Inequality Measures Research Articles

Trends and inequalities in adequate antenatal care coverage among women in Sierra Leone, 2008-2019.

Prenatal care is a critical component of maternal and child health, providing essential preventive, diagnostic, and therapeutic services to pregnant women. Adequate antenatal care has been linked to reduced maternal and infant mortality and improved birth outcomes. Despite its importance, disparities in antenatal care coverage persist globally, including Sierra Leone,with significant implications for maternal and child health. This study examined the trends and inequalities in antenatal care utilisation in Sierra Leone. We used data from the 2008, 2013, and 2019 Sierra Leone Demographic and Health Surveys. Simple inequality measures (Difference and Ratio) and complex measures (Population Attributable Risk and Population Attributable Fraction) were computed using the World Health Organization's Health Equity Assessment Toolkit software. Inequality in antenatal care was calculated on six stratefiers:age groups for women, birth order, educational levels, economic status, residential areas, and sub-national province. There was a significant increase in adequate antenatal care coverage from 2008 (15.2%) to 2013 (36.5%) but a decrease in 2019 (22.1%). The inequality in age increased over time from a Difference of2.7 percentage points in 2008 to a Difference of 5.3 percentage points in 2019, indicating age-related inequalities. The Population Attributable Fraction decreased from 2.7% in 2008 to zero in 2013, indicating no further improvement in the national average of adequate antenatal care coverage can be achieved in the absence of age-related inequalities. However, it increased to 7.7% in 2019, indicating that the national average of adequate antenatal care coverage would have increased by 7.7% in the absence of age-related inequalities. The birth order inequality increased from a Difference of - 5.2 percentage points in 2008 to 2.6 percentage points in 2019. The Population Attributable Fraction was zero in 2008 and3.4% in 2019, showing that the national average of adequate antenatal care coverage would have increased by 3.4% if there was no parity-based inequality. Inequality in economic status decreased from 32.1 percentage points in 2008(Difference = 32.1) to 2.8 percentage points in 2019(Difference = 2.8). The Population Attributable Fraction revealed that the national average could have been 164.4% higher in 2008 and 20.8% higher in 2013; however, it was zero in 2019, indicating that no further improvement can be achieved in the national average if there was no inequality related to economic status. Inequality for education decreased from 49.9 percentage points in 2008(Difference = 49.9) to 11.0 percentage points in 2019(Difference = 11.0). Inequality decreased from a Difference of20.8 percentage points in 2008 to a Difference of1.7 percentage points in 2019 for place of residence inequality, showing a reduction in inequality. Provincial inequality decreased from a Difference of 33.9 percentage points in 2008 to 8.5 percentage points in 2019. While there have been notable improvements in antenatal care coverage in Sierra Leone, adequate antenatal care coverage is still below the WHO target of 78% in 2016, and significant inequalities persist. Addressing these inequalities requires a multifaceted approach considering demographic, economic, educational, and geographic indicators considered in this study. Sustained efforts and targeted interventions are critical by the Sierra Leone government to ensure that all women, regardless of their background, have access to essential antenatal care services up to at least eight visits.

Inequalities in measles immunization coverage among two-year-olds in Sierra Leone, 2008-2019.

