Socioeconomic Inequalities Research Articles

To appreciate the influence of contributed determinants on dental care utilization in the context of socio-economic inequalities

BackgroundTo appreciate dental care utilization in ‌the context of socio-economic inequalities, it is imperative to identify sources of inequalities and evaluate the extent to which dental care utilization is still related to socio-economic status. This study aimed to quantify the influence of contributed determinants on dental care utilization in the context of socio-economic inequalities amongst adults residing in Tehran metropolis.MethodsIn this cross-sectional community-based study, a stratified random sample of 1,510 subjects aged over 18 years was investigated by the zero-inflated Poisson analysis to measure the effect of determinants on utilization of dental care, and concentration index as well as the decomposition approach to identify the contributions of deterministic variables to the socio-economic inequality. Data was obtained by employing a phone interview survey. Individuals who were not willing or able to answer the questions in the telephone interview due to hearing or neurological problems did not participate in the interview. Dental care utilization was measured using the number of dental appointments.ResultsGender (male), oral health-related behaviors (such as brushing and dental flossing), experience of toothache, and concern about dental appearance were associated with an increased likelihood of utilizing dental care. Individuals who belonged to advanced age groups and lived alone significantly underutilized dental care. The concentration index equaling 0.05 (SE = 0.05) corroborates a pro-rich inequality. Decomposition analysis demonstrated the impact of oral health-related behaviors (i.e. dental brushing and use of dental flossing), concern about dental appearance, toothache, gender (male), insurance coverage of dental care, and smoking habit on the poor-rich gap in the dental care utilization.ConclusionsThe influence of socio-economic inequalities on dental care utilization is discernable along the entire spectrum of socio-economic status. Individuals with lower socio-economic status experience more underutilization of dental care. Community subgroups, particularly the more deprived bracket, require consideration from key stakeholders, including policymakers and health professionals for the enhancement of dental care utilization as revealed by underlying determinants.

Income inequality in the face of climate change: an empirical investigation on unequal nations, vulnerable regions and India

Climate change is the paramount challenge of our era. While considerable attention has been given to its impact on financial stability and economic productivity, there is limited focus on its effects on income inequality. We introduce a unique criterion for sample selection. We aim to provide an empirical analysis of how climate change impacts income inequality in 43 most climate-vulnerable countries, 39 most unequal countries in terms of income distribution, and India separately (1971–2021). We select the most vulnerable countries to investigate the magnitude of income inequality caused by climate change. Given that climate hazards enhance inequality in countries with prevailing socioeconomic inequalities, we choose unequal countries to investigate whether climate change is a significant determinant of their existing condition. We also analyse the relationship for India because India is one of the most climate-vulnerable and unequal countries. We use three climate change indices—vulnerability to climate change, annual surface temperature change, and frequency of climate-related disasters—to check the effects of particular aspects of climate change. We deploy a standard panel regression analysis followed by a series of robustness checks and an autoregressive distributed lag (ARDL) bounds test approach to analyse the link for India. We find that climate change has adverse impacts in both groups and in India, both in the long and short term. Our findings suggest that policymakers in developing countries may need to equally place importance on developmental and climate change abatement goals as well as expedite their environmental targets.

Integration of Artificial Intelligence into Sustainable Development Goals in India

