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Domènech-Abella J, Muntaner C, Rodeiro J, Gabarrell-Pascuet A, Haro JM, Ayuso-Mateos JL, Miret M, Olaya B. The association of material deprivation with major depressive disorder and the role of loneliness and social support: A cross-sectional study. J Affect Disord 2024; 368:172-179. [PMID: 39278471 DOI: 10.1016/j.jad.2024.09.071] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/14/2024] [Revised: 09/10/2024] [Accepted: 09/12/2024] [Indexed: 09/18/2024]
Abstract
BACKGROUND Existing research has highlighted the positive association of material deprivation, loneliness, and poor social support with major depressive disorder (MDD). However, there is limited information on the complex interplay between these risk factors. In this study, we investigated (1) whether loneliness and social support moderate the relationship between material deprivation and MDD and (2) whether social support moderates the association between material deprivation and loneliness. METHODS We conducted a cross-sectional study analyzing responses from a representative sample of the Spanish adult population, comprising 2790 individuals who were interviewed between 2019 and 2021. The 12-month prevalence of MDD was assessed using the Composite International Diagnostic Interview (CIDI). Loneliness was measured using the three-item UCLA Loneliness Scale, and social support was evaluated with the Oslo social support scale. Material deprivation was measured using an instrument developed by the Spanish National Institute of Statistics (INE). Regression models were constructed to investigate moderating effects. RESULTS About 25 % of participants experienced material deprivation and 2.8 % had MDD. Among those with lower levels of loneliness, the probability of MDD was almost 0.10 and no significant differences were found in relation to material deprivation. Conversely, differences depending on material deprivation ranged from 0.10 (95 % CI 0.03, 0.18) to 0.44 (95 % CI 0.24, 0.65) among those with higher levels of loneliness. Social support effectively moderated the association between material deprivation and loneliness. LIMITATION The cross-sectional nature limits causal inferences. CONCLUSION Social support has the potential to improve loneliness and mental health in individuals with economic difficulties.
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Affiliation(s)
- Joan Domènech-Abella
- Instituto de Salud Carlos III, Centro de Investigación Biomédica en Red de Salud Mental, CIBERSAM, Spain; Parc Sanitari Sant Joan de Déu, Universitat de Barcelona, Sant Boi de Llobregat, Barcelona, Spain
| | | | - Jordi Rodeiro
- Parc Sanitari Sant Joan de Déu, Universitat de Barcelona, Sant Boi de Llobregat, Barcelona, Spain
| | - Aina Gabarrell-Pascuet
- Instituto de Salud Carlos III, Centro de Investigación Biomédica en Red de Salud Mental, CIBERSAM, Spain; Parc Sanitari Sant Joan de Déu, Universitat de Barcelona, Sant Boi de Llobregat, Barcelona, Spain
| | - Josep Maria Haro
- Instituto de Salud Carlos III, Centro de Investigación Biomédica en Red de Salud Mental, CIBERSAM, Spain; Parc Sanitari Sant Joan de Déu, Universitat de Barcelona, Sant Boi de Llobregat, Barcelona, Spain; Department of Psychiatry, Hospital Universitario de La Princesa, Instituto de Investigación Sanitaria Princesa (IIS-Princesa), Madrid, Spain.
| | - José Luis Ayuso-Mateos
- Instituto de Salud Carlos III, Centro de Investigación Biomédica en Red de Salud Mental, CIBERSAM, Spain; Department of Psychiatry, Hospital Universitario de La Princesa, Instituto de Investigación Sanitaria Princesa (IIS-Princesa), Madrid, Spain; Department of Psychiatry, Universidad Autónoma de Madrid, Spain
| | - Marta Miret
- Instituto de Salud Carlos III, Centro de Investigación Biomédica en Red de Salud Mental, CIBERSAM, Spain; Department of Psychiatry, Universidad Autónoma de Madrid, Spain
| | - Beatriz Olaya
- Instituto de Salud Carlos III, Centro de Investigación Biomédica en Red de Salud Mental, CIBERSAM, Spain; Parc Sanitari Sant Joan de Déu, Universitat de Barcelona, Sant Boi de Llobregat, Barcelona, Spain
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Rhodes AP, Dwyer RE, Houle JN. Debt Collection Pressure and Mental Health: Evidence from a Cohort of U.S. Young Adults. JOURNAL OF HEALTH AND SOCIAL BEHAVIOR 2024:221465241268477. [PMID: 39225254 DOI: 10.1177/00221465241268477] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 09/04/2024]
Abstract
The debt collection industry in the United States has grown in tandem with rising indebtedness. Prior research on debt and mental health mainly treats debt as a resource and liability rather than a power relationship between creditors and debtors. We study the mental health consequences of debt collection pressure using data from the National Longitudinal Survey of Youth-1997 Cohort (N = 7,236). Drawing on stress theory and health power resources theory, we posit collection pressure as a relational stressor that undermines well-being through negative interactions with debt collectors, financial strain, role strain, and stigma. We find that more than one out of every three young adults in this cohort faced debt collection pressure by around age 40, with higher rates among low-income and Black young adults. Individual fixed-effects and lagged dependent variable regression models indicate that debt collection pressure is associated with increased psychological distress, with more severe consequences among low-income young adults.
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Najman JN, Williams GM, Clavarino AM, McGee TR, King L, Scott JG, Bor W. Family poverty over the early life course and adult experiences of intimate partner violence: a cohort study. Public Health 2024; 234:143-151. [PMID: 39013235 DOI: 10.1016/j.puhe.2024.06.020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2023] [Revised: 04/30/2024] [Accepted: 06/16/2024] [Indexed: 07/18/2024]
Abstract
OBJECTIVES This study aimed to determine whether family poverty over the early childhood, adolescent, and adult periods of the life course independently predicts experiences of intimate partner violence (IPV) in adulthood. STUDY DESIGN This was a birth cohort study in Brisbane, Australia, with pregnant women recruited at their first booking-in visit and their children, followed up to 30 and 40 years of age. METHODS Family income was obtained from the mother when the child was 6 months, 5 and 14 years of age. Offspring reported their own family income at 21, 30, and 40 years of age. The offspring completed the Composite Abuse Scale at 30 and 40 years. Adjusted logistic regression models are used to predict experiences of IPV at 30 (n = 2157) and 40 (n = 1438) years. RESULTS The findings at 30 and 40 years of age are consistent. Only poverty experienced concurrently with the assessment of IPV is strongly associated. At the 40-year follow-up, family poverty predicts higher ratios of all four forms of IPV; severe combined abuse (odds ratio [OR] = 2.24, 95% confidence interval [CI] = 1.24, 4.05), physical abuse (OR = 3.37, 95% CI = 1.95, 5.82), emotional abuse (OR = 2.09, 95% CI = 2.58, 8.57) and harassment (OR = 4.70, 95% CI = 2.58, 8.57). CONCLUSION Concurrent family poverty is strongly and consistently associated with patterns of IPV. These associations are for cross-sectionally collected data with the prospectively collected data not replicating these findings. Although it is not possible to identify a specific causal pathway, the findings suggest that the immediate consequences of poverty are strongly associated with IPV. Programmes that address poverty reduction provide the best prospect for reducing societal levels of IPV.
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Affiliation(s)
- J N Najman
- School of Public Health, University of Queensland, Herston Queensland 4006, Australia.
| | - G M Williams
- School of Public Health, University of Queensland, Herston Queensland 4006, Australia
| | - A M Clavarino
- School of Public Health, University of Queensland, Herston Queensland 4006, Australia
| | - T R McGee
- School of Criminology and Criminal Justice, Griffith University, Mt Gravatt Queensland, 4122, Australia
| | - L King
- School of Public Health, University of Queensland, Herston Queensland 4006, Australia
| | - J G Scott
- Child Health Research Centre, The University of Queensland, South Brisbane, QLD, Australia; Child and Youth Mental Health Service, Children's Health Queensland, South Brisbane, Qld Australia
| | - W Bor
- School of Public Health, University of Queensland, Herston Queensland 4006, Australia
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4
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Ignatow G, Gutin I. Elite class self-interest, socioeconomic inequality and U.S. population health. SOCIOLOGY OF HEALTH & ILLNESS 2024. [PMID: 38923915 DOI: 10.1111/1467-9566.13813] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/03/2023] [Accepted: 06/08/2024] [Indexed: 06/28/2024]
Abstract
Class-based perspectives on the persistent social gradients in health within modern welfare states largely focus on the adverse consequences of unfettered neoliberalism and entrenched meritocratic socioeconomic selection. Namely, neoliberal-driven economic inequality has fuelled resentment and stress among lower-status groups, while these groups have become more homogeneous with regard to health behaviours and outcomes. We synthesise several sociological and historical literatures to argue that, in addition to these class-based explanations, socioeconomic inequality may contribute to persistent social gradients in health due to elite class self-interest-in particular elites' preferences for overdiagnosis, overprescription and costly high-technology medical treatments over disease prevention, and for increased tolerance for regulatory capture. We demonstrate that this self-interest provides parsimonious explanations for several contemporary trends in U.S. health inequality including (A) supply-side factors in drug-related deaths, (B) longitudinal trends in the social gradients of obesity and chronic disease mortality and (C) the immigrant health advantage. We conclude that sociological theories of elite class self-interest usefully complement theories of the psychosocial effects of neoliberalism and of meritocratic social selection while answering recent calls for research on the role advantaged groups play in generating inequalities in health, and for research that moves beyond technological determinism in health sociology.
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Affiliation(s)
- Gabe Ignatow
- Department of Sociology, The University of North Texas, Denton, Texas, USA
| | - Iliya Gutin
- Maxwell School of Citizenship & Public Affairs, Syracuse University, Syracuse, New York, USA
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Hajat A, Andrea SB, Oddo VM, Winkler MR, Ahonen EQ. Ramifications of Precarious Employment for Health and Health Inequity: Emerging Trends from the Americas. Annu Rev Public Health 2024; 45:235-251. [PMID: 38012123 PMCID: PMC11128534 DOI: 10.1146/annurev-publhealth-071321-042437] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2023]
Abstract
Precarious employment (PE), which encompasses the power relations between workers and employers, is a well-established social determinant of health that has strong ramifications for health and health inequity. In this review, we discuss advances in the measurement of this multidimensional construct and provide recommendations for overcoming continued measurement challenges. We then evaluate recent evidence of the negative health impacts of PE, with a focus on the burgeoning studies from North America and South America. We also establish the role of PE in maintaining and perpetuating health inequities and review potential policy solutions to help alleviate its health burden. Last, we discuss future research directions with a call for a better understanding of the heterogeneity within PE and for research that focuses both on upstream drivers that shape PE and its impacts on health, as well as on the mechanisms by which PE causes poor health.
