Rachel's Democracy & Health News #874
"Environment, health, jobs and justice--Who gets to decide?"
Thursday, September 28, 2006............Printer-friendly version
www.rachel.org -- To make a secure donation, click here.
^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^ Featured stories in this issue... The Health of U.S. Citizens Is Poor and Declining The health of U.S. citizens is abysmally poor, compared to that of other wealthy, industrialized societies. When we look for causes, we often don't examine the real fundamentals -- the "social determinants of health." These "social determinants" are, in turn, created or modified by specific public policies. This week and next we depart somewhat from our usual journalistic approach to offer this important new statement on the poor health of U.S. citizens and the public policies that lie behind the shocking numbers. The statement is framed as a challenge to the public health community in the U.S. Our Billionaire Bunch The 400 exceedingly wealthy individuals on the annual Forbes list now hold, as a group, nearly as much wealth as the poorer half of America's households. This has real consequences for public health. Intersex Fish Raises Pollution Concerns in U.S. The cleanup of the Potomac River has long been considered one of the nation's great success stories. Ever since Lady Bird Johnson made it a priority in the 1960s, the Potomac has been getting cleaner. Now, new evidence indicates that perhaps we were measuring success incorrectly. The Ascent of Wind Power "Wind power may still have an image as something of a plaything of environmentalists more concerned with clean energy than saving money. But it is quickly emerging as a serious alternative not just in affluent areas of the world but in fast-growing countries like India and China that are avidly seeking new energy sources." :::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::: From: Rachel's Democracy & Health News #874, Sept. 28, 2006 [Printer-friendly version] THE HEALTH OF U.S. CITIZENS IS POOR AND DECLINING Is the Public Health Community Prepared to Become Involved? By Dennis Raphael [Editors' introduction: Dr. Dennis Raphael is a professor in the School of Health Policy and Management, York University, Toronto. In recent years he has edited two volumes on the social determinants of health -- Staying Alive: Critical Perspectives on Health, Illness, and Health Care (2006), and The Social Determinants of Health: Canadian Perspectives (2004). He is the author of Inequality is Bad for Our Hearts; Why Low Income and Social Exclusion are Major Sources of Heart Disease in Canada (2001). If you have a high-speed internet connection, you can see and hear Dr. Raphael delivering an interesting lecture. If you are not familiar with the concept of "social determinants of health," you might read this short article in Wikipedia. In manuscript, this article was originally titled, "Public Policies Drive the Deteriorating Population Health Profile in the USA."] Introduction International interest in the social determinants of health represents yet another cycle of recognition of the importance of structural determinants of health that began in earnest in the 1850's (1, 2). Yet, recent waves of concern with structural determinants of health appear to have bypassed the mainstream American public health community (3-5). Analysis of how early life, education, employment and working conditions, food security, housing, income and its distribution, and unemployment and employment security (6) shape health and creates health inequalities seem especially timely as the USA presents one of the worse population health profiles among wealthy developed nations and one of the most undeveloped public policy environments in support of health (7, 8). These public policy issues concern income distribution, employment security and working conditions, and quality of the social infrastructure in support of health. Despite evidence that the USA has become a striking outlier among wealthy developed nations in its population health and public policy profiles, the USA public health community is taking only cautious steps towards addressing the structural antecedents of health and disease (4, 9) . And when the social determinants of health concept is explored the analyses are typically narrow and strangely depoliticized (10-13). Public policy antecedents of health determinants such as family, labor, tax, social assistance, and taxation policy, as examples, are rarely mentioned and when they are, are done in a rather perfunctory manner (14, 15). Resignation that progressive public policy change in support of health in the USA is unlikely is frequently a message conveyed in these analyses (16-19). What roles could the public health community play in this effort and how likely is it that these efforts could succeed? Social Determinants of Health The renewed focus on social determinants of health (6, 20-25) grew out of efforts by UK researchers to identify the specific exposures by which members of different socio-economic groups come to experience varying degrees of health and illness (26). It is no accident that the term social determinants of health made its contemporary appearance during the Thatcher era in a UK volume concerned with policy, social organization, and health (27). The concept struck a responsive chord in many wealthy industrialized nations where growing income and wealth inequalities, the weakening of the welfare state, and increasing evidence of social exclusion were causes for concern (28-30). The social determinants of health concept failed to gain much traction within the USA pubic health community even though the growth in income and wealth inequalities since the 1980's has been greater than any other wealthy developed nation (8). Despite sporadic mention of the concept in various American academic articles (10, 14, 31, 32), the USA public health community gaze is firmly focused on rather narrow issues of identifying racial and ethnic disparities, health care access, and behavioral risk factors rather than structural issues concerned with the distribution of economic and social resources (4, 33). When the social determinants of health are considered, these are strangely de-politicized such that their public policy antecedents are rarely mentioned and certainly not criticized through a consistent political analyses. The key exceptions to this trend include the work of Smeeding and Rainwater who have labored over the years to raise issues of poverty, income distribution, and service distribution, their public policy antecedents, and their implications for health (8, 34-36). Similarly, the recent volume by Hofrichter brought together much of the sparse literature on the structural determinants of population health in the USA (37). See also Alesina and Glaeser, (38), Rank (39), Kawachi and Kennedy (40), Brooks-Gunn (41) and Auerbach and colleagues (42) and work on income and wealth inequality by numerous non-governmental organizations (43-46). At the same time the public health community gazes on ethnic and racial disparities, access to health care, and behavioral risk factors, the public policy environment in support of health deteriorates (43, 47-49). Much of this has to do with the neo-liberal and neo-conservative resurgence that began in earnest during the Reagan presidency which