Browsing by Subject "Inequality"

Objective: This study aims to investigate the cancer epidemiology and impact of healthcare system reform on patient out-of-pocket expense, presence of catastrophic health expenditures (CHE), healthcare utilization, and inpatient/outpatient medical expenditure in China after 2009 from the perspective of health system reforms.

Methods: This study is a mixed-methods study, includes an analysis of quantitative data and key informant interviews with major stakeholders. Quantitative analysis was performed on data collected from the China Health and Retirement Longitudinal Study (CHARLS) in 2011 and 2018 to investigate the correlation between cancer prevalence, CHE incidence (households that spend 40% of their non-food incomes on healthcare), and socioeconomic characteristics. This analysis explored the healthcare utilization and out-of-pocket expenses (OOPE) of cancer patients across different socioeconomic status groups and in urban and rural areas, as well as in the eastern, central, and western regions. Key informant interviews were conducted with major stakeholders including physicians, scholars, and disease control leaders/managers. The transcripts of the interviews were coded and analyzed for themes on the results of the quantitative study, inequalities in healthcare service utilization, and inequalities in healthcare insurance finance.

Results: The self-reported prevalence rate of cancer increased from 0.93% in 2011 to 1.02% in 2018. The incidence of CHE of cancer patients increased from 45.40% in 2011 to 58.50% in 2018. Urban-Rural Resident Basic Medical Insurance (URRBMI) beneficiaries are more likely to experience CHE than Urban Employee Basic Medical Insurance (UEBMI) beneficiaries. In 2018, the incidence of CHE was significantly lower in the group with the highest socioeconomic status compared to other groups. Compared to 2008 and 2011, the outpatient visit rate for cancer patients decreased by 7% in 2018, while the hospitalization rate significantly increased by nearly 30%. Urban residents have a higher hospitalization rate, which may be related to the concentration of hospitals providing cancer treatment services in cities, and urban employees enjoy a more comprehensive health insurance benefit package. In groups with higher socioeconomic status, cancer patients tend to have higher rates of outpatient visits and hospitalizations. This may be due to their greater ability to afford the expenses associated with cancer treatment.Both the average outpatient visits expenditure and the average inpatient care expenditure have increased significantly (outpatient visits expenditure per time increased by ¥500, and inpatient per time increased by ¥7000 from 2011 to 2018). While healthcare expenditure has significantly increased, the percentage of out-of-pocket expenses (OOPE) has decreased. Reasons for the decrease include more cancer drugs being included in the reimbursement list, a reduction in the medical insurance deductible, and an increase in the reimbursement ratio.

Conclusions: The health system reforms have improved access to healthcare services, especially inpatient care, and improved drug accessibility. However, inequality in healthcare service utilization and healthcare insurance financing still exists. Inequality is mainly reflected in urban-rural differences and different socioeconomic statuses. To address inequalities within the country, China needs to take a series of coordinated actions. Include improving mechanisms used to mobilize the health insurance funds in China, and making comprehensive changes to health insurance benefit packages and healthcare resource contributions.

When do individuals feel that economic inequality needs to be corrected through redistributive government policy, such as progressive taxes or social spending? Using a cross-national data set of public opinion across both developing and developed countries, this dissertation finds that political context plays a key role in determining how individuals view economic inequality and their support for redistributive social policy. An overarching theme throughout the dissertation is that political elites are key in making inequality a prominent issue for the public. This is done by framing individual attributes such as income, ethnic identity or geographic local (urban vs. rural) in a way that will either maximize or minimize support for redistribution. When political elites lack incentives to mobilize public opinion on the issue, it becomes unlikely that individual attributes such as income or ethnicity will predict support for redistribution.