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Affiliation(s)
- Anjum Hajat
- Department of Epidemiology, School of Public Health, University of Washington, Seattle, Washington, USA;
| | - Sarah B Andrea
- School of Public Health, Oregon Health and Sciences University-Portland State University, Portland, Oregon, USA
| | - Vanessa M Oddo
- Department of Kinesiology and Nutrition, College of Applied Health Sciences, University of Illinois Chicago, Chicago, Illinois, USA
| | - Megan R Winkler
- Department of Behavioral, Social and Health Education Sciences, Rollins School of Public Health, Emory University, Atlanta, Georgia, USA
| | - Emily Q Ahonen
- Division of Occupational and Environmental Health, Department of Family and Preventive Medicine, School of Medicine, University of Utah, Salt Lake City, Utah, USA
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Pattanshetty S, Inamdar A, Dsouza VS, Bhatt K, Jash A, Gudi N, Brand H. Scoping review of international relations theories in health security: A cue for health diplomacy. F1000Res 2024; 13:184. [PMID: 38779318 PMCID: PMC11109696 DOI: 10.12688/f1000research.145568.1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 02/26/2024] [Indexed: 05/25/2024] Open
Abstract
Background Health security as a domain has gained tremendous importance in the recent past. Emerging and re-emerging diseases globally, coupled with the derailment of the determinants of health mainly the socio-political environment, has made health security a cross-cutting entity in diverse fields including International Relations (IR). With the ongoing global polycrisis, the health-related issues which were previously sidelined as a concept of less strategic importance in the IR field, are now contributing to the shift of the world order. This has instilled an increased participation of IR scholars in the discussions and debates on health security concerns. The field of IR contains numerous theoretical lenses through which scholars analyze such situations, policies, and systems of the world. Methods In this paper, we use a scoping review method to inspect how IR theories have been applied in analyzing health security concerns. Results We observed that various diverging IR theories have been used to deliberate on states' actions in tackling the recent pandemic and have also been prescriptive about the changing notions of multilateralism and international governing organizations. Realism, liberalism, and securitization were among the most frequently applied IR theories in the context of health security discussions. Conclusions This work provides an impetus to enhance the interaction among interdisciplinary teams leading to evolving solutions that can address issues of global importance in the contemporary world.
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Affiliation(s)
- Sanjay Pattanshetty
- Centre for Health Diplomacy, Department of Global Health Governance, Prasanna School of Public Health, Manipal Academy of Higher Education, Manipal 576104, Karnataka, India
- Department of International Health, Care and Public Health Research Institute—CAPHRI, Faculty of Health, Medicine and Life Sciences, Maastricht University, 6211 LK Maastricht, The Netherlands
| | - Aniruddha Inamdar
- Centre for Health Diplomacy, Department of Global Health Governance, Prasanna School of Public Health, Manipal Academy of Higher Education, Manipal 576104, Karnataka, India
| | - Viola Savy Dsouza
- Centre for Regulatory Science, Department of Health Information, Prasanna School of Public Health, Manipal Academy of Higher Education, Manipal, Karnataka, 576104, India
| | - Kiran Bhatt
- Centre for Health Diplomacy, Department of Global Health Governance, Prasanna School of Public Health, Manipal Academy of Higher Education, Manipal 576104, Karnataka, India
| | - Amrita Jash
- Department of Geopolitics and International Relations, Manipal Academy of Higher Education, Manipal, Karnataka, 576104, India
| | - Nachiket Gudi
- Department of Health Information, Prasanna School of Public Health, Manipal Academy of Higher Education, Manipal, Karnataka, 576104, India
| | - Helmut Brand
- Department of International Health, Care and Public Health Research Institute—CAPHRI, Faculty of Health, Medicine and Life Sciences, Maastricht University, 6211 LK Maastricht, The Netherlands
- Department of Health Policy, Prasanna School of Public Health, Manipal Academy of Higher Education, Manipal, Karnataka, 576104, India
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Yadavendu VK. Looking Beyond the Lamp Post: Health Inequality in the Times of COVID-19. INTERNATIONAL JOURNAL OF SOCIAL DETERMINANTS OF HEALTH AND HEALTH SERVICES 2023; 53:478-487. [PMID: 37491845 PMCID: PMC10372503 DOI: 10.1177/27551938231189203] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 07/27/2023]
Abstract
In times of a pandemic, the world lives in the throes of colossal economic and public health crises. The world seems unprepared and ill-equipped to cater to the catastrophic pandemic of COVID-19. The apocalyptic infectious diseases keep revisiting to expose the global widening economic and health inequalities. This review in its different sections argues that with the "financialization of everything," a new consciousness comprising a more general heightened sense of awareness and interest in personal health and well-being pervades whereby citizens become customers. This effectively forefends the dynamics of interaction between the individual and her/his environment with its consequent impact on health and promotes an individuated risk and responsibility. Even in times of a pandemic, draconian state surveillance, lockdown, behavior modification, self-help, and self-care have emerged as guiding principles of public health. There is an urgent need for a radical reordering of the world order beyond the hegemonic, neoliberal, capitalistic ethos of rabid consumerism and unconstrained private profit.
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Eisenberg-Guyot J, Finsaas MC, Prins SJ. Dead Labor: Mortality Inequities by Class, Gender, and Race/Ethnicity in the United States, 1986-2019. Am J Public Health 2023; 113:637-646. [PMID: 36926964 PMCID: PMC10186820 DOI: 10.2105/ajph.2023.307227] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/03/2023] [Indexed: 03/17/2023]
Abstract
Objectives. To estimate social class inequities in US mortality using a relational measure based on power over productive property and workers' labor. Methods. We used nationally representative 1986-2018 National Health Interview Survey data with mortality follow-up through December 31, 2019 (n = 911 850). First, using business-ownership, occupational, and employment-status data, we classified respondents as incorporated business owners (IBOs), unincorporated business owners (UBOs), managers, workers, or not in the labor force (NLFs). Next, using inverse-probability-weighted survival curves, we estimated class mortality inequities overall, after subdividing workers by employment status and occupation, and by period, gender, race/ethnicity, and education. Results. UBOs, workers, and NLFs had, respectively, 6.3 (95% confidence interval [CI] = -8.1, -4.6), 6.6 (95% CI = -8.1, -5.0), and 19.4 (95% CI = -21.0, -17.7) per 100 lower 34-year survival rates than IBOs. Mortality risk was especially high for unemployed, blue-collar, and service workers. Inequities increased over time and were greater among male, racially minoritized, and less-educated respondents. Conclusions. We estimated considerable mortality inequities by class, gender, and race/ethnicity. We also estimated that class mortality inequities are increasing, threatening population health. Public Health Implications. Addressing class inequities likely requires structural, worker-empowering interventions. (Am J Public Health. 2023;113(6):637-646. https://doi.org/10.2105/AJPH.2023.307227).
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Affiliation(s)
- Jerzy Eisenberg-Guyot
- Jerzy Eisenberg-Guyot and Megan C. Finsaas are with the Department of Epidemiology and Seth J. Prins is with the Departments of Epidemiology and Sociomedical Sciences, Mailman School of Public Health, Columbia University, New York, NY
| | - Megan C Finsaas
- Jerzy Eisenberg-Guyot and Megan C. Finsaas are with the Department of Epidemiology and Seth J. Prins is with the Departments of Epidemiology and Sociomedical Sciences, Mailman School of Public Health, Columbia University, New York, NY
| | - Seth J Prins
- Jerzy Eisenberg-Guyot and Megan C. Finsaas are with the Department of Epidemiology and Seth J. Prins is with the Departments of Epidemiology and Sociomedical Sciences, Mailman School of Public Health, Columbia University, New York, NY
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Lin JL, Wang YK. Lessons from the stigma of COVID-19 survivors: A Marxist criticism appraisal. Front Public Health 2023; 11:1156240. [PMID: 37064674 PMCID: PMC10097934 DOI: 10.3389/fpubh.2023.1156240] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2023] [Accepted: 03/14/2023] [Indexed: 03/31/2023] Open
Abstract
Stigma refers to devalued stereotypes that create barriers for stigmatized individuals. During the COVID-19 pandemic, the stigmatization of survivors worsened existing inequalities and triggered mass hysteria. The paper delves into the stigmatization experienced by COVID-19 survivors and the role of Marxist criticism in analyzing this issue. The main findings from the empiricist tradition approach suggest that the perception of COVID-19 stigma is higher among those who are older, belong to ethnic minorities, lack social support, have manual occupations, and possess lower levels of education. The proposed destigmatization pathways include psychological counseling services, social support, and health education. Employing a Marxist perspective can aid in illuminating how economic practices and material conditions influence prevalent ideologies related to stigma. The stigmatization of COVID-19 survivors may be perceived as a consequence of social power inequality, although the current emphasis on individual characteristics as triggers for stigma may neglect the wider systemic forces in operation. Thus, it’s crucial to establish improved social care policies to combat exploitation and oppression due to power imbalances. The ultimate objective of such an examination is to identify effective approaches to tackle and eradicate stigma regarding health-related concerns. An interdisciplinary approach integrating a pluralistic perspective would benefit investigating how social systems and individual attributes contribute to the exacerbation of social inequality and stigmatization.
