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Why do racial inequalities endure despite numerous attempts to expand civil rights in certain sectors? A major reason for this endurance is due to lack of attention to structural racism. Although structural and institutional racism are often conflated, they are not the same. Herein, we provide an analogy of a “bucky ball” (Buckminsterfullerene) to distinguish the two concepts. Structural racism is a system of interconnected institutions that operates with a set of racialized rules that maintain White supremacy. These connections and rules allow racism to reinvent itself into new forms and persist, despite civil rights interventions directed at specific institutions. To illustrate these ideas, we provide examples from the fields of environmental justice, criminal justice, and medicine. Racial inequities in power and health will persist until we redirect our gaze away from specific institutions (and specific individuals), and instead focus on the resilient connections among institutions and their racialized rules.

Despite overwhelming evidence of its existence, White privilege has received relatively little attention in psychological science. However, given the chronic and pervasive benefits tied to racial privilege, it stands to reason that living with such privilege affects Whites’ everyday psychology. Here, we explore this psychology of privilege, connecting Whites’ everyday experiences and behaviors to underlying motivations (i.e., innocence and maintenance) shaped by their privileged position in the social hierarchy. We shed light on Whites’ use of strategies designed to protect their sense of innocence and, importantly, the consequences of these individual actions in aggregate. Specifically, we aim to resolve the tension between Whites’ motivated blindness in response to evidence of privilege and their everyday experience of privilege as invisible. We argue that privilege is not inherently invisible; rather, Whites use cloaking strategies to address the discomfort associated with naked privilege. We further suggest that individuals acting to protect their own innocence leads to the emergence of invisibility at the societal level. A herd invisibility results, protecting both the innocence and privileges of individual Whites, but without their necessarily having to act on individual innocence or maintenance motivations.

Humans can integrate social contextual information into decision-making processes to adjust their responses toward inequity. This context dependency emerges when individuals receive more (i.e., advantageous inequity) or less (i.e., disadvantageous inequity) than others. However, it is not clear whether context-dependent processing of advantageous and disadvantageous inequity involves differential neurocognitive mechanisms. Here, we used fMRI to address this question by combining an interactive game that modulates social contexts (e.g., interpersonal guilt) with computational models that enable us to characterize individual weights on inequity aversion. In each round, the participant played a dot estimation task with an anonymous coplayer. The coplayerwould receive pain stimulation with 50% probability when either of them responded incorrectly. At the end of each round, the participant completed a variant of dictator game, which determined payoffs for him/herself and the coplayer. Computational modeling demonstrated the context dependency of inequity aversion: when causing pain to the coplayer (i.e., guilt context), participants cared more about the advantageous inequity and became more tolerant of the disadvantageous inequity, compared with other conditions. Consistently, neuroimaging results suggested the two types of inequity were associated with differential neurocognitive substrates. While the context-dependent processing of advantageous inequity was associated with social- and mentalizing-related processes, involving left anterior insula, right dorsolateral prefrontal cortex, and dorsomedial prefrontal cortex, the context-dependent processing of disadvantageous inequity was primarily associated with emotion- and conflict-related processes, involving left posterior insula, right amygdala, and dorsal anterior cingulate cortex. These results extend our understanding of decision-making processes related to inequity aversion.

Fairness is a hallmark of humans' ability to maintain cooperative relationships with large numbers of unrelated others. It influences many aspects of daily life, from how people share their resources with partners to how policymakers shape income distribution policy. The right temporoparietal junction (rTPJ) is a hub of the mentalizing network and it has been proposed to play a key role in guiding human reciprocal behavior; however, its precise functional contribution to fair behavior in situations of advantageous and disadvantageous inequity remains unclear. The purpose of this study was to clarify the role of the rTPJ in relation to fair behavior in situations of advantageous and disadvantageous inequity by modulating the activation of the rTPJ through transcranial direct current stimulation (tDCS). Anodal tDCS at 1.5 mA over the primary visual cortex (VC) or rTPJ was performed and participants subsequently played a binary-choice version of the Dictator Game . We found that anodal tDCS over the rTPJ increased the participants' equity choices in the disadvantageous inequity situation but not in the advantageous inequity situation. The tDCS effect is moderated by sex and, in particular, the tDCS effect increases female equity choices. The results suggest that the rTPJ plays a distinct role in inequity aversion in these two types of inequity situations.

Differences in the accessibility to urban resources between different racial and socioeconomic groups have exerted pressure on effective planning and management for sustainable city development. However, few studies have examined the multiple factors that may influence the mitigation of urban green spaces (UGS) inequity. This study reports the results of a systematic mapping of access inequity research through correspondence analysis (CA) to reveal critical trends, knowledge gaps, and clusters based on a sample of 49 empirical studies screened from 563 selected papers. Our findings suggest that although the scale of cities with UGS access inequity varies between countries, large cities (more than 1,000,000 population), especially in low- and middle-income countries (LMICs), are particularly affected. Moreover, the number of cities in which high socioeconomic status (high-SES) groups (e.g., young, rich, or employed) are at an advantage concerning access to UGS is substantially higher than the number of cities showing better accessibility for low-SES groups. Across the reviewed papers, analyses on mitigating interventions are sparse, and among the few studies that touch upon this, we found different central issues in local mitigating strategies between high-income countries (HICs) and LMICs. An explanatory framework is offered, explaining the interaction between UGS access inequity and local mitigating measures.

