Search Results (163)

Pediatric tuberculosis (TB) remains a critically underrecognized contributor to global childhood morbidity and mortality, with the highest burden concentrated in low-resource settings. Although children comprise a minority of overall TB cases, mortality is disproportionately high, particularly among those under five years of age, driven largely by delayed diagnosis, inadequate linkage to care, and limited access to effective treatment. The continued rise of pediatric multidrug-resistant TB (MDR-TB), especially in regions with low sociodemographic development, further highlights persistent gaps in current control strategies. This review synthesizes key aspects of pediatric TB pathogenesis and host immune responses that predispose young children to rapid disease progression and severe outcomes, including immune immaturity and paucibacillary infection. We summarize pulmonary and extrapulmonary disease manifestations and identify populations at heightened risk, including children with HIV, malnutrition, type 1 diabetes mellitus, and congenital or treatment-related immunosuppression. Ongoing challenges in diagnosis and treatment are discussed, including limitations of existing microbiologic and immunologic tests, specimen collection constraints, regimen toxicity, and barriers to adherence. Prevention remains central to reducing pediatric TB mortality. We highlight the sustained importance of bacille Calmette–Guérin (BCG) vaccination in preventing severe disease and death, the context-dependent variability in vaccine effectiveness, and the structural and socioeconomic determinants of vaccine coverage. We conclude that integrating equitable vaccine delivery, scalable preventive therapy, and child-adapted diagnostic strategies is essential to meaningfully reduce the global pediatric TB burden. Full article

Background/Objectives: Childhood obesity remains a major public health issue, particularly in Mediterranean countries such as Greece. Although parental influences on children’s weight have been extensively studied, fewer studies have jointly examined parental mental health, feeding practices, sociodemographic factors, and biological stress markers. This study aimed to investigate associations between psychological status, educational level, feeding behaviors, and children’s Body Mass Index (BMI) in a Greek sample. A pilot assessment of salivary cortisol was included in evaluating its feasibility as an objective biomarker of parental stress. Subjects and Methods: A total of 103 parent–child dyads participated in this cross-sectional study. Children’s BMI was classified using World Health Organization (WHO) growth standards. Parental stress, anxiety, and depressive symptoms were assessed using the Perceived Stress Scale-14 (PSS-14) and the Depression Anxiety Stress Scale-21 (DASS-21) questionnaires. Feeding practices were evaluated with the Comprehensive Feeding Practices Questionnaire (CFPQ). Statistical analyses included Pearson correlations, independent samples t-tests, one-way ANOVA, Mann–Whitney U, and Kruskal–Wallis tests. A subsample provided saliva samples for cortisol analysis to assess feasibility and explore the potential associations with parental stress indicators. Results: Parental BMI showed a strong positive association with child BMI (p = 0.002). Higher parental anxiety (p = 0.002) and depression (p = 0.009) were also associated with increased child BMI. Restrictive (p < 0.001) and emotion-driven (p < 0.001) feeding practices were associated with higher child BMI, whereas monitoring (p = 0.013) and health-promoting feeding practices (p = 0.001) appeared protective. Lower parental education was related to a higher BMI in both parents (p = 0.001) and children (p = 0.002) and to more frequent use of restrictive feeding strategies (p = 0.001). WHO charts identified a greater proportion of children as overweight or obese compared with the Centers for Disease Control and Prevention (CDC) criteria. The analysis showed statistically significant differences between the two classification systems (χ² (4) = 159.704, p < 0.001), indicating that BMI categorization varies considerably depending on the reference system used. No significant associations were observed with residential environment or salivary cortisol, likely due to the limited size of the pilot biomarker subsample. Conclusions: The findings highlight the combined effect of parental mental health status, educational level, and feeding practices on child BMI within the Greek context. The preliminary inclusion of a biological stress marker provides added value to the existing research in this area. These results underscore the importance of prevention strategies that promote parental psychological wellbeing and responsive feeding practices while addressing socioeconomic disparities to reduce the childhood obesity risk. Full article

