Persistent Social Inequalities Research Articles

Neonatal mortality in countries of the Americas, 2000-2020: trends, inequalities, and target-setting.

To analyze temporal trends and inequalities in neonatal mortality between 2000 and 2020, and to set neonatal mortality targets for 2025 and 2030 in the Americas. A descriptive ecological study was conducted using 33 countries of the Americas as units of analysis. Both the percentage change and average annual percentage change in neonatal mortality rates were estimated. Measurements of absolute and relative inequality based on adjusted regression models were used to assess cross-country social inequalities in neonatal mortality. Targets to reduce neonatal mortality and cross-country inequalities were set for 2025 and 2030. The estimated regional neonatal mortality rate was 12.0 per 1 000 live births in 2000-2004 and 7.4 per 1 000 live births in 2020, representing a percentage change of -38.3% and an average annual percentage change of -2.7%. National average annual percentage changes in neonatal mortality rates between 2000-2004 and 2020 ranged from -5.5 to 1.9 and were mostly negative. The estimated excess neonatal mortality in the 20% most socially disadvantaged countries, compared with the 20% least socially disadvantaged countries, was 17.1 and 9.8 deaths per 1 000 live births in 2000-2004 and 2020, respectively. Based on an extrapolation of recent trends, the regional neonatal mortality rate is projected to reach 7.0 and 6.6 neonatal deaths per 1 000 live births by 2025 and 2030, respectively. National and regional health authorities need to strengthen their efforts to reduce persistent social inequalities in neonatal mortality both within and between countries.

RACIAL/ETHNIC DISPARITIES IN MARITAL STATUS AND LIVING ARRANGEMENT TRANSITIONS AMONG US OLDER ADULTS

Abstract US older adults’ family life, including marital status and living arrangement, has become increasingly complex and diverse in recent decades. However, there is limited understanding of the average duration each racial/ethnic group typically spends in different marital statuses and living arrangements during older ages. Using data from the Health and Retirement Study 1992-2018, this research note investigates the racial/ethnic differences in the expected years to be spent at age 50 in each of the marital statuses (i.e., married, divorced, widowed, and never married) and living arrangements (i.e., living alone, living with spouse, living with non-spouses only, and nursing home. At age 50, Whites spend significantly more time married compared to Blacks and Hispanics, primarily due to the latter spending longer years divorced or never-married. Regarding living arrangements, Whites also spend notably more time living with spouse than Blacks and Hispanics, with the latter spending more time living only with non-spouses. These findings suggest that Whites have a distinct advantage in maintaining a stable, two-person family structure in late adulthood, while Blacks and Hispanics are more likely to spend their later years without their spouses. These patterns have broad implications for understanding persistent social inequality in late adulthood.

Assessing COVID-19 pandemic policies and behaviours and their economic and educational trade-offs across US states from Jan 1, 2020, to July 31, 2022: an observational analysis

