Persistent Inequalities Research Articles

HPR7 Racialized Economic Segregation and Inequities in Survival Among Patients with Multiple Myeloma

Structural racism – including racial and economic segregation – may drive persistent inequities in multiple myeloma (MM) treatment and survival. Here we examined the association of the Index of Concentration at the Extremes (ICE) for area-level racialized economic segregation, and real-world overall survival (rwOS) among patients with MM.

Culture of Education and Gender Relation: A study on goals of education for women in Sasak, Samawa and Mbojo tribes in Nusa Tenggara Barat

This study aims to discuss the main issue of education for women in Sasak, Samawa and Mbojo ethnic families. The academic problem based on idea of this research is the persistence of gender-based inequality that is suspected to originate from cultural practices and misconception religious understanding of women-male relations. These two social entities then influence the pattern of education transferred in a family that can shape gender perspectives and relations. The results showed that the purpose of education for women in the three tribes has similarities, namely to produce ideal women according to their respective local wisdom perspectives, namely women who obey customs, have a knowledge, skills, and economic independence.

Oral health inequalities-Developments in research, policy and practice over the last 50 years.

At times of major geopolitical conflict, macroeconomic crisis and the 'aftershocks' of the COVID-19 syndemic still having a global impact, it is the most vulnerable and disadvantaged in society who undoubtedly suffer the most. During these turbulent and uncertain times, it is essential that sufficient policy attention is given to tackling the persistent and stark health inequalities that exist both between and within countries. This commentary aims to critically reflect on developments in oral health inequalities research, policy and practice over the last 50 years. Despite often challenging political contexts, progress has undoubtedly been made in our understanding of the nature and underlying social, economic and political causes of oral health inequalities. A developing body of global research has highlighted patterns of inequalities in oral health that exist across the lifecourse, but less progress has been made in implementing and evaluating policy interventions to tackle these unfair and unjust inequalities in oral health. At a global level through WHO leadership, oral health is at a 'tipping point' with a unique window of opportunity for policy change and development. Transformative policy and system reforms co-produced with community and other key stakeholders are now urgently needed to tackle oral health inequalities.

Explaining Course Enrollment Gaps in High School: Examination of Gender-Imbalance in the Applied Sciences

Federal policy in the United States has urged high schools to expand offerings in career and technical education (CTE) coursework to address persistent gender inequities in science, technology, engineering, mathematics, and medical (STEMM) fields. Unfortunately, gender composition in engineering and health sciences CTE enrollment is highly imbalanced and reflects postsecondary and labor market trends. Using data from the High School Longitudinal Study of 2009, we use decomposition techniques to examine which student, family, and school factors explain gender-imbalanced enrollment in STEMM-focused CTE courses. The results indicate student occupational expectations were the largest contributor to gender gaps across content areas.

Disparities in Lung Cancer: A Targeted LiteratureReview Examining Lung Cancer Screening, Diagnosis, Treatment, and Survival Outcomes in the United States.

Although incidence and mortality of lung cancer have been decreasing, health disparities persist among historically marginalized Black, Hispanic, and Asian populations. A targeted literature review was performed to collate the evidence of health disparities among these historically marginalized patients with lung cancer in the U.S. Articles eligible for review included 1) indexed in PubMed®, 2) English language, 3) U.S. patients only, 4) real-world evidence studies, and 5) publications between January 1, 2018, and November 8, 2021. Of 94 articles meeting selection criteria, 49 publications were selected, encompassing patient data predominantly between 2004 and 2016. Black patients were shown to develop lung cancer at an earlier age and were more likely to present with advanced-stage disease compared to White patients. Black patients were less likely to be eligible for/receive lung cancer screening, genetic testing for mutations, high-cost and systemic treatments, and surgical intervention compared to White patients. Disparities were also detected in survival, where Hispanic and Asian patients had lower mortality risks compared to White patients. Literature on survival outcomes between Black and White patients was inconclusive. Disparities related to sex, rurality, social support, socioeconomic status, education level, and insurance type were observed. Health disparities within the lung cancer population begin with initial screening and continue through survival outcomes, with reports persisting well into the latter portion of the past decade. These findings should serve as a call to action, raising awareness of persistent and ongoing inequities, particularly for marginalized populations.

