Unequal Outcomes Research Articles

The Muslim Gaze and the COVID-19 Syndemic

COVID-19 has replicated and intensified pre-existing health inequities by creating a vicious syndemic that brings together concurrent biological, psychosocial and structural epidemics with synergistic interactions that reinforce unequal outcomes. In the UK, the Muslim community has been disproportionately impacted by excess morbidity and mortality from COVID-19. This article uses a transdisplinary lens in the context of COVID-19 to analyse the role of Islamophobia as a fundamental driver of health inequities in Britain’s Muslim community. It highlights multilevel policy reforms and recommendations that centre community empowerment, social justice and cultural humility to close the gap and achieve justice and good health for all.

Going green and (un)equal ? Political coalitions, redistribution, and the environment

This paper presents a political economy model in which people express conflicting demands about equality and ecology, and coalitions emerge as political equilibria. We also examine the environmental and redistributive policies associated with such equilibria, the incentives for ecological transition, and the consequences for ex-post inequalities. For these purposes, we consider three socio-economic groups: the educated bourgeoisie (BE), the working class (CP), and the financial elite (EF). Specifically, we elaborate an original perspective on social groups’ preferences regarding environmental protection and capital-financed redistribution. Under the disjoint majority vote, this model delivers full capital protection, no redistribution, and no environmental policies. This is the best solution for the EF group. Consequently, a two-party coalition can be formed that improves the welfare of the BE and CP groups. Moreover, the coalitions’ equilibria deliver redistributive and environmental policies entailing higher incentives for the ecological transition and lower ex-post inequalities. Finally, in line with the rise of green finance, we investigate the surge of new alliances and highlight the risks of unequal ecological outcomes.

Reward type influences adults' rejections of inequality in a task designed for children.

In the context of economic games, adults sacrifice money to avoid unequal outcomes, showing so-called inequity aversion. Child-friendly adaptations of these games have shown that children, too, show inequity aversion. Moreover, inequity aversion shows a clear developmental trajectory, with young children rejecting only disadvantageously unequal distributions and older children rejecting both disadvantageously and advantageously unequal distributions. However, based on existing work, it is difficult to compare adult and child responses to inequity because (1) adapting economic games to make them child-friendly may importantly alter the dynamics of the fairness interaction and (2) adult work typically uses abstract rewards such as money while work with children typically uses more concrete rewards like candy, stickers or toys. Here we adapted the Inequity Game-a paradigm designed to study children's responses to inequality in isolation from other concerns-to test inequity aversion in adults (N = 104 pairs). We manipulated whether participants made decisions about concrete rewards (candy) or abstract rewards (tokens that could be traded in for money). We found that, like children, adults rejected unequal payoffs in this task. Additionally, we found that reward type mattered: adults rejected disadvantageous-but not advantageous-monetary distributions, yet rejected both disadvantageous and advantageous candy distributions. These findings allow us to draw clearer comparisons across child and adult responses to unfairness and help paint a fuller picture of inequity aversion in humans.

Do Community-level Disadvantages Account for Racial Disparities in the Safety of Spine Surgery? A Large Database Study Based on Medicare Claims.

