Peeking into Private Lives in the Arab World

This week's Economist carries a review of a book recently published by Shereen El Feki, titled "Sex and the Citadel: Intimate Life in a Changing Arab World." The demographic question of interest is what might this tell us about the prospects for fertility change in the region? The Economist sets up their review with the following background comments:

The Arab world today is widely criticised for its sexual intolerance. Women hide their charms under dark billows of fabric; girls have their genitals mutilated by elders determined to keep their desires in check; gay men are arrested and then raped by their jailers.

Once upon a time things were different. The Prophet Muhammad urged his followers to satisfy their partners in the bedroom. Prudish medieval Christians despised his detailed advice on the ins and outs of sex as “a cunning ploy to win converts”, which undermine their own faith’s fixation on virginity, chastity and monogamy. When Gustave Flaubert travelled to Egypt in the 19th century, he spent hazy days watching bawdy skits on the streets of Cairo about “whores and buggering donkeys”, and fleshy nights enjoying the local prostitutes.

Today East and West have shifted positions.

The book review reminded me that I had recently heard Ms. El Feki interviewed on NPR and was fascinated by her insights:

What she learned, she says, is that "the patriarchy is alive and well in Egypt and the wider Arab world," and that women, too, "are some of the staunchest upholders of patriarchal attitudes."

Women, for example, decide whether or not to circumcise their daughters and granddaughters. Men are not traditionally part of the decision-making process when it comes to female genital mutilation (FGM).

"[Women] are making the decisions about their daughters' well-being and FGM, to cut or not to cut," El Feki says. "They are making these decisions based on faulty information, but the fact is, they have agency; and the key to moving forward is to recognize that power and to shift it to a decision which is recognizing and respecting their child's physical and mental rights."

Admittedly, there are no clear lessons in her comments about the impact of intimacy on reproduction, but the winds of change seem to be blowing a bit in the direction of more control by women over their private lives. Historically, that has been accompanied by a decline in fertility and in most Arab countries that is the direction that the birth rate has been going.

Getting to Know the Center of the US

As I noted almost exactly two years ago, the US Census Bureau calculated from the 2010 census data that Plato, Missouri, was the new population center of the United States--the geographic point that averages the location of all Americans. In this months' Orion magazine, Jeremy Miller has a lengthy essay which starts with his trip to Plato to see where the center lies, and then spins off from there in a variety of directions (no pun intended), talking especially about how that center has shifted over time and how we can read history (and forecast the future) from that movement.

To trace the path of the centroid is to skim a great narrative spanning 220 years. That narrative is the nation’s history of growth, with each point along the way emerging as a sort of chapter: the rise of industrialism in the Northeast, the expansion of the western frontier, the waves of European, Latin American, and Asian immigration, the post–World War II population boom.

In 1790, the first decennial census plotted the center of population in Kent County, Maryland, some twenty-three miles east of Baltimore. It was just two years after the ratification of the Constitution, and the U.S. population was concentrated along the Eastern Seaboard in the port cities of Boston, New York, Baltimore, and Charleston. New York, with a population of a little more than thirty-three thousand, was the nation’s largest city—and has remained so ever since. It’s hard to imagine, however, that Marblehead—today a quaint and touristic village a half-hour north of Boston—was then the nation’s tenth largest city, with a population of just under six thousand.

And here is a comment with which I completely agree and yet it does not get enough attention:

But arguably, the most influential factor in this change of course is air conditioning. That the centroid is headed, of all directions, southward, is a testament to our ability to blithely overpower climate with the brute force of fossil fuel. According to the 2010 Census, the Sunbelt cities of Los Angeles, Houston, Phoenix, San Diego, San Antonio, and Dallas now comprise six of the country’s ten largest cities. Over the last decade, the population of southern states has increased by around 14 percent, the fastest growth of any region in the country, outpacing the national growth rate of nearly 10 percent.

But, on the other hand, he slipped a bit with this comment:

Today there are an estimated 11 million undocumented (which is to say, uncounted) immigrants scattered across the country. Any talk of the centroid or its “advance” must be considered in light of these unaccounted-for populations.

