Related Inequalities Research Articles

The link Between traumatic experiences and health in late life: challenges and opportunities for US-based longitudinal aging cohorts.

Trauma, defined as exposure to actual or threatened death, serious injury or sexual violence, is a pervasive, major public health challenge that disproportionately burdens socially disadvantaged groups and has known consequences for health outcomes in early and midlife. Despite plausible mechanisms by which trauma may also be a critically important risk factor for health outcomes in late life, there is presently a lack of literature evaluating the consequences of trauma on aging related health outcomes and inequities, such as dementia. In this commentary, we (a) discuss drivers of the paucity of epidemiological evidence on trauma and health outcomes in late life, namely a lack of available data, supported by detailed review of trauma measures, including interpersonal violence-a particularly common form of trauma-in seven established longitudinal aging cohort studies in the United States (US); (b) address four common concerns about the inclusion of trauma measures in cohort studies; and (c) suggest ways forward, including specific assessment tools to measure interpersonal violence after a structured review of the PhenX Toolkit, to facilitate critical research to understand the impact of trauma on outcomes in late life.

Closing the gap? Results-based financing and socio-economic-related inequalities in maternal health outcomes in Zimbabwe.

The results-based financing (RBF) programme, first implemented in Zimbabwe in 2011 and gradually expanded to other districts, aimed to address disparities in maternal health outcomes by improving the utilization of health services. This study leverages the staggered rollout of the programme as a quasi-experimental design to assess its impact on asset wealth-related inequalities in selected maternal health outcomes. The objective is to determine whether RBF can effectively reduce these disparities and promote equitable healthcare access. We employ an extended two-way fixed effects (ETWFE) model to exploit temporal variation in RBF implementation as well as individual-level variation in birth timing for identification. Utilizing pooled cross-sectional and nationally representative data from the Zimbabwe demographic and health surveys collected between 1999 and 2015, our analysis reveals significant reductions in relative and absolute maternal health inequalities, especially in the frequency and timing of prenatal care, delivery by caesarean section and family planning. Specifically, the RBF programme is associated with reductions in disparities for completing at least four or more prenatal care visits (-0.026, P < 0.01), first-trimester prenatal care (-0.033, P < 0.01), delivery by caesarean section (-0.028, P < 0.005) and family planning (-0.033, P < 0.005). Additionally, the programme is associated with improved prenatal care quality, as evidenced by progress on the prenatal care quality index (-0.040, P < 0.01). These effects are more pronounced among lower socio-economic groups in RBF districts, highlighting RBF's potential to promote equitable healthcare access. Our findings advocate for targeted policy interventions prioritizing expanding access to critical maternal health services in underserved areas and incorporating equity-focused measures within RBF frameworks to ensure inclusive and effective healthcare delivery in Zimbabwe and other low-income countries.

Healthcare Utilization and Discrepancies by Income Level Among Patients With Newly Diagnosed Type 2 Diabetes in Korea: An Analysis of National Health Insurance Sample Cohort Data.

The use of qualitative healthcare services or its discrepancy between different income levels of the type 2 diabetes (T2D) patients has seldom been studied concurrently. The present study is unique that regarding T2D patients of early stages of diagnosis. Aimed to assess the utilization of qualitative healthcare services and influence of income levels on the inequality of care among newly diagnosed patients with T2D. A retrospective cohort study of 7590 patients was conducted by the National Health Insurance Service National Sample Cohort 2.0 from 2002 to 2015. Insured employee in 2013 with no history of T2D between 2002 and 2012 were included. The standard of diabetes care includes hemoglobin A1c (HbAlc; 4 times/y), eyes (once/y) and lipid abnormalities (once/y). Multivariate logistic regression analysis was performed to examine the difference between income levels and inequality of care. From years 1 to 3, rates of appropriate screening fell from 16.9% to 14.1% (HbA1c), 15.8% to 14.5% (eye), and 59.2% to 33.2% (lipid abnormalities). Relative to income class 5 (the highest-income group), HbA1 screening was significantly less common in class 2 (year 2: odds ratio [OR], 0.78; 95% confidence interval [CI], 0.61 to 0.99; year 3: OR, 0.79; 95% CI, 0.69 to 0.91). In year 1, lipid screening was less common in class 1 (OR, 0.84; 95% CI, 0.73 to 0.98) than in class 5, a trend that continued in year 2. Eye screening rates were consistently lower in class 1 than in class 5 (year 1: OR, 0.73; 95% CI, 0.60 to 0.89; year 2: OR, 0.63; 95% CI, 0.50 to 0.78; year 3: OR, 0.81; 95% CI, 0.67 to 0.99). Newly diagnosed T2D patients have shown low rate of HbA1c and screening for diabetic-related complications and experienced inequality in relation to receiving qualitative diabetes care by income levels.

