Unfair Inequalities Research Articles

Inégalités des chances dans le recours aux soins des jeunes adultes en France

Alors que la sante des jeunes adultes est un enjeu reconnu de sante publique en France, moins d’attention est accordee a leur recours aux soins. Cet article s’interroge sur l’existence d’ine‑galite des chances dans le recours aux soins des jeunes adultes a partir des donnees de l’Enquete nationale sur les ressources des jeunes (2014). En mobilisant le cadre de la philosophie de la responsabilite, une distinction est faite entre des inegalites « injustes » liees a des circonstances en dehors du controle des jeunes et des inegalites « justes » liees a des caracteristiques relevant de leur responsabilite. Des modeles de probabilite lineaire sont mobilises pour estimer les associations entre les probabilites de non‑recours (non‑utilisation et renoncement aux soins) et les caracteristiques parentales (assurance complementaire sante, activite principale, revenu, situation familiale et statut vital) d’une part et celles du jeune (education, activite principale, cohabitation, ressources financieres, assurance complementaire sante) d’autre part, traduisant respectivement l’existence d’inegalites injustes et d’inegalites justes. La decomposition de la variance permet de quantifier ces inegalites et suggere que les inegalites injustes sont plus importantes que les inegalites justes.

Health and fairness with other-regarding preferences

This paper explores how to rank social allocations when individuals have other-regarding preferences (ORPs). Unlike the few existing studies on this issue, we focus on two different private goods, only one of which generates ORPs concerns. Specifically, individuals exhibit other-regarding views about the social health state but have standard self-centered preferences over other goods, namely consumption. Our social evaluation also incorporates a fairness view that aims to reduce inequalities that originate from factors for which individuals should not be deemed responsible. By resorting to a non-resourcist approach, we derive social preferences that seek to reduce individual well-being inequalities. Such differences are assessed by means of an interpersonal comparable measure that is related to an ideal situation which involves neither externalities nor unfair inequalities. We obtain that the use of the state of perfect health as the reference value leads society to give a higher priority to those who exhibit more altruistic preferences.

Unfair inequality, governance and individual beliefs

Unfair inequality arises when incentives are not fairly tied to effort or investment across the socio-economic spectrum. The actual limitations on economic activity from this failure may depend on whether people believe the system is unfair, and how well governing institutions safeguard fair-play. In this paper, I study whether unfair wealth inequality is correlated with beliefs about fairness, and whether good governance can be a substitute in belief formations for decreases in unfair inequality. I find a that people in countries with recent increases in unfair wealth inequality are less likely to believe that inequality is due to fair processes. This relationship holds when“fair” determinants of inequality include effort, as well as moral and meritocratic components. The relationship is strongest in countries with poor quality governance. In countries with high quality governance, people appear to be more tolerant of unfair inequality, as it is only weakly reflected in their beliefs about process fairness.

Racism in tourism reviews

Racism is increasingly recognised as a key driver of unfair inequalities in power, resources and opportunities across racial groups. A comprehensive understanding of racism is beneficial to activist groups, policymakers and governments. Traditional approaches, such as surveys and interviews, are usually time-consuming and inefficient in capturing the occurrence of large-scale racism. In this study, we utilise routinely collected data available on tourism websites to assess self-reported racism in the tourism domain. We present a data acquisition procedure that collects racism-related reviews from the Internet at the global scale and then utilise statistics and natural language processing techniques to analyse and explore racism in terms of its tendency, distribution, semantics and characteristics. The effectiveness of the proposed method is demonstrated in a case study, in which we acquire racism-related data at the global scale and validate the impact of racial discrimination on tourists’ experience.

Estimating Social Variation in the Health Effects of Changes in Health Care Expenditure.

Background. A common aim of health expenditure is to reduce unfair inequalities in health. Although previous research has attempted to estimate the total health effects of changes in health expenditure, little is known about how changes affect different groups in the population. Methods. We propose a general framework for disaggregating the total health effects of changes in health expenditure by social groups. This can be performed indirectly when the estimate of the total health effect has first been disaggregated by a secondary factor (e.g., disease area) that can be linked to social characteristics. This is illustrated with an application to the English National Health Service. Evidence on the health effects of expenditure across 23 disease areas is combined with data on the distribution of disease-specific hospital utilization by age, sex, and area-level deprivation. Results. We find that the health effects from NHS expenditure changes are produced largely through disease areas in which individuals from more deprived areas account for a large share of health care utilization, namely, respiratory and neurologic disease and mental health. We estimate that 26% of the total health effect from a change in expenditure would accrue to the fifth of the population living in the most deprived areas, compared with 14% to the fifth living in the least deprived areas. Conclusions. Our approach can be useful for evaluating the health inequality impacts of changing health budgets or funding alternative health programs. However, it requires robust estimates of how health expenditure affects health outcomes. Our example analysis also relied on strong assumptions about the relationship between health care utilization and health effects across population groups.