Racial health disparities across orthopaedic surgery subspecialties, including spine surgery, are well established. However, the underlying causes of these disparities, particularly relating to social determinants of health, are not fully understood. (1) Is there a racial difference in 90-day mortality, readmission, and complication rates ("safety outcomes") among Medicare beneficiaries after spine surgery? (2) To what degree does the Centers for Disease Control and Prevention Social Vulnerability Index (SVI), a community-level marker of social determinants of health, account for racial disparities in safety outcomes? To examine racial differences in 90-day mortality, readmission, and complications after spine surgery, we retrospectively identified all 419,533 Medicare beneficiaries aged 65 or older who underwent inpatient spine surgery from 2015 to 2019; we excluded 181,588 patients with endstage renal disease or Social Security disability insurance entitlements, who were on Medicare HMO, or who had missing SVI data. Because of the nearly universal coverage of those age 65 or older, Medicare data offer a large cohort that is broadly generalizable, provides improved precision for relatively rare safety outcomes, and is free of confounding from differential insurance access across races. The Master Beneficiary Summary File includes enrollees' self-reported race based on a restrictive list of mutually exclusive options. Even though this does not fully capture the entirety of racial diversity, it is self-reported by patients. Identification of spine surgery was based on five Diagnosis Related Groups labeled "cervical fusion," "fusion, except cervical," "anterior-posterior combined fusion," "complex fusion," and "back or neck, except fusion." Although heterogeneous, these cohorts do not reflect inherently different biology that would lead us to expect differences in safety outcomes by race. We report specific types of complications that did and did not involve readmission. Although complications vary in severity, we report them as composite measures while being cognizant of the inherent limitations of making inferences based on aggregate measures. The SVI was chosen as the mediating variable because it aggregates important social determinants of health and has been shown to be a marker of high risk of poor public health response to external stressors. Patients were categorized into three groups based on a ranking of the four SVI themes: socioeconomic status, household composition, minority status and language, and housing and transportation. We report the "average race effects" among Black patients compared with White patients using nearest-neighbor Mahalanobis matching by age, gender, comorbidities, and spine surgery type. Mahalanobis matching provided the best balance among propensity-type matching methods. Before matching, Black patients in Medicare undergoing spine surgery were disproportionately younger with more comorbidities and were less likely to undergo cervical fusion. To estimate the contribution of the SVI on racial disparities in safety outcomes, we report the average race effect between models with and without the addition of the four SVI themes. After matching on age, gender, comorbidities, and spine surgery type, Black patients were on average more likely than White patients to be readmitted (difference of 1.5% [95% CI 0.9% to 2.1%]; p < 0.001) and have complications with (difference of 1.2% [95% CI 0.5% to 1.9%]; p = 0.002) or without readmission (difference of 3.6% [95% CI 2.9% to 4.3%]; p < 0.001). Adding the SVI to the model attenuated these differences, explaining 17% to 49% of the racial differences in safety, depending on the outcome. An observed higher rate of 90-day mortality among Black patients was explained entirely by matching using non-SVI patient demographics (difference of 0.00% [95% CI -0.3% to 0.3%]; p = 0.99). However, even after adjusting for the SVI, Black patients had more readmissions and complications. Social disadvantage explains up to nearly 50% of the disparities in safety outcomes between Black and White Medicare patients after spine surgery. This argument highlights an important contribution of socioeconomic circumstances and societal barriers to achieving equal outcomes. But even after accounting for the SVI, there remained persistently unequal safety outcomes among Black patients compared with White patients, suggesting that other unmeasured factors contribute to the disparities. This is consistent with evidence documenting Black patients' disadvantages within a system of seemingly equal access and resources. Research on racial health disparities in orthopaedics should account for the SVI to avoid suggesting that race causes any observed differences in complications among patients when other factors related to social deprivation are more likely to be determinative. Focused social policies aiming to rectify structural disadvantages faced by disadvantaged communities may lead to a meaningful reduction in racial health disparities. Level III, therapeutic study.

Predictors of Nonprofit Ethno-Racial Diversity: Examining Local Community Demographics and Political Ideology

Although the practitioner and the academic literatures both note the importance of ethno-racial diversity in the nonprofit sector, we pursue a better understanding of this sector’s ethno-racial diversity dynamics by exploring the drivers of ethno-racial diversity at multiple organizational hierarchy levels—boards of directors, executive staff teams, and full-time staff. Using data from nonprofit organizations participating in Candid’s Diversity, Equity, and Inclusion initiative, we find evidence that upward mobility for ethno-racial minority group members remains limited. Our findings also indicate a positive relationship between ethno-racial diversity in a nonprofit’s local community and ethno-racial diversity at each organizational hierarchy level. This relationship is partially mediated by the political liberalness of the local community, with the strongest mediating effects at the board of directors and executive staff organizational levels. This partial mediation suggests that the local environment’s tolerance of societal hierarchies and unequal outcomes may be related to nonprofit organizational diversity, equity, and inclusion efforts.