In the pursuit of sustainable development, the fusion of artificial intelligence (AI) with legal mechanisms emerges as a potent force for transformative change. This paper delves into the intricate interplay between AI technologies and the legal framework, elucidating their collective capacity to address multifaceted challenges and propel progress towards the Sustainable Development Goals (SDGs). At the forefront of environmental stewardship, AI-driven solutions offer unprecedented capabilities in pollution monitoring, waste management, and climate change adaptation. From predictive analytics for air quality assessment to real-time monitoring of deforestation patterns, AI empowers stakeholders with actionable insights to mitigate environmental degradation and foster resilience. Simultaneously, AI applications hold promise in addressing socio-economic inequities through innovative approaches to poverty alleviation, financial inclusion, and inclusive growth strategies. By leveraging predictive modelling and data analytics, AI facilitates targeted interventions tailored to the unique needs of marginalized communities, thereby fostering sustainable development trajectories. However, the ethical and regulatory dimensions of AI deployment necessitate careful consideration within the legal framework. Ensuring data privacy, algorithmic transparency, and equitable access emerges as imperatives in harnessing the full potential of AI for societal benefit. Through the formulation of robust regulatory frameworks and ethical guidelines, the legal system plays a pivotal role in safeguarding against potential risks and maximizing the societal dividends of AI innovation. Moreover, interdisciplinary collaboration and stakeholder engagement are paramount in navigating the evolving landscape of AI governance, fostering dialogue, and consensus-building among diverse stakeholders. Thus, this paper advocates for a holistic approach to sustainable development, synergizing the transformative potential of AI with the protective mechanisms of the legal system. By fostering innovation, inclusivity, and accountability, this symbiotic relationship serves as a catalyst for advancing the global agenda towards a more equitable, resilient, and sustainable future. Keywords: Artificial Intelligence, Climate Change Adaptation, Deforestation, Education, Healthcare, Legal System, Pollution, Poverty, Sustainable Development Goals, Water and Waste Management.

Socio-economic inequalities in climate policies: unpacking energy efficiency barriers in low-income households

ABSTRACT While it seems sensible for households to invest in energy-efficient appliances if for nothing else than to save money, many do not. Studying this from the perspective of Low-income Households (LIH) is of particular interest as it must be recognized that they face a different set of barriers. This paper establishes that there is an energy efficiency gap in LIH and the analysis of survey results revealed a few key reasons as to why this is the case based on an analysis of the interrelationship between the barriers. The findings of this study not only show that any single policy is unable to address the energy efficiency gap for LIH, it also sheds light on the importance of considering the interactions between different factors affecting sustainable consumption decision-making for LIH for policy-making. This paper argues that a policy toolkit must be adopted to address these different factors simultaneously.

Prophecy, Pentecostals and South Africa’s socio-economic inequality

Background: The article dissected white South African classical Pentecostals’ concept of prophecy in the context of widespread poverty and the resulting socio-economic inequality that characterises their society. As a rule, most white Pentecostals do not respond to the challenges of inequality and disparities by getting involved in assemblies in former apartheid-segregated ‘black’ communities that are characterised by widespread poverty. The legacy of apartheid’s separate neighbourhoods is still intact, implying that racial distinctions determine, to a great extent, who lives where. In addition to preaching practices, the congregational prophecies that occur among them also do not reflect these dire circumstances that characterise a majority of South Africans and play no role in arousing their social conscience.Objectives: The article aims to define Pentecostal prophecy against the context of South African socio-economic inequality.Method: A qualitative conversation with 43 white Apostolic Faith Mission of South Africa (AFM) pastors at the level of regional and national conferences during 2024 provides a view of white Pentecostals regarding the church’s handling of social inequality.Results: Most white Pentecostals in South Africa (SA) are aware of the social inequality that mars the separateness between formerly white and black neighbourhoods. However, the awareness has not infiltrated their spirituality to the extent that it is reflected in the prophetic practice.Conclusion: Most white South African Pentecostals still live in neighbourhoods separated from the squalid conditions of many black townships and ignore the structural, political, economic, and social issues that cause poverty. They interpret their prophetic task to exclude consideration of social ethics and structural challenges. What is needed is an urgent reconsideration of prophecy and its relevance for current socio-economic challenges.Contribution: The article was presented to awaken and stir up the consciences of white Pentecostals for the dire economic circumstances of most South Africans threatened by unemployment and poverty.

Gender-Based Socio-Economic Inequalities in the Pre-Vaccination Era of the COVID-19 Pandemic in Istanbul: A Neighborhood-Level Analysis of Excess Mortality.