While some of these people probably were not counted, in general we estimate the number of undocumented immigrants by comparing counts of foreign-born persons in the census and other Census Bureau surveys, such as the Current Population Survey and the American Community Survey, with the counts of authorized immigrants from those countries. The difference is assumed to represent the undocumented population. They are undocumented, but they are also counted.

Health in Africa

Since my own research over the past several years has focused on spatial inequalities in health in Accra, Ghana, the broader issue of health in Africa is obviously of interest to me. However, it really should be of interest to all of us, since sub-Saharan Africa is projected to have the fastest rate of population growth of any region in the world between now and the middle of this century. Thus, you really should tune it to a "Health Check" podcast by BBCNews on the topic of "Science Africa 3: What if..."

Four leading doctors [and this is an all-star cast] who have all worked on AIDS in Uganda discuss how to improve Africa’s health with Gareth Mitchell and Alan Kasujja.

Full disclosure: it is a 49 min podcast, so be ready for that.

Spoiler alert: If you have seen the Broadway hit "Book of Mormon" you will especially relate to this.

People Are Good For Your Health

Humans are, by nature, social creatures. Thus, no matter how many times you have wished that someone would just leave you alone, or no matter how much of an introvert you might be, some contact with humans is better than no contact. Indeed, a new study with those kinds of results was just published in the Proceedings of the National Academy of Sciences and summarized by Nature.com:

The scientists analysed data from 6,500 people aged 52 and older enrolled in the English Longitudinal Study of Ageing, which monitors the health, social well-being and longevity of people living in England. The researchers evaluated social isolation on the basis of the amount of contact participants reported having with family, friends and civic organizations, and they assessed loneliness using a questionnaire. They tracked sickness and mortality in study participants from 2004 to 2012.

The researchers found that social isolation was correlated with higher mortality — even after adjusting for pre-existing health conditions and socioeconomic factors — but loneliness was not.

“When we think about loneliness and social isolation, we often think of them as two faces of the same coin,” says Andrew Steptoe, a psychologist and epidemiologist at University College London, who led the study. But the findings suggest that a lack of social interaction harms health whether or not a person feels lonely, he says. “When you’re socially isolated, you not only lack companionship in many cases, but you may also lack advice and support from people.”

Other studies, referenced in the Nature article, have suggested that loneliness is not good for your health, and the authors of this study are not discounting the negative psychological effects of loneliness, but their analysis suggests that lives are shortened by social isolation, but not necessarily by loneliness. I guess the lesson is that you can be lonely in a crowd, but the crowd is good for your health.

Explaining Lower Than Expected Life Expectancy in the US

Despite being the world's richest country and despite the fact that the average American pays much more per person for health care than anyone else in the world, US life expectancy is not even in the top 20 in the world, as I have mentioned before. But why does the US lag behind others? Although a seemingly obvious answer had been that African-Americans on average lack the same access to health care as do whites, that difference--although real--had never been able to close the gap. Now a doctoral student in demography at the University of Pennsylvania, Jessica Ho, has helped us unlock this puzzle in a paper just published in the journal Health Affairs (subscription required). The story is summarized by futurity.org:

The new study finds that excess mortality among Americans younger than 50 accounted for two-thirds of the gap in life expectancy at birth between American males and their counterparts and two-fifths between females and their counterparts in the comparison countries.

Most of the excess mortality of those younger than 50 was caused by noncommunicable diseases, including perinatal conditions, such as pregnancy complications and birth trauma, homicide, and unintentional injuries including drug overdose, which Ho says is a striking finding of the study.

“These deaths have flown under the radar until recently,” Ho says. “This study shows that they are an important factor in our life expectancy shortfall relative to other countries.”

She points out that the majority of the drug overdose deaths stemmed from prescription drug use.

Ho says her study underscores the importance of focusing on policies to prevent the major causes of deaths below age 50 and to reduce the social inequalities that lead to them.

It is no surprise, of course, that her dissertation committee includes Samuel Preston, who quite literally wrote the book on how different causes of death shape a nation's life expectancy. Most recently, he was part of the National Research Council committee that published an important report on "U.S. Health in International Perspective: Shorter Lives, Poorer Health."

Ho's contribution is incredibly important, but we still have that other one-third of the life expectancy gap to explain...