coincided -- and was incompatible -- with growing international interest in structural approaches to health promotion (50). Now, 20 years after the Reagan Revolution led to astounding increases in income and wealth inequality, the dismantling of much of the American welfare state, and hardening public attitudes towards governmental provision of services, the public health community is taking cautious steps towards addressing structural determinants of health. How likely are these efforts to be successful? Within most nations, social class, occupational status, and income are analyzed as key issues that interact with public policy approaches to resource distribution and service provision to shape health inequalities and population health (28, 51, 52). Social stratification interacts with public policy to produce differential exposures to societal resources that shape health (53, 54). In the USA however, issues of social class, occupational position, and income take a back seat to analysis of "racial and ethnic disparities" in health (4). Indeed, discussion of resource distribution including income and general social provision as determinants of health is clearly undeveloped in the USA. Analysis of social stratification and social class as health determinants is even less so (42, 55-57).The reasons for this and the impact this focus has on public health researchers and workers' activities in the service of health are discussed below. The USA Population Health Profile The social determinants of health and their public policy antecedents are especially relevant to the USA as its health profile is especially poor in relation to other wealthy industrialized nations. For the following indicators of population health of a nation, a rank of 1 is best, with increasing rank indicating poorer relative performance as compared to the wealthy industrialized nations of the Organization for Economic Cooperation and Development (OECD). Life Expectancy In 2002, life expectancy for American males was 74.4 years, and for women, 79.8 years providing a relative rank of 22nd of 30 wealthy developed nations for men; and 25th of 30 for women (7). The average life expectancy increase in the USA of 7.2 years from 1960 to 2002 was well below the OECD average of 9.2 years giving the USA a rank of 22nd of 30 nations. Infant Mortality Rate In 2002, the USA's 2002 rate of 6.8/1000 gives it a rank of 25th of the 29 wealthy industrialized nations for which these data are available (7). Low Birthweight Rate In 2003 the USA's low birthweight rate was 7.9 per 100 newborns giving it a ranking of 25th of 28 wealthy industrialized nations for which these data were available (7). Childhood Death by Injury Rate During the period 1991-1995, 14.1 American children per 100,000 died from injuries giving the USA a ranking of 23rd of 26 wealthy industrialized nations (58). Child Maltreatment Deaths During the 1990's the incidence of childhood death by maltreatment per 100,000 children in the USA was 2.2 per 100,000 (59). This gave the USA an overall rank of 26th of 27 wealthy industrialized nations. A ranking that takes into account "undetermined intent" raises the USA's rate to 2.4 per 100,000 and a relative ranking of 25th of 27. Teenage Pregnancy Rate The USA's rate during the 1990's of 51.1 births to 1000 women below 20 years of age gives it a rank of 28th of 28 wealthy industrialized nations. These rates are exceptionally high -- 21 points higher than the nearest nation, the UK. To summarize, the USA shows a very poor population health profile on a variety of health indicators. It does poorly on male and female life expectancy, infant mortality rank, low birthweight rate, deaths from child injury and child maltreatment. Poverty as a Health Determinant: USA Rates in International Perspective Poverty is increasingly seen as the greatest threat to human development and a nation's quality of life (60, 61). The experience of poverty also results in -- as well as contributes to -- social exclusion, a process identified by the European Union and the World Health Organization as the primary threat to the smooth functioning of developed societies (62, 63). Where does the USA stand on this indicator? Overall National Poverty Rates and Poverty Gaps Using the internationally agreed-upon convention of poverty as the percentage of individuals with disposable income less than 50% of the median income of the population, the USA's overall poverty rate for the mid 1990's was 16.6% (7). By 2000 it had increased to 17.0% which was well above the OECD average of 10.2%. The USA's relative rank in this important rating was 26th of 27 wealthy industrialized nations. In terms of the gap between the average incomes of those living in poverty and the median income of the population, the USA's gap of 34.3% is above the OECD average of 27.7%, providing a rank of 23rd of 27. Child Poverty -- Relative and Absolute Rates During the late 1990s, the USA's relative child poverty rate of 22.4% gave it a ranking of 22nd of 23 wealthy industrialized nations (64). These rates can be compared with those seen for the Nordic nations (Denmark, 5.1%; Finland, 4.3%; Norway, 3.9%; and Sweden, 2.6%), Belgium (4.4%); and Luxembourg (4.5%). Absolute child poverty rates are generated by applying the USA poverty standard to other nations adjusting for national currencies and national purchasing power. The USA poverty standard is set very low and is usually seen as an indicator of very limited resources associated with serious material and social deprivation (64). The USA's rate of 13.9% places it 11th of 19 nations for whom these data were available. The Nordic nations also have very low absolute poverty rates (Sweden, 5.3%; Norway, 3%; Denmark, 5.1%; Finland, 6.9%), Belgium (7.5%), and Luxembourg (1.2%) thereby maintaining their low rankings on both kinds of poverty indicators. Recent Analyses from the Luxembourg Income Study (LIS) How does the very high level of poverty in the USA come about? An analysis of LIS data by Smeeding provides insights into this process among 11 wealthy developed nations (36). These nations represent four Anglo-Saxon nations, Canada, Ireland, United Kingdom, and the USA; four central European nations, Austria, Belgium, Germany, and the Netherlands; one Southern European nation, Italy; and two Nordic nations, Finland and Sweden. These analyses highlight how public policy determines poverty rates. Poverty rates are based on the international convention of a poverty cut-off of less than 50% of median adjusted disposable income for individuals. The USA's overall poverty rate of 17% places it as the highest of these 11 nations. For USA children living in single parent households the poverty rate is a striking 41.4%, almost four times the rate for Swedish children living in this situation and almost six times the rate for Finnish children. The situation for USA elders does not fare much better. The USA's elder poverty rate of 28.4% is the second highest among these nations exceeded only by the strikingly high rate of 48.3% seen in Ireland. Similarly, the USA's poverty rate for childless adults is at 18.8%, exceeding every nation. Have USA rates changed over time? Smeeding compares overall poverty rates for each nation over a 23 year period from the base year of 1987 to 2000. In 1987, the relative poverty rate for the USA was 17.8%. For 2000 he