Systemic Inequalities Research Articles

Social, cultural and political conditions for advancing health equity: examples from eight country case studies (2011–2021)

Progress in addressing systematic health inequities, both between and within countries, has been slow. However, there are examples of actions taken on social determinants of health and policy changes aimed...

“Our American Optimism”: Race, Recognition, and Belonging in Claudia Rankine’s Don’t Let Me Be Lonely: An American Lyric

This paper explores Claudia Rankine’s representation of the feelings of racialisation in her 2004 poetry collection Don’t Let Me Be Lonely: An American Lyric. Contextualising this work within wider debates in Afropessimist philosophy, it considers how the poet’s portrayal of emotional pain, depression, and numbness exemplify a form of ‘social death’ instigated by the ubiquitous violence of antiblackness. Through close readings of select sequences, it argues that Rankine frames death as an ongoing structure of African American experience, rather than a singular event. In turn, this paper also considers how her innovative and hybrid “American Lyric” form functions to create a new grammar for Black self-expression in an ostensibly ‘post-race’ culture that obfuscates contemporary systems of racial inequality. It argues that Rankine’s collection cultivates an ethics of attention to the experiences and pain of others, offering poetry as a form of “exhausted hope” to challenge the dehumanising force of White supremacy.

Education as oppression

In assessing leverage points to promote educational equality, this paper examines Freire’s concept of education as oppression to highlight the potential of reclaiming resources currently dedicated to oppressive education. Harel Ben-Shahar’s concepts of education as a positional good as well as the potential lack of instrumental value in contributing to students’ social, health, relational, and other holistic aspects of wellbeing are mobilized to disentangle varying forms of education. Practitioner experience with students living with disabilities in a postcolonial global south establishes the foundational context to consider how education has capacity to challenge the following: economic domination; restraint on traditional Indigenous knowledge; limited basic livelihood; and media stereotypes on effort committed by the marginalized—yet often chooses not to. Disentangling what precisely constitutes education as oppression emerges as a challenging task, since Freire’s conceptualization of conformity is often required of students if they wish to meet essential survival needs. Lisu case studies in rural agricultural economies, traditional ecological knowledge, and postcolonial curriculum demonstrate that education as oppression can emerge naturally with or without intent, and that education mobilized to gatekeep social resources or justify the inequitable distribution of life opportunities can reinforce existing systematic inequalities. Notably, resources and opportunities in disadvantaged communities can already be stratified by preexisting racist; sexist; ableist; classist; or colonial discrimination, and suggest that the intersection between education and basic survival of students should not be viewed as too tangential or basic for future policy discourse. Four forms of education as oppression are preliminarily considered, toward supporting future discourse on eliminating inadvertent oppressive impacts via funded pedagogy.

Putting People First in Data Quality: Feminist Data Ethics for Open Government Datasets

ABSTRACTOpen government information systems offer great potential for advancing civic life and democracy, but they also reflect and reinforce the biases and systematic inequalities faced by members of socially marginalized groups. We present results from a critical data modeling project that uses a data quality framework to examine open datasets published by police departments in order to understand how data modeling choices shape the social impact of these datasets. Using an arrest record dataset published by the Los Angeles Police Department as a case study, we present we present results detailing the representation of racial data and the presence of children in the dataset. We argue that current data quality frameworks for open government data are insufficient for critical data studies due to an orientation around institutional and computational interests. Incorporating feminist data ethics into data quality analysis provides an approach to data quality that centers people and communities. We propose a definition for data quality of open government datasets based on an ethics of care that centers the needs of vulnerable populations and accountability of institutions toward their communities.

Ethnoracial disparities in childhood growth trajectories in Brazil: a longitudinal nationwide study of four million children

Growth is an important marker of child health and development. It is related to aspects such as social-economic conditions, being affected by social inequalities. Race is a social construct that functions as an essential tool of racism. It creates social hierarchy, resulting in segregation, different quality and access to health care, and unequal distributions of social determinants on health. Understanding the effects of ethno-racial inequalities on growth trajectories is essential to improve children development and well-being. In the study we investigated child growth according to maternal ethno-racial group using a nationwide Brazilian database. Data were obtained via linkage of the CIDACS Birth Cohort and the Brazilian Food the Nutrition Surveillance System. It included 4,090,271 children under 5 years old, born at term, followed-up between 2008 and 2017. We used mixed-effects model to estimate both original and standardized forms of length/height and weight trajectories. Results pointed out to growth differences among the racial groups, concerning both markers. Children born to Indigenous mothers presented the most critical situation, followed by those born to Parda, Asian-descent, and Black mothers. The strengthening of policies aimed at protecting Indigenous children should be urgently undertaken to address systematic ethno-racial health inequalities. Additionally, these findings may help policymakers to achieve the United Nation’s 2030 Sustainable Development Goals (eradication of hunger and all forms of malnutrition).