The USA struggled in responding to the COVID-19 pandemic, but not all states struggled equally. Identifying the factors associated with cross-state variation in infection and mortality rates could help to improve responses to this and future pandemics. We sought to answer five key policy-relevant questions regarding the following: 1) what roles social, economic, and racial inequities had in interstate variation in COVID-19 outcomes; 2) whether states with greater health-care and public health capacity had better outcomes; 3) how politics influenced the results; 4) whether states that imposed more policy mandates and sustained them longer had better outcomes; and 5) whether there were trade-offs between a state having fewer cumulative SARS-CoV-2 infections and total COVID-19 deaths and its economic and educational outcomes. Data disaggregated by US state were extracted from public databases, including COVID-19 infection and mortality estimates from the Institute for Health Metrics and Evaluation's (IHME) COVID-19 database; Bureau of Economic Analysis data on state gross domestic product (GDP); Federal Reserve economic data on employment rates; National Center for Education Statistics data on student standardised test scores; and US Census Bureau data on race and ethnicity by state. We standardised infection rates for population density and death rates for age and the prevalence of major comorbidities to facilitate comparison of states' successes in mitigating the effects of COVID-19. We regressed these health outcomes on prepandemic state characteristics (such as educational attainment and health spending per capita), policies adopted by states during the pandemic (such as mask mandates and business closures), and population-level behavioural responses (such as vaccine coverage and mobility). We explored potential mechanisms connecting state-level factors to individual-level behaviours using linear regression. We quantified reductions in state GDP, employment, and student test scores during the pandemic to identify policy and behavioural responses associated with these outcomes and to assess trade-offs between these outcomes and COVID-19 outcomes. Significance was defined as p<0·05. Standardised cumulative COVID-19 death rates for the period from Jan 1, 2020, to July 31, 2022 varied across the USA (national rate 372 deaths per 100 000 population [95% uncertainty interval [UI] 364-379]), with the lowest standardised rates in Hawaii (147 deaths per 100 000 [127-196]) and New Hampshire (215 per 100 000 [183-271]) and the highest in Arizona (581 per 100 000 [509-672]) and Washington, DC (526 per 100 000 [425-631]). A lower poverty rate, higher mean number of years of education, and a greater proportion of people expressing interpersonal trust were statistically associated with lower infection and death rates, and states where larger percentages of the population identify as Black (non-Hispanic) or Hispanic were associated with higher cumulative death rates. Access to quality health care (measured by the IHME's Healthcare Access and Quality Index) was associated with fewer total COVID-19 deaths and SARS-CoV-2 infections, but higher public health spending and more public health personnel per capita were not, at the state level. The political affiliation of the state governor was not associated with lower SARS-CoV-2 infection or COVID-19 death rates, but worse COVID-19 outcomes were associated with the proportion of a state's voters who voted for the 2020 Republican presidential candidate. State governments' uses of protective mandates were associated with lower infection rates, as were mask use, lower mobility, and higher vaccination rate, while vaccination rates were associated with lower death rates. State GDP and student reading test scores were not associated with state COVD-19 policy responses, infection rates, or death rates. Employment, however, had a statistically significant relationship with restaurant closures and greater infections and deaths: on average, 1574 (95% UI 884-7107) additional infections per 10 000 population were associated in states with a one percentage point increase in employment rate. Several policy mandates and protective behaviours were associated with lower fourth-grade mathematics test scores, but our study results did not find a link to state-level estimates of school closures. COVID-19 magnified the polarisation and persistent social, economic, and racial inequities that already existed across US society, but the next pandemic threat need not do the same. US states that mitigated those structural inequalities, deployed science-based interventions such as vaccination and targeted vaccine mandates, and promoted their adoption across society were able to match the best-performing nations in minimising COVID-19 death rates. These findings could contribute to the design and targeting of clinical and policy interventions to facilitate better health outcomes in future crises. Bill & Melinda Gates Foundation, J Stanton, T Gillespie, J and E Nordstrom, and Bloomberg Philanthropies.

Improvement of the Brazilian nutritional scenario despite the persistence of social inequalities.

Improvement of the Brazilian nutritional scenario despite the persistence of social inequalities.

A Culturally Responsive Disposition: How Professional Learning and Teachers’ Beliefs About and Self-Efficacy for Culturally Responsive Teaching Relate to Instruction

Persistent social inequities in the United States demand attention to culturally responsive (CR) teaching, which requires a specific disposition toward students and teaching. Using survey data of secondary teachers ( N = 417) in seven urban districts across the country engaging in equity-oriented professional learning (PL) initiatives, we examine the relationship between teachers’ beliefs about, self-efficacy for, and engagement in PL around CR teaching and their self-reported CR teaching practices. We find correlational evidence that teacher-reported self-efficacy with CR teaching and engagement in PL focused on CR teaching are associated with higher self-reported frequency of CR teaching. We also find that teachers who have beliefs aligned with CR teaching have a stronger relationship between their CR teaching self-efficacy and self-reported CR teaching practices. Finally, we find evidence that changes in CR teaching self-efficacy are associated with changes in self-reported CR teaching—suggesting that CR teaching self-efficacy may drive changes in CR teaching.

