Causes Of Inequality Research Articles

Geography, inequities, and the social determinants of health in transplantation.

Among the causes of inequity in organ transplantation, geography is oft-cited but rarely defined with precision. Traditionally, geographic inequity has been characterized by variation in distance to transplant centers, availability of deceased organ donors, or the consequences of allocation systems that are inherently geographically based. Recent research has begun to explore the use of measures at various geographic levels to better understand how characteristics of a patient's geographic surroundings contribute to a broad range of transplant inequities. Within, we first explore the relationship between geography, inequities, and the social determinants of health. Next, we review methodologic considerations essential to geographic health research, and critically appraise how these techniques have been applied. Finally, we propose how to use geography to improve access to and outcomes of transplantation.

Decomposition of socioeconomic inequalities in glaucoma knowledge in Taiwan.

Glaucoma knowledge is strongly associated with medication adherence and preventive behavior. Studies have frequently reported socioeconomic inequalities in glaucoma knowledge. This study aimed to decompose such inequalities. Decomposition analysis enables the design of policies directly targeting the underlying causes of inequality. We performed a cross-sectional survey from January 1, 2019 to June 30, 2019, at the departments of ophthalmology of 2 medical centers belonging to a hospital chain in northern Taiwan. Socioeconomic inequalities in glaucoma knowledge were ranked based on 3 aspects of socioeconomic status (SES): (1) education, (2) income, and (3) self-perceived financial status. The concentration index was calculated and decomposed using decomposition analysis. Elasticity and marginal effects were estimated for each decomposed factor. In total, 1,203 patients completed the survey. Both measures of glaucoma knowledge and overall glaucoma knowledge score significantly contributed to the progressivity of knowledge inequalities (pro-high-SES inequalities). The concentration index for overall knowledge score with respect to education was 0.166 (p<0.001). Both objective and subjective measures of SES were associated with pro-high-SES inequalities. Our decomposition analysis revealed that demographic factors and attitudinal factors such as the level of concern regarding developing glaucoma contributed significantly to SES-based inequalities in glaucoma knowledge. Our decomposition analysis provided empirical evidence regarding the underlying causes of SES-based inequalities in glaucoma knowledge. Efforts to improve glaucoma knowledge should consider specific factors that drive SES-based inequalities, such as age, sex, and concern about vision health, to ultimately achieve low SES-based inequalities.

Abstract IA019: Implementation science as an opportunity to address cancer equity

Abstract The past decade of research has continued to identify and understand health disparities for cancer prevention and control. Although emerging, progress in addressing these disparities continues to fall short achieving equity. Specifically, for cancer prevention and control, Khan and colleagues in 2021 showed a 15-year lag in implementation of evidence-based interventions (i.e., HPV vaccinations, cancer screenings, etc.). This gap highlights the lack of attention towards the implementation of scientific evidence, the complexity and fragmentation of health systems, and lays bare the structural causes of inequities that continue to persist from a population perspective. Integrating implementation science in cancer prevention and control research can provide a pathway to reduce the time to translation while addressing and advancing cancer equity. Implementation science is defined as the study of methods to promote the adoption and integration of evidence-based practices, interventions, and policies into routine health care and public health settings to improve the impact on population health. Implementation science has pushed the cancer prevention and control field to pay close attention to how we dissemination scientific information towards the adoption of interventions (i.e., dissemination research) and how we systematically study strategies (i.e., the building blocks) that aid in the implementation, scale-up, and sustainability of interventions (i.e., implementation science). With implementation research, there has been a push towards hybrid designs that considers intervention effectiveness and its implementation within the same study. Given the dearth of literature around the implementation of interventions, the science of implementation continues to build on a foundational theoretical base that further provide important opportunities for the promoting equitable outcomes for cancer prevention and control research. In this educational session, we will discuss why and how applying a health equity lens to implementation science is crucial to achieve equity in cancer prevention and control. Using ongoing and completed research studies as examples, this session will help attendees learn about core elements of implementation science including theories, models, and frameworks; implementation strategies; and focal areas of adaptations and de-implementation. Citation Format: Prajakta Adsul. Implementation science as an opportunity to address cancer equity [abstract]. In: Proceedings of the 16th AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2023 Sep 29-Oct 2;Orlando, FL. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2023;32(12 Suppl):Abstract nr IA019.

