Background Worldwide obesity has more than doubled since 1980. Researchers have attributed rising obesity rates to factors related to globalization processes, which are believed to contribute to obesity by flooding low-income country markets with inexpensive but obesogenic foods and diffusing Western-style fast food outlets (dependency/world systems theory). However, alternative explanations include domestic factors such as increases in unhealthy food consumption in response to rising income and higher women’s labor force participation as countries develop economically (“modernization” theory). To what extent are processes of globalization driving rising global overweight/obesity rates versus domestic economic and social development processes? This study evaluates the influence of economic globalization versus economic development and associated processes on global weight gain. Results Using two-way fixed-effects OLS regression with a panel dataset of mean body weight for 190-countries over a 30-year period (1980–2008), we find that domestic factors associated with “modernization” including increasing GDP per capita, urbanization and women’s empowerment were associated with increases in mean BMI over time. There was also evidence of a curvilinear relationship between GDP per capita and BMI: among low income countries, economic growth predicted increases in BMI whereas among high-income countries, higher GDP predicted lower BMI. By contrast, economic globalization (dependency/world systems theory) did not significantly predict increases in mean BMI and cultural globalization had mixed effects. These results were robust to different model specifications, imputation approaches and variable transformations. Discussion Global increases in overweight/obesity appear to be driven more by domestic processes including economic development, urbanization and women’s empowerment, and are less clearly negatively impacted by external globalization processes suggesting that the harms to health from global trade regimes may be overstated. Electronic supplementary material The online version of this article (10.1186/s12992-019-0457-y) contains supplementary material, which is available to authorized users.

Administrative burden is widely recognized as a barrier to program enrollment, denying legal entitlements to many potentially eligible individuals. Building on recent research in behavioral public administration, this article examines the effect of voluntary state reductions in administrative burden (administrative easing) on Medicaid enrollment rates using differential implementation of the Affordable Care Act. Using a novel data set that includes state-level data on simplified enrollment and renewal procedures for Medicaid from 2008 to 2017, the authors examine how change in Medicaid enrollment is conditioned by the adoption of rule-reduction procedures. Findings show that reductions in the administrative burden required to sign up for Medicaid were associated with increased enrollments. Real-time eligibility and reductions in enrollment burden were particularly impactful at increasing enrollment for both children and adults separate from increases in Medicaid income eligibility thresholds. The results suggest that efforts to ease the cognitive burden of enrolling in entitlement programs can improve take-up. Evidence for Practice• The administrative burden associated with enrolling in social safety net programs in the United States imposes high costs on applicants. As a consequence, many eligible individuals do not receive the benefits that they are lawfully entitled to. • Insights from behavioral economics, including streamlining of the enrollment process and automated benefit determinations, can be effectively employed-in some cases-to reduce the cognitive burden associated with program enrollment processes and increase take-up of benefits. • States that have implemented simple changes to enrollment processes, including administrative verification of income and real-time decision-making, have seen greater increases in Medicaid enrollments than those that did not implement such changes.is primarily interested in policies that could work for obesity prevention, with a focus on the feasibility and effectiveness of policies.Her research investigates how state and local health departments shape policies and their effects on individual health. She also studies safety net programs and how statelevel program variances lead to different health outcomes.

Understanding reasons for COVID-19 vaccine hesitancy is necessary to ensure maximum uptake, needed for herd immunity. We conducted a cross-sectional online survey between May 29-June 20, 2020 among a national sample of U.S. adults ages 18 years and over to assess cognitive, attitudinal and normative beliefs associated with not intending to get a COVID-19 vaccine. Of 1,219 respondents, 17.7% said that they would not get a vaccine and 24.2% were unsure. In multivariable analyses controlled for gender, age, income, education, religious affiliation, health insurance coverage, and political party affiliation, those who reported that they were unwilling be vaccinated (versus those who were willing) were less likely to agree that vaccines are safe/effective (Relative Risk Ratio (RRR): 0.45, 95% confidence interval (CI): 0.31, 0.66), that everyone has a responsibility to be vaccinated (RRR: 0.39, 95% CI: 0.30, 0.52), that public authorities should be able to mandate vaccination (RRR: 0.75, 95% CI: 0.58, 0.98), and that if everyone else were vaccinated they would not need a vaccine (RRR: 1.36, 95% CI: 1.04, 1.78). Our results suggest that health messages should emphasize the safety and efficacy of vaccines, as well as the fact that vaccinating oneself is important, even if the level of uptake in the community is high.

No abstract

No abstract

Administrative burden in social welfare programs is increasingly recognized as a barrier to eligible individuals' access to their legally entitled benefits. Using composite indices of administrative rules for three major safety‐net programs (Temporary Assistance to Needy Families, Supplemental Nutrition Assistance Program, and Medicaid) that vary in the degree and type of costs conferred on claimants across states between 2000 and 2016, we examine the effect of rule burden on program participation using two‐way fixed effects models. We find that each program contained numerous rules that confer a high degree of learning and compliance costs, and psychological costs to a lesser extent, though to varying degrees. Reducing costs associated with burdensome administrative rules was associated with higher program inclusivity across the programs, with relaxing some rules contributing more than others. Rules that automate enrollment/renewal, link eligibility with other programs and reduce asset tests seem especially promising. Easing burdensome administrative rules can increase access to services to which claimants are legally entitled.

Cost analysis complements cost-effectiveness analysis in evaluating program performance and guiding improvements.

Background The principle of equity is fundamental to many current debates about social issues and plays an important role in community and individual health. Traditional research has focused on singular dimensions of equity (e.g., wealth), and often lacks a comprehensive perspective. The goal of this study was to assess relationships among three domains of equity, health, wealth, and civic engagement, in a nationally representative sample of U.S. residents. Methods We developed a conceptual framework to guide our inquiry of equity across health, wealth, and civic engagement constructs to generate a broad but nuanced understanding of equity. Through Ipsos’ KnowledgePanel service, we conducted a cross-sectional, online survey between May 29–June 20, 2020 designed to be representative of the adult U.S. population. Based on our conceptual framework, we assessed the population-weighted prevalence of health outcomes and behaviors, as well as measures of wealth and civic engagement. We linked individual-level data with population-level environmental and social context variables. Using structural equation modeling, we developed latent constructs for wealth and civic engagement, to assess associations with a measured health variable. Results We found that the distribution of sociodemographic, health, and wealth measures in our sample (n = 1267) were comparable to those from other national surveys. Our quantitative illustration of the relationships among the domains of health, wealth, and civic engagement provided support for the interrelationships of constructs within our conceptual model. Latent constructs for wealth and civic engagement were significantly correlated (p = 0.013), and both constructs were used to predict self-reported health. Beta coefficients for all indicators of health, wealth, and civic engagement had the expected direction (positive or negative associations). Conclusion Through development and assessment of our comprehensive equity framework, we found significant associations among key equity domains. Our conceptual framework and results can serve as a guide for future equity research, encouraging a more thorough assessment of equity.