Rising demographic diversity and persistent social inequality are two defining features of youths’ social worlds, and schools and neighborhoods are key developmental contexts where this component of contemporary life plays out. This dissertation aimed to better understand the developmental implications of these twin phenomena, focusing specifically on adolescence, a critical period of development characterized by profound neurobiological and social cognitive changes. Across three studies, I asked, (1) how does exposure to different types of diversity and inequality in schools and neighborhoods relate to adolescent mental health and academic engagement? and (2) how do these relations differ across contexts and according to individual socioeconomic and racial-ethnic identity?The first chapter examined the relation between how schools say they value diversity and adolescent belonging, mental health, and academic engagement across racial groups. Results indicate that when schools’ mission statements conveyed explicit support for diversity (versus exhibiting color-evasive ideologies), racial disparities in mental health, educational aspirations, and reading achievement were smaller. However, when there was a mismatch between how schools said they value diversity and how such values were put into practice, schools’ proclaimed support for diversity was negatively associated with mental health, especially among White youth. The second chapter examined how exposure to rising inequality within neighborhoods—vis-à-vis gentrification—may impact educational outcomes. I found small positive associations between living in a gentrifying (versus chronically disinvested) neighborhood and 12th grade cumulative grade point average, intentions to pursue higher education, and one dimension of school quality: exposure to experienced teachers. However, these potential benefits of gentrification were concentrated among youth who were not economically disadvantaged and White youth. Further, for Black youth, the relation between gentrification and postsecondary plans varied according to the degree of racial turnover occurring in gentrifying neighborhoods—Black gentrification was positively associated with intentions to pursue college, but White gentrification was not. The third chapter examined two psychological mechanisms through which living in a gentrifying neighborhood may impact reading and math achievement: educational aspirations and psychological distress. Overall, there was a positive direct association between gentrification and achievement, and limited evidence of mediation. However, the pathways linking gentrification to educational aspirations, psychological distress, and achievement differed across socioeconomic and racial groups in nuanced ways that illuminate the potential costs and benefits of living in a changing neighborhood during adolescence. These three studies contribute to advancing the education, adolescent, and neighborhood literatures by examining understudied aspects of schools and neighborhoods. Findings suggest that the relation between context, identity, and development is more nuanced than is often assumed, with policy implications for how schools and neighborhoods can better address rising demographic diversity and persistent inequality.

This dissertation explores the interrelated dynamics of economic and political inequality, economic insecurity, and psychological well-being through three connected empirical studies. The first study adjudicates between conflicting findings in the unequal policy responsiveness literature. Many studies of the relative influence of income groups on U.S. policy have focused on issues over which affluent and average Americans disagree. However, scholars have posited different ways of both defining policy disagreement and measuring policy responsiveness. I assess the impact of 22 definitions of policy disagreement and two methods of measuring policy influence—based on win rates and policy change rates—on analyses of unequal responsiveness. The results of this analysis consistently indicate that U.S. policymaking institutions respond to the preferences of the affluent, but not those of average Americans. The second study examines gendered effects of unemployment on the subjective well-being of different-sex U.S. couples using recent data from the Panel Study of Income Dynamics (PSID). I eliminate the confounding influence of time-invariant person-specific characteristics that could impact both unemployment transitions and well-being through fixed effects analysis. While husbands’ unemployment is negatively associated with wives’ well-being, I find no evidence that wives’ unemployment spills over to impact husbands’ cognitive or affective well-being. The final study looks at the relationship between income change and psychological health and investigates possible asymmetry in this relationship. Analyzing data from the PSID with a combination of first-difference estimation and spline regression, I find support for the hypothesis that income losses have a larger impact than income gains on subjective well-being among partnered adults. The relationships between income changes and well-being are insignificant for single adults. Together, these studies offer new insights into the ways economic power and vulnerability shape the subjective and material realities of life for individuals and families in the United States.

The ability to raise revenue is one of the most fundamental requirements for state- hood. Without revenues, states are unable to perform even the most basic tasks. In this dissertation I aim to answer the question: When do authoritarian elites in- vest in fiscal capacity? First, I develop a theoretical argument using computational modeling techniques. I contend that inequality increases the costs associated with higher fiscal capacity due to a possible regime change in the future. On the other hand, elite demand for government spending can raise the incentives for autocrats to increase the tax capacity of the state. Complimentarity between elite-owned capital and government investment can lead to a demand for higher taxation. Based on their personal utility associated with government spending, elites weigh the current benefit of higher tax capacity with possible future costs.

