Societal Inequality Research Articles

COVID-Related Victimization, Racial Bias and Employment and Housing Disruption Increase Mental Health Risk Among U.S. Asian, Black and Latinx Adults.

Background: The mental health of racial/ethnic minorities in the U.S. has been disproportionately impacted by the COVID-19 pandemic. This study examined the extent to which disruptions in employment and housing, coronavirus-specific forms of victimization and racial bias independently and conjointly contributed to mental health risk among Asian, Black, and Latinx adults in the United States during the pandemic.Methods: This study reports on data from 401 Asian, Black, and Latinx adults (age 18–72) who participated in a larger national online survey conducted from October 2020–June 2021, Measures included financial and health information, housing disruptions and distress in response to employment changes, coronavirus related victimization distress and perceived increases in racial bias, depression and anxiety.Results: Asian participants had significantly higher levels of COVID-related victimization distress and perceived increases in racial bias than Black and Latinx. Young adults (<26 years old) were more vulnerable to depression, anxiety, and coronavirus victimization distress than older respondents. Having at least one COVID-related health risk, distress in response to changes in employment and housing disruptions, pandemic related victimization distress and perceived increases in racial bias were positively and significantly related to depression and anxiety. Structural equation modeling indicated COVID-related increases in racial bias mediated the effect of COVID-19 related victimization distress on depression and anxiety.Conclusions: COVID-19 has created new pathways to mental health disparities among racial/ethnic minorities in the U.S. by exacerbating existing structural and societal inequities linked to race. Findings highlight the necessity of mental health services sensitive to specific challenges in employment and housing and social bias experienced by people of color during the current and future health crises.

“Un”Fair Machine Learning Algorithms

Ensuring fairness in algorithmic decision making is a crucial policy issue. Current legislation ensures fairness by barring algorithm designers from using demographic information in their decision making. As a result, to be legally compliant, the algorithms need to ensure equal treatment. However, in many cases, ensuring equal treatment leads to disparate impact particularly when there are differences among groups based on demographic classes. In response, several “fair” machine learning (ML) algorithms that require impact parity (e.g., equal opportunity) at the cost of equal treatment have recently been proposed to adjust for the societal inequalities. Advocates of fair ML propose changing the law to allow the use of protected class-specific decision rules. We show that the proposed fair ML algorithms that require impact parity, while conceptually appealing, can make everyone worse off, including the very class they aim to protect. Compared with the current law, which requires treatment parity, the fair ML algorithms, which require impact parity, limit the benefits of a more accurate algorithm for a firm. As a result, profit maximizing firms could underinvest in learning, that is, improving the accuracy of their machine learning algorithms. We show that the investment in learning decreases when misclassification is costly, which is exactly the case when greater accuracy is otherwise desired. Our paper highlights the importance of considering strategic behavior of stake holders when developing and evaluating fair ML algorithms. Overall, our results indicate that fair ML algorithms that require impact parity, if turned into law, may not be able to deliver some of the anticipated benefits. This paper was accepted by Kartik Hosanagar, information systems.

The response to COVID-19 and legal determinants

The panelist will focus on the distinction between ethics, law and on requirements towards building progressive alternatives from the legal perspective. It will also examine the impact legislative and regulatory framework and jurisprudence have on the enjoyment of the right of health during COVID-19. During the pandemic many national frameworks used emergency law in order to introduce containment and mitigation measures into society. Most of these were enacted as emergency legislation, and this poses certain additional challenges in terms of the rule of law, given the often limited impact assessment or the absence of judicial review. These key characteristics that carry an element which can only be deemed appropriate given temporal limitations. From divergent national responses to combat COVID-19 to broader multilateral agreements on global health security, inequities have come to the fore. Assessing the proportionality of measures adopted to achieve legal aims necessitates an interdisciplinary and cross-sectoral collaboration and examination, as well as embedding mechanisms to systematically monitor broader implications for global health, and societal cohesion and resilience. Law is a part of interdisciplinary collaboration needed to achieve efficient commitments in order to combat the COVID-19 pandemic effectively. Even though law itself is not a panacea, remedying broader societal inequities, it is an essential step needed towards implementation of effective health policies into society. Indicative examples on aspects of interest and steps taken by payers to ensure equitable access for all will be elaborated upon. An overview on the implications of dynamics between developed and developing countries will also be presented, with due emphasis on the future of both European and global health and partnerships for accessibility and accountability.

