Disadvantaged Households Research Articles

Less School (Costs), More (Female) Education? Lessons from Egypt Reducing Years of Compulsory Schooling

Exploiting a unique policy reform in Egypt that reduced the number of years of compulsory schooling, we show that it unexpectedly increased education attainment. This impact is almost entirely driven by girls from more disadvantaged households staying in school longer. Treated women later experienced important positive improvements in labor market opportunity and marriage quality, as measured by bride price received and household bargaining power. We reject changes in school quality as a driving mechanism and attribute the increased investment in girl's human capitcal to adjustments by credit-constrained families when school costs dropped combined with strongly non-linear returns to female education.

Do Remittances reduce poverty in Kosovo? - A counterfactual analysis

Abstract Migration and remittances are argued to be an effective mechanism for mitigating poverty, as well as a coping mechanism for disadvantaged households with no or little employment and earning opportunities in Kosovo. A considerable part is reported to be directed towards consumption and very little for investment or enterpreneurship purposes. The high dependence of households on remittances suggests that poverty rates would be much higher without the safety net provided through migration and remittances. The conventional approach of empirically estimating determinants of remittances, including those focusing on Kosovo, treats both remittance and migration behaviour as independent decisions. Empirically estimating determinants of remittances while overlooking the importance of variables that influenced the decision to migrate will leave out these determinants and also bias the results. Hence, this study treats migration and remittance decision as a joint process and focuses on the household. More precisely, it analyses the impact that remittances and migration have on the poverty in Kosovo, in a hypothetical case, without remittances and migration using data from the Household Budget Survey 2011. Due to the potential presence of selection bias, this study uses a two-stage Heckman-type selection procedure which suggests that there is no selection bias. The study develops counterfactual consumption estimates for remittance recipient households through the use of survey bootstrap procedure to predict the consumption of households in the case of no remittances. The results support the hypothesis that remittances increase the consumption of recipient households. The poverty rate would be higher for a considerable proportion of households in the case of no remittances. The poverty rates would increase particularly in rural areas. The novelty of this study lies on the methodological approach chosen to investigate the impact of remittances on poverty in Kosovo. In contrast to previous analysis, this study controls for potential selection bias and empirically assesses whether the expectations on the poverty reducing effect of remittances in Kosovo hold.

Emerging trends and the clinical impact of food insecurity in patients with diabetes.

Food insecurity is a major public health concern in the United States affecting 15 million households according to data in 2017 from the US Department of Agriculture. Food insecurity, or the inability to consistently obtain nutritious food, disproportionately affects socioeconomically disadvantaged households, as well as those with chronic diseases including diabetes mellitus (DM). This review article explores the literature over the past 10 years pertaining to the complex relationship between food insecurity, social determinants of health, and chronic disease with an emphasis on diabetes and glycemic control. Those with diabetes and food insecurity together have been shown to have worse glycemic control compared to those who are food secure, but it remains unclear exactly how food insecurity affects glycemic control. Prior interventional studies have targeted aspects of food insecurity in patients with diabetes but have reported variable outcomes with respect to improvement in glycemic control despite effectively reducing rates of food insecurity. Additionally, few data exist regarding long-term outcomes and diabetes-related complications in this population. It is likely that many factors at both the community and individual levels impact glycemic control outcomes in the setting of food insecurity. Further studies are needed to better understand these factors and to create multifaceted targets for future interventional studies aimed at improving glycemic control in this population.

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.

Housing market dualization: linking insider–outsider divides in employment and housing outcomes

Past decades of economic growth, relatively widespread employment security and expanding mortgage markets promoted growing homeownership. Recent years have witnessed this growth undercut across advanced economies, evidenced by a rise in other tenures and increasing housing precarity. Studies have shown that these housing outcomes follow more fundamental changes in labour markets. By adapting the established concept of labour market dualization to housing, this paper examines how employment and housing positions are intertwined under late capitalism, and how their relationship has changed through the Global Financial Crisis. Examining the salient case of the Netherlands through household-level data from the LISS panel, we demonstrate that being a labour market ‘outsider’ vastly increases the likelihood of being an ‘outsider’ across housing market dimensions, in terms of housing equity, affordability and prospective asset accumulation. Comparing housing and labour dualization over 2008 and 2016, we further show that the share of multiply disadvantaged households has grown substantially, both among labour market insiders and outsiders.

