Methodological Approaches to Structural Change: Epidemiology and the Case for Reparations.

Scholars, activists, and policymakers have long called for reparations - a process of repair and restitution for harm and injustices done - to descendants of enslaved Africans in the U.S. as a structural intervention to address historic and ongoing injustices. However, there has been very limited epidemiologic work examining reparations. We explore some of the epidemiologic benefits and challenges of using causal inference frameworks to model reparations as an example of a large-scale, structural intervention that pushes the limits of what is considered "well-defined" and may violate key identification assumptions. Finally, we weigh these methodological limitations with the utility of assessing public health implications of reparations policies and conclude by discussing implications for future epidemiologic research.

Wealth disparities in maternal health service utilization among women of reproductive age in Ethiopia: findings from the mini-EDHS 2019.

BACKGROUND: Ethiopia has made strides in reducing maternal mortality, but significant discrepancies in maternal health service utilization exist across socioeconomic levels. According to studies, women from higher-income households are far more likely to use essential services such as antenatal care, delivery care, and postnatal care than poorer women. This wealth disparity is a primary contributor to persistently high maternal mortality, particularly among poor populations. The study's goal was to assess wealth disparities in maternal health service uptake and identify contributing factors. METHODS AND MATERIALS: We used the Ethiopian Mini Demographic Health Survey (EMDHS), conducted in 2019 on women aged 15-49 living in selected census areas, with a weighted sample size of 3,909. The Erreygers Concentration Index (ECI) was used to measure wealth inequalities in maternal health care, and the ECI decomposition was used to identify factors contributing to inequality in maternal health services. RESULTS: Maternal health service utilization was pro-rich among women in Ethiopia. The prevalence of antenatal care service (ANC), delivery, and postnatal care (PNC) service utilization showed a pro-rich distribution among Ethiopian women, with ECI = 0.115 (95% CI: 0.091-0.137), ECI = 0.223 (95% CI: 0.191-0.276), and ECI = 0.121 (95% CI: 0.041-0.200), respectively. The ECI indices were decomposed to examine the contributing factors to disparities in maternal service utilization in Ethiopia. Mother's current age, household family size, region, birth order, and parity were contributors to maternal health service utilization. CONCLUSION: The ANC service, delivery service and PNC service utilization showed a pro-rich distribution among Ethiopian women. Mother's current age, household family size, region, birth order, and parity are important contributors of maternal health service inequality. To improve access and usage among low-income women, policymakers can develop programs including increasing the number of free or subsidized services and providing transportation.

Closing the gap? Results-based financing and socioeconomic-related inequalities in maternal health outcomes in Zimbabwe.

The results-based financing (RBF) program, first implemented in Zimbabwe in 2011 and gradually expanded to other districts, aimed to address disparities in maternal health outcomes by improving the utilisation of health services. This study leverages the staggered rollout of the program as a quasi-experimental design to assess its impact on asset wealth-related inequalities in selected maternal health outcomes. The objective is to determine whether RBF can effectively reduce these disparities and promote equitable healthcare access. We employ an extended two-way fixed effects (ETWFE) model to exploit temporal variation in RBF implementation as well as individual-level variation in birth timing for identification. Utilising pooled cross-sectional and nationally representative data from the Zimbabwe demographic and health surveys collected between 1999 and 2015, our analysis reveals significant reductions in relative and absolute maternal health inequalities, especially in the frequency and timing of prenatal care, delivery by caesarean section, and family planning. Specifically, the RBF program is associated with reductions in disparities for completing at least four or more prenatal care visits (-0.026, p < 0.01), first-trimester prenatal care (-0.033, p < 0.01), delivery by caesarean section (-0.028, p < 0.005), and family planning (-0.033, p < 0.005). Additionally, the program is associated with improved prenatal care quality, as evidenced by progress on the prenatal care quality index (-0.040, p < 0.01). These effects are more pronounced among lower socioeconomic groups in RBF districts, highlighting RBF's potential to promote equitable healthcare access. Our findings advocate for targeted policy interventions prioritising expanding access to critical maternal health services in underserved areas and incorporating equity-focused measures within RBF frameworks to ensure inclusive and effective healthcare delivery in Zimbabwe and other low-income countries.

Are spatial imbalances in industrial structural change widening the common wealth gap?

