Justice in the Eye of the Beholder: How Comparison Framing Affects the Perception of Global Inequality Through Social Emotions and Justice Sensitivity

Global inequality is one of today’s major challenges. How people mentally represent inequality is often determined by its comparative framing. In the present work, we seek to analyze whether putting the focus of a comparison on the disadvantaged or advantaged group affects legitimacy perceptions of and action intentions against global inequality. Results of two preliminary studies indicated that global inequality is perceived as less legitimate and action intentions are increased when the disadvantaged group is the grammatical subject of the comparison, but only when the size of the economic inequality is perceived to be large (vs. small). In addition, social emotions mediated the relationship between comparative framing and legitimacy perceptions. Building on these preliminary studies, we present a planned large-scale study in which we aim to replicate these effects and to additionally test whether the strength of individuals’ emotional responses to comparative framing is moderated by their justice sensitivity. We will discuss findings with regard to the role of how framing elicits certain mental representations of justice.

8. Post-positivist Approaches: Post-structuralism, Postcolonialism, Feminism

This chapter examines post-positivist approaches in international relations (IR). Post-positivism rejects any claim of an established truth valid for all. Instead, its focus is on analysing the world from a large variety of political, social, cultural, economic, ethnic, and gendered perspectives. The chapter considers three of the most important issues taken up by post-positivist approaches: post-structuralism, which is concerned with language and discourse; postcolonialism, which adopts a post-structural attitude in order to understand the situation in areas that were conquered by Europe, particularly Africa, Asia, and Latin America; and feminism, which argues that women are a disadvantaged group in the world, in both material terms and in terms of a value system which favours men over women. It also reflects on recent calls for ‘Global IR’, where voices from outside of Western research environments are heard. The chapter concludes with an overview of criticisms against post-positivist approaches and the post-positivist research programme.

Representing the Disadvantaged

The limited attention Congress gives to disadvantaged or marginalized groups, including Black Americans, LGBTQ, Latinx, women, and the poor, is well known and often remarked upon. This is the first full-length study to focus instead on those members who do advocate for these groups and when and why they do so. Katrina F. McNally develops the concept of an 'advocacy window' that develops as members of Congress consider incorporating disadvantaged group advocacy into their legislative portfolios. Using new data, she analyzes the impact of constituency factors, personal demographics, and institutional characteristics on the likelihood that members of the Senate or House of Representatives will decide to cultivate a reputation as a disadvantaged group advocate. By comparing legislative activism across different disadvantaged groups rather than focusing on one group in isolation, this study provides fresh insight into the tradeoffs members face as they consider taking up issues important to different groups.

Vaso-Occlusive Events in Pediatric Sickle Cell Disease: Quantifying Social Disadvantage and Its Impact on Hospitalizations

Background: Sickle Cell Disease (SCD) has established socioeconomic disadvantage resulting in increased healthcare utilization. Among the pediatric population, the implementation of preventative care measures within the medical home model has improved outcomes and lifespan. Area deprivation index (ADI) is an established method for quantifying socioeconomic disadvantage and has been shown to be associated with increased hospital readmission in adults and pediatric patients with chronic disease (Singh Am J Public Health. 2003, Kind et al. Ann Intern Med. 2014). ADI has been applied to adults with SCD and vaso-occlusive events (VOE) but has not been investigated in pediatric patients. We explored the role of ADI in pediatric patients with SCD admitted with VOE in order to characterize disadvantage and the hospitalization characteristics that impact hospital readmission. Methods: This retrospective review included 675 consecutive emergency department and hospital admissions for VOE among 101 pediatric (≤ 21 years old) patients with SCD from 2016-2019 at a single urban, US-based medical center. One hospital admission for each patient was selected at random. Information extracted included demographics, SCD characteristics, admission complications, entry and discharge pain scores, length of stay, and management characteristics. Variables were compiled in a descriptive table and compared in logistic regression models against a primary outcome of 7-day readmission. The 2018 ADI dataset was used to assign an ADI value based on the census block corresponding to the patient-reported zip-code for the specific hospital admission (https://www.neighborhoodatlas.medicine.wisc.edu). ADI values were grouped by most and least deprived with higher scores (6-10) indicating more deprivation. Summary statistics described patient and disease characteristics in these groups. Results: Within our cohort, the state and national ADI was calculated for 101 patients with a median age of 14 years (50.4% female; 98.0% Black) (Table 1). Most patients were publicly insured (80.2%). The Hb SS genotype was the most common genotype, followed by Hb SC (22.7%). Median ADI rank was 9 with 11 patients (10.9%) classified as less disadvantaged (ADI 1-5) and 90 patients (89.1%) as more disadvantaged (ADI 6-10). We found the less disadvantaged group had even numbers of public and private insurance use while 83.3% of the patients in the more disadvantaged group had public insurance. The Hb SS genotype was more common in the less disadvantaged (90.9%) than the more disadvantaged (74.4%), where Hb SC was overrepresented (24.4%). Greatest prevalence of mental health disease and hospital complications, including acute chest syndrome, avascular necrosis, and pneumonia, were observed in the more disadvantaged. Additionally, the more disadvantaged group included a greater number of patients with scheduled follow-up (61.1%) and shorter time to follow-up (median: 31 days). For treatment and management, both groups had high numbers of prescriptions for hydroxyurea (HU) and opiates, with slightly higher numbers in the less disadvantaged group (82% HU; 100% opioids) compared to the more disadvantaged (61% HU; 81% opioids). Length of hospital-stay and pain scores were similar across groups. The 7-day readmission rate was 9% for the less disadvantaged group and 14% for the more disadvantaged group. Conclusions: We applied a validated measure of socioeconomic disadvantage to a group of pediatric patients with SCD and VOE. Our cohort consists of more disadvantaged patients across ADI scales. Readmission rate was low for both groups and there was no relationship between greater ADI scores and hospital readmission. Within the more disadvantaged group, the higher prevalence of mental health illness as well as associated disease complications may have been countered by protective factors including established follow-up, shorter time to follow-up, and high number of prescriptions for hydroxyurea and opiates. Our results are consistent with the protective effect of ADI on recurrent acute chest syndrome in pediatric SCD patients (Alishlash et al. Pediatr. Blood Cancer. 2021) highlighting the importance of preventative care within the SCD medical home. Further research is warranted on identifying key protective factors that may reduce acute care utilization and social disparity in this population. Figure 1 Figure 1. Disclosures Novelli: Novartis Pharmaceuticals: Consultancy.

‘It’s Been a Massive Struggle’: Exploring the Experiences of Young People Leaving Care During COVID-19

This article explores the experiences of young people leaving state care during COVID-19. Twenty-one young people, predominantly from Wales, engaged in semi-structured interviews and/or contributed poems and artwork conveying their experiences of the pandemic. The data generated offered insights into young people’s daily lives, including their routines and relationships, as well as access to resources and services. The study found stark disparity in young people’s experiences, with some reassured by support responses, and others feeling neglected and forgotten. As an already disadvantaged group, the challenges presented by COVID-19 further hinder young people’s transitions to adulthood. The ‘massive struggles’ faced by some young people reflect immediate difficulties which also have the potential for longer-term impacts. The recommendations of the study, informed by care-experienced young people, seek to positively influence policy and practice.