Maternal socioeconomic position and inequity in child deaths: An analysis of 2012 South Korean birth cohort of 466,636 children.

Background: Inequalities in child mortality occur via interactions between socio-environmental factors and their constituents. Through childhood developmental stages, we can observe changing patterns of mortality. By investigating these patterns and social inequalities by cause and developmental stage, we aim to gain insights into health policies to reduce and equalize childhood mortality. Methods: Using vital statistics, we examined the Korean birth cohort of 2012, including all children born in 2012 up to five years of age (N = 466,636). The dependent variables were all-cause and cause-specific mortality by developmental stage (i.e., neonatal, post-neonatal, and childhood). A Cox proportional hazard regression model was built to compare child mortality according to maternal education. The distribution of inequalities in cause-specific mortality by child age was calculated using the slope index of inequality (SII). Results: Inequalities in child mortality due to maternal education occur during the neonatal period and increase over time. After adjusting for covariates, the Cox proportional hazard models showed that "injury and external causes" (HR = 2.178; 95% CI = [1.283-3.697]) and "unknown causes" (HR = 2.299; 95% CI = [1.572-3.363]) in the post-neonatal period, and "injury and external causes" (HR = 2.153; 95% CI = [1.347-3.440]) in the childhood period significantly contributed to socioeconomic inequalities in child mortality. For each period, the leading causes of inequality were identified as follows: "congenital" (96.7%) for the neonatal period, "unknown causes" (58.2%) and "injury and external causes" (28.4%) for the post-neonatal period, and "injury and external causes" (56.5%) for the childhood period. Conclusion: We confirmed that the main causes of death in mortality inequality vary according to child age, in accordance with the distinctive context of child development. Strengthening the health system and multisectoral efforts that consider families' and children's needs according to spatial contexts (e.g., home, community) may be necessary to address the social inequalities in child health.

Who loses more? Identifying the relationship between hospitalization and income loss: prediction of hospitalization duration and differences of gender and employment status.

BACKGROUND: The major determinants of health and well-being include wider socio-economic and political responses to poverty alleviation. To data, however, South Korea has no related social protection policies to replace income loss or prevent non-preferable health conditions for workers. In particular, there are several differences in social protection policies by gender or occupational groups. This study aimed to investigate how hospitalization affects income loss among workers in South Korea. METHODS: The study sample included 4876 Korean workers who responded to the Korean Welfare Panel Study (KoWePS) for all eight years from 2009 to 2016. We conducted a receiver operating characteristics (ROC) analysis to determine the cut-off point for the length of hospitalization that corresponded to the greatest loss of income. We used panel multi-linear regression to examine the relationship between hospitalization and income loss by gender and employment arrangement. RESULTS: The greatest income loss for women in non-standard employment and self-employed men was observed when the length of hospitalization was seven days or less. When they were hospitalized for more than 14 days, income loss also occurred among men in non-standard employment. In addition, when workers were hospitalized for more than 14 days, the impact of the loss of income was felt into the subsequent year. CONCLUSION: Non-standard and self-employed workers, and even female standard workers, are typically excluded from public insurance coverage in South Korea, and social security is insufficient when they are injured. To protect workers from the vicious circle of the poverty-health trap, national social protections such as sickness benefits are needed.

Evaluating the impact of the nationwide public-private mix (PPM) program for tuberculosis under National Health Insurance in South Korea: A difference in differences analysis.

