Widening Socioeconomic Inequalities Research Articles

Trends in traffic accident mortality and social inequalities in Ecuador from 2011 to 2022

BackgroundTraffic accidents (TA) remain a significant global public health concern, impacting low—and middle-income countries. This study aimed to describe the trend in TA mortality and inequalities in Ecuador for 2011–2022, distributed by year, gender, age group, geographical location, type of accident, and social inequalities.MethodsAn ecological study was conducted using INEC national-level data on TA fatalities in Ecuador. Mortality rates were calculated per 100,000 population and analyzed by year, gender, age group, geographic region, and accident type. Annual percentage variation (APV) was determined using linear regression models. Inequality analyses examined associations between TA mortality and socioeconomic factors like per capita income and literacy rates. Complex measures such as the Slope Inequality Index (SII) were calculated to assess the magnitude of inequalities.ResultsThere were 38,355 TA fatalities in Ecuador from 2011 to 2022, with an overall mortality rate of 19.4 per 100,000 inhabitants. The rate showed a non-significant decreasing trend (APV − 0.4%, p = 0.280). Males had significantly higher mortality rates than females (31.99 vs. 7.19 per 100,000), with the gender gap widening over time (APV 0.85%, p = 0.003). The Amazon region had the highest rate (24.4 per 100,000), followed by the Coast (20.4 per 100,000). Adults aged ≥ 60 years had the highest mortality (31.0 per 100,000), followed by those aged 25–40 years (28.6 per 100,000). The ≥ 60 age group showed the most significant rate decrease over time (APV − 2.25%, p < 0.001). Pedestrians were the most affected group after excluding unspecified accidents, with a notable decreasing trend (APV − 5.68%, p < 0.001). Motorcyclist fatalities showed an increasing trend, ranking third in TA-related deaths. Lower literacy rates and per capita income were associated with higher TA mortality risks. Inequality in TA mortality between provinces with the highest and lowest per capita income increased by 247.7% from 2011 to 2019, as measured by the SII.ConclusionWhile overall TA mortality slightly decreased in Ecuador, significant disparities persist across demographic groups and geographic regions. Older adults, males, pedestrians, and economically disadvantaged populations face disproportionately higher risks. The increasing trend in motorcycle-related fatalities and widening socioeconomic inequalities are particularly concerning.

Structural change and socio-economic disparities in a net zero transition

A net zero transition is likely to generate substantial and irreversible economic transformation. High-carbon industries and their related occupations will disappear, while new low-carbon industries and occupations will be created. In the aggregate, the impact of the transition on GDP and employment is commonly projected to be relatively moderate. However, such estimates hide drastic distributional issues that are sectorally and regionally concentrated. We use three sectorally detailed and regionally disaggregated macroeconomic models to explore the possible levels and impacts of structural change in a well below 2°C scenario. In addition to the expected decline in the carbon-intensive industries, we observe secondary impacts, particularly in the services sectors, that vary significantly between models. The risks entailed with structural change involve worsening economic disparity and societal division that could exacerbate existing socioeconomic and political polarisation. Impact assessments of decarbonisation should consider such distributional issues to avoid post-industrial decline and widening socioeconomic inequalities.

Socioeconomic determinants of income loss during COVID-19 in a mountainous area in Vietnam

ABSTRACT Identifying vulnerable socioeconomic groups enables policymakers to design relevant intervention strategies and garner the support necessary to implement them. Previous studies indicate that COVID-19 contributed to widening socioeconomic inequalities, but a gap remains in understanding the impacts of the pandemic on ethnic groups in mountainous areas in Vietnam. We conducted interviews and applied logistic regression methods to analyse the relationships between socioeconomic factors and the likelihood of losing income due to the pandemic. We found that Indigenous people, communes, jobholders with more physical contact at work, groups that include more boys, and smaller residential landholders were more likely to suffer from COVID-19-related income loss. The findings of this study enable the Vietnamese Government and practitioners to better understand the impacts of COVID-19 on households in mountainous areas. This study may guide the government toward developing policies for reducing the impact of similar pandemics on those groups in mountainous locations.

