inequality

Technological advancements, demographic shifts, and lifestyle changes have led to increased healthcare expenditures, making access to healthcare services more challenging. People with disabilities, who frequently require specialized healthcare and rehabilitation services, encounter substantial financial and structural barriers to access. Economic and social inequalities significantly influence access to rehabilitation services, often preventing individuals with disabilities, particularly in developing countries, from utilizing these services due to financial constraints and inadequate insurance coverage.

This study aims to examine socioeconomic inequalities in healthcare and rehabilitation expenses for persons with disabilities in Iran, highlighting the financial burden and disparities in access to essential services.

This descriptive-analytical quantitative study utilized secondary data from a national survey conducted in 2020. The analysis employed the Gini coefficient and Concentration Index to assess socioeconomic inequalities. The dataset included responses from 483 adults with physical disabilities who were members of the Iranian Disabled Community and had participated in the original survey through a structured electronic questionnaire. The data were analyzed using Stata software.

The average total cost was 24,600,000 Iranian Tomans (PPP 270.09$ US), indicating significant economic pressure on individuals with disabilities. The Gini coefficient, nearing 0.90, reflects severe inequality in the distribution of total healthcare and rehabilitation expenditure among people with disabilities. This inequality implies that some individuals face high expenses for these services, while others pay much less. The Concentration Index based on income was positive, indicating that inequality favors higher-income groups, while based on educational status, inequality favors individuals with lower education levels.

The findings reveal a significant level of inequality in healthcare and rehabilitation expenditure for individuals with disabilities. These expenses are typically high and can be particularly burdensome for this population, many of whom face challenges related to inadequate education and insufficient income. These findings emphasize the necessity of targeted policy interventions to alleviate financial barriers and ensure equitable access to rehabilitation services across socioeconomic groups. Such policies could enhance health outcomes and improve the quality of life for individuals with disabilities.

Ensuring equal utilization of health services has always been a priority in health systems globally. Iran implemented reforms such as the Health Transformation Plan (HTP), in which one objective was to reduce inequity in access to inpatient and outpatient services. These studies aimed to measure inequality in health services utilization in Qazvin, Iran, and clarify inpatient and outpatient utilization patterns among socioeconomic subgroups of the population. This cross-sectional study recruited 442 households living in Qazvin, Iran, in 2019. We collected data using a tool that included demographic characteristics, socioeconomic status, and health services utilization. We applied the concentration index to measure inequality and performed data analysis using STATA 15. Based on our estimates, the utilization rates of outpatient and inpatient services in the study sample were 0.89±1.39 and 0.45±0.94, respectively. There was no statistically significant difference in the use of outpatient healthcare services in terms of gender and insurance coverage of the households, while literacy, age, and health condition had statistically significant effects on inpatient healthcare utilization (P<0.05). Furthermore, the marginal effects of age and literacy on the utilization of outpatient services were statistically significant (P<0.05), so that literacy and aging increased the outpatient HSU. Except for age, the marginal effects of other characteristics on the utilization of inpatient services were statistically significant (P<0.05). Our findings indicated that inequality in healthcare utilization reduced over time, showing that in addition to reducing inequality in HSU, population groups with lower socio-economic status have benefited more from both inpatient and outpatient services.

People with disabilities (PWD) typically face a range of obstacles when accessing healthcare, particularly when compared with the general population. This challenge becomes more pronounced for PWDs in lower socioeconomic groups. This study aimed to assess the socioeconomic-related disparity in financial access to rehabilitation services among Iranian PWDS.  

A total of 766 Iranian PWDs aged ≥18 years participated in this cross-sectional study. We employed the concentration index (C) to estimate socioeconomic inequality in accessing rehabilitation services.  

In this study, 766 Iranian adults aged 18 to 70 took part, with a mean age of 36.50 (SD, ±10.02) years. The findings revealed that 72.15% (n = 469) of participants had to borrow money to cover the costs of rehabilitation services. The concentration index (C = -0.228, P = 0.004) demonstrated a notable concentration of inadequate financial access to rehabilitation services among individuals with lower socioeconomic status (SES). Decomposition analysis identified the wealth index as the primary contributor to the observed socioeconomic disparities, accounting for 309.48%.  

