Perspectives on Equity: Inputs versus Outputs

Current estimates of the contribution of education to economic growth have been questioned because they ignore the interaction of education with ability. Whether the neglect of ability differences in the analyses of the income-education relationship results in estimates that are too high was considered in an earlier paper by one of the authors (Griliches 1970), and a negative answer was conjectured. In this paper, we pursue this question a bit further, using a new and larger body of data. Unfortunately, a definitive answer to this question is hampered both by the vagueness and elasticity of "education" and "ability" as analytical concepts and by the lack of data on early (preschooling) intelligence. The data examined in this paper are based on a 1964 sample of U.S. military veterans. The variables measured include scores on a mental ability test, indicators of parental status, region of residence while growing up, school years completed before service, and school years completed during or after service. These have allowed us to inquire into the separate effects of parental background, intelligence, and schooling. The basic problem and analytical framework can be set out very simply. Let income be a linear function of education and ability, or, Y a + P1E + P(2G + u, where Y is income, E is education, G is ability,

Weight gain and metabolic complications are major adverse effects of many psychotropic drugs. We aimed to understand how socio-economic status (SES), defined as the Swiss socio-economic position (SSEP), is associated with cardiometabolic parameters after initiation of psychotropic medications known to induce weight gain. Cardiometabolic parameters were collected in two Swiss cohorts following the prescription of psychotropic medications. The SSEP integrated neighborhood-based income, education, occupation, and housing condition. The results were then validated in an independent replication sample (UKBiobank), using educational attainment (EA) as a proxy for SES. Adult patients with a low SSEP had a higher risk of developing metabolic syndrome over one year versus patients with a high SSEP (Hazard ratio (95% CI) = 3.1 (1.5–6.5), n = 366). During the first 6 months of follow-up, a significant negative association between SSEP and body mass index (BMI), weight change, and waist circumference change was observed (25 ≤ age < 65, n = 526), which was particularly important in adults receiving medications with the highest risk of weight gain, with a BMI difference of 0.86 kg/m2 between patients with low versus high SSEP (95% CI: 0.03–1.70, n = 99). Eventually, a causal effect of EA on BMI was revealed using Mendelian randomization in the UKBiobank, which was notably strong in high-risk medication users (beta: −0.47 SD EA per 1 SD BMI; 95% CI: −0.46 to −0.27, n = 11,314). An additional aspect of personalized medicine was highlighted, suggesting the patients’ SES represents a significant risk factor. Particular attention should be paid to patients with low SES when initiating high cardiometabolic risk psychotropic medications.

Growing taller unequally? Adult height and socioeconomic status in Spain (Cohorts 1940–1994)

For over four decades, Americans have enjoyed near universal access to treatment for ESRD irrespective of age, lack of qualifying disability, or their ability to pay. However, the health insurance benefits of the Medicare ESRD program do not extend to individuals in earlier stages of CKD, even to

Overall declines in human immunodeficiency virus (HIV) mortality may mask patterns for subgroups, and prior studies of disparities in mortality have used area-level vs individual-level socioeconomic status measures. The aim of this study was to examine temporal trends in HIV mortality by sex, race/ethnicity, and individual level of education (as a proxy for socioeconomic status). We examined HIV deaths among non-Hispanic white, non-Hispanic black, and Hispanic men and women aged 25 to 64 years in 26 states (1993-2007; N=91 307) reported to the National Vital Statistics System. The main outcome measures were age-standardized HIV death rates, rate differences, and rate ratios by educational attainment and between the least- and the most-educated (≤12 vs ≥16 years) individuals. Between 1993-1995 and 2005-2007, mortality declined for most men and women by race/ethnicity and educational levels, with the greatest absolute decreases for nonwhites owing to their higher baseline rates. Among men with the most education, rates per 100 000 population decreased from 117.89 (95% CI, 101.08-134.70) to 15.35 (12.08-18.62) in blacks vs from 26.42 (24.93-27.92) to 1.79 (1.50-2.08) in whites. Rates were unchanged for the least-educated black women (26.76; 95% CI, 24.30-29.23; during 2005-2007) and remained high for similarly educated black men (52.71; 48.96-56.45). Relative declines were greater with increasing levels of education (P < .001), resulting in widening disparities. Among men, the disparity rate ratio (comparing the least and the most educated) increased from 1.04 (95% CI, 0.89-1.21) during 1993-1995 to 3.43 (2.74-4.30) during 2005-2007 for blacks and from 0.98 (0.91-1.05) to 2.82 (2.34-3.40) for whites. Although absolute declines in HIV mortality were greatest for nonwhites, rates remain high among blacks, especially in the lowest educated groups, underscoring the need for additional interventions.

