Changes In Socioeconomic Inequalities Research Articles

The changes in socioeconomic inequalities and inequities in health services utilization among patients with hypertension in Pearl River Delta of China, 2015 and 2019

BackgroundAssessing inequities in health services utilization contributes to build effective strategies for health equity promotion. This study aimed to evaluate the socioeconomic inequalities and inequities in health services utilization among hypertensive patients and explore the changes between 2015 and 2019 in Pearl River Delta of China.MethodsThe cross-sectional surveys were conducted using the questionnaire. Eight hundred thirty and one thousand one hundred sixty-six hypertensive patients in 2015 and 2019 were interviewed, respectively. The concentration index (CI) and the horizontal inequity index (HI) were used to access the socioeconomic inequalities and horizontal inequities in outpatient and inpatient health services use. The contribution of influential factors to the overall inequalities was estimated via the concentration index decomposition. Oaxaca-type decomposition technique was utilized to measure the changes in socioeconomic inequalities between the observation periods.ResultsIn 2015 and 2019, the CIs for outpatient and inpatient utilization decreased from 0.1498 to 0.1198, 0.1982 to 0.1648, respectively, and the HIs for outpatient and inpatient utilization decreased from 0.1478 to 0.1078, 0.1956 to 0.1390, respectively. Economic status contributed the maximum ratio of the socioeconomic inequalities in the use of outpatient service (81.05% in 2015, 112.89% in 2019) and inpatient service (82.46% in 2015, 114.68% in 2019) in these 2 years. Oaxaca decomposition revealed that educational level (78.30% in outpatient, 53.79% in inpatient) and time to the nearest health facilities (66.78% in outpatient, 31.06% in inpatient) made the main positive contributions to decline the inequalities. While the main factor pushing the equalities toward deterioration was economic status (− 46.11% in outpatient, −76.56% in inpatient).ConclusionThere were certain declines in the socioeconomic inequalities and inequities in health services utilization by hypertensive patients in Pearl River Delta of China over time. The widening economic gap was the largest contribution to the observed inequalities. Interventions to protect the vulnerable group deserve further concern from policy makers.

Assessing Intertemporal Socioeconomic Inequalities in Alcohol Consumption in South Africa.

Background: This paper assesses changes in the socioeconomic inequality in alcohol consumption by exploring whether alcohol consumption (current and binge drinkers) is more prevalent among the wealthier (pro-rich) or poorer (pro-poor) group over time.Methods: Data come from the 2008, 2010/11, 2012, and 2014/15 waves of the National Income Dynamics Study (NIDS). Various equity stratifiers (sex, age, race, and rural/urban) are used to analyze the prevalence of alcohol consumption and to investigate differences in socioeconomic inequalities. Changes in socioeconomic inequality in alcohol consumption between 2008 and 2014/15 were also assessed using the concentration index.Results: Current drinkers were more concentrated among richer South Africans, while binge drinkers were concentrated among the poorer population. For current drinkers, irrespective of sex, race, age, and urban, socioeconomic inequality in alcohol consumption had become less pro-rich between 2008 and 2014/15; while inequality in binge drinking, outside of the Asian/Indian and rural categories, had become less pro-poor between 2008 and 2014/15.Conclusion: The results show evidence that binge drinking is a bigger problem among those of low-SES, young individuals, male and African populations. This paper concludes that the SA government should continue to push forward policies aiming to reduce the prevalence of binge drinking.

Decline in Current Tobacco Use and Socio-Economic Inequalities in 22 Sub-Saharan African Countries Between 2003 and 2018

