Article

Pandemics within the pandemic: confronting socio-economic inequities in a datafied world

Authors:
To read the full-text of this research, you can request a copy directly from the author.

Abstract

The pandemic has brought to light and exacerbated inequities that have plagued the world even before COVID-19 spread. Despite its medical and technological advances, much of the western world was unprepared for what its people faced. With a death toll and mortality rates unseen in modern times, the datafied world amidst some populist regimes witnessed additional pandemics within the pandemic of raging infections. In the changing world broadband internet access is becoming more essential to enabling people to lead their lives while locked-down and/or in quarantine. People become accustomed to accessing healthcare information, resources and providers through mobile and or other devices for their COVID 19 information, while tracking and tracing is being carried out using mobile applications. Those at the margins become vulnerable to digital biopolitics or efforts by governments and corporations to maximize knowledge and control of populations using digital means for political and economic power. In this the datafied society, increased data surveillance offered cause for activism and fight for human rights and freedoms. This also referred to as the datafied pandemic in which life revolves on the internet more than ever through access to tools, basic services, and social environments. Within these digital divides, the forces of globalization forge ahead with perils and promises. These issues are explored in this editorial and ways of tackling the pandemics offered in the light of papers in this issue. ICT4D research offers ways in which we may together create a better world for all.

No full-text available

Request Full-text Paper PDF

To read the full-text of this research,
you can request a copy directly from the author.

... The impacts of the COVID-19 pandemic, disproportionally affecting vulnerable people and deepening pre-existing inequalities (Drèze, 2020;Qureshi, 2021), have interested the very same "development" processes that the IFIP Working Group 9.4 on the Implications of Information and Digital Technologies for Development has dealt with over time. A global development paradigm (Oldekop et al., 2020) has emerged in response to the global nature of the crisis, infusing new meaning in the spirit of "making a better world" with ICTs (Walsham, 2012) that always have characterised ICT4D research. ...
... A global development paradigm (Oldekop et al., 2020) has emerged in response to the global nature of the crisis, infusing new meaning in the spirit of "making a better world" with ICTs (Walsham, 2012) that always have characterised ICT4D research. Such a new meaning contextualises our research in the landscape of the first pandemic of the datafied society (Milan & Trerè, 2020), coming to terms with the silencing of narratives from the margins within the pandemic (Milan et al., 2021) -in Qureshi's (2021) words, a "pandemics within the pandemic" producing new socio-economic inequities in a state of global emergency. ...
Preprint
Full-text available
The impacts of the COVID-19 pandemic, disproportionally affecting vulnerable people and deepening pre-existing inequalities (Dreze, 2020; Qureshi, 2021), have interested the very same "development" processes that the IFIP Working Group 9.4 on the Implications of Information and Digital Technologies for Development has dealt with over time. A global development paradigm (Oldekop et al., 2020) has emerged in response to the global nature of the crisis, infusing new meaning in the spirit of "making a better world" with ICTs (Walsham, 2012) that always have characterised ICT4D research. Such a new meaning contextualises our research in the landscape of the first pandemic of the datafied society (Milan & Trere, 2020), coming to terms with the silencing of narratives from the margins within the pandemic (Milan et al., 2021) - in Qureshi's (2021) words, a "pandemics within the pandemic" producing new socio-economic inequities in a state of global emergency.
... The impacts of the COVID-19 pandemic, disproportionally affecting vulnerable people and deepening pre-existing inequalities (Drèze, 2020;Qureshi, 2021), have interested the very same "development" processes that the IFIP Working Group 9.4 on the Implications of Information and Digital Technologies for Development has dealt with over time. A global development paradigm (Oldekop et al., 2020) has emerged in response to the global nature of the crisis, infusing new meaning in the spirit of "making a better world" with ICTs (Walsham, 2012) that always have characterised ICT4D research. ...
... A global development paradigm (Oldekop et al., 2020) has emerged in response to the global nature of the crisis, infusing new meaning in the spirit of "making a better world" with ICTs (Walsham, 2012) that always have characterised ICT4D research. Such a new meaning contextualises our research in the landscape of the first pandemic of the datafied society (Milan & Trerè, 2020), coming to terms with the silencing of narratives from the margins within the pandemic (Milan et al., 2021) -in Qureshi's (2021) words, a "pandemics within the pandemic" producing new socio-economic inequities in a state of global emergency. ...
Conference Paper
Full-text available
The impacts of the COVID-19 pandemic, disproportionally affecting vulnerable people and deepening pre-existing inequalities (Drèze, 2020; Qureshi, 2021), have interested the very same "development" processes that the IFIP Working Group 9.4 on the Implications of Information and Digital Technologies for Development has dealt with over time. A global development paradigm (Oldekop et al., 2020) has emerged in response to the global nature of the crisis, infusing new meaning in the spirit of "making a better world" with ICTs (Walsham, 2012) that always have characterised ICT4D research. Such a new meaning contextualises our research in the landscape of the first pandemic of the datafied society (Milan & Trerè, 2020), coming to terms with the silencing of narratives from the margins within the pandemic (Milan et al., 2021)-in Qureshi's (2021) words, a "pandemics within the pandemic" producing new socioeconomic inequities in a state of global emergency. The landscape of the pandemic has affected the way ICT4D research is conducted, discussed and communicated. The conduct of "fieldwork" as we knew it in a world of few mobility restrictions, as well as the community participation that has systematically characterised ICT4D research production over the last decades (Walsham, 2017) have become impracticable. In a world of movement restrictions, the "new normal" are digital interactions. Conferencing, the space where research is communicated and our community is built and rebuilt, constituting the soul of IFIP 9.4, has had to be equally rebuilt for a digital world, changing the taken-for-granted practices that have characterised the community for the past decades. Resilience, seen with Heeks and Ospina (2019) as "the ability of systems to cope with external shocks and trends", has become fundamental in the making of research and in the interactive aspects of communicating it. It was these considerations that brought us to choose Resilient ICT4D as the theme of the 1 st IFIP 9.4 Virtual Conference on Implications of Information and Digital Technologies for Development, which took place on 26-28 May 2021. The Conference was, in the first place, an occasion to leverage the digital means to abate the barriers-of geography, geopolitical constraints, movement costs and viability-that characterise conferencing in the physical world, and whose removal has allowed community conversations that would have been very difficult in the physical world scenario. Organised virtually, with a shared governance model led by a collective of 32 Track Chairs without a host institution, the event was also a route to questioning the unilateral organisational model taken for granted when conferencing. Such a combination of the digital means with shared governance has afforded the creation of 13 conference tracks, reflecting communities from different walks of ICT4D and generating new occasions for cross-community mutual learning. A DIFFERENT PHD DAY When launching the First IFIP 9.4 Virtual Conference, the question of how to organise a PhD Day-a space for PhD candidates from around the globe to convene and discuss research and the academic world-immediately came to mind. One route to do this, following the blueprint of multiple "doctoral consortia" from academic disciplines, was that of formulating a call for applications, then selecting the "best" ones and forming a small group of 15-20 to run the event. Such a model would have had some value: small groups, it is known, allow for better interaction
... As per the findings in Table 2, the government has not been efficiently supporting entrepreneurship ideas in Nigeria financially, given that the cost of starting a business in a country like such is already incredibly high. Nigeria must be seen as an appropriate situation to fund and support the entrepreneurial innovativeness aimed at advancing ICT and better health conditions in the country and healing the most impacted services due to the pandemic (Dwivedi et al., 2020;Qureshi, 2021). Further, to fuel this transition, the government should invest massively in entrepreneurship development and develop impactful programs to facilitate business startups, operations, and growth in Nigeria (Okafor et al., 2021). ...
