Pandemic inequalities: emerging infectious diseases and health equity

The frequency and scale of Emerging Infectious Diseases (EIDs) with pandemic potential has been increasing over the last two decades and, as COVID-19 has shown, such zoonotic spill-over events are an increasing threat to public health globally. There has been considerable research into EIDs – especially in the case of COVID-19. However, most of this has focused on disease emergence, symptom identification, chains of transmission, case prevalence and mortality as well as prevention and treatment. Much less attention has been paid to health equity concerns and the relationship between socio-economic inequalities and the spread, scale and resolution of EID pandemics. This commentary article therefore explores socio-economic inequalities in the nature of EID pandemics. Drawing on three diverse case studies (Zika, Ebola, COVID-19), it hypothesises the four main pathways linking inequality and infectious disease (unequal exposure, unequal transmission, unequal susceptibility, unequal treatment) – setting out a new model for understanding EIDs and health inequalities. It concludes by considering the research directions and policy actions needed to reduce inequalities in future EID outbreaks.

Gender Inequalities and Sex-Differential Mortality in Pre-War Greece: A Regional Perspective

Previous studies have indicated gender-based discriminatory practices as a result of son preference up to the first half of the 20th century in Greece. Demographic indices calculated from published vital statistics, such as sex ratios at birth and at childhood, were distorted to such an extent that certain scholars suggest that this distortion was due to sex-selective infanticide and neglect of the girls. Although we cannot exclude this possibility, the aim of this paper is to assess to what extent under-registration of female births (in the civil registration system) and under-enumeration of females (in censuses) accounted for the skewed sex ratios and to pinpoint that gender-based discrimination was not the same all over Greece. There were areas in insular Greece, notably the Ionian islands and the Aegean Archipelago, and one area in mainland Greece (Epirus) where demographic indices imply that gender inequalities were less acute. On the other hand, there were areas in mainland Greece, notably in Thessaly, where sex-differential mortality denotes extremely unequal treatment of girls.

GROUNDS (CRITERIA) OF DISCRIMINATION IN THE LIGHT OF THE AMENDMENT TO THE LABOUR CODE OF 16 MAY 2019 IN THE CONTEXT OF INTERNATIONAL AND EU LAW

On 7 September 2019, another amendment to the Labour Code entered into force, which introduced, among other things, an open catalogue of the grounds (criteria) of discrimination. De lege lata enumeration of the grounds of discrimination in the Labour Code is illustrative regardless of whether such criteria pertain to personal characteristics of an employee, an employee’s life choices unrelated to their job, job performed by an employee or a legal status of an employer, etc. It means that any unequal treatment of employees not justified by objective reasons is now regarded as discrimination in employment. However, the new grounds (criteria) of discrimination should be actual, specific and socially relevant. Employees’ claims in this respect should be based on a legitimate (well-balanced and objective) reason and make it objectively plausible. As a consequence, employees will be able to claim compensation under Article 183d of the Labour Code from the employer on various grounds of discrimination, and not only those referred to and specified in the Labour Code.

What Do Placebo and Nocebo Effects Have to Do With Health Equity? The Hidden Toll of Nocebo Effects on Racial and Ethnic Minority Patients in Clinical Care

A placebo effect is a positive clinical response to non-specific elements of treatment with a sham or inert replica of a drug, device, or surgical intervention. There is considerable evidence that placebo effects are driven by expectation of benefit from the intervention. Expectation is shaped by a patient’s past experience, observations of the experience of others, and written, verbal, or non-verbal information communicated during treatment. Not surprisingly, expectation in the clinical setting is strongly influenced by the attitude, affect, and communication style of the healthcare provider. While positive expectations can produce beneficial effects, negative information and experiences can lead to negative expectations, and consequently negative or nocebo effects. Key components identified and studied in the placebo and nocebo literature intersect with factors identified as barriers to quality care in the clinical setting for Black patients and other patients of color, including poor patient-clinician communication, medical mistrust, and perceived discrimination. Thus, in the context of discrimination and bias, the absence of placebo and presence of nocebo-generating influences in clinical settings could potentially reinforce racial and ethnic inequities in clinical outcomes and care. Healthcare inequities have consequences that ripple through the medical system, strengthening adverse short- and long-term outcomes. Here, we examine the potential for the presence of nocebo effects and absence of placebo effects to play a role in contributing to negative outcomes related to unequal treatment in the clinical encounter.

Republicans treated Chinese-born US residents relatively worse than US-born US residents, compared to non-Republicans throughout the COVID-19 pandemic

Asian Americans became targets of increasingly hostile behavior during the COVID-19 pandemic. What motivated this? Fears of contagion arising from a behavioral immune system (BIS) may have motivated differential treatment towards Chinese-born US residents, especially early in the pandemic and among those vulnerable to COVID-19. On the other hand, rhetoric from right-wing media figures may have legitimated anti-Asian behavior. We explore these questions using a behavioral game with a representative sample of Americans at two points: in spring and fall 2020. Participants were partnered with a US- or Chinese-born US resident. The average American treated Chinese-born US residents worse compared to US-born residents in the spring but not the fall, when China was no longer a COVID-19 hotspot. But among Republicans, likely more receptive to right-wing rhetoric, unequal treatment was both stronger in the spring and persisted into the fall.