Our findings show that socioeconomic inequalities disproportionately impact PWDs in lower socioeconomic groups. It is recommended that efforts be made to enhance the national capacity for monitoring the financial protection of PWDs and to develop equitable mechanisms that promote prepayment and risk pooling, thus reducing reliance on out-of-pocket payments at the time of service utilization.

Inequality in the use of dental services is a primary concern of global health, and few studies have been done in this field in Iran. Therefore, the present study aimed to conduct a decomposition analysis of socioeconomic inequalities in the utilization of oral health services.   

This was a cross-sectional study in which 715 households, including 2680 people living in Ahvaz, were included using a stratified-cluster sampling. Data were collected using a questionnaire. For data analysis and estimating the elasticity of the influencing factors, the logistic model and Stata software were used. The social and economic disparities in oral health variables were broken down into determinant components using the Van Doorslaer and Wagstaff technique.  

The key factors determining social and economic inequalities in the utilization of these services were insurance status, education level, income quintile, and occupation. Nearly 31% of utilization inequalities can be attributed to the insurance status of households. In addition, the education level of household members (about 28%) was the second factor of inequality. The variables of income quintile and occupation are also considered as the third factor, and the age of household members had a negative role in the socioeconomic inequality.  

The utilization of oral health services can be improved by improving economic and social variables in society. Therefore, including oral health services in insurance plans and primary health care services and supporting people with low-income levels can play an important role in reducing these inequalities.

Labonté proposes that health equity and environmental sustainability may be best obtained through a care economy. Because a care economy plays a key role in Labonté’s formulation, its position in the capitalist political economy, the work it entails, and the workers who do it all merit further reflection. I aim to complement Labonté’s editorial by elaborating on care economies and the work of social reproduction. The existing care economy is a structural part of capitalism that largely generates and sustains inequities, reinforcing Labonté’s argument that transformation is needed. Transformation could, and should, change the perceived value, status, and material rewards of work in the care economy. I then touch on the policy tools Labonté describes, highlighting how they connect to my broader point: that the care economy is currently an integral, but devalued part of capitalism. For a transformation to take place, raising perceived value, status, and material rewards of caring work and the people who do it must be an explicit policy goal.

Several scholars across many disciplines argue that neoliberal, free-market economic conditions drive inequalities, generating poverty and misery due to unfair austerity, ultimately affecting human health. Professor Labonté’s prescription is that we jettison these policies targeting economic growth and development for generating greater fairness for the world’s poor. This rejoinder argues contrarily that the criticism of neoliberal policies are misplaced, and that degrowth is really “self-imposed austerity,” which will not benefit the poor. This rejoinder scrutinizes some simple stylized fact and assesses the soundness of the broader arguments. The evidence suggests clearly that becoming wealthy and following prudent economic policies is the best path to improving population health, equity, and other progressive outcomes. Badly required growth for the poor comes from free markets and good governance, and equity for the sake of fairness neither results in better health outcomes, nor an improved environment.

  Italy was among the first countries in the world to experience the devastating consequences of the COVID-19 emergency and suffered its consequences to a devastating scale. Understanding how the country got there in spite of a relatively well-resourced public and private health system in at least part of the country, is imperative to be able to operationalise any lessons learnt for future epidemics in Italy and beyond.

  The paper reports the findings from a research scoping exercise conducted in Italy in 2020. We conducted extensive archival research and collected 29 testimonies either in writing or as semi-structured interviews. We sampled purposively with a stratification strategy in mind, specifically aiming to gain testimonies from different social groups,classes, ages, and nature of employment. Our sample also reflects the different experiences between the Northern and Southern regions, a divide that has long been economically and politically salient in the country.

  Evidence and considerations of epidemiological nature normally guide public health responses to crises. This study supports the idea that socio-economic, cultural and political factors also affect transmission outcomes. We highlight specifically the role that socio-economic and health inequalities play in this respect, through factors such as overcrowded dwellings, lack of alternatives to in-person work, informal work set-ups, pervasive organised crime presence, poorly planned social support and communication strategies.

