Systemic Inequalities Research Articles

Web of Science and Scopus are not global databases of knowledge

Both Web of Science and Scopus are critical components of our research ecosystem, providing the basis for university and global rankings, as well as for bibliometric research. However, both are structurally biased against research produced in non-western countries, non-English language research, and research from the arts, humanities and social sciences. This viewpoint emphasises the damage that these systematic inequities pose upon our global knowledge production systems, and the need to research funders to unite to form a more globally-representative, non-profit, community-controlled infrastructure for our global research knowledge pool.

Women, academic leadership and the ‘constricting’ gender equity policies in Nigerian universities: an integrated feminist approach

ABSTRACT Concerted efforts to transform gender cultures within Nigerian universities have introduced formal strategies aimed at reinforcing gender equity principles and practice. This is evidenced through the creation of gender centres and the adoption of gender equity policies in some Nigerian universities. However, existing literature reveals that despite these formal measures, gender imbalance in academic leadership is still prevalent. This paper seeks to investigate why gender equity policies in Nigerian universities have failed to gain traction, especially for advancing women to academic leadership positions. Using documentary data gathered from purposively selected universities in Nigeria, this paper unveils the various ways in which the content and enactment of institutional gender policies are gendered and potentially reinforce systems of inequality. Informed by a Feminist Institutionalism and Feminist Policy Analysis framework, I analyse gender policy documents and identify areas of silence, women’s exclusion, and how male dominance is perpetuated in the policy.

The development of gendered health-related support dynamics over the course of a marriage

ABSTRACT For married adults with chronic illnesses or functional limitations, informal support from a spouse is often essential for their well-being, but support around health issues is not confined to later life. Attention to processes of support throughout the entire intimate relationship can provide insight into support dynamics in later life. Additionally, health-related support from a spouse tends to be gendered with women providing more support. Our analysis of relationship timeline interviews with 23 older adult couples demonstrates that these gendered support dynamics develop and are sustained throughout a marriage. We identify three patterns of support: (1) acknowledged gender inequality in support in which women readily provided support when their husbands had health issues but men provided support less consistently for their wives‘ health issues throughout the relationship; (2) mutual support in which both spouses provided support for the other whenever there were health needs; and (3) independence, in which men and women provided relatively little support to one another, viewing each other as responsible for their own health and well-being. These support patterns are established early within marriages and continue as health issues intensify. These patterns of spousal support are linked to broader systems of gender inequality and societal messages about gender. Our study moves away from conceptualizations of support provisions around health issues as only being situated in later life. We instead show how dynamics of support are developed and normalized throughout a marriage and suggest that spousal support studies should take into account long-term marital dynamics.

Global English: From “Tyrannosaurus Rex” to “Red Herring”

The rise of English as the world’s main international language has prompted a social justice agenda underpinned by an assumption that English causes or exacerbates inequality and injustice in the world. In this position statement, I set out to problematise and complexify this assumption, suggesting that English is neither a “Tyrannosaurus Rex”, a “Cuckoo” nor a “Lingua Frankensteinia”, but a “Red Herring”, distracting attention away from the underlying causes of inequality. Within the theoretical framework of “verbal hygiene” (Cameron 1995, 2012a), and drawing on my own empirical work and that of others, I argue for widening the scope of global English and more broadly applied linguistics. I suggest that as socially committed applied linguists, we stand a better chance of solving “real-world problems” (Brumfit 1995: 27) if greater attention is accorded to systems of inequality that are not obviously language-based. I will suggest that a too narrow focus on linguistic injustice risks losing sight of the underlying non-linguistic conditions that produce this injustice. I conclude by suggesting some ways forward that centre on co-thinking language with political, social, economic, cultural and material conditions.