BACKGROUND: Public-private mix (PPM) programs on tuberculosis (TB) have a critical role in engaging and integrating the private sector into the national TB control efforts in order to meet the End TB Strategy targets. South Korea's PPM program can provide important insights on the long-term impact and policy gaps in the development and expansion of PPM as a nationwide program. METHODS AND FINDINGS: Healthcare is privatized in South Korea, and a majority (80.3% in 2009) of TB patients sought care in the private sector. Since 2009, South Korea has rapidly expanded its PPM program coverage under the National Health Insurance (NHI) scheme as a formal national program with dedicated PPM nurses managing TB patients in both the private and public sectors. Using the difference in differences (DID) analytic framework, we compared relative changes in TB treatment outcomes-treatment success (TS) and loss to follow-up (LTFU)-in the private and public sector between the 2009 and 2014 TB patient cohorts. Propensity score matching (PSM) using the kernel method was done to adjust for imbalances in the covariates between the 2 population cohorts. The 2009 cohort included 6,195 (63.0% male, 37.0% female; mean age: 42.1) and 27,396 (56.1% male, 43.9% female; mean age: 45.7) TB patients in the public and private sectors, respectively. The 2014 cohort included 2,803 (63.2% male, 36.8% female; mean age: 50.1) and 29,988 (56.5% male, 43.5% female; mean age: 54.7) patients. In both the private and public sectors, the proportion of patients with transfer history decreased (public: 23.8% to 21.7% and private: 20.8% to 17.6%), and bacteriological confirmed disease increased (public: 48.9% to 62.3% and private: 48.8% to 58.1%) in 2014 compared to 2009. After expanding nationwide PPM, absolute TS rates improved by 9.10% (87.5% to 93.4%) and by 13.6% (from 70.3% to 83.9%) in the public and private sectors. Relative to the public, the private saw 4.1% (95% confidence interval [CI] 2.9% to 5.3%, p-value < 0.001) and -8.7% (95% CI -9.7% to -7.7%, p-value <0.001) higher rates of improvement in TS and reduction in LTFU. Treatment outcomes did not improve in patients who experienced at least 1 transfer during their TB treatment. Study limitations include non-longitudinal nature of our original dataset, inability to assess the regional disparities, and verify PPM program's impact on TB mortality. CONCLUSIONS: We found that the nationwide scale-up of the PPM program was associated with improvements in TB treatment outcomes in the private sector in South Korea. Centralized financial governance and regulatory mechanisms were integral in facilitating the integration of highly diverse South Korean private sector into the national TB control program and scaling up of the PPM intervention nationwide. However, TB care gaps continued to exist for patients who transferred at least once during their treatment. These programmatic gaps may be improved through reducing administrative hurdles and making programmatic amendments that can help facilitate management TB patients between institutions and healthcare sectors, as well as across administrative regions.

Has the long-term care insurance resolved disparities in mortality for older Koreans? examination of service type and income level.

The long-term care insurance (LTCI) has been implemented to help the government take responsibility for social prevention and protection measures to maintain and improve older adults' health and well-being since 2008. This study aimed to evaluate the effects of LTCI on mortality of elders in South Korea. The data used from the national representative Elderly Cohort Database for 2009 to 2013. We analyzed longitudinal panel data from 61,235 persons aged 65 years and older. We generated Kaplan-Meier survival curves and Cox proportional hazard models by use and type of long-term care services (LTCSs) (e.g., non-user, facility, and in-home benefits) and income level. The covariate-adjusted approximate mortality rates by LTCSs type for facility and in-home benefits group compared to non-LTCS users were 0.761 and 0.803, respectively. The approximate mortality rates were higher in the middle low- (Hazard Ratio [HR] = 1.131, p < .001), low- (HR = 1.125, p < .001), and middle- (HR = 1.122, p < .001) than the high income group. In particular, the disparities in mortality by income gap in in-home care users of LTCS was greater than that of facility care users in Korea. Consequently, these findings point to the need for program improvements to the quality and quantity of the in-home LTCSs for elderly Koreans. Ensuring a "continuum of care" through education for service providers and stronger relationships with the recipients' families could improve overall quality. There is a particular need to devote more attention to the needs of low-income elderly who currently lack sufficient the health coverage.

A stakeholder analysis of community-led collaboration to reduce health inequity in a deprived neighbourhood in South Korea.

Intersectoral collaboration amongst health and other sectors, as well as between government and non-governmental organisations, has been highlighted as a way to improve health equity. We used a mixed-methods approach to assess collaborative relationships between multiple government sectors and civil society and to suggest possible health promotion interventions and policy alternatives for the urban poor in deprived neighborhoods. A total of 18 participants involved in health promotion interventions and policy processes related to the inner-city area of Seoul were recruited using purposive sampling methods. Participants included stakeholders working for or engaging in governments (3), public health care institutions (5), social service providers (3), community-based organisations (CBOs) (4) and faith-based organisations (3). We conducted semi-structured, one-on-one interviews and then collected survey data. Quantitative data were analysed using social network analysis, and qualitative data were analysed through iterative and consensus processes. The social network analysis indicated that a CBO plays the most substantial role in sharing and controlling informational resources to promote health. A stakeholder analysis showed that the CBO neutrally and negatively viewed the possibility of collaboration with other stakeholders. Three themes related to challenges to intersectoral collaboration emerged: (1) lack of trust and communication, (2) need of a coalition with a committed leading actor for future collaboration and (3) organisational and political silos within and across public sectors. Increased understanding of the current status of and challenges to collaboration can inform the planning and implementation of complex intervening strategies and policies tailored to vulnerable people in deprived neighborhoods. Community-led collaborative actions empower people in marginalised communities to envision a healthier community.

