Americans like to believe that theirs is the land of opportunity, but the hard facts are that children born into poor families in the United States tend to stay poor and children born into wealthy families generally stay rich. Other countries have shown more success at lessening the effects of inequality on mobility—possibly by making public investments in education, health, and family well-being that offset the private advantages of the wealthy. What can the United States learn from these other countries about how to provide children from disadvantaged backgrounds an equal chance in life? Making comparisons across ten countries, Persistence, Privilege, and Parenting brings together a team of eminent international scholars to examine why advantage and disadvantage persist across generations. The book sheds light on how the social and economic mobility of children differs within and across countries and the impact private family resources, public policies, and social institutions may have on mobility.

In what ways do parents pass advantage or disadvantage on to their children? Persistence, Privilege, and Parenting is an expansive exploration of the relationship between parental socioeconomic status and background and the outcomes of their grown children. The authors also address the impact of education and parental financial assistance on mobility. Contributors Miles Corak, Lori Curtis, and Shelley Phipps look at how family economic background influences the outcomes of adult children in the United States and Canada. They find that, despite many cultural similarities between the two countries, Canada has three times the rate of intergenerational mobility as the United States—possibly because Canada makes more public investments in its labor market, health care, and family programs. Jo Blanden and her colleagues explore a number of factors affecting how advantage is transmitted between parents and children in the United States and the United Kingdom, including education, occupation, marriage, and health. They find that despite the two nations having similar rates of intergenerational mobility and social inequality, lack of educational opportunity plays a greater role in limiting U.S. mobility, while the United Kingdom’s deeply rooted social class structure makes it difficult for the disadvantaged to transcend their circumstances. Jane Waldfogel and Elizabeth Washbrook examine cognitive and behavioral school readiness across income groups and find that pre-school age children in both the United States and Britain show substantial income-related gaps in school readiness—driven in part by poorly developed parenting skills among overburdened, low-income families. The authors suggest that the most encouraging policies focus on both school and home interventions, including such measures as increases in federal funding for Head Start programs in the United States, raising pre-school staff qualifications in Britain, and parenting programs in both countries.

A significant step forward in the study of intergenerational mobility, Persistence, Privilege, and Parenting demonstrates that the transmission of advantage or disadvantage from one generation to the next varies widely from country to country. This striking finding is a particular cause for concern in the United States, where the persistence of disadvantage remains stubbornly high. But, it provides a reason to hope that by better understanding mobility across the generations abroad, we can find ways to do better at home.

TIMOTHY M. SMEEDING is director of the Institute for Research on Poverty and Distinguished Professor of Public Affairs at the University of Wisconsin–Madison.

ROBERT ERIKSON is professor of sociology at the Swedish Institute for Social Research, Stockholm University.

MARKUS JANTTI is professor of economics at the Swedish Institute for Social Research, Stockholm University.

CONTRIBUTORS: Jo Blanden, Miles Corak, Lori J. Curtis, Matthew Di Carlo, Greg J. Duncan, Robert Erikson, John Ermisch, Gøsta Epsing-Andersen, David B. Grusky, Robert Haveman, Markus Jäntti, John Jerrim, Jan O. Jonsson, Ariel Kalil, Bertrand Maître, John Micklewright, Carina Mood, Brian Nolan, Fabian T. Pfeffer, Shelley Phipps, Reinhard Pollak, Chiara Pronzato, Timothy M. Smeeding, James P. Smith, Kjetil Telle, Sander Wagner, Jane Waldfogel, Elizabeth Washbrook, Christopher T. Whelan, Kathryn Wilson, Kathleen M. Ziol-Guest, Julie M. Zissimopoulos

"Culture counts" has long been a rallying cry among health advocates and policymakers concerned with racial disparities in health care. A generation ago, the women’s health movement led to a host of changes that also benefited racial minorities, including more culturally aware medical staff, enhanced health education, and the mandated inclusion of women and minorities in federally funded research. Many health professionals would now agree that cultural competence is important in clinical settings, but in what ways? Shattering Culture provides an insightful view of medicine and psychiatry as they are practiced in today’s culturally diverse clinical settings. The book offers a compelling account of the many ways culture shapes how doctors conduct their practices and how patients feel about the care they receive.

