Reduction Of Social Inequalities Research Articles

Reclaiming the Land, Reclaiming the Nation: Adjacent or Twin Questions?

This article explores the relationship between the agrarian and national questions. It is argued that the ambiguities and gaps in the developmental theories after the Second World War have been progressively unveiled by the more successful processes of capitalist development of the twentieth century, which combined sustainable economic growth, reduction of social inequalities and improvement of political institutions with the progressive inclusion of the working masses. The relevance of the relation between the agrarian and the national questions was often obscured in prescriptive theories, but came to be anticipated in some of them, providing heuristic tools for the development of new projects and new utopias. The article interrogates one of these analysts, Fernando Fajnzylber, key ideologue of the neostructuralism in Latin America, with regard to his vision on development, an explicitly knowledge-based one, and much more rural-based than assumed by the old ECLA structuralism.

Ações Afirmativas como Medida de Proteção das Minorias

This article addresses the subject of a final paper, submitted on June 15, 2011, as a partial requirement for obtaining a bachelor’s degree in Law. The 1988 Federal Constitution (CF/88) has established a new constitutional order by means of a series of fundamental rights, among which is equality, based on provisions of a material nature, i.e., a way to ensure material equality to the most disadvantaged by providing them equal opportunities in a biased society. This principle alone does not guarantee the achievement of equality through equal opportunities. It associates itself with the principle of human dignity and the fundamental objectives of the Republic, among which are the reduction of social inequalities and the ban on any discrimination. The provisions quoted above stem from the 1988 constitutional legislator’s acknowledgement of a neglectful and permissive State that violates the fundamental human rights and that allowed the establishment of a biased society. Hence the affirmative action, whose major objective is to protect minority groups historically and socially excluded by the ruling class by promoting material equality through equal opportunities, thus leveraging an equitable society. These actions are instituted through government and State plans, implemented by the State and the private sector through public policies.

SOCIAL INEQUALITY AND ITS ENVIRONMENTAL HEALTH CONSEQUENCES AMONG 9-10 YEAR OLD CHILDREN

Background and Aims: Socio-economic status (SES) determines the people’s potentials and the most essential environmental related health effects from the moment of fertilization until death. During the data analysis of the Hungarian country-wide respiratory survey we often met the determining role of social inequalities in both the level of environmental exposure and the health status of the children. The poster presents some of these “dose-response” relationships using a complex SES variable. Methods: Source of the analysed data was the database of the country-wide survey on the children’s respiratory health (OGYELF) covering all children attending 3rd grade classes with at least 10 pupils. The parents-completed questionnaires containing questions on the presence of respiratory and allergic symptoms and their possible risk factors, including socio-economic status, were sent back from 2,160 schools (79.2%) out of the 2,726 ones approached. Altogether 62,711 questionnaires (76.4% of the ones sent to these schools) were evaluated. A complex SES variable was constructed from 4 questions (low level of the mother’s education, one-parent family, regular state benefit and self-rated low level of subsistence). Associations were analysed by multivariate logistic regression using STATA/SE 10.0. Results: Several environmental risk factors showed significant dose-response relationships with SES which are, even in themselves, significant risk factors of the studied respiratory symptoms (e.g. heating with coal or wood-fired stoves or with gas cooker, crowdedness, environmental tobacco smoke, smoking during pregnancy, waste dump site near the home). Out of the studied health outcomes the prevalence of both chronic bronchitic and asthmatic symptoms showed significant dose-response relationships with the disadvantageous socio-economic status, while the prevalence of allergic symptoms showed opposite tendency. Conclusions: Besides decreasing the harmful effects of environmental risk factors, reduction of social inequalities is inevitable in order to improve the health status of the population.