The evolution of China's industrial structure from 2010 to 2021 is assessed based on the rationalization and sophistication of its industries. The Theil index quantifies spatial variability, while the Quadratic Assignment Procedure (QAP) investigates if changes in industrial structure imbalance will increase wealth disparity. The study's findings indicate a noticeable spatial imbalance in industrial structure change. The overall level of common wealth is low but steadily increasing, following a stepped-down structure of "east-center-west." Additionally, the north and south regions exhibit a pattern of "high in the north and low in the south." There is a pattern of higher values in the north and lower values in the south. In terms of common wealth and its dimensions, there is a ladder-like pattern with high values at the core decreasing towards the west. Between 2010 and 2021, the common wealth development shifted from a lower level to a higher one. Beijing, Jiangsu, and Shanghai constantly ranked in the top echelon, while Guangxi remained in the fifth echelon. The speed and difficulty of transitioning between echelons vary. Moving from the fourth echelon to the third echelon takes longer, while transitioning from the third echelon to higher echelons presents tougher challenges. Spatial imbalances in industrial structure changes widen the gap in common wealth. In particular, the impact of the gap in the advanced industrial structure on the common wealth gap is significantly higher than that of the gap in industrial rationalization. Reducing disparities in advanced industrial structure is more effective in reducing the overall wealth gap.

Racial/Ethnic Differences in Loneliness Among Older Adults: The Role of Income and Education as Mediators.

Background and Objectives: Loneliness is a major public health concern; however, limited research has examined the mechanisms contributing to racial/ethnic inequities in loneliness. Race/ethnicity has been hypothesized to be a distal factor influencing loneliness, and racial/ethnic inequities in loneliness may be attributable to socioeconomic factors (e.g., income and education). Our study seeks to confirm these hypotheses by examining mechanisms that contribute to racial/ethnic inequities in loneliness. In other words, if racial/ethnic differences in loneliness among older adults are mediated by income and education. Research Design and Methods: Data came from the Health and Retirement Study Leave-Behind Questionnaire, 2014-2016. Loneliness was measured by the UCLA 3-item loneliness scale. Race/ethnicity categories were White, Black, and Hispanic/Latino. The mediator variables were household income and education. Multivariable linear regression models were used to determine differences in loneliness by race/ethnicity. The Karlson-Holm-Breen (KHB) mediation method was used to determine if income and education mediated racial/ethnic differences in loneliness. Results: In models examining income and education together, a complete mediation was found between White and Black older adults, in that income and education completely mediated differences in loneliness between these groups. A partial mediation was found between White and Hispanic, and Black and Hispanic older adults. When examining income and education separately, we found that income solely accounted for racial/ethnic differences in loneliness compared to education. Discussion and Implications: Our study is the first to explicitly determine if socioeconomic factors mediate race/ethnicity differences in loneliness among a national sample of older adults. These findings illustrate that income may have greater proximate effects for loneliness among older adults in comparison to education. Additionally, these findings can inform evidence-based interventions to reduce loneliness among older adults. Interventions that enhance quality of life and provide opportunities for socialization for racialized low-income older adults may help decrease racial/ethnic inequities in loneliness.

Effects of the Local Environment and Nutritional Status on the Incidence of Acute Respiratory Infections Among Children Under 5 Years Old in Indonesia.

Objectives: This study aimed to map the incidence of acute respiratory infections (ARIs) among under-5 children in Indonesia, address the triple burden of malnutrition, and analyze the impact of malnutrition on ARIs, taking into account the environmental and wealth disparities in Indonesia. Methods: This study utilized an ecological design, analyzing aggregate data from the Indonesia Nutrition Survey, 2022. It encompassed 33 provinces and 486 districts/cities, involving a total of 334,848 children under 5 years of age. Partial least squares structural equation modeling was employed to investigate the relationships among wealth, environment, malnutrition (stunting, wasting, and underweight), and ARIs. Results: The proportion of ARI cases in Indonesia was generally concentrated in central Sumatra, the western and eastern parts of Java, and eastern Papua. In contrast, the northern part of Sumatra, central Kalimantan, central Sulawesi, and central Papua had a higher proportion of malnutrition cases compared to other regions. Negative associations were found between malnutrition and ARIs (path coefficient = -0.072, p<0.01) and between wealth and environment (path coefficient = -0.633, p<0.001), malnutrition (path coefficient = -0.399, p<0.001), and ARIs (path coefficient = -0.918, p<0.001). Conclusions: An increasing wealth index is expected to contribute to reducing ARIs, malnutrition and environmental burdens in the future. This study emphasizes the necessity for focused strategies that address both immediate health challenges and the underlying socioeconomic determinants to improve child health outcomes in the Indonesian context.