Determinants of access to eHealth services in regional Australia

BackgroundAustralia has a universal public healthcare system, but access to eHealth services (i.e. use of the Internet and related technologies for healthcare services) remains a remarkable challenge, particularly in regional, rural and remote communities. Similar to many other countries, Australia faces the challenges of an ageing population and chronic disease management as well as balancing the supply of and the demand for quality healthcare and advanced medical procedures. The prima facie case for inequality in accessing eHealth services across geographical settings is widely acknowledged. However, regional residents’ perceptions on access to eHealth services lack empirical evidence. Therefore, this study empirically investigates the current state and predictors of eHealth service access in regional Australia. MethodsA cross-sectional questionnaire-based household survey was conducted within a total of 390 randomly selected adults from the Western Downs Region in Southeast Queensland, Australia. Bivariate analysis was conducted to examine the relationship between eHealth access and respondents’ characteristics. A multivariate logistic regression model was also performed to identify the significant predictors of eHealth service access in regional Australia. ResultsApproximately 78% of the households have access to eHealth services. However, access to eHealth services in socioeconomically disadvantaged households was lower (19%) than that of their advantaged counterparts (25%). Factors that significantly increased the likelihood of accessing eHealth services included middle age (odds ratio [OR] = 2.75, 95% confidence interval [CI]: 1.84, 8.66), household size (three to four members) (OR = 2.29, 95% CI: 1.19, 4.73), broadband Internet access (OR = 1.67, 95% CI: 1.15, 2.90) and digital literacy (OR = 2.39, 95% CI: 1.23, 4.59). Factors that negatively influenced access to eHealth services were low educational levels (OR = 0.28, 95% CI: 0.09, 0.61), low socioeconomic status (OR = 0.65, 95% CI: 0.28, 0.83) and remote locations (OR = 0.66, 95% CI: 0.23, 0.80). ConclusionEmerging universal eHealth access provides immense societal benefits in regional settings. The findings of this study could assist policy makers and healthcare practitioners in identifying factors that influence eHealth access and thereby formulate effective health policies to optimise healthcare utilisation in regional Australia.

Sociaal werk in stadswijken waar problemen zich opstapelen

The impact of residualisation on social work has so far hardly been explored. Based on existing literature and recently started empirical research in Amsterdam we analyze several consequences. Residualisation refers to the process whereby urban social housing is strictly allocated to the lowest income groups. What does this concentration of disadvantaged households mean for the role of social workers? Firstly, for community workers residualisation mostly implies a renewed role as instigators of residents’ participation in urban renewal trajectories for social mix. Furthermore community activities are increasingly used to offer safe havens for new and old groups of residents and also to prevent expensive treatments for several residential groups. For social workers focusing on individual support or casework residualisation results in an increasingly complex caseload. Residualisation does not imply extra formation for social work, but rather extra attention for the effortful coproduction of welfare between formal and informal actors. Within this playing field, we distinguish link work as vital for both formal and informal social work. Link work is about establishing vertical and horizontal connections between different worlds, across sectoral, professional or trust gaps. We expect that in areas of residualisation successful urban social work is dependent on strong linking skills.