Parental socioeconomic status and children’s cognitive ability in China

It is widely recognized that intergenerational transmission is one of the primary causes of persistent social inequality. Using nationally representative data, the China Family Panel Studies, this paper is one of the first to comprehensively investigate parental SES and children’s cognitive outcomes in China and moves beyond existing work by accounting for the direct intergenerational transmission of cognitive ability and by examining various novel mechanisms. Our results show that parents’ education rather than income is positively associated with their children’s cognitive abilities. The analysis of mechanisms shows that educational disparity widens the gap in parental investment, as well as parental beliefs regarding education and expectations for their children. Nevertheless, we do not find differences in parenting productivity. In addition, we find that the impact is more prominent in rural areas where education resources are much more limited. Various tests have been performed to prove the robustness of our findings.

Enjoying the fruit of development? Working conditions and the earnings of low-skilled internal migrants in China across two decades (1993–2015)

ABSTRACT China’s unprecedented economic growth in recent decades can largely be attributed to millions of migrant labourers that made China the ‘world’s factory’. It is well documented, however, that migrant labourers experience discrimination in the labour market. Despite China’s phenomenal economic growth, few studies have investigated whether the working conditions of low-skilled migrants have improved. In this study, we ask: in the past two decades, have disparities in working conditions and earnings between low-skilled rural-to-urban migrant workers and their urban counterparts decreased? We contrast the working conditions and earnings between migrants and urban residents who lack a high school degree and age 18–55 years using panel data, the China Health and Nutrition Survey (1993–2015), and individual fixed effects models to account for selection problems. Findings indicate that over a span of twenty years migrants and urban residents had similar trends in employment and earned incomes, but migrants’ weekly working hours and tendency to work more than legal work hours increased more than urban residents’. Working longer without earning more suggests persistent social inequality in Chinese society in general and deeper injustice among migrant workers.

Prevalence of overweight, obesity, and early adiposity rebound in nursery school children in southeastern France

BackgroundThe aim of the present study was to assess the prevalence of overweight, obesity, and early adiposity rebound in nursery school children aged 3.5–4.5 years and to evaluate associations with deprivation. MethodsA cross-sectional study was conducted in the Bouches-du-Rhône department in southeastern France. Data for all nursery school children aged 3.5–4.5 years were collected during systematic medical examinations. The prevalence of overweight and obesity was determined using French, International Obesity Task Force (IOTF), and World Health Organization reference values. A French ecological deprivation index was used to assess associations with deprivation. ResultsAmong 19,295 children included in the study, the prevalence of overweight (IOTF-25 < BMI < IOTF-30) was 9.1% and the prevalence of obesity (BMI > IOTF-30) was 2.6%. Children attending nursery schools in the most disadvantaged areas were 4.3 times more likely to be affected by obesity than those from schools in the most advantaged areas (OR: 4.32; 95% CI: 2.98–6.25, p < 0.001), after adjusting for gender, age group, and school status. Early adiposity rebound was observed in 2131 of 9872 children (21.6%). ConclusionPrograms to prevent childhood overweight and obesity in France should be intensified and take account of major persistent social inequalities. Medical practitioners should learn to systematically assess BMI curve dynamics and early adiposity rebound.

ASAM speakers: M.D.s must make equity part of healing mission

Addiction medicine specialists need to make their voices heard stronger in their communities in order to correct persistent social inequities in service delivery, the commissioner of the New York Office of Addiction Services and Supports (OASAS) told attendees of this month's annual conference of the American Society of Addiction Medicine (ASAM). Chinazo Cunningham, M.D., delivered her remarks in an April 1 scientific plenary session that outlined personal career milestones that reflected her desire to close wide disparities in care.

