Socioeconomic Inequalities In Access Research Articles

Associations of socioeconomic and health factors with dental non-attendance: A comparison of three cohorts of women.

Most studies on factors influencing dental attendance are cross-sectional and focus on specific age groups. The associations between private ancillary health insurance, tobacco smoking, alcohol consumption and overweight/obesity with dental attendance were examined in three cohorts of Australian women of different ages using multiple waves of data over similar time periods. Data from 10233, 12 378 and 7892 women born in 1973-1978, 1946-1951 and 1921-1926 participating in the Australian Longitudinal Study on Women's Health were used. Poisson regression using generalized estimating equations was used to investigate factors associated with self-report of not visiting the dentist in the 12 months before completing each wave. The role of dental non-attendance was higher in women without insurance (versus those with insurance) in all cohorts with adjusted rate ratios (RR) of 1.52 95%CI 1.48-1.57, RR 1.45 95%CI 1.41-1.49 and RR 1.32 95%CI 1.28-1.36 in the 1973-78, 1946-51 and 1921-26 cohorts respectively. Current smokers at any intensity (versus never smokers) had a higher risk of non-attendance and the risk was strongest for women in the 1946-51 cohort who smoked ≥20 cigarettes/day (RR 1.35 95%CI 1.30-1.41). Compared with low-risk drinkers, non-drinkers were more likely to be non-attenders, but only in the two older cohorts. Women who were overweight or obese (versus healthy weight) were more likely to be non-attenders in all cohorts, with the risk of non-attendance higher with increasing BMI. This study emphasizes the continued need to address socioeconomic inequities in access to dental care, along with strategies to overcome barriers for those who are obese or smoke. In this study, barriers to access existed for women of all ages, indicating that interventions need to be appropriate across age groups.

Developments in paediatric cancer care throughout the COVID-19 pandemic: Lessons from China

Developments in paediatric cancer care throughout the COVID-19 pandemic: Lessons from China

Unequal impact of the COVID-19 pandemic on paediatric cancer care: a population-based cohort study in China

SummaryBackgroundThe COVID-19 pandemic has had widespread adverse collateral effects on health care delivery for non-COVID-19 disease conditions. Paediatric oncology care is reliant on prompt testing and diagnosis and on timely and coordinated multimodal treatment, all of which have been impacted by the pandemic. This study aimed to quantify the initial and enduring effects of the COVID-19 pandemic on the utilization of paediatric cancer care and to examine whether the pandemic differentially impacted specific demographic groups.MethodWe performed an interrupted time series analysis using negative binomial regression to estimate the change in the monthly admissions for paediatric cancer patients (Age 0-17) associated with the COVID-19 pandemic and subsequent lockdown policies. We obtained data from deidentified individual electronic medical records of paediatric cancer inpatients admitted between January 1, 2015 and May 31, 2021 to a tertiary hospital that provides general and specialized healthcare services to an estimated population of 8.4 million in Jining China. Relative risk (RR) estimates representing monthly admissions compared with expected admissions had the pandemic not occurred were derived. The number of inpatient admissions lost due to the pandemic were estimated.FindingsThe overall denominator for the paediatric population was 1 858 209 individuals in January 2015, which increased to 2 043 803 by May 2021. In total, there were 4 901 admissions for paediatric cancer during the study period, including 1 479 (30%) since February 2020 when the lockdown was implemented. A 33% reduction (95% CI: -43% to -22%) in admissions was observed in February 2020, with the largest relative reduction (-48%, 95% CI: -64% to -24%) among first-time admissions and admissions for patients from rural districts (-46%, 95% CI: -55% to -36%). Admissions quickly rebounded in March 2020 when many government-imposed mobility restrictions were lifted, and continued to resume gradually over time since April 2020, leading to a full recovery as of November 2020. However, the recovery for first-time admissions, and among female patients, younger patients (<5 years) and patients from rural districts was slower over time and incomplete (first-time admissions and rural patients) as of January 2021.InterpretationThe COVID-19 pandemic has had substantial impact on the timely utilization of paediatric oncology services in China, particularly in the early stage of the first wave. Importantly, some population groups were disproportionately affected and the recovery of admissions among those subgroups has been slow and incomplete, warranting targeted approaches to address potentially exacerbated gender and socio-economic inequalities in access to healthcare resources.

