Structural inequality is defined as a condition that arises out of attributing an unequal status to a category of people in relation to one or more other categories, a relationship that is perpetuated and reinforced by a confluence of unequal relations in roles, functions, decisions rights, and opportunities.

As opposed to cultural inequality, which focuses on the individual decisions associated with inequality, structural inequality refers specifically to the inequalities that are systemically rooted in the normal operations of dominant social institutions, within the fabric of racial and ethnic discrimination, residential segregation, housing, education, and transportation, as well as sex discrimination, child care, health and health care, retirement insecurity, and legal deprivation.

Globalization

Globalization

Globalization refers to the increasingly global relationships of culture, people and economic activity. Most often, it refers to economics: the global distribution of the production of goods and services, through reduction of barriers to international trade such as tariffs, export fees, and import...

 has a complex association with development and inequality, and mandates a new framework to help describe its effects. On one level, global competition in production can lead to productivity improvements that lead to a situation where industrial employment falls behind industrial output in a local market. This can have an enormous impact on developing economies that focus on industrialization.

Combating structural inequality therefore often requires the broad, policy based structural change

Structural change

Structural change of an economy refers to a long-term widespread change of the fundamental structure, rather than microscale or short-term output and employment. For example, a subsistence economy is transformed into a manufacturing economy, or a regulated mixed economy is liberalized...

 on behalf of government organizations, and is often a critical component of poverty reduction.

Education

See: Structural inequality in education

Structural inequality in education

Structural inequality has been identified as the bias that is built into the structure of organizations, institutions, governments or, social networks. Structural inequality occurs when the fabric of organizations, institutions, governments or social networks contain an embedded bias which...

One particularly influential form of structural inequality can be found in education, since education affects many other opportunities. Examples of institutionalized racism, for example, include student tracking, access to college, access to technology, and school finance.

Spatial/Regional

Globally, the problem of spatial and regional segregation is largely a question between urban and rural disparities. A study commissioned by the United Nations University WIDER project have shown that for 26 countries studied over a time show that spatial inequalities have been high and on the increase, especially for developing nations. Many of these inequalities were traced back to “second nature” geographic forces that describe the infrastructure a society has in place for facilitating the trade of goods and employment between economic agents.

In the United States and many other developed countries, spatial inequality has developed into more specific forms described by residential segregation and housing discrimination. This has especially come into focus as education and employment are often tied into where a household is located relative to urban centers, and a variety of metrics, from education levels to welfare benefits have been correlated to spatial data.

Consequences

Specifically, studies have identified a number of economic consequences of housing segregation. Perhaps the most obvious is the isolation of minorities, which creates a deficit in the potential for developing human capital. Second, many of the public schools that areas of low socioeconomic status have access to are underperforming, in part due to the limited budgeting the district receives from the limited tax base in the same area. Finally, another large factor is simply the wealth and security homeownership represents. Property values rarely increase in areas where poverty is high in the first place.

Causes

The causes of spatial inequality, however, are more complex. The mid-20th century phenomenon of the large-scale migration of white middle class families from urban centers has coined the term “white flight.” While the current state of housing discrimination can be partly attributed to this phenomenon, a larger set of institutionalized discrimination have helped to perpetuated the division created since then. These include bias found in the banking and real estate industries as well as discriminatory public policies that promote racial segregation. In addition, rising income inequality between blacks and whites since the 1970s have created affluent neighborhoods that tend to be composed of a homogeneous racial background of families within the same income bracket. A similar situation within the racial lines have helped to explain how more than 32% of blacks now live in suburbs. However, these new suburbs are often divided along racial lines, and a 1992 survey showed that 82% of blacks preferred to live a suburb where their race is in the majority. This is further aggravated by practices like racial steering

Racial steering

Racial steering refers to the practice in which real estate brokers guide prospective home buyers towards or away from certain neighborhoods based on their race...

, in which realtors guide home buyers towards neighborhood based on race.

