Placing poverty-inequality at the centre of psychiatry.
Ontology highlight
ABSTRACT:
SUBMITTER: Byrne P
PROVIDER: S-EPMC7525584 | biostudies-literature | 2020 Oct
REPOSITORIES: biostudies-literature
Publications
Placing poverty-inequality at the centre of psychiatry.
BJPsych bulletin 20201001 5
We examine epidemiological evidence for the central role of inequalities (principally economic) in driving the onset of mental disorders, physical ill health and premature mortality. We locate the search for solutions in current UK contexts, and include known and likely effects of the COVID-19 pandemic. Prevention of mental disorders and adverse outcomes such as premature mortality must begin with efforts to mitigate rising poverty-inequality. ...[more]
Similar Datasets
Project description:The relationship between growth, inequality and poverty remains elusive, despite considerable scholarship. To what extent can governments rely on growth to eradicate poverty without reducing inequality? We derive a closed-form relationship between a minimum income threshold, changes in the Gini index of income inequality and average national income required to meet this target, independent of the form of income distribution. We develop a generalized form of redistribution and validate it against historical changes in inequality. We use this formulation to illustrate feasible growth-redistribution strategies to raise entire populations above the International Poverty Line ($1.90/day) by 2030, the Sustainable Development Goal 1, in two selective countries: India and Rwanda. We show that meeting this target would require unprecedented rates of both growth and inequality reduction in Rwanda. India could not eradicate acute poverty by 2030 with growth alone, but it could with only a modest reduction in inequality.
| S-EPMC10641217 | biostudies-literature
Project description:This paper examines patterns and trends in racial inequality in poverty and affluence over the 1959 to 2015 period. Analyzing data from decennial censuses and the American Community Survey, I find that that disparities have generally narrowed over the period. Nevertheless, considerable disparities remain, with whites least likely to be poor and Asians most likely to be affluent on the one hand, and blacks and American Indians much more likely to be poor and less likely to be affluent on the other-and Hispanics somewhat in between. Sociodemographic characteristics, such as education, family structure, and nativity explain some of the disparities-and an increasing proportion over the 1959 to 2015 period, indicative of the growing importance of disparities in human capital, the immigrant incorporation process, and the interaction between economic conditions and cultural shifts in attitudes towards marriage in explaining racial inequality in poverty and affluence. There also are still significant portions of the gaps that remain unexplained, especially for blacks and American Indians. The presence of this unexplained gap indicates that other factors are still at work in producing these disparities, though their effects have declined over time.
| S-EPMC6934366 | biostudies-literature
Project description:The contributions of psychology to the development and evaluation of preschool-to-third-grade prevention programs are analyzed with an emphasis on poverty alleviation through implementation of effective services for a greater number of children. The need to alleviate poverty and increase economic success is high. Early childhood programs have been found to be an effective strategy for promoting educational success and economic well-being, but the availability of high quality programs that are aligned and integrated with schools across the learning continuum is limited. Psychology has made major contributions to knowledge and practice in (a) defining and evaluating educational enrichment and (b) understanding mechanisms of behavioral change. As an empirical illustration of these contributions for enhancing economic well-being, we report new midlife income data in the Child-Parent Centers, a preschool-to-third-grade program that integrates the two major contributions to improve life course outcomes. Based on a well-matched alternative-intervention design with high sample retention (86%; N = 1,329), findings indicate that participation was associated with a 25% increase in average annual income at age 34 years ($22,708 vs. $18,130; p < .01). Graduates were also more likely to be in the top income quartile (?$27,500; 30.7% vs. 20.2%; p < .01). Most of the main effects were explained by cognitive, school, and family factors, though further corroboration is needed. Implications for strengthening the impacts of early childhood programs as an avenue for increasing well-being and reducing inequality emphasize redressing ecological barriers, improving continuity and alignment with other strategies, and implementing effectiveness elements widely. (PsycINFO Database Record (c) 2019 APA, all rights reserved).
