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This paper examines rural-urban inequities in dusty lung (pneumoconiosis) deaths in China from 2002 to 2016 and possible causes for such inequities in the framework of social and spatial justice. The research reveals alarming results that have not been reported before. Dusty lung death rates for rural men increased twice as fast as those among urban men. The rural rates were particularly higher among middle-aged men, but lower in older age groups, as compared to urban rates. There were dramatic increases in death rates from 2011 to 2016 particularly among rural men aged 40-49 years old, who were many times more likely to die from dusty lung than urban men of a similar age. Chinese rural male victims also die at a younger age, compared to men in any of the seven countries or regions included in the study. For example, rural Chinese men aged 35-59 years old were many times more likely to die from dusty lung than their American, German, Polish, and Spanish counterparts. A possible explanation for the high death rates among middle-aged rural Chinese men is the tendency for rural migrant workers to be employed in unhealthy and unsafe working conditions in decent decades. Other explanations for the severe spatial injustice include the Hukou (household registration) system and the development policies that prioritize economic growth and urban development over occupational health and safety. The paper demonstrates the usefulness and weakness of the social and spatial justice concepts in understanding health inequity. Therefore, it proposes new definitions and models of social justice and spatial justice that combine the competing distribution and capabilities approaches and highlight interactions among multiple attributes.

This study aims to investigate whether and to what extent income inequality of country of origin modifies the health trajectories of immigrants to the United States (U.S.). Much previous research has found a negative association between income inequality and health across nations. A separate, large literature shows that characteristics of immigrants' countries of origin affect their health status after migration. However, there is no evidence about whether income inequality of countries of origin affects postmigration health trajectories. Merging individual data from the Current Population's Annual Social and Economic Supplement (ASEC CPS) (2013) with macro-level data, I find that income inequality exerts a statistically significant negative effect on immigrants' health trajectories. While immigrants arriving from countries with greater income inequality tend to be healthier than immigrants arriving from countries that are more egalitarian, their health tends to decline at a faster rate over time. The results are consistent with at least two mechanisms. Immigrants from higher-inequality countries may arrive in the U.S. with fewer transferable skills and take up low-paid jobs, with negative consequences for their long-term health. Alternatively, the harmful consequences of early exposure to high-income inequality in home countries before immigration may persist over the life course, damaging individuals' health even after they have left their home nations.

Despite their unique histories, environments, and lifestyles, historically subjugated populations consistently show poorer health outcomes compared to the general population. The theory of historical trauma, which argues that a collective trauma experienced by one generation can negatively impact the wellbeing of future generations, is a potential framework to understand the adverse health outcomes seen among populations with histories of subjugation. However, the biological pathways through which historical trauma actually impacts health have been unclear. In this paper, we present a cumulative, two pathway model that describes how historical trauma can impact health in contemporary generations. The first pathway suggests that personal exposure to trauma or stressors, which are more common among populations that have experienced historical trauma, can induce epigenetic modifications that can contribute to the development of poor health. The second pathway posits that poor health can occur through intergenerational epigenetic modifications in response to parental and grandparental trauma or stressor exposures. Taken together, these pathways can provide insight into the higher rates of adverse health outcomes among individuals from populations that have historically endured collective trauma. Importantly, the potential reversible nature of epigenetic modifications suggests that these trauma-induced epigenetic effects are not necessarily permanent and that improvements in environmental conditions could reduce the high prevalence of poor health among historically disadvantaged communities.

With more than half the world's population residing in urban areas and this proportion rising, it is important to understand how well-planned urban environments might improve, and reduce inequalities in, quality of life (QoL). Although studies suggest city-level characteristics hold independent influence on QoL, they generally lack a theoretically informed approach to understanding how the whole city landscape might be implicated, have paid scant attention to inequalities in QoL and often focus on small numbers of cities or countries. We applied theory and methods from landscape ecology to explore associations between cities' land cover/use, residents' reported life satisfaction and within-city socio-economic inequalities in life satisfaction. We joined individual-level responses to the European Urban Audit (EUA) Perception Surveys (2012, 2015) with city-level data from the European Urban Atlas classifying land cover/use into 26 different classes. Our sample included 63,554 people from 66 cities in 28 countries. Multilevel binary logistic models found that specific land use measures were associated with life satisfaction, including the amount of a city which was: residential (OR:0.991, 95%CI 0.984-0.997); isolated structures (OR:1.046, 95 CI 1.002-1.091); roads (OR:0.989, 95%CI 0.982-0.996); pastures (OR: 1.002, 95% CI 1.002-1.003) and herbaceous vegetation (OR:0.998, 95%CI 0.997-0.100). A more even distribution of land cover/use (β: 1.561, 95%CI -3.021 to -0.102) was associated with lower inequality in life satisfaction. This is the first study to theorise and examine how the entire urban landscape may affect levels of and inequalities in wellbeing in a large international sample. Our finding that more equal distribution of land cover/use is associated with lower levels of socio-economic inequality in life satisfaction supports the idea that city environments could be equigenic - that is, could create equality. Our findings can aid urban planners to develop and build cities that can contribute to improving, and narrowing inequalities in, residents' life satisfaction.