Implementation of a rhythm and movement intervention to support self-regulation skills of preschool-aged children in disadvantaged communities

Self-regulation skills are an important predictor of school readiness and early school achievement. Research identifies that experiences of early stress in disadvantaged households can affect young children’s brain architecture, often manifested in poor self-regulatory functioning. Although there are documented benefits of coordinated movement activities to improve self-regulation, few interventions have focused exclusively on music and rhythmic activities. This study explores the effectiveness of a preschool intervention, delivered across 8 weeks, which focused on coordinated rhythmic movement with music to improve self-regulation and executive function. The study involved 113 children across three preschools in disadvantaged communities. The intervention group received 16 sessions of a rhythm and movement program over 8 weeks, whereas the control group undertook the usual preschool program. Executive functions were directly assessed, and teachers reported on children’s self-regulation before and after the intervention. Path analyses found positive intervention effects for emotional regulation reported by teachers and, for boys, on the measure of shifting in the executive function assessment. Teacher-reported cognitive and behavioral regulation also improved in one research site. These early findings suggest that a rhythm and movement intervention has the potential to support the development of self-regulation skills in preschool; however, further research is required.

Trends of inequalities in childhood immunization coverage among children aged 12-23 months in Kenya, Ghana, and C\xf4te d\u2019Ivoire

BackgroundImmunization is one of the most cost-effective health intervention to halt the spread of childhood diseases, and improve child health. Yet, there is a substantial disparity in childhood immunization coverage. The overall objective of the study is to investigate the trends of within-country inequalities in childhood immunization coverage among children aged 12–23 months in Kenya, Ghana, and Côte d’Ivoire. The three countries included in this study are countries that are on the verge of entering the accelerated phase of the Gavi, the Vaccine Alliance’s co-sharing of costs of vaccine and eventually assuming full costs of vaccines. Côte d’Ivoire is in the Gavi preparatory transition phase, entering the accelerated transition phase in 2020, with an expected transition to full self-financing in 2025. Ghana is expected to enter the accelerated transition phase in 2021 and to full self-financing in 2026 while Kenya will enter in 2022 and fully self-finance in 2027.We examine the pattern of inequality in childhood immunization coverage over time through an equity lens by mainly exploring the direction of inequality in coverage.MethodsWe use data from the Demographic Health Surveys and Multiple Indicator Cluster Surveys. The rate difference, rate ratio, and relative concentration index are used as measures of inequality.ResultsResults of the study suggest that in most years inequality in immunization coverage in the three countries persist over time, and it favors the most-advantaged households. However, there is a sharp decrease pattern in inequalities in childhood immunization coverage in Ghana over time.ConclusionPolicymakers could be more strategic in addressing pro-rich inequality in immunization coverage by designing health interventions through an equity lens. Using inequality data and putting disadvantaged households at the center of health intervention designs could increase the efficiency of the primary health care system and reduce the incidence of mortality and morbidity as a result of vaccine-preventable disease.

“Coal is in our food, coal is in our blood”: everyday environmental injustices of rural community gardening in Central Appalachia

ABSTRACTCentral Appalachia's historical dependence on natural resource extraction industries has contributed to a long history of under- and uneven development, including trends of persistent poverty, cycles of unemployment, weakened local governance, environmental degradation, and severe social inequalities relative to the rest of the nation. Though these trends have been well documented at structural and community-levels, scholarship is more limited in assessing how the conditions of natural resource dependency may shape the everyday experiences of those who live in such regions and how those everyday experiences may illuminate challenges for future development. Employing an embedded case study design, this study examines how everyday environmental injustices may be experienced via community gardening activities, a sustainable development-oriented activity celebrated in urban locations but largely unexplored in rural environments. Drawing upon in-depth interviews with 43 gardening programme coordinators and participants, the findings demonstrate that everyday environmental injustices are experienced across four distinct, yet overlapping and mutually reinforcing, dimensions: natural, built, human health, and socioeconomic environments. These factors in turn constrain programme participation and beneficial programme outcomes, particularly for more disadvantaged households that are affected by chronic illness, geographic isolation, and environmental hazards. Although the interviewees viewed many of these challenges as further justification for pursuing grassroots initiatives like community gardening programmes, these constraints also interacted in a way that limited the success of these locally-oriented sustainable development efforts, particularly for individuals who are the most socially, economically, and environmentally marginalised.

Measuring and decomposing socioeconomic inequality in catastrophic healthcare expenditures in Iran.

