Equity Consequences Research Articles

The Nature of Labor’s Vulnerability to Exploitation

I identify a hitherto unrecognized contribution of labor to production stemming from an innate sense of psychological ownership of the fruits of one’s labor. This is rooted in the consciousness accompanying all human activities and is distinct from legal ownership. Consciousness is inalienable; it cannot be contracted on. Labor’s psychological ownership generates quasi-rents, which can be appropriated by capitalist firms with market power. Monopsony power, now empirically seen to be ubiquitous in labor markets, has more serious efficiency and equity consequences than recognized. In a neoclassical framework, I also show why labor is uniquely vulnerable to exploitation—reconciling it with Marxian views. If capitalist owners are taken to be unaware of their workers’ psychological ownership, this exploitation occurs even in competitive labor markets. JEL Classification: P12, J22, J3, J42, D41

The Health and Social Implications of Racism During Covid-19: Insights from Melbourne’s Multicultural Communities

ABSTRACT The health, social, and economic uncertainties that accompany crisis events make them fertile ground for racism, as observed on a global scale during the COVID-19 pandemic, with evidence of significant social and health consequences for those targeted. In this article, we present the findings of a reflexive, interpretive thematic analysis of semi-structured interviews with 10 service providers and community leaders who have supported multicultural communities during the pandemic in Melbourne, Australia. Interviewees discussed numerous social and health equity consequences of pandemic-related racism and offered best-practice recommendations for policy, research, and advocacy. Drawing on Systemic Racism Theory, our analysis reveals significant social and health implications of racism in Melbourne during COVID-19, lending further support to the concept of racism as both a social determinant of health and a key driver of social inequity. Participants advocated collaborative, community-led antiracism and advocacy approaches that centre the knowledge and expertise of people with lived experience of racism. These recommendations are discussed with consideration of contemporary challenges in research, policy, and practice efforts to address the ongoing health and social equity issues facing multicultural communities in times of crisis.

Whose Neighborhood Needs? Assessing the Spatial Distribution of Federal Community Development Funds

Local governments must balance their growth ambitions against needs arising from social inequities. The Community Development Block Grant (CDBG) program aims to redress these disparities by directing funds toward disinvested tracts. We ask whether a city's institutional design, public and private actor composition, and resource availability influence the decision to invest in communities with greater levels of social need. Utilizing a social equity framework, we connect place-level procedural fairness mechanisms with neighborhood-level access equity consequences. Combining U.S. local government survey data over two decades with census tract-level CDBG expenditures, we find that in neighborhood where 51 percent or more of the families are low-to-moderate income (LMI), its likelihood of receiving funds increases with its share of LMI population relative to the city's, but at a diminished rate compared to non-LMI tracts. Further, city-level factors moderate this relationship (e.g., including community development corporations in planning processes).

The nature, drivers andequity consequences ofinformal payments formaternal andchild health care inprimary health centres inEnugu, Nigeria.

In Nigeria, most basic maternal and child health services in public primary health-care facilities should be either free of charge or subsidized. In practice, additional informal payments made in cash or in kind are common. We examined the nature, drivers and equity consequences of informal payments in primary health centres (PHC) in Enugu State. We used three interlinked qualitative methods: participant observation in six PHC facilities and two local government area (LGA) headquarters; in-depth interviews with frontline health workers (n = 19), managers (n = 4) and policy makers (n = 10); and focus group discussions (n = 2) with female service users. Data were analysed thematically using NVivo 12. Across all groups, informal payments were described as routine for immunization, deliveries, family planning consultations and birth certificate registration. Health workers, managers and policy makers identified limited supervision, insufficient financing of facilities, and lack of receipts for formal payments as enabling this practice. Informal payments were seen by managers and health workers as a mechanism to generate discretionary revenue to cover operational costs of the facility but, in practice, were frequently taken as extra income by health workers. Health workers rationalized informal payments as being of small value, and not a burden to users. However, informal payments were reported to be inequitable and exclusionary. Although they tended to be lower in rural PHCs than in wealthier urban facilities, participant observation revealed how, within a PHC, the lowest earners paid the same as others and were often left unattended if they failed to pay. Some female patients reported that extra payments excluded them from services, driving them to seek help from retail outlets or unlicensed health providers. As a result, informal payments reduced equity of access to essential services. Targeted policies are needed to improve financial risk protection for the poorest groups and address drivers of informal payments and unfairness in the health system.