Struggles for a Dignified Life: A Documentation of Invisible Resistance of Kuchbandhiya Community in Bundelkhand Region of Uttar Pradesh

Dalits are mostly seen as a homogeneous category, but the inherent heterogeneity cannot be ignored. Numerous influential constructions of Dalit social and political identity are now emerging and widely circulating in very prominent ways within the public sphere in North India. Dalit assertion in North India, especially in the state of Uttar Pradesh, has become very visible. The Dalit communities are trying to recreate their cultural history and identity. This is true, however, for only a few visible Dalit communities such as Chamar, Dhobi, Jatav, Kori and Pasi. A large section of marginalized communities are left behind. They are suffering from vertical and horizontal marginality, added by regional impediments. These communities are overshadowed by visible and politically strong castes. In Bundelkhand region, there are a few voiceless, powerless and under-represented communities. One such community is the Kuchbandhiya Kanjar. It is a sub-caste of Kanjar. It is essentially nomadic in nature and belongs to the state category of scheduled caste (SC). They do not have a voice to claim their identity. Thus they lack the strength needed to get rid of their invisibility. Our social system makes weak communities who are victims of systematic inequality, in which they are denied opportunities, choices, freedom and dignity. In this research article, I try to highlight why they do not have aspirations and dissent. Why they have no voice in the democratic system? Which process or trajectory has pushed them to the periphery and made them mute? Is there any possibility of their emergence as a counter public?

1.D. Workshop: Food and water insecurities in a warming climate: What role for Public Health?

Abstract Food and water are fundamental environmental health determinants. They are necessities of life, such that shortfalls in ready access in sufficient quality and quantity precipitate poor health, failure to thrive, susceptibility to disease, and if not rectified, ultimately lead to death. Archeological and historical records testify that large scale interruptions to food and water supplies trigger widespread social upheaval and when driven by systematic inequities in distribution, can overthrow governments. The desperation to secure survival is deep-seated. Competition for scarce resources, mass migration and conflict further generate environmental damage, disruptions to social cohesion, and can also herald novel challenges to health and wellbeing. Climate change is accelerating and with it, increasing intensity of extreme events such as heatwaves, droughts, fires, storms and floods. These interrupt food and water supplies and income generation. Unless transformative and rapid reductions in global greenhouse gas emissions can be achieved, and achieved promptly, the global population will be forced to confront escalation in shortfalls. Will wealthy nations accommodate the needs of the global disadvantaged? Exposure of agricultural sectors to climate extremes is already reversing gains made towards ending malnutrition and achieving SDG1: Reducing global hunger and malnutrition. Global water insecurity is also intensifying. A perfect storm is looming with accelerated global warming against a backdrop of rapid population growth and existing challenges in ensuring water and food security for all. The combination of lethal heat extremes and intensifying insecurities in these basic human needs threatens to make many homelands uninhabitable. Humanity is creating a Climate Change Emergency, which translates to a Global Public Health Emergency. It is thus incumbent upon the world's public health community to move beyond engagement in this climate change crisis. We must step up and take leadership to protect the health of all. Is the PPRR risk management model: Prevent, Prepare, Respond and Recover, the way forward? Workshop participants will have the opportunity to hear from a panel of three public health experts from the World Federation of Public Health Association to gain a deep understanding of the relationship pathways between climate change and these accelerating health threats. Recent global disasters events will illustrate the diversity and extent of this unfolding crisis. Examples of promising Public Health Response solutions will highlight what can be achieved by applying a coordinated public health lens. This interactive session elicits audience involvement through facilitated Question and Answer discussion. Following the panel presentations, the Q&A session will enable workshop participants to explore how better engagement of the public health sector can serve to help ameliorate the risks, and build resilience through Climate Change PPRR. Key messages Interruptions to food and water security generate disease, famine, conflict and in severe circumstances mass migration, disproportionately harming the global disadvantaged, and ultimately everyone. Climate change risks food & water security and thus threatens human wellbeing. Observed effects will dramatically escalate. The global public health community must engage to protect health.