Based on interviews with clinicians, health care staff, and patients, Shattering Culture shows the human face of health care in America. Building on over a decade of research led by Mary-Jo Good, the book delves into the cultural backgrounds of patients and their health care providers, as well as the institutional cultures of clinical settings, to illuminate how these many cultures interact and shape the quality of patient care. Sarah Willen explores the controversial practice of matching doctors and patients based on a shared race, ethnicity, or language and finds a spectrum of arguments challenging its usefulness, including patients who may fear being judged negatively by providers from the same culture. Seth Hannah introduces the concept of cultural environments of hyperdiversity describing complex cultural identities. Antonio Bullon and Mary-Jo Good demonstrate how regulations meant to standardize the caregiving process—such as the use of templates and check boxes instead of narrative notes—have steadily limited clinician flexibility, autonomy, and the time they can dedicate to caring for patients. Elizabeth Carpenter-Song looks at positive doctor-patient relationships in mental health care settings and finds that the most successful of these are based on mutual “recognition”—patients who can express their concerns and clinicians who validate them. In the book’s final essay, Hannah, Good, and Park show how navigating the maze of insurance regulations, financial arrangements, and paperwork compromises the effectiveness of mental health professionals seeking to provide quality care to minority and poor patients.

Rapidly increasing diversity on one hand and bureaucratic regulations on the other are two realities that have made providing culturally sensitive care even more challenging for doctors. Few opportunities exist to go inside the world of medical and mental health clinics and see how these realities are influencing patient care. Shattering Culture provides a rare look at the day-to-day experiences of psychiatrists and other clinicians and offers multiple perspectives on what culture means to doctors, staff, and patients and how it shapes the practice of medicine and psychiatry.

MARY-JO DELVECCHIO GOODis professor of social medicine at Harvard Medical School and teaches in the Department of Sociology at Harvard University, in addition to being a faculty affiliate of the Asia Center, the Center for Middle Eastern Studies, and the Weatherhead Center for International Affairs.

SARAH S. WILLEN is assistant professor of anthropology at the University of Connecticut.

SETH DONAL HANNAH is lecturer on sociology at Harvard University.

KEN VICKERY is director of external fellowships at the University of Illinois, Urbana-Champaign.

LAWRENCE TAESENG PARK assistant professor of psychiatry at Massachusetts General Hospital.

CONTRIBUTORS: Antonio Bullon, Joseph D. Calabrese,  Elizabeth Carpenter-Song,  Sadeq Rahimi, Lisa Stevenson, Marina Yaroshenko.  

During his winning presidential campaign, Barack Obama promised to counter rising economic inequality and revitalize America’s middle-class through a series of wide-ranging reforms. His transformational agenda sought to ensure affordable healthcare; reform the nation’s schools and make college more affordable; promote clean and renewable energy; reform labor laws and immigration; and redistribute the tax burden from the middle class to wealthier citizens. The Wall Street crisis and economic downturn that erupted as Obama took office also put U.S. financial regulation on the agenda. By the middle of President Obama’s first term in office, he had succeeded in advancing major reforms by legislative and administrative means. But a sluggish economic recovery from the deep recession of 2009, accompanied by polarized politics and governmental deadlock in Washington, DC, have raised questions about how far Obama’s promised transformations can go. Reaching for a New Deal analyzes both the ambitious domestic policy of Obama’s first two years and the consequent political backlash—up to and including the 2010 midterm elections.

Reaching for a New Deal opens by assessing how the Obama administration overcame intense partisan struggles to achieve legislative victories in three areas—health care reform, federal higher education loans and grants, and financial regulation. Lawrence Jacobs and Theda Skocpol examine the landmark health care bill, signed into law in spring 2010, which extended affordable health benefits to millions of uninsured Americans after nearly 100 years of failed legislative attempts to do so. Suzanne Mettler explains how Obama succeeded in reorienting higher education policy by shifting loan administration from lenders to the federal government and extending generous tax tuition credits. Reaching for a New Deal also examines the domains in which Obama has used administrative action to further reforms in schools and labor law. The book concludes with examinations of three areas—energy, immigration, and taxes—where Obama’s efforts at legislative compromises made little headway.

