisation des services de santé et de disponibilité des ressources en matière de santé dans la province de Québec

Objectif : L’objectif général de cette étude est de comprendre en quoi l’utilisation des services de santé et de disponibilité des ressources en santé au Québec sont équitables. Méthodes : De type transversal et corrélationnel, cette étude intéresse les 95 territoires CSSS du Québec, et couvre les années 2006-2007 et 2008-2009. L’indice de défavorisation matérielle et sociale de Pampalon est mis en lien avec deux séries de variables, soit celles d’utilisation des services par CSSS (services hospitaliers; services médicaux; services CLSC) et celles de disponibilité des ressources (capacité financière; capacité matérielle, capacité humaine; viabilité). Pour ce faire, des analyses de variance ont été effectuées. Le modèle intégrateur de la performance des services de santé EGIPSS et celui de l’utilisation des services de santé de Donabedian servent de cadre d’analyse. Résultats : L’utilisation des services de santé est équitable en ce qui concerne la défavorisation matérielle, mais pas en ce qui a trait à la défavorisation sociale. L’utilisation des services médicaux dispensés par les omnipraticiens est plus élevée chez les populations les plus favorisées socialement comparativement aux populations les plus défavorisées. Toutefois, l’utilisation des médecins spécialistes est plus équitable que celle des omnipraticiens, cela, chez les populations défavorisées autant matériellement que socialement. Les hospitalisations évitables sont plus élevées chez les populations les défavorisées socialement comparativement aux populations les plus favorisées. En termes de disponibilité des ressources, les populations défavorisées disposent de plus de ressources que les plus favorisées, sauf en ce qui concerne la répartition du personnel. Conclusion : En général, il existe très peu d’iniquités dans l’utilisation des services de santé au Québec. Par ailleurs, la disponibilité des ressources en santé est relativement équitable au Québec, exception faite de la disponibilité du personnel.

The shape of change: memetic analysis of poverty definitions from the 1970s to the 2000s

The authors illustrate how notions of poverty are constructed around specific ‘memes’, or replicating units of cultural information, around which concepts and ideas develop and change. Three ‘memes’ characterising definitions of poverty over the previous years were identified: ‘basic needs’, ‘multidimensional’ and ‘deprivation’. The analysis illustrated the semantic space in which each term was utilised and to the extent it changed and modified over time by different actors. The results revealed how ‘memes’ compete with one another across the discourse. Within this competition, older concepts are almost never fully abandoned, but rather repackaged and reutilised. Thus, new definitions of poverty are less innovative than portrayed in the wider literature.

Multidimensional Deprivation in Contemporary Switzerland Across Social Groups and Time

We have investigated the phenomenon of deprivation in contemporary Switzerland through the adoption of a multidimensional, dynamic approach. By applying Self Organizing Maps (SOM) to a set of 33 non-monetary indicators from the 2009 wave of the Swiss Household Panel (SHP), we identified 13 prototypical forms (or clusters) of well-being, financial vulnerability, psycho-physiological fragility and deprivation within a topological dimensional space. Then new data from the previous waves (2003 to 2008) were classified by the SOM model, making it possible to estimate the weight of the different clusters in time and reconstruct the dynamics of stability and mobility of individuals within the map. Looking at the transition probabilities between year t and year t+1, we observed that the paths of mobility which catalyze the largest number of observations are those connecting clusters that are adjacent on the topological space.

Deprivation viewed from a multidimensional perspective: The case of Brazil

Includes bibliography.

