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Introduction: To contribute to addressing diagnostic health inequalities in the United Kingdom, this review aimed to investigate determinants of diagnostic service use amongst people experiencing high deprivation in the United Kingdom. Methods: A systematic review was conducted using three databases (EBSCO, Web of Science and SCOPUS) to search studies pertaining to diagnostic service use amongst people experiencing high deprivation. Search terms related to diagnostics, barriers and facilitators to access and deprivation. Articles were included if they discussed facilitators and/or barriers to diagnostic service access, contained participants' direct perspectives and focussed on individuals experiencing high deprivation in the United Kingdom. Articles were excluded if the full text was unretrievable, only abstracts were available, the research did not focus on adults experiencing high deprivation in the United Kingdom, those not including participants' direct perspectives (e.g., quantitative studies) and papers unavailable in English. Results: Of 14,717 initial papers, 18 were included in the final review. Determinants were grouped into three themes (Beliefs and Behaviours, Emotional and Psychological Factors and Practical Factors), made up of 15 sub‐themes. These were mapped to a conceptual model, which illustrates that Beliefs and Behaviours interact with Emotional and Psychological Factors to influence Motivation to access diagnostic services. Motivation then influences and is influenced by Practical Factors, resulting in a Decision to Access or Not. This decision influences Beliefs and Behaviours and/or Emotional and Psychological Factors such that the cycle begins again. Conclusion: Decision‐making regarding diagnostic service use for people experiencing high deprivation in the United Kingdom is complex. The conceptual model illustrates this complexity, as well as the mediative, interactive and iterative nature of the process. The model should be applied in policy and practice to enable understanding of the factors influencing access to diagnostic services and to design interventions that address identified determinants. Patient or Public Contribution: Consulting lived experience experts was imperative in understanding whether and how the existing literature captures the lived experience of those experiencing high deprivation in South England. The model was presented to lived experience experts, who corroborated findings, highlighted significant factors for them and introduced issues that were not identified in the review. [ABSTRACT FROM AUTHOR]

This paper reviews the work of the Glasgow Quality of Life Group, a limited life project (1986–1990) within the Applied Population Research Unit of the then Department of Geography and Topographic Science at the University of Glasgow. It explores the contribution of Ronan Paddison, and the wider innovations and impact of the group's work. It argues that these innovations were methodological, strategic, and challenged the prevailing wisdom of the day that understood GB to riven by a simple north-south divide, in which the 'north' was perceived to be the poorer partner in every way. Although of a time and place, the work of the GQLG remains pertinent to contemporary challenges and concerns. [ABSTRACT FROM AUTHOR]

The prevalence of xenophobic violence toward foreigners has hindered South Africa’s ambition to become a developmental state since 2007, when the concept of a “democratic developmental state” was first endorsed during the African National Congress (ANC) conference in Polokwane. This ambition has also been thwarted by the inability of the post-apartheid regime to provide adequate and sustainable services to the citizens. Xenophobia has disrupted economic growth and has contributed to poor service delivery in local municipalities, thus leading to social protests. The developmental state depends mainly on a solid balance of economic growth and human development. It also leans on the capacity of the state to establish policies that address poverty and promote the expansion of solid economic opportunities. In this endeavor, migrants increase economic growth and make it sustainable, increase productivity, and promote the labor market. They also promote the labor force and human capital, economic growth, and public finance, thus enabling the realization of a developmental state. However, xenophobia has limited migrants’ contributions to economic growth and social well-being in South Africa. It has destructive effects on South Africa’s economic structure and growth, thus affecting the delivery of adequate services that would enhance its ability to achieve a developmental state. The paper recommends that there is a need for South Africa to understand that xenophobia affects economic growth and the service delivery framework. To address the prevalence of xenophobia and achieve its ambition of a developmental state, South Africa needs to hasten its responses to curb xenophobia and integrate migrants into economic opportunities. The paper adopted a qualitative research methodology and conceptual and document analysis techniques to collect data that enabled the achievement of the above assertions. [ABSTRACT FROM AUTHOR]