Spatial Income Inequality, Convergence, and Regional Development in a Lower Middle‐Income Country: Satellite Evidence from the Philippines

This paper examines spatial income inequality and convergence in the Philippines—a lower middle‐income country with historically high inequality—and its course over the process of economic development. Combining higher quality nighttime lights (NTLs) with gridded population data, I construct subnational measures of spatial inequality for the 17 administrative regions in the country in the period 2000–2020. Using this unique dataset, I first document the tremendous improvement in income disparities over the last two decades. Income per capita across provinces has converged rapidly, and income dispersion within administrative regions has narrowed markedly. Then, I uncover a U‐shaped relationship between spatial inequality and economic development, which is robust; across alternative measures of inequality; to the outlier effects of highly urbanized cities; across parametric and semiparametric specifications; to business‐cycle effects; and to persistence of spatial inequality. Finally, I confirm that structural transformation acts as a transmission channel of this U‐shaped link.

The rhetoric of community participation in urban South African water governance

The persistence of the water insecurity challenge has manifested in weak government financial systems, insufficient technical capacity, and ineffective water governance systems in the global arena. This paper is a contextual analysis of community participation in water governance in urban South Africa since 1994. Limited community participation in urban water governance results in persistent inequality in access to water and sanitation services. New strategies and effective mechanisms are needed to include communities in water governance and pricing.

Research and Evaluation in a Child-Focused Place-Based Initiative: West Philly Promise Neighborhood.

Place-based initiatives attempt to reduce persistent health inequities through multisectoral, cross-system collaborations incorporating multiple interventions targeted at varying levels from individuals to systems. Evaluations of these initiatives may be thought of as part of the community change process itself with a focus on real-time learning and accountability. We described the design, implementation, challenges, and initial results of an evaluation of the West Philly Promise Neighborhood, which is a comprehensive, child-focused place-based initiative in Philadelphia, Pennsylvania. Priorities for the evaluation were to build processes for and a culture of ongoing data collection, monitoring, and communication, with a focus on transparency, accountability, and data democratization; establish systems to collect data at multiple levels, with a focus on multiple uses of the data and future sustainability; and adhere to grant requirements on data collection and reporting. Data collection activities included the compilation of neighborhood-level indicators; the implementation of a program-tracking system; administrative data linkage; and neighborhood, school, and organizational surveys. Baseline results pointed to existing strengths in the neighborhood, such as the overwhelming majority of caregivers reporting that they read to their young children (86.9%), while other indicators showed areas of need for additional supports and were programmatic focuses for the initiative (e.g., about one-quarter of young children were not engaged in an early childhood education setting). Results were communicated in multiple formats. Challenges included aligning timelines, the measurement of relationship-building and other process-focused outcomes, data and technology limitations, and administrative and legal barriers. Evaluation approaches and funding models that acknowledge the importance of capacity-building processes and allow the development and measurement of population-level outcomes in a realistic timeframe are critical for measuring the success of place-based approaches.

“An extra layer of pressure to be my best self”: Healthcare provider perspectives on how doulas foster accountability and bridge gaps in pregnancy-related care

Despite the importance of respectful pregnancy care, birthing people experience high rates of mistreatment in clinical settings in the United States. In light of persistent racialized maternal and infant health inequities, doula care is increasingly promoted as an intervention. Limited research has examined healthcare providers’ experiences with doulas.As part of an evaluation of community doula programs in San Francisco, California, we interviewed physicians (n ​= ​11), certified nurse-midwives (n ​= ​7), and nurses (n ​= ​10) who worked in hospitals and clinics where doula clients receive care. Using reflexive thematic analysis, we identified two themes around how providers perceive doulas to affect pregnancy-related care. First, providers described doulas fostering accountability at multiple levels. Providers described how their personal sense of accountability to patients increased in the presence of doulas; at times, this mitigated racism and implicit bias in clinical settings. Additionally, through the partnership between the community doula organization and local hospitals, doulas engaged in bidirectional feedback with providers, creating opportunities for institutional-level accountability. Second, providers perceived doulas to bridge gaps in care for pregnant and birthing people by providing services, such as continuous labor support, that are not realistic for clinicians to provide.This analysis contributes to the broader literature on doula care by describing mechanisms through which doulas improve pregnancy-related care. Doulas may be critical for birthing people who are most likely to experience mistreatment due to racism and other dimensions of oppression. Future research should explore facilitators and barriers to developing partnerships between clinical sites and doula organizations and the long-term effects of these partnerships on health equity.