Background: Tobacco companies have shifted their marketing and production to Sub-Saharan African countries which are in an early stage of tobacco epidemic. We report changes in current tobacco use and socio-economic inequalities between 2003 and 2019. Methods: We estimated country-level, sex-wise, age-standardised prevalence estimates of current tobacco use in 22 SSA countries using sequential Demographic and Health Survey data. On pooled baseline (2003-11) and most recent survey (2011-19) data, prevalence by education, wealth, and age groups; Slope index of inequality and relative index of inequality were estimated. Change in prevalence in each country and by socio-economic subgroups and change in socio-economic inequalities (pooled data) were calculated. Findings: Tobacco use among men ranging [6·1% (Ghana) to 38·3 (Lesotho)] at baseline and [4·5% (Ghana) to 46·0% (Lesotho)] most recent surveys. Decline in prevalence points ranged from 1·5% (Ghana) to 9·6% (Sierra Leone). For women countries where prevalence was <1% rose from nine to 15. In most countries prevalence of current tobacco use significantly declined. WHO target of 30% decline was achieved in 15 and 10 countries for women and men, respectively. In both sexes, tobacco use rate and decline were higher among less educated and poor while magnitude and direction of inequalities were consistently declined. Absolute inequalities three-fold higher among men, while relative inequalities were nearly twice higher among women. Interpretation: Tobacco use declined in a third of SSA countries. Persistence of socio-economic inequalities warrants stricter implementation of tobacco control measures to reach the vulnerable groups and continued monitoring of inequalities. Funding Statement: Authors did not receive any funding for this research. Declaration of Interests: Both authors have nothing to declare. Ethics Approval Statement: DHS survey protocols undergo ethical review in the United States with ICF’s (Inner City Fund) institutional review board. In each country, institutional review boards of the implementing agency approved the DHS survey. Permissions were sought from the governmental agencies in each country. Each eligible participant was explained about the survey procedures and verbal consent was sought before the interview.

Changes in socio-economic inequality in nutritional status among children in EAG states, India.

The primary purpose of this study is to examine changes in socio-economic inequality in nutritional status (stunting and underweight) among children in Empowered Action Group (EAG) states. The study is based on the most recent two wave's cross-sectional data from the National Family Health Survey (NFHS) conducted in 2005-2006 (NFHS-3) and 2015-2016 (NFHS-4). The study used height-for-age (stunting) and weight-for-age (underweight) of children as anthropometric indicators. EAG states including Bihar, Chhattisgarh, Jharkhand, Madhya Pradesh, Odisha, Rajasthan, Uttarakhand and Uttar Pradesh in India. The study includes a total of 11 858 (NFHS-3) and 92 630 (NFHS-4) children under 5 years of age. The socio-economic inequality in stunting remained unchanged in all EAG states. At the same time, the inequality in underweight decreased during 2005-2016. On decomposing, the factors contributing to socio-economic inequality revealed that household wealth index, mother's education and mother's nutritional status were the largest contributors to stunting (47 %, 24 % and 8 %) and underweight (51 %, 21 % and 16 %), respectively, in 2015-2016. The study concluded the socio-economic inequality in underweight among children under 5 years of age increased over the years in EAG states in India. Altogether, household wealth index, mother's education and mother's nutritional status contributed to nearly 80 % to inequality in stunting and 90 % to inequality in underweight in 2015-2016. Hence, efforts should be made to minimise the socio-economic inequality in the nutritional status of children, particularly in EAG states in India.

Decomposition of changes in socioeconomic inequalities in catastrophic health expenditure in Kenya.

BackgroundCatastrophic health expenditure (CHE) is frequently used as an indicator of financial protection. CHE exists when health expenditure exceeds a certain threshold of household consumption. Although CHE is reported to have declined in Kenya, it is still unacceptably high and disproportionately affects the poor. This study examines the socioeconomic factors that contribute to inequalities in CHE as well as the change in these inequalities over time in Kenya.MethodsWe used data from the Kenya household health expenditure and utilisation (KHHEUS) surveys in 2007 and 2013. The concertation index was used to measure the socioeconomic inequalities in CHE. Using the Wagstaff (2003) approach, we decomposed the concentration index of CHE to assess the relative contribution of its determinants. We applied Oaxaca-type decomposition to assess the change in CHE inequalities over time and the factors that explain it.ResultsThe findings show that while there was a decline in the incidence of CHE, inequalities in CHE increased from -0.271 to -0.376 and was disproportionately concentrated amongst the less well-off. Higher wealth quintiles and employed household heads positively contributed to the inequalities in CHE, suggesting that they disadvantaged the poor. The rise in CHE inequalities overtime was explained mainly by the changes in the elasticities of the household wealth status.ConclusionInequalities in CHE are persistent in Kenya and are largely driven by the socioeconomic status of the households. This implies that the existing financial risk protection mechanisms have not been sufficient in cushioning the most vulnerable from the financial burden of healthcare payments. Understanding the factors that sustain inequalities in CHE is, therefore, paramount in shaping pro-poor interventions that not only protect the poor from financial hardship but also reduce overall socioeconomic inequalities. This underscores the fundamental need for a multi-sectoral approach to broadly address existing socioeconomic inequalities.

