Increasing health inequality in China: An empirical study with ordinal data

This paper employs a recently introduced method of income-health matrix to study health inequality in China. The method overcomes the problems associated with ordered self-reported health (SRH) responses when the conventional tools of inequality analysis are used. Applying the new method to the China Health and Nutrition Survey (CHNS) data, we find that over the study period of thirteen years, health inequality has increased by more than one hundred percent in spite of the multifold increase in average income. We conclude that the most likely explanations for the recent increase in China’s health inequality are: aging population, worsening income inequality and poverty, division between urban and rural, and environment deterioration.     

Education and the changing shape of the income gradient in health

Research on the social determinants of health has increasingly sought to understand the relative importance of different features of socioeconomic status. Much of the ensuing debate has wavered between education and income, with recent research leaning increasingly toward income. This research has not, however, consistently explored interactions between different features of socioeconomic status and, in trying to understand the independent effects of different components of socioeconomic status, may have missed important features of socioeconomic position. With an eye toward examining how features of socioeconomic status combine and coalesce, this paper examines variation in the income-health association by level of education. Theories derived both from medical sociology and health economics suggest synergistic interactions between income and education, but they are unclear as to the direction and magnitude of these interactions. Results from two large and nationally representative data sets (the 1996-1997 Community Tracking Study and the 1972-2000 General Social Survey) indicate that the positive relationship between income and health varies substantially in both its strength and shape by level of education. Education improves health, and its effects are larger at lower levels of income. Moreover, education reduces the strength and curvature of the income-health relationship. Consequently, those with more education have better health for all levels of income, and fewer income-based disparities exist among the well educated than among the less well educated. The linear "gradient" relationship between income and health is, thus, more characteristic of groups with higher levels of education. Additional analyses indicate that these interactions existed in the United States in each of the last three decades. The results are discussed in light of theory regarding the perpetuation of health disparities, as well as current debates regarding the apparent incompatibility of distributive versus aggregative goals in health policy.     

Socioeconomic position and health: the differential effects of education versus income on the onset versus progression of health problems

This article seeks to elucidate the relationship between socioeconomic position and health by showing how different facets of socioeconomic position (education and income) affect different stages (onset vs. progression) of health problems. The biomedical literature has generally treated socioeconomic position as a unitary construct. Likewise, the social science literature has tended to treat health as a unitary construct. To advance our understanding of the relationship between socioeconomic position and health, and ultimately to foster appropriate policies and practices to improve population health, a more nuanced approach is required--one that differentiates theoretically and empirically among dimensions of both socioeconomic position and health. Using data from the Americans' Changing Lives Study (1986 through 2001/2002), we show that education is more predictive than income of the onset of both functional limitations and chronic conditions, while income is more strongly associated than education with the progression of both.     

Race-Ethnicity and Health Trajectories: Tests of Three Hypotheses across Multiple Groups and Health Outcomes

Racial-ethnic disparities in static levels of health are well documented. Less is known about racial-ethnic differences in age trajectories of health. The few studies on this topic have examined only single health outcomes and focused on black-white disparities. This study extends prior research by using a life course perspective, panel data from the Health and Retirement Study, and multilevel growth curve models to investigate racial-ethnic differences in the trajectories of serious conditions and functional limitations among blacks, Mexican Americans, and whites. We test three hypotheses on the nature of racial-ethnic disparities in health across the life course (aging-as-leveler, persistent inequality, and cumulative disadvantage). Results controlling for mortality selection reveal that support for the hypotheses varies by health outcome, racial-ethnic group, and life stage. Controlling for childhood socioeconomic status, adult social and economic resources, and health behaviors reduces but does not eliminate racial-ethnic disparities in health trajectories.     

We're not rich,but we're definitely not poor: Young children's conceptions of social class

Relative deprivation theory suggests that perceived socioeconomic standing has implications for multiple aspects of life. Early childhood is critical for later development and concern about effects of rising inequality on children has grown along with inequality in recent decades. However, one of the key requirements for relative deprivation to matter for child outcomes is that children must have a sense of social class and their socioeconomic standing. Because the voices of children are often lost among current debates, this paper poses two questions: 1) How do young children conceive of social class and their standing in the distribution in the context of high inequality; and 2) How do these conceptions develop over time? We conducted longitudinal, semi-structured interviews with 44 young children (ages 5–6), who attend the same three elementary schools in a small Midwestern city. By following the same children over two years, this study is uniquely able to shed light on how conceptions of class develop over time. We found that, as children got older, they increasingly associated money with differences in quality, became more likely to assign value judgements to money, and became less reliant on verbal proof of wealth. Although many children misreport their own socioeconomic standing, our findings suggest young children are aware of social class inequality and may therefore experience relative deprivation. Reducing inequality could mitigate potential implications of relative deprivation for child development.     

