Related Inequalities Research Articles

Inequalities in Water Insecurity in Kenya: A Multidimensional Approach

Water insecurity is a global concern likely to be compounded by increases in population and climate change. Existing water insecurity measurement methods capture multidimensional deprivation only at regional or sub-regional levels. Such estimates do not capture heterogeneous household experiences of water supply, proximity to water sources and affordability, which can vary substantially from regional averages. Accurate measurement requires a method that captures the incidence and intensity of a household’s simultaneous deprivation in dimensions of water accessibility, affordability, sufficiency and safety. We propose such a method and assess related inequalities using an approach analogous to the Alkire–Foster methodology for multidimensional poverty. Using household-level data from the Kenya Integrated Household Budget Survey 2015/16, we find that 63% of the Kenyan population experience multiple deprivation in water access. The dimensions of water affordability and sufficiency contribute most to multidimensional water insecurity, highlighting the need to ensure an adequate supply of affordable water. Disparities by household place of residence, dwelling type, and socio-economic status are evident. The estimates of multidimensional water insecurity are robust to different deprivation and poverty cutoffs. Our analysis is an invitation to rethink water insecurity metrics, allowing water deprivation to be measured more frequently and with greater precision to understand its impact clearly.

Inequalities in the use of dental services by people with and without disabilities in Brazil: a National Health Survey.

The present cross-sectional study aimed to evaluate if social, racial, and gender inequalities disproportionally affect the use of dental services by people with and without disabilities in Brazil in the year 2013. The study used data from the 2013 National Health Survey and the dependent variable was the use of dental services. The outcome was stratified by gender, race, and social variables. Descriptive analysis was represented by absolute and relative frequencies. Two inequality measures were used to investigate the inequalities: the Slope Index of Inequalities (SII) and the Concentration Index of Inequalities (CIX). The SII expresses the absolute difference and the CIX identifies the relative inequality. Of 145,580 adults evaluated, 7.7% reported disability. The proportion of adults without disabilities who used dental services in the last 12 months was higher (45.2%; 95%CI 44.2-46.1) than adults with disabilities (33.9%; 95%CI 32.0-35.9). There was an absolute difference of 40% points (SII 0.40; CI95% (0.36-0.45) in the use of dental services between poorer and richer people with disabilities. Absolute and relative inequalities were identified in the use of dental services, considering the education of the head of the family and family income, with similar results for people with and without disabilities. High inequality is observed concerning race. Racial minorities (Black, Brown, Yellow, and Indigenous) without disabilities presented a higher use of dental services in the last 12 months than racial minorities with disabilities. Our findings demonstrate that social and racial inequities negatively affect individuals with and without disabilities. Inequalities exist in the use of oral health services for people with and without disabilities.

Socioeconomic inequalities in adverse pregnancy outcomes in India: 2004-2019.

Although India has made substantial improvements in public health, it accounted for one-fifth of global maternal and neonatal deaths in 2015. Stillbirth, abortion, and miscarriage contribute to maternal and infant morbidity and mortality. There are known socioeconomic inequalities in adverse pregnancy outcomes. This study estimated changes in socioeconomic inequalities in rates of stillbirth, abortion, and miscarriage in India across 15 years. We combined data from three nationally representative health surveys. Absolute inequalities were estimated using the slope index of inequality and risk differences, and relative inequalities were estimated using the relative index of inequalities and risk ratios. We used household wealth, maternal education, and Scheduled Caste and Scheduled Tribe membership as socioeconomic indicators. We observed persistent socioeconomic inequalities in abortion and stillbirth from rates of 2004-2019. Women at the top of the wealth distribution reported between 2 and 5 fewer stillbirths per 1,000 pregnancies over the study time period compared to women at the bottom of the wealth distribution. Women who completed primary school, and those at the top of the household wealth distribution, had, over the study period, 5 and 20 additional abortions per 1,000 pregnancies respectively compared to women who did not complete primary school and those at the bottom of the wealth distribution. Women belonging to a Scheduled Caste or Scheduled Tribe had 5 fewer abortions per 1,000 pregnancies compared to other women, although these inequalities diminished by the end of the study period. There was less consistent evidence for socioeconomic inequalities in miscarriage, which increased for all groups over the study period. Despite targeted investments by the Government of India to improve access to health services for socioeconomically disadvantaged groups, disparities in pregnancy outcomes persist.

