Socioeconomic inequalities are functions not only of intrinsic differences between persons or groups, but also of the dynamics of their interactions. Inequalities can arise and become stabilized if there are advantages (such as generalized wealth including “human capital”) which are self-enhancing, whereas depletion of limiting resources is widely distributed. A recent theory of biological pattern formation has been generalized, adapted and applied to deal with this process. Applications include models for the non-Gaussian distribution of personal income and wealth, for (...) overall economic growth in relation to inequalities and for effects of uncoupling strategies between developing and developed countries. Note added after publication: The equations (14) for the model of the income distribution, with its characteristic non-Gaussian extension towards higher incomes (fig.4), are closely related to the Fokker-Planck equation that is widely applied in many fields of physics. (shrink)

Suicide is complex; yet suicide research is dominated by ‘psy’ disciplines which can falter when seeking to explain social patterning of suicide rates, and how this relates to individual actions. This article discusses a multidisciplinary report which aimed to advance understandings of socioeconomic inequalities in suicide rates in the UK. Contrasts are drawn between health psychology and sociology. Important intersections are highlighted, including a lack of attention to socioeconomic inequalities, and an emphasis on adverse life experiences and emotions (...) to understand inequalities and suicide. There are also curious disconnects, both within and between relevant psychological and sociological perspectives. The article argues that there are significant gaps in existing theorization regarding suicide, which can only be addressed through meaningful inter-disciplinary collaborations between sociologists, psychologists and others. Current theorization in mainstream suicide research is limited by its failure to engage with enduring, yet vitally important sociological debates regarding structure and agency, nature and culture. (shrink)

There is currently enough systematic literature presents about socioeconomic inequalities across different disciplines. However, this study relates socioeconomic inequality to rural students educational management information systems in different schools in China. The dynamic force of information technology could not be constrained in the modern techno-based world. Similarly, the study was qualitative and ethnographic. Data were collected through an interview guide and analyzed with thematic scientific analysis. Ten male and ten female students were interviewed based on data saturation (...) point. The purposive sampling technique was used for the rural school and students’ selection. This study summarizes the findings and brings together in-depth emic and etic findings based on new Marxist conflict theory, exploitation, and domination power lens. The study found that SEI creates disparities among EMIS. Household income inequality has influenced on educational achievements of rural areas’ students. Gender-based SEI was not present among students. Family wealth and SES-based exploitation are present regarding EMIS among male and female students. Household wealth is significant for the EMIS. The study put forward a recommendation to the policymakers that exploitation could be overcome among students if the government provides equal opportunities for access to the EMIS. (shrink)

BackgroundImplementation of quarantine and lockdown to COVID-19 pandemic has created dramatic negative psychological impact mainly the general population’s health worldwide. We aimed to assess the prevalence and predictors of anxiety and stress severity among the Palestinian population.MethodsA cross-sectional web-based survey was conducted. An anonymous online questionnaire and snowball recruiting technique were used to target the general public in Palestine between 6 and 16 April, 2020 during COVID-19 pandemic lockdowns. Multivariate logistic regression models were developed for the outcome variables.ResultsOf the 2819 (...) individuals who completed the questionnaire, more than two thirds of them were females. Nearly, were residing at the West Bank. The mean age of participants was 29.47 years. The anxiety prevalence was with had mild/moderate severity. The stress prevalence was with had mild/moderate severity. The prevalence of both anxiety and stress was. In multivariate analysis, exposure to confirmed case of COVID-19, inadequacy of food supply and jobs that acquire leaving home during lockdown were significantly related to higher anxiety degree. As for stress, low monthly income, cohabitation with a person of a high-risk group and inadequacy of food supply were significantly related to higher stress degree.ConclusionYoung adults with low socioeconomic status and inadequate food supply were more likely to have a higher degree of stress and/or anxiety. Providing alternative economical sources for those in need, and spreading more awareness regarding the pandemic, supporting the population’s psychological wellbeing, community connection and the availability of specialist mental health services are crucial to overcome the mental impacts of COVID-19 in Palestine. (shrink)

Socioeconomic inequality is perpetuated and exacerbated by an overlooked yet serious epidemic of time theft: the act of causing others to lose their time without adequate cause, compensation, or consent. We explain why time theft goes unnoticed, how it drives socioeconomic inequality, and what businesses and policymakers can do to address it.