Where have I got to? Associations of age at marriage with marital household assets in educated and uneducated women in lowland Nepal.

Background: Women's underage marriage (<18 years) is associated with adverse maternal and child health outcomes. Poverty in the natal household has been widely considered to be a key risk factor for underage marriage, but the evidence base is unreliable. When investigating this issue, most studies use marital wealth inappropriately, as a proxy for wealth in the natal household. In contrast, we investigated whether the timing of women's marriage was associated with the wealth of the households they marry into, and how this may vary by women's education level. This approach allows us to explore a different set of research questions which help to understand the economic value placed on the timing of women's marriage. Methods: We used data on 3,102 women aged 12-34 years, surveyed within 1 year of marriage, from the cluster-randomized Low Birth Weight South Asia Trial in lowland rural Nepal. Linear mixed-effects regression models investigated independent associations of women's marriage age and education level with marital household wealth, and their interactive effects. Models adjusted for marital household traits. We analysed the full sample, and then only the uneducated women, who comprised a substantial proportion in our sample. Results: In the full sample, we found that each later year of women's marriage was associated with 1.5% lower asset score for those with primary education, and with 0.3% and 1.3% higher asset score for those with lower secondary or secondary/higher education, respectively. For uneducated women, relative to marrying ≤14 years, marrying at 15, 16, 17 and ≥18 years was associated with 1.5%, 4.4%, 2.4% and 6.2% greater marital asset score respectively. Conclusion: On average, marrying ≥18 years was associated with greater marital assets for secondary-educated women. There were only very modest benefits in terms of marital household wealth for delaying marriage beyond 16 years for uneducated women or those with low education. These findings elucidate potential trade-offs faced by families, including decisions over how much education, if any, to provide to daughters. They may help to understand the economic rationale underpinning the timing of marriage, and why early marriage remains common despite efforts to delay it.

Wealth-based disparities in the prevalence of short birth interval in India: insights from NFHS-5.

BACKGROUND: Short birth interval (SBI) has profound implications for the health of both mothers and children, yet there remains a notable dearth of studies addressing wealth-based inequality in SBI and its associated factors in India. This study aims to address this gap by investigating wealth-based disparities in SBI and identifying the underlying factors associated with SBI in India. METHODS: We used information on 109,439 women of reproductive age (15-49 years) from the fifth round of the National Family Health Survey (2019-21). We assessed wealth-based inequality in SBI for India and its states using the Erreygers Normalised Concentration Index (ECI). Additionally, we used a multilevel binary logistic regression to assess the factors associated with SBI in India. RESULTS: In India, the prevalence of SBI was 47.8% [95% CI: 47.4, 48.3] during 2019-21, with significant variation across states. Bihar reported the highest prevalence of SBI at 61.2%, while Sikkim the lowest at 18.1%. SBI prevalence was higher among poorer mothers compared to richer ones (Richest: 33.8% vs. Poorest: 52.9%). This wealth-based inequality was visible in the ECI as well (ECI= -0.13, p < 0.001). However, ECI varied considerably across the states. Gujarat, Punjab, and Manipur exhibited the highest levels of wealth-based inequality (ECI= -0.28, p < 0.001), whereas Kerala showed minimal wealth-based inequality (ECI= -0.01, p = 0.643). Multilevel logistic regression analysis identified several factors associated with SBI. Mothers aged 15-24 (OR: 12.01, p < 0.001) and 25-34 (2.92, < 0.001) were more likely to experience SBI. Women who married after age 25 (3.17, < 0.001) and those belonging to Scheduled Caste (1.18, < 0.001), Scheduled Tribes (1.14, < 0.001), and Other Backward Classes (1.12, < 0.001) also had higher odds of SBI. Additionally, the odds of SBI were higher among mothers in the poorest (1.97, < 0.001), poorer (1.73, < 0.001), middle (1.62, < 0.001), and richer (1.39, < 0.001) quintiles compared to the richest quintile. Women whose last child had passed away were also significantly more likely to have SBI (2.35, < 0.001). Furthermore, mothers from communities with lower average schooling levels (1.18, < 0.001) were more likely to have SBI. Geographically, mothers from eastern (0.67, < 0.001) and northeastern (0.44, < 0.001) regions of India were less likely to have SBI. CONCLUSION: The significant wealth-based inequality in SBI in India highlights the need for targeted interventions focusing on economically disadvantaged women, particularly in states with high SBI prevalence. Special attention should be given to younger mothers and those from socially disadvantaged groups to enhance maternal and child health outcomes across the country.