In recent years, there has been a dramatic increase in obesity in low and middle income countries. However, there is limited research in these countries showing the prevalence and determinants of obesity. In this study, we examine the socioeconomic inequalities in obesity among South African adults. We use nationally representative data from the South Africa National Income Dynamic Survey of 2008 to: (1) construct an asset index using multiple correspondence analyses (MCA) as a proxy for socioeconomic status; (2) estimate concentration indices (CI) to measure socioeconomic inequalities in obesity; and (3) perform a decomposition analysis to determine the factors that contribute to socioeconomic related inequalities. Consistent with other studies, we find that women are more obese than men. The findings show that obesity inequalities exist in South Africa. Rich men are more likely to be obese than their poorer counterparts with a concentration index of 0.27. Women on the other hand have similar obesity patterns, regardless of socioeconomic status with CI of 0.07. The results of the decomposition analysis suggest that asset index contributes positively and highly to socio-economic inequality in obesity among females; physical exercise contributes negatively to the socio-economic inequality. In the case of males, educational attainment and asset index contributed more to socio-economic inequalities in obesity. Our findings suggest that focusing on economically well-off men and all women across socioeconomic status is one way to address the obesity problem in South Africa.

Multimorbidity, body pain, sleep disturbance, and depression are major clinical and public health challenges. This paper aimed to examine the associations of multimorbidity with body pain, sleep duration, and depression; and whether the associations varied by socioeconomic status. Data was derived from four waves of the nationally representative China Health and Retirement Longitudinal Study (CHARLS), including participants aged 45 years and older in 2011. 12 physical non-communicable diseases and 1 mental chronic disease were used to measure multimorbidity. Educational attainment and annual per-capita household consumption expenditure were employed as proxies for socioeconomic status. Of the 16,931 participants aged 45 + years old, the proportion of people with multimorbidity was 37.87% at baseline. The number of multimorbidity increased with older age and higher socioeconomic status. Multimorbidity was associated with more body pain (incidence rate ratio (IRR) = 1.53, 95% CI = 1.45-1.61), and decreased sleep duration (β = -0.26, 95% CI = -0.36--0.15). Furthermore, multimorbidity was associated with increased depression risks (odds ratio (OR) = 1.54, 95% CI = 1.44-1.64, adjusted for sociodemographic variables), with the mediating effects of the number of body pain and sleep duration. The associations between multimorbidity and depression persisted among different socioeconomic groups. Multimorbidity was associated with increased body pain, decreased sleep duration, and further led to increased depression risks. It is necessary to pay attention to the multimorbidity of middle-aged and older adults, relieve their body pain, guarantee sufficient sleep, so as to reduce depression risks.

BackgroundSeveral studies have examined the association between socioeconomic status (SES) and the proportion of untreated hypertension, but have produced conflicting findings. In addition, no study has been conducted to determine sex differences in the association between SES and untreated hypertension. Thus, the aim of this study was to examine whether the associations between SES and the proportion of untreated hypertension differed by sex in Vietnam.MethodsThis study was conducted using the data of 1189 individuals (558 males and 631 females) who were judged to have hypertension during the baseline survey of a prospective cohort study of 3000 residents aged 40–60 years in the Khánh Hòa Province. A multilevel Poisson regression model with a robust variance estimator was used to examine whether sex and SES indicators (household income and educational attainment) interacted in relation to untreated hypertension.ResultsThe proportion of untreated hypertension among individuals identified as hypertensive was 69.1%. We found significant interaction between sex and SES indicators in relation to untreated hypertension (education: p < 0.001; household income: p < 0.001). Specifically, the association between SES and untreated hypertension was inverse among males while it was rather positive among females.ConclusionsOur finding suggests that the role of SES in the proportion of untreated hypertension might differ by sex.

