Marker Of Inequality Research Articles

Severe obesity among patients with left ventricular assist devices

Patients with obesity and advanced heart failure requiring left ventricular assist device (LVAD) support are more likely to experience LVAD complications and may be disproportionately Black and/or female when compared to patients without obesity. Among these patients, obesity may represent a barrier to transplant eligibility and a marker of inequity in heart transplantation and health outcomes in advanced heart failure. To better understand this issue at our institution, we examined our active LVAD cohort and found that almost one-third of all patients had severe obesity with BMI ≥ 35 kg/m2. Patients with LVADs and severe obesity were significantly younger and more likely to self-identify as Black, and numerically more likely to be female. Weight management in this group represents a vital area for improved equity in health outcomes and barriers to heart transplantation. NA.

Suicides, drug poisonings, and alcohol-related deaths cluster with health and social disadvantage in 4.1 million citizens from two nations.

Deaths from suicides, drug poisonings, and alcohol-related diseases ('deaths of despair') are well-documented among working-age Americans, and have been hypothesized to be largely specific to the U.S. However, support for this assertion-and associated policies to reduce premature mortality-requires tests concerning these deaths in other industrialized countries, with different institutional contexts. We tested whether the concentration and accumulation of health and social disadvantage forecasts deaths of despair, in New Zealand and Denmark. We used nationwide administrative data. Our observation period was 10 years (NZ = July 2006-June 2016, Denmark = January 2007-December 2016). We identified all NZ-born and Danish-born individuals aged 25-64 in the last observation year (NZ = 1 555 902, Denmark = 2 541 758). We ascertained measures of disadvantage (public-hospital stays for physical- and mental-health difficulties, social-welfare benefit-use, and criminal convictions) across the first nine years. We ascertained deaths from suicide, drugs, alcohol, and all other causes in the last year. Deaths of despair clustered within a population segment that disproportionately experienced multiple disadvantages. In both countries, individuals in the top 5% of the population in multiple health- and social-service sectors were at elevated risk for deaths from suicide, drugs, and alcohol, and deaths from other causes. Associations were evident across sex and age. Deaths of despair are a marker of inequalities in countries beyond the U.S. with robust social-safety nets, nationwide healthcare, and strong pharmaceutical regulations. These deaths cluster within a highly disadvantaged population segment identifiable within health- and social-service systems.

Congenital syphilis in Switzerland: a marker of inequality? A mini-review.

Syphilis remains a global public health problem, with growing incidence in most regions of the world, particularly among women of childbearing age. This alarming trend has led to an increase in cases of congenital syphilis, resulting in devastating consequences. While the implementation of measures by the World Health Organization (WHO) and various governments has contributed to a decline in the global incidence of congenital syphilis, many countries are facing an escalating crisis, as incidence continues to rise. This mini-review aims to provide an overview of the current state of this disease in different parts of the world, focusing on the most affected populations and highlighting congenital syphilis as a marker of vulnerability. It also focuses on Switzerland, a country with a robust economy, to identify shortcomings in the healthcare system that contribute to the persistence of congenital syphilis, even though the infection is easily detectable and treatable. In conclusion, this mini-review highlights the persistent risk of congenital syphilis worldwide, regardless of country prevalence or economic status, and underscores the need for sustained efforts to reach underserved women, emphasizing the vital role of comprehensive training for healthcare professionals.

A global assessment of the impact of violence on lifetime uncertainty.

Uncertainty around age at death, or lifetime uncertainty, is a key public health indicator and a marker of inequality in survival. How does the extent of violence affect lifetime uncertainty? We address this question by quantifying the impact of violence on dispersion in the ages at death, the metric most used to measure lifetime uncertainty. Using mortality data from the Global Burden of Disease Study and the Internal Peace Index between 2008 and 2017, we find that the most violent countries are also those with the highest lifetime uncertainty. In the Middle East, conflict-related deaths are the largest contributor to lifetime uncertainty. In Latin America, a similar pattern is attributable to homicides. The effects are larger in magnitude for men, but the consequences remain considerable for women. Our study points to a double burden of violence on longevity: Not only does violence shorten individual lives, but it also makes the length of life less predictable.