Dissecting the digital divide: A household fixed effects approach to estimating gender gaps in digital skills of youth in low- and middle-income economies.

This study investigates gender gaps in digital skills among youth (15-24 years old) in 32 low- and middle-income economies using data from UNICEF-supported and internationally comparable Multiple Indicator Cluster Surveys (MICS). Utilizing a household fixed effects approach, we aim to isolate gender-based disparities from household-level variations. The intra-household analysis reveals significant inequalities, with biases against young women in possessing digital skills, including the very basic ones. Supplementary analysis using a mixed-effects model, which accounts separately for within- and between-household variation, highlights that wealthier households exhibit larger gender gaps in digital skills, disadvantaging young women primarily due to a floor effect in the poorest households. The paper concludes with policy implications aimed at reducing gender gaps in digital skills.

Housing wealth, fertility and children's health in China: A regression discontinuity design.

This paper examines the influence of housing wealth on fertility outcomes through a regression discontinuity design based on a 2006 Chinese housing-market policy. Our analysis reveals that the positive impact of this policy on housing wealth significantly enhances the likelihood of fertility by 7.3 %. Our result implies that a 1 % increase in housing wealth can raise the fertility rate by 0.18 %. Furthermore, we observe that children born subsequent to the positive housing wealth shock exhibit improved health, not only at birth but also over the long term. Lastly, we present suggestive evidence suggesting that both parental pre-birth time allocation and parental health may help explain the documented positive effects of housing wealth on fertility rates.

Poor coverage of quality-adjusted antenatal care services: a population-level assessment by visit and source of antenatal care services in Bihar state of India.

Background: Despite the evidence on the poor quality of antenatal care (ANC) services, significant gap remains in the understanding of quality-adjusted coverage at the population-level for each ANC visit and by the source of ANC services, and in equity in this coverage. Methods: All births between July 2020 and June 2021 were listed from 261,124 households (91.5% participation) representative of the Bihar state. Mothers of all stillbirths and neonatal deaths, and of 25% random sample of livebirths who survived the neonatal period provided data on each ANC visit up to a maximum of first 4 ANC visits, including the source of ANC services and the services received (weight measurement, blood pressure checked, abdomen checked, urine sample taken, and blood sample taken). An ANC visit was deemed of quality if all of these services were received in that visit. We report the coverage of quality-adjusted ANC services (Q-ANC) for ANC visits 1-4 disaggregated by source of ANC services and wealth index (WI). Weighted proportions are reported to take into account the sampling design. Findings: A total of 30,412 births were reported by 29,517 women, and 7270 (82.1%) of the 8853 eligible women participated. Overall, 19,950 unique ANC visits from 6929 women were available for analysis, of which 41.7%, 13.8% and 44.5% were at Village Health and Nutrition Day (VNHD), public facility, and with a private provider, respectively. A total of 4409 (65.3%) of the 1st ANC visits were undertaken at VHND, with the proportion of private provider ANC visits increasing significantly from ANC visit 1 to ANC visit 4 (p < 0.001). Q-ANC coverage considering all ANC visits was 20.9% (95% CI 20.7-21.2); and was 0.9% (95% CI 0.8-1.0), 29.9% (95% CI 29.2-30.7) and 36.9% (95% CI 36.5-37.4) for ANC visits in VHND, public facilities, and with private provider, respectively. Q-ANC coverage in the public facility was significantly lower in the 4th ANC visit (25.1%; 95% CI 23.4-26.9) as compared with visits 1 to 3, whereas it was the highest for 1st ANC visit with private provider (50.2%; 95% CI 49.2-51.1) and then dropped for visits 2 to 4. Irrespective of the source of ANC services, Q-ANC coverage increased significantly with increasing WI quartile for ANC visits 1 and 2, with WI quartile 3 women having significantly less coverage for ANC visit 3 compared to the rest, and no significant difference seen in the coverage of ANC 4 visit. Varied pattern of Q-ANC coverage by WI for each ANC visit was seen for public facility and private provider visits. Interpretation: With only 2 of 10 ANC visits deemed of adequate quality, sustainable delivery of quality ANC services are needed for every pregnant woman through-out the pregnancy irrespective of gestation period, number of ANC visit, and source of ANC services. Funding: The funding was provided by the India office of the Bill & Melinda Gates Foundation, USA.

