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In the field of American state politics, the tension between majoritarian institutions and equality has largely been ignored. Do state institutions that empower majority preferences exacerbate disparities in social outcomes? Under what conditions do majoritarian institutions exacerbate inequalities in the American states? Our argument is that equality is most likely to be threatened under majoritarian institutions when (1) there are systemic participatory biases and/or (2) there are widespread prejudices about particular groups in society. We find that more majoritarian institutions are associated with larger disparities between White and Black life expectancy and poverty rates across the American states, but not differences in educational attainment. We also find that this effect is moderated by racial context, with majoritarian institutions being associated with greater disparities for states with diverse racial contexts and smaller disparities in more homogenous states. These findings suggest that majoritarian institutions operate to the benefit of the White majority, while coming at the cost of minority population outcomes when a racial threat is perceived, and presumably, public opinion is biased.
Nozick’s ‘utility monster’ is often regarded as impossible, because one life cannot be better than a large number of other lives. Against that view, I propose a purely marginalist account of utility monster defining the monster by a higher sensitivity of well-being to resources (instead of a larger total well-being), and I introduce the concept of collective utility monster to account for resource predation by a group. Since longevity strengthens the sensitivity of well-being to resources, large groups of long-lived persons may, if their longevity advantage is sufficiently strong, fall under the concept of collective utility monster, against moral intuition.
Social prescribing is growing rapidly globally as a way to tackle social determinants of health. However, whom it is reaching and how effectively it is being implemented remains unclear.
Aims
To gain a comprehensive picture of social prescribing in the UK, from referral routes, reasons, to contacts with link workers and prescribed interventions.
Method
This study undertook the first analyses of a large database of administrative data from over 160 000 individuals referred to social prescribing across the UK. Data were analysed using descriptive analyses and regression modelling, including logistic regression for binary outcomes and negative binomial regression for count variables.
Results
Mental health was the most common referral reason and mental health interventions were the most common interventions prescribed. Between 72% and 85% of social prescribing referrals were from medical routes (primary or secondary healthcare). Although these referrals demonstrated equality in reaching across sociodemographic groups, individuals from more deprived areas, younger adults, men, and ethnic minority groups were reached more equitably via non-medical routes (e.g. self-referral, school, charity). Despite 90% of referrals leading to contact with a link worker, only 38% resulted in any intervention being received. A shortage of provision of community activities – especially ones relevant to mental health, practical support and social relationships – was evident. There was also substantial heterogeneity in how social prescribing is implemented across UK nations.
Conclusions
Mental health is the leading reason for social prescribing referrals, demonstrating its relevance to psychiatrists. But there are inequalities in referrals. Non-medical referral routes could play an important role in addressing inequality in accessing social prescribing and therefore should be prioritised. Additionally, more financial and infrastructural resource and strategic planning are needed to address low intervention rates. Further investment into large-scale data platforms and staff training are needed to continue monitoring the development and distribution of social prescribing.
Reducing inequalities in preconception health and care is critical to improving the health and life chances of current and future generations. A hybrid workshop was held at the 2023 UK Preconception Early and Mid-Career Researchers (EMCR) Network conference to co-develop recommendations on ways to address inequalities in preconception health and care. The workshop engaged multi-disciplinary professionals across diverse career stages and people with lived experience (total n = 69). Interactive discussions explored barriers to achieving optimal preconception health, driving influences of inequalities and recommendations. The Socio-Ecological Model framed the identified themes, with recommendations structured at interpersonal (e.g. community engagement), institutional (e.g. integration of preconception care within existing services) and environmental/societal levels (e.g. education in schools). The co-developed recommendations provide a framework for addressing inequalities in preconception health, emphasising the importance of a whole-systems approach. Further research and evidence-based interventions are now needed to advance the advocacy and implementation of our recommendations.