  A socio-economic and political lens is needed in addition to an epidemiological one to fully understand the social experiences and implications of public health crises such as the COVID-19 pandemic and to devise effective response measures that are locally relevant and acceptable. Thus insights provided by multi-disciplinary task forces can render policy-making and social support interventions as well as communication strategies more effective.

Prostate cancer (PC) ranks as the second most commonly diagnosed neoplasia and the fifth cause of death in men with cancer, with an increasing trend in incidence. The aim of this study was to investigate the epidemiological situation of prostate cancer and relationship with the human development index (HDI) in the Asian continent.

All accessible data sources from the 2019 Global Burden of Disease study were used to estimate the prevalence, mortality and disability-adjusted life years and burden prostate cancer in Asia from 1990 to 2019. We estimated all-cause and cause-specific mortality, years of life lost (YLLs), years lived with disability (YLDs) and disability-adjusted life-years (DALYs). All estimates were presented as counts and age-standardized rates per 100 000 population, with uncertainty intervals (UIs). Concentration Index analysis and Concentration Curve were used to determine the relationship between Prostate cancer burden and human development index.

The highest incidence of prostate cancer in Asia in 2019 is Japan (90.5 per 100,000) and the highest mortality rate is Georgia (27.87 per 100,000). The highest DALY, YLL and YLD of prostate cancer is Georgia. The results showed that the percentage of changes in the incidence in 1990-2019 was positive in all countries of the Asian continent except for Afghanistan and Kyrgyzstan. The results of the concentration index showed that the incidence and mortality of prostate cancer is more concentrated in countries with a high HDI level. Examining the DALY, YLL and YLD index also showed the value of concentration index, which shows that DALY, YLL and YLD of prostate cancer are more concentrated in countries with high HDI level.

Given that the incidence, mortality and burden of prostate cancer are increasing in most Asian countries and are mostly concentrated in the HDI drawers, obtaining accurate estimates in these countries to prepare for the potential change in public health burden due to this disease which is very important.

Inequitable distribution of health resources leads to high costs and sustainable poverty for households. Therefore, it is necessary to study distribution in health. The most common indicator for measuring inequality is the Gini coefficient. Therefore, the present study was conducted to measure and analyze inequality in the distribution of various pharmacies using the Gini coefficient and the Lorenz curve in Iran. This research was a retrospective cross-sectional study that looked at the state and trend of inequality in the distribution of various types of pharmacies in 11 Lorestan cities from 2016 to 2021. Data was gathered from various data centers. Finally, the Gini coefficient and the Lorenz curve were determined. Excel was utilized in this project. The results study showed an increase in the Gini coefficient of the total pharmacies in Lorestan province (0.436) which is relatively indicative of the unfair distribution of the pharmacies but this value is higher for private pharmacies (0.545). The Gini coefficient of public pharmacies was (0.377) and for rural pharmacies was (0.282). So, to achieve an appropriate level of justice in the distribution of pharmaceuticals and pharmacies, resources should be distributed according to the requirements of city residents. Different kinds of pharmacies should be considered for different population groups when developing policies.

The trend of chronic diseases is increasing globally. Socioeconomic status (SES) is a major factor underlying many chronic diseases. This study was conducted to investigate the socioeconomic inequalities in distribution of chronic diseases in Iran, as a middle-income country.

This cross-sectional study was conducted using the baseline data of the Kharameh cohort study, that were collected between 2014 and 2016. The number of participants in this study was 10663 people in the age range of 35 to 70 years. Principal component analysis was used for calculating the SES of the people under study. In addition, we used concentration index and concentration curve to measure socioeconomic inequality in chronic disease.

The mean age of 10,663 participants in our study was 52.15±8.22 years and the male to female ratio was 1.26. Recurrent headache (25.8%( and hypertension (23.5%) were the most prevalent diseases. The concentration index showed that the distribution of movement disorder, recurrent headaches and gastroesophageal reflux diseases is significantly concentrated among people with low SES, and obesity among people with high SES. The results of the analysis by gender were similar to the results seen in all participants.

The findings of this study show that socioeconomic inequality is the cause of the concentration of non-communicable diseases among people with low socio-economic status. Therefore, health policy makers should pay special attention to identifying vulnerable subgroups and formulate strategic plans to reduce inequalities.

