Economic Exclusion Research Articles

Polycystic ovary syndrome and labor market attachment in Swedish women

Abstract Background Polycystic ovary syndrome (PCOS) is a common endocrine disorder in women of fertile age and is associated with several burdensome comorbidities. We use Swedish longitudinal register data to identify and compare clusters of employment trajectories among working age women, in order to investigate how PCOS affects labor market attachment. Data and Methods A cohort of 157,356 women born in 1975-1977 were followed annually between the ages of 30 and 39. Labor market states were constructed by combining detailed data on various types of earned income. PCOS was identified through national inpatient and outpatient registers. Sociodemographic covariates (civil status, region of origin, highest attained education, number of children) were measured at the age of 29 years. Sequence analysis was used to identify clusters of typical labor market trajectories. Multinomial logistic regression was employed to assess the associations between being diagnosed with PCOS and belonging to the identified clusters. Results Women with PCOS spent less time in employment and were more dependent on sickness benefits during the follow-up time than those without PCOS. Five clusters of trajectories were identified: stable employment, education into employment, labor market exclusion, continuous unstable position, long-term sickness. Compared to being in stable employment cluster, women diagnosed with PCOS were 97% more likely to experience long-term sickness (RRR (relative risk ratio): 1.97 [CI: 1.90-2.05]), and had 11% higher risk of belonging to education into employment (RRR: 1.11 [CI: 1.07-1.15]) and a 4% higher risk (RRR: 1.04 [CI: 1.00-1.09]) of experiencing labor market exclusion. The magnitude of the association increased for education into employment and labor market exclusion after adjusting for covariates. Conclusions PCOS can lead to disadvantaged labor market outcomes and better strategies are needed in order to prevent economic exclusion among women diagnosed with the condition. Key messages • PCOS leads to disadvantaged labor market outcomes. • Women with PCOS may experience economic exclusion.

Factors Influencing Seniors’ Anxiety in Using ICT

The ability of older adults to engage with information and communication technologies (ICT) is crucial in today’s more digital and connected world. Anxiety about and failure to adopt and engage with ICT is increasingly likely to be a barrier in daily living for older adults, potentially reducing their freedom as consumers, quality of life, independence, and wellbeing. It may also be a significant factor in social and economic exclusion. Drawing on consumer behaviour, ICT theories and frameworks, and a quantitative survey of 706 older Australian adults, this paper examines factors influencing anxiety in engaging with ICT. Our findings show that perceived anxiety was associated with increased subjective norms or when others placed pressure on older people to engage more with ICT and when older adults perceived increased risks associated with ICT engagement. Conversely, reduced levels of perceived anxiety were correlated with a positive attitude towards ICT and when older people had the technical and cognitive resources to adopt and engage with ICT. The results highlight the importance of building, renewing, and reinforcing digital competencies in older consumers. Understanding factors associated with ICT-related anxiety means that organisations will be better placed to develop campaigns, products, programmes, and policies for older consumers that actively reduce anxiety, increase their use of ICT, and reduce the digital divide.

For a method for evaluating the economic integration of peri-urban space. Case study Mitidja of Algiers, Algeria

The peri-urban area poses a complex challenge, acknowledged for its diverse morphologies and temporalities. This article aims to provide a tool for understanding this area better and to assess the integration or exclusion of the Mitidja peri-urban area in the territorial dynamics of the Algiers metropolitan area. Geomatics and multi-criteria decision support tools, employing the AHP method and geographic information systems, were utilized. The analysis assessed the relative economic contribution considering variables like distance, population, industry, trade, and services. Results revealed significant economic roles played by certain peri-urban municipalities, challenging preconceived notions about their limited economic impact and exclusion from the Algiers metropolitan area. The research analysis clearly shows that peri-urbanization is constantly expanding, with peri-urban municipalities evolving under the shadow of the economic, social and environmental transformations of the Algiers metropolitan region.