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Affiliation(s)
- Jin-Long Lin
- School of Marxism, Tsinghua University, Beijing, China
| | - Yu-Kun Wang
- School of Sociology and Law, Shanxi Normal University, Taiyuan, China
- *Correspondence: Yu-Kun Wang,
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Whitley E, McCartney G, Bartley M, Benzeval M. Examining the impact of different social class mechanisms on health inequalities: A cross-sectional analysis of an all-age UK household panel study. Soc Sci Med 2022; 312:115383. [PMID: 36155357 DOI: 10.1016/j.socscimed.2022.115383] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2022] [Revised: 08/24/2022] [Accepted: 09/16/2022] [Indexed: 01/10/2023]
Abstract
BACKGROUND Socioeconomic inequalities are well established across health, morbidity and mortality measures. Social class theory describes how social groups relate, interact and accrue advantages/disadvantages relative to one another, with different theorists emphasising different dimensions. In the context of health inequalities, different social class measures are used interchangeably to rank population groups in terms of health rather than directly exploring the role of social class in creating inequalities. We aim to better understand how four distinct social class mechanisms explain differences in a range of self-reported and biological health outcomes. METHODS We use data from the UK Household Longitudinal Study, a representative population survey of UK adults, to identify measures pertaining to Early years, Bourdieusian, Marxist, and Weberian social class mechanisms. Using logistic and least-squares regression we consider the relative extent to which these mechanisms explain differences in health (Self-reported health, SF12 Physical (PCS) and Mental (MCS) Component Scores, General Health Questionnaire; N = 21,446) and allostatic load, a biomarker-based measure of cumulative stress (N = 5003). RESULTS Respondents with higher social position according to all social class measures had better self-rated, physical and mental health, and lower allostatic load. Associations with Marxist social class were among the strongest (e.g. Relative Index of Inequality for very good/excellent self-rated health comparing highest versus lowest Marxist social class: 4.96 (4.45, 5.52), with the Weberian measure also strongly associated with self-rated (4.35 (3.90, 4.85)) and physical health (Slope Index of Inequality for SF12-PCS: 7.94 (7.39, 8.48)). Health outcome associations with Bourdieusian and Marxist measures were generally stronger for women and older respondents, and physical health associations with all measures were stronger among those aged 50+ years. CONCLUSIONS The impact of social class on health is multi-faceted. Policies to reduce health inequalities should focus more on unequal capital ownership, economic democracy and educational inequalities, reflecting Marxist and Weberian mechanisms.
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Affiliation(s)
- Elise Whitley
- MRC/CSO Social and Public Health Sciences Unit, University of Glasgow, Glasgow, G3 7HR, UK.
| | - Gerard McCartney
- School of Social and Political Sciences, University of Glasgow, Glasgow, G12 8RT, UK
| | - Mel Bartley
- Institute of Epidemiology & Health, University College London, London, WC1E 7HB, UK
| | - Michaela Benzeval
- Institute for Social and Economic Research, University of Essex, Colchester, CO4 3SQ, UK; Institute of Health and Wellbeing, University of Glasgow, Glasgow, G12 8RZ, UK
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11
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Eisenberg-Guyot J, Keyes KM, Prins SJ, McKetta S, Mooney SJ, Bates LM, Wall MM, Platt JM. Wage theft and life expectancy inequities in the United States: A simulation study. Prev Med 2022; 159:107068. [PMID: 35469776 PMCID: PMC9246227 DOI: 10.1016/j.ypmed.2022.107068] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/13/2021] [Revised: 02/07/2022] [Accepted: 04/17/2022] [Indexed: 10/18/2022]
Abstract
Wage theft - employers not paying workers their legally entitled wages and benefits - costs workers billions of dollars annually. We tested whether preventing wage theft could increase U.S. life expectancy and decrease inequities therein. We obtained nationally representative estimates of the 2001-2014 association between income and expected age at death for 40-year-olds (40 plus life expectancy at age 40) compiled from tax and Social Security Administration records, and estimates of the burden of wage theft from several sources, including estimates regarding minimum-wage violations (not paying workers the minimum wage) developed from Current Population Survey data. After modeling the relationship between income and expected age at death, we simulated the effects of scenarios preventing wage theft on mean expected age at death, assuming a causal effect of income on expected age at death. We simulated several scenarios, including one using data suggesting minimum-wage violations constituted 38% of all wage theft and caused 58% of affected workers' losses. Among women in the lowest income decile, mean expected age at death was 0.17 years longer in the counterfactual scenario than observed (95% confidence interval [CI]: 0.11-0.22), corresponding to 528,685 (95% CI: 346,018-711,353) years extended in the total 2001-2014 age-40 population. Among men in the lowest decile, the estimates were 0.12 (95% CI: 0.07-0.17) and 380,502 (95% CI: 229,630-531,374). Moreover, among women, mean expected age at death in the counterfactual scenario increased 0.16 (95% CI: 0.06-0.27) years more among the lowest decile than among the highest decile; among men, the estimate was 0.12 (95% CI: 0.03-0.21).
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Affiliation(s)
- Jerzy Eisenberg-Guyot
- Department of Epidemiology, Mailman School of Public Health, Columbia University, NY, USA.
| | - Katherine M Keyes
- Department of Epidemiology, Mailman School of Public Health, Columbia University, NY, USA
| | - Seth J Prins
- Department of Epidemiology, Mailman School of Public Health, Columbia University, NY, USA; Department of Sociomedical Sciences, Mailman School of Public Health, Columbia University, NY, USA
| | - Sarah McKetta
- Department of Epidemiology, Mailman School of Public Health, Columbia University, NY, USA
| | - Stephen J Mooney
- Department of Epidemiology, School of Public Health, University of Washington, Seattle, WA, USA
| | - Lisa M Bates
- Department of Epidemiology, Mailman School of Public Health, Columbia University, NY, USA
| | - Melanie M Wall
- Department of Biostatistics, Mailman School of Public Health, Columbia University, NY, USA
| | - Jonathan M Platt
- Department of Epidemiology, College of Public Health, University of Iowa, Iowa City, IA, USA
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12
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Zhang W, Chen X. Does ’class count’? The evolution of health inequalities by social class in early 21st century China (2002–2013). CRITICAL PUBLIC HEALTH 2022. [DOI: 10.1080/09581596.2022.2077700] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Affiliation(s)
- Wei Zhang
- School of Marxism, Tsinghua University, Beijing, China
| | - Xuan Chen
- School of Labor and Human Resources, Renmin University of China, Beijing, China
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Øversveen E, Kelly CA. Alienation: A useful concept for health inequality research. Scand J Public Health 2022; 50:1018-1023. [PMID: 35549496 PMCID: PMC9578084 DOI: 10.1177/14034948221085394] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
AIMS While Marxist class analysis has strongly influenced the development of health inequality research, other aspects of Marx's theory have received less attention. Among the most relevant of Marx's theoretical contributions for social inequalities in health is the theory of alienation. As empirical applications of the theory of alienation are currently scarce, the purpose of this commentary is to invigorate interest in alienation theory within the field of health inequality research by demonstrating its potential to illuminate the relationship between social inequality, psycho-social affects and health outcomes. RESULTS Alienation theory describes how the class structure of capitalist societies creates experiences of powerlessness, estrangement and isolation. These experiences are further posited as emerging from the exploitation of labour, thus connecting social inequality to psychological wellbeing. Alienation theory is particularly compatible with psycho-social explanations of health inequalities, which similarly posits that social inequality affects health through psychological mechanisms. We argue that alienation theory contributes in three ways to health inequality research: a) by suggesting potential mechanisms and offering predictions that may be put to use in empirical research, b) by providing a potential explanation of the welfare state paradox, and c) by situating the psycho-social determinants of health within a critical analysis of the sources of social inequality in capitalist society. CONCLUSIONS Alienation theory may provide a more textured understanding of the relationship between inequality and psycho-social health, while also foregrounding issues of class, power and exploitation that are often absent from psycho-social explanations.
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Affiliation(s)
- Emil Øversveen
- Department of Sociology and Political Science, NTNU, Trondheim, Norway
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14
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Zelner J, Masters NB, Naraharisetti R, Mojola SA, Chowkwanyun M, Malosh R. There are no equal opportunity infectors: Epidemiological modelers must rethink our approach to inequality in infection risk. PLoS Comput Biol 2022; 18:e1009795. [PMID: 35139067 PMCID: PMC8827449 DOI: 10.1371/journal.pcbi.1009795] [Citation(s) in RCA: 14] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022] Open
Abstract
Mathematical models have come to play a key role in global pandemic preparedness and outbreak response: helping to plan for disease burden, hospital capacity, and inform nonpharmaceutical interventions. Such models have played a pivotal role in the COVID-19 pandemic, with transmission models—and, by consequence, modelers—guiding global, national, and local responses to SARS-CoV-2. However, these models have largely not accounted for the social and structural factors, which lead to socioeconomic, racial, and geographic health disparities. In this piece, we raise and attempt to clarify several questions relating to this important gap in the research and practice of infectious disease modeling: Why do epidemiologic models of emerging infections typically ignore known structural drivers of disparate health outcomes? What have been the consequences of a framework focused primarily on aggregate outcomes on infection equity? What should be done to develop a more holistic approach to modeling-based decision-making during pandemics? In this review, we evaluate potential historical and political explanations for the exclusion of drivers of disparity in infectious disease models for emerging infections, which have often been characterized as “equal opportunity infectors” despite ample evidence to the contrary. We look to examples from other disease systems (HIV, STIs) and successes in including social inequity in models of acute infection transmission as a blueprint for how social connections, environmental, and structural factors can be integrated into a coherent, rigorous, and interpretable modeling framework. We conclude by outlining principles to guide modeling of emerging infections in ways that represent the causes of inequity in infection as central rather than peripheral mechanisms.
