Global Inequality Research Articles

A more equitable approach to economic evaluation: Directly developing conceptual capability wellbeing attributes for Tanzania and Malawi

Capability wellbeing can potentially provide a holistic outcome for health economic evaluation and the capability approach seems promising for African countries. As yet there is no work that has explored the evaluative space needed for health and care decision making at the whole population level and procedures that merely translate existing measures developed in the global north to contexts in the global south risk embedding structural inequalities. This work seeks to elicit the concepts within the capability wellbeing evaluative space for general adult populations in Tanzania and Malawi. Semi-structured interviews with 68 participants across Tanzania and Malawi were conducted between October 2021 and July 2022. Analysis used thematic coding frames and the writing of analytic accounts. Interview schedules were common across the two country settings, however data collection and analysis were conducted independently by two separate teams and only brought together once it was clear that the data from the two countries was sufficiently aligned for a single analysis. Eight common attributes of capability wellbeing were found across the two countries: financial security; basic needs; achievement and personal development; attachment, love and friendship; participation in community activities; faith and spirituality; health; making decisions without unwanted interference. These attributes can be used to generate outcome measures for use in economic evaluations comparing alternative health interventions. By centring the voices of Tanzanians and Malawians in the construction of attributes that describe a good life, the research can facilitate greater equity within economic evaluations across different global settings.

Perinatally Acquired HIV: Viral Evolution and its Implications for Adolescents

This literature review explores the implications of viral evolution on the health outcomes of adolescents with perinatally acquired HIV, offering recommendations for enhancing public health practices. Since the emergence of HIV in the 1980s, perinatal transmission from parent to child has become increasingly prevalent in developing countries. Antiretroviral therapy (ART) has greatly improved the life expectancy of children with perinatally acquired HIV, allowing them to reach adolescence. ART plays a critical role in suppressing HIV and reducing the risk of transmission. Nevertheless, low adherence or lack of treatment can lead to viral evolution and drug resistance, posing significant threats to adolescents. Challenges faced by adolescents with perinatally acquired HIV are multifaceted, including increased viral evolution and difficulties in adhering to ART. The impact of stigma, behavioral factors, and social and familial dynamics contribute to low adherence rates. Global inequities and systems-level challenges further complicate the situation, particularly in resource-limited settings. Adequate public health infrastructure and innovative approaches, such as long-acting injectable ART, are imperative to address these structural barriers and reduce drug resistance among adolescents. Comprehensive data collection and longitudinal studies are needed to understand the long-term consequences of perinatally acquired HIV and its impact on viral evolution. A multidisciplinary approach involving healthcare providers, virologists, and social scientists is crucial to meeting global HIV goals and addressing the specific needs of this vulnerable population.

Global Medical Supply Inequities

The global issue of medical supply inequity exists as some countries have excess medical supplies, which leads to large amounts of medical supply waste resulting in both economical and environmental harm. However, many countries face the opposite issue and instead have a shortage of necessary, life-saving medical supplies. The duality of the issue is a harsh and widespread reality throughout the world. For example, the United States generates about 4.7 million pounds of medical waste yearly (Zygourakis et al., 2015; Thiel et al., 2020). In contrast, India, especially during the COVID-19 epidemic, faced a massive shortage of essential equipment like N-95 respirators, face shields, as well as ventilators. To reduce the worldwide inequities that arise due to the imbalance of medical supplies, Blueprints for Pangaea (B4P), a medical surplus recovery organization was founded. B4P, headquartered at the University of Michigan in Ann Arbor, redistributes unused medical supplies to places in need both locally and internationally, effectively reducing medical supply inequities one shipment at a time. This paper aims to explore the key components and global dynamics contributing to medical waste and to consider B4P as a potential model for addressing this problem.

Addressing Global Inequities in Poxvirus Vaccination: Strategies for a More Equitable Future

Addressing Global Inequities in Poxvirus Vaccination: Strategies for a More Equitable Future

Inflation and income inequality in an open-economy growth model with liquidity constraints on R&D

This study presents a framework to understand the relationship between inflation and income inequality in an open-economy Schumpeterian growth model with heterogeneous households, firm-level innovation, and cash-in-advance constraints on R&D investment. We show that the global real interest rate channel can play a key role in defining this relationship. In smaller economies that have negligible impacts on the global interest rate, income inequality is likely to exacerbate as inflation rates rise. In contrast, for larger economies that can significantly affect the global interest rate, inflation and income inequality may demonstrate a U-shaped relationship. These theoretical predictions are supported by the quantitative analysis in a model calibrated to the economies of the US and the eurozone, as well as empirical estimates using cross-country data.