The gradient of social determinants of health and related inequalities and early childhood development: Analysis of two rounds of a cross-sectional survey.

Social determinants of health (SDH) have a critical role in child development. Yet these determinants are often overshadowed. This study examines the effect of composites of five SDH on early childhood development (ECD) of children of age 36-59 months. We used two 2013 and 2019 rounds of Multiple Indicator Cluster Survey Bangladesh data. The analytical sample included ECD data for 25 721 children. ECD was computed following United Nations International Children's Emergency Fund's psychometric approach. Three composite indices of SDH were developed to examine their gradient effects on ECD. Poisson regression with robust variance was used to examine the relationship between SDH indices and ECD. The concentration index was computed, and a concentration curve was developed to measure inequalities in being on track of ECD among children with various levels of SDH. Almost 69% of children were on track in their ECD, a higher percentage in 2019 (74.85%) than in 2017 (65.37%). The prevalence of children on track in their ECD significantly rises per unit in the score of three SDH composites (adjusted prevalence ratios are 1.04 (95% confidence interval (CI): 1.03-1.04) for summative and standardised indexes and 1.49 (95% CI: 1.41-1.58) for weighted index). There is almost a linear positive relationship between the SDH composite and ECD. Significant concentration indexes suggest SDH-related inequalities in ECD. Children's early development can be hampered due to unfavourable SDH. Although ECD plays a vital role in creating and maintaining socio-economic and health inequalities through to adulthood, favourable SDH needs to be ensured during childhood.

Trends in Norwegian adolescents’ substance use between 2014 and 2022: socioeconomic and gender differences

BackgroundSubstance use is a global health concern and early onset among adolescents increases health risks. We explore national overall trends in prevalence and trends in socioeconomic inequalities in past year alcohol intoxication, cannabis use, and use of other illicit drugs among Norwegian adolescents (ages ∼ 15–19 years of age) between 2014 and 2022.MethodThe present study builds on data from a nationwide repeated cross-sectional survey collected in 2014–2016 (T1), 2017–2019 (T2), 2021 (T3) and 2022 (T4). In total 415,560 adolescents (50.3% girls) completed the questionnaire during the study period. Trends in socioeconomic inequalities were assessed using the Slope Index of Inequality (SII) and the Relative Index of Inequality (RII).ResultsWhile the prevalence of alcohol intoxication remained fairly stable, the prevalence of cannabis and other illicit drug use increased between 2014 and 2022 among upper secondary school boys (13.3–17.6%, and 2.0–5.2%, respectively) and girls (8.8–12.8%, and 1.1–2.7%, respectively). Similar trends were observed among 10th-grade adolescents. Boys were more likely than girls to use cannabis or other illicit drugs, but the gender gap in cannabis use narrowed during the study period. Among upper secondary girls, use of cannabis and other illicit drugs was higher among those from less affluent backgrounds, with absolute and relative inequalities in cannabis use increasing between 2014 and 2022. Small inequalities in cannabis use and decreasing relative inequalities in the use of other illicit drug were observed among upper secondary boys.ConclusionsThe increasing use of cannabis and other illicit drugs among Norwegian adolescents is concerning. Future studies should explore the underlying causes of this rise and explore the complex factors influencing adolescent substance use behaviours. A comprehensive understanding of these factors is essential for developing targeted and effective interventions.

Inequalities in severe COVID-19 outcomes in Wales, UK

ObjectiveResearch evidence shows that COVID-19 has disproportionately affected people from more deprived backgrounds. In Wales (UK), there is strong evidence of a socioeconomic gradient in total hospitalisations, critical care admissions and deaths. This study focussed on a cohort of the Welsh population using anonymised individual-level linked population-scale data in the SAIL Databank. ApproachThis analysis examines the impact of confounding/mediating factors on severe health outcomes. We used logistic regression, considering the Welsh Index of Multiple Deprivation (WIMD) 2019 as a predictor, to investigate how the coefficient for WIMD is changed when other variables (such as comorbidities, smoking status, Body Mass Index) are added, aiming to understand whether inequalities are mediated by observed characteristics or related to other unobserved factors. ResultsInitial findings show that age-standardised rates of hospital admissions, Intensive Care Unit (ICU) admissions and deaths were roughly twice as high in the most deprived vs least deprived WIMD quintile in Wales. We estimated Years of Life Lost per 1,000 due to COVID-19 as 28.9, with variation between WIMD quintiles of 38.4 for the most deprived and 22.2 for the least deprived. The project also produced regression formulas to evaluate the contribution of the different confounding factors. ConclusionThis study built on existing research findings and further explored the potential reasons for known socioeconomic inequalities in relation to COVID-19 outcomes. Insights from this study have broadened the knowledge around the impact of mediating factors and may contribute to future pandemic preparedness and the formation of future policies.