Similarities and intersections – A comprehensive view in three studies

Abstract Background Various groups face difficulties in access to, and usage of health care. Research on marginalization in health care, and programs aiming to reduce inequalities usually focus on one single group at a time. Regarding the heterogeneity of groups defined by a few social characteristics, our aim was to question the specificity of barriers, and similarities between different groups. Methods The results of a mixed methods study focusing on elderly people with Turkish migration background were compared to the interim results of a qualitative study focusing on transgender persons, and the interim results of a qualitative study focusing persons with trauma related psychiatric diagnoses. Results 1) While relevant barriers in access to, and usage of health care seem to be group-specific at the first view, their underlying mechanisms of emergence are analogous. 2) Beside more obvious similarities, 3) further barriers arise by the combination of more than the mainly addressed characteristics of the different groups. Conclusions Barriers analogous or similar among different groups lead to underlying structural or professionality-related issues. If different dimensions of marginalization intersect, they may be disguised by a concentration on single characteristics. To target health inequalities on the long term, a closer look on similarities between groups facing health inequalities could improve the development of programs for a broader range of persons. Key messages The comparison of different marginalized groups is useful to identify and target systematic inequalities in health care. Researchers and stakeholders should consider mechanisms of multiple marginalization.

Capacity Building Together: Shifting Roles for Research and Implementation in Health Resilience Among American Indians in Arizona.

Community engagement has become a leading framework for supporting health equity. The process of engagement includes groups working together to continually identify and erode existing inequalities to promote a justice-oriented approach to health and wellness for all. Missing from the literature is a fine-grained study of processes that occur between and among project partners building the foundation for ongoing trust and reciprocity. Our project, Health Resilience among American Indians in Arizona, brought new and seasoned researchers together to collect and analyze data on healthcare provider knowledge and American Indian resilience. Four years after the conclusion of the project, central members of the team developed a postproject self-assessment to investigate lasting impacts of project participation using what we call an "Iterative Poly-knowledge Evaluation Cycle approach." Results highlight the value of flexibility of roles and organic change within projects, the importance of a focus on strengths rather than deficits, and the identification of lasting change on project team members at all levels to build and bolster multisectoral scaffolding for partnerships for health. We present this case study to contribute to an understanding of impacts of community-engaged, Indigenous research projects on people who work together toward challenging existing systems of inequality for better community health.

Figures of merit and statistics for detecting faulty species identification with DNA barcodes: A case study in Ramaria and related fungal genera.

DNA barcoding can identify biological species and provides an important tool in diverse applications, such as conserving species and identifying pathogens, among many others. If combined with statistical tests, DNA barcoding can focus taxonomic scrutiny onto anomalous species identifications based on morphological features. Accordingly, we put nonparametric tests into a taxonomic context to answer questions about our sequence dataset of the formal fungal barcode, the nuclear ribosomal internal transcribed spacer (ITS). For example, does DNA barcoding concur with annotated species identifications significantly better if expert taxonomists produced the annotations? Does species assignment improve significantly if sequences are restricted to lengths greater than 500 bp? Both questions require a figure of merit to measure of the accuracy of species identification, typically provided by the probability of correct identification (PCI). Many articles on DNA barcoding use variants of PCI to measure the accuracy of species identification, but do not provide the variants with names, and the absence of explicit names hinders the recognition that the different variants are not comparable from study to study. We provide four variant PCIs with a name and show that for fixed data they follow systematic inequalities. Despite custom, therefore, their comparison is at a minimum problematic. Some popular PCI variants are particularly vulnerable to errors in species annotation, insensitive to improvements in a barcoding pipeline, and unable to predict identification accuracy as a database grows, making them unsuitable for many purposes. Generally, the Fractional PCI has the best properties as a figure of merit for species identification. The fungal genus Ramaria provides unusual taxonomic difficulties. As a case study, it shows that a good taxonomic background can be combined with the pertinent summary statistics of molecular results to improve the identification of doubtful samples, linking both disciplines synergistically.

Disability Incidence Rates for Men and Women in 23 Countries: Evidence on Health Effects of Gender Inequality