ObjectivesEquity in financial protection against healthcare expenditures is one the primary functions of health systems worldwide. This study aimed to quantify socioeconomic inequality in facing catastrophic healthcare expenditures (CHE) and to identify the main factors contributing to socioeconomic inequality in CHE in Iran.MethodsA total of 37 860 households were drawn from the Households Income and Expenditure Survey, conducted by the Statistical Center of Iran in 2017. The prevalence of CHE was measured using a cut-off of spending at least 40% of the capacity to pay on healthcare services. The concentration curve and concentration index (C) were used to illustrate and measure the extent of socioeconomic inequality in CHE among Iranian households. The C was decomposed to identify the main factors explaining the observed socioeconomic inequality in CHE in Iran.ResultsThe prevalence of CHE among Iranian households in 2017 was 5.26% (95% confidence interval [CI], 5.04 to 5.49). The value of C was -0.17 (95% CI, -0.19 to -0.13), suggesting that CHE was mainly concentrated among socioeconomically disadvantaged households in Iran. The decomposition analysis highlighted the household wealth index as explaining 71.7% of the concentration of CHE among the poor in Iran.ConclusionsThis study revealed that CHE is disproportionately concentrated among poor households in Iran. Health policies to reduce socioeconomic inequality in facing CHE in Iran should focus on socioeconomically disadvantaged households.

How does perinatal maternal mental health explain early social inequalities in child behavioural and emotional problems? Findings from the Wirral Child Health and Development Study.

BackgroundThis study aimed to assess how maternal mental health mediates the association between childhood socio-economic conditions at birth and subsequent child behavioural and emotional problem scores.MethodsAnalysis of the Wirral Child Health and Development Study (WCHADS), a prospective epidemiological longitudinal study of the early origins of child mental health (n = 664). Household income at 20-weeks gestation, a measure of socio-economic conditions (SECs) in pregnancy, was the main exposure. The outcome measure was externalising and internalising problems, as measured by the Child Behaviour Checklist at 5 years. We assessed the association of household income with child behavioural outcomes in sequential linear models adjusting for maternal mental health in the pre- and post- natal period.ResultsChildren of mothers in more disadvantaged households had higher scores for externalising behaviour with a difference of 3.6 points comparing the most affluent to the most disadvantaged families (the socio-economic (SEC) gap). In our regression model adjusting for baseline confounders, comparing children of mothers in the most disadvantaged households to the least disadvantaged, we found that most disadvantaged children scored 45 percentage points (95% CI 9, 93) higher for externalising problems, and 42% of this difference was explained in the fully adjusted model. Adjusting for prenatal maternal depressive symptomology attenuated the SEC gap in externalising problems by about a third, rendering the association non-significant, whilst adjusting for pre- and post-natal maternal mental health attenuated the SEC gap by 42%. There was no significant relationship between household income and internalising problems.ConclusionSocial disadvantage is associated with higher child externalising behaviour problems score at age 5, and about 40% of this was explained by maternal perinatal mental health. Policies supporting maternal mental health in pregnancy are important to address the early emergence of inequalities in child mental health.

Land Tenure Security and Resident’s Stability in Squatter Settlements of Lahore

Squatters have now become integral part of urban centers in most developing countries like Pakistan, with Lahore experiencing growth of such informal settlements at its peak. A myriad of issues and challenges associated with economic, social, spatial, environmental and political contexts within squatters has become a great hindrance towards home improvement and better life style. Tenure security brings a sense of homeownership to socioeconomically disadvantaged households. Recently, promotion of increased security of tenure of all whether living in formal or informal settlements has been affirmed by New Urban Agenda of Habitat III. Therefore, it is need of the time to look into present tenure types of squatters being offered by the city to solve problem of housing backlog and to provide promote inclusivity ensuring healthy, affordable and sustainable environment for all inhabitants.Proposed argument has got stronger foundation due to comparative analysis of squatter having secured land tenure with squatter of unsecure tenure. In this paper we explore that tenure security is one of the key factors which leads to resident’s stability, through case study approach by investigating two squatters based on their tenure types. The data collected through questionnaire will help us to identify other key factors associated with resident stability in squatters. Study reveals that limited secured tenure options and poor governance in present urban scenario projects as major obstacles in coping with urban sprawl and squatter settlements. Findings help us to understand the phenomena of inter-connection of land tenure security and residential stability of squatters in Lahore, suffering from housing shortage and informal settlements.