Transgender and Gender Diverse (TGD) Asian Americans in the United States: Experiences of Violence, Discrimination, and Family Support

Transgender and gender diverse (TGD) Asian Americans in the U.S. have multiple stigmatized identities, yet their experiences of violence and discrimination are not well understood. We utilized the 2015 United States Trans Survey, the largest survey to date with U.S. TGD people, to study the experiences of TGD Asian Americans. Our study included 699 TGD Asian Americans who experienced violence and discrimination in the form of unequal treatment, verbal harassment, and physical attack. We assessed how experiences differed by sociodemographic characteristics, including birthplace, income, age, education, disability, gender identity, and region. We also explored how family support was associated with experiences of violence in the sample. Bivariate analyses and multivariable regressions were used to understand how sociodemographic variables and family support are linked to experiences of violence and discrimination. Results indicated that income, age, disability, gender identity, and family support are significantly associated with violence and discrimination. As TGD Asian Americans currently experience high levels of violence and discrimination due to transphobia and a rapidly rising anti-Asian bias stemming from the COVID-19 pandemic, efforts to better understand factors that may increase vulnerability and identify how family support can mitigate those experiences are imperative.

Human dignity - source and foundation of human rights and freedoms in the 21st century

Human dignity is a criterion of appreciation among people, because each of us wants dignity, it comes from our own nature, but it can be achieved in the community of which we are part. Throughout the existence and development of mankind, there have been various situations in which, however, human dignity has been violated. These situations, in turn, in addition to making the problem visible, served as a pillar for inventing new areas of protection of human dignity, such as: from the perspective of unbearable social conditions and the marginalization of poor social classes; unequal treatment of women and men at work; discrimination against foreigners and cultural, linguistic, religious and racial minorities; brutal expulsion of illegal immigrants and applicants today, disability, medicine, etc. In light of such specific challenges, various aspects of the significance of human dignity arise from the multitude of experiences of what it means to be humiliated and deeply hurt. All these have taken to a new level the perception of human dignity and have generated, depending on the stated problem, different legal, international instruments meant to protect the dignity of human being.

Too Small to Matter? On the Copyright Directive’s Bias in Favour of Big Right-Holders

This chapter shows how Art 17 of the Copyright in the Digital Single Market Directive (DSM Directive) contains an inherent bias favouring large right-holders to the prejudice of small creators. It studies the likely trajectories and incentives of the relevant actors and concludes that the licensing model of Art 17 is tailored to the needs of powerful content owners. Only smaller right-holders must monitor the market, review the use of their works by third parties, and approach each online-content sharing service provider separately. The enforcement mechanism of Art 17 has similar effects on amateur creators, who will often have to rely on exceptions to copyright when creating content in distinction to larger units that can typically resort to licensing. Collective licensing could offer a potential solution to alleviate the identified problems in unequal treatment of different types of copyright owners. The chapter discusses these effects from the perspective of the principle of equal treatment, protected under Art 20 of the EU Charter. It argues that, unless Member States resort to legal mechanisms—such as collective licensing—that can better balance competing rights and interests and not discriminate between different actors, the end-result will be unconstitutional.

GESTATIONAL LOSS: EMOTIONAL AND LEGAL ASPECTS

This study attempts to verify the conditions of mothers who have gone through gestational loss. It is designed according to semi-structured interviews of affected mothers. Through semi-structured recorded interviews, directed questions were asked to ascertain perceptions that they were living through at that moment, about their adaptation to daily life, and about their mourning process and the quality of their professional activities. From the interviews, eight categorizations were created: symptoms of mourning; the time to return to work and daily routines; lack of societal recognition of mourning; mourning and spirituality; seeking of healthcare support; the fathers’ pain; the need of someone; who is this baby? And the following feelings were documented from the interviews: feelings of losing control of one’s life; broken dreams; feelings of incompleteness, guilt, and personal defeat; feelings of inferiority as a woman; subjective losses; losses in identity and eroticism; a woman’s role in society. Lastly, the study examines how gestational loss is unrecognized and unsupported by legislation, exposing a weakness in workers’ rights and unequal treatment regarding gender.

The Situation of Women of a Refugee and Immigrant Background in the Netherlands

The problem of discrimination and unequal treatment of women from culturally diverse backgrounds affects countries such as the Netherlands. The centuries of tolerance and openness to an “alien” seem to be ending. This is evidenced by numerous reports and scientifi c studies, statements from specialists, and experts on the issues of immigrant integration. Increasingly, feeling marginalised and deprived of development opportunities, immigrant or refugee women come to the fore. Some of them (those remaining in isolation) are represented by aid organisations, i.e. foundations, associations, volunteer groups, and the municipalities themselves. This article covers the existing issue of the increasing number of refugees and immigrants in the Netherlands, especially refugee and immigrant women towards whom, according to specialists, integration policy should be redefi ned.