Transportation

Government policies that have tended to promote spatial inequalities include actions by the Federal Housing Administration

Federal Housing Administration

The Federal Housing Administration is a United States government agency created as part of the National Housing Act of 1934. It insured loans made by banks and other private lenders for home building and home buying...

 (FHA) in promoting redlining

Redlining

Redlining is the practice of denying, or increasing the cost of services such as banking, insurance, access to jobs, access to health care, or even supermarkets to residents in certain, often racially determined, areas. The term "redlining" was coined in the late 1960s by John McKnight, a...

, a practice where mortgages could be selectively administered while excluding certain urban neighborhood deemed risky, oftentimes because of race. Practices like this continued to prevent home buyers from getting mortgages in redlined areas until the 1960s, when the FHA discontinued the determination of restrictions based on racial composition.

The advent of freeways also added a complex layer of incentives and barriers which helped to increase spatial inequalities. First, these new networks allowed for middle-class families to move out to the suburbs while retaining connections like employment to the urban center. Second, and perhaps more importantly, freeways were routed through minority neighborhoods, oftentimes creating barriers between these neighborhoods and central business districts and middle class areas. Highway plans often avoided a more direct route through upper or middle class neighbors because minorities did not have sufficient power to prevent such actions from happening.

Solutions

Massey identifies three goals specifically for America to end residential segregation: reorganize the structure of metropolitan government, make greater investment in education, and finally open housing market so full participation More specifically, he advocates broader, metropolitan-wide units of taxation and governance where the tax base and decisions are made equally by both the urban and suburban population. Education is the key to closing employment inequalities in a post-manufacturing era. And finally, the federal government must take large strides towards enforcing the anti-segregation measures related to housing is has already put into place, like the Fair Housing Act

Fair housing

In the United States, the fair housing policies date largely from the 1960s. Originally, the terms fair housing and open housing came from a political movement of the time to outlaw discrimination in the rental or purchase of homes and a broad range of other housing-related transactions, such as...

, the Home Mortgage Disclosure Act

Home Mortgage Disclosure Act

The United States Home Mortgage Disclosure Act was passed in 1975. It requires financial institutions to maintain and annually disclose data about home purchases, home purchase pre-approvals, home improvement, and refinance applications involving 1 to 4 unit and multifamily dwellings...

, and the Community Reinvestment Act

Community Reinvestment Act

The Community Reinvestment Act is a United States federal law designed to encourage commercial banks and savings associations to help meet the needs of borrowers in all segments of their communities, including low- and moderate-income neighborhoods...

.

Healthcare

The quality of healthcare that a patient receives is strongly dependent on its accessibility. Kelley et. al. define access to healthcare as “the timely use of personal health services to achieve the best health outcomes”. Manifestations of inequality in healthcare appear throughout the world and are a topic of urgency in the United States. In fact, studies have shown that income-related inequality in healthcare expenditures favors the wealthy to a greater degree in the United States than most other Western nations. The enormous costs of healthcare, coupled with the vast number of Americans lacking health insurance, indicate the severe inequality and serious problems that exist. The healthcare system in the United States perpetuates inequality by “rationing health care according to a person’s ability to pay, by providing inadequate and inferior health care to poor people and persons of color, and by failing to establish structures that can meet the health needs of Americans”.

Studies show that people with health insurance receive significantly more care than those who are uninsured, the most vulnerable groups being minorities, young adults, and low-income individuals. The same trend for uninsured versus insured patients holds true for children as well. Hadley, Steinberg, and Feder (1991) found that hospitalized patients who are not covered under health insurance are less likely to receive high-cost, specialized procedures and as a result, are more likely to die while hospitalized. Feder, Hadley, and Mullner (1984) noticed that hospitals often ration free care by denying care to those who are unable to pay and cutting services commonly used by the uninsured poor.

