Addressing socioeconomic inequality in access to university education: an analysis of synergies and tensions in Scottish policy

BackgroundBenin and Mali introduced user fee exemption policies focused on caesarean sections (C-sections) in 2005 and 2009, respectively. These policies had a positive impact on access to C-sections and facility based deliveries among all women, but the impact on socioeconomic inequality is still highly uncertain. The objective of this study was to observe whether there was an increase or a decrease in urban/rural and socioeconomic inequalities in access to C-sections and facility based deliveries after the free C-section policy was introduced.MethodsWe used data from three consecutive Demographic and Health Surveys (DHS): 2001, 2006 and 2011–2012 in Benin and 2001, 2006 and 2012–13 in Mali. We evaluated trends in inequality in terms of two outcomes: C-sections and facility based deliveries. Adjusted odds ratios were used to estimate whether the distributions of C-sections and facility based deliveries favoured the least advantaged categories (rural, non-educated and poorest women) or the most advantaged categories (urban, educated and richest women). Concentration curves were used to observe the degree of wealth-related inequality in access to C-sections and facility based deliveries.ResultsWe analysed 47,302 childbirths (23,266 in Benin and 24,036 in Mali). In Benin, we found no significant difference in access to C-sections between urban and rural women or between educated and non-educated women. However, the richest women had greater access to C-sections than the poorest women. There was no significant change in these inequalities in terms of access to C-sections and facility based deliveries after introduction of the free C-section policy.In Mali, we found a reduction in education-related inequalities in access to C-sections after implementation of the policy (p-value = 0.043). Inequalities between urban and rural areas had already decreased prior to implementation of the policy, but wealth-related inequalities were still present.ConclusionsUrban/rural and socioeconomic inequalities in C-section access did not change substantially after the countries implemented free C-section policies. User fee exemption is not enough. We recommend switching to mechanisms that combine both a universal approach and targeted action for vulnerable populations to address this issue and ensure equal health care access for all individuals.

BackgroundHospital admissions for cardiogenic shock have increased in the United States. Temporary mechanical circulatory support (tMCS) can be used to acutely stabilize patients. We sought to evaluate the presence of racial, ethnic, and socioeconomic inequities in access to MCS in the United States among patients with cardiogenic shock. MethodsMedicare data were used to identify patients with cardiogenic shock admitted to hospitals with advanced tMCS (microaxial left ventricular assist device [mLVAD] or extracorporeal membranous oxygenation [ECMO]) capabilities within the 25 largest core-based statistical areas, all major metropolitan areas. We modeled the association between patient race, ethnicity, and socioeconomic status and use of mLVAD or ECMO. ResultsAfter adjusting for age and clinical comorbidities, dual eligibility for Medicaid was associated with a 19.9% (95% CI, 11.5%-27.4%) decrease in odds of receiving mLVAD in a patient with cardiogenic shock (P < .001). After adjusting for age, clinical comorbidities, and dual eligibility for Medicaid, Black race was associated with 36.7% (95% CI, 28.4%-44.2%) lower odds of receiving mLVAD in a patient with cardiogenic shock. Dual eligibility for Medicaid was associated with a 62.0% (95% CI, 60.8%-63.1%) decrease in odds of receiving ECMO in a patient with cardiogenic shock (P < .001). Black race was associated with 36.0% (95% CI, 16.6%-50.9%) lower odds of receiving ECMO in a patient with cardiogenic shock, after adjusting for Medicaid eligibility. ConclusionsWe identified large and significant racial, ethnic, and socioeconomic inequities in access to mLVAD and ECMO among patients presenting with cardiogenic shock to metropolitan hospitals with active advanced tMCS programs. These findings highlight systematic inequities in access to potentially lifesaving therapies.

In India, the National Education Policy 2020 recommends ensuring universal access to high-quality early childhood care and education for children aged 3–6 years by 2030. Using the 75th round of National Statistical Office data (2017–2018), this paper analyses the regional and socioeconomic inequalities in access to pre-primary education. Also, we investigate the specific role of households’ economic status and educational attainment in explaining these inequalities. We find considerable regional (rural/urban) and socioeconomic inequalities in access to pre-primary education in India, with girls and children belonging to historically disadvantaged social groups (scheduled castes and scheduled tribes) less likely to attend early childhood education, particularly in rural areas. We find that a substantial portion of the rural–urban gap in access to pre-primary education can be removed by controls for households’ economic condition and household head’s educational status. In addition, we find gender and socioeconomic inequalities in the household investment in early years education. These findings highlight the need to put policy efforts and commitments to reducing barriers to accessing pre-primary education for children in disadvantaged conditions in India.

