Unfair Inequalities Research Articles

Moral judgment is sensitive to bargaining power.

For contractualist accounts of morality, actions are moral if they correspond to what rational or reasonable agents would agree to do, were they to negotiate explicitly. This, in turn, often depends on each party's bargaining power, which varies with each party's stakes in the potential agreement and available alternatives in case of disagreement. If there is an asymmetry, with one party enjoying higher bargaining power than another, this party can usually get a better deal, as often happens in real negotiations. A strong test of contractualist accounts of morality, then, is whether moral judgments do take bargaining power into account. We explore this in five preregistered experiments (n = 3,025; U.S.-based Prolific participants). We construct scenarios depicting everyday social interactions between two parties in which one of them can perform a mutually beneficial but unpleasant action. We find that the same actions (asking the other to perform the unpleasant action or explicitly refusing to do it) are perceived as less morally appropriate when performed by the party with lower bargaining power, as compared to the party with higher bargaining power. In other words, participants tend to give more moral leeway to parties with better bargaining positions and to hold disadvantaged parties to stricter moral standards. This effect appears to depend only on the relative bargaining power of each party but not on the magnitude of the bargaining power asymmetry between them. We discuss implications for contractualist theories of moral cognition and the emergence and persistence of unfair norms and inequality. (PsycInfo Database Record (c) 2024 APA, all rights reserved).

The effects of social exclusion on distributive fairness judgements and cooperative behaviour.

In this article, we investigate how being socially excluded (vs. included) affects people's distributive fairness judgements and their willingness to cooperate with others in subsequent interactions. For this purpose, we conducted three experiments in which we assessed individual differences in having experienced being socially excluded (Experiment 1, N = 164), and manipulated social exclusion (Experiment 2, N = 120; Experiment 3, N = 492). We studied how this impacted fairness judgements of three different outcome distributions (disadvantageous inequality, advantageous inequality, and equality) both within-participants (Experiments 1 and 2) and between-participants (Experiment 3). To assess behavioural consequences, we then also assessed participants' cooperation in a social dilemma game. Across the three experiments, we consistently found that social exclusion impacted fairness judgements. Compared to inclusion, excluded participants judged disadvantageous inequality as more unfair and advantageous inequality as less unfair. Moreover, compared to socially included participants, socially excluded participants were more willing to cooperate after experiencing advantageous rather than disadvantageous inequality, and feelings of acceptance served as a mediator in these associations.

Limiting lifetime inheritances and gifts

This paper provides a defence of a lifetime limit on how much a person can receive in the form of gifts and inheritances, that is, a person's accessions. I argue that any accessions above that limit should be taxed at a rate of 100%. The analysis shows how this proposal can bring into equilibrium the core values and other goals at stake in the design of taxation on inheritances and gifts. To counter the low level of support for inheritance taxation in general, the analysis must include a proposal concerning what will be done with the tax revenues. I propose turning the accession tax revenues into an unconditional citizen's stake that is granted to young adults. Such an institutional design would create additional value by reducing unfair inequalities between age groups.

The grass is always greener on the other side: (Unfair) inequality and support for democracy

Does inequality undermine support for democracy? While previous research has either focused on macro-level associations or alleged a uniform relationship between inequality and individual democratic support across countries, this paper documents the importance of the current regime type and of the source of inequality for such a linkage. Exploiting differential transition to democracy after the collapse of the Soviet Union allows to investigate the association of democratic support across regimes with differing levels of democracy. Inequality is found to erode democratic support in democracies and to foster democratic beliefs in non-democracies. In other words, inequality always subverts individual-level support for the current regime type. Further, evidence is provided for the relevance of disentangling the sources of economic inequality in line with fairness concerns: While unfair inequality (generated by factors beyond an individual’s control) and total inequality both are significantly correlated to democratic support, unfair inequality appears to be the relevant inequality component driving this association.

Fairness with unequal productive skills among other-regarding individuals

AbstractThis paper deals with the fair ranking of allocations when individuals endowed with heterogeneous skills have other-regarding preferences over the average consumption of the other members of society. By assuming that such preferences matter for equality, we construct three social ordering functions that aim to reduce differences which originate in unequal productivities. These functions seek to maximise the smallest value of an interpersonally comparable measure of individual well-being that is related to a situation which involves neither unfair opportunities nor inequalities in consumption. More importantly, they provide society with different options at the time of making welfare evaluations when individuals are endowed with unequal productive skills and heterogeneous preferences.