A health equity framework to support the next generation of cancer population simulation models.

Over the past 2 decades, population simulation modeling has evolved as an effective public health tool for surveillance of cancer trends and estimation of the impact of screening and treatment strategies on incidence and mortality, including documentation of persistent cancer inequities. The goal of this research was to provide a framework to support the next generation of cancer population simulation models to identify leverage points in the cancer control continuum to accelerate achievement of equity in cancer care for minoritized populations. In our framework, systemic racism is conceptualized as the root cause of inequity and an upstream influence acting on subsequent downstream events, which ultimately exert physiological effects on cancer incidence and mortality and competing comorbidities. To date, most simulation models investigating racial inequity have used individual-level race variables. Individual-level race is a proxy for exposure to systemic racism, not a biological construct. However, single-level race variables are suboptimal proxies for the multilevel systems, policies, and practices that perpetuate inequity. We recommend that future models designed to capture relationships between systemic racism and cancer outcomes replace or extend single-level race variables with multilevel measures that capture structural, interpersonal, and internalized racism. Models should investigate actionable levers, such as changes in health care, education, and economic structures and policies to increase equity and reductions in health-care-based interpersonal racism. This integrated approach could support novel research approaches, make explicit the effects of different structures and policies, highlight data gaps in interactions between model components mirroring how factors act in the real world, inform how we collect data to model cancer equity, and generate results that could inform policy.

When fairness is not enough: The disproportionate contributions of the poor in a collective action problem.

Many of our most pressing challenges, from combating climate change to dealing with pandemics, are collective action problems: situations in which individual and collective interests conflict with each other. In such situations, people face a dilemma about making individually costly but collectively beneficial contributions to the common good. Understanding which factors influence people's willingness to make these contributions is vital for the design of policies and institutions that support the attainment of collective goals. In this study, we investigate how inequalities, and different causes of inequalities, impact individual-level behavior and group-level outcomes. First, we find that what people judged to be fair was not enough to solve the collective action problem: if they acted according to what they thought was fair, they would collectively fail. Second, the level of wealth (rich vs. poor) altered what was judged to be a fair contribution to the public good more than the cause of wealth (merit vs. luck vs. uncertain). Contributions during the game reflected these fairness judgments, with poorer individuals consistently contributing a higher proportion of their wealth than richer participants, which further increased inequality-particularly in successful groups. Finally, the cause of one's wealth was largely irrelevant, mattering most only when it was uncertain, as opposed to resulting from merit or luck. We discuss implications for policymakers and international climate change negotiations. (PsycInfo Database Record (c) 2023 APA, all rights reserved).

Awareness of racial/ethnic inequities in time to treatment among breast cancer providers.

584 Background: Cancer patients who self-identify as Black and Latinx are more likely to receive delays in care compared with Non-Latinx White patients. Research suggests that while providers are aware of racial/ethnic inequities in access to treatment at a national-level, they fail to recognize these differences at the hospital- or individual-level. This phenomenon is not well understood and has yet to be studied among oncologists. We sought to evaluate awareness of national and local time-to-treatment inequities in breast cancer providers. Methods: We conducted an educational intervention at the Smilow Cancer Hospital, the clinical arm of the Yale Cancer Center, in February 2023. Breast cancer providers (including breast surgeons, medical oncologists, radiation oncologists, breast radiologists, and advanced practice nurses) completed an online survey that assessed their understanding of treatment inequities at three levels (national, hospital, and individual) before and after they watched a 20-minute live presentation. The presentation included real-world national and breast-team specific data on differences in time-to-treatment metrics by race/ethnicity from the Flatiron electronic health record-derived de-identified database. Differences between surveys were evaluated with Fisher’s exact tests. Results: Among 18 providers, most were female (78%), Non-Latinx White (83%), had an average of 15 years of experience (SD=10), and half reported at least 10-25% of the patients they care for were non-White. Awareness of race/ethnicity as a factor in influencing differences in oncological care increased significantly (33% to 77 %, p = 0.02) pre-to-post intervention at the hospital-level but did not significantly change at the national- (78% to 83%, p &gt; 0.05) or individual- (17% to 28%, p &gt; 0.05) level. Providers identified adverse social determinants of health, such as housing insecurity, poor employment conditions, and food insecurity, as the main cause of inequities both nationally and within their disease team. On average, at the post-survey, most providers agreed that patient factors (62%) rather than provider factors (30%) were driving differences in oncological care metrics. However, they reported that larger systems, such as healthcare agencies, government, and providers (all 89%), rather than patients, were responsible for reducing these inequities. Conclusions: In this pilot study, a brief educational intervention increased awareness of local hospital-level factors, but not national- and individual-level factors, associated with racial/ethnic inequities in time to cancer treatment. As the oncology field continues to address inequities in care, it is crucial for providers to not only acknowledge the existence of these inequities but also to establish successful interventions to reduce these inequities within their own disease team.