Article
Full-text available
The study develops a crisis response theory that could help Nigeria sustain itself in the present crisis, which is deepening unemployment, poverty, and misery due to the tremendous economic crisis it faced after the global pandemic. Entrepreneurship is viewed as a pivotal engine for reinstating the declining economic state of a country. Through the positivist research approach, the study is conducted on the owners and business executives of SMEs established and operated by entrepreneurs in Nigeria. The data analyzed through surveys, in-depth telephone interviews, and secondary sources shows that Nigeria’s economic instability is mainly because of a lack of financial assistance, industrialization, and technology limitations. Though it was observed that the government reduced certain unfriendly business regulations, corruption still caused funding conditions to shift frequently, and unreliable government policies made it challenging for entrepreneurs to thrive.
... The globe is confronted with many difficult concerns regarding addressing issues such as expanding populations, rising poverty levels, global pandemics, and civil instability (Rasul et al. 2021;Qureshi 2021). As we enter the new century, it is critical to develop realistic economic models that employ elements that most support the circumstances required for prosperity to grow and to define the appropriate objectives that should be pursued to achieve such conditions (Robèrt 2000;Rodrik and Sabel 2020). ...
Article
Full-text available
This study examines the impact of religious and educational freedoms on prosperity. The system GMM model is applied by using the data of 45 lower-, middle-, and high-income countries from 2009 to 2018. The results show that religious and academic freedoms are positively and statistically significantly associated with prosperity. It is revealed from the results that the lagged impact of both religious and education freedoms has a higher impact on prosperity than the current level of both variables. Interestingly, the interaction term between academic and religious freedom is also positive and statistically significant, indicating that their combined effect further increases prosperity. Further, the interaction term between government effectiveness and gross fixed capital formation is introduced. Its impact is positive and significant, indicating that capital investment positively affects prosperity in the case of higher government effectiveness. This study uses gross fixed capital formation and trade openness as control variables and these variables have a positive impact on prosperity, but the impact of trade openness on prosperity is insignificant. Thus, this study recommends religious and education freedom to achieve prosperity, especially in low-income countries that are already lagging.
... Some groups have demonstrated greater physical resilience in response to the virus, such as those who already have 'killer T cells' remaining from a previous, less dangerous infection (Joy, 2021, in reference to Mallajosyula et al., 2021). Resilience to the virus, and also resilience to the impact of the pandemic as a whole, however, has more often been the consequence of the socio-economic context than of purely biological traits of those groups (Strang et al., 2020;Qureshi, 2021). Thus, the conception of personal resilience here entails the ability to cope well with the broader effects of the pandemic, such as stress, isolation and its economic impact, social determinants of health that in turn affect biological resilience to disease as well. ...
Chapter
Full-text available
We study value change due to the corona pandemic. With the help of topic modelling, we analysed COVID-related news articles for changes in the frequency of how often these news articles address eleven different values. We looked at news articles from six countries (US, UK, South Africa, India, Japan, South Korea) and new articles spanning a longer period (2016–20); the latter also contained non-COVID news. We find that in the first few months of the pandemic, there is a punctuated shock in the frequency in which values are addressed. While we see a sharp increase in the value of health and safety, we see a significant decline in the values of democracy, privacy, and socio-economic equality. However, after the first months, we see a move in the opposite direction, which suggests that the punctuated shock’s effect may be cancelled over time. We also present – and offer possible explanations for – differences between countries and compare our results with the literature. We do not find evidence that the COVID-19 pandemic confronts us with a moral dilemma of health versus economic welfare, or lives versus livelihoods, as has sometimes been suggested. Our study also indicates a degree of moral resilience in the studied countries, in the sense of the ability to pay attention to morally important values, despite being put under pressure during a crisis.
... Some groups have demonstrated greater physical resilience in response to the virus, such as those who already have 'killer T cells' remaining from a previous, less dangerous infection (Joy, 2021, in reference to Mallajosyula et al., 2021). Resilience to the virus, and also resilience to the impact of the pandemic as a whole, however, has more often been the consequence of the socio-economic context than of purely biological traits of those groups (Strang et al., 2020;Qureshi, 2021). Thus, the conception of personal resilience here entails the ability to cope well with the broader effects of the pandemic, such as stress, isolation and its economic impact, social determinants of health that in turn affect biological resilience to disease as well. ...
Chapter
Full-text available
What is the best way for democratic societies to experiment with digital surveillance technologies? This chapter contributes to answering this question through the analysis of the relational ideal of democracy. I contend that the relational conception of democracy offers a viable approach to experimentations with new technologies. The relational conception of democracy, which views democracy as a way of life (or culture), supports a deliberative and context-sensitive approach to new digital technologies. To clarify what this approach entails in practice, the chapter discusses the case of South Korea’s introduction of new digital surveillance technologies during the first year of the COVID-19 pandemic. These reflections shed new light on what democracy means and provide us with valuable insights on how to design post-pandemic democracies.