Objectives: DETERMIND (DETERMinants of quality of life, care and costs, and consequences of INequalities in people with Dementia and their carers) is designed to address fundamental, and, as yet unanswered questions about inequalities, outcomes and costs following diagnosis with dementia. These answers are needed to improve the quality of care and equity of access to care, and therefore the quality of life, of people with dementia and their carers.Method: DETERMIND is a programme of research consisting of seven complementary workstreams (WS) exploring various components that may result in unequal dementia care: WS1: Recruitment and follow-up of the DETERMIND cohort-900 people with dementia and their carers from three geographically and socially diverse sites within six months following diagnosis, and follow them up for three years. WS2: Investigation of the extent of inequalities in access to dementia care. WS3: Relationship between use and costs of services and outcomes. WS4: Experiences of self-funders of care. WS5: Decision-making processes for people with dementia and carers. WS6: Effect of diagnostic stage and services on outcomes. WS7: Theory of Change informed strategy and actions for applying the research findings.Outcomes: During the life of the programme, analysing baseline results and then follow-up of the DETERMIND cohort over 3 years, we will establish evidence on current services and practice. DETERMIND will deliver novel, detailed data on inequalities in dementia care and what drives positive and negative outcomes and costs for people with dementia and carers, and identify factors that help or hinder living well with dementia. [ABSTRACT FROM AUTHOR]

Urban poverty is a complex phenomenon and people experiencing poverty suffer from various deprivations. Multidimensional poverty measurement has been one of the best indicators of this deprivation. In general, slum dwellers are considered homogenous groups, but it is not valid in multidimensional deprivation. This paper aims to find out the correlates of multidimensional poverty in slums. Spatiality and correlates of poverty in Varanasi City have been tapped using statistical modelling. The paper is based on primary data collected from 384 households through an interview schedule from 12 slums across three geographical zones of the city. The MPI index for slums, based on global MPI, was used to compute MPI for each geographical zone. Further ANOVA and hierarchical regression analysis were performed to find spatiality and correlates of multidimensional deprivation. The paper reveals that socio-religious categories, occupation and geographical location are significant determinants or at least correlates of multidimensional poverty in slums. [ABSTRACT FROM AUTHOR]

Spatial policy targeting can differ greatly across programs due to myriad thematic goals, geographical unit systems, and conceptualisations. The current paper seeks to better understand how these differences may impact policy effectiveness by examining the theory of spatial targeting accuracy and the methodological tools for assessing it ex ante. It is the first comprehensive examination, to the extent of the author's knowledge, of these concepts. The paper finds two clear families of diagnostic tools—concentration-based measures and characteristic-based measures—and two conceptual camps for improving ex ante accuracy—one based on economic potential and one based on deprivation. [ABSTRACT FROM AUTHOR]

Coronavirus disease-19 (COVID-19) has disproportionately affected certain demographics in England, exacerbating existing health disparities. Effective therapeutics are a critical line of defence against COVID-19, particularly for patients at elevated risk for severe disease. Surveillance systems were established to monitor the usage of COVID-19 therapeutics in hospital and community settings and to inform stewardship. Three antiviral therapies—nirmatrelvir plus ritonavir (Paxlovid®), remdesivir (Veklury®), and molnupiravir (Lagevrio®)—and two neutralising monoclonal antibody therapies (nMAbs)—sotrovimab (Xevudy®) and casirivimab with imdevimab (Ronapreve®)—were in use in England between July 2020 and April 2023. This paper aims to illuminate trends in the utilisation of COVID-19 therapeutics treatment in both hospital and community settings, stratified by the Index of Multiple Deprivation (IMD) in England. Chapter 3 of the English Surveillance Programme for Antimicrobial Utilisation and Resistance (ESPAUR) Report 2022 to 2023 also discusses the epidemiological surveillance of these five directly acting antiviral COVID-19 therapeutics' use in England between 2022 and 2023. [ABSTRACT FROM AUTHOR]

In 2018, EU Member States adopted a 17-item scale to measure child deprivation and monitor progress in their fight against child poverty. This indicator will be collected in future every three years via an ad hoc module of the European Union Statistics on Income and Living Conditions (EU-SILC). Previous research has shown how deprivation measures can be implemented more efficiently and with minimal information loss using adaptive testing, at least in the context of a single country. This paper examines the scope to implement the adaptive approach in a multi-national context with wide variations in deprivation levels and potentially in cultural preferences for consumption. The paper shows that the adaptive approach works effectively in this context. Time savings of around 40 per cent can be achieved with very minimal information losses both at the EU level and at the level of each individual country. Time savings are much greater in countries with lower deprivation. The adaptive approach may therefore offer particular advantages in a multi-national context as it can provide a consistent measure for all participating countries while targeting survey time and resources where they are most needed. [ABSTRACT FROM AUTHOR]