Measles, a highly contagious and potentially fatal disease, remains a significant public health concern, particularly in low- and middle-income countries. Vaccination is the most effective way to prevent measles and achieving high immunization coverage is crucial for protecting children and communities. This study investigated the trends and inequalities in measles immunization coverage among two-year-olds in Sierra Leone between 2008 and 2019. The study utilized data from the Sierra Leone Demographic Health Surveys conducted in 2008, 2013, and 2019. The World Health Organisation Health Equity Assessment Toolkit was used to calculate various inequality measures, including Difference(D), Ratio(R), Population Attributable Risk (PAR), and Population Attributable Fraction (PAF). An inequality assessment was conducted for six stratifiers: age, economic status, level of education, place of residence, sex of the child, and sub-national province. In Sierra Leone, measles immunization coverage increased between 2008 and 2013 and decreased slightly in 2019. In 2008, 66.2% of two-year-olds were immunized, which increased to 86.2% in 2013 and then fell slightly to 82.2% in 2019. There was a decrease in inequality for age from 4.2 percentage points in 2008 to 3.0 percentage points in 2019(D = 4.2 in 2008 and 3.0 in 2019). Economic-related inequality decreased from 8.1 percentage points in 2008 to 7.5 percentage points in 2019(D = 8.1 in 2008 and 7.5 in 2019). Inequality in education decreased from 10.3 percentage points in 2008 to 7.4 percentage points in 2019based on results from the inequality measure D. For place of residence, inequality decreased from 6.0 percentage points in 2008 to 4.0 percentage points in 2019. For the child's sex, the inequality increased from 1.9 percentage points in 2008 to 4.5 percentage points in 2019. The PAF revealed that the setting average could have been 1.4% higher in 2008 and 2.7% higher in 2019 without the child's sex inequality. Provincial inequality decreased from 19.4 percentage points in 2008 to 16.9 percentage points in 2019(D = 19.4 in 2008 and 16.9 in 2019). The observed fluctuations in national measles immunization coverage for children under two underscore the need for sustained efforts in vaccination programs. While improvements in access based on age, socioeconomic status, education level, and place of residence suggest progress in reducing inequalities, the persistent provincial disparities, with a significant gap in 2019, highlight ongoing challenges that must be addressed to ensure equitable health outcomes. Additionally, the increase in inequalities based on the child's sex during the study period raises concerns about targeted interventions that may inadvertently neglect specific groups. These findings imply that policymakers must prioritize strategies that maintain high vaccination rates and focus on closing the geographical and sex-based gaps, particularly in underserved provinces and among vulnerable populations.

Effect of a multicomponent school-based intervention with parental involvement on socioeconomic inequalities in smoking initiation: equity impact analysis of the TOPAS study

BackgroundAs prevalence of tobacco use falls, socioeconomic inequalities in tobacco use are increasing in many high-income countries. Evidence is lacking on the effect of preventive interventions on socioeconomic inequalities in...

Trends and inequalities in anaemia prevalence among children aged 6–59 months in Ghana, 2003–2022

BackgroundAnaemia, characterised by a deficiency in red blood cells or haemoglobin, is a public health issue in Ghana, particularly among children. The prevalence of anaemia in this age group has been a longstanding concern due to its adverse effects on cognitive development, physical growth, and well-being. This study examined the trends and inequalities in anaemia prevalence among children aged 6–59 months in Ghana between 2003 and 2022.MethodsData from the Ghana Demographic Health Survey conducted between 2003 and 2022 was used to analyse the prevalence of anaemia in children aged 6–59 months. The World Health Organization’s Health Equity Assessment Toolkit software calculated several inequality measures, including difference, ratio, population-attributable risk, and population-attributable percentage. An inequality assessment was performed for six stratifiers: child’s age, mother’s economic status, maternal educational level, place of residence, child’s sex, and sub-national region.ResultsAnaemia prevalence among children aged 6–59 months in Ghana declined from 76.1% in 2003 to 48.9% by 2022. The results revealed an age-related inequality in anaemia prevalence among children in Ghana, with younger age group ( 6–11 months) consistently showing higher rates. The age-related inequality Difference was 24.6 percentage points in 2022, indicating that age is crucial to understanding anaemia risk. Economic-related inequality between children of mothers in Quintile 5 (richest) and Quintile 1 (poorest) increased from a Difference of 21.1 percentage points in 2003 to 32.7 percentage points in 2022 highlighting the stark inequalities across wealth quintiles. Education inequality between children of mothers with higher education and no education decreased from a Difference of 29.4 percentage points in 2003 to 25.3 percentage points in 2022, suggesting that children from less educated households are still at higher risk. Place of residence inequality between children of mothers living in urban areas and rural areas increased from a Difference of 12.3 percentage points in 2003 to 14.8 percentage points in 2022 reflecting urban-rural disparities. Sex-related inequality between male and female children decreased from a Difference of -0.3 percentage points in 2003 to -5.5 percentage points in 2022 indicating the absence of inequality based on sex of the child. Lastly, regional inequalities are pronounced, as indicated by an increase in the Difference from 21.2 percentage points in 2003 to 34.0 percentage points in 2022, highlighting that children in certain regions like the Northern and Upper East are more affected by anaemia.ConclusionThe decline in anaemia prevalence among children aged 6–59 months in Ghana, reflects substantial progress; however, notable inequalities persist across age, economic status, education, place of residence, and region. To address these disparities, strategies such as enhancing access to healthcare services in underserved regions, implementing community education programs to raise awareness about nutrition and health, and promoting economic empowerment initiatives can be effective. Additionally, community education can play a crucial role in offsetting the effects of low household education levels, fostering a more informed population that can advocate for better health practices and policies. By addressing these key areas, we can work towards reducing anaemia prevalence and improving child health outcomes across all populations in Ghana.