Adherence, Sexual Behavior and Sexually Transmitted Infections in a New Zealand Prospective PrEP Cohort: 12 Months Follow-up and Ethnic Disparities

Inequities in pre-exposure prophylaxis (PrEP) experiences will impede HIV epidemic elimination among gay and bisexual men (GBM). Ethnicity is a strong marker of inequity in the United States, but evidence from other countries is lacking. We investigated experiences on-PrEP to 12 months follow-up in a prospective cohort of 150 GBM in Auckland, New Zealand with an equity quota of 50% non-Europeans. Retention at 12 months was 85.9%, lower among Māori/Pacific (75.6%) than non-Māori/Pacific participants (90.1%). Missed pills increased over time and were higher among Māori/Pacific. PrEP breaks increased, by 12 months 35.7% of Māori/Pacific and 15.7% of non-Māori/Pacific participants had done so. Condomless receptive anal intercourse partners were stable over time. STIs were common but chlamydia declined; 12-month incidence was 8.7% for syphilis, 36.0% gonorrhoea, 46.0% chlamydia, 44.7% rectal STI, 64.0% any STI. Structural interventions and delivery innovations are needed to ensure ethnic minority GBM gain equal benefit from PrEP.Clinical trial number ACTRN12616001387415.

Women, Gendered Violence, and the Construction of the 'Domestic'

This Chapter provides background material for conversations held at the 2020 Global Constitutionalism Seminar (a Part of the Gruber Program on Global Justice and Women’s Rights) at Yale Law School. This Chapter begins with an examination of the centuries-long assumption that gender-based violence was a “private” issue meant that legislatures, law enforcement agencies, and courts were unresponsive. It then maps how social movements and critical lawyering reframed gendered violence as one form of subordination that is in fact a marker of inequality and provides examples of national and transnational law that debate the bases, contours, and implications of rights to be free from such oppression. Having explored what affirmative obligations governments have toward their own populations to protect against gendered violence, this Chapter considers whether international refugee law, humanitarian law, and jurisdictions’ own constitutional law require offering a haven for people escaping gendered violence. Across the world, many courts have read constitutions to require that law aim to provide protection against and safety from gendered violence. Such mandates for an active state presence (often through criminalization) contrast with traditional approaches in which courts have insisted that law not interfere when acts are marked as private, intimate, or domestic. This Chapter explores the demands on the state and the repertoire of remedies deployed when governments work towards achieving substantive equality.

Brechas de origen, brechas de trayectoria. La desigual transición a la educación superior en dos grupos de jóvenes peruanos

Este artículo tiene como objetivo contrastar los resultados de dos estudios realizados con jóvenes peruanos que se encuentran en la etapa transicional de la educación secundaria a la superior. El primero se enfoca en jóvenes que residen en un distrito rural del departamento de Ayacucho; y el segundo, en jóvenes urbanos de hogares de la clase alta limeña y que estudian en algunos de los colegios más caros del país. El artículo busca fundamentar que las diferencias en los entornos familiares, las características de las instituciones educativas y los soportes con los que cuentan los jóvenes en la etapa transicional constituyen marcadores de desigualdad que los acompañarán a lo largo de su trayectoria. Si bien ambas investigaciones responden a contextos diametralmente distintos, el artículo da cuenta de la fragmentación del sistema educativo peruano y las formas de desigualdad que se vienen reproduciendo a través de este.

The threshold age of the lifetable entropy

Background: Indicators of relative variation of lifespans are markers of inequality at the population level and of uncertainty at the time of death at the individual level. In particular, the lifetable entropy H represents the elasticity of life expectancy to a change in mortality. However, it is unknown how this measure changes over time and whether a threshold age exists, as it does for other lifespan variation indicators. Results: The time derivative of H can be decomposed into changes in life disparity e† and life expectancy at birth eo. Likewise, changes over time in H are a weighted average of age-specific rates of mortality improvements. These weights reflect the sensitivity of H and show how mortality improvements can increase (or decrease) the relative inequality of lifespans. Further, we prove that in the assumption that mortality is reduced at all ages, H, as well as e†, has a threshold age below which saving lives reduces entropy, whereas improvements above that age increase entropy. Contribution: We give a formal expression for changes of H over time and provide a formal proof of the existence of a unique threshold age that separates reductions and increases in lifespan variation as a result age-specific mortality improvements.

Indicators of chronic noncommunicable diseases in women of reproductive age that are beneficiaries and non-beneficiaries of Bolsa Família.