The strong correlation between people’s socioeconomic position and health within high income countries is a well-documented fact. A person’s occupation, income and education level tell us a lot about that person’s prospects on a long and healthy life, such that we can speak of a ‘social gradient in health’, or a ‘socioeconomic health gap’. This association is often perceived to be unjust. Therefore, it is generally thought that governments should aim to reduce socioeconomic health inequalities. However, this (...) idea needs ethical justification, for it is not evident if and why exactly these inequalities are unjust. For instance, are inequalities in health unjust per se? Or because the underlying socioeconomic inequalities are unjust? And does justice require equal health levels, or a minimum level of health? What complicates the issue, is that the width of the health gap, or the steepness of the social gradient, depends on what health measures are used. Overall, the more subjective the measure, the greater the inequalities appear to be. But are all these measures equally morally relevant? This dissertation aims to give a better understanding of these philosophical questions. It does so by investigating the question of what we should understand by health in the first part, after which it addresses the question of how to evaluate socioeconomic health inequalities in the light of justice. The introduction begins with a description of the phenomenon of socioeconomic health inequalities, and how it has been addressed by politicians, epidemiologists and philosophers in the past and today. The chapter continues by formulating the central question of the dissertation – that of which health inequalities should be focused in the light of a concern with social justice. It explicates how this dissertation contributes to answering that question, by discussing the potential relation between the conceptualisation of health and justice evaluations, and by discussing which questions are addressed in each of the following chapters. The chapter 2 addresses the question of how health is conceptualised in the philosophical and public heath literature, and how theoretical concepts of health differ. It proposes to approach health concepts as a Wittgensteinian family of thick concepts and argues that while theories on health generally argue in favour of one specific concept, a comparison of concepts shows that we may need different concepts of health given the variety of health practices. By explicating the differences between five concepts of health, this chapter argues that each captures aspects of health that all seem relevant when we talk and think about health. Classifying these concepts based on their distinctions reveals them as members of a conceptual family: each of the discussed concepts differs from the others in at least one respect and resembles the others in several respects. Moreover, the discussion of the concepts shows that ‘health’ always both describes a condition and values that condition at the same time. Having both descriptive and evaluative dimensions, we can see health concepts as ‘thick concepts’. Given this evaluative dimension, it is important to reflect on the question of what understanding of health guides specific practices. Moreover, the distinctions revealed by the classification can serve as a conceptual toolbox for reflection on the assumptions and purposes of health practices. How such reflection could work is illustrated by a brief exploration of what health aspects are focused upon in three specific health practices. Chapter 3 presents a study into the question of how health is conceptualised by ordinary citizens and to what extent conceptualisations of health differ between socioeconomic groups. By making use of the method of concept mapping, this study analyses how different socioeconomic groups formulate their own answers regarding the question ‘what does health mean to you?’. It presents concept maps of health for three different socioeconomic groups living in the city of Utrecht that reveal that all groups have a multidimensional understanding of health. An interpretation of the concept maps reveals nuanced differences between groups. The multiple aspects of health were also ranked by importance. It appears that each group assigned most importance to mental health. All in all, the study shows that people in lower socioeconomic groups are more likely to show a conceptualisation of health that refers to 1) the absence of health threats, 2) a person within his/her circumstances, 3) the value of functional notions, and 4) an accepting attitude towards life. Chapter 4 addresses the question of what the theoretical and empirical study to concepts of health could imply for health equity practices. It does so by exploring further the suggestions made in chapters 2 and 3. Regarding the question of which health aspects should guide health equity policies, this chapter discusses the question of whether we should primarily look at subjective or objective health measures, and whether a universal or relative standard of health should be central. While justice-related concerns of impartiality and equal treatment may seem to favour an objective perspective and a universal health standard, it appears that we have good reason to account for the subjective perspective as well. It is also argued that a concern for recognition and participatory parity gives room for relative health standards. Th room for relative health standards confronts us with the question of how to deal with mechanisms like adaptive preferences that the concept maps reveal. It proposes a way out, by arguing for society-relative health standards. Chapter 5 examines the question of whether inequalities in health should be evaluated ‘directly’, thus independently of a distribution of their social determinants. It proposes a sufficientarian perspective, such that the central question of evaluation is that of whether everyone is – or can be – healthy enough. By discussing two sufficientarian approaches to health and social justice – by Powers & Faden and by Nussbaum – this chapter distinguishes two ways of setting a threshold level for health. Both approaches appear to provide an unsatisfactory basis for justice evaluations and lead us away from direct evaluation if we try to settle health minima that are less arbitrary. In anticipation to chapters 6 and 7, it is argued that the perspective of sufficient health for relational equality escapes this arbitrariness: compared to that of a decent human life, it better helps to answer both the question of what socioeconomic health inequalities a society is due to avoid, and the question of when socioeconomic health inequalities are unjust considering their consequences. Chapter 6 discusses to what extent Daniels’s theory of health justice provides a satisfactory answer to the question of what health inequalities a society is due to avoid. Daniels proposes an indirect evaluative approach by arguing that we should evaluate socioeconomic health inequalities in the light of Rawls’s principles of justice as fairness. That is, if socioeconomic inequalities are in accordance with fair equality of opportunity and with the difference principle, the corresponding health inequalities would be just. It is shown that the suggestion that Rawls’s principles regulate the social determinants of health neglects that not all social determinants of health belong to society’s basic structure as conceived of by Rawls and are thereby not subjected to the principles of justice. To acknowledge the social mechanisms leading to socioeconomic health inequalities in their full complexity, it is argued that we should broaden our understanding of society’s structure in accordance with Young’s notion of social structural processes. This renders the question of what health inequalities a society is due to avoid into a question of what we can expect from the side of the various actors that uphold the social structures that produce socioeconomic health inequalities. Lastly, it is discussed how a shift to Young’s theory completes the shift to non-ideal theorising that seem already initiated by Daniels, and that with this, the distinction between direct and indirect evaluation dissolves. Chapter 7 discusses to what extent equality in health is of instrumental value for a society of free and equals. It thus takes up the idea proposed in chapter 5, that an evaluation of the consequences of health inequalities is also due. Taking relational equality as an evaluative framework reveals three ways in which inequalities in life expectancy threaten this ideal. That is, via unequal risks to stigmatisation, unequal risks to unemployment and the risk of unequal pension enjoyments. It is thereby shown that these risks are especially great for those lower down the socioeconomic strata. It thus concludes that equality in health is of instrumental value to relational equality. The chapter continues to argue that our instrumental approach opens a new perspective: to mitigate the identified injustices by changing society, rather than by reducing inequalities in health. This is argued to be an advantage in the light of the realistic assumption that of the socioeconomic health inequalities will persist. The paper thus offers a complementary approach to both the evaluation and the mitigation of the injustice of socioeconomic inequalities in health. The discussion chapter summarises the central findings of the analyses of health concepts and discusses questions regarding the philosophical and practical merits of comparing theoretical health concepts, the need for developing new health measures or concepts and the importance or nonsense of studying citizen’s views on health. Repeating this for the dissertation’s second part, the central findings of the chapters on justice evaluation are summarised and followed by a discussion of questions and issues that have remained unaddressed so far. Here, central points of discussion are my take on rules of distribution, the distinction of direct and indirect evaluation, the role of ideal and non-ideal theory, the idea of relational equality, and personal responsibility for health. The chapter concludes by noting that also in the light of justice evaluations, all commonly used health measures are relevant for justice. Therefore, my recommendations for policy and further research entail that inequalities in each of these measures deserve attention by both policymakers and researchers. Specifically, policymakers and researchers should give attention to how exactly each of these health inequalities come about, in such a way that a discussion about the question of who can be assigned responsibility to alleviate them is well-informed; and both should give attention to the effects of health inequalities on the opportunities for people to live on equal standing, in such a way that when these opportunities are diminished, actions can be considered to aim to restore relational equality. (shrink)

Rawls's signature is the thought experiment he introduced to sort out the requirements of justice. Rawls argues that “justice as fairness” will be a form of political liberalism. Rawls claims that under free institutions we should expect “profound and irreconcilable differences” in people's religious and philosophical worldviews, and in people's basic notions of what makes life worth living. In his vision of democracy, the solidarity required to support common political values and egalitarian norms of distributive justice must be built through (...) productive and fair social cooperation. Social solidarity is needed to support democratic equality, and this solidarity must be built through the mutual production and reciprocal sharing of the fruits of social cooperation. Constraining socioeconomic inequality is an essential aspect of a just scheme of social cooperation and a necessary basis for securing a mutual commitment to the rights, liberties, and opportunities that give democracy its substance and meaning. (shrink)