Health Care Utilization Inequality in a Mixed Public-Private Health Care System: An Insight from the National Survey in Iran

Background: Equitable health care utilization is a pillar of the Universal Health Coverage (UHC) and is also a concern to policymakers. Measuring and quantifying the inequalities are essential in assessing the progress toward achieving the UHC goals. Several studies have focused on overall measures of unfair inequality in health care utilization. The overall approaches to outpatient and inpatient services are not representative of the differences in health care usage in public and private sectors in a mixed healthcare system, like Iran. A few studies have assessed inequality measures for general practitioners (GPs), specialists (SPs), and hospital admission services in different sectors, separately. Objectives: This study aimed at measuring health care utilization inequalities in outpatient and inpatient health services in public and private sectors in Iran. Methods: In this study, national representative data derived from the utilization of health services survey (UHSS) in 2014 was used. The concentration curve (CC) and concentration index (CI) were applied to assess inequalities in health care utilization services, including the number of GP visits, SP visits, and admission in hospitals. We used ADePT software to produce a nonlinear estimation of CI for these count variables. The indirect standardization method was used to standardize the services for differences in needs by age and gender. The inequality in health care utilization was examined in both public and private sectors, separately. Results: Based on the results, public and private outpatient settings, except for the private GP visits, followed a pro-poor pattern. Inpatient admission in the public sector had a pro-poor model, but it showed a pro-rich pattern in the private sector. GP visits in the private sector changed in favor of the poorer people and SP visits in the public sector changed toward a pro-rich pattern after standardization for differences in needs. CI for family physician (FP) and GP visits in public and private sectors, and also SP visits in public and private sectors was -0.089, -0.086, -0.010, 0.025, and -0.018, respectively. CI for the inpatient admission in public and private sectors was -0.126 and 0.157, respectively. GP, SP and hospital services utilization showed a pro-poor pattern. Conclusions: The results of this study showed that most of the health care utilization followed a pro-poor model in the mixed health care system in Iran. SP visits in the public sector changed toward a pro-rich pattern after standardization for differences in needs. Although public outpatient services need more attention to maintain their pro-poor distribution, SP visits in the public sector should be more considered to follow a pro-poor pattern. Health policymakers are recommended to take measures to eliminate barriers to access this service. This may lead to reduce a gap between the poor and rich people in the utilization of the health care and moving toward the UHC.

Public Policies and Equality of Opportunity for Wellbeing in Multiple Dimensions: A Theoretical Discussion and Evidence from Bolivia

Roemer’s equality of opportunity (EOp) theory is increasingly used as the framework for assessing the link between public policies and social justice. Most studies focus on a single (monetary) wellbeing indicator and take individual efforts as being randomly distributed. However, recent development theories have uniformly advocated the use of a multidimensional wellbeing measure and the importance of individual responsibility. We propose a theoretical framework and a modelling tool to include these aspects in an assessment of the connection between public policies and inequality of opportunity for wellbeing within a Romerian setting. Using Bolivian data, we demonstrate the empirical usefulness of our framework and find that Bolivian social programmes are strongly associated with the reduction of unfair inequalities arising from ethnicity and family background, although their levels are far away from being optimal. We highlight the role of effort in this connection and show that it is a fundamental mediating factor.

Decomposition of Socioeconomic Inequality in Catastrophic Health Expenditure: An Evidence from Iran

BackgroundEvidences showed that the incidence of catastrophic health expenditure is unequally distributed among disadvantaged populations. The present study has tried to explain the contributors of this unfair inequality in Hamadan, Iran. MethodsThe target population was households that utilized inpatient services in hospitals of Hamadan. A proportional stratified random sampling method was used to determine study sample (N = 770). The associated factors of catastrophic health expenditure were estimated using logistic regression analysis. The inequality of catastrophic health expenditure was measured by concentration index and explained by decomposition analysis. The data were analyzed by using STATA version 12. ResultsThe key determinants of catastrophic health expenditure were poor economic status, lower household size, lack of supplementary insurance and the number of hospitalizations. The overall concentration index of catastrophic health expenditure in Hamadan was −0.163 (95% CI: −0.242 to −0.083). Household economic status (63.60%) and household size (39.90%) were considered as the first and the second largest contributors of catastrophic health expenditure inequality, respectively. ConclusionIt is demonstrated that catastrophic health expenditure inequality in Iran could be explained by the factors beyond the health sector scope. Hence, future policy efforts need to consider both health system factors and the factors beyond the health system to eliminate catastrophic health spending burden and its inequality.