provides two rates. The 2000 relative rate applies the same calculation to 2000 as applied in 1987: the poverty line as less than 50% of the median disposable income for all residents. For the USA, the relative poverty rate in 2000 was 17% showing little change form 1987. The anchored rate refers to the percentage of Americans in 2000 living below the poverty line as it was calculated in 1987 and adjusted for increases in the cost of living since that time. In the USA, this figure is 13.8%. There has been therefore some improvement in the actual income of those at the bottom, but in relative terms poverty rates in USA are virtually unchanged from 1987 to 2000. Poverty rates are shaped by government spending programs. Market income refers to income derived from gainful employment or investments and other private sources. Relying upon the market as the source of income provides rather high overall poverty rates across all nations. The USA's poverty rate based on market income is lower than most nations. Social insurance and taxes -- referring to transfers such as child benefits and children's allowances and changes in distribution resulting from taxation -- reduces the USA's poverty rate to 19.3%. The USA's poverty rate associated with the provision of a few more varied benefits -- called social assistance -- further reduces the poverty rate to 17.0%. What is the calculated effect on poverty rates of these government programs? In the USA, social insurance programs reduce the poverty rate by 16.5% and all programs reduce it by 26.4% which is the smallest amount among these nations. In contrast, the overall reduction rate is 60.9% for the nations included in this analysis. Indeed, Sweden reduces its poverty rate by 77.4% by such actions. Belgium, Germany, Austria, and Finland also reduce their overall poverty rate by at least 70% through government action. The USA expends a miserly 2.3% of Gross Domestic Product (GDP) on non-elderly citizens. In contrast, Finland and Sweden spend over 10% of GDP on citizen benefits. The importance of government expenditures in reducing poverty is illustrated by an analysis that reveals that non-elderly cash and near-cash (e.g., housing subsidies, active labor market subsidies, etc.) predict 61% of the variation among these nations' non-elderly poverty rates. Nations that spend more money on these benefits have lower poverty rates. Nations that spend less have higher poverty rates. Smeeding also shows that the percentage of low-paid workers is strongly related to the percentage of non-elderly citizens within a nation living in poverty (36). The USA has 25% of its workers identified as earning less than 65% of the median wage and a poverty rate of 17.8%. In contrast only 5% of Finnish and Swedish workers earn low wages and their poverty rates are 4.5% and 6% respectively. These variations in numbers of low paid workers accounts for a strikingly high 85% of the variation among nations in the number of people living in poverty. In essence, the single best predictor of the number of people living in poverty in a nation is the number of people earning low wages. This begs the question of why so many USA workers are low-paid, an issue discussed in following sections. Nations that transfer less resources to citizens are more likely to have higher levels of poverty -- and as other evidence shows -- poorer population health profiles (65-67). Nations that tolerate greater proportions of low-paid workers have higher poverty rates and the associated population health consequences. The next sections explore the nature of these differences in governmental support of citizens through transfers and programs. USA Public Policy in Perspective Health inequalities and population health profiles associated with these inequalities result from systematic variations in approaches to public policy (68, 69). Commonly termed the welfare state, this basket of public policies serves to promote human, social and economic development, reduce citizen uncertainty, and foster health and well-being. This political economy of health is well developed in Europe, much less so in North America (70, 71). It is especially undeveloped in the USA. Societal Commitments to Citizens and Governmental Spending Public commitment to supporting citizens is seen in percentage of Gross Domestic Product (GDP) transferred to citizens through programs, services, or cash benefits. Nations may choose to transfer relatively small amounts, allowing the marketplace to serve as the primary arbiter of how economic resources are distributed (72). Or a nation may choose to intervene to control the marketplace and make decisions concerning these allocations of resources (73). Nations that transfer a greater proportion of resources are more likely to show better population health profiles, and relatively less health inequalities (67). These health and inequality differences emerge through a series of mechanisms that involve degree of poverty and the material and social deprivation that are associated with such levels (65). An especially important indicator is extent of government transfers. Transfers refer to governments taking fiscal resources that are generated by the economy and distributing them to the population as services, monetary supports, or investments in social infrastructure. Such infrastructure includes education, employment training, social assistance or welfare payments, family supports, pensions, health and social services, and other benefits (7). Among the developed nations of the OECD, the average public expenditures in 2001 was 21% of Gross Domestic Product (GDP) (74). There is rather large variation among countries with Denmark (spending 29.2% of GDP) and Sweden (spending 28.9% of GDP) being the highest public spenders. The USA ranks 26th of 30 wealthy industrialized nations and spends just 14.8% of GDP on public expenditures. The only nations that allocate a smaller percentage of GDP to public expenditure are Ireland (13.8%); Turkey (13.2%); Mexico (11.8%); and Korea (6.1%). The USA is the highest spender on total expenditure on health care. However, it is in the mid-range on public spending for health care as much of its spending on health care is from private sources. It is in the other areas of benefits and supports to citizens that the USA reveals itself as a very frugal public spender. The USA ranks near the bottom of nations in allocations to old-age related spending, primarily pensions with a rank of 26th of 30 wealthy industrialized nations. The USA also ranks among the lowest spenders on incapacity or disability-related issues for a rank of 25th of 29 wealthy industrialized nations. And the USA ranks very poorly on family benefits achieving a rank of 28th of 29 of these wealthy industrialized nations. Another way to slice up the expenditure pie is to consider spending on income support to the working age population and social services as well as health and pensions. Income support involves family benefits, wage subsidies, and child support paid by governments to help keep low-income individuals and families out of poverty. Social services include counseling, employment supports, and other community services. Not surprisingly, the USA ranks relatively low on income supports to the working-aged population and social services. The USA spends just 7.9% of GDP in income supports to the working