This review essay looks at two important recent books on the empirical social science of inequality, Richard Wilkinson and Kate Pickett's The Spirit Level and John Hills et al .'s Towards a More Equal Society? , situating these books against the important work of Michael Marmot on epidemiology and health inequalities. I argue that political philosophy can gain a great deal from careful engagement with empirical research on the nature and consequences of inequality, especially in regard to empirical (...) work on the relationship between socioeconomic inequality, status, self-respect, domination, autonomy, the quality of social relations, and societal health outcomes. The essay also raises some methodological questions about the approach taken by Wilkinson and Pickett, as well as questioning the ways in which their argument is (or is not) best understood as being fundamentally egalitarian in character. It concludes with some reflections, prompted by Hills et al ., on the lessons that should be learned by egalitarians from the experience of the Blair and Brown governments in the UK. (shrink)

This paper uses multilevel modelling and Demographic and Health Survey data from five African countries to investigate the relative contributions of compositional and contextual effects of socioeconomic status and place of residence in perpetuating differences in the prevalence of malnutrition among children in Africa. It finds that community clustering of childhood malnutrition is accounted for by contextual effects over and above likely compositional effects, that urban–rural differentials are mainly explained by the socioeconomic status of communities and households, that (...) childhood malnutrition occurs more frequently among children from poorer households and/or poorer communities and that living in deprived communities has an independent effect in some instances. This study also reveals that socioeconomic inequalities in childhood malnutrition are more pronounced in urban centres than in rural areas. (shrink)

In this paper we examine some issues of distributive justice in relation to the distribution of health in a population. Our focus is on socioeconomic inequalities in health within a society. Research suggests that socioeconomic status and level of education are strongly correlated with level of health such that those with lower status in a society are relatively sicker than their counterparts who have higher status. Importantly, the correlation we are concerned with is not the obvious correlation between (...) poor health and absolute material deprivation, or poor health and bad health habits. In nearly all countries, those at the bottom of the socioeconomic scale suffer anywhere from 2–4 times the mortality and morbidity rates of those at the top. This startling statistic apparently holds true regardless of differences in the material position of the worst-off. Moreover, even in the wealthiest countries the groups who have the highest status enjoy better health and longer life than those who have the next-highest status, and so on down the socioeconomic scale. Our question is whether these social inequalities in health are unjust in and of themselves. -/- . (shrink)

Income inequality is emerging as the socioeconomic topic of our era. Yet there is no clear conclusion as to how income inequality affects the most comprehensive human outcome measure, subjective well-being. This study provides an explanation for the relationship between income inequality and SWB, by delving into its mechanisms, including egalitarian preferences, perceived fairness, social comparison concerns, as well as perceived social mobility. In a rigorous analysis using a large cross-country dataset, and accounting for the nested (...) structure of the data, as well as controlling for a variety of individual and country characteristics, we find that SWB is higher where income inequality is higher. Importantly, we also find support for this relationship being moderated by perceptions of poverty being caused by unfairness, an individual’s relative socioeconomic standing, as well as beliefs about hard work leading to success. Our study highlights the dire need for further scholarly attention to income inequality and its complex effects on SWB. (shrink)

BackgroundDespite five decades of increasingly elegant studies aimed at advancing the pathophysiology and treatment of mental illness, the results have not met expectations. Diagnoses are still based on observation, the clinical history, and an outmoded diagnostic system that stresses the historic goal of disease specificity. Psychotropic drugs are still based on molecular targets developed decades ago, with no increase in efficacy. Numerous biomarkers have been proposed, but none have the requisite degree of sensitivity and specificity, and therefore have no usefulness (...) in the clinic. The obvious lack of progress in psychiatry needs exploration.MethodsThe historical goals of psychiatry are reviewed, including parity with medicine, a focus on diagnostic reliability rather than validity, and an emphasis on reductionism at the expense of socioeconomic issues. Data are used from Thomas Picketty and others to argue that our failure to advance clinical care may rest in part on the rise in social and economic inequality that began in the 1970s, and in part on our inability to move beyond the medical model of specificity of disease and treatment.ResultsIt is demonstrated herein that the historical goal of specificity of disease and treatment has not only impeded the advance of diagnosis and treatment of mental illness, but, in combination with a rapid increase in socioeconomic inequality, has led to poorer outcomes and rising mortality rates in a number of disorders, including schizophrenia, anxiety, and depression.ConclusionsIt is proposed that Psychiatry should recognize the fact of socioeconomic inequality and its effects on mental disorders. The medical model, with its emphasis on diagnostic and treatment specificity, may not be appropriate for investigation of the brain, given its complexity. The rise of scientific inequality, with billions allocated to connectomics and genetics, may shift attention away from the need for improvements in clinical care. Unfortunately, the future prospects of those suffering from mental illness appear dim. (shrink)

A socioeconomic and demographic analysis of U.S. Google Trends for queries about Business Ethics and Greed is proposed in the context of the 2008 financial crisis. The framework is grounded in the ethical decision-making literature. Two models using micro and macro-type variables are tested using GLM and GEE regression techniques. The frequency of these Google queries varies positively with the ratio of females, educational attainment, younger adult age, some measures of economic hardship or inequalities, and the lesser the weight (...) of the finance industry represented in each State. The frequency of queries intensifies for these same socioeconomic and demographic categories, in the aftermath of the financial crisis. This article is the first to study the salience of business ethics as an issue in the empirical literature using a nationwide database. It also provides a first empirical study in the specialized literature on “ethics in a time of crisis”. This study lays a preliminary groundwork to identify pro-ethical reform segments of the population, with practical use for financial regulatory agencies. (shrink)

This article describes overlapping links among incarceration, poor health, race, and stigma, and stigma's impact on the health of former prisoners and their families and communities. The authors include policy recommendations to reduce the impact of incarceration and stigma.

