“What’s in the middle”: Scratching beneath the surface of the middle class(es) in Brazil, Côte d’Ivoire, Turkey and Vietnam

The 'developing world's middle class' is defined here as those who are not poor when judged by the median poverty line of developing countries, but are still poor by US standards. The 'Western middle class' is defined as those who are not poor by US standards. Although barely80 million people in the developing world entered the Western middle class over 1990-2002, economic growth and distributional shifts allowed an extra 1.2 billion people to join the developing world's middle class. Four-fifths came from Asia, and half from China. Most of the new entrants remained fairly close to poverty, with incomes now bunched up just above $2 a day. The vulnerability of this new middle class to aggregate economic contractions is evident in the fact that one in six people in the developing world live between $2 and $3 per day. Over time, the developing world has become more sharply divided between countries with a large middle class and those with a relatively small one, with Africa prominent in the latter group. Poor people in countries with smaller middle classes may well be more exposed to slowing economic growth.

To assess the influence of socioeconomic status on the prevalence of the metabolic syndrome in an urban south Indian population in Chennai. The Chennai Urban Population Study is an epidemiological study involving two residential colonies in Chennai (formerly Madras) in south India representing the middle and lower income groups. All individuals > or = 20 years of age living in the colonies were invited to participate in the study. Of the total 1399 eligible subjects, 1262 individuals (479 belonging the middle income group colony and 783 from the low income group colony) participated in the study. The overall response rate was 90.2%. The main outcome measures were the prevalence rates of the various components of the metabolic syndrome. There were significant differences in the socioeconomic status and lifestyle of the inhabitants of the two areas. The mean monthly income of the Tirumangalam (middle income) group (Rs8075 +/- 3859) was significantly higher than the T. Nagar (low income) group (Rs1399 +/- 916). The dietary profile of the middle income group showed higher intake of calories, fat and sugar compared to low income group (P < 0.001). The age-standardized prevalence rates of the various components of the metabolic syndrome were significantly higher in the middle compared to the low income group - diabetes (12.4 vs. 6.5%), impaired glucose tolerance (7.5 vs. 2.9%), hypertension (14.9 vs. 8.4%), obesity (males 38 vs. 13.4%, females 33.1 vs. 24.2%), hypercholesterolaemia (24.2 vs. 14.2%) and hyperinsulinaemia (16.7 vs. 6.6%) P < 0.001). Although the prevalence of coronary artery disease and hypertriglyceridaemia were higher in the middle income group, the differences did not reach statistical significance. The relative odds ratio for diabetes and impaired glucose tolerance increased significantly with increase in income while hypercholesterolaemia, hypertriglyceridaemia, hypertension and coronary artery disease showed no significant changes. Logistic regression analysis revealed that geographical area (higher social class) had a strong association with the components of the metabolic syndrome even after inclusion of other risk factors like age and body mass index in the model. Significant differences exist in the prevalence of various components of the metabolic syndrome even within an urban environment and this appears to be influenced by socioeconomic status.

Continuity of the hegemony is largely achieved by the socialization process and construction of the social consciousness in the process.While hegemony provides a window to see the world through the eyes of the ruling class, it also prevents ideas that are harmful to it from spreading, studied and accepted. So it is unrealistic to expect a social consciousness that was constructed in favor of the ruling class to include class consciousness. Foundation of the class consciousness is the feeling of belonging to a class. However the class consciousness is a threatening element to hegemony. So this study was done believing that social consciousness acts for the continuity of the hegemony, based on ''an ordinary person doesn't have a clear 'social class concept' in their mind, which brings belonging feelings and class consciousness, the notion is vague in their minds.'' hypothesis. In a research that was conducted between March-July 2019 by stratified random sampling method, the participants were asked in an open ended way ''Which class do you feel belonging to?''. Instead of a question aiming to make the participants choose between multiple answers of already existing class templates, the open ended question aimed to discover what the participants know about class structures that are used in defining them and how they interpret these classes in their minds. During the study it has been observed that one third of the participants didn't have a meaningful interpretation of the class concept corresponding in their minds thus being unable to answer the question. Nearly half of the participants who answered the question stated they think themselves as ''middle class''. Among the participants who stated they belonged in the ''middle class'', it is remarked that a quarter of them never once bought a book, 31 percent never visited the theatre, 6.7 percent never traveled out of their city and 5 percent never dined in a restaurant in their lives. When evaluating the income level of the participants who thought they belonged in the ''middle class'', it was discovered that 45.3 percent of the participants were of minimum wage to lower or no income for themselves while 51 percent of the participants had an income of minimum wage to 6k liras which showed that over half of the participants who thought themselves belonging in ''middle class'' were on the border of the poverty threshold. When factors like education, income level, social and cultural way of life considered, it was understood that the participants who gave the response ''middle class'' were implying the middle class of their vicinity, not the middle class defined by ranking of 20 percent income groups.

