Is Social Mobility Really Declining? Intergenerational Class Mobility in Britain in the 1990s and the 2000s

This paper contributes to the ongoing debate on social mobility in contemporary Britain among economists and sociologists. Using the 1991 British Household Panel Survey and the 2005 General Household Survey, we focus on the mobility trajectories of male and female respondents aged 25-59. In terms of absolute mobility, we find somewhat unfavourable trends in upward mobility for men although long-term mobility from the working class into salariat positions is still in evidence. An increase in downward mobility is clearly evident. In relation to women, we find favourable trends in upward mobility and unchanging downward mobility over the fourteen-year time period. With regard to relative mobility, we find signs of greater fluidity in the overall pattern and declining advantages of the higher salariat origin for both men and women. We consider these findings in relation to the public debate on social mobility and the academic response and we note the different preoccupations of participants in the debate. We conclude by suggesting that the interdisciplinary debate between economists and sociologists has been fruitful although a recognition of similarities, and not simply differences in position, pushes knowledge and understanding forward.Social Class, Absolute and Relative Mobility, Gender Difference, Social Fluidity

Incorporating social determinants of health into the clinical management of type 2 diabetes

Type 2 diabetes (T2DM) is increasing in global and national prevalence. It is more common among people with poor social determinants of health (SDoH). Furthermore, SDoH are known to influence health related choice, and therefore the glycaemic management of people with T2DM. There is a growing body of evidence affirming an irrefutable relationship between SDoH and T2DM. Currently SDoH are considered at a population level, whereas T2DM is usually managed individually. Assessing and addressing SDoH related barriers, at an individual, clinical level may contribute to improved glycaemic management for people with T2DM. Developing an approach to assess SDoH related management barriers, and incorporating it into usual clinical care will allow insight into ‘nonclinical’ obstacles to self-management. Additionally, investigation into strategies to address the identified barriers will extend and contextualise this approach, and could broaden and augment current efforts to improve glycaemic management for people with T2DM. An exploratory, descriptive research design will facilitate the exploration of the most appropriate methods and strategies for incorporating SDoH into clinical practice. These approaches can then be trialled and evaluated to inform an evidence-based approach for this addition to the usual clinical care of people with T2DM. This presentation will describe a current research project that is investigating how SDoH can be incorporated into the clinical management of T2DM, and discuss the findings so far

Utilising clinical settings to identify and respond to the social determinants of health of individuals with type 2 diabetes - a review of the literature

Type 2 diabetes (T2DM) is increasing in global prevalence. It is more common among people with poor social determinants of health (SDoH). Social determinants of health are typically considered at a population and community level; however, identifying and addressing the barriers related to SDoH at an individual and clinical level, could improve the self-management of T2DM. This literature review aimed to explore the methods and strategies used in clinical settings to identify and address the SDoH in individuals with T2DM. A systematic search of peer-reviewed literature using the electronic databases MEDLINE, CINAHL, Scopus and Informit was conducted between April and May 2017. Literature published between 2002 and 2017 was considered. Search results (n = 1,119) were screened by title and abstract against the inclusion and exclusion criteria and n = 56 were retained for full text screening. Nine studies met the inclusion criteria. Review and synthesis of the literature revealed written and phone surveys were the most commonly used strategy to identify social determinant-related barriers to self-management. Commonly known SDoH such as; income, employment, education, housing and social support were incorporated into the SDoH assessments. Limited strategies to address the identified social needs were revealed, however community health workers within the clinical team were the primary providers of social support. The review highlights the importance of identifying current and individually relevant social determinant-related issues, and whether they are perceived as barriers to T2DM self-management. Identifying self-management barriers related to SDoH, and addressing these issues in clinical settings, could enable a more targeted intervention based on individually identified social need. Future research should investigate more specific ways to incorporate SDoH into the clinical management of T2DM

Improving type 2 diabetes care and self-management at the individual level by incorporating social determinants of health

Objective: Suboptimal social determinants of health impede type 2 diabetes self-management. They are usually considered at population and community levels, not individually. The study objective was to draw on perspectives of people who have type 2 diabetes to identify and explore the impact of social determinants on self-management and ways to incorporate them into individual care. Methods: Purposively selected participants chose to partake in focus groups or interviews. Data were analysed and themes identified through deductive and inductive thematic analysis. Results: Social issues hinder type 2 diabetes self-management. Additionally, an individual’s feelings and poor mental health, competing priorities and understanding about diabetes are important considerations. Support was provided via health professionals, community supports, financial support, personal support and informal self-management support. Conclusions: Social determinants of health could be formally incorporated into individual care for people with type 2 diabetes if a socio-ecological view of health is taken as it considers the broader social and environmental circumstances in peoples lives. Implications for public health: Care for people with type 2 diabetes could be transformed if social determinants of health are formally assessed and responded to at an individual level. A socio-ecological view of health in individual care and clinical settings would enable social determinants of health to be formally incorporated into type 2 diabetes care