COVID-19 has uncovered the vulnerabilities, inequalities and fragility present within our social community which has exposed and exacerbated the pre-existing racial and socioeconomic inequalities that disproportionately affect health outcomes for Black, Asian and Minority Ethnic (BAME) people. Such disparities are fuelled by complex socioeconomic health determinants and longstanding structural inequalities. This paper aims to explore the inequalities and vulnerabilities of BAME communities laid bare by the Public Health England (PHE) reports published in June 2020, concluding with suggested strategies (...) to address inequalities in a post COVID-19 recovery. (shrink)

There is a vast amount of evidence across countries that the use of health care services (including hospitalizations, physician services, and clinical preventive services) is positively associated with income, education and other markers of socioeconomic position. In some analyses, lower socioeconomic status (SES) is associated with greater physician and hospital use, although it appears that these findings are primarily driven by higher rates of poor health status or medical need in socioeconomically disadvantaged populations. Three general sets of explanations (...) have been investigated to explain SES differences in health care use: (1) financial access or affordability differences (e.g. the poor use fewer services because they have fewer financial means); (2) knowledge, attitudinal and cultural differences in seeking care (e.g. the poor use fewer services because they value and/or understand the benefits of health care less than other people); and (3) health care system factors (e.g. the poor use fewer services because of ways in which the health care system is organized). The empirical evidence from a number of countries suggests that health care system variables, especially non-financial components of access, offer the greatest explanatory power regarding SES differences in utilization. The policy implications of such findings are important, for they suggests that providing universal coverage or offering free health services to the poor is not a panacea for reducing social inequalities in health care utilization. Research across countries also suggests that, although SES differences in the use of health care services may contribute to some portion of observed SES disparities in health status, the contribution here is likely to be small. Social inequalities in health status are driven by myriad factors other than access to and use of personal health services. (shrink)

Human activity is causing high rates of biodiversity loss. Yet, surprisingly little is known about the extent to which socioeconomic factors exacerbate or ameliorate our impacts on biological diversity. One such factor, economic inequality, has been shown to affect public health, and has been linked to environmental problems in general. We tested how strongly economic inequality is related to biodiversity loss in particular. We found that among countries, and among US states, the number of species that are (...) threatened or declining increases substantially with the Gini ratio of income inequality. At both levels of analysis, the connection between income inequality and biodiversity loss persists after controlling for biophysical conditions, human population size, and per capita GDP or income. Future research should explore potential mechanisms behind this equality-biodiversity relationship. Our results suggest that economic reforms would go hand in hand with, if not serving as a prerequisite for, effective conservation. (shrink)

In this paper I respond to the central claims presented in Samuel Moyn’s influential book, Not Enough: Human Rights in an Unequal World. Moyn argues that human rights have the following features: they are powerless to combat growing material inequality; they share key characteristics with neoliberalism; they make only minimalist or sufficientarian demands and therefore are not enough to achieve the equality demanded by justice. He suggests, in particular, that Henry Shue’s Basic Rights exemplifies these features. My response argues (...) that Moyn does not accurately present the core conceptual and normative characteristics of human rights, nor does he succeed in implicating Shue’s conception in his critique. I suggest that Moyn’s own ideas about global justice are incompletely developed, including his views about the scope, content, and distributive principles that should guide an account of global justice. Finally, I argue that, even though human rights are only part of an account of global justice, nonetheless they do provide reasons to limit socioeconomic inequality. This point is exemplified by the claim that a human right to democracy requires limits on material inequality in order to prevent power hierarchy. In short, I agree with Moyn that human rights are not enough by themselves to achieve global justice, but I reject his multi-pronged critique of human rights, specifically his claim that they imply no constraints on socioeconomic inequality. (shrink)

Status anxiety, the constant concern about individuals’ position on the social ladder, negatively affects social cohesion, health, and wellbeing. Given previous findings showing that status anxiety is associated with economic inequality, we aimed in this research to test this association experimentally. A cross-sectional study was run in order to discard confounding effects of the relationship between perceived economic inequality and status anxiety, and to explore the mediating role of a competitive climate. Then we predicted that people assigned to (...) a condition of high inequality would perceive more status anxiety in their social context, and they would themselves report higher status anxiety. Thus, in an experimental study PEI was manipulated. In Study 1, PEI uniquely predicted status anxiety, and perceived competitiveness mediated the relationship. In Study 2 PEI increased perceived contextual status anxiety, a specific form of perceived competitiveness based on socioeconomic status. Moreover, preliminary evidence of an indirect effect was found from PEI to personal status anxiety, through perceived contextual status anxiety. These preliminary findings provide experimental evidence for the effects of economic inequality on status anxiety and the mechanism involved. Economic inequality makes people feel that they live in a society where they are constantly concerned and competing with each other for their SES. These results could have important implications as health and wellbeing could be promoted by reducing economic inequalities and the competitive and materialistic environments of our societies. (shrink)

ObjectivesAlthough socioeconomic status has been shown to be an important determinant of physical activity in adults, the association in children and adolescents remains less consistent based on evidence from western developed countries. The purpose of this study, therefore, is to investigate associations between SES and PA among Chinese children and adolescents.MethodsA cross-sectional study was conducted with a self-reported questionnaire in China. The multi-stage stratified cluster sampling method was used, and 2,955 children and adolescents were enrolled in this study. SES (...) was assessed by measuring parental education levels, perceived family wealth, and Family Affluence Scale II. PA was assessed by reliable and valid items from the Health Behavior School-aged Children Surveillance questionnaires. Descriptive statistics were used to report sample characteristics, including demographic characteristics, levels of PA, and SES. The Chi-square test was applied to analyze the differences of PA in gender and school period. Binary logistic regression was used to analyze the association between SES and PA among children and adolescents.ResultsOverall, 10.4% of children and adolescents accumulated moderate-to-vigorous physical activity at least 60 min per day. Boys were more physically active than girls. Higher socioeconomic status was positively associated with higher physical activity levels among children and adolescents, especially using FAS and mother education level as SES measures. The association between SES and PA varied by gender and grade group, and the effects of SES are also different on weekdays and weekends.ConclusionThis study found socioeconomic disparities in PA among Chinese children and adolescents, and showed the importance of targeting children and adolescents with low SES intervention priority. Based on these research findings, it is suggested that SES, especially for FAS and mother education level, should be considered when designing and implementing the promotion of regular PA in children and adolescents. Health policymakers may use this information to develop interventions to reduce health inequalities among children and adolescents in the future. (shrink)

Growing data on the socioeconomic determinants of health pose a challenge to analysis and application of fairness in health. In Just health: meeting health needs fairly, Norman Daniels argues for a change in the population end of our thinking about just health. What about clinical care? Given our knowledge of the importance of wealth, education or social status to health, is fairness in medicine served better by continuing to avoid considering our patients’ social status in setting clinical priorities, or (...) by attempting to equalise existing health inequalities by giving priority to the socioeconomically disadvantaged at the point of care? In this article, I argue that doctors should not attempt the latter. Granted, giving priority to low status would go some way towards compensating unjust health inequalities and the impression of being left aside in other social spaces. It would represent reverse discrimination, but could still be justified inasmuch as disadvantaged groups could be identifiable, and as long as the intent was compensation rather than retribution. However, under current circumstances such priority would risk being attributed arbitrarily, would represent a form of medical proselytising, risk leaving the worst-off with less by alienating the powerful, and require teaching doctors to act in strongly counter-cultural ways—possibly at great cost. Crucially, however, we protect both equal health and equal regard by treating all alike: priority to low status would promote the first somewhat, but at the expense of sacrificing the second. (shrink)