A study on production of hydrogen using Al scrap feedstock.

A sustainable future, concerning the energy transformation of a country, heavily relies on the availability of energy resources, particularly renewables such as solar, wind, hydropower, and clean hydrogen. Among these, hydrogen is the most promising energy source due to its high calorific value, ranging between 120 and 140 MJ/kg. It has the potential to lead the market in various industries such as power generation, steel, chemical, petrochemical, and automotive. Significant research has been going on in hydrogen production technologies to reduce costs and improve competitiveness with fossil fuels. One such potential approach includes the use of metal-water reactions, which offer unique opportunities for producing clean hydrogen and other valuable byproducts. However, the quantity of hydrogen produced varies depending on the metal feedstock, type of electrolyte, and the activator or catalyst, used in combination with water. This latest work discusses recent progress on hydrogen production and the effects of variations in different parameters on the process, with a focus on aluminum (Al)-water reactions. Investigations have been conducted and reported on the effect of various activators with different concentrations, the quantity of aluminum scrap feedstock, and the volume of the electrolyte on the kinetics of the metal-water reactions and hydrogen production. Sodium hydroxide (NaOH) was observed to be more effective than potassium hydroxide (KOH) in promoting metal-water reactions. These activator-assisted metal-water reactions help produce clean hydrogen, along with other value-added products such as hydroxides. This work clearly sheds light on the potential utilization of industrial aluminum scrap as feedstock for producing clean hydrogen.

Justification of Intimate Partner Violence among Women in Nigeria: How Does it Differ by Socioeconomic Status?

Intimate partner violence (IPV) is a significant challenge that has a profound impact on women, and a contributing factor to its high prevalence is the justification of IPV. Various research works have shown that women's socioeconomic status (SES) is connected to IPV justification. The major objective of this study is to investigate the socioeconomic disparities in justification of IPV by women in Nigeria. The study involved an analysis of the 2018 Nigeria Demographic and Health Survey data using a sample comprising 116,958 women. The study utilized chi-square tests and logistic regression as the classical test, and the Bayesian Regression Model in Stan for its analysis. The results were presented using odds ratios along with the 95% confidence limits. The study found that the occurrence of IPV justification by women in Nigeria stood at 32.9%. Additionally, it shows a significant but weak relationship between women's age and the justification of IPV. Controlling for covariates, women who lacked formal education possess a higher likelihood of justifying IPV with a 54% increase in odds in comparison to women with a higher education level. The study also found that women in the poorest wealth category had a 17% increase in odds of justifying IPV compared to women in the middle-class category, indicating a concerning trend of tolerance toward domestic violence among women with lower SES. IPV has detrimental effects on women and their children. To combat this issue, programs aimed at contextualizing IPV, improving women's SES, advocating for the end of IPV, and empowering women are highly important. Ultimately, IPV is unjustifiable, regardless of the rationale behind it, and action is needed to reduce the victimization of women within our societies.

Private equity firms and industrial policy: elaborating the state-finance nexus in state-led markets.

