Socioeconomic Gradient Research Articles

The Association of Socioeconomic Status With Hypertension in 76 Low- and Middle-Income Countries

BackgroundEffective equity-focused health policy for hypertension in low- and middle-income countries (LMICs) requires an understanding of the condition’s current socioeconomic gradients and how these are likely to change in the future as countries develop economically. ObjectivesThis cross-sectional study aimed to determine how hypertension prevalence in LMICs varies by individuals’ education and household wealth, and how these socioeconomic gradients in hypertension prevalence are associated with a country’s gross domestic product (GDP) per capita. MethodsWe pooled nationally representative household survey data from 76 LMICs. We disaggregated hypertension prevalence by education and household wealth quintile, and used regression analyses to adjust for age and sex. ResultsWe included 1,211,386 participants in the analysis. Pooling across all countries, hypertension prevalence tended to be similar between education groups and household wealth quintiles. The only world region with a clear positive association of hypertension with education or household wealth quintile was Southeast Asia. Countries with a lower GDP per capita had, on average, a more positive association of hypertension with education and household wealth quintile than countries with a higher GDP per capita, especially in rural areas and among men. ConclusionsDifferences in hypertension prevalence between socioeconomic groups were generally small, with even the least educated and least wealthy groups having a substantial hypertension prevalence. Our cross-sectional interaction analyses of GDP per capita with the socioeconomic gradients of hypertension suggest that hypertension may increasingly affect adults in the lowest socioeconomic groups as LMICs develop economically.

Socioeconomic Inequities in Vaccine Hesitancy Among Native Hawaiians and Pacific Islanders.

Purpose:COVID-19 vaccine hesitancy exists in communities of color who are disproportionately impacted by COVID-19. In many states, Native Hawaiians and Pacific Islanders (NHs/PIs) experience the highest rates of COVID-19 confirmed cases and mortality among U.S. ethnic/racial groups. National trends regarding vaccine hesitancy among NHs/PIs are currently lacking.Methods:Data were derived from the Asian American and NH/PI COVID-19 Needs Assessment Project, a national survey conducted during January–April 2021. The final analytic sample included 868 NH/PI adults. Logistic regression analyses were conducted to estimate odds ratios for vaccine hesitancy.Results:Vaccine hesitancy ranged from 23% among Other PIs to 56.3% among Tongan adults. Younger adults (18–24 and 25–44 years), those with lower educational attainment, and those with lower income were more vaccine hesitant. Overall, education and income showed a strong association with vaccine hesitancy in bivariate logistic models. However, the associations between vaccine hesitancy and education and income varied by NH/PI groups. NHs, Samoans, and Multiethnic NHs/PIs showed the most consistent associations between the socioeconomic position variables and vaccine hesitancy.Conclusions:The examination of vaccine hesitancy among NHs/PIs follows the socioeconomic gradient for some ethnic groups but not others. More studies are needed to determine what other socioeconomic indicators may be associated with health among specific NH/PI ethnic groups.Policy Implications:Reforms are needed to overcome structural racism underlying NH/PI evidence production, which currently renders NHs/PIs invisible. Innovative solutions based on successful community efforts can help deconstruct racist data inequities experienced by NHs/PIs.

A qualitative study of perceptions of control over potential causes of death and the sources of information that inform perceptions of risk