Child deprivation has severe short-term as well as life-long consequences for children experiencing it. Using the new child-specific deprivation indicator adopted by the European Union in 2018 and computed from the EU Statistics on Income and Living Conditions dataset, the paper analyses the determinants of child deprivation in 31 European countries. It applies negative binomial multilevel models, which combine household-level and country-level variables. The latter include various macro-level variables that are new to the deprivation literature. The results show the combined impact of factors related to "household's longer-term command over resources" and factors explaining "household needs". Regarding the role of the welfare state and social transfers in child deprivation, the paper highlights the impact of cash benefits, which operates through household income, and of in-kind benefits, which decrease a household's needs and increase household's resources. Another important conclusion is that the provision of affordable education reduces child deprivation, as it can mitigate the cost burden faced by parents. In terms of policy implications, the paper shows the importance of investing in social protection and public services in order to reduce child deprivation. [ABSTRACT FROM AUTHOR]

Background and aims: Sepsis is a serious and life-threatening condition caused by a dysregulated immune response to an infection. Recent guidance issued in the UK gave recommendations around recognition and antibiotic treatment of sepsis, but did not consider factors relating to health inequalities. The aim of this study was to summarise the literature investigating associations between health inequalities and sepsis. Methods: Searches were conducted in Embase for peer-reviewed articles published since 2010 that included sepsis in combination with one of the following five areas: socioeconomic status, race/ethnicity, community factors, medical needs and pregnancy/maternity. Results: Five searches identified 1,402 studies, with 50 unique studies included in the review after screening (13 sociodemographic, 14 race/ethnicity, 3 community, 3 care/medical needs and 20 pregnancy/maternity; 3 papers examined multiple health inequalities). Most of the studies were conducted in the USA (31/50), with only four studies using UK data (all pregnancy related). Socioeconomic factors associated with increased sepsis incidence included lower socioeconomic status, unemployment and lower education level, although findings were not consistent across studies. For ethnicity, mixed results were reported. Living in a medically underserved area or being resident in a nursing home increased risk of sepsis. Mortality rates after sepsis were found to be higher in people living in rural areas or in those discharged to skilled nursing facilities while associations with ethnicity were mixed. Complications during delivery, caesarean-section delivery, increased deprivation and black and other ethnic minority race were associated with post-partum sepsis. Conclusion: There are clear correlations between sepsis morbidity and mortality and the presence of factors associated with health inequalities. To inform local guidance and drive public health measures, there is a need for studies conducted across more diverse setting and countries. [ABSTRACT FROM AUTHOR]

Roma groups in Greece are a long-standing socially deprived population that faces extreme social exclusion and segregation. Their marginalization includes limited access to education, employment, and housing. This paper explores their spatial position and social exclusion, comparing the social profile and life conditions in two case studies of Roma settlements with those of the municipal and regional units to which they belong. Methodologically, we analyze quantitative data from the 2011 Population Census to measure life conditions at three levels (settlement, municipal unit, regional unit), and we also use qualitative data from interviews with representatives of local agencies and residents of the two settlements to document our hypotheses on the causal relations between the spatial position and the social exclusion of Roma groups. The comparison shows that the two Roma settlements are clearly different from their entourage, assembling the lowest positions in the labor market, the weakest performances in education, the largest households, and the worst housing conditions. This case of extreme social exclusion in ghettoized spatial proximity raises the question about the significance of micro-segregation and the way it works in different contexts, as well as the need for further research for a more comprehensive understanding of the relation between social inequality and spatial distance. [ABSTRACT FROM AUTHOR]

Much effort has been expended on measuring deprivation in neighbourhoods across the UK and elsewhere. However, there has been only a relatively limited concern with deprivation histories of areas. This paper takes as its focus Belfast in Northern Ireland and it capitalises on rich data sources on deprivation generally and unemployment specifically. The study makes use of data on multiple time points – the Census from 1971 to 2011, multiple deprivation measures for 2005, 2010, and 2017, and benefits claimant count data for 2020. The paper explores the changing geography of deprivation and unemployment, identifying areas with persistently high deprivation and unemployment across time and across measures. It is argued that trajectories are important, particularly in terms of targeting resources. The final section of the analysis uses claimant count data to assess changing unemployment rates following the outbreak of the COVID‐19 pandemic and it shows that changes in these rates are strongly related to long‐term deprivation and unemployment patterns. [ABSTRACT FROM AUTHOR]