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Affiliation(s)
- Jon Zelner
- Dept. of Epidemiology, University of Michigan School of Public Health, Ann Arbor, Michigan, United States of America
- Center for Social Epidemiology and Population Health, University of Michigan School of Public Health, Ann Arbor, Michigan, United States of America
- * E-mail:
| | - Nina B. Masters
- Dept. of Epidemiology, University of Michigan School of Public Health, Ann Arbor, Michigan, United States of America
| | - Ramya Naraharisetti
- Dept. of Epidemiology, University of Michigan School of Public Health, Ann Arbor, Michigan, United States of America
- Center for Social Epidemiology and Population Health, University of Michigan School of Public Health, Ann Arbor, Michigan, United States of America
| | - Sanyu A. Mojola
- Dept. of Sociology, School of Public and International Affairs & Office of Population Research, Princeton University, Princeton, New Jersey, United States of America
| | - Merlin Chowkwanyun
- Dept. of Sociomedical Sciences, Mailman School of Public Health, Columbia University, New York, New York, United States of America
| | - Ryan Malosh
- Dept. of Epidemiology, University of Michigan School of Public Health, Ann Arbor, Michigan, United States of America
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15
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Eisenberg-Guyot J, Prins SJ, Muntaner C. Free agents or cogs in the machine? Classed, gendered, and racialized inequities in hazardous working conditions. Am J Ind Med 2022; 65:92-104. [PMID: 34796514 PMCID: PMC8752498 DOI: 10.1002/ajim.23314] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2021] [Revised: 11/01/2021] [Accepted: 11/06/2021] [Indexed: 02/03/2023]
Abstract
INTRODUCTION Few epidemiologic studies have used relational social class measures based on control over productive assets and others' labor to analyze inequities in health-affecting working conditions. Moreover, these studies have often neglected the gendered and racialized dimensions of class relations, dimensions which are essential to understanding population patterns of health inequities. Our study fills these gaps. METHODS Using data from the 2002-2018 U.S. General Social Survey, we assigned respondents to the worker, manager, petit bourgeois, or capitalist classes based on their supervisory authority and self-employment status. Next, we estimated class, class-by-gender, and class-by-race inequities in compensation/safety, the labor process, control, and conflict, using Poisson models. We also estimated gender-by-race inequities among workers. RESULTS We identified substantial class inequities, with worse conditions for workers, which is the largest class within genders and racialized groups, but also disproportionately consists of women and people of color (POC), particularly women of color (WOC). For example, relative to workers, capitalists were less likely to report that safety is not a priority (prevalence ratio [PR]: 0.41, 95% confidence interval [CI]: 0.21, 0.82), repetitive tasks (PR: 0.36, 95% CI: 0.21, 0.61), and lacking freedom (PR: 0.11, 95% CI: 0.05, 0.24). We also identified inequities among workers, with women and POC, particularly WOC, reporting worse conditions than white male workers, especially greater discrimination/harassment (WOC PR: 1.70, 95% CI: 1.36, 2.13). CONCLUSION We identified substantial inequities in working conditions across intersecting classes, genders, and racialized groups. These inequities threaten workers' health, particularly among women and POC.
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Affiliation(s)
- Jerzy Eisenberg-Guyot
- Department of Epidemiology, Mailman School of Public Health, Columbia University, NY, NY
| | - Seth J. Prins
- Department of Epidemiology, Mailman School of Public Health, Columbia University, NY, NY,Department of Sociomedical Sciences, Mailman School of Public Health, Columbia University, NY, NY
| | - Carles Muntaner
- Social & Behavioural Health Sciences Division, Dalla Lana School of Public Health, University of Toronto, Toronto, ON,Bloomberg Faculty of Nursing, University of Toronto, Toronto, ON
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16
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Reynolds MM. Health Power Resources Theory: A Relational Approach to the Study of Health Inequalities. JOURNAL OF HEALTH AND SOCIAL BEHAVIOR 2021; 62:493-511. [PMID: 34846187 PMCID: PMC10497238 DOI: 10.1177/00221465211025963] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/13/2023]
Abstract
Link and Phelan's pioneering 1995 theory of fundamental causes urged health scholars to consider the macro-level contexts that "put people at risk of risks." Allied research on the political economy of health has since aptly demonstrated how institutions contextualize risk factors for health. Yet scant research has fully capitalized on either fundamental cause or political economy of health's allusion to power relations as a determinant of persistent inequalities in population health. I address this oversight by advancing a theory of health power resources that contends that power relations distribute and translate the meaning (i.e., necessity, value, and utility) of socioeconomic and health-relevant resources. This occurs through stratification, commodification, discrimination, and devitalization. Resurrecting historical sociological emphases on power relations provides an avenue through which scholars can more fully understand the patterning of population health and better connect the sociology of health and illness to the central tenets of the discipline.
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Affiliation(s)
- Megan M. Reynolds
- Department of Sociology, University of Utah, Salt Lake City, UT, USA
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17
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Kim H. The implicit ideological function of the global health field and its role in maintaining relations of power. BMJ Glob Health 2021; 6:bmjgh-2021-005620. [PMID: 33853846 PMCID: PMC8054087 DOI: 10.1136/bmjgh-2021-005620] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2021] [Revised: 04/01/2021] [Accepted: 04/01/2021] [Indexed: 01/16/2023] Open
Affiliation(s)
- Hani Kim
- Global Health, Bill & Melinda Gates Foundation, Seattle, Washington, USA
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18
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Mahabir DF, O'Campo P, Lofters A, Shankardass K, Salmon C, Muntaner C. Classism and Everyday Racism as Experienced by Racialized Health Care Users: A Concept Mapping Study. INTERNATIONAL JOURNAL OF HEALTH SERVICES 2021; 51:350-363. [PMID: 33949220 PMCID: PMC8204040 DOI: 10.1177/00207314211014782] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Abstract
In Toronto, Canada, 51.5 % of the population are members of racialized groups. Systemic
labor market racism has resulted in an overrepresentation of racialized groups in
low-income and precarious jobs, a racialization of poverty, and poor health. Yet, the
health care system is structured around a model of service delivery and policies that fail
to consider unequal power social relations or racism. This study examines how racialized
health care users experience classism and everyday racism in the health care setting and
whether these experiences differ within stratifications such as social class, gender, and
immigration status. A concept mapping design was used to identify mechanisms of classism
and everyday racism. For the rating activity, 41 participants identified as racialized
health care users. The data analysis was completed using concept systems software.
Racialized health care users reported “race”/ethnic-based discrimination as moderate to
high and socioeconomic position-/social class-based discrimination as moderate in
importance for the challenges experienced when receiving health care; differences within
stratifications were also identified. To improve access to services and quality of care,
antiracist policies that focus on unequal power social relations and a broader systems
thinking are needed to address institutional racism within the health care system.
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Affiliation(s)
| | | | | | | | - Christina Salmon
- 518773Knowledge Translation Li Ka Shing Knowledge Institute, St. Michael's Hospital, Toronto, ON, Canada
| | - Carles Muntaner
- 7938University of Toronto, Toronto, ON, Canada.,Dalla Lana School of Public Health, 7938University of Toronto, ON, Canada
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19
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Structural determination and social practice: towards a new understanding of ‘structure’ in health inequality research. SOCIAL THEORY & HEALTH 2021. [DOI: 10.1057/s41285-021-00163-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
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20
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Kim H, Novakovic U. Towards Solving Health Inequities: A Method to Identify Ideological Operation in Global Health Programs. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:4393. [PMID: 33919017 PMCID: PMC8122602 DOI: 10.3390/ijerph18094393] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/07/2021] [Revised: 04/08/2021] [Accepted: 04/16/2021] [Indexed: 12/23/2022]
Abstract
The function of ideology is to naturalize and maintain unequal relations of power. Making visible how ideology operates is necessary for solving health inequities grounded in inequities of resources and power. However, discerning ideology is difficult because it operates implicitly. It is not necessarily explicit in one's stated aims or beliefs. Philosopher Slavoj Žižek conceptualizes ideology as a belief in overarching unity or harmony that obfuscates immanent tension within a system. Drawing from Žižek's conceptualization of ideology, we identify what may be considered as 'symptoms' of ideological practice: (1) the recurrent nature of a problem, and (2) the implicit externalization of the cause. Our aim is to illustrate a method to identify ideological operation in health programs on the basis of its symptoms, using three case studies of persistent global health problems: inequitable access to vaccines, antimicrobial resistance, and health inequities across racialized communities. Our proposed approach for identifying ideology allows one to identify ideological practices that could not be identified by particular ideological contents. It also safeguards us from an illusory search for an emancipatory content. Critiquing ideology in general reveals possibilities that are otherwise kept invisible and unimaginable, and may help us solve recalcitrant problems such as health inequities.
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Affiliation(s)
- Hani Kim
- Bill & Melinda Gates Foundation 500 5th Ave North, Seattle, WA 98109, USA
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21
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García-Mayor J, Moreno-Llamas A, la Cruz-Sánchez ED. High educational attainment redresses the effect of occupational social class on health-related lifestyle: findings from four Spanish national health surveys. Ann Epidemiol 2021; 58:29-37. [PMID: 33640485 DOI: 10.1016/j.annepidem.2021.02.010] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2020] [Revised: 11/26/2020] [Accepted: 02/18/2021] [Indexed: 11/16/2022]
Abstract
PURPOSE Social determinants as occupational social class or educational attainment might influence health outcomes. This phenomenon is known as the social gradient of health and is related to a skewed distribution of health behaviours that might explain differences in morbidity and mortality between social groups. But social class and educational attainment differ in their nature and might have distinct effects on health. Here we study the combined effect of educational attainment and occupational social class on health-related lifestyle. METHODS We retrieved data from four large-scale, national representative Spanish surveys (n = 67,171). A latent class regression analysis was run to identify clusters of health-related lifestyle behaviours. Clusters were made according to sociodemographic factors, including a combined analysis of education and occupational social class. RESULTS Higher educational attainment and occupational social class were associated with a healthier lifestyle for both sexes. The combined analysis of education and social class indicated that women with secondary education showed a high risk combination of unhealthy behaviours, as men with middle, primary or no education. CONCLUSIONS Regardless of social class, a higher educational attainment redresses the effect of occupational social class on health-related behaviours. Our results suggest that education likely plays a crucial role in population health outcomes through its effects on lifestyle.