Impact of Housing Provision Package on Treatment Outcome Among Homeless Tuberculosis Patients in South Korea.

The objective of this study was to assess the effect of a housing provision package on treatment outcomes among homeless South Korean tuberculosis (TB) patients. We conducted a prospective, single-arm, community-based study with historical controls as follows: community-based intervention group (COM), who were provided housing, nutrition, and case management, and received directly observed therapy services; a first historical control that was treated as usual (TAU); and a second historical control that comprised homeless TB patients residing in long-term TB-care facility (FAC). A multivariable logistic regression model was constructed to identify predictors associated with treatment success among homeless TB patients. Treatment was successful in 86.0%, 58.3%, and 96.1% of patients in the COM, TAU, and FAC groups, respectively. Interventions, including those found in the COM and FAC groups, were the only predictors of treatment success. Therefore, we determined that housing provision package positively influenced the treatment outcomes of homeless TB patients.

Gender equality policies, nursing professionalization, and the nursing workforce: A cross-sectional, time-series analysis of 22 countries, 2000-2015.

BACKGROUND: Nursing professionalization has substantial benefits for patients, health care systems, and the nursing workforce. Currently, however, there is limited understanding of the macro-level factors, such as policies and other country-level determinants, influencing both the professionalization process and the supply of nursing human resources. OBJECTIVES: Given the significance of gender to the development of nursing, a majority-female occupation, the purpose of this analysis was to investigate the relationship between gender regimes and gender equality policies, as macro-level determinants, and nursing professionalization indicators, in this case the regulated nurse and nurse graduate ratios. DESIGN: This cross-sectional, time-series analysis covered 16 years, from 2000 to 2015, and included 22 high-income countries, members of the Organisation for Economic Co-operation and Development. We divided countries into three clusters, using the gender policy model developed by Korpi, as proxy for gender regimes. The countries were grouped as follows: (a) Traditional family - Austria, Belgium, France, Germany, Greece, Italy, Netherlands, Portugal, and Spain; (b) Market-oriented - Australia, Canada, Ireland, Japan, New Zealand, South Korea, Switzerland, United Kingdom, and the United States; and (c) Earner-carer - Denmark, Finland, Norway, and Sweden. METHODS: We used fixed-effects linear regression models and ran Prais-Winsten regressions with panel-corrected standard errors, including a first-order autocorrelation correction to examine the effect of gender equality policies on nursing professionalization indicators. Given the existence of missing observations, we devised and implemented a multiple imputation strategy, with the help of the Amelia II program. We gathered our data from open access secondary sources. RESULTS: Both the regulated nurse and nurse graduate ratios had averages that differed across gender regimes, being the highest in Earner-carer regimes and the lowest in Traditional family ones. In addition, we identified a number of indicators of gender equality policy in education, the labour market, and politics that are predictive of the regulated nurse and nurse graduate ratios. CONCLUSION: This study's findings could add to existing upstream advocacy efforts to strengthen nursing and the nursing workforce through healthy public policy. Given that the study consists of an international comparative analysis of nursing, it should be relevant to both national and global nursing communities.

The influence of welfare state factors on nursing professionalization and nursing human resources: A time-series cross-sectional analysis, 2000-2015.