I then test the overarching theoretical argument across two different datasets. First, I empirically investigate the question on a sample of over 90 authoritarian regimes from 1980 to 2006. Estimating a number of different models and including a variety of controls, I find that inequality has a strong negative long term effect on fiscal capacity. On the other hand, more industrial countries have higher levels of capacity. In the second empirical chapter, I investigate the theoretical argument on newly collected data on tax revenue and administrative spending in local Prussian counties in the 19th century. Again, I find that local inequality has strong negative effects, while more industrial areas are associated with higher levels of fiscal capacity.

Between 2015 and 2019, approximately 1.8 million Venezuelans fled into neighboring Colombia, increasing Colombia’s population by almost 4%. In this dissertation, I study the effects of this large and unprecedented migration wave on Colombian labor market outcomes and attitudes towards foreigners. In Chapter 1, I study the economic effects of the migration using variation in the migration rate across 79 metropolitan areas, labor survey data, and an instrumental variable strategy based on historical migration rates. I find that Venezuelan migration caused a moderate decrease in the hourly wages of native Colombians that is most concentrated among low-wage and informal workers. Existing studies of this migration wave using similar methods and data have estimated different magnitudes for this wage effect, and I demonstrate the differences in specification that drive these discrepancies. In Chapter 2, I study the consequences of migrant occupational downgrading by estimating an aggregate production function that incorporates imperfect substitutability between migrants and natives and migrant occupational downgrading. I find that downgrading concentrates economic competition among less educated natives and decreases output in both the short- and long-term, thus affecting both wage equality and productivity. In Chapter 3, I study the effect of migration on trust towards foreigners using a nationwide survey on social preferences. While migration has no effect on trust on average, the effect is positive in municipalities that are more urbanized, have greater access to high-quality public goods, and where there is more residential integration between migrants and natives.

While men account for 93 percent of the U.S. prison population, women have seen an increase of over 700 percent in incarceration rates since the 1980s. Despite this, most sociological and criminological research examines the incarceration and reentry experiences and consequences of men. Existing research on system-involved women rarely disentangles the role of race in women’s criminal justice involvement. Thus, this dissertation uses an intersectional approach to explore how formerly incarcerated women navigate various institutions during the incarceration and reentry period. For this project, I use 40 semi-structured interviews with women primarily in North Carolina. The chapters in this dissertation explore the following research questions; 1) How do institutional responses to women’s childhood victimization and adult entrapment shape women’s pathways to prison? 2) How do mothers define and construct their maternal identities while imprisoned? 3) What strategies do women use to navigate reentering the paid labor market?

As an aggregate, American households have shown rising debt levels over the past few decades, yet we do not understand how debt varies within households over time and what factors influence this variation in a meaningful way. To date, household debt appears predominantly as a component of measures of net worth, obscuring heterogeneity in the meaning of debt within a household. Moreover, most studies focusing specifically on indebtedness rely on cross-sectional data. In addition, no cohesive theoretical model exists to account for changing patterns of debt. This dissertation seeks to fill these gaps. Utilizing a variety of methodological approaches and drawing on longitudinal data from the National Longitudinal Survey of Youth 1979, it adds sociological explanation to a social process that has been previously ignored and under-theorized.

First, drawing from literature in economics and sociology, I propose a dynamic, life course model of indebtedness that specifies three mechanisms driving differentiation in household indebtedness: institutional context (period), social heterogeneity, and patterned disadvantage, or structural risk. Second, I use multilevel logistic regressions to explore the association between the hypothesized mechanisms and the likelihood of holding non-collateralized debt. While experiencing negative life course risks increases the likelihood of holding debt, I find that occupying positions of structural disadvantage--being black, being in poverty--decreases the likelihood of holding debt, while having advantages--higher education, being married, holding assets--increases the likelihood of holding debt, pointing to distinct differences in who can access debt to buffer life course shocks and who cannot. Examining the interrelationships between debts and assets further underscores the tenuous economic well-being of the disadvantaged. I find that those most likely to experience negative life events are both less likely to have financial assets with which to buffer these events and more likely to experience constrained access to non-collateralized debt.