Older Adults in an LGBT Residential Community: Impact of a Safe Space on Occupation and Well-Being

Background: LGBT seniors have suffered a lifetime of societal and institutional discrimination and health care inequalities. The number of LGBT people 50 years of age and older will surpass five million in the coming decades. LGBT seniors are at greater risk of disability, isolation, physical and mental health issues, and substance abuse. Supportive social environments and networks are correlated with higher quality of life. The purpose of this study was to better understand how living in a safe and secure apartment community specifically for low-income LGBT older adults impacted the residents’ daily life and well-being.

Meeting the Real “Gini” of India:

Based on our fraught human history of widespread revolts, it is often presumed that income inequality can disrupt the status-quo. In recent years, researchers have come to question this connection between actual inequality and adverse political results. The findings show that most people around the world are unable to gauge societal inequality through relative comparisons, and are uncertain about both the magnitude and directionality of the gap. The aim of this study was twofold: 1) to assess the disparity between Indian respondents’ perceived and actual ratings of income inequality in India using a Gini Coefficient score; and 2) to identify factors that influenced these ratings. Almost 250 respondents from a wide cross-section of India participated in an online survey to give their perceived ratings of India’s Gini coefficient score along with the factors that influenced their responses. Over 90.2% considered the degree of inequality in India to be far higher than the actuality, thus showing the great extent to which they consider their country to be an unequal one. The analysis identifies “Quality of Governance” as the only statistically significant predictor for improving income inequality, showing that the government is considered to be the primary bearer of responsibility for providing quality education and healthcare, which is sadly lacking. Nonetheless, the findings constitute a “call to action” for the Indian Government to implement more effective policies to tackle these issues. Future studies could delve deeper into the problem to determine the extent to which governance influences perceived income inequality in India.

Naming the Problem: Publishing Trends within in Urology on Race, Health Disparities and Structural Racism

ObjectivesTo assess publishing trends regarding the contribution of societal systems on health disparities within the urology literature. MethodsWe performed a bibliometric analysis of the top 15 urology journals for titles and abstracts with the term race or ethnicity between 2000-2021. Articles were graded by the presence of (1) race, (2) disparities secondary to race, or (3) racial disparities secondary to structural biases. Frequencies were tabulated and logistic regression was used to determine odds of disparities publishing. ResultsOur query returned 934 articles for review. In 484 (52%) articles, race was mentioned as a demographic/covariate. 110 (12%) abstracts noted a racial health disparity and only 2 articles implicated racism. Rates of more direct language varied significantly by journal and year of publication. Discussion of disparities increased over time, ranging from 0% in 2002 to 25% in 2020 (P-trend <.001). Logistic regression demonstrated an 11% annual increase in the likelihood of disparity publishing (OR=1.11, 95%CI=1.08-1.14; P<.001). ConclusionsWhile it is widely acknowledged that race is a determinant of health, often “race” itself is ascribed the risk when societal inequities are largely at fault. Despite the frequent use of race as a key covariate within the urologic literature, health-disparities relating to structural racism are rarely explicitly named. In order to address the systemic biases that underpin these inequities, increased awareness through clear language in publishing is needed.

Societal Inequality, Corruption and Relation-Based Inequality in Organizations.

Our paper contributes to emerging management research on the effects of societal inequality. It aims to study the relationship between societal-level inequality and perceived unequal HR practices within organizations based on relationships which we term “relation-based inequality” (RBI). We further examine the moderating effect of country corruption on the RBI-employee commitment link. Thus, whereas previous research has looked at single countries, there is still much to know about societal effects of inequality and corruption on employee perceptions and attitudes at work across countries. By surveying 691employees from five countries and using country-level indicators we take a first step in this direction, and establish that inequality (income, health and education) is linked to higher levels of relation-based HR practices. We also show that the effect of RBI is different for continuance, affective and normative commitment, and contingent on country corruption levels.

