science and technology perpetuates inequality gp essay

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Innovative technologies and social inequalities in health: A scoping review of the literature

Daniel weiss.

1 Department of Public Health and Nursing, Norwegian University of Science and Technology, Trondheim, Norway

2 HUNT Research Center, Department of Public Health and Nursing, Norwegian University of Science and Technology, Levanger, Norway

Håvard T. Rydland

3 Department of Sociology and Political Science, Norwegian University of Science and Technology, Trondheim, Norway

Emil Øversveen

Magnus rom jensen.

4 Library Section for Humanities, Education and Social Sciences, Norwegian University of Science and Technology, Trondheim, Norway

Solvor Solhaug

Steinar krokstad.

5 Levanger Hospital, Nord-Trøndelag Hospital Trust, Levanger, Norway

Associated Data

All studies and available data included in this review are made available as a supporting file ( S1 File .txt) or included in the main text of this manuscript.

The aim of this study was to systematically review the range, nature, and extent of current research activity exploring the influence of innovative health-related technologies on social inequalities in health, with specific focus on a deeper understanding of the variables used to measure this connection and the pathways leading to the (re)production of inequalities. A review process was conducted, based on scoping review techniques, searching literature published from January 1, 1996 to November 25, 2016 using MEDLINE, Scopus, and ISI web of science. Search, sorting, and data extraction processes were conducted by a team of researchers and experts using a dynamic, reflexive examination process. Of 4139 studies collected from the search process, a total of 33 were included in the final analysis. Results of this study include the classification of technologies based on how these technologies are accessed and used by end users. In addition to the factors and mechanisms that influence unequal access to technologies, the results of this study highlight the importance of variations in use that importantly shape social inequalities in health. Additionally, focus on health care services technologies must be accompanied by investigating emerging technologies influencing healthy lifestyle, genomics, and personalized devices in health. Findings also suggest that choosing one measure of social position over another has important implications for the interpretation of research results. Furthermore, understanding the pathways through which various innovative health technologies reduce or (re)produce social inequalities in health is context dependent. In order to better understand social inequalities in health, these contextual variations draw attention to the need for critical distinctions between technologies based on how these various technologies are accessed and used. The results of this study provide a comprehensive starting point for future research to further investigate how innovative technologies may influence the unequal distribution of health as a human right.

Introduction

Despite expectations to the contrary, social inequalities in health appear to be increasing in many of the world’s most developed countries during an era of rapid innovative technological development [ 1 – 3 ]. As the quantification of health in modern society intensifies and innovative health technologies become the cornerstone of this transition, the connection between technology and health is garnering increased attention [ 4 – 7 ]. Recent years have witnessed an era of intensified technology use in health care services [ 8 ] as well as developments in personalized medicine and the use of big data for health purposes. These advances have promoted a growing dependency on technology in society and the collection of advanced information, including that of the personal genome, which are then used to influence the decisions and behaviors of not just ordinary citizens but also health personnel, private companies, and large institutions [ 9 – 11 ]. These innovations are generally seen as positive developments, improving the diagnostics and treatment of disease as well as general public health, however their wider societal implications can be questioned [ 10 , 12 – 14 ]. It appears likely that these technologies could be improving general public health but at the cost of increasing inequalities in health [ 13 , 15 ].

Various publications have addressed the importance of further investigating the potential implications that the rapid development and increased prioritization of various technological innovations in health have on the health of society as a whole [ 3 , 10 – 12 , 16 , 17 ]. Other studies have empirically investigated the production of inequalities in health due to the advent of innovative technologies [ 18 – 20 ]. These studies demonstrate that individuals of higher socioeconomic status (SES) are the first to adopt, and benefit most from, the introduction of innovative technologies in health, creating social inequalities in health where they were once very low or nonexistent, or in some cases even inverting these inequalities (where improved health outcomes have moved from lower SES groups to higher SES groups). This phenomenon is further illustrated by results demonstrating larger social inequalities in health among populations suffering from illnesses for which effective preventive or treatment techniques have been developed [ 21 ]. These studies provide a starting point for investigating additional mechanisms that may explain the (re)production of social inequalities in health [ 22 , 23 ]. As the rate of innovative health technology intensifies, a better understanding of this perspective is becoming increasingly important.

Still missing from the literature is a broad foundation from which to further investigate and explain the connection between technological innovations and social inequalities in health. The following questions are still in need of clarification:

• How are innovative health technologies defined in a social inequalities context?
• What are the implications of using various measurements of social inequality?
• How do existing studies explain the potential relationship between innovative health technology and social inequalities in health?
• How may innovative health technologies reduce or (re)produce social inequalities in health?