Third, I employ multilevel linear regressions to examine the association between the proposed mechanisms and three unique indicators of debt burden. I find that many of the standard coefficients included in models of net worth are not significant predictors of the level of non-collateralized, non-revolving debt, suggesting that we know much more about the correlates of income and wealth than we do household debt. Variation in debt burden may be better understood by heterogeneity in non-economic variables frequently not captured in survey research. To better explore this unobserved heterogeneity, I utilize latent class regression models to estimate the early life course trajectories of debt burden for the NLSY79 cohort. I find four distinct trajectories of indebtedness with varying consequences for later life financial outcomes. Overall, I conclude that household debt is nuanced and contextually contingent. More importantly, debt adds to our understanding of long-term stratification processes when studied as a unique indicator of inequality.

This dissertation is a three-part analysis examining how the welfare state in advanced Western democracies has responded to recent demographic changes. Specifically, this dissertation investigates two primary relationships, beginning with the influence of government spending on poverty. I analyze two at-risk populations in particular: immigrants and children of single mothers. Next, attention is turned to the influence of individual and environmental traits on preferences for social spending. I focus specifically on religiosity, religious beliefs and religious identity. I pool data from a number of international macro- and micro-data sources including the Luxembourg Income Study (LIS), International Social Survey Program (ISSP), the World Bank Databank, and the OECD Databank. Analyses highlight the power of the welfare state to reduce poverty, but also the effectiveness of specific areas of spending focused on addressing new social risks. While previous research has touted the strength of the welfare state, my analyses highlight the need to consider new social risks and encourage closer attention to how social position affects preferences for the welfare state.

This paper examines the trend of variation in development performance within

China's Eastern Zone and the underlying mechanism of the changing trend. Empirical descriptions as well as analyses are provided based on the comparison between data on development performance of regions and provinces and records of policy transformation from 1949 to the end of 20th century. Furthermore, a comparative case study on two of China's leading provinces in the Eastern Zone, Guangdong and Shanghai, is conducted in order to reveal how the interplay of differences in geographical conditions and policy makes contributions to their development disparities in Maoist development period and post-Mao development period. This study finds that development as well as policy advantages are not unevenly shared in China or in China's Eastern Zone. Furthermore, the study reveals that a two-way interaction between policy and certain aspects of geographical conditions exists and it gives rise to development disparities in China's Eastern Zone. According to detailed analysis, there are two main channels through which the interaction functions. On the one hand, geographical conditions act as an important shaping force underlying policy formulation and then a specific set of policy is issued to assist development of a specific province based on the influence of its geographical conditions. On the other hand, the influence of geographical conditions comes to shape development performance directly even at the time when a similar set of policy is carried out by provinces.

Why do agents react to economic shocks privileging their identities and distrust of elites over their economic interests? This dissertation argues that this paradox can be explained by the logic of democratic representation. In a democracy, citizens delegate their economic interests to elites and institutions and forge a \emph{long-run relationship} with them. It shows that three factors -trust, identity and economic aspirations- regulate this relationship, and the fact that conflicts are processed within it can explain two puzzles: a) why economic disagreements arise while economic conditions remain unchanged and b) why economic shocks result in polarization or populism.

Firstly, it looks at the link between living standards and anti-establishment politics after financial crises. It pools 250 opinion and spending surveys and shows that unfulfilled economic aspirations undermine the trust in elites and institutions. Citizens protect their economic interests making their trust contingent on their economic aspirations. Financial crises undermine their well-being, and the ensuing decline in trust can interact with pre-existing political identities, and polarize politics along lines apparently unrelated to economic deprivations.

Secondly, it examines the link between affective polarization and economic expectations looking at 27 European countries since 1993. It identifies partisan bias looking at how citizens react to cabinet shifts. It shows that citizens with identical fundamentals but different identities update their subjective expectations in opposite directions. It argues that partisan bias is driven by affective polarization: the polarization of elites increases the hostility towards opponents, and citizens express it through their subjective expectations. However, bias does not push citizens to act against their economic self-interest. I reject alternative explanations about the source of bias including (a) lack of information (b) disagreements over the expected effects of government policy or its competence.