Resilient Self-Triggered Model Predictive Control of Cyber-Physical Systems Under Two-Channel False Data Injection Attacks

Abstract This paper presents a novel resilient self-triggered model predictive control (ST-MPC) method to alleviate potential threats of false data injection (FDI) attacks on cyber-physical systems (CPSs). First, considering that the data transmitted via the sensor-to-controller (S–C) and controller-to-actuator (C–A) channels in CPS may be tampered with by FDI attacks, a novel input reconstruction strategy combined with the ST-MPC mechanism is proposed to alleviate the threats of FDI attacks while reducing the computational and communication resources, in which key optimal control signals are selected and protected based on systematic performance inequalities. Correspondingly, a resilient ST-MPC algorithm combined with the dual-mode strategy is further proposed. Moreover, the iterative feasibility and the closed-loop stability are strictly demonstrated. Finally, the effectiveness of the proposed strategy is verified via a simulation study.

Critical geographies of disaster, and the geographical imagination

This paper combines assemblage theory, feminist ethics of care and decolonial theory to build on recent work in disaster studies that seeks to address the systematic and intersectional inequalities that underlie the emergence of disaster. We argue that Western logics of “risk” do not always have traction with communities, and so researchers must “stay with the trouble” in engaging with tensions between lifeworlds. We suggest that geographical imaginaries provide a means to analyze the diverse ways of being and knowing that are involved in this process.

Unbiased care, unequal outcomes: a nursing telehealth intervention reveals systematic inequities in COVID-19 care delivery

BackgroundThe Covid Connected Care Center (C4), a low-barrier telephone nurse hotline, was developed at an academic medical center to increase access to healthcare information and services across the state of Oregon, including to those without a usual source of care. Other studies have demonstrated that telephone triage services can positively influence health behaviors, but it is not known how this effect is maintained across racial/ethnic groups. The objective of this study was to show that the C4 reached throughout the state of Oregon, was valuable to callers, and that recommendations given affected callers’ subsequent health-related behaviors.MethodsThis mixed-methods study, informed by the RE-AIM (Reach, Effectiveness, Addoption, Implementation and Maintenance) framework, assessed caller demographics and clinical care from March 30 2020 until September 8, 2021. Descriptive statistics, multivariable risk models and Zou’s modified Poisson modeling were applied to electronic health record and call system data; An inductive approach was used for patient and staff experience surveys and semi-structured interviews. Approval was obtained from the OHSU Institutional Review Board (Study 00021413).Results145,537 telephone calls and 92,100 text-based contacts (61% and 39%, respectively) were included. Callers tended to not have a usual source of primary care and utilized recommended services. Emergency department utilization was minimal (1.5%). Racial or ethnic disparities were not detected in the recommendations, but Black (RR 0.92, CI 0.86–0.98) and Multiracial (RR 0.90 CI 0.81–0.99) callers were less likely than non-Hispanic white callers to receive a COVID-19 test. Participants in the post-call survey (n = 50) would recommend this service to friends or family. Interviews with callers (n = 9) revealed this was because they valued assistance translating general recommendations into a personalized care plan. C4 staff interviewed (n = 9) valued the opportunity to serve the public. The C4 was a trusted resource to the public and reached the intended audiences. However, disparities in access to COVID-19 testing persisted.ConclusionsNursing triage hotlines can guide caller behavior and be an effective part of a robust public health information infrastructure.

Illustrating and Enacting a Critical Quantitative Approach to Measurement with MIMIC Models

Quantitative methodology and the field of measurement have racist, sexist, and eugenicist histories. These histories have led many to abandon quantitative methods, believing that achieving equity is not possible with methods developed to propagate oppression. However, more critical and emerging scholarship has begun to articulate a Critical Quantitative (CQ) perspective. This paper aims to move beyond the critique of quantitative methods and to consolidate this emerging CQ literature, by articulating specific applications and enactments of a CQ framework. To do so, this paper articulates five guiding principles (i.e., foundation, goals, parity, subjectivity, and self-reflexivity) and details how CQ can address racism and inequity. We then use two examples to illustrate how CQ researchers can use MIMIC models to identify and mitigate racist uses of measurements. Finally, we note that while CQ can help scholars identify and mitigate how racism permeates measurement, this is not the same as directly intervening on the interlocking systems of inequality that perpetuate racism, anti-Blackness, and other forms of oppression that constrain humanity and opportunity.