An Occupational Lens on Social Inequality

Social inequality, i.e., the unequal opportunities and outcomes based on social group membership, is one of the grand challenges of our time. The current literature on social inequality foregrounds organizational practices and structures that contribute to patterns of social inequality. Given that organizations distribute most of the economic and social resources in our society, this research has yielded important insights into the drivers of social inequality both within and beyond organizational boundaries. However, such studies have predominantly focused on patterns of vertical segregation of individuals across organizational ranks. This focus has distracted from patterns of horizontal segregation of individuals into different occupations and industries, based on their social group membership. In this symposium we seek to develop an occupational lens on social inequality by bringing together organization theorists whose work is exemplar of this new direction. This symposium, which is both timely and relevant, is grounded in recent empirical work. The experts will draw on their own research to discuss how an occupational lens can help us to better understand social inequality. In discussing patterns of intra- and inter-occupational dynamics of social inequality, we seek to generate insights from the rich studies that the panelists have conducted and elaborate on why and how an occupational lens can enrich our understanding of social inequality. The symposium should be immensely useful for researchers and practitioners looking to address social inequality within the workplace by not only focusing on broad patterns of social inequality across occupations but also by addressing some of the micro-dynamics of social inequality within the workplace. We hope that this symposium will provide a forum for discussion about an occupational lens on social inequality and provoke insights into future research direction.

The International Political Economy of the Middle-income Trap

Developing countries face uncertain trajectories for growth in the twenty-first century, with many finding themselves a ‘middle-income trap’. Extant theories in the politics of development that focus on domestic institutional strength and weakness represent necessary but not fully sufficient explanations for the trajectories of middle-income countries. In order to explain uncertain and uneven development outcomes in an era of heightened globalisation, this article seeks to explore the impact of international institutions, specifically the post-Cold War structures of trade and investment and global value chains, on the possibilities for growth for middle-income countries. The particular character of rules and norms defining trade and investment and the power dynamics behind their design suggest that international institutions as well as domestic factors explain disappointing and increasingly unequal development outcomes among middle-income countries.

Aboriginal Cultural Safety: A Case Study of Collaborative Practice at the Intersection of Family Violence and Child Protection

ABSTRACT There has been little research into what enables culturally safe collaboration between Aboriginal services and statutory child protection organisations, particularly when family violence is a concern. This article reports on a qualitative study that analysed working group data from practice between KWY Family Safety Services and the Department for Child Protection, South Australia, who came together to build culturally safe collaboration when working with Aboriginal families. The study found that when methods are put into place to deliberately make visible the power dynamics within this context, space for the development of meaningful collaboration with Aboriginal services become possible. However, open and regular communication to raise and work through issues of power as they arose was continually needed to ensure both agencies had the same information and decision making was shared. The implication for practice is that openness to work differently by statutory child protection was reinforced through respect for Aboriginal practice and strengths. IMPLICATIONS Collaboration between Aboriginal services and child protection organisations can be complex and challenging, especially due to the historical and continued discrimination experienced by Aboriginal people. Culturally safe collaboration is enabled through building sustainable relationships; shared understandings and accountability between agencies; redressing of unequal relationships, structures, and outcomes; and respect for Aboriginal ways of working.

Analysing the socio-economic impacts of COVID-19: a new regional geography or pandemic enhanced inequalities?