Ordenaciones de material genético a partir de información multidimensional

Nuevas biotecnologías permiten obtener información para caracterizar materiales genéticos a partir de múltiples marcadores, ya sean éstos moleculares y/o morfológicos. La ordenación del material genético a través de la exploración de patrones de variabilidad multidimensionales se aborda mediante diversas técnicas de análisis multivariado. Las técnicas multivariadas de reducción de dimensión (TRD) y la representación gráfica de las mismas cobran sustancial importancia en la visualización de datos multivariados en espacios de baja dimensión ya que facilitan la interpretación de interrelaciones entre las variables (marcadores) y entre los casos u observaciones bajo análisis. Tanto el Análisis de Componentes Principales, como el Análisis de Coordenadas Principales y el Análisis de Procrustes Generalizado son TRD aplicables a datos provenientes de marcadores moleculares y/o morfológicos. Los Árboles de Mínimo Recorrido y los biplots constituyen técnicas para lograr representaciones geométricas de resultados provenientes de TRD. En este trabajo se describen estas técnicas multivariadas y se ilustran sus aplicaciones sobre dos conjuntos de datos, moleculares y morfológicos, usados para caracterizar material genético fúngico.

Detecting and measuring deprivation in primary care: development, reliability and validity of a self-reported questionnaire: the DiPCare-Q.

OBJECTIVES: Advances in biopsychosocial science have underlined the importance of taking social history and life course perspective into consideration in primary care. For both clinical and research purposes, this study aims to develop and validate a standardised instrument measuring both material and social deprivation at an individual level. METHODS: We identified relevant potential questions regarding deprivation using a systematic review, structured interviews, focus group interviews and a think-aloud approach. Item response theory analysis was then used to reduce the length of the 38-item questionnaire and derive the deprivation in primary care questionnaire (DiPCare-Q) index using data obtained from a random sample of 200 patients during their planned visits to an ambulatory general internal medicine clinic. Patients completed the questionnaire a second time over the phone 3 days later to enable us to assess reliability. Content validity of the DiPCare-Q was then assessed by 17 general practitioners. Psychometric properties and validity of the final instrument were investigated in a second set of patients. The DiPCare-Q was administered to a random sample of 1898 patients attending one of 47 different private primary care practices in western Switzerland along with questions on subjective social status, education, source of income, welfare status and subjective poverty. RESULTS: Deprivation was defined in three distinct dimensions: material (eight items), social (five items) and health deprivation (three items). Item consistency was high in both the derivation (Kuder-Richardson Formula 20 (KR20) =0.827) and the validation set (KR20 =0.778). The DiPCare-Q index was reliable (interclass correlation coefficients=0.847) and was correlated to subjective social status (r(s)=-0.539). CONCLUSION: The DiPCare-Q is a rapid, reliable and validated instrument that may prove useful for measuring both material and social deprivation in primary care.

General practitioners can evaluate the material, social and health dimensions of patient social status

OBJECTIVE: To identify which physician and patient characteristics are associated with physicians' estimation of their patient social status.DESIGN: Cross-sectional ulticentric survey. SETTING: Fourty-seven primary care private offices in Western Switzerland. PARTICIPANTS: Random sample of 2030 patients ≥ 16, who encountered a general practitioner (GP) between September 2010 and February 2011. MAIN MEASURES: PRIMARY OUTCOME: patient social status perceived by GPs, using the MacArthur Scale of Subjective Social Status, ranging from the bottom (0) to the top (10) of the social scale.Secondary outcome: Difference between GP's evaluation and patient's own evaluation of their social status. Potential patient correlates: material and social deprivation using the DiPCare-Q, health status using the EQ-5D, sources of income, and level of education. GP characteristics: opinion regarding patients' deprivation and its influence on health and care. RESULTS: To evaluate patient social status, GPs considered the material, social, and health aspects of deprivation, along with education level, and amount and type of income. GPs declaring a frequent reflexive consideration of their own prejudice towards deprived patients, gave a higher estimation of patients' social status (+1.0, p = 0.002). Choosing a less costly treatment for deprived patients was associated with a lower estimation (-0.7, p = 0.002). GP's evaluation of patient social status was 0.5 point higher than the patient's own estimate (p<0.0001). CONCLUSIONS: GPs can perceive the various dimensions of patient social status, although heterogeneously, according partly to their own characteristics. Compared to patients' own evaluation, GPs overestimate patient social status.