Reaching for a New Deal combines probing analyses of Obama’s domestic policy achievements with a big picture look at his change-oriented presidency. The book uses struggles over policy changes as a window into the larger dynamics of American politics and situates the current political era in relation to earlier pivotal junctures in U.S. government and public policy. It offers invaluable lessons about unfolding political transformations in the United States.

THEDA SKOCPOL is Victor S. Thomas Professor of Government and Sociology at Harvard University.

LAWRENCE R. JACOBS is the Walter F. and Joan Mondale Chair for Political Studies and Director of the Center for the Study of Politics and Governance in the Hubert H. Humphrey Institute and Department of Political Science at the University of Minnesota.

CONTRIBUTORS:  Andrea Louise Campbell, Daniel Carpenter, Judith A. Layzer,  Lorraine M. McDonnell, Suzanne Mettler,  John D. Skrentny,  Dorian T. Warren.    

An insightful chronicle of the changing public health demands in New York City.

The first permanent Board of Health in the United States was created in response to a cholera outbreak in New York City in 1866. By the mid-twentieth century, thanks to landmark achievements in vaccinations, medical data collection, and community health, the NYC Department of Health had become the nation’s gold standard for public health. However, as the city’s population grew in number and diversity, the department struggled to balance its efforts between the treatment of diseases—such as AIDS, tuberculosis, and West Nile Virus—and the prevention of illness-causing factors like lead paint, heroin addiction, homelessness, smoking, and unhealthy foods. In Epidemic City, historian of public health James Colgrove chronicles the challenges faced by the health department since New York City’s mid-twentieth-century “peak” in public health provision. This insightful volume draws on archival research and oral histories to examine how the provision of public health has adapted to the competing demands of diverse public needs, public perceptions, and political pressure.

Epidemic City analyzes the perspectives and efforts of the people responsible for the city’s public health from the 1960s to the present—a time that brought new challenges, such as budget and staffing shortages, and new threats like bioterrorism. Faced with controversies such as needle exchange programs and AIDS reporting, the health department struggled to maintain a delicate balance between its primary focus on illness prevention and the need to ensure public and political support for its activities. In the past decade, after the 9/11 attacks and bioterrorism scares partially diverted public health efforts from illness prevention to threat response, Mayor Michael Bloomberg and Health Commissioner Thomas Frieden were still able to pass New York’s Clean Indoor Air Act restricting smoking and significant regulations on trans-fats used by restaurants. This legislation—preventative in nature much like the department’s original sanitary code—reflects a return to the nineteenth century roots of public health, when public health measures were often overtly paternalistic. The assertive laws conceived by Frieden and executed by Bloomberg demonstrate how far the mandate of public health can extend when backed by committed government officials.

Epidemic City provides a compelling historical analysis of the individuals and groups tasked with negotiating the fine line between public health and political considerations. By examining the department’s successes and failures during the ambitious social programs of the 1960s, the fiscal crisis of the 1970s, the struggles with poverty and homelessness in the 1980s and 1990s, and in the post-9/11 era, Epidemic City shows how the NYC Department of Health has defined the role and scope of public health services for the entire nation.

JAMES COLGROVE is associate professor in the Center for the History and Ethics of Public Health at Columbia University’s Mailman School of Public Health.

Read an interview with James Colgrove here.

Today, one third of all American babies are born to unmarried mothers—a startling statistic that has prompted national concern about the consequences for women, children, and society. Indeed, the debate about welfare and the overhaul of the federal welfare program for single mothers was partially motivated by the desire to reduce out of wedlock births. Although the proportion of births to unwed mothers has stopped climbing for the first time since the 1960s, it has not decreased, and recent trends are too complex to attribute solely to policy interventions. What are these trends and how do they differ across groups? Are they peculiar to the United States, or rooted in more widespread social forces? Do children of unmarried mothers face greater life challenges, and if so what can be done to help them? Out of Wedlock investigates these questions, marshalling sociologists, demographers, and economists to review the state of current research and to provide both empirical information and critical analyses.