ABSTRACT In the UK the socio-economic impacts of the COVID-19 mitigations over the course of the pandemic (March 2020 to the time of writing in January 2022) have been experienced unevenly and with differential intensities at both the regional and local scales. Using individual-level geocoded data (from the Understanding Society: UK Household Longitudinal Survey COVID-19 study) linking people to the places in which they live, we consider the regional and local disparities in the risks and outcomes of financial hardship as a result of early stage mitigations. This paper provides direct evidence from the UK of a concentration of vulnerabilities in areas of high deprivation, undermining the capacity of individuals within those areas to shelter from economic shocks. Furthermore, the geography of financial hardship appears largely compositional – attributable to the pre-existing characteristics of individuals within regions and neighbourhoods, rather than being explicitly driven by the spatial contextual effect of their social or physical environments. This has implications for UK regional economic policy, and the Levelling Up agenda in particular. It is not the regions and neighbourhoods that give rise to COVID-19 hardship per se, but the concentration of individual disadvantages of the people living within them. The persistence of compositional dis/advantages means that there is a need not only to direct ameliorative packages to the individual but also to use local areas as places where the (regional) Levelling Up agenda can break long-term place trajectories that lock in existing disparities which in turn yield unequal financial opportunities and outcomes in periods of crisis.

Assessing research methodologies used to evaluate inequalities in end-of-life cancer care research: a scoping review protocol

IntroductionTo provide equitable cancer care at the end of life, it is essential to first understand the evidence underpinning the existence of unequal cancer outcomes. Study design, measurement and analytical...

Aging With Incarceration Histories: An Intersectional Examination of Incarceration and Health Outcomes Among OlderAdults.

Experiences with incarceration are linked to poor mental and physical health across the life course. The purpose of this research is to examine whether incarceration histories are associated with worse physical and mental health among older adults. We apply an intersectionality framework and consider how the intersection of sexism and racism leads to unequal health outcomes following incarceration among women and people of color. We employ 2 measures of health (i.e., number of depressive symptoms and physical limitations) to broadly capture mental and physical health. Using data from Waves 11 and 12 of the Health and Retirement Study, we estimated a series of general linear models to analyze differences in health by incarceration history, gender/sex, and race/ethnicity. Findings suggest that experiences with incarceration are associated with a greater number of physical limitations and more depressive symptoms among older men and women, net of sociodemographic characteristics, early-life conditions, and lifetime stressful events. Formerly incarcerated women, particularly women of color, had more physical limitations and depressive symptoms relative to other groups. These findings suggest that incarceration histories have far-reaching health implications. Older women of color with incarceration histories experience markedly high levels of physical limitations and depressive symptoms in later life.

Price-Setting Power in Global Value Chains: The Cases of Price Stabilisation in the Cocoa Sectors in Côte d’Ivoire and Ghana

This paper calls for integrating price-setting power and related uneven exposure to price risks into the analysis of governance in global value chains (GVCs) as it adds to other power dimensions in producing unequal distributional outcomes. This is shown for the cocoa GVC, in which—unlike in today’s mostly liberalised market structures—the world’s top cocoa-producing countries, Côte d’Ivoire and Ghana, pursue price stabilisation measures. These measures address intra-seasonal producer price volatility, and recent collaboration has achieved a living-income differential on top of export prices, but such measures do not shield export and producer prices from inter-seasonal variations in world prices determined on commodity derivatives markets. Based on interviews with actors along the cocoa GVC, we argue that this is related to the price-setting power of ‘grinder-traders’ and the key role of financial hedging and trading on commodity derivatives markets in their business strategies. Financialisation processes have increased derivatives trading’s complexity and short-termism, accelerating consolidation among grinder-traders and making price stabilisation more challenging. Through their price stabilisation systems, Côte d’Ivoire and Ghana have maintained some price-setting power in the cocoa GVC, but largely remain ‘global price-takers’, with prices determined on derivatives markets and transmitted along the cocoa GVC through grinder-traders.