Under what conditions can the state discipline private equity firms into delivering the investment required to meet the coming needs of industrial transformation? States have sought to crowd in private capital to finance industrial development, but the results have so far been less than satisfactory. Prevailing accounts of financial industry power largely characterise an arms-length state-finance relationship that has unfolded in private-led markets where private equity firms have contributed to the secular growth in non-productive economic activity. This article problematises the assumption of private-led markets and argues that state-led markets present a counterfactual in which the disbursement of public money entails strict policy discipline and tight embedding between the state and private equity firms, which provides the conditions for them to emerge as unlikely champions of industrial policy. Two cases of co-investment between Chinese and European sovereign wealth funds demonstrate the power dynamics at play. Where PE firms in the Sino-Irish co-investment facilitated the international scaling of Irish firms in China, the PE firms operating in Europe failed to embed Chinese firms into regional supply chains in the Sino-Belgian co-investment.

Association among Household Wealth, Maternal Employment, and Undernutrition in Children under Three Years of Age in Pakistan.

BACKGROUND: There is an abundance of studies explaining the separate impact of female employment and household wealth status in reducing malnutrition. However, our study has unraveled the combined impact of maternal employment and household wealth on undernutrition among children under three in Pakistan. METHODS: Using a sample of 1093 children under three years of age from the Pakistan Demographic and Health Survey 2017-2018, a binary logistic model was employed to gauge factors influencing the children's undernutrition. RESULTS: Our results indicated that children up to a certain age (three years old) with residence in certain regions (Pakistan) and recent episodes of diarrhea had an increased risk of undernutrition. Conversely, secondary and higher maternal education, access to improved water sources, and sanitation facilities lowered the chances of undernutrition in children under three in Pakistan. The interaction between maternal employment and household wealth showed that maternal employment significantly lowered the risk of stunting, being underweight, and wasting among the average, rich, and richest households; however, it did not contribute to child nutrition among the poorer and poor households. Notably, regardless of whether the mother was employed, the wealth status of being rich and richest reduced the risk of stunting, being underweight, and wasting. CONCLUSIONS: In overcoming undernutrition, maternal employment significantly contributed to middle-income households. However, in the richer and richest households, the wealth status played a more crucial role compared to the maternal employment. This indicates that while employment plays a supportive role in household resources, the wealth status is overall more influential in reducing undernutrition.

Unveiling the adverse effects of artificial intelligence on financial decisions via the AI-IMPACT model.

There is considerable enthusiasm for the potential of artificial intelligence (AI) to improve financial well-being. Despite this enthusiasm, it is important to underscore AI's potential adverse effects on consumers' financial decisions. We introduce the AI-IMPACT model, a unifying theoretical framework for how AI can influence consumers' financial decisions. The model details how AI impacts the marketplace, affecting psychological processes and consumer traits core to financial decision-making (e.g., pain of payment, financial literacy). We use the AI-IMPACT model to illustrate one way AI can reduce financial well-being as its influence on the marketplace (e.g., facilitating biometric payment methods) decreases consumers' pain of payment, increasing spending. Lastly, we use the AI-IMPACT model to identify areas for future research at the intersection of AI and financial decision-making.

Wealth-related inequalities in self-reported health status in the United States and 14 high-income countries.

OBJECTIVE: To examine wealth-related inequalities in self-reported health status among older population in the United States and 14 European countries. DATA SOURCES AND STUDY SETTING: We used secondary individual-level data from Health and Retirement Survey (HRS) and the Survey of Health, Ageing, and Retirement in Europe (SHARE) in 2011 and 2019. STUDY DESIGN: In this cross-sectional study, we used two waves from HRS (wave 10 and 14) and SHARE (wave 4 and 8) to compare wealth-related health inequality across countries, age groups, and birth cohorts. We estimated Wagstaff concentration indices to measure these inequalities across three age groups (50-59, 60-69, 70-79) and two birth cohorts (1942-1947, 1948-1953) in the US and 14 European countries. DATA COLLECTION/EXTRACTION METHODS: We performed secondary analysis of survey data. PRINCIPAL FINDINGS: Focusing on older population, we found evidence of wealth-related inequalities in self-reported health status across several high-income countries, with the US demonstrating higher levels of inequality than its European counterparts. The magnitude of these inequalities with respect to wealth remained unchanged over the study period across all countries. Our findings also suggest that wealth-related health inequalities differ at different stages of workforce engagement, especially in the United States. This could be explained either by potential redistributive effects of retirement or by uneven survivor effect, as less wealthy may drop out of the observations at a greater rate partly due to their poorer health. CONCLUSIONS: Wealth-related inequalities in self-reported health status are strong and persistent across countries. Our results suggest that there is meaningful variation across high-income countries in health-wealth dynamics that merits further investigation to better understand whether certain health or welfare systems are more equitable. They also highlight the need to consider social policy and wealth redistribution mechanisms as strategies for improving population health among the less wealthy, in the United States and elsewhere.