... Some groups have demonstrated greater physical resilience in response to the virus, such as those who already have 'killer T cells' remaining from a previous, less dangerous infection (Joy, 2021, in reference to Mallajosyula et al., 2021). Resilience to the virus, and also resilience to the impact of the pandemic as a whole, however, has more often been the consequence of the socio-economic context than of purely biological traits of those groups (Strang et al., 2020;Qureshi, 2021). Thus, the conception of personal resilience here entails the ability to cope well with the broader effects of the pandemic, such as stress, isolation and its economic impact, social determinants of health that in turn affect biological resilience to disease as well. ...
Chapter
Full-text available
It is widely accepted that a liberal state has a general duty to protect its people from undue health risks. However, the unprecedented emergent measures against the COVID-19 pandemic taken by governments worldwide give rise to questions regarding the extent to which this duty may be used to justify suspending a vaccine rollout on marginal safety grounds. In this chapter, I use the case of vaccination to argue that while a liberal state has a general duty to protect its people’s health, there is a limit to the measures this duty can be used to justify. First, I argue that since every available option involves different risks and benefits, the incommensurability of the involved risks and benefits forbids the prioritisation of a particular vaccine. Second, I argue that given epistemic limitations and uncertainty, policies that favour certain vaccines are not only epistemically ill-founded but also morally unacceptable. I conclude that in a highly uncertain situation such as the unfolding pandemic, the duty a liberal state ought to uphold is to properly communicate the knowns and unknowns to the general public and help people decide which option to choose for themselves. I call this duty the duty to facilitate risk-taking.
... Some groups have demonstrated greater physical resilience in response to the virus, such as those who already have 'killer T cells' remaining from a previous, less dangerous infection (Joy, 2021, in reference to Mallajosyula et al., 2021). Resilience to the virus, and also resilience to the impact of the pandemic as a whole, however, has more often been the consequence of the socio-economic context than of purely biological traits of those groups (Strang et al., 2020;Qureshi, 2021). Thus, the conception of personal resilience here entails the ability to cope well with the broader effects of the pandemic, such as stress, isolation and its economic impact, social determinants of health that in turn affect biological resilience to disease as well. ...
Chapter
Full-text available
The COVID-19 pandemic has brought about the first real opportunity to test the efficacy of the Responsible Research and Innovation framework or RRI in a global health crisis. This is in view of the bold new approaches to health research and innovation that the pandemic has paved the way for. One such approach is the digital contact tracing application (CTA). Although contact tracing has been a fundamental part of infectious disease control for decades, this is the first time this technique has been used in mobile applications. Based on a Multivocal Literature Review, the development of CTAs in four countries – France, Germany, Spain, and the UK – was assessed to understand what dimensions of RRI can be identified in the governments’ response to COVID-19. This chapter shows that although from 2011, RRI has been promoted as a governance approach for increasing societal desirability of the processes and products of science and technology, very little is known about how the framework may be applied in a health crisis. Notwithstanding that RRI was not explicitly referenced during the development of CTAs in France, the UK, Spain, and Germany, the analysis has identified some interesting linkage to this framework. It shows that while no RRI approach was explicitly embraced by these governments, some key components were present – even though inadequately. It also indicates that, while it is challenging to apply RRI in crises, there is value in using it as an analytical tool for techno-social responses in situations, like those created by the COVID-19 health crisis.
... Some groups have demonstrated greater physical resilience in response to the virus, such as those who already have 'killer T cells' remaining from a previous, less dangerous infection (Joy, 2021, in reference to Mallajosyula et al., 2021). Resilience to the virus, and also resilience to the impact of the pandemic as a whole, however, has more often been the consequence of the socio-economic context than of purely biological traits of those groups (Strang et al., 2020;Qureshi, 2021). Thus, the conception of personal resilience here entails the ability to cope well with the broader effects of the pandemic, such as stress, isolation and its economic impact, social determinants of health that in turn affect biological resilience to disease as well. ...
Chapter
Full-text available
This chapter looks closely at the use of resilience as a value in pandemic discourses, and particularly at how it reflects the moral complexity of the situation the pandemic presents: an extended crisis where shocks and stressors interact and have an uncertain end. We review key aspects of how resilience has been conceptualised, generally speaking, focusing on its normative implications. Insofar as resilience is suggested as a goal, or used to evaluate individuals, groups and systems, the rhetorical use of resilience in the pandemic has moral implications that we unpack. Asking questions such as resilience to what, of what, and for whom, drives our analysis of the multiple scales at which morally relevant factors must be considered, in terms of distance and certainty, and across space and over time. Further, we highlight the importance of particularly challenging, intersecting scales both within and beyond the pandemic, such as the interaction between other- and self-regarding concerns and the tension between transformation and conservation, as we consider when to take up opportunities for improving ourselves, our society and our systems, in times of extended crises and radical change. Given that a ‘return to normal’ is neither universally desirable nor likely, we recommend in this chapter ways to address resilience as a value that can shape approaches to policy and behaviour while also being explicit about the normative—evaluative and also prescriptive—implications of its use.
... Some groups have demonstrated greater physical resilience in response to the virus, such as those who already have 'killer T cells' remaining from a previous, less dangerous infection (Joy, 2021, in reference to Mallajosyula et al., 2021). Resilience to the virus, and also resilience to the impact of the pandemic as a whole, however, has more often been the consequence of the socio-economic context than of purely biological traits of those groups (Strang et al., 2020;Qureshi, 2021). Thus, the conception of personal resilience here entails the ability to cope well with the broader effects of the pandemic, such as stress, isolation and its economic impact, social determinants of health that in turn affect biological resilience to disease as well. ...
Chapter
Full-text available
In this chapter, the COVID-19 crisis is examined as an episode that reveals various complications in the relation between values and institutions. I argue that these complications cannot be addressed satisfactorily by ethics, as this field is characterised by a gap between the identification of values worth pursuing and the effectuation of these values in society through politics. This chapter aims to bridge this gap between ethics and politics by outlining the dialectical relation between values and institutions. It will do so by first presenting values as collectively held understandings that emerge in public deliberation. Second, these values are safeguarded by setting up appropriate institutions, which, at the same time, also allows the further substantiation of these values. However, it also needs to be acknowledged that institutions are not mere instrumental solutions to further societal values. On the contrary, they have their own morally laden dynamics. As such, they should also be susceptible to adjustment following societal demand.