Understanding and Promoting the ‘Leaving No One Behind’ Ambition Regarding the Sustainable Development Agenda: A Review

Abstract With the adoption of the 2015–2030 Sustainable Development Goals (SDGs), the United Nations (UN) Member States pledged to ensure that no one would be left behind. This article highlights the essentials (meaning, importance, history, framework, pillars, related key studies, and role of key actors) in respect of the ‘Leaving No One Behind’ (LNOB) pledge. The review shows that the LNOB pledge has three-pronged strategic development imperatives: (i) to end poverty in all its forms, (ii) to stop the discrimination and inequality that have resulted in unequal outcomes for the disadvantaged population, and (iii) to reach the furthest behind first. The framework for achieving the ambition is anchored on implementing the SDGs, ‘empowering the left-behind by ensuring their meaningful participation in decision-making; and enforcing equity-focused policies, and interventions with a dedicated budget to support rights-holders and duty-bearers to address the deprivations of the people left behind. The UN, Governments, Businesses, Civil Society Organisations and other actors should collaborate to translate the mantra into reality by addressing the pervasive societal issues of poverty, inequality, and discrimination. Germane to achieving the LNOB ambition are reliable disaggregated people-centered data, research, and stakeholder/actor commitment to the pledge.

Communication in multilateral bargaining with joint production

We experimentally investigate the effect of pre-bargaining communication on productive incentives in a multilateral bargaining game with joint production under two conditions: observable and unobservable investments. In both conditions, communication fosters fair sharing and is rarely used to pit individuals against each other. Proportional sharing arises with observable investments with or without communication, leading to high efficiency gains. Without investment observability, communication is widely used to truthfully report investments and call for equitable sharing, allowing substantial efficiency gains. Since communication occurs after production, our results highlight a novel indirect channel through which communication can enhance efficiency in social dilemmas. Our results contrast with previous findings on bargaining over an exogenous fund, where communication leads to highly unequal outcomes, competitive messages, and virtually no appeals to fairness.

Like wildfire: creating rumor content in the face of disaster

ABSTRACT Rumors spread during disasters as community members seek information and attempt to make sense of unexpected, anxiety-producing events. While considerable sociological research has examined the transmission and spread of rumors, less attention has been given to the creation of rumor narrative content itself. Drawing on interviews with wildfire survivors in one rural Northern California county, this study shows that rumor narrative creation reflects existing cultural values and power arrangements. In a contested post-disaster landscape, rumors are used to frame new information to maintain coherence with existing cultural beliefs while reinforcing prevailing ideas about safety, deservingness, and class. In this case, rumors are created to reflect cultural schemas such as beliefs about the government and environmental protection, and normative power arrangements instantiated through symbols of spatial stigma. The data presented in this article extends research on stigma, culture, and disaster by arguing existing dominant cultural values shape the content of rumors by dictating which pieces of information are seen as reasonable and reliable, providing residents with opportunities to frame information to explain and justify unequal disaster outcomes. In disaster situations where the transmission of reliable information is especially important, local culture enables and restricts which narratives are produced, shared, and believed.

Mapuche Transitions from Education to Work: Vulnerable Transitions and Unequal Outcomes

This article investigates vulnerabilities in transitions from secondary and tertiary education to work among the indigenous Mapuche youth in Chile. The study draws from a 2014 social survey and qualitative in-depth interviews of indigenous students in secondary and higher education focused on the magnitude of accumulative disadvantages and the decision processes involved in their choice of future life-paths. Despite socioeconomic convergence with the non-Mapuche population, the results reveal the importance of urban economic conditions and previous educational disadvantages in shaping the aspirations of Mapuche youth.

A Computational Model of Non-optimal Suspiciousness in the Minnesota Trust Game.

This study modelled spite sensitivity, the worry that others are willing to incur a loss to hurt you, which is thought to undergird suspiciousness and persecutory ideation. Two samples performed a parametric, non-iterative trust game known as the Minnesota Trust Game (MTG). The MTG distinguishes suspicious decision-making from otherwise rational mistrust by incentivizing the player to trust in certain situations but not others. In Sample 1, 243 undergraduates who completed the MTG showed less trust as the amount of money they could lose increased. However, only for choices where partners had a financial disincentive to betray the player was variation in the willingness to trust associated with suspicious beliefs. We modified the Fehr-Schmidt (1999) inequity aversion model, which compares unequal outcomes in social decision-making tasks, to include the possibility for spite sensitivity. An anticipated partner's dislike of advantageous inequity (i.e., guilt) parameter included negative values, with negative guilt indicating spite. We hypothesized that the anticipated guilt parameter would be strongly related to suspicious beliefs. Our modification of the Fehr-Schmidt model improved estimation of MTG behavior. Furthermore, the estimation of partner's spite-guilt was highly correlated with choices associated with beliefs in persecution. We replicated our findings in a second sample. This parameter was weakly correlated with a self-reported measure of persecutory ideation in Sample 2. The "Suspiciousness" condition, unique to the MTG, can be modeled to isolate spite sensitivity, suggesting differentiation from inequity aversion or risk aversion. The MTG offers promise for future studies to quantify persecutory beliefs in clinical populations.