Data snapshots of the access and participation of ‘women’ academics in UK universities: Questioning continued gendered, racialised and geopolitical inequalities

AbstractReplete with espoused discourses of equality, diversity and inclusion within public bodies, is the UK, wherein lauded initiatives reward its universities’ commitments to increasing the access and positioning of ‘women’ in higher education. This paper contributes a critical quantitative analysis of the state of representation and participation of academic staff within these universities generally, and the majority‐female discipline of education particularly. Education is important because it has a direct relation to social change and ethicality. It may maintain or reproduce the status quo; however, exercising its transformative potential is essential for the success of various international frameworks aiming to address global inequality, including most recently the Sustainable Development Goals. Sensitised by QuantCrit principles, a descriptive statistical exploration was undertaken of the staff composition and employment conditions captured within the administrative datasets reported on academic staff by all the public universities in the devolved nations of England, Northern Ireland, Scotland, and Wales from 2015 to 2020. The findings of this study confirmed: (i) the continuation of gendered inequalities across the academic hierarchy, particularly as the pyramid narrows to the assigned intellectual leadership position of ‘professor’; (ii) racialised, gendered inequalities in access to employment, and in positioning once employed; and (iii) more adverse conditions where gendered, racialised and geopolitical inequalities intersect, most extremely for Black African female academics. The study demonstrates that the centring of ‘race’ and consideration of nationality are required to challenge coloniality, and to bring to the fore the differential impacts of systems of discrimination within this globally influential sector.

Use of artificial intelligence to address health disparities in low- and middle-income countries: a thematic analysis of ethical issues

ObjectivesArtificial intelligence (AI) is reshaping health and medicine, especially through its potential to address health disparities in low- and middle-income countries (LMICs). However, there are several issues associated with the use of AI that may reduce its impact and potentially exacerbate global health disparities. This study presents the key issues in AI deployment faced by LMICs. Study designThematic analysis. MethodsPubMed, Scopus, Embase and the Web of Science databases were searched, from the date of their inception until September 2023, using the terms “artificial intelligence”, “LMICs”, “ethic∗” and “global health”. Additional searches were conducted by snowballing references before and after the primary search. The final studies were chosen based on their relevance to the topic of this article. ResultsAfter reviewing 378 articles, 14 studies were included in the final analysis. A concept named the ‘AI Deployment Paradox’ was introduced to focus on the challenges of using AI to address health disparities in LMICs, and the following three categories were identified: (1) data poverty and contextual shifts; (2) cost-effectiveness and health equity; and (3) new technological colonisation and potential exploitation. ConclusionsThe relationship between global health, AI and ethical considerations is an area that requires systematic investigation. Relying on health data inherent with structural biases and deploying AI without systematic ethical considerations may exacerbate global health inequalities. Addressing these challenges requires nuanced socio-political comprehension, localised stakeholder engagement, and well-considered ethical and regulatory frameworks.

The global, regional, and national patterns of change in the burden of non-malignant upper gastrointestinal diseases from 1990 to 2019 and the forecast for the next decade.