The impact of internet medical service on rural gender inequality in health opportunity: a cross-sectional study

BackgroundThe increasing popularity of Internet medical service may have alleviated the gender inequality in health opportunity faced by rural women. However, research to ascertain the association between Internet medical service and gender inequality in health opportunity is scarce. This study explored the impact of Internet medical service on gender inequality in health opportunity among rural women and the underlying mechanisms involved.MethodsA multistage stratified cross-sectional survey was conducted across six counties in three provinces in China, yielding 3,108 responses for a 97.13% response rate. The questionnaire was used to collect information on Internet healthcare use, health status, health behaviors, social activities and personal exercise, chronic disease status, and demographic and socio-economic characteristics of the participants. Based on Roemer's theory of equality of opportunity (EOP), we established a decomposition strategy for the fairness gap between genders, which we used for the measurement of the gender inequality in health opportunity Fixed effects models, propensity score matching (PSM), and least absolute shrinkage and selection operator (LASSO) regression were utilized to explore the impact of Internet medical service on rural gender inequality in health opportunity.ResultsOn average, rural women experienced a gender health fairness gap of 1.63. Internet medical service significantly mitigated this inequality (β = -0.0602, P = 0.0002), and this finding remained significant across propensity score matching (PSM) and LASSO regression analyses. Mechanistic analysis revealed that human capital positively moderates this effect (β = -0.0510, P < 0.01), while income (β = 0.0370, P < 0.001) and marital status (β = 0.2039, P < 0.001) have negative moderating effects.ConclusionsBy focusing on gender inequality in the digital era, this study highlights the mitigating role of Internet medical service on gender inequality in health opportunity in rural areas. This study proposes and validates the mechanisms through which Internet medical service alleviates gender inequality in health opportunity, suggesting that human capital amplifies this effect, while high personal income and marital status attenuate this effect. These findings contribute to understanding how the digital age can narrow gender health opportunity equality, providing support for future interventions aimed at promoting health equity and gender equality.

Trends and inequalities in the use of deworming medication during pregnancy in Sierra Leone, 2008–2019