This article analyses Adam Smith's and Sophie de Grouchy's accounts of sympathy to show how they arrive at strikingly different views on whether inequality is a threat to, or precondition of, social order. Where many scholars have recently sought to recover Smith's egalitarianism, I instead focus on how his account of sympathy in The Theory of Moral Sentiments naturalises socioeconomic inequalities, while also highlighting the wider inegalitarian implications of his analysis. I demonstrate that Grouchy was alert to these (...) implications and reveal how her own account of sympathy challenges the moral psychology underlying Smith's position on inequality. By reconstructing Grouchy's response to Smith, I illustrate how retrieving the insights of long‐overlooked thinkers can reorient the way we understand key debates in the history of philosophy, since Grouchy was far more concerned than Smith with exposing how economic inequality imperils the prospects of relating to one another as equals. (shrink)

Shortages of life-saving medical resources caused by COVID-19 have prompted hospitals, healthcare systems, and governmentsto develop crisis standards of care, including 'triage protocols' to potentially ration medical supplies during the public health emergency. At the same time, the pandemic has highlighted and exacerbated racial, ethnic, and socioeconomic health disparities that together constitute a form of structural racism. These disparities pose a critical ethical challenge in developing fair triage systems that will maximize lives saved without perpetuating systemic inequities. Here we (...) review alternatives to 'utilitarian' triage, including first-come first-served, egalitarian, and prioritarian systems of allocating scarce medical resources. We assess the comparative advantages and disadvantages of these allocation schemes. Ultimately, we argue that while triage protocols should not exacerbate disparities, they are not an adequate mechanism for redressing systemic health inequities. Entrenched health disparities must be addressed through broader social change. (shrink)

Why does sub-Saharan Africa exhibit the highest rates of gender inequality in the world? This article evaluates the contributions of Christian missionary societies in German East Africa to current socioeconomic gender inequalities in Tanzania. Previous studies ascribe a comparatively benign long-term effect of missionary societies, in particular of the Protestant denomination, on economic, developmental, and political outcomes. This article contrasts that perception by focusing on the wider cultural impact of the civilizing mission in colonial Africa. The analysis rests (...) on a novel georeferenced dataset on German East Africa—based on digitized colonial maps and extensive historical records available in the German colonial archives—and the most recently available DHS-surveys. The results highlight the formative role of Catholic missionary societies in German East Africa in shaping gender inequalities currently witnessed in Tanzania. (shrink)

Concerns about girls’ low self-esteem have generated many social programs to enhance their psychological well-being. Yet few studies determine whether the influence of self-esteem is the same for women and men. Using the High School and Beyond, 1980 Sophomore Cohort Study, the author examines the relation between gender, adolescent self-esteem, and three outcomes: Educational status, occupational status, and income attainment. She finds a positive association between gender, self-esteem, and the socio-economic outcomes initially. Taking into account social context and individual-level factors, (...) self-esteem in adolescence is not related to women’s socioeconomic achievements, but it continues to have a positive estimated effect on men’s occupational status and income attainment. However, the influence of self-esteem on men’s achievements is small in practical terms. The author suggests that adolescent girls and boys would be better served by social programs that explain how social structural arrangements contribute to gender inequality and encourage them to take part in social change. (shrink)

Roma communities across Europe still remain a neglected population group by way of the social and economic disadvantage that largely characterizes their lives. Roma communities continue to experience structural socioeconomic health inequalities on the grounds of their ethnic origin, alarmingly unveiling a pattern of systematic discrimination and ethnic marginalization. Without any doubt, such a highly worrying situation calls for States to incorporate Roma health rights within their law and policy agendas in a manner consistent with right to health requirements. (...) Against this background, this paper seeks to identify an operational human rights framework for States as a driver for better informed policies and implementation as well as for Roma engagement in the deliberations about their life prospects. The paper argues that continuing, concerted, and proactive State engagement is required for effectively addressing the structural obstacles impeding Roma socioeconomic health rights realization and maximizing Roma opportunities for well-being. (shrink)

How rich should the 1% be? And, most importantly, when does the distance in economic resources between the richest citizens and ‘us’, the average citizenry, become a concern for justice? This volume explores how excessive economic inequality gives the best-off considerably more political influence than average citizens, thereby violating political equality. It argues that the gap between the best-off and the worst-off should not be reduced because it is good, but rather as an inescapable instrument to protect citizens from (...) the risk of material domination. For this reason, it defends the ‘principle of proportionality’: economic inequality should not exceed a certain range or proportion to enable both the best-off and the worst-off to be co-authors of the legal, political, and socioeconomic rules that govern the ‘social’ relations in which they are involved. Further, the book discusses material domination and explains how money influences politics and what are the remedies for this phenomenon; how social justice should face and harmonise power, poverty, efficiency, individual merit, and economic liberties; and, most importantly, how to determine income and wealth limit ratios in a liberal democracy. A thoughtful investigation on the interdependencies of money and justice and their influence our socio-political systems, this volume will be of great interest to students and researchers of political theory, political philosophy, economics and development, economics theory and philosophy, and social policy. (shrink)