age population (rank 28th of 30) and 6.7% on social services (rank 20th of 30). Active Labor Policy Active labor policy refers to the extent that governments support training and other policies that foster employment and reduce unemployment. The USA allocates 0.53% of GDP to such policies. This provides it with a ranking of 20th of 22 wealthy industrialized nations for which data was available. Public Policy and Citizen: Implications for Day-to-Day Life How do these differing commitments to supporting citizens translate into differing conditions of day-to-day life? Only a few sets of issues can be examined here: resources available to the unemployed, level of social assistance benefits, level of minimum wages, and levels of pension benefits. Unemployment Benefits over a Five Year Period for an Average Production Worker For most Americans, benefits that would be available over a five year period would be unemployment insurance which would expire after a year of benefits. A family with liquid assets would then need to liquidate these prior to receiving social assistance benefits. For these non- destitute families, unemployment insurance provides only 6% replacement income over this period. This ranks the USA 27th of 28 wealthy industrialized nations in its generosity of benefit. If families did qualify for social assistance, the benefit percentage would be 30%, providing a ranking of 26th of 28 nations (7). Social Assistance or Welfare The OECD identifies as social assistance and welfare support as "benefits of last resort." On average, USA social assistance benefits for a married couple with two children provide 22% of median average income. This places these benefits as 28% less than the <50% of median income-indicator of poverty. As compared to the other nations for which these data are provided, the USA ranks 20th of 23 nations in providing these benefits of last resort (7). Minimum Wages Percentage of low-paid workers is the best predictor of percentage of citizens living in poverty. How does the USA compare to other nations in having minimum wages that keep people out of poverty? For an American two-child family with one full-time minimum wage earner, the wages received places the family at 34% of the median household income, well below the commonly accepted poverty cut-off of 50% of median poverty level (7). For a two-parent family with two children working full-time at minimum wages, the level of median income achieved is 46% of the poverty level. The USA's ranking for single parent working family is 12th of 15 wealthy industrialized nations. For the two-parent working family, the USA rank is 14th of 15. Pensions The Social Security System provides benefits to individuals upon retirement. The OECD provides data on the value of pension benefits provided by each nation as a function of the gross earnings of an average production worker (7). For a worker earning 50% of an average production worker, the USA's pension provides a rate of 61% of these earnings. For an American earning the average production worker's income, the rate is 51%. The rates for average-waged workers are very low by international comparison giving the USA a rank of 25th of 30 wealthy industrialized nations. For very low-paid workers, the USA achieves an even lower rank of 28th of 30. [To be continued next week.] References 1. Engels F. The condition of the working class in England. New York: Penguin Classics; 1845/1987. 2. Virchow R. Report on the Typhus Epidemic in Upper Silesia. In: Rather LD, editor. Collected Essays on Public Health and Epidemiology,. Canton MA: Science History Publications; 1848. p. 205-319. 3. Hofrichter R. The politics of health inequities: Contested terrain. In: Health and Social Justice: A Reader on Ideology, and Inequity in the Distribution of Disease. San Francisco: Jossey Bass; 2003. 4. Raphael D, Bryant T. The State's role in promoting population health: Public health concerns in Canada, USA, UK, and Sweden. Health Policy 2006;79:39-55. 5. Raphael D, Bryant T. The limitations of population health as a model for a new public health. Health Promotion International 2002;17:189-199. 6. Raphael D, editor. Social Determinants of Health: Canadian Perspectives. Toronto: Canadian Scholars Press; 2004. 7. Organization for Economic Cooperation and Development. Society at a Glance: OECD Social Indicators 2005 Edition. Paris, France; 2005. 8. Smeeding T. Public Policy and Economic Inequality: The United States in Comparative Perspective. Syracuse NY: Maxwell School of Citizenship and Public Affairs, Syracuse University; 2004. 9. Raphael D. A society in decline: The social, economic, and political determinants of health inequalities in the USA. In: Hofrichter R, editor. Health and Social Justice: A Reader on Politics, Ideology, and Inequity in the Distribution of Disease. San Francisco: Jossey Bass; 2003. 10. Berkman LF, Lochner KA. Social determinants of health: Meeting at the crossroads. Health Affairs 2002;21(2):291. 11. Huckabee M. A vision for a healthier America: What the states can do. Health Affairs 2006;25(4):1005-1008. 12. Benjamin GC. Putting the public in public health: New approaches. Health Affairs 2006;25(4):1040-1043. 13. McGinnis JM. Can public health And medicine partner In the public interest? Health Affairs 2006;25(4):1044. 14. Gostin LO, Powers M. What does social justice require for the public's health? Public health ethics and policy imperatives. Health Affairs 2006;25(4):1053. 15. Fielding JE, Briss PA. Promoting evidence-based public health policy: Can we have better evidence and more action? Health Affairs 2006;25(4):969-977. 16. Mechanic D. Disadvantage, Inequality and Social Policy. Health Affairs 2002;21(2):48-59. 17. Mechanic D. Rediscovery Of the 'Public' In public health. Health Affairs 2006;25(4):1178-1179. 18. Mechanic D. Policy challenges In addressing racial disparities and improving population health. Health Affairs 2005;24(2):335-338. 19. Mechanic D. Disadvantage, inequality, and social policy. Health Affairs 2002;21(2):48. 20. Marmot M, Wilkinson R. Social Determinants of Health. 2nd ed. Oxford, UK: Oxford University Press; 2006. 21. World Health Organization. WHO to Establish Commission on Social Determinants of Health. In. Geneva: WHO; 2004. 22. Institute of Medicine. The Future of the Public's Health in the 21st Century. Washington DC: National Academies Press; 2002. 23. U.S. Department of Health and Human Services. Healthy people 2010: Understanding and improving health. Washington DC: U.S. Department of Health and Human Services; 2000. 24. Minnesota Department of Health. A Call to Action: Advancing Health for All Through Social and Economic Change. In. St. Paul, MN: Minnesota Department of Health; 2001. 25. Turning Point. States of change: Stories of transofromation in public health. Seattle, WA: Robert Woods Johnson Foundation; 2004. 26. Townsend P, Davidson N, Whitehead M, editors. Inequalities in Health: the Black Report and the Health Divide. New York: Penguin; 1992. 27. Tarlov A. Social determinants of health: The sociobiological translation. In: Blane D, Brunner E, Wilkinson R, editors. Health and Social Organization: Towards a Health Policy for the 21st Century. London UK: Routledge; 1996. 28. Mackenbach J, Bakker M. Tackling socioeconomic inequalities in health: Analysis of European experiences. Lancet 2003;362:1409-1414. 