Worldwide excess mortality (EM) data have the potential to provide a better estimation of the impact of the pandemic. This study aims to investigate and map the inequalities in EM in Istanbul during the pre-vaccination era of the COVID-19 pandemic in 2020 and its association with selected demographic and socio-economic variables at the neighborhood level according to gender. This ecological study was conducted with the EM data of Istanbul. The EM data were obtained from the Istanbul Metropolitan Municipality (IMM) and analyzed according to socio-demographic indicators (gender, age), neighborhood-level indicators (population density, educational attainment) and neighborhood vulnerability (socio-economic and transportation) for the 808 neighborhoods, then presented separately according to gender to examine gender-specific factors. Socio-economic and transportation vulnerability indexes are provided the IMM. The excess mortality rate per 1000 (EMR) in 2020 has been calculated by using the number of deaths in the years 2018-2019. We have mapped EMRs of each neighborhood and used linear regression analysis in three datasets to examine gender specific factors. EMRs in Istanbul showed two peaks one in April and one in November. Male EMRs were higher compared to females in Istanbul during the pre-vaccination era of the pandemic. Higher EMRs were observed in neighborhoods with a higher share of 50+ year old age groups and higher neighborhood socio-economic vulnerability scores. Neighborhood socio-economic vulnerability was significantly associated with EMRs in males but not in females. Unequal distribution of EM between neighborhoods underlines the need for gender-specific pandemic measures to alleviate the burden of the COVID-19 pandemic, especially in socio-economically vulnerable settings. Increased use of area-based indicators with a gender perspective can enhance pandemic measures.

Methodological approaches to the assessment of balanced spatial development of regions

Subject. This article discusses the problem of uneven development of regions. Objectives. The article aims to analyze the methods of smoothing spatial polarization and develop an algorithm for assessing the balance of regional development. Methods. For the study, we used a comparative analysis, and the tabular and graphic visualization techniques. Results. The article finds that the processes of polarization are due to socio-economic inequality, and it presents an original methodology for assessing the balance of spatial development, developed on the basis of the cluster approach. Conclusions. At the State level, it is necessary to approve a unified methodology for assessing the balance of Russia's spatial development. When developing programmes for the development of regions, it is necessary to be guided by the concept of leveling spatial imbalances.

Twelve–year (2008–2019) trends in socioeconomic inequalities in cardiovascular risk factors in a Swiss representative survey of the general population

ObjectiveWe assessed trends in socioeconomic inequalities in cardiovascular risk factors prevalence among Swiss adults from 2008 to 2019. MethodsUsing data from the Bus Santé study, an annual survey of adults living in Geneva, Switzerland, we calculated the prevalence per period and by demographic and socioeconomic indicators, assessing inequality trends using the relative index of inequality (RII) and the slope index of inequality (SII). ResultsAmong 10,739 participants, most CVD risk factors decreased over time, while diabetes, obesity, and smoking prevalence remained steady. In 2017–2019, prevalence of most CVD risk factors was higher in socioeconomically disadvantaged groups. Relative and absolute inequalities decreased over time, but mostly remained, for hypertension [in 2017–2019, education-RII (95 % CI) = 1.27 (1.12–1.46), income-RII = 1.27 (1.10–1.47)], hypercholesterolemia [education-RII = 1.15 (1.00–1.32)], and sedentarity [education-RII = 1.95 (1.52–2.51), income-RII = 1.69 (1.28–2.23)], and appeared to have reversed for hazardous alcohol use [income-RII = 0.75 (0.60–0.93)]. Substantial and persistent relative and absolute inequalities in diabetes prevalence were observed [education-RII = 2.39 (1.75–3.27), income-RII = 3.18 (2.25–4.48), and subsidy-RII = 2.77 (1.89–4.05)]. Inequalities were also marked across all socioeconomic indicators for obesity prevalence [education-RII = 3.32 (2.63–4.19), income–RII = 2.37 (1.85–3.04), subsidy-RII = 1.98 (1.48–2.66)] and for smoking [education-RII = 2.42 (2.06–2.84), income-RII = 2.37 (1.99–2.84), subsidy-RII = 1.91 (1.56–2.35)]. ConclusionsOver 12 years in Geneva, Switzerland, socioeconomic inequalities in hypertension, hypercholesterolemia, hazardous alcohol use, and sedentarity decreased but persist, while substantial inequalities in diabetes, obesity, and smoking remained unchanged.