Health, economic, and equity consequences of future tobacco control policies in England: a microsimulation study

BackgroundSmoking still generates a huge, costly, and inequitable burden of disease. The UK tobacco-free generation target to reduce smoking prevalence to below 5% by 2030 will be missed if current trends continue. We aimed to determine whether additional policies could speed progress towards meeting the tobacco-free generation target. MethodsWe developed, calibrated, and validated a microsimulation model, IMPACTHINT simulating English adults aged 30–89 years from 2023 to 2072. The model included a detailed smoking history and quantified policy health outcomes including smoking prevalence and smoking-related diseases, economics, and equity. We simulated five scenarios: (1) baseline trends; (2) increasing the minimum age of access to tobacco to 21 years (MinAge21); (3) a 30% increase in tobacco duty (TaxUP); (4) improved smoking cessation services (ServicesUP); and (5) a combination of TaxUP and ServicesUP. We estimated the smoking prevalence, smoking-related diseases and cumulative cases prevented or postponed, and deaths. We evaluated the scenario cost-effectiveness from the societal perspective. Lastly, we analysed the results by deprivation quintile. We present in our findings cumulative cases prevented or postponed over 50 years. FindingsNone of the scenarios would reduce overall smoking prevalence to below 5% by 2030. However, that goal could be reached by 2035 under the TaxUP and the combination of TaxUP and ServicesUP scenarios, by 2037 under the ServicesUP scenario, or by 2038 under the MinAge21 and the baseline scenarios. By 2072, the combined scenario might reduce smoking-related diseases by 160 000 cases (95% CI 140 000–200 000), greatly exceeding the reductions by 140 000 cases (120 000–180 000) with TaxUP, 69 000 cases (53 000–86 000) with MinAge21, or 22 000 cases (14 000–31 000) with ServicesUP. Some 50% of all disease-years reduced by TaxUP would occur in the most deprived quintile. The most affluent quintile could reach the 5% goal sooner than the most deprived quintile (by 2032 for the least deprived vs 2038 for the most deprived), and it could reach the 5% target by 2030 under the combined TaxUP and ServicesUP scenario. Finally, all policies would save costs compared with the baseline trend. InterpretationAffluent groups will achieve the 5% tobacco-free goal a decade sooner than the most deprived. However, that goal could be achieved in all groups by 2035 through a 30% increase in tax and enhanced smoking cessation services. Our limitations included the uncertainties of any 50-year forecast. However, that long time-horizon can capture the potential policy benefits for younger age groups. FundingEconomic and Social Research Council.

EE459 Racial Health Disparities in Acute Ischemic Stroke: A Targeted Literature Review for Estimates to be Used in Distributional Cost-Effectiveness Analysis

Racial health disparities in acute ischemic stroke (AIS) are documented across the patient journey, from incidence to treatment access. Equity-informative cost-effectiveness analyses, such as distributional cost-effectiveness analysis (DCEA), can allow for clear quantification of disparities and can estimate the equity consequences of treatment and access decisions. The objective of this review is to summarize existing disparities across race and ethnicity as well as social determinants of health in AIS to inform DCEA.

The NDIS at ten years: designing an equitable scheme for the next decade.

The NDIS at ten years: designing an equitable scheme for the next decade.

School-based screening strategies to prevent the spread of COVID-19 in school: a systematic review of the literature

to describe studies that evaluated the screening programmes implemented in the school during the COVID-19 pandemic. a systematic literature review was conducted according to the PRISMA 2020 Guidelines. Studies published until December 2021 were included. The methodological quality of the studies was assessed with validated scales. Study selection, data extraction, and quality assessment were carried out by two authors independently. teachers and students belonging to schools of all levels, including universities. a. transmission-related outcomes (such as the number or proportion of cases, cumulative frequency, incidence); b. feasibility/acceptability of the screening strategies; c. socioeconomic outcomes (such as testing cost, number of days spent in school, quarantine). after having removed duplicate articles, 2,822 records were retrieved. Thirty-six studies were included (15 used an observational design and 21 modelling study). Regarding the former, the methodological quality has been rated as high in 2 studies, intermediate in 6 and low in 2; in the remaining ones, it was not evaluated because only descriptive. Screenings were quite different in terms of school study population, types of tests used, methods of submission and analysis, and level of incidence in the community at the time of implementation. Outcome indicators were also varied, a heterogeneity that, on the one hand, did not allow for meta-analysis of results and, on the other, allowed for testing the performance of the screenings in very different settings. All of the field studies claim that the screenings reduced SARS-CoV-2 exposure and infection among children, adolescents, and college students, curbing at-school transmission and helping to reduce the number of closing school days. Studies that evaluated the cost of the intervention emphasized its cost-effectiveness, while those that focused on the acceptability of the instrument showed a preference among children, adolescents, and parents for minimally invasive, self-administered tests with high sensitivity and lower frequency of repetition. Simulation-based studies are mostly based on compartmental and agent-based models. Their quality is quite high methodologically, although uncertainty quantification and external validation, aimed at verifying the model ability to reproduce observed data, are lacking in many cases. The contexts to which the simulations refer are all school-based, although 7 studies consider residential situations, which are poorly suited to the Italian context. All simulation-based models indicate the importance of planning repeated testing on asymptomatic individuals to limit contagion. However, the costs of these procedures can be high unless assessments are spaced out or pool testing procedures are used. Obtaining high student adherence to the screening programme is extremely important to maximize results. school-based screenings, especially when combined with other preventive measures, have been important public health tools to contain infections during COVID-19 waves and to ensure children's and adolescents' right to education and to prevent the fallout in physical and mental health (with strong equity consequences) associated with school closures.