This paper offers a partial defence of the Epicurean claim that death is not bad for the one who dies. Unlike Epicurus and his present‐day advocates, this defence relies not on a hedonistic or empiricist conception of value but on the concept of 'existential' value. Existential value is agent‐relative value for which it is constitutive that it can be truly self‐ascribed in the first person and present tense. From this definition, it follows that death (post‐mortem non‐existence), while perhaps bad in some respects, cannot be an existential harm for the one who dies. This paper argues that existential goods are central to any explanation of why life appears good to us from a self‐interested perspective, which means that death is not bad in the very respect in which life is most saliently good (from that perspective). A corresponding error theory shows why this truth is easily overlooked and explains why we tend to think that death is significantly worse than it really is. [ABSTRACT FROM AUTHOR]

The harmful effects of Covid 19 on children living in poverty have refocused attention on the complex nature of child poverty and the vexed question of its relationship to education. The paper examines a tension at the heart of much discussion of child poverty and education. On the one hand, education is often regarded as essential for children's flourishing and a means by which children can "escape" poverty; yet on the other hand, education systems, institutions, and practices, often reflect and entrench the disadvantages associated with poverty. Narratives concerning education as an escape from poverty tend not to deal in any depth with the injustices associated with poverty, stressing instead the transformative potential of education. By contrast, largely sociological analyses of the ways in which schooling reproduces inequalities tend to stop short of developing a normative account of how education can contribute to transforming the structural injustices related to poverty and its effects on children's lives. In working to move beyond this analytic impasse, the paper shows how the cluster of concepts, which Robeyns (2018) locates as central to the capability approach, give insights which help to address these two different lacunae. The notion of conversion factors highlights the significance of taking account of existing relationships in education, while the distinction between capabilities and functionings helps guide practices regarding the education of children living in poverty. Drawing on literature on the heightened inequalities associated with poor children's experience of lack of schooling during the COVID pandemic, the paper sketches some of the ways in which sociological analysis and normative evaluation can be linked in taking forward an "ethically engaged political philosophy" (Wolff, 2018) to discuss child poverty and education in real schools. [ABSTRACT FROM AUTHOR]

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In Germany, as in many other European countries, vast changes in the welfare regime – towards workfare – have taken place. As a central activating element of workfare, sanctions were introduced to take effect by temporarily increasing deprivation through benefit cuts. This paper provides first quantitative insights on the effect of first sanctions on deprivation and contributes to the recent debate on the (un)constitutionality of sanctions, which re-emerged after a verdict of the Federal Constitutional Court, criticizing the lack of knowledge about the effects of sanctions on those affected. We implement a difference-in-differences propensity score matching approach that addresses selection on observables and individual time constant unobserved differences. High data accuracy is ensured by combining the "Panel Labour Market and Social Security" (PASS) with administrative data from the Federal Employment Agency. The results illustrate a slightly higher yet statistically insignificant level of deprivation for first-sanctioned unemployment/basic income recipients compared to non-sanctioned recipients. The results hint in the direction that higher levels of deprivation are not what activates the sanctioned beneficiaries to reintegrate into the labour market. We discuss whether the results imply a significant deviation from the socio-cultural subsistence minimum of sanctioned recipients and a failure of the welfare state. [ABSTRACT FROM AUTHOR]

The measurement of deprivation for small areas in the UK has provided the basis for the development of policies and targeting of resources aimed at reducing spatial inequalities. Most measures summarise the aggregate level of deprivation across all people in a given area, and no account is taken of differences between people with differing characteristics, such as age, sex or ethnic group. In recognition of the marked inequalities between ethnic groups in the UK, and the distinctive geographies of these inequalities, this paper presents a new ethnic group‐specific neighbourhood deprivation measure—the Ethnic Group Deprivation Index (EGDI). This index, using a custom cross‐tabulated 2021 Census dataset on employment, housing tenure, education and health by ethnic group, reveals the small area geographies of ethnic inequalities that have to date received scant attention, and yet have profound impacts on life chances and well‐being. Drawing on the methodological framework of the widely used English Index of Multiple Deprivation (IMD) and for the same geographies (Lower Layer Super Output Areas), the EGDI measures deprivation for each ethnic group using data from the 2021 Census of England and Wales. The EGDI reveals the complex geographies of ethnic inequality and demonstrates that while one ethnic group in a neighbourhood may have high relative levels of deprivation, another ethnic group in that same neighbourhood may experience very low relative levels. The EGDI explores ethnic inequalities within and between neighbourhoods, complementing and augmenting existing measures by offering an important means of better understanding ethnic inequalities. The EGDI can be used to help shape locally and culturally sensitive policy development and resource allocation. [ABSTRACT FROM AUTHOR]