29. Scarth T, editor. Hell and High Water: An Assessment of Paul Martin's Record and Implications for the Future. Ottawa: Canadian Centre for Policy Alternatives; 2004. 30. Madanipour A, Cars G, Allen J. Social Exclusion in European Cities. London: Jessica Kingsley; 1998. 31. Lurie N. What the Federal Government can do About the Nonmedical Determinants of Health. Health Affairs 2002;21(2):94-106. 32. McGinnis JM, Williams-Russo P, Knickman JR. The Case for More Active Policy Attention to Health Promotion. Health Affairs 2002;21(2):78. 33. Nettleton S. Surveillance, health promotion and the formation of a risk identity. In: Sidell M, Jones L, Katz J, Peberdy A, editors. Debates and Dilemmas in Promoting Health. London, UK: Open University Press; 1997. p. 314-324. 34. Rainwater L, Smeeding T. Doing Poorly: The Real Income of American Children in a Comparative Perspective. In: Luxembourg Income Study; 1995. 35. Rainwater L, Smeeding TM. Poor Kids in a Rich Country: America's Children in Comparative Perspective. New York: Russell Sage Foundation; 2003. 36. Smeeding T. Poor People in Rich Nations:The United States in Comparative Perspective. Syracuse: Luxembourg Income Study Working Paper #419. Syracuse University, Syracuse, New York; 2005. 37. Hofrichter R, editor. Health and Social Justice: A Reader on Politics, Ideology, and Inequity in the Distribution of Disease. San Francisco: Jossey Bass; 2003. 38. Alesina A, Glaeser EL. Fighting poverty in the US and Europe: A world of difference. Toronto: Oxford University Press; 2004. 39. Rank MR. One Nation, Underprivileged: Why American Poverty Affects Us All. New York: Oxford University Press; 2004. 40. Kawachi I, Kennedy B. The Health of Nations: Why Inequality Is Harmful to Your Health. New York: New Press; 2002. 41. Brooks-Gunn J, Duncan GJ, Britto PR. Are SES Gradients for Children Similar to Those for Adults? Achievement and Health of Children in the United States. In: Keating DP, Hertzman C, editors. Developmental Health and the Wealth of Nations: Social, Biological and Educational Dynamics. New York: Guilford Press; 1998. 42. Auerbach JA, Krimgold B, editors. Income, Socioeconomic Status, and Health: Exploring the Relationships. Washington, DC: National Policy Association; 2001. 43. Collins C, Hartman C, Sklar H. Divided Decade: Economic Disparity at the Century's Turn. Boston: United for a Fair Economy; 1999. 44. Association of Community Organizations for Reform. ACORN'S Living Wage Web Site. In; 2003. 45. Bernstein J, Brocht C, Spade-Aguilar M. How much is enough: Basic family budgets for working families. Washington DC: Economic Policy Institute; 2000. 46. Mishel L, Bernstein J, Boushey B. The State of Working America 2002/2003. Ithaca: Cornell University Press; 2003. 47. Heymann J. The Work, Family, and Equity Index: Where does the United States Stand Globally? Boston: The Project on Global Working Families; 2004. 48. Brink S, Zeeman A. Measuring Social Well-Being: An Index of Social Health for Canada: Human Resources Development Canada, Applied Research Branch,; 1997. Report No.: Report R-97-9E. 49. Deaton A, Paxson C. Mortality, Income, and Income Inequality Over Time in Britain and the United States: National Bureau of Economic Research; 2001 October. Report No.: NBER Working Paper No.w8534. 50. World Health Organization. Ottawa Charter for Health Promotion. In. Geneva, Switzerland: World Health Organization European Office; 1986. 51. Raphael D, Macdonald J, Labonte R, Colman R, Hayward K, Torgerson R. Researching income and income distribution as a determinant of health in Canada: Gaps between theoretical knowledge, research practice, and policy implementation. Health Policy 2004;72:217-232. 52. Mackenbach J, Bakker M, editors. Reducing Inequalities in Health: A European Perspective. London UK: Routledge; 2002. 53. Diderichsen F, Evans T, Whitehead M. The Social Basis of Disparities in Health. In: Evans T, Whitehead M, Diderichsen F, Bhuiya A, Wirth M, editors. Challenging Inequalities in Health: From Ethics to Action. New York: Oxford University Press; 2001. 54. Muntaner C, Borrell C, Kunst A, Chung H, Benach J, Ibrahim S. Social class inequalities in health: Does welfare state regime matter? In: Raphael D, Bryant T, Rioux M, editors. Staying Alive: Critical perspectives on Health, Illness, and Care. Toronto: Canadian Scholars Press; 2006. 55. Muntaner C. Commentary: Social Capital, Social Class, and the Slow Progress of Psychosocial Epidemiology. International Journal of Epidemiology 2004;33(4):1-7. 56. Navarro V. The politics of health inequlities research in the United States. International Journal of Health Services 2004;34(1):87-99. 57. Oliver MN, Muntaner C. Researching health inequities among African Americans: The imperative to understand social class. International Journal of Health Services 2005;35(3):485-498. 58. Innocenti Research Centre. A league table of child deaths by injury in rich nations. 2001. 59. Innocenti Research Centre. A League Table of Child Maltreatment Deaths in Rich Nations. Florence: Innocenti Research Centre; 2003. 60. Esping-Andersen G. A child-centred social investment strategy. In: Esping-Andersen G, editor. Why we need a new welfare state. Oxford UK: Oxford University Press; 2002. p. 26-67. 61. Esping-Andersen G. Towards the good society, once again? In: Esping-Andersen G, editor. Why we need a new welfare state. Oxford UK: Oxford University Press; 2002. p. 1-25. 62. Percy-Smith J, editor. Policy Responses to Social Exclusion: Towards Inclusion? Buckingham UK: Open University Press; 2000. 63. Galabuzi GE. Social exclusion. In: Raphael D, editor. Social determinants of health: Canadian perspectives. Toronto: Canadian Scholars Press.; 2004. 64. Innocenti Research Centre. A league table of child poverty in rich nations. Florence Italy: Innocenti Research Centre; 2000. 65. Navarro V, Borrell C, Benach J, Muntaner C, Quiroga A, Rodrigues- Sanz M, et al. The importance of the political and the social in explaining mortality differentials among the countries of the OECD, 1950-1998. In: Navarro V, editor. The Political and Social Contexts of Health. Amityville NY: Baywood Press; 2004. 66. Coburn D. Beyond the income inequality hypothesis: Globalization, neo-liberalism, and health inequalities. Social Science & Medicine 2004;58:41-56. 67. Coburn D. Health and Health Care: A Political Economy Perspective. In: Raphael D, Bryant T, Rioux M, editors. Staying Alive: Critical Perspectives on Health, Illness, and Health Care. Toronto: Canadian Scholars Press; 2006. p. 59-84. 68. Navarro V, editor. The Political Economy of Social Inequalities: Consequences for Health and Quality of Life. Amityville, NY: Baywood Press; 2002. 69. Navarro V, Muntaner C, editors. Political and Economic Determinants of Population Health and Well-being: Controversies and Developments. Amityville NY: Baywood Press; 2004. 70. Bambra C. The worlds of welfare: illusory and gender blind? Social Policy and Society 2004;3(3):201-211. 71. Bambra C, Fox D, Scott-Samuel A. Towards a politics of health. Health Promot. Int. 2005;20(2):187-193. 72. Saint-Arnaud S, Bernard P. Convergence or resilience? A hierarchial cluster analysis of the welfare regimes in advanced countries. Current Sociology 2003;51(5):499-527. 73. Brady D. The politics of poverty: Left political institutions, the welfare state, and poverty. Social Forces 2003;82:557-588. 