Mixed Signals? Economically (Dis)advantaged Students’ College Attendance Under Mandatory College and Career Readiness Assessments

In 2015, Wisconsin began mandating the ACT college entrance exam and the WorkKeys career readiness assessment. With population-level data and several quasi-experimental designs, we assess how this policy affected college attendance. We estimate a positive policy effect for middle/high-income students, no effect for low-income students, and greater effects at high schools that had lower ACT participation before the policy. We further find little evidence that being deemed college-ready by one’s ACT scores or career-ready by one’s WorkKeys scores affects college attendance probabilities. Pragmatically, the findings highlight the policy’s excellence and equity consequences, which are complex given that the policy has principally helped advantaged students. Theoretically, the findings shed light on students’ (dis)inclinations to update educational beliefs in light of new signals.

Organizing to advance equitable climate and health solutions: The medical society consortium on climate and health

In 2016, concern among physicians about the health harms of climate change led to the founding of the Medical Society Consortium on Climate and Health, a coalition of medical societies and ultimately other health organizations, to publicly sound the alarm and address profound and growing health and equity consequences of climate change. Building on strong public trust in medical and other health professionals, in partnership with other health organizations, in 2019 the Consortium declared climate change a health emergency and now pursues a policy agenda of equitable climate solutions that protect and promote health. The health case for climate action is compelling because while solutions provide climate benefits in the future , many solutions provide powerful health benefits in the present , and primarily in communities taking such actions. The economic case is also compelling, with the cost of electricity from clean renewable sources now lower than fossil fuels, and the cost of inaction continuing to grow: Recent estimates of the health cost of climate change show it surpassing $800 billion per year. The Consortium supports decarbonizing the U.S. health sector and international efforts to convince the world's leaders to limit global warming to no more than 1.5C, which is the upper limit of the safe zone.

P25 Income and Equity Effect of Modelled Sugar Tax and Fruit and Vegetable Subsidy Program across Different Income Groups in Canada

Food taxes and subsidies have been implemented in many countries, and they have effectively improved the dietary patterns of populations and reduced disease risks, enhanced quality of life, and saved healthcare costs. However, the equity consequences of these interventions are not well understood. This study aims to assess the impact of sugar tax and fruit and vegetable subsidy programs on future health care spending for chronic disease management and treatment by income quintiles in Canada.

Designing Equitable Health Care Outreach Programs From Machine Learning Patient Risk Scores.

There is growing interest in ensuring equity and guarding against bias in the use of risk scores produced by machine learning and artificial intelligence models. Risk scores are used to select patients who will receive outreach and support. Inappropriate use of risk scores, however, can perpetuate disparities. Commonly advocated solutions to improve equity are nontrivial to implement and may not pass legal scrutiny. In this article, we introduce pragmatic tools that support better use of risk scores for more equitable outreach programs. Our model output charts allow modeling and care management teams to see the equity consequences of different threshold choices and to select the optimal risk thresholds to trigger outreach. For best results, as with any health equity tool, we recommend that these charts be used by a diverse team and shared with relevant stakeholders.