To evaluate the prevalence of noncommunicable disease (NCD) indicators, including laboratory tests, in the population of Brazilian women of reproductive age, according to whether or not they receive the Bolsa Família (BF) benefit. A total of 3,131 women aged 18 to 49 years old who participated in the National Health Survey (Pesquisa Nacional de Saúde ) laboratory examination sub-sample were considered. We compared indicators among women of reproductive age (18 to 49 years old) who reported receiving BF or not, and calculated prevalence and confidence intervals, using Pearson's χ2. Women of reproductive age who were beneficiaries of BF had worse health outcomes, such as a greater occurrence of being overweight (33.5%) and obese (26.9%) (p < 0.001), having hypertension (13.4% versus 4.4%, p < 0.001), used more tobacco (11.2% versus 8.2%, p = 0.029), and perceived their health as worse (6.2% versus 2.4%, p < 0.001). Several NCD indicators were worse among women of childbearing age who were beneficiaries of BF. It should be emphasized that this is not a causal relationship, with BF being a marker of inequalities among women. The benefit has been directed to the population with greater health needs, and seeks to reduce inequities.

Indicators of chronic noncommunicable diseases in women of reproductive age that are beneficiaries and non-beneficiaries of Bolsa Família

ObjectiveTo evaluate the prevalence of noncommunicable disease (NCD) indicators, including laboratory tests, in the population of Brazilian women of reproductive age, according to whether or not they receive the Bolsa Família (BF) benefit.MethodsA total of 3,131 women aged 18 to 49 years old who participated in the National Health Survey (Pesquisa Nacional de Saúde) laboratory examination sub-sample were considered. We compared indicators among women of reproductive age (18 to 49 years old) who reported receiving BF or not, and calculated prevalence and confidence intervals, using Pearson’s χ2.ResultsWomen of reproductive age who were beneficiaries of BF had worse health outcomes, such as a greater occurrence of being overweight (33.5%) and obese (26.9%) (p < 0.001), having hypertension (13.4% versus 4.4%, p < 0.001), used more tobacco (11.2% versus 8.2%, p = 0.029), and perceived their health as worse (6.2% versus 2.4%, p < 0.001).ConclusionSeveral NCD indicators were worse among women of childbearing age who were beneficiaries of BF. It should be emphasized that this is not a causal relationship, with BF being a marker of inequalities among women. The benefit has been directed to the population with greater health needs, and seeks to reduce inequities.

Global Cholera Epidemiology: Opportunities to Reduce the Burden of Cholera by 2030.

While safe drinking water and advanced sanitation systems have made the Global North cholera-free for decades, the disease still affects 47 countries across the globe resulting in an estimated 2.86 million cases and 95,000 deaths per year worldwide. Cholera impacts communities already burdened by conflict, lack of infrastructure, poor health systems, and malnutrition. In October 2017, the Global Task Force on Cholera Control (GTFCC) launched an initiative titled Ending Cholera: A Global Roadmap to 2030, with the objective to reduce cholera deaths by 90% worldwide, and eliminate cholera in at least 20 countries by 2030. The GTFCC is working to position cholera control not as a vertical programme but instead using cholera as a marker of inequity and an indicator of poverty, linking the objectives of the Roadmap to the SDGs. The roadmap consists of targeted multi-sectoral interventions, supported by a coordination mechanism, along 3 axes: (1) early detection and quick response to contain outbreaks; (2) a multisectoral approach to prevent cholera recurrence in hotspots; (3) an effective partnership mechanism of coordination for technical support, countries capacity building, research and M&E, advocacy and resource mobilization. Every case and every death from cholera is preventable with the tools we have today.

Social inequality and fractures-secular trends in the Danish population: a case-control study.

We explored whether the risk of hip, humerus, and wrist fracture was associated with markers of inequality using data from Danish health registries. All patients 50years or older with a primary hip (ICD10 S720, S721, S722, and S729) humerus (ICD10S422, S423, S424, S425, S426, and S427), or wrist (ICD10: S52) fracture were identified from 1/1/1995 to 31/12/2011. Fracture patients were matched 1:1 by age, sex, and year of fracture, to a non-fracture control. Markers of inequality were as follows: income (fifths); marital status (married, divorced, widowed, or unmarried); area of residence (remote, rural, intermediate, or urban). Conditional logistic regression was used to investigate associations between these exposures, and risk of fracture, adjusting for covariates (smoking, alcohol, and Charlson co-morbidity). Interactions were fitted between exposure and covariates where appropriate. A total of 189,838 fracture patients (37,500 hip, 45,602 humerus, and 106,736 wrist) and 189,838 controls were included. Mean age was 73.9years (hip), 67.5years (humerus), and 65.3years (wrist). High income (5th quintile) was significantly associated with a lower odds ratio of all three fractures, compared to average income (3rd quintile). Married subjects had a significantly decreased odds ratio across all three fractures. However, no overall secular difference was observed regarding the influence of the markers of inequality. In conclusion, we have demonstrated important, stable associations between social inequality, assessed using income, marital status, and area of residence, and fracture at the population level. These findings can inform approaches to healthcare, and suggest that much thought should be given to novel interventions aimed especially at those living alone, and ideally societal measures to reduce social inequality.