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22
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Flynn MB. Global capitalism as a societal determinant of health: A conceptual framework. Soc Sci Med 2020; 268:113530. [PMID: 33288355 DOI: 10.1016/j.socscimed.2020.113530] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Revised: 11/03/2020] [Accepted: 11/12/2020] [Indexed: 01/24/2023]
Abstract
Recent scholarship has sought to distinguish between the deeper societal factors that shape the more proximate social determinants of health. One of these socio-structural institutions is global capitalism. While critical scholarship has advanced our understanding of the relationships between capitalist globalization and health, more work is needed to understand the transnational economic, political, and cultural practices that affect various global health issues. This paper argues that the theory of global capitalism provides an important, critical perspective for understanding different phenomena associated with global health. The theory's key concepts of transnational corporations, financialization, consumerism, transnational social classes, and transnational state comprise the conceptual framework. When applied to various global health topics, the theory advances our understanding of the health-related institutional structures of today's global economy, provides a holistic view that integrates various strands of health research, highlights various forms of health activism, and offers new questions for addressing persistent health injustice across the world.
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Affiliation(s)
- Matthew B Flynn
- Georgia Southern University, PO Box 8051, Statesboro, GA 30460, USA.
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23
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Eisenberg-Guyot J, Peckham T, Andrea SB, Oddo V, Seixas N, Hajat A. Life-course trajectories of employment quality and health in the U.S.: A multichannel sequence analysis. Soc Sci Med 2020; 264:113327. [PMID: 32919256 PMCID: PMC7607590 DOI: 10.1016/j.socscimed.2020.113327] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Revised: 08/20/2020] [Accepted: 08/21/2020] [Indexed: 10/23/2022]
Abstract
The organization of employment in the U.S. has changed dramatically since the 1970s, causing decreased power and security for workers across many dimensions of the employment relationship. Multidimensional employment-quality (EQ) measures can be used to capture these changes and test their association with health. However, most public-health EQ studies have used cross-sectional, unidimensional data. We addressed these limitations using a longitudinal, multidimensional EQ measure and data on 2779 1985-2017 Panel Study of Income Dynamics respondents. First, using a multichannel sequence-analysis approach, we identified gender-specific clusters of mid-career (ages 29-50) EQ trajectories based on respondents' employment stability, material rewards, working-time arrangements, collective organization, and power relations. Next, we examined cross-cluster variation in respondent characteristics. Finally, we estimated the gender-specific associations between cluster-membership and post-sequence-analysis-period prevalence of poor/fair self-rated health (SRH) and moderate mental illness (Kessler-K6≥5). We identified five clusters among women and seven among men. Respondents in poor-EQ clusters were disproportionately people of color and less-educated; they also tended to report worse health. For example, among women, the prevalence of poor/fair SRH and moderate mental illness was lowest among standard-employment-relationship-like-non-union workers and the becoming self-employed, and greatest among minimally-attached, returning-to-the-labor-force, and precariously-employed workers. Meanwhile, among men, the prevalence of the outcomes was lowest among stably-high-wage workers and the wealthy self-employed, and greatest among exiting-the-labor-force and precariously-employed workers. Given the potential role of EQ in health inequities, researchers and practitioners should consider EQ in their work.
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Affiliation(s)
- Jerzy Eisenberg-Guyot
- Department of Epidemiology, School of Public Health, University of Washington, Seattle, WA, USA.
| | - Trevor Peckham
- Department of Environmental and Occupational Health Services, School of Public Health, University of Washington, Seattle, WA, USA
| | - Sarah B Andrea
- Department of Epidemiology, School of Public Health, University of Washington, Seattle, WA, USA
| | - Vanessa Oddo
- Department of Kinesiology and Nutrition, College of Applied Health Sciences, University of Illinois at Chicago, Chicago, IL, USA
| | - Noah Seixas
- Department of Environmental and Occupational Health Services, School of Public Health, University of Washington, Seattle, WA, USA
| | - Anjum Hajat
- Department of Epidemiology, School of Public Health, University of Washington, Seattle, WA, USA
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Eisenberg-Guyot J, Hajat A. Under capital's thumb: longitudinal associations between relational social class and health. J Epidemiol Community Health 2020; 74:453-459. [PMID: 32086371 PMCID: PMC7173644 DOI: 10.1136/jech-2019-213440] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2019] [Revised: 01/09/2020] [Accepted: 02/05/2020] [Indexed: 11/04/2022]
Abstract
BACKGROUND We used a relational social-class measure based on property ownership and managerial authority to analyse the longitudinal relationships between class, self-rated health (SRH) and mental illness. To our knowledge, this is the first study using a relational social-class measure to evaluate these relationships longitudinally. METHODS Using Panel Study of Income Dynamics data from 1984 to 2017, we first assigned respondents aged 25-64 to the not in the labour force (NILF), worker, manager, petit bourgeois (PB) or capitalist classes based on business ownership, managerial authority and employment status. Next, using Cox models, we estimated the confounder-adjusted associations between 2-year-lagged class and incidence of poor/fair SRH and serious mental illness. We also tested whether the associations varied by gender, whether they persisted after more-fully adjusting for traditional socioeconomic-status measures (education and income) and how they changed temporally. RESULTS We identified large inequities in poor/fair SRH. NILFs had the greatest hazard, followed by workers, PBs, managers and capitalists. We also identified large inequities in serious mental illness; NILFs and workers had the greatest hazard, while capitalists had the lowest. Class inequities in both outcomes lessened but remained considerable after confounder and socioeconomic-status adjustment, and we found some evidence that the class-SRH relationship varied by gender, as being NILF was more harmful among men than women. Additionally, class inequities in the outcomes decreased somewhat over time. CONCLUSION We identified substantial class inequities in SRH and mental illness. Our findings demonstrate the importance of using relational social-class measures to deepen understanding of health inequities' root causes.
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Affiliation(s)
| | - Anjum Hajat
- Epidemiology, University of Washington, Seattle, Washington, USA
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25
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Eisenberg-Guyot J, Mooney SJ, Hagopian A, Barrington WE, Hajat A. Solidarity and disparity: Declining labor union density and changing racial and educational mortality inequities in the United States. Am J Ind Med 2020; 63:218-231. [PMID: 31845387 PMCID: PMC7293351 DOI: 10.1002/ajim.23081] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2019] [Revised: 12/02/2019] [Accepted: 12/03/2019] [Indexed: 12/12/2022]
Abstract
BACKGROUND Recently, United States life expectancy has stagnated or declined for the poor and working class and risen for the middle and upper classes. Declining labor-union density-the percent of workers who are unionized-has precipitated burgeoning income inequity. We examined whether it has also exacerbated racial and educational mortality inequities. METHODS From CDC, we obtained state-level all-cause and overdose/suicide mortality overall and by gender, gender-race, and gender-education from 1986-2016. State-level union density and demographic and economic confounders came from the Current Population Survey. State-level policy confounders included the minimum wage, the generosity of Aid to Families with Dependent Children or Temporary Assistance for Needy Families, and the generosity of unemployment insurance. To model the exposure-outcome relationship, we used marginal structural modeling. Using state-level inverse-probability-of-treatment-weighted Poisson models with state and year fixed effects, we estimated 3-year moving average union density's effects on the following year's mortality rates. Then, we tested for gender, gender-race, and gender-education effect-modification. Finally, we estimated how racial and educational all-cause mortality inequities would change if union density increased to 1985 or 1988 levels, respectively. RESULTS Overall, a 10% increase in union density was associated with a 17% relative decrease in overdose/suicide mortality (95% confidence interval [CI]: 0.70, 0.98), or 5.7 lives saved per 100 000 person-years (95% CI: -10.7, -0.7). Union density's absolute (lives-saved) effects on overdose/suicide mortality were stronger for men than women, but its relative effects were similar across genders. Union density had little effect on all-cause mortality overall or across subgroups, and modeling suggested union-density increases would not affect mortality inequities. CONCLUSIONS Declining union density (as operationalized in this study) may not explain all-cause mortality inequities, although increases in union density may reduce overdose/suicide mortality.
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Affiliation(s)
- Jerzy Eisenberg-Guyot
- Department of Epidemiology, School of Public Health,
University of Washington, Seattle, WA
| | - Stephen J. Mooney
- Department of Epidemiology, School of Public Health,
University of Washington, Seattle, WA
- Harborview Injury Prevention & Research Center,
University of Washington, Seattle, WA
| | - Amy Hagopian
- Department of Health Services, School of Public Health,
University of Washington, Seattle, WA
- Department of Global Health, School of Public Health,
University of Washington, Seattle, WA
| | - Wendy E. Barrington
- Department of Epidemiology, School of Public Health,
University of Washington, Seattle, WA
- Department of Psychosocial and Community Health, School of
Nursing, University of Washington, Seattle, WA
| | - Anjum Hajat
- Department of Epidemiology, School of Public Health,
University of Washington, Seattle, WA
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Mlinarić M, Schreuders M, Graen L, Lessenich S. Transnational tobacco companies and the mechanism of externalization: A realist synthesis. Health Place 2019; 61:102240. [PMID: 31734138 DOI: 10.1016/j.healthplace.2019.102240] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/21/2018] [Revised: 10/16/2019] [Accepted: 11/01/2019] [Indexed: 11/24/2022]
Abstract
Externalization theory assumes that risks and costs are systematically displaced from high-income countries (HICs) to low- and middle-income countries (LMICs). We review how and why transnational tobacco companies (TTCs) influence the local circumstances of LMICs that trigger externalization mechanisms, leading to tobacco-attributable risk outcomes. Our realist synthesis of scientific evidence and gray literature identifies externalization mechanisms with risk outcomes at the level of health policy, smoking trends, and tobacco production. The results reveal the mediating role of local and global third parties and intermediaries. Externalization mechanisms produce systematic tobacco-attributable inequalities between places located in HICs and those located in LMICs.