Obesity has emerged as an epidemic worldwide. The present study was conducted to assess the prevalence of overweight and obesity amongst children in the age group of 5-18 years belonging to low, middle and high income group in National Capital Territory NCT of Delhi. A total of 16,595 children (LIG 5087, MIG 5134 and HIG 6368) were covered in the present study. Overweight and obesity were assessed using Body Mass Index (BMI) and Triceps Skin Fold Thickness (TSFT) utilizing age and sex specific cut off points. Considering the BMI cut off points, the prevalence of obesity and overweight in Low Income Group (LIG) school children was 0.1 and 2.7 percent respectively, amongst Middle Income Group (MIG) school children it was 0.6 and 6.5 percent and in High Income Group (HIG) school children was 6.8 and 15.3 percent respectively (p<0001). With regard to the TSFT criteria, the prevalence of obesity and overweight in LIG school children was 1.2 and 2.4 percent, amongst MIG school children it was 2.5 and 4.9 percent and in children belonging to HIG schools was 9.3 and 13.1 percent respectively (p<0.001). The present study documented that the prevalence of overweight and obesity was higher in the HIG children as compared to the MIG and the LIG for all age groups, highlighting the possible role of change in the dietary pattern and physical activities with increase in income levels.

Category: Ankle; Ankle Arthritis Introduction/Purpose: There is limited literature on the effects of socioeconomic factors on outcomes after total ankle arthroplasty (TAA). In the setting of hip or knee arthroplasty, patients of a lower socioeconomic status demonstrate poorer post- operative satisfaction, longer lengths of stay, and larger functional limitations. It is important to ascertain whether this phenomenon is present in ankle arthritis patients. This is the first study to address the weight of potential socioeconomic factors in affecting various socioeconomic classes, in terms of how they benefit from ankle arthroplasty. Methods: This is retrospective cohort study of 447 patients who underwent a TAA. Primary outcomes included pre-operative and final follow-up AAOS pain, AAOS disability, and SF-36 scores. We then used postal codes to determine median household income using Canadian 2015 census data. Incomes were divided into quintiles based on equal amounts over the range of incomes. These income groups were then compared for differences in outcome measures. Statistical analysis was done using unpaired t- test. Results: A total of 447 patients were divided into quintiles by income. From lowest income to highest income, the groups had 54, 207, 86, 64, and 36 patients, respectively. The average time from surgery to final follow up was 85.6 months. Interestingly, we found that patients within the middle household income groups had significantly lower AAOS disability scores compared to the lowest income groups at final follow-up (26.41 vs 35.70, p=0.035). Furthermore, there was a trend towards middle income households and lower post-operative AAOS pain scores compared to the lowest income group (19.57 vs 26.65, p=0.063). There was also a trend toward poorer AAOS disability scores when comparing middle income groups to high income groups post- operatively (26.41 vs 32.27, p=0.058). Pre-operatively, patients within the middle-income group had more pain, compared to the lowest and the highest income groups. Conclusion: Patients from middle income groups who have undergone TAA demonstrate poorer function and possibly more pain, compared to lower and higher income groups. This suggests that TAA is a viable option for lower socioeconomic groups and should not be a source of discouragement for surgeons. In this circumstance there is no real disparity between the rich and the poor. Further investigation is needed to explore reasons for diminished performance in middle class patients.