Understanding and tackling oral health inequalities in vulnerable adult populations: from the margins to the mainstream.

Vulnerable and socially excluded groups in society persistently experience significantly worse oral health and poorer access to dental services than the mainstream population. Action to tackle these unfair, unjust and avoidable inequalities in oral health needs to be informed by an understanding of the broad range of interacting factors that ultimately influence oral health across society and specifically the most vulnerable and marginalised. Failure to understand the underlying factors that create and perpetuate the oral health equity gap risks the development and implementation of ineffective interventions that do not achieve meaningful improvements in oral health for the most vulnerable. This paper presents a theoretical framework that combines a broad public health perspective on oral health inequalities, combined with more specific factors determining the oral health of vulnerable and marginalised groups. Actions to improve access to dental services and policies to combat oral health inequalities among vulnerable adult populations are then presented.

(Un)Equitable distribution of health resources and the judicialization of healthcare: 10 years of experience in Brazil

BackgroundEquity has been acknowledged as a required principle for the fulfilment of the universal right to health once it seeks to tackle avoidable and unfair inequalities among individuals. In Brazil, a country marked by iniquities, this principle was adopted in the Brazilian National Health System (SUS) organization. But the phenomenon known as judicialization of healthcare, anchored in the argument of universality of the right, has been consolidated as a health policy parallel to the SUS. The analysis of these lawsuits distribution according to their beneficiaries’ socio-economic profile can contribute to the verification of the judicialization’s potential for reducing inequalities, thus becoming an auxiliary activity in the fulfilment of the universal and egalitarian right to health. This study aimed to assess what socioeconomic factors are associated to municipalities that had larger numbers of beneficiaries from lawsuits in health in the state of Minas Gerais, Brazil, from 1999 to 2009.MethodsIt is a descriptive quantitative study of the residence municipalities of beneficiaries registered in database regarding all deferred lawsuits against the state of Minas Gerais from 1999 to 2009. The verification of cities’ socio-economic profile was performed based on information of the Brazilian Institute of Geography and Statistics’ 2010 Demographic Census and on indexes derived from it. The variables studied for each municipality were: number of beneficiaries; resident population; Social Vulnerability Index (IVS); and Municipal Human Development Index (IDHm). Descriptive and statistical analysis were used to verify factors associated with a larger number of beneficiaries in a municipality.ResultsOut of 853 municipalities in Minas Gerais, 399 were registered as residence of at least one of the 6.906 beneficiaries of studied lawsuits. The residence non-information index was 11,5%. The minimum number of identified beneficiaries living in a municipality was 1 (one) while the maximum was 1920. The binary logistic regression revealed that high and very high IDHm (OR = 3045; IC = 1773-5228), IVS below 0.323 (OR = 2044; IC = 1099- 3800) and population size above 14.661 inhabitants (OR = 6162; IC = 3733-10,171) are statistically associated to a greater number of beneficiaries of lawsuits in health within a municipality.ConclusionsThe judicialization of health care in Minas Gerais, from 1999 to 2009, didn’t reach the most vulnerable municipalities. On the contrary, it favored a concentration of health resources in municipalities with better socioeconomic profiles. The register of all beneficiaries’ municipalities of residence as well as individual socioeconomic data can contribute to a more conclusive analysis. Nevertheless, in general, the results of this study suggest that the judicial health policy conducted from 1999 to 2009 was not an auxiliary tool for the fulfilment of an equitable right to health in Minas Gerais.

The evolution of inequality of opportunity in Europe

ABSTRACTThe paper tests whether inequality of opportunity (IO) in Europe has increased between 2004 and 2010. IO is understood as unfair inequality due to circumstances beyond individual control (such as family background, race or sex). We show that over 2004–2010 IO increased significantly in Austria, Greece and Spain, while it decreased in Poland and Portugal. Relative IO (ratio of IO to overall income inequality) has grown in Austria, Belgium, Greece and Norway. In Greece, several social groups with an immigrant background have experienced sizable declines an opportunity for income acquisition.