“Economic exclusion and the health and wellbeing impacts of the oil industry in the Niger Delta region: a qualitative study of Ogoni experiences”

BackgroundWhen managed effectively, oil wealth can drive economic development and improve wellbeing. Conversely, as has been the experience in Ogoniland in the Niger Delta, the presence of the oil industry can lead to environmental degradation and social and economic vulnerabilities with negative impacts on health and wellbeing. Few studies have explored the experiences and perceptions of these impacts among residents of host communities themselves.MethodsThis qualitative study explored Ogoni residents’ experiences and perceptions of oil-industry related economic exclusion and associated impacts on health and wellbeing. In-depth interviews with 22 participants from four Local Government Areas (LGAs) were analyzed with open (inductive) coding. Guided by constructivist philosophy, interpretation of emerging themes was informed by the concept of social exclusion which recognizes that multi-dimensional processes can deprive individuals or groups of resources, rights, goods, and services, thus limiting broader societal participation.ResultsFindings highlight the exclusionary impacts of the oil industry at the intersection of i) damaged livelihoods and family income, that increased economic vulnerability and reduced participants’ ability to meet basic needs including ability to pay for healthcare; ii) lack of progress on environmental remediation and non-transparent benefit sharing schemes that exacerbate economic displacement and contribute to ongoing exposures to air and water pollution; and iii) insufficient of investment in economic development and essential health services, limiting employment opportunities and ability to access adequate healthcare.ConclusionAddressing these issues requires integrated policy interventions focusing on equitable resource distribution, environmental restoration, and inclusive economic development to promote sustainable community resilience.

Planetary media: Decolonizing the space industry through Indigenous ownership

The colonial relationship between Indigenous people and people of European origin has been characterized by conflicts, economic exclusions, and epistemological discriminations as well as the mutual sharing of knowledge, practices, and technologies. In many cases, the industrial development of space technologies such as telescopes and rocket test sites has continued the exploitative nature of colonialism. This article, however, offers a different story and concept of Indigenous decolonization that is not antagonistic but complementary to the space industry and Western liberalism more generally. The case is Space Enterprises, a company and Earth station owned by the Center for Appropriate Technologies in Alice Springs, Northern Territories, Australia and conceived by its Aboriginal owners, workers, and board of directors as representing a beneficial integration of their Indigenous self-determination and the space industry. This essay offers synthetic decolonization as an example of this integration with Western liberalism. Understanding the flows between the Indigenous-owned Earth station and satellites, as well as the connections between Indigenous and Western liberal planetary imaginaries, requires a theory of mediation. Towards that goal, planetary media is offered as a way of conceptualizing the flows of information between local Indigenous and planetary spaces and imaginaries. This essay argues that another decolonization is possible, one based on mediation between Indigenous and Western liberal systems of thought.

Rural–Urban Features of Social Innovation: An Exploratory Study of Work Integration Social Enterprises in Ireland

Geography is a significant element of social innovation. This paper focuses on exploring differences and similarities in the characteristics and contributions towards impact of Work Integration Social Enterprises (WISEs), a form of social innovation which provides otherwise unmet services and opportunities to people at risk of social and economic exclusion and distant from the labour market, in rural and urban areas of Ireland. To do so, we use data from 336 surveys from urban (213) and rural (123) WISEs and conduct an exploratory and spatially sensitive analysis to compare the characteristics, in terms of organisational age, legal and governance form, multiplicity of activities, revenue diversification; and contributions towards impact, in terms of geographical focus/reach, employment, volunteers, and income generation. Our analysis shows that WISEs in urban and rural areas present rather similar organisational characteristics and ways of functioning (legal structure, multiactivity, multiple sources of funding), but their contributions to socioeconomic impact differ according to their spatial location, with urban WISEs generating significantly more employment and income than their rural counterparts. Our study illustrates that socially innovative organisations are spatially sensitive, and that context influences their capacity to create sustainable employment opportunities and contribute to the local economy.

BORDERS AT THE MARGINS: LIVED EXPERIENCES AND GOVERNANCE CHALLENGES OF BORDER COMMUNITIES IN JAMMU AND KASHMIR

This study re-envisions border studies by focussing on the lived experiences of communities in Jammu and Kashmir’s border regions, where borders transcend mere geopolitical lines and become vibrant socio-cultural landscapes. This research paper highlights the complex issues these communities face, such as security threats, economic exclusion, and restricted access to essential services like education and healthcare. These challenges are intensified by the region’s geographic isolation, intermittent military conflicts, and political volatility, which create an environment marked by instability and vulnerability. By examining historical conflicts, systemic neglect, and geopolitical tensions, the study reveals how these factors compound the hardships of border populations. Furthermore, this paper evaluates the effects of leadership measures, such as construction projects, health, schooling, and living characteristics in enhancing conditions in such deprived regions. Consequently, the analysis presented in the research contributes to the existing body of knowledge on effective and efficient policy implementation and governance in borderland regions, while questioning the dominant paradigms of development. Thus, this work contributes to the existing literature on border studies by providing a systematic understanding of borders, community resilience, and governance in their complex interrelationships.