BackgroundIntestinal worm infections are a significant public health concern for pregnant women in low- and middle-income countries. These infections can lead to anaemia, malnutrition, and adverse pregnancy outcomes, including premature birth and low birth weight. Deworming medication during pregnancy is a safe and effective strategy to prevent these complications and improve maternal and child health. This study aims to investigate the trends and inequalities in the use of deworming medication during pregnancy among women in Sierra Leone between 2008 and 2019.MethodsThe study utilised data from the Sierra Leone Demographic Health Surveys conducted in 2008, 2013, and 2019. We used the Health Equity Assessment Toolkit developed by the World Health Organisation to calculate various measures of inequality, including difference, ratio, population attributable risk, and population attributable fraction. An inequality assessment was conducted for five stratifiers: age, economic status, level of education, place of residence, and sub-national province.ResultsThe prevalence of deworming medication during pregnancy was 43.8% in 2008, 72.4% in 2013, and 83.5% in 2019 in Sierra Leone. There was a decrease in age-related inequality from a difference of 3.7% in 2008 to −0.8% in 2019. Economic-related inequality increased from a difference of −8.5% in 2008 to −8.2% in 2019. Both population attributable fraction and population attributable risk were zero in all survey years for economic status, indicating no improvement in the setting average without economic-related inequality. Inequality in education increased from a difference of -8.9% in 2008 to −8.4% in 2019 and decreased from a difference of −2.6% in 2008 to –5.5% in 2019 for place of residence. Provincial inequality decreased from a difference of 29.5% in 2008 to 11.8% in 2019. The population attributable risk for province reveals that the setting average could have been 10.5 percentage points lower in 2008, 8.2 percentage points lower in 2013, and 5.9 percentage points lower in 2019 without provincial inequality.ConclusionThe prevalence of deworming medication use during pregnancy substantially increased from 2008 to 2019 (43.8% to 83.5%) in Sierra Leone. This suggests a positive public health trend in maternal healthcare access and education. Inequalities related to economic status and education increased slightly while age-related, place of residence and provincial inequalities decreased. This indicates an inequitable distribution of this essential healthcare intervention across these stratifiers. The government and policymakers should continue efforts to raise awareness and promote the use of deworming medication during pregnancy.

Some Notes on the Gini Index and New Inequality Measures: The nth Gini Index

A new family of inequality indices based on the deviation between the expected maximum and the expected minimum of random samples, called the nth Gini index is presented. These indices generalize the Gini index. At the same time, this family of indices and the S-Gini index are generalized by proposing the uv-Gini index, which turns out to be a convex combination of the S-Gini index and the Lorenz family of inequality measures. This family of Gini indices provides a methodology for achieving perfect equality in a given distribution of incomes. This is achieved through a series of successive and equal increases in the incomes of each individual.

Changes in suicide inequalities in the context of an increase and a decrease in suicide mortality: The case of South Korea, 1995–2020

South Korea experienced a sharp increase until 2010 followed by a gradual decrease in suicide mortality. This study examined changes in socioeconomic inequalities in suicide over 25 years and how suicide inequalities changed in the context of both an increase and a decrease in suicide mortality. Data with five-year intervals were extracted from the Korean death registry and census data between 1995 and 2020. Using Poisson regression, four measures of suicide inequalities were calculated for the slope of inequality index (SII), relative index of inequality, rate ratios, and ratio differences. Educational inequalities in suicide were obvious across all sub-populations, measures, and periods. The widening of suicide inequalities, particularly with absolute measures, followed an increase in suicide mortality until 2010. In contrast, a decline of suicide inequalities concurred after 2010 during the period of a decline in suicide mortality. SII among the total population decreased by 35.4%, from 62.4 per 100,000 people (95% confidence interval [CI], 59.8–64.9) in 2010 to 40.3 (95% CI, 38.3–42.4) in 2020. The pattern of widening and narrowing in suicide inequalities observed in the whole population was only concordant with the older population. However, the younger and the middle-aged population showed a gradual increase or stalemate in the inequalities throughout the period. Overall, suicide inequalities narrowed in the recent decade. This decline was largely led by the older population, and was attributed to the provision of social protection. A decline of suicide inequalities can accompany a decline in suicide mortality, when the provision of social protection favored the less educated.

Analyzing the Dynamics of Inflation, Exchange Rates and Economic Growth through the Gini Index: Modeling VAR in Morocco

In this study, we analyze the cross-impact of inflation, exchange rates and economic growth on income inequality in Morocco between 2000 and 2022, based on the GINI index as a measure of inequality. Its main objective is to understand how these macroeconomic variables influence income disparities. Our methodology is based on a VAR model to capture dynamic interactions between variables. To validate the robustness of the model, Granger causality tests and specification tests, including tests of homoscedasticity and autocorrelation of residuals, were used. The result is that inflation has a significant positive impact on income inequality, and exchange rate fluctuations directly influence inequality. Furthermore, economic growth helps to reduce inequality, although this effect depends on the distribution of the benefits of this growth. This study contributes to the existing literature by providing empirical evidence of the importance of macroeconomic stability and educational and fiscal policies in reducing income inequality.