The aim of this study, therefore, was to systematically review the range, nature, and extent of current research activity exploring the influence of innovative health technologies on social inequalities in health, with specific focus on a deeper understanding of the variables used to measure this connection and the pathways leading to its (re)production.

A systematic search process was conducted, based on scoping review techniques, [ 24 , 25 ] for literature published from January 1, 1996 to November 25, 2016 using the following databases: MEDLINE, Scopus, and ISI web of science. The search was updated on November 25, 2016. Scoping review methods were used for their ability to explore broad research questions and interpret large amounts of material from various forms of data and research, while providing an important first step in synthesizing a complex body of research that can be used to guide the direction of future research [ 26 , 27 ].

Search terms were categorized into four categories (“public health,” “social inequality,” “technology and innovation,” “theoretical foundation”) in order to provide additional organization when combining terms during the search process ( Fig 1 ). Only peer-reviewed studies based on original data analysis were included in this study, as interest was focused on collecting empirical analyses. A full overview of inclusion/exclusion criteria can be found in Table 1 .

The initial search process was performed by two research librarians with expertise in the use of literature databases. Extensive testing of the search strings was performed before the search process. To reduce the number of irrelevant hits and increase accuracy of the searches, a proximity operator was used as well as custom search strings for each database. Rationale and search strings for each individual database can be found in Table 2 .

The initial search resulted in a total of 4139 studies, after cleaning of the original data file. After sorting the dataset alphabetically by study title, the entire dataset was divided into four equal subsets. Each subset was then sorted independently by two individual researchers. Studies deemed relevant by both researchers automatically advanced to secondary sorting. A third researcher, who had not previously worked with the respective subset, then sorted those studies deemed relevant by only one of the two original researchers. Studies deemed relevant by the third researcher also advanced to secondary screening. All relevant studies from the initial screening process were then combined into a single dataset (465 studies) for use during the secondary screening process. During the secondary screening process, three individual researchers independently sorted all studies deemed relevant from the initial sorting process using abstracts (if abstracts were not present, results and conclusion sections were used to determine relevance). Only studies deemed relevant by all three researchers advanced to the final sorting process. In the final sorting process, three individual researchers independently read full texts of all included studies. Studies deemed relevant by all three researchers automatically advanced to the data extraction process, while studies deemed irrelevant by all three researchers were automatically excluded. Studies with inconsistent evaluations were discussed by all three researchers until agreement for inclusion or exclusion was met. The resultant studies from this multi-stage systematic sorting process were included in the data extraction process and presented in our results section ( Fig 2 ). The inclusion/exclusion criteria was strictly applied at each stage of the sorting process and articles were excluded if deemed by multiple researchers to meet exclusion criteria based on title and keywords (stage 1), abstracts (stage 2), or full text (stage 3).

Data extraction was facilitated by the use of a data extraction form designed using procedures outlined by Armstrong et al. [ 25 ]. A data extraction form was used to systematically extract information relevant to the aims of this study as well as standard descriptive information. Along with standard title, author and year of publication information, categories included: study location; geographical level (local, regional, national or international); study population; methods used; specific illness addressed; technological innovation addressed/measured; method of implementation for the addressed technology; definition/measurement of social class/inequality; theoretical perspectives; main outcome measures (including health outcomes); overview of main results and conclusions. All full texts were read and analyzed by three individual researchers and individual data extraction forms were then merged into a single, unifying document used for the interpretation and presentation of results. Following typical scoping review methods, methodological quality of the included articles was not assessed systematically, however only peer-reviewed articles were included in our review process [ 24 , 25 , 28 ]. The lack of a systematic analysis of methodological quality is both a weakness and a strength of scoping review techniques. Although it is difficult for a scoping review to draw conclusions based on the quality of the included studies, the strength of a scoping review is in its ability to condense large amounts of material and guide the direction of future research including more comprehensive analyses of the quality of relevant methods [ 27 , 28 ]. Assurance of methodological quality throughout the search, sorting and extraction processes in the current study however was protected using a systematic design based on a dynamic, reflexive examination process whereby multiple researchers, working at each stage of the process independently, regularly compared results and met to discuss, and reach agreement on, discrepancies [ 24 , 27 ].

Results and discussion

Overview of included studies.