Gradient flows of generalized relative entropy and functional inequalities on graphs

We derive the discrete forms of the porous medium equation and fast diffusion equation with drift terms on a finite graph as gradient flows of the m-relative entropy, with the global existence of solutions. We show the Łojasiewicz inequality to prove the convergence of solutions and some important functional inequalities. More specifically, the Łojasiewicz inequality holds near the stationary solution with exponent 12, which leads to the exactly exponential convergence rate with a finite trajectory length. It can also be applied to show the Talagrand-type inequality and the log-Sobolev-type inequality directly.

A microsimulation model of smoking prevalence in England: exploring potential impacts of ‘Tobacco 21’ and e-cigarette policy scenarios on socioeconomic and regional inequalities

Background The burden of morbidity and mortality in England, is greater among priority groups such as those with lower income or routine and manual occupations. Using a microsimulation model, we estimate projected changes in smoking prevalence according to socio-economic position under selected policy scenarios that are relevant to ongoing policy implementation and debate. Methods Initiated using real-world data from adult (16+) respondents to the Smoking Toolkit Study (STS), the ‘QuitSimX’ microsimulation model projects individual-level smoking uptake and cessation in England over time. The simulation was run under two separate policy scenarios, raising the age of sale of tobacco products to 21 (simulations run from 2013–2023), and moving a proportion of all individuals quitting using a certain method (such as over the counter nicotine replacement therapy), or no method, to using e-cigarettes instead (simulations run from 2015–2025). Under each scenario, the size of effect were specified, and the outcomes simulated and assessed by indicators of socio-economic position. Absolute and relative inequalities were examined by comparing at the initial and final timepoint the i) absolute difference in smoking prevalence between less and more advantaged groups subgroups and ii) the ratio of smoking prevalence. Results While absolute and relative inequalities in smoking prevalence declined across the simulated period under all policy scenarios and the counterfactual ‘no intervention’ scenario, at the final time point absolute and relative inequalities between social grades and regions were similar across all scenarios, with the exception that the relative (but not absolute) inequality under the most impactful tobacco 21 scenario as marginally higher than under the baseline scenario. Conclusion A microsimulation model of smoking in England illustrates that absolute inequalities are projected to decrease under a Tobacco 21 or quitting with e-cigarettes scenario but that some policy solutions (Tobacco 21) may result in an increase in relative inequalities.

Age- and gender-based social inequalities in palliative care for cancer patients: a systematic literature review.

Cancer is a major public health problem worldwide, given its magnitude and growing burden, in addition to the repercussions on health and quality of life. Palliative care can play an important role improving quality of life and it is cost-effective, but some population groups may not benefit from it or benefit less based on age and gender inequalities. The aim of this systematic review was to analyze the available evidence on age- and gender-based social inequalities in access to and use of palliative care in cancer patients. A systematic review was conducted following the PRISMA guidelines. An exhaustive literature research was performed in Pubmed, CINHAL and Embase until November 2022 and were not restricted by language or date of publication. Eligible studies were observational studies analyzing the access and use of palliative care in cancer patients. Fifty-three studies were included in the review. Forty-five analyzed age and 44 analyzed gender inequalities in relation to use of and access to palliative care. Our results show that older people receive poorer quality of care, worst symptom control and less preferences for palliative care. In relation to gender, women have a greater preference for the use of palliative care and generally have more access to basic and specialized palliative care services and palliative care facilities. This review reveals difficulties for older persons and men for access to key elements of palliative care and highlights the need to tackle access barriers for the most vulnerable population groups. Innovative collaborative services based around patient, family and wider community are needed to ensure optimal care.