Our objective was to determine the frequency of inadequate functional health literacy (FHL) among adult Kurd population, and infer the contribution index of sociodemographic factors for FHL across gender.  In this cross-sectional study, multistage cluster sampling was employed to recruit 1000 people older than 18 years from 38 urban and 14 rural healthcare centers in Sanandaj, Iran. Data on FHL was collected from May to July 2019, through face-to-face interviews by using the validated Persian version of the Test of functional health literacy in adults (TOFHLA). The concentration index method was used to measure inequality in FHL.  Overall, 869 respondents (response rate: 86.9%) with a mean age of 33.68 (±13.0) completed the TOFHLA questionnaire. The average TOFHLA score was 51.9, which was 52.2 (±0.46) among males and 50.7 (±0.40) among females, p<0.001. Among females, the place of residence, monthly income, age, education level, and being head of the household contributed to 43%, 32%, 13%, 11.5%,  and 11% of FHL inequality, respectively. While, among males, the place of residence (45.2%), household size (15.1%), and monthly income (13.5%) contributed most to inequality in FHL.  FHL has disparities by gender and location. Males and rural people are at particular risk for poor FHL. For ease and better resolution of poor FHL, each population, gender, and area type should be considered as a stand-alone, which may help in identifying tailored interventions for males and females with low levels of FHL.

 During the past three decades, neonate, infant, and child mortality declined in North Africa and Middle East. However, there is substantial heterogeneity in mortality rates across countries.

 This study is part of the Global Burden of Diseases study (GBD) 2019. We report the number as well as mortality rates for neonates, infants, and children by cause across 21 countries in the region since 1990.

 Between 1990 and 2019, the neonate mortality rate in the region declined from 31.9 (29.8, 34.0) to 12.2 (11.1, 13.3) per 1000 live births. Respective figures for under 5 mortality rates (U5MRs) were 79.1 (75.7, 82.7) in 1990 and 24.4 (22.3, 26.7) per 1000 live births in 2019. The majority of deaths among children under 5 years were due to under 1 year deaths: 75.9% in 1990 and 81.8% in 2019. Mortality rates in males were higher than females. The mortality rate among neonates ranged from 2.4 (2.1, 2.6) per 1000 live births in Bahrain to 25.0 (21.6, 28.4) in Afghanistan in 2019. Similarly, in 2019, the U5MR ranged from 5.0 (4.2–6.0) per 1000 live births in United Arab Emirates to 55.3 (47.9–63.5) in Afghanistan. Neonatal disorders, congenital birth defects, and lower respiratory infections were the three main causes of neonate, infant, and child mortality in almost all countries in the region.

 In 2019, most countries in this region have achieved the SDG targets for neonate and child mortality. However, there is still substantial heterogeneity across countries.

  Even in countries having nearly universal healthcare provision some individuals forgo or postpone healthcare to which they are entitled. Socioeconomic and geographic inequalities can make access to healthcare difficult for some people, such that they fail to seek it, particularly if they deem the type of care as non-essential. The need to pay at the point of care, the complexity and cost of top-up health insurance, and delays or only partial reimbursement can discourage take-up of care. This can affect the general health of the population.

To estimate the rate of forgoing healthcare in the general French population, between 2015 and 2018 we conducted a nationwide cross-sectional survey of individuals visiting French primary healthcare insurance agencies (Caisse Primaire d’Assurance Maladie, CPAM). We asked whether the person had foregone or postponed healthcare in the last 12 months, if so the types of healthcare forgone or put-off, and reasons. Individuals were stratified by the type of complementary (top-up) health insurance they had.

  Out of 164 092 individuals who responded, 158 032 were included in the analysis. Respondents had either private complementary (top-up) insurance (60%), top-up insurance subsidized by the state (29%), or no top-up health insurance (11%). Forgoers (n=40 115; 25.4%) most often lived alone (with or without children), were unemployed, and/ or female. Dental care (54%) and consultations with ophthalmologists, gynaecologists and dermatologists (41%) were most commonly forgone. The reasons were: inability to advance payment and/or to pay the uninsured part (69%), time constraints and difficulty in obtaining appointments (26%).

