China private tutoring rules will have lasting impact

Significance Some USD126bn in market capitalisation has been erased from Chinese education-related stocks traded in the United States, China and Hong Kong this year in anticipation of stronger regulations. The government argues that the changes are necessary to redress educational inequalities and achieve 'common prosperity'. Impacts The intense pressure which the education system places on parents and children is unlikely to be relieved without more substantive reforms. The regulations will affect the aspiring middle class more than the truly affluent, who will always find ways to advantage their children. The reform will do little to change the stark regional inequalities in education nationwide, nor the urban-rural divide in future outcomes.

1469Inequalities in diabetes management by area deprivation: the mediating role of healthcare resource distribution

Background We sought to identify the existence of regional socioeconomic inequalities in diabetes management and to examine whether the distribution of healthcare resources could explain regional inequalities in diabetes management. Methods Data were derived from the Korean Community Health Survey in 2018. Our study subjects included 23,760 participants who have been diagnosed with diabetes by a doctor. The dependent variables were self-reported glycemic control, Hemoglobin A1c (HbA1c) testing, recognition of the term HbA1c, and diabetic complications testing. Socio-demographics, health behavior-related factors, and factors related to regional healthcare resources were considered as potential mediating variables in explaining the association between diabetes management and area deprivation. A multilevel logistic regression analysis was used. Results Compared to the least deprived area, the likelihood of not taking HbA1c tests, not recognizing the term HbA1c, and not taking diabetic complication tests in the most deprived area were approximately 1.5, 2.6, and 2 times higher, respectively. In the most deprived areas, the coefficient of variation value of clinics was the highest and the number of doctors was the lowest. Regional healthcare resource factors explained regional inequalities in managing diabetes by 14% to 18%, especially in the most deprived area. Conclusions Policy interventions for more even distribution of healthcare resources would contribute to reducing the magnitude of regional inequalities in diabetes management. Key messages Our study suggests that reducing inequality in diabetes management could be possible through the appropriate allocation of healthcare resources.

Inequality and Income Segregation in Brazilian cities: A Nationwide Analysis

Urban segregation has brought significant challenges to cities worldwide and has important implications for health. This study aimed to assess income segregation in the 152 largest Brazilian cities included in the SALURBAL Project and identify specific socioeconomic characteristics related to residential segregation by income. Using the Brazilian demographic census database of the year 2010, we calculated the income dissimilarity index (IDI) at census tract level for each SALURBAL city; subsequently comparing it with Gini and other local socioeconomic variables. We evaluated our results' robustness using a bootstrap correction to the IDI to examine the consequences of using different cut-offs of income that were relevant in the context of strong urban and regional inequalities. We identified a 2 minimum wages cut-off as the most appropriate and found little evidence of upward bias in the calculation of the IDI regardless of the cut-off used. Among the 10 most segregated cities, 9 are in the Northeast region, the region with the highest income inequality and poverty in Brazil. Our results indicate that the Gini index and poverty are the main variables associated with residential segregation, measured by the IDI. Social and environmental characteristics were also associated with IDI, reinforcing the notion that access to education, water, sanitation, and better residential conditions are fundamental to improving social equity.

Regional inequalities and substitutability of health resources in the Czech Republic: a five methods of evaluation

Background An analysis of the regional distribution of health resources is one of the tools for evaluating equal geographic access to health care. The usual analytical approach to an assessment of regional differences is to evaluate each health resource separately. This is a sensible approach, because there may be systematic reasons for any differences, for example, higher salaries in urban areas. However, a separate evaluation of the regional distribution of health resource capacities may be misleading. We should evaluate all health resource capacities as a whole and consider the substitutability of resources. Objective This study aims to measure regional inequalities in the Czech Republic with the help of alternative approaches to the evaluation of regional inequalities in the case of several substitutable health resources. Methods Five alternative evaluation methods (models) are described and applied: the separate evaluation, expert model, market model, common weights model, and production frontier model. Results The regional distribution of physicians and nurses in the Czech Republic in 2017 was evaluated. In spite of many regulations at the national and regional levels, we have found inequalities in regional resource distribution. The models that consider all health resources and the possibility of a resource substitution show lower inequalities between regional health resource capacities. Conclusion Both researchers and policy-makers should always consider the possibility of resource substitutions in the assessment of regional inequalities.