ABSTRACT Background Investigating perceptions of control over mortality risk may be fundamental to understanding health behaviours and tackling socioeconomic gradients in health. Few studies have explored perceptions of control over different causes of death and there is a lack of qualitative risk research. Our aim was to examine participants’ perceptions of control over potential causes of death and the sources that inform perceptions of risk. Method We conducted semi-structured interviews with 24 participants (14 female and 10 male) and conducted a template analysis to analyse the transcripts. Findings We identified six themes to represent participants’ perceptions of control over potential mortality risks and the sources that inform these perceptions: Health-Related Mortality Risks, External Causes of Risk, Finding Balance, Family Medical History, Online Sources of Risk and Health-Related Information, and Health Misinformation. Dying from heart disease was broadly reported as being a controllable risk, whereas cancer was mostly discussed as uncontrollable. Gender-specific cancers were perceived as posing a significant risk to life, however controlling this risk was discussed in terms of screening and treatment, not prevention. Family medical history was discussed as an informative source for longevity predictions, but less so for specific causes of death. Most risk information is retrieved from ‘Dr Google’, though trusted sources, such as NHS websites, are used for validation. Health misinformation online was seen as a problem experienced by other people, rather than the individual. Conclusions Causal pathways between behaviours and specific cancers may not be obvious to individuals. Messages emphasising the broader links between diet, alcohol and general cancer risk may highlight the controllability of cancer risk through improved health behaviours. Furthermore, given the rise in health misinformation, and the belief that it is other people not ourselves that are typically susceptible to believing misinformation online, further attempts are needed to combat this growing ‘infodemic’.

Analysis of Multiple Health Risky Behaviours and Associated Disease Outcomes Using Scottish Linked Hospitalisation Data.

BackgroundDisease incidence and premature deaths tend to be influenced by multiple health risky behaviours, including smoking, excessive alcohol consumption and unhealthy diet. Risky behaviours tend not to be independent and may have a multiplicative effect on disease incidence and healthcare cost. Thus, understanding the interrelationship between health behaviours and their effect on health outcomes is crucial in designing behavioural intervention programmes.ObjectiveTo examine the interrelationship between health risky behaviours and associated disease outcomes amongst Scottish adults.MethodsWe use hospitalisation episode data from the Scottish Morbidity Records, (SMR), that have been administratively linked to Scottish Health Surveys (SHeS) respondents with target disease defined by relevant ICD9 and 10 codes. We apply a recursive multivariate probit model to jointly estimate the health risky behaviours and disease incidence to adequately control for unobserved heterogeneity. The model is estimated separately by gender.ResultsModelling health risk behaviours and disease incidence equations independently rather than jointly may be misleading. We find a clear socioeconomic gradient predicting health risky behaviours and the results differ by gender. Specifically, smoking appears to be a key driver of other health risky behaviours. Current smokers are more likely to be drinking above the recommended limit, physically inactive, and eating inadequate diet.ConclusionsInterventions targeting current smokers to quit could spillover to other behaviours by reducing excessive drinking, improve physical activity and adequate diet. Thus, improvements in one behaviour may increase the likelihood of adopting other healthier lifestyle behaviours.

Socioeconomic environment and survival in patients after ST-segment elevation myocardial infarction (STEMI): a longitudinal study for the City of Vienna

ObjectivesThis study investigates the relationship between socioeconomic environment (SEE) and survival after ST-segment elevation myocardial infarction (STEMI) separately for women and men in the City of Vienna, Austria.DesignHospital-based observational data...

COVID-19 cases, hospitalizations, outpatients, and deaths in Mexico by ethnicity and state-level income.

Mexico is one of the countries that is most affected by mortality due to COVID-19. Once infected, the indigenous population living in the lower-income states had worse outcomes. Our objectives were to analyze outcomes by ethnic group, and determine the association between state-level income and the incidence, hospitalizations, outpatients, and death rates per 100,000 population. We analyzed 1,037,567 confirmed COVID-positive cases from February 29 to November 13, 2020 recorded in the Mexican COVID-19 cases database. Sociodemographic characteristics, comorbidities, and outcomes were analyzed. Data was allocated according to the state where the patients were treated. Statistical association between age-adjusted incidence and death rates with state-level GDP per capita (as a measure of income), were ascertained using Spearman correlations. Kruskal-Wallis tests examine the association of cumulative incidence, hospitalizations, outpatients, and death rates, with income quartiles. When significant, a follow-up analysis (Mann-Whitney) was conducted. Respective cumulative incidence rates and death rates were: 900.3 (non-indigenous) and 94.4 (indigenous), and 87.1 (non-indigenous) and 13.9 (indigenous). Spearman correlation coefficients of income with age-standardized incidence and death rates were 0.657 and 0.607 (p < 0.001 for both). Kruskal-Wallis H-Values indicate significant median differences by income in total population rates: cumulative incidence 13.47 (p < 0.01), hospitalizations 11.67 (p < 0.01), outpatients 12.86 (p < 0.01), and deaths 8.92 (p < 0.05). Cumulative incidence, hospitalizations, outpatients, and mortality rates presented a reversed socioeconomic status health gradient in Mexico. Less adverse outcomes were observed in the lowest-income states compared to higher-income states.