Mechanisms of Inclusion: Evidence from Zambia’s Farmer Organisations

Policymakers and donors increasingly rely on farmer organisations (FOs) when implementing rural development strategies, though research suggests that targeted groups such as poorer households tend to participate less in FOs than richer ones. Here, we discuss mechanisms that may contribute towards the inclusion of disadvantaged households, using primary data from Zambian FOs involved in implementing an agricultural subsidy programme, and applying qualitative comparative analysis to identify individual and combined effects of four explanatory factors on inclusion. Our results suggest long-term commitment as a necessary condition. We further identify three alternative pathways that explain inclusion while within-case analysis describes their underlying causal mechanism: inclusion develops in FOs that show commitment and either provide financial services to vulnerable members, promote social identities or compensate disadvantaged members for not being able to access subsidised inputs. These results can explain why some FOs are more effective than others in reaching disadvantaged target groups.

Impact of fruits and vegetables vouchers on food insecurity in disadvantaged families from a Paris suburb

BackgroundSocial inequalities in nutrition lead a high number of families to struggle with food insecurity, even in developed countries. We aimed to assess the impact of fruits and vegetables vouchers on food security among disadvantaged households from a Paris suburb.MethodsWe used a pre-post assessment design. Families answered face-to-face questionnaires on food consumption and food security status before and after a randomly assigned intervention. Households in the intervention group received vouchers to buy exclusively fruits and vegetables over one year. Both intervention and control groups benefitted from nutritional education through workshops performed by dieticians during the study period. The Household Food Security Module (HFSM) was used to assess food security status of households at inclusion. Food Insufficiency Indicator (FSI) was used to assess food security at inclusion and follow-up. Evolution of FSI on both groups was evaluated using McNemar test.ResultsAmong the 91 families included between May 2015 and May 2016, 64 completed the post assessment questionnaire. At inclusion, 68.3% of families were experiencing food insecurity and 78.1% were experiencing food insufficiency. No association was found between food consumptions and food security status. After one-year follow-up, the prevalence of food insufficiency was significantly decreased in the intervention group (61.8%, with p value = 0.03), and unchanged in the control group.ConclusionIn this pilot study, food insufficiency was significantly decreased in families receiving vouchers for fruits and vegetables over a one-year period.Trial registrationNCT02461238, registered 3 June 2015 – Retrospectively registered, https://clinicaltrials.gov/ct2/show/NCT02461238

Inequality of opportunity and household education expenditures: Evidence from panel data in China

This paper offers one of the first pieces of empirical evidence on the impact of inequality of opportunity on household education investment by using the panel data from China Family Panel Studies (CFPS) in three waves (2010, 2012 and 2014). Our result suggests that inequality of opportunity has a negative effect on household education expenditures. This result is robust to a series of robustness checks. Furthermore, for relatively disadvantaged households (household heads with less education, income, or rural hukou status), inequality of opportunity has a larger negative effect on their education expenditures. Policy suggestions to lower inequality of opportunity may include reducing labor market discrimination based on gender and hukou status, balancing education resources to create more equal educational opportunities, and offering children education subsidies in low-income families.