middle class, cultural-specific dimensions, civil society, social risks this article deals with the question of types of 're-formation' of the insecure (german) middle class in times of crisis. 1 The aim is to emphasise the influence of cultural-specific orientation on social groups.This is exemplified in the group of overindebted middle-class people.Two perspectives appear to be central: first, the individual perspective and related strategies of these actors, and second, the structural perspective at the level of action in organisations or networks.The focus is on: How does the self-positioning of the middle class change in crisis situations? it is about the dialectics of the social conditions, which are perceived and adopted as 'critical' by the individuals on the one hand, and their reflexive interpretation and acting (re-) formation towards a (new) formation of the middle class on the other.this, in turn, provides opportunities for living together in community and society. in doing so, we focus on the (self-) positioning of the actors as middle-class members in the context of the increasingly complex everyday societal world. miDDle Class anD Crisisthe middle class is one category of a model of society, which can be subdivided into three classes: the upper, the middle, and the lower. 2of course, society can also be described in more differentiated terms: social milieus, which have been introduced into the scientific discourse with Hardil [2000] and Vester [2001] as well as Schulze [1995] were introduced into the public discourse with the sinus 1 the research group of the author of the Kempten University of applied Sciences is involved in various projects and work on the subject of social risks.The aim of the Kempten University of applied Sciences is to give this area the attention it deserves in the current tension between social change and social issues and to broaden the spectrum of research.2 already authors of classic sociology deal with the concept 'middle class '.Vogel [2010] provides an overview of their assessments.common to them (be it Simmel, Bourdieu or Marbach) is that the middle class is a poorly delineated category.the chicago School tries to handle the problem qualitatively-empirical: in doing so, there can be taken a view over the subjective perspective of potential middle-class members on their life situations as well as on the handling of living conditions.

Differences in diet patterns of mothers of preschool children from low and middle income groups

It is sometimes difficult to tell which group is more distressed about the purportedly deteriorating well-being of Canada’s middle class: Politicians courting middle-class voters, or the Canadians who actually identify as middle class. Even more difficult to discern is whether either group truly understands precisely who it is they are worrying about. There is no firm consensus on where the upper and lower boundaries of the middle class lie, with economists and statisticians disagreeing on the income levels and brackets that should be included in the definition of middle class, and some even arguing that income itself may be an inappropriate measure (preferring instead, for instance, consumption and lifestyle). And yet, despite all the conflicting approaches to measuring the middle class, what emerges from a review of the array of definitions and data sources is that the politicians and voters can at least partly justify their angst. While the middle class has seen its income grow, it has not kept pace with the income growth rate of higherearning groups. But not all members of the so-called middle class face the same plight. The workers who have lost the most ground relative to higher-income groups, are those with below-average human capital (that is, lower skill and education), and are at the lower end of the middle-income bracket. The largest source of downward pressure on middle-class incomes has been the decline of Canada’s manufacturing industry. Beginning in the postwar years, factory jobs developed a misplaced reputation for being well-paying middleclass work. In fact, the work provided generous pay and benefits only relative to the low human capital that was necessary to find employment in manufacturing. As manufacturing has declined across all industrialized countries, lower-skilled workers have been forced to accept lower rates of income growth. Meanwhile, more gains have been made by those with high levels of human capital. Public-sector professionals in particular have come to share the human-capital and income characteristics of Canada’s highest-paid managers and professionals, often enjoying greater job security as well. In reality, anxiety over the state of the middle class and its future is actually about the working class. Lumping middle-class factory workers and clerical assistants in with middle-class teachers and nurses — as current political discussion tends to do — obscures the truth about which members of that group are genuinely struggling to keep up. As long as politicians continue to promote policies aimed at helping everyone within such a vague and broad target group, they can only end up misdirecting resources by enriching those who are already doing reasonably well, rather than focusing on those working-class Canadians who truly are not. Already net transfers through the tax system to middle-income groups have grown markedly. These transfers have managed to offset about half the erosion of middle-class incomes in the marketplace. Those transfers have been financed through increased tax payments from high-income groups, but also through shrinking transfers to low-income groups. These developments raise serious policy issues for which there are no simple answers. The breadth of Canada’s middle class obviously means that it encompasses the largest proportion of families, by far. Any further policies aimed at transferring wealth from other income groups to appease middle-class voters will be costly. Given that the main cause for concern is the worsening situation of lowerskilled workers, politicians who truly want to help those struggling in the “middle class,” should focus their efforts on helping Canadians acquire more education and more skills.

