Extreme Inequality Research Articles

Regional Disparity of Reperfusion Therapy for Acute Ischemic Stroke in Japan: A Retrospective Analysis of Nationwide Claims Data from 2010 to 2015.

BackgroundWe aimed to determine whether a regional disparity exists in usage of reperfusion therapy (intravenous recombinant tissue plasminogen activator [IV rt‐PA] and endovascular thrombectomy [EVT]) and post‐reperfusion 30‐day mortality in patients with acute ischemic stroke, and which regional factors are associated with their usage.Methods and ResultsWe retrospectively investigated 69 948 patients (mean age±SD, 74.9±12.0 years; women, 41.4%) with acute ischemic stroke treated with reperfusion therapy between April 2010 and March 2016 in Japan using nationwide claims data. Regional disparity was evaluated using Gini coefficients for age‐ and sex‐adjusted usage of reperfusion therapy and 30‐day post‐reperfusion in‐hospital death ratio in 47 administrative regions. The association between regional factors and reperfusion therapy usage was evaluated with fixed‐effects regression models. During the study period, Gini coefficients showed low inequality (0.11–0.15) for use of IV rt‐PA monotherapy and IV rt‐PA and/or EVT and extreme inequality (0.49) for EVT usage in 2010, which became moderate inequality (0.25) by 2015. The densities of stroke centers and endovascular specialists, as well as market concentration, were associated with increased usage of reperfusion therapy whereas the proportion of rural residents and delayed ambulance transport were negatively associated with usage. Inequality in the standardized death ratio after EVT was extreme (0.86) in 2010 but became moderate (0.29) by 2015; inequality was low to moderate (0.17–0.23) for IV rt‐PA monotherapy and IV rt‐PA and/or EVT.ConclusionsScrutinizing existing data sources revealed regional disparity in reperfusion therapy for acute ischemic stroke and its associated regional factors in Japan.

Steady Habits in the Constitution State: Connecticut's Inequitable System of Representation, 1639–1965

Steady Habits in the Constitution State: Connecticut's Inequitable System of Representation, 1639–1965

The Image of Class Immobility in Chang-dong Lee’s Film Burning and William Faulkner’s “Barn Burning”

Chang-dong Lee is a well-known Korean director whose films reflect the repressive social and political reality of South Korea. The film Burning (2018) is one of his recent movies which well reveals a current depressing atmosphere of the young people in contemporary Korea. The narrative and the construction of the movie follows the plot of William Faulkner’s short story “Barn Burning” (1938). The director adroitly adopted and transformed the plot-line to fit into the current atmosphere and times of the Korean society. Therefore, this thesis aims to discuss how the film elaborates the culture of the early southern US, which contemporary Korea bears no resemblance to, and modify it into the tragedy – extreme class inequality and immobility – which Korean society faces nowadays. This paper places the movie in a dialogue with the original text and, based on it, examines the social ramifications of the movie text. In doing so, it focuses on how both works are alike in the aspect of the devastating and fearful reality of each society.

Private-sector innovation processes in development cooperation: perspectives from Finnish technology enterprises

ABSTRACT The development community has become an important financer of innovation processes in the Global South. This research scrutinizes Finnish private enterprises receiving development assistance for their innovation processes, targeting the markets of the Global South. Beyond the critical rationales, there is a lack of contextual understanding about the development impacts of private sector – focused development cooperation. The research reveals that the private sector’s role in development is heterogeneous and complex. Although, companies’ involvement has brought innovations, new actors, and funding to development cooperation, it has only fragile ties to the conventional objectives of development – to reduce extreme poverty and inequality. Innovation activities of the Finnish companies focus on rather developed markets of middle-income countries and an educated wealthy minority. Local communities have minor involvement in the design, profit sharing, or value addition of such projects, and their main role is the consumption of end products.

The Crisis of Extreme Inequality in India.

The Covid-19 pandemic and the lockdowns have exposed and exacerbated the crisis of extreme inequalities in India. Using multiple nationally representative sample surveys, we analyse various dimensions of inequality in the labour market and in the access to basic amenities. We briefly indicate our most striking findings. Substantial gaps in earnings by gender, caste and area of residence persist. On average, female earnings were 63% of male earnings, earnings of the Scheduled Castes were 55% of the earnings of the relatively advantaged social groups, and rural earnings were only half of urban earnings in 2018–2019. About 905 million people did not have access to piped water, 287 million did not have access to toilets, 127 million lived in rented accommodations, and one-fourth of the population lived in single-room dwellings in 2017–2018. The implications of the long-term neglect of the public healthcare system and the disparities in the access to education are discussed. The evidence highlights the need for a new paradigm of development—one that puts redistribution at the heart of its agenda.