Examining health inequalities intersectionally is gaining in popularity and recent quantitative innovations, such as the development of intersectional multilevel methods, have enabled researchers to expand the number of dimensions of inequality evaluated while avoiding many of the theoretical and methodological limitations of the conventional fixed effects approach. Yet there remains substantial uncertainty about the effects of integrating numerous additional interactions into models: will doing so reveal statistically significant interactions that were previously hidden or explain away interactions seen when fewer dimensions were considered? Furthermore, how does the multilevel approach compare empirically to the conventional approach across a range of conditions? These questions are essential to informing our understanding of population-level health inequalities. I address these gaps using data from the National Longitudinal Study of Adolescent to Adult Health by evaluating conventional and multilevel intersectional models across a range of interaction conditions (ranging from six points of interaction to more than ninety, interacting gender, race/ethnicity/immigration status, parent education, family income, and sexual identification), different model types (linear and logistic), and seven diverse dependent variables commonly examined by health researchers: body mass index, depression, general self-rated health, binge drinking, cigarette use, marijuana use, and other illegal drug use. Findings suggest that adding categories to intersectional analyses will tend to reveal new points of interaction. Stratum-level results from the multilevel approach are robust to cross-classification by school context. Conventional and multilevel approaches differ substantially when tested empirically. I conclude with a detailed consideration of the origin of these differences and provide recommendations for future scholarship of intersectional health inequalities.

Health communication inequality is one of the potential mechanisms linking socioeconomic status (SES) to health disparities. To our knowledge, no previous study has examined the association between exposure to health information and mortality. We analyzed 3-year follow-up cohort data from the Japan Gerontological Evaluation Study (JAGES), involving 8544 males and 9698 females aged 65 years or older, to examine associations between exposure to health information via different types of media and mortality. The baseline survey was conducted from October to December 2013 in 21 municipalities in Japan. Adjusted for health conditions, health behaviors, and other potential confounders, Cox proportional hazards models were used to estimate hazard ratios (HRs) of all-cause mortality. Over a mean of 3.2 years of follow-up, 956 deaths occurred. Among females, receiving health information from TV programs was associated with lower mortality (HR = 0.90; 95% confidence interval [CI] = 0.83, 0.98). By contrast, there were no significant associations among males. Our findings suggest that improving the accuracy of health information delivered via television might be beneficial.

Morbidity and mortality are on the rise among Baby Boomers and younger cohorts. This study investigates whether this unfavorable health trend across birth cohorts 1925–1999 is related to rising income inequality Americans face during childhood. We use two nationally representative datasets: National Health and Nutrition Examination Surveys (NHANES) 1988–2018 and Panel Studies of Income Dynamics (PSID) 1968–2013, and two health outcomes: biomarkers of physiological dysregulation, and a chronic disease index. Childhood income inequality is measured by the average of the Gini index at the national level each birth cohort is exposed to between birth and age 18, where the Gini index from 1925 to 2016 is computed based on Internal Revenue Service income data. By merging childhood income inequality to individual level data from NHANES or PSID based on birth cohort, we find childhood income inequality is positively associated with the risk of physiological dysregulation in adulthood for all gender and racial groups in the NHANES data. It is also significantly related to the risk of chronic disease in the PSID data. This association is robust to controls for individual level childhood health and family background, adulthood socioeconomic and marital status, and contemporary macro socioeconomic factors. More importantly, childhood income inequality exposure explains a substantial amount of variation in these two health outcomes across cohorts, a pattern not observed for other early life exposures that display negative temporal trends similar to those for childhood income inequality. This study provides important evidence that income inequality experienced during childhood may have a long-lasting negative consequence for adult health, which partially explains the adverse health trends experienced by Baby Boomers and younger cohorts in the United States.

In their paper, published in this journal, Dijkstra & Horstman critically reflect on a selection of social epidemiological articles and examine how low socioeconomic status populations are constructed in these articles. They identify four components which they argue represent the “dominant thought style” of this literature: 1) proliferation, 2) generalization, 3) problematization and 4) individualization. We largely agree with their first two points, but strongly disagree with the other two, and explain why in our reply. All in all, we believe that their analysis is a wake-up call for social epidemiologists, rightly pointing to the risk that the relevance and moral origins of the use and study of categories, like ‘low socioeconomic status’, can easily become less visible, and therefore should be articulated and explained every time.

Background Fatalism – beliefs about the causes and controllability of disease – has been negatively associated with prevention behaviors. Fatalism has been suggested as a mechanism for health disparities because ethnic minorities are especially likely to hold fatalistic beliefs. However, the construct has been criticized: Fatalism fails to account for structural barriers to health faced by vulnerable populations that also score highly on measures of fatalism. Another critique suggests that operationalizations of fatalism expose communication failures: “Fatalism” rather reflects information overload from an environment riddled with misinformation and contradictions. This study aimed to expand understanding of one mechanism through which communication may contribute to disparities by considering the context of nutrition among bicultural Latinas, who face increased risk from dietary acculturation. Method Mixed-methods (semi-structured in-depth interview, survey) with Mexican-American women ages 18–29 (n = 24) in rural California. Results Contrary to previous studies, the majority of this sample of Mexican-American women did not endorse fatalistic beliefs; most demonstrated clear understanding of the link between diet and risk of diseases: Diabetes and heart disease were understood to result from behaviors within one's control. Yet despite articulating links between diet and disease, participants felt overloaded and confused about conflicting information from public and interpersonal sources. Moreover, despite reporting feeling inundated with information, participants noted critical information gaps, distinguishing between information available and information needed. Conclusions We found minimal support for fatalistic beliefs among a sample of Mexican-American women, but considerable information overload and confusion, together with a desire for specific knowledge and skills. Results extend understanding of how communication may influence disparities: Information overload may be conflated with fatalism, challenging the notion that fatalism is a cultural belief. Moreover, inequalities in access to and ability to process information compound overload effects. We discuss opportunities to improve the clarity of communication about nutrition science and dietary recommendations.