... Some groups have demonstrated greater physical resilience in response to the virus, such as those who already have 'killer T cells' remaining from a previous, less dangerous infection (Joy, 2021, in reference to Mallajosyula et al., 2021). Resilience to the virus, and also resilience to the impact of the pandemic as a whole, however, has more often been the consequence of the socio-economic context than of purely biological traits of those groups (Strang et al., 2020;Qureshi, 2021). Thus, the conception of personal resilience here entails the ability to cope well with the broader effects of the pandemic, such as stress, isolation and its economic impact, social determinants of health that in turn affect biological resilience to disease as well. ...
Chapter
Full-text available
The inclusion of stakeholders in science is one of the core ideas in the field of responsible innovation. Conspiracists, however, are not your garden-variety stakeholders. As the COVID-19 pandemic has shown, the conflict between conspiracists and science is deep and intractable. In this paper, we ask how the game of responsible innovation can be played with those who believe that the game is rigged. Understanding the relationship between conspiracism and responsible innovation is necessary in order to understand the unvisited corners of the science-society interface in the post-pandemic future. We claim that pluralism, already part of the philosophical background that spurred responsible innovation, can offer insights into how conspiracism can be approached. As a case in point, we develop these insights starting from the policy on conspiracism developed in 2021 by the European Commission. We show that the ideal of inclusion can only be extended to conspiracists by accepting a pluralist framework, and we explain this pluralist response.
... Some groups have demonstrated greater physical resilience in response to the virus, such as those who already have 'killer T cells' remaining from a previous, less dangerous infection (Joy, 2021, in reference to Mallajosyula et al., 2021). Resilience to the virus, and also resilience to the impact of the pandemic as a whole, however, has more often been the consequence of the socio-economic context than of purely biological traits of those groups (Strang et al., 2020;Qureshi, 2021). Thus, the conception of personal resilience here entails the ability to cope well with the broader effects of the pandemic, such as stress, isolation and its economic impact, social determinants of health that in turn affect biological resilience to disease as well. ...
Chapter
Full-text available
In most countries, including the Netherlands, decision-making about the COVID-19 policy measures was initially based on medical information, and only later did it also include insights from social sciences. However, ethical implications of COVID-19 policy measures have not frequently been explicitly considered. As a result, critical ethical issues have been overlooked, and values, concerns, and emotions have not been considered appropriately. In this chapter, I will argue that emotions can help to make important moral dilemmas around decision-making about COVID-19 explicit and to make ethically justified decisions. I will do so by zooming in specifically on how the Netherlands has handled the pandemic so far. My discussion aims to contribute to morally better and more socially acceptable decision-making about the challenges that COVID-19 poses, as well as to hopefully learn lessons for possible future pandemics.
... Some groups have demonstrated greater physical resilience in response to the virus, such as those who already have 'killer T cells' remaining from a previous, less dangerous infection (Joy, 2021, in reference to Mallajosyula et al., 2021). Resilience to the virus, and also resilience to the impact of the pandemic as a whole, however, has more often been the consequence of the socio-economic context than of purely biological traits of those groups (Strang et al., 2020;Qureshi, 2021). Thus, the conception of personal resilience here entails the ability to cope well with the broader effects of the pandemic, such as stress, isolation and its economic impact, social determinants of health that in turn affect biological resilience to disease as well. ...
Chapter
Full-text available
This chapter explores the shift in the balance of individual versus collective values instigated by the COVID-19 pandemic. The incredible viral spread rate among the population and its relatively high fatality rate has initially resulted in an assertion of the primacy of collective values (such as collective safety, collective responsibility, conformism). In contrast, individual rights and values (such as the individual counterparts of autonomy, freedom, responsibility, and privacy) took a ‘back seat’ for the good of the collective. However, as the pandemic extended over the months, there emerged a pressure to reject the primacy of collective values and restore the importance of individual values. If we are to return to a healthy and prosperous living within a well-functioning society, this balance shift between collective and individual values will have to be re-negotiated and resolved to reach a societally acceptable balance position. We conduct this ethical exploration, first, by following the ethico-philosophical discussion on the balance between individual and collective values generally, as well as in times of crisis, with special focus on the COVID-19 crisis. Second, we explore this topic through the lens of recent changes to how particular technologies were and are used before and during the COVID-19 pandemic. More precisely, we identify and explore broad trends we see relevant to ethics – with a particular focus on crowd management and nudging and on the balance shift between individual and collective values. Finally, by exploring findings from a sociophysics case study dealing with crowd management of people before and during the pandemic, we argue that some sociophysical phenomena can be used as proxies for ethical principles. Here, distance is used as a conceptual proxy for individual and collective responsibility, having in mind COVID-19 distancing rules and recommendation. With all the above, we identify several broad trends that have been instigated by the pandemic that are relevant to ethics. These changes relate to future crowd management, nudging, and control; individual (per-person) tracking; insistence on the importance of collective values in times of crisis, and the rejection of this infringement upon individual rights. In this regard, we assert that such value changes are an opportunity to rethink and (re)set balance points between individual and collective rights for each particular society.
... Some groups have demonstrated greater physical resilience in response to the virus, such as those who already have 'killer T cells' remaining from a previous, less dangerous infection (Joy, 2021, in reference to Mallajosyula et al., 2021). Resilience to the virus, and also resilience to the impact of the pandemic as a whole, however, has more often been the consequence of the socio-economic context than of purely biological traits of those groups (Strang et al., 2020;Qureshi, 2021). Thus, the conception of personal resilience here entails the ability to cope well with the broader effects of the pandemic, such as stress, isolation and its economic impact, social determinants of health that in turn affect biological resilience to disease as well. ...
Chapter
Full-text available
Our world is changing in rapid and unanticipated ways. Given technology’s central role in those changes, engineers face difficult design decisions. In dominant consequentialist and deontological engineering ethics paradigms, making design choices implies having sufficient information on those choices and their trade-offs, which is often lacking. Some scholars have pointed to virtue ethics as an alternative approach to engineering ethics, but how can virtue ethics support engineers in situations of uncertainty? In this chapter, we explore how virtue ethics is conducive to sound engineering in different conditions of uncertainty.
... Those at the margins become vulnerable to digital biopolitics or efforts by governments and corporations to maximize knowledge and control of populations using digital means for political and economic power. In this the datafied society, increased data surveillance offered cause for activism and fight for human rights and freedoms (Qureshi, 2021). If the cyber-world is seen as an alternative sphere that is devoid of the true institutions of power and oppression then it can be seen as a place for people to network and collaborate but ultimately only a landscape of ideas. ...