Introduction: A life course approach has been suggested as the most appropriated to establish the actual impact of socioeconomic status (SES) on health outcomes. Hypothesis: We assessed the hypothesis that SES trajectories from childhood to adulthood are useful to better evaluate the role of SES towards mortality risk in a large general population-based cohort. Methods: Longitudinal analysis on 22,194 subjects recruited in the general population of the Moli-sani study, Italy (2005-2010). Educational attainment (low/high) and SES in adulthood (measured by a score including occupational social class, housing and overcrowding, and dichotomized as low/high) were used to define four possible trajectories both in low and high SES in childhood (age of 8). Hazard ratios (HR) with 95% confidence intervals (95%CI) were calculated by multivariable Cox regression and competing risk models. Results: Over a median follow-up of 8.3 years (182,924 person-years), 1155 all-cause, of which 414 cardiovascular (CVD), deaths were ascertained. In the group with low SES in childhood, as opposed to those stably low (low education and low SES in adulthood), an upward in both educational attainment and material factors in adulthood was associated with lower risk of both all-cause (HR=0.64; 95%CI 0.52-0.79; Table) and CVD mortality (HR=0.62; 0.43-0.88), respectively. Subjects with high childhood SES experienced an increased risk of total and CVD death in absence of higher educational attainment despite a higher SES in adulthood (HR=1.47; 1.04-2.07 and HR=1.75;1.00-3.05, respectively) as compared to the group with both high education and high SES in adulthood. Conclusions: In conclusion, for individuals with low SES in childhood, an upward of both educational attainment and material factors over the life course is associated with lower risk of total and CVD death. In advantaged groups in childhood, lack of a higher educational attainment, rather than material factors, over the life course appears to be unfavourably associated with survival.

International large-scale assessments (ILSAs) require national governments to invest significant resources in both time and money. With such investment national governments expect the results of ILSAs to provide policy and research communities with evaluative information on their educational system. Armed with this evaluative information, policymakers in many participating countries have used the results to stimulate reform. However, systematically tracking this influence and judging the validity of the claims has proven difficult for both the policy and research communities. There can be an erroneous expectation in the wider education community, and sometimes amongst policymakers themselves, that ILSA data automatically suggests policy solutions. Because of this error, a means for better systematizing the policymaking process responding to ILSA results is required. The model developed here can assist the policy and research community to better understand whether ILSAs are providing valid evidence to support their use in policy formation enactment and can be used to analyze ongoing consequences of that influence. Two worked examples demonstrate the utility of the model.

To present and compare socioeconomic status (SES) rankings of households using consumption and an asset-based index as two alternative measures of SES; and to compare and evaluate the performance of these two measures in multivariate analyses of the socioeconomic gradient in malaria prevalence. Data for the study come from a survey of 557 households in 25 study villages in Tanzania in 2004. Household SES was determined using consumption and an asset-based index calculated using Principal Components Analysis on a set of household variables. In multivariate analyses of malaria prevalence, we also used two other measures of disease prevalence: parasitaemia and self-report of malaria or fever in the 2 weeks before interview. Household rankings based on the two measures of SES differ substantially. In multivariate analyses, there was a statistically significant negative association between both measures of SES and parasitaemia but not between either measure of SES and self-reported malaria. Age of individual, use of a mosquito net, and wall construction were negatively and significantly associated with parasitaemia, whilst roof construction was positively associated with parasitaemia. Only age remained significant when malaria self-report was used as the measure of disease prevalence. An asset index is an effective alternative to consumption in measuring the socioeconomic gradient in malaria parasitaemia, but self-report may be an unreliable measure of malaria prevalence for this purpose.

The Medical College Admissions Test (MCAT) remains a significant barrier for students from low socioeconomic status (SES) backgrounds, with performance disparities driven by unequal access to resources rather than by differences in aptitude. Holistic admissions practices seek to contextualize exam performance alongside other essential pre-medical competencies such as resilience, empathy, and scientific inquiry. Evidence shows that students with middle-tercile MCAT scores who demonstrate these qualities will succeed in medical school and beyond. However, only those who apply can benefit from such holistic review. Little is known about application behaviors at this pivotal stage, when examinees must decide whether to apply with their achieved MCAT score. This study examines the relationship between socioeconomic status, MCAT performance, and application probability. This study analyzed de-identified Association of American Medical Colleges (AAMC) data for all MCAT examinees between 2017 and 2019, including sociodemographic characteristics and total MCAT score. The outcome was allopathic (M.D.) medical school application status through the 2021 application cycle, allowing examinees at least two full years to apply. The AAMC parental education and occupation (EO) indicator stood as a proxy for SES – ranging from EO-1 (less than college degree, any occupation) to EO-5 (doctoral degree; executive, managerial or professional occupations). Socioeconomic disadvantage (SED) was defined as EO-1 and EO-2. Middle- or top-tercile MCAT scores were achieved by 51.8% of examinees with SED (middle, 33.2%; top, 18.6%) compared with 73.1% of examines without SED (middle, 34.4%; top, 38.7%). The probability of applying to medical school was closely tied to MCAT performance, and regardless of SES, the probability of application with any given MCAT score was similar. While most top-tercile performers (92 to 94%) applied, a much lower proportion of middle-tercile performers (78 to 80%) applied. Socioeconomically disadvantaged MCAT examinees infrequently score in the top tercile where application rates are uniformly high. Those with acceptable, middle-tercile performance may under-appreciate their academic achievements through economic adversity, as over 20% do not apply to medical school. Targeted interventions are needed to promote application and maximize the impact of holistic review.