Infrastructure inequality is a characteristic of urbanization

Urbanization can challenge sustainable development if it produces unequal outcomes. Infrastructure is an important urbanization dimension, providing services to support diverse urban activities. However, it can lock in unequal outcomes due to its durable nature. This paper studies inequalities in infrastructure distributions to derive insights into the structure and characteristics of unequal outcomes associated with urbanization. We analyzed infrastructure inequalities in two emerging economies in the Global South: India and South Africa. We developed and applied an inequality measure to understand the structure of inequality in infrastructure provisioning (based on census data) and infrastructure availability (based on satellite nighttime lights [NTLs] data). Consistent with differences in economic inequality, results show greater inequalities in South Africa than in India and greater urban inequalities than rural inequalities. Nevertheless, inequalities in urban infrastructure provisioning and infrastructure availability increase from finer to coarser spatial scales. NTL-based inequality measurements additionally show that inequalities are more concentrated at coarse spatial scales in India than in South Africa. Finally, results show that urban inequalities in infrastructure provisioning covary with urbanization levels conceptualized as a multidimensional phenomenon, including demographic, economic, and infrastructural dimensions. Similarly, inequalities in urban infrastructure availability increase monotonically with infrastructure development levels and urban population size. Together, these findings underscore infrastructure inequalities as a feature of urbanization and suggest that understanding urban inequalities requires applying an inequality lens to urbanization.

Migration in the Midst of a Pandemic: A Case Study of Pacific Islanders in Oregon

The Pacific Islander population in the United States continues to grow due to outmigration and a unique immigration arrangement. Under the Compacts of Free Association (COFA), citizens from three Remote Oceania countries can travel to the United States to live and work without restriction. Given the special status of COFA migrants, there is a growing interest among policymakers and researchers to better understand this population, which has often been overlooked. Unfortunately, the COVID-19 pandemic has recently spotlighted this community due to their exceedingly high rates of infection, hospitalization, and morbidity. This study examines how migration is experienced during a pandemic via a case study of first-generation Micronesians living in Oregon’s Willamette Valley, one of the largest Micronesian communities in the United States. Interviews reveal how social determinants of health – such as economic stability, non-discrimination and equal treatment, access to healthcare, employment, and housing – may contribute to unequal health outcomes between Pacific Islander immigrants and other racial and ethnic populations. These determinants also contribute to human dignity. Using the emergent Migration with Dignity framework, this study assesses how the pandemic has challenged the six dimensions of dignity and disrupted the migration experience, including the push-pull factors for deciding to emigrate to and stay in the United States. Finally, the study assesses resources available for COFA citizens and avenues for improved support.

Son preference and sex differentials in receipt of key dimensions of children’s healthcare: Evidence from Pakistan

Almost all research on son preference and the consequent sex differentials in child health has focused on India. Pakistan—a country with the second strongest stated desire for sons, no evidence of sex-selective abortion, and relatively high fertility—offers a different context in which to understand unequal health outcomes for boys and girls. I use three rounds of the Pakistan Demographic and Health Survey to examine sex differentials in child healthcare receipt across different family contexts. I find evidence of generalized discrimination: all girls, regardless of sibling composition or birth order, are less likely to receive full immunization or medical treatment. I do not find evidence that girls with older sisters face greater discrimination than other girls. For boys, I find some evidence of selective preferential treatment: among larger families, first sons are more likely to receive healthcare than other sons or daughters.