These findings suggest that democracy can transform the experience of citizens of economic antagonisms into conflicts with elites or about identity. However, trust and identities do not diminish the impact of economic factors, it only makes it more complex.

In the United States, poverty has been historically higher and disproportionately concentrated in the American South. Despite this fact, much of the conventional poverty literature in the United States has focused on urban poverty in cities, particularly in the Northeast and Midwest. Relatively less American poverty research has focused on the enduring economic distress in the South, which Wimberley (2008:899) calls “a neglected regional crisis of historic and contemporary urgency.” Accordingly, this dissertation contributes to the inequality literature by focusing much needed attention on poverty in the South.

Each empirical chapter focuses on a different aspect of poverty in the South. Chapter 2 examines why poverty is higher in the South relative to the Non-South. Chapter 3 focuses on poverty predictors within the South and whether there are differences in the sub-regions of the Deep South and Peripheral South. These two chapters compare the roles of family demography, economic structure, racial/ethnic composition and heterogeneity, and power resources in shaping poverty. Chapter 4 examines whether poverty in the South has been shaped by historical racial regimes.

The Luxembourg Income Study (LIS) United States datasets (2000, 2004, 2007, 2010, and 2013) (derived from the U.S. Census Current Population Survey (CPS) Annual Social and Economic Supplement) provide all the individual-level data for this study. The LIS sample of 745,135 individuals is nested in rich economic, political, and racial state-level data compiled from multiple sources (e.g. U.S. Census Bureau, U.S. Department of Agriculture, University of Kentucky Center for Poverty Research, etc.). Analyses involve a combination of techniques including linear probability regression models to predict poverty and binary decomposition of poverty differences.

Chapter 2 results suggest that power resources, followed by economic structure, are most important in explaining the higher poverty in the South. This underscores the salience of political and economic contexts in shaping poverty across place. Chapter 3 results indicate that individual-level economic factors are the largest predictors of poverty within the South, and even more so in the Deep South. Moreover, divergent results between the South, Deep South, and Peripheral South illustrate how the impact of poverty predictors can vary in different contexts. Chapter 4 results show significant bivariate associations between historical race regimes and poverty among Southern states, although regression models fail to yield significant effects. Conversely, historical race regimes do have a small, but significant effect in explaining the Black-White poverty gap. Results also suggest that employment and education are key to understanding poverty among Blacks and the Black-White poverty gap. Collectively, these chapters underscore why place is so important for understanding poverty and inequality. They also illustrate the salience of micro and macro characteristics of place for helping create, maintain, and reproduce systems of inequality across place.

How does gender inequality persist in the art world today? Or, more generally, what role do social characteristics like gender play in markets for cultural goods, such as art? That is the focus of this research. Using a novel dataset of 255,887 contemporary artworks produced by 18,624 artists and gleaned from an online marketplace, I employ the case of gender in the art world to investigate how social characteristics of producers can impact market outcomes and structures. Although there is prominent scholarship on product markets and inequality within sociology, questions such as these are rarely posed. Work generally focuses on the quality of goods and on the status of producing organizations, without attention to individual producer characteristics, including gender.The first study of this dissertation implements machine learning classification to examine whether female and male artists produce artworks with different characteristics. These analyses rely on a taxonomy of over 1,000 art-relevant features, coded by a team of art historians, to describe the disciplines, physical attributes, styles and periods, object types, and settings of each artwork in the dataset. I find that artworks by women and men do not substantively differ on the majority of aesthetic, conceptual, or material features that they depict. While some, less common, features of art appear more in work by women or men, by in large these two groups of producers do not bring different products to the art market. Studies two and three of this dissertation move to address alternative hypotheses for disparity in the economic outcomes of women and men in the contemporary art market. With mixed effect regression, I test whether artworks by women are priced differently than artworks by men, even after accounting for the categories and features they depict. I find that art by women is listed at a discount of approximately 10 to 12 percent relative to art by men. I also find that, of those art qualities that differ in use between women and men, qualities of art predominantly made by women are valued less than those predominantly made by men, net of who creates them. In combination, these findings echo and extend calls to value the labor of women and men comparably. They also broaden our understanding of the potential for social status characteristics, like gender, to act as organizing structures in the production, meaning, and valuation of markets.