Designing for a Flow: Navigating Temporalities in Housing Considerations in Low-Income and Hazard-Prone Caribbean Contexts

The urgency of addressing housing challenges in low-income areas is increasing due to widening socio-economic inequalities and the worsening impact of natural disasters. Saint Martin, a small Caribbean island, is struggling to provide affordable housing amidst hurricanes, floods, and heat waves. As a result, there has been a rise in self-organized housing units, which are built incrementally and are susceptible to risks. The main challenge is to balance durability, functionality, and esthetic appeal over time. Inspired by St. Martin’s self-organized units, this article explores housing considerations in low-income, hazard-prone contexts by emphasizing their temporalities. Integrating insights from a formative study, including a literature review and ethnographic research, the paper draws on Stewart Brand’s “Layers of Change” and the concept of “Flow”. The study identifies layers within self-organized units corresponding to durability, functionality, and esthetic appeal. It delves into their connection with building activities over time, unveiling the temporalities of housing considerations. This exploration leads to the proposition of “Designing for a Flow” as a novel design approach. Offering practical insights within a concise framework, the study provides nuanced perspectives on mitigating housing challenges in low-income and hazard-prone contexts.

Trends in cancer incidence by socioeconomic deprivation in Germany in 2007 to 2018: An ecological registry-based study.

Age-standardized cancer incidence has decreased over the last years for many cancer sites in developed countries. Whether these trends led to narrowing or widening socioeconomic inequalities in cancer incidence is unknown. Using cancer registry data covering 48 million inhabitants in Germany, the ecological association between age-standardized total and site specific (colorectal, lung, prostate and breast) cancer incidence in 2007 to 2018 and a deprivation index on district level (aggregated to quintiles) was investigated. Incidence in the most and least deprived districts were compared using Poisson models. Average annual percentage changes (AAPCs) and differences in AAPCs between deprivation quintiles were assessed using Joinpoint regression analyses. Age-standardized incidence decreased strongly between 2007 and 2018 for total cancer and all cancer sites (except female lung cancer), irrespective of the level of deprivation. However, differences in the magnitude of trends across deprivation quintiles resulted in increasing inequalities over time for total cancer, colorectal and lung cancer. For total cancer, the incidence rate ratio between the most and least deprived quintile increased from 1.07 (95% confidence interval: 1.01-1.12) to 1.23 (1.12-1.32) in men and from 1.07 (1.01-1.13) to 1.20 (1.14-1.26) in women. Largest inequalities were observed for lung cancer with 82% (men) and 88% (women) higher incidence in the most vs the least deprived regions in 2018. The observed increase in inequalities in cancer incidence is in alignment with trends in inequalities in risk factor prevalence and partly utilization of screening. Intervention programs targeted at socioeconomically deprived and urban regions are highly needed.

Does Internal Migration Contribute to the Intergenerational Transmission of Socioeconomic Inequalities? The Role of Childhood Migration.

The widening of socioeconomic inequalities in most developed countries makes it essential to improve understanding of the mechanisms underpinning social reproduction-that is, the transmission of advantage and disadvantage between generations. This article proposes that internal migration plays a role in transmitting socioeconomic inequalities. Theoretically, the article formulates a conceptual framework building on three lines of inquiry: (1) the intergenerational transmission of internal migration behavior, (2) the role of internal migration in social mobility, and (3) the educational selectivity of internal migration. Empirically, the article quantifies the links between long-distance internal migration and social reproduction in 15 European countries by using a structural equation model on retrospective life history data. The results show that children from higher socioeconomic backgrounds are more likely to migrate, increasing their chances of migrating in adulthood, which is associated with higher socioeconomic status later in life. In addition, advantaged children are more likely to migrate to urban centers with their greater educational and employment opportunities. These results illuminate the socioeconomic impact of internal migration across generations, highlight the importance of conceptualizing internal migration as a life course trajectory, and emphasize the lifelong legacy of childhood migration.