What’s pension got to do with it? Mortality inequality at older ages

Abstract Background The potential role of social protection systems and welfare states for population health and mortality has attracted increased interest in recent decades but mostly focused on overall characteristics or clusters of countries. Moreover, often neglecting older people even though the great majority of all deaths in high-income countries occur at later ages. We focus on the key social protection scheme for old adults: the generosity of the level of pensions. We compare pensions based on previous work history to basic minimum pensions. Our study is novel both by linking pension system to remaining life expectancy at age 65(LE65+), but also by studying the association to variation in LE65+, since that gives a measure of inequality. We do so across countries and over time. Methods and Materials Our sources of data are from the Human Mortality Database and the Social Policy Indicator Database. Data for OECD countries are matched over a long period of time and analysed by pooled time-series regression analyses with fixed effects. Results Although the results indicate that the generosity of pensions based on both pervious work history and basic minimum income our results primarily show the importance of basic minimum income. Here the effect sizes are larger and especially for women than for men (0.149*** vs. 0,.0715***). Concerning the variation in LE (65+) we find that more generous basic pensions are associated with reduced variation for women -4.64e-05**. Conclusions We provide new insights in how pension policies potentially influence mortality among older persons especially by extending our analyses also to inequality in mortality. Our results points to the importance of basic pensions. The gendered division of labour is a plausible explanation for the findings and to have an adequate pension for all should be of primary concern for public health. Key messages • Adequate basic pension for all of importance for remaining life expectancy among older people. • Adequate basic pension for all of importance for reducing mortality inequality among women.

Are health inequalities decreasing in Sweden?

Abstract Background The overarching national goal for the Swedish public health policy is to create societal conditions for good and equitable health for all and to eliminate avoidable inequalities within a generation (until 2048). To know whether we are heading towards the public health policy goal, a surveillance system which follows a combination of several inequality measures over time, is needed. Methods All-cause mortality in age 25-64 and life expectancy at age 30, in the total population of Sweden, were used as measures of health and followed 2006-2022. Education (low, middle, high) was used to measure socioeconomic position. Both absolute and relative, and both simple and complex measures were used to analyse inequalities in mortality: rate difference (RD), relative risk (RR), population attributable fraction (PAF) and population attributable number (PIN). Life expectancy was analysed as absolute and relative difference in remaining number of years. Results Life expectancy has increased and mortality in age 25-64 have decreased in the Swedish general population. Comparing those with low and high education, both absolute and relative inequalities have increased, e.g. differences in life expectancy increased to &amp;gt; 6 years among men and almost 7 years among women, and relative inequality in mortality in age 25-64 increased to &amp;gt; 3 times higher risk (RR 3.1; CI 3.0-3.3). Inequality, measured with regard to all groups in the population, showed no noticeable changes over time. Conclusions The results show that Sweden is facing a challenge in achieving the public health goal to eliminate avoidable inequalities by 2048, with regard to life expectancy and mortality in age 25-64. To use a combination of health inequality measures strengthens the surveillance system and gives a more nuanced picture of the development. It enables, in parallel with universal health improving efforts, focus on the groups with the poorest health, where efforts have the greatest effect. Key messages • Sweden is facing a challenge in achieving the public health goal to eliminate avoidable inequalities by 2048, with regard to life expectancy and mortality in age 25–64. • A more nuanced picture of inequalities is crucial to be able to parallel universal health-improving efforts with a focus on the groups with the poorest health, where efforts have the greatest effect.