Banking for the Culture: Black-owned banks as cultural assets during the subprime lending boom

Today, black-owned banks are important financial resources challenging economic exclusion. Nevertheless, they do not associate strongly with building black wealth. Some scholars argue this signals black-owned banks are ornamental, or ineffective responses to legacies of economic exclusion in black segregated neighborhoods. To engage these critiques, I draw on the dialectical theoretical frames of cultural assets and structural deficits to examine the effectiveness of black-owned banks during the subprime lending boom—a period when bank practices exploiting a history of economic exclusion in black segregated neighborhoods intensify. Specifically, I analyze administrative data from the Federal Deposit Insurance Corporation (FDIC) and the Home Mortgage Disclosure Act (HMDA) to assess whether black-owned banks associate with access to mortgage credit when the subprime lending boom peaks in 2006. Using propensity score matching with inverse probability weighting, I find black-owned banks do not associate with mortgage originations in 2006; but neighborhoods with black-owned banks receive fewer subprime mortgage loans, compared to matched ones without them. As such, black-owned banks appear to effectively shield black segregated neighborhoods from the time period's predation. Overall, findings imply black-owned banks support protective credit markets during periods of intensifying economic exclusion and exploitation.

A longitudinal study on self-rated health changes in disabled older people.

There is a growing demand for quality healthcare for senior citizens among the disabled older population, considering their rising numbers. This study examines the longitudinal change in the health status of disabled older people and determines its effects on social exclusion and differences based on age at disability onset. The analysis was performed using a multilevel growth model on the health data for disabled older people (≥60 years) derived from the Korea Welfare Panel Study (KWePS). The following findings were observed based on the stated model: (1) The Self-Rated Health (SRH) of disabled older people increased over time, with significant individual differences in the initial status and growth rate; (2) The domains of economic and social network exclusion were associated with changes in the health status of disabled older people; and (3) The longitudinal effects of social exclusion on SRH changes in disabled older people varied according to the age at disability onset. Based on these results, strategies and implications for the development of health-promoting interventions for disabled older people were presented.

Does timing matter? Language course participation and language outcomes amongst new immigrants

Host country language acquisition is widely considered an important factor to prevent the social and economic exclusion of immigrants. High-income countries invest considerably in language courses for new immigrants, yet hitherto our understanding of when participation in such courses seems to stimulate language acquisition remains limited. As a result, this article addresses whether the timing of language course enrolment is related to course outcomes in terms of credentialed language proficiency. This study benefits from longitudinal population data including all new migrants entering Flanders (Belgium) in 2009–2021, to assess whether associations between language course timing and outcomes persist, for different legal categories of immigrants, when controlling for compositional factors. Findings indicate that for most immigrant categories, negative associations between course postponement and host country language attainment are explained by migration background and human capital. However, amongst family and humanitarian migrants, a negative association between course timing and outcomes persists. This persistent negative linkage suggests a stronger vulnerability to less effective (informal) learning trajectories and downward spiralling opportunities and motivation in the case of language course postponement, but also highlights the need for future research using causal estimation strategies. As such, research on language course timing and outcomes contributes to the literature highlighting that timing – e.g. regarding asylum procedures, housing, but also language programmes – matters in immigrants’ trajectories of integration in host countries.

Development Planning in Rural Communities in Bolivia: A Study in the Department of Oruro

This research aims to determine the most important elements that contribute to the development planning processes in the rural communities of the department of Oruro, Bolivia; It is based on the proposition that democracy in Latin America is in a situation characterized by advances in political rights and deficiencies in the civil and social rights of citizens, rural communities are where the most acute indicators of political, social, cultural and economic exclusion occur. Therefore, the effective membership of rural communities emerges as a peremptory task for the consolidation of their development based on community development planning. It assumes a quantitative qualitative approach, and is of a correlational descriptive type, which seeks the association and relationship of the variables that intervene and influence the community planning processes. A survey is applied to 384 people who live in communities in rural areas, among them the actors in the development of the localities are considered, such as community leaders and heads of households. For the statistical analysis, descriptive statistics and a multiple regression model are incorporated. The research establishes that community participation, ancestral knowledge, along with natural resources are the most important elements that contribute to the planning of the development of rural communities. Received: 16 February 2024 / Accepted: 8 April 2024 / Published: 5 May 2024