PEQUENA PRODUÇÃO FAMILIAR NO BRASIL: problemas e alternativas – uma leitura

This paper is mainly aimed to present a brief reflection on the small family production, characterizing it and focusing on issues and alternatives for changing the current situation for this sector extremely important: the reduction of social inequalities, the power of the poorest and security and food sovereignty. The methodology is based on theories of reading authors with different backgrounds who have published in the 1990s, such as Tedesco (1999), Miorin, Brose (1999), documents of DESER(Departamento sindical de estudos rurais) - Department of association of rural studies, Abramovay (2000 ), Alentejo (1999) and Wanderley (1999). After analysis and reflections can be said that the main problems of small family farming can be grouped into issues related to land (quality and concentration) to the workforce and financial resources. Also, we clarify that the alternatives and prospects for the sector are in the success of agrarian reform for small landowners in the actions and policies to generate local development from the small production, the existence of specific policies and associations.

PEQUENA PRODUÇÃO FAMILIAR NO BRASIL: problemas e alternativas – uma leitura

This paper is mainly aimed to present a brief reflection on the small family production, characterizing it and focusing on issues and alternatives for changing the current situation for this sector extremely important: the reduction of social inequalities, the power of the poorest and security and food sovereignty. The methodology is based on theories of reading authors with different backgrounds who have published in the 1990s, such as Tedesco (1999), Miorin, Brose (1999), documents of DESER(Departamento sindical de estudos rurais) - Department of association of rural studies, Abramovay (2000 ), Alentejo (1999) and Wanderley (1999). After analysis and reflections can be said that the main problems of small family farming can be grouped into issues related to land (quality and concentration) to the workforce and financial resources. Also, we clarify that the alternatives and prospects for the sector are in the success of agrarian reform for small landowners in the actions and policies to generate local development from the small production, the existence of specific policies and associations.

A Decline of Identity Politics

Religious actors and religious language are not absent from the Arab revolutions, but a striking feature of these movements is that they depart from Islamist identity politics, which tended to portray the problems of the Arab world as the result of Muslims’ betrayal of their religious identity. Slogans referencing Islam are remarkably few, even in contexts like Egypt where Islamist movements are an important organized political force. Similar to many Islamist activists, the youth who initiated these movements are exasperated by growing economic inequalities. Unlike the former, however, they do not feel the need to frame this issue in religious terms, but rather mobilize universal notions such as democracy, freedom, justice, and equality. This is the case even in societies with sharp religious divides such as Bahrain, where the overwhelmingly Shiʿi demonstrators oppose a Sunni-dominated regime. Regardless of whether the uprisings will succeed in achieving a genuine regime change, new political movements are likely to emerge that focus on political freedom and the reduction of social inequalities rather than projects maintaining Islam as a solution. The question remains whether this trend simply went unnoticed by the majority of the scholarly community working on the Middle East or whether it is something that emerged in the dynamics of the uprisings themselves. Either way, the phenomenon must now be analyzed. Does it mean a decline of the Islamist ideology? Will it permit an empowerment of existing liberal political movements? Of trade unionism? What does it reveal about the integration of the Middle East within global political trends?

Reduction of social inequalities in life expectancy in a city of Southeastern Brazil

BackgroundAround the world the life expectancy at birth has risen steadily over time. However, this increase in life years is not equally distributed among different social segments of the population. Studies have demonstrated that social groups living in deprived areas have a shorter life expectancy at birth in comparison to affluent ones. The aim of this study was to evaluate inequalities in life expectancy by socioeconomic strata in a city with one million inhabitants in Southeastern Brazil, in 2000 and 2005.MethodsThrough an ecological approach, the 49 areas of health care units of the city were classified into three socioeconomic strata, defined according to variables of income and educational level of the heads of household obtained from the 2000 Census. Life tables were constructed by sex for each of the three socioeconomic strata in 2000 and 2005.ResultsThe life expectancy at birth for men and women living in poor areas was 6.9 and 5.5 years lower in comparison to the affluent ones in 2000. Between 2000 and 2005, these social inequalities in life expectancy at birth reduced, since the groups with lower socioeconomic level had gained more life years. The increase in life expectancy at birth experienced by areas with worse living conditions was 3 times higher than the increment estimated for prosperous areas for both sexes. Males had the greatest gain in life years, leading to a narrowing of gender differentials in life expectancy between 2000 and 2005.ConclusionsThe reduction of social inequalities in life expectancy suggests that living and health conditions have improved over time, due to social and health policies. The expansion of both health care coverage and cash transfer policies could have had positive effects on mortality reduction and on the consequent increase in the life expectancy, especially for the poor population.

