The aim of this research was to undertake cross-county comparisons within the UK in relation to cross-border HE study mobility in order to inform understanding of, and raise issues in relation to, social inequalities between students, and the role and effect in this of policy and sectoral conditions associated with where they live. The research examined whether cross-border mobility for study within the UK reinforces inequalities in higher education (HE) participation, in relation to students’ social origin, educational background and ethnicity. It contributes new knowledge on this form of HE participation, to wider research on social inequalities in HE, and on issues of social citizenship in post-devolution UK. Sectoral and policy differences within the UK provided context for the study, which also drew on research evidence on student choice and participation, and theoretically on the concept of situated rationality in both rational action theory, specifically relative risk aversion, and cultural reproduction theory as applied to HE participation. Student and country/region differences in mobility to geographical and institution destinations were analysed using Higher Education Statistics Agency (HESA) data, principally of young full-time undergraduate entrants in 2012 (N=290510; N movers=22155). Key variables were social characteristics, attainment, field of study and tariff level of the institution entered; and additionally field of study supply, average earnings and professional employment rates. Descriptive, logistic regression, marginal effects and average marginal effects analyses provided findings on student differences and inequalities in outward mobility. The findings suggest that cross-border mobility serves different purposes by country of domicile. Established paths in relation to social and geographical origin appeared important in the high outward mobility from Northern Ireland and Wales, as did HE supply within Northern Ireland, and to a lesser extent within Wales. From Scotland, there was less concentration of destinations in relation to place, with patterns of mobility explained better by institution type entered; and from England mobility was defined more strongly by place of domicile for movement to Wales and by institution type entered for movement to Scotland. Mobility was associated with entering an institution with a higher average entry tariff compared to staying in the home country. An overall relationship was found between socio-economic advantage and mobility, but there were important findings that could not be interpreted as simply reproducing wider inequalities in HE participation which sectoral and policy contextual factors helped to explain. Although social class effect on mobility from England was limited, and being ‘first generation’ was positively associated with mobility from Northern Ireland. Despite the extent of mobility from Northern Ireland and Wales of students from a range of backgrounds, social class effects were strong for students from both. Shorter compared to longer distance cross-border mobility appeared less strongly associated with socio-economic advantage and more strongly with movement to lower tariff institutions. Relative field of study under-supply within the home country was associated more with mobility to lower than higher tariff institutions. Some Black and Minority Ethnic students may be mobile to enter an HEI or location with greater ethnic mix than their home area. Inflows from the rest of the UK had the strongest impact on Welsh and Scottish institutions. Cross-border mobility can be conceptualised as reasoned action based on a cost-benefit evaluation influenced both by the students’ cultural and financial resources, and external constraints and opportunities. It reinforces social inequalities in HE participation, but there is under-recognised social diversity in this mobility, as enabling policy conditions also benefit those from less socio-economically advantaged backgrounds. Such students are least likely to have the resources to mitigate any policy changes that increase the cost of or create barriers to cross-border mobility; and would be least likely to have the resources to be mobile to overcome any reduction in the availability and accessibility of HE in the home country. These groups of students that should be the main focus of concern and attention both in further policy development and in future research.

<p>Adverse birth outcomes like preterm birth and infant mortality are unevenly distributed across socio-economic groups. Risks are usually lowest in groups with high socio-economic status and increase with decreasing status.</p><p>The general aim of this thesis was to contribute to the understanding of the relation between socio-economic status and birth outcomes, focussing on maternal education and class, studying a range of birth outcomes. More specific aims were to investigate the relation between maternal education and infant health, to study the combined influence of maternal childhood and adult social class on inequalities in infant health and to explore the contribution of maternal working conditions to class inequalities in birth outcomes. The studies are population based, focussing on singletons births 1973-1990. During the period under study, educational differences in birth outcomes increased, especially between those with the lowest and highest education. The low birth weight paradox emerged, suggesting that the distribution of determinants for low birthweight infants differs for these groups.</p><p>Further, an independent association was found between maternal childhood social class and low birthweight and neonatal mortality, but not for postneonatal mortality. Since this was found for the two outcomes closest to birth, this indicates that the association is mediated through the maternal body.</p><p>Finally, there is a contribution of maternal working conditions to class inequalities in birth outcome. Lower job control, higher job hazards and higher physical demands were all to some degree related to increased risk of the following adverse birth outcomes: infant mortality, low birthweight, very low birthweight, foetal growth, preterm birth, very and extremely preterm birth. Working conditions demonstrated disparate associations with the birth outcomes, indicating a high complexity in these relationships.</p>

Adverse birth outcomes like preterm birth and infant mortality are unevenly distributed across socio-economic groups. Risks are usually lowest in groups with high socio-economic status and increase with decreasing status. The general aim of this thesis was to contribute to the understanding of the relation between socio-economic status and birth outcomes, focussing on maternal education and class, studying a range of birth outcomes. More specific aims were to investigate the relation between maternal education and infant health, to study the combined influence of maternal childhood and adult social class on inequalities in infant health and to explore the contribution of maternal working conditions to class inequalities in birth outcomes. The studies are population based, focussing on singletons births 1973-1990. During the period under study, educational differences in birth outcomes increased, especially between those with the lowest and highest education. The low birth weight paradox emerged, suggesting that the distribution of determinants for low birthweight infants differs for these groups. Further, an independent association was found between maternal childhood social class and low birthweight and neonatal mortality, but not for postneonatal mortality. Since this was found for the two outcomes closest to birth, this indicates that the association is mediated through the maternal body. Finally, there is a contribution of maternal working conditions to class inequalities in birth outcome. Lower job control, higher job hazards and higher physical demands were all to some degree related to increased risk of the following adverse birth outcomes: infant mortality, low birthweight, very low birthweight, foetal growth, preterm birth, very and extremely preterm birth. Working conditions demonstrated disparate associations with the birth outcomes, indicating a high complexity in these relationships.