Risk and Protective Factors for Preterm Birth Among Racial, Ethnic, and Socioeconomic Groups in California

Preterm birth (PTB) (gestational age <37 weeks) is a major cause of infant mortality and morbidity in the US and is marked by racial and ethnic and socioeconomic inequities. Further research is needed to elucidate the association of risk and protective factors with trends in PTB rates and with related inequities. To describe the association of PTB rates with inequities as well as related risk and protective factors over the past decade in a US population-based cohort. This retrospective cohort study of singleton live births in California from January 1, 2011, to December 31, 2022, was conducted using vital statistics records and hospital records. The cohort included births with a gestational age of 22 to 44 weeks. Preterm birth rates by racial and ethnic group and by public and nonpublic insurance (considered as a proxy for socioeconomic status) were studied across years. Log-linear regression (relative risks with 95% CIs) was used to evaluate risk and protective factors within groups. Associations of PTB rates with risk and protective factors were assessed. This study included 5 431 018 singleton live births to individuals who identified as American Indian or Alaska Native (0.3%), Asian (14.2%), Black (4.9%), Hispanic (47.8%), or White (27.0%). A total of 43.1% of births were to individuals with public health insurance. From 2011 to 2022, the overall PTB rate increased from 6.8% to 7.5% (change [SE], 10.6% [0.6%]; z score of 18.5; P < .001). Differences in PTB rates and associated changes were observed for racial and ethnic groups and insurance groups. For example, 2022 PTB rates ranged from 5.8% among White individuals with nonpublic insurance to 11.3% among Black individuals with public health insurance. From 2011 to 2022, PTB rates decreased from 9.1% to 8.8% (change [SE], -3.5% [4.2]; z score of -0.8; P = .42) among Black individuals with nonpublic insurance, whereas they increased from 6.4% to 9.5% (change [SE], 49.8% [16.0%]; z score of 3.1; P = .002) among American Indian or Alaska Native individuals with nonpublic insurance. Increases in some risk factors (eg, preexisting diabetes, sexually transmitted infections, mental health conditions) were observed in most groups, and decreases in some protective factors (eg, participation in the California Women, Infants, and Children program) (P for trend < .001 from 2011 to 2021) were observed mostly in low-income groups. In this cohort study of singleton live births in California, PTB rates increased in many groups. Persistent racial and ethnic and socioeconomic inequities were also observed. Changes in risk and protective factors provided clues to patterns of PTB. These data point to an urgent need to address factors associated with PTB at both the individual and population levels.

Variasjonar i psykisk helsevern – status og forklaringsfaktorar

Introduction: Reducing unwanted variation is one of the goals of Norwegian health policy. We mapped variations among municipalities in Health Region West in the use of specialist health services that fall under the chapter on mental health care and substance use in ICD-10, and looked at various variables that may be related to these. Method: Data were retrieved from the Samhandlingsbarometer, an online open-source portal, and systematized by the authors. The annual rate per 1,000 inhabitants of hospital admissions and outpatient/day treatments per municipality was used as the result variables. Bivariate and multivariable linear regression were useful for investigating the association between independent variables and outcome variables. Results: The results showed large differences in the use of specialist health services in the municipalities, with a factor of 6.7 (hospital admissions) and 8.3 (outpatient clinic contacts). In adjusted analyses, we found that higher overall costs for health and care services in the municipalities were associated with fewer hospital admissions (β –.378 – 95% CI –.616; –.142) and fewer outpatient/day treatments (β –.541 –.649; –.323). The number of users in municipal mental health services was associated with more hospital admissions (β .514 .298; .726) and more use of psychotropic drugs in connection with outpatient/day treatments (β .485 .263; .703). Home-based care for younger inhabitants (&lt; 67 years) was also positively associated with the use of both hospital admissions (β .494, .266; .724) and outpatient/day treatments (β .471 .239; .703). Both the prevalence of marginalisation (not in employment, education or training) and a high level of education were associated with higher use of outpatient clinics (β .355 .132; .577 and β .296 .064; .528), while a dispersed housing pattern was associated with fewer hospital admissions (β –.421 –.679; –.158) and outpatient day treatments (β –.386 –.627; –.145). The explained variance of the multivariable models was small to moderately high (R2 .07 – .51). Conclusion: Morbidity, use of resources for municipal health care, and sociodemographic differences are related to the rate of admissions and outpatient/day treatments. The findings do not unequivocally indicate that greater resource use in the municipalities covaries with less use of specialist health services, although some of the findings point in that direction. Relative inequalities in municipalities, where many inhabitants have a high level of education and where many experience marginalisation (not in employment, education or training) are associated with high consumption of specialist health services in mental health care. Keywords: practice variation, specialist health service, psychiatry, substance use treatment

Unbalanced burden is escalating: Urban inequality landscape under sudden shocks?