The current debate presents the middle class in the Global South as a driver of democratic change and the core of civil society. The activities of NGOs, or student protests, for instance, seem to support this notion. However, these examples should not be overstretched. Before confirming the idea that the ‘middle class’ is a carrier of political protest and a driver of democratic change, we need to answer at least two questions. Is the ‘middle class’ really a class in the strict sociological sense, with a common class consciousness or just a group with a middle-income: ‘middle-income group’? And are the protests really representative of the middle-income group? Taking Kenya as an example, we cannot identify a ‘middle class’ in the strict sense of the sociological class concept. Neither does the political commitment of the middle-income group follow socio-economic differences. More important are patterns of socio-cultural differentiation that can be conceptualised as socio-cultural ‘milieus’.

class and the spread of modern mass marketing has long been highlighted (Coleman 1983). The ever-increasing purchasing power of the middle class has stimulated the emergence of a mass-market consumer society (Blumin 1989). Nowadays, understanding the evolution of international strategic marketing in emerging countries calls for studying the middle class there. Formulating ‘profiles’ to describe the middle class in different geographic contexts in order to make comparisons between them is an important part of this process of market representation for strategic marketing. The relation between the emergence of a middle class and marketing involves multiple levels and its study is bound to lead to the creation of theory as well as practical applications. Brands aimed mainly at middle-class members, which represents a major objective of modern worldwide retail distribution. But what is ‘the middle class’? And what are the best parameters on which to base a definition of middle class? On the one hand, it is a segment of the population that has discretionary income at its disposal. So, it is a consuming class whose spending is not oriented solely to subsistence. Moreover, its emergence is quite closely related to urbanization. However, this is just one component of the phenomenon – the tip of the iceberg. The submerged bulk of the iceberg involves its members’ education levels and occupations, and at an even more basic level, their values and expectations. Observing middle class evolution in both advanced and emerging countries today is a fundamental issue in international strategic marketing. The ongoing mega-trends involving the middle class in traditional industrial power economies, as well as the newly developing ones, mirror the processes of globalization. Such trends present a two-faced ‘Janus’ aspect, leading, on the one hand, to the creation of a transnational market with converging purchasing power, but on the other, the simultaneous persistence of many cultural differences. By way of example, although the Chinese midTRENDS IN MIDDLE CLASS AS A DRIVER FOR STRATEGIC MARKETING

On the Updating and Reformulations, Added by Adam Smith and J M Keynes, to Aristotle's Universal, General Theory of Economics, Politics, Civics, and Institutions

Based on Social Cognitive Theory, this exploratory study examined the relationship between self-efficacy and saving among a sample of middle and low income households. Logistic regression was used to test the hypothesis that higher levels of self-efficacy are associated with greater likelihood of saving when controlling for age and income levels. The results show that higher self-efficacy, older age, and middle incomes are associated with a higher likelihood of savings. When controlling for age and income, respondents with low self-efficacy were only 60% as likely to save as those with high self-efficacy scores. The results confirm that saving behavior is associated with general self-efficacy. Enhancing self-efficacy for middle and low income individuals may encourage saving. Implications of this research suggest a need for additional research to further explore this relationship and how it might be used to enhance outreach aimed at improving savings behavior.