| S-EPMC6767908 | biostudies-literature
Project description:Little research exists on health determinants among adults living in economically deprived regions despite the fact that these areas comprise a good part of the world. This paper examines the distribution of wealth then tests associations between wealth inequality and a variety of health outcomes, among older adults, in one of the world's poorest regions--rural Cambodia. Data from the 2004 Survey of the Elderly in Cambodia are employed. Using a disablement framework to conceptualize health, associations between four health components and a wealth inequality measure are tested. The wealth inequality measure is based on an index that operationalizes wealth as ownership of household assets and household structural components. Results confirm difficult economic conditions in rural Cambodia. The lowest wealth quintile lives in households that own nothing, while the next quintiles are only slightly better off. Nevertheless, logistic regressions that adjust for other covariates indicate heterogeneity in health across quintiles that appear qualitatively similar, with the bottom quintiles reporting the most health problems. An exception is disability, which presents a U-shaped association. It is difficult to determine mechanisms behind the relationship using cross-sectional data, but the paper speculates on possible causal directions, both from wealth to health and vice-versa. The analysis suggests the ability to generalize the relationship between wealth inequality and health to extremely poor populations as a very small difference in wealth makes a relatively large difference with respect to health associations among those in meager surroundings.
| S-EPMC2171035 | biostudies-literature
Project description:Social distancing and lockdown measures taken to contain the spread of COVID-19 may have distributional economic costs beyond the contraction of GDP. Here we evaluate the capacity of individuals to work under a lockdown based on a Lockdown Working Ability index which considers their teleworking capacity and whether their occupation is essential or closed. Our analysis reveals substantial and uneven potential wage losses across the distribution all around Europe and we consistently find that both poverty and wage inequality rise in all European countries. Under four different scenarios (2 months of lockdown and 2 months of lockdown plus 6 months of partial functioning of closed occupations at 80%, 70% and 60% of full capacity) we estimate for 29 European countries an average increase in the headcount poverty index that goes from 4.9 to 9.4 percentage points and a mean loss rate for poor workers between 10% and 16.2%. The average increase in the Gini coefficient ranges between 3.5% to 7.3% depending on the scenario considered. Decomposing overall wage inequality in Europe, we find that lockdown and social distance measures produce a double process of divergence: both inequality within and between countries increase.
| S-EPMC7417923 | biostudies-literature
Project description:RationaleIndividuals living in Scotland's most deprived communities experience a higher burden of morbidity and early mortality than those living in more affluent areas. Experiences of poverty-based stigma may be one psychosocial mechanism through which socioeconomic position influences health, although there is little available data on this issue from a Scottish perspective.ObjectiveThe aim of this study was to identify which aspects of poverty stigma are particularly salient to individuals with lived experience of poverty, and may therefore contribute to health inequalities.MethodsFive focus groups were conducted with 39 individuals with experience of living on low incomes in Scotland in order to explore their experiences and perceptions of poverty stigma.ResultsFive main themes were identified, reflecting aspects of poverty stigma operating at various structural, public and individual levels: media representations of poverty; negative encounters with social security systems; perceived public attitudes regarding poverty in Scotland; lowered self-esteem and internalisation of negative attitudes, and; emotional responses to stigma.ConclusionThese dimensions of stigma potentially influence public health and health inequalities in Scotland, although future research will be necessary to quantify these and estimate their relationships with health outcomes.
| S-EPMC6597943 | biostudies-literature
Project description:The novel Coronavirus that spread around the world in early 2020 triggered a global pandemic and economic downturn that affected nearly everyone. Yet the crisis had a disproportionate impact on the poor and revealed how easily working-class individuals' financial security can be destabilised by factors beyond personal control. In a pre-registered longitudinal study of Americans (N = 233) spanning April 2019 to May 2020, we tested whether the pandemic altered beliefs about the extent to which poverty is caused by external forces and internal dispositions and support for economic inequality. Over this timespan, participants revealed a shift in their attributions for poverty, reporting that poverty is more strongly impacted by external-situational causes and less by internal-dispositional causes. However, we did not detect an overall mean-level change in opposition to inequality or support for government intervention. Instead, only for those who most strongly recognized the negative impact of COVID-19 did changes in poverty attributions translate to decreased support for inequality, and increased support for government intervention to help the poor.
