Academic literature on the topic 'Socio-economic status, birth outcomes, inequality, social stratification'

South Africa’s history of colonialism and Apartheid contributed to its extreme levels of inequality. Twenty-five years after the transition to democracy, socio-economic and health inequalities continue to rank among the highest in the world. The Birth to Twenty+ study follows a cohort born in urban Johannesburg in 1990 through their early lives and into young adulthood. Also known as ‘Mandela’s Children’, these ‘children of the ‘90s’ were the first generation to be raised in a democratic society, whose elected government implemented policies to achieve greater socio-economic and health equality. Correlating early life outcomes to those of their parents provides a baseline estimate of intergenerational transmission of historical inequality. Analyses of their early life course indicates the potential breakdown in inequality in the first generation. This paper provides an overview of empirical results on intergenerational change in socio-economic status and health during South Africa’s political transition. Access to infrastructural services improved, and poverty reduced following the rapid expansion of unconditional cash transfers mainly to children and pensioners. However, unemployment remained high and job discrimination continued. Inequalities in health follow similar patterns, and progress did not equate to convergence. Some catch-up physical growth occurred—both across groups and over time—but not sufficient to bridge cognitive inequalities. Socio-economic and health inequalities continued as the children of the ‘90s reached young adulthood. Based on knowledge of other transitions, it is likely that these inequalities will only start to break down in later generations, provided social and economic progress holds steady.

Studies show lighter skinned Black people are advantaged on a number of social indicators—a phenomenon called “colorism.” These studies generally contend preferences for light-skinned and/or Mulatto slaves endured the postbellum period to shape social outcomes into today. Following this idea, other studies examine differences in social outcomes between Mulattos and Blacks in the 19th century, but few empirically connect antebellum life to postbellum Mulatto–Black stratification. With that in mind, I examine whether the socio-economic differences between Mulattos and Blacks varied across geographic space in proportion to places’ reliance on slave labor and the characteristics of its free African American population. This allows me to examine whether differences in economic status between Mulattos and Blacks are a result of Mulatto advantage in the form of privileged positions during slavery. My results reveal that Mulattos have higher occupational statuses relative to Blacks in places where slavery was more prominent and where free Mulattos were literate. This suggests the intraracial hierarchy established during slavery was more likely to be replicated in places where slavery was more important, and Mulattos were able to capitalize on freedom by leveraging their literacy into better economic statuses after emancipation. These results support the idea that skin color stratification was initiated at least in part by practices during chattel slavery and offers some plausible mechanisms for its transmission.

Abstract At country-level, a host of evidence suggests there is a sizeable direct effect of social origin (DESO) on initial labour market outcomes, net of educational attainment. What is true at country-level is not always true below country-level, however. Using data from the UK Household Longitudinal Survey and the German Socio-Economic Panel, we show that variable spatial opportunity structures moderate the size of DESO at labour market entry, such that there are places where DESO disappears. Social origins assume greater importance as local labour market conditions deteriorate: in weak local labour markets, non-graduates are approximately 16 percentage points less likely to find employment if their parents are care workers rather than secondary school teachers, while graduates typically obtain first jobs that are 7–9 ISEI points lower in status. These findings highlight the distinctive geography of social stratification processes at labour market entry and potentially beyond.

Abstract Background While in general a country’s life expectancy increases with national income, some countries “punch above their weight”, while some “punch below their weight” – achieving higher or lower life expectancy than would be predicted by their per capita income. Discovering which conditions or policies contribute to this outcome is critical to improving population health globally. Methods We conducted a mixed-method study which included: analysis of life expectancy relative to income for all countries; an expert opinion study; and scoping reviews of literature and data to examine factors that may impact on life expectancy relative to income in three countries: Ethiopia, Brazil, and the United States. Punching above or below weight status was calculated using life expectancy at birth and gross domestic product per capita for 2014–2018. The scoping reviews covered the political context and history, social determinants of health, civil society, and political participation in each country. Results Possible drivers identified for Ethiopia’s extra 3 years life expectancy included community-based health strategies, improving access to safe water, female education and gender empowerment, and the rise of civil society organisations. Brazil punched above its weight by 2 years. Possible drivers identified included socio-political and economic improvements, reduced inequality, female education, health care coverage, civil society, and political participation. The United States’ neoliberal economics and limited social security, market-based healthcare, limited public health regulation, weak social safety net, significant increases in income inequality and lower levels of political participation may have contributed to the country punching 2.9 years below weight. Conclusions The review highlighted potential structural determinants driving differential performance in population health outcomes cross-nationally. These included greater equity, a more inclusive welfare system, high political participation, strong civil society and access to employment, housing, safe water, a clean environment, and education. We recommend research comparing more countries, and also to examine the processes driving within-country inequities.