Racial Inequality

Racial disparity in access and quality of healthcare is a serious problem in the United States. The Agency for Healthcare Research and Quality

Agency for Healthcare Research and Quality

The Agency for Healthcare Research and Quality is a part of the United States Department of Health and Human Services, which supports research designed to improve the outcomes and quality of health care, reduce its costs, address patient safety and medical errors, and broaden access to effective...

 (AHRQ), directed by Congress, led an effort for the development of two annual reports by the Department of Health and Human Services (DHHS), the National Healthcare Quality Report and the National Healthcare Disparities Report, which tracked disparities in healthcare in relation to racial and socioeconomic factors. These reports developed about 140 measures of quality of care and about 100 measures of access to care, which were used to measure the healthcare disparities. The first reports, released in December 2003, found that blacks and Hispanics experienced poorer healthcare quality for about half of the quality measures reported in the NHQR and NDHR. Also, Hispanics and Asians experienced poorer access to care for about two thirds of the healthcare access measures (Kelley et al. 2005). Recent studies on Medicare patients show that black patients receive poorer medical care than their white counterparts. Compared with white patients, blacks receive far fewer operations, tests, medications and other treatments, suffering greater illnesses and more deaths as a result.

Spatial Inequality

Spatial distribution and geographic location also affect access and quality of healthcare. A study done by Rowland, Lyons, and Edwards (1988) found that rural patients were more likely to be poor and uninsured. Because of the fewer healthcare resources available in rural areas, these patients received fewer medical services than urban patients. Race and spatial distribution, when combined, also affect patients’ self-reported quality of healthcare. A 2004 study conducted by Haas et. al. “suggested that for blacks, Latinos, and whites, the racial and ethnic demographics if one’s county of residence is associated with an individual’s access to health care”. The results suggested that blacks and Latinos were less likely to report difficulties in obtaining healthcare or financial barriers to healthcare if they lived in counties with higher proportions of their respective races.

Economic Inequality

Socioeconomic background is another source of inequality in healthcare. The studies in the NHQR and NDHR showed that low-income people experienced poorer care for about two thirds of the quality and access measures. Another study also found that not only is there a strong correlation between income inequality and self-reported health conditions and mortality, but there is a gradient in health by income and education level; the prevalence of certain health conditions increases with decreasing income. A study done on Medicare recipients also showed that despite the uniform benefits offered, high-income elderly patients received 60% more physician services and 45% more days of hospital care than lower-income elderly patients not covered by Medicaid. After adjustment for health status, people with higher incomes are shown to have higher expenditures, indicating that the wealthy are strongly favored in income-related inequality in medical care. However, this inequality differs across age groups. Inequality was shown to be greatest for senior citizens, then adults, and least for children. This pattern showed that financial resources and other associated attributes, such as educational attainment, were very influential in access and utilization of medical care.

Solutions

The acknowledgement that access to health services differed depending on race, geographic location, and socioeconomic background was an impetus in establishing health policies to benefit these vulnerable groups. In 1965, specific programs, such as Medicare and Medicaid, were implemented in the United States in an attempt to extend health insurance to a greater portion of the population. Medicare is a federally funded program that provides health insurance for people aged 65 or older, people younger than 65 with certain disabilities, and people of any age who have End-Stage Renal Disease (ERSD). Medicaid, on the other hand, provides health coverage to certain low income people and families and is largely state-governed. However, studies have shown that for-profit hospitals tend to make healthcare less accessible to uninsured patients in addition to those under Medicaid in an effort to contain costs. Another program, the State Children’s Health Insurance Program (SCHIP) provides low cost health insurance to children in families who do not qualify for Medicaid but cannot afford private health insurance on their own.

The necessity of achieving equity in quality of and access to healthcare is glaring and urgent. According to Fein (1972), this goal could include equal health outcomes equal expenditures per capita regardless of race, gender, or socioeconomic background. Some have proposed that a national health insurance plan with comprehensive benefits and no deductibles or other costs from the patients would provide the most equity. Fein also stressed that healthcare reform was needed, specifically in eliminating financial assistance to treat patients that depended on patient income or the quantity of services given. He proposed instead paying physicians on a salaried basis. Another study, by Reynolds (1976), found that community health centers improved access to health care for many vulnerable groups, including youth, blacks, and people with serious diseases. The study indicated that community health centers provided more preventive care and greater continuity of care, though there were problems in obtaining adequate funding as well as adequate staffing.