Levels of and changes in socioeconomic inequality in delivery care service: A decomposition analysis using Bangladesh Demographic Health Surveys.

Socioeconomic inequality in maternity care is well-evident in many developing countries including Bangladesh, but there is a paucity of research to examine the determinants of inequality and the changes in the factors of inequality over time. This study examines the factors accounting for the levels of and changes in wealth-related inequality in three outcomes of delivery care service: health facility delivery, skilled birth attendance, and C-section delivery in Bangladesh. This study uses from the Bangladesh Demographic and Health Survey of 2011 and 2014. We apply logistic regression models to examine the association between household wealth status and delivery care measures, controlling for a wide range of sociodemographic variables. The Erreygers normalised concentration index is used to measure the level of inequalities and decomposition method is applied to disentangle the determinants contributing to the levels of and changes in the observed inequalities. We find a substantial inequality in delivery care service utilisation favouring woman from wealthier households. The extent of inequality increased in health facility delivery and C-section delivery in 2014 while increase in skilled birth attendance was not statistically significant. Wealth and education were the main factors explaining both the extent of and the increase in the degree of inequality between 2011 and 2014. Four or more antenatal care (ANC4+) visits accounted for about 8% to 14% of the observed inequality, but the contribution of ANC4+ visits declined in 2014. This study reveals no progress in equity gain in the use of delivery care services in this decade compared to a declining trend in inequity in the last decade in Bangladesh. Policies need to focus on improving the provision of delivery care services among women from poorer socioeconomic groups. In addition, policy initiatives for promoting the completion of quality education are important to address the stalemate of equity gain in delivery care services in Bangladesh.

Trends in teenage motherhood in Ecuador: challenges and inequalities.

ObjectivesTo describe trends in teenage motherhood (TM), based on the socioeconomic groups teenagers belong to, and factors related to their first experience of heterosexual intercourse (FEHI). We took into consideration women aged 20–24 years, comparing three surveys from 1999, 2004, and 2012.MethodsWe obtained data from the Ecuadorian Demographic and Health Surveys about 4,696 women aged 20–24 years who had given birth as teenagers. Prevalence ratios and their confidence intervals (95% CI) were calculated to estimate changes in socioeconomic inequalities and factors related to the FEHI.ResultsThe prevalence of TM increased from 48% in 1999 to 60% in 2012 among women with complete primary education. The social gradient among socioeconomic groups were sustained. We detected no changes in the socioeconomic inequalities characterizing TM, and in the factors related to the FEHI across the three studies in Ecuador.ConclusionsSocioeconomic inequalities in TM and disadvantageous circumstances at FEHI remained unchanged for 14 years. Some factors are vital for reducing teenage motherhood in Ecuador: gender-equitable economic development, access to comprehensive-sexual education, contraception, health services, and safe abortion.

Socioeconomic inequalities in women\u2019s access to health care: has Ecuadorian health reform been successful?

BackgroundOver the last 12 years, Ecuador has implemented comprehensive health sector reform to ensure equitable access to health care services according to need. While there have been important achievements in terms of health care coverage, the effects of these reforms on socioeconomic inequalities in health care have not been analysed. The present study assesses whether the health care reforms implemented in the decade between 2007 and 2017 have contributed to reducing the socioeconomic inequalities in women’s health care access.MethodsThe present study was based on two waves (2006 and 2014) of the Living Standards Measurement Survey conducted in Ecuador. Data from women of reproductive age (15 to 49 years) were analysed to evaluate health care coverage across three indicators: skilled birth attendance, cervical cancer screening, and the use of modern contraceptives. Absolute risk differences were calculated between the heath care indicators and the socioeconomic variables using binomial regression analysis for each time period. The Slope Index of Inequality (SII) was also calculated for each socioeconomic variable and period. A multiplicative interaction term between the socioeconomic variables and period was included to assess the changes in socioeconomic inequalities in health care over time.ResultsAccess to health care increased in the three studied outcomes during the health sector reform. Significant reductions in inequality in skilled birth attendance were observed in all socioeconomic variables except in the occupational class. Cervical cancer screening inequalities increased according to education and occupation, but decreased by wealth. Only a poorer education was observed for modern contraceptive use.ConclusionsWhile most socioeconomic inequalities in skilled birth attendance decreased during the reform period, this was not the case for inequalities in cervical cancer screening or the use of modern contraceptives. Further studies are needed to address the social determinants of these health inequalities.