Centralization of care in high volume hospitals and inequalities in access to care.

Socioeconomic inequalities in cancer incidence and access to health services among children and adolescents in China: a cross-sectional study

BackgroundDespite numerous efforts, South Asia is the second most leading region for maternal mortality and morbidity. Although there have been notable advancements on this continent, progress in maternal healthcare access has been slow. Inequalities remain in different maternal health services across diverse population groups. The aim of this study is to better understand the socioeconomic inequalities in maternal healthcare access in South Asian countries. MethodsTwo databases (MEDLINE and Google Scholar) were searched for identifying studies. Studies with data on socioeconomic factors, maternal healthcare, inequality, and South-Asian countries were included. Mixed method appraisal tool was used for quality assessment of the identified studies. ResultsA total of 55 studies from India, Nepal, Bangladesh, Afghanistan and Pakistan were included in the final analysis. Overall, quantitative study showed that maternal healthcare access is linked to economic status, education, occupation, and women’s autonomy. Qualitative studies demonstrated poverty, lack of awareness of complication and service and inability in decision making on healthcare was the reason for not accessing maternal health care. Significant finding from this review includes effect of education mostly evident after secondary education and paternal occupation was significant rather than maternal occupation. ConclusionFindings of this review indicates a large disparity in access to maternal health care services. Policymakers should create interventions and financial schemes that are tailored to the mothers from low socioeconomic background.

Socioeconomic inequalities significantly impact access to healthcare services for individuals with type 2 diabetes mellitus (T2DM). This study investigates these inequalities in Iran, focusing on factors such as asset, sex, urban-rural residence, age, education, employment status, and marital status. Cross-sectional study. This study used data from the national 'Diabetes Care (DiaCare)' study, a population-based survey conducted from 2018 to 2020 in Iran. Socioeconomic status (SES) was assessed using Principal Component Analysis (PCA) based on assets. Socioeconomic inequalities in access to physicians, pharmacies and laboratories were measured using the Concentration Index (CI) and Erreygers Corrected Concentration Index (ECI). Decomposition analysis was performed using a probit regression model to assess the contributions of various factors to the observed inequalities. Among 13 315 patients with T2DM, 5.8% lacked access to physicians, 6.8% to pharmacies and 8.7% to laboratories. The CI was positive and statistically significant for access to physicians (0.0614), pharmacies (0.0787) and laboratories (0.0875), indicating better access concentrated among higher SES individuals. Urban residents had the largest positive marginal effects on access to physicians (0.032), pharmacies (0.078) and laboratories (0.053), with percentage contributions of 13.21%, 23.23% and 17.39%, respectively. Higher asset quintiles showed substantial contributions to inequalities, with the highest quintile contributing 10.5% to physician access inequality, 9.68% to pharmacy access and 9.16% to laboratory access. Education level also positively impacted access, with high school education contributing 0.64% and college education 0.52% to access inequalities. Sex differences showed a negative marginal effect for women, indicating slightly lower access. Socioeconomic factors, particularly asset, residence and education, significantly impact access to healthcare services for patients with T2DM in Iran. Policies should focus on reducing barriers to healthcare access, especially for lower SES and rural populations.

Prostate cancer is one of the most common cancers with 36,016 registered cases in 2020 in the United Kingdom. Access to cancer care remains a policy priority across OECD countries, but there are concerns that socioeconomic inequalities have been amplified following the COVID-19 pandemic due to accumulated backlogs. Using administrative data from the Hospital Episodes Statistics, this study examines socioeconomic inequalities in different dimensions of access to prostate cancer surgery in England in 2015–22, and whether such inequalities increased after COVID-19. Access is a multifaceted concept encompassing several dimensions along the patient pathway. We investigate socioeconomic inequalities in the volume of surgeries, waiting time of patients on the list (patient responsiveness), hospital length of stay (intensity of care), 30-day emergency readmissions and 3-year mortality (health outcomes). We find that, after controlling for a range of factors (e.g. age composition, ethnicity, rurality, primary care availability), the number of prostate surgeries for the most income-deprived quintile is 41.0 % lower than the least income-deprived quintile in the pre-COVID period. The gradient appears similar in the post-COVID period in proportionate terms when volume dropped. We generally find no evidence of inequalities in other dimensions of access, such as waiting times (from patient addition to treatment list) and length of stay (from hospital admission to discharge). We also find no evidence of inequalities in the probability of being readmitted as an emergency within 30 days from discharge. Instead, patients in the most income-deprived quintile have a higher mortality rate by at least one percentage point relative to the least-deprived quintile. This difference in mortality does not appear to be related to differences in the quality of care across hospitals. The analysis highlights the need to take a multidimensional approach when assessing socioeconomic inequalities in access to hospital care along the patient pathway.