An overview of included studies is offered in Table 3 . An overview of excerpts from selected studies representing the formation of the narrative presented in the results and discussion section can be found as a table in supporting information ( S1 Table . Forming the narrative–representative excerpts from selected studies). Data from the studies included in our results was most often collected using purely quantitative methods (N = 28), with some articles choosing to use mixed methods (N = 2) or qualitative methods (N = 3). Data collection varied widely between studies, with some studies addressing national populations, while others collected data at the hospital level or individual level. Of the studies addressing a specific illness (N = 18), approximately half of these addressed either HIV or blood/heart related illnesses. Of the technologies addressed by included studies, information/communication technologies (electronic health records and internet portals, e-health, internet-based social networks) and medical services technologies (prescription drugs, medical imaging, and diagnostic and treatment tools) dominated. Measurements of social position and inequality were relatively consistent with commonly used socio-economic variables, varying between income (or GDP in country comparisons), education, and employment status, in addition to geographical location, age, gender, and race/ethnicity. Outcome measures varied widely, however most studies were interested in investigating factors influencing the access, distribution, and/or use of specific technologies by various social groups (for example individual behaviors, facilitators and/or barriers). Some studies, however, addressed consequences associated with poor or limited access to these technologies, including related morbidity and/or mortality.

Addressing classification and measurement challenges: Towards a more precise terminology

Social inequality.

All variables used in included studies to address, define and measure social position acknowledge that these variables represent various social groups, or classes, that live in relative advantage/disadvantage to one another. These variables can be divided into three distinct approaches. The first approach is characterized by a distinction between selected social groups based on fixed (or ascriptive) factors. These studies use age, gender and/or race/ethnicity to define and measure differences between social groups. The second approach is characterized by social position determining an individual’s control of various flexible resources that are to a relative degree amendable [ 15 ]. These studies generally stratify social position based on socio-economic variables such as education, income, and insurance or employment status. Unlike the two aforementioned approaches, the third approach is distinguished by the characteristics of place [ 29 ]. These studies use geographic location as a measure of social stratification, often defined as (but not limited to) a distinction between rural and urban settings.

These distinct approaches are similarly used to investigate social inequalities, however it is possible to question whether these distinct approaches can be used interchangeably to understand variations in the distribution of population health and innovative health technologies. Although SES may, for example, include various measures such as education, income, and occupational status, used alone or in combinations, one could question whether the mechanisms connecting education to health and technology are the same as the mechanisms connecting occupation or insurance status to health and technology. In relevant literature, such reflections are by and large missing, and very different measures of social position are often treated and interpreted similarly, which may affect the applicability and usability of results [ 30 ]. The implications of choosing one approach over another may have consequences on both theoretical and practical understandings of the specific social factors that influence access and use of innovative health technologies. In the studies included in our analysis, it is possible to observe variations in measured inequality based on chosen variables. The variation in results from these studies illustrate that whether or not inequalities in access and use of innovative health technologies are observable are dependent on the approach used to measure these inequalities and that common measures of social inequality in health cannot be used uncritically.

Our findings, however, may suggest that variations in measurement techniques are, in part, rooted in cultural or scientific traditions. It is interesting to note, for example, that although many of the studies from North America and Australia used a variety of approaches to measuring social inequality, race/ethnicity was often included. Race/ethnicity was, however, never included as a variable in collected studies originating from European, Asian, or South American countries, which instead favored the use of various measures of socio-economic status, such as income or education. Our results do not provide a clear explanation to this finding, but one may question whether this is due purely to availability of data or to cultural and historical factors, where race and ethnicity are more strongly associated with social stratification and class positions in North America and Australia [ 31 , 32 ]. Regardless, the previous findings raise important questions regarding the extent to which social inequalities in access and use of innovative health technologies are dependent on the approach used to measure and define social groups, which must be critically addressed in future research.

Innovative health technologies

Although it is possible to broadly categorize technologies in included studies by type, a potentially more informative method of categorizing these technologies from a social inequalities in health context is by variations in access and use. Using an approach similar to those presented by Cotterman and Kumar [ 33 ], and a focus on level of perceived end-user control, it is possible to propose a division of technologies into three main categories (see Fig 3 ): technologies accessed and used directly by the end user (type 1 or direct end-user technologies ), technologies used by the end user but accessed through someone other than the end user (type 2, or direct-use gatekeeper technologies ), and technologies accessed and used by someone other than the end user (type 3, or indirect-use gatekeeper technologies ). In this case “end user” is defined as the individual, or group of individuals, for which the technology is developed. End users generally do not include individuals who develop, operate, or distribute these technologies, unless these individuals are also end users (the operator of a direct end-user technology, for example, is also the end user). As the name implies, “gatekeepers,” in this case, are individuals that guard access and eventual use of technologies by end users [ 13 ].