Changes in Socioeconomic Inequalities in Amenable Mortality after the Economic Crisis in Cities of the Spanish Mediterranean Coast.

Several studies have described a decreasing trend in amenable mortality, as well as the existence of socioeconomic inequalities that affect it. However, their evolution, particularly in small urban areas, has largely been overlooked. The aim of this study is to analyse the socioeconomic inequalities in amenable mortality in three cities of the Valencian Community, namely, Alicante, Castellon, and Valencia, as well as their evolution before and after the start of the economic crisis (2000–2007 and 2008–2015). The units of analysis have been the census tracts and a deprivation index has been calculated to classify them according to their level of socioeconomic deprivation. Deaths and population were also grouped by sex, age group, period, and five levels of deprivation. The specific rates by sex, age group, deprivation level, and period were calculated for the total number of deaths due to all causes and amenable mortality and Poisson regression models were adjusted in order to estimate the relative risk. This study confirms that the inequalities between areas of greater and lesser deprivation in both all-cause mortality and amenable mortality persisted along the two study periods in the three cities. It also shows that these inequalities appear with greater risk of death in the areas of greatest deprivation, although not uniformly. In general, the risks of death from all causes and amenable mortality have decreased significantly from one period to the other, although not in all the groups studied. The evolution of death risks from before the onset of the crisis to the period after presented, overall, a general pro-cyclical trend. However, there are population subgroups for which the trend was counter-cyclical. The use of the deprivation index has made it possible to identify specific geographical areas with vulnerable populations in all three cities and, at the same time, to identify the change in the level of deprivation (ascending or descending) of the geographical areas throughout the two periods. It is precisely these areas where more attention is needed in order to reduce inequalities.

Measuring Out-of-pocket Payment, Catastrophic Health Expenditure and the Related Socioeconomic Inequality in Peru: A Comparison Between 2008 and 2017.

Objectives:Describe out-of-pocket payment (OOP) and the proportion of Peruvian households with catastrophic health expenditure (CHE) and evaluate changes in socioeconomic inequalities in CHE between 2008 and 2017.Methods:We used data from the 2008 and 2017 National Household Surveys on Living and Poverty Conditions (ENAHO in Spanish), which are based on probabilistic stratified, multistage and independent sampling of areas. OOP was converted into constant dollars of 2017. A household with CHE was assumed when the proportion between OOP and payment capacity was ≥0.40. OOP was described by median and interquartile range while CHE was described by weighted proportions and 95% confidence intervals (CIs). To estimate the socioeconomic inequality in CHE we computed the Erreygers concentration index.Results:The median OOP reduced from 205.8 US dollars to 158.7 US dollars between 2008 and 2017. The proportion of CHE decreased from 4.9% (95% CI, 4.5 to 5.2) in 2008 to 3.7% (95% CI, 3.4 to 4.0) in 2017. Comparison of socioeconomic inequality of CHE showed no differences between 2008 and 2017, except for rural households in which CHE was less concentrated in richer households (p<0.05) and in households located on the rest of the coast, showing an increase in the concentration of CHE in richer households (p<0.05).Conclusions:Although OOP and CHE reduced between 2008 and 2017, there is still socioeconomic inequality in the burden of CHE across different subpopulations. To reverse this situation, access to health resources and health services should be promoted and guaranteed to all populations.

Changes in socioeconomic inequality in access to study abroad programs: A cross-country analysis

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.

Four decades of socio-economic inequality and secular change in the physical growth of Guatemalans.