Sex and gender gaps in medicine and the androcentric history of medical research

Sex and gender gaps in medicine and the androcentric history of medical research

Is the male disadvantage real? Cross-national variations in sex gaps in COVID-19 incidence and mortality

ABSTRACT Although the excess male mortality from COVID-19 is well-known, the variations in sex gaps in incidence and mortality across countries and the sources of such variations are not well understood. This study explored the patterns and the sources of variation in the sex gap in COVID-19 incidence and mortality rates across 100 countries where sex-disaggregated cases and deaths were available as of September 2020. Our results show that there is generally a male disadvantage in both incidence and mortality; however, COVID-19 incidence exhibited a lower male disadvantage (1.2 times higher risk for males) than COVID-19 mortality (1.5 times higher risk for males). The extent of male disadvantages in COVID-19 outcomes across countries varied by societal gender inequalities and behavioural factors. Greater gender equality, both socially and behaviourally, was associated with more equal COVID-19 incidence and mortality between men and women. The findings imply that male disadvantages in COVID-19 outcomes, particularly incidence, are socially determined, whereas further investigation is needed to understand behavioural and biological elements yielding a male disadvantage in mortality.

The Evolving Role of Nurse Leadership in the Fight for Health Equity

Devastating disparities in COVID-19 infection and outcomes among socioeconomically marginalized groups have resulted in a public outcry to address longstanding societal inequities that have contributed to the present situation. Nurse leaders have an opportunity and an obligation in this moment to lend their skills as scientists, innovators, advocates, and educators to lead in these efforts, advancing health equity for all.

MP58-02 NAMING THE PROBLEM: PUBLISHING TRENDS ON RACE, HEALTH DISPARITIES AND STRUCTURAL RACISM

You have accessJournal of UrologyHealth Services Research: Quality Improvement & Patient Safety IV (MP58)1 Sep 2021MP58-02 NAMING THE PROBLEM: PUBLISHING TRENDS ON RACE, HEALTH DISPARITIES AND STRUCTURAL RACISM Adrien Bernstein, Ruchika TalwarR, Cheyenne Williams, Andres Correa, and Brandon Mahal Adrien BernsteinAdrien Bernstein More articles by this author , Ruchika TalwarRRuchika TalwarR More articles by this author , Cheyenne WilliamsCheyenne Williams More articles by this author , Andres CorreaAndres Correa More articles by this author , and Brandon MahalBrandon Mahal More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000002088.02AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Health-outcome differences across racial and ethnic lines have been clearly demonstrated. The specific contribution of our societal systems on these disparities, however, is rarely explicitly addressed in the scientific literature. The extent to which these topics are described within urology has yet to be evaluated. To that end, we sought to assess publishing trends regarding race within the urology literature. METHODS: We performed a systematic literature review of the top 15 urology journals determined by impact and H factor, querying Web of Science, Pubmed, Ovid and Scopus for titles and abstracts with the term race or ethnicity between 2000 and 2021 (n=1206). Abstracts, reply to editors and non-US based literature were excluded (n=254). Articles were graded by the presence of (1) race (2) disparities secondary to race or (3) racial disparities secondary to structural biases. RESULTS: Our query returned 952 articles for review. In 450 (47%) articles, race was solely mentioned in the abstract as a demographic term or a covariate of an alternative outcome of interest. Of the remaining 505 articles which articulated racial differences in health, 116 (22%) utilized language to specify the difference as a health disparity and only 1 article used stronger language to implicate structural racism. Rates of more direct language varied significantly by journal and year of publication (figure). Discussion of health disparities increased overtime, ranging from 0% at the beginning of the study period to 24% of articles mentioning race in 2020. CONCLUSIONS: Despite frequent use of race as a key covariate within the urologic literature, racial health disparities relating to structural biases are rarely explicitly named. While it is widely acknowledged that in the US race is a determinant of health, often race itself is ascribed the risk when societal inequities more often are at fault. In order to address the systemic biases that underpin these inequities, and in turn improve the health of our patients, increased awareness through clear language in publishing is needed. Source of Funding: n/a © 2021 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 206Issue Supplement 3September 2021Page: e988-e989 Advertisement Copyright & Permissions© 2021 by American Urological Association Education and Research, Inc.MetricsAuthor Information Adrien Bernstein More articles by this author Ruchika TalwarR More articles by this author Cheyenne Williams More articles by this author Andres Correa More articles by this author Brandon Mahal More articles by this author Expand All Advertisement Loading ...