Land, caste and tenancy: understanding the origins and effects of absentee landlordism in the changing context

ABSTRACT India is witnessing a transition in policy perspective from the creation of peasant proprietorship to tenancy liberalisation as a part of market friendly land reforms in contrast with state-led redistributive land reforms. The proposed market friendly reforms are more oriented towards landlord interests compared with landless tenants and agricultural labourers. This justifies the historical unjust and unfair forms of the process of accumulation. The present article, by explicitly considering the case of tenancy liberalisation, argues that the policy absolves the problem of widening socio-economic inequalities and abstains from addressing the issues of absentee landlordism. The research maps evidence of the concentration of land with the feature of absenteeism amongst dominant castes and fallowisation. Hence, a case is made for enabling land ownership by the cultivator in order to achieve equity, efficiency and sustainability in agriculture.

Impact of Socioeconomic Status on the Perception of Accessibility to and Quality of Healthcare Services during the COVID-19 Pandemic among Poles-Pilot Study.

This pilot study was conducted on the reported hypothesis that the COVID-19 pandemic outbreak had an impact on the accessibility and quality of healthcare services and exacerbated socioeconomic inequalities. The aim was to determine whether economic status and education had an impact on the perception of access and quality to healthcare services during the COVID-19 pandemic and whether, according to patients, accessibility and quality had changed significantly compared to the pre-pandemic period in Poland. The study was based on the authors’ questionnaire and the results were statistically analyzed. Two hundred forty-seven feedback responses were received with a responsiveness rate of 93 percent. Statistically significant differences were found when comparing education level and utilization of healthcare services during the COVID-19 pandemic. A comparison of gender and economic situation, and average monthly income found no statistically significant differences. The outbreak of the COVID-19 pandemic has undoubtedly affected the provision of health services in many countries around the world. One result of the pandemic crisis has been widening socioeconomic inequalities among patients.

What\u2019s important to you? Socioeconomic inequalities in the perceived importance of health compared to other life domains

BackgroundPressing issues, like financial concerns, may outweigh the importance people attach to health. This study tested whether health, compared to other life domains, was considered more important by people in high versus low socioeconomic positions, with future focus and financial strain as potential explanatory factors.MethodsA cross-sectional survey was conducted in 2019 among N=1,330 Dutch adults. Participants rated the importance of two health-related domains (not being ill, living a long life) and seven other life domains (e.g., work, family) on a five-point scale. A latent class analysis grouped participants in classes with similar patterns of importance ratings. Differences in class membership according to socioeconomic position (indicated by income and education) were examined using structural equation modelling, with future focus and financial strain as mediators.ResultsThree classes were identified, which were defined as: neutralists, who found all domains neutral or unimportant (3.5% of the sample); hedonists, who found most domains important except living a long life, work, and religion (36.2%); and maximalists, who found nearly all domains important, including both health domains (60.3%). Of the neutralists, 38% considered not being ill important, and 30% considered living a long life important. For hedonists, this was 92% and 39%, respectively, and for maximalists this was 99% and 87%, respectively. Compared to belonging to the maximalists class, a low income predicted belonging to the neutralists, and a higher educational level and unemployment predicted belonging to the hedonists. No mediation pathways via future focus or financial strain were found.ConclusionsLower income groups were less likely to consider not being ill important. Those without paid employment and those with a higher educational level were less likely to consider living a long life important. Neither future focus nor financial strain explained these inequalities. Future research should investigate socioeconomic differences in conceptualisations of health, and if inequalities in the perceived importance of health are associated with inequalities in health. To support individuals dealing with challenging circumstances in daily life, health-promoting interventions could align to the life domains perceived important to reach their target group and to prevent widening socioeconomic health inequalities.

Charlie Eaton. Bankers in the Ivory Tower: The Troubling Rise of Financiers in US Higher Education. Chicago, IL: University of Chicago Press, 2022. 203p. Hardcover, $23.30 (ISBN: 978-0-226-72042-5).

Charlie Eaton has written a book exploring a topic many of us are aware of and probably appalled by—the insidious relationship between high finance and higher education. What Eaton has done, however, is put names to the connections and provided plenty of data to back up his assertions in Bankers in the Ivory Tower . This is a text that anyone connected to academia, including librarians, alumni, and the unfortunate group of debt-ridden nongraduates, can benefit from. In this well-documented book, where the data never becomes too intrusive, Eaton shines a light on people in high finance (private equity bankers and hedge fund investors) both emerging from and then influencing the Ivies and most selective universities. Their influence also extends to the for-profit university system (referred to as “the bottom”) and what Eaton calls “the middle” or the less-selective public universities. While the author’s conclusions are not as far-reaching as the situation demands, he makes an argument for collective action to combat widening socioeconomic inequality that disproportionately harms Black and brown folks.