Non-malignant upper gastrointestinal diseases, including peptic ulcer disease (PUD), gastritis and duodenitis (GD), and gastroesophageal reflux disease (GERD), significantly challenge global healthcare. These conditions not only impact patient health but also highlight socio-economic development issues and healthcare system accessibility and efficiency. Utilizing the Global Burden of Disease (GBD) database, this study aims to assess the global burden of PUD, GD, and GERD comprehensively, examining their association with the sociodemographic index (SDI). Employing data from the GBD 2019 database, this study analyzed the disability-adjusted life years (DALYs) for PUD, GD, and GERD. We integrated the SDI with the inequality slope index and concentration index for an international health inequality analysis, assessing disparities in the burden of these non-malignant upper gastrointestinal diseases. Decomposition analysis was conducted to determine the effects of population growth, aging, and epidemiological shifts on disease burden. Frontier analysis was performed to identify potential improvement areas and disparities among countries by development status. Disease time trends were depicted using a Joinpoint regression model, and the Bayesian age-period-cohort (BAPC) model projected the disease burden up to 2030. Between 1990 and 2019, the age-standardized DALYs rates (ASDR) for non-malignant upper gastrointestinal diseases declined. However, global geographic heterogeneity remained evident, closely linked to the SDI. Notably, low-SDI countries experienced higher disease burdens. Population growth and aging emerged as principal contributors to the increasing disease burden. Despite development levels, many countries have considerable potential for reducing the burden of these diseases. Furthermore, significant variations in the time trends of non-malignant upper gastrointestinal diseases were observed among countries and regions with different SDI levels, a pattern expected to continue through 2030. Non-malignant upper gastrointestinal diseases demonstrate notable heterogeneity across age, gender, and geography, with the disparities most marked in underdeveloped regions or countries. Consequently, it is imperative to focus research on policy development and to enact prevention and treatment strategies tailored to high-risk groups. This targeted approach is essential for mitigating the disease burden effectively.

“Going beyond the call of duty”: academic agency and promoting transformation for sustainability in higher education

Purpose In the past decade, against increasing global inequality, higher education has grappled with increased demands for social justice, transformation and decolonisation. While a lot of research in South Africa has focused on the (im)possibilities of fostering racial, gendered, socio-economic and cultural change, the connection of such change to questions of sustainability has been less explored. The purpose of this paper is to specifically explore the agency of academics to foster transformative initiatives for sustainability within the context of institutions historically serving under-represented populations. Design/methodology/approach Using a qualitative methodology, this paper highlights the importance of considering sustainability in processes of transformation. This paper is specifically interested in how academic faculty and those in assigned leadership positions view their agency in relation to promoting transformation for sustainability at the institutional level. Drawing on data generated from semi-structured interviews with 13 participants at an historically Black university in South Africa, this paper details academics' and leaders’ experiences and perceptions of their agency. Findings This study reveals the adverse interactional dynamics within higher education institutions, which negatively impact academics’ participation as key agents in change processes. Positional and identity challenges faced reveal the persistence of colonial and apartheid legacies of racism, sexism, Afrophobia and xenophobia – which casts a shadow on possible trajectories of transformation and sustainability. This has serious implications for the common good, given South Africa's regional import for knowledge production and decolonisation within universities; its key role in the African 2063 Agenda; and the wider global Sustainable Development agenda. Originality/value This study highlights insufficient engagement with the sustainability of transformation efforts within the context of South Africa. This study also emphasises the relation between transformation imperatives and racial, socio-economic, gender and epistemic justice imperatives of sustainable development.

Cognitive household labor: gender disparities and consequences for maternal mental health and wellbeing.

Although the division of unpaid household labor has been studied as a driver of global gender inequity, the cognitive dimension of household labor-planning, anticipating, and delegating household tasks-has received less empirical investigation. Cognitive household labor represents a form of invisible and often unacknowledged domestic work that has been challenging to measure. Within 322 mothers of young children, we assessed the division of both cognitive ("planning") and physical ("execution") household labor within 30 common household tasks using a self-report measure. We found that while mothers did more of the overall domestic labor than their partners, the division of cognitive labor was particularly gendered, such that women's share of cognitive labor was more disproportionate than physical household labor. We found that cognitive labor was associated with women's depression, stress, burnout, overall mental health, and relationship functioning. This study is one of the first to investigate cognitive labor quantitatively, and the first to investigate cognitive and physical dimensions within the same household tasks. Understanding how cognitive labor affects mothers' mental wellbeing has important implications for both practice and policy.