Pandemics, past and present: The role of biological anthropology in interdisciplinary pandemic studies

Biological anthropologists are ideally suited for the study of pandemics given their strengths in human biology, health, culture, and behavior, yet pandemics have historically not been a major focus of research. The COVID‐19 pandemic has reinforced the need to understand pandemic causes and unequal consequences at multiple levels. Insights from past pandemics can strengthen the knowledge base and inform the study of current and future pandemics through an anthropological lens. In this paper, we discuss the distinctive social and epidemiological features of pandemics, as well as the ways in which biological anthropologists have previously studied infectious diseases, epidemics, and pandemics. We then review interdisciplinary research on three pandemics–1918 influenza, 2009 influenza, and COVID‐19–focusing on persistent social inequalities in morbidity and mortality related to sex and gender; race, ethnicity, and Indigeneity; and pre‐existing health and disability. Following this review of the current state of pandemic research on these topics, we conclude with a discussion of ways biological anthropologists can contribute to this field moving forward. Biological anthropologists can add rich historical and cross‐cultural depth to the study of pandemics, provide insights into the biosocial complexities of pandemics using the theory of syndemics, investigate the social and health impacts of stress and stigma, and address important methodological and ethical issues. As COVID‐19 is unlikely to be the last global pandemic, stronger involvement of biological anthropology in pandemic studies and public health policy and research is vital.

Confronting Gender Inequalities in Education Leadership: A Case of Zimbabwe

The persistence of the marginalisation of women has dominated education leadership research recently. This study examined literature on women’s education leadership and management through the lens of social justice. The study used Shields’s tenets of transformative leadership to unearth and dissect issues of gender discrimination in education leadership. As a catalyst for a recent systematic review of research on Zimbabwean women’s education leadership literature, the study reviewed 22 publications used earlier in the systematic research review. The studies were identified through numerous electronic searches following carefully defined eligibility criteria. A thematic analysis was conducted through the use of mind maps to deduce common themes. The results suggested a transformation of persistent political, institutional, structural, economic, cultural and social inequalities and human rights violations to achieve social justice in education leadership. Further research should be undertaken to examine the root causes of persistent gender imbalances and the failure of gender equity.

Get Unstuck!

AbstractExamining women's magazines and lifestyle coaching, the article explores how positivity imperatives in contemporary culture call forth a happy, confident, hopeful, and vibrant subject during the COVID-19 pandemic. The analysis shows how these positivity imperatives acknowledge stress and difficulty, and at times highlight their gendered impacts, yet nevertheless systematically figure responses and solutions in individual, psychological, and often consumerist terms. The discussion demonstrates how positivity imperatives operate not only through verbal advice but also through visual, embodied, and affective means and through an emphasis on developing new social practices—from holding one's body differently, to keeping gratitude journals, to cultivating a new virtual persona for online work meetings. The article highlights a profound paradox: in times of a global pandemic that has affected women disproportionally, and when structural injustices and inequalities have been made ever more visible, positivity and individualized self-care interpellations to women flourish, anger is muted, and critiques of structural inequality are largely silenced. Thus seemingly benign and often undoubtedly well-meaning messages of confidence, calm, and positivity during the pandemic work to buttress a neoliberal imaginary and persistent social inequalities.

Housing Movements and Participation in Institutional Spaces

This article sets out to examine the inclusion of social movements in the designing of public policy in Brazil. I situate the Brazilian political and social context in terms of its persistent social inequalities and the inclusion of social movements in policy-making during the course of 2003–2010 (Lula da Silva’s first and second terms as president) and 2011–2014 (Dilma Rousseff’s first term as president). I discuss and explore mechanisms of participatory democracy, and more specifically, I look at the process of integration of civil society in spaces of decision-making related to housing issues. This paper found that, despite some concrete results of implementing greater popular participation, the inclusion of social movements still faces challenges to be effectively included in spaces of decision-making, especially under the current conservative administration.

Reclaiming power

Intimate partner violence against women and children is a growing concern for feminist scholarship in the Anglophone Caribbean. This scholarship is significant in challenging patriarchal gender ideologies at the intersections of race, class and sexuality. This body of work reveals how violence is embedded in the state and governmental bodies, and highlights the overall disparities in the implementation of laws. Furthermore, this work demonstrates how neoliberal restructuring policies implicate and affect women differently based on their positionality. While this work is critical in addressing intimate partner violence against women and children, the LGBTQ community in the region has remained vulnerable to violence at multiple levels of society. This article contributes to this work by focusing on same-sex intimate partner violence between women in Guyana. The aim of this article is twofold: first, to map out the traditional gendered framing of violence against heterosexual and women loving women; second, to argue that in Guyana’s context of persistent social, political and economic inequalities, women loving women use violence as a resource of resolution to reclaim and secure power.