My dissertation investigates twin financial interventions—urban development and emergency management—in a single small town. Once a thriving city drawing blacks as blue-collar workers during the Great Migration, Benton Harbor, Michigan has suffered from waves of out-migration, debt, and alleged poor management. Benton Harbor’s emphasis on high-end economic development to attract white-collar workers and tourism, amidst the poverty, unemployment, and disenfranchisement of black residents, highlights an extreme case of American urban inequality. At the same time, many bystanders and representative observers argue that this urban redevelopment scheme and the city’s takeover by the state represent Benton Harbor residents’ only hope for a better life. I interviewed 44 key players and observers in local politics and development, attended 20 public meetings, conducted three months of observations, and collected extensive archival data. Examining Benton Harbor’s time under emergency management and its luxury golf course development as two exemplars of a larger relationship, I find that the top-down processes allegedly intended to alleviate Benton Harbor’s inequality actually reproduce and deepen the city’s problems. I propose that the beneficiaries of both plans constitute a white urban regime active in Benton Harbor. I show how the white urban regime serves its interests by operating an extraction machine in the city, which serves to reproduce local poverty and wealth by directing resources toward the white urban regime and away from the city.

Allan Bloom observes that the “Enlightenment wished to convert the selfishness of man in the state of nature into the enlightened self-interest of man capable of joining civil society.” Amidst this backdrop of philosophers championing self-interest as man’s only true desire and reason as man’s most effective moral tool, Rousseau emerges as their greatest contrarian. Rousseau is adamant that there is not one but two principles of nature: self-preservation and pity. These two principles work together in tandem for the benefit of mankind. Pity is what naturally restrains us from unduly harming each other in the pursuit of our individual desires—it is what makes men more than “monsters.”

According to Rousseau, there was a de facto state of equality in nature, and the moral problems of society are actually the result of the interplay between reason and self-interest which make men establish and crave artificial inequalities (like wealth and power). In the Social Contract, Rousseau argues that well-ordered societies are those that tend to the general will, which refers to the collective desires of the state, or the body politic. The general will exists on account of the social pact in which each member of state has equal sovereignty. Although Rousseau does not make explicit mention of pity in the Social Contract, this paper examines the literature more wholistically in order to draw connections between pity and the general will. These connections point to how pity should be considered more seriously as a moral and social tool to remedy society. Whereas the history of Western philosophy tends to focus on self-interest and individualism, Rousseau’s emphasis on pity and the general will presents a fruitful avenue of exploration for those looking for alternative (and more collectively-oriented) solutions.

Although women’s underrepresentation in senior level positions in the workplace has multiple causes, women’s self-improvement or “empowerment” at work has recently attracted cultural attention as a solution. For example, the bestselling book “Lean In” states that women can tackle gender inequality themselves by overcoming the “internal barriers” (e.g., lack of confidence and ambition) that prevent success. I sought to explore the consequences of this type of women’s empowerment ideology. Study 1 found that perceptions of women’s ability to solve inequality were associated with attributions of women’s responsibility to do so. Studies 2, 3, and 5 experimentally manipulated exposure to women’s empowerment messages, finding that while such messages increase perceptions that women are empowered to solve workplace gender inequality, they also lead to attributions that women are more responsible both for creating and solving the problem. Study 4 found a similar pattern in the context of a specific workplace problem, and found that such messages also lead to a preference for interventions focused on changing women rather than changing the system. Study 5 documents the weakened effects of messages that explicitly explain that women’s “internal barriers” are the products of “external barriers” obstructing women’s progress. Study 6 found that women’s empowerment messages are not successful in helping women feel empowered, but rather make them feel more responsible for causing workplace gender inequality. Studies 7a and 7b suggest that these negative consequences go beyond women’s empowerment and also apply to empowerment of African Americans in the context of racial inequality. In sum, these findings suggest that self-improvement messages intended to empower women to take charge of gender inequality may also yield potentially harmful societal beliefs, and that the processes demonstrated with women’s empowerment messages may apply to other disadvantaged groups like African Americans.