74. Organization for Economic Cooperation and Development. Society at a Glance: OECD Social Indicators 2002 Edition. Paris, France; 2003. 75. Navarro V, Schmitt J. Economic efficiency versus social equality? The U.S. liberal model versus the European social model. 2005;35(4):613-630. 76. American Public Health Association. Leave no one behind: Elimimating racial and ethnic disparities in health and life expectancy. Washington DC: American Public Health Association; 2004. 77. American Public Health Association. Disparities in Health Fact Sheets. Washington, DC: American Public Health Association; 2004. 78. United Health Foundation. America's Health: State Health Rankings. Minnetonka, MN: United Health Foundation; 2004. 79. Public Health Association of New York City. Agenda for Public Health. In: Public Health Association of New York City; 2005. 80. Bryant T. Politics, public policy and population health. In: Raphael D, Bryant T, Rioux M, editors. Staying Alive: Critical Perspectives on Health, Illness, and Health Care. Toronto: Canadian Scholars Press; 2006. p. 193-216. 81. Navarro V. The Politics of Health Policy: The US Reforms 1980-1994. Cambridge MA: Blackwell Publishers; 1994. 82. Auerbach JA, Krimgold B, Lefkowitz B. Improving Health: It Doesn't Take a Revolution. Washington, DC: National Policy Association; 2000. Report No.: NPA report # 298. 83. Raphael D. Social justice is good for our hearts: why societal factors -- not lifestyles -- are major causes of heart disease in Canada and elsewhere. In. Toronto, Canada: Centre for Social Justice Foundation for Research and Education (CSJ); 2002. 84. Raphael D, Anstice S, Raine K. The social determinants of the incidence and management of Type 2 Diabetes Mellitus: Are we prepared to rethink our questions and redirect our research activities? Leadership in Health Services 2003;16:10-20. 85. Popay J, Williams GH, editors. Researching the People's Health, Routledge. London UK: Routledge; 1994. 86. Bryant T. Role of knowledge in public health and health promotion policy change. Health Promotion International 2002;17(1):89-98. 87. Park P. What is participatory research? A theoretical and methodological perspective. In: Park P, Brydon-Miller M, Hall B, Jackson T, editors. Voices of change: Participatory research in the United States and Canada. Toronto: Ontario Institute for Studies in Education Press; 1993. p. 1-19. 88. Minkler M, Wallerstein N, Hall B. Community Based Participatory Research for Health. San Francisco: Jossey Bass; 2002. 89. Minkler M. Community-Based Research Partnerships: Challenges and Opportunities. Journal of Urban Health 2005;82(Supplement 2):ii3- ii12. 90. Lipset M. Continental Divide: The Values and Institutions of the United States and Canada. New York: Routledge; 1990. 91. Lipset M, Marks G. It Didn't Happen Here: Why Socialism Failed in the United States. New York: W. W. Norton; 2000. 92. Navarro V, Shi L. The Political Context of Social Inequalities and Health. In: Navarro V, editor. The Political Economy of Social Inequalities: Consequences for Health and Quality of Life. Amityville, NY: Baywood; 2002. 93. Organisation for Economic Co-operation and Development. OECD Employment Outlook 2004. Paris: Organisation for Economic Co-operation and Development; 2004. 94. Zweig M. The working class majority: America's best kept secret. Ithaca: Cornell University Press; 2000. 95. Zweig M, editor. What's Class Got to Do with It?: American Society in the Twenty-First Century. Ithaca NY: Cornell University Press; 2004. 96. National Association of County and City Health Officials. Tackling health inequities through public health practice: A handbook for action. Washington DC: National Association of County and City Health Officials; 2006. 97. Minnesota Department of Health. Healthy Minnesotans: Public Health Improvement Goals 2004. Minneapolis: Minnesota Department of Health,; 1998. 98. Office of Minority Health M. Populations of Color in Minnesota: Health Status Report. Minneapolis: Minnesota Department of Health; 1997. 99. Hayward K, Colman R. The Tides of Change: Addressing Inequity and Chronic Disease in Atlantic Canada. Halifax NS: Atlantic Regional Office, Health Canada; 2003. 100. Public Health Agency of Canada. Turning the Tide: Why Acting on Inequity Can Help Reduce Chronic Disease. 2005. Halifax, NS: Public Health Agency of Canada; 2006. 101. European Committee for Health Promotion Development. Reducing Inequalities in Health: Proposals for Health Promotion Policy and Action. In: World Health Organization; 2000. 102. Phillips K. Wealth and Democracy. New York: Broadway Books; 2002. 103. Rifkin J. The European Dream: How Europe's Vision of the Future is Quietly Eclipsing the American Dream. New York: Tarcher; 2004. Return to Table of Contents :::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::: From: Too Much, Sept. 25, 2006 [Printer-friendly version] OUR BILLIONAIRE BUNCH The only official arm of the United States government that systematically tracks the wealth of America's wealthy, the Federal Reserve, does not -- for privacy reasons -- count the wealth of America's very wealthiest. Thank goodness we have Forbes. Every year, ever since 1982, this business magazine has assembled a research team that dives deep into the nation's business records to count the dollars of both exhibitionists eager to flaunt their wealth and the shy anxious to hide it. The resulting annual list of America's richest 400 may not be absolutely accurate. But few people on the Forbes list, or left off it, ever end up complaining. In a world of imperfect information, the annual Forbes 400 numbers give us a reasonably accurate -- and intensely sobering -- look at our grotesquely unequal nation. How grotesquely unequal? Back in 1982, the year Forbes started publishing an annual list of America's 400 richest, the magazine could find only 13 billionaires in the entire United States. The nation's entire billionaire population could stand, quite comfortably, in a living room. Not anymore. The just-released Forbes 400 list for 2006 includes, for the first time ever, only billionaires. Together, these 400 billionaires own $1.25 trillion in total net worth. Let's put this total in a more comprehensible context. In 2004, the most current year with stats available, the 56 million American families who make up the poorer half of America's wealth distribution had a total combined net worth of just $1.29 trillion. In other words, our nation's richest 400 households own just about as much of our nation's treasure as our poorest 56 million. That treasure appears to be concentrating at economic warp speed. In 1982, a deep-pocket in the United States needed a mere $90 million to enter the lofty ranks of the Forbes 400. In 2004, the price of admission stood at $750 million. On last year's Forbes list, the cut- off jumped to $900 million. This year's entry fee: a straight $1 billion. Let's put that number in context, too. An average American could win, three times over, the biggest lottery jackpot ever -- the $315 million payout recorded in California last November -- and still need over $50 million more to knock on the Forbes 400 door. This year's fastest-growing Forbes 400 fortune belongs, somewhat fittingly, to Sheldon Adelson, the CEO of the Las Vegas Sands, the global gambling industry giant. Worth $20.5 billion, this casino magnate holds the