Causes Of Inequality Research Articles

The need for improved Australian data on social determinants of health inequities

The need for improved Australian data on social determinants of health inequities

Disparities in Level of Care and Outcomes Among Patients with COVID-19: Associations Between Race/Ethnicity, Social Determinants of Health and Virtual Hospitalization, Inpatient Hospitalization, Intensive Care, and Mortality.

ObjectiveTo examine the role of race/ethnicity and social determinants of health on COVID-19 care and outcomes for patients within a healthcare system that provided virtual hospital care.MethodsThis retrospective cohort study included 12,956 adults who received care for COVID-19 within an integrated healthcare system between 3/1/2020 and 8/31/2020. Multinomial models were used to examine associations between race/ethnicity, insurance, neighborhood deprivation measured by Area Deprivation Index (ADI), and outcomes of interest. Outcomes included (1) highest level of care: virtual observation (VOU), virtual hospitalization (VACU), or inpatient hospitalization; (2) intensive care (ICU); and (3) all-cause 30-day mortality.ResultsPatients were 41.8% White, 27.2% Black, and 31.0% Hispanic. Compared to White patients, Black patients had 1.86 higher odds of VACU admission and 1.43 higher odds of inpatient hospitalization (vs. VOU). Hispanic patients had 1.24 higher odds of inpatient hospitalization (vs. VOU). In models stratified by race/ethnicity, Hispanic and Black patients had higher odds of inpatient hospitalization (vs. VOU) if Medicaid insured compared to commercially insured. Hispanic patients living in the most deprived neighborhood had higher odds of inpatient hospitalization, compared to those in the least deprived neighborhood. Black and Hispanic patients had higher odds of ICU admission and 30-day mortality after adjustment for other social determinants.ConclusionsInsurance and ADI were associated with COVID-19 outcomes; however, associations varied by race/ethnicity. Racial/ethnic disparities in outcomes are not fully explained by measured social determinants of health, highlighting the need for further investigation into systemic causes of inequities in COVID-19 outcomes.

Comparative study of two birth cohorts: did the explanatory role of behavioural, social and psychological factors in educational inequalities in mortality change over time?

ObjectivesTo investigate the contribution of behavioural, social and psychological factors to inequalities in mortality by educational level between birth cohorts.DesignCohort-sequential design.SettingTwo population-based studies in the Netherlands: the Longitudinal Aging Study...

There are no equal opportunity infectors: Epidemiological modelers must rethink our approach to inequality in infection risk.

Mathematical models have come to play a key role in global pandemic preparedness and outbreak response: helping to plan for disease burden, hospital capacity, and inform nonpharmaceutical interventions. Such models have played a pivotal role in the COVID-19 pandemic, with transmission models—and, by consequence, modelers—guiding global, national, and local responses to SARS-CoV-2. However, these models have largely not accounted for the social and structural factors, which lead to socioeconomic, racial, and geographic health disparities. In this piece, we raise and attempt to clarify several questions relating to this important gap in the research and practice of infectious disease modeling: Why do epidemiologic models of emerging infections typically ignore known structural drivers of disparate health outcomes? What have been the consequences of a framework focused primarily on aggregate outcomes on infection equity? What should be done to develop a more holistic approach to modeling-based decision-making during pandemics? In this review, we evaluate potential historical and political explanations for the exclusion of drivers of disparity in infectious disease models for emerging infections, which have often been characterized as “equal opportunity infectors” despite ample evidence to the contrary. We look to examples from other disease systems (HIV, STIs) and successes in including social inequity in models of acute infection transmission as a blueprint for how social connections, environmental, and structural factors can be integrated into a coherent, rigorous, and interpretable modeling framework. We conclude by outlining principles to guide modeling of emerging infections in ways that represent the causes of inequity in infection as central rather than peripheral mechanisms.

Elites on Equality: Room for Gender Balance and Ethnic Diversity in Leadership Positions?

Access to resources, wealth, and power positions varies systematically with membership in social categories. This article asks what role the elites themselves – as holders of power and regulators of access to influential positions – can play in maintaining, but also changing, the demographic composition of elites. Drawing on a unique survey among the entire Norwegian elite, we investigate what holders of elite positions believe are the main causes of gender imbalance and lack of ethnic diversity, and whether their beliefs influence their willingness to implement measures to promote gender equality and ethnic diversity. In line with expectations drawn from the literatures on policy representation and critical frame analysis, we find a strong, positive relationship between the belief in the importance of institutionalized causes of inequality and the willingness to introduce ameliorative measures to increase diversity. Conversely, we find a negative relationship between the belief in individualized explanations, such as the lack of qualifications, and the willingness to introduce measures. As elites are key holders of power, the findings imply that how elites view the causes of categorical inequality has strong bearings on the room for structural change.