Aging and hypertension among the global poor-Panel data evidence from Malawi.

Hypertension is a rapidly growing disease burden among older persons in low-income countries (LICs) that is often inadequately diagnosed and treated. Yet, most LIC research on hypertension is based on cross-sectional data that does not allow inferences about the onset or persistence of hypertension, its correlates, and changes in hypertension as individuals become older. The Mature Adults Cohort of the Malawi Longitudinal Study of Families and Health (MLSFH-MAC) is used to provide among the first panel analyses of hypertension for older individuals in a sub-Saharan LIC using blood pressure measurements obtained in 2013 and 2017. We find that high blood pressure is very common among mature adults aged 45+, and hypertension is more prevalent among older as compared to middle-aged respondents. Yet, in panel analyses for 2013-17, we find no increase in the prevalence of hypertension as individuals become older. Hypertension often persists over time, and the onset of hypertension is predicted by factors such as being overweight/obese, or being in poor physical health. Otherwise, however, hypertension has few socioeconomic predictors. There is also no gender differences in the level, onset or persistence in hypertension. While hypertension is associated with several negative health or socioeconomic consequences in longitudinal analyses, cascade-of-care analyses document significant gaps in the diagnosis and treatment of hypertension. Overall, our findings indicate that hypertension and related high cardiovascular risks are widespread, persistent, and often not diagnosed or treated in this rural sub-Saharan population of older individuals. Prevalence, onset and persistence of hypertension are common across all subgroups-including, importantly, both women and men. While age is an important predictor of hypertension risk, even in middle ages 45-55 years, hypertension is already widespread. Hypertension among adults aged 45+ in Malawi is thus more similar to a "generalized epidemic" than in high-income countries where cardiovascular risk has strong socioeconomic gradients.

Socio-ecological inequality in heat: The role of green infrastructure in a subtropical city context

Urban green infrastructure is central to integrated climate responses linking ecosystem services and social equity within urban planning for extreme heat in cities. This study examines the extent to which temperature regulating services from green infrastructure influence electricity consumption along with socio-economic gradient across urban neighbourhoods of Taipei Basin, Taiwan. Socio-ecological inequality was found to follow a complicated pattern, whereby green polarisation was revealed - both privileged and deprived neighbourhoods had greener and cooler environments. Yet, household salary was a more important factor for determining the increase of electricity consumption in summer than environmental attributes of greenspace proportion, distance to waters and temperature. Indigenous populations were socio-economically more disadvantaged, but they tended to receive greater cooling services from semi-natural areas and increased electricity usage less in summer. Neighbourhoods with a higher female proportion of population were less green, but socio-economically more privileged. In line with this spatial pattern, this study draws attention to the need to take various kinds of green infrastructure into account in a heat adaptation plan, and prioritise greening initiatives in areas which are subject to joint disparity in natural cooling services and economic capacity for house cooling.

Exploring the Role of Physical Activity in Mediating the Association between Educational Level and Health-Related Quality of Life in an Adult Lifespan Sample from Madeira Island.