Borders: A view from ‘nowhere’1

Borders separating two states are the markers of inequality in terms of gender as well as in terms of other intersecting social locations of marginalization and discrimination. Mobile populations generate cartographic anxieties for the keepers of these borders who, in turn, respond by increasingly criminalizing unwanted border crossing. While mainstream criminology has historically focused on matters of exclusion, integration and identity, discussion of its relation to borders and more specifically, ‘gendered borders’ has been oblique. This article presents the narratives of young Bangladeshi women, detained in Kolkata, India under the Foreigners Act (1946), on borders and border crossings, bringing into the discussion women’s understandings of their ‘transgressions’ in relation to normative and androcentric paradigms of state sovereignty and border control. It connects the newly emerging body of work on the criminalization of mobility with feminist theorizations and methodologies for an empirical understanding of the lived experiences of those subject to practices of border control. By focusing on the narratives of Bangladeshi women imprisoned in India for infractions against the sanctity of the Indo-Bangladeshi border, the article provides an insight into how everyday border crossings can be framed and understood differently, in juxtaposition to dominant rationales underpinning criminalization discourses.

Applying Intersectionality in Organizations: Inequality Markers, Cultural Scripts and Advancement Practices in a Professional Service Firm

This paper presents an intersectional analysis of career advancement practices in professional service firms. It reveals how gender, class, racio‐ethnicity and culture intersect at the individual, organizational and societal levels to create and reinforce advantages and disadvantages across complex dimensions of difference. Based on a qualitative analysis of data collected in a Big Four firm in Mexico, this article advances the empirical study of intersectionality in organizations by applying the construct of ‘cultural scripts’ and proposing the use of ‘markers of inequality’ to illuminate the simultaneous construction of differences of gender, class and racio‐ethnicity in a specific socio‐cultural context. Our findings show that career trajectories and advancement in this firm are contradictory processes, over‐determined by individual employees' lived identities, work interactions shaped by those identities, as well as formal and informal organizational practices embedded in an already raced, classed and gendered societal context and culture.

Wish-fulfilling jewel pills: Tibetan medicines from exclusivity to ubiquity

Despite the recent growth of social science literature concerning the traditional medicine industry in Asia, insights into the contemporary dynamics of so-called ‘classical formulae’ remain relatively scant, as do studies of small-scale, less capitally intensive and technologically advanced modes of production. This paper seeks to address these gaps by considering a single Sowa Rigpa (Tibetan medicine) formula known as Samphel Norbu, or ‘wish-fulfilling jewel’, which appears in numerous texts and is today among the most popular Tibetan medicines in the world. Drawing primarily upon long-term fieldwork in Himalayan India, the paper follows Samphel Norbu's rise from exclusivity to popularity and examines the ways it has been transformed in the process, both materially and in its economic, social and clinical significance. The paper shows how Samphel Norbu acts as a marker of inequality between different groups of healers, and examines the role the medicine played in the development of commercial pharmacy and the proliferation of complex medicines. Tracing out wide variations in the medicine's formulation, composition, mode of production and pattern of circulation places the issue of multiplicity at the centre of analysis, and leads to a questioning of the assumptions that underpin the category ‘classical formula’. The paper reflects upon the repositioning of such formulae within emergent configurations of knowledge, power, industry and market, and on their transformations and transformative effects both over time and in the present moment.