Socioeconomic inequalities in access and use of skilled birth attendants during childbirth in Ghana: a decomposition analysis

BackgroundEquitable access to skilled birth attendance during delivery is vital for reducing global maternal deaths to 70 deaths per 100, 000 to achieve the Sustainable Development Goals (SDGs) by 2030. Although several initiatives have been implemented to reduce maternal mortality in Ghana, inequalities in access to skilled birth attendance during delivery still exist among women of different socioeconomic groups. This study assesses the socioeconomic inequalities in access and use of skilled birth attendants during delivery in Ghana.MethodsResearch was conducted through literature reviews and document reviews, and a secondary data analysis of the 2014 Ghana Demographic and Health Survey (GDHS), a nationally representative survey. A total of 1305 women aged 15–49 years, who had a live birth the year before to the survey in the presence of a skilled birth attendant were analysed using concentration indices and curves. The indices were further decomposed to identify the major socioeconomic factors contributing most to the inequalities.ResultsThe results found that access to skilled birth attendants was more among women from rich households showing a pro-rich utilization. The decomposition analysis revealed that household wealth index, educational level of both mother and husband/partner, area of residence and mother’s health insurance coverage were the major contributing factors to socioeconomic inequalities in accessing skilled birth attendants during child delivery among Ghanaian women.ConclusionThis study confirms that a mother’s socioeconomic status is vital to reducing maternal deaths. Therefore, it is worthy to focus attention on policy interventions to reduce the observed inequalities as revealed in the study.

Exploring socioeconomic inequities in access to palliative and end-of-life care in the UK: a narrative synthesis

BackgroundEfforts to tackle socioeconomic inequities in access to palliative and end-of-life care require comprehensive understanding about the extent of and reasons for inequities. Most research on this topic examines differences in receipt of care. There is a need, particularly in the UK, for theoretically driven research that considers both receipt of care and the wider factors influencing the relationship between socioeconomic position and access to palliative and end-of-life care.MethodsThis is a mixed studies narrative synthesis on socioeconomic position and access to palliative and end-of-life care in the UK. Study searches were conducted in databases AMED, Medline, Embase, CINAHL, SocIndex, and Academic Literature Search, as well as grey literature sources, in July 2020. The candidacy model of access, which describes access as a seven-stage negotiation between patients and providers, guided study searches and provided a theoretical lens through which data were synthesised.ResultsSearches retrieved 5303 studies (after de-duplication), 29 of which were included. The synthesis generated four overarching themes, within which concepts of candidacy were evident: identifying needs; taking action; local conditions; and receiving care.ConclusionThere is not a consistent or clear narrative regarding the relationship between socioeconomic position and receipt of palliative and end-of-life care in the UK. Attempts to address any inequities in access will require knowledge and action across many different areas. Key evidence gaps in the UK literature concern the relationship between socioeconomic position, organisational context, and assessing need for care.

Socio-Economic Inequalities in Access to Drinking Water among Inhabitants of Informal Settlements in South Africa.

While evidence from several developing countries suggests the existence of socio-economic inequalities in the access to safe drinking water, a limited number of studies have been conducted on this topic in informal settlements. This study assessed socio-economic inequalities in the use of drinking water among inhabitants of informal settlements in South Africa. The study used data from “The baseline study for future impact evaluation for informal settlements targeted for upgrading in South Africa.” Households eligible for participation were living in informal settlements targeted for upgrading in all nine provinces of South Africa. Socio-economic inequalities were assessed by means of multinomial logistic regression analyses, concentration indices, and concentration curves. The results showed that the use of a piped tap on the property was disproportionately concentrated among households with higher socio-economic status (concentration index: +0.17), while households with lower socio-economic status were often limited to the use of other inferior (less safe or distant) sources of drinking water (concentration index for nearby public tap: −0.21; distant public tap: −0.17; no-tap water: −0.33). The use of inferior types of drinking water was significantly associated with the age, the marital status, the education status, and the employment status of the household head. Our results demonstrate that reducing these inequalities requires installing new tap water points in informal settlements to assure a more equitable distribution of water points among households. Besides, it is recommended to invest in educational interventions aimed at creating awareness about the potential health risks associated with using unsafe drinking water.