Pharmacogenomic technologies: a necessary "luxury" for better global public health?

BackgroundPharmacogenomic technologies aim to redirect drug development to increase safety and efficacy of individual care. There is much hope that their implementation in the drug development process will help respond to population health needs, particularly in developing countries. However, there is also fear that novel pharmacogenomic drugs will remain too costly, be designed for the needs of the wealthy nations, and so constitute an unnecessary "luxury" for most populations. In this paper, we analyse the promise that pharmacogenomic technologies hold for improving global public health and identify strategies and challenges associated with their implementation.DiscussionThis paper evaluates the capacity of pharmacogenomic technologies to meet six criteria described by the University of Toronto Joint Centre for Bioethics group: 1) impact of the technology, 2) technology appropriateness, 3) capacity to address local burdens, 4) feasibility to be implemented in reasonable time, 5) capacity to reduce the knowledge gap, and 6) capacity for indirect benefits. We argue that the implementation of pharmacogenomic technologies in the drug development process can positively impact population health. However, this positive impact depends on how and for which purposes the technologies are used. We discuss the potential of these technologies to stimulate drug discovery in the case of rare (orphan diseases) or neglected diseases, but also to reduce acute adverse drug reactions in infectious disease treatment and prevention, which promises to improve global public health.ConclusionsThe implementation of pharmacogenomic technologies may lead to the development of drugs that appear to be a "luxury" for populations in need of numerous interventions that are known to have a demonstrable impact on population health (e.g., secure access to potable water, reduction of social inequities, health education). However, our analysis shows that pharmacogenomic technologies do have the potential to redirect drug development and distribution so as to improve the health of vulnerable populations. Strategies should thus be developed to better direct their implementation towards meeting the needs and responding to the realities of populations of the developing world (i.e., social, cultural and political acceptability, and local health burdens), making pharmacogenomic technologies a necessary "luxury" for global public health.

Contribution of material, occupational, and psychosocial factors in the explanation of social inequalities in health in 28 countries in Europe

ObjectivesTo analyse the associations between socio-economic status (SES), measured using occupation, and self-reported health, and to examine the contribution of various material, occupational and psychosocial factors to social inequalities in...

Health inequalities in the Caribbean: increasing opportunities and resources

Social inequalities in health are not a priority in the Caribbean region. However, a few studies suggested such disparities and indicators show important socioeconomic disparities between and within countries. There are indications that governments' investment in health and other social programs is insufficient in the region and that regional health institutions that guide national health policies and programs do not make the reduction of social inequalities a priority. Furthermore, the public health sector is generally weak and health services are mainly focusing on curative services. The author argues that there is a need to develop and to implement social policies that include equity and social justice as core values. In order to increase the focus on health inequalities in the region, there is also a need to strengthen the Public Health field that integrates Health Promotion strategies. It is also suggested that international, regional and national health sectors that include academic and research institutions, health-related journals and associations, and non-governmental organizations put health inequalities in the Caribbean on their agenda. Furthermore, there should be a fundamental switch from a biomedical perspective of health to a paradigm that considers health as the expression of political, social and economic circumstances.