Other suggested improvements include expanding health insurance coverage and giving hospitals a financial incentive to provide free care since hospitals have been known to diminish quality of care to uninsured patients.

The idea of universal health care

Universal health care

Universal health care is a term referring to organized health care systems built around the principle of universal coverage for all members of society, combining mechanisms for health financing and service provision.-History:...

, which is implemented in many other countries, has been a subject of heated debate in the United States.

Employment

Employment is a key source of income for a majority of the world’s population, and therefore is the most direct method through which people can escape poverty. However, unequal access to decent work and persistent labor market inequalities frustrate efforts to reduce poverty. Studies have further divided employment segregation into two categories: first generation and second generation discrimination. First generation discrimination occurs as an overt bias displayed by employers, and since the end of the civil rights era has been on the decline. Second generation discrimination; on the other hand, is less direct and therefore much harder to legislate against. This helps explain the disparity between female hiring rates and male/female ratios, which have gone up recently, and the relative scarcity of women in upper-level management positions. Therefore, while there is extensive legislation passed regarding employment discrimination, informal barriers still exist in the workplace. For instance, gender discrimination often takes the form of working hours and childcare-related benefits. In many cases, female professionals who must take maternity leave or single mothers who must care for their children often are at a disadvantage when it comes to promotions and advancement.

Education Level

Employment discrimination is also closely linked to education and skills. One of the most important factors that can help describe employment disparities was that for much of the post-WWII-era, many Western countries began shedding the manufacturing jobs that provided relatively high-wage jobs to people with moderate to low job skills. Starting from the 1960’s, the United States began a shift away from low-wage jobs, especially in the manufacturing sector, towards technology-based or service-based employment. This had an unbalanced effect of decreasing employment opportunities for the least educated in the labor force while at the same time increasing the productivity and therefore wages of the skilled labor force, increasing the level of inequality. In addition, globalization has tended to compound this decrease in demand of domestic unskilled labor.

Finally, weak labor market policies since the 70’s and 80’s have failed to address the income inequalities that those who are employed at lower income levels have to face. Namely, the union movement began to shrink, decreasing the power for employees to negotiate employment terms, and the minimum wage was prevented from increasing alongside inflation.

Racial

Other barriers include human capital

Human capital

Human capitalis the stock of competencies, knowledge and personality attributes embodied in the ability to perform labor so as to produce economic value. It is the attributes gained by a worker through education and experience...

 occupations that require an extensive network for developing clientele, like lawyers, physicians, and salesmen. Studies have shown that for blacks and whites in the same occupation, whites can often benefit for a wealthier pool of clients and connections. In addition, studies show that only a small percentage of low-skilled employees are hired through advertisements or cold calls, highlighting the importance of social connections with middle- and upper- class employers.

Gender

Though women have become an increasing presence in the workforce, there currently exists a gender gap in earnings. Statistics show that women who work full-time year-round earn 75% of the income as their male counterparts. Part of the gender gap in employment earnings is due to women concentrating in different occupational fields than men, which is known as occupational segregation

Occupational segregation

Occupational segregation is the distribution of groups defined by ascribed characteristics, mostly gender, across occupations. More basically, it is the concentration of a similar group of people in a job. Occupational segregation levels differ on a basis of perfect segregation and integration...

 The 1990 Census data show that more than 50% of women would have to change jobs before women would be distributed in the same way as men within the job market, achieving complete gender integration. This can be attributed to the tendency of women to choose degrees that funnel into jobs that are less lucrative than those chosen by men.