Background: People more socioeconomically vulnerable tend to have a poorer health-related quality of life (HRQoL). Studies are trying to analyse the factors that may condition this relationship, including physical activity (PA), which may influence the relationship between socioeconomic status (SES) and HRQoL. This study aimed to analyse the relationship between SES and HRQoL through specific domains of PA. Methods: A total of 381 adults (≥18 years) from the Autonomous Region of Madeira completed the measurements. Mediation analyses using bootstrapping methods adjusted for confounding variables were performed to relate SES and HRQoL; the latter was evaluated using the physical component score (PCS) of the SF-12, the mental component score (MCS) of the SF-12, and the total score in the SF-12 questionnaire (SF-12 score), through physical activity. Results: Educational level was positively related to PCS and SF-12 score. Leisure-time PA (not including sports PA) and PA at work, as single mediating variables, did not mediate the relationship between SES and HRQoL. The total PA suppressed the socioeconomic gradient of HRQoL by 8–10%, 39–46%, and 15–16%, respectively, for the PCS, MCS, and the SF-12 score; sports PA mediated the relationship by 13–16%, 50%, and 15–21%, respectively. Conclusions: The results suggest that sports PA contributes to reducing the socioeconomic gradient of HRQoL.

The socioeconomic gradient in mortality from ovarian, cervical, and endometrial cancer in Australian women, 2001-2018: A population-based study.

Socio-economic (SE) status is closely linked to health status and the mechanisms of this association are complex. One important adverse effect of SE disadvantage is vulnerability to cancer and cancer is a major cause of morbidity and mortality in Australia. We aimed to estimate the effect of SE status on mortality rates from ovarian, cervical, and endometrial cancer. National mortality data were obtained from the Australian Bureau of Statistics (ABS) for the calendar years from 2001 to 2018, inclusive. Individual deaths were grouped by the ABS Index of Relative Socio-economic Advantage and Disadvantage. Population data were obtained to provided denominators allowing calculation of mortality rates (deaths per 100 000 women aged 30-79 years). Statistical analyses performed included tabulating point-estimates of mortality rates and their changes over time and modelling the trends of rates using maximum likelihood method. Age-standardised mortality rates for ovarian and cervical cancer fell over the study period but increased for endometrial cancer. There was clear evidence of a SE gradient in the mortality rate for all three cancers. This SE gradient increased over the study period for ovarian and cervical cancer but remained unchanged for endometrial cancer. Women at greater SE disadvantage have higher rates of death from the commonest gynaecological cancers and this gradient has not reduced over the last two decades. After the COVID-19 pandemic efforts must be redoubled to ensure that Australians already at risk of ill health do not face even greater risks because of their circumstances.

Educational Gradients Behind Medical Adverse Event Deaths in the US-A Time Series Analysis of Nationwide Mortality Data 2010-2019.

BackgroundDeaths due to medical care appear common. Individuals with low socioeconomic position seem to be at a higher risk for sustaining a medical adverse event and premature death. This time series analysis aimed to assess educational gradients behind adverse event deaths in the US over the period 2010–2019.MethodsPublicly available mortality and census data were retrieved from official sources. The data included age, sex, educational attainment, and underlying cause of death. Adverse event deaths were identified by ICD-10 codes Y40—Y84 and Y88. Four education categories were created in accordance with the International Standard Classification of Education 2011 coding scheme [No high school or General Educational Development (GED); High school or GED; Some college; Bachelor's degeree or higher]. To capture also highly educated individuals, the analysis was delimited to ≥30-year-olds. Age-adjusted mortality rates (AMRs) were compared between education categories by means of mortality plots and linear mixed models.ResultsA total of 25,897,334 certified deaths occurred among ≥30-year-olds during the study period. The underlying cause of death was an adverse event in a rarity of cases (0.12%, n = 31,997). Individuals with Bachelor's degeree or higher had the lowest adverse event AMRs (6.1–12.4 per million per year), followed by the Some college category (9.6–18.6), the High school or GED category (17.1–35.4), and finally the No high school or GED category (20.0–36.0). AMRs showed a gradual increase as education level decreased (p ≤ 0.001 against those with Bachelor's degeree or higher). Moreover, the temporal increase in adverse event AMRs was more pronounced among individuals with low than high education; the contrasts between categories were greatest toward the end of the study period.ConclusionThe findings of this study suggest that the widening socioeconomic gradients in mortality extend also to fatal adverse events. Future studies should aim to analyze whether access to care, severity of the condition at presentation, quality of care, and social determinants of health may drive the gradients.