Walking on ‘‘Mars’’: Gendered Group Processes in Space Analog Missions

Most research on mixed-gender teams in space analog environments focuses on individual-level variation and overlooks structural causes of inequality. Status characteristics theory posits how socially recognized traits, such as gender, contribute to the formation of informal hierarchies by denoting perceived levels of competence to group members. We investigated gender as a status characteristic in groups in space analog environments. We used data from the Mars Desert Research Station (MDRS) and hypothesized that women crew members are less likely than men to be selected to participate in simulated extravehicular activities during a Mars simulation at the MDRS. We used reports and biographies from 30 randomly selected crews (n = 177) posted on the MDRS website to construct our dataset and multilevel generalized regression models to test our hypothesis. Women crew members were 6% less likely to participate in simulated extravehicular activities than men, controlling for crew role, education, and other factors. Our study shows that gender acts as a status characteristic and influences group decisions in crews in space analogs. These results highlight the need for more studies on interactional inequalities in preparation for a long-term human spaceflight.

PEOPLE, POWER AND PROFITS: PROGRESSIVE CAPITALISM FOR AN AGE OF DISCONTENT

There has been a significant increase in labour productivity in recent decades. Despite that, the lifestyle of the middle class is unattainable for the majority of the population. At the same time, the inequality gap between rich and poor is constantly growing. The author of the book, Joseph E. Stiglitz, winner of the Nobel Prize in Economics in 2001, looks for the causes of inequality and solutions that would enable a fairer distribution of profits from productivity growth and globalisation. Critically analysing the situation in the economy today and during the past four decades, the author re-examines the role of political populism and blinding confidence in the market.

Accelerating Upstream Together: Achieving Infant Health Equity in the United States by 2030.

Accelerating Upstream Together: Achieving Infant Health Equity in the United States by 2030.

Towards a Political Ecology of Caste and the City

ABSTRACT In this contribution, I reflect on the under-recognized role of caste and its allied notions of pollution and purity in the making of deeply inequitable, environmentally unjust, and splintered Indian cities. Published in 2001, Graham and Marvin’s Splintering Urbanism addressed the fragmented and unequal nature of infrastructure networks in the wake of globalization in cities of the Global South. Of particular interest to scholars since then has been to trouble the historicity of the book’s central thesis, demonstrating that postcolonial cities have always been splintered along the lines of race, class, and ethnicity via unequal infrastructural networks and segregated housing; as such, globalization is not the primary cause of inequality. Yet, the category of caste, intersecting with class, religion, and gender, still has not featured centrally in critical urban studies and urban political ecology. Drawing on long-term research on Bangalore (southern India), I sketch mutually reinforcing axes of a research agenda in urban political ecology, namely the interrogation of caste power in urban property, infrastructure, and labor regimes.

Reproductive genetic carrier screening for cystic fibrosis, fragile X syndrome and spinal muscular atrophy: patterns of community and healthcare provider participation in a Victorian screening program.

The Royal Australian and New Zealand College of Obstetricians and Gynaecologists and The Royal Australian College of General Practice recommend that information on carrier screening for at least the most common inherited genetic conditions in our population, that is, thalassaemia, cystic fibrosis (CF), spinal muscular atrophy (SMA), and fragile X syndrome (FXS), should be offered to all women planning pregnancy or in early pregnancy regardless of family history or ethnicity. The aim of this study was to investigate patterns of participation by healthcare providers (HCP) and the community in screening. Participation in a Victorian program screening for CF, SMA and FXS between September 2013 and October 2018 was analysed. Requesting HCP and patient data were extracted from screening request forms. Data were analysed with respect to profession of requesting HCP, and characteristics of women screened (age, pregnancy status, socioeconomic status, geographic location, and family history of CF, SMA or FXS). In total, 21 172 women and 1288 HCPs participated in the program over this period. There was a steep socioeconomic gradient in screening uptake, with nearly half the women screened (10 349) being in the highest socioeconomic quintile. The screening rate was much higher in metropolitan areas than in regional areas. Obstetricians made most of the requests for screening, whereas 20% of requests were by GPs. Most participating GPs only made a single screening request (78%) and very few GPs made >100 screening requests compared with obstetricians (0.2% vs 17%). GPs were more likely to screen women before pregnancy compared with obstetricians (47% vs 11%). Approximately 1.5% of Victorian women of child-bearing age and 3% of pregnant Victorian women were screened by this program over the period of this study. This study highlights the translation gap between recommendations and practice, with marked inequity of access to reproductive genetic carrier screening in relation to socioeconomic status and geography. Increased participation by GPs could improve community access to reproductive genetic carrier screening, particularly access to preconception screening. Addressing the causes of inequity of access will allow more women and couples the opportunity to make informed choices about participation in screening.