The major aim of International Large-Scale Assessments (ILSAs) of school systems is to collect comprehensive information about factors related to learning, teaching, and student outcomes from various education systems in order to identify possible factors and areas for improvements on different levels and with different perspectives. Although ILSAs differ in their specific research and policy focus, the overall study designs rely on a common understanding of the structure and processes within education systems. Learning in schools is perceived as being embedded into the context of (a) the local school with its different actors, facilities, and regulations, and (b) the national or regional context. More recently, due to continuous globalization, school systems are increasingly perceived, analyzed, and described in a global perspective. The development of respective theoretical foundations describing students’ learning within the school system can be tracked back to the 1960s when the idea of opportunity to learn developed. Recent extensions are based upon the input-process-and-output models and draw from economic and system theories. They provide a comprehensive and elaborated framework describing learning as a dynamic process within the school system. The main aim of this chapter is to first review the most prominent frameworks of school learning. Next, ILSAs are reviewed with respect to the extent they draw implicitly or explicitly on these frameworks. Finally, possibilities for further developments are discussed. The structure of the chapter follows these aims.KeywordsDevelopment of ILSAComprehensive Theoretical FrameworksEffectivenes of Education Systems

International large-scale assessments, such as PISA and TIMSS, have had a profound effect on educational policy and school accountability. In an open letter to the OECD in 2014, a large number of academics expressed their concerns over the continuous cycle of global testing and how it negatively affects student’s well-being and impoverishes classrooms, as it inevitably involves more and longer batteries of multiple-choice testing, more scripted “vendor”-made lessons, and less autonomy for teachers. Others have pointed to the ways in which international large-scale assessments have opened up education systems and built country’s assessment capacities. This chapter reviews the ways in which international standardized assessments permeate national policy and school-level decision-making, drawing on the sociology of numbers to understand the appeal of standardization and benchmarking. The OECD initiative “PISA for Schools” is described and how it potentially extends the influence of international assessments on the classroom. An alternative project within the OECD (the “Strategic Education Governance” project) is presented and how the approach of case studies and learning seminars allows countries to learn more holistically about how to hold schools accountable and improve education. Openness, situational awareness, and a consideration for the complexity of successful reform are presented as necessary “habits of mind” to successfully improve learning outcomes. The final conclusion reflects on the limitations and potential usage of international large-scale assessments for effective education reform.KeywordsAccountabilityCommensurationStandardizationEducational governance

Environmental exposures experienced by pregnant women living in cities of low- and middle-income countries are poorly described. We collected information on housing characteristics, household and ambient air pollution, and work-related exposures through questionnaires in a cohort of 400 pregnant women in Nairobi, Kenya and examined exposures in relation to educational attainment, a proxy for socioeconomic status. Participants were median 26 years of age, mostly married (85%) and self-described homemakers (54%), with at least some secondary school education (74%). Housing generally consisted of one room (58%) with one window (57%), access to electricity (94%), and no piped water (88%). Participants commonly reported living near sewers (55%) and the Dandora dumpsite (34%). Liquified petroleum gas (LPG) was the primary domestic cooking fuel, followed by kerosene, with 65% and 32%, respectively, reporting use most days to daily. Most participants reported exposure to outdoor cooking smoke (73%) and vehicle exhaust (66%) most days to daily. Employed participants (N = 151) reported work-related exposure to vehicle exhaust (68%), cigarettes (37%), marijuana (33%), dusty/unpaved roads (32%), welding (30%), and the dumpsite (30%) most days to daily. Exposure to rubbish burning was reported by 4.5% of participants at home, by 24% outdoors, and by 25% related to work most days to daily. Relative to women with primary school education or lower, women with at least secondary school education were more likely to use LPG (p < 0.001) and less likely to use kerosene (p < 0.001). This study highlights a high prevalence of pregnant women in an urban African context experience multiple sources of combustion related air pollution sources. Exposure to cooking emissions, vehicle exhaust, and rubbish burning were frequent. Kerosene, the second most common and a dirty domestic fuel, was used more by women with lower educational attainment. These data may inform future studies of prenatal and early childhood environmental exposures and interventions.