Can 'health resilience' explain international differences in COVID‐19 mortality? This paper aims to understand the significant diversity in mortality rates between countries in terms of their degree of preparedness for the crisis and the underlying health conditions of the population. We integrate COVID‐19 data from the first year of the pandemic with panel data from 2009 to 2017 for 188 countries around the world in order to investigate international variation in COVID‐19 mortality rates. Country‐level data on health, medical, social and policy variables are compared with COVID‐19 mortality rates, with further controls imposed to adjust for infection rate, population and health spending. The results show that prior health conditions, social deprivation and the demography of the country all have significant effects on the mortality rates associated with the virus. The evidence also suggests that countries with higher levels of health‐related policy targets demonstrated lower levels of mortality during the crisis. Finally, we confirm that social habits such as smoking, alcohol consumption and over‐eating create a highly vulnerable group of individuals who were exposed to a greater risk of mortality during the outbreak. [ABSTRACT FROM AUTHOR]

This paper proposes a measure for deprivation in social participation, an important but so far neglected dimension of human well-being. Operationalisation and empirical implementation of the measure are conceptually guided by the capability approach. Essentially, the paper argues that deprivation in social participation can be convincingly established by drawing on extensive non-participation in customary social activities. In doing so, the present paper synthesizes philosophical considerations, axiomatic research on poverty and deprivation, and previous empirical research on social exclusion and subjective well-being. An application using high-quality German survey data supports the measure's validity. Specifically, the results suggest, as theoretically expected, that the proposed measure is systematically different from related concepts like material deprivation and income poverty. Moreover, regression techniques reveal deprivation in social participation to reduce life satisfaction substantially, quantitatively similar to unemployment. Finally, the validity of the measure and the question of preference vs. deprivation are discussed. [ABSTRACT FROM AUTHOR]

The last decade has seen strong developments in child poverty measurement. Children are largely recognised to have age-specific needs, which has led to the development of child-specific poverty measures. One of the current ongoing debates is how best to collect that information. Questions regarding child deprivation are most often answered by a reference adult and assume that adult respondents provide accurate reports about their children's needs. These assumptions have largely gone untested. Making use of a unique feature of the Fijian Household Income and Expenditure Survey (2019/20), this paper explores the effect of respondent selection on child deprivation estimates. We compare three approaches to the selection of adult respondents commonly used in survey design: the children's mother, the household head, and a random adult respondent in the household. We find that adults largely agree on whether children are deprived of specific items. However, in between 5 to 24% of households (depending on the indicator), adults provide different responses regarding whether children have specific items. Despite these differences, respondent selection does not substantially alter child multiple deprivation estimates or the socio-demographic characteristics of the deprived child population. The article will be of interest to those designing surveys or questionnaires to measure child poverty and children's unmet needs. [ABSTRACT FROM AUTHOR]

Deprivation scales are becoming increasingly familiar in research and official statistics on poverty. Taking advantage of the basis of these scales in Item Response Theory, this paper proposes a more efficient approach to implementation using adaptive testing. This maximises information collected for a given amount of survey time by screening respondents on the basis of initial answers, and halting questioning where it is very unlikely any further information will be gathered. The paper illustrates various implementations using data from eight years of the UK's Family Resources Survey (FRS). Results show that an adaptive approach collects more than 99% of the information from the UK's official deprivation measure in half the survey time. In addition, the paper suggests improvements in the design of the UK's official deprivation scale as well as lessons for the development of future deprivation scales more generally. [ABSTRACT FROM AUTHOR]

In many high-income countries, governments seek to ensure that households at least have sufficient incomes to afford basic essentials such as food and clothing, but also to help citizens reach socially acceptable living standards allowing full participation in society. Their success in doing so is commonly monitored in terms of how many citizens are below a poverty line set relative to median income, and by how far below it they fall (the 'poverty gap'). Yet the threshold below which this gap starts to be measured is arbitrary, begging the question of what level of low income needs addressing. A more ambitious measure, presented in this paper, considers the extent to which people fall short of a benchmark representing a socially agreed minimum standard. This 'low income gap' can be used to represent the distance a society has to go to eliminate income that is undesirably low. The paper presents the indicator, its meaning and some recent trends in the United Kingdom, where the methodology behind the indicator has been pioneered. The results demonstrate that this empirically derived benchmark has the potential to be of value in other countries, in assessing whether they are making progress in reducing low income. [ABSTRACT FROM AUTHOR]