Decomposing the inequalities in the catastrophic health expenditures on the hospitalization in India: empirical evidence from national sample survey data.

Sustainable Development Goal (SDG) Target 3.8.2 entails financial protection against catastrophic health expenditure (CHE) by reducing out-of-pocket expenditure (OOPE) on healthcare. India is characterized by one of the highest OOPE on healthcare, in conjunction with the pervasive socio-economic disparities entrenched in the population. As a corollary, India has embarked on the trajectory of ensuring financial risk protection, particularly for the poor, with the launch of various flagship initiatives. Overall, the evidence on wealth-related inequities in the incidence of CHE in low- and middle-Income countries has been heterogenous. Thus, this study was conducted to estimate the income-related inequalities in the incidence of CHE on hospitalization and glean the individual contributions of wider socio-economic determinants in influencing these inequalities in India. The study employed cross-sectional data from the nationally represented survey on morbidity and healthcare (75th round of National Sample Survey Organization) conducted during 2017-2018, which circumscribed a sample size of 1,13,823 households and 5,57,887 individuals. The inequalities and need-adjusted inequities in the incidence of CHE on hospitalization care were assessed via the Erreygers corrected concentration index. Need-standardized concentration indices were further used to unravel the inter- and intra-regional income-related inequities in the outcome of interest. The factors associated with the incidence of CHE were explored using multivariate logistic regression within the framework of Andersen's model of behavioral health. Additionally, regression-based decomposition was performed to delineate the individual contributions of legitimate and illegitimate factors in the measured inequalities of CHE. Our findings revealed pervasive wealth-related inequalities in the CHE for hospitalization care in India, with a profound gap between the poorest and richest income quintiles. The negative value of the concentration index (EI: -0.19) indicated that the inequalities were significantly concentrated among the poor. Furthermore, the need-adjusted inequalities also demonstrated the pro-poor concentration (EI: -0.26), denoting the unfair systemic inequalities in the CHE, which are disadvantageous to the poor. Multivariate logistic results indicated that households with older adult, smaller size, vulnerable caste affiliation, poorest income quintile, no insurance cover, hospitalization in a private facility, longer stay duration in the hospital, and residence in the region at a lower level of epidemiological transition level were associated with increased likelihood of incurring CHE on hospitalization. The decomposition analysis unraveled that the contribution of non-need/illegitimate factors (127.1%) in driving the inequality was positive and relatively high vis-à-vis negative low contribution of need/legitimate factors (35.3%). However, most of the unfair inequalities were accounted for by socio-structural factors such as the size of the household and enabling factors such as income group and utilization pattern. The study underscored the skewed distribution of CHE as the poor were found to incur more CHE on hospitalization care despite the targeted programs by the government. Concomitantly, most of the inequality was driven by illegitimate factors amenable to policy change. Thus, policy interventions such as increasing the awareness, enrollment, and utilization of Publicly Financed Health Insurance schemes, strengthening the public hospitals to provide improved quality of specialized care and referral mechanisms, and increasing the overall budgetary share of healthcare to improve the institutional capacities are suggested.

Fairness and Gini decomposition

We propose a new decomposition of the Gini coefficient that nests a structuralist and an individualistic definition of unfair inequality, as well as ex ante and ex post measures of inequality of opportunity. We illustrate the decomposition on Belgian data, highlighting the source of a consistent difference between these views about unfair inequality.

Race, Healthcare, and Health Disparities: A Critical Review and Recommendations for Advancing Health Equity.