In the case of indirect-use gatekeeper technologies (type 3) and direct-use gatekeeper technologies (type 2), end-users are dependent on gatekeepers in order to gain access to these technologies. Korda et al. [ 20 ], for example, investigated the use of a number of coronary procedure technologies dependent on the expertise of health care personnel in which end users have very little direct control over the use and administration of these types of technologies [ 20 , 34 ]. The technology examined by Rubin et al. [ 35 ] (highly-active antiretroviral therapy) differed in that, although access is dependent on a physician, use of the technology is significantly dependent on behavior by the end-user. Results by both Korda et al. [ 20 ] and Rubin et al. [ 35 ] demonstrate that, after the initial adoption of these technologies, social inequalities in health grew, regardless of whether the use of these technologies was dependent on end user behavior and, furthermore, regardless of the fact that these technologies must be accessed by way of trained health personnel. Results by Korda et al. [ 20 ] however also suggest that these inequalities may decline over time, as the adoption by lower SES groups increases.

“The SES inequalities in diffusion observed for angiography and CABG are consistent with the lag in diffusion/inverse inequality hypothesis–for both these procedures, rates peaked earlier in the higher SES patients than the lower SES patients resulting in inequalities, which then disappeared over time…”[ 20 , 36 ]

Similar findings are corroborated by He et al. [ 37 ], Ohl et al. [ 38 ], and Stanley et al. [ 39 ]. Moreover, results by Goldman and Lakdawalla [ 40 ] demonstrate that complicated treatment regimens increase social inequalities in health while simplifying treatment regimens reduce inequalities, illustrating the dynamic complexity of the relationship between access and use of innovative technologies and variations in social inequalities in health.

“Simply by improving the productivity of healthcare, new technologies can widen disparities across socioeconomic groups. However, new treatments that simplify the production of health and reduce the importance of patient effort work in the opposite direction…complex new treatments for HIV appear to have increased disparities among HIV+ individuals, while pharmaceutical breakthroughs in the treatment of hypertension made self-management less important and coincided with a contraction in disparities…”[ 40 ]

Nevertheless, the results highlighted above suggest that SES influences variations in the use of innovative technologies by end users even when access is dependent on a “gatekeeper”.

Direct end-user technologies (type 1), contrary to direct-use gatekeeper (type 2) and indirect-use gatekeeper technologies (type 3), are directly accessed and used by end users. The access and use of these technologies is assumed largely dependent on individual agency, or in other words, the assumption that individuals are equally able to consciously make decisions to access or use these technologies for purposes of influencing health. However, the studies included in our results consistently demonstrated that access and use of these technologies was far from equal. Baum et al. [ 41 ], for example, demonstrated that low socio-economic groups have restricted access and use of digital information and communication technologies that, in turn, affect access to a range of social determinants of health, creating a vicious cycle of disadvantage and poorer health.

“The educational opportunities to acquire fundamental literacy also shape health literacy, which therefore in turn affects people's ability to improve their health status and health outcomes. This disadvantage is compounded because digital literacy is increasingly a pre-requisite for health service delivery and access to health information.”[ 41 ]

Gonzales et al. [ 42 ] indicate that access to technologies for disadvantaged groups is unstable, and can be regularly disrupted, suggesting that simply measuring access to technology adoption across socioeconomic groups ignores the possibility that unstable access–or unequal use–can have large consequences on social inequalities in health. Perez et al. [ 43 ] support these results, further demonstrating that purely having access to a particular technology does not guarantee equal use. In fact, an increase in social inequalities in health after the implementation of health technologies is often demonstrated by studies included in our results. Importantly, regardless of findings suggesting that these inequalities will decrease as access to these resources becomes more universal, results from included studies illustrate that access to resources does not necessarily eliminate the (re)production of social inequalities in health.

Unfortunately, our results do not clearly illustrate whether any one of the categories of technologies highlighted in included studies has the potential to influence social inequalities in health to a greater degree than another. Our findings do, however, illustrate a complex relationship, suggesting that the pathways and mechanisms through which inequalities increase or decrease over time vary depending on the factors that influence both access and use, as well as type, of these technologies. Furthermore, it was rare for studies included in our results to explicitly measure health outcomes related to the access or use of these technologies. Therefore, studies rarely addressed or investigated specific mechanisms or pathways linking health technology access and/or use to unique explanations of variations in health. Consequently, it is clear that more research is needed to further understand these complex mechanisms.