To investigate changes in socio-economic inequalities in growth in height, weight, BMI and grip strength in children born during 1955-1993 in Guatemala, a period of marked socio-economic-political change. We modelled longitudinal data on height, weight, BMI and hand grip strength using Super-Imposition by Translation and Rotation (SITAR). Internal Z-scores summarising growth size, timing and intensity (peak growth velocity, e.g. cm/year) were created to investigate inequalities by socio-economic position (SEP; measured by school attended). Interactions of SEP with date of birth were investigated to capture secular changes in inequalities. Urban and peri-urban schools in the region of Guatemala City, Guatemala. Participants were 40 484 children and adolescents aged 3-19 years of Ladino and Maya ancestry (nobservations 157 067). The difference in height (SITAR size) between lowest and highest SEP decreased from -2·0 (95 % CI -2·2, -1·9) sd to -1·4 (95 % CI -1·5, -1·3) sd in males, and from -2·0 (95 % CI -2·1, -1·9) sd to -1·2 (95 % CI -1·3, -1·2) sd in females over the study period. Inequalities also reduced for weight, BMI and grip strength, due to greater secular increases in lowest-SEP groups. The puberty period was earlier and shorter in higher-SEP individuals (earlier SITAR timing and higher SITAR intensity). All SEP groups showed increases in BMI intensity over time. Inequality narrowed between the 1960s and 1990s. The lowest-SEP groups were still >1 sd shorter than the highest. Risks remain for reduced human capital and poorer population health for urban Guatemalans.

Retrospective voting in Central and Eastern Europe: Hyper-accountability, corruption or socio-economic inequality?

We investigate retrospective voting in the Central–Eastern European countries since the democratic transition. We find that the phenomenon of ‘hyper-accountability’ identified by earlier scholarship is still prevalent in the region – incumbents lose substantially on average. Economic conditions – unemployment and wealth – exert influence on the chances of incumbent re-election. However, contrary to expectations expressed in earlier scholarship, the influence of the economy on the election results does not strengthen over time. We also explore additional facets of retrospective voting and find that changes in socio-economic inequality are correlated with the vote share of incumbents. Finally, we also find evidence of an interaction between economic conditions and corruption as well as inequality when it comes to explaining incumbents’ electoral results.

Understanding Changes in Socioeconomic Inequality of Unintended Pregnancy Among Iranian Married Women: A Blinder-Oaxaca Decomposition Analysis

Background: Policymakers are interested in investigating effects of governments' policies on socioeconomic inequality in public health. Objectives: This study aimed to analyze levels of and changes in socioeconomic inequality of unintended pregnancy after the changes in family planning policies and to investigate determinants of its changes in Iran. Methods: Required data were extracted from Iran's Multiple Indicator Demographic and Health Surveys conducted in 2010 and 2015. We used data from 1123 and 900 married pregnant women aged 15 - 49 years in 2010 and 2015, respectively. Wagstaff normalized concentration index was used to measure unintended pregnancy inequality. The contribution of various factors to the measured inequality in 2010 and 2015 was investigated by decomposing concentration index. Changes in the unintended pregnancy inequality in 2010 - 2015 and its determinants were assessed using Blinder-Oaxaca decomposition method. Results: Pro-rich unintended pregnancy inequality declined by 120% from -0.145 to 0.030 in 2010 - 2015. However, the pro-poor unintended pregnancy inequality in 2015 was not statistically significant. Households’ economic status and women’s age at pregnancy were the two leading factors with positive contributions while contraceptive non-use before pregnancy and women’s education level had the most negative contributions to the reduced pro-rich inequality of unintended pregnancy in 2010 - 2015. Conclusions: Pro-rich unintended pregnancy inequality not only did not increase, but also declined to zero after the changes in family planning policies. Providing sustainable livelihood for disadvantaged households with women at reproductive ages can maintain this favorable condition in the future.

Trends in Socioeconomic Inequalities in the Use of Antenatal Care Services by Women Aged 15 to 49 Years in Vietnam

Despite considerable variations in the use of antenatal care (ANC) services in Vietnam, limited information is available on socioeconomic inequalities concerning the use of ANC services. This study aimed to assess the trends and changes in socioeconomic inequalities in the use of ANC services by women aged 15 to 49 years in Vietnam from 2006 to 2014. We used data from the Multiple Indicator Cluster Survey conducted in 2006, 2011, and 2014. The percentage of women who received ANC services increased significantly from 26.5% in 2006 to 42.7% in 2011 and reached 56.6% in 2014. We found a decreasing trend in the concentration indices of the use of ANC services from 0.36 in 2006 to 0.19 in 2014. The common factors significantly associated with the higher percentage of the use of ANC services in 2006, 2011, and 2014 were women belonging to the Kinh and Hoa ethnic groups and belonging to wealthier groups. Our study showed a reduction in socioeconomic inequality in the use of ANC services between 2004 and 2014. However, significant inequalities still exist in the use of ANC services based on women's education, ethnicity, and economic status.