BACKGROUND: Pre-gestational hypertension (HTN) remains a compelling problem, both cardiological and obstetrical. It can increase risk of unfavorable maternal and neonatal outcomes, especially in patients without adequate prenatal care. Little is known about factors associated with inadequate prenatal care in women with pre-gestational HTN, beyond racial and ethnic disparities. HYPOTHESIS: We hypothesized that social factors are associated with inadequate prenatal care in pre-gestational HTN women, beyond race/ethnicity-related disparities. METHODS: A case-control study of adequacy of prenatal care was conducted in 1,635 women with pre-gestational HTN who were living and gave birth in the State of Ohio in 2010. The comprehensive births data for the year 2010 were obtained from the Ohio Department of Health. Cases were identified as those with inadequate prenatal care; controls were identified as those with adequate-plus, adequate, or intermediate care, as defined by the Adequacy of Prenatal Care Utilization Index (the Kotelchuk Index). Adjusted odds ratios for inadequate care in pre-gestational HTN women in relation to their demographic and socio-economic characteristics were obtained using multivariable logistic regression (SAS software). RESULTS: A total of 14.4% (235 of 1,635) pre-gestational HTN women received inadequate prenatal care. In pre-gestational HTN women, adequacy of prenatal care was statistically significantly associated with their level of educational attainment and marital status, even after adjustment for race and ethnicity. Compared to pre-gestational HTN women with a higher educational level (at least some college or higher), pre-gestational HTN women with a lower educational level (high school or below) were 1.69 times more likely to receive inadequate prenatal care as measured by the Kotelchuk Index (began prenatal care late and/or completed less than 50% of the recommended visits) (OR 1.69, 95% CI 1.20-2.38, p<0.01). Unmarried pre-gestational HTN women were statistically significantly more likely to receive inadequate care than their married counterparts (OR 1.57, 95% CI 1.09-2.27, p=0.02). Compared to white pre-gestational HTN women, black (OR 2.52, 95% CI 1.76-3.62, p<0.001), Asian (OR 3.82, 95% CI 1.50-9.71, p=0.01), and Native American (OR 4.84, 95% CI 1.03-22.87, p=0.04) pre-gestational HTN women were at higher risk of receiving inadequate care. No statistically significant difference between Hispanic and non-Hispanic pre-gestational HTN women was observed. CONCLUSIONS: Although white women with pre-gestational HTN are at lowest risk of receiving inadequate prenatal care, these disparities cannot be attributed to race and ethnicity only. Pre-gestational HTN women with lower educational attainment and unmarried women are at higher risk of receiving inadequate prenatal care. Pre-gestational risk stratification and management of HTN in women during pregnancy by the cardiologist are warranted.

This dissertation is a collection of three empirical chapters contributing to the understanding of the relationship between family of origin socio-economic background and birth outcomes. For this investigation, I draw from high quality cohort studies from the United Kingdom and vital statistics from Spain. Overall, I find that there is a strong and persistent relationship between family of origin socio-economic background and birth outcomes. The first study shows that disadvantaged mothers delivered children with poorer birth outcomes respect to their advantaged counterparts for the large share of the last fifty years in the United Kingdom. And maternal unhealthy behaviors such as prenatal smoking play an important role in accounting for socio-economic disparities. In the second study, I report substantial geographical variation in the association between family socio-economic background and birth outcomes in Spain, suggesting that spatial patterns of intergenerational mobility found by previous research may be visible as early as at birth. In the third empirical chapter, I study a natural experiment and show that exposure to exogenous prenatal maternal stress is more detrimental for disadvantaged mothers, and that maternal behaviors or the complex biology behind stress may account for this result. All in all, these results bring novel evidence on the early transmission of status across generations, integrating classic stratification research with insights from epidemiological, economic and health research. Finally, I outline how further research may improve our understanding of the role of birth outcomes in the stratification process.