Forbidden Conversations: A Comprehensive Exploration of Taboos in Sexual and Reproductive Health.

This scoping review aims to comprehensively explore the landscape of taboos and their impact on sexual and reproductive health. Titled "Forbidden Conversations," it delves into the intricate web of societal, cultural, and religious norms that have contributed to the elusive and often stigmatized nature of sexual and reproductive health topics. The review navigates through the multifaceted dimensions of these taboos, shedding light on their impact on individuals, communities, and public health while advocating for a paradigm shift toward open, inclusive, and informed dialogue. The analysis within this review spans a decade, capturing the most recent and relevant literature to map the landscape of taboos in sexual and reproductive health. It explores the persistent societal apprehensions and subsequent stigmatization surrounding topics such as menstruation, contraception, fertility, sexual orientation, and gender identity. The review contextualizes the multifaceted challenges presented by these prevailing norms by tracing historically rooted taboos and their evolution across different cultures and contexts. The scoping review identifies the profound implications of these taboos on public health, highlighting how they contribute to disparities in access to healthcare, perpetuate misinformation, and infringe upon the fundamental rights of individuals. It addresses the challenges in sexual education, emphasizing how these taboos impede comprehensive understanding and enforcement of sexual and reproductive health rights among adolescents and young adults. The intersectional approach taken in this review situates these taboos within broader systems of inequality, emphasizing the compounded impact they have on marginalized populations. Through this comprehensive exploration, the review aims to provide actionable insights and identify existing research, policy, and practice gaps. It seeks to lay the foundation for future initiatives that advocate for destigmatization, empowerment, and equity in sexual and reproductive health. Ultimately, "Forbidden Conversations" aims to steer the conversation toward openness and inclusivity while advocating for unbiased, comprehensive sexual and reproductive healthcare with dignity for all individuals.

Secularity and Muslim-Christian Relations in Uganda

Abstract The article reconstructs aspects of the secularizing project of the British colonial administration in Uganda by exploring how state regulatory practices in the field of Western school education set the conditions for two forms of religious difference: first, relations between Muslims as members of a religious minority and the Christian majority, and second, dynamics among Muslims that transpired not only in leadership competition but also in controversies over education and proper religious practice. Focusing on the intersections between a state regulatory regime and the activities of Muslims who claimed religious and political leadership on behalf of other Muslims in the areas of Buganda and Bugisu, the article argues that these Muslim intellectuals mediated and contributed to the colonial administration’s production of Muslims as a religious minority. As articulators of Islam, they (re)formulated and debated the forms and purpose of Muslim education and partly novel understandings of proper religious practice, and what it means to be a modern, pious Muslim in the new colonial order. Their political aspirations were hampered, not only as a direct consequence of the colonial administration’s production of systematic inequalities between Christians and Muslims, but also as a result of the dynamics of intra-Muslim plurality.

Toward a Sociological Perspective on the Gender and Sexuality of Friendship

ABSTRACTThis article reviews friendship research to offer a conceptual framework that helps us better understand the co‐constructive nature of gender, sexuality, and friendship in the United States. Scholarship across psychology and sociology considers friendship experiences, friendship processes, friendship patterns, friendship schemas, and the social implications of friendship. Psychological research identifies that friendship experiences and friendships processes differ by gender and explores the social implications for individuals. While sociology has dedicated less attention to friendship, this perspective offers insights on the social construction and structural basis of friendship. Sociological perspectives reveal how friendship schemas—based in amatonormativity, heteronormativity, and gender essentialism—shape friendship experiences, friendship processes, and friendship patterns in gendered ways. In addition, sociological research examines the social implications of friendship at both individual and institutional levels, documenting friendship's roles in systems of inequality. Thus, I argue that a sociological perspective is necessary to fully grasp how societies in general and cultural understandings of gender and sexuality in particular, shape and are shaped by friendships.