Bridging the health inequality gap: an examination of South Africa\u2019s social innovation in health landscape

BackgroundDespite the end of apartheid in the early 1990s, South Africa remains racially and economically segregated. The country is beset by persistent social inequality, poverty, unemployment, a heavy burden of disease and the inequitable quality of healthcare service provision. The South African health system is currently engaged in the complex project of establishing universal health coverage that ensures the system’s ability to deliver comprehensive care that is accessible, affordable and acceptable to patients and families, while acknowledging the significant pressures to which the system is subject. Within this framework, the Bertha Centre for Social Innovation & Entrepreneurship works to pursue social impact towards social justice in Africa with a systems lens on social innovation within innovative finance, health, education and youth development. The aim of this study is to demonstrate the capacity for social innovation in health with respect for South Africa, and to highlight some current innovations that respond to issues of health equity such as accessibility, affordability, and acceptability.MethodsDifferent data types were collected to gain a rich understanding of the current context of social innovation in health within South Africa, supported by mini-case studies and examples from across the African continent, including: primary interviews, literature reviews, and organisational documentation reviews. Key stakeholders were identified, to provide the authors with an understanding of the context in which the innovations have been developed and implemented as well as the enablers and constraints. Stakeholders includes senior level managers, frontline health workers, Ministry of Health officials, and beneficiaries. A descriptive analysis strategy was adopted.ResultsSouth Africa’s health care system may be viewed, to a large extent, as a reflection of the issues facing other Southern African countries with a similar disease burden, lack of systemic infrastructure and cohesiveness, and societal inequalities. The evolving health landscape in South Africa and the reforms being undertaken to prepare for a National Healthcare Insurance presents the opportunity to understand effective models of care provision as developed in other African contexts, and to translate these models as appropriate to the South African environment.ConclusionsAfter examining the cases of heath innovation, it is clear that no one actor, no matter how innovative, can change the system alone. The interaction and collaboration between the government and non-state actors is critical for an integrated and effective delivery system for both health and social care.

Measuring Hohokam Household Inequality with Construction Costs of Domestic Architecture at Pueblo Grande

Recent archaeological efforts to explain the emergence and persistence of social inequality have been hampered by little information about how wealth was transmitted across generations, and how it may have accumulated or diminished over time. Building on studies that have shown domestic architecture to be an excellent material expression of household wealth, we provide a method for reconstructing the amount of labor invested in house construction among the Hohokam of southern Arizona. We also account for different architectural styles from different time periods. To illustrate the utility of the method for addressing broader social issues, we investigate the relationship among population increases, resource shortages, and wealth differentials at Pueblo Grande—one of the preeminent settlements in the Hohokam region. Inequality at Pueblo Grande was tracked over time and compared to similar results at the Grewe site. High-status households at both sites were distinguished architecturally by larger and, in some instances, more elaborate houses. The proximity of these households to public areas for ceremonial expression further suggests that access to ritual played a key role in creating and maintaining inequality in Hohokam society.

Importing American racial reasoning to social science research in Sweden

How does one research racial categorizations and exclusion while remaining sensitive to context? How does one engage the social reality of racial categorizations and the history of racialized exclusions without falling into the trap of race essentialism? These concerns prompt debate about, and also resistance to, examining race in Swedish social science. In this article, Voyer and Lund offer American racial reasoning as one possible approach to researching race in the Swedish context. American racial reasoning means being attentive to how power and the processes of social inequality operate through categories of racial and ethnic difference, and also seeing the path to greater equality in the embrace of those categories. American racial reasoning is a valuable research tool that uncovers dynamics of social inequality and possibilities for social justice that are otherwise difficult to grasp. Taking up the topic of immigration in Sweden, Voyer and Lund demonstrate the analytical value of American racial reasoning for understanding persistent social inequality and exclusion even when explicit racial categories are not in wide use in everyday life.