Out of Wedlock employs a wealth of data, including the age, race, education, and other life circumstances of unwed mothers, and draws telling comparisons with other industrialized nations. Other nations have also experienced sharp increases in nonmarital fertility, but their births largely occur among cohabiting couples. Unwed mothers in the United States tend to be younger, less educated, from minority backgrounds, and to be living separately from their child's father. These trends may help explain the high rate of childhood poverty in this country. Out of Wedlock also examines such issues as the role of child support in providing income to children born outside of marriage, as well as the social and emotional outcomes for children of unwed mothers from infancy through early adulthood.

The conflicting data on nonmarital fertility give rise to a host of vexing theoretical, methodological, and empirical issues, some of which researchers are only beginning to address. Out of Wedlock breaks important new ground, bringing clarity to the data and examining policies that may benefit these particularly vulnerable children.

LAWRENCE L. WU is professor of sociology at the University of Wisconsin, Madison.

BARBARA WOLFE is professor of economics, public affairs, and preventive medicine at the University of Wisconsin, Madison.

CONTRIBUTORS:
Judi Bartfeld, Larry Bumpass, Andrew Cherlin, John Ermisch, Deborah DeGrafe, Michael Foster, Irwin Garfinkel, Robert Haveman, Saul Hoffman, Theodore Joyce, Robert Kaestner, Kelleen Kaye, Kathleen Kiernan, Sanders Korenman, Daniel Lichter, Lee Lillard, Shelley Lundberg, Sara McLanahan, Daniel Meyer, Robert Moffitt, Kelly Musick, Constantijn Panis, Karen Pence, Nancy Reichman, Julien Teitler, Dawn Upchurch, Barbara Wolfe, Lawrence Wu

America's current system of health insurance, which relies almost exclusively on employer-sponsored coverage, is in danger of collapse, and this problem is not limited to the poor and working class. An increasing number of middle class Americans do not have employer-provided insurance and—due to skyrocketing premiums—cannot afford to purchase coverage for themselves. Reinsuring Health, by economist Katherine Swartz, examines this growing national crisis and outlines a concrete plan to make health insurance accessible and affordable for all Americans.

Reinsuring Health documents why the number of uninsured Americans—now 45.5 million people—has grown in the last twenty-five years. Swartz focuses on how labor market changes—such as the decline of domestic manufacturing, decreased unionization, and the growth of non-standard work arrangements—have led U.S. employers to retreat from providing health insurance for their workers. These trends, combined with the increasing costs of medical care, have led to an explosion in health insurance premiums and a decline in coverage, particularly among the middle-class. Since those who seek insurance as individuals are generally most likely to need health care, private insurers charge higher premiums in the individual (non-group) markets than to people who obtain group insurance. This makes individual health insurance less attractive to the young and increasingly unaffordable for middle-class Americans. Similarly, insurers charge higher per person (or per family) premiums to small firms than to large companies, so many small firms do not sponsor coverage for their employees. Reinsuring Health shows how these problems can be overcome if the federal government provides a new reinsurance program which would protect insurance companies that provide small group and individual health insurance against the possibility that their policy-holders will incur very high medical expenses. By assuming some of the risk that people will face extremely costly medical bills, the government will make insurers less hesitant to offer coverage to high-risk individuals, and will help drive down premiums for others. Reinsuring Health demonstrates that this form of government reinsurance has worked in the past, helping to establish smooth running private markets for catastrophe insurance and secondary mortgages.

Today, growing numbers of middle class Americans lack health insurance. Protection against the possibility of falling ill or getting hurt and having to pay extraordinary health care bills should not be a luxury available only to the very rich and the very poor. Reinsuring Health proposes a straightforward solution that would bring health insurance back within the reach of the increasing ranks of the uninsured, particularly those who are in the middle class.