Socioeconomic inequalities in effective service coverage for reproductive, maternal, newborn, and child health: a comparative analysis of 39 low-income and middle-income countries.

BackgroundReducing socioeconomic inequalities in access to good quality health care is key for countries to achieve Universal Health Coverage. This study aims to assess socioeconomic inequalities in effective coverage of reproductive, maternal, newborn and child health (RMNCH) in low- and middle-income countries (LMICs).MethodsUsing the most recent national health surveys from 39 LMICs (between 2014 and 2018), we calculated coverage indicators using effective coverage care cascade that consists of service contact, crude coverage, quality-adjusted coverage, and user-adherence-adjusted coverage. We quantified wealth-related and education-related inequality using the relative index of inequality, slope index of inequality, and concentration index.FindingsThe quality-adjusted coverage of RMNCH services in 39 countries was substantially lower than service contact, in particular for postnatal care (64 percentage points [pp], p-value<0·0001), family planning (48·7 pp, p<0·0001), and antenatal care (43·6 pp, p<0·0001) outcomes. Upper-middle-income countries had higher effective coverage levels compared with low- and lower-middle-income countries in family planning, antenatal care, delivery care, and postnatal care. Socioeconomic inequalities tend to be wider when using effective coverage measurement compared with crude and service contact measurements. Our findings show that upper-middle-income countries had a lower magnitude of inequality compared with low- and lower-middle-income countries.InterpretationReliance on the average contact coverage tends to underestimate the levels of socioeconomic inequalities for RMNCH service use in LMICs. Hence, the effective coverage measurement using a care cascade approach should be applied. While RMNCH coverages vary considerably across countries, equitable improvement in quality of care is particularly needed for lower-middle-income and low-income countries.FundingNone.

Understanding the Dynamics of Green and Blue Spaces for Health and Wellbeing Outcomes in Ireland: A Systemic Stakeholder Perspective

Despite the recognised benefits to human health from green and blue spaces, socioeconomic inequalities in access to and use of such spaces have been observed. Using a multidisciplinary, multistakeholder systems approach and structural equation modelling, this paper examines the structural and behavioural dynamics of green and blue spaces, people and health and wellbeing outcomes. Systems thinking offers a deeper understanding of the dynamics of collective choices at all levels within the determinants and the circular causality of these processes. The resulting map shows that behavioural and structural dynamics of green and blue spaces reinforce social cohesion, mental and physical benefits and their circular causality. Acknowledging the importance of multiple uses of green and blue spaces, this paper concludes that delivering universal services at a scale and intensity proportionate to the degree of need is vital to ensure services and health and wellbeing benefits are available to all, not only the most advantaged.

Are there socio-economic inequities in access to reperfusion therapy: The stroke 69 cohort

Background and purposeLow socio-economic status of individuals has been reported to be associated with a higher incidence of stroke and influence the diagnosis after revascularization. However, whether it is associated with poorer acute stroke management is less clear. To determine whether social deprivation was associated with a poorer access to reperfusion therapy, either intravenous thrombolysis (IVT) and/or endovascular thrombectomy (EVT) in a population-based cohort. MethodsOver a 14-month period, all consecutive adult patients admitted to any emergency department or a comprehensive or primary stroke center (CSC/PSC) of the Rhône county with a confirmed ischemic stroke were included. The socioeconomic status of each patient was measured using the European Deprivation Index (EDI). The association between EDI and access to reperfusion therapy was assessed in univariate and multivariate logistic regression analyses. ResultsAmong the 1226 consecutive IS patients, 316 (25%) were admitted directly in a PSC or CSC, 241 (19.7%) received a reperfusion therapy; 155 IVT alone, 20 EVT alone, and 66 both therapies. Median age was 79 years, 1030 patients had an EDI level of 1 to 4, and 196 an EDI of 5 (the most deprived group). The most deprived patients (EDI level 5) did not have a poorer access to reperfusion therapy compared to all other patients in univariate (OR 1.22, 95%CI [0.85; 1.77]) nor in multivariate analyses (adjOR 0.97, 95%CI [0.57; 1.66]). ConclusionsWe did not find any significant association between socioeconomic deprivation and access to reperfusion therapy. This suggests that the implementation of EVT was not associated with increased access inequities.