Background/Objectives: Food is Medicine (FIM) programs have been shown to be effective at addressing food and nutrition insecurity among individuals. However, more evidence is needed to determine effective interventions at the household level and their impact on child health outcomes. Feeding the Family is a randomized controlled trial which aims to determine whether the amount of food provided and the ability to select foods in FIM interventions have an incremental effect on child and caregiver clinical outcomes relative to nutrition counseling alone. The objective of this paper is to describe the population at baseline among those enrolled in Feeding the Family, an FIM family intervention. Methods: A pragmatic randomized controlled trial (pRCT) with a 2 × 2 factorial study design was used at an urban primary care clinic. Participants were randomized into one of four arms for a 3-month intervention: (1) medically tailored meals (MTMs), (2) grocery prescription (GP), (3) combined MTMs + GP, and (4) delayed control. Primary outcomes consisted of child and caregiver biomarkers (BMI, blood pressure, A1c, LDL, and HDL). Secondary outcomes included child and caregiver dietary behaviors, nutrition security, and food security. Spearman correlations and Kruskal–Wallis rank sum tests determined correlations between caregiver and child biomarkers, as well as correlations between caregiver socioeconomic factors and child outcomes, respectively. Results: Thirty-one caregivers and fifty-one children were enrolled. Nearly 90% of caregivers reported low–very low household food security; 93.6% experienced ongoing financial strain. Several caregiver–child biomarker correlations were observed, including caregiver and child BMI (r = 0.59, p = 0.043), caregiver LDL and child A1c (r = −0.79, p = 0.004), and caregiver total cholesterol and child BMI (r = −0.62, p = 0.032). In addition, food assistance status was associated with child vegetable intake (H = 6.16, df = 2, p = 0.046), and caregiver food security score was associated with child food security score (H = 18.31, df = 9, p = 0.032). Conclusions: There are robust correlations between caregiver and child clinical outcomes at baseline. These findings underscore the need for FIM research to examine how a tailored program can improve the clinical outcomes of entire households to address health disparities effectively. Full article

This study examines how parental legal status operates as a fundamental social determinant of health and educational equity, focusing on long-term outcomes among U.S.-born and foreign-born children of immigrants. We hypothesized that intergenerational stress and institutional exclusion associated with undocumented status would lead to lower educational attainment and poorer health. Using data from the National Longitudinal Study of Adolescent to Adult Health (Add Health), a nationally representative cohort, participants were classified by inferred parental legal status: native-born, documented immigrant, and undocumented immigrant. Outcomes included high school graduation, college enrollment, depression scores, and chronic health conditions. Children of undocumented parents exhibited the most adverse outcomes—lower graduation (63.8%) and college enrollment rates (39.9%), higher depression, and greater chronic illness. In models controlling for socioeconomic factors, parental undocumented status independently predicted reduced odds of college enrollment (OR = 0.61, p < 0.001) and increased odds of reporting fair/poor health (OR = 2.10, p < 0.001). Findings highlight legal precarity as a potent driver of intergenerational disadvantage and underscore the need for policies addressing the barriers faced by children in undocumented families to promote health and educational equity. Full article

Background: Hepatocellular carcinoma (HCC) poses a significant public health challenge in Australia, with poorer survival observed in non-metropolitan populations. This study investigated whether survival disparities persist between non-metropolitan and metropolitan patients if only those with early-stage HCC treated at metropolitan tertiary referral centres are considered. Methods: We performed a retrospective cohort study across ten Australian tertiary centres involving patients with a new diagnosis of Barcelona Clinic Liver Cancer (BCLC) stage 0 or A, recorded from 1 January 2016 to 31 December 2020. Residential postcodes were entered using the Modified Monash (MM) model to define metropolitan versus non-metropolitan residence. The primary endpoint was adjusted for all-cause mortality. Results: Our study included 854 patients (metropolitan n = 612, and non-metropolitan n = 242) with a median follow-up of 42.6 months. We found no significant survival or mortality differences between the two groups with the unadjusted Kaplan–Meier survival analysis (log-rank test p = 0.612) and with the Cox proportional hazards regression analysis (adjusted HR 0.93, 95% CI 0.64–1.34, p = 0.690). As expected, tumour burden, Child–Pugh Score, and Charlson Comorbidity Index (CCI) were significant predictors of mortality. Conclusions: Our findings suggest that previously observed survival disparities may stem from delayed diagnosis and reduced access to tertiary care in non-metropolitan regions and highlight the need for improved HCC surveillance and referral pathways, particularly for rural and Indigenous communities, to mitigate geographic inequities. Full article