Objectives To quantify the contribution variation in socioeconomic status in predicting the distribution of COVID-19 cases and deaths. Methods Analyses used incidence data on daily COVID+ case counts from all counties from the initial wave of infections, merged with data from the U.S. census data to measure county-level SES and confounders. Multivariable analyses relied on survival analyses and Poisson regression to examine timing of county-level index cases and of COVID-19 incidence and mortality in infected counties to examine the spread and severity of COVID-19 while adjusting for adjusted for Black race, Hispanic ethnicity, age, gender, and urbanicity. Effect moderation by social distancing parameters was examined. Results Results indicate that higher SES was associated with earlier incidence of index cases, but that as social distancing took place inequalities in SES inverted so that growth in incidence was slower in higher SES counties, where case-fatality rates were lower. Conclusions This study is the first to date to show what happens when an opportunistic disease that could affect anyone meets the American system of inequality and is powerfully shaped by it., Highlights • Socioeconomic inequalities in health emerge and change predictably as they infect communities • This study found that higher socioeconomic status was associated with earlier COVID-19 exposure • Lower socioeconomic status was associated with higher incidence and mortality rates • Despite being a new disease, social inequalities emerged alongside prevention implementation

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

The developmental origins of health and disease and the comparative international approach are two important strands of research exploring population health. Despite the potential insights to be gained from integrating the two approaches, their nexus remains an underexplored frontier. The current study investigates international variation in the early life origins of health among aging cohorts in 13 countries. We examine cross-national differences in exposure to poor childhood health and socioeconomic disadvantage, whether the long-term health associations with those exposures vary across contexts, and whether they persist in the face of subsequent accumulation of socioeconomic and behavioral risk. Finally, we investigate whether childhood health and socioeconomic circumstances help explain between-country differences in later life health. The findings suggest substantial international variation in the exposure to early life health and socioeconomic insults. We also find variation in their association with later life health. However, early life factors appear to play a modest role in explaining international differences in later life health in the contexts examined here.

As part of a larger research programme undertaking the development of a global index of wellbeing (GLOWING) through the exploration of population wellbeing in low to middle income countries (LMICs), this paper examines the role of inequality in shaping experiences of wellbeing. The paper explores various conceptualizations of wellbeing and inequality and outlines an integrated framework for understanding the importance of measuring the wellbeing of places. We conclude by urging geographers to explicitly engage with theory and cross-disciplinary research in order to adequately conceptualize the role of place in 'Beyond GDP' and progress measures.

Background: Analyzing Body Mass Index as a didactical example, the study by Evans, Williams, Onnela, and Subramanian (EWOS study) introduce a novel methodology for the investigation of socioeconomic disparities in health. By using multilevel analysis to model health inequalities within and between strata defined by the intersection of multiple social and demographic dimensions, the authors provide a better understanding of the health heterogeneity existing in the population. Their innovative methodology allows for gathering inductive information on a large number of stratum-specific interactions of effects and, simultaneously, informs on the discriminatory accuracy of such strata for predicting individual health. Their study provides an excellent answer to the call for suitable quantitative methodologies within the intersectionality framework. Rationale: The EWOS study is a well-written tutorial; thus, in this commentary, I will not repeat the explanation of the statistical/epidemiological concepts. Instead, I will share with the reader a number of thoughts on the theoretical consequences derived from the application of multilevel analysis of individual heterogeneity and discriminatory accuracy (MAIHDA) in (social) epidemiology in general, and within the intersectional framework in particular. MAIHDA is a reorganization of concepts that allows for a better understanding of the distribution and determinants of individual health and disease risk in the population. Conclusions: By applying MAIHD within an intersectional framework, the EWOS study provides a superior theoretical and quantitative instrument for documenting health disparities and it should become the new gold standard for investigating health disparities in (social) epidemiology. This approach is more appropriate for eco-social perspectives than the habitual probabilistic strategy based on differences between group average risks. However, both, the translation of intersectionality theory into (social) epidemiology and the intersectional quantitative methodology (especially for generalized linear models) are still under development.

The task of studying the impact of social class on physical and mental health involves, among other things, the use of a conceptual toolbox that defines what social class is, establishes how to measure it, and sets criteria that help distinguish it from closely related concepts. One field that has recently witnessed a wealth of theoretical and conceptual research on social class is psychology, but geographers' and sociologists' attitude of diffidence toward this "positivistic" discipline has prevented them from taking advantage of this body of scholarship. This paper aims to highlight some of the most important developments in the psychological study of social class and social mobility that speak to the long-standing concerns of health geographers and sociologists with how social position, perceptions, social comparisons, and class-based identities impact health and well-being.