Balancing the scales? Evaluating the impact of results-based financing on maternal health outcomes and related inequality of opportunity in Zimbabwe

This study evaluates the impact of results-based financing (RBF) on maternal health outcomes and the inequality of opportunity (IOP) in these outcomes in Zimbabwe. We employ a difference-in-differences approach that leverages the staggered implementation of the programme across 60 districts, exploiting temporal variation in the introduction of RBF and individual-level variation in birth timing. Our analysis uses nationally representative, pooled cross-sectional data from the 2005/2006, 2010/2011, and 2015 Zimbabwe demographic and health surveys. Employing the extended two-way fixed effects (ETWFE) estimator to address biases associated with staggered rollouts, we find significant positive effects of RBF on maternal health outcomes. The programme is associated with an increase in the number of prenatal care visits by 0.185 units (p < 0.01), first-trimester care by 7.7 percentage points (pp) (p < 0.01), facility births by 8.6 pp (p < 0.01), and professional delivery assistance by 3.4 pp (p < 0.01), while reducing C-section rates by 1.3 pp (p < 0.01). Additionally, RBF is associated with reductions in IOP in prenatal care visits, early prenatal care, facility births, and professional delivery assistance by 3.8, 1.3, 8.4, and 4.9 pp (p < 0.01), respectively. These findings underscore the potential of RBF to enhance maternal health outcomes and promote health equity. Integrating equity considerations into health system strengthening initiatives is essential. Policymakers should ensure that health interventions improve access and balance opportunities across various socio-economic and demographic groups. This evidence suggests that RBF schemes can improve access to and equity in healthcare services, particularly in low-income settings such as Zimbabwe.

Exploring health inequalities in Gypsy and Traveller communities in the UK.

Health inequalities between groups of people are often unjust and avoidable and are influenced by social determinants of health, the non-medical factors that influence health outcomes. Gypsy and Traveller communities experience significant health inequalities, including barriers to accessing healthcare services and suboptimal health outcomes compared with the general population. This article provides an overview of health inequalities in relation to Gypsy and Traveller communities and examines three social determinants of health - discrimination and racism, accommodation and access to healthcare - that influence these inequalities. The authors propose that accurate data collection as well as delivery of culturally competent health services and care may facilitate access to healthcare for Gypsy and Traveller communities and potentially reduce health inequalities.

Trends and inequalities in neonatal mortality rate in Bangladesh: Evidence from cross-sectional surveys.

Given the significance of addressing neonatal mortality in pursuing the 2030 Sustainable Development Goal on child health, research focus on this area is crucial. Despite the persistent high rates of neonatal mortality rate (NMR) in Bangladesh, there remains a notable lack of robust evidence addressing inequalities in NMR in the country. Therefore, this study aims to fill the knowledge gap by comprehensively investigating inequalities in NMR in Bangladesh. The Bangladesh Demographic and Health Survey (BDHS) data from 2000 to 2017 were analyzed. The equity stratifiers used to measure the inequalities were wealth status, mother's education, place of residence, and subnational region. Difference (D) and population attributable fraction (PAF) were absolute measures, whereas population attributable risk (PAR) and ratio (R) were relative measures of inequality. Statistical significance was considered by estimating 95% confidence intervals (CIs) for each estimate. A declining trend in NMR was found in Bangladesh, from 50.2 in 2000 to 31.9 deaths per 1000 live births in 2017. This study detected significant wealth-driven (PAF: -20.6, 95% CI: -24.9, -16.3; PAR: -6.6, 95% CI: -7.9, -5.2), education-related (PAF: -11.6, 95% CI: -13.4, -9.7; PAR: -3.7, 95% CI: -4.3, -3.1), and regional (PAF: -20.6, 95% CI: -27.0, -14.3; PAR: -6.6, 95% CI: -8.6, -4.6) disparities in NMR in all survey points. We also found a significant urban-rural inequality from 2000 to 2014, except in 2017. Both absolute and relative inequalities in NMR were observed; however, these inequalities decreased over time. Significant variations in NMR across subgroups in Bangladesh highlight the need for comprehensive, and targeted interventions. Empowering women through improved access to economic resources and education may help address disparities in NMR in Bangladesh. Future research and policies should focus on developing strategies to address these disparities and promote equitable health outcomes for all newborns.