From the Athletes’ Perspective: A Social-Relational Understanding of How Coaches Shape the Disability Sport Experience

The purpose of this study was to explore athletes’ perceptions of how coaches shaped their experiences in disability sport throughout development. Athletes with physical disabilities (N = 21) participated in life history interviews. Participants outlined their sport history and responded to questions targeting the roles that coaches played in their development, which laid the foundation for broader conversations about how coaches shaped the disability sport experience. Using thematic analysis, patterns in coach knowledge, beliefs, and behaviors were captured in 4 themes. Three themes were discussed in relation to positive experiences in disability sport (consideration, collaboration, professionalism), and 1 theme was related to negative disability sport experiences (prejudice). The findings of this work are analyzed through the lens of the social-relational model of disability, thus challenging the dominant discourse that underpins understandings of (dis)ability in the sport context. Practical recommendations for disability sport coaches include reflective practice and introspective examination of implicit biases and assumptions, as well as a focus on interpersonal skills that assist coaches in collaborating with athletes—thus encouraging the integration of sport- and disability-specific knowledge.Lay SummaryAthletes with physical disabilities were interviewed about how coaches shaped their experiences in sport over time. Differences in how coaches created positive experiences were identified at each stage of development, reflecting varied combinations of knowledge and behaviors. Negative experiences stemmed from perceptions of unfair treatment and inequality.

Восприятие и оценка справедливого и несправедливого неравенства в среде российской молодежи

Восприятие и оценка справедливого и несправедливого неравенства в среде российской молодежи

Восприятие и оценка справедливого и несправедливого неравенства в среде российской молодежи

Восприятие и оценка справедливого и несправедливого неравенства в среде российской молодежи

Inequalities in early childhood mortality in Myanmar - Association between parents’ socioeconomic status and early childhood mortality

ABSTRACTBackground: Despite global achievements in reducing early childhood mortality, disparities remain. There have been empirical studies of inequalities conducted in low- and middle-income countries. However, there have been no epidemiological studies on socioeconomic inequalities and early childhood survival in Myanmar.Objective: To estimate associations between two measures of parental socioeconomic status – household wealth and education – and age-specific early childhood mortality in Myanmar.Methods: Using cross-sectional data obtained from the Myanmar Demographic Health Survey (2015–2016), univariate and multiple logistic regressions were performed to investigate associations between household wealth and highest attained parental education, and under-5, neonatal, post-neonatal and child mortality. Data for 10,081 children born to 5,932 married women (aged 15–49 years) 10 years prior to the survey, were analysed.Results: Mortality during the first five years was associated with household wealth. In multiple logistic models, wealth was protective for post-neonatal mortality. After adjusting for individual proximate determinants, the odds of post-neonatal mortality in the richest households were 85% lower (95% CI: 50–96%) than in the poorest households. However, significant association was not found between wealth and neonatal mortality. Parental education was important for early childhood mortality; the highest benefit from parental education was for child mortality in the one- to five-year age bracket. After adjusting for proximate determinants, children with a higher educated parent had 95% (95% CI 77–99%) lower odds of death in this age group compared with children whose parents’ highest educational attainment was at primary level. The association between parental education and neonatal mortality was not significant.Conclusions: In Myanmar, household wealth and parental education are important for childhood survival before five years of age. This study identified nuanced age-related differences in associations. Health policy must take socioeconomic determinants into account in order to address unfair inequalities in early childhood mortality.

The trade-off between equity and efficiency in population health gain: Making it real