Association of socioeconomic status with nonsuicidal self-injury and suicidal ideation in young Korean adults.

Although nonsuicidal self-injury (NSSI) in youth is an important mental health concern worldwide, limited studies have investigated its sociodemographic correlates in early adulthood. This study explored associations between socioeconomic status (SES) and self-harm behaviors, including NSSI and suicidal ideation, in a community-based sample of young adults. A total of 414 Korean young adults engaged in NSSI and 200 controls completed online self-report questionnaires assessing sociodemographic and clinical characteristics, using logistic regression to estimate the odds ratio and analyzed risk factors for NSSI, especially the independent influence of SES on NSSI risk. Multivariate regression was performed to identify the role of socioeconomic disadvantage in suicidal ideation in NSSI people. Logistic regression showed that low SES significantly increased NSSI risk. Multivariable regression also revealed that lower SES was related to more severe suicidal ideation in young adults with NSSI after controlling for gender and the higher-severity NSSI index, including the number of NSSI methods used and NSSI intrapersonal functions. This is the first study to directly address socioeconomic gradients of a general population of young adults with NSSI and its effects, and socioeconomic status should be considered preemptively when defining suicide risks of this group and when intervening in self-injurious behaviors.

Stratification in parents’ selection of developmentally appropriate books for children: register-based evidence from Danish public libraries

ABSTRACT This paper studies socioeconomic gradients in parents' selection of developmentally appropriate children's books from public libraries. I draw on developmental gradients research to hypothesize that families with high socioeconomic status (SES) select a higher share of books that match children's developmental stage in order to best improve children's learning environments. Based on Danish registry data on all books borrowed from public libraries in 2020, I find that highly educated families are more likely to use libraries and borrow more books, but they do not select a larger share of developmentally appropriate books; in fact, they select a slightly lower share. In contrast, high-income families borrow both a little more books and a little higher share of developmentally appropriate books, than low-income families. The supplementary analyses show that results are robust across families with children of different ages and to account for nonrandom selection into the sample of library users, socioeconomic differences in children's reading skills, and the impact of library lockdowns due to Covid-19. I conclude that stratification in library book selection is more prominent concerning the voraciousness with which highly educated parents provide reading inputs (more books) than how discriminating they are in terms of selecting developmentally appropriate books.

Inequality begets inequality: Income inequality and socioeconomic achievement gradients across the United States

Social scientists have found income inequality is associated with an array of health and social problems, however the implications of income inequality for education are the subject of debate. Across 100 different areas (individual counties or collections of small counties) of the United States, we investigated how income inequality was associated with 1) average mathematics and reading achievement and 2) socioeconomic gradients in mathematics and reading achievement. Using data from the Kindergarten to Fifth Grade waves of the Early Childhood Longitudinal Study, Kindergarten Class of 2011 (ECLS-K 2011), we found areas of the United States with higher income inequality had lower average achievement in mathematics and a larger socioeconomic achievement gradient in reading. In further analyses, we investigated what characteristics of school and home environments mediated the relationship between income inequality and academic achievement. We found the association between income inequality and academic achievement was partly explained by the clustering of disadvantaged students in high poverty schools/districts and more intensive parenting practices among high SES parents (structured activity participation, educational expectations).