Association Between Socioeconomic Inequalities in Pain and All-Cause Mortality in the China Health and Retirement Longitudinal Study: Longitudinal Cohort Study.

Few studies focus on the equality of pain, and the relationship between pain and death is inconclusive. Investigating the distribution of pain and potential mortality risks is crucial for ameliorating painful conditions and devising targeted intervention measures. Our study aimed to investigate the association between inequalities in pain and all-cause mortality in China. Longitudinal cohort data from waves 1 and 2 of the China Health and Retirement Longitudinal Study (2011-2013) were used in this study. Pain was self-reported at baseline, and death information was obtained from the 2013 follow-up survey. The concentration index and its decomposition were used to explain the inequality of pain, and the association between pain and death was analyzed with a Cox proportional risk model. A total of 16,747 participants were included, with an average age of 59.57 (SD 9.82) years. The prevalence of pain was 32.54% (8196/16,747). Among participants with pain, the main pain type was moderate pain (1973/5426, 36.36%), and the common pain locations were the waist (3232/16,747, 19.3%), legs (2476/16,747, 14.78%) and head (2250/16,747, 13.44%). We found that the prevalence of pain was concentrated in participants with low economic status (concentration index -0.066, 95% CI -0.078 to -0.054). Educational level (36.49%), location (36.87%), and economic status (25.05%) contributed significantly to the inequality of pain. In addition, Cox regression showed that pain was associated with an increased risk of all-cause mortality (hazard ratio 1.30, 95% CI 1.06-1.61). The prevalence of pain in Chinese adults is concentrated among participants with low economic status, and pain increases the risk of all-cause death. Our results highlight the importance of socioeconomic factors in reducing deaths due to pain inequalities by implementing targeted interventions.

Critical school finance: special volume commentary

ABSTRACT This collection of papers in this special volume explains how school funding policies and community policies perpetuate racial and socioeconomic inequities in the United States, Canada, and Australia. These papers highlight two important research themes in school finance that have been missing: (a) the role that race plays in creating enduring educational funding disparities and by extension school facilities; and (b) the danger that privatisation poses for meeting the resource needs of less affluent and minoritised communities. This commentary explains how these papers contribute to the burgeoning field of critical school finance.

Peeling the multiple layers of inequalities in free higher education policies

ABSTRACT It has long been debated as to whether higher education (HE) is a site of social mobility that promotes meritocracy or social reproduction that creates and exacerbates inequalities in societies. In this paper, I will argue that HE, even when democratised and provided free to everyone, reproduces inequalities unless coupled with an inclusive sectoral design, an expansion of funding, and a wider strategy to reduce socio-economic inequalities. To do so, I studied the case of Syria, which has always claimed to have a meritocratic HE system that is designed to achieve equality in society by providing free HE for all since the 1970s. I analysed the database of the Ministry of Higher Education (MoHE) for 15 academic years from 2001 to 2015. This database included data on students’ access and graduation rate divided by the type of education (public, private, higher institutes, and technical institutes), level of education (undergraduate and postgraduate), gender (male and female), city, faculty, and specialisations. This analysis unpacked four types of inequalities, namely education type-based inequalities, specialisation-based inequalities, city-based inequalities, and gender-based inequalities. Finally, I show how gender dynamics and roles are changing in the HE sector as a result of the Syrian conflict.

Determinants of Inequalities in the Exposure to and Adoption of Multiple Health Risk Behaviors among Brazilian Adolescents, 2009-2019.