Sudden and unforeseen events, notably the COVID-19 pandemic has underscored and exacerbated pre-existing urban inequalities. These disruptions have disproportionately affected the most vulnerable sectors of society, thereby further aggravating existing inequalities. Addressing these inequality issues requires systematic research into academic community's response to significant global disturbances. Therefore, we have integrated bibliometric analysis with meta-analysis (quantitatively combines research results from systematic reviews) techniques, culminating in a research framework based on KNIME software (a software for creating data applications and services) and Python programming. Noteworthy for its open-source nature, scalability, and reproducibility, this framework tries to decode the developmental patterns and response characteristics of urban inequality research under sudden shocks. Additionally, it seeks to clarify its causal pathways, predict the emergence of new or strengthened inequalities, and provide effective suggestions to promote inclusive and sustainable urban development. Our findings indicate that the COVID-19 has exacerbated the existing urban inequality, attracting widespread attention in fields such as society and public health. Issues of fairness and justice of human health, resource allocation, urban resilience and vulnerability have become hot topics around COVID-19 related urban inequalities. Simultaneously, the sudden shocks have led to disparities in research areas and themes. Social, economic, and urban planning are the main drivers behind urban inequality, and particularly affecting vulnerable groups, including low-income populations and those living in remote regions. Before and after the COVID-19, the average global urban inequality are 0.57 and 0.61, respectively. Inequality issues are particularly severe in Africa and countries such as Afghanistan, Pakistan, and India. The pandemic changed the focus of urban inequality to health and social issues, worsening inequality performance in these regions and deepening global gaps. Additionally, countries with high urban inequality are more prone to large-scale outbreaks and higher mortality rates. To this end, we advocate academia for in-depth research and comprehensive evaluation, focusing on vulnerable groups, providing integrated policy recommendations, supporting interdisciplinary exchanges and cooperation, and committing to find long-term sustainable solutions. These efforts aim to propose more comprehensive and reasonable solutions to alleviate and address complex urban inequality issues under sudden shocks.

The link Between traumatic experiences and health in late life: challenges and opportunities for US-based longitudinal aging cohorts.

Trauma, defined as exposure to actual or threatened death, serious injury or sexual violence, is a pervasive, major public health challenge that disproportionately burdens socially disadvantaged groups and has known consequences for health outcomes in early and midlife. Despite plausible mechanisms by which trauma may also be a critically important risk factor for health outcomes in late life, there is presently a lack of literature evaluating the consequences of trauma on aging related health outcomes and inequities, such as dementia. In this commentary, we (a) discuss drivers of the paucity of epidemiological evidence on trauma and health outcomes in late life, namely a lack of available data, supported by detailed review of trauma measures, including interpersonal violence-a particularly common form of trauma-in seven established longitudinal aging cohort studies in the United States (US); (b) address four common concerns about the inclusion of trauma measures in cohort studies; and (c) suggest ways forward, including specific assessment tools to measure interpersonal violence after a structured review of the PhenX Toolkit, to facilitate critical research to understand the impact of trauma on outcomes in late life.

Closing the gap? Results-based financing and socioeconomic-related inequalities in maternal health outcomes in Zimbabwe.