Individualism, innovation, and inequality: Exploring the nexus

We provide an alternative explanation for the direction of technological change and the related wage inequality between skilled and unskilled workers. To this end, we formulate a skill-biased technological change model in which households’ decisions on consumption, savings, and human-capital accumulation are influenced by the level of individualism. We conclude that more individualistic cultures experience higher technological-knowledge bias toward skilled technologies, larger output growth rates, and higher wage inequality between skilled and unskilled workers. We also find that union bargaining only reduces wage inequality between skilled and unskilled at moderate levels of individualism, while introducing redistributive income taxes does not necessarily reduce income inequality.

QCD bounds on leading-order hadronic vacuum polarization contributions to the muon anomalous magnetic moment

QCD bounds on the leading-order (LO) hadronic vacuum polarization (HVP) contribution to the anomalous magnetic moment of the muon [aμHVP,LO, aμ=(g−2)μ/2] are determined by imposing Hölder inequalities and related inequality constraints on systems of finite-energy QCD sum rules. This novel methodology is complementary to lattice QCD and data-driven approaches to determining aμHVP,LO. For the light-quark (u, d, s) contributions up to five-loop order in perturbation theory in the chiral limit, LO in light-quark mass corrections, next-to-leading order in dimension-four QCD condensates, and to LO in dimension-six QCD condensates, we find that (657.0±34.8)×10−10≤aμHVP,LO≤(788.4±41.8)×10−10, bridging the range between lattice QCD and data-driven values. Published by the American Physical Society 2024

“I don’t believe that I have been wanted”: Processes of Overinclusion and Exclusion in Racialized and Gendered Organizations

Abstract Many studies document that faculty of color, and particularly women of color, find the academy unwelcoming. Yet research that centers intersectional understanding of the mechanisms leading to these inequalities is underdeveloped. We identify three context-dependent mechanisms of racial and gender disadvantage among faculty: active exclusion, overinclusion, and passive exclusion. Taking an explicitly intersectional approach that builds on relational inequality theory, our study focuses on 32 faculty of color, including 18 women and 14 men, comparing their experiences to 30 same-rank white departmental colleagues. Comparing the experiences of faculty who share the same rank and department but differ by race and gender provides a deeper understanding of how race and gender inequalities intersect and are shaped by organizational processes. Active exclusion involves the devaluation of BIPOC faculty’s research, as well the barring of access to resources and positions. Overinclusion is characterized by the overreliance of the university on the labor of faculty of color, particularly women of color, without appropriate compensation. Finally, we conceptualize a more passive kind of exclusion, where BIPOC faculty are left out of collaborations, mentoring, and decision-making relative to white colleagues. Moving beyond rhetoric to disrupting racism in the academy requires addressing overinclusion, and both active and passive forms of exclusion.

Cross-sectional Average Length of Life Entropy (HCAL\\documentclass[12pt]{minimal} \\usepackage{amsmath} \\usepackage{wasysym} \\usepackage{amsfonts} \\usepackage{amssymb} \\usepackage{amsbsy} \\usepackage{mathrsfs} \\usepackage{upgreek} \\setlength{\\oddsidemargin}{-69pt} \\begin{document}$${\\mathcal{H}}_{\ ext{CAL}}$$\\end{document}): International Comparisons and Decompositions