The occurrence of multiple risk behaviors among adolescents imposes challenges in the context of public policies of health, particularly in low- and middle-income countries. Evidence on the conditions leading to the exposure to and adoption of multiple risk behaviors allows the identification of vulnerable groups of adolescents, and may support the proposition of targeted strategies directed to individuals at risk. Therefore, the aim of this study was to perform a quantitative analysis to identify recent trends in the exposure to and adoption of multiple health risk behaviors among Brazilian adolescents, highlighting individual-, household-, and school-level characteristics linked to inequalities among social groups. The analysis was based on cross-sectional data from the National Student Health Survey (PeNSE), conducted by the Brazilian Institute for Geography and Statistics in 2009, 2012, 2015, and 2019. The trends in the occurrence of multiple risk behaviors among adolescents were estimated according to social strata, allowing the calculation of concentration indexes and their disaggregation into major determinants of inequalities in the exposure and adoption of risk behaviors. The analyses were conducted using a complex survey design to allow representativeness at the population level. The results showed a rise in the incidence of multiple risk behaviors among youngsters in Brazil from 2009 to 2019. Factors influencing inequalities in the exposure to multiple risk behaviors were socioeconomic status and the characteristics of the household and school environments, whilst the adoption of multiple risk behaviors was also influenced by early exposure to multiple risk behaviors. Furthermore, trends in inequalities in the exposure to and adoption of multiple risk behaviors showed an intensification from 2009 to 2019, being initially concentrated among wealthier adolescents, followed by a transition to higher incidence in the lower socioeconomic strata in 2012 and 2015, respectively. The findings underscore the role of support systems for adolescents at risk within the familial and school contexts, whereas strategies of public policies of health based on the strengthening of community ties may require improvements to tackle socioeconomic inequalities in the occurrence of risk behaviors among youngsters.

Andean Lakes, a proposal of lake districts

The Andes is the world's longest mountain system (8,500 km) and harbour important headwater systems, constituting crucial water resources for South America. Their complex topography significantly influences climate and hydrology. The Andes have a wide diversity of aquatic environments, with more than 5,000 lakes (> 0.1 km2, permanent and excluding man-made reservoirs) with different morphometry, including the largest and the deepest in South America (Titicaca and Viedma, respectively). Here we applied a grouping analysis based on available systematised information to delimit different lake districts along the Andes. More than 60% of the surface area of all Andean lakes is concentrated in only nine large lakes, while more than 80% of the lakes have less than a square kilometre area. The analysis proposes eleven lake districts corresponding two to the North Andes, six to the Central Andes and three to the South Andes. Each lake district is described based on the different morphologies, geological origins, climatic factors, and available limnological information. We consider that this study will benefit not only scientists but also decision-makers and stakeholders working in integrated water resources management in a region under climate change and socio-economic inequalities scenarios.

Making the case for a new typology of dental care systems.

Dental care systems have the potential to influence population oral health and patterns of socioeconomic inequalities. Therefore, understanding the impact of the ways in which countries fund, provide, and organize their dental care services is key in the analysis of determinants of oral health. In this commentary we offer a synopsis of recent typologies of healthcare systems, based on a rapid review, and highlight that none of them fit dental care services given the separation of dental care from general healthcare provision in many countries. The paper also summarizes evidence on dental care systems as determinants of population oral health and argues why a new typology of dental care systems is needed. We argue that a typology must consider institutional arrangements, structures, and processes behind the provision of dental care, and that specific dimensions/variables that inform the typology should result from a process of discussion and consensus. Some methodological considerations for developing typologies are also discussed, including the challenges in the collection and analysis of data followed by an advanced cluster analysis. Despite their limitations, typologies have evolved into an essential tool for comparing the similarities and differences of healthcare systems across countries. Therefore, a dental specific typology for health systems will be useful for researchers, policymakers, and dental professionals to characterize the provision of dentalcare services in different countries. This will also enable examining their potential role as determinants of population oral health and inequalities.

Cities facing the European green deal: Urban policy and locals’ perspective in the post-socialist area

The European Green Deal (EGD) is a comprehensive and ambitious strategy to achieve climate neutrality in the European Union. Cities play a crucial role as places of accumulation of resources, as well as increased consumption. This study attempts to respond to whether the largest cities in Poland (the main development cores of the country and, more broadly, Central Europe) address the development challenges of the EU articulated in the EGD and derived from the concept of a smart city.In this study, not only the theory behind the smart city concept but also the strategic documents of the largest Polish cities in that matter are analysed. The socio-spatial analyses identified the existing discrepancies between the perspectives of local authorities and inhabitants in implementing contemporary development concepts. There were indicated SHS (smart hot spots) - which are those located in the city centre and places that act as mobility hubs, as well as SCS (smart cold spots) - which are remote from the centre or degraded and decapitalised places. The crucial challenge for urban policymakers is to level internal environmental and socio-economic inequalities and prevent the formation of “emerald islands” in the city interior.The proposed inclusive approach offers a tool that could be used in many similar case studies, including the need for dialogue with local society, the special consideration of the local context, heterogeneity and greater attention to the new sources of knowledge, including GIS tools, enabling the building of a viable local system.