Background: Childhood undernutrition and overnutrition continue to be major public health challenges in South Africa. There is limited evidence on how socio-economic factors and dietary behaviors influence nutritional outcomes among school-aged children, particularly in rural areas such as Thulamela Municipality. Objective: This study aimed to examine the socio-demographic determinants, dietary patterns, and nutritional status among school-aged children in Thulamela Municipality, Limpopo Province, South Africa. Methods: A cross-sectional survey was conducted with 347 children aged 8–12 years. Simple random sampling was used to select eight villages from a total of 227 within the municipality. A snowball sampling method was used to recruit eligible children. Data on socio-demographic characteristics, including the child’s sex, parental education level, marital status, and employment status, were collected. Additionally, their dietary habits and meal frequency patterns were collected using structured questionnaires. Anthropometric measurements including height, weight, and BMI-for-age were obtained following WHO growth standards. Associations between variables were assessed using chi-square tests, with p-values < 0.05 considered statistically significant. Results: The prevalence of severe and moderate stunting was 20.5% and 21.0%, respectively. Overweight conditions and obesity affected 32.6% and 16.2% of participants, respectively. Parental education (p = 0.027), marital status (p = 0.001), and household income (p = 0.043) showed significant associations with height-for-age and BMI-for-age Z-scores. Additionally, regular breakfast consumption and the frequent intake of vegetables and dairy products were positively associated with improved nutritional outcomes (p < 0.05). Conclusions: The nutritional profile of school-aged children in Thulamela Municipality reflects a double burden of malnutrition, with concurrent high rates of stunting, overweight conditions, and obesity. Interventions that promote balanced diets and address socio-economic disparities are crucial for improving child growth and overall health. Socio-economic factors, including parental education, marital status, and household income, were significantly associated with children’s height-for-age and BMI-for-age. Furthermore, the regular consumption of breakfast, vegetables, and dairy products was associated with better nutritional outcomes, highlighting the influence of both dietary behaviors and socio-demographic determinants on child growth and health. Implementing nutrition education programs within schools that emphasize the value of balanced diets and highlighting the significance of eating breakfast regularly and incorporating vegetables and dairy products into daily meals is important. These programs should include both children and their caregivers to support regular healthy eating behaviors at home and in school. Additionally, schools should carry out regular growth monitoring and nutritional assessments to identify early indications of undernutrition or overnutrition, enabling prompt referrals and interventions for children who may be at risk. Full article

According to the Australasian Society for Developmental Paediatrics, experiential learning and outdoor play contain elements of risk, bravery, uncertainty, exploration, personal challenge, and adventure. These attributes are fundamental to a child’s growth, development, and wellbeing, and yet, in contemporary society, outdoor experiences have significantly declined. This scoping review explores the benefits and affordances of nature-based risky play and adventure education across early childhood and adolescence, asking what developmental opportunities emerge when children and adolescents engage in meaningful outdoor challenges. Adopting a benefit–risk approach where safety is “as safe as necessary” rather than “as safe as possible,” the review identifies common elements across developmental stages. A scoping review following PRISMA-ScR guidelines synthesised empirical studies (2015–2025). Our review included 40 empirical studies from a total of 5218 references, using diverse methodologies conducted predominantly in Western nations. All 40 studies reported positive associations across multiple developmental domains. Eight key themes developed: resilience and confidence, wellbeing, physical skills, autonomy and agency, nature connectedness, quality play provision, and educator influence. Authentic child agency and autonomy functioned as critical mechanisms through which benefits are realised across early childhood and school-aged populations. Key benefits included enhanced mental health, social competence, and anxiety prevention. Implementation barriers persist, including parental anxiety, institutional liability concerns, and cultural risk aversion. Evidence overwhelmingly supports nature-based risky play and outdoor adventure education as beneficial for child and adolescent development. Translation into practice remains limited by stakeholder attitudes and systemic barriers. Future research should prioritise longitudinal studies, cross-cultural investigation, and equity-focused approaches addressing disparities in access to positive risk-taking. Full article