Is (in)access to infrastructure driven by physical delivery or weak governance? Power and knowledge asymmetries in Cape Town, South Africa

Despite widespread scholarly recognition that infrastructure delivery and consumption is as much a socio-political process as a technical-material product, global development agendas (e.g. United Nations’ Sustainable Development Goals) continue to prioritise the universal provision of public infrastructure as a static transfer of physical goods/services without explicit recognition of their socio-political dimensions. This paper explores the everyday ways in which citizens negotiate public infrastructure delivery and access, situated in a global South context of extreme inequality and limited state capacity. Using a case study of two low-income settlements in Cape Town with differing infrastructure provision, we demonstrate how governance processes can undermine the physical delivery of infrastructure. While participatory governance remains a core policy mechanism to democratise service delivery, in practice the capacity of citizens to participate is affected by power and knowledge asymmetries that function both within and between communities and the state. These asymmetric power relations and knowledge flows contribute to clientelistic politics that not only limit citizen engagement in participatory governance, but actively undermine low-income urban dwellers’ access to services that have been physically delivered and targeted to meet their needs. Framed by a case study of energy interventions, we conclude that widening access to public infrastructure requires significant investment in effective governance processes for low-income urban dwellers.

Direct Caregiving in Older Adults: How Systems of Care Perpetuate the Grand Challenges and What Social Workers Can Do about It.

Direct care workers (DCWs) provide personal care, emotional support, and companionship, helping older adults maintain quality lives. DCWs earn low wages, have little training, and experience high turnover rates. While the demand for DCWs grows, real wages continue to fall. Undervaluing DCWs threatens the continuity and quality of care that older adults receive. Through the social work grand challenges lens, this article discusses two qualitative studies, in home care (n = 24) and nursing homes (n = 23), that demonstrate that while DCWs help advance long and productive lives, they experience extreme economic inequality and lack equal opportunity and justice. The article concludes with a discussion of social work's role in advancing opportunity and justice.

Quantile panel-type analysis for income inequality and healthcare expenditure

This study investigates the causal relationship between Income Inequality and Healthcare Expenditure within a quantile panel-type causality framework using yearly panel data from 2004 to 2017. The empirical results show that within the high-growth regime of health expenditure to income ratio, reducing the deterioration of income inequality can make the ratio of health expenditure to income keep increasing. Besides, within the extreme income inequality regime, the ratio of health expenditure to income continues to increase, which can reduce the deterioration degree of income inequality. This paper presents evidence that to improve the continuous deterioration of income inequality; it should focus on the continuous increase in the ratio of health expenditure to income, not just the continuous increase in health expenditure. Accordingly, policy-makers should be cautious about the momentum between the ratio of health expenditure to income and income inequality when they reach the extremely quantiles.

Africa: A Land of Wealth and a Land of Poverty: Why the Richest Resource Continent Suffers from Poverty.

The African continent is no doubt the most resource-abundant continent. Resources such as gold, diamond, oil, natural gas, copper, uranium, among others are mined in different parts of the continent. Almost every country in Africa has a deposit of natural resources, Africa is also the poorest continent in the world. Per capita income in African countries is among the lowest in the world. This is evidenced by the failure to meet the Millenium Development Goals. The paper examines the phenomenon of the natural resource curse in Africa. Understanding the reason why a natural resource-rich continent like Africa is still grappling with extreme poverty, inequality, and underdevelopment is key to policymakers and researchers. The paper also examines the effect of foreign aid on economic growth in Africa. The goal here is to contribute to the debate on whether the African continent benefits significantly from the flow of aid into the continent.

Kasi Football: an Ethnography of South African Rural Working-Class Football Traditions

Kasi football is the most popular form of informal urban football that emerged in the low-income black working-class neighbourhoods of South Africa. This football tradition took shape in the early 20th century in the context of forced labour migration in the industrializing South Africa. Autonomously organised, free-flowing, football games played for a sum of money or other stakes not only served as a way to cope with pressures of rapid urbanisation and displacement, but also as a way to reclaim ownership over their leisure space and time. In this paper, I examine how these urban football traditions are reimagined and performed among the rural working-class in contemporary South Africa. This ethnography of kasi football, games played almost every weekend, exposes the cultural robustness, adaptability to the conditions of disenfranchisement, as well as rawness of extreme inequality, which sustain these practices.

Vision and the Pursuit of Constructive Social Change

At this moment in history, when we are confronting the reality of systemic racism and when a global pandemic is revealing in deadly detail the consequences of extreme inequality, we need to pay attention to the process of social change. The intolerable reality of African American men killed by police has drawn thousands of people around the world into public rejections of racist structures, symbols, and thought....