Accounting for Multisectoral Dynamics in Supporting Equitable Adaptation Planning: A Case Study on the Rice Agriculture in the Vietnam Mekong Delta

AbstractThe need for explicitly considering equity in climate change adaptation planning is increasingly being recognized. However, evaluations of adaptation often adopt an aggregated perspective, while disaggregation of results is important to learn about who benefits when and where. A typical example is adaptation of rice agriculture in the Vietnam Mekong Delta (VMD). Efforts focused on flood protection have mainly benefitted large‐scale farmers while harming small‐scale farmers. To investigate the distributional consequences of adaptation policies in the VMD, we assess both aggregate total output and equity indicators, as well as disaggregated impacts in terms of district‐level farming profitability. Doing so requires an adequate representation of the multisectoral dynamics between the human and biophysical systems which influence farming profitability. We develop a spatially explicit integrated assessment model that couples inundation, sedimentation, soil fertility and nutrient dynamics, and behavioral land‐use change and farming profitability calculation. We find that inter‐district inequality responds in a non‐linear way to climatic and socio‐economic changes and choices of adaptation policies. The patterns of who wins and who loses could change substantially when a different policy is implemented or if a slightly different uncertain future materializes. We also find that there is no simple ranking of alternative adaptation policies, so one should make trade‐offs based on agreed preferences. Accounting for equity implies exploring the distribution of outcomes over different groups over a range of uncertain futures. Only by accounting for multisectoral dynamics can planners anticipate the equity consequences of adaptation and prepare additional measures to aid the worse‐off actors.

Exploring equity in health and poverty impacts of control measures for SARS-CoV-2 in six countries

BackgroundPolicy makers need to be rapidly informed about the potential equity consequences of different COVID-19 strategies, alongside their broader health and economic impacts. While there are complex models to inform...

Exploring Equity in Health and Poverty Impacts of Control Measures for SARS-CoV-2 in Six Countries

Background: Policy makers need to be rapidly informed about the potential equity consequences of different COVID-19 strategies, alongside their broader health and economic impacts. While there are complex models to inform both potential health and macro-economic impact, there are few tools available to rapidly assess potential equity impacts of interventions.Methods: We created an economic model to simulate the impact of lockdown measures in Pakistan, Georgia, Chile, United Kingdom, Philippines, and South Africa. We consider impact of lockdown in terms of inability to socially distance, and income loss during lockdown, and tested the impact of assumptions on social protection coverage in a scenario analysis.Findings: In all examined countries, lower socioeconomic quintiles were likely to experience disproportionately more income loss and greater inability to socially distance during lockdown. Improving social protection increased the percentage of the workforce able to socially distance from 40% (30% Chile - 55% UK) to 60% (57% Chile - 67% UK). We estimate the cost of this social protection would be equivalent to an average of 0.5% GDP.Interpretation: We illustrate the potential for using publicly available data to rapidly assess the equity implications of social protection and non-pharmaceutical intervention policy. We highlight potential for social protection to mitigate inequitable health and economic impacts of lockdown. Although social protection is usually targeted to the poorest, middle quintiles will likely also need support as they suffer the worst income losses and are disproportionately more exposed.Funding: This work was supported by the UK Foreign, Commonwealth and Development Office and Wellcome [grant number 221303/Z/20/Z].Declaration of Interests: We declare no competing interests.

Development of the engagement questionnaire (EQ): A tool to measure panelist engagement during sensory and consumer evaluations

Sensory and consumer testing are primary strategies companies use to collect insights about consumer products. However, frequently, unreliable results from these tests can lead to failed product launches which can have enormous financial and/or brand equity consequences. One potential reason is sensory tasks are often deliberately devoid of additional stimulation which reasonably has the possibility to reduce a panelist’s engagement with the task. Engagement may drive involvement and focus during testing and help generate reliable data. The overall objective of this study was to develop (Study 1), refine (Study 2), and validate (Studies 3–5) an engagement questionnaire (EQ), a tool to empirically assess varying engagement levels with a task. Prior literature and an exploratory qualitative assessment through an online platform (Study 1, N = 87) were used to operationalize the dimensionality of engagement and develop a preliminary questionnaire consisting of 54 items covering 7 themes (ability, attention, passivity, involvement, interest, motivation, and relevance). To assess the effectiveness of the initial item set, participants recalled being engaged with a task and answered the preliminary EQ (Study 2, N = 186). Results collected underwent an exploratory factor analysis (EFA) in order to explore the dimensionality and refine the scale by strategically eliminating items. To validate the tool, the EQ was distributed following numerous consumer sensory tests that spanned a variety of food and beverage products, test lengths, number, and types of questions (Studies 3–5). EFA was conducted in Study 3 (N = 774), which resulted in a three-factor, 10-item model with good reliability (α = 0.856). The new model was subsequently validated in two additional consumer sensory studies (Study 4A, N = 416 and Study 4B, N = 446). Both validation studies produced acceptable to good model fit indices with an RMSEA below 0.07, SRMR below 0.04, both CFI and TLI above 0.95 and good reliability (α > 0.850). When tested in a different sensory testing facility, the EQ produced acceptable model fit indices (Study 5, N = 247) and tracked as expected with participants’ perceived workload collected using the NASA Task Load Index; confirming the content and convergent and divergent validity of the instrument. Such an instrument allows for deeper understanding of panelist engagement and its impact on data quality, enabling the design of sensory tests capable of generating more reliable data both within the field of food science and beyond.