An Examination of COVID‐19 Mortality in High‐Minority Nursing Homes

Research ObjectiveRacial/ethnic disparities in healthcare have been highlighted by the recent COVID‐19 pandemic. Using the Centers for Medicare and Medicaid Services’ Nursing Home COVID‐19 Public File, we examined the relationship between nursing home racial/ethnic mix and COVID‐19 resident mortality. Additionally, we examined the effects of resident characteristics, market resource availability, and organizational characteristics as it relates to nursing home racial/ethnic disparities in COVID‐19 mortality.Study DesignMultivariate regressions were used to model the relationship between COVID‐19 deaths and the proportion of racial/ethnic minority residents (Black and Hispanic residents). Given the over‐dispersion of the count dependent variable (number of COVID‐19 deaths), negative binomial regressions were used. We used four nested sequential models to examine the separate contributions of facility‐level resident characteristics, resource availability, and other organizational characteristics to racial/ethnic disparities in COVID‐19 deaths. In addition, we controlled for size and interstate differences using state fixed effects.Population StudiedThe study sample consisted of all US nursing homes included in the CMS Nursing Home COVID‐19 Public File, or 15,382 nursing homes, which mirrors the national census of facilities.Principal FindingsAs of October 25, 2020, high minority nursing homes reported 6.5 COVID‐19 deaths as compared to 2.6 deaths for nursing homes that had no racial/ethnic minorities. After controlling for interstate differences, facility‐level resident characteristics, resource availability, and organizational characteristics, high‐minority nursing homes had 61% more COVID‐19 deaths (Incidence Rate Ratio [IRR] = 1.61; p < 0.001) as compared to nursing facilities with no minorities.ConclusionsFrom a policy perspective, nursing homes, that serve primarily minority populations, may need additional resources, such as, funding for staffing and personal protective equipment in the face of the pandemic. The COVID‐19 pandemic has sharpened the focus on healthcare disparities and societal inequalities in the delivery of long‐term care.Implications for Policy or PracticeThis study shows the disparate effect that COVID‐19 has had on nursing home mortality based on resident racial/ethnic mix. Even after controlling for interstate differences, facility‐level resident characteristics, resource availability, and organizational characteristics, high‐minority nursing homes had almost three times the probability of having COVID‐19 deaths compared to those with no minorities. These findings highlight the existing and systemic health disparities in nursing homes and the tangible impact it has on racial/ethnic minorities. Death due to COVID‐19 is greater risk for racial/ethnic minorities in nursing homes relative to White residents. Nursing homes that serve larger minority populations may need additional resources to combat this crisis.

Synergies Between COVID-19 and Climate Change Impacts and Responses

The COVID-19 pandemic and anthropogenic climate change are global crises. We show how strongly these crises are connected, including the underlying societal inequities and problems of poverty, substandard housing, and infrastructure including clean water supplies. The origins of all these crises are related to modern consumptive industrialisation, including burning of fossil fuels, increasing human population density, and replacement of natural with human dominated ecosystems. Because business as usual is unsustainable on all three fronts, transformative responses are needed. We review the literature on risk management interventions, implications for COVID-19, for climate change risk and for equity associated with biodiversity, water and WaSH, health systems, food systems, urbanization and governance. This paper details the considerable evidence base of observed synergies between actions to reduce pandemic and climate change risks while enhancing social justice and biodiversity conservation. It also highlights constraints imposed by governance that can impede deployment of synergistic solutions. In contrast to the response to the COVID-19 pandemic, governance systems have procrastinated on addressing climate change and biodiversity loss as these are interconnected chronic crises. It is now time to address all three to avoid a multiplication of future crises across health, food, water, nature, and climate systems.