In lieu of an abstract, here is a brief excerpt of the content:Reviewed by:Women, Ethics, and Inequality in US Healthcare: “To Count among the Living” by Aana Marie Vigen, and: New Feminist Christianity: Many Voices, Many Views ed. by Mary E. Hunt and Diann L. NeuKelly Denton-BorhaugWomen, Ethics, and Inequality in US Healthcare: “To Count among the Living” By Aana Marie Vigen NEW YORK: PALGRAVE MACMILLAN, 2011. 304 PP. $31.11New Feminist Christianity: Many Voices, Many Views Edited by Mary (...) E. Hunt and Diann L. Neu WOODSTOCK, VT: SKYLIGHT PATHS, 2010. 384 PP. $24.99In this age of the Supreme Court Hobby Lobby decision, which declared that corporation owners’ religious commitments could provide a basis for denial of their employees’ critical reproductive health insurance benefits (with particular impact on the lives of women), ethical investigation of medical sociology, theology, and the realities of women’s lives is more important than ever. Originally released in 2006, Aana Marie Vigen’s Women, Ethics, and Inequality in US Healthcare makes important headway through these complex waters. And for this volume in the Palgrave Macmillan Series on Black Religion / Womanist Thought / Social Justice, editors Dwight N. Hopkins [End Page 202] and Linda E. Thomas set forth the goal to “pioneer conceptual work and boundary-pushing effort engaging Black Religion or Womanist thought, and social justice” (xiv).Rereleased in paperback in 2011 with a new preface, Vigen’s updated health statistics reveal how racial-ethnic minorities “continue to be overrepresented among the ranks of the uninsured and/or of those living in poverty” (xliii). Her project is to better understand what enables and perpetuates this inequitable distribution and oppression, and to suggest methods of redress and reform. But in order to accomplish any of this, society in general and especially those with socioeconomic power—including administrative leaders in health care, medical providers, and ethicists—need to listen much more deeply to the stories of those who are most vulnerable and are being most negatively affected by current health care systems and practices. For Vigen, this meant a decision to focus on in-depth interviews with eight black and Latina women with breast cancer, in addition to six health care providers.With this method, Vigen pursues a very ambitious goal to, as she puts it, “begin a conversation among several distinct dialogue partners: medical sociology, biomedical ethics, ethnography, theology, and feminist social ethics” (5). She uses a “reflexive” practice, striving for openness to the new insights and ideas that emerged from this creative, multidisciplinary encounter. However, even before launching her interviews, her analysis of the process to seek approval from the Institutional Research Board illustrates the “clash of cultures” she would encounter, as she writes, “one cannot take for granted that others will share the view that women of color are able to speak truth in their own right and out of their own experiences—without comparison to others—about human personhood, dignity, and adequate healthcare quality” (107). It is to Vigen’s credit that she remained undeterred; if anything, the struggle she encountered with powerful leaders helped to confirm and focus the value of this work: not to tell every story, “but to tell a few with care and attention to detail” (108).Vigen’s ethnographical method makes it possible for her to illuminate and address not only stark inequities but also much subtler dynamics of racism combined with socioeconomic discrimination. Along the way, she illustrates a wide variety of experiences of oppression. In contrast to the experience of white patients, these female patients of color tended to be sent to the accounting/financing office before being allowed to see the doctor (144). Though white patients may express strong emotions in medical settings, some women of color felt pressured to reassure white doctors that they could be rational and not overly emotional (141). Socioeconomic and racial discrimination often reinforced one another in these settings. Perhaps most alarming, Vigen notes, the white care providers she interviewed seemed to be very unconscious of [End Page 203] their own racial identity and its role in medical care encounters (165). Her final chapter concludes with a series of immensely practical ethical mandates that would help alter these oppressive patterns. Clergy, students of ethics, and anyone... (shrink)

This theoretical exploration is an attempt to conceptualize the link between gender and urban environmental health. The proposed ecofeminist framework enables an understanding of the link between the urban physical and social environments and health inequities mediated by gender and socioeconomic status. This framework is proposed as a theoretical magnifying glass to reveal the underlying logic that connects environmental exploitation on the one hand, and gendered health inequities on the other. Ecofeminism has the potential to reveal an inherent, normative (...) conceptual analysis and argumentative justification of western society that permits the oppression of women and the exploitation of the environment. This insight will contribute to a better understanding of the mechanisms underlying gendered environmental health inequities and inform healthy public policy that is supportive of urban environmental health, particularly for low‐income mothers. (shrink)

Purpose This conceptual contribution is based on the observation that digital inequalities literature has not sufficiently considered digital footprints as an important social differentiator. The purpose of the paper is to inspire current digital inequality frameworks to include this new dimension. Design/methodology/approach Literature on digital inequalities is combined with research on privacy, big data and algorithms. The focus on current findings from an interdisciplinary point of view allows for a synthesis of different perspectives and conceptual development of digital footprints (...) as a new dimension of digital inequality. Findings Digital footprints originate from active content creation, passive participation and platform-generated data. The literature review shows how different social groups may experience systematic advantages or disadvantages based on their digital footprints. A special emphasis should be on those at the margins, for example, users of low socioeconomic background. Originality/value By combining largely independent research fields, the contribution opens new avenues for studying digital inequalities, including innovative methodologies to do so. (shrink)

Schools are interesting as complex organizations in and of themselves but even more so for how they refract the societal dynamics by which inequality is reproduced, an enduringly vexing question (Fligstein & McAdam, 2012:3). Educational attainment is core to socioeconomic status and connected to outcomes in housing, health, and employment. Unequal schools in fields characterized by stratification are often the subject of reform attempts (Tyack, 1974). We examine how a wealthier and a poorer school responded to a state-level (...) regulatory mandate for change, in the U.S. context of schools as putative engines of opportunity. Bourdieu’s “master concepts” of field, habitus, and cultural capital (Swartz, 2008) are often applied, and we used them to answer frequent but still relatively unanswered calls in the literature: first, to use the master concepts together rather than singularly, and second, to attend specifically to the organization level and what it refracts (Dobbin, 2008; Emirbayer & Johnson, 2008; Hallett & Gougherty, 2018; Lounsbury & Ventresca, 2003; Mohr, 2013). For this integrative and organizational level approach, we derived the concept of “class signature,” which enabled us to focus on practices in organizations. This lens revealed “resistant compliance” in the wealthier school and “compliant resistance” in the poorer school, both of which reshaped the stratified field, even if stratification was not rectified. These responses appeared to reproduce inequality, not simplistically, we argue, but along a winding path fraught with practical experiments, protection against penalties, redefinition of the reform’s terms, and some small gains to remedy intra-organizational inequalities. (shrink)

The postwar welfare state provides social insurance against economic, health, and related risks in an uncertain world. Because everyone can envision themselves to be among the unfortunate, social insurance fuses self-interest and solidarism in a normative principle Friedman (2020) calls probabilistic justice. But there is a competing principle of status defense, where the aim is to erect boundaries between socioeconomic strata and discourage cross-class mobility. We argue that this principle dominates when inequality is high and uncertainty low. The (...) current moment is one of high inequality and high uncertainty, which results in intense status anxiety, yet does not rule out solidaristic solutions. Our contributions are to diagnose the causes of our current malaise, and to theorize the normative bases for the political choice facing contemporary western democracies. (shrink)