Behavioural intervention to promote the uptake of planned care in urgent dental care attenders: study protocol for the RETURN randomised controlled trial

BackgroundPeople with disadvantaged backgrounds are less likely to visit the dentist for planned care, even though they have disproportionately poorer oral health. They are correspondingly more likely to experience dental problems and use urgent dental care, general practices and Accident and Emergency departments, which not only makes meeting their needs expensive, but, since these services often rely on prescriptions rather than addressing the clinical cause, can contribute to antimicrobial resistance.MethodsThe RETURN intervention has been developed with substantial community co-production, to be delivered opportunistically in urgent dental care settings. This brief intervention is delivered by dental nurses and involves material relevant to the ‘in-group’ targeted. The material includes booklets relating to barriers to planned dental visiting with corresponding short video clips featuring local people and including a modelling element. Dental nurses are trained to have supportive and non-judgemental conversations, assisting patients to set personal goals and action plans, which are reinforced in a follow-up text within a few weeks. A randomised controlled trial will be undertaken in 3 types of sites: dental practices delivering urgent care (a) within working hours, (b) out of hours, and (c) in a Dental Hospital. The trial will recruit 1180 adult urgent dental care users over 12 months, who have not visited a dentist for a planned care appointment for 2 years or more and do not have a dentist who they visit for routine care. It aims to investigate the effectiveness and cost-effectiveness of the intervention and to explore whether the intervention has different effects across the socio-economic gradient. Participants will be followed up at 6, 12 and 18 months after randomisation. Co-primary outcomes are attendance at a dental practice for planned care within 12 months and self-reported oral health-related quality of life at 12 months.DiscussionThis is a pragmatic trial, evaluating the effectiveness of the intervention under the usual condition in which it might be applied. Since dental practices work as independent contractors to the NHS, this brings implementation and fidelity challenges which will be explored and described in embedded qualitative work.Trial registrationISRCTN registry identifier ISRCTN84666712. Registered 12/04/2021.

A comparison of health and socioeconomic gradients in health between the United States and Canada

Data from the early 2000s indicated worse overall health and larger socioeconomic (SES) health inequalities in the U.S. than in Canada. Yet, sociopolitical contexts, health levels, and SES-health inequalities have changed in both countries during the intervening two decades. Drawing on new data, we update the comparison of health levels and SES-health gradients between the two countries.Analyses, focused on self-rated health, are based on two complementary sets of data sources: Resilience and Recovery (RR) data, a harmonized U.S.-Canada survey of social conditions collected in 2020 (N = 3743); and a pair of leading nationally representative health data sources from each country: the National Health Interview Surveys (NHIS, N = 104,027) and the Canadian Community Health Survey (CCHS, N = 97,605), both collected in 2017–2018. Health levels and disparities, net of demographic and socioeconomic covariates, were estimated using modified Poisson models for relative comparisons; descriptives and predicted levels of fair/poor health show the comparisons from absolute perspective.Both data sources show that U.S. adults continue to have significantly worse health than Canadians; the disadvantage may be due to SES differences between the two populations. However, the two data sources yield conflicting findings on SES-health inequalities: the RR data indicate no difference between the two countries in socioeconomic health gradients, while the NHIS/CCHS data show a significantly steeper gradient in the U.S. than in Canada for both education and income.Canadian adults continue to report better health than their U.S. peers, but it is unclear whether health inequalities remain smaller as well. We discuss potential reasons for the conflicting findings and call for a large new cross-national data collection, which will enable scholars and policymakers to better understand health and wellbeing in the U.S. and Canadian contexts.

Socioeconomic gradients in child development: Evidence from a Chilean longitudinal study 2010–2017

Empirical evidence shows that lack of resources during infancy and the process of accumulating disadvantages throughout childhood have important consequences for cognitive and socio-emotional development. This paper examines socioeconomic gradients across language and socio-emotional measures. Using longitudinal data from 7-year, three-wave panel data, we study the patterns of socioeconomic status and child development in Chile and estimate how much of the wealth gap can be explained by different mediators like maternal educational and skills, child attendance of preschool and school, possession of books, or domestic violence indicators. We show that there are strong associations between household wealth and child development, and that, as the child grows, the gap between the most extreme quintiles of the distribution, both in cognitive and socio-emotional skills, persists but decreases in magnitude. Taking advantage of the longitudinal nature of the data, we calculate a permanent skill for each child and each skill dimension in this 7-year period. The analysis for the permanent component shows that wealth gaps are important to determine language, but not socio-emotional skills, and that the gap is larger for girls than for boys in the early childhood period. While mediators account for some of the associations, there is still a large socioeconomic gap that persists in receptive language among children. The most important factors that mediate the wealth gaps are inherited from maternal characteristics. By understanding the dynamism of social and cognitive vulnerability experienced during childhood and employing longitudinal data and methods, this study contributes to and extends the existing literature on socioeconomic gaps and child development in the Latin American context.