Development of an Equity, Diversity, Inclusion, and Anti-racism Pledge as the Foundation for Action in an Academic Department of Neurology.

Recent racial inequities as illustrated by the health disparities in COVID-19 infections and deaths, the recent killings of Black men and women by law enforcement, and the widening socioeconomic inequality and have brought systemic racism into a national conversation. These unprecedented times may have deleterious consequences, increasing stress, and trauma for many members of the neurology workforce. The Equity, Diversity, Inclusion and Anti-Racism Committee within our Department of Neurology provides infrastructure and guidance to foster a culture of belonging and addresses the well-being of faculty, staff, and trainees. Here, we present the creation and implementation of our Equity, Diversity, Inclusion, and Anti-Racism (EDIA) Pledge, which was central to our committee's response to these unprecedented times. We outline the process of developing this unique EDIA Pledge and provide a roadmap for approaching these important topics through a Continuing Medical Education Neurology Grand Rounds aimed at fostering a diverse, inclusive, equitable, and antiracist work environment. Through the lived experiences of 4 faculty members, we identify the impact of bias and microaggressions and encourage allyship and personal development for cultural intelligence. We hope that these efforts will inspire neurology departments and other academic institutions across the globe to make a similar pledge.

The Bidirectional Relationship Between Debts and Common Mental Disorders: Results of a longitudinal Population-Based Study.

Researchers and politicians have regularly expressed their worries about a widening of socioeconomic inequalities in physical and mental health. Debts have been relatively understudied as a specific aspect of socioeconomic disadvantage contributing to poor mental health. This study examines the bidirectional association between debts and common mental disorders (CMDs) in the adult population of the Netherlands. Data were obtained from the second (‘baseline’) and third (3-year follow-up) wave of the Netherlands Mental Health Survey and Incidence Study-2, a representative cohort of adults. Questions were asked about debts and difficulty in repaying debts in the past 12 months. The answers were combined into one variable: no debts, easy, difficult, and very difficult to pay back debts. Twelve-month CMDs were assessed with the Composite International Diagnostic Interview version 3.0. Increasing levels of difficulty in repaying debts predicted onset of CMD at follow-up in those without 12-month CMD at baseline, and persistence of CMD at follow-up in those with 12-month CMD at baseline. Conversely, CMD was not linked to onset of debts at follow-up in those without 12-month debts at baseline, but was associated with persistence of difficulty to pay back debts at follow-up in those with 12-month debts at baseline. These associations remained significant after adjustment for baseline sociodemographic variables, negative life events and physical health. Health professionals and debt counsellors should pay more attention to patients’ debts and clients’ mental health respectively in order to refer those with financial or mental health problems to the appropriate services.Supplementary InformationThe online version contains supplementary material available at 10.1007/s10488-021-01131-9.

Mental health in higher education students and non-students: evidence from a nationally representative panel study.

Despite increasing policy focus on mental health provision for higher education students, it is unclear whether they have worse mental health outcomes than their non-student peers. In a nationally-representative UK study spanning 2010–2019 (N = 11,519), 17–24 year olds who attended higher education had lower average psychological distress (GHQ score difference = − 0.37, 95% CI − 0.60, − 0.08) and lower odds of case-level distress than those who did not (OR = 0.91, 95% CI 0.81, 1.02). Increases in distress between 2010 and 2019 were similar in both groups. Accessible mental health support outside higher education settings is necessary to prevent further widening of socioeconomic inequalities in mental health.Supplementary InformationThe online version contains supplementary material available at 10.1007/s00127-021-02032-w.