nation's third-largest fortune. Adelson's fortune, over the past two years, has grown at the rate of nearly $1 million an hour. Return to Table of Contents :::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::: From: Reuters, Sept. 7, 2006 [Printer-friendly version] INTERSEX FISH RAISES POLLUTION CONCERNS IN U.S. By Deborah Zabarenko, Environment Correspondent Washington -- The discovery of intersex fish -- males with some female characteristics, including some carrying eggs -- in Washington's Potomac River is raising concerns about pollution from chemicals that can affect hormones. A preliminary investigation by the U.S. Geological Survey found a high incidence of intersex among smallmouth bass in the South Branch of the Potomac and Shenandoah Rivers, both near Washington. "We ended up identifying a problem that is typical of endocrine disruption, that is, seeing eggs in the testes of sexually mature fish," Chris Ottinger, an immunologist at the Geological Survey's National Fish Health Research Laboratory, said on Thursday. "It was something that warranted further investigation." These so-called endocrine disrupting chemicals are used widely in industry and in consumer products including pharmaceuticals, cosmetics, perfumes, plastics and even materials used to keep barnacles from clinging to boat bottoms. Theo Colburn, an environmental health analyst who has specialized in studying the effects of endocrine disruptors, said they work during gestation, and have been linked to feminization of male fish in the Great Lakes, smaller penises in alligators and polar bears, and hermaphroditic whales -- with genitalia of both sexes -- in the St. Lawrence River. Safe To Drink Laboratory studies have shown developmental effects from very low doses of hormone disruptors, but it would be technically impossible at present to remove such low concentrations of these compounds from drinking water, Colburn said by telephone from her office in Colorado. The manager of the water utility that covers a large swath of the Washington area stressed that drinking water is safe. "As water plant manager, what I know is that there is no evidence pointing to any concentrations of these substances in the water that are having human effects," said Thomas Jacobus, manager of the Washington Aqueduct. "The water is safe to drink." Jacobus said the water was tested for some endocrine disrupting chemicals, but noted that there are potentially 20,000 of these compounds in existence. The U.S. Environmental Protection Agency said in a statement that the exact amounts of these chemicals, especially at extremely low doses, in the environment are difficult to determine. "Little is known about the potential harm posed by trace amounts of PPCPs (pharmaceuticals and personal care products) in drinking water," the agency said in a statement. "Current water treatment processes may remove some PPCPs, but more research is needed to determine how efficiently these compounds are removed by various treatment technologies." Copyright 2006 Reuters Limited Return to Table of Contents :::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::: From: The New York Times, Sept. 28, 2006 [Printer-friendly version] THE ASCENT OF WIND POWER By Keith Bradsher KHORI, India -- Dilip Pantosh Patil uses an ox-drawn wooden plow to till the same land as his father, grandfather and great-grandfather. But now he has a new neighbor: a shiny white wind turbine taller than a 20-story building, generating electricity at the edge of his bean field. Wind power may still have an image as something of a plaything of environmentalists more concerned with clean energy than saving money. But it is quickly emerging as a serious alternative not just in affluent areas of the world but in fast-growing countries like India and China that are avidly seeking new energy sources. And leading the charge here in west-central India and elsewhere is an unlikely champion, Suzlon Energy, a homegrown Indian company. Suzlon already dominates the Indian market and is now expanding rapidly abroad, having erected factories in locations as far away as Pipestone, Minn., and Tianjin, China. Four-fifths of the orders in Suzlon's packed book now come from outside India. Not even on the list of the world's top 10 wind-turbine manufacturers as recently as 2002, Suzlon passed Siemens of Germany last year to become the fifth-largest producer by installed megawatts of capacity. It still trails the market leader, Vestas Wind Systems of Denmark, as well as General Electric, Enercon of Germany and Gamesa Tecnologica of Spain. Suzlon's past shows how a company can prosper by tackling the special needs of a developing country. Its present suggests a way of serving expanding energy needs without relying quite so much on coal, the fastest-growth fossil fuel now but also the most polluting. And Suzlon's future is likely to be a case study of how a manufacturer copes with China, both in capturing sales there and in confronting competition from Chinese companies. Suzlon is an outgrowth in many ways of India's dysfunctional power- distribution system. Electricity boards owned by state governments charge industrial users more than twice as much for each kilowatt-hour as such customers pay in the United States -- and they still suffer blackouts almost every day, especially in northern India. Subject to political pressures, the boards are often slow to collect payments from residential consumers and well-connected businesses, especially before elections. As a result, they often lack the money to invest in new equipment. To stay open and prevent crucial industrial or computer processes from stopping, a wide range of businesses -- including auto parts factories and outsourcing giants -- rely on still more costly diesel generators. With natural gas prices climbing as well, wind turbines have become attractive to Indian business. The Essar Group of Mumbai, a big industrial conglomerate active in shipping, steel and construction, is now working on plans for a wind farm near Chennai, formerly Madras, after concluding that regulatory changes in India have made it financially attractive. "The mechanisms didn't used to be there; now they are," said Jose Numpeli, vice president for operations at Essar Power. The electricity boards "know how to cost it, they know how to pay for it." Roughly 70 percent of the demand for wind turbines in India comes from industrial users seeking alternatives to relying on the grid, said Tulsi R. Tanti, Suzlon's managing director. The rest of the purchases are made by a small group of wealthy families in India, for whom the tax breaks for wind turbines are attractive. Wind will remain competitive as long as the price of crude oil remains above $40 a barrel, Mr. Tanti estimated. To remain cost-effective below $40 a barrel, wind energy may require subsidies, or possibly carbon-based taxes on oil and other fossil fuels. Mr. Tanti and his three younger brothers were running a textile business in Gujarat, in northwestern India, when they purchased a German wind turbine -- only to find that they could not keep it running. So they decided to build and maintain turbines themselves, starting Suzlon in 1995 and later leaving the textile business. To minimize land costs, wind farms are typically in rural areas, chosen for the strength of the wind there as well as low prices for land. But