Obesity in Chile disproportionately affects women of low socioeconomic status (SES). Research has shown that ideals of body size and differences in perceived social pressure for being slim across socioeconomic strata contribute to the social stratification of body size among women in modern societies. Thinness is most valued by high SES women, following western standards of Ideal body size.Aiming to understand the link between ideals of body size and SES, this qualitative study explored how 36 Chilean women construct their bodily ideals according to their social position. A purposive sample of women with different profiles with regard to educational attainment, nutritional status and body size (dis)satisfaction was defined, aiming to cover a diverse spectrum of bodily perceptions. Data were collected through semi structured interviews and approached through a thematic and narrative analysis.Drawing on Bourdieu's concepts of habitus, field, capital and embodiment of the social context, this study explains how ideals of body size and appearance are strongly linked to class-dependent gender roles and social roles. The existing gender and class inequalities in the Chilean social structure have been literally embodied by these women through a 'gendered class habitus'. Compliance with the thin ideal confers women different degrees of power according to their social position in different fields, such as in marriage and on the labour market, which turns thinness into an embodied form of capital.The societal dynamic behind obesity rates cannot be disregarded when approaching possible solutions. Promoting obesity-related lifestyle modification at an individual level might appear an over-simplistic and individualistic approach to a complex social issue. Context-oriented interventions that take cultural constructions of gender and social class into account might yield better results in the long term, while advocating for a more equitable society and social justice as a public health concern.

Background Chronic stress is a known risk factor for preterm birth, yet little is known about how healthcare experiences add to or mitigate perceived stress. In this study, we described the pregnancy-related healthcare experiences of 54 women of color from Fresno, Oakland, and San Francisco, California, with social and/or medical risk factors for preterm birth. Methods This study was a secondary analysis of focus group data generated as part of a larger project focused on patient and community involvement in preterm birth research. English and Spanish speaking women, age 18 or greater with social and/or medical risk factors for preterm birth participated in two focus groups, six weeks apart. Data from the first focus groups are included in this analysis. Results Five themes emerged from thematic analysis of the transcripts. Participants described disrespect during healthcare encounters, including experiences of racism and discrimination; stressful interactions with all levels of staff; unmet information needs; and inconsistent social support. Despite these adverse experiences, women felt confidence in parenting and newborn care. Participant recommendations for healthcare systems improvement included: greater attention to birth plans, better communication among multiple healthcare providers, more careful listening to patients during clinical encounters, increased support for social programs such as California's Black Infant Health, and less reliance on past carceral history and/or child protective services involvement. Discussion The women in this study perceived their prenatal healthcare as a largely disrespectful and stressful experience. Our findings add to the growing literature that women of color experience discrimination, racism and disrespect in healthcare encounters and that they believe this affects their health and that of their infants.

Welfare states are assumed to play a fundamental role in the protection and promotion of the health and socioeconomic well-being of citizens. However, empirical evidence on the effect of the welfare state is still contradictory. The inconsistency of the results has led researchers to a lack of consensus in defining the mechanisms that might explain the relationship between the welfare state and health. To shed some light on the current debate, we rely on individual and country data from the European Social Survey (ESS) and Eurostat to explore the direct and indirect effects of the welfare state on health inequalities in a sample of European countries. We use multilevel models to test the hypothesized impact of social expenditure on reducing health inequalities. Firstly, results show that health inequalities are lower in countries where social expenditure is higher. Secondly, the relationship between socio-economic status (SES) and health is moderated by social expenditure. The positive effect of SES on health decreases in countries where social expenditure is higher, while this effect is higher in countries with lower social expenditure. Our findings suggest that social spending has a positive impact on equalizing health conditions in Europe.

Residential segregation is the spatial manifestation of entrenched socioeconomic and racial inequities and is considered a fundamental cause of racial inequalities in health. Despite the well-documented racialized spatial inequalities that exist in urban areas throughout Brazil, few empirical investigations have examined the link between residential segregation and health and considered its implications for racial health inequalities in this setting. In the present study, we used data from the Brazilian Longitudinal Study of Adult Health (2008e2010) to examine the association between economic residential segregation and two major cardio-metabolic risk factorsdhypertension and diabetes. We also examined whether associations were stronger for historically marginalized racial groups in Brazil. Residential segregation was calculated for study-defined neighborhoods using the Getis-Ord Local Gi* statistic and was based on household income data from the 2010 IBGE demographic census. Multivariable logistic regression models were used to examine associations. In our sample, Blacks and Browns were more likely to live in economically segregated neighborhoods. After taking into account income, education, and other demographic characteristics we found that individuals living in the most economically segregated neighborhoods were 26% more likely to have hypertension and 50% more likely to have diabetes than individuals living in more affluent areas. Although Blacks and Browns living in highly segregated neighborhoods had higher prevalence of hypertension and diabetes compared to Whites, we observed no statistically significant racial differences in the associations with residential segregation. Our findings suggest that residential segregation may be an important structural determinant of cardio-metabolic risk factors in Brazil. Moreover, the systematic and disproportionate exposure of Blacks and Browns to highly segregated neighborhoods may implicate these settings as potential drivers of racial inequalities in cardio-metabolic risk factors in urban settings in Brazil.

Studies on how education shapes adult health have largely conceptualized education as the quantity of schooling attained, coined the "vertical dimension" of education. While this dimension is important, heterogeneity within levels of education (the "horizontal dimension") may also shape health. Using data from the 2010-2014 American Community Survey on adults aged 45-64 with a Bachelor's degree (N = 667,362), we investigate the association between a key indicator of adult health (physical functioning) and an understudied horizontal dimension of education (college major). We find that physical functioning in midlife varies significantly by college major. For instance, the odds of poor functioning for men who majored in Psychology/Social Work were 1.9 (95% CI: 1.7, 2.1) times greater than for men who majored in Business. However, all college graduates, regardless of major, report better functioning than non-graduates. We also find that inequalities in midlife functioning across majors largely reflect differences in human capital skills and financial returns in the labor market. Taken together our findings suggest that college major is an important component of health stratification and should be integrated into the literature on health inequalities.