Background: Inequality in gender varies across social contexts, which may influence the health of both men and women. Based on theories of gender as a social system, we examine whether systematic gender inequality at the macro level influences health of men and women in 23 countries. Methods: Using harmonized panel data from the Gateway to Global Aging Data in 23 high and middle income countries (N=168,873), we estimate disability incidence over a 16 year time period for men and women (2000–2016). We first investigate gender differences in age gradients of disability onset within each country or geographic region. We then pool data from all countries and test the hypothesis that gender inequality increases the risk of disability incidence for men and women. Results: We found substantial cross-country variation in disability incidence rates, and this variation is greater for women than for men. Among ages 65-69, disability incidence rates ranged from 0.4 to 5.0 for men and from 0.5 to 9.4 for women. Our within-country analysis showed significant gender differences in age gradients of disability incidence in the U.S., Korea, Southern Europe, Mexico, and China, but not in Northern, Central, and Eastern Europe, England and Israel. Testing hypothesized effects of gender inequality, we find that gender inequality is significantly associated with disability incidence for women, but not for men. Conclusions: Macro-level societal gender inequality is significantly associated with risk of disability onset for women. Reducing and eliminating gender inequality is crucial to achieving good health for women.

Hidden populations: Uncovering the developmental experiences of minoritized populations across contexts.

This introduction to the special section on hidden populations across contexts in developmental science defines what is meant by "hidden populations" and summarizes the studies along thematic lines. Hidden populations are generally minoritized populations embedded in larger systems of oppression and inequality encapsulated within historical time and place, and importantly, they are underrepresented in developmental science. The set of 8 empirical articles discusses how being "hidden" is contextualized and operationalized through explicit and implicit ways and uses multiple methodologies to elucidate the experiences of children, youth, and families. The collection of articles is grounded in developmental and sociocultural developmental theories highlighting important cultural and contextual developmental mechanisms that impact and promote the well-being of hidden populations. Thematically, the set of articles, implicitly and explicitly, addresses minoritization and its consequences as well as elucidates resilience through multiple processes at different levels. Together, the special section advances developmental science by diversifying the populations that are represented to understand normative and culturally and contextually dependent development. (PsycInfo Database Record (c) 2020 APA, all rights reserved).

Interrupting Microaggressions in Health Care Settings: A Guide for Teaching Medical Students.

IntroductionMicroaggressions are connected to broader conceptualizations of the impact of implicit bias and systems of inequity. The body of evidence supporting the need for more-open discussions in medical education about race, racism, and their impact on health disparities continues to grow. Some have advocated for the importance of bringing anti-racist pedagogy into medical education curricula, which involves explicitly attempting to move beyond people's comfort zones and acknowledging that discomfort can be a catalyst for growth. To discuss the intent and impact of microaggressions in health care settings and how we might go about responding to them, we developed a workshop for third-year undergraduate medical students within a longitudinal undergraduate medical education diversity and inclusion curriculum.MethodsThis workshop occurred during a regularly scheduled clerkship intersession during the 2016–2017 academic year for third-year undergraduate medical students (N = 154). Prior to the workshop, the students were asked to anonymously submit critical incident reports on any microaggressions experienced or witnessed to develop case studies for problem-based learning. Teaching modalities included lecture, problem-based learning with case studies, pair and share, and facilitated small- and large-group debriefs.ResultsThe session was evaluated using a 4-point Likert scale to assess students' comfort in learning about the information presented. Ninety-eight percent felt confident in identifying microaggressions, and 85% felt confident in interrupting microaggressions when they occur.DiscussionThis personalized workshop exposes students to microaggressions personally experienced by colleagues with an attempt to interrupt them using empathy, awareness, and communication techniques.

Spatial Creaming and Parking?: the Case of the UK Work Programme

Public policies are inherently spatial in nature yet their geographical dimensions remain frequently underdeveloped and marginalised in policy practice and scholarship. This paper reflects critically on these common spatial blind spots, using as its case study example the UK’s Work Programme employment support policy. Whilst social ‘creaming’ (i.e. deliberate prioritisation) and ‘parking’ (i.e. deliberate neglect) by providers of differently placed service users within public policies is widely acknowledged and researched, this paper introduces to the literature equivalent but neglected risks around spatial creaming and parking of differently positioned local areas. The paper’s framing identifies that the Work Programme’s particular treatment of place exposes areas to high risks of spatial creaming and parking. Building on these critical spatial foundations, the paper moves on to present sophisticated statistical analyses of official and comprehensive Work Programme data. These original analyses demonstrate systematic spatial inequality in outcomes and financial resource that are at the expense of already more deprived geographies and that are consistent with our spatial creaming and parking hypotheses. The paper highlights the need to consider more fully the role of place within public policy practice and scholarship.