Background: Childhood immunization is one of the most effective public health strategies for reducing morbidity and mortality from vaccine-preventable diseases. Although overall vaccination coverage in the United States remains high, disparities persist across socioeconomic and healthcare access groups. Understanding these disparities is particularly important in the post-COVID-19 era, when increased vaccine hesitancy may threaten progress in maintaining equitable coverage. Materials and Methods: We analyzed data from the National Immunization Survey–Child (NIS-Child), focusing on U.S. children aged 19–35 months in 2023, corresponding to cohorts reaching this age during or after the COVID-19 pandemic. The primary outcome was receipt of the up-to-date combined 7-vaccine series (4:3:1:3:3:1:3: ≥4 doses of DTaP, ≥3 doses of polio, ≥1 dose of measles-containing vaccine, full Hib series, ≥3 doses of hepatitis B, ≥1 dose of varicella, and ≥3 doses of PCV). Logistic regression models were used to estimate associations between vaccination coverage and key explanatory variables: household income-to-poverty ratio, maternal education, health insurance type, and provider facility type, controlling for demographic and regional covariates. Disparities were quantified using concentration indices (CIs). Results: Among children in the analytic sample, overall coverage for the 7-vaccine series was only 78.5%. Nonetheless, disparities were evident. Children from households with lower income-to-poverty ratios (<1 × FPL: OR = 0.44, 95% CI = 0.37–0.53; 100–200%: OR = 0.66, 95% CI = 0.56–0.79), those covered by Medicaid (OR = 0.54, 95% CI = 0.45–0.64), other insurance (OR = 0.48, 95% CI = 0.37–0.61), or uninsured (OR = 0.27, 95% CI = 0.18–0.42), and those whose mothers had lower educational attainment (<12 years: OR = 0.35, 95% CI = 0.28–0.44) had significantly lower odds of being up-to-date. Similar associations were observed across specific vaccines. Unadjusted CIs for income-to-poverty ratio (0.04, p < 0.01), maternal education (0.04, p < 0.01), health insurance (0.03, p < 0.01), and provider type (0.03, p < 0.01) decreased but remained statistically significant after adjustment (0.02, 0.02, 0.01, and 0.02, respectively; all p < 0.01). No significant disparities were found by census region or race/ethnicity. Discussion: Despite relatively high overall vaccination coverage among U.S. children born during and after the COVID-19 pandemic, disparities by socioeconomic and healthcare access factors persisted. However, the absolute magnitude of these disparities was very small (concentration indices ≤ 0.04). These findings suggest that while inequities remain statistically measurable, their scale is limited in absolute terms. Targeted efforts to address income, insurance, maternal education, and provider-related barriers will be important to sustain equitable immunization coverage in the post-pandemic era. Full article

Docosahexaenoic acid (DHA) is a long-chain omega-3 fatty acid essential for neurodevelopment, immune regulation, and key physiological functions during early life. In low- and middle-income countries (LMICs), limited access to DHA-rich foods contributes to disparities in intake and health outcomes. This narrative review describes the current evidence on dietary patterns of DHA intake and supplementation from pregnancy through childhood in LMICs and highlights the implications of these patterns for child health. The review is based on a systematic search conducted in PubMed using Medical Subject Heading (MeSH) terms related to DHA, dietary patterns, health outcomes, and LMICs. Studies published between 2014 and 2025 were screened using Covidence software. Eligible studies included observational, interventional, and review designs that reported DHA through dietary intake, supplementation, or measurement in biological samples during pregnancy, lactation, infancy, or childhood. Data extraction followed the PICOS (Population, Intervention, Comparison, Outcome, Study Design) framework. A total of 76 studies were included. Across LMICs, DHA intake was consistently insufficient among pregnant and lactating women, infants, and children. Reported dietary sources were generally low in DHA content. Intake or supplementation was associated with neurodevelopment, immune response, pregnancy outcomes, and cardiometabolic health, although findings were sometimes mixed or modified by gene–environment interactions. Results varied by study design, contextual factors, income level, and geographic access. Large gaps remain in nationally representative intake data. Despite its physiological relevance, DHA intake remains inadequate in LMICs during early life. This review underscores the importance of improving DHA intake in vulnerable populations and identifies evidence gaps to guide future research and inform context-specific nutrition strategies. Full article