Article
As the world watches millions of refugees whose livelihoods ripped apart by deadly missile attacks, this editorial investigates the forces that lead to the marginalization of populations as they battle for their sovereignty from the margins. It draws upon current publications to offer insights into the transformation of the lives of those residing in world's economic margins. Places that were once economic peripheries are now at the center of the digital transformation of the global economy as it changes how those at the margins can attain their freedoms. Insights from patching development and technologies of the oppressed offer unique insights into ways out of the structural oppression. Insights from these and papers published in this issue offer contributions to what we know about digital transformation in the context of socio-economic and human development and how the battle for the soul of self-sovereignty is won by digital transformation at the margins.
... As per the ndings in Table 2, the government has not been e ciently supporting the entrepreneurship ideas in Nigeria nancially, given that the cost of starting a business in a country like such is already incredibly high. It must be seen as an appropriate situation in Nigeria to fund and support the entrepreneurial innovativeness aimed at advancing ICT and better health conditions in the country and healing the most impacted services due to the pandemic (Qureshi, 2021;Dwivedi et al., 2020). Further, to fuel this transition, the government should invest massively in entrepreneurship development and develop impactful programs to facilitate business startups, operations, and growth in Nigeria (Okafor et al., 2021). ...
Preprint
Full-text available
Being a mono-economic nation, Nigeria is undergoing a tremendous economic crisis due to the increased impact of recession after the global pandemic appeared. The present scenario of COVID-19 and the prevalent economic crisis in Nigeria demand a crisis response. This study develops a crisis response theory that could help Nigeria sustain itself in the present crisis, which is deepening unemployment, poverty, and misery. Entrepreneurship is viewed as a pivotal engine for reinstating the declining economic state of a country. Thus, surveys are put together in this research from different institutions and entrepreneurial ventures to evaluate the impact of COVID-19. This research suggests possible solutions based on entrepreneurial innovativeness for a better future, as it affects Nigeria vis-à-vis its economic relationship with global economic dynamics. The pandemic has worsened the prevailing economic crisis in Nigeria. Entrepreneurship can help the Nigerian economy grow, but the deep roots of corruption and unreliable government policies make it challenging for entrepreneurs to thrive.
... The COVID-19 pandemic brought forth varied attitudes by parents on learning from home, whether disengaged, positive, or negative (Pratama & Firmansyah, 2021). A "pandemic within the pandemic" evolved within which life centered more than ever around family access to digital tools while locked down or in quarantine (Qureshi, 2021). ...
Article
Full-text available
This survey of parents of children ages 2–18 (n = 240) investigated children’s frequency of access to public library materials prior to (T1), during (T2), and predicted after (T3) the COVID-19 pandemic. Frequency of access to public library materials was compared by demographic and other factors. Repeated measures ANOVA showed a significant difference T1-T2 and T2-T3. Significant interactions were found for school environment and frequency of access over time, with online and hybrid students showing a significant decrease in access from T1 to T2 and an expected significant increase from T2 to T3. Results suggest that children’s reading behaviors were impacted, thus academic performance may have been impeded.
... This study showed a 50% higher use of the internet for Brazilian medical students, the same difference is observed in the human development index (HDI) of both countries (WHO, 2020b) and in the use of the internet by the general population (PRC, 2016) for both countries. Qureshi (2021) reviewed this specific point, observing that Covid-19 pandemic highlighted the disparities of information access around the world based on the following chain: socioeconomic inequities -HDI -economic growth -digital startups -digital divide and poverty -health inequities. Technological, individual, domestic, institutional, and community barriers cause many difficulties in online learning. ...
Article
Full-text available
Covid-19 pandemic affected medical students in all countries of the world. These are times of challenges and opportunities to increase medical knowledge and to practice preventive measures. There is a considerable number of situations that can cause psychological symptoms in medical students, including human development. The aim of this study is to compare medical knowledge, preventive measures, and psychological perceptions in Brazilian and Mozambican medical students. Electronic questionnaires were sent by social network, then descriptive statistics and data pairing were performed. Comparison of groups data showed that internet was the first font of information for most Brazilian students (internet: 59,3%, television: 11,1%) and television was the first font most declared by Mozambicans (television: 40,7%, internet: 33,3%) (p=0,033). Brazilian students performed better in the knowledge test (global average: 74,8% vs. 53,0%, p=0,001). Mozambican student adopted preventive measures with better adherence (do not touching oral, nasal, or ocular mucosa: 85,2 vs. 51,9, p: 0,014) but reported more use of self-medication (37,0% vs. 74,1%, p=0,048). Brazilian student presented more psychological effects, as being restless (77,8% vs. 33,3%, p=0,005), with worsening in the past 30 days (48,1% vs 22,2%, p=0,049) and partial inability in 10,6 vs. 3,9 days in the last 30 days (p=0,022). Human development index, internet access, and other issues are discussed as possible important factors for these differences.
Chapter
This paper explores notions of resilience and adaptability in the context of the design, development and pilot of a mobile phone application, COVID-Aware, for enhancing risk awareness during the COVID-19 pandemic. Through an interdisciplinary team approach, we explore the utilization of an information and communications technology platform in supporting resilience and wellbeing at the individual and collective levels among community members. The study integrated data models, that were developed in Jamaica to predict the risk of COVID-19, with existing epidemiological models developed for COVID-19 in different parts of the world. Participants’ perspectives on adapting to the use of the app on their mobile devices assisted with exploring ways to share visualisations of this data, and their views of adaptations to health protocols provided feedback for participatory development of the app. The use of the mobile application to support risk awareness, assessment and potential choices, and implications for resilience are discussed.
Article
Full-text available
Article
Disasters like forest fires have become a persistent challenge in Himalayan regions due to highly inflammable Pine leaves. Solutions like producing bio-briquettes require involvement of local villagers, which depends on creating socio-economic and social entrepreneurship opportunities. Our research addresses these challenges by developing and evaluating governance interventions to connect villagers with local market through a mobile app platform and shape an ecosystem. We conduct an interpretive case study based on literature on digital platform ecosystems and multi-sided platforms. We use activity theory to analyze case data on implementation of governance interventions and behavior of ecosystem actors towards the challenge of producing and selling pine briquettes through the platform. Our findings suggest that characteristic features of a platform ecosystem running in a socio-economic setting differ substantially from commercial ecosystems. Our research could be one of the first to contribute to digital platforms for development in a local socioeconomic context.