Keyfitz and Leser’s life table entropy was proposed to serve as a relative inequality in mortality measure. Entropy considers the variation around the age at death relative to the length of lifespan in a population, allowing comparisons across time and populations. It is used widely in period and cohort applications. Here, we propose extending this measure and present an index that incorporates the history of survival of all cohorts present at a given time, namely the cross-sectional average length of life entropy, or CAL-entropy (HCAL\\documentclass[12pt]{minimal} \\usepackage{amsmath} \\usepackage{wasysym} \\usepackage{amsfonts} \\usepackage{amssymb} \\usepackage{amsbsy} \\usepackage{mathrsfs} \\usepackage{upgreek} \\setlength{\\oddsidemargin}{-69pt} \\begin{document}$${\\mathcal{H}}_{\ ext{CAL}}$$\\end{document}). We decompose cross-population differences of CAL-entropy into the contribution of longevity and lifespan variation, and the change of those differences across time. Our illustrations show that populations are converging regarding lifespan inequality. Lifespan variation holds a noticeable share in the CAL-entropy gap among selected European populations. Longevity held once a pronounced share in CAL-entropy differences and their change, but its influence has receded over the years. The US demonstrates a unique trend where it performs worse across time compared to the selected European populations, and lifespan variation has played a major role in this process. This study signals the importance of lifespan variation in reducing inequality in mortality among developed and longevous populations.

Determinants of wealth-related inequalities in full vaccination coverage among children in Nepal: a decomposition analysis of nationally representative household survey data

BackgroundOver the past two decades, child health indicators in Nepal have improved significantly at the national level. Yet, this progress hasn’t been uniform across various population subsets. This study identified the determinants associated with childhood full vaccination, assessed wealth-related inequalities, and delved into the key factors driving this inequality.MethodsData for this study were taken from the most recent nationally representative Nepal Demographic and Health Survey 2022. A total of 959 children aged 12–23 months who had received routine childhood basic antigens as per the national immunisation program were considered for analysis. Binary logistic regression models were conducted to identify the associated factors with outcome variable (uptake of full vaccination). The concentration curve and Erreygers normalized concentration index were used to assess inequality in full vaccination. Household wealth quintile index scores were used to measure wealth-related inequality and decomposition analysis was conducted to identify determinants explaining wealth-related inequality in the uptake of childhood vaccination.ResultsThe coverage of full vaccination among children was 79.8% at national level. Several factors, including maternal health service utilisation variables (e.g., antenatal care, institutional delivery), financial challenges related to visiting health facilities, and mothers’ awareness of health mother group meetings within their ward, were associated with the uptake of full vaccination coverage among children. The concentration curve was below the line of equality, and the relative Erreygers normalized concentration index was 0.090, indicating that full vaccination was disproportionately higher among children from wealthy groups. The decomposition analysis identified institutional delivery (20.21%), the money needed to visit health facilities (14.25%), maternal education (16.79%), maternal age (8.53%), and caste (3.03%) were important contributors to wealth related inequalities in childhood full vaccination uptake.ConclusionsThere was notable wealth-related inequality in full vaccine uptake among children in Nepal. Multisectoral actions involving responsible stakeholders are pivotal in reducing the inequalities, including promoting access to maternal health services and improving educational attainment among mothers from socioeconomically disadvantaged communities.

New Grüss’s inequalities estimates considering the [formula omitted]-fractional integrals

Careful study of applied sciences and their development requires us to expand the scope of analytical studies. We aim during introducing the current manuscript to rediscover and present Grüss inequality in a new framework. In order to do that, we use the recently generalized proportional fractional integral operator for a certain function with respect to another continuous and strictly increasing function. Furthermore, we prove some new related inequalities using the current fractional integral operator. Some special cases of the presented results will be discussed.

Twelve–year (2008–2019) trends in socioeconomic inequalities in cardiovascular risk factors in a Swiss representative survey of the general population