The Politics of Menstruation

Menstrual blood is still regarded as embarrassing and taboo in many places all over the world. This article focuses on the study of the Red Tent as an example of feminist-spiritual menstrual activism established in 2007 in the US because it represents an important form of breaking the menstrual taboo. Although contemporary spiritualities present themselves as nonhierarchical and gender equal, spirituality and well-being in the women's circles is predominantly practiced by cisgender, heterosexual, and white middle-class women, excluding lesbian, gay, bisexual, transgender, queer/questioning, and others (LGBTQ+). Constructs around the sacredness of female experiences (menstruation, menopause) are problematic for transgender women who do not share these experiences, and a lack of diversity may perpetuate systematic inequities and discrimination. This article discusses whether the Red Tent in Slovenia is open to include transgender and nonbinary people. By creating alternative domains of representation in which nonnormative bodies can exist, we disrupt the sex/gender system and dismantle normative femininity and masculinity. The article argues that in this way the Red Tent has the potential to subvert the dominant ideology of gender binary construction by providing alternative models for the embodiment of gender to challenge traditional conservative gender essentialisms in society. The methodology employed consists of ethnographic fieldwork, which was performed in the Red Tent gatherings and semistructured in-depth interviews with participants who host or participate in them. Because a part of the scope of the research “lives” in the cyber world, the ethnographic research methodology was integrated with the phenomena and data obtained from the internet in the form of netnography.

Unequal exchange of labour in the world economy

Researchers have argued that wealthy nations rely on a large net appropriation of labour and resources from the rest of the world through unequal exchange in international trade and global commodity chains. Here we assess this empirically by measuring flows of embodied labour in the world economy from 1995–2021, accounting for skill levels, sectors and wages. We find that, in 2021, the economies of the global North net-appropriated 826 billion hours of embodied labour from the global South, across all skill levels and sectors. The wage value of this net-appropriated labour was equivalent to €16.9 trillion in Northern prices, accounting for skill level. This appropriation roughly doubles the labour that is available for Northern consumption but drains the South of productive capacity that could be used instead for local human needs and development. Unequal exchange is understood to be driven in part by systematic wage inequalities. We find Southern wages are 87–95% lower than Northern wages for work of equal skill. While Southern workers contribute 90% of the labour that powers the world economy, they receive only 21% of global income.

Doing Gender, Undoing Race: Token Processes For Women With Multiple Subordinate Identities

Through interviews with 29 Asian American women tech workers, this article demonstrates how cultural frameworks around race and gender shape identity salience and construct a token process for workers with multiple subordinate identities. This approach to tokenism better accounts for multiple systems of inequality affecting workers and demonstrate how certain identities are prioritized—and others neglected—through institutional interventions and cultural ideologies. It also provides an additional lens through which to interpret the emphasis on gender inequality within the high-tech industry: Whereas gender inequality is generally considered a critical step in achieving an equitable work environment, I consider how it is intentionally leveraged within organizations to divert from interventions toward establishing racial equality. Results suggest serious barriers preventing the high-tech industry from reckoning with racial inequality for Asian American women workers; more broadly, they hint at how other racial groups with white-adjacent privileges are similarly exploited to uphold the high-tech industry’s white racial project.

A performative critical management studies: Developing a critical management pedagogy as intellectual activism praxis

In this paper, I take Contu’s call for a performative turn in critical management studies into my teaching as a form of intellectual activism praxis. I problematise management learning and education in regard to perpetuating inequalities, and offer a critical management pedagogy as a form of intellectual activism praxis to help infuse management education with a critical and socially conscience awareness. This paper is a reflexive account of the development of my critical management pedagogy and an analytical discussion weaving together the practice of a critical management education with intellectual activism. I argue that business schools need to question the relationship between neoliberal capitalism and our global epoch of crisis and uncertainty, and that as management educators we must consider how we might inform this relationship. In our teaching, we are often complicit in practices and institutions that reproduce economic and environmental exploitation, white supremacy, heteronormativity and colonial and patriarchal relations. Inspired by Freire’s critical pedagogy, I developed a critical management module to try engage students’ critical and social conscience by providing them with a space to think critically about the social, political and economic phenomena that shape individuals and societies, and the tools to engage in new ways of thinking to challenge systematic inequalities. This paper contributes insight into the context and praxis of developing and delivering this module.

Health markers, depressive symptoms, and community deprivation in a type 2 diabetes multidisciplinary care clinic for youth