On social class, anno 2014

This article responds to the critical reception of the arguments made about social class in Savage et al. (2013). It emphasises the need to disentangle different strands of debate so as not to conflate four separate issues: (a) the value of the seven class model proposed; (b) the potential of the large web survey – the Great British Class Survey (GBCS) for future research; (c) the value of Bourdieusian perspectives for re-energising class analysis; and (d) the academic and public reception to the GBCS itself. We argue that, in order to do justice to the full potential of the GBCS, we need a concept of class which does not reduce it to a technical measure of a single variable and which recognises how multiple axes of inequality can crystallise as social classes. Whilst recognising the limitations of what we are able to claim on the basis of the GBCS, we argue that the seven classes defined in Savage et al. (2013) have sociological resonance in pointing to the need to move away from a focus on class boundaries at the middle reaches of the class structure towards an analysis of the power of elite formation

Investigating the structural compaction of biomolecules upon transition to the gas-phase using ESI-TWIMS-MS

Collision cross-section (CCS) measurements obtained from ion mobility spectrometry-mass spectrometry (IMS-MS) analyses often provide useful information concerning a protein’s size and shape and can be complemented by modeling procedures. However, there have been some concerns about the extent to which certain proteins maintain a native-like conformation during the gas-phase analysis, especially proteins with dynamic or extended regions. Here we have measured the CCSs of a range of biomolecules including non-globular proteins and RNAs of different sequence, size, and stability. Using traveling wave IMS-MS, we show that for the proteins studied, the measured CCS deviates significantly from predicted CCS values based upon currently available structures. The results presented indicate that these proteins collapse to different extents varying on their elongated structures upon transition into the gas-phase. Comparing two RNAs of similar mass but different solution structures, we show that these biomolecules may also be susceptible to gas-phase compaction. Together, the results suggest that caution is needed when predicting structural models based on CCS data for RNAs as well as proteins with non-globular folds

Indigenous Australian perspectives on incorporating the social determinants of health into the clinical management of type 2 diabetes

Introduction: Type 2 diabetes mellitus and social disadvantage are related. In Australia, this association is most pronounced among Indigenous Australians (Aboriginal and Torres Strait Islander peoples). Indigenous Australians are among the most socially disadvantaged in the country, having the worst social determinants of health (SDoH). SDoH are typically addressed at a population level, and not on an individual or a clinical level. However, the SDoH-related needs of individuals also require attention. The adverse link between type 2 diabetes and SDoH suggests that simultaneous consideration at an individual, clinical level may be beneficial for type 2 diabetes care and self-management. Identifying and addressing SDoH-related barriers to type 2 diabetes self-management may augment current care for Indigenous Australians. This study aimed to combine the perspectives of Indigenous Australians with type 2 diabetes and Indigenous health workers to explore the SDoH-related barriers and facilitators to self-managing type 2 diabetes, and how SDoH could be incorporated into the usual clinical care for Indigenous Australians with type 2 diabetes. Methods: Under the guidance of a cultural advisor and Indigenous health workers, seven Indigenous Australians with type 2 diabetes and seven Indigenous health workers from rural and remote north Queensland, Australia, participated in a series of semi-structured, in-depth face-to-face interviews and yarning circles. A clinical yarning approach to data collection was used, and both an inductive and a deductive data analysis were applied. Data were analysed, and themes were identified using NVivo v12. Results: Study participants described a holistic view of health that innately includes SDoH. Specific to type 2 diabetes care, participants identified that culturally responsive service delivery, suitable transport provision, an infinite flexible approach to accommodate for individuals' unique social circumstances, appropriate client education and appropriate cultural education for health professionals, support mechanisms and community support services were all essential components. These were not seen as separate entities, but as interrelated, and all were required in order to incorporate SDoH into care for Indigenous Australians with type 2 diabetes. Conclusion: SDoH are implicit to the Indigenous Australian holistic view of health. Consequently, an approach to type 2 diabetes care that complements this view by simultaneously considering SDoH and usual type 2 diabetes clinical management could lead to enhanced type 2 diabetes care and self-management for Indigenous Australians