  We present a snapshot of forgoing healthcare in a developed country, highlighting the need for continuing review by policy-makers of payment regimens, insurance cover, availability and accessibility. While initiatives have already emerged from the results, further reforms are needed to address the problem of people forgoing preventative or perceived non-urgent healthcare, particularly for disadvantaged subgroups.

Health, both physically and mentally, raises the level of human capital. This study aims to challenge the performance of the Fifth Development Plan (2011-2015) regarding inequality in the distribution of health facilities among the provinces of the country. 

This study is analytical cross sectional. In this research, using the TOPSIS method and using the Gini coefficient index and inequality ratios, was evaluated the distribution of health facilities among the provinces of the country. Also, to determine the degree of health development among the provinces of the country, from 13 indices including hospital per capita, hospital bed per capita, health house per capita, health center per capita, laboratory per capita, pharmacy per capita, general practitioner per capita, specialist physician per capita and other health care staff per capita were used. The software used in this research is SPSS 25.

The results show that in 2011, the provinces of Tehran, Khorasan Razavi and Isfahan were at the highest level and the provinces of South Khorasan, Ilam and Kohgiluyeh and Boyer-Ahmad were at the lowest level in this regard. While, in 2015, the provinces of Tehran, Khorasan Razavi maintained their previous position and Fars province was in the third place. The province of Ilam, was still at the lowest level. The Gini coefficient of distribution of health facilities among the provinces of the country in 2011 was 0.49, and increased to 0.52 in 2015. The share ratio of the top 20% to the bottom 20% among the provinces in terms of enjoying health facilities in 2011 and 2015 was equal to 32 and 37, respectively.

The severity of inequality of health facilities among the provinces of the country has intensified during the Fifth Plan. The results show that the provinces have a significant difference in their position in access to health facilities and this indicates equal distribution of health facilities among the provinces of the country.

Dear Editor, According to the latest report of World Health Organization,  which was published on November 8, 2021, more than 249,743,428 people were infected with COVID-19 and 5,047,652 people died from  this disease worldwide. Furthermore, more than seven billion doses of vaccine have been used against the COVID-19 pandemic across the world (1). COVID-19 can take two forms including the asymptomatic and symptomatic forms and may cause a wide and varied range of symptoms (2-6). One of the most serious and current human rights is to have access to diagnostic, treatment and vaccination facilities against COVID-19, especially in the poor areas and low-income countries. In addition, vaccination is regarded to be a very important primary preventive measure since it causes a significant reduction in the COVID-19 development, decreases its morbidity, and reduces its mortality rates (7). In fact, health inequality is a comprehensive concept that reflects the differences and inequalities in people's access to health care (8). It is obvious that health-care-access injustice ultimately leads to inequality in health (9). At the beginning of 2021, several COVID-19 vaccines were developed. These vaccines were classified into three categories. The first category involved the RNA messenger vaccines (mRNA) which included Moderna and Pfizer-BioNTech vaccines. The second category comprised the vaccines which were made with the help of human and mammalian adenoviruses such as Spuntink-V, Astera-Zenec, and Johnson & Johnson. Finally, the third category involved the inactivated viral vaccines such as Bharat Biotech, Sinopharm, and Sinovac (10). These vaccines and the new medications have been effective (11). Nonetheless, there are still countries around the world which are not able to purchase the approved vaccines. Moreover, a number of the people, who have access to the vaccines, are not willing to trust a new vaccine. These two issues are major concerns which severely affect the vaccination coverage rate, the break in the disease transmission chain, and the end of the COVID-19 pandemic (12). Finally, it can be stated that the causes of low vaccination coverage include the following factors (13, 14): Lack of access to vaccines Distrust of governments Negative role of national media Poor performance of health personnel Negative role of social and virtual networks Complications of vaccination Low knowledge about the consequences of the COVID-19 among the general population. In conclusion, it can be noted that, the above mentioned factors influence inequality in COVID-19 vaccination coverage. More specifically, the countries have different vaccination coverage rates. Therefore, the consequences of COVID-19 and the general health status are different across the world.