The aim of this study was to explore the associations between diet quality, socio-demographic measures, smoking, and weight status in a large, cross-sectional cohort of adults living in Yorkshire and Humber, UK. Data from 43, 023 participants aged over 16 years in the Yorkshire Health Survey, 2nd wave (2013–2015) were collected on diet quality, socio-demographic measures, smoking, and weight status. Diet quality was assessed using a brief, validated tool. Associations between these variables were assessed using multiple regression methods. Split-sample cross-validation was utilised to establish model portability. Observed patterns in the sample showed that the greatest substantive differences in diet quality were between females and males (3.94 points; P < 0.001) and non-smokers vs smokers (4.24 points; P < 0.001), with higher diet quality scores observed in females and non-smokers. Deprivation, employment status, age, and weight status categories were also associated with diet quality. Greater diet quality scores were observed in those with lower levels of deprivation, those engaged in sedentary occupations, older people, and those in a healthy weight category. Cross-validation procedures revealed that the model exhibited good transferability properties. Inequalities in patterns of diet quality in the cohort were consistent with those indicated by the findings of other observational studies. The findings indicate population subgroups that are at higher risk of dietary-related ill health due to poor quality diet and provide evidence for the design of targeted national policy and interventions to prevent dietary-related ill health in these groups. The findings support further research exploring inequalities in diet quality in the population.
Understanding inequalities in outcomes between demographic groups is a necessary step in addressing them in clinical care. Inequalities in treatment uptake between demographic groups may explain disparities in outcomes in people with first-episode psychosis (FEP).
Aims
To investigate disparities between broad demographic groups in symptomatic improvement in patients with FEP and their relationship to treatment uptake.
Method
We used data from 6813 patients from the 2021–2022 National Clinical Audit of Psychosis data-set. Data were grouped by category type to obtain mean outcomes before adjustment to see whether disparities in outcomes remained after differences in treatment uptake had been accounted for. After matching, the average effect of each demographic variable in terms of outcome change was calculated. Moderator effects on specific treatments were investigated using interaction terms in a regression model.
Results
Observational results showed that patients aged 18–24 years were less likely to improve in outcome, unless adjusted for intervention uptake. Patients classified as Black and Black British were less likely to improve in outcome (moderation effect 0.04, 95% CI 0–0.07) after adjusting for treatment take-up and demographic factors. Regression analysis showed the general positive effect of supported employment interventions in improving outcomes (coefficient −0.13, 95% CI −0.07 to −0.18, P < 0.001), and moderator analysis suggested targeting particular groups for interventions.
Conclusions
Inequalities in treatment uptake and psychotic symptom outcome of FEP by social and demographic factors require monitoring over time. Our analysis provides a framework for monitoring health inequalities across national clinical audits in the UK.
The role of housing in providing a welfare asset has been widely explored. With the growth in home ownership between 1979 and 2008 and erosion of the welfare state, housing wealth has become part of the welfare mix in the UK. Here, we present analysis of housing outcomes, as measured in the UK Household Longitudinal Survey (UKHLS), among people who identify as lesbian, gay, or bisexual in Great Britain. This shows that lesbian, gay, and bisexual (LGB) people have poorer housing outcomes than heterosexual counterparts: they are less likely to be homeowners; more likely to be private renters; and more likely to be social renters. With growing intergenerational inequalities in access to home ownership, we argue that, as openly LGB (and broader trans and queer) people being on average younger than the rest of the population, this could lead to LGB people, as a group, being excluded from asset-based welfare in the future as they age.
Edited by
Richard Williams, University of South Wales,Verity Kemp, Independent Health Emergency Planning Consultant,Keith Porter, University of Birmingham,Tim Healing, Worshipful Society of Apothecaries of London,John Drury, University of Sussex
The COVID-19 pandemic severely disrupted the educational and social lives of millions of children across the globe. Many governments attempted to curb the spread of the virus by closing schools or allowing them to remain open only for certain students, necessitating a rapid adjustment to remote home learning for schools and families. In the UK, this led to huge variability in the provision of educational materials, in children’s engagement, and in parents’ capacity to support home learning. This chapter describes the impacts of the school closures on families’ and students’ educational and socioemotional development.
The aim of the study was to analyze gender differences in life expectancy free of depressive symptoms among the adult population in Chile between 2003 and 2016. The Sullivan method was used to estimate the total and marginal life expectancy, based on prevalence data from the National Health Survey (2003, 2010 and 2016), and abridged life tables for the Chilean population. There was a compression of morbidity among middle-aged men during the first period and among younger and older women during the last one. Men at all ages could expect to live a higher proportion of their lives without depressive symptoms during the whole period. The gender gap in the proportion of life expectancy free of depressive symptoms reached 10 percent points or more, considering almost all ages and periods. Unemployment and lower education increased the probability of depressive symptoms, and these effects were more marked among women. Public policies should have a gender-sensitive approach to address the gap in depression and the disadvantage experienced by women in life expectancy free of depressive symptoms, considering those dimensions that intersect with gender, such as access to education, employment or income.