Determinants of Income Inequality in South Africa: A Vector Error Correction Model Approach

The issue of income disparity has long plagued South Africa because of the political environment that existed before the country’s 1994 democratic transition. Based on the widely used Gini index, which gauges global inequality, the nation routinely has some of the highest rates of income disparity in the world. Income inequality in South Africa keeps rising even after a number of frameworks and policies have been put in place, which has a big influence on society. Thus, it is essential to comprehend the causes of income disparity and put suitable policies in place to remedy it. The purpose of this study is to look into the relationship between South Africa’s income disparity and its determinants. Using the Vector Error Correction Model (VECM) approach, this study empirically examines the effects of government spending on social grants, gross savings, population growth, and economic growth on income inequality from 1975 to 2017. Data on the Gini index are sourced from the Standardized World Income Inequality Database (SWIID). Findings reveal a statistically significant negative correlation between government spending on social grants and income inequality. Moreover, income inequality demonstrates a negative relationship with both gross savings and economic growth. However, population growth exhibits a positive correlation with income inequality. This study highlights the significance of implementing a comprehensive strategy to address income inequality in South Africa. This strategy should involve augmenting government expenditure on social grants, cultivating a savings culture within households, and enacting policies that incentivize job creation, particularly in areas with rapid population growth. In addition to making a substantial contribution to the body of evidence already available on income disparity, this study offers insightful information to policymakers working to improve the socioeconomic climate in South Africa.

Human papillomavirus vaccination coverage among young women in the three sub-Saharan African countries using Demographic and Health Surveys data

ABSTRACT Cervical cancer is the fourth most common cancer, with 99% of cases linked to human papillomavirus (HPV) infection. It reflects global inequity as its burden is highest in low- and middle-income countries. The aim of this study was to determine the HPV vaccination coverage and its determinant factors among young women in the three sub-Saharan African countries. Data from the Demographic and Health Surveys among three sub-Saharan African countries were used for analysis. A total of 4,952 women were included in the study. Stata 14 was used to analyze the data. The determinants of the outcome variable were identified using a multilevel mixed-effects logistic regression model. Factors with p-values < 0.05 at 95% confidence interval were declared statistically significant. About 7.5% young women were vaccinated for HPV vaccine against cervical cancer in the current study. Younger age, use of internet, rich economic class, and individual-level media exposure were found to be favorable conditions, whereas being employed was negatively associated with HPV vaccination. Only few segments of young women in these three countries got HPV vaccination. The authors recommend that increasing internet use, media exposure, and economic level of young women will increase the HPV vaccination rates. Furthermore, creating awareness among employed women will also increase the possibility of HPV vaccination.

Geopolitical determinants of mental health and global health inequities

Geopolitical determinants of health have been well recognized by the World Health Organization and are increasingly being discussed across governments, institutions, academics, policy makers, and across global health sector. Geopolitical determinants of health are events, structures, processes, and factors that influence individual health including mental health, public and population mental health both directly and indirectly. Consequently, nation’s responses to these factors will affect short-term and long-term health outcomes. Geopolitical factors are becoming increasingly more important as they influence directly and indirectly social determinants of health. These factors clearly impact both physical and mental health leading to health inequities and inequalities. It is important to factor in geopolitical determinants in resource allocation and funding as well as policy making as has been highlighted by the recent pandemic and variable access to vaccines. Geopolitical determinants would be integral when addressing all global health inequities. These play a major role in resource allocation, policy and planning to meet today’s global health challenges.

Teaching assistants in Argentina have greater intentions to migrate abroad as physicians than other medical students

The brain drain of physicians from lower-middle-income countries to high-income countries is a growing phenomenon that contributes to global health inequalities. Retention strategies are difficult to implement locally and to specifically target the population at risk of migrating. We hypothesize that medical students who are teaching assistants have greater intentions to migrate to practice Medicine abroad. Medical students from Argentina were invited to an online survey of 22 multiple-choice questions based on the LIRHUS Network survey, previously used in Latin America. 2,301 medical students were enrolled. Most were young (23 [20-25] years old), single (90%), and female (79%). The majority studied at public universities (87%). The intention to migrate to practice Medicine abroad was more frequent among teaching assistants (36% vs 31%; χ2 = 4.4982; p = 0.0339). After adjusting for sex and age, being a teaching assistant was associated with the intention to migrate to practice Medicine abroad (OR = 1.26; 95% CI 1.02 - 1.55; p = 0.002). Argentine teaching assistants have a greater risk of migrating to practice Medicine abroad. Given their high academic profile, these are valuable human resources trained using the public financing of low-middle-income countries. The loss of these resources could contribute to health inequalities. This is an easily identifiable and accessible subgroup toward which local retention policies could be directed.

