The global inverse care law: a distorted map of blindness

“Eye care for all” is the motto of this year’s World Sight Day. But there are stark global inequalities in access to eye care. In 1971, Hart described the, ‘Inverse Care Law’ as the availability of good medical care varying inversely with the need for it in the population served. Hart was describing the situation in the National Health Service in Great Britain at the time in which he practiced as both a General Practitioner and an epidemiologist.
Two recently published articles demonstrate the ‘Inverse Care Law’ on a global level. The prevalence of blindness worldwide in 2010 was reported by the WHO and verified that low- and middle-income countries, as expected, have the highest prevalence of blindness and visual impairment. In stark contrast to this, a more recent report describes the,“Number of ophthalmologists in training and practice worldwide” providing global data for the number of ophthalmologists per county and demonstrates that despite a growing number in practice the gap between need and supply is widening.
The situation is also magnified within individual countries of high, middle and low-income. For example, in France, an inverse correlation was found between the number of ophthalmologists and the prevalence of low vision for subjects of similar age and socio-professional category and another example is in Kenya where of the 86 practicing ophthalmologists, 43 are based in Nairobi (personal correspondence). That equates to 50% of the countries ophthalmologists serving 8% of an already underserved population.
We have developed two cartograms to depict the data from these two papers using Gastner & Newman diffusion-based method. This allowed us to create density-equalised maps based on the absolute values provided in the papers. In the maps, each of the reference areas (WHO regions and countries) is resized according to these values. Larger areas represent higher numbers and smaller areas proportionally smaller data values:

Cartograms of Blindness and Opthmamologists
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Global Gender Gap in Secondary Education

100% Equality was the theme of a session at this year’s Nexus Europe Youth Summit in London last week. As a member of the panel I started off by giving a global overview of the state of gender (in)equality and how this is being measured by different institutions, such as the United Nations Development Programme, the World Economic Forum, or the European Institute for Gender Equality. While they draw very different pictures in their detailed indicators, there are also a lot of similarities, with the European Nordic countries almost always being in the top spots of the overall index, which does not mean that in any of these countries absolute gender equality has been achieved. Globally seen, health equality is furthest progressed, why empowerment and participation remain amongst the most pressing issues.
The following map is from my slides that I have shown and displays the gender gap in secondary education around the world projected on an equal-population projection using a gridded cartogram transformation:

Map of the global gender education gap
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Students and research funding in England

Ten research-intensive universities in the South of England will get more than £2,000 each year in quality-related research funding for every student at the institution. As shown in the following map, no institution in the North will get the same amount using the same measure, which takes each university’s QR income and divides it by its student population.

Map of quality related research funding and student numbers in England
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Global Gender Inequality

The unequal treatment of individuals based on their gender is a deeply rooted problem in most societies. It started becoming an important part of academic research in the 1980s. The issue of gender inequality also became in various measures part of the Human Development Index (HDI), the annual report by the United Nations Development Programme (UNDP), and was eventually integrated as the Gender Inequality Index (GII) in the 2010 report. It is designed to measure the loss of achievement within a country caused by gender inequality.

Map of Global Gender Inequality as shown in the Gender Inequality Index
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Women in Parliament

#makeithappen - International Women's Day 2015Make it happen is this year’s theme of International Women’s Day. The day is Internationally the day is celebrated every year on March 8th since 1911 and in 1917 demonstrations in the context of the Women’s Day lead to the outbreak of the Russian Revolution. What had started as a socialist event to recognize women’s economic, political, and social struggles and achievements has now lost this ideological connotation. Today it is rather regarded as an opportunity to raise awareness for the inequality women still experience in all societies.
In some countries the day is still an official holiday, such as in Russia and other former socialist republics, but also in Afghanistan, Angola and Eritrea. In China, Madagascar, Macedonia and Nepal it is a holiday solely for women.
Gender inequality remains a pressing challenge globally and is seen as a major barrier to human development which is why the UN’s Human Development Index (HDI) has a specific indicator to take these problems into account. The Gender Inequality Index (GII) measures gender (in)equity in health, education, work and politics.
The following map shows one indicator from the current GII that highlights the political representation of women in parliaments worldwide measured by the share of seats in parliament (with data for 2013). The map uses an equal-population projection which gives every person on the planet an equal amount of space:

Map of women in Parliament
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Changing Poverty and Wealth in England

England is increasingly divided between the rich and the poor, with a 60% increase in poor households and a 33% increase in wealthy households. This has come at a time – 1980 to 2010 – when the number of middle-income households went down by 27%.” In a Londonmapper report that was featured in today’s Observer newspaper we showed how the groups of poor and wealthy and the remaining ‘middle’ have changed in England over the past three decades.
London's Changing Wealth: Poor, Wealthy and the Middle
These two charts, showing the absolute and relative changes in the number of households in each group, highlight that poor and middle households have come to being almost equally large groups in the British capital in the period, with a clear trend in growing numbers of poor and wealthy households and a shrinking middle part. These polarising trends of growing inequality are not only prevalent in London, but also continue in the rest of the country. The following cartogram visualisation uses the absolute changes between 1980 and 2010 and shows how the increase in poverty and wealth compares across the regions of England and the Borough of London and looks at the decline in the middle in the same way. How the middle is squeezed out of London becomes particularly apparent in these images, as London dominates much of the map while growing numbers of poor and wealthy households are more evenly distributed across the country:

Visualising England's Changing Wealth(click for larger version)

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