This paper addresses an important point with regard to the critical question of equality during a pandemic – are poor societies more vulnerable to public health emergencies? The available data with respect to the coronavirus crisis reveal that the majority of countries affected by the pandemic belong to the developed economies. This investigation determines the correlation between affluence and the spread of the contagion. It argues that the inequality among nations does not have any significant relation to disease movement, (...) infection, and high mortality rate. However, addressing the problem of urbanization and investing in public health will be crucial in terms of confronting the socioeconomic ramifications of the COVID-19 pandemic. (shrink)

Research in the Unites States concerning the relative access of women and men to financial resources has focused on the influence of women's increasing market work but has largely overlooked the also critical issue of what happens to money after it enters couple households. To fill this gap, this article employs a typology of household allocative systems developed in Great Britain to analyze money management and control in a sample of U.S. couples drawn from the Fragile Families and Child Wellbeing (...) Study. I find that the use of these systems varies substantially across socioeconomic, racial, ethnic, and relationship status groups, as well as by partners' relative household contributions. The patterns suggest that many women, already disadvantaged in earnings, either absolutely or relative to their partners, are in couples in which men's control over or withholding of income may reproduce or exacerbate their earnings disadvantage. (shrink)

This study provides much-needed empirical study of workplace inclusion of underresourced employees of low socioeconomic status. Based upon a conservation of resources perspective, we have examined the centrality of resources as a key inclusion process for well-being outcomes for employees with insufficient resources. In the context of misuse of institutional power over operative workers within highly segmented and hierarchical work settings, this study validates the importance of economic inclusion for fostering workers’ well-being via fair employment practices. This study also (...) offers new knowledge of the integrative resource model of workplace inclusion research by validating workers’ personal resources of learning orientation as an internal condition for strengthening the positive effect of economic inclusion on well-being. (shrink)

Deep and enduring socioeconomic inequalities form the backdrop to any public health policy, and influenza policy is no different. And although social justice is a core value of public health, it is important to be reminded that public health officials can neglect the disadvantaged and even exacerbate underlying inequalities.

Integrating local knowledge about environmental and socioeconomic circumstances is necessary in order for development efforts to be responsive to local realities and needs. However, knowledge-integ...

A growing body of evidence has linked consumption of trans fatty acids to cardiovascular disease. To promote public health, numerous state and local governments in the United States have banned the use of artificial trans fats in restaurant foods, and additional bans may follow. Although these policies may have a positive impact on human health, they open the door to excessive government control over food, which could restrict dietary choices, interfere with cultural, ethnic, and religious traditions, and exacerbate socioeconomic (...) inequalities. These slippery slope concerns cannot be dismissed as far-fetched, because the social and political pressures are place to induce additional food regulations. To protect human freedom and other values, policies that significantly restrict food choices, such as bans on types of food, should be adopted only when they are supported by substantial scientific evidence, and when policies that impose fewer restrictions on freedom, such as educational campaigns and product labeling, are likely to be ineffective. (shrink)

Socioeconomic differences in behaviour are pervasive and well documented, but their causes are not yet well understood. Here, we make the case that a cluster of behaviours is associated with lower socioeconomic status, which we call “the behavioural constellation of deprivation.” We propose that the relatively limited control associated with lower SES curtails the extent to which people can expect to realise deferred rewards, leading to more present-oriented behaviour in a range of domains. We illustrate this idea using (...) the specific factor of extrinsic mortality risk, an important factor in evolutionary theoretical models. We emphasise the idea that the present-oriented behaviours of the constellation are a contextually appropriate response to structural and ecological factors rather than a pathology or a failure of willpower. We highlight some principles from evolutionary theoretical models that can deepen our understanding of how socioeconomic inequalities can become amplified and embedded. These principles are that small initial disparities can lead to larger eventual inequalities, feedback loops can embed early-life circumstances, constraints can breed further constraints, and feedback loops can operate over generations. We discuss some of the mechanisms by which SES may influence behaviour. We then review how the contextually appropriate response perspective that we have outlined fits with other findings about control and temporal discounting. Finally, we discuss the implications of this interpretation for research and policy. (shrink)

This paper takes a fresh look at Elizabeth Anderson’s democratic egalitarianism and its relation to luck egalitarianism in the light of recent trends toward greater socioeconomic inequality. Anderson’s critique of luck egalitarianism and her alternative ideal of democratic equality are set out. It is then argued that the former is not very powerful, and that the latter is vulnerable to many of Anderson’s criticisms of luck egalitarianism. The paper also seeks to show that, on many of the issues (...) over which Anderson disagrees with luck egalitarians, the latter can adopt the view she canvasses without abandoning their luck egalitarianism. At most, her critique shows that we have reason to prefer some views within the luck egalitarian family over others—not that we have reason to reject luck egalitarianismas such. (shrink)

Given the grim global statistics of extreme poverty and socioeconomic inequalities, moral and political philosophers have focused on the duties of justice and assistance that arise therefrom. What the needy are morally permitted to do for themselves in this context has been, however, a mostly overlooked question. Reviving a medieval and early modern account of the right of necessity, I propose that a chronically deprived agent has a right to take, use and/or occupy whatever material resources are required to (...) guarantee her self-preservation, or the means necessary to acquire them. There are three individually necessary and jointly sufficient conditions: the need is basic, the claimant does not violate other equally important moral interests, and it is a last resort. I present two recommendations to be followed by the claimants, and offer some examples where this principle may be applied today. I reply to the objections that understanding the right of necessity in this way kills its intuitive plausibility, and that it is a remedy worse than the disease. I conclude that, while not the best solution for the problem of global poverty, the exercise of this right should be accepted if we believe in the human right to subsistence. (shrink)

Mutually beneficial exchanges in markets can be exploitative because one party takes advantage of an underlying injustice. For instance, employers of sweatshop workers are often accused of exploiting the desperate conditions of their employees, although the latter accept the terms of their employment voluntarily. A weakness of this account of exploitation is its tendency for over-inclusiveness. Certainly, given the prevalence of global and domestic socioeconomic inequalities, not all exchanges that take place against background injustices should be considered exploitative. This (...) paper offers a framework to identify exploitation in mutually beneficial exchange, focusing on the case of sweatshop labor. It argues that an employer can be viewed as taking unfair advantage of an underlying injustice if and only if the employer’s surplus from the exchange in the unjust state of affairs exceeds the surplus it could maximally obtain in a just state of affairs. The paper illustrates the applicability of this framework using three different conceptions of justice and argues that it is superior to microlevel accounts of exploitation that regard background justice as irrelevant. The paper concludes by describing some normative implications that follow from judging an exchange exploitative. (shrink)