Book
Full-text available
In the first pandemic of the datafied society, the disempowered were denied a voice in the heavily quantified mainstream narrative. Featuring stories of invisibility, injustice, hope and resistance, this book gives voice to communities at the margins in the Global South and beyond. The multilingual, polycentric and pluriversal narration invites the reader to enact and experience “Big Data from the South(s)” as a decolonial lens to read the pandemic.
Article
Full-text available
Background The COVID-19 pandemic has become a global public health event, which has raised concerns regarding individuals’ health. Individuals need to cope with the COVID-19 pandemic with guidelines on symptom recognition, home isolation, and maintain mental health. Besides routine use of mobile health (mHealth) such as accessing information to keep healthy, individuals can use mHealth services in situations requiring urgent medical care, which is defined as mHealth emergency use. It is not known whether individuals have increased their daily mHealth services emergency use as a result of disruptions caused by the COVID-19 pandemic. Objective The purpose of this diary analysis study is to assess the influences of daily disruptions related to the COVID-19 pandemic on individuals’ mHealth emergency use. The secondary purpose of this study is to explore the mediating role of COVID-19–induced strain and the moderating role of promotion regulatory focus in the relationship between daily disruptions of COVID-19 and mHealth emergency use. Drawing from the cognitive activation theory of stress, we investigated the underlying mechanism and boundary condition of the influence of COVID-19–related disruptions on daily mHealth emergency use. Methods To test the proposed model, this study adopts the experience sampling method to collect daily data. The experience sampling method helps researchers to capture participants’ fluctuations in emotions, mental engagement in an activity, and experienced stress. This study collected 550 cases nested in 110 samples in mainland China to test the conceptual model. In addition, we employed hierarchical linear modeling analysis to test the effect of COVID-19–related disruptions on mHealth emergency use. Results We found that COVID-19–related disruptions increased COVID-19–induced strain (γ=0.24, P<.001) and mHealth emergency use on a daily basis (γ=0.28, P<.001). COVID-19–induced daily strain mediated this relationship (effect=0.09, 95% CI 0.05-0.14). Promotion regulatory focus moderated the relationship between COVID-19–induced strain and mHealth emergency use (γ=0.35, P=.02). In addition, the indirect relationship between disruptions and mHealth emergency use intentions through COVID-19–induced strain is contingent upon promotion regulatory focus: this relationship was stronger in those with high promotion regulatory focus (effect=0.12, 95% CI 0.06-0.19) than in those with low promotion regulatory focus (effect=0.06, 95% CI 0.02-0.11). Conclusions Event disruption of the COVID-19 pandemic induced mHealth emergency use intention through increased psychological strain. Furthermore, individuals’ promotion regulatory focus amplified this indirect relationship. Our findings extend our understanding of the factors underlying mHealth emergency use intention and illustrate the potential contingent role of promotion regulatory focus in the cognitive activation theory of stress. This study also opens avenues for future research on mHealth emergency use intention in other countries and cultural settings.
Book
Full-text available
This book analyses the role of public action in solving the problem of hunger in the modern world. The study is divided into four parts. The first, making extensive use of the concepts of entitlements and capabilities explores the interaction of nutritional, economic, social, and political elements and their influence on hunger and deprivation. The problem of famine prevention is the main focus of the second part, with special attention given to Africa and India. The third part is devoted to the issue of fighting chronic undernourishment and the lessons to be learnt from the policies of China, India, and some other countries. The last part draws together the main themes and concerns of the earlier chapters, and provides an integrated view of the role of public action in eliminating hunger. The study suggests that there is indeed some space for public action in solving the problem of hunger and deprivation. In the case of famine prevention, social security could provide early warning systems and employment provision plans. To fight endemic deprivation, the authors suggest, among other things, that basic health care, elementary education, and food programmes should be looked at.
Article
Full-text available
Quantification is central to the narration of the COVID-19 pandemic. Numbers determine the existence of the problem and affect our ability to care and contribute to relief efforts. Yet many communities at the margins, including many areas of the Global South, are virtually absent from this number-based narration of the pandemic. This essay builds on critical data studies to warn against the universalization of problems, narratives, and responses to the virus. To this end, it explores two types of data gaps and the corresponding “data poor.” The first gap concerns the data poverty perduring in low-income countries and jeopardizing their ability to adequately respond to the pandemic. The second affects vulnerable populations within a variety of geopolitical and socio-political contexts, whereby data poverty constitutes a dangerous form of invisibility which perpetuates various forms of inequality. But, even during the pandemic, the disempowered manage to create innovative forms of solidarity from below that partially mitigate the negative effects of their invisibility.
Article
Full-text available
The release of final rules from the Office of the National Coordinator for Health Information Technology’s (ONC) Cures Act in March 2020 places a new focus on patients’ access to their health data.¹ The ONC rules make “health data more computable and [give] patients more control of their medical record.”¹ Hopefully, patients will be able to interact more easily with their data through patient portals and mobile health apps, and “shop for care by comparing costs, understanding possible treatments, and expected health outcomes.”¹ The new rules intend to increase the pace of innovation and investment in patient-facing tools. Building on more than 300 000 health apps and $7.4 billion in digital health investments in 2019 alone, this policy environment may significantly transform the ways patients access care.
Article
Full-text available
Background: The coronavirus disease (COVID-19) pandemic is the biggest global economic and health challenge of the century. Its effect and impact are still evolving, with deaths estimated to reach 40 million if unchecked. One effective and complementary strategy to slow the spread and reduce the impact is to trace the primary and secondary contacts of confirmed COVID-19 cases using contact tracing technology. Objective: The objective of this paper is to survey strategies for digital contact tracing for the COVID-19 pandemic and to present how using mobile positioning data conforms with Nigeria’s data privacy regulations. Methods: We conducted an exploratory review of current measures for COVID-19 contact tracing implemented around the world. We then analyzed how countries are using mobile positioning data technology to reduce the spread of COVID-19. We made recommendations on how Nigeria can adopt this approach while adhering to the guidelines provided by the National Data Protection Regulation (NDPR). Results: Despite the potential of digital contact tracing, it always conflicts with patient data privacy regulations. We found that Nigeria’s response complies with the NDPR, and that it is possible to leverage call detail records to complement current strategies within the NDPR. Conclusions: Our study shows that mobile position data contact tracing is important for epidemic control as long as it conforms to relevant data privacy regulations. Implementation guidelines will limit data misuse.