Two fundamental goals of health systems are to maximise overall population health gain (referred to as efficiency) and to minimise unfair health inequalities (equity). Often there is a trade-off in maximising efficiency vis a vis equity and the relative weight given to one goal over the other is acknowledged to be essentially a value judgement. Health systems necessarily make those value judgements but in making them would benefit from relevant and accurate opportunity cost information. Unfortunately the development of practical tools to measure equity-efficiency trade-offs has lagged theoretical advances in this area. We address this gap by presenting a practical technique to reveal opportunity costs of equity (and efficiency) gains in decentralised population-based health systems, applying stochastic data envelopment analysis to ethnic-specific life expectancy (LE) changes for 20 New Zealand (NZ) District Health Boards for the inter-census period 2006–2013, thereby deriving a notional health frontier from 10,000 Monte Carlo simulations. Four different ways to increase health equity emerge. These show that a trade-off between equity and efficiency does not always exist. In particular, improving both productive efficiency and allocative efficiency (up to its maximum) can also yield gains in equity through reductions in LE inequalities. However, in NZ's case, the opportunity cost (in sacrificed European life-years) of achieving gains in equity beyond the point of maximum productive and allocative efficiency is relatively high, even for quite small reductions in the LE gap between Māori and European populations. This high opportunity cost may explain why, despite governments' strong rhetorical commitment to equity, NZ's health gains have not strayed far from the path of maximising allocative efficiency. Nevertheless, this opportunity cost could be reduced significantly by measures which shift the health frontier outward, highlighting the importance of technical and organisational innovation as potential drivers of greater equity in health outcomes.

Egalitarianism under Severe Uncertainty

In the spring of 2009, a novel strain of the H1N1 influenza virus, containing a never before witnessed combination of gene segments from human influenza, two forms of swine influenza, and avian influenza, 1 was declared a global pandemic. The UK Government had to decide whether to undertake, at a cost of £1.2 billion (USD 1.9 billion at the time, equivalent to 1 percent of that year’s health budget), an extensive set of preparatory measures, including the purchase of both antiviral medication and a novel vaccine in quantities sufficient to cover the entire UK population, or whether instead to take substantially less costly measures, which would involve having only a limited supply of these medicines and vaccines at hand.2 The possible.

Testing inequality of opportunities in Italy using the ANOVA framework

While the analysis of inequality has been central to economic studies for centuries, it was only in recent years that studies have concentrated on the distinction between inequality of opportunity and inequality of returns to effort and have attempted empirical estimates of the two components. The decomposition of a general inequality index into these two components allows to analyse the prevalence of fair or unfair income inequality within a country. This paper suggests to test the differences between the two sources of inequality in a simple way using the ANOVA framework adapted to decompose the coefficient of variation, to better suit the requirements of an inequality index. The proposed procedure is applied to the Italian Survey on Income and Living Condition (IT-SILC data, wave 2005 and 2011). The empirical results help identifying the circumstances that foster the rise of inequality of opportunities in Italy. Our analysis shows, in particular, that father education, region of residence and gender result as the most relevant circumstances determining inequality of opportunity. On the other side, the role of mother education starting from a lower level as an inequality of opportunity factor has increased its influence over time.

NOTAS SOBRE A PAZ. PROPÓSITO DE UM CONSTITUCIONALISMO CIDADÃO

A existência dos indivíduos somente pode ser explicada se realizada em sociedade. A harmonia e o equilíbrio comunitário podem ser alcançados com a paz, ausência de guerra e regulação da violência por intermédio do direito. A Constituição do Estado apresenta-se como a peça mais celebrada para disciplinar a administração da força estatal: uma linguagem voltada para a paz. A Lei Suprema fundamenta o Estado e com suas regras estimula um controle responsável da paz. Assim, a Constituição desenvolve um papel decisivo como norma processual: alcançar e consolidar a paz relativa de uma comunidade. A procura da paz constitui o bem mais apreciado numa comunidade, porque mantêm coesos a todos seus cidadãos. Neste sentido, chama-se “constitucionalismo cidadão” ao processo que, com ativa participação, inclui a todos os cidadãos de uma comunidade dentro do tipo “Estado constitucional”, que, com respeito e diligência, definem a orientação para a paz relativa. Alcançada essa, a desigualdade crescente e injusta que apresenta-se como um flagelo, com capacidade suficiente para afetar a paz social obtida, devem ser resolvidas.

Measuring Unfair Inequality: Reconciling Equality of Opportunity and Freedom from Poverty

Rising income inequalities are widely debated in public and academic discourse. In this paper, we contribute to this debate by proposing a new family of measures of unfair inequality. To do so, we acknowledge that inequality is not bad per se, but that its underlying sources need to be taken into account. Thereby, this paper is the first to reconcile two prominent fairness principles, namely equality of opportunity and freedom from poverty, into a joint measure of unfair inequality. Two empirical applications provide important new insights on the development of unfair inequality both over time (in the US) and across countries (in Europe). First, unfair inequality shows different time trends and country rankings compared to total inequality. Second, average unfair inequality doubles when complementing the ideal of an equal opportunity society with poverty aversion. Furthermore, we show that an exclusive focus on top incomes may misguide fairness judgments.