ABSTRACTThis article explores how neoliberal and populist elements were initially fused in US political talk to legitimize the expansion of corporate power and socioeconomic inequality that has occurred over recent decades. Applying neo-Gramscian critical semiotic analysis to speeches, news texts and legislative statements about the 1981 Reagan economic plan, I illustrate how a distinctive neoliberal-populist discourse articulates signs of ‘the American people’ with signs of market individualism, and further connects these signs to the neoliberal political project’s policy moves (...) to roll back state protections and deliver large tax cuts. Neoliberal populism is a paradigmatic instance of what Stuart Hall has termed the ‘trans-coding’ of distinct semantic elements to form a new hegemonic discourse. Through neoliberal-populist signifying processes, people who are deemed unable or unwilling to inhabit market-centric subjectivities, or to promote policies defined as ‘free market,’ are ideologically drawn outside the perimeters of social esteem and political legitimacy. These processes have created obstacles to imagining a unified, politically effective opposition to the neoliberal project in the United States. Moreover, by ideologically constructing ‘the American people’ as anti-statists in the realm of economic and social welfare policy, neoliberal-populist discourse makes it difficult to articulate democratic values and practices with the state as a mechanism through which greater economic equality and substantive democracy could be realized. My analysis illuminates the immediate historical roots of a public discourse with deep anchors in popular common sense which continues to pervade official US policy talk. The cultural resonance and political influence of neoliberal-populist discourse help to explain the persistence of the neoliberal project in the USA. (shrink)

The recent Covid-19 pandemic has brought a broad range of ethical problems to the forefront, raising fundamental questions about the role of government in response to such outbreaks, the scarcity and allocation of health care resources, the unequal distribution of health risks and economic impacts, and the extent to which individual freedom can be restricted. In this clear introduction to the topic Iwao Hirose explores these ethical questions and analyzes the central issues in the ethics of pandemic response and preparedness (...) such as: The general nature of pandemics and the ethics of preparedness Ethical questions about general goals of pandemic response and preparedness The distribution of scarce resources, e.g., ventilators, hospital beds, antiviral drugs and vaccines Restrictions on individual freedom Ethical questions in the wake of pandemics, including contact-tracing, vaccine passports and socioeconomic inequalities. With the use of real-life examples and a clear philosophical approach, The Ethics of Pandemics is a much-needed introduction to some of the most important ethical issues surrounding pandemics. It is essential reading for students of ethics, bioethics, and political philosophy and will also be of interest to those working in related areas such as public policy, public health, health law, nursing and life sciences. (shrink)

How can we assess the reciprocal impacts of politics and medicine in the contemporary period? Using the example of rickets in twentieth century Britain, I will explore the ways in which a preventable, curable non-infectious disease came to have enormous political significance, first as a symbol of socioeconomic inequality, then as evidence of racial and ethnic health disparities. Between the 1920s and 1980s, clinicians, researchers, health workers, members of Parliament and later Britain's growing South Asian ethnic communities repeatedly (...) confronted the British state with evidence of persistent nutritional deficiency among the British poor and British Asians. Drawing on bitter memories of the ‘Hungry Thirties’, postwar rickets—so often described as a ‘Victorian’ disease—became a high-profile sign of what was variously constructed as a failure of the Welfare State; or of the political parties charged with its protection; or of ethnically Asian migrants and their descendants to adapt to British life and norms. Here I will argue that rickets prompted such consternation not because of its severity, the cost of its treatment, or even its prevalence; but because of the ease with which it was politicised. I will explore the ways in which this condition was envisioned, defined and addressed as Britain moved from the postwar consensus to Thatcherism, and as Britain's diverse South Asian communities developed from migrant enclaves to settled multigenerational ethnic communities. (shrink)

The article explores the main forms of domination which structure that category of classless societies in which inequalities of wealth and socioeconomic inequalities are absent, and which are often grouped together under the heading “primitive communism”. Our aim is to show that, contrary to the image conveyed by a certain Marxist tradition drawing on a rather sketchy body of ethnological information, such societies do actually present various forms of domination, which can sometimes be extremely harsh and formalized. These practices (...) in particular involve the domination exercised by the old on the young, by the holders of the esoteric knowledge on the uninitiated or the common people and, perhaps most of all, by men over the women. (shrink)

There is growing international interest in the choice of socioeconomic indicators for health research. This study used a combination of standard and novel methods to compare three occupation-based measures of social position in terms of their ability to explain variation and measure inequality in self-assessed health. The recently developed National Statistics Socioeconomic Classification (NS-SEC) is compared with its predecessor, the Registrar General64 living in private households in Scotland, logistic regression models are used to compare the classifications' ability (...) to predict self-assessed health. Concentration indices are estimated to compare how well they capture inequality in self-assessed health. The study shows that all three classifications are strongly associated with self-assessed health, though the associations are heavily attenuated by adjustment for one another and for other measures of social position. Despite their differing theoretical bases, the three are closely related. No evidence is found that any of them systematically under- or overstate the extent of inequality in self-assessed health in either men or women, and the extent to which they measure independent dimensions of social inequality is questioned. It is concluded that the availability of the new classifications is unlikely to transform our understanding of the extent or the causes of socioeconomic inequality in health, but provides useful opportunities for sensitivity analysis. (shrink)

Despite some recognition that Aboriginal women who have experienced breast cancer may have unique health needs, little research has documented the experiences of Aboriginal women from their perspective. Our main objective was to explore and to begin to make visible Aboriginal women's experiences with breast cancer using the qualitative research technique, photovoice. The research was based in Saskatchewan, Canada and participants were Aboriginal women who had completed breast cancer treatment. Although Aboriginal women cannot be viewed as a homogeneous group, participants (...) indicated two areas of priority for health‐care: (i) Aboriginal identity and traditional beliefs, although expressed in diverse ways, are an important dimension of breast cancer experiences and have relevance for health‐care; and (ii) there is a need for multidimensional support which addresses larger issues of racism, power and socioeconomic inequality. We draw upon a critical and feminist conception of visuality to interrogate and disrupt the dominant visual terrain (both real and metaphorical) where Aboriginal women are either invisible or visible in disempowering ways. Aboriginal women who have experienced breast cancer must be made visible within health‐care in a way that recognizes their experiences situated within the structural context of marginalization through colonial oppression. (shrink)