Socioeconomic Inequalities in Adolescent Substance Use: Evidence From Twenty-Four European Countries

Background: While there is evidence for socioeconomic inequalities in some adolescent substance use behaviors, there is limited information on how socioeconomic inequalities compare across European countries and over time. Objectives: To compare socioeconomic inequalities in problematic adolescent substance use (regular smoking, heavy episodic drinking, and cannabis use) across 24 European countries at two time points. Methods: We use the European School Survey Project on Alcohol and Other Drugs (ESPAD) to examine socioeconomic inequalities in problematic adolescent substance use across 24 European countries in 2007 (n = 73,877) and 2011 (n = 71,060) using within country logistic regressions. Socioeconomic inequalities are measured using a relative index of inequality based on highest level of parental education relative to country of residence within survey year. Countries are ranked according to socioeconomic differentials. Results: In 2007, lower socioeconomic status (SES) adolescents had significantly higher odds of heavy episodic drinking in 10 countries, regular smoking in 12 countries, and recent cannabis use in 1 country. In 2011, the number of countries were 11, 15, and 0, respectively. In 2007, lower SES adolescents had a significantly lower odds of heavy episodic drinking in one country, regular smoking in one country, and cannabis use in four countries. In 2011, the number of countries were two, one, and six, respectively. There was little evidence for changes in socioeconomic inequalities over time. Conclusions: There are large country level differences in socioeconomic inequalities in adolescent substance use.

Widening socioeconomic inequalities in Australian suicide, despite recent declines in suicide rates.

This study aims to investigate trends in socioeconomic inequalities of suicide from 1979 to 2013 for Australian males and females aged 15-34years and 35-64years. Data on suicides and population were obtained from national registries. An area-based measure of socioeconomic status (SES) was used, and categorized into low, middle, and high SES areas. Suicide rates for each SES groups were estimated using a negative binomial regression model, adjusted for confounders. Socioeconomic inequalities in suicide were assessed using absolute and relative risk of low-to-high SES areas. Secular changes in socioeconomic inequalities were assessed using trend tests for relative risk. For young males, there was an increase in socioeconomic inequality driven by a significant decrease in suicide rates in high SES areas. For older males, inequality in suicide increased by 29%, which was related to a marked increase in suicide rates in low SES areas. Inequalities in both young and older female suicides also increased. These increases occurred when corresponding suicide rates in high SES areas decreased. Recent widening socioeconomic inequalities in Australian suicide have been primarily associated with declines in suicide rates in high SES areas. However, an increasing inequality in older male suicide is linked with low SES. Efforts targeting people from poor areas, especially older males, should be considered when developing suicide prevention strategy.

Ethnic inequality, cultural distance, and social integration: evidence from a native-settler conflict in the Philippines

ABSTRACTA key debate in studies of native-migrant relations relates to the barriers to integration created by ethno-cultural differences and socio-economic disadvantage. How do changes in socio-economic inequality between ethnic groups affect interethnic ties in a divided society? I investigate this question by analysing the effect of ethnic inequality on the evolution of cross-ethnic marriages in a society fractured by conflict between natives and settlers. I find the effect is contingent on the ethnic group. Certain groups intermarry more in response to reductions in socio-economic disadvantage; others, however, remain indifferent. I suggest the difference relates to cultural distance. Specifically, I point to differences between groups in the power of the norms and sanctions regulating members’ social interactions outside of the group. These ‘closure’ norms interpose an ethno-cultural distance. I establish these findings with field interviews and census data on over six million marriages in Mindanao, an ethnically diverse region in the southern Philippines and location of an insurgency waged by rebels, drawn from the native Muslim Moro population, resentful of the influx of Christian settlers. I find Moro intermarriage unresponsive to socio-economic equalisation and suggest the strength of their ethno-cultural norms, derived from their ethno-religious identification, accounts for their distinctive response.

Explaining changes in child health inequality in the run up to the 2015 Millennium Development Goals (MDGs): The case of Zambia.