Can fashion ever be fair?

The recent global economic crisis has highlighted the vulnerability of millions of women in apparel supply chains worldwide. Despite decades of activism and a plethora of corporate social responsibility and ethical labelling initiatives, there has been little evidence of progress toward greater equity in the fashion sector. Why can’t we make fashion more fair? This article explains historically rooted causes of inequity for Black and Brown women in apparel supply chains and details the rise of Fair Trade initiatives intended to use market forces to improve existing practices and support alternatives. Attempts to use consumerism and market forces to drive social change raised deep questions for social movement actors regarding first principles. Notwithstanding years of effort, Fair Trade apparel has failed to achieve any significant market penetration. Yet the sector as a whole is experiencing overlapping shocks of digitisation, climate change and pandemic-exacerbated disruptions to supply chains. Social movement actors are also targeting the sector with new demands for social and economic justice. This may provide opportunities to redesign our thinking around Fair Trade and what constitutes fairness in fashion.

Access to orphan drugs for the treatment of spinal muscular atrophy in Spain

Spinal muscular atrophy (SMA) is a rare disease whose diagnosis and treatment are complex. In Spain, there are two orphan medicines that are currently financed by the state, nusinersen and onasemnogene abeparvovec and, a third in process, risdiplam. The objective was to detect possible causes of inequity in the diagnosis and treatment of SMA in Spain. Descriptive study realized in two phases: a first phase of bibliographic revision and a second phase of semi-structured interviews with clinical experts in SMA in Andalusia, Castilla-La Mancha, Catalonia and Murcia. The number of centers, services or units of reference, the availability of regional autonomous plans for rare diseases and pilot programs of neonatal screenings can regulate access to treatments. The number of new patients diagnosed per year is estimated between one and six in the four autonomous communities (ACs) of Spain studied. Differences were not found in logistical resources. Two of the four ACs studied have regional autonomous plans for rare diseases, however, their utility has only had relevance in one of two of the ACs. Important differences in access to nusinersen were not identified in the studied ACs The diagnosis of SMA requires clinical specialized experts and specialized centers for early intervention of disease-modifying therapies.

THREE SOURCES OF ECONOMIC INEQUALITY

AbstractThere are three distinct forces that conspire to produce a great deal of economic misery. We can refer to them, for convenience, as misfortune, unfairness, and improvidence. Political philosophers have often shown an interest in one or another of these, but seldom all three. Furthermore, those who do acknowledge all three have often felt driven to collapse them into one root cause of inequality. My goal in this essay will be to argue that the three are independent of one another, but more importantly, that they each require distinct remedies. This is important for egalitarians because it defeats any attempt to develop a “one-size-fits-all” policy aimed at creating a more equal society. This analysis helps us to understand several of the tensions that arise in our attempts to combat inequality that are often obscured by an overemphasis on the power of redistributive taxation as well as generalized inattention to the way that successful welfare states achieve meaningful progress in promoting greater equality.

Growth and Common Prosperity in China

AbstractThis paper introduces a decomposition method that quantifies the contributions to common prosperity of labor market performance and social policies and extends the idea of shared prosperity to a new measure of inequity in opportunities. The resulting common prosperity indices and opportunity equality indices are then applied to five waves of the Chinese Household Income Project data from 1988 to 2018. This paper shows that the labor market performance and social policies have been improving over the last 30 years and have helped China move towards common prosperity for everyone. The indices developed in this paper allow us to quantify the extent of shared prosperity that a country has achieved and to carry out empirical studies on which policy is working and which is not. It can also help us identify the fundamental causes of inequality and aid us in achieving equality in opportunity among all members of society.

Remaking Research Tools: Toward Transforming Systems of Inequality through Social Science Research

This commentary takes up the question raised by Socius editor Adam Gamoran regarding the role of social scientists in reducing inequalities. Gamoran asks, “Can we make changes to existing practices or do we need radical reconstruction?” In considering Gamoran’s question and two springboard articles published in the special collection, the author considers three questions: First, does the field truly understand enough about the causes of inequalities to be sure that the solutions generated are appropriate? Second, what does it mean to assess the feasibility of solutions within a system that operates on the assumption that inequalities are part and parcel of its economic and social systems? Finally, how do social scientists think about the power of their research to make transformational change, when current strategies operate inside existing systems of power and inequality? After musing on these questions, the author offer a few suggestions for remaking our research to foster systems transformation.

