Understanding the pathways leading to socioeconomic inequalities in HIV testing uptake in 18 sub-Saharan African countries.

OBJECTIVE: To better understand the different pathways linking socioeconomic position and HIV testing uptake in 18 sub-Saharan African countries. DESIGN: We used cross-sectional population-based surveys between 2010 and 2018. METHODS: Using a potential outcomes framework and the product method, we decomposed the total effect linking wealth and recent (<12 months) HIV testing into direct effects, and indirect effects, via internal (related to individual's ability to perceive need for and to seek care) or external (ability to reach, pay for and engage in healthcare) mediators to calculate the proportion mediated (PM) by each mediator. RESULTS: High levels of inequalities were observed in nine and 15 countries among women and men, respectively. The mediator indirect effect varied greatly across countries. The PM tended to be higher for internal than for external mediators. For instance, among women, HIV-related knowledge was estimated to mediate up to 12.1% of inequalities in Côte d'Ivoire; and up to 31.5% for positive attitudes towards people with HIV (PWH) in Senegal. For the four external mediators, the PM was systematically below 7%. Similar findings were found when repeating analyses on men for the internal mediators, with higher PM by attitudes towards PWH (up to 39.9% in Senegal). CONCLUSIONS: Our findings suggest that wealth-related inequalities in HIV testing may be mediated by internal more than external characteristics, with important variability across countries. Overall, the important heterogeneities in the pathways of wealth-related inequalities in HIV testing illustrate that addressing inequalities requires tailored efforts and upstream interventions.

Gig Workers during the COVID-19 Crisis in France: Financial Precarity and Mental Well-Being.

We set out to explore how precarious workers, particularly those employed in the gig economy, balance financial uncertainty, health risks, and mental well-being. We surveyed and interviewed precarious workers in France during the COVID-19 crisis, in March and April 2020. We oversampled gig economy workers, in particular in driving and food delivery occupations (hereafter drivers and bikers), residing in metropolitan areas. These workers cannot rely on stable incomes and are excluded from the labor protections offered to employees, features which have been exacerbated by the crisis. We analyzed outcomes for precarious workers during the mandatory lockdown in France as an extreme case to better understand how financial precarity relates to health risks and mental well-being. Our analysis revealed that 3 weeks into the lockdown, 56% of our overall sample had stopped working and respondents had experienced a 28% income drop on average. Gig economy drivers reported a significant 20 percentage point larger income decrease than other workers in our sample. Bikers were significantly more likely to have continued working outside the home during the lockdown. Yet our quantitative analysis also revealed that stress and anxiety levels were not higher for these groups and that bikers in fact reported significantly lower stress levels during the lockdown. While this positive association between being a biker and mental health may be interpreted in different ways, our qualitative data led to a nuanced understanding of the effect of gig work on mental well-being in this population group.

Parents' education and child body weight in France: The trajectory of the gradient in the early years.

This paper explores the relationship between parental education and offspring body weight in France. Using two large datasets spanning the 1991-2010 period, we examine the existence of inequalities in maternal and paternal education and reported child body weight measures, as well as their evolution across childhood. Our empirical specification is flexible and allows this evolution to be non-monotonic. Significant inequalities are observed for both parents' education--maternal (respectively paternal) high education is associated with a 7.20 (resp. 7.10) percentage points decrease in the probability that the child is reported to be overweight or obese, on average for children of all ages. The gradient with respect to parents' education follows an inverted U-shape across childhood, meaning that the association between parental education and child body weight widens from birth to age 8, and narrows afterward. Specifically, maternal high education is correlated with a 5.30 percentage points decrease in the probability that the child is reported to be overweight or obese at age 2, but a 9.62 percentage points decrease at age 8, and a 1.25 percentage point decrease at age 17. The figures for paternal high education are respectively 5.87, 9.11, and 4.52. This pattern seems robust, since it is found in the two datasets, when alternative variables for parental education and reported child body weight are employed, and when controls for potential confounding factors are included. The findings for the trajectory of the income gradient corroborate those of the education gradient. The results may be explained by an equalization in actual body weight across socioeconomic groups during youth, or by changes in reporting styles of height and weight.

Winning big but feeling no better? The effect of lottery prizes on physical and mental health.

We use British panel data to determine the exogenous impact of income on a number of individual health outcomes: general health status, mental health, physical health problems, and health behaviours (drinking and smoking). Lottery winnings allow us to make causal statements regarding the effect of income on health, as the amount won by winners is largely exogenous. Positive income shocks have no significant effect on self-assessed overall health, but a significant positive effect on mental health. This result seems paradoxical on two levels. First, there is a well-known gradient in health status in cross-sectional data, and second, general health should partly reflect mental health, so that we may expect both variables to move in the same direction. We propose a solution to the first apparent paradox by underlining the endogeneity of income. For the second, we show that lottery winnings are also associated with more smoking and social drinking. General health will reflect both mental health and the effect of these behaviours and so may not improve following a positive income shock.

Family income and child health in the UK.

Recent studies examining the relationship between family income and child health in the UK have produced mixed findings. We re-examine the income gradient in child general health and its evolution with child age in this country, using a very large sample of British children. We find that there is no correlation between income and child general health at ages 0-1, that the gradient emerges around age 2 and is constant from age 2 to age 17. In addition, we show that the gradient remains large and significant when we reduce the endogeneity of income. Furthermore, our results indicate that the gradient in general health reflects a greater prevalence of chronic conditions among low-income children and a greater severity of these conditions. Taken together, these findings suggest that income does matter for child health in the UK and may play a role in the intergenerational transmission of socioeconomic status.

Measuring health polarization with self-assessed health data.

This paper proposes an axiomatic foundation for new measures of polarization that can be applied to ordinal distributions such as self-assessed health (SAH) data. This is an improvement over the existing measures of polarization that can be used only for cardinal variables. The new measures of polarization avoid one difficulty that the related measures for evaluating health inequalities face. Indeed, inequality measures are mean based, and since only cardinal variables have a mean, SAH has to be cardinalized to compute a mean, which can then be used to calculate an inequality measure. In contrast, the new polarization measures are median based and hence do not require to impose cardinal scaling on the categories. After deriving the properties of these new polarization measures, we provide an empirical illustration using data from the British Household Panel Survey that demonstrates that SAH polarization is also a relevant question on empirical grounds, and that the polarization measures are adequate to evaluate polarization phenomena whereas inequality measures are not adequate in these cases.