BackgroundChild health interventions were drastically scaled up in the period leading up to 2015 as countries aimed at meeting the 2015 target of the Millennium Development Goals (MDGs). MDGs were defined in terms of achieving improvements in average health. Significant improvements in average child health are documented, but evidence also points to rising inequality. It is important to investigate factors that drive the increasing disparities in order to inform the post-2015 development agenda of reducing inequality, as captured in the Sustainable Development Goals (SDGs). We investigated changes in socioeconomic inequality in stunting and fever in Zambia in 2007 and 2014. Unlike the huge literature that seeks to quantify the contribution of different determinants on the observed inequality at any given time, we quantify determinants of changes in inequality.MethodsData from the 2007 and 2014 waves of the Zambia Demographic and Health Survey (DHS) were utilized. Our sample consisted of children aged 0–5 years (n = 5,616 in 2007 and n = 12,714 in 2014). We employed multilevel models to assess the determinants of stunting and fever, which are two important child health indicators. The concentration index (CI) was used to measure the magnitude of inequality. Changes in inequality of stunting and fever were investigated using Oaxaca-type decomposition of the CI. In this approach, the change in the CI for stunting/fever is decomposed into changes in CI for each determinant and changes in the effect—measured as an elasticity—of each determinant on stunting/fever.ResultsWhile average rates of stunting reduced in 2014 socioeconomic inequality in stunting increased significantly. Inequality in fever incidence also increased significantly, but average rates of fever did not reduce.The increase in the inequality (CI) of determinants accounted for the largest part (42.5%) of the increase in inequality of stunting, while the increase in the effect of determinants explained 35% of the increase. The determinants with the greatest total contribution (change in CI plus change in effect) to the increase in inequality of stunting were mother’s height and weight, wealth, birth order, facility delivery, duration of breastfeeding, and maternal education.For fever, almost all (86%) the increase in inequality was accounted for by the increase in the effect of determinants of fever, while the distribution of determinants mattered less. The determinants with the greatest total contribution to the increase in inequality of fever were wealth, maternal education, birth order and breastfeeding duration.In the multilevel model, we found that the likelihood of a child being stunted or experiencing fever depends on the community in which they live.ConclusionsTo curb the increase in inequality of stunting and fever, policy may focus on improving levels of, and reducing inequality in, access to facility deliveries, maternal nutrition (which may be related to maternal weight and height), complementary feeding (for breastfed children), wealth, maternal education, and child care (related to birth order effects). Improving overall levels of these determinants contribute to the persistence of inequality if these determinants are unequally concentrated on the well off to begin with.

Socioeconomic Inequalities in Smoking and Smoking Cessation Due to a Smoking Ban: General Population-Based Cross-Sectional Study in Luxembourg.

This study aimed to measure changes in socioeconomic inequalities in smoking and smoking cessation due to the 2006 smoking ban in Luxembourg. Data were derived from the PSELL3/EU-SILC (Panel Socio-Economique Liewen Zu Letzebuerg/European Union—Statistic on Income and Living Conditions) survey, which was a representative survey of the general population aged ≥16 years conducted in Luxembourg in 2005, 2007, and 2008. Smoking prevalence and smoking cessation due to the 2006 smoking ban were used as the main smoking outcomes. Two inequality measures were calculated to assess the magnitude and temporal trends of socioeconomic inequalities in smoking: the prevalence ratio and the disparity index. Smoking cessation due to the smoking ban was considered as a positive outcome. Three multiple logistic regression models were used to assess social inequalities in smoking cessation due to the 2006 smoking ban. Education level, income, and employment status served as proxies for socioeconomic status. The prevalence of smoking decreased by 22.5% between 2005 and 2008 (from 23.1% in 2005 to 17.9% in 2008), but socioeconomic inequalities in smoking persisted. Smoking prevalence decreased by 24.2% and 20.2% in men and women, respectively; this difference was not statistically significant. Smoking cessation in daily smokers due to the 2006 smoking ban was associated with education level, employment status, and income, with higher percentages of quitters among those with a lower socioeconomic status. The decrease in smoking prevalence after the 2006 law was also associated with a reduction in socioeconomic inequalities, including differences in education level, income, and employment status. Although the smoking ban contributed to a reduction of such inequalities, they still persist, indicating the need for a more targeted approach of smoke-free policies directed toward lower socioeconomic groups.