KATHERINE SWARTZ is professor of health policy and management at the School of Public Health, Harvard University

This work is the fifth in a series of bulletins on the applications of sociology to various fields of professional practice prepared under the joint sponsorship of the American Sociological Association and the Russell Sage Foundation. Previous bulletins have dealt with applications of sociology in the fields of corrections, mental health, education, and military organization.

Dr. Suchman has performed an important service in his clear delineation of the great potential sociology and related disciplines have for sharpening our understanding of the social factors in health and disease, for intelligent planning and mounting of appropriate action programs, and for improving the organizational structure and institutional mechanisms of the health professions themselves.

EDWARD A. SUCHMAN is professor of sociology at the University of Pittsburgh.

Over the past three decades, the contours of American social, economic, and political life have changed dramatically. The post-war patterns of broadly distributed economic growth have given way to stark inequalities of income and wealth, the GOP and its allies have gained power and shifted U.S. politics rightward, and the role of government in the lives of Americans has changed fundamentally. Remaking America explores how these trends are related, investigating the complex interactions of economics, politics, and public policy.

Remaking America explains how the broad restructuring of government policy has both reflected and propelled major shifts in the character of inequality and democracy in the United States. The contributors explore how recent political and policy changes affect not just the social standing of Americans but also the character of democratic citizenship in the United States today. Lawrence Jacobs shows how partisan politics, public opinion, and interest groups have shaped the evolution of Medicare, but also how Medicare itself restructured health politics in America. Kimberly Morgan explains how highly visible tax policies created an opportunity for conservatives to lead a grassroots tax revolt that ultimately eroded of the revenues needed for social-welfare programs. Deborah Stone explores how new policies have redefined participation in the labor force—as opposed to fulfilling family or civic obligations—as the central criterion of citizenship. Frances Fox Piven explains how low-income women remain creative and vital political actors in an era in which welfare programs increasingly subject them to stringent behavioral requirements and monitoring. Joshua Guetzkow and Bruce Western document the rise of mass incarceration in America and illuminate its unhealthy effects on state social-policy efforts and the civic status of African-American men.

For many disadvantaged Americans who used to look to government as a source of opportunity and security, the state has become increasingly paternalistic and punitive. Far from standing alone, their experience reflects a broader set of political victories and policy revolutions that have fundamentally altered American democracy and society. Empirically grounded and theoretically informed, Remaking America connects the dots to provide insight into the remarkable social and political changes of the last three decades.

JOE SOSS is the Cowles Professor for the Study of Public Service at the Hubert H. Humphrey Institute of Public Affairs, University of Minnesota.

JACOB S. HACKER is professor of political science at Yale University and resident fellow of the Institution for Social and Policy Studies.

SUZANNE METTLER is Clinton Rossiter Professor of American Institutions in the Government Department at Cornell University.

CONTRIBUTORS:  Andrea Louise Campbell, Richard B. Freeman, Joshua Guetzkow, Jennifer Hochschild,  Helen Ingram,  Lawrence R. Jacobs,  R. Shep Melnick,  Kimberly J. Morgan,  Frances Fox Pivens,  Paul Pierson,  Joel Rogers,  Sanford F. Schram,  Deborah Stone,  Vasla Weaver,  Bruce Western.  

After acts of airline terrorism, air travel tends to drop dramatically—yet Americans routinely pursue the far riskier business of driving cards, where accidents resulting in death or injury are much more likely to occur. Reporting on Risk argues that this selective concern with danger is powerfully shaped by the media, whose coverage of potentially hazardous events is governed more by a need to excite the public than to inform it.