The Shadow of Peasant Past: Seven Generations of Inequality Persistence in Northern Sweden

The authors use administrative data linked to parish records from northern Sweden to study how persistent inequality is across multiple generations in education, occupation, and wealth, going from historical to contemporary time. The data cover seven generations and allow the authors to follow ancestors of individuals living in Sweden around the new millennium back more than 200 years, covering the mid-18th century to the 21st century. In a sample of around 75,000 traceable descendants, they analyze (a) up to fifth cousin correlations and (b) dynastic correlations over seven generations based on aggregations of ancestors’ social class/status. With both approaches, the authors find that past generations structure life chances many generations later, even though the results align with traditional stratification research in that mobility across multiple generations is high. The results imply that today’s inequality regime may have been formed many generations back.

A qualitative exploration of Indigenous patients' experiences of racism and perspectives on improving cultural safety within health care.

In Canada, Indigenous Peoples continue to experience persistent health inequities, resulting in disproportionately poorer health outcomes compared with non-Indigenous Canadians. This study engaged Indigenous patients accessing health care in Vancouver, Canada, about their experiences of racism and improving cultural safety within health care. A research team consisting of Indigenous and non-Indigenous researchers committed to employing a Two-Eyed Seeing approach and conducting culturally safe research hosted 2 sharing circles in May 2019 with Indigenous people recruited from urban health care settings. Talking circles were led by Indigenous Elders, and thematic analysis was used to identify overarching themes. A total of 26 participants attended 2 sharing circles, which included 25 self-identifying women and 1 self-identifying man. Thematic analysis resulted in the identification of 2 major themes: negative experiences in health care and perspectives on promising health care practices. For the first major theme, subthemes included the following: experiences of racism lead to poorer care experiences and health outcomes, Indigenous-specific racism results in mistrust in the health care system, and participants experience discrediting of traditional medicine and Indigenous perspectives on health. For the second major theme, subthemes included the following: Indigenous-specific services and supports improve trust in health care, Indigenous cultural safety education is necessary for all health care-involved staff, and providing welcoming, Indigenized spaces for Indigenous patients encourages health care engagement. Despite participants' racist health care experiences, receiving culturally safe care was credited with improving trust in the health care system and well-being. The continued expansion of Indigenous cultural safety education, the creation of welcoming spaces, recruitment of Indigenous staff, and Indigenous self-determination over health care services can improve Indigenous patients' health care experiences.

Less Talk, More Action: Strategies to Mitigate Inequities Experienced by Indigenous Peoples in the Healthcare System.

Healthcare policy and decision makers in Canada have the power to address the persistent inequities experienced by Indigenous Peoples. Bold, immediate actions are necessary to address the varying manifestations of systemic racism, the ongoing denial of racism and the negative impacts on access to care and health outcomes. The perspectives presented in this issue of HealthcarePapers highlight a clear imperative: much more must be done at multiple levels to make healthcare systems safer for Indigenous Peoples. The actions discussed in this introductory paper reflect key, evidence-informed strategies to guide healthcare policy and decision makers in Canada and, potentially, other jurisdictions.

Empty satisfaction—a social phenomenology of late modern enjoyment

Phenomenological analyses of enjoyment are relatively rare; also, the few known attempts (e.g. Levinas) are elaborated in a transcendental fashion, without reflecting on the socio-historical constituents. The article aims at filling this gap by elaborating a social phenomenology of late modern enjoyment. Firstly, the experience is analysed with the help of general phenomenological descriptions: the visceral, existential and ethical constituents are mapped. The second section explores the structural transformations affecting these constituents, based on various critical theories of modernization: the impact of the reified control over the visceral; social disintegration; persistent inequalities; over-burdening of intimacy is analysed. In the concluding section, a diagnosis of times is elaborated: the cost of controlling enjoyment on the visceral level is the giving up of its existential and ethical constituents. To break this paradoxical cycle, the “actor-networks” (Latour) of visceral stimulation need to be “hacked” by including existential and ethical dimensions as well.