Whites in the USA are the dominant racial group, with greater than average access to most material and social rewards. Yet, while whites have better outcomes than other racial groups on some health indicators, whites paradoxically compare poorly on other measures. Further, whites in the USA also rank poorly in international health comparisons. In this paper, we present a framework that combines the concept of whiteness-a system that socially, economically, and ideologically benefits European descendants and disadvantages people in other groups-with research from a variety of fields in order to comprehensively model the social factors that influence whites' health. The framework we present describes how whiteness and capitalism in the USA shape societal conditions, individual social characteristics and experiences, and psychosocial responses to circumstances to influence health outcomes. We detail specific examples of how social policies supported by whiteness, the narratives of whiteness, and the privileges of whiteness may positively and negatively affect whites' health. In doing so, we suggest several areas for future research that can expand our understanding of how social factors affect health and can contribute to the patterns and paradoxes of whites' health. By expanding research to include theoretically-grounded analyses of the dominant group's health, we can achieve a more complete picture of how systems of racial inequity affect health.

There is increasing evidence that racism is a cause of poor health outcomes in the United States, including adverse birth outcomes among Blacks. However, research on the health consequences of racism has faced measurement challenges due to the more subtle nature of contemporary racism, which is not necessarily amenable to assessment through traditionally used survey methods. In this study, we circumvent some of these limitations by examining a previously developed Internet query-based proxy of area racism (Stephens-Davidowitz, 2014) in relation to preterm birth and low birthweight among Blacks. Area racism was measured in 196 designated market areas as the proportion of total Google searches conducted between 2004 and 2007 containing the "n-word." This measure was linked to county-level birth data among Blacks between 2005 and 2008, which were compiled by the National Center for Health Statistics; preterm birth and low birthweight were defined as

Structural racism has been linked to racial health inequalities and may operate through an unequal labor market that results in inequalities in psychosocial workplace environments (PWE). Experiences of the PWE may be a critical but understudied source of racial health disparities as most adults spend a large portion of their lives in the workplace, and work-related stress affects health outcomes. Further, it is not clear if the objective characteristics of the workplace are important for health inequalities or if these inequalities are driven by the perception of the workplace. Using data from the 2008 to 2012 waves of the Health and Retirement Study (HRS), a probability-based sample of US adults 50 years of age and older and the Department of Labor’s Occupational Information Network (O*NET), we examine the role of both standardized, objective (O*NET) and survey-based, subjective (as in HRS) measures of PWEs on health and Black-White health inequalities. We find that Blacks experience more stressful PWEs and have poorer health as measured by self-rated health, episodic memory function, and mean arterial pressure. Mediation analyses suggest that these objective O*NET ratings, but not the subjective perceptions, partially explain the relationship between race and health. We discuss these results within the extant literature on workplace and health and health inequalities. Furthermore, we discuss the use of standardized objective measures of the PWE to capture racial inequalities in workplace environment.

© 2017 Prison-based therapeutic community (TC) programming is derived from the perspective that drug addiction is primarily symptomatic of cognitive dysfunction, poor emotional management, and underdeveloped self-reliance skills, and can be addressed in a collaborative space where a strong ideological commitment to moral reform and personal responsibility is required of its members. In this space, evidence of rehabilitation is largely centered on the client's relationship to language and the public adoption of a “broken self” narrative. Failure to master these linguistic performances can result in the denial of material and symbolic resources, thus participants learn how to use TC language to present themselves in ways that support existing institutionalized hierarchies, even if that surrender spells their self-denigration. This research examines the interview narratives of 300 former prisoners who participated in a minimum of 12 months of prison-based TC programming, and described how programming rhetoric impacted their substance abuse treatment experiences. While many of the respondents described distressing experiences as TC participants, White respondents were more likely to eventually embrace the “addict” label and speak of privileges and reintegrative support subsequently received. Black respondents were more likely to defy the treatment rhetoric, and either fail to complete the program or simulate a deficit-based self-narrative without investing in the content of those stories. The following explores the significance of language and identity construction in these carceral spaces, and how treatment providers as well as agency agendas are implicated in the reproduction of racial disparities in substance abuse recovery.

Exit from work leads to different effects on health, partially depending on the socioeconomic status (SES) of people in the work exit. Several studies on the effects of exit from work on health across socioeconomic groups have been performed, but results are conflicting. The aim of this review is to systematically review the available evidence regarding the effects of exit from work on health in high and low socioeconomic groups. A systematic literature search was conducted using Pubmed, Embase, Web of Science, CINAHL and PsycINFO. Search terms related to exit from work, health, SES and design (prospective or retrospective). Articles were included if they focused on: exit from work (early/statutory retirement, unemployment or disability pension); health (general, physical or mental health and/or health behaviour); SES (educational, occupational and/or income level); and inclusion of stratified or interaction analyses to determine differences across socioeconomic groups. This search strategy resulted in 22 studies. For general, physical or mental health and health behaviour, 13 studies found more positive effects of exit from work on health among employees with a higher SES compared to employees with a lower SES. These effects were mainly found after early/statutory retirement. In conclusion, the effects of exit from work, or more specific the effects of early/statutory retirement on health are different across socioeconomic groups. However, the findings of this review should be interpreted with caution as the studies used heterogeneous health outcomes and on each health outcome a limited number of studies was included. Yet, the positive effects of exit from work on health are mainly present in higher socioeconomic groups. Therefore, public health policies should focus on improving health of employees with a lower SES, in particular after exit from work to decrease health inequalities.