Estimating the Unknown: Greater Racial and Ethnic Disparities in COVID-19 Burden After Accounting for Missing Race and Ethnicity Data.

Black, Hispanic, and Indigenous persons in the United States have an increased risk of SARS-CoV-2 infection and death from COVID-19, due to persistent social inequities. However, the magnitude of the disparity is unclear because race/ethnicity information is often missing in surveillance data. We quantified the burden of SARS-CoV-2 notification, hospitalization, and case fatality rates in an urban county by racial/ethnic group using combined race/ethnicity imputation and quantitative bias analysis for misclassification. The ratio of the absolute racial/ethnic disparity in notification rates after bias adjustment, compared with the complete case analysis, increased 1.3-fold for persons classified Black and 1.6-fold for those classified Hispanic, in reference to classified White persons. These results highlight that complete case analyses may underestimate absolute disparities in notification rates. Complete reporting of race/ethnicity information is necessary for health equity. When data are missing, quantitative bias analysis methods may improve estimates of racial/ethnic disparities in the COVID-19 burden.

Examining the Impact of Systemic Tensions on Agency and Identity: The Multiple Positions of Reggie in Production-Centered, Technology-Mediated Activity

This paper presents two examples of production-centered, technology-mediated activities in a one-to-one laptop classroom, and examines how those activities supported vastly divergent forms of student agency and participation. As schools turn to large-scale technology programs, such as one-to-one initiatives, to overcome persistent educational and social inequalities, growing concerns over a widening participation gap in production-centered activities are calling on educators to forge new technology-mediated learning experiences that bridge students’ lived experiences and interests with educational content. The findings of this study, however, show that production-centered, technology-mediated activities may inadvertently stifle engagement and agency if they do not leverage students’ personal funds of knowledge in the co-construction of new educational practices or participation structures. Analyzed through the lenses of cultural historical activity theory and identities-in-practice, the paper follows Reggie, a high school senior and native Haitian who chronically disengaged from classroom activities, despite an interest and significant background knowledge in digital media production. Discussion centers on the ways in which classroom activities afforded opportunities for Reggie to leverage this knowledge, leading, in one case, to rule-based tensions that ended in the elimination of projects and student autonomy, and in the other, to a remarkable transformation of Reggie’s identity-in-practice, in which he helped to co-construct a new division of labor for achieving the object of activity. The paper ends with an argument for the consideration of coordinated changes to multiple elements of activity, and their implications on social practice as essential components of technology program design, and of framing participation-based digital education inequities.

Equality versus equity: Barriers to health care access for Indigenous populations in Canada

Abstract Canada's universal and publicly funded health-care system aims to promote universal and equitable access to care based on the needs of individuals, rather than on their capacity to pay for these services. Despite these principles, some groups, such as Indigenous peoples, experience significant and persistent social inequalities in health compared to the general population. This situation results from the continuing impacts of colonialism, which has an undeniable influence on social determinants of health, including access to care. This is surprising for many health professionals because it contradicts the democratic ideals of justice and equality that underlie the health-care system, as well as the rhetoric of their professional practice which asserts that 'everyone is treated the same'. Based on literature and on research findings, this presentation will demonstrate several ways in which a universal and homogeneous approach to health-care can contribute to creating social inequalities in health for Indigenous populations. First, health professionals tend to favor socially and culturally neutral practice, which can hinder the recognition of the influence of historical and socio-cultural factors on patients' health. This kind of practice may encourage a distorted reading of patients' issues and can lead to inappropriate responses. Second, a homogenous approach to care refers by default to health-care models and practices that are rooted in values and perspectives of the dominant culture, which contributes to the provision of culturally unsafe care for Indigenous patients. Finally, this type of approach overlooks the critical and specific needs of vulnerable groups, who often require more than the general population to achieve the same results. We will conclude by outlining some potential solutions, mainly how cultural safety as a transformative approach to care allows health professionals to better consider the needs and cultural identity of Indigenous patients.