General Motor Holden's closure in Playford, South Australia: Analysis of the policy response and its implications for health

AbstractDeindustrialisation and the closure of automotive manufacturing can differentially affect the socioeconomic prospects of workers and their communities, and contribute to social and health inequity. We used Bacchi's problematisation approach to examine the South Australian (SA) Labor government's policy responses to the General Motors Holden (GMH) Elizabeth plant closure announcement. We focused on the way that these policy responses framed the ‘problem’ of this major economic shock, particularly the extent to which potential social and health equity consequences were addressed. We found a narrow focus on economic strategies, neglecting the compounding impact of poverty in Playford, which may exacerbate health inequity. The community effects from the GMH closure remain uncertain and may be delayed for several years. SA requires better integrated social and economic policies to minimise social and health inequalities, as the consequences of the car manufacturing loss are realised.

Research Commentary: Critiques of the Common Core in Early Math: A Research-Based Response

We respond to a call to analyze issues of curriculum standards and to present alternative storylines by addressing criticisms of the Common Core State Standards in early childhood. We describe a storyline from multiple media and evaluate this storyline's criticisms, focusing on the criticism that the standards are developmentally inappropriate. We review research and conclude that the criticism is invalid and may reflect a historical belief in the primacy of development over learning rather than the research record. Misinterpreting or ignoring relevant research has equity consequences because it may particularly harm those children most in need of learning support in learning grade-level mathematics. Fortunately, theory and research illuminate learning trajectories that help all children meet these standards.

The relationship between urban forests and race: A meta-analysis

There is ample evidence that urban trees benefit the physical, mental, and social health of urban residents. The environmental justice hypothesis posits that environmental amenities are inequitably low in poor and minority communities, and predicts these communities experience fewer urban environmental benefits. Some previous research has found that urban forest cover is inequitably distributed by race, though other studies have found no relationship or negative inequity. These conflicting results and the single-city nature of the current literature suggest a need for a research synthesis. Using a systematic literature search and meta-analytic techniques, we examined the relationship between urban forest cover and race. First, we estimated the average (unconditional) relationship between urban forest cover and race across studies (studies = 40; effect sizes = 388). We find evidence of significant race-based inequity in urban forest cover. Second, we included characteristics of the original studies and study sites in meta-regressions to illuminate drivers of variation of urban forest cover between studies. Our meta-regressions reveal that the relationship varies across racial groups and by study methodology. Models reveal significant inequity on public land and that environmental and social characteristics of cities help explain variation across studies. As tree planting and other urban forestry programs proliferate, urban forestry professionals are encouraged to consider the equity consequences of urban forestry activities, particularly on public land.

The Relationship between Urban Forests and Income: A Meta-Analysis

There is well-documented evidence that urban trees benefit the physical, mental, and social health of urban residents. The environmental justice hypothesis posits that environmental amenities like urban forest cover are inequitably low in poor and minority communities. If so, these communities experience fewer urban forest benefits, and so experience a form of environmental injustice. While some previous, mostly city-specific, studies have found that urban forest cover is inequitably distributed by race, other studies have found no relationship, or even negative inequity. Both the city-specific nature of the existing literature and its conflicting results suggest a need for a research synthesis. Using a systematic literature search and meta-analytic techniques, this paper examines the relationship between urban forest cover and race. First, it estimates the average (unconditional) relationship between urban forest cover and race across studies and finds evidence of significant race-based inequity in urban forest cover. Second, by including characteristics of the original studies and study sites in meta-regressions, it illuminates some of the drivers of variation in the distribution of urban forest cover between studies. Meta-regressions reveal the magnitude and significance of the relationship varied across racial groups and methodological choices, cautioning authors to make methodological choices and interpretation carefully. Models reveal significant inequity on public land across racial groups and that environmental and social features of cities help explain variation across studies. As tree planting and other urban forestry programs proliferate around the world, urban forestry professionals and policy makers are encouraged to investigate current tree cover in their city and consider the equity consequences of urban forestry activities, particularly on public land.