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Affiliation(s)
- Martin Mlinarić
- Institute of Medical Sociology, Medical Faculty - Martin Luther University Halle-Wittenberg, Germany.
| | - Michael Schreuders
- Department of Public Health, Amsterdam UMC, University of Amsterdam, Amsterdam Public Health Research Institute, Amsterdam, Netherlands
| | | | - Stephan Lessenich
- Political Sociology of Inequalities, Institute of Sociology, Ludwig Maximilians University Munich, Germany
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Eisenberg-Guyot J, Prins SJ. Relational Social Class, Self-Rated Health, and Mortality in the United States. INTERNATIONAL JOURNAL OF HEALTH SERVICES 2019; 50:7-20. [PMID: 31698990 DOI: 10.1177/0020731419886194] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Applying a relational class theory based on property ownership, authority, and credentials/skill, we analyzed the relationship between class, self-rated health (SRH), and mortality using the 1972–2016 General Social Survey. In a simple measure of class, we assigned respondents to worker, manager, petty bourgeois, or capitalist classes. In a complex measure, we subdivided workers (less-skilled/more-skilled), managers (low/high), and capitalists (small/large). Next, we estimated trends in class structure. Finally, after gender-stratification, we estimated the relationships between class, SRH, and mortality and, in sensitivity analyses, tested for class-by-race interaction. Class structure changed little over time, with workers constituting over half the population each decade. Concerning SRH, for the simple measure, managers, petty bourgeoisie, and capitalists reported better health than workers. For the complex measure, patterns were similar, although skilled workers reported better health than less-skilled workers, low managers, and petty bourgeoisie. Concerning mortality, for the simple measure, inequities were small among women; among men, only capitalists’ hazard was lower than workers’ hazard. For the complex measure, across genders, the hazards of less-skilled workers and petty bourgeoisie were highest, while skilled workers’ hazard resembled that of managers and capitalists. Finally, we found some evidence that the relationship between class and mortality varied by race, although the estimates were imprecise.
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Affiliation(s)
- Jerzy Eisenberg-Guyot
- Department of Epidemiology, University of Washington School of Public Health, Seattle, Washington, USA
| | - Seth J Prins
- Departments of Epidemiology and Sociomedical Sciences, Columbia University Mailman School of Public Health, New York, New York, USA
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Wesp LM, Malcoe LH, Elliott A, Poteat T. Intersectionality Research for Transgender Health Justice: A Theory-Driven Conceptual Framework for Structural Analysis of Transgender Health Inequities. Transgend Health 2019; 4:287-296. [PMID: 31663035 PMCID: PMC6818474 DOI: 10.1089/trgh.2019.0039] [Citation(s) in RCA: 96] [Impact Index Per Article: 19.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Transgender people experience intersecting forms of social marginalization and are disproportionately affected by health inequities. We elucidate a novel conceptual framework for transgender health research that theorizes the constructs and pathways through which social inequities produce health inequities for transgender populations. Drawing on theories of intersectionality and structural injustice, Intersectionality Research for Transgender Health Justice (IRTHJ) posits that social and health inequities affecting transgender populations are the result of status quo power relations produced within and between oppressive structures, institutional systems, and socio-structural processes. The IRTHJ framework delineates three main actions for improving transgender health research: (i) name intersecting power relations, (ii) disrupt the status quo, and (iii) center embodied knowledge. The authors show how IRTHJ provides tools for researchers to transform the design, implementation, and interpretation of transgender health research, and they discuss implications for programs, policy, and action for transgender health justice.
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Affiliation(s)
- Linda M Wesp
- University of Wisconsin-Milwaukee College of Nursing, Milwaukee, Wisconsin
| | - Lorraine Halinka Malcoe
- University of Wisconsin-Milwaukee Joseph J. Zilber School of Public Health, Milwaukee, Wisconsin
| | | | - Tonia Poteat
- Center for Health Equity Research, UNC School of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
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McCartney G, Hearty W, Arnot J, Popham F, Cumbers A, McMaster R. Impact of Political Economy on Population Health: A Systematic Review of Reviews. Am J Public Health 2019; 109:e1-e12. [PMID: 31067117 PMCID: PMC6507992 DOI: 10.2105/ajph.2019.305001] [Citation(s) in RCA: 76] [Impact Index Per Article: 15.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/27/2018] [Indexed: 01/08/2023]
Abstract
Background. Although there is a large literature examining the relationship between a wide range of political economy exposures and health outcomes, the extent to which the different aspects of political economy influence health, and through which mechanisms and in what contexts, is only partially understood. The areas in which there are few high-quality studies are also unclear. Objectives. To systematically review the literature describing the impact of political economy on population health. Search Methods. We undertook a systematic review of reviews, searching MEDLINE, Embase, International Bibliography of the Social Sciences, ProQuest Public Health, Sociological Abstracts, Applied Social Sciences Index and Abstracts, EconLit, SocINDEX, Web of Science, and the gray literature via Google Scholar. Selection Criteria. We included studies that were a review of the literature. Relevant exposures were differences or changes in policy, law, or rules; economic conditions; institutions or social structures; or politics, power, or conflict. Relevant outcomes were any overall measure of population health such as self-assessed health, mortality, life expectancy, survival, morbidity, well-being, illness, ill health, and life span. Two authors independently reviewed all citations for relevance. Data Collection and Analysis. We undertook critical appraisal of all included reviews by using modified Assessing the Methodological Quality of Systematic Reviews (AMSTAR) criteria and then synthesized narratively giving greater weight to the higher-quality reviews. Main Results. From 4912 citations, we included 58 reviews. Both the quality of the reviews and the underlying studies within the reviews were variable. Social democratic welfare states, higher public spending, fair trade policies, extensions to compulsory education provision, microfinance initiatives in low-income countries, health and safety policy, improved access to health care, and high-quality affordable housing have positive impacts on population health. Neoliberal restructuring seems to be associated with increased health inequalities and higher income inequality with lower self-rated health and higher mortality. Authors' Conclusions. Politics, economics, and public policy are important determinants of population health. Countries with social democratic regimes, higher public spending, and lower income inequalities have populations with better health. There are substantial gaps in the synthesized evidence on the relationship between political economy and health, and there is a need for higher-quality reviews and empirical studies in this area. However, there is sufficient evidence in this review, if applied through policy and practice, to have marked beneficial health impacts. Public Health Implications. Policymakers should be aware that social democratic welfare state types, countries that spend more on public services, and countries with lower income inequalities have better self-rated health and lower mortality. Research funders and researchers should be aware that there remain substantial gaps in the available evidence base. One such area concerns the interrelationship between governance, polities, power, macroeconomic policy, public policy, and population health, including how these aspects of political economy generate social class processes and forms of discrimination that have a differential impact across social groups. This includes the influence of patterns of ownership (of land and capital) and tax policies. For some areas, there are many lower-quality reviews, which leave uncertainties in the relationship between political economy and population health, and a high-quality review is needed. There are also areas in which the available reviews have identified primary research gaps such as the impact of changes to housing policy, availability, and tenure.
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Affiliation(s)
- Gerry McCartney
- Gerry McCartney, Wendy Hearty, and Julie Arnot are with Public Health Science, NHS Health Scotland, Glasgow, Scotland. Frank Popham is with Medical Research Council/Chief Scientist Office Social and Public Health Sciences Unit, University of Glasgow, Glasgow. Gerry McCartney, Andrew Cumbers, and Robert McMaster are with Adam Smith Business School, University of Glasgow
| | - Wendy Hearty
- Gerry McCartney, Wendy Hearty, and Julie Arnot are with Public Health Science, NHS Health Scotland, Glasgow, Scotland. Frank Popham is with Medical Research Council/Chief Scientist Office Social and Public Health Sciences Unit, University of Glasgow, Glasgow. Gerry McCartney, Andrew Cumbers, and Robert McMaster are with Adam Smith Business School, University of Glasgow
| | - Julie Arnot
- Gerry McCartney, Wendy Hearty, and Julie Arnot are with Public Health Science, NHS Health Scotland, Glasgow, Scotland. Frank Popham is with Medical Research Council/Chief Scientist Office Social and Public Health Sciences Unit, University of Glasgow, Glasgow. Gerry McCartney, Andrew Cumbers, and Robert McMaster are with Adam Smith Business School, University of Glasgow
| | - Frank Popham
- Gerry McCartney, Wendy Hearty, and Julie Arnot are with Public Health Science, NHS Health Scotland, Glasgow, Scotland. Frank Popham is with Medical Research Council/Chief Scientist Office Social and Public Health Sciences Unit, University of Glasgow, Glasgow. Gerry McCartney, Andrew Cumbers, and Robert McMaster are with Adam Smith Business School, University of Glasgow
| | - Andrew Cumbers
- Gerry McCartney, Wendy Hearty, and Julie Arnot are with Public Health Science, NHS Health Scotland, Glasgow, Scotland. Frank Popham is with Medical Research Council/Chief Scientist Office Social and Public Health Sciences Unit, University of Glasgow, Glasgow. Gerry McCartney, Andrew Cumbers, and Robert McMaster are with Adam Smith Business School, University of Glasgow
| | - Robert McMaster
- Gerry McCartney, Wendy Hearty, and Julie Arnot are with Public Health Science, NHS Health Scotland, Glasgow, Scotland. Frank Popham is with Medical Research Council/Chief Scientist Office Social and Public Health Sciences Unit, University of Glasgow, Glasgow. Gerry McCartney, Andrew Cumbers, and Robert McMaster are with Adam Smith Business School, University of Glasgow
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McCartney G, Bartley M, Dundas R, Katikireddi SV, Mitchell R, Popham F, Walsh D, Wami W. Theorising social class and its application to the study of health inequalities. SSM Popul Health 2019; 7:015-15. [PMID: 31297431 PMCID: PMC6598164 DOI: 10.1016/j.ssmph.2018.10.015] [Citation(s) in RCA: 23] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2018] [Revised: 10/29/2018] [Accepted: 10/30/2018] [Indexed: 01/24/2023] Open
Abstract
The literature on health inequalities often uses measures of socio-economic position pragmatically to rank the population to describe inequalities in health rather than to understand social and economic relationships between groups. Theoretical considerations about the meaning of different measures, the social processes they describe, and how these might link to health are often limited. This paper builds upon Wright's synthesis of social class theories to propose a new integrated model for understanding social class as applied to health. This model incorporates several social class mechanisms: social background and early years' circumstances; Bourdieu's habitus and distinction; social closure and opportunity hoarding; Marxist conflict over production (domination and exploitation); and Weberian conflict over distribution. The importance of discrimination and prejudice in determining the opportunities for groups is also explicitly recognised, as is the relationship with health behaviours. In linking the different social class processes we have created an integrated theory of how and why social class causes inequalities in health. Further work is required to test this approach, to promote greater understanding of researchers of the social processes underlying different measures, and to understand how better and more comprehensive data on the range of social class processes these might be collected in the future.