The Grand Theory Is Alive: An Interview with Jonathan H. Turner

Jonathan H. Turner is the Distinguished Professor of Sociology at the University of California at Riverside and, for many decades, the world’s leading authority on sociological theory, with research interests in many other areas such as human and societal evolution, social stratification and inequality, philosophy of science, and historical sociology. Professor Turner has authored, co-authored, edited, or co-edited a number of works, including more than 43 influential books, which have been published in twelve different languages, including The Structure of Sociological Theory, The Emergence of Sociological Theory, and many others. He is a member of the American Sociological Association and a former president of the Pacific Sociological Society and the journal editor for Sociological Theory. Professor Turner received a B.A. with honors from University of California at Santa Barbara, a M.A. and a doctorate in sociology from Cornell University. The interview is Professor Turner’s critical reply to the arguments raised in the article “Against Grand Theories: A (Cautionary) Tale of Two Disciplines,” which presents the view that universally accepted grand theories in social sciences are not achievable because of the lack of a common methodology or a theoretical core which results in their multiparadigmatic nature, value-leadenness and insufficient objectivity. The interview took place on March 23, 2021 online.

World-mindedness of young people during the rise in migration in Europe: a case study of Czechia, Finland, Germany and The Netherlands

During the 2015 sudden rise in migration movements in Europe, approximately 2.4 million refugees arrived in Europe and 1.2 million asylum applications were received in the European Union countries. We were interested in finding out whether these rapid changes and the polarised attitudes represented in the media affected young people’s attitudes towards people with different cultural backgrounds. This study, therefore, examined young people’s global understanding in four European countries: Czechia, Finland, Germany and the Netherlands. The aim was to identify the level of world-mindedness of young people and compare the results with an earlier study (conducted in 2010) with the same research design. The research was targeted at a group of upper-secondary students in these countries. In total, 962 students participated in the study in 2017. Although the context in the observed countries varied, the findings revealed a stable state, or rather a slightly positive change of world-mindedness, to 2010 in all the countries. The results stress the need to remain sensitive to students’ opinions and attitudes towards other people and cultures in geography lessons in general and especially when teaching and learning about current societal issues, inequality, exclusion and solidarity.

Walls, Cracks and Change: The Challenges and Opportunities of Critically Engaged Research Within Current Academic and Refugee Research Structures

Many consider academic research an important means to address societal inequality of marginalized groups, such as refugees. However, transformative research arguably requires critically engaged practices that consider and transform dominant exclusive structures permeating both society and knowledge production. This paper discusses challenges and opportunities of such research practices, especially given power and (neoliberal) politics around knowledge production within Dutch academic and refugee research structures. Based on 14 researchers’ narratives, the results reveal how critically engaged refugee research is challenged by its marginalized position, academic pressures and culture as well as the recently emerged ‘refugee research business’. However, the paper also uncovers various ways in which researchers manoeuvre within challenging and facilitating structures by operating outside or in the margins of academic structures, making use of facilitating spaces and strategically employing dominant discourses. Finally, researchers arguably transform academic structures by challenging dominant research paradigms and transforming the institution of academics itself.