Less obesity but higher inequalities in Portuguese children: Trends of childhood obesity between 2002–2016

To observe the trends of overweight and obesity among Portuguese children from 2002 to 2016, before and during the years of the economic crisis, and compare these trends according to family's socio-economic position (SEP). Prevalence rates were calculated using data from six studies providing comparable estimates from 2002, 2009, 2011, 2013 and 2016 for children aged 6-10-years living in the Portuguese Midlands (n=7192; 50.2% girls). Height and weight were objectively measured; children and family characteristics were collected by standard questionnaires. A logistic regression was used to test the association between variables. Between 2002 and 2016, there was a decrease in the prevalence of overweight and obesity, which reached a statistical significance for girls. The prevalence of overweight, including obesity, was high (low-SEP=30.5%; high-SEP=20.5%) and a widening of socio-economic inequalities was found. Socio-economically disadvantaged children had more than 2 times the odds of having obesity than children from higher-SEP, even after adjusting for sex, physical activity and screen-time. While a decrease in overall rates of overweight and obesity was observed from 2002 to 2016, the social inequalities have been widened which suggest the need for public efforts to promote healthy weight at a population level, especially in lower socio-economic classes.

An egalitarian society? Widening inequalities in premature mortality from non-communicable diseases in Australia, 2006-16.

The recent slowdown in life expectancy increase in Australia has occurred concurrently with widening socioeconomic and geographical inequalities in all-cause mortality risk. We analysed whether, and to what extent, mortality inequalities among specific non-communicable diseases (NCDs) in Australia at ages 35-74 years widened during 2006-16. Registered deaths that occurred during 2006-16 in Australia were analysed. Inequalities were measured by area socioeconomic quintile [ranging from Q1 (lowest) to Q5 (highest)] and remoteness (major cities, inner regional, outer regional/remote/very remote). Age-standardized death rates (ASDR) for 35-74 years were calculated and smoothed over time. NCD mortality inequalities by area socioeconomic quintile widened; the ratio of Q1 to Q5 ASDR for males increased from 1.96 [95% confidence interval (CI) 1.91-2.01] in 2011 to 2.08 (2.03-2.13) in 2016, and for females from 1.78 (1.73-1.84) to 1.96 (1.90-2.02). Moreover, Q1 NCD ASDRs did not clearly decline from 2011 to 2016. CVD mortality inequalities were wider than for all NCDs. There were particularly large increases in smoking-related mortality inequalities. In 2016, mortality inequalities were especially high for chronic respiratory diseases, alcohol-related causes and diabetes. NCD mortality rates outside major cities were higher than within major cities, and these differences widened during 2006-16. Higher mortality rates in inner regional areas than in major cities were explained by socioeconomic factors. Widening of inequalities in premature mortality rates is a major public health issue in Australia in the context of slowing mortality decline. Inequalities are partly explained by major risk factors for CVDs and NCDs: being overweight or obese, lack of exercise, poor diet and smoking. There is a need for urgent policy responses that consider socioeconomic disadvantage.

Temporal trends in coverage, quality and equity of maternal and child health services in Rwanda, 2000–2015

IntroductionAchieving the maternal and child health (MCH)-related Sustainable Development Goals (SDG) will require equitable and effective (quality-adjusted) coverage of recommended health interventions in low- and middle-income countries. We assessed effective...

Interpretable socioeconomic status inference from aerial imagery through urban patterns

Urbanization is a great challenge for modern societies, promising better access to economic opportunities, but widening socioeconomic inequalities. Accurately tracking this process as it unfolds has been challenging for traditional data collection methods, but remote sensing information offers an alternative way to gather a more complete view of these societal changes. By feeding neural networks with satellite images, the socioeconomic information associated with that area can be recovered. However, these models lack the ability to explain how visual features contained in a sample trigger a given prediction. Here, we close this gap by predicting socioeconomic status across France from aerial images and interpreting class activation mappings in terms of urban topology. We show that trained models disregard the spatial correlations existing between urban class and socioeconomic status to derive their predictions. These results pave the way to build more interpretable models, which may help to better track and understand urbanization and its consequences. Neural network models can predict the socioeconomic wealth of an area from aerial views, but fall short of explaining how visual features trigger a given prediction. The authors develop a pipeline for projecting class activation maps onto the underlying urban topology, to help interpret such predictions.