The concept of intersectionality has been used to analyze and understand how multiple forms of identity and oppression interact to shape life experiences of marginalized groups. We conducted a qualitative study to explore how Black Brazilian women experience the intersections of race, class, and gender and the ways in which these intersecting experiences act as social determinants of health. Nine focus groups were conducted with Black, White, and mixed-race women of childbearing age (n = 37), social and health activists (n = 11), and health professionals (n = 20). The focus groups took place in two cities in the Brazilian state of Bahia during October and November 2012. Using a comparative approach, we describe participants' responses regarding the life experiences of women of differing racial and class backgrounds. Our findings highlight how the intersectional relationship between race, class, and gender alters women's social context and life course opportunities, as well as their stressors and protective buffers. We argue that the differing intersectional experiences of women due to race and class create unique social contexts that define the parameters of health and wellness. In addition, we argue that the experiences at each intersection (i.e., raceXclass, raceXgender, classXgender, raceXclassXgender) have a unique character that can be qualitatively described. Improved specification of exposures experienced by marginalized populations who experience intersecting forms of oppression can help explain intra- and inter-group differences in health outcomes, and may also lead to improved intervention models.

Representations of the world enable global health research (GHR), discursively constructing sites in which studies can legitimately take place. Depoliticized portrayals of the global South frequently obscure messy legacies of colonialism and motivate technical responses to health problems with political and economic root causes. Such problematic representations of the world have not yet been rigorously examined in relation to global health ethics, a major site of scholarly effort towards GHR that promotes justice and fairness. We carried out a discourse analysis of four guidance documents relevant to the ethical practice of GHR, purposively selecting texts covering different genres (UN documents and journal articles) and prominent GHR foci (HIV and clinical trials). In light of increasing acknowledgement of the lessons Indigenous health scholarship holds for global health ethics, the four analyzed texts also included a set of principles developed to support Indigenous nation-building. Three of four documents featured global disparities as reasons for ethical caution. These inequalities appeared without explanation or causes, with generation of new scientific knowledge following as a logical response to such disparities. The fourth - Indigenous health-focused - document clearly identified 'colonialism' as a reason for both inequities in society, and related harmful research practices. Solutions to disparities in this text did not necessarily involve cutting-edge research, but focused instead on empowerment and responsiveness to community priorities and needs. These contrasting representations of the world were accomplished in ways that depended on texts' 'participants', or the people they represented; specific vocabularies or language usages; intertextual relationships to prior texts; and overall objectives or intentions of the author(s). Our results illustrate how ethics and other guidance documents serve as an important terrain for constructing, naturalizing or contesting problematic representations of the world of GHR.

Latin America is the most unequal region in the world. The current sustainable development agenda increased attention to health inequity and its determinants in the region. Our aim is to investigate the social gradient in health in Latin America and assess the effects of social capital and income inequality on it. We used cross-sectional data from the World Values Survey and the World Bank. Our sample included 10,426 respondents in eight Latin American countries. Self-rated health was used as the outcome. Education level was the socioeconomic position indicator. We measured social capital by associational membership, civic participation, generalized trust, and neighborhood trust indicators at both individual and country levels. Income inequality was operationalized using the Gini index at country-level. We employed fixed effects logistic regressions and cross-level interactions to assess the impact of social capital and income inequality on the heath gradient, controlling for country heterogeneity. Education level was independently associated with self-rated health, representing a clear social gradient in health, favoring individuals in higher socioeconomic positions. Generalized and neighborhood trust at country-level moderated the effect on the association between socioeconomic position and health, yet favoring individuals in lower socioeconomic positions, especially in lower inequality countries, despite their lower individual social capital. Our findings suggest that collective rather than individual social capital can impact the social gradient in health in Latin America, explaining health inequalities.

To honour the 175th anniversary of Edwin Chadwick's seminal ‘Report on the Sanitary Conditions of the Labouring Poor’, we update Chadwick's famous analysis of geographical differences in occupational based inequalities. Much of the field of Health Geography owes both its direction of development and its initial impetus to his 1842 report. The report presented evidence for the importance of local context to health, with individuals of the lowest occupations in Rutland living longer than individuals of the highest occupations in Liverpool. Here we update the 1842 analysis using data from the Office of National Statistics on individual mortality records by occupation (2010-12) and population data from the 2011 Census. Sex-specific directly standardised premature (16-74) mortality rates were calculated for hierarchical occupational categories similar to Chadwick's categories, for the nearest equivalent areas to those used in Chadwick's report. Although there is no longer consistent evidence on individuals in the lowest occupational group having lower mortality rates than those in the highest group, there were clear social gradients in mortality within each area and the extent of these inequalities varied between areas. Individuals who live in Rutland had lower premature mortality rates across each occupational group compared to the other areas. Our results demonstrate that while life expectancy has nearly doubled since Chadwick's report, social and spatial inequalities in health have persisted. We suggest that Chadwick's legacy on the importance of locality continues., Highlights • We update Edwin Chadwick's seminal work to honour its 175 year anniversary. • Social and spatial inequalities in health have remained consistent over 175 years. • Premature mortality rates were highest in the lowest occupational group. • Occupational based inequalities still varied spatially, as they also did in 1842. • Our results show that Chadwick's legacy on the importance of locality continues.