“Bringing Sandton into Soweto”

Over the past five decades, a vast literature on gentrification has developed. Evidence of gentrification in South African cities has been recorded in historically White neighbourhoods or city districts. The presence of gentrification in peripheral, poor, traditionally Black townships has had very little (if any) consideration in the literature, and this investigation aims to address aspects of this scholarly oversight. The paper is set in the iconic South African township of Soweto. It is argued that the Vilakazi precinct in Orlando West is an example of tourism-led gentrification. The investigation unpacks the development and gentrification of the precinct and the range of tourism roles therein. The study found that residents’ experiences were mixed; some aspects of expanded leisure and services were seen positively, while forms of economic and social exclusion were also recorded following the literature on township tourism. This unique case study connects the Global North and South experience of tourism-led gentrification, arguing that much common ground between these regions is to be found.

A qualitative exploration of the barriers and facilitators to self-managing multiple long-term conditions amongst people experiencing socioeconomic deprivation.

Globally, it is estimated that one in three adults live with two or more long-term conditions (multiple long-term conditions, MLTCs), that require self-management. People who experience socioeconomic deprivation face significant health inequalities due to a range of interrelated characteristics that lead to a lack of resources and opportunities. Previous research with underserved populations indicate low levels of trust towards primary care providers and potential barriers for developing patient-healthcare professional relationships. The purpose of this paper is to explore the barriers and facilitators to self-managing MLTCs, amongst people who experience socioeconomic deprivation. Semistructured one-to-one interviews with adults (n = 28) living in London and Sheffield, United Kingdom with MLTCs who are experiencing socioeconomic deprivation. Participants were recruited through general practices, community channels and social media. Data were analysed in NVivo using reflexive thematic analysis methods. Four analytical themes were developed: (1) challenges in accessing healthcare services, financial assistance, and cultural awareness; (2) empowerment and disempowerment through technology, including digital exclusion, and use of technology; (3) impact and causes of exclusion on self-management, including social isolation, area-based and economic exclusion, and health-related stigma and (4) adapting self-management strategies, including cost-effective, and culturally/lifestyle appropriate strategies. Future health interventions and services need to be developed with consideration of the combined complexities of managing MLTCs while experiencing socioeconomic deprivation. Increased awareness in practitioners and commissioners of the complexities surrounding the lives of people experiencing socioeconomic deprivation, and the need for targeted strategies to promote self-management of MLTCs are of great importa. A patient advisory group contributed to all stages of the study, including providing important feedback on study documents (topic guides and recruitment materials), as well as providing critical insights surrounding the interpretation of interview data.

Revisiting Calls to Restructure Nigerian Styled Federalism

Over-dependence by federating units on the central government on financial matters, created some misgivings over the operational trajectory of federalism and its acclaimed dysfunctionality in Nigeria. The paper revisits the calls to restructure Nigeria's peculiar federalism, evaluates the historical antecedents, assessed government's response to such calls, at the same time, examines altercations for and against restructuring. It adopted political economy for theoretical framework, and descriptive research design, utilising secondary source of data with content analysis. The paper found that the main bone of contention is anchored around economic exclusivity by the federal government, which is breeding dissatisfaction. Nature of politics influenced lopsided restructuring that concentrated on territorial aspects, rather than the economic domain, this disabled fiscal federalism. It concluded that the policy of concentrating revenue allocation at the centre, does not give room for each federating unit to leverage on their capacity to internally generate revenue from the resources in their environment. In order to enjoy the dividend of federalism, and advance towards achieving sustainable development a revisit to calls for restructuring is needed. There is fluidity in government's commitment toward restructuring, seen in the lack of implementation of various committees reports on restructuring and fiscal federalism. Also, there is absence of the political will to change the status quo of unitarized federalism. The paper recommends that comprehensive restructuring, with the states and local government revenue generating capacity as the kick-off point. It urgently requires cutting down cost of governance to the barest minimum.