Inequalities in access to safe drinking water in Peruvian households according to city size: an analysis from 2008 to 2018

BackgroundPeru is one of the countries with the lowest percentage of population with access to safe drinking water in the Latin American region. This study aimed to describe and estimate, according to city size, socioeconomic inequalities in access to safe drinking water in Peruvian households from 2008 to 2018.MethodsSecondary analysis of cross-sectional data using data from the 2008–2018 ENAHO survey. Access to safe drinking water, determined based on the presence of chlorinated water supplied by the public network, as well as socioeconomic variables were analyzed. A trend analysis from 2008 to 2018, and comparisons between 2008 versus 2018 were performed to understand and describe changes in access to safe drinking water, according to city size. Concentration curves and Erreygers concentration index (ECI) were estimated to measure inequalities in access to safe drinking water.ResultsIn 2008, 47% of Peruvian households had access to safe drinking water, increasing to 52% by 2018 (p for trend < 0.001). For small cities, access to safe drinking water did not show changes between 2018 and 2008 (difference in proportions − 0.2 percentage points, p = 0.741); however, there was an increase in access to safe drinking water in medium (difference in proportions 3.3 percentage points, p < 0.001) and large cities (difference in proportions 12.8 percentage points, p < 0.001). The poorest households showed a decreasing trend in access to safe drinking water, while the wealthiest households showed an increasing trend. In small cities, socioeconomic inequalities showed an increase between 2008 and 2018 (ECI 0.045 and 0.140, p < 0.001), while in larger cities, socioeconomic inequality reduced in the same period (ECI: 0.087 and 0.018, p = 0.036).ConclusionsWe report a widening gap in the access to safe drinking water between the wealthiest and the poorest households over the study period. Progress in access to safe drinking water has not been equally distributed throughout the Peruvian population. Promoting and supporting effective implementation of policies and strategies to safe drinking water, including equity-oriented infrastructure development and resource allocation for most vulnerable settings, including emerging small cities, is a priority.

Income-based inequality in full immunization coverage of children aged 12-23 months in Eastern India: A decomposition analysis

IntroductionNotably, less than two-thirds of under-5 children received full immunization in 2016 in India. It is critical to understand the inequalities in access to immunization for determining an effective health policy agenda to ensure universal health coverage. Hence, we performed a study to assess the determinants of income-based inequality in the full immunization of children aged 12–23 using Fairlie decomposition analysis. MethodsThis cross-sectional study was a part of a community-based project that aimed to improve maternal and child health in the backward states of India, namely Bihar and Assam. The study was conducted in the rural and urban areas of Munger and Darrang districts of Bihar and Assam, respectively. The degree of income-related inequality in full immunization coverage was obtained through the concentration index. The Fairlie decomposition was employed to quantify the absolute contribution of socio-demographic factors explaining the group differences (higher or lower income) in the probability of having full immunization. ResultsThere were 73 fully and 82 non-fully immunized children. The concentration curve was lying above the line of equality, which implied that full immunization coverage was concentrated towards the lower-income group. Maternal education (7.5%) and place of residence (5.1%) widened the inequality gap, and caste (−13.5%) and age of the child (−2.5%) narrowed down the inequality gap for full immunization among lower and higher-income groups. ConclusionsThe socio-economic inequalities in access to full immunization can be mitigated by multi-sectoral interventions with a focus on children with less-educated mothers and living in urban slums.