“I Am in a Privileged Situation”: Examining the Factors Promoting Inequity in Open Access Publishing

ABSTRACTDespite increasing advocacy for open access (OA), the uptake of OA in some disciplines has remained low. Existing studies have linked the low uptake in OA publishing in the humanities and social sciences (HSS) to disciplinary norm, limited funding to pay for article processing charges (APCs), and researchers' preferences. However, there is a growing concern about inequity in OA scholarly communication, as it has remained inaccessible and unaffordable to many researchers. This study therefore investigated inequity in OA publishing in Canada. Using semi‐structured interviews, qualitative data was collected from 20 professors from the HSS disciplines of research‐intensive universities in Canada. Data was analyzed with NVivo software following the reflexive thematic analysis approach. Findings revealed three main causes of inequity in OA publishing among the participants. These are the cost of APCs, unequal privileges, and gender disparities. Hence, there is a need for concerted efforts by funding agencies, stakeholders, higher education institutions, and researchers to promote equity in OA scholarly communication. Some recommendations for improving equity in OA publishing are provided in this paper.

Synthetic population Catalyst: A micro-simulated population of England with circadian activities

The Synthetic Population Catalyst (SPC) is an open-source tool for the simulation of populations. Building on previous efforts, synthetic populations can be created for any area in England, from a small geographical unit to the entire country, and linked to geolocalised daily activities. In contrast to most transport models, the output is focussed on the population itself and the way people socially interact together, rather than on a precise modelling of the volume of transport trips from one area to another. SPC is therefore particularly well suited, for example, to study the spread of a pandemic within a population. Other applications include identifying segregation patterns and potential causes of inequality of opportunity amongst individuals. It is fast, thanks to its Rust codebase. The outputs for each lieutenancy area in England are directly available without having to run the code.

An Invitation to Imagine: Conclusion of the HPP Series "What Is Anti-Racism in Health Promotion Practice?"

Throughout Volume 24 (2023) of Health Promotion Practice, we presented responses to our Call for content addressing the question, "What is Anti-Racism in Health Promotion Practice?" With Editorial Board colleagues, Aditi Srivastav Bussells and Carlos Rodríguez-Diaz, we (Keon L. Gilbert and Kathleen M. Roe) sought frameworks for action and practical examples that would catalyze, support, and (re)invigorate the field in response to the urgent need to eliminate racism as a cause of inequalities in health. This conversation with artist Wriply Bennett concludes the series. We invite scholars and practitioners to review all 17 contributions to the series and to continue to ask - and address - the question 'What is anti-racism in our practice, scholarship, and lives?"

Asians and Asian Americans in the US Higher Education System: A Minority to Be Noticed

Under social movements calling to stop Asian Hate, inequality in higher education admissions became a key focus, especially race-based admissions. Asians, as one of the main minorities in America, have an impact that cant be ignored. The research investigates the cause of inequality and how different social groups benefit or lose from current admissions policies. The issue directly challenges Americas value of equity and is one of the greatest issues it ever faces. Research methods mainly include analysis of data from college official admissions office websites and government, along with a literature review of past authority scholars research and conclusions. It could be seen that current policies and Asians themselves should both make changes in order to improve the situation including breaking stereotypes and race-based admissions.