Article
Full-text available
Even though the effects of mobile phone and internet usage on the health and wellbeing of a population are becoming apparent, few studies have uncovered the nature of this relationship to the equitable provision of healthcare. The contribution is in discovering the relationships between mobility effects and human development where inequities in income play an important role, the relationships to socio-economic development and in showing how the mobility effect can assist in addressing health inequities.
Article
Full-text available
This paper seeks to illuminate the significance of datafication for anti-poverty programmes, meaning social protection schemes designed specifically for poor people. The conversion of beneficiary populations into machine-readable data enables two core functions of social protection, those of recognising entitled beneficiaries and assigning entitlements connected to each anti-poverty scheme. Drawing on the incorporation of Aadhaar, India’s biometric population database, in the national agenda for social protection, we unpack a techno-rational perspective that crafts datafication as a means to enhance the effectiveness of anti-poverty schemes. Nevertheless, narratives collected in the field show multiple forms of data injustice on recipients, underpinned by Aadhaar’s functionality for a shift of the social protection agenda from in-kind subsidies to cash transfers. Based on such narratives the paper introduces a politically embedded view of data, framing datafication as a transformative force that contributes to reforming existing anti-poverty schemes.
Article
Full-text available
The role of data within international development is rapidly expanding. However, the recency of this phenomenon means analysis has been lagging; particularly, analysis of broader impacts of real-world initiatives. Addressing this gap through a focus on data’s increasing presence in urban development, this paper makes two contributions. First – drawing from the emerging literature on ‘data justice’ – it presents an explicit, systematic and comprehensive new framework that can be used for analysis of datafication. Second, it applies the framework to four mapping initiatives in cities of the global South. These initiatives capture and visualise new data about marginalised communities: residents living in slums and other informal settlements about whom data has traditionally been lacking. Analysing across procedural, rights, instrumental and structural dimensions, it finds these initiatives deliver real incremental gains for their target communities. But it is external actors and wealthier communities that gain more; thus, increasing relative inequality.
Article
Full-text available
We examine the current 'datafication' process underway in low- and middle-income countries (LMICs), and the power shifts it is creating in the field of international development. The use of new communications and database technologies in LMICs is generating 'big data' (for example from the use of mobile phones, mobile-based financial services and the internet) which is collected and processed by corporations. When shared, these data are also becoming a potentially valuable resource for development research and policy. With these new sources of data, new power structures are emerging within the field of development. We identify two trends in particular, illustrating them with examples: first, the empowerment of public-private partnerships around datafication in LMICs and the consequently growing agency of corporations as development actors. Second, the way commercially generated big data is becoming the foundation for country-level 'data doubles', i.e. digital representations of social phenomena and/or territories that are created in parallel with, and sometimes in lieu of, national data and statistics. We explore the resulting shift from legibility (Scott, 1998) to visibility, and the implications of seeing development interventions as a byproduct of larger-scale processes of informational capitalism.
Article
Full-text available
The health of rural America is more important than ever to the health of the United States and the world. Rural Healthy People 2020's goal is to serve as a counterpart to Healthy People 2020, providing evidence of rural stakeholders' assessment of rural health priorities and allowing national and state rural stakeholders to reflect on and measure progress in meeting those goals. The specific aim of the Rural Healthy People 2020 national survey was to identify rural health priorities from among the Healthy People 2020's (HP2020) national priorities. Rural health stakeholders (n = 1,214) responded to a nationally disseminated web survey soliciting identification of the top 10 rural health priorities from among the HP2020 priorities. Stakeholders were also asked to identify objectives within each national HP2020 priority and express concerns or additional responses. Rural health priorities have changed little in the last decade. Access to health care continues to be the most frequently identified rural health priority. Within this priority, emergency services, primary care, and insurance generate the most concern. A total of 926 respondents identified access as the no. 1 rural health priority, followed by, no. 2 nutrition and weight status (n = 661), no. 3 diabetes (n = 660), no. 4 mental health and mental disorders (n = 651), no. 5 substance abuse (n = 551), no. 6 heart disease and stroke (n = 550), no. 7 physical activity and health (n = 542), no. 8 older adults (n = 482), no. 9 maternal infant and child health (n = 449), and no. 10 tobacco use (n = 429). © 2015 The Authors The Journal of Rural Health published by Wiley Periodicals, Inc. on behalf of National Rural Health Association.
Article
Full-text available
In the past 15 years, we have seen a marked increase in research on socioeconomic status (SES) and health. Research in the first part of this era examined the nature of the relationship of SES and health, revealing a graded association; SES is important to health not only for those in poverty, but at all levels of SES. On average, the more advantaged individuals are, the better their health. In this paper we examine the data regarding the SES-health gradient, addressing causal direction, generalizability across populations and diseases, and associations with health for different indicators of SES. In the most recent era, researchers are increasingly exploring the mechanisms by which SES exerts an influence on health. There are multiple pathways by which SES determines health; a comprehensive analysis must include macroeconomic contexts and social factors as well as more immediate social environments, individual psychological and behavioral factors, and biological predispositions and processes.
Article
Objectives: Information and communication technology (ICT) has emerged as an appealing approach to address the changing life satisfaction of the aging population. This study explores the influence of perceived benefit and social support on the life satisfaction of elderly individuals via the mediation of their ICT use, from a motivation perspective. Additionally, we explore the moderating effect of health consciousness on the relationship between perceived benefit, social support and ICT use for the elderly. Methods: Using 237 valid samples from elderly individuals in China, we conducted a survey to evaluate their ICT use, perceived benefit, social support and life satisfaction. Results: Perceived benefit and social support both can influence life satisfaction of elderly individuals, and the effects of these factors are mediated by elderly ICT use. Furthermore, health consciousness can moderate the relationship among perceived benefit, social support and ICT use for the elderly. Conclusions: Both intrinsic and extrinsic motivations can influence ICT use by elderly individuals as well as their life satisfaction. ICT use plays an important role in life satisfaction for elderly people, and their individual health consciousness is a crucial factor.
Book
There is widespread concern that the growth of the Internet is exacerbating inequalities between the information rich and poor. Digital Divide examines access and use of the Internet in 179 nations world-wide. A global divide is evident between industrialized and developing societies. A social divide is apparent between rich and poor within each nation. Within the online community, evidence for a democratic divide is emerging between those who do and do not use Internet resources to engage and participate in public life. Part I outlines the theoretical debate between cyber-optimists who see the Internet as the great leveler. Part II examines the virtual political system and the way that representative institutions have responded to new opportunities on the Internet. Part III analyzes how the public has responded to these opportunities in Europe and the United States and develops the civic engagement model to explain patterns of participation via the Internet.