AIM: The aim of this study was to examine the relationship between welfare states and nursing professionalization indicators. DESIGN: We used a time-series, cross-sectional design. The analysis covered 16 years and 22 countries: Australia, Austria, Belgium, Canada, Denmark, Finland, France, Germany, Greece, Ireland, Italy, Japan, Netherlands, New Zealand, Norway, Portugal, South Korea, Spain, Sweden, Switzerland, United Kingdom, and the United States, allocated to five welfare state regimes: Social Democratic, Christian Democratic, Liberal, Authoritarian Conservative, and Confucian. METHODS: We used fixed-effects linear regression models and conducted Prais-Winsten regressions with panel-corrected standard errors, including a first-order autocorrelation correction. We applied the Amelia II multiple imputation strategy to replace missing observations. Data were collected from March-December 2017 and subsequently updated from August-September 2018. RESULTS: Our findings highlight positive connections between the regulated nurse and nurse graduate ratios and welfare state measures of education, health, and family policy. In addition, both outcome variables had averages that differed among welfare state regimes, the lowest being in Authoritarian Conservative regimes. CONCLUSION: Additional country-level and international comparative research is needed to further study the impact of a wide range of structural political and economic determinants of nursing professionalization. IMPACT: We examined the effects of welfare state characteristics on nursing professionalization indicators and found support for the claim that such features affect both the regulated nurse and nurse graduate ratios. These findings could be used to strengthen nursing and the nursing workforce through healthy public policies and increase the accuracy of health human resources forecasting tools.

Social selection in historical time: The case of tuberculosis in South Korea after the East Asian financial crisis.

The perspectives of social selection and causation have long been debated. Social selection theory is as "social" as social causation theory, since all diseases are social and no biological process occurs outside society. To identify the social selection pathway and historical juncture affected by socioeconomic and political changes, we investigated the reciprocal impact of suffering from tuberculosis (TB) on the current socioeconomic position (SEP), stratified by childhood SEP. We also examined the extent to which the social consequences of ill health changed since the East Asian economic downturn. Data were collected for 2007-2012 from the Korea National Health and Nutritional Examination Survey. To identify associations between TB history and current household income (HHI), we constructed an ordinal logistic regression model adjusted for covariates, including age, gender, educational attainment, and job status. We adopted a recursive regression model to examine trend changes in this association from 1980-2012 to 2003-2012. Of 28,136 participants, 936 had experienced TB. In the first ordinal logistic regression, the TB group was more likely to have lower HHI than the non-TB group. The odds ratios (ORs) increased from 1.30 (1980-2012) to 1.86 (2003-2012) for the TB group, increasing their probability of having low HHI. Among the low childhood SEP group, the TB group's probability of having low HHI was 1.35 (95% confidence interval [CI]: 1.16-1.57) during 1980-2012, which increased to 2.01 (95% CI: 1.37-2.95) during 2003-2012. For the high childhood SEP group, the TB group's OR range fluctuated, similar to that for the non-TB group. The results support the social selection pathway from TB history to adverse impact on current SEP. Our study identified downward social mobility due to TB history among the low childhood SEP group. Moreover, negative social consequences deteriorated since the East Asian economic crisis.

Association of social deprivation and outdoor air pollution with pulmonary tuberculosis in spatiotemporal analysis.

The objective of this study was to identify the association between social deprivation, outdoor air pollution, and tuberculosis (TB) incidence rate or mortality rate. The study sample comprised 25 districts in Seoul, Korea. We used two public data derived from the Community Health Survey and Seoul Statistics. The geographic information system analysis and random effects Poisson regression were applied to explore the association of social deprivation and air pollution with TB incidence and mortality. An 1 ppb increase in sulfur dioxide (SO2) concentration was significantly associated with the risk of TB incidence (risk ratio [RR] = 1.046, 95% confidence interval [CI]: 1.028, 1.065). An 1 unit increase in the deprivation index was significantly related to a6% increase in the mortality of TB (RR = 1.063, 95% CI: 1.031, 1.097). : Our results imply that social deprivation and air pollution may affect the different TB outcomes. Effective policy-making for TB control should reflect the differing outcomes between TB incidence and mortality.

Nursing professionalization and welfare state policies: A critical review of structural factors influencing the development of nursing and the nursing workforce.

Nursing professionalization is both ongoing and global, being significant not only for the nursing workforce but also for patients and healthcare systems. For this reason, it is important to have an in-depth understanding of this process and the factors that could affect it. This literature review utilizes a welfare state approach to examine macrolevel structural determinants of nursing professionalization, addressing a previously identified gap in this literature, and synthesizes research on the relevance of studying nursing professionalization. The use of a welfare state framework facilitates the understanding that the wider social, economic, and political system exercises significant power over the distribution of resources in a society, providing a glimpse into the complex politics of health and health care. The findings shed light on structural factors outside of nursing, such as country-level education, health, labor market, and gender policies that could impact the process of professionalization and thus could be utilized to strengthen nursing through facilitating increased professionalization levels. Addressing gender inequalities and other structural determinants of nursing professionalization could contribute to achieving health equity and could benefit health systems through enhanced availability, skill-level, and sustainability of nursing human resources, improved and efficient access to care, improved patient outcomes, and cost savings.