The results-based financing (RBF) program, first implemented in Zimbabwe in 2011 and gradually expanded to other districts, aimed to address disparities in maternal health outcomes by improving the utilisation of health services. This study leverages the staggered rollout of the program as a quasi-experimental design to assess its impact on asset wealth-related inequalities in selected maternal health outcomes. The objective is to determine whether RBF can effectively reduce these disparities and promote equitable healthcare access. We employ an extended two-way fixed effects (ETWFE) model to exploit temporal variation in RBF implementation as well as individual-level variation in birth timing for identification. Utilising pooled cross-sectional and nationally representative data from the Zimbabwe demographic and health surveys collected between 1999 and 2015, our analysis reveals significant reductions in relative and absolute maternal health inequalities, especially in the frequency and timing of prenatal care, delivery by caesarean section, and family planning. Specifically, the RBF program is associated with reductions in disparities for completing at least four or more prenatal care visits (-0.026, p < 0.01), first-trimester prenatal care (-0.033, p < 0.01), delivery by caesarean section (-0.028, p < 0.005), and family planning (-0.033, p < 0.005). Additionally, the program is associated with improved prenatal care quality, as evidenced by progress on the prenatal care quality index (-0.040, p < 0.01). These effects are more pronounced among lower socioeconomic groups in RBF districts, highlighting RBF's potential to promote equitable healthcare access. Our findings advocate for targeted policy interventions prioritising expanding access to critical maternal health services in underserved areas and incorporating equity-focused measures within RBF frameworks to ensure inclusive and effective healthcare delivery in Zimbabwe and other low-income countries.

Healthcare Utilization and Discrepancies by Income Level Among Patients With Newly Diagnosed Type 2 Diabetes in Korea: An Analysis of National Health Insurance Sample Cohort Data.

The use of qualitative healthcare services or its discrepancy between different income levels of the type 2 diabetes (T2D) patients has seldom been studied concurrently. The present study is unique that regarding T2D patients of early stages of diagnosis. Aimed to assess the utilization of qualitative healthcare services and influence of income levels on the inequality of care among newly diagnosed patients with T2D. A retrospective cohort study of 7590 patients was conducted by the National Health Insurance Service National Sample Cohort 2.0 from 2002 to 2015. Insured employee in 2013 with no history of T2D between 2002 and 2012 were included. The standard of diabetes care includes hemoglobin A1c (HbAlc; 4 times/y), eyes (once/y) and lipid abnormalities (once/y). Multivariate logistic regression analysis was performed to examine the difference between income levels and inequality of care. From years 1 to 3, rates of appropriate screening fell from 16.9% to 14.1% (HbA1c), 15.8% to 14.5% (eye), and 59.2% to 33.2% (lipid abnormalities). Relative to income class 5 (the highest-income group), HbA1 screening was significantly less common in class 2 (year 2: odds ratio [OR], 0.78; 95% confidence interval [CI], 0.61 to 0.99; year 3: OR, 0.79; 95% CI, 0.69 to 0.91). In year 1, lipid screening was less common in class 1 (OR, 0.84; 95% CI, 0.73 to 0.98) than in class 5, a trend that continued in year 2. Eye screening rates were consistently lower in class 1 than in class 5 (year 1: OR, 0.73; 95% CI, 0.60 to 0.89; year 2: OR, 0.63; 95% CI, 0.50 to 0.78; year 3: OR, 0.81; 95% CI, 0.67 to 0.99). Newly diagnosed T2D patients have shown low rate of HbA1c and screening for diabetic-related complications and experienced inequality in relation to receiving qualitative diabetes care by income levels.

Balancing the scales? Evaluating the impact of results-based financing on maternal health outcomes and related inequality of opportunity in Zimbabwe

This study evaluates the impact of results-based financing (RBF) on maternal health outcomes and the inequality of opportunity (IOP) in these outcomes in Zimbabwe. We employ a difference-in-differences approach that leverages the staggered implementation of the programme across 60 districts, exploiting temporal variation in the introduction of RBF and individual-level variation in birth timing. Our analysis uses nationally representative, pooled cross-sectional data from the 2005/2006, 2010/2011, and 2015 Zimbabwe demographic and health surveys. Employing the extended two-way fixed effects (ETWFE) estimator to address biases associated with staggered rollouts, we find significant positive effects of RBF on maternal health outcomes. The programme is associated with an increase in the number of prenatal care visits by 0.185 units (p < 0.01), first-trimester care by 7.7 percentage points (pp) (p < 0.01), facility births by 8.6 pp (p < 0.01), and professional delivery assistance by 3.4 pp (p < 0.01), while reducing C-section rates by 1.3 pp (p < 0.01). Additionally, RBF is associated with reductions in IOP in prenatal care visits, early prenatal care, facility births, and professional delivery assistance by 3.8, 1.3, 8.4, and 4.9 pp (p < 0.01), respectively. These findings underscore the potential of RBF to enhance maternal health outcomes and promote health equity. Integrating equity considerations into health system strengthening initiatives is essential. Policymakers should ensure that health interventions improve access and balance opportunities across various socio-economic and demographic groups. This evidence suggests that RBF schemes can improve access to and equity in healthcare services, particularly in low-income settings such as Zimbabwe.