Background Intersectionality is a powerful theoretical framework that is useful in describing the lived experiences of people with multiple marginalized statuses. By focusing on power and domination (e.g., racism, sexism), and the ways in which they are inextricably linked and mutually constructing, researchers can better understand experiences of all people, not just those with one or more master statuses. This framework is valuable in understanding how discrimination relates to health and in attempts to reduce health disparities. Rationale Population health researchers have only recently begun to consider intersectionality in their theories and measurement (Bowleg, 2012), and have been hindered by the challenges of measuring and analyzing experiences of discrimination in intersectional ways. We need new methodological strategies to enable empirical research to catch up with theoretical advances. Conclusions The pair of articles in this issue by Scheim and Bauer (2019), and Bauer and Scheim (2019), offer important new data collection instruments and data analytic strategies to advance our ability to measure discrimination intersectionally. When using these new tools, it is important to not lose track of the origins and historical underpinnings of intersectionality and to focus on the transformative goal of intersectionality to eradicate inequality.

The Nordic Paradox of inequality describes how the Nordic countries have puzzlingly high levels of relative health inequalities compared to other nations, despite extensive universal welfare systems and progressive tax regimes that redistribute income. However, the veracity and origins of this paradox have been contested across decades of literature, as many scholars argue it relates to measurement issues or historical coincidences. Disentangling between potential explanations is crucial to determine if widespread adoption of the Nordic model could represent a sufficient panacea for lowering health inequalities, or if new approaches must be pioneered. As newfound challenges to welfare systems continue to emerge, evidence describing the benefits of welfare systems is becoming ever more important. Preliminary evidence indicates that the COVID-19 pandemic is drastically exacerbating social inequalities in health across the world, via direct and indirect effects. We argue that the COVID-19 pandemic therefore represents a unique opportunity to measure the value of welfare systems in insulating their populations from rising social inequalities in health. However, COVID-19 has also created new measurement challenges and interrupted data collection mechanisms. Robust academic studies will therefore be needed—drawing on novel data collection methods—to measure increasing social inequalities in health in a timely fashion. In order to assure that policies implemented to reduce inequalities can be guided by accurate and updated information, policymakers, academics, and the international community must work together to ensure streamlined data collection, reporting, analysis, and evidence-based decision-making. In this way, the pandemic may offer the opportunity to finally clarify some of the mechanisms underpinning the Nordic Paradox, and potentially more firmly establish the merits of the Nordic model as a global example for reducing social inequalities in health.

In 1845, Friedrich Engels identified how the living and working conditions experienced by English workers sent them prematurely to the grave, arguing that those responsible for these conditions -- ruling authorities and the bourgeoisie -- were committing social murder. The concept remained, for the most part, dormant in academic journals through the 1900s. Since 2000, there has been a revival of the social murder concept with its growth especially evident in the UK over the last decade as a result of the Grenfell Tower Fire and the effects of austerity imposed by successive Conservative governments. The purpose of this paper is to document the reemergence of the concept of social murder in academic journal articles. To do so we conducted a scoping review of content applying the social murder concept since 1900 in relation to health and well-being. We identified two primary concepts of social murder: social murder as resulting from capitalist exploitation and social murder as resulting from bad public policy across the domains of working conditions, living conditions, poverty, housing, race, health inequalities, crime and violence, neoliberalism, gender, food, social assistance, deregulation and austerity. We consider reasons for the reemergence of Engels' social murder concept and the role it can play in resisting the forces responsible for the living and working conditions that kill.

Rationale Current evidence suggests that mental health across the globe has suffered significantly during the COVID-19 global pandemic, and that disadvantaged communities are suffering these impacts more acutely. Lower income, female gender, and younger age have all been associated with worse psychopathology during COVID-19. Objective and methods The goal of this study was to determine whether these disparities are more pronounced in places where the pandemic is more severe. We analyzed self-report data and objective metrics from a large global sample (N = 11,227) in order to test the hypothesis that country-level severity of COVID-19 moderates the relationship between the target demographic variables (Subjective SES, gender and age) and psychopathology indicators. Results Severity of the pandemic emerged as a significant moderator of the relationship between these demographic variables and mental health outcomes. This pattern was extremely consistent for Subjective SES and gender, but slightly more nuanced for age. Conclusion Overall, we interpreted our data as suggesting that mental health disparities are greater in countries with more severe COVID-19 outbreaks. These findings are critical for understanding the ways that the ongoing pandemic is affecting global mental health, and contribute to the broader literature surrounding collective trauma.

The relationship between adverse individual socio-economic circumstances and suicidal behaviour is well established. However, the impact of adverse collective circumstances - such as the socio-economic context where people live - is less well understood. This systematic review explores the extent to which area-level socioeconomic disadvantage is associated with inequalities in suicidal behaviour and self-harm in Europe. We performed a systematic review (in MEDLINE, Embase, PsycINFO, EconLit and Social Sciences Citation Index) from 2005 to 2015. Observational studies were included if they were based in Europe and had a primary suicidal behaviour and self-harm outcome, compared at least two areas, included an area-level measure of socio-economic disadvantage and were published in the English language. The review followed The Joanna Briggs Institute guidelines for quality appraisal. We identified 27 studies (30 papers) from 14 different European countries. There was a significant association (in 25/27 studies, all of which were rated as of medium or high quality) between socioeconomic disadvantage and suicidal behaviour (and self-harm), particularly for men, and this was a consistent finding across a variety of European countries. Socio-economic disadvantage was found to have an independent effect in several studies whilst others found evidence of mediating contextual and compositional factors. There is strong evidence of an association between suicidal behaviours (and self-harm) and area-level socio-economic disadvantage in Europe, particularly for men. Suicide prevention strategies should take this into account.