Report of the WHO commission on social determinants of health: a French perspective

Seen from France, this report underlines how far we still have to go in our country to reduce social inequalities in health. France is not one of the partner countries of the Commission1 and the conceptions of health determinants which are developed in the report appear far removed from the paradigm which predominates in our country. We can no longer say that France is at the ‘pre-contemplative’ stage:2 data exist, the phenomenon of social inequalities in health is known and well documented for numerous states of health. But these efforts, which issue largely from the world of research, have not resulted in a system of routine statistical surveillance. Furthermore, at this ‘contemplative’ stage, there is no explicit public policy and no objective written down in law. In the law on public health policy of 2004, objective 34 touches on this question, but restricts it to the state of health of the most precarious populations. As stated in the report, reduction of social inequalities in health is above all a political problem, but it is essential to provide evidence. In this respect, the report lends support to those who, in France, think that it is important to continue to increase our knowledge of the subject, but that the most pressing question is how we can move on to the active stage. It is strange to see how our country, always ready to give others lessons on human rights, tolerates a problem as well documented as social inequalities in health. Although the right to optimal health is laid down in a number of texts, this question of social justice and ethics does not mobilize opinion. This is so in France, but also throughout the world. The question thus remains to find out on what basis opinion and the decision makers …

Resposta brasileira à tuberculose: contexto, desafios e perspectivas

Tuberculosis (TB) has affected mankind for more than 8,000 years. Before the mid-19th century TB was not recognized as a contagious disease and was attributable to several causes such as hereditary, miasmas, and other environmental and social determinants. But, in 1882, Robert Koch identifi ed Mycobacterium tuberculosis, which allowed to defi ning TB as an infectious disease. Then blossoming biomedical research started its quest for vaccines and drug therapies. BCG vaccine was applied for the fi rst time in humans in 1921. Years later, in 1944, streptomycin was successfully used in TB treatment and it was the starting point for a number of anti-TB drug therapies. These breakthroughs created new opportunities for TB prevention and treatment. However, in the 19th century, TB mortality in Europe was remarkably higher than that seen in Africa today. Yet a sharp decline in TB mortality was seen by the end of that century, long before the advent of modern preventive and therapeutic alternatives, most likely due to improved life conditions. Today, in developed countries, TB is a condition confi ned to population groups comprising immigrants from poor countries and other marginalized people (homeless, alcoholics, inmates, among others). Although TB is a potentially curable and preventable disease, it has remained a public health concern in developing countries, including Brazil. Worldwide, it is estimated two billion people have latent TB infection and around 8.8 million new cases are diagnosed every year. In Brazil, about 80,000 cases and 6,000 deaths are reported every year. Owing to its immunosuppressive effect which makes people more susceptible to develop TB, HIV-AIDS epidemic, among other consequences, has contributed to increasing TB cases in many countries. In children, BCG knowingly provides clear protection when given neonatally while, in adults, protection against TB clinical forms is highly variable worldwide, a phenomenon not yet understood. As vaccine is not consistently effective and the major source of TB infection is sick people, the best prevention available in health care is still early detection and treatment of cases. Untreated or inadequately treated cases can infect other people and thus perpetuate TB dissemination chain. TB requires long-term complex treatment with the administration of several drugs for a period of time even after patients have clinically recovered. Treatment default is high and can produce drug-resistant forms of M. tuberculosis, which hinders disease control. The World Health Organization recommends implementation of the directly observed short-course treatment (DOTS) strategy for a fully effective treatment. In Brazil, the successful Family Health Program provides favorable opportunities for expanding access to health care and more effective detection and treatment of diseases such as TB. Starting from 1999, the Brazilian Ministry of Health has set TB as a priority in the health agenda. TB control actions aims at diagnosing at least 90% of expected cases and curing at least 85% of diagnosed cases. The implementation of TB control actions in all municipalities is part of primary health care and local and state administrators are expected to plan and coordinate actions to assure TB control including the implementation of DOTS strategy. Yet this course of action faces great challenges at all levels of health care and social organization: Brazil’s huge territorial area marked by geographical and cultural differences between its regions; inadequately trained providers; lack of research to propose solutions to health care operations; modest involvement of society in TB control; lack of continual regular support to the National Program for Tuberculosis Control; no guarantee of universal, comprehensive and equal access to health care; all in a scenario of huge social inequalities and deprived life conditions of most Brazilian population. TB control is not only an indicator of health care quality but also of social justice. This supplement approaches TB from several different perspectives within the framework of evaluation of the guidelines adopted in Brazil in the last ten years. In the light of all these subjects there is a clear need for the involvement of different actors – civil society, governments and administrators, universities and research centers. By jointly devising effective strategies and thus maximizing the contribution of each segment, within an expected reduction of social inequalities, TB control goals can be attainable in Brazil.