Exploring health inequalities in Gypsy and Traveller communities in the UK.

Health inequalities between groups of people are often unjust and avoidable and are influenced by social determinants of health, the non-medical factors that influence health outcomes. Gypsy and Traveller communities experience significant health inequalities, including barriers to accessing healthcare services and suboptimal health outcomes compared with the general population. This article provides an overview of health inequalities in relation to Gypsy and Traveller communities and examines three social determinants of health - discrimination and racism, accommodation and access to healthcare - that influence these inequalities. The authors propose that accurate data collection as well as delivery of culturally competent health services and care may facilitate access to healthcare for Gypsy and Traveller communities and potentially reduce health inequalities.

Trends and inequalities in neonatal mortality rate in Bangladesh: Evidence from cross-sectional surveys.

Given the significance of addressing neonatal mortality in pursuing the 2030 Sustainable Development Goal on child health, research focus on this area is crucial. Despite the persistent high rates of neonatal mortality rate (NMR) in Bangladesh, there remains a notable lack of robust evidence addressing inequalities in NMR in the country. Therefore, this study aims to fill the knowledge gap by comprehensively investigating inequalities in NMR in Bangladesh. The Bangladesh Demographic and Health Survey (BDHS) data from 2000 to 2017 were analyzed. The equity stratifiers used to measure the inequalities were wealth status, mother's education, place of residence, and subnational region. Difference (D) and population attributable fraction (PAF) were absolute measures, whereas population attributable risk (PAR) and ratio (R) were relative measures of inequality. Statistical significance was considered by estimating 95% confidence intervals (CIs) for each estimate. A declining trend in NMR was found in Bangladesh, from 50.2 in 2000 to 31.9 deaths per 1000 live births in 2017. This study detected significant wealth-driven (PAF: -20.6, 95% CI: -24.9, -16.3; PAR: -6.6, 95% CI: -7.9, -5.2), education-related (PAF: -11.6, 95% CI: -13.4, -9.7; PAR: -3.7, 95% CI: -4.3, -3.1), and regional (PAF: -20.6, 95% CI: -27.0, -14.3; PAR: -6.6, 95% CI: -8.6, -4.6) disparities in NMR in all survey points. We also found a significant urban-rural inequality from 2000 to 2014, except in 2017. Both absolute and relative inequalities in NMR were observed; however, these inequalities decreased over time. Significant variations in NMR across subgroups in Bangladesh highlight the need for comprehensive, and targeted interventions. Empowering women through improved access to economic resources and education may help address disparities in NMR in Bangladesh. Future research and policies should focus on developing strategies to address these disparities and promote equitable health outcomes for all newborns.

Individualism, innovation, and inequality: Exploring the nexus

We provide an alternative explanation for the direction of technological change and the related wage inequality between skilled and unskilled workers. To this end, we formulate a skill-biased technological change model in which households’ decisions on consumption, savings, and human-capital accumulation are influenced by the level of individualism. We conclude that more individualistic cultures experience higher technological-knowledge bias toward skilled technologies, larger output growth rates, and higher wage inequality between skilled and unskilled workers. We also find that union bargaining only reduces wage inequality between skilled and unskilled at moderate levels of individualism, while introducing redistributive income taxes does not necessarily reduce income inequality.

QCD bounds on leading-order hadronic vacuum polarization contributions to the muon anomalous magnetic moment

QCD bounds on the leading-order (LO) hadronic vacuum polarization (HVP) contribution to the anomalous magnetic moment of the muon [aμHVP,LO, aμ=(g−2)μ/2] are determined by imposing Hölder inequalities and related inequality constraints on systems of finite-energy QCD sum rules. This novel methodology is complementary to lattice QCD and data-driven approaches to determining aμHVP,LO. For the light-quark (u, d, s) contributions up to five-loop order in perturbation theory in the chiral limit, LO in light-quark mass corrections, next-to-leading order in dimension-four QCD condensates, and to LO in dimension-six QCD condensates, we find that (657.0±34.8)×10−10≤aμHVP,LO≤(788.4±41.8)×10−10, bridging the range between lattice QCD and data-driven values. Published by the American Physical Society 2024