MEASURING AND ANALYZING CLASS INEQUALITY WITH THE GINI INDEX INFORMED BY MODEL-BASED CLUSTERING

The most widely used measure for studying social, economic, and health inequality is the Gini index/ratio. Whereas other measures of inequality possess certain useful characteristics, such as the straightforward decomposability of the generalized entropy measures, the Gini index has remained the most popular, at least in part due to its ease of interpretation. However, the Gini index has a limitation in measuring inequality. It is less sensitive to how the population is stratified than how individual values differ. The twin purposes of this paper are to explain the limitation and to propose a model-based method—latent class/clustering analysis for understanding and measuring inequality. The latent cluster approach has the major advantage of being able to identify potential "classes" of individuals who share similar levels of income or one or more other attributes and to assess the fit of the model-based classes to the empirical data, based on different cluster distributional assumptions and the number of latent classes. This paper distinguishes class inequality from individual inequality, the type that is better captured by the Gini. Once the classes are estimated, the membership of estimated classes obtained from the best fitting model facilitates the decomposition of the Gini index into individual and class inequality. Class inequality is then measured by two relative stratification indices based on either the relative size of the Gini between-class components or the relative number of stratified individuals. Therefore, the Gini index is extended and assisted by model-based clustering to measure class inequality, thereby realizing its great potential for studying inequality. Income data from France and Hungary are used to illustrate the application of the method.     

Maternal depression and childhood health inequalities

An increasing body of literature documents considerable inequalities in the health of young children in the United States, though maternal depression is one important, yet often overlooked, determinant of children's health. In this article, the author uses data from the Fragile Families and Child Wellbeing Study (N = 4,048) and finds that maternal depression, particularly recurrent or chronic depression, puts children at risk of having unfavorable health when they are five years old. This finding persists despite adjusting for a host of demographic characteristics of the mothers and children (including children's prior health) and is consistent across multiple health outcomes. Family instability, maternal health, and socioeconomic status account for the association between maternal depression and children's health. Given that poor childhood health may lead to poor health and low socioeconomic status in adulthood, maternal depression may contribute to the intergenerational transmission of inequality.     

Perceived Freedom and its Sociological Effects: An Inquiry into the Relationship Between Liberalism and Inequality

Abstract:  Individual freedom has been regarded as one of the most important criteria for a desirable society and life. Recently, the theories of liberalism and distributive justice have received increasing attention as a theoretical basis for tackling problems pertaining to socioeconomic inequality and poverty. However, few quantitative analyses focus on the meaning of freedom in the context of socioeconomic inequality and political order in an existing liberal-democratic society. In this paper, I construct a self-rated measure of freedom—the overall perceived freedom scale—and examine (1) whether socioeconomic inequality is related to inequality of freedom, (2) whether freedom is related to subjective well-being, and (3) whether freedom affects people's political attitude toward inequalities. Analyses using data from a 2005 Japanese national survey ( N  = 1320) reveal the following results: (1) people with higher personal income (not household income), higher education, and better health tend to perceive greater freedom, (2) people with higher perceived freedom are more likely to be satisfied with their life, and (3) individuals with higher perceived freedom are more likely to oppose the government's egalitarian policy, and their opposition is based on the liberal principle of freedom and self-responsibility. On the basis of these findings, the double-edged possibility of individual freedom and liberalism as an "enhancer" and "moderator" of socioeconomic inequalities and political conflicts is suggested.     

Untangling the tolerance of socioeconomic inequality: Comparing Japan,the United States,South Korea,and the People's Republic of China

The last three decades have witnessed major institutional and structural transformations across both economically developed and developing countries. While many individuals and groups have benefited from these changes, they have simultaneously resulted in growing disparities between the haves and have-nots. The growing socioeconomic inequalities, however, have not been met with significant resistance and it has been even observed that people have become more tolerant of inequalities. This article explores the motivations behind tolerating socioeconomic inequality, and investigates how the tolerance of socioeconomic inequality has changed over the past 25 years, while also comparing it across very distinctive political and socioeconomic regimes. This study overcomes a gap in research by employing longitudinal, cross-sectional survey data to analyze temporal change in attitudes towards inequality. Fixed effects models are applied on five waves of World Values Survey data (1994–2020) on four distinctly different post-industrial countries: Japan, the People's Republic of China, South Korea, and the United States. The paper argues that, on an individual level, there is a tendency to accept inequality normalizing narratives and defend one's own self-interest, derived from one's structural position. This accounts for a considerable part of the variation in tolerance for socioeconomic inequality across these nations. The article concludes that trends in tolerating socioeconomic inequality have over time become more similar across these four countries with distinctly different political–economic regimes.     