Has the European Union created a healthy food environment for its citizens? Application of the Food Environment Policy Index (Food-EPI)

Abstract Background European Union (EU) Member states' food environments are shaped by both national and EU policies. To date however, studies assessing food environment policies developed and set by the EU are scarce. The aim of this study was to assess the strength of EU policies to improve food environments as well as to assess the extent these policies could lead to a decrease or widening of socio-economic inequalities in dietary intake. Methods We compiled evidence on the EU policies for each of the Food-EPI 47 indicators. A European panel of independent, non-government experts (N = 30) specialized in nutrition, obesity or chronic diseases, using the Food-EPI evidence, rated the strength of EU policies to improve food environments during an online survey in February-March 2020. The experts also rated to which extent policies could lead to a decrease or widening of socio-economic inequalities in dietary intake. In addition, experts formulated actions to improve EU food environment policies, which were prioritized during a follow-up online survey. Results The overview of EU-level policies resulted in a 79-pages document, describing policies (or the lack thereof) for each of the 47 Food-EPI indicators. This document has been verified for completeness and accuracy by EU governmental officials. The evidence document shows that the EU has mainly binding legislation on the food labelling whereas policies on the other Food-EPI domains are mostly voluntary. Results from the online survey and the formulated prioritized actions will be presented during the conference. The results will reflect the experts' ratings supported by documented evidence and will provide meaningful guidance to EU officials and public health advocates in their efforts to improve the food environment policies set by the EU.

Has the Netherlands created a healthy food environment for its citizens? Application of the Food Environment Policy Index (Food-EPI)

Abstract Background Healthy food environments have the potential to improve population nutrition and decrease NCDs. The aim of the study was to assess the efforts of the National Government in the Netherlands towards creating healthier food environments using the Healthy Food Environment Policy Index (Food-EPI). Methods We compiled evidence on national food environment policies in the Netherlands for each of the 47 indicators. This document has been verified for completeness and accuracy by Dutch governmental officials. A panel of independent, nongovernment experts specialized in nutrition, obesity or chronic diseases, was provided with this evidence and rated the extent of implementation of Dutch policies by benchmarking these policies against international best practices during an online survey in May-July 2020. The experts also rated to which extent policies could lead to a decrease or widening of socio-economic inequalities in dietary intake. In addition, experts formulated actions to improve food environment policies in the Netherlands. Results This is the first interdisciplinary study to assess food environment policies developed and set by the Netherlands. The overview of national level policies resulted in a evidence document, describing policies (or the lack thereof) for each of the 47 indicators. The evidence document shows that the Netherlands has mostly voluntary policies, mainly through the National Prevention Agreement (launched in 2018) and Agreement on Product Improvement (launched in 2014). Results from the online survey and the formulated actions will be presented during the conference. The results will reflect the experts' ratings supported by documented evidence and will provide meaningful guidance to governmental officials and public health advocates in their efforts to improve the food environment policies in the Netherlands.

Widening inequalities in premature mortality in Australia, 2006-16

Background Increases in Australia’s life expectancy have slowed since 2003. Within this context, it is important to analyse whether socio-economic and geographic inequalities in premature mortality have changed in recent years.&#x0D; Aim The aim is to measure the extent of and change in inequalities in premature mortality (under 75 years) by area socio-economic status and remoteness in Australia from 2006-16.&#x0D; Data and methods This study uses Australian death registration data from 2006-16. We identify area socio-economic quintile (Q1 lowest to Q5 highest) and remoteness (major cities, inner regional, outer regional/ remote/very remote) for each decedent. Age-standardised death rates (ASDR) at ages 35-74 and 0-34 years are calculated and smoothed over time.&#x0D; Results ASDR decline at ages 35-74 years has slowed markedly, and from 2011-16 Q1 ASDRs stagnated. The Q1:Q5 ASDR ratio for females rose from 2011-16 for males (1.97 to 2.11) and females (1.78 to 1.98), and also widened in the Q2:Q5 and Q3:Q5 comparisons for females. ASDRs outside major cities stagnated from 2011-16 and inequalities compared with major cities widened to be 40% higher in 2016. ASDR declines at 0-34 years were quicker than for 35-74 years and inequalities widened slightly.&#x0D; Conclusions Slowing declines in premature mortality in Australia are accompanied by substantial and widening socioeconomic and geographic inequalities. Without reductions in mortality in lower socio-economic groups and outside capital cities, future life expectancy growth in Australia will likely be hampered.