A Study to Assess the Maternal PerceivedQuality of Life Following Child Birth amongPostnatal Mothers in Selected Hospital atNagpur City

Introduction: The women are mass likely to experience depression in her lifetime. Women experienced at least one mistreatment type during childbirth. Verbal abuse increased the likelihood of having postpartum depression among mothers. There are also significant socio-economic inequalities in access to postpartum care even for those accessing facility-based care. Less attention paid to postpartum mothers by health care provider after delivery. Family members and relatives’ disrespect, abuse or neglectful treat to mothers following childbirth leads to postpartum depression. Aim of the study was to examine the mother’s quality of life that is essential to explore predictor affecting the quality of life of mothers. Objectives: The objectives of the study were to assess the maternal perceived quality of life among postnatal mothers following childbirth and to determine the association between selected demographic variables and quality of life among the postnatal mothers by using maternal postpartum quality of life questionnaire (MAPP-QOL). Method: The research design used was descriptive research design. The sample was 30 postnatal mothers from Daga Memorial Hospital at Nagpur city. Non-probability convenience sampling techniques were used. The data was collected by using Maternal Postpartum Quality of life questionnaires (MAPP-QOL) by WHO. The data collected tool was validated by 7 experts. The data collected were tabulated, analyzed and interpreted by researchers. Result: The main study to assess maternal perceived quality of life following childbirth among postnatal mothers. The data was calculated by using Chi square test and the mean percentage of maternal perception of quality of life is 110.36 and standard deviation for quality of life 17.33826.The finding of the study revealed that there was significant association between demographic variables and maternal perceived quality of life following childbirth among the postnatal mothers at the level of significance 0.05. Conclusion: The study shows that maternal perceived quality of life following childbirth among postnatal mothers, 0% postnatal mothers having very dissatisfied quality of life, 6.666% postnatal mothers having dissatisfied quality of life, 13.33% postnatal mothers having neither satisfied nor dissatisfied quality of life, 66.66% postnatal mothers having satisfied quality of life, 13.33% of postnatal mothers having very satisfied quality of life.

Gendering psychosocial care: risks and opportunities for global mental health

Recent conversations in The Lancet Psychiatry have highlighted the ways global mental health institutions reflect and reproduce wider social inequalities.1 Gendered practices of employment and remuneration are an understudied dimension of this problem. The past decade has seen a proliferation of psychosocial interventions delivered by lay community workers, a predominantly female workforce. Under the right conditions, task shifting in this way can address geographical and socioeconomic inequities in access to care and support women's empowerment.

Disparities in disc golf course distribution in the United States

ABSTRACT Research questions To what extent are racial, socioeconomic and health characteristics of US counties associated with access to a specific recreational resource – disc golf courses? We contribute to the literature by using a national scope and exploring how these relationships vary along the rural-urban continuum. Research methods We use data from six sources to (1) map the county-level locations of disc golf courses, (2) provide descriptives of the sociodemographic and health characteristics for US counties, including by rural-urban distinctions and by presence/absence of at least one disc golf course and (3) show via multivariate logistic regression the relationship between these county-level variables and the presence of at least one disc golf course for US counties and by rural-urban distinction (N = 3,138). Results and findings Disc golf courses exist throughout the US, but are prevalent in the upper Midwest, the mid-Atlantic I-95 corridor, the Pacific Coast and New England. A greater proportion of urban counties have disc golf courses than rural counties. Counties are more likely to have a disc golf course as poverty and the percent of black residents decrease and as educational attainment and percent of residents under age 25 increase. However, when looking only at urban counties, the relationship between poverty and disc golf availability reverses – poverty is positively associated with the presence of a disc golf course. Healthier counties are associated with a higher likelihood of disc golf presence but do little to improve model fit. Implications The findings provide evidence in favor of both sides of an ongoing empirical debate about racial and socioeconomic inequities in access to recreational resources. At the national level, the findings support the many studies showing that poorer, black communities tend to have fewer activity-supportive resources than richer, white communities. However, the results also partially support several urban-based studies that have refuted these relationships. While contributing to this important debate, we also argue that disc golf courses can be creatively built in areas with fewer financial resources, thereby lessoning the inequities in access to health-benefiting public recreation.