1231-P: Type 2 Diabetes Care and Management: A Comparison of German and American Approaches

Within their multi-payer healthcare system, Germany has employed Disease Management Programs (“DMP”s) nationwide to manage T2D since 2002. Studies have suggested T2D financial burden reduction and improved health outcomes since DMP implementation. No such standardized programs exist in the fragmented U.S. healthcare-system. This study evaluated German and American primary care physicians’ opinions of efficacy of their nation’s respective T2D management methods in improving health outcomes, healthcare costs, and quality of care. German physicians reported consistent protocol and resource availability for T2D management, while American physicians’ responses varied widely by their clinical network and their patients’ insurers. Strengths of Germany’s T2D DMPs included lack of financial barrier to care and increased frequency of diabetic visits and patient accountability. Weaknesses included bureaucratic documentation and lack of customization. Strengths of American methods revolved around opportunity for innovation, resulting in increasing utilization of technological tools and motivational interviewing techniques. Weaknesses stemmed from systematic inequality of access, including lack of insurance-covered diabetes education, prohibitively high costs of medication, and lack of affordable preventive care. Despite these differences between German and American T2D care, both nations struggle with imperfect patient compliance and difficulty of achieving sustainable lifestyle changes. This study provides primary care physicians’ opinions on best directions forward for chronic disease management, particularly addressing these universal challenges. Recommendations included widespread insurance coverage of dieticians, intensive diabetes education courses, and mental health counselors, as well as increased use of team-based care, telemedicine and apps to improve patient accountability, and value-based reimbursement. Disclosure S. Dinegar: None. Funding Northwestern University

Patterns of Health-Related Gender Inequalities—A Cluster Analysis of 45 Countries

PurposeThe paper explores gender inequalities between 45 countries across 10 health indicators among adolescents and whether those differences in health correlate with gender inequality in general. MethodsData from 71,942 students aged 15 years from 45 countries who participated in the 2018 Health Behaviour in School-aged Children survey were analyzed. For this purpose, 10 indicators were selected, representing a broad spectrum of health outcomes. The gender differences in the countries were first presented using odds ratios. Countries with similar risk profiles were grouped together using cluster analyses. For each of the 10 indicators, the correlation with the Gender Inequality Index was examined. ResultsThe cluster analysis reveals systematic gender inequalities, as the countries can be divided into seven distinct groups with similar gender inequality patterns. For eight of the 10 health indicators, there is a negative correlation with the Gender Inequality Index: the greater the gender equality in a country, the higher the odds that girls feel fat, have low support from families, have low life satisfaction, have multiple health complaints, smoke, drink alcohol, feel school pressure, and are overweight compared with boys. Four indicators show a divergence: the higher the gender equality in a country in general, the larger the differences between boys and girls regarding life satisfaction, school pressure, multiple health complaints, and feeling fat. ConclusionsCountries that are geographically and historically linked are similar in terms of the health risks for boys and girls. The results challenge the assumption that greater gender equality is always associated with greater health equality.

Team Sports and Sexual Violence: Examining Perpetration by and Victimization of Adolescent Males and Females.

The authors examined whether team athletic involvement is related to sexual violence victimization and perpetration among male and female high school students. A secondary data analysis was conducted with Minnesota Student Survey data gathered from 122,501 Minnesota eighth-grade, ninth-grade, and 11th grade students. Multivariable logistic regression indicates that sport-involved youth are more likely to be involved in sexual violence than peers not involved in sports. For example, highly sport-involved males are significantly more likely to coerce a partner into sex (odds ratio [OR] = 1.35, 95% confidence interval [CI] = [1.01, 1.67]) and be coerced (OR = 1.19, 95% CI = [1.02, 1.38]) than nonsport peers. The results suggest high school sport programs could be an important site to implement comprehensive sexual violence prevention programs targeted at individual actions as well as harmful cultural norms and systematic inequities.