An overwhelming body of evidence points to an inextricable link between race and health disparities in the United States. Although race is best understood as a social construct, its role in health outcomes has historically been attributed to increasingly debunked theories of underlying biological and genetic differences across races. Recently, growing calls for health equity and social justice have raised awareness of the impact of implicit bias and structural racism on social determinants of health, healthcare quality, and ultimately, health outcomes. This more nuanced recognition of the role of race in health disparities has, in turn, facilitated introspective racial disparities research, root cause analyses, and changes in practice within the medical community. Examining the complex interplay between race, social determinants of health, and health outcomes allows systems of health to create mechanisms for checks and balances that mitigate unfair and avoidable health inequalities. As one of the specialties most intertwined with social medicine, emergency medicine (EM) is ideally positioned to address racism in medicine, develop health equity metrics, monitor disparities in clinical performance data, identify research gaps, implement processes and policies to eliminate racial health inequities, and promote anti-racist ideals as advocates for structural change. In this critical review our aim was to (a)provide a synopsis of racial disparities across a broad scope of clinical pathology interests addressed in emergency departments-communicable diseases, non-communicable conditions, and injuries-and (b)through a race-conscious analysis, develop EM practice recommendations for advancing a culture of equity with the potential for measurable impact on healthcare quality and health outcomes.

Social inequality in the context of natural justice

The problem of social equality and social inequality is investigated in the light of the concept of justice, the concept of just inequality and unfair equality. The author substantiates the interrelation of justice and equality as concepts and phenomena that are presented in an indissoluble unity and are actually a two-pronged problem. Justice is interpreted by the author as a measure of social equality and social inequality. The author explores the problem of social inequality from the point of view of a materialistic understanding of history, the principle of development and an axiological approach. The concept of natural justice is investigated as the basis of justice established by people, that is, social justice. The legitimacy of the conditional use of the concept of natural justice as a natural right of an individual to use his natural gifts, which under certain conditions of social life activity can be decisive in human life, can give him fair advantages over other members of the society. The natural personal potential of an individual can cause significant differences in the intellectual and spiritual abilities of people, which, in the presence of diligence, determination and appropriate social norms, necessarily generate social inequality in society. Fair inequality does not contradict natural justice. Natural justice is contradicted by unfair inequality. A person by nature has the right to life, freedom and property in compliance with the mandatory norms established in this society. Justice established by people should not contradict natural justice. The validity of the use of the concept of legitimate elite as the most outstanding personalities in various respects, having high achievements and services to society in various spheres of human activity, is substantiated.

Unfair inequality and growth*

AbstractFighting against economic inequality is one fundamental social goal in the agendas of most governments. However, recent studies highlight that people actually prefer unequal societies, as they accept inequality generated by an individual's effort and wish to reduce only unfair inequality (generated by factors beyond an individual's control). This distinction might help to explain the fundamental unsolved question about whether inequality is good or bad for growth: unfair inequality (UI) could be growth‐deterring, while fair inequality (FI) might be growth‐enhancing. We derive a reduced‐form growth equation from a stylized overlapping‐generations model with human capital that includes FI, UI, and poverty. Then, using an instrumental variable approach, we show for alternative samples and inequality measures at the worldwide level that the estimated coefficient associated with UI is always negative, while the coefficient of total inequality increases when UI is included in the regression. Moreover, we find that poverty mediates this relationship because the higher the poverty rate, the smaller the impact of either type of inequality on growth.

Data’s Impact on Algorithmic Bias

Algorithmic bias refers to systematic and structured errors in an artificial intelligence system that generate unfair results and inequalities. This column discusses how bias in algorithms appears, amplifies over time, and shapes people’s thinking, potentially leading to discrimination.

Oral health inequalities-Developments in research, policy and practice over the last 50 years.

At times of major geopolitical conflict, macroeconomic crisis and the 'aftershocks' of the COVID-19 syndemic still having a global impact, it is the most vulnerable and disadvantaged in society who undoubtedly suffer the most. During these turbulent and uncertain times, it is essential that sufficient policy attention is given to tackling the persistent and stark health inequalities that exist both between and within countries. This commentary aims to critically reflect on developments in oral health inequalities research, policy and practice over the last 50 years. Despite often challenging political contexts, progress has undoubtedly been made in our understanding of the nature and underlying social, economic and political causes of oral health inequalities. A developing body of global research has highlighted patterns of inequalities in oral health that exist across the lifecourse, but less progress has been made in implementing and evaluating policy interventions to tackle these unfair and unjust inequalities in oral health. At a global level through WHO leadership, oral health is at a 'tipping point' with a unique window of opportunity for policy change and development. Transformative policy and system reforms co-produced with community and other key stakeholders are now urgently needed to tackle oral health inequalities.