Перспективи впровадження безумовного базового доходу в Україні

The article reveals the role of unconditional basic income (UBI) as an innovative tool for the development of the national economy. Based on the analysis of scientific works of domestic and foreign scientists, its advantages and disadvantages are determined. According to its supporters, the advantages of UBI include: transparency, efficiency, poverty reduction, positive impact on economic growth. Among the shortcomings, the following can be distinguished: high cost, probable loss of motivation by citizens to work, impossibility to eliminate the fundamental causes of inequality with the help of UBI. Examples of the implementation of UBI in developed, developing countries, and countries with emerging markets are given. The current socio-economic situation in Ukraine is characterized, taking into account the influence of endogenous and exogenous negative factors, the consequences of the full-scale Russian invasion, in particular the loss of territories with significant deposits of natural resources and powerful industrial potential, mass migration of the population, etc. Our state is currently unable to use its powerful economic potential. An analysis of the expenditures of the State Budget of Ukraine for 2023 on social protection and pension provision of the population was carried out. It is proposed to introduce the UBI in Ukraine as a reliable tool of social protection with the use of international aid funds (during martial law) and rent payments as sources of its payment. It is concluded that the payment of UBI will increase the level of trust in the state and reduce corruption, as citizens will have less need to receive additional income outside the tax system and state support programs.

Intersectional Prevalence of Suicide Ideation, Plan, and Attempt Based on Gender, Sexual Orientation, Race and Ethnicity, and Rurality

Suicidal thoughts and behaviors (STBs) are major public health problems, and some social groups experience disproportionate STB burden. Studies assessing STB inequities for single identities (eg, gender or sexual orientation) cannot evaluate intersectional differences and do not reflect that the causes of inequities are due to structural-level (vs individual-level) processes. To examine differences in STB prevalence at the intersection of gender, sexual orientation, race and ethnicity, and rurality. This cross-sectional study used adult data from the 2015-2019 National Survey on Drug Use and Health (NSDUH), a population-based sample of noninstitutionalized US civilians. Data were analyzed from July 2022 to March 2023. Outcomes included past-year suicide ideation, plan, and attempt, each assessed with a single question developed for the NSDUH. Intersectional multilevel analysis of individual heterogeneity and discriminatory accuracy (MAIHDA) models were estimated, in which participants were nested within social strata defined by all combinations of gender, sexual orientation, race and ethnicity, and rurality; outcome prevalence estimates were obtained for each social stratum. Social strata were conceptualized as proxies for exposure to structural forms of discrimination that contribute to health advantages or disadvantages (eg, sexism, racism). The analytic sample included 189 800 adults, of whom 46.5% were men; 53.5%, women; 4.8%, bisexual; 93.0%, heterosexual; 2.2%, lesbian or gay; 18.8%, Hispanic; 13.9%, non-Hispanic Black; and 67.2%, non-Hispanic White. A total of 44.6% were from large metropolitan counties; 35.5%, small metropolitan counties; and 19.9%, nonmetropolitan counties. There was a complex social patterning of STB prevalence that varied across social strata and was indicative of a disproportionate STB burden among multiply marginalized participants. Specifically, the highest estimated STB prevalence was observed among Hispanic (suicide ideation: 18.1%; 95% credible interval [CrI], 13.5%-24.3%) and non-Hispanic Black (suicide plan: 7.9% [95% CrI, 4.5%-12.1%]; suicide attempt: 3.3% [95% CrI, 1.4%-6.2%]) bisexual women in nonmetropolitan counties. In this cross-sectional study, intersectional exploratory analyses revealed that STB prevalence was highest among social strata including multiply marginalized individuals (eg, Hispanic and non-Hispanic Black bisexual women) residing in more rural counties. The findings suggest that considering and intervening in both individual-level (eg, psychiatric disorders) and structural-level (eg, structural discrimination) processes may enhance suicide prevention and equity efforts.

Oral health-related stigma: Describing and defining a ubiquitous phenomenon.

This paper is the fourth of a series of narrative reviews to critically rethink underexplored concepts in oral health research. The series commenced with an initial commissioned framework of Inclusion Oral Health, which spawned further exploration into the social forces that undergird social exclusion and othering. The second review challenged unidimensional interpretations of the causes of inequality by bringing intersectionality theory to oral health. The third exposed how language, specifically labels, can perpetuate and (re)produce vulnerability by eclipsing the agency and power of vulnerabilised populations. In this fourth review, we revisit othering, depicted in the concept of stigma. We specifically define and conceptualize oral health-related stigma, bringing together prior work on stigma to advance the robustness and utility of this theory for oral health research.