Wealth Inequality and the Financial Accumulation Process

Previous theoretical and computational analyses demonstrate that uncorrelated variations in individual asset returns promote extreme inequality in financial wealth. This paper describes a standard individual-based computational model of this financial accumulation process and then extends it in order to expose other key influences on wealth inequality. We find large effects of individual behavior, cultural practices, tax policy, and technological change. Specifically, we present simulation experiments with heterogeneous saving rates, a stylized marriage institution, a wealth tax structured to mirror contemporary policy proposals, and variations in wage growth. These experiments demonstrate that modest concessions to realism have large effects on long-run wealth inequality in models of the financial accumulation process.

Cancer diagnosis, treatment and care: A qualitative study of the experiences and health service use of Roma, Gypsies and Travellers.

Early diagnosis and treatment are key to reducing deaths from cancer, but people from Black and Minority Ethnic (BME) groups are more likely to encounter delays in entering the cancer care system. Roma, Gypsies and Travellers are ethnic minorities who experience extreme health inequalities. To explore the experiences of cancer diagnosis, treatment and care among people who self-identify as Roma or Gypsies and Travellers. A participatory qualitative approach was taken. Peer researchers conducted semi-structured interviews (n=37) and one focus group (n=4) with community members in Wales and England, UK. Cancer fatalism is declining, but Roma, Gypsies and Travellers experience barriers to cancer healthcare at service user, service provider and organisational levels. Communication was problematic for all groups, and Roma participants reported lack of access to interpreters within primary care. Clear communication and trusting relationships with health professionals are highly valued and most frequently found in tertiary care. This study suggests that Roma, Gypsies and Travellers are motivated to access health care for cancer diagnosis and treatment, but barriers experienced in primary care can prevent or delay access to diagnostic and treatment services. Organisational changes, plus increased cultural competence among health professionals, have the potential to reduce inequalities in early detection of cancer.

Homicides of black people in Brazil: A study of different regions, using generalized additive regression models-with a geo-spatial component.

The number of homicides in Brazil has reached record numbers, and when the race/colour of the victims is considered-an extreme inequality is evident- with a particularly high number of deaths in black and brown populations. The goal of this work was to analyse homicide rates of black people in Brazil from the years 2000 to 2016, using generalized additive regression models, with a geo-spatial component. The statistics were applied to understand the social reasons for homicide risks in the black population in Brazil's 26 states and Federal District with reference to the human development index and its components (education, longevity and income) as well as social inequality indices (Gini and Theil). This socioecological, epidemiological study to estimate the risk of homicide in the black population with a time series component, shows that this risk has increased linearly over time. Less longevity and low income correlated with a greater risk of homicide-while the Gini and Theil indices showed that in places where there are greater inequalities, there is also a higher risk of homicide in both black and non-black populations. The results - regarding the possibility of relating social indicators to homicide risk in the regional units under study, would support implementation of interventional public policy measures.

A Right Against Extreme Wage Inequality: A Social Justice Modernisation of International Labour Law?

The ILO centenary celebrated in 2019 offered an occasion for reflection on the past, present and future of international labour law. With inequality described by ILO as ‘one of the most daunting challenges for future of work', international labour law confronts the task of developing regulatory responses to the ever-widening gap between the remuneration of corporate executives and those of low-paid workers. In search of new solutions for reversing this process, this article makes the case for the recognition of a new international labour right against extreme wage inequality grounded in the ‘just share’ imperative of the Declaration of Philadelphia. It also advances a novel regulatory model for implementing this right.

Disparate Recoveries: Wealth, Race, and the Working Class after the Great Recession

What does it mean to be working class in a society of extreme racial wealth inequality? Using data from the Survey of Consumer Finances, we investigate the wealth holdings of Black, Latinx, and white working-class households during the post–Great Recession (pre–COVID-19) period that spanned 2010 to 2019. We then explore the relationship between working-class and middle-class attainment using a wealth-based metric. We find that, in terms of their net worth, fewer Black working-class households benefitted from the economic recovery than white working-class households. Among white households, the working class saw the greatest increase in wealth in both absolute and relative terms. Working-class households were less likely to be middle class as defined by their wealth holdings, and Black and Latinx households were also less likely to be middle class. For Black households, racial identity is a stronger predictor of wealth attainment than occupational sector.