Welfare States, Labor Markets, Political Dynamics, and Population Health: A Time-Series Cross-Sectional Analysis Among East and Southeast Asian Nations.

Recent scholarship offers different theories on how macrosocial determinants affect the population health of East and Southeast Asian nations. Dominant theories emphasize the effects of welfare regimes, welfare generosity, and labor market institutions. In this article, we conduct exploratory time-series cross-sectional analyses to generate new evidence on these theories while advancing a political explanation. Using unbalanced data of 7 East Asian countries and 11 Southeast Asian nations from 1960 to 2012, primary findings are 3-fold. First, welfare generosity measured as education and health spending has a positive impact on life expectancy, net of GDP. Second, life expectancy varies significantly by labor markets; however, these differences are explained by differences in welfare generosity. Third, as East and Southeast Asian countries become more democratic, welfare generosity increases, and population health improves. This study provides new evidence on the value of considering politics, welfare states, and labor markets within the same conceptual framework.

Prescription Drug Use Among Adults With Chronic Conditions in South Korea: Dual Burden of Health Care Needs and Socioeconomic Vulnerability.

The aim of this study is to identify the social determinants of prescription drug use among adults with chronic diseases by examining the associations between socioeconomic position and prescription medicine use and perceived burden for pharmaceutical expenditure, using a sample of the Korean population from the 2008 Korea Health Panel, with 4 analytic models. Controlled with health status and the type of health insurance, the probability of using prescription drugs and overall spending on drugs significantly increased with rising income level, while perceived burden for out-of-pocket payment significantly decreased. These results imply that the poor are likely to underuse prescription drugs compared with their wealthier counterparts with the same need for health care, probably due to economic barriers.

Two decades of Neo-Marxist class analysis and health inequalities: A critical reconstruction.

Most population health researchers conceptualize social class as a set of attributes and material conditions of life of individuals. The empiricist tradition of 'class as an individual attribute' equates class to an 'observation', precluding the investigation of unobservable social mechanisms. Another consequence of this view of social class is that it cannot be conceptualized, measured, or intervened upon at the meso- or macro levels, being reduced to a personal attribute. Thus, population health disciplines marginalize rich traditions in Marxist theory whereby 'class' is understood as a 'hidden' social mechanism such as exploitation. Yet Neo-Marxist social class has been used over the last two decades in population health research as a way of understanding how health inequalities are produced. The Neo-Marxist approach views social class in terms of class relations that give persons control over productive assets and the labour power of others (property and managerial relations). We critically appraise the contribution of the Neo-Marxist approach during the last two decades and suggest realist amendments to understand class effects on the social determinants of health and health outcomes. We argue that when social class is viewed as a social causal mechanism it can inform social change to reduce health inequalities.

Social class and mental health: testing exploitation as a relational determinant of depression.

This study tests whether social class exploitation operates as a relational mechanism that generates mental health inequalities in the nursing home industry. We ask, does social class exploitation (i.e., the acquisition of economic benefits from the labor of those who are dominated) have a systematic and predictable impact on depression among nursing assistants? Using cross-sectional data from 868 nursing assistants employed in 50 nursing homes in three U.S. states, we measure social class exploitation as "ownership type" (private for-profit, private not-for-profit, and public) and "managerial domination" (labor relations violations, perceptions of labor-management conflict). Depression is assessed using the original and revised versions of the Center for Epidemiologic Studies Depression Scale (CES-D and CESD-R). Using two-level logistic regressions, we find that private for-profit ownership and higher managerial domination are predictive of depression among nursing assistants even after adjustment for potential confounders and mediators. Our findings confirm the theoretical and empirical value of applying a social class approach to understanding how mental health inequalities are generated through exploitative mechanisms. Ownership type and managerial domination appear to affect depression through social relations that generate mental health inequalities through the process of acquiring profits, controlling production, supervising and monitoring labor, and enforcing disciplinary sanctions.

Complementarities or contradictions? Scoping the health dimensions of "flexicurity" labor market policies.