Transport-related social exclusion and mobility in developing countries: the South African case

IntroductionTransport-related social exclusion has been studied in many countries, and from many different perspectives. In Africa, however, there is little recent research into the phenomenon, even though African cities tend to have poor transport services, urban sprawl is extensive usually resulting in long travel times and high travel costs, and certain areas experience high levels of crime. By implication, there are several factors that impact the ability of people to access economic and societal opportunities, however these are not well documented. Building on previous work from several authors, this research sought to describe transport-related social exclusion in a large metropolitan area in an emerging economy.MethodsUsing a qualitative methodology, 60 interviews were conducted with City of Johannesburg residents. The data was analyzed using manual thematic and classic content analysis.ResultsThe study found that residents often did not have access to services due to availability, but also that economic, geographic and fear-based exclusion were particularly prevalent in the sample, although there were several other psychological exclusion dimensions, as well as information exclusion.DiscussionThis study is the first recent study in South Africa to consider a wide range of commuters from varying demographic strata, thus providing a novel perspective on TRSE in a major urban area in the country. The study recommends that policy actions be considered, taking into account the minibus taxi industry, which is often overlooked in government policy. TRSE should also be an inherent element in urban (and other) transport planning, as well as take into account the broader societal realities faced by citizens. Future research directions include conducting broader quantitative studies across a variety of urban areas in South Africa, and beyond, to determine specific TRSE dimensions in various urban areas. Policy analysis is also recommended, to determine TRSE policy gaps and align interventions with specific commuter needs.

The Youth Guarantee, Vulnerability, and Social Exclusion Among NEETs in Southern Europe

Young people neither in employment, education, or training (NEETs) are particularly vulnerable to social and economic exclusion. Indeed, recognition of this fact was a key motivating factor underlying the development of the Youth Guarantee. This article uses data from the EU Labour Force Survey and EU Statistics on Income and Living Conditions to examine how the characteristics of the NEET population and their associated vulnerability to social exclusion vary across different sub-groups of young NEETs and how this has changed in Italy, Portugal, and Spain since 2015. The analysis focuses on the determinants of NEET status, youth vulnerability to poverty and social exclusion, and also examines the propensity of young NEETs to engage with public employment services in order to assess the extent to which young people most at risk of social exclusion are within the purview of the Youth Guarantee’s activities. The article highlights how the composition and vulnerability of young NEETs have altered between 2015 and 2021. While the risks of poverty and social exclusion of long-term unemployed NEETs have remained unchanged since 2015, the vulnerability of the most at-risk subgroup of young people, those who are NEET due to family responsibilities, has become more pronounced. Moreover, the engagement with public employment services of the most at-risk NEET sub-groups has remained persistently low. The findings suggest that greater efforts are needed to remove the obstacles to labour market re-integration faced by the most vulnerable groups within the purview of the programme and, above all, young women with family responsibilities.

Economic Inclusion: Green Finance and the SDGs

Persistent economic exclusion and the high levels of natural resource depletion are alarming. The Sustainable Development Goals (SDGs) are among a few global initiatives aimed at bringing a turnaround in both of these areas of concern. Giving action to productive economic inclusion and transitioning towards a circular, regenerative economy is challenging for countries, particularly because of a lack of economic incentives. Green finance has emerged in the last few decades as a valuable mechanism that has the potential to meet this challenge. In answering the question of how to facilitate the necessary transition to a green, inclusive economy, the paper attempts to bring green finance and economic inclusion together as a possible means (like a bridge) to address economic exclusion and resource degeneration. That is the primary aim of the study, and it is investigated through an analysis of theoretical literature. The key findings include: a strong synergy exists between green finance and economic inclusion; different forms of green finance are able to facilitate economic inclusion; and green finance can be instrumental in attracting investors to fast-track SDG attainment. A key conclusion is that green finance can play a vital role in activating and prolonging broad-based benefit sharing in an eco-conscious way.