Singer and Endreny survey a wide range of print and electronic media to provide an unprecedented look at how hundreds of different hazards are presented to the public—from toxic waste and food poisoning to cigarette smoking, from transportation accidents to famine, and from experimental surgery to communicable diseases. Their investigations raise thought-provoking questions about what the media tell us about modern risks, which hazards are covered and which ignored, and how the media determine when hazards should be considered risky. Are natural hazards reported differently than man-made hazards? Is greater emphasis placed on the potential benefits or the potential drawbacks of complex new technologies? Are journalists more concerned with reporting on unproven cures or informing the public about preventative measures? Do newspapers differ from magazines and television in their risk reporting practices?

Reporting on Risk investigates how the media place blame for disasters, and looks at how the reporting of risks has changed in the past twenty-five years as such hazards as nuclear power, birth control methods, and industrial by-products have grown in national prominence. The authors demonstrate that the media often fail to report on risks until energized by the occurrence of some disastrous or dramatic event—the Union Carbide pesticide leak in Bhopal, the Challenger explosion, the outbreak of famine in Somalia, or the failed transplant of a baboon heart to "Baby Fae." Sustained attention to these hazards depends less on whether the underlying issues have been resolved than on whether they continue to unfold in newsworthy events.

Reporting on Risk examines the accuracy and the amount of information we receive about our environment. It offers a critical perspective on how our perceptions of risk, as shaped by the media, may contribute to misguided individual and public choices for action and prevention in an increasingly complex world. The authors' probing assessment of how the media report a vast array of risks offers insights useful to journalists, policy analysts, risk specialists, legislators, and concerned citizens.

ELEANOR SINGER is senior research scholar at the Center for the Social Sciences, Columbia University, and social science analyst with the U.S. Bureau of the Census.

PHYLLIS M. ENDRENY is social research consultant in Chicago, and was previously assistant professor of mass communications and mass media at the University of Illinois at Chicago.

The United States spends billions of dollars annually on social and economic policies aimed at improving the lives of its citizens, but the health consequences associated with these policies are rarely considered. In Making Americans Healthier, a group of multidisciplinary experts shows how social and economic policies seemingly unrelated to medical well-being have dramatic consequences for the health of the American people.

Most previous research concerning problems with health and healthcare in the United States has focused narrowly on issues of medical care and insurance coverage, but Making Americans Healthier demonstrates the important health consequences that policymakers overlook in traditional cost-benefit evaluations of social policy. The contributors examine six critical policy areas: civil rights, education, income support, employment, welfare, and neighborhood and housing. Among the important findings in this book, David Cutler and Adriana Lleras-Muney document the robust relationship between educational attainment and health, and estimate that the health benefits of education may exceed even the well-documented financial returns of education. Pamela Herd, James House, and Robert Schoeni discover notable health benefits associated with the Supplemental Security Income Program, which provides financial support for elderly and disabled Americans. George Kaplan, Nalini Ranjit, and Sarah Burgard document a large and unanticipated improvement in the health of African-American women following the enactment of civil rights legislation in the 1960s.

Making Americans Healthier presents ground-breaking evidence that the health impact of many social policies is substantial. The important findings in this book pave the way for promising new avenues for intervention and convincingly demonstrate that ultimately social and economic policy is health policy.
 

ROBERT F. SCHOENI is professor of public policy and economics, the University of Michigan.

JAMES S. HOUSE is Angus Campbell Collegiate Professor of Sociology and Survey Research, the University of Michigan.

GEORGE A. KAPLAN is the Thomas Francis Collegiate Professor of Public Health, the University of Michigan.

HAROLD POLLACK is associate professor of social service administration, University of Chicago.

CONTRIBUTORS: Marianne P. Bitler, Jeanne Brooks-Gunn, Sarah A. Burgard, Janet Currie, David M. Cutler, Rebecca C. Fauth, Irv Garfinkel. Ben B. Hansen, Pamela Herd, Hilary Hoynes, Daniel Keating, Jean Knab, Adriana Lleras-Muney, Sara McLanahan, Jeffrey D. Morenoff, Enrico Moretti, Theresa L. Osypuk, Richard H. Price,  Nalini Ranjit, Ana V. Diez Roux, Christopher J. Ruhm, Sharon Z. Simonton.

A Volume in the National Poverty Center Series on Poverty and Public Policy