Intellectual Property Rights: The Other Side of the Coin

The modern world operates on the survival of the fittest rule. Hence, there is cutthroat competition among the states, and every state is striving for greater economic development. Development is based on the minimal use of resources which in turn is dependent upon technological innovations. These innovations incur huge research and development costs and can easily be copied to serve as the basis for further developments by the rivals. Thus, the idea of Intellectual Property Rights (IPR) was introduced. While there are many advantages that these rights have to offer, they also prove to be deleterious in some ways as they also play a role in restricting innovation by the global North, which further widens the gap between both worlds. This paper traces the history of the IPR and develops an argument that proposes that IPR has been a cause of inequalities and has restricted innovation.

Healthcare in Pregnancy and Access to Midwives according to Socio-Economic Situation: An Analysis with Routine Data from BARMER Health Insurance

Socio-economic status is an important cause of inequality in health status and access to healthcare. This also applies to pregnancy, birth and the postpartum period. Healthcare during pregnancy plays a crucial role in the success of the life phase around birth. On the basis of routine data from BARMER health insurance, the study investigated which services pregnant women received during pregnancy depending on their socio-economic situation. The study population comprised 237,251 women insured with BARMER with 278,237 births in 2015-2019. The services billed by gynaecologists and midwives during pregnancy were considered in relation to the socio-economic situation of the women involved. Physicians dominated the provision of preventive healthcare. For almost 98% of the pregnant women, a medical preventive healthcare flat rate was billed in at least three quarters. A regular participation of the midwife in preventive healthcare from the fourth month of pregnancy with more than four preventive services was the case in only 1.2% of women. Women from low-income backgrounds received fewer antenatal healthcare services from both gynaecologists and midwives, with 31% of women with low income having no antenatal midwife contact at all, compared to only 11% of high-income women. High-income earning women were also more likely to have had early contact with a midwife (47 vs. 37% in the first trimester). The timing of the first contact seemed to be relevant for the subsequent cooperative antenatal healthcare by both professional groups. The potentials of midwifery healthcare are not being leveraged. Midwives should be significantly more involved in prenatal healthcare overall, and access to midwives must be improved, especially for socially disadvantaged women. These women could benefit in particular from midwifery healthcare, as it takes greater account of social aspects in healthcare and also provides outreach services.

‘The race for space’: capitalism, the country and the city in Britain under covid 19

ABSTRACT This article draws on the work of Raymond Williams to argue that under covid-19 the dominant ‘ways of seeing’ the countryside and the city in Britain are working to obscure the structural violence of capitalism. Cultural narratives of ‘exodus’ from the city abound in British media, fuelling a material ‘race for space’ as the middle class rush to buy up rural properties. The ‘cottagecore’ social media aesthetic has proliferated, offering privatized solutions to the crisis through nostalgic imagery of pastoral escape. At the same time, nineteenth-century discourses of dark, diseased cities have been rearticulated, providing ideological support for racist migration policies. Exploited migrant workers in Leicester are framed as ‘modern slaves’ in the city’s ‘dark factories’; their bodies are transcoded as ‘dirt’ which must be ‘rooted out’ of the nation. We argue that these binary narratives and aesthetics of a bountiful, white countryside and an infested, racialized city lead to an ‘unseeing’ of the deep structural causes of inequality. We develop Williams’s analysis to show how these cultural imaginaries also sustain the gendered and racialized division of labour under capitalism, arguing that the country-city distinction, and the material injustices it obscures, ought to become a central focus for cultural studies.

A content analysis of newspaper coverage of maternal mortality from 2010-2019

ABSTRACT Pregnancy-related death, the death of a woman during or within one year after pregnancy, is between three and four times more likely to occur in Black women than White women. To better understand communication about this public health crisis, we examined features of news coverage on maternal mortality in 155 newspaper articles. Very few articles included a clear definition of the problem, and only about a third mentioned that these deaths are largely preventable. Additionally, 61% referenced the racial disparity, but within those, most did not discuss substantive causes of inequities. In terms of message features, about one third of articles used a patient narrative, with less than 10% referencing a celebrity’s patient experience. Very few (5%) articles included information about the history of mistreatment of Black patients in American health care. Together, the findings suggest current newspaper coverage does not effectively address social determinants of maternal health outcomes.

Legal Cynicism and System Avoidance: Roma Marginality in Central and Eastern Europe

Abstract The Roma are Europe’s largest minority group and face extensive discrimination across the continent. Drawing on a survey of Roma and non-Roma households in twelve Central and Eastern European countries, we analyze the extent to which legal cynicism, as a cognitive frame, is connected to the avoidance of helpful social institutions. We thus expand existing research on legal cynicism to focus on individuals’ contacts with potentially helpful institutions that can buffer inequality. We conclude that the interplay of legal cynicism and system avoidance, which have provided deep insights into the reproduction of structural disadvantage in American cities, also provide us with international insights into the causes of inequality and minority disadvantage across hundreds of towns in Central and Eastern Europe. In this way, legal cynicism and system avoidance work to reproduce durable inequality.