Flexicurity, or the integration of labor market flexibility with social security and active labor market policies, has figured prominently in economic and social policy discussions in Europe since the mid-1990s. Such policies are designed to transcend traditional labor-capital conflicts and to form a mutually supportive nexus of flexibility and security within a climate of intensified competition and rapid technological change. International bodies have marketed flexicurity as an innovative win-win strategy for employers and workers alike, commonly citing Denmark and The Netherlands as exemplars of best practice. In this article, we apply a social determinants of health framework to conduct a scoping review of the academic and gray literature to: (a) better understand the empirical associations between flexicurity practices and population health in Denmark and (b) assess the relevance and feasibility of implementing such policies to improve health and reduce health inequalities in Ontario, Canada. Based on 39 studies meeting our full inclusion criteria, preliminary findings suggest that flexicurity is limited as a potential health promotion strategy in Ontario, offers more risks to workers' health than benefits, and requires the strengthening of other social protections before it could be realistically implemented within a Canadian context.

Egalitarian policies and social determinants of health in Bolivarian Venezuela.

In 1999, newly-elected Venezuelan President Hugo Chávez initiated a far-reaching social movement as part of a political project known as the Bolivarian Revolution. Inspired by the democratic ideologies of Simón Bolívar, this movement was committed to reducing intractable inequalities that defined Venezuela's Fourth Republic (1958-1998). Given the ambitious scope of these reforms, Venezuela serves as an instructive example to understand the political context of social inequalities and population health. In this article, we provide a brief overview of the impact of egalitarian policies in Venezuela, stressing: (a) the socialist reforms and social class changes initiated by the Bolivarian Movement; (b) the impact of these reforms and changes on poverty and social determinants of health; (c) the sustainability of economic growth to continue pro-poor policies; and (d) the implications of egalitarian policies for other Latin American countries. The significance and implications of Chávez's achievements are now further underscored given his recent passing, leading one to ask whether political support for Bolivarianism will continue without its revolutionary leader.

Welfare state regimes, gender, and depression: a multilevel analysis of middle and high income countries.

Using the 2002 World Health Survey, we examine the association between welfare state regimes, gender and mental health among 26 countries classified into seven distinct regimes: Conservative, Southeast Asian, Eastern European, Latin American, Liberal, Southern/Ex-dictatorship, and Social Democratic. A two-level hierarchical model found that the odds of experiencing a brief depressive episode in the last 12 months was significantly higher for Southern/Ex- dictatorship countries than for Southeast Asian (odds ratio (OR) = 0.12, 95% confidence interval (CI) 0.05-0.27) and Eastern European (OR = 0.36, 95% CI 0.22-0.58) regimes after controlling for gender, age, education, marital status, and economic development. In adjusted interaction models, compared to Southern/Ex-dictatorship males (reference category), the odds ratios of depression were significantly lower among Southeast Asian males (OR = 0.16, 95% CI 0.08-0.34) and females (OR = 0.23, 95% CI 0.10-0.53) and Eastern European males (OR = 0.41, 95% CI 0.26-0.63) and significantly higher among females in Liberal (OR = 2.00, 95% CI 1.14-3.49) and Southern (OR = 2.42, 95% CI 1.86-3.15) regimes. Our results highlight the importance of incorporating middle-income countries into comparative welfare regime research and testing for interactions between welfare regimes and gender on mental health.

Social class, politics, and the spirit level: why income inequality remains unexplained and unsolved.

Richard Wilkinson and Kate Pickett's latest book, The Spirit Level: Why Equality is Best for Everyone, has caught the attention of academics and policymakers and stimulated debate across the left-right political spectrum. Interest in income inequality has remained unabated since the publication of Wilkinson's previous volume, Unhealthy Societies: The Afflictions of Inequality. While both books detail the negative health effects of income inequality, The Spirit Level expands the scope of its argument to also include social issues. The book, however, deals extensively with the explanation of how income inequality affects individual health. Little attention is given to political and economic explanations on how income inequality is generated in the first place. The volume ends with political solutions that carefully avoid state interventions such as limiting the private sector's role in the production of goods and services (e.g., non-profit sector, employee-ownership schemes). Although well-intentioned, these alternatives are insufficient to significantly reduce the health inequalities generated by contemporary capitalism in wealthy countries, let alone around the world.