that can mean culture shock. "There were no big changes until the turbines came," Mr. Patil said, pausing from plowing here with his father in this remote, hilly, tribal area 200 miles northeast of Mumbai, where oxen remain at the center of farm life and motorized vehicles are uncommon. Doing business in rural areas of the developing world carries special challenges. The new Suzlon Energy wind farm in Khori is a subject of national pride. More than 300 giant wind turbines, with 110-foot blades, snatch electricity from the air. But it has also struggled with the sporadic lawlessness that bedevils India. S. Mohammed Farook, the installation's manager, was far from happy one recent afternoon. At least 63 new turbines, worth $1.3 million apiece and each capable of lighting several thousand homes when the wind blows, could not be put into service because thieves had stolen their copper power cables and aluminum service ladders for sale as scrap. The copper or aluminum fetches as little as $1 from black-market scrap dealers. But each repair costs thousands of dollars in parts and staff time, in a country that is desperately short of electricity and technicians. "I am crying inside," Mr. Farook said. Despite such problems, Suzlon has expanded rapidly as global demand for wind energy has taken off. Its sales and earnings tripled in the quarter ended June 30, as the company earned the equivalent of $41.6 million on sales of $202.4 million. The demand for wind turbines has particularly accelerated in India, where installations rose nearly 48 percent last year, and in China, where they rose 65 percent, although from a lower base. Wind farms are starting to dot the coastline of east-central China and the southern tip of India, as well as scattered mesas and hills across central India and even Inner Mongolia. Coal is the main alternative in the two countries, and is causing acid rain and respiratory ailments while contributing to global warming. China accounted for 79 percent of the world's growth in coal consumption last year and India used 7 percent more, according to statistics from BP. Worried by its reliance on coal, China has imposed a requirement that power companies generate a fifth of their electricity from renewable sources by 2020. This target calls for expanding wind power almost as much as nuclear energy over the next 15 years. India already leads China in wind power and is quickly building more wind turbines. Chinese and Indian officials are optimistic about relying much more heavily on wind. "I believe we may break through these targets -- if not, we should at least have no problem reaching them," said Zhang Yuan, vice general manager of the China Longyuan Electric Power Group, the renewable- energy arm of one of China's five state-owned electric utilities, China Guodian. Kamal Nath, India's minister of commerce and industry, was even more enthusiastic. "India is ideally suited for wind energy," he said. "The cost of it works well and we have the manufacturing capability." International experts are more skeptical that wind will displace coal to a considerable extent, saying that while electricity production from wind is likely to increase rapidly, the sheer scale of energy demands suggests that coal burning will expand even more. Suzlon still sees plenty of opportunity in China and has decided to build some of its latest designs in China for the market there, despite the risk of having them copied by Chinese manufacturers. "Being an Asian leader," Mr. Tanti said, "we cannot afford to ignore China." A dozen Chinese manufacturers have jumped into wind-turbine manufacturing as well. They have struggled with quality problems and have limited production capacity so far, resulting in long delivery delays. But the Chinese producers already have an edge on price over imported equipment, according to Meiya Power of Hong Kong, which owns and operates power plants in China and across Asia, and is considering a wind farm in windswept Inner Mongolia. Mr. Tanti said that rapid innovation and design changes would allow Suzlon to stay ahead of copycats. "It's a time-consuming process," he said, estimating that it would take two to three years for rivals to clone Suzlon turbines because they use unique or proprietary parts. Suzlon manufactures its turbines at two factories in India, but has begun test production at a just-completed turbine-blade factory in Minnesota, where it already supplies turbines for a wind farm operated by the Edison Mission Group and Deere & Company. It has also begun test production at a Chinese factory that will make both turbines and blades. To reach the Suzlon wind farm here, the huge rotors travel by night on special trucks for a 300-mile journey from northwestern India on a succession of paved and dirt roads. Squatter huts have had to be removed along the way to allow the long trucks to turn; Suzlon is not required to pay compensation but often makes donations in these cases, Mr. Farook said. The truck crews also carry wooden poles to prop up electricity wires across the road and pass underneath. The trucks sometimes attract gawkers, and live wires occasionally burn bystanders. "With human error, it may touch human flesh," Mr. Farook said. "In that case, we have to pay compensation." Villagers in Khori said that thievery and even robberies by rock- throwing gangs were nothing new, and were a problem long before Suzlon began setting up wind turbines. The company's response -- stepping up patrols by security guards -- has reduced everyday crime. That has made villagers more willing to rent land at the edge of their fields for the turbines. At first, "we were really confused about what was going on," Mr. Patil said. "But now we're O.K. on it." Return to Table of Contents :::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::: Rachel's Democracy & Health News (formerly Rachel's Environment & Health News) highlights the connections between issues that are often considered separately or not at all. The natural world is deteriorating and human health is declining because those who make the important decisions aren't the ones who bear the brunt. Our purpose is to connect the dots between human health, the destruction of nature, the decline of community, the rise of economic insecurity and inequalities, growing stress among workers and families, and the crippling legacies of patriarchy, intolerance, and racial injustice that allow us to be divided and therefore ruled by the few. In a democracy, there are no more fundamental questions than, "Who gets to decide?" And, "How do the few control the many, and what might be done about it?" As you come across stories that might help people connect the dots, please Email them to us at firstname.lastname@example.org. Rachel's Democracy & Health News is published as often as necessary to provide readers with up-to-date coverage of the subject. Editors: Peter Montague - email@example.com Tim Montague - firstname.lastname@example.org :::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::: To start your own free Email subscription to Rachel's Democracy & Health News send a blank Email to: email@example.com. In response, you will receive an Email asking you to confirm that you want to subscribe. ::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::
Environmental Research Foundation
P.O. Box 160, New Brunswick, N.J. 08903