| S-EPMC7666538 | biostudies-literature
Project description:Using the Iranian Household Expenditure and Income Survey for 2011/12, we estimate the impact and effectiveness of various components of Iran's fiscal system on reducing inequality and poverty. We utilize the marginal contribution analysis to determine the impact of each component, and we introduce newly developed indicators of effectiveness to calculate how well various taxes and transfers are operating to reduce inequality and poverty. We find that the fiscal system reduces the poverty-head-count-ratio by 10.5 percentage points and inequality by 0.0854 Gini points. Transfers are generally more effective in reducing inequality than taxes while taxes are especially effective in raising revenue without causing poverty to rise. Although transfers are not targeted toward the poor, they reduce poverty significantly. The main driver is the Targeted Subsidy Program (TSP), and we show through simulations that the poverty reducing impact of TSP could be enhanced if resources were more targeted to the bottom deciles.
| S-EPMC6743812 | biostudies-literature
Project description:BACKGROUND:Achieving fair access to healthcare and improving population health are crucial in all settings. Properly staffed and fairly distributed primary health care (PHC) facilities are prerequisites to ensure accessible healthcare services. Nevertheless, availability and accessibility issues are common public health concerns, especially in under-resourced countries including Ethiopia. Measuring inequalities in accessibility of healthcare resources guide policy decisions to improve PHC services and ultimately achieving universal health coverage (UHC). PURPOSE:To assess availability and measure magnitude and trend of inequalities in accessibility of health centre-based PHC resources in Ethiopia during 2015 to 2017. METHODS:We conducted a cross-sectional population-based analysis of district-level data collected from 16th December 2017 until 24th May 2018. Afar, Dire-Dawa, and Tigray regions were purposefully included in the study to represent the four pastoralist/semi-pastoralist, three urban and four agrarian regions in Ethiopia, respectively. We used ratios, different inequality indices and Gini decomposition techniques to characterise the inequalities. RESULTS:In 2017, median of health centres (HCs) per 15,000 inhabitants and their Gini indices (GIs) for Afar, Dire-Dawa, and Tigray were 0.781, 0.566, 0.591 vs. 0.237, 0.280, 0.216 respectively. Median overall skilled health workers (SHWs) per 10,000 inhabitants were 5.250, 7.539, and 6.246, respectively. These accounted for 11.80%, 16.94% and 14.04% of the WHO target of 44.5 to achieve SDGs. The corresponding GIs for the regions were 0.347, 0.186 and 0.175. Despite a higher overall SHWs inequality in the urban districts of Tigray (GI = 0.301), only Tigray showed significant inequality reductions in GHE (p < 0.001) and in all categories of SHWs (p < 0.05). CONCLUSIONS:Our analysis provided a clear picture of availability and inequalities in PHC resources across three regions in Ethiopia. Identifying contributing factors to low densities and high inequalities of SHWs may help improve PHC services nationwide, along with pathway towards UHC.
| S-EPMC6440637 | biostudies-literature
Project description:OBJECTIVES:Medical records are critical to patient care, but often contain incomplete information. In UK hospitals, record-keeping is traditionally undertaken by junior doctors, who are increasingly completing early-career placements in psychiatry, but negative attitudes towards psychiatry may affect their performance. Little is known about the accuracy of medical records in psychiatry in general. This study aimed to evaluate the accuracy of Electronic Medical Records (EMRs) pertinent to clinical decision-making ("rationale") for prescribing completed by junior doctors during a psychiatry placement, focusing on the differences between psychotropic vs. non-psychotropic drugs and the temporal association during their placement. RESULTS:EMRs of 276 participants yielding 780 ward round entries were analysed, 100% of which were completed by Foundation Year or General Practice specialty training junior doctors rather than more senior clinicians. Compared with non-psychotropic drugs, documentation of prescribing rationale for psychotropic drugs was less likely (OR?=?0.24, 95% CI 0.16-0.36, p?<?0.001). The rate of rationale documentation significantly declined over time especially for psychotropic drugs (p?<?0.001). Prescribing documentation of non-psychotropic drugs for people with mental illness is paradoxically more accurate than that of psychotropic drugs. Early-career junior doctors are therefore increasingly shaping EMRs of people receiving psychiatric care.
| S-EPMC6727574 | biostudies-literature