Income Inequality across Micro and Meso Geographic Scales in the Midwestern United States, 1979–20091

This article examines the spatial distribution of income inequality and the socioeconomic factors affecting it using spatial analysis techniques across 16,285 block groups, 5,050 tracts, and 618 counties in the western part of the North Central Region of the United States. Different geographic aggregations result in different inequality outcomes, suggesting spatial scale needs to be carefully considered in inequality research. Inequality is spatially clustered in suburban areas of larger metro areas and around Native American reservations in the Dakotas. Higher inequality is associated with better socioeconomic conditions, counter to the social inequality literature but consistent with the inequality growth literature. However, growing inequality is associated with worse socioeconomic outcomes. Results partially support the polarization thesis that declines in industrial sectors and growth in services has caused incomes to diverge. Higher and growing inequality is associated with both low‐skill and high‐skill services jobs. However, employment in agricultural and industrial sectors experiencing large losses over the past three decades is also linked to higher and growing inequality. This suggests a dual process where many former agricultural and industrial workers are now employed in other sectors at lower wages, while the remaining workers in these sectors earn higher and growing wages.     

On the measurement of socioeconomic inequality of health between countries

This paper focuses on the measurement of socioeconomic inequality of health between countries and its evolution over time, by means of population-weighted indicators. We show that rank-dependent indicators of inequality can be highly sensitive to small changes in the socioeconomic variable when estimating inequality in samples consisting of countries with large differences in population weights. Since larger countries count more than smaller countries, changes in the former tend to have bigger effects than changes in the latter. When using rank-dependent indicators, however, the sensitivity to small changes in the variable which is used for ranking can be so extreme, that the indicator may suggest trend reversals in inequality which do not really exist. An empirical study shows that this is not a freak case. The use of rank-dependent indicators may therefore produce misleading results when it comes to the measurement of population-weighted between-country inequality. We propose a simple diagnostic test to check how sensitive rank-dependent indices are to small changes in the variable used for ranking.     

Well‐being among adolescent boys

Most studies on mental health in the adult population have found a significant relationship between mental health and social class. No study has thoroughly examined this relationship in the adolescent population. This article, based on the Bachman, O'Malley, and Johnston “Youth in Transition” data set, tests the social class/mental state relationship among adolescents. Three separate measures—well‐being, psychiatric symptoms, and depression—are used to indicate mental state. Social class is based on a composite measure of socioeconomic level that exists within the “Youth in Transition” data set. Surprisingly, no relationship was found. These results persisted even when more traditional measures of social class based on parents’ education and the Duncan ranking of the fathers’ occupations were substituted for socioeconomic level. An alternative explanation supporting social stress is discussed in light of Thornberry's developmental hypothesis.     

Class Formation and Class Identity: Birth,Death, and Possibilities for Renewal

While social class served as a powerful organizing identity for much of the 19th and 20th centuries, many doubt its contemporary relevance. This article examines the formation and development of theories of class identity over the past century. From a debate largely among Marxists in the early 20th century about the conditions under which the working class will mobilize to defend its interests – moving from a “class in itself” to a “class for itself” – the question of the relationship between individuals' class position, social interests, and political mobilization attracted greater attention among social scientists following World War II. However, postwar socioeconomic transformations led some to argue for the “death of class” as a central organizing principle for modern social and political life. While others countered that class identities remained relevant, the sharp decline in class‐based organization in the late 20th century led scholars to develop more nuanced understandings of the relationship between individuals' class position and collective identities. Although current scholarship shows that there is no natural translation of class identities into collective action, the reality of growing socioeconomic inequality, along with the resurgence of social and political mobilizations to contest that growth, suggests that class identities retain the capacity to unite.     

On the welfare loss caused by inequality of opportunity

Based on the ethical principle of equality of opportunity, this paper presents a measure of the welfare loss that is caused by an unfair distribution of a particular outcome (income, health, education, etc). The key idea is that a fair society should produce outcomes that depend on individuals’ effort and not on their external circumstances such as gender, socioeconomic background, etc. We propose measuring inequality of opportunity as the welfare loss attributed to the outcome differences among individuals who exert a similar level of effort. Our results are in line with those aspects of fairness literature that give priority to the ex post compensation approach to equality of opportunity. Finally, we present an empirical application for the measurement of the welfare loss in the income distribution in Europe. We have observed a high degree of heterogeneity among European countries. The welfare loss due to inequality of opportunity ranges in those, from basically zero to almost one fifth of their potential welfare.     

