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In this chapter, I review recent evidence on the developmental origins of health inequality. I discuss the origins of the education-health gradient, the long-term costs caused by early life adversity, and how early life experiences affect the biology of the body. Additionally, I provide complementary evidence on enrichment interventions which can at least partially compensate for these gaps. I highlight emerging lines of scientific inquiry which are likely to have a significant impact on the field. I argue that, while the evidence that early life conditions have long-term effects is now uncontroversial, the literature needs to be expanded both in a theoretical and empirical direction. On the one hand, a model linking early life origins to ageing needs to be developed; on the other hand, a better understanding of the mechanisms – both biological and socioeconomic – is required, in order to design more effective interventions.

Neurodiverse conditions, or developmental disorders, are neither well-known nor understood by the general population in Trinidad and Tobago. Awareness of, or sensitivity toward, children with autism spectrum disorder (ASD), in particular, is lacking in Trinidad and Tobago. Generation A is those persons who will reach adulthood in the next decade or so and be seeking employment opportunities. Given the current challenges faced by persons with ASD in securing and maintaining employment and the fact that this is a generally underexplored area of research, focusing on Generation A provides an opportunity to explore what provisions are in place for individuals with ASD to assist with future transitions into the workplace in Trinidad and Tobago. This chapter focuses on the existing policy, legal, and institutional framework in Trinidad and Tobago for ASD in the workplace, with particular reference to Generation A, to determine how it is currently addressed and what accommodations are being made to facilitate this demographic. A review of ASD-related data and select, relevant policy, law and institutions in Trinidad and Tobago has revealed that very few preparations, if any, are being made to facilitate Generation A individuals' entry into the workplace. The most relevant sector for addressing ASD needs falls to the NGO movement, but these organizations do not focus on employment preparation. Several recommendations for the key stakeholders in this process have been made that can assist in this regard.

From the sixteenth to eighteenth century, China underwent a commercial revolution similar to the one in contemporaneous Europe. The rise of market did foster the rise of a nascent bourgeois and the concomitant rise of a liberal, populist version of Confucianism, which advocated a more decentralized and less authoritarian political system in the last few decades of the Ming dynasty (1368–1644). But after the collapse of the Ming Empire and the establishment of the Qing Empire (1644–1911) by the Manchu conquerors, the new rulers designated the late-Ming liberal ideologies as heretics, and they resurrected the most conservative form of Confucianism as the political orthodoxy. Under the principle of filial piety given by this orthodoxy, the whole empire was imagined as a fictitious family with the emperor as the grand patriarch and the civil bureaucrats and subjects as children or grandchildren. Under the highly centralized administrative and communicative apparatus of the Qing state, this ideology of the fictitious patrimonial state penetrated into the lowest level of the society. The subsequent paternalist, authoritarian, and moralizing politics of the Qing state contributed to China’s nontransition to capitalism despite its advanced market economy, and helped explain the peculiar form and trajectory of China’s popular contention in the eighteenth century. I also argue that this tradition of fictitious patrimonial politics continued to shape the state-making processes in twentieth-century China and beyond.

Social and economic disparities between racial/ethnic groups are a feature of the American context into which immigrants are incorporated and a key determinant of population health. We ask whether racial/ethnic disparities in diabetes vary by nativity and whether native-immigrant disparities in diabetes vary by race and over time in the United States. Using the 2000–2015 National Health Interview Survey, we estimate logistic regressions to examine the interaction of race/ethnicity, nativity, and duration in the US in shaping diabetes patterns. Relative to their native-born co-ethnics, foreign-born Asian adults experience a significant diabetes disadvantage, while foreign-born Hispanic, Black, and White adults experience a significant advantage. Adjusting for obesity, education, and other covariates eliminates the foreign-born advantage for Black and White adults, but it persists for Hispanic adults. The same adjustment accentuates the disadvantage for foreign-born Asian adults. For Black and Hispanic adults, the protective foreign-born effect erodes as duration in the US increases. For foreign-born Asian adults, the immigrant disadvantage appears to grow with duration in the US. Relative to native-born White adults, all non-white groups regardless of nativity see a diabetes disadvantage because the racial/ethnic disadvantage either countervails a foreign-born advantage or amplifies a foreign-born disadvantage. Racial/ethnic differentials in diabetes are considerable and are influenced by each group’s nativity composition. Obesity and (for the foreign-born) time in the US influence these disparities, but do not explain them. These findings underscore the importance of unmeasured, systemic determinants of health in America’s race-conscious society.

This paper is the first to use the individual level, longitudinal catch-up growth of boys and girls in a historical population to measure their relative deprivation. The data is drawn from two government schools, the Marcella Street Home (MSH) in Boston, MA (1889–1898), and the Ashford School of the West London School District (1908–1917). The paper provides an extensive discussion of the two schools including the characteristics of the children, their representativeness, selection bias and the conditions in each school. It also provides a methodological introduction to measuring children’s longitudinal catch-up growth. After analysing the catch-up growth of boys and girls in the schools, it finds that there were no substantial differences between the catch-up growth by gender. Thus, these data suggest that there were not major health disparities between boys and girls in late-nineteenth-century America and early-twentieth-century Britain.

X = multiple interpretations

Risk preference theory posits that females are more religious than males because they are more risk averse and are thus more motivated by the threat of afterlife punishment. We evaluate the theory formally and empirically. Formally, we show that the rational choice reasoning implied by the theory leads to unexpected conclusions if one considers belief in eternal rewards as well as eternal punishment. Empirically, we examine cross-cultural data and find that, across many populations, sex differences in religiosity are no smaller among those who do not believe in hell. We conclude by arguing that psychological characteristics are almost certainly crucial to understanding the difference, just not risk preference.

Since World War II, rates of type 2 diabetes (henceforth diabetes) have skyrocketed, leading to talk of an “epidemic,” believed to result from formerly “adaptive” genotypes colliding with “affluent” postindustrial societies – largely their food excesses and physically undemanding jobs. Hence, experts describe diabetes as a struggle between biology and behaviors – “genes-as-destiny” and “lifestyles-as-choice” – said to have spared no social group. However, racial and ethnic minorities and the poor are affected disproportionately.

In this paper I challenge the “genes–lifestyle” framework and argue that the epidemic, particularly its distribution, is produced not by affluence but by poverty. The cumulative effect of malnutrition or hyperglycemia during pregnancy, of stunting in young children, of structural constraints over healthy lifestyles, and of the lack of a right to adequate medical care, which are all the results of poverty, leads to diabetes and its complications, and to disparities in their distribution among social groups. Hence, diabetes disparities are not mere differences but differences that are avoidable, unnecessary, and unjust. I also highlight selected conceptual problems of the genes–lifestyle framework that mislead about the potential contributions of genetics to human health.

I conclude that because the roots of the diabetes epidemic lie in inequities in social power, the solutions required are not medical but political, and ought to concern a sociologically informed bioethics. I also conclude that insofar as dominant accounts of the diabetes epidemic ignore or downplay these roots, they will legitimize research and policies that reproduce or even increase diabetes disparities. The paper is part of a larger project on the political ecology of diabetes.