The geographical pension gap: Understanding the causes of inequality in China's pension funds.

The sustainability of social pension insurance is of great significance in guaranteeing the essential life of the elderly and promoting social stability. Based on the provincial panel data from 2012 to 2020, this study uses non-spatial measurement methods, ArcGIS visualization research methods, and geographic detectors to study the regional differences in China's pension fund balances and the underlying influencing factors. Compared with the traditional way of establishing regression equations to explore the correlation of influencing factors, geographic detectors can quantify the strength of each influencing factor and detect the interaction of different influencing factors. This study found that: First, the growth rate of China's overall pension fund balances has been declining yearly, with the fastest decline in northeast China, the middle in the Western and Central regions of China, and the slowest decline in Eastern China. Second, the spatial distribution of pension fund balances shows agglomeration characteristics, with high-value areas mainly distributed in Eastern China and low-value regions distributed primarily in Western and Northeastern China. Third, the overall Theil index for pension fund balances is trending down, but the Theil index for the Eastern region is on the rise. Fourth, seven factors, including the working-age population, the population aged 65 and above, and regional GDP, are the main factors that lead to regional differences in the balance of urban and rural residential insurance funds. Finally, the superimposed effects of each element are reflected in double-factor enhancement or non-linear enhancement relation.

How well-intentioned white male physicists maintain ignorance of inequity and justify inaction

BackgroundWe present an analysis of interviews with 27 self-identified progressive white-male physics faculty and graduate students discussing race and gender in physics. White cis men dominate most STEM fields and are particularly overrepresented in positions of status and influence (i.e., full professors, chairs, deans, etc.), positioning them as a potentially powerful demographic for enacting systemic reform. Despite their proclaimed outrage at and interest in addressing inequity, they frequently engage in patterns of belief, speech and (in)action that ultimately support the status quo of white male privilege in opposition to their intentions.ResultsThe white male physicists we interviewed used numerous discourses which support racist and sexist norms and position them as powerless to disrupt their own privilege. We present and discuss three overarching themes, seen in our data, demonstrating how highly educated, well-intentioned people of privilege maintain their power and privilege despite their own intentions: (1) denying inequity is physically near them; (2) locating causes of inequity in large societal systems over which they have little influence; and (3) justifying inaction.ConclusionsDespite being progressively minded and highly educated, these men are frequently complicit in racism and sexism. We end with recommendations for helping cis men engage the power they hold to better work with marginalized people to disrupt inequity.

Understanding Health Equity in Public Health Practice in the United States.

Understanding the extent to which equity-focused work is occurring in public health departments (eg, in chronic disease programs) can identify areas of success and what is needed to move the needle on health equity. The study objective was to characterize the patterns and correlates of equity-related practices in US state and territorial public health practice. The design was a multimethod (quantitative and qualitative), cross-sectional study. The setting included US state and territorial public health departments. Chronic disease prevention practitioners (N = 600) completed self-report surveys in July 2022 through August 2022 (analyzed in September 2022 through December 2022). Health equity data were obtained across 4 domains: (1) staff skills, (2) work unit practices, (3) organizational priorities and values, and (4) partnerships and networks. There was a wide range in self-reported performance across the health equity variables. The highest values (those agreeing and strongly agreeing) were related to staff skills (eg, the ability to describe the causes of inequities [82%]). Low agreement was reported for multiple items, indicating the lack of systems for tracking progress on health equity (32%), the lack of hiring of staff members who represent disadvantaged communities (33%), and limited use of principles for community engagement (eg, sharing decision-making authority with partners [34%]). Qualitative data provided tangible examples showing how practitioners and their agencies are turning an array of health equity concepts into actions. There is urgency in addressing health equity and our data suggest considerable room for enhancing health equity practices in state and territorial public health. To support these activities, our findings provide some of the first information on areas of progress, gaps in practice, and where to target technical assistance, capacity building efforts, and accreditation planning.