Continuity and Change in Place Stratification: Spatial Inequality and Middle‐Range Territorial Units*

Abstract Sociologists have produced large, well‐known literatures on inequality across geographic territory at two ends of the spatial scale continuum, within the city and across nation‐states. In this paper, I discuss a different scale of focus, subnational stratification processes across middle‐range spatial units, those between the city and nation‐state. While characterizing much contemporary rural sociological research, this approach to spatial inequality does not tend to be seen as a coherent tradition that cross‐cuts substantive areas. First, I discuss why attention to subnational inequality, rural regions, and middle‐range spatial units are important to social science understanding of stratification processes. Second, I provide an overview of contemporary research traditions in rural sociology which, taken together, form a distinct and innovative approach to spatial inequality. Third, I draw from my own work to explain how factors affecting socioeconomic inequalities across middle‐range territorial units may be conceptualized and provide two sets of empirical examples. Finally, I discuss what should be done in terms of furthering rural sociology's regional approach to spatial inequality.     

Measuring inequality of opportunity with imperfect data: the case of Turkey

The measurement of inequality of opportunity has hitherto not been attempted in a number of countries because of data limitations. This paper proposes two alternative approaches to circumventing the missing data problems in countries where a demographic and health survey (DHS) and an ancillary household expenditure survey are available. One method relies only on the DHS, and constructs a wealth index as a measure of economic advantage. The alternative method imputes consumption from the ancillary survey into the DHS. In both cases, we compute a lower bound estimator of the share of (ex-ante) inequality of opportunity in total inequality. Parametric and non-parametric estimates are calculated for each method, and the parametric approach is shown to yield preferable lower-bound measures. In an application to the sample of ever-married women aged 30–49 in Turkey, inequality of opportunity accounts for at least 26% (31%) of overall inequality in imputed consumption (the wealth index).     

Income Inequality and Chronic Health Conditions: A Multilevel Analysis of the U.S. States

Recently, scholarly work has examined the effect of rising income inequality on health outcomes. However, this work is somewhat inconclusive. The mechanisms that could produce such an association are still being sorted out. Much of this work focuses on mortality outcomes with little attention to how this process operates for actual health conditions, including chronic health problems—arguably the main public health concerns of the developed world. In a series of multilevel binary logistic regression models using data from the 2005 and 2007 Behavioral Risk Factor Surveillance System, we examine the association between state-level income inequality, poverty, and social welfare measures on spending and policy to examine the association between these factors for three chronic health outcomes: diabetes, hypertension, and coronary heart disease. We find that income inequality is conditionally positively related only to the diagnosis of diabetes and hypertension, and only in 2007. However, absolute poverty is related to the outcome across all three dependent variables. Certain social welfare measures attenuate the effects of both income inequality and absolute poverty, suggesting that some policies reduce this association.     

Basil Bernstein 1924-2000

This paper introduces the Tog coefficient, which can be used to measure the level of inequality in a cross-tabulation of two ordinal-level variables. The Gini coefficient is a standard measure of income inequality which has been adapted by other authors for use in different contexts such as the measurement of health inequalities and the quantification of occupational segregation; the Tog coefficient represents a further stage in this process of development. The paper outlines the construction of the Tog coefficient and illustrates this using a social mobility table based on data from the 1972 Oxford Mobility Study. The trend in social mobility-related inequality as measured by the Tog coefficient is compared with the findings of Goldthorpe et al. based on odds ratios. A more elaborate application of the Tog coefficient uses a variety of data relating to the similarity of spouses' class backgrounds to demonstrate the existence of a long-term decline in the level of inequality in British society.     

The 1981 socioeconomic index for occupations in Canada

Nous présentons ici un nouvel index socio-économique des occupations, basé sur le recensement de 1981. Il est généralement admis que l'occupation est le meilleur indicateur de statut socio-économique, mais l'importance accordée au prestige, au revenu et à léducation dans la hiérarchisation des occupations demeure matière à débats. Pour cet index, nous avons décidé d'accorder un poids égal aux niveaux d'éducation et de revenu, en rant que composantes additives du statut socio-économique. Aussi, pour fins de continuité, nous avons calibré l 'index sur la base de l échelle Pineo-Porter de prestige.
This article presents a socioeconomic index for the total Canadian labour force, based on 1981 Census data. It also reviews the problems and criticisms of indexes of this kind, and attempts to specify the meaning of socioeconomic scales and the uses to which they may be legitimately put. The present index is most applicable in situations where access to data is limited to occupational titles and where one desires a unidimensional contextual indicator which locates individuals in the Canadian occupational structure at a given point in time. Sociological analysis of structured inequality, however, may be advanced most effectively if, where feasible, a full range of methodological options is considered, including the assessment of conditions on the level of the individual, the use of other contextual levels such as the workplace, and the investigation of occupation, gender and class as interdependent historical products.