Background/Objectives: The structure and adequacy of health financing critically shape population health outcomes. This study examines financing typologies in relation to healthy life expectancy (HALE) and infant mortality across 38 OECD countries and Türkiye (2000–2021), quantifying financing model effectiveness and sex-disaggregated disparities. Methods: Time-weighted averages (exponential weighting, λ = 1.5) emphasized recent policy environments while preserving historical context. Principal component analysis addressed multicollinearity among six financial indicators. Multidimensional scaling (stress = 1.16 × 10⁻¹²) and K-means clustering identified four financing typologies. TOPSIS composite scores measured proximity to ideal outcomes (maximum HALE, minimum infant mortality), with success rates calculated as the percentage achieving top-quartile performance (TOPSIS ≥ 70). Sex-disaggregated analysis examined gender gaps across clusters. Results: High-Public-Spending systems achieved an 81.2% success rate (mean TOPSIS = 76.0), those with Balanced High-Expenditure achieved 77.8%, whereas Moderate/Emerging systems exhibited only 8.3% success. Türkiye ranked 36th of the 38 (TOPSIS = 24.8), 45% below cluster average, with extreme deficits in HALE (percentile = 15.8%) and infant mortality (7.9%). Low-resource systems showed significantly wider gender gaps (HALE: 3.43 vs. 1.66 years; infant mortality male excess: 1.04 vs. 0.53 per 1000; p < 0.01), with Türkiye demonstrating the third-highest male excess mortality globally (1.69 per 1000), indicating critical neonatal care deficiencies. Conclusions: Robust public financing (>USD 3500 per capita, >7% GDP) is necessary and nearly sufficient for superior outcomes, with success rates differing 10-fold between high- and low-resource systems (81% vs. 8%). Türkiye’s extreme underperformance reflects both inadequate public investment (USD 813 per capita, 22% of high-performing averages) and efficiency deficits requiring doubled expenditure alongside targeted maternal–child health interventions. Full article

Cybersexual victimization is a growing public health concern with severe psychosocial consequences, particularly for younger populations. Despite growing awareness of its prevalence, understanding how cybersexual victimization evolves across different demographic and regional contexts remains limited. The aim was to analyze sex- and age-specific temporal trends and projections of cybersexual victimization in Spain (2011–2022), disaggregated by sex, age group, autonomous community, and offense type, to identify where disparities emerge and persist (particularly from adolescence (<18) into midlife) while also examining gender and regional inequalities to provide evidence for prevention strategies that are both gender-sensitive and tailored to different developmental stages and territorial contexts. Spanish national police-reported data on seven cybersexual offenses (sexual abuse, sexual harassment, corruption of minors, grooming, exhibitionism, child sexual abuse images, and sexual provocation) from 2011 to 2022 were analyzed. Data were disaggregated by sex, age group, and regions. Mean rates per 100,000 inhabitants were calculated, independent-sample t-tests assessed sex differences, and linear regression models projected trends to 2035 for each age-sex group. Between 2011 and 2022, cybersexual crimes in Spain increased across most offense types, with grooming, child sexual abuse images, and contact offenses showing the steepest upward trends (all p < 0.001). Women consistently presented higher mean victimization rates than men in most offense types and age groups. Among those under 18, mean grooming rates were 2.55 for females versus 0.95 per 100,000 for males (p < 0.001), with significant differences also in corruption of minors (p < 0.01). In young adulthood (18–25 years), women showed higher rates in sexual harassment (p < 0.001) and sexual abuse (p < 0.01), while, in midlife (26–40 and 41–50 years), female predominance persisted for sexual harassment, sexual abuse, and sexual provocation (all p < 0.05). Projections to 2035 indicate that sex gaps will remain or widen, particularly among females under 18 and in the 26–40 age group. The Balearic, Canary Islands, and Andalusia regions recorded the highest mean rates, whereas Galicia and Castilla-La Mancha reported the lowest. Cybersexual victimization in Spain disproportionately affects females from adolescence into midlife, with the most considerable disparities emerging before age 18 and persisting into adulthood. The combination of rapid offense growth, persistent sex-based disparities, and marked regional inequalities underscores the urgent need for gender-sensitive, developmentally targeted prevention strategies that address both early vulnerability and the reinforcement of risk in adult digital environments. Full article