Air pollution is deleterious to human health, and numerous studies have documented racial and socioeconomic inequities in air pollution exposures. Despite the marginalized status of lesbian, gay, bisexual, and transgender (LGBT) populations, no national studies have examined if they experience inequitable exposures to air pollution. This cross-sectional study investigated inequities in the exposure of same-sex partner households to hazardous air pollutants (HAPs) in the US. We examined cancer and respiratory risks from HAPs across 71,207 census tracts using National Air Toxics Assessment and US Census data. We calculated population-weighted mean cancer and respiratory risks from HAPs for same-sex male, same-sex female and heterosexual partner households. We used generalized estimating equations (GEEs) to examine multivariate associations between sociodemographics and health risks from HAPs, while focusing on inequities based on the tract composition of same-sex, same-sex male and same-sex female partners. We found that mean cancer and respiratory risks from HAPs for same-sex partners are 12.3% and 23.8% greater, respectively, than for heterosexual partners. GEEs adjusting for racial/ethnic and socioeconomic status, population density, urban location, and geographic clustering show that living in census tracts with high (vs. low) proportions of same-sex partners is associated with significantly greater cancer and respiratory risks from HAPs, and that living in same-sex male partner enclaves is associated with greater risks than living in same-sex female partner enclaves. Results suggest that some health disparities experienced by LGBT populations (e.g. cancer, asthma) may be compounded by environmental exposures. Findings highlight the need to extend the conceptual framework for explaining LGBT health disparities beyond psycho-behavioral mechanisms translating social stress into illness to include environmental mechanisms. Because psycho-behavioral and environmental factors may together exacerbate health disparities, we call for a shift toward interdisciplinary research on LGBT health that takes into account cumulative risks, including the role of environmental exposures.

Rationale Persistent racial disparities in adverse birth outcomes are not fully explained by individual-level risk factors. Racial residential segregation–degree to which two or more groups live apart from one another–may contribute to the etiology of these birth outcome disparities. Our aim was to assess associations between segregation and adverse birth outcomes by race. This review focused on formal measures of segregation, using Massey and Denton's framework (1998) that identifies five distinct operationalizations of segregation, in addition to proxy measures of segregation such as racial composition, in order to gain a deeper understanding of the operationalizations of segregation most salient for birth outcomes. Method Review and meta-analyses were conducted using PubMed, PsycINFO and Web of Science and included articles from inception through April 30, 2017. Results Forty-two articles examined associations between segregation and adverse birth outcomes among Black and White mothers separately. Meta-analyses showed that among Black mothers, exposure was associated with increased risk of preterm birth ( OR = 1.17, 95% CI = 1.10, 1.26), and low birth weight ( OR = 1.13, 95% CI=1.06, 1.21), and Black racial composition was associated with increased risk of preterm birth ( OR = 1.20, 95% CI=1.05, 1.37), among those living in most- compared to least-segregated neighborhoods. Few studies were conducted among White mothers and only exposure was associated with increased risk of preterm birth and low birth weight. Qualitative analyses indicated that among Black mothers, exposure and hypersegregation were associated with multiple adverse birth outcomes; findings were mixed for evenness and clustering. Conclusions and future directions Associations between segregation and adverse birth outcomes differ by race. Methodological heterogeneity between studies may obscure true associations. Research can be advanced through use of multilevel frameworks and by examining mechanistic pathways between segregation and adverse birth outcomes. Elucidation of pathways may provide opportunities to intervene to reduce seemingly intractable racial disparities in adverse birth outcomes.

Objective Black mothers are 60 percent more likely than white mothers to have preterm births and twice as likely to have a baby with low birth weight. We examine whether these black-white gaps in birth outcomes are larger in counties with higher levels of racial prejudice. Method We use data from the restricted-use natality files in the United States, which provide information on birth weight, gestation, and maternal characteristics for over 31 million births from 2002 to 2012, combined with county-level data measures of both explicit and implicit racial prejudice from Project Implicit from over a million individuals who took the Implicit Association Test during this same period. We compare counties that are one standard deviation above the mean (high prejudice) with those that are one standard deviation below the mean (low prejudice) in terms of their average level of racial prejudice. Results The black-white gap in low birth weight is 14 percent larger in counties with high implicit racial prejudice compared to counties with low prejudice. The black-white gap in preterm births is 29 percent larger in the high prejudice counties. The gaps are even larger when we use explicit measures of racial prejudice with high prejudice counties having a black-white gap that is 22 percent larger for low birth weight and 36 percent larger for preterm births. These relationships do not appear to be biased by the way the prejudice sample is constructed, since the racial gap in birth outcomes is unrelated to other county-level biases such as those based on gender or sexual orientation. Conclusion The black-white gap in United States’ birth outcomes is larger in those counties that have the highest levels of racial prejudice. This is true for both implicit and explicit racial prejudice, though the strength of the relationship is strongest for explicit racial prejudice.