Article
Digital health literacy is an extension of health literacy and uses the same operational definition, but in the context of technology. Technology solutions have the potential to both promote health literacy or be a barrier. To be effective, health technology solutions should go beyond building literacy and numeracy skills to functional and critical skills, such as navigating the healthcare system, communication with healthcare providers, and shared decision making. New and emerging technologies are highlighted: AI/machine learning, voice first, remote patient monitoring, wearables, and apps and web sites. Health technology represents enormous promise in the building of digital health literacy skills and improved health outcomes in patients with cardiovascular and other chronic conditions. This is a promise, however, that is yet to be fulfilled. TOPICS: Hypertension, Rehabilitation, Metabolic Syndrome, Health Policy, Risk Factor.
Chapter
Undoubtedly one of the highlights of the 1999 Conference was the plenary session in which Professors David Held and Mahdi Elmandjra came together to discuss the theme of ‘“Globalization”: Democracy and Diversity’. The Conference also witnessed the launch of Global Transformations (Polity Press, 1999), at which David Held was joined by two of his three coauthors, Professor Anthony McGrew and Dr Jonathan Perraton. Global Transformations is the product of almost a decade’s work by a research team (based at the Open University and supported by the ESRC) who have produced what James. N. Rosenau has called ‘the definitive work on globalization’. It is a study which not only synthesises an extraordinary amount of information from research on globalization in a range of social science disciplines, but also makes its own distinctive contribution to our understanding of the complex range of forces which are reshaping the world order. We are delighted to be able to reproduce here an ‘executive summary’ of Global Transformations that summarises the major findings of this 500-page survey in just six thousand words.
Article
John W. Sewell takes up the ‘politics of development’, looking specifically at the politics of aid in the United States and overall at the impact of globalization on development co-operation and its implications for ODA and offers some suggestions on the impact of globalization on the politics of development.Development (1999) 42, 31–35. doi:10.1057/palgrave.development.1110057
Article
An unprecedented federal effort is under way to boost the adoption of electronic health records and spur innovation in health care delivery. We reviewed the recent literature on health information technology to determine its effect on outcomes, including quality, efficiency, and provider satisfaction. We found that 92 percent of the recent articles on health information technology reached conclusions that were positive overall. We also found that the benefits of the technology are beginning to emerge in smaller practices and organizations, as well as in large organizations that were early adopters. However, dissatisfaction with electronic health records among some providers remains a problem and a barrier to achieving the potential of health information technology. These realities highlight the need for studies that document the challenging aspects of implementing health information technology more specifically and how these challenges might be addressed.
Article
Incl. bibl., abstract. Philippe Quéau illustrates how the global information society tends to create a unified market of formatted exchanges and practices, which do not always take into account the cultural specificities and the special needs of the many 'knowledge societies' around the world. The global information society also has to confront the extreme disparities of access to information and knowledge between the industrialized countries and the developing countries, as well as within societies themselves. This inevitably induces the need for fundamental political choices and arbitrages on the goals socially desirable, and a definition of the 'global common good'.
Article
Taken from The Alfred Deakin Lectures on 15 May 2001, broadcast by the Australian Broadcasting Corporation (ABC) National Radio, Amartya Sen looks critically at the anti-globalization protestors in his discussion of global doubts as global solutions. Development (2002) 45, 11–16. doi:10.1057/palgrave.development.1110341
Article
Incl. bibl. notes, index.
Article
This article reflects on contemporary social development, and suggests that we need to initiate a process of thinking about a post neo-liberal development agenda. As a step in this direction, it is suggested we need to re-approach the social as a conceptual category in order to consider social analysis not simply as an epiphenomenon of economic development, but as a social sphere in its own right. To start thinking about this process, the social is approached through the metaphor of the middle ground, which acts as a device to help conceptualize a field of action between social life and policy processes. Exploration of this field of action is used to consider changes in the policy community by focusing on the implications of 'liberal freedom' and 'negative freedom' for people's actions. This provides a basis to take a critical view of concepts such as social capital and approaches such as sustainable livelihoods, reflect neo-liberal social development discourses. This leads us to argue for the need to consider the potential of contemporary biological science and of social movements for reinvigorating our understanding of social development. Copyright © 2003 John Wiley & Sons, Ltd.
Article
Because social development is primarily concerned with practical matters, little attention has been paid to the ideas, concepts and theories that inform social development interventions. Most publications on social development make little reference to theoretical issues, and most practitioners are unaware of the conceptual derivation of their activities. However, although seldom recognized or acknowledged, social development practice has, in a subtle and indirect way, been informed and shaped by a variety of intellectual ideas that, in turn, reveal a commitment to different normative perspectives. This paper traces the contribution these perspectives have made to social development over the years. By documenting this intellectual heritage, it hopes to promote a greater awareness of theoretical issues and, at the same time, to foster social development's conceptualization. Copyright © 2003 John Wiley & Sons, Ltd.
Article
Development Studies has been dominated by a mainstream economics-based agenda that has failed to study and recognise the importance of social and political processes and patterns of poverty. Agencies and institutions within development and aid are beginning to acknowledge this deficiency, but in Africa and elsewhere poverty is still increasing and welfare decreasing. Changing from Development Studies to Poverty Studies offers an opportunity to incorporate ideas and methodologies from other disciplines into the social analysis of poverty, including the politics of patronage and decision-making in organizations with responsibility for issues where there are immediate implications for poverty and wealth. This article analyzes the alternative futures for Development Studies according to how far and how urgently its exponents are prepared to accept this change. The establishment of an African Tertiary educational facility for the social analysis of policy is proposed. Copyright © 1999 John Wiley & Sons, Ltd.
Article
Mortality rates in the developed world have fallen sharply during the twentieth century. Individuals of lower socioeconomic status, however, generally have faced higher mortality rates than individuals of higher status. The literature documenting the relationship between socioeconomic status and health is reviewed, including several recent contributions and evidence from other countries. A conceptual framework then draws two distinctions: one contrasting the relative impact of lifestyle habits with the use of health care on health outcomes; and the other seeking to quantify the importance of resources relative to behavioral factors in explaining differential outcomes. The literature to date has been more successful in documenting health inequalities than in explaining why these inequalities persist.