Global development and urban studies: tactics for thinking beyond the North–South binary

Recent calls to shift from an “international” to a “global” development paradigm have sought to challenge global North–South binaries. This has provoked lively debate, with criticisms focusing on two issues: the empirical question of North–South convergence since 1990, and the political-theoretical basis of the proposed paradigm. In response, this paper draws on innovations in postcolonial and comparative urban studies to propose three “tactics” for thinking globally about development: thinking from the South to understand the North; comparing across difference; and exploring transnational flows, circuits and relationships. These tactics demonstrate how it is possible to disrupt geographical binaries while also addressing the two major criticisms of the global development approach. First, they demonstrate that establishing convergence is not a prerequisite to thinking about development across the global North–South distinction. Second, they are informed by critical theoretical approaches that animate a deep commitment to transforming the structural causes of inequalities globally.

Higher Education in Post-Neoliberal Times: Building Human Capabilities in the Emergent Period of Uncertainty

This paper argues that the neoliberal consensus about education finance has broken down due to growing economic inequality. First, I use a comparative historical analysis of political alliances to examine patterns of world trade and nations’ policies for economic and educational development since World War II. The United States emphasized STEM-collegiate preparation for all students, while most countries continued the dual emphasis on technical-tertiary and higher education. Educational policy in the US and Pacific region also shifted towards a reliance on markets and student loans resulting in worsening economic inequality in access. Nations with dual technical and academic pathways in secondary and postsecondary education systems expand college enrollment rates more rapidly than the US. They also experience class conflict between the working–middle class and the new technological elite. Next, I examine how education policy shifted from national planning aligned with public funding to market-based incentives for institutional development, further exposing gaps in opportunity within nations. Finally, recognizing the variations in systemic causes of inequality, I argue that governments, education agencies, and civic activists can best promote equity by organizing to address barriers to opportunity for groups left behind in the wake of withering neoliberal education policy.

Income inequality and taxes – an empirical assessment

ABSTRACT Economic literature offers several distinct explanations for the raising income inequality observed in several countries. In the debate about the causes of inequality a growing strand of research focuses on the effects of taxation on income inequality. We contribute to this literature by providing a systematic empirical account of the relationship between income inequality and personal income taxation (PIT) for a set of countries over the period 1981–2005. In order to take alternative explanations into account and to isolate the effects of tax progressivity, we include a wide range of control variables. We address potential reverse causality between inequality and PIT by using the variation in tax schedules of neighbouring countries. Our results confirm a statistically significant negative association between the progressivity of PIT and income inequality. Overall, we find that especially the average and the marginal tax rate have the potential to reduce income inequality. This finding is qualitatively robust across various different empirical specifications.

중증장애인생산품 지정 직업재활시설의 운영 성과 및 지역 별 차이 분석 연구

This study utilized 2020 data on the operation of Vocational Rehabilitation Centers (VRCs) to assess their current state, examine the impact of the Preferential Purchase Policy (PPP) on their performance, and analyze regional disparities among VRCs that are designated for PPP. By using the QGIS program, this study found statistically significant disparity in the regional distribution of VRCs that are designated for products made by people with severe disabilities (PWSD), with the top 20% of VRCs accounting for nearly 80% of total sales. Furthermore, this study concluded that the PPP for PWSD-made products is a significant factor in enhancing the job performance and sales outcomes of VRCs. Based on the findings, the study recommends the following strategies for the development and operation of the PPP and VRCs: increasing the production of products made by PWSD and raising the preferential purchase rate to ensure consistent positive effects across all VRCs; implementing an evaluation system that incentivizes the purchase of products made by PWSD in the performance assessments of national institutions and public corporations; developing specialized strategies for VRCs in regions with a low ratio of preferential purchase from designated centers compared to other cities and provinces, including analyzing their capabilities and competitive factors and suggesting alternatives; and assessing the local government's willingness to support these centers and monitoring their performance. To improve the system and reduce the concentration of sales and resources in VRCs, it is crucial to systematically examine the causes of inequality. An effective resource allocation strategy should be established to allow the top 20% of facilities to share their expertise and resources to benefit the remaining VRCs. In addition, the roles of the Korea Association of Vocational Rehabilitation Facilities for the Disabled and Korea Disabled People's Development Institute should be strengthened to establish a coordination and monitoring system.