Monitoring the level of health and inequality over time using the Population Health Performance Index

Abstract Background The Population Health Performance Index (PHPI) is a composite measure that combines average health outcomes and their distribution within a population, thereby allowing for a comprehensive assessment of population health and inequality. The aim of this study is to examine the extent to which the PHPI adds value to monitoring of health and inequality over time in comparison to absolute and relative inequality. Methods Data from the WHO Equity Monitor database on under-5 mortality disaggregated by wealth quintiles for Nepal, Ethiopia, Peru, Rwanda, and Zimbabwe were analysed using different years between 1994 and 2020. Descriptive comparative statistics were employed to assess trends in the PHPI and conventional pairwise measures of absolute and relative inequalities, with consideration of different weights for inequality aversion. Results PHPI trends correspond to the trend of absolute inequality in all five countries, although they exhibit less volatility over time. Relative inequality follows the trend of the PHPI in only two of the five countries (Ethiopia and Zimbabwe), reflecting the methodology utilised for the PHPI. PHPI scores vary based on different inequality aversion weights, highlighting the sensitivity of the index to methodological adjustments. Conclusions The PHPI demonstrates notable convergence of trends with conventional methods, thereby substantiating its utility as a comprehensive tool for the simultaneous measurement of health and inequality. As it is able to consider both absolute and relative inequality within its own calculations, the PHPI allows for independent analysis of its two key components. The PHPI facilitates a more nuanced understanding of population health and may be more easily understood by policymakers and other stakeholders. As it does not address the underlying causes of changes in health inequalities, further research is necessary to supplement monitoring activities. Key messages • PHPI is a valuable tool for health and inequality monitoring by integrating both average health and disparity in a single index, facilitating communication of trends over time. • The dual focus complements conventional methods with its multidimensionality and may enable stakeholders to assess health and inequalities in alignment with broader health policy objectives.

Asymptotic synchronisation for coupled heterogeneous complex networks via L' Hoptial' rule

This paper considers the global asymptotic synchronisation (GAS) for the drive-response coupled heterogeneous complex networks (DRCHCNS). By using the different inequality techniques (DIT), L' Hoptial' rule and limit algorithms, three criteria to assure the GAS for the DRCHCNS are derived. Up to now, the results on GAS for DRCHCNS have been obtained usually by applying linear matrix inequality (LMI) and matrix measure approach (MMA). But, in this paper, without applying above approaches, we establish the GAS criteria for the DRCHCNS by using L' Hoptial' rule and limit algorithms. So, our study approach for the complex networks (CNS) extends the study fields of synchronisation of the CNS.

Exploring the fundamental properties and MGF of a 3-component mixture of power distributions: a simulation study

This paper estimates the parameters of the 3-component mixture of power distributions. The expressions of fundamental properties of the said distribution are presented, and for judgment, the numerical results of mean, median, variance, mode and skewness are evaluated. The closed-form expressions of the reliability properties, the statistical properties and necessary inequality measures are discussed. The trend of reliability measures is shown with the help of numerical results and graphs by taking different values of parameters and proportion parameters. The mathematical expressions of certain related statistical functions are derived from the reliability functions, the moment generating function, the characteristics function, the probability generating function, and the factorial moment generating function. The expressions of essential entropies, Shannon’s entropy, the B-entropy and Renyi’s entropy, are derived. The mathematical expressions of inequality indexes, the Gini index, the Lorenz curve, the Bonferroni curve, the Zinga index, the Atkinson index and the generalized entropy index are also analysed. The RF, the HRF, the CHR, the RHR, the MRL, and the MWT functions are derived in reliability analysis. The numerical values and graphs for different parameters and proportion components are discussed to judge the behaviour of reliability properties.

Long-run measurement of income-related inequalities in health care under universal coverage: evidence from longitudinal analysis in Korea