Understanding the blended impacts of COVID-19 and systemic inequalities on sub-Saharan African immigrants in Canada

The COVID-19 pandemic poses a grave health threat and has serious socio-economic implications for all. However, crises are not experienced equally; the pandemic has disproportionately affected immigrants in several countries, including Canada and the United States. The effects of COVID-19 have exposed the realities of societal and structural inequities, worsened the socio-economic status of many immigrants, and placed them at higher risks of poor health outcomes. Emerging research on COVID-19 and race in Canada addresses the structural inequities that shape the disproportionate harms of COVID-19 on immigrants. For sub-Saharan African immigrants, these inequities are worse due to the intersecting systems of race, gender, and class marginalization. They tend to be more exposed and less protected amid the pandemic. Given the lack of research on sub-Saharan African immigrants’ experiences in Canada, this paper discusses how multiple axes of inequities shape their health and livelihood during COVID-19. The objective is to provide a broader scientific understanding of issues related to systemic inequities and health for sub-Saharan African immigrants in Canada and the related implications for public health advocates, policymakers, and the public.

The Racialized Pandemic: Wave One of COVID-19 and the Reproduction of Global North Inequalities

We document the broad patterns of COVID-19 as it affects minority communities. We present a theoretical framework rooted in Global North democracies’ racial and ethnic legacies to analyze the health and economic disparities between these communities and the white majority population. Marshalling first-cut empirical evidence from the United States, the United Kingdom, the Netherlands, and Sweden, we find patterns of the pandemic’s distribution consistent with how the burden of racial and ethnic legacies endures: people from minority communities have worse health and economic outcomes under normal circumstances, inequalities the COVID-19 crisis has exacerbated. The comparison shows that the impact of racial and ethnic discrimination on pandemic policy outcomes is not unique to the United States. Health inequalities stemming in part from patterns of institutional racism and discrimination perversely help reproduce these societal inequities. We find that governments’ initial responses have failed to mitigate the disproportionate impact of this health and economic crisis on minority communities because they did not acknowledge or address the particular challenges that these groups face.

Comparing COVID-19 risk factors in Brazil using machine learning: the importance of socioeconomic, demographic and structural factors

The COVID-19 pandemic continues to have a devastating impact on Brazil. Brazil’s social, health and economic crises are aggravated by strong societal inequities and persisting political disarray. This complex scenario motivates careful study of the clinical, socioeconomic, demographic and structural factors contributing to increased risk of mortality from SARS-CoV-2 in Brazil specifically. We consider the Brazilian SIVEP-Gripe catalog, a very rich respiratory infection dataset which allows us to estimate the importance of several non-laboratorial and socio-geographic factors on COVID-19 mortality. We analyze the catalog using machine learning algorithms to account for likely complex interdependence between metrics. The XGBoost algorithm achieved excellent performance, producing an AUC-ROC of 0.813 (95% CI 0.810–0.817), and outperforming logistic regression. Using our model we found that, in Brazil, socioeconomic, geographical and structural factors are more important than individual comorbidities. Particularly important factors were: The state of residence and its development index; the distance to the hospital (especially for rural and less developed areas); the level of education; hospital funding model and strain. Ethnicity is also confirmed to be more important than comorbidities but less than the aforementioned factors. In conclusion, socioeconomic and structural factors are as important as biological factors in determining the outcome of COVID-19. This has important consequences for policy making, especially on vaccination/non-pharmacological preventative measures, hospital management and healthcare network organization.

High-Minority Nursing Homes Disproportionately Affected by COVID-19 Deaths

Racial/ethnic disparities in healthcare have been highlighted by the recent COVID-19 pandemic. Using the Centers for Medicare and Medicaid Services’ Nursing Home COVID-19 Public File, we examined the relationship between nursing home racial/ethnic mix and COVID-19 resident mortality. As of October 25, 2020, high minority nursing homes reported 6.5 COVID-19 deaths as compared to 2.6 deaths for nursing homes that had no racial/ethnic minorities. After controlling for interstate differences, facility-level resident characteristics and resource availability, high-minority nursing homes had 61% more COVID-19 deaths (Incidence Rate Ratio [IRR] = 1.61; p < 0.001) as compared to nursing facilities with no minorities. From a policy perspective, nursing homes, that serve primarily minority populations, may need additional resources, such as, funding for staffing and personal protective equipment in the face of the pandemic. The COVID-19 pandemic has sharpened the focus on healthcare disparities and societal inequalities in the delivery of long-term care.