After evaluating the different elements explaining the power structure, the final chapters of the book are devoted to policy strategies. As an introduction to these, the chapter considers ethical issues: the individual-society opposition, the notion of the common good, the debate concerning the notion of justice (deontological versus consequentialist conceptions, meritocratic versus equalitarian views, equality of starting points versus equality of points of arrival), the different notions of freedom (such as positive versus negative freedom. Rossellis liberal socialism is illustrated, together with Croces criticism. Finally, a distinction is drawn between fanciful and realistic utopias.
To effectively target public health interventions for greatest impact, it is essential that public health practitioners have a clear understanding of the populations they work with. As described in Chapter 1, understanding these populations, their health status and health needs draws on skills from several disciplines, including demography, epidemiology and statistics. Brought together, these skills allow the practitioner to understand the characteristics of the population of interest, the key health issues that it faces and the broader factors that have a particular influence on the health of that population. These broader factors are generally referred to as the wider determinants of health or the social determinants of health. Information is also vital in allowing practitioners to assess the impact of public health interventions.
Effective health-care makes a large and increasing contribution to preventing disease and prolonging life by reducing the population burden of disease. However, only the right kind of health-care delivered in the right way, at the right time, to the right person can improve health. Health-care interventions that are powerful enough to improve population health are also powerful enough to cause harm if incorrectly used. How can public health specialists know whether their interventions are having the desired effect? Clinicians can monitor the impact of their treatments on an individual patient basis, but how do we examine the impact of a new service? This chapter looks at what we mean by quality of health-care and considers some frameworks for its evaluation.
The causes of ill health and death are changing and, as we live longer, new health-preventable problems emerge, bringing new challenges. Improving health (physical, mental or both) and promoting general well-being remain major priorities.
Just as important, the difference in health status between rich and poor continues to grow. At a global level, the picture is even more complex. Although there is some evidence that life expectancy is beginning to plateau in developed countries such as the UK, the biggest potential to improve health still lies in addressing inequality between or within countries.
Therefore, this chapter:
summarizes the models of health improvement that are prevalent today;
introduces a combined conceptual model to describe the factors affecting health in modern times; and
presents some case studies of interventions designed to improve health which offer important insight and learning.
This chapter starts by considering the key differences that make public health practice focused on children unique to that focused on adults and older people and emphasizes the importance of early intervention as part of a life-course approach. The demography of the health of children is detailed, followed by a description of the major causes of ill health in children and young people, key public health challenges for this age group and their families and a summary of effective public health interventions to improve health and well-being and reduce inequalities. Three case studies are offered: the impact of the COVID-19 pandemic; childhood obesity; and children’s and adolescents’ mental health. These highlight the complexity of these major public health challenges, how the tools described in Part 1 can be used to understand them and the importance of strategic and system-wide approaches.
This chapter extends the consideration of the changing global burden of diseases and discusses what is required to mount an effective response to public health challenges, particularly in countries where people are living in extreme poverty. It considers the role of international development assistance and the responsibilities of the international community in improving the health of poor people.
To estimate the self-reported and parent-reported mental well-being of adolescents (aged 14 and 17) with/without intellectual disability in a sample of young people representative of the UK population.
Methods
Secondary analysis of data collected in Waves 6 and 7 of the UK’s Millennium Cohort Study. The analytic sample consisted of 10,838 adolescent respondents at age 14 (361 with intellectual disability and 10,477 without) and 9,408 adolescent respondents at age 17 (292 with intellectual disability and 9,116 without).
Results
Parental reports of adolescent problems on the Strengths and Difficulties Questionnaire (SDQ) indicated that adolescents with intellectual disability at ages 14 and 17 were more likely to have problems than those without intellectual disability across all SDQ domains. Adolescent self-report data at age 17 indicated that adolescents with intellectual disability were more likely to (self)-report that they had problems than those without intellectual disability on all but one SDQ domain. The magnitude of relative inequality between those with and without intellectual disability was consistently lower for self-report than parental report. On indicators of depression, mental well-being, self-harm, positive mental health, happiness and general psychological distress at ages 14 and 17, we found no self-reported group differences between adolescents with and without intellectual disability.