Sistem Pendukung Keputusan Dalam Menentukan Pengguna Listrik Subsidi Dan Nonsubsidi Menggunakan Metode Fuzzy Mamdani (Studi Kasus : PT. PLN Tanjung Balai)

Abstract - The electricity subsidy program is one of the poverty reduction programs by providing electricity subsidies to poor and disadvantaged households paid by the Government of Indonesia to PT. PLN (Persero). At PT. PLN (Persero) Area Rantau Prapat Rayon Tanjung Balai which is located on Jl. General Sudirman has a problem that is faced, namely regarding the subsidy budget, it turns out that there have been many wrong targets, most of the subsidy funds have fallen to economically capable people. The government applies the electricity subsidy policy on target, subsidies must be really enjoyed by poor people. To provide electricity subsidies to poor households and poor households, both humans and agencies cannot be separated from information technology systems. This system is usually called a decision support system that is designed to assist in making a decision where no one knows exactly how the decision should be made. The problem of decision-making systems using fuzzy logic systems is very suitable for definite reasoning or estimation, especially for systems with difficult mathematical models and inappropriate data to get a definite decision. Keywords - Decision Support System, Electricity Subsidies, Fuzzy Logic.

Are renewables affecting income distribution and increasing the risk of household poverty?

The worldwide electricity mix has become diversified, mainly through the exploitation of endogenous and green resources. However, doubt has been cast on the much-vaunted advantages of renewables due to some of their characteristics, such as availability, security and affordability. In fact, growth in the installed capacity of renewable energy has increased electricity prices, which raises the question of how households have withstood the cost of energy transition. The main aim of this study is to empirically assess and discuss: (i) whether different types of household have suffered dissimilar effects from the promotion of renewables; (ii) the consequences of promoting renewables on household income; and (iii) if the promotion of renewables has reduced the risk of poverty and social exclusion. A panel data of European countries has been analysed using Kao's residual cointegration test, and an Autoregressive Distributed Lag approach, to assess the relationships. This paper proves that both income and risk of household poverty are directly linked with renewable energies, in both the short- and long-run. The energy transition to renewables has had negative consequences for households. Thus, the disadvantaged households should be helped to meet the increased cost arising from the energy transition.

Improving Access and Quality in Early Childhood Development Programs: Experimental Evidence from the Gambia

This paper studies two experiments of early childhood development programs in The Gambia: one increasing access to services, and another improving service quality. In the first experiment, new community-based early childhood development (ECD) centers were introduced to randomly chosen villages that had no pre-existing structured ECD services. In the second experiment, a randomly assigned subset of existing ECD centers received intensive provider training. We find no evidence that either intervention improved average levels of child development. Exploratory analysis suggests that, in fact, the first experiment, which increased access to relatively low quality ECD services, led to declines in child development among children from less disadvantaged households. Evidence supports that these households may have been steered away from better quality early childhood settings in their homes.

Development of a Smoke-Free Homes Intervention for Parents: An Intervention Mapping Approach.

Exposure to second-hand smoke (SHS) is associated with various ill-health outcomes for children and adults. Barriers to creating a smoke-free home (SFH) are well-documented. Feasible and effective interventions to create smoke-free homes for disadvantaged households are lacking. Interventions that include providing parents with objective information about the impact of smoking on air quality in their home may be particularly effective. This study describes the development of a novel, theory- and evidence-based smoke-free homes intervention using objectively-assessed air quality feedback. The intervention was developed using the six-step Intervention Mapping (IM) protocol. Findings from literature reviews, focus groups with parents, interviews with health/care professionals, and expert panel discussions shaped intervention content and materials. Findings highlighted the importance of parents receiving personalised information on second-hand smoke levels in their home. Professionals considered the use of non-judgemental language essential in developed materials. Previous literature highlighted the need to address home smoking behaviour at a household rather than individual level. The AFRESH intervention is modular and designed to be delivered face-to-face by healthcare professionals. It includes up to five meetings with parents, two sets of five days’ air quality monitoring and personalised feedback, and the option to involve other household members in creating a smoke-free home using educational, motivational, and goal setting techniques. Further research is needed to evaluate the acceptability and effectiveness of the AFRESH intervention and which specific groups of parents this intervention will most likely benefit. IM was a useful framework for developing this complex intervention. This paper does not present evaluation findings.