Background: Heart disease may take a greater toll on Black Americans than White Americans despite similar levels of traditional risk factors. Elevated alcohol consumption (EAC) and chronic inflammation are two potentially important additional risk factors to consider. Both are relevant to understanding health disparities in cardiovascular health. Methods: Couples with a Black preadolescent or early adolescent child living in the home were recruited and followed. In waves 5 and 6 of data collection, biological samples were also collected allowing the characterization of elevated alcohol consumption, chronic inflammation, and cardiac risk using DNA methylation indices. 383 individual partners comprising 221 couples were examined across the two waves of data, yielding 661 person-wave observations from 383 individuals. Results: EAC at wave 5 forecast increased cardiac risk at W6 (R² change = 0.276), β = −0.193, p = 0.001. However, chronic inflammation at wave 5 did not add significantly to the baseline model, β = −0.042, p = 0.549. Conversely, the slope of change for chronic inflammation was associated with slope of change in cardiac risk (R² change = 0.111), b = −0.014, p = <0.001, but EAC change was not significantly associated with change in cardiac risk, b = −0.001, p = 0.185. Conclusions: Elevated alcohol consumption may be an important risk factor for increased cardiac risk over time in middle age. If so, it could be an important avenue for preventative intervention to decrease cardiac risk. Future research should examine whether similar associations are observed for other racial or minoritized groups and for non-minoritized groups. Full article

Background: Immunisation remains one of the most effective and cost-efficient public health interventions for preventing infectious diseases in children. Despite global progress, Sub-Saharan Africa (SSA) continues to face challenges in achieving equitable immunisation coverage. Gender-related disparities, rooted in sociocultural and structural inequalities, significantly influence the prevalence of zero-dose and under-immunised children in the region. This review critically examines the gender-associated barriers to routine childhood immunisation in SSA to inform more inclusive and equitable health interventions. Methods: A critical literature review was conducted generally following some steps of the PRISMA-P and CRD guidelines. Using the Population–Concept–Context (PCC) framework, studies were selected that examined gender-related barriers to routine immunisation for children under five in Sub-Saharan Africa. Comprehensive searches were performed across PubMed, Google Scholar, and relevant organisational websites, targeting articles published between 2015 and 2025. A total of 3683 articles were retrieved, with 24 studies ultimately meeting the inclusion criteria. Thematic analysis was used to synthesise the findings. Results: Four major themes emerged: (1) women’s empowerment and autonomy, including limited decision-making power, financial control, and the impact of gender-based violence; (2) male involvement and prevailing gender norms, where patriarchal structures and low male engagement negatively influenced vaccine uptake; (3) socioeconomic and structural barriers, such as poverty, geographic inaccessibility, maternal workload, and service availability; and (4) education, awareness, and health system responsiveness. Conclusions: Gender dynamics have a significant impact on childhood immunisation outcomes in Sub-Saharan Africa. Future policies must integrate these insights to improve immunisation equity and reduce preventable child morbidity and mortality across the region. Full article

(1) Background: University students face increasing mental health challenges, with sociodemographic disparities shaping well-being outcomes and highlighting the need for machine learning approaches to identify distinct psychological profiles. (2) Methods: This cross-sectional study surveyed 4911 Chinese university students (aged 18–25) using the EPOCH Questionnaire, which measures Engagement, Perseverance, Optimism, Connectedness, and Happiness. Data were collected via WenjuanXing (WJX), with recruitment promoted through official channels. Well-being profiles were identified through exploratory K-means clustering, with internal validity and the optimal cluster number assessed using the silhouette coefficient. (3) Results: Cluster analysis identified two distinct groups: Cluster 0 (41.09%) with higher well-being scores and Cluster 1 (58.91%) with lower scores. Differences across all five EPOCH dimensions exceeded 1.0, most notably in Optimism (Δ = 1.31) and Happiness (Δ = 1.37). A subgroup of concern within Cluster 1 (n = 92), primarily male sophomores from rural, low-income, multi-child families receiving financial aid, showed particularly low scores in Connectedness (Δ = −0.57) and Happiness (Δ = −0.43). In contrast, a high well-being subgroup in Cluster 0 (n = 108), mainly urban female freshmen from high-income, only-child families, exhibited elevated scores, especially in Connectedness (Δ = 0.69) and Happiness (Δ = 0.65). (4) Conclusions: This exploratory clustering study identified distinct well-being profiles among Chinese university students, with demographic and socioeconomic vulnerabilities associated with diminished psychological well-being, particularly in Connectedness, Happiness, and Optimism. These findings highlight the need for targeted interventions that integrate psychosocial support with financial assistance to reduce inequalities and promote flourishing. Full article