Inequalities in Entry to Higher Education: a Comparison Over Time between Scotland and England and Wales

AbstractThis paper uses data from the Scottish School Leavers Surveys and the England and Wales Youth Cohort Study to analyse changes over time in gender and social class inequalities in the opportunities of young people to participate in higher education (HE) in Scotland, England and Wales. The results show that in Great Britain, in the period from the end of the 1980s to 2001–2002, HE expansion has benefited more women than men, and in the most recent time points has led to a reduction in social inequalities. However, gender and social class differences persist at degree level and in the choice of subject studied. The results also show that higher proportions of working class students enter HE in Scotland than in England and Wales, but that social inequalities are more marked in Scotland. The larger availability of vocational routes in Scotland, at both sub‐degree and degree level, may explain country differences in HE participation rate of working class students.

Targeting services to reduce social inequalities in utilisation: an analysis of breast cancer screening in New South Wales

BackgroundMany jurisdictions have used public funding of health care to reduce or remove price at the point of delivery of services. Whilst this reduces an important barrier to accessing care, it does nothing to discriminate between groups considered to have greater or fewer needs. In this paper, we consider whether active targeted recruitment, in addition to offering a 'free' service, is associated with a reduction in social inequalities in self-reported utilization of the breast screening services in NSW, Australia.MethodsUsing the 1997 and 1998 NSW Health Surveys we estimated probit models on the probability of having had a screening mammogram in the last two years for all women aged 40–79. The models examined the relative importance of socio-economic and geographic factors in predicting screening behaviour in three different needs groups – where needs were defined on the basis of a woman's age.ResultsWe find that women in higher socio-economic groups are more likely to have been screened than those in lower groups for all age groups. However, the socio-economic effect is significantly less among women who were in the actively targeted age group.ConclusionThis indicates that recruitment and follow-up was associated with a modest reduction in social inequalities in utilisation although significant income differences remain.

Persistent social disparities in the risk of hospital admission of paediatric diabetic patients in Germany—prospective data from 1277 diabetic children and adolescents

Reduction of social inequality in health care is a major target in many countries. The risk of hospital admission is thought to be higher in diabetic children from socially deprived families but actual data are lacking. Based on a nationwide prospective computer-based documentation program (DPV), we determined the association between three social parameters (parental professional education, one-parent family vs. complete family, migration background) and the risk for post-onset hospital admission, as well as the number of hospital admission days in children and adolescents < 20 years of age with diabetes onset in 2002-2005 [n = 1277, 56% male, mean age at onset 8.5 (4.1) years]. We estimated relative risks with 95% confidence intervals, adjusting for age, sex, and diabetes centre (cluster), using random effect models. Forty-two per cent of the study subjects were admitted to hospital at least once during follow-up. The incidence of hospital admissions was 0.46 (0.43-0.49) per person year, and there were 2.72 (2.65-2.80) hospital days per person year. Hospital admissions and hospital days were higher in girls than in boys (significant for hospital days, P < 0.05), and significantly lower in adolescents aged 15-19 compared with children aged 0-4 years (P < 0.05 in all models). Hospital admission rates were significantly higher in children from lower-educated parents, single-parent families, and families with a migration background (all P < 0.05). We found post-onset hospital admission rates to be higher in diabetic children and adolescents from socially deprived families. In comparison with an analysis in the 1990s, no decrease in social disparity in hospital admission risk was found.