Socio-economic inequality in the distribution of health care in the UK

Abstract This commentary begins with a discussion of how health care is modelled in a human capital approach and what that implies for inequality in the distribution of health care. This is followed by an outline of some of the key issues in the measurement of inequalities in health care. It ends with a brief review of what the empirical literature shows on inequality in health-care utilization in the UK by socio-economic status.1

The contribution of adult experiences, multimorbidity and positive psychological well-being to social inequalities in health

Abstract We focus on three aspects of health inequalities. The first is the role of adult adversities such as chronic work stress, breakdown of intimate relationships, social isolation and discrimination, all of which contribute to increased morbidity and to premature mortality. These experiences are more common among less advantaged groups, so promote health inequalities. Second, we emphasize the impact of multimorbidity, the presence of two or more long-term physical and mental health conditions, on health inequalities. Inequalities in mental ill-health early in life are directly linked to later physical health inequalities, highlighting the critical importance of managing multiple conditions effectively. Third, we discuss socio-economic inequalities in protective psychological characteristics, such as purpose in life, optimism and positive well-being. These experiences are graded by education, income and occupational prestige. They are not only health protective but also malleable. Enhancing these factors through psychological and social interventions may contribute to reductions in health inequalities.

Living at the sharp end of socio-economic inequality: everyday experiences of poverty and social security receipt

Abstract This commentary explores lived experiences of social security and poverty, drawing on qualitative data generated over 11 years, and across four research studies. The research shows clearly the relational harms caused by poverty, inequality and social security delivery which is highly conditional and too often fails to treat individuals with dignity and respect. The commentary details the misrecognition and disrespect that routinely feature in claimants encounters with social security, and sets out the importance of policy change that encompasses both redistribution and recognition of the very real contributions made by people experiencing poverty. It is also vital to centre reforms that focus on the relational dimension of social security receipt, and improvements herein.

Geographies of socio-economic inequality

Abstract Over many decades, academics, policymakers, and governments have been concerned with both the presence of inequalities and the impacts these can have on people when concentrated spatially in urban areas. This concern is especially related to the influence of spatial inequalities on individual outcomes in terms of health, education, work and income, and general well-being amongst other outcomes. In this commentary, we provide an overview of the literature on spatial inequalities and on contextual and neighbourhood effects. We address some of the main challenges in modelling contextual effects and provide evidence that no single study can definitively provide the answer to the question whether—and how much—spatial context effects are relevant for understanding individual outcomes. It is only when taken together that the rich body of research on spatial context effects shows convincingly that spatial context effects are relevant. The commentary ends with the presentation of the vicious circle of the segregation model and suggest some ways in which this vicious circle of spatial inequality and segregation can be broken.

Structural change and socio-economic disparities in a net zero transition

A net zero transition is likely to generate substantial and irreversible economic transformation. High-carbon industries and their related occupations will disappear, while new low-carbon industries and occupations will be created. In the aggregate, the impact of the transition on GDP and employment is commonly projected to be relatively moderate. However, such estimates hide drastic distributional issues that are sectorally and regionally concentrated. We use three sectorally detailed and regionally disaggregated macroeconomic models to explore the possible levels and impacts of structural change in a well below 2°C scenario. In addition to the expected decline in the carbon-intensive industries, we observe secondary impacts, particularly in the services sectors, that vary significantly between models. The risks entailed with structural change involve worsening economic disparity and societal division that could exacerbate existing socioeconomic and political polarisation. Impact assessments of decarbonisation should consider such distributional issues to avoid post-industrial decline and widening socioeconomic inequalities.