What explains differences in waiting times for health care across socioeconomic status?

In publicly funded health systems, waiting times act as a rationing mechanism that should be based on need rather than socioeconomic status. However, several studies suggest that individuals with higher socioeconomic status wait less. Using individual-level data from administrative registers, we estimate and explain socioeconomic inequalities in access to publicly funded care for seven planned hospital procedures in Denmark. For each procedure, we first estimate the association between patients' waiting time for health care and their socioeconomic status as measured by income and education, controlling for patient severity. Then, we investigate how much of the association remains after controlling for (i) other individual characteristics (patients' family status, labor market status, and country of origin) that may be correlated with income and education, (ii) possible selection due to patients' use of a waiting time guarantee, and (iii) hospital factors which allow us to disentangle whether inequalities in waiting times arise across hospitals or within the hospital. Only for a few procedures, we find inequalities in waiting times related to income and education. These inequalities can be explained mostly by geographical and institutional factors across hospitals. But we also find inequalities for some procedures in relation to non-Western immigrants within hospitals.

Centralization of care in high volume hospitals and inequalities in access to care.

In 2018, the French National Health Insurance proposed to increase the minimum volume threshold for breast cancer and to set a specific threshold for ovarian cancer in order to get an authorization to treat these patients. Using an exhaustive nationwide data set, the aim of this study is to evaluate the impact of the application of minimum volume thresholds for breast cancer and ovarian cancer in France on socioeconomic and spatial inequalities in patient access to care, taking into account patient preferences for their preferred provider. Our findings indicate that it would increase spatial inequalities and introduce socioeconomic inequalities in access to specialized care in terms of travel distance and will contribute to the medical desertification in rural areas that already have less access to non-specialized care. Our results underline that ignoring patient preferences when assessing the impact of such policies drastically underestimate the deterioration in patient access to care.

Access to drinking water in sub-Saharan Africa: does the developmental state doctrine matter?

Using data from 14 sub-Saharan African countries, this study investigates the relevance of the developmental state doctrine to enhancing access to improved drinking water sources and to reducing urban–rural inequalities in access to improved sources and piped-on premises. Although access to improved water sources and urban–rural inequality seems better in developmental states than in non-developmental states, we have not found sufficient support for the claim that the developmental state approach is the best alternative. The influence of corruption is, unexpectedly, higher in developmental states than in non-developmental states. Moreover, both developmental states and non-developmental states were not significantly investing in access to drinking water supply programs. We find that the total population growth rate is the strongest predictor, rather than regime type. Other factors that explain the variation between all samples of developmental states and non-developmental states are identified and discussed, and implications are outlined. Points for practitioners There is significant variation in access to improved drinking water sources and urban–rural inequalities in access to improved sources and piped-on premises between developmental states and non-developmental states. The relevance of the developmental state doctrine to improving access to drinking water, reducing socio-economic inequalities in access to drinking water, and realizing Sustainable Development Goal targets in sub-Saharan Africa is ambiguous. We advise strengthening a functional Weberian bureaucracy and promoting political decentralization.

How COVID-19 has exposed inequalities in the UK food system: the case of UK food and poverty