In the immediate aftermath of disaster, governments usually act quickly to reduce risk and to recover their communities’ socio-economic functioning. Policy makers in these situations need—but may not have the capacity or time for—substantial analysis and public debate about how to balance short- and long-term societal needs. Inadequate attention to this challenge may result in a deepening of the inequities that increase vulnerability to disaster impacts. We review case examples to illustrate how post-disaster policies may influence the nature, pace, and inclusiveness of community recovery. We then apply a vulnerability/inequity framework to conceptualize how to enhance disaster recovery and avoid perpetuating inequities when weighing the diverse needs of communities across long time horizons.

Abstract Although the World Health Organization’s (WHO’s) framework on social and structural determinants of health and health inequities (SSDHHI) has done much to raise awareness of these determinants, it does not go far enough in considerations of politics and power. The framework has become more de-politicized since its publication, with the definition of social determinants shifting toward downstream and individualized factors. In the meantime, new research fields on legal, commercial and political determinants of health and health inequities have emerged; however, these have not become integrated adequately into broader SSDHHI frameworks. To address these challenges, we argue for a re-politicization and an expansion of the WHO’s framework by including the agents who have power over shaping structural determinants and the ways they use power to shape these determinants. We also provide a more detailed conceptualization of structural determinants to facilitate research. We propose a guideline for evaluating studies according to the extent to which they point upstream versus downstream and incorporate agents and considerations of power. We then use this framework to encourage more research on associations among agents, mechanisms of power, and structural determinants; how changes in structural determinants affect power dynamics among agents; and a wider focus on structural determinants beyond laws and policies, such as broad economic and sociopolitical systems. We also urge researchers to consider societal and institutional forces shaping their research with respect to SSDHHI. Research based on this framework can be used to provide evidence for advocacy for structural changes and to build more just systems that respect the fundamental human right to a healthy life.

Cooperative behavior represents a situation in which individuals sometimes act in a way that produces a gain to another at a cost to themselves. This may be explained by a history of repeated interactions with others in which such behavior has resulted in reciprocal cooperation from others. Sometimes, even with reciprocal cooperation, gains and costs are unbalanced between partners. In this case, there is evidence that people may present an aversion to both disadvantageous and advantageous distributions of gains. In other words, they may act in such a way as to ensure an equal outcome among all group members. Aversion to inequity that benefits oneself (advantageous inequity (AI) aversion) may be more dependent on social and cultural cues than aversion to inequity that benefits others (disadvantageous inequity (DI) aversion). Using both between-subjects (Experiment 1) and within-subjects (Experiment 2) manipulations, the influence of recent experience with AI on participants’ willingness to produce DI was explored within the context of a two-player card game. In initial game phases, the percentage of trials in which the participant experienced AI was manipulated. In subsequent game phases, participants had the opportunity to produce DI to themselves. The results from both experiments suggest that aversion to DI is reduced by recent experience with AI. This procedure allows social influences on DI to be tested, which may be important for providing a psychological explanation of cultural differences in aversion to DI.

Purpose of ReviewThis study aims to identify health inequities related to the medical treatment and supportive care of patients with advanced/metastatic cancer and recommend solutions to promote health equity.Recent findingsDespite robust strides in the development of therapeutic strategies for advanced and metastatic cancer, significant disparities in treatment access and implementation exist. Race, socioeconomic status, gender, and geography represent just a few of the individual-level factors which contribute to challenges in treatment administration, thorough evaluation of germline genetics and tumor genomics, and quality palliative and end-of-life care.SummaryGiven the increasing complexity of cancer treatments and our enhanced understanding of tumor biology, efforts to uniformly provide equitable and high-level care to all patients are needed. In this review we will discuss factors that contribute to health inequities in patients with advanced and metastatic cancer diagnoses, highlighting opportunities for intervention, ongoing challenges in change implementation, and national and international society recommendations to eliminate disparities. Acknowledging existing inequities and engaging in multilevel discourse with key stakeholders is needed to optimize care practices to the benefit of all patients.

Background Inequities in implementation contribute to the unequal benefit of health interventions between groups of people with differing levels of advantage in society. Implementation science theories, models and frameworks (TMFs) provide a theoretical basis for understanding the multi-level factors that influence implementation outcomes and are used to guide implementation processes. This study aimed to identify and analyse TMFs that have an equity focus or have been used to implement interventions in populations who experience ethnicity or ‘race’-related health inequities. Methods A scoping review was conducted to identify the relevant literature published from January 2011 to April 2022 by searching electronic databases (MEDLINE and CINAHL), the Dissemination and Implementation model database, hand-searching key journals and searching the reference lists and citations of studies that met the inclusion criteria. Titles, abstracts and full-text articles were screened independently by at least two researchers. Data were extracted from studies meeting the inclusion criteria, including the study characteristics, TMF description and operationalisation. TMFs were categorised as determinant frameworks, classic theories, implementation theories, process models and evaluation frameworks according to their overarching aim and described with respect to how equity and system-level factors influencing implementation were incorporated. Results Database searches yielded 610 results, 70 of which were eligible for full-text review, and 18 met the inclusion criteria. A further eight publications were identified from additional sources. In total, 26 papers describing 15 TMFs and their operationalisation were included. Categorisation resulted in four determinant frameworks, one implementation theory, six process models and three evaluation frameworks. One framework included elements of determinant, process and evaluation TMFs and was therefore classified as a ‘hybrid’ framework. TMFs varied in their equity and systems focus. Twelve TMFs had an equity focus and three were established TMFs applied in an equity context. All TMFs at least partially considered systems-level factors, with five fully considering macro-, meso- and micro-level influences on equity and implementation. Conclusions This scoping review identifies and summarises the implementation science TMFs available to support equity-focused implementation. This review may be used as a resource to guide TMF selection and illustrate how TMFs have been utilised in equity-focused implementation activities.