Social inequalities and health inequity in Morocco

BackgroundAccording to the last census, Morocco has a population approaching 30 million people. The country has made good progress in the control of preventable childhood diseases but social inequalities and health inequities remain major problems for the third millennium. Despite the progress achieved during the last decade, the country still ranks at the 125th place according to the Human Development Index. This unpleasant position is mainly explained by illiteracy, education and health indicators.MethodOur study was based mainly on annual reports and regular publications released by the United Nations (UN), United Nations Development Programme (UNDP), World Health Organisation (WHO), The Moroccan Health Ministry and related papers published in international journals.Results and discussionAs indicated by the last Arab Human Development Reports (AHDR 2002, AHDR 2003, AHDR 2004) and implicitly confirmed by the "National Initiative for Human Development" (NIHD) launched in May 2005 by the King of Morocco, many districts and shanty towns, urban or peri-urban, and a multitude of rural communes live in situations characterized by difficult access to basic social services of which education and health are examples.ConclusionRecent evidence showed that improved health is more than a consequence of development. It is a central input into economic and social development and poverty reduction. Serious initiatives for human development should consider the reduction of social inequalities and health inequities as a first priority. Otherwise, the eventual development achieved cannot be sustained.

Age–period–cohort effects on inequalities in psychological distress, 1981–2000

In the closing decades of the twentieth century, changes in population sociodemographics took place that might be thought to have an adverse influence on the nation's psychological distress. Here, we examine the stability of social and gender inequalities in psychological distress throughout the 1980s and 1990s. The study uses data from the 1958 National Child Development Study and the 1970 British Cohort Study collected when the cohort members were aged between 23 and 42. Multilevel logistic regression models were used to examine the effects of social class, gender, age, period and cohort on psychological distress as measured by the Malaise Inventory. We identify clear social inequalities in psychological distress during 1981-2000 that reduced in magnitude over this period. Non-linear age effects were observed: psychological distress improves in early adulthood but declines again on approaching mid-life. The 1970 cohort had poorer psychological distress than the 1958 cohort. Although women had higher rates of psychological distress than men, gender differences reduced in magnitude. Declining rates of women's psychological distress over time have not been matched in men. A reduction in social inequalities over time was also observed. Improvements in the psychological health of those in manual occupations were not equalled among those in non-manual occupations. Both social and gender inequalities have narrowed in the last two decades of the twentieth century.

Reconceptualizing HIV Infection Among Poor Black Adolescent Females: An Urban Poverty Paradigm

Recent research of HIV infection has attributed high rates of infection among heterosexual Black adolescents to multiple sexual partners and inconsistent condom use. Social science explanations emphasize limited family support, poor access to information, and unwillingness to change. This article presents an analysis of the effects of economic inequality and changes in urban areas on sexual risk-taking among poor Black women. Data come from an ongoing ethnographic study involving 53 young women in New Haven, Connecticut. Theoretical frameworks of urban development, economic isolation, and opportunity structures inform the results. Findings show that structural, social, and individual characteristics influence how young Black women define and assess personal risk. The residual and cumulative effects of racial inequality, poverty, and destabilization of communities contribute to risk-taking. Teenagers are more likely to engage in risky behavior when they believe their life options are limited. Recommendations include focusing on the reduction of social inequality as a health-seeking strategy.

Reconceptualizing HIV Infection among Poor Black Adolescent Females: An Urban Poverty Paradigm

Recent research of HIV infection has attributed high rates of infection among heterosexual Black adolescents to multiple sexual partners and inconsistent condom use. Social science explanations emphasize limited family support, poor access to information, and unwillingness to change. This article presents an analysis of the effects of economic inequality and changes in urban areas on sexual risk-taking among poor Black women. Data come from an ongoing ethnographic study involving 53 young women in New Haven, Connecticut. Theoretical frameworks of urban development, economic isolation, and opportunity structures inform the results. Findings show that structural, social, and individual characteristics influence how young Black women define and assess personal risk. The residual and cumulative effects of racial inequality, poverty, and destabilization of communities contribute to risk-taking. Teenagers are more likely to engage in risky behavior when they believe their life options are limited. Recommendations include focusing on the reduction of social inequality as a health-seeking strategy.

Analysis of trends in premature mortality by Labour voting in the 1997 general election

Mortality relates to voting patterns within areas: mortality is higher the greater the proportion of the electorate who vote Labour or abstain and the converse is the case with regard...