Long-term inequalities in health among older Mexican adults: An outcome-wide analysis.

The relationship between socioeconomic level and health outcomes in older people has been widely studied, but less information about health inequalities associated with gender and place of residence exists. Also, there is scarce evidence of longitudinal inequalities, particularly in countries from the global south. This study aimed to describe the longitudinal patterns of health inequalities associated with wealth, gender, and residence area among older Mexican adults. We used data from two longitudinal studies in Mexico: The Study on Global AGEing and Adult Health (SAGE) and the Mexican Health and Aging Study (MHAS). Three domains to characterize health inequities were used: wealth, gender, and rurality. We conducted an outcome-wide analysis with nine health indicators assessing older adults' physical and cognitive function. The Slope Index of Inequality and the Relative Index of Inequality were used as inequality measurements. Our results indicate that the greatest inequalities are observed in relation to wealth and gender. Older adults with lower socioeconomic status demonstrated higher rates of depression, sarcopenia, falls, and limitations in both basic and instrumental activities of daily living compared to their wealthier counterparts, with increasing trends in physical functionality over time. Furthermore, women experienced higher rates of depression, sarcopenia, frailty, and physical limitations compared to men. The only significant difference related to rurality was a lower rate of frailty among rural older adults. Longitudinal trajectories revealed an increase in the gap of inequality for various health indicators, especially in terms of wealth and gender. Health inequalities in old age are one of the greatest challenges facing health systems globally. Actions like universal coverage of health services for older people and the empowerment of individuals and their communities to have control over their lives and circumstances must be guaranteed.

Medicaid Enrollment and Intergenerational Transfers of Wealth Among Older Adults.

BACKGROUND AND OBJECTIVES: Medicaid look-back periods are meant to prevent Medicaid applicants from gifting assets to meet eligibility requirements. These policies have the potential to affect families across generations given their ability to restrict the transfer of assets between parent and child. RESEARCH DESIGN AND METHODS: Using 2008-2018 data from the Health and Retirement Study, this study analyzed the estate planning and familial wealth transfer behaviors of a cohort of older adults aged 65 and older who became Medicaid recipients during a 10-year period. RESULTS: There were 8,347 respondents aged 65 and older in 2008 and 11.96% of respondents who were not Medicaid recipients at baseline became recipients over the study period. A little more than one third (36.47%) of Medicaid recipients participated in estate planning and asset transfer prior to becoming a recipient, with significant differences among select demographic characteristics. Married recipients were more likely to transfer money compared to their widowed counterparts (51.69% compared to 36.44%; p < .001) and transferred larger amounts compared to those unmarried ($16,286.94 compared to 5,379.13). White, well-educated, married, men participated in higher rates of estate planning, likely a reflection of who has access to resources to make necessary arrangements early. DISCUSSION AND IMPLICATIONS: This analysis concludes that more structurally advantaged groups are more likely to engage in estate planning prior to Medicaid enrollment. This analysis demonstrates that some individuals may circumvent Medicaid policies like look-back periods and estate recovery, while others cannot. Policymakers should consider policies that promote the financial health of low-income families.

From a national elite to the global elite: Possibilities and problems in scaling up.

This research note highlights emerging findings that speak to the challenges of joining the transnational elite, particularly for those coming from the Global South. For a longitudinal study of wealth inheritors becoming more transnational via their educational paths, we spoke with 16 young people who were all in their early 20s and primarily from economic elite families in the Global South. Some participants had clear ambitions, while others were less sure about their future, wondering where they should move and what they should do when they got there. Their various narratives reveal that underlying the possibilities and problems of where to locate themselves was our participants' access to different constellations of economic, social and cultural capital, as well as their race, citizenship and 'home' country's geopolitical situation. Their parents' ambitions that they become part of a global elite remained in most cases largely unfulfilled-despite a significant economic investment in their secondary and university educations. Only a small minority of our participants aspired to and/or were able to secure such transnational futures.