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Affiliation(s)
- Gerry McCartney
- NHS Health Scotland, 5th Floor, Meridian Court, 5 Cadogan Street, Glasgow, Scotland, UK
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Zhang W, Wu Q. The Relationship Between Public Sector Employment and Population Health: Evidence From the 1980s and Its Contemporary Implications. INTERNATIONAL JOURNAL OF HEALTH SERVICES 2019; 49:555-581. [PMID: 30839247 DOI: 10.1177/0020731419833530] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
This article explores the relationship between public sector employment and population health both theoretically and quantitatively. First, we build a theoretical framework to situate public employment in the literature that explores the link between politics and health. We argue that public employment, as an instrument of pro-redistributive policies in both the labor market and the welfare state, improves equality and ultimately health. Second, based on a cross-country dataset from the 1980s, and by applying regression analysis and outlier identification techniques, we find that population health measured by life expectancy improves with the size of public employment. The association is stronger for countries with lower income and for women. When policymakers contemplate downsizing state enterprises and government functions, they should consider the health effect of public employment.
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Affiliation(s)
- Wei Zhang
- 1 School of Marxism, Tang Scholar, Tsinghua University, Beijing, China
| | - Qingjun Wu
- 2 Qingjun Wu, School of Labor and Human Resources, Renmin University of China, Beijing, China
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Muntaner C, Gunn V. In Defense of Class Wars in Population Health: The New Landscape of Social Class With Bourdieu, Neo-Marxists, and the Kohn/Schooler/Wright Integrative Models. INTERNATIONAL JOURNAL OF HEALTH SERVICES 2019; 49:102-107. [PMID: 30798685 DOI: 10.1177/0020731418818409] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
The field of social inequalities in health has been dominated by an individual attributes approach with a small number of indicators, namely occupation, income, and education. We review the weakness of this approach and detail the emergence of sociological alternatives tied to the writings of Bourdieu, Marx, and Weber. A particularly rich theoretical development stems from the integration of Weberian and Marxian approaches, associated with sociologists Melvin Kohn, Carmi Schooler, and Erik Olin Wright.
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Affiliation(s)
- Carles Muntaner
- 1 Lawrence S. Bloomberg Faculty of Nursing, Dalla Lana School of Public Health, University of Toronto, ON, Canada
| | - Virginia Gunn
- 2 Lawrence S. Bloomberg Faculty of Nursing, Global Health Collaborative Specialization, Dalla Lana School of Public Health, University of Toronto, ON, Canada
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Kim H, Novakovic U, Muntaner C, Hawkes MT. A critical assessment of the ideological underpinnings of current practice in global health and their historical origins. Glob Health Action 2019; 12:1651017. [PMID: 31431145 PMCID: PMC6713144 DOI: 10.1080/16549716.2019.1651017] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2019] [Accepted: 07/27/2019] [Indexed: 12/17/2022] Open
Abstract
Background: The current approach to global health has significantly contributed to improving it, as evidenced by the progress made toward the Millennium Development Goals (MDGs). However, the health gains achieved are often highly unequitable, and the current approach is expected to be insufficient to meet the future health equity challenges. There is an urgent need to re-think and expand the scope of research and programmatic strategies. Objective: This paper aims to assess the ideological underpinnings of the currently dominant norms in global health, with the goal of highlighting the research and programmatic areas that are marginalized and warrant greater efforts in order to resolve persistent health inequity and achieve the UN Sustainable Development Goals (SDGs). Methods: We have conducted a critical review of the literature that traces the historical origins of global health to the period between the mid-19th century and the end of the 20th century. Results: Critical review of the historical origins of global health reveals a set of dominant norms in global health that are ideological in character, and profoundly shape the current practice. We identified key manifestations of the ideological underpinnings as 1) Democratic deficit, 2) Depoliticization of the discourse, 3) Marginalization of the scholarship that interrogates the relations of power. Conclusion: Examination of the dominant norms that shape the foundation of our knowledge and action in global health is required to solve persistent health inequity challenges and meet the SDGs. Inversion of the key manifestations of the dominant norms can serve as guiding principles to elaborate alternative frameworks that have the theoretical and programmatic potential for a fundamental rather than an incremental change in the practice of global health.
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Affiliation(s)
- Hani Kim
- Bill & Melinda Gates Foundation, Global Health, Seattle, WA, USA
| | - Uros Novakovic
- Department of Interdisciplinary Research, Office OU, Toronto, Canada
| | - Carles Muntaner
- Dalla Lana School of Public Health, University of Toronto, Toronto, Canada
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Novrinda H, Han DH, Jung-Choi K, Ryu JI. Neo-Marxian social class inequalities in oral health among the South Korean population. Community Dent Oral Epidemiol 2018; 47:162-170. [PMID: 30548668 DOI: 10.1111/cdoe.12439] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2018] [Revised: 11/12/2018] [Accepted: 11/13/2018] [Indexed: 12/27/2022]
Abstract
AIM The aims of this study were to examine inequalities in periodontitis and tooth loss among South Korean adults using the Wright's Neo-Marxian social class (NMSC) indicator and to assess the impact of material, psychosocial, health behavioural and workplace environmental factors in the association of social class with oral health. METHODS This study used the data from the 4th Korea National Health and Nutrition Examination Survey with 6710 participants aged 19-54 years old. Participants were classified into 12 social class positions based on the Wright's social class map. Healthy gum and absence of tooth loss were the health outcomes. Mediating factors were material (M), psychosocial (PS), health behavioural (HB) and workplace environmental (WPE) factors. A series of logistic regressions were performed to analyse the data. Odds ratio (OR) and 95% confidence interval (CI) were used to report the results. RESULTS For the absence of periodontal pockets status, expert supervisors were the healthiest periodontal group among the social classes (OR = 2.15 95% CI 1.59-2.90) in the age and gender adjusted model. For the absence of tooth loss, skilled workers had the highest OR for absence of tooth loss (OR = 1.64 95% CI 1.31-2.05) in the age- and gender-adjusted model. For absence of periodontal pockets, the explanatory power of the M factor was the highest in all social class positions except for nonskilled supervisors followed by the HB factor. Additionally, the absence of tooth loss had a fairly similar pattern. The explanatory power of the M factor was the highest in all social class positions except for the petty bourgeoisie (highest: HB) and nonskilled supervisors (highest: WPE) followed by the HB and WPE factors. CONCLUSION There were nongradient oral health inequalities among the South Korean population according to the NMSC. Oral health promotion programmes that focus on changing the socioeconomic environment and health behaviours should be implemented.
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Affiliation(s)
- Herry Novrinda
- Department of Preventive and Social Dentistry, Seoul National University School of Dentistry, Seoul, Korea.,Department of Dental Public Health and Preventive Dentistry, Universitas Indonesia, Jakarta, Indonesia
| | - Dong-Hun Han
- Department of Preventive and Social Dentistry, Seoul National University School of Dentistry, Seoul, Korea.,Dental Research Institute, Seoul National University, Seoul, Korea
| | - Kyunghee Jung-Choi
- Department of Preventive Medicine, Ewha Womans University School of Medicine, Seoul, Korea
| | - Jae-In Ryu
- Department of Preventive and Social Dentistry, Kyung Hee University, Seoul, Korea
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Obradors-Rial N, Ariza C, Rajmil L, Muntaner C. Socioeconomic position and occupational social class and their association with risky alcohol consumption among adolescents. Int J Public Health 2018; 63:457-467. [PMID: 29396604 DOI: 10.1007/s00038-018-1078-6] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2017] [Revised: 01/04/2018] [Accepted: 01/10/2018] [Indexed: 11/27/2022] Open
Abstract
OBJECTIVES To compare different measures of socioeconomic position (SEP) and occupational social class (OSC) and to evaluate their association with risky alcohol consumption among adolescents attending the last mandatory secondary school (ages 15-17 years). METHODS This was a cross-sectional study. 1268 adolescents in Catalonia (Spain) participated in the study. Family affluence scale (FAS), parents' OSC, parents' level of education and monthly familiar income were used to compare socioeconomic indicators. Logistic regression analyses were conducted to evaluate socioeconomic variables and missing associated factors, and to observe the relation between each SEP variable and OSC adjusting by sociodemographic variables. RESULTS Familiar income had more than 30% of missing values. OSC had the fewest missing values associated factors. Being immigrant was associated with all SEP missing values. All SEP measures were positively associated with risky alcohol consumption, yet the strength of these associations diminished after adjustment for sociodemographic variables. Weekly available money was the variable with the strongest association with risky alcohol consumption. CONCLUSIONS OSC seems to be as good as the other indicators to assess adolescents' SEP. Adolescents with high SEP and those belonging to upper social classes reported higher levels of risky alcohol consumption.
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Affiliation(s)
- Núria Obradors-Rial
- Facultat de Ciències de la Salut de Manresa, Universitat de Vic - Universitat Central de Catalunya (UVic-UCC), Manresa, Spain.