25 Background: Prostate Cancer, the third most commonly diagnosed cancer in 2020 and the fifth leading cause of cancer mortality worldwide, has exhibited significant disparities in global prevalence and impact over recent decades. This study assesses the trends in incidence, mortality, and disability-adjusted life years from prostate cancer in the World Bank regions based on country income levels from 1990 to 2019. Methods: The Global Burden of Disease Study database was used to extract Age-standardized incidence rates (ASIR), age-standardized (ASDR), and life years (DALYs) for prostate cancer from different World Bank regions based on income levels from 1990 to 2019. Annual percentage change was also acquired. Mortality-to-incidence ratios (MIR) were then computed. Trends were assessed using Joinpoint regression. Results: Between 1990 and 2019, ASIRs increased across all income levels, with the greatest growth in the upper middle income (+64.7%). While ASDRs decreased in high income, upper middle income, and lower middle income levels, they notably increased in low income levels (+14.3%). DALYs decreased in high income and upper middle income levels, primarily in the high income (-25.7%), and increased in lower middle and low income levels, primarily in the low income (+13.8%). MIRs decreased in all countries, with the largest decrease in high income levels (-50%). In the last 30 years, high income countries have consistently observed the highest ASIR (2019: 77.5/100,000). However, in 1990 high income countries also had the highest ASDRs and DALYs. Interestingly, by 2019 this pattern shifted, with low income surpassing high income countries in both. Conclusions: Over the last 30 years, the incidence of prostate cancer has been rising regardless of income level. Despite the universal decrease of MIRs implying improved outcomes, screening, and therapeutical strategies, the contrasting trends in ASDRs and DALYs across income levels underscore the disparities in health outcomes. Higher income countries experienced highest cancer incidence but also the highest decrease in the mortality rates while lower income countries faced the opposite challenges with lower increase but higher mortality rates. [Table: see text]

Business Cycles Synchronicity and Income Levels: Has Globalization Brought Us Closer than Ever?

<i>Background</i>: HIV/AIDS is one of the major diseases with multifaceted burdens; health, emotional and financial. After the introduction of the Antiretroviral Therapy (ART), HIV/AIDS became a chronic disease that requires long-term management thus competing with other day-to-day economic obligations of People Living with HIV/AIDS (PLWH). There have been limited studies assessing economic burden of accessing ART treatment vis-a-vis catastrophic health expenditure (CHE) in this environment. Therefore, this survey explores the CHE resulting from accessing ART treatment and identifying some of the predictors for CHE among PLWH in Lagos State, Nigeria. <i>Materials and methods</i>: This study was a descriptive cross-sectional, quantitative survey that was carried out among 217 consenting PLWH recruited from 15 Support groups in Lagos State, Nigeria. The data was collected using 29-items self-administered questionnaire (research assistants aided PLWH who cannot read or write) developed from the review of relevant literatures. The data were analyzed using SPSS version 20. Chi-square at p-value of < 0.05 was used to determine significance of factors associated with CHE. Results: Age of the respondents was 42.81±8.517 years. Female respondents were more than 70% (171) and about half of the respondents, 109 (50.2%) were married. Above half, 129 (59%), of the respondents attend drug pick-up sites for their ARVs monthly. Less than 60% of the respondents (mean annual income 1111.203±821.371 dollars) earn below $1000 annually with 41.2%, 39.0% and 19.8% of the respondents in low, middle and high income groups respectively. Only 5% of the PLWH expend $200 annually for refill of ARVs. Considering the global definition of CHE (health expenditure>10% of household consumption,) 40% of the surveyed respondents experienced CHE. Using chi-square to determine factors associated with CHE among respondents; occupation, income group and ARVs refill frequency were significant at P<0.05. However, the binary logistic regression identified formal occupation (aOR=0.025, 95% C.I=0.02-0.35, p-value=0.006), being in middle income group (aOR=0.007, 95% C.I=0.001-0.05, p-value=0.0001) and high income group (aOR=0.035, 95% C.I=0.10-0.12, p-value=0.0001) and visiting health care facility for ARVs refill bi-monthly (aOR=17.555, 95% C.I=4.64-66.40, p-value=0.0001) as predictors of CHE among respondents. Conclusions: The results of this survey revealed that having formal employment, belonging to middle and high income groups protects respondents from CHE while bi-monthly ARVs refill predisposes PLWH in this survey to CHE.