BackgroundMany countries have sought to promote well-being for their entire populations through the implementation of universal health coverage (UHC). To identify the extent to which UHC has been attained, it is necessary to evaluate equity of access to use of needed care and the cost burden of health services for the country’s entire population. This study considers income-related inequalities in health care utilization and spending in a long-term perspective for the case of the Republic of Korea.MethodsExploiting longitudinal data from a nationally representative health survey from 2008 to 2018, this study investigates how income-related inequalities in health care in Korea have varied over time and examines the extent to which need and non-need factors contribute those inequalities, using an in‐depth decomposition analysis, allowing for heterogeneous responses across income groups.ResultsThe empirical results show that overall health care utilization is disproportionately concentrated among the poor over both the short and long run. Income-group differences and non-need determinants, such as marital status and private health insurance, make larger pro-poor contributions to inequality in inpatient care use, while chronic disease prevalence greatly pushes outpatient care utilization in a pro-poor direction. The results regarding inpatient care expenses indicate a similar pattern of pro-poor bias. Long-run inequality favors the better-off in terms of outpatient care expenses, where the contribution of income-group differences has the largest impact.ConclusionMy findings suggest that it is important for health care policy in Korea to focus on improvements in the health status and well-being of low-income groups, as poor people are likely to be in poorer health. Non-need contributors could worsen pro-poor inequalities if the economic disparity across households were to increase due to the demographic transition. Higher spending on inpatient care may be a heavier financial burden for low-income people. Additional supportive measures should be provided to prevent them from suffering economic hardship. By contrast, people in high-income groups may spend most on costly services in outpatient care, including uninsured services, with the help of private health insurance. Nevertheless, the expansion of income disparity should be alleviated even from a health care policy perspective.

Deprivation and NHS General Ophthalmic Service sight testing activity in England in 2022-2023.

Socioeconomic deprivation is associated with an increased incidence of sight-loss. To inform potential developments in eyecare, General Ophthalmic Service (GOS) sight-testing activity was explored in relation to deprivation for GOS contractors submitting National Health Service (NHS) claims in England. Data on NHS sight-test claims for the financial year 2022-2023 were sought from NHS England (NHSE), including number of sight-tests by GOS contractors, their unique Organisation Data Service codes and postcodes and age-bands of patients accessing sight-testing. Deprivation scores were assigned to contractor practices using the Index of Multiple Deprivation (IMD) and the average number of sight-tests for all contractors within each IMD decile calculated, allowing rate of sight-testing per 1000 population per decile of deprivation to be estimated using Office of National Statistics (ONS) Lower Layer Super Output Area mid-year population estimates. Inequality was examined using the Odds Ratio (OR) and slope and relative index of inequality measures (SSI and RII). Overall, 12.94 million NHS sight-tests were provided by 5622 GOS contractors in England in 2022-2023. Most affluent decile GOS contractors undertook an average ~2200 NHS sight-tests, while in the most deprived decile, average NHS sight-tests per contractor was ~1100. Rate of sight-testing per 1000 population in the most deprived decile was one quarter of that in the most affluent, with an OR of 5.29 (95% CI 5.27-5.30), indicating those in the most affluent areas were ~five times more likely to access NHS sight-tests. Overall, SII and RII were 333.5 (95% CI 333.52-333.53) and 6.4 (95% CI 6.39-6.40), respectively, findings reflective of substantial inequality in uptake. There remains substantial unwarranted variation in uptake of NHS sight-testing, with those in more affluent areas accessing sight-testing substantially more than those in more deprived areas. Strategies are required to facilitate primary care optometry to provide more equitable access to eyecare.

Trends and inequalities in oral rehydration therapy and continued feeding for children under five with diarrhoea in Sierra Leone