In recent years, the 15-minute city has gained prominence as a vision for urban development, aiming to create attractive and vibrant neighborhoods where essential services are within a 15-minute walk. However, its implementation raises concerns about socio-spatial segregation, as the potential increase in desirability of these neighborhoods—combined with various underlying factors—can lead to increased housing prices, potentially excluding economically vulnerable groups. Despite its popularity, few studies have thoroughly explored how access to the 15-minute city varies among different socio-economic groups and across different cities and towns, highlighting a significant research gap. This study aims to explore potential socio-economic inequalities in 15-minute city access across the 200 largest built-up areas in Sweden. Specifically, our study compares average incomes among residents living in neighborhoods that either meet or do not meet various 15-minute city criteria within each built-up area. These criteria are designed to operationalize the proximity dimension of the 15-minute city by capturing which residents that have access to different sets of non-work urban social functions (e.g., healthcare, restaurants, retail) within 1 km from their homes. Two research questions guide the study: Are there differences in access to the 15-minute city, in terms of proximity to non-work urban social functions, across different income groups in Swedish built-up areas? How do variations in the types of functions included in the 15-minute city model, as well as differences in built-up areas characterized by population size, density, land use mix, and the proportion of older buildings, affect these outcomes? Findings reveal significant impact from both the definition of the 15-minute city and across different types of built-up areas. When the 15-minute city only encompasses basic functions such as a grocery store, school, restaurant, etc., average incomes are lower, irrespective of population size. However, mean incomes are notably higher for residents who can locally access many different urban social functions, indicative of larger cities with a higher population density and jobs-to-worker ratio. This highlights a cautionary aspect for cities and planners implementing the 15-minute city vision, as the city characteristics strongly correlated with effective adherence to the 15-minute city may also contribute to excluding lower-income groups.

While online learning was widely adopted by schools during the COVID-19 pandemic globally, little is known about its effects on preschool children’s development in China. Using a unique dataset collected in Yunnan Province, China in 2020, with a sample of 11,990 children aged 3–5 years from 285 kindergartens, we provide the first comprehensive assessment of socioeconomic inequalities in access to online learning and its association with early childhood development (ECD). The study demonstrates significant inequalities in access to online learning. Particularly, preschoolers with rural household residential registration (Hukou), lower maternal schooling, and lower family income are less likely to have access to online learning than their counterparts. Regression results based on the Generalized Linear Model (GLM) and the Instrumental Variable (IV) method show that access to online learning is positively associated with a child’s ECD score. The empirical evidence of the unequal access to online learning and its possible consequence in ECD during the pandemic has policy implications that the ever-widening developmental gap for those lacking access to online learning needs to be addressed accordingly when the pandemic is over.

BackgroundEquitable access to skilled birth attendance during delivery is vital for reducing global maternal deaths to 70 deaths per 100, 000 to achieve the Sustainable Development Goals (SDGs) by 2030. Although several initiatives have been implemented to reduce maternal mortality in Ghana, inequalities in access to skilled birth attendance during delivery still exist among women of different socioeconomic groups. This study assesses the socioeconomic inequalities in access and use of skilled birth attendants during delivery in Ghana.MethodsResearch was conducted through literature reviews and document reviews, and a secondary data analysis of the 2014 Ghana Demographic and Health Survey (GDHS), a nationally representative survey. A total of 1305 women aged 15–49 years, who had a live birth the year before to the survey in the presence of a skilled birth attendant were analysed using concentration indices and curves. The indices were further decomposed to identify the major socioeconomic factors contributing most to the inequalities.ResultsThe results found that access to skilled birth attendants was more among women from rich households showing a pro-rich utilization. The decomposition analysis revealed that household wealth index, educational level of both mother and husband/partner, area of residence and mother’s health insurance coverage were the major contributing factors to socioeconomic inequalities in accessing skilled birth attendants during child delivery among Ghanaian women.ConclusionThis study confirms that a mother’s socioeconomic status is vital to reducing maternal deaths. Therefore, it is worthy to focus attention on policy interventions to reduce the observed inequalities as revealed in the study.