Conclusions
Further research is needed to understand: (1) why the magnitude of mental health inequalities between those with and without intellectual disability on the SDQ may be dependent on the identity of the informant; and (2) whether such differences are also apparent for other measures of mental health or well-being.
In Latin America, Colombia stands out for its more significant and persistent rural–urban educational performance gaps. This paper studies the evolution of this under-performance of Colombian rural areas by conducting a long-term descriptive analysis of a new dataset. The results suggest that the role of the national government is a source of these educational inequalities because rural education was introduced late and deficiently. That is, the national government delayed the provision of education to rural areas. Moreover, even when implemented, these rural educational initiatives proved deficient due to their lack of funds, lower quality, curricula detached from the rural context and a design that amplified regional disparities, thus producing and maintaining significant and persistent rural–urban gaps in education.
How can we better situate resource inequities between schools in the longer history of racial oppression and discrimination in the United States? This article provides both a historiographical panorama of the field on a range of topics related to school finance and a roadmap of archival and research paths. It seeks to sketch out the contours of a burgeoning field to show that historians of school finance have the potential to make racial dispossession a central tenet of their analyses. First, I lay out a longer timeline for the periodization of school finance history than most of the previous scholarship has adopted to recast school funding inequality within the racialized context of land and capital dispossession. Second, I situate school finance more explicitly in US political history, showing how the study of school funding policies can illuminate major historiographical debates such as the history of tax revolts, federalism, local governance, and the development of US capitalism. Finally, I chart some of the directions historians can follow to study a wider array of school finance policies beyond the surface of state school funding formulae to make the role of policymakers at all levels of education policy more visible, and to further ground school finance developments in their racial contexts.
Edited by
Cecilia McCallum, Universidade Federal da Bahia, Brazil,Silvia Posocco, Birkbeck College, University of London,Martin Fotta, Institute of Ethnology, Czech Academy of Sciences
Focusing on key themes, this chapter highlights how kinship and relatedness constitute a vital lens for understanding gender. First, the everyday is the principal ground for examining relatedness. It illumines how gender shapes our lives and is, in turn, formed, maintained, and altered over time. The borders between gender and other aspects of life can be porous. Second, the seemingly merely domestic or intimate can be generative – a theme that builds on earlier feminist insights. Kinship has wider consequences, including for politics or economics. Finally, kinship is imbued with the potential for hierarchy and inequality, ambivalence, ruptures, and failure. Its generativity includes its less amiable aspects. Gendered inequities and enmities arise from these aspects. Breaks in the fabric of kinship, however, imply the possibility of repair, which may depend on gendered forms of labor. Threading through these themes is care, a key aspect of everyday life and relatedness alike. Care encompasses whole economies and traverses national borders. Care speaks, too, to the vulnerability that is at the heart of what it means to be human. It mirrors, and at times heightens, the difficulties inherent in kinship.
Whole-genome sequencing (WGS) information has played a crucial role in the SARS-CoV-2 (COVID-19) pandemic by providing evidence about variants to inform public health policy. The purpose of this study was to assess the representativeness of sequenced cases compared with all COVID-19 cases in England, between March 2020 and August 2021, by demographic and socio-economic characteristics, to evaluate the representativeness and utility of these data in epidemiological analyses. To achieve this, polymerase chain reaction (PCR)-confirmed COVID-19 cases were extracted from the national laboratory system and linked with WGS data. During the study period, over 10% of COVID-19 cases in England had WGS data available for epidemiological analysis. With sequencing capacity increasing throughout the period, sequencing representativeness compared to all reported COVID-19 cases increased over time, allowing for valuable epidemiological analyses using demographic and socio-economic characteristics, particularly during periods with emerging novel SARS-CoV-2 variants. This study demonstrates the comprehensiveness of England’s sequencing throughout the COVID-19 pandemic, rapidly detecting variants of concern, and enabling representative epidemiological analyses to inform policy.