This article draws upon our perspective as academic-practitioners working in the fields of food insecurity, food systems, and inequality to comment, in the early stages of the pandemic and associated lockdown, on the empirical and ethical implications of COVID-19 for socio-economic inequalities in access to food in the UK. The COVID-19 pandemic has sharpened the profound insecurity of large segments of the UK population, an insecurity itself the product of a decade of “austerity” policies. Increased unemployment, reduced hours, and enforced self-isolation for multiple vulnerable groups is likely to lead to an increase in UK food insecurity, exacerbating diet-related health inequalities. The social and economic crisis associated with the pandemic has exposed the fragility of the system of food charity which, at present, is a key response to growing poverty. A vulnerable food system, with just-in-time supply chains, has been challenged by stockpiling. Resultant food supply issues at food banks, alongside rapidly increasing demand and reduced volunteer numbers, has undermined many food charities, especially independent food banks. In the light of this analysis, we make a series of recommendations. We call for an immediate end to the five week wait for Universal Credit and cash grants for low income households. We ask central and local government to recognise that many food aid providers are already at capacity and unable to adopt additional responsibilities. The government's – significant – response to the economic crisis associated with COVID-19 has underscored a key principle: it is the government's responsibility to protect population health, to guarantee household incomes, and to safeguard the economy. Millions of households were in poverty before the pandemic, and millions more will be so unless the government continues to protect household incomes through policy change.

How COVID-19 has exposed inequalities in the UK food system: The case of UK food and poverty

This article draws upon our perspective as academic-practitioners working in the fields of food insecurity, food systems, and inequality to comment, in the early stages of the pandemic and associated lockdown, on the empirical and ethical implications of COVID-19 for socio-economic inequalities in access to food in the UK. The COVID-19 pandemic has sharpened the profound insecurity of large segments of the UK population, an insecurity itself the product of a decade of ‘austerity’ policies. Increased unemployment, reduced hours, and enforced self-isolation for multiple vulnerable groups is likely to lead to an increase in UK food insecurity, exacerbating diet-related health inequalities. The social and economic crisis associated with the pandemic has exposed the fragility of the system of food charity which, at present, is a key response to growing poverty. A vulnerable food system, with just-in-time supply chains, has been challenged by stockpiling. Resultant food supply issues at food banks, alongside rapidly increasing demand and reduced volunteer numbers, has undermined many food charities, especially independent food banks. In the light of this analysis, we make a series of recommendations. We call for an immediate end to the five week wait for Universal Credit and cash grants for low income households. We ask central and local government to recognise that many food aid providers are already at capacity and unable to adopt additional responsibilities. The government’s - significant - response to the economic crisis associated with COVID-19 has underscored a key principle: it is the government’s responsibility to protect population health, to guarantee household incomes, and to safeguard the economy. Millions of households were in poverty before the pandemic, and millions more will be so unless the government continues to protect household incomes through policy change.

Utilization of Integrated Child Development Services in India: Programmatic Insights from National Family Health Survey, 2016.

The Integrated Child Development Services (ICDS) program launched in India in 1975 is one of the world’s largest flagship programs that aims to improve early childhood care and development via a range of healthcare, nutrition and early education services. The key to success of ICDS is in finding solutions to the historical challenges of geographic and socioeconomic inequalities in access to various services under this umbrella scheme. Using birth history data from the National Family Health Survey (Demographic and Health Survey), 2015–2016, this study presents (a) socioeconomic patterning in service uptake across rural and urban India, and (b) continuum in service utilization at three points (i.e., by mothers during pregnancy, by mothers while breastfeeding and by children aged 0–72 months) in India. We used an intersectional approach and ran a series multilevel logistic regression (random effects) models to understand patterning in utilization among mothers across socioeconomic groups. We also computed the area under the receiver operating characteristic curve (ROC-AUC) based on a logistic regression model to examine concordance between service utilization across three different points. The service utilization (any service) by mothers during pregnancy was about 20 percentage points higher for rural areas (60.5 percent; 95% CI: 60.3; 30.7) than urban areas (38.8 percent; 95% CI: 38.4; 39.1). We also found a lower uptake of services related to health and nutrition education during pregnancy (41.9 percent in rural) and early childcare (preschool) (42.4 percent). One in every two mother–child pairs did not avail any benefits from ICDS in urban areas. Estimates from random effects model revealed higher odds of utilization among schedule caste mothers from middle-class households in rural households. AUC estimates suggested a high concordance between service utilization by mothers and their children (AUC: 0.79 in rural; 0.84 in urban) implying a higher likelihood of continuum if service utilization commences at pregnancy.