IntroductionType 2 diabetes disproportionately affects non-Hispanic/Latino Black and Hispanic/Latino youth. The purpose of this study was to examine whether differences in metabolic risk factors and depressive symptoms exist by race/ethnicity and socioeconomic deprivation and whether these impact clinic attendance and health markers over 1 year in a multidisciplinary type 2 diabetes clinic for youth.MethodsThis study was a retrospective chart review of 54 youth with type 2 diabetes who had both an initial and follow-up visit. Demographic information, metabolic health markers [body mass index (BMI), hemoglobin A1C, liver enzymes, lipid panel, and urine microalbumin], depressive symptoms, and clinic attendance data were obtained from the medical record. Patient address was geocoded to the census tract level to calculate community socioeconomic deprivation.ResultsLiver enzymes (ALT and AST) were significantly higher in patients identifying as Hispanic/Latino (ALT M = 97.0 ± 40.6, AST M = 53.6 ± 21.4) and lowest in patients identifying as non-Hispanic/Latino Black (ALT M = 23.1 ± 11.3, F = 10.6 p < .001; AST M = 23.1 ± 11.4, F = 8.1; p < .001) at initial visit. From initial visit to follow-up, there were significant improvements in ALT (F = 13.43, p < .001), AST (F = 6.58, p < .05), and BMIz (F = 18.39, p < .001). Patients identifying as Black or Hispanic showed an increase in depressive symptoms over time, while patients identifying as non-Hispanic White showed a decrease (F = 11.08; p < .05). Unexpectedly, patients living in areas with higher socioeconomic deprivation showed a decrease in hemoglobin A1C over time, while patients living in lower socioeconomic deprivation showed an increase (F = 5.15, p < .05).ConclusionsDifferences exist in metabolic health parameters by race/ethnicity and by socioeconomic deprivation. Multidisciplinary care for youth with type 2 diabetes needs to consider and work to address the systems of inequity experienced by patients that drive disparities in health outcomes.

The psychology of precarity: A critical framework.

This article presents the rationale and a new critical framework for precarity, which reflects a psychosocial concept that links structural inequities with experiences of alienation, anomie, and uncertainty. Emerging from multiple disciplines, including anthropology, cultural studies, sociology, political science, and psychology, the concept of precarity provides a conceptual scaffolding for understanding the complex causes of precarious life circumstances while also seeking to identify how people react, adapt, and resist the forces that evoke such tenuous psychosocial experiences. We present a critical conceptual framework as a nonlinear heuristic that serves to identify and organize relevant elements of precarity in a presumably infinite number of contexts and applications. The framework identifies socio-political-economic contexts, material conditions, and psychological experiences as key elements of precarity. Another essential aspect of this framework is the delineation of interrelated and nonlinear responses to precarity, which include resistance, adaptation, and resignation. We then summarize selected implications of precarity for psychological interventions, vocational and organizational psychology, and explorations and advocacy about race, gender, and other systems of inequality. Future research directions, including optimal methodologies to study precarity, conclude the article. (PsycInfo Database Record (c) 2024 APA, all rights reserved).

Challenging anti-racism in nursing education: A moral and professional call to action

The call to implement anti-racism pedagogy in nursing education and practice is reverberating globally. Racist ideologies are foundational to systems of health inequity. An antiracist approach is critical to dismantling systemic racism and promoting optimal health outcomes in the quest for health equity. Therefore, employing an anti-racist pedagogy within nursing education that allows students and teachers to reflect on their roles in dismantling racist structures and transforming equity outcomes in practice and society, is a moral undertaking. However, for nursing education to make significant inroads in health equity, it cannot be guided by the same Eurocentric motives and value systems that continue to shape health inequities. We must transcend the boundaries of Eurocentric knowledge construction to intentionally shift how nurses think and practice within systems of inequities. Alongside the pressing and growing call for radical transformation of students and teachers through anti-racist pedagogy, we also provide directions to teaching strategies that support the uptake of anti-racism in nursing curricula and classroom engagement.

‘A storm is coming:' The New York Times coverage of the COVID-19 pandemic in American prisons

ABSTRACT In this research, we analyzed the content of 171 articles published between March and August 2020 in the New York Times (NYT) on COVID-19 in American correctional institutions. We observed that the NYT coverage decreased significantly over 6 months. Our analysis uncovered 8 themes within two broader frames: institutional and systemic inequity. Although the themes are not mutually exclusive, we argue that ‘Responding to COVID-19,’ ‘A storm is Coming,' ‘Collective Experience,' and ‘Critiquing Prison Conditions' are within the institutional framing. ‘Redefining Public Safety,' ‘Categorizing Prisoners,' ‘Doing Injustice,' and ‘Making it as a Celebrity' are the themes that highlight systemic inequity, systematic inequalities, and vulnerabilities of incarcerated people, especially minorities. Although this study is not a test of any theory, the themes are viewed via the lenses of conflict theory. Our analysis showed also that American prisons faced two simultaneous crises: mass incarceration and the COVID-19 pandemic, and that mass incarceration is not strictly a criminal justice problem, but also a public health issue. We found that the policies introduced during pandemic in the American correctional institutions were not only inadequate, but also revealed significant systemic inequalities.