BackgroundSierra Leone has improved child health outcomes in recent decades. However, diarrhoeal diseases remain a public health concern, particularly among children under five. This study investigates the trends and inequalities in oral rehydration therapy and continued feeding for children under five with diarrhoea in Sierra Leone in 2008, 2013 and 2019.MethodsThe analysis utilised data from the Sierra Leone Demographic Health Survey rounds conducted in 2008, 2013, and 2019. The software utilised for the calculation of various measures of inequality, including simple difference, ratio, population-attributable risk, and population-attributable fraction, was the World Health Organization Health Equity Assessment Toolkit. An inequality assessment was conducted for six stratifiers: maternal age, maternal economic status, maternal level of education, place of residence, sex of the child, and sub-national region.ResultsOur findings reveal that children under five with diarrhoea receiving oral rehydration therapy and continued feeding increased from 56.5% in 2008 to 59.7% in 2019 in Sierra Leone. Children of mothers aged 20–49 had more coverage over time than those with mothers aged 15–19. Children of mothers who are wealthy, more educated, and living in urban areas show a decrease in coverage with time compared to the poor, the lowly educated, and those residing in rural areas. Male children had higher coverage than female children. Regional inequality decreased slightly from 21.5 percentage points in 2008 to 21.2 percentage points in 2019.ConclusionThe findings revealed a mixed picture of progress in oral rehydration therapy and continued feeding for children under five in Sierra Leone. While national coverage has increased, inequalities persist. Children of older mothers and those from disadvantaged backgrounds have experienced improvements, while children of younger, wealthier, and more educated mothers in urban areas have seen a decline in coverage. The gender and regional inequalities remain. Expanding community-based health programs, providing subsidised or free supplies, and strengthening health systems in underserved areas are key strategies to ensure equitable and effective healthcare for all children in Sierra Leone.

Labour market skills, endogenous productivity and business cycles

This paper analyses how labour market heterogeneity affects unemployment, productivity and business cycle dynamics. To this aim, we set up a model with asymmetric search and matching frictions across skilled and unskilled workers, and endogenous productivity through R&D investment and intangible capital accumulation. Skill mismatch and skill-specific labour market institutions have three main effects on business cycles and growth dynamics. First, the relative scarcity of skilled workers increases the natural rate of unemployment and reduces total factor productivity with long-run effects on the growth rate of output. Second, skill heterogeneity in the labour market generates asymmetric outcomes and amplifies measures of employment, wages and consumption inequality. Finally, the model provides important insights for the Phillips and Beveridge curves. Incorporating skill heterogeneity leads to a flattening of the Phillips curve as wages and unemployment respond unevenly across skill types. Also, the model generates sideward shifts of the Beveridge curve following business cycle shocks, with the extent of these shifts depending on the degree of skill heterogeneity.

The Consequences of Universal Basic Income

Universal Basic Income (UBI) has gained attention in both academic and policy circles. However, its implications are not fully understood. This paper develops a general equilibrium model with uninsured income risks to examine such implications. Multiple policy alternatives are considered under both deficit-expanding and deficit-neutral structures. If the UBI policy is not financed through additional taxation, its impact on measures of inequality is unclear. The consumption and income inequality decrease while wealth inequality rises. Deficit-neutral UBIs resolve this ambiguity as the higher marginal tax rates prevent the wealth inequality from rising, which leads to a more equal distribution of consumption and income. However, the aggregate effects are amplified. The income tax must be as high as 80% of the output to keep the deficit from expanding. The interest rate rises, and the output and capital-to-output ratio sharply fall as the precautionary saving motives are weakened.Copyright© 2024 The Author(s). This article is distributed under the terms of the license CC-BY 4.0., which permits any further distribution in any medium, provided the original work is properly cited.

The Experience of Housing Discrimination and Housing Deprivation Across Social Groups in Ireland

This study focuses on housing inequalities across diverse social groups with respect to two housing indicators: subjective housing discrimination; and objective housing deprivation. By scrutinizing the correspondence in inequalities between the two indicators, we enhance the measurement of housing inequality and at the same time we shed light on the relationship between subjective and objective dimensions of housing— a relationship that has received little empirical examination so far. Existing research suggests that housing discrimination can contribute to housing deprivation through two channels: inadequate information and limited economic resources. Our focus is the post-2008 housing market crash era in Ireland. We use two separate large-scale individual-level surveys, the QNHS (2004, 2010, 2014) for analysing housing discrimination and SILC (2014, 2015) for analysing housing deprivation. Our findings reveal a robust convergence between perceptions of housing discrimination and objective housing deprivation across various social groups. Traditionally vulnerable groups—such as young individuals, those with disabilities, non-natives (excluding EU citizenship holders), single parents, and individuals without children—experience both discrimination and deprivation. Notably, certain groups exhibit persistent disparities in discrimination and disadvantage, even after considering factors like human capital, regional and tenure differences.