Financial Literacy in the Age of Digital Finance: A Global Perspective

Global financial landscapes have changed recently due to the digitalization of financial services, which presents opportunities and difficulties for improving financial literacy. To comprehend how digitalization affects people's financial knowledge, abilities, and behaviors across various socioeconomic and cultural contexts, this study investigates the effects of digital finance on financial literacy levels globally. The main goal is to look into how digital finance affects financial literacy around the world. To clarify the main factors influencing financial literacy in digital contexts, this study will examine the body of existing literature and empirical research. Additionally, it seeks to evaluate the success of ongoing financial literacy programs and suggest methods for improving financial literacy in the face of growing digitization. The study makes use of qualitative research techniques, which include a thorough evaluation of the literature that includes scholarly articles, reports, and policy papers. In addition, document analysis of industry reports and regulatory frameworks pertaining to digital finance and financial literacy is part of it. Effective personal financial management requires financial literacy, which is becoming more and more important when it comes to digital finance. Peer-to-peer lending, digital wallets, and mobile banking are examples of digital finance. While they increase financial inclusion, they also come with a learning curve that must be overcome in order to fully reap the rewards. Research highlights the beneficial relationship between better financial decision-making and financial literacy, which is aided by digital learning resources. Consumer education on digital financial hazards is particularly important in light of challenges with consumer protection and data privacy. Programs for financial literacy that are effective should be customized for a range of demographics and make use of digital platforms to increase relevance and involvement. Developing strong regulatory frameworks to protect digital financial transactions, raising consumer awareness through focused educational initiatives, and improving financial literacy programs to incorporate training in digital financial skills are some of the recommendations. Improving digital infrastructure and adapting educational activities to local contexts are necessary to address global inequities. It is advised to do longitudinal study to evaluate long-term effects, and novel pedagogical strategies such as gamification ought to be investigated to improve financial practices worldwide. This conclusion of the study emphasizes how critical it is to address issues and take advantage of opportunities in digital banking in order to improve global financial literacy. By putting these suggestions into practice, stakeholders can create a robust and inclusive financial ecosystem that protects consumer interests and encourages responsible financial conduct while enabling people all around the world to successfully manage digital banking. In the digital era, this study supports evidence-based policies and practices that promote financial inclusion and sustainable economic development.

Global Inequality Challenge: An Analysis of the Disparities in Wealth and Power

Global inequality is central to the explanation of the disparity between the global North and global South in terms of level of development. World systems theorists have pointed to colonial exploitation of the South by countries in the North as the cause of the disparities in wealth and power between regions. This paper examines global inequality challenges to identify the disparities in wealth and power between the North and the South. The study relied essentially on qualitative data predicated on secondary data. The paper adopted world systems theory as its framework of analysis. The paper showed that the unequal relationship between the global North and the global South was made possible by the colonial exploitation of the South by the North. By adopting the world system theory, the paper revealed how unequal division of labour, terms of trade imbalance, and Bretton Woods Institutions (IMF and World Bank) reinforced global inequality. The study recommended, amongst other things, that the South address internal conditions impeding their development; IMF and World Bank-assisted projects should not be attached with strict conditions.

Southern agency in global norms creation: Bangladesh in the SDGs formulation process

This paper examines which institutions, ideas, and interests have shaped the position of Bangladesh in creating the norms of the United Nations (UN)’s Sustainable Development Goals (SDGs). Bangladesh’s contribution to the SDGs norms creation process is examined in two distinct stages: drafting a position paper (June 2012–June 2013) and participating in UN Open Working Group (OWG) negotiations (March 2013–July 2014). Findings reveal how a small cohort of policy entrepreneurs played a key role in both stages. They gave prominence to ideas such as poverty alleviation, global inequality, and migrants’ rights in structuring the SDGs agenda. In the final round of OWG negotiations, Bangladeshi delegates calculated that active participation in the norms creation process would best serve the interests of the Global South by challenging the Global North which wanted to impose its interests. This paper offers an important insight into the norms literature by showing convergence and divergence of interests and agendas of global and local actors.