ПСИХІЧНИЙ, СОЦІАЛЬНИЙ ТА ЕКОНОМІЧНИЙ ДОБРОБУТ

The issue of well-being is a constantly important issue for the existence of humanity in terms of its components. The ideology of the dominance of the "mother" model increasingly appears as a marked kind of animation, becoming at the same time a universally recognized priority and a cultural and "status" compulsion related to the quality of life. The purpose of the article is to determine the interdisciplinary principles of well-being in terms of its mental, social and economic components. The subject of research is the conceptual foundations of mental, social and economic well-being. Research methods: analysis and synthesis, comparison, grouping and analogies. Presenting main material. The article reveals the authors' reflections on well-being. Arguments and reasons are presented to confirm the principle of equal opportunities in access to social and economic benefits of individuals, which in turn predict their mental well-being. Issues related to well-being in the above dimensions will be considered in the context of the need for changes that are introduced in social life through, among other things, man's opus magnum, which is the phenomenon of globalization. The issue of well-being and, as a result, happiness is presented as a subject of interdisciplinary analysis carried out by representatives of many scientific disciplines, including philosophy, psychology, sociology, economics and ethics. Different interpretations of approaches to well-being and well-being are presented. The essence of the concept of well-being in the system of related concepts, such as wealth, standard of living, quality of life, economic well-being and social well-being, is revealed. Attention is focused on socio-economic well-being, which is revealed in the context of the implementation of the above-mentioned principle of equal opportunities in access to benefits related to the spheres of mental, social and economic components. Originality and practical significance of the research. The practical value of the research lies in the fact that the obtained results deepen in the conditions of globalization and consist, among other things, in supporting poor countries and equalizing differences in the income levels of citizens of different countries. Access to and use of even basic economic goods and services is critical to the integration of members of modern society. Research conclusions. In the conditions of deepening globalization, the problem of economic and social well-being takes on a new expression. On the one hand, it will be economic alienation, and on the other - alienation in the social sphere. It should be remembered that economic and social exclusion (caused, among other things, by low income or even no access to the labor market, inability to meet certain needs, services, etc.) is closely related to mental well-being. Therefore, the modern world must face the problem of economic and social inequality and organize social life in such a way that it promotes the development of all people as much as possible, i.e. "pro publico bono", which in turn will contribute to the equalization of their mental well-being

Can Startups Disrupt the Gender Pay Gap? Disruption of Economic Exclusion A Two-Tiered Approach,

La disruption entrepreneuriale pourrait-il mitiger l’écart de rémunération entre les hommes et les femmes. Des recherches récentes sur les détails de l’écart salariale démontrent son caractère persistant, ainsi que ses nuances au niveau de l’industrie. Alors que les données européennes indiquent que les femmes de l’UE gagnent nettement moins par heure que les hommes, les données sectorielles révèlent une extrême hétérogénéité de l’écart de rémunération dans les États membres de l’UE et de l’EEE. Cette hétérogénéité est particulièrement prononcée dans des secteurs comme la finance, qui se caractérisent par des structures de marché très concentrées ainsi que par de grandes entreprises déjà solidement implantées. Alors que les start-ups et l’investissement en capital-risque deviennent des sujets d’intérêt majeurs dans les écosystèmes d’entreprises, des travaux de recherche ont révélé des écarts significatifs entre les hommes et les femmes dans la sélection et la valorisation des start-ups, ainsi que à la tête des entreprises. En utilisant une base de données originale sur les investissements de capital risque dans l’UE et l’EEE, et une approche empirique à deux niveaux reposant à la fois sur le MCO ainsi que sur l’apprentissage automatique, cette étude examine l’impact des valorisations et de la concentration entrepreneuriale sur l’écart de rémunération au niveau sectoriel dans l’UE. Les résultats indiquent que c’est l’émergence des start-ups à forte valorisation qui sont capables de perturber la structure du marché au niveau sectoriel permettent à la fois de mitiger les écarts de rémunération et de réduire le retranchement par des insiders au niveau sectoriel, ce qui mesure l’exclusion économique en général. Cette étude contribue à la compréhension du rôle joué par la disruption des startups pour mitiger l’exclusion économique basée sur le genre.

Perfect smiles, aesthetic citizenship, and the U.S. State

ABSTRACT Through analysis of archival research and in-depth interviews this article traces the development of the social expectation in the United States for perfected smiles, produced through orthodontic treatment, and discusses its implication for two dimensions of citizenship: rights and sense of belonging. Belonging is facilitated by normative embodiment. In the contemporary United States, an irregular smile is a mark of alterity, indicating poverty, parental neglect, or foreign birth. Decades of health care policy shaped by neoliberal ideology that limited the supply of medical personnel, thwarted efforts to develop universally available state-subsidized medical care and supported private medical insurance as the primary solution to medical need, contributed to the establishment of a dental system oriented toward the production of profit. Profit-oriented dentistry made the perfect smile emblematic of the American middle class and intensified the social and economic exclusion of people with irregular smiles.