Stochastic Ordering of Stationary Distributions of Linear Recurrences: Further Results and Economic Applications

We investigate pairwise stochastic comparisons of stationary solutions to the linear recurrence Xt+1=AtXt+Bt, where At and Bt are non-negative random variables. We establish novel order-preserving properties, which enable us to obtain comparison theorems about well-known measures of conditional size, tail variability and skewness across probability distributions. While useful in studies of ergodic wealth accumulation processes and the persistence of inequality, our results can fruitfully be exploited to conduct comparative statics exercises in structural models entailing Kesten-type reduced-form representations. An application of our analysis to a dynamic asset accumulation model uncovers the qualitatively similar effects of capital income and earnings taxation on expected wealth concentration over higher quantiles as well as on conditional upper tail dispersion of wealth holdings, qualifying previous results that solely rely on the determination of Pareto exponents.

Inequality in professional work

The persistence of income inequality despite inclusion efforts is a paradox that remains central to academic and policy inquiry alike. In this special issue, we bring together nine articles published in the Journal of Professions and Organizations (JPO) to highlight the ways in which professional stratification is moderated by intersectional identities and organizational diversity initiatives. Professions have long provided an excellent lens to investigate processes of social inequality and continue to be an important site to understand new formulations of identity and resource circulation globally (Harrington and Seabrooke 2020). We propose that the body of research around inequality in the professions answers three important questions; First, how do individuals experience and create strategies to manage their professional lives? Second, how do factors outside of the workplace influence professional experiences? And, third, how do organizations try to increase diversity and what are the outcomes of these initiatives? Altogether, we see these articles as building on the argument that social structure and inequality are not static concepts and hence, addressing their challenges requires dynamic and interconnected solutions. Social structure and inequality are processes influenced by multiple interactions between people, organizations, cultures, and environments. Using empirical illustrations and new theoretical frameworks, these selected articles reinforce the premise that professional expertise is often ‘done’ (West and Zimmerman 1987) and that such performances call for attention across different levels of analysis (Risman 2004).

Migrating for children’s better future: Intergenerational mobility of internal migrants’ children in Indonesia

Internal migration dominates population mobility in Indonesia; according to the 2010 census, there were almost 30 million permanent migrants, around 12.5 percent of the population. The effects of this internal migration on the second generation continue to be under-explored. This paper investigates the long-term impact of parents’ migration on their children’s intergenerational per capita expenditure when adults. We argue that parental migration affects the human capital investment on their children, which has a direct impact on the children’s outcomes when adults and on their deviation from the parents’ economic status, hence their intergenerational mobility. We pooled the five waves of data from the Indonesian Family Life Survey (IFLS), and we tackled the self-selection of parents’ migration using an endogenous treatment regression. Our findings show that despite the fact that parental migration increases the education level of children and their per capita expenditure, it increases intergenerational mobility of the children as adults compared with non-migrants’ children when they live in urban areas as adults, come from the poorest parents, or had migrated during childhood. The left-behind children have more intergenerational mobility only if their father migrated, while there is no significant impact on intergenerational mobility if their mother migrated. The results are consistent with the persistence of Indonesian individual inequality.

Do Experiences of Success and Failure Influence Beliefs about Inequality? Evidence from Selective University Admission

Previous research suggests that beliefs about inequality are often biased in ways that serve people’s own interests. By contrast, people might uphold system-justifying beliefs, such as meritocratic beliefs. We test these assumptions against real-life experience of highly selective university admission. Using panel data on German medical school applicants allows us to measure belief changes through experiences of success or failure in admission. We find support that self-serving bias in beliefs outweighs the motivation for system justification: success strengthens the belief that admission depends on effort, while failure reinforces the belief that admission depends on luck. These patterns partly manifest themselves in beliefs about societal inequality. Additionally, we argue that previous experiences (long-term experiences of social upbringing and short-term experiences in university admissions) provide a frame for new experiences, examine respective effect heterogeneity, and discuss implications of our findings of diverging paths in inequality beliefs of winners and losers for the persistence of inequality.

The impact of guidance counselling on gender segregation: Major choice and persistence in higher education. An experimental study.