Private health insurance, mental health and service use in Australia

To report on the private health insurance (PHI) status of individuals with and without a mental health problem, and examine whether PHI status is associated with access to psychological services. This is a descriptive study of nationally representative population-based data collected in 2009 (HILDA) with participants aged 15-93 (n = 13,301). Key measures included: PHI status (categorised as 'hospital cover only', 'extras cover only', or 'both hospital and extras cover'); mental health status (categorised as 'have a mental health problem' or 'do not have a mental health problem' using the mental health index (MHI) of the medical outcomes study short form); mental health service use (access to a mental health professional (psychologist/psychiatrist) in the past 12 months categorised as 'yes' or 'no'). Individuals with a mental health problem were less likely to have PHI than those without a mental health problem. However, PHI was not associated with access to a mental health professional in the past 12 months. The findings suggest that while the discrepancy in PHI status is a marker of inequity between those with and without a mental health problem, it is not a key factor in facilitating access to mental health services.

The White (Male) Effect and Risk Perception: Can Equality Make a Difference?

Previous research has shown that white males have a relatively low perception of risks, known as the "white male effect" (WME). Many of the explanations of this effect refer to the privileged position of this particular demographic group in society, adducing white males' socio-economic resources, sense of control, worldviews, etc. It can thus be argued that inequality leads women and ethnic minorities to have higher risk perception than men and the ethnic majority. Therefore, the aim of this study is to investigate the WME in a gender-equal country, Sweden, to see if the pattern is similar to previous studies from the comparably less gender-equal United States. The empirical analyses are based on a national survey (n= 1,472) on the perception of risk conducted in Sweden in the winter of 2005. The results show that in Sweden there is no significant difference between men and women in risk perception, while people with foreign backgrounds perceive risks higher than native people. The chief finding is that there is no WME in Sweden, which we concluded results from the relative equality between the sexes in the country. On the other hand, ethnicity serves as a marker of inequality and discrimination in Sweden. Consequently, ethnicity, in terms of foreign background, mediates inequality, resulting in high risk perception. Equality therefore seems to be a fruitful concept with which to examine differences in risk perception between groups in society, and we propose that the "societal inequality effect" is a more proper description than the "WME."

Adolescent pregnancies in the Amazon Basin of Ecuador: a rights and gender approach to adolescents’ sexual and reproductive health

In the Andean region of Latin America over one million adolescent girls get pregnant every year. Adolescent pregnancy (AP) has been associated with adverse health and social outcomes, but it has also been favorably viewed as a pathway to adulthood. AP can also be conceptualized as a marker of inequity, since it disproportionately affects girls from the poorest households and those who have not been able to attend school.Using results from a study carried out in the Amazon Basin of Ecuador, this paper explores APs and adolescents’ sexual and reproductive health from a rights and gender approach. The paper points out the main features of a rights and gender approach, and how it can be applied to explore Aps. Afterward it describes the methodologies (quantitative and qualitative) and main results of the study, framing the findings within the rights and gender approach. Finally, some implications that could be generalizable to global reserach on APs are highlighted.The application of the rights and gender framework to explore APs contributes to a more integral view of the issue. The rights and gender framework stresses the importance of the interaction between rights-holders and duty-bearers on the realization of sexual and reproductive rights, and acknowledges the importance of gender–power relations on sexual and reproductive decisions. A rights and gender approach could lead to more integral and constructive interventions, and it could also be useful when exploring other sexual and reproductive health matters.This article has been commented on by Johanne Sundby. Please follow this link – http://www.globalhealthaction.net/index.php/gha/article/view/5347 – to read her Commentary

Black-White Preterm Birth Disparity: A Marker of Inequality

The racial disparity in preterm birth (PTB) is a persistent feature of perinatal epidemiology. Its consistency is not only an outcome of reproductive interest but may function as a persistent inequality to which women are exposed over time. Herein we sought to analyze exposure to area-level PTB disparity and its association with individual-level PTB risk. Using geocoded birth records (1999-2001) and year 2000 census data for Wake County, North Carolina, we created a tract-level PTB disparity variable for each woman in our study area, comprising all births in her tract excluding her birth. Multilevel random intercept models for exposure to neighborhood PTB disparity and odds of PTB were fit. Exposure to area-level PTB disparity was associated with increased odds of PTB for all women. After adjustment for maternal and neighborhood covariates, odds of delivering preterm increased by 25%, 26%, and 36% for the second, third, and fourth quartiles of exposure to PTB disparity (odds ratio [OR]=1.25, 95% confidence interval [CI]: 1.00-1.57; OR=1.26, 95% CI: 1.01-1.58; and OR=1.36, 95% CI: 1.06-1.75, respectively). Exposure to persistent inequality, in the form of PTB disparity, appears associated with individual-level PTB risk. Knowing where PTB disparity is greatest has implications for PTB prevention policy efforts to buffer adverse conditions.