The role of national education systems is changing, and many drivers of this phenomenon have been identified (Green, 1997). On the one side, there is a growing convergence in global education policy developments given by globalisation processes, on the other side, a political and ideological discourse has spread that promotes education as essential to the achievement of a model of economic productivity and competitiveness (Ball, 2013). The current research aims to shed light not only on the degree to which national education policy in the last two decades have been influenced by this movement, referred to as the Global Education Reform Movement (GERM) by Sahlberg (2016), but also on its possible consequences on equity. In order to do so, three western and European countries have been chosen: England, Sweden, and Italy. Through a mixed-method approach, in which the analysis of policy reforms is combined with PISA secondary data, each country’s specific political landscape and variation in socio-economic inequalities in the period between 2000 and 2020 is discussed. The final comparison between the countries allows seeing that even if all three countries present features of the GERM in the policy reforms enacted from the 2000s on, the consequences on equity are ambiguous. While the three countries present divergent trends both in PISA results and indicators of socio-economic inequalities, one common phenomenon worth deepening considering the increasing focus on standards is the steep increment in scores’ variation.

De nombreuses études ont montré que les femmes âgées atteintes de cancer du sein sont sous traitées par rapport aux plus jeunes. Si des publications suggèrent l’existence de fortes inégalités socio-économiques et géographiques dans le stade de découverte et la qualité de vie des patientes, l’effet différentiel de ces facteurs en fonction de l’âge est cependant largement méconnu en France. Les objectifs de ce travail étaient d’identifier les déterminants socio-économiques et géographiques du stade de découverte du cancer du sein en fonction de l’âge, de décrire la prise en charge et la survie des patientes atteintes de cancer du sein en fonction de l’âge, et d’identifier les déterminants de la qualité de vie, en fonction de l’âge chez des survivantes à 5 ans du cancer du sein. Les résultats des travaux réalisés ont montré que les femmes âgées de 50-74 ans et qui vivaient dans des zones économiquement défavorisées étaient diagnostiquées à des stades avancés pour leur cancer du sein. Les résultats ont également permis de mettre en évidence une diminution du traitement par chirurgie conservatrice et une augmentation de la proportion de femmes ne recevant aucun traitement chez les femmes les plus âgées. La survie était également moins bonne chez ces femmes. Enfin, cinq ans après le diagnostic du cancer du sein, chez les femmes âgées, seuls les comorbidités et le score de précarité EPICES impactaient la qualité de vie. Afin d’améliorer la survie et la qualité de vie des patientes âgées, une approche pluridisciplinaire par l’évaluation oncogériatrique, présente un intérêt et serait d’une importance capitale pour permettre une prise en charge individualisée de ces patientes. / Numerous studies have shown that older women with breast cancer are undertreated in comparison with the youngest. Although several reports suggest strong socio-economic and geographic inequalities in the disease stage at diagnosis and in quality of life in breast cancer patients, the effects of these factors according to age are largely unknown in France. The objectives of this work were to determine the impact of socio-economic and geographic disparities on disease stage in breast cancer patients according to age, to describe treatments and relative survival factors in breast cancer patients according to age, and to identify age-related socioeconomic and clinical determinants of quality of life among breast cancer survivors five years after the diagnosisThe results showed that living in a deprived area was linked to advanced-stage breast cancer at diagnosis only in women aged 50-74 years old. The use of breast conserving surgery decreased in older women while the proportions of women without treatment increased with age. Furthermore, survival was poor in elderly women. Finally, the results showed that, five years after breast cancer diagnosis in older women, only comorbidities and a low socio-economic status decreased quality of life scores.To improve survival and quality of life in elderly patients, a multidisciplinary approach by a comprehensive geriatric assessment, is a major step in breast cancer management as it can lead to individualized care for elderly patients with breast cancer.

The collapse of the communist regimes in Central and Eastern Europe in 1989-1990 heralded the beginning of an economic transition from central planning to market economies. The subsequent period was marked by malfunctioning of these countries’ social sectors, including their health care systems, raising serious issues of equity. This thesis examines the impact of the transition period and the introduction of social insurance on equity in health care provision in Bulgaria. Equity in health care is investigated with respect to function - i.e. financing (according to ability to pay) and delivery (according to need) - and outcomes - i.e. health status, income inequality and poverty. Differences in health, health care financing and delivery are explored by income, education, ethnic, employment, marital status, age and sex groups. Furthermore, the thesis outlines the impact of health care provision, in particular social insurance, on poverty and health inequalities. The thesis employs empirical analysis based on household data. Its methodology includes concentration and decomposition analysis, and provides new ways of modelling health care financing and delivery, as well as the link between health and health care delivery. The thesis concludes that social insurance does not provide a uniform means of improving equity and that the root cause of the problem lies in the large proportion of out-of-pocket payments and the rather limited size of the health insurance sector. Inequity in health care provision leads to poverty and untreated illness. The data suggests that there are differences between socio-economic groups as regards their likelihood to seek treatment for their ill health, which result in differences in their health status. The social factors that have impacted the most on health are low education and low income.