Mary Susan Malahlela: practising medicine under apartheid

Until well into the 20th century, the only way Black South Africans could train as doctors was to travel abroad. This was an expensive option and there were few scholarships, so the numbers remained small. Not until 1941 did South African medical schools agree to admit a small minority of students of Indian or African ancestry. One of the first through the doors at the University of Witwatersrand (Wits) in Johannesburg was Mary Susan Malahlela. In 1947, she became the first Black woman to qualify in South Africa. The next year the government introduced its racist policy of apartheid, and she pursued her entire medical career against a background of extreme racial segregation and inequality. After Malahlela's death, her daughter told a reporter that when Malahlela graduated, her class photograph—a Black woman amid a sea of white men—appeared in the local Afrikaans newspaper, captioned “The black danger”. Women making medical history: introducing A Woman's PlaceIn December, 2017, The Lancet issued a call for papers for its special theme issue on women in science, medicine, and global health .1 The Comment outlined the gender inequalities in medicine that still persist, long after many overt barriers to women's participation have fallen. While that theme issue will be forward-looking, I believe we can also gain insights from looking to the past for examples of women who have made their mark against the odds, and by asking what it was about their particular circumstances that enabled them to do so. Full-Text PDF Rebecca Lee Crumpler: first Black woman physician in the USAA passionate vocation to care for others and a desire to empower her patients drove Rebecca Lee Crumpler (1831–95) to overcome 19th-century prejudice against her gender and ethnicity and qualify as “doctress of medicine” (the term she used), the first African American woman to do so. Crumpler gained extensive experience treating destitute former enslaved people in the southern states after the end of the American Civil War, and published A Book of Medical Discourses: in Two Parts, a practical guide to the care of infants and women's health. Full-Text PDF

“Creative, Good Will for All Men:” Martin Luther King Jr. the Moralist

This essay considers how Ruth Grant’s understanding of hypocrisy and integrity might be applied to Martin Luther King Jr. Putting Grant and King in conversation, I argue, helps democratic citizens and theorists think about political ethics in contexts of extreme inequality.

Leaning In or All in the Family? Gender Equality, Dynastic Legacies, and Female Leaders

Until the second half of the twentieth century, it was relatively rare for women to become leaders of states. As gender equality has increased, so has the number of female leaders. In countries that have made the greatest strides toward gender equity women’s roles have evolved, including directly participating in political leadership. While the chances of a woman becoming head of state or government increase with overall gender equity, at the opposite end of the equality spectrum there are also a number of women who achieved the most powerful office in the nation, including Benazir Bhutto, Indira Gandhi, Corazon Aquino, and Aung San Suu Kyi, and Cristina Fernandez de Kirchner. What can explain how women rise to power in patriarchal societies with extreme gender inequity? This paper addresses the puzzle of female leaders in states with high levels of gender inequality, and considers how these women came to power. Specifically, we hypothesize that women in countries with less gender equality are more likely to come to power through dynastic legacies as the relatives of former leaders. These familial connections often allow women to connect to political legacies powerful enough to overcome society’s preference for men in positions of influence. In the most extreme cases, dynastic female leaders may actually be evidence of gender inequality as they are seen as little more than the extension of male relatives. This paper uses case studies and multi-country panel regression to investigate the relationship between gender inequality and dynastic female leadership.

23 Frailty, Older Age-Associated Conditions, and Multimorbidity Amongst People Experiencing Homelessness in A Hostel in London

Abstract Introduction People experiencing homelessness (PEH) face poor health outcomes and extreme health inequity, and evidence suggests earlier onset of older age-associated conditions and signs of premature ageing. This is the first UK study to assess frailty in this population. The objective was to assess frailty, age-associated conditions, and multimorbidity in PEH residing in hostel accommodation, drawing comparisons with population data. Methods Participants were drawn from a hostel in London for PEH aged over 30. Age-associated conditions were identified using validated tools and a questionnaire modelled on comprehensive geriatric assessments. Participants’ keyworkers completed questionnaires to provide collateral information. Frailty was defined according to five criteria in Fried’s phenotype model: participants with three or more criteria are classified as frail, one or two criteria as vulnerable, and no criteria as not frail. Multimorbidity was defined as the presence of two or more long-term conditions in one person. Comparisons were made with population data from The English Longitudinal Study of Ageing and Health Survey for England. Results Thirty-three people participated (83% of eligible residents), with a mean age of 55.7 years (range 38–74). Frailty was identified in 18/33 participants (55%), with 13/33 (39%) classified as vulnerable, and 2/33 (6%) as not frail. Participants met an average of 2.6/5 frailty phenotype criteria, comparable to 90-year-olds in the general population. The most common age-associated conditions identified were: falls (in 61%), visual impairment (61%), low grip strength (61%), mobility impairment (52%), and cognitive impairment (45%). Multimorbidity was present in all thirty-three participants. Conclusions A wide range of unmet health needs was identified. The high prevalence of frailty and age-associated conditions support evidence of premature ageing, indicating a need to include holistic older-age assessments in PEH at a younger age. Involvement of health professionals with experience of working with older people could contribute to improving health outcomes for homeless patients.