Did the Socio-Economic Gradient in Depression in Later-Life Deteriorate or Weaken during the COVID-19 Pandemic? New Evidence from England Using Path Analysis.

It is well established that there is a socioeconomic gradient in adult mental health. However, little is known about whether and how this gradient has been exacerbated or mitigated by the COVID-19 pandemic. This study aims to identify the modifiable pathways involved in the association between socioeconomic position (SEP) and mental health during the COVID-19 pandemic. The analysis included 5107 adults aged 50+ living in England and participating in the English Longitudinal Study of Ageing Wave nine (2018–2019) and the COVID-19 study (June 2020). Mental health was measured using a shortened version of the Centre for Epidemiologic Studies Depression scale. Path analysis with multiple mediator models was used to estimate the direct effect of SEP (measured by educational qualification and household wealth) on mental health (measured by depression), along with the indirect effects of SEP via three mediators: COVID-19 infection symptoms, service accessibility and social contact. The results show that the prevalence of depression for the same cohort increased from 12.6% pre-pandemic to 19.7% during the first wave of the pandemic. The risk of depression increased amongst older people who experienced COVID-19 infection, difficulties accessing services and less frequent social contact. The total effects of education and wealth on depression were negatively significant. Through mediators, wealth and education were indirectly associated with depression. Wealth also directly affected the outcome. The findings suggest that the socioeconomic gradient in depression among older people may have deteriorated during the initial phase of the pandemic and that this could in part be explained by increased financial hardship, difficulties in accessing services and reduced social contact.

Blue-space availability, environmental quality and amenity use across contrasting socioeconomic contexts

Over 60% of the global population are expected to live in urban areas by 2050. Urban blue spaces are critical for biodiversity, provide a range of ecosystem services, and can promote human health and wellbeing. Despite this, access to blue space is often unequally distributed across socioeconomic gradients, and the availability of quality blue space could extend to environmental justice issues. Three stages of analysis were carried out in Mexico City, Mexico and Bristol, UK to (i) assess associations between blue space and socioeconomic metrics at a regional scale, (ii) apply a rapid assessment tool to assess amenity, access and environmental quality, (iii) consider local quality across socioeconomic gradients at a regional scale. Still water availability was indicative of higher socioeconomic status, but contrasting city evolutions underpinned differences. Locally, there were environmental gradients from more complex to disturbed habitats that influenced potential wellbeing and amenity benefits. In combination, this may exacerbate inequalities and risk increasing ecosystem disservices. If cities are to be socially, and environmentally resilient to higher levels of disturbance in the future, healthy ecosystems will be key. However, further research is needed to address various dimensions of injustice in urban areas beyond blue space distribution.

What explains the socioeconomic status-health gradient? Evidence from workplace COVID-19 infections

This paper studies the contribution of the workplace to the SES-health gradient. Our analysis is based on a unique dataset that tracks various health outcomes and workplace risks among healthcare workers during the first four months of the coronavirus 2019 (COVID-19) pandemic. The setting provides an exceptional opportunity to test for work-related disparities in health, while controlling for confounding determinants of the SES-health gradient. We find that low-SES nurses were systematically more likely to contract COVID-19 as a result of workplace exposure. These differentials existed in all healthcare institutions, but were particularly large in non-hospital settings. In contrast, we find no relationship between SES and nonwork-related infection rates. The differences in workplace infection rates are substantially larger than those implied by standard ‘task-based’ indices of transmission risk, and cannot be attributable to easily identifiable metrics of workplace risk. Together, our results show how subtle differences in work conditions or job duties can substantially contribute to the SES-health gradient.