ObjectiveWe assessed trends in socioeconomic inequalities in cardiovascular risk factors prevalence among Swiss adults from 2008 to 2019. MethodsUsing data from the Bus Santé study, an annual survey of adults living in Geneva, Switzerland, we calculated the prevalence per period and by demographic and socioeconomic indicators, assessing inequality trends using the relative index of inequality (RII) and the slope index of inequality (SII). ResultsAmong 10,739 participants, most CVD risk factors decreased over time, while diabetes, obesity, and smoking prevalence remained steady. In 2017–2019, prevalence of most CVD risk factors was higher in socioeconomically disadvantaged groups. Relative and absolute inequalities decreased over time, but mostly remained, for hypertension [in 2017–2019, education-RII (95 % CI) = 1.27 (1.12–1.46), income-RII = 1.27 (1.10–1.47)], hypercholesterolemia [education-RII = 1.15 (1.00–1.32)], and sedentarity [education-RII = 1.95 (1.52–2.51), income-RII = 1.69 (1.28–2.23)], and appeared to have reversed for hazardous alcohol use [income-RII = 0.75 (0.60–0.93)]. Substantial and persistent relative and absolute inequalities in diabetes prevalence were observed [education-RII = 2.39 (1.75–3.27), income-RII = 3.18 (2.25–4.48), and subsidy-RII = 2.77 (1.89–4.05)]. Inequalities were also marked across all socioeconomic indicators for obesity prevalence [education-RII = 3.32 (2.63–4.19), income–RII = 2.37 (1.85–3.04), subsidy-RII = 1.98 (1.48–2.66)] and for smoking [education-RII = 2.42 (2.06–2.84), income-RII = 2.37 (1.99–2.84), subsidy-RII = 1.91 (1.56–2.35)]. ConclusionsOver 12 years in Geneva, Switzerland, socioeconomic inequalities in hypertension, hypercholesterolemia, hazardous alcohol use, and sedentarity decreased but persist, while substantial inequalities in diabetes, obesity, and smoking remained unchanged.

Узагальнені обернені нерівності Єнсена-Штеффенсена та пов’язані нерівності

We compare two linear functionals that are negative on convex functions. Further, using Green's functions we give some new conditions for reversed Jensen-Steffensen and related inequalities to hold. Using Green's function we also give refinement of Levinson type generalization of reversed Jensen-Steffensen and related inequalities. The acquired results are then used for constructing mean-value theorems.

SOME DIAMOND INTEGRAL REVERSE HÖLDER-TYPE INEQUALITIES ASSOCIATED WITH SPECHT’S RATIO ON TIME SCALES

This paper is devoted to studying some new reverse Hölder-type inequalities associated with the dynamic integral called diamond on time scale, which is expressed as an ’approximate’ symmetric integral on time scales. Some related inequalities are also presented. The obtained inequalities extend known results related with discrete and continuous forms.

Understanding experiences of adverse digital incorporation of ridesharing drivers in Bangladesh

PurposeBangladesh recently experienced frequent demonstrations by drivers of ridesharing applications. Since the drivers are not excluded from the technology environment, rather they are a part of the digital ecosystem, these protests may point toward the existence of unequal interactional outcomes for different stakeholders afforded by the digital system within the country’s social and cultural contexts. This research is an attempt to unveil the reasons behind value inequality experienced by drivers of ridesharing applications in Bangladesh and understand how power asymmetries influence adverse digital incorporation that can result in the emergence of resistance.Design/methodology/approachWe obtain the data by conducting interviews with 91 drivers of ridesharing platforms in Dhaka, Bangladesh and analyze our data using thematic analysis. We propose an integrated framework unifying adverse digital incorporation (ADI) with the “powercube” model to illuminate our inquiry.FindingsWe find the existence of all three drivers to ADI – ignorance/deceit, direct compulsion and exclusion – exclusion being the most prevalent – that are experienced by the drivers of ridesharing applications in Bangladesh. We also find support for the four causes behind value inequality – design inequality, resource inequality, institutional inequality and relational inequality with the respondents placing the highest emphasis on relational inequality. There are visible, hidden and invisible forms of power involved in how the drivers are incorporated into the ridesharing platforms. The forms of power in the platform environment are exercised primarily in closed spaces and the invited spaces for the drivers are very few. The drivers in response to the closed spaces of power create their own space (claimed space) through the help of social media and other messaging apps. We also find that the power over the drivers is exercised at global, national and local levels.Practical implicationsOur research identifies norms specific to the social and cultural contexts of Bangladesh and can help decision-makers to make more informed choices during the formulation of future digital platform guidelines. Based on the research findings, the paper also makes short-term and long-term policy recommendations.Social implicationsThis research has implications for creating a decent work environment for ridesharing drivers which broadly falls under the Sustainable Development Goal 8 (SDG 8).Originality/valueTo the best of the authors’ knowledge, this is the first paper that integrates the ADI model with the “powercube” framework to reveal that the drivers working on the ridesharing platforms in Bangladesh are adversely incorporated into the digital system where value inequalities are operating within the power dimensions.