Gender segregation in higher education is considered one of the main drivers of persistent economic gender inequality. Yet, though there has been considerable research identifying and describing the underlying mechanisms that cause gendered educational choices in higher education, little is known about how gender segregation in higher education could be changed. Accordingly, this article aims to determine the potential of educational interventions during high school to foster gender desegregation in higher education. We focused on two different processes that contribute to gender segregation in majors among higher education graduates: first, the selection into specific majors and, second, the selection out of specific majors. We investigated whether an intensive counselling programme leads to more gender-atypical choices among high-school graduates and examined whether intensive counselling supports several indicators of students' persistence in gender-atypical majors. Based on data from an experimental study of a counselling programme for German high-school students (N = 625), we estimated the programme's effect with linear probability models and intention-to-treat analysis. Our results show that high-school graduates are more likely to choose a gender-atypical major if they have received intensive counselling. This applies more to men than to women. In addition, the programme improved some persistence indicators for students in gender-atypical majors. Although we found a significant programme effect only for perceived person-major fit and student satisfaction, the coefficients of all aspects of students' persistence show a trend indicating that the programme was beneficial for students in gender-atypical majors. As experimental studies can also be affected by various types of bias, we performed several robustness checks. All analyses indicated stable results. In conclusion, we suggest that intensive counselling programmes have the potential to reduce gender segregation in higher education. More students were motivated to choose a gender-atypical major, and different aspects of student persistence were supported by the programme for students in gender-atypical majors.

Higher education decision making of Australian women with caring responsibilities

It is well established that women bear greater caring responsibilities than men, however little is known about how this care work influences the decision-making processes of female carers who are considering Higher Education (HE). These deliberations occur well before women commit to enrolling and frequently result in carers making decisions to delay or not pursue HE, with consequences for their own careers and the persistence of gender inequalities more broadly. A scoping review of academic literature published since 1980 which followed the PRISMA-ScR process for scoping reviews was conducted to answer the research question “What is the scope of the literature regarding the influence of caregiver responsibilities on Australian women’s tertiary education decision making processes?” Studying the literature in one national context enabled the influences of personal as well as contextual influences to be identified. The results show that very little is known about how women who have caring responsibilities make decisions about whether or not to undertake HE studies. Important issues were identified such as the lack of a clear definition of carer and recognition of this cohort as an equity group. A complex array of personal, cultural and structural factors which may enable women’s HE decisions were identified, including the desire to achieve personal life goals, the encouragement and support of family members and supportive workplaces. However, constraints such as competing time demands, the continuing prevalence of traditional gendered expectations and idealised notions of HE students as unencumbered were also noted. No studies directly addressed decision-making processes, or how the many elements combined to influence female carers prior to enrolment. The paucity of research points to an urgent need for studies which will address the gaps in knowledge. This review points to new directions in research and decision-making theories to encompass the role of context and care in decisions, and provides some advice meanwhile to inform career practitioners, HE providers and career researchers.

172 Health Inequities in Access to Treatment for Unruptured Intracranial Aneurysms in the United States over 20 Years

INTRODUCTION: Literature suggests that minority racial and ethnic groups have lower treatment rates for unruptured intracranial aneurysms (UIA). It is uncertain how these disparities have changed across time. METHODS: The National Inpatient Sample (NIS) database was queried using diagnostic and procedural codes for adult patients who underwent open surgical or endovascular treatment for UIA. Aneurysmal SAH patients were used as a substitute control for patients with intracranial aneurysms that progressed to hemorrhage before intervention. A multivariable logistic regression model was constructed using patient factors and hospital factors to identify predictors of treatment. RESULTS: A total of 213,350 UIA patients and 173,375 aSAH patients from 2000-2019 were included in the final analysis. After adjusting for covariates, Black patients (0.715, 95% CI 0.699-0.730), Hispanic patients (0.734, 95% CI 0.717-0.751) and other racial/ethnic minority patients (0.633, 95% CI 0.617-0.651) had lower odds of intervention for UIA compared to White patients with UIA. Medicare patients had higher odds of treatment than private insurance patients while Medicaid and the uninsured patients had lower odds. Non-White/Hispanic females (0.697, 95% CI 0.646-0.752) and males (0.602, 95%CI 0.556-0.651) had lower treatment odds than their white counterparts, irrespective of insurance status. Multivariable regression analysis revealed that the treatment odds of Black patients improved over time, while other minority group patients had variable treatment odds over time. CONCLUSIONS: This analysis of NIS data from 2000 to 2019 demonstrates disparities in treatment for UIA across race, sex, insurance status, and hospital factors. The persistence of inequalities over time requires attention in order to target improvement.