Socio-economic accounting of inequalities in excess weight: a population-based analysis

BackgroundThe prevalence of excess weight has been increasing globally in the last decades, affecting disproportionally adults from low socio-economic backgrounds and putting undue pressure on health systems and societal resources. In England, tackling unfair and unjust health inequalities is at the heart of national public health policy, and a prerequisite for enabling these decision makers to set policy priorities is an understanding of the prevalence and determinants of excess weight inequalities in their local population.MethodsWe conducted both pooled (England) and regional-level (nine regions: North-East, North-West, Yorkshire and Humber, East Midlands, West Midlands, East of England, London, South East and South West) analyses of individual level data from a nationally representative sample of adults (N = 6,387). We used the Corrected Concentration Index (CCI) to measure absolute inequalities in excess weight across three dimensions of socio-economic deprivation: neighbourhood-level deprivation, occupational status and educational qualification. We used a Shapley decomposition method to evaluate their relative contribution to inequality.ResultsAt a national level, all three dimensions of socio-economic deprivation were found to be positively associated with excess weight across the adult population, as measured by the CCI, with educational qualification ranking first [CCI: -0.090, p < 0.01], closely followed by neighbourhood-level deprivation [CCI: -0.050, p < 0.01]. Large variation was found between regions and genders, with inequality being either considerably higher or exclusively patterned among women. The strongest independent factor contributing to excess weight inequalities was having a long-lasting limiting illness, especially among women and towards the right tail of the excess weight spectrum. Heterogeneous patterns of contribution across the excess weight spectrum were found, however age played a dominant role toward the left tail of the distribution.ConclusionsWhile socio-economic inequalities in excess weight exist in the English adult population, our findings underscore the importance of considering multiple dimensions of deprivation and the unique needs of different populations when developing policies to address overweight and obesity. Targeted interventions for adults with overweight and obesity with long-lasting illnesses and women can generate both short-term and long-term economic benefits, by reducing healthcare costs and increasing workforce productivity.

Addressing the rise of inequalities: How relevant is Rawls's critique of welfare state capitalism?

Addressing the rise of inequalities: How relevant is Rawls's critique of welfare state capitalism?

It’s Life as I See It: Black Cartoonists in Chicago, 1940–1980

It’s Life as I See It: Black Cartoonists in Chicago, 1940–1980

Gini decomposition: An inequality of opportunity perspective

Economic inequality that arises due to circumstances is unfair, whereas fair inequality is the one that emerges because of differences in individual efforts. We assume that an individual’s income is determined only by circumstances and efforts, where both factors are evident and can be ordered. We then decompose the Gini coefficient into unfair, fair, and residual Gini. The last component emerges whenever circumstance and effort jointly affect income differences, where distinguishing between fair and unfair inequalities becomes impossible.

Inequality in psychological distress among young adults: An integrative model of economic, social, and environmental determinants.

Differences in economic, social, and environmental circumstances lead to systematic and unfair health inequalities. Yet, this inequality is modifiable. Drawing on the social determinants approach to health this study explored: (a) the association between economic, social-relational, and environmental stressors with psychological distress (PD) among a representative sample of young adults in Israel (N = 2,407); (b) the collective impact of these multiple stressors on PD and the extent to which the co-occurrence of stressors demonstrated a stepped relationship with PD. Social determinants included subjective poverty, perceived income adequacy, material deprivation indices, social trust, trust in institutions, perceived discrimination, loneliness, and indicators for the quality of the neighborhood environment. Bivariate analysis was used to assess associations between economic, social-relational, and environmental stressors with PD. Hierarchical linear regressions, estimated to predict PD, showed that the social determinants shaped PD in young adulthood, with each stressor domain making a distinct contribution to explaining PD. Subjective poverty, material deprivation, and loneliness were particularly detrimental. Social determinants were additive, constituting cumulative stressors that convey increased risk for young adults' mental well-being. The findings suggest that health inequality can be reduced by directly addressing its social determinants. Although important, improved access to social and mental health services alone is unlikely to relieve the burden of PD and its adverse consequences both for individual suffering and at the national level. Broader and combined policy measures are required to combat poverty and deprivation, discrimination, lack of trust, and loneliness. (PsycInfo Database Record (c) 2023 APA, all rights reserved).

Addressing inequalities in the identification and management of perinatal mental health difficulties: The perspectives of minoritised women, healthcare practitioners and the voluntary sector.