Relational inequality in a (deeply) educationally polarized society: feasible strategies in the longer term

Abstract Fifty per cent of young people in the UK will now go on to university. We focus here not so much on the consequent divisive material inequality but on relational and epistemic inequality, the inequality of respect and esteem adversely felt by the less educated. The huge advances in ICT have radically changed workplaces, creating more relational and ICT-intensive environments, in which social skills typically acquired at universities are central. In response to this we envisage an on-going growth in HE participation, the result of which if sufficiently large over time will be the spreading of respect and esteem. But we argue that success depends on a transformation of the HE system in the UK: we need more 2-year vocational colleges (especially in health, care and education), widely located; and we need 3-year degrees and professional schools to teach students to work cooperatively, in a more multidisciplinary and interdisciplinary way.

Race/ethnic inequalities in health: moving beyond confusion to focus on fundamental causes

Abstract This commentary will focus on health inequalities in relation to race/ethnicity, and in doing so, it will connect with the health inequalities article by Case and Kraftman and the race and ethnic inequalities article by Mirza and Warwick, both in this collection. The central argument of this commentary is that to make sense of the (complex and often confusing) patterning of race/ethnic inequalities in health in the UK and to move towards developing policy to address these inequalities, we must adopt a theoretically informed approach that centres on the fundamental causes of race/ethnic inequalities—processes that flow from (structural, interpersonal and institutional) racism. To make this argument, first I critically review the data on race/ethnic inequalities in health and interpretations of these data. Second, I discuss the central role of social and economic inequalities in driving these inequalities. Third, I provide a more detailed discussion of how racism operates to shape social and economic inequalities and thereby to shape health outcomes. Fourth, I discuss the implications of this analysis for policy, particularly how this points to the need to address institutional racism and how this might be done. Finally, I briefly revisit the question of fundamental causes and the implications of this for considerations of other dimensions of inequality, such as those related to class and gender.1

Getting the measure of inequality

Abstract I focus on one of the most commonly cited ‘facts’ about UK income inequality—that it has changed little over the last 30 years—and reflect on how robust that description is. I look at a number of fundamental issues in inequality measurement related to inequality concepts (e.g. inequality aversion, relative versus absolute inequality, and inequality of opportunity versus outcome), definitions of ‘income’, the income-receiving unit, and the reference period, and related data issues. There are grounds for arguing that income inequality levels are higher, and the inequality increase over time greater, than conventional approaches indicate.

Inequalities in the production and use of cement and concrete, and their consequences for decarbonisation and sustainable development

Concrete is vital for constructing infrastructure and housing, and cement is the key binding material within concrete. Concrete is an enabler of development, as concrete structures are key to delivering societal services in many sectors. Much recent research on cement and concrete has focussed on technical solutions to decarbonisation; however, there is a knowledge gap around how cement and concrete intersect with other facets of sustainable development. This study explores the intersection of cement and concrete with inequalities, both through their production as commodities and through their use in built assets. An exploratory analysis of this issue was carried out, comprising an evaluation of industry associations’ conceptions of sustainable development and inequalities, an analysis of underlying power dynamics for several inequality issues using Lukes’ three dimensional framework of power, and a reflection on how certain inequalities may pose risks to achieving decarbonisation and sustainable development aims. Our study shows that industry associations’ narratives around sustainable development generally lack a detailed vision for addressing inequalities, in comparison to their focus on decarbonisation. We find that inequalities are a systemic issue for cement and concrete, spanning intra- and inter-national scales, and all three dimensions of power. These findings highlight that several inequalities are consequential from structural, underlying inequalities, whilst other inequalities are specific to the sectors themselves. The cement and concrete sectors are recommended to develop their conception of inequalities in relation to sustainable development: this can help reduce inequalities within their own workforces more effectively, and also reduce the risks of missing their decarbonisation targets. For large, complex socio-technical systems, such as cement and concrete, it is vital for consideration of inequalities to inform strategic planning with regards to decarbonisation and sustainable development.