Global, regional, and national health inequalities of Alzheimer’s disease and Parkinson’s disease in 204 countries, 1990–2019

BackgroundAlzheimer’s disease and related dementias (ADRD) and Parkinson’s disease (PD), pose growing global health challenges. Socio-demographic and economic development acts paradoxically, complicating the process that determines how governments worldwide designate policies and allocate resources for healthcare.MethodsWe extracted data on ADRD and PD in 204 countries from the Global Burden of Disease 2019 database. Health disparities were estimated using the slope index of inequality (SII), and concentration index (CIX) based on the socio-demographic index. Estimated annual percentage changes (EAPCs) were employed to evaluate temporal trends.ResultsGlobally, the SII increased from 255.4 [95% confidence interval (CI), 215.2 to 295.5)] in 1990 to 559.3 (95% CI, 497.2 to 621.3) in 2019 for ADRD, and grew from 66.0 (95% CI, 54.9 to 77.2) in 1990 to 132.5 (95% CI, 118.1 to 147.0) in 2019 for PD; CIX rose from 33.7 (95% CI, 25.8 to 41.6) in 1990 to 36.9 (95% CI, 27.8 to 46.1) in 2019 for ADRD, and expanded from 22.2 (95% CI, 21.3 to 23.0) in 1990 to 29.0 (95% CI, 27.8 to 30.3) in 2019 for PD. Age-standardized disability-adjusted life years displayed considerable upward trends for ADRD [EAPC = 0.43 (95% CI, 0.27 to 0.59)] and PD [0.34 (95% CI, 0.29 to 0.38)].ConclusionsGlobally, the burden of ADRD and PD continues to increase with growing health disparities. Variations in health inequalities and the impact of socioeconomic development on disease trends underscored the need for targeted policies and strategies, with heightened awareness, preventive measures, and active management of risk factors.

Adventures in ageing: the gender-ageing nexus and older North American women’s engagement with communities of care through lifestyle migration

Drawing from ethnographic research and interviews with older North American women who migrated alone to retire in Ecuador, this article grows the body of literature on gender and ageing, examining how these women position themselves within a gender-ageing nexus, contradicting certain gender norms in their attempt to obtain later-life self-fulfilment. Particularly, we examine how this group positions the third age as a time of individual adventure and self-actualisation, challenging normative gender ideals about femininity and care but meeting (many) social expectations to “age well.” We argue that the lifestyles of these women demonstrate new experiments with gendered ageing, facilitated by global inequalities but challenging some normative ideals around femininity and old(er) age.

The global burden, trends, and inequalities of individuals with developmental and intellectual disabilities attributable to iodine deficiency from 1990 to 2019 and its prediction up to 2030.

The objective of this study was to assess the global burden of disease for developmental and intellectual disabilities caused by iodine deficiency from 1990 to 2019. Using data from the global burden of disease (GBD) 2019, we conducted a cross-country inequity analysis to examine the worldwide burden of developmental and intellectual disabilities caused by the issue of iodine deficiency from 1990 to 2019. Absolute and relative inequality were assessed by the slope index of inequality and the concentration index, respectively. After summarising the latest evidence, we also projected the age-standardized prevalence and years lived with disability (YLD) rates up to 2030 using the BAPC and INLA packages in R statistical software. In 2019, the global age-standardized prevalence and YLD rates for developmental and intellectual disabilities due to iodine deficiency were 22.54 per 100,000 population (95% UI 14.47 to 29.23) and 4.12 per 100,000 population (95% UI 2.25 to 6.4), respectively. From 1990 to 2019, the age-standardized prevalence and YLD rates of developmental and intellectual disabilities due to iodine deficiency decreased significantly. Geographic distribution showed that areas with lower socio-demographic indices (SDI) were the most affected. The correlation between higher SDI and lower prevalence highlights the role of economic and social factors in the prevalence of the disease. Cross-national inequity analysis shows that disparities persist despite improvements in health inequalities. In addition, projections suggest that the disease burden may decline until 2030. This research underscores the necessity for targeted interventions, such as enhancing iodine supplementation and nutritional education, especially in areas with lower SDI. We aim to provide a foundation for policymakers further to research effective preventative and potential alternative treatment strategies.