Perinatal mental health (PMH) difficulties affect approximately one in five birthing women. If not identified and managed appropriately, these PMH difficulties can carry impacts across generations, affecting mental health and relationship outcomes. There are known inequalities in identification and management across the healthcare pathway. Whilst barriers and facilitators have been identified there is a lack of clarity about how these relate to the avoidable and unfair inequalities experienced by various groups of women. Further research is required to understand how to address inequalities in PMH. To understand the key factors that enable and hinder access to PMH care for women from minoritised groups across the PMH care pathway, and how these have been affected by the COVID-19 pandemic. A sequential mixed-methods approach gathered views and experiences from stakeholders in one region in northern England. This included an online survey with 145 NHS healthcare practitioners and semi-structured interviews with 19 women from ethnic minority and/or socio-economically deprived backgrounds who had experienced PMH difficulties, and 12 key informants from the voluntary and community sector workforce. Quantitative data were analysed using descriptive statistics and framework analysis was applied to qualitative data. Barriers and facilitators were mapped using a socio-technical framework to understand the role of (i) processes, (ii) people (organised as women, practitioners and others), (iii) technology, and (iv) the system as a whole in deepening or alleviating inequalities. Influences that were identified as pertinent to inequalities in identification and management included provision of interpreters, digital exclusion, stigma, disempowerment, distrust of services, practitioner attitudes, data capture, representation in the workforce, narrow rules of engagement and partnership working. Stakeholder groups expressed that several barriers were further compounded by the COVID-19 pandemic. The findings highlight the need for change at the system level to tackle inequalities across the PMH care pathway. Four inter-connected recommendations were developed to enable this systems change: building emotional safety between professionals and women; making PMH a part of core healthcare business; increasing cultural competency specific to PMH; and enhanced partnership working.

Health-related quality of life by household income in Chile: a concentration index decomposition analysis

BackgroundHealth inequities have a profound impact on all dimensions of people’s lives, with invariably worse results among the most disadvantaged, transforming them into a more fragile and vulnerable population. These unfair inequalities also affect dimensions focused on subjectivity, such as health-related quality of life (HRQoL), which has been positioned, in recent decades, as an important outcome in health decision-making. The main objective of this study is to estimate socioeconomic inequality in HRQoL of Chilean by household income. MethodsSecondary analysis of the National Health Survey (ENS 2016–2017, Chile). This survey includes a nationally representative, stratified, and multistage household sample of people aged 15 and above. Socioeconomic inequality in HRQoL (EQ5D) is estimated by the concentration index (CI) ranked by household income. Decomposition analysis is conducted to examine potential explanatory sociodemographic factors. ResultsThe CI for household income inequality in HRQoL was -0.063. The lower the household income, the worse the HRQoL reported by in Chile. The decomposition analysis revealed that socioeconomic position contributes 75,7% to inequality in the quality of life, followed by educational level (21.8%), female gender (17.3%), and type of Health Insurance (15%), age (-19.7%) and residence (-10.8%). Less than 1% corresponds to the unexplained residual component.ConclusionsOur findings suggest the existence of a disproportionate concentration of worse HRQoL in the most disadvantaged socioeconomic groups in Chile. This inequality is largely, yet not completely, associated with household income. Other significant factors associated with this inequality are education, gender, and healthcare insurance. These results suggest the need of strengthening efforts to reducing socioeconomic gaps in health outcomes in Chile, as a means to achieve social justice and equity in health and healthcare.

Emerging inequality in Kenyan secondary schools: Dilemmas of educational expansion and quality improvement

This article examines the emerging unfair inequality in Kenyan secondary schools through comparative case studies of three secondary schools in western Kenya. Qualitative data were collected through fieldwork over a four-year period, with participant observation and semi- or non-structured interviews, to understand how interactions among schools, households, and communities impact the improvement of educational quality. This study demonstrates that educational inequality stems from economic background and academic performance. While establishing new schools allowed students to choose better schools in their vicinity, increasing school competition resulted in a school hierarchy restricting uniform access due to factors of affordability and academic achievement. This suggests that the unplanned establishment of new schools constrains vulnerable students from continuing their education. Expanding educational opportunities and improving quality are important facets of education; however, it is necessary to pay attention to the beneficiaries of this process, as economic inequality may translate into educational inequality.