Other studies have shown that the Hay system, which evaluates jobs, undervalues the occupations that tend to be filled by women, which continues to bias wages against women’s work. Once a certain job becomes associated with women, its social value decreases. Almost all studies show that the percentage of women is correlated with lower earnings for both males and females even in fields that required significant job skills, which suggests a strong effect of gender composition on earnings.
Additionally, women tend to be hired into less desirable jobs than men and are denied access to more skilled jobs or jobs that place them in an authoritative role. In general, women tend to hold fewer positions of power when compared to men. A study done by Reskin and Ross (1982) showed that when tenure and productivity-related measurements were controlled, women had less authority and earned less than men of equal standing in their occupation (Jacobs 11). Exclusionary practices provide the most valuable job openings and career opportunities for members of groups of higher status which, in the United States, mostly means Caucasian males. Therefore, males are afforded more advantages than females and perpetuate this cycle while they still hold more social power, allocating lower-skilled and lower-paying jobs to females and minorities.

Inequality in Investment of Skills

Another factor of the gender earnings gap is reflected in the difference in job skills between women and men. Studies suggest that women invest less in their own occupational training because they stay in the workforce for a shorter period of time than men (because of marriage or rearing children) and therefore have a shorter time span to benefit from their extra efforts. However, there is also discrimination by the employer. Studies have shown that the earnings gap is also due to employers investing less money in training female employees, which leads to a gender disparity in accessing career development opportunities.

Prescribed Gender Roles

Women tend to stay in the workforce for less time than men due to marriage or the time devoted to raising children. Consequently, men are typically viewed as the “breadwinners” of the family, which is reflected in the employee benefits provided in careers that are traditionally occupied by males. A study done by Heidi M. Berggren, assessing the employee benefits provided to nurses (a traditional female career) and automobile mechanics and repairmen (a traditional male career), found that the latter provided more significant benefits such as health insurance and other medical emergency benefits whereas the former provided more access to sick leave with full pay. This outlines the roles allotted to women as the caregivers and the men as the providers of the family which subsequently encourages men to seek gainful employment while encouraging women to have a larger role at home than in the workplace. Many parental leave policies in the US are poorly developed and reinforce the roles of men as the breadwinner and women as the caregiver.

Glass Ceiling

Women have often described subtle gender barriers in career advancement, known as the “glass ceiling”. This refers to the limited mobility of women in the workforce due to social restrictions that limit their opportunities and affect their career decisions.

Solutions

A study done by Doorne-Huiskes, den Dulk, and Schippers (1999) showed that in countries with government policy addressing the balance between work and family life, women have high participation in the work force and there is a smaller gender wage gap, indicating that such policy could encourage mothers to stay in their occupations while also encouraging men to take on a greater child-rearing role. Such measure include mandating employers to provide paid parental leave for employees so that both parents can care for children without risk to their careers. Another suggested measure is government-provided day care for children aged 0-6 or financial support for employees to pay for their own child-care.

In 1978, the Pregnancy Discrimination Act was passed and amended Title VII of the Civil Rights Act of 1964. This act designated discrimination based on pregnancy, childbirth, or associated medical issues as illegal gender discrimination. The Family and Medical Leave Act, passed in 1993, required employers to give up to twelve weeks of unpaid leave for the birth or adoption of a child and providing care for immediate family members who are ill. These two acts helped publicize the important role women play in caring for family members and gave women more opportunities to retain jobs that they would have previously lost. However, the Family and Medical Care Leave Act of 1993 is limited in that only 60% of all employees in the U.S. are eligible for this leave since many small business are exempt from such coverage.

The fact that parental leave measures continue to enforce traditional division of labor between the genders indicates a need to reduce the stigma of male parenting as well as the stigma of parenthood on female employment opportunities. Some possible developments to improve parental leave include: offering job protection, full benefits, and substantial pay as a part of parental leave to heighten the social value of both parents caring for children, making parental leave more flexible so that both parents can take time off, reducing the negative impact of parental leave on job standing, and encouraging fathers to care for children by providing educational programs regarding pre-natal and post-natal care.