Treatment advantage in HBV/HIV coinfection compared to HBV monoinfection in a South African cohort

ObjectivesPrompted by international targets for elimination of hepatitis B virus (HBV), we set out to characterise individuals with HBV monoinfection vs. those coinfected with HBV/HIV, to evaluate the impact of therapy and to guide improvements in clinical care. MethodsWe report observational data from a real world cross-sectional cohort of 115 adults with chronic hepatitis B infection (CHB), at a university hospital in Cape Town, South Africa. HIV coinfection was present in 39 (34%) subjects. We recorded cross-sectional demographic, clinical and laboratory data. ResultsCompared to those with HIV coinfection, HBV monoinfected adults were less likely to be HBeAg-positive (p=0.01), less likely to have had assessment with elastography (p<0.0001), and less likely to be on antiviral treatment (p<0.0001); they were more likely to have detectable HBV viraemia (p=0.04), and more likely to have features of liver disease including moderate/severe thrombocytopaenia (p=0.007), elevated bilirubin (p=0.004), and elevated APRI score (p=0.02). Three cases of hepatocellular carcinoma all arose in HBV monoinfection. ConclusionsOur data demonstrate that individuals with HBV monoinfection may be disadvantaged compared to those with HIV coinfection, highlighting potential systematic inequities in referral, monitoring and treatment.

Sticking points: Sites for developing capacity to enact socially just instruction

Preparing preservice teachers (PSTs) to enact socially just instruction, especially in fieldwork contexts, remains a challenging, understudied goal addressed by this research. Analysis of data from two qualitative studies reveals how Daybook conversations served as pedagogical and discursive spaces that helped PSTs negotiate conflicts, or sticking points, which emerged in their fieldwork. Their rehearsals during these conversations enabled PSTs to create space for instructional experimentation to enact socially just instruction. The article offers possibilities for modeling with and for PSTs how their teaching can work to disrupt systems of inequity across relationships, diverse teaching contexts, and time.

Frontier finance: the role of microfinance in debt and violence in post-conflict Timor-Leste

Microfinance programs targeting poor women are considered a ‘prudent’ first step for international financial institutions seeking to rebuild post conflict economies. IFIs continue to visibly support microfinance despite evidence and growing consensus that microfinance neither reduces poverty nor breaks the cycle of domestic violence. In the case of Timor-Leste, a feminist political economy approach reveals how microfinance engendered debt allows for the control, extraction, and accumulation of profits and resources by an elite class and exacerbates gender-based violence. Timorese elite classes have benefitted from microfinance during the Indonesian occupation and in today’s post-conflict regime. Extractive debt relations between elite classes and ordinary citizens are enabled by a gender order that is regulated by brideprice and characterized by gendered circuits of violence. Brideprice weds the exchange of women to the class system in which the (violent) control of women is paramount to retaining political power. Microfinance adds liquidity and high interest rates to the debt relations of brideprice helping to create the very conditions for poor women’s disempowerment in a fragile state. Thus, the success of microfinance is predicated on systems of gender inequality and gendered circuits of violence, debt, and the exchange of women.

The Development of Student's Understanding of Self, Inequality, and Service during a Critical International Service Learning Program in the Dominican Republic

Since January 2018, my colleague and I have co-led a two-week, three-credit critical international service learning course to Santiago de Los Caballeros, Dominican Republic. Our course is designed to question and complicate students’ relationship to service through the use of intergroup dialogue pedagogy and theory. Intergroup dialogue (IGD) encourages students to understand one another across their social identities (e.g., race, gender, sexuality, ability, nationality, ability, etc.) by engaging in conversations around social issues and power that allow us to unpack our relationship to systems of oppression and inequality (Zúñiga 2003). My proposed research is focused on the 2020 iteration of this program and will look more closely at the impact on student learning to see how, if it all, students' ideas around identity, the nature of inequality, and the purpose of service shift throughout their experience abroad. Through analysis of student reflection journals and multiple interviews with participants, I hope to gain insight into this question. This research will add to the growing field of critical studies of international service learning by assessing whether or not our program and its pedagogy is able to undo oppressive ideologies and/or strengthen existing ideologies built on collective solidarity that our students carry regarding identity, inequality and service.