- Facultat de Ciències de la Salut de Manresa, Fundació Universitària del Bages, Av. Universitària 4-6, 08242, Manresa, Barcelona, Spain.
| | - Carles Ariza
- Agència de Salut Pública de Barcelona, Barcelona, Spain
- Ciber de Epidemiología y Salud Pública (CIBERESP), Madrid, Spain
- Instituto de Investigación Biomédica Sant Pau (IIB Sant Pau), Sant Antoni Maria Claret 167, 08025, Barcelona, Spain
| | - Luis Rajmil
- IMIM-Institut de Recerca Hospital del Mar, Barcelona, Spain
| | - Carles Muntaner
- Bloomberg Faculty of Nursing and Dalla Lana School of Public Health, Division of Social and Behavioral Health Sciences, University of Toronto, Toronto, Canada
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Mladovsky P, Ba M. Removing user fees for health services: A multi-epistemological perspective on access inequities in Senegal. Soc Sci Med 2017; 188:91-99. [PMID: 28734964 DOI: 10.1016/j.socscimed.2017.07.002] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2016] [Revised: 07/03/2017] [Accepted: 07/05/2017] [Indexed: 11/24/2022]
Abstract
Plan Sésame (PS) is a user fee exemption policy launched in 2006 to provide free access to health services to Senegalese citizens aged 60 and over. Analysis of a large household survey evaluating PS echoes findings of other studies showing that user fee removal can be highly inequitable. 34 semi-structured interviews and 19 focus group discussions with people aged 60 and over were conducted in four regions in Senegal (Dakar, Diourbel, Matam and Tambacounda) over a period of six months during 2012. They were analysed to identify underlying causes of exclusion from/inclusion in PS and triangulated with the household survey. The results point to three steps at which exclusion occurs: (i) not being informed about PS; (ii) not perceiving a need to use health services under PS; and (iii) inability to access health services under PS, despite having the information and perceived need. We identify lay explanations for exclusion at these different steps. Some lay explanations point to social exclusion, defined as unequal power relations. For example, poor access to PS was seen to be caused by corruption, patronage, poverty, lack of social support, internalised discrimination and adverse incorporation. Other lay explanations do not point to social exclusion, for example: poor implementation; inadequate funding; high population demand; incompetent bureaucracy; and PS as a favour or moral obligation to friends or family. Within a critical realist paradigm, we interpret these lay explanations as empirical evidence for the presence of the following hidden underlying causal mechanisms: lacking capabilities; mobilisation of institutional bias; and social closure. However, social constructionist perspectives lead us to critique this paradigm by drawing attention to contested health, wellbeing and corruption discourses. These differences in interpretation lead to subsequent differential policy recommendations. This demonstrates the need for the adoption of a "multi-epistemological" perspective in studies of health inequity and social exclusion.
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Affiliation(s)
- Philipa Mladovsky
- Department of International Development, LSE Health, London School of Economics and Political Science, Houghton Street, London, WC2A 2AE, UK.
| | - Maymouna Ba
- Center for Research on Social Policies (CREPOS), S/C West African Research Center, Rue E X Léon Gontran Damas, Fann Résidance BP: 25 233, Fann, Dakar, Senegal.
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Muntaner C, Davis O, McIsaack K, Kokkinen L, Shankardass K, O’Campo P. Retrenched Welfare Regimes Still Lessen Social Class Inequalities in Health. INTERNATIONAL JOURNAL OF HEALTH SERVICES 2017. [DOI: 10.1177/0020731417712509] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
This article builds on recent work that has explored how welfare regimes moderate social class inequalities in health. It extends research to date by using longitudinal data from the EU-SILC (2003–2010) and examines how the relationship between social class and self-reported health and chronic conditions varies across 23 countries, which are split into five welfare regimes (Nordic, Anglo-Saxon, Eastern, Southern, and Continental). Our analysis finds that health across all classes was only worse in Eastern Europe (compared with the Nordic countries). In contrast, we find evidence that the social class gradient in both measures of health was significantly wider in the Anglo-Saxon and Southern regimes. We suggest that this evidence supports the notion that welfare regimes continue to explain differences in health according to social class location. We therefore argue that although downward pressures from globalization and neoliberalism have blurred welfare regime typologies, the Nordic model may continue to have an important mediating effect on class-based inequalities in health.
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Affiliation(s)
- C. Muntaner
- Bloomberg Faculty of Nursing and Dalla Lana School of Public Health, University of Toronto, Toronto, Canada
| | - O. Davis
- School of Social Policy, Sociology and Social Research, University of Kent, UK
| | - K. McIsaack
- Nova Scotia Health Authority, Research Services, Nova Scotia, Canada
| | - L. Kokkinen
- Centre of Expertise for the Development of Work and Organizations, Finnish Institute of Occupational Health, Tampere and Helsinki, Finland
| | - K. Shankardass
- Department of Health Sciences, Wilfrid Laurier University, Waterloo, Ontario, Canada
- Centre for Urban Health Solutions, The Li Ka Shing Knowledge Institute of St. Michael’s Hospital, Toronto, Canada
- Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
| | - P. O’Campo
- Centre for Urban Health Solutions, The Li Ka Shing Knowledge Institute of St. Michael’s Hospital, Toronto, Canada
- Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
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Axelsson Fisk S, Merlo J. Absolute rather than relative income is a better socioeconomic predictor of chronic obstructive pulmonary disease in Swedish adults. Int J Equity Health 2017; 16:70. [PMID: 28472960 PMCID: PMC5418843 DOI: 10.1186/s12939-017-0566-2] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2017] [Accepted: 04/25/2017] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND While psychosocial theory claims that socioeconomic status (SES), acting through social comparisons, has an important influence on susceptibility to disease, materialistic theory says that socioeconomic position (SEP) and related access to material resources matter more. However, the relative role of SEP versus SES in chronic obstructive pulmonary disease (COPD) risk has still not been examined. METHOD We investigated the association between SES/SEP and COPD risk among 667 094 older adults, aged 55 to 60, residing in Sweden between 2006 and 2011. Absolute income in five groups by population quintiles depicted SEP and relative income expressed as quintile groups within each absolute income group represented SES. We performed sex-stratified logistic regression models to estimate odds ratios and the area under the receiver operator curve (AUC) to compare the discriminatory accuracy of SES and SEP in relation to COPD. RESULTS Even though both absolute (SEP) and relative income (SES) were associated with COPD risk, only absolute income (SEP) presented a clear gradient, so the poorest had a three-fold higher COPD risk than the richest individuals. While the AUC for a model including only age was 0.54 and 0.55 when including relative income (SES), it increased to 0.65 when accounting for absolute income (SEP). SEP rather than SES demonstrated a consistent association with COPD. CONCLUSIONS Our study supports the materialistic theory. Access to material resources seems more relevant to COPD risk than the consequences of low relative income.
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Affiliation(s)
- Sten Axelsson Fisk
- Unit for Social Epidemiology, Faculty of Medicine, Lund University, CRC, Jan Waldeströms gata, 35, S-205 02 Malmö, Sweden
| | - Juan Merlo
- Unit for Social Epidemiology, Faculty of Medicine, Lund University, CRC, Jan Waldeströms gata, 35, S-205 02 Malmö, Sweden
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Muntaner C. Global precarious employment and health inequalities: working conditions, social class, or precariat? CAD SAUDE PUBLICA 2017; 32:S0102-311X2016000600501. [PMID: 27333138 DOI: 10.1590/0102-311x00162215] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2015] [Accepted: 10/15/2015] [Indexed: 11/22/2022] Open
Abstract
Changes in employment conditions since the 1980s have been referred to as precarious employment, and terms like flexible, atypical, temporary, part-time, contract, self-employed, irregular, or non-standard employment have also been used. In this essay I review some of the current critiques to the precarious employment construct and advance some potential solutions for its use in epidemiology and public health.
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Affiliation(s)
- Carles Muntaner
- Lawrence S. Bloomberg Faculty of Nursing, University of Toronto, Toronto, Canada., University of Toronto, Lawrence S. Bloomberg Faculty of Nursing, University of Toronto, Toronto , Canada.,Dalla Lana School of Public Health, University of Toronto, Toronto, Canada., University of Toronto, Dalla Lana School of Public Health, University of Toronto, Toronto , Canada
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Kong KA, Khang YH, Cho HJ, Jang SM, Jung-Choi K. Neo-Marxian social class inequalities in self-rated health among the employed in South Korea: the role of material, behavioral, psychosocial, and workplace environmental factors. BMC Public Health 2017; 17:345. [PMID: 28427359 PMCID: PMC5397726 DOI: 10.1186/s12889-017-4269-9] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2016] [Accepted: 04/13/2017] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND The aim of this study was to examine the pattern of social inequality in self-rated health among the employed using the Wright's social class location indicator, and to assess the roles of material, behavioral, psychosocial, and workplace environmental factors as mediating factors in explaining the social class inequality in self-rated health in South Korea. METHODS This study used data from the 4th Korea National Health and Nutrition Examination Survey from 2007 to 2009. Study subjects included the employed population of 4392 men and 3309 women aged 19-64 years. Subjects were classified into twelve social class positions based on the Wright's social class map. The health outcome was self-rated health. Material, psychosocial, behavioral, and workplace environmental factors were considered as potential mediators in explaining social class health inequality. We calculated prevalence ratios of poor self-rated health according to social class, adjusted for age and mediating factors using Poisson regression models. RESULTS Nonskilled workers and petty bourgeoisie reported worse self-rated health than other social classes among men. The age-adjusted prevalence of petty bourgeoisie and nonskilled workers were about four-fold greater than that of managers. Expert supervisors in the contradictory class location had a greater prevalence of poor self-rated health than experts in men. In women, the prevalence of poor self-rated health was greater in most social classes than their male counterparts, while the differences among social classes within women were not statistically significant. Workplace environmental factors explained the social class inequality by from 24 to 31% in nonskilled and skilled workers and nonskilled supervisors, respectively, and material factors showed an explanatory ability of about 8% for both nonskilled workers and petty bourgeoisie in men. CONCLUSIONS We showed the inequality in self-rated health according to the Wright's social class in an industrialized Asian country. Policy efforts to improve workplace environments in nonskilled and skilled workers and nonskilled supervisors would have a moderate effect on reducing the magnitude of social class inequality in self-rated health. Furthermore, the means to improve power relations in the workplace should be devised to further reduce the social class inequalities in health.
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Affiliation(s)
- Kyoung Ae Kong
- Department of Preventive Medicine, Ewha Womans University School of Medicine, Seoul, Korea
| | - Young-Ho Khang
- Department of Health Policy and Management and Institute of Health Policy and Management, Seoul National University College of Medicine, Seoul, Korea
| | - Hong-Jun Cho
- Department of Family Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Sung-Mi Jang
- Department of Occupational and Environmental Medicine, Ewha Womans University School of Medicine, Seoul, Korea
| | - Kyunghee Jung-Choi
- Department of Occupational and Environmental Medicine, Ewha Womans University School of Medicine, Seoul, Korea.
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Crammond BR, Carey G. What do we mean by ‘structure’ when we talk about structural influences on the social determinants of health inequalities? SOCIAL THEORY & HEALTH 2016. [DOI: 10.1057/s41285-016-0020-3] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
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