Several studies have explored green economy and the needs for improvement on the standard of living among low-income families or households in many developing countries including Bangladesh. Similarly, there is an emphasis on economic growth and vision 2030 is regarded stressed. Nonetheless, there is less attention in exploring green economy in propelling sustainable financial inclusion among low-income families and households in Bangladesh in order to attain vision 2030 and overall economic growth. The primary objective is to explore green economy in fostering sustainable financial inclusion among low-income families and households in Bangladesh in enhancing economic growth and vision 2030 in Bangladesh. Content Analysis (CA) and systematic literature review (SLR) as an integral part of qualitative research. Secondary data were gathered through different sources such as: Web of Science (WOS), related journals, published references, research papers, library sources and reports. The results indicated that poverty is a prime challenge impeding sustainable financial inclusion among low-income families and households in Bangladesh. The study has further established the potential of green economy in improving well-beings and social fairness in fostering sustainable and inclusive finance among families or households with low-income in the country. The paper also highlighted the necessity of implementing policy relating to vision 2030 by enhancing sustainable and inclusive finance among low-income households in particular and overall economic growth in the country in general. In conclusion, it has been reiterated that green economy has been a mechanism for achieving sustainable development in general and poverty eradication among low-income households in Bangladesh. It is therefore suggested that the government and economic policymakers should provide enabling environment for improving green economy among low-income households in achieving Vision 2030 and overall economic growth in the country.

BackgroundIn countries with gatekeeping and equitable access to general practitioners (GPs), social inequalities in GP-patient interaction could be an important mechanism by which inequalities in access to medical specialists arise. The aim of this study was to investigate whether socioeconomic inequalities in experiences with general practice are associated with socioeconomic inequalities in access to specialist services.MethodsThe study included 6,067 participants in the third survey of the Nord-Trøndelag Health Study (HUNT3, 2006–08) who were asked to evaluate their experiences with primary care and their regular general practitioner in Norway. Self-reported data on health status and number of visits to GP and specialist services in the last 12 months were included in the study. Socioeconomic status was measured by education and household income and rescaled to relative index of inequality (RII). Relative risks were calculated using Poisson regression.ResultsWe found that a majority of patients reported positive experiences with general practice. Low socioeconomic status (SES) and male gender were associated with negative experiences. Patient experiences both directly and indirectly related to referrals were associated with the probability and quantity of specialist utilization: perception of low subjective influence on decisions about choice of medical care was associated with lower probability and quantity of specialist utilization, whereas desire to change the regular GP or to use GPs other than the regular GP and critical evaluations of the GP were associated with higher specialist consultation frequency. However, the level of education-related inequity in access to specialists was not sensitive to adjustment by survey responses.ConclusionPatient experiences with general practice were associated with the patients’ level of utilization of specialist services. There are socioeconomic inequalities in patient experiences with general practice, however the aspects measured in this study do not explain the observed socioeconomic inequity in access to specialists.

The growing evidence about the benefits of studying abroad calls for increased public efforts to equalize study abroad opportunities among university students from different socioeconomic backgrounds. Using student-level data from the nationally representative surveys of three European countries (Italy, France and Germany) between the 2000s and mid-2010s, this paper investigates how the social gap in access to study abroad programs changed over time and what are the factors driving these changes. Logistic regressions are used in order to identify the determinants of study abroad program participation and a decomposition technique is employed in an attempt to both determine how much of the gap each factor explains and compare its relative contribution over time. The results indicate that, not only has disparity in study abroad participation rate between students from more and less advantaged backgrounds not decreased in any of the countries considered here, but there is consistent evidence showing that it has increased in Germany. Differences in earlier educational trajectories and performance between these two groups of students are important predictors of the gap. However, a large part of this gap remains unexplained, and this underscores the important role played by unobserved or difficult-to-measure factors in accounting for inequality.

Since the COVID-19 outbreak, there has been renewed interest in remote work. While socioeconomic gap in remote work usage is well-studied, little is known about a key underlying aspect of inequality: access to remote work. Using Japanese panel data from January 2020 to 2024, this study examines the evolution of class and education gaps in access, distinguishing between active use (“access and use”) and potential use (“access but non-use”) among access. Results show that higher-class and more-educated workers experienced a greater increase in “access and use,” a trend that peaked mid-pandemic. In addition, while the class gap in “access but non-use” grew steadily, the education gap did not. While task differences partially explain the increased class gap in “access and use,” they do not explain the remaining education or class gaps. The findings suggest that formal access has become an institutionalized workplace policy and an established benefit for advantaged workers.