It is also clear that some important technologies are missing from the literature. The technologies addressed by studies included in our results focus predominantly on technologies designed and used in health care services. Included in this collection of technologies is a growing focus on the internet and internet-based tools, as the use of these technologies also become an integrated resource in health care services [ 3 , 4 , 42 , 44 – 46 ]. However, as various researchers have highlighted in recent years, technologies that have the potential to greatly influence health and social inequalities in health are not limited to those found in health care services [ 3 , 6 , 7 , 11 ]. These technologies include innovations used to monitor and control individual health, such as genome sequencing and lifestyle technologies (wearable devices and personal, digital applications, for example). It is, therefore, clear that future research investigate the potential implications of these types of innovative technologies on social inequalities in health.

Discussing potential pathways: Conceptualizing access and use

The studies included in this article exhibit varying approaches for conceptualizing the relationship between innovative health technologies and social inequalities in health. Studies discussing a perspective grounded in individual access and adoption of these technologies [ 18 , 20 , 39 , 47 – 49 ] often refer to the diffusion of innovations theory, which categorizes adopters of innovations based on individual characteristics related to social positioning [ 13 ]. These studies use this theory to establish that lower SES groups are slowest to adopt, and therefore benefit less from, innovative health technologies. However, as access to these technologies “diffuses” throughout the population, and lower SES groups begin to adopt, these inequalities begin to diminish and may potentially disappear [ 18 , 20 , 37 – 40 , 47 ].

“Income gradients were positive in an era prior to statins, but became negative in the period subsequent to the advent and dissemination of statins. While the more advantaged were once more likely to have high levels of cholesterol and LDL, they are now definitively less likely. Additionally, exploratory analyses suggest that income is positively associated with statin use accounting for clinical need… While resources affect access to technologies, some technologies can also affect resources, lessening the productivity of various health inputs.”[ 18 ]

Although this perspective assumes that the unequal adoption of these technologies is relatively unavoidable, they argue that the extent to which these innovations influence social inequalities in health is subject to the rate at which these technologies diffuse.

Building on this explanation, a number of studies [ 18 , 19 , 35 , 47 , 50 ] draw attention to the fundamental cause theory, which suggests that individuals “deploy” flexible resources, “such as money, knowledge, power, prestige, and beneficial social connections…to avoid risks and adopt protective strategies” [ 15 ]. These studies use this theory to illustrate that innovative health technologies are accessed to a greater degree by individuals of higher social position.

“The SES–HIV/AIDS mortality association, although present in the pre HAART period, was greater in the peri-HAART period and greater still in the post HAART period, even when race and other factors were controlled…These findings are consistent with fundamental cause theory, which holds that when innovations render a disease more treatable, the benefits of such developments are not evenly distributed.”[ 35 ]

Explanations referring to the fundamental cause theory and the diffusion of innovations, however, often assume that as innovative health technologies become more evenly distributed–or adopted–across social strata, so too will their benefits.

The above perspectives are contrasted by studies presenting social inequalities more specifically as a consequence of variations in use of innovative health technologies. These discussions often refer to explanations grounded in theories related to health literacy [ 43 , 44 , 51 , 52 ] or digital divide [ 41 , 42 , 46 , 53 – 55 ]. While health literacy refers to an individual’s ability to assess, understand, and use information critical to using health services and making decisions regarding health [ 52 ], digital divide refers to variations in the use of digital technologies between social strata [ 54 ]. These studies suggest that, regardless of access, inequalities exist due to the characteristics of social position determining an individual’s proficiency in using innovative health technologies to benefit health. Perez et al. [ 43 ], for example, demonstrate that, regardless of access to internet-based tools, health information searching and processing strategies vary by SES, benefitting higher educated individuals.

“When confronted with a specific set of symptoms, higher-SES participants tended to use search strategies that branch out—the exploration of conditions they expect contribute to the symptoms and systematically exploring offshoots of that condition, such as related conditions or symptoms. Lower-SES participants used heuristics to prune the scope of their Internet search—i.e., heuristics to ignore or remove search topics believed to be superfluous to the condition.”[ 43 ]

Results by Zibrik et al. [ 52 ] and Newman et al. [ 55 ] illustrate the significance of socioeconomic and cultural factors influencing variations in the quality of use of innovative health technologies, favoring individuals of higher social position. These studies emphasize the experiences of individuals with innovative health technologies, demonstrating that variations in user experience as a result of social positioning has the potential to undermine the benefits assumed by universal access.

The above theories, however, seem to suggest that these inequalities are driven by the potential of social positioning to provide individuals with the ability to make conscious choices and “consume” these resources [ 56 ], assuming that these choices are made consciously and with motivated intent to improve health [ 23 ]. However, numerous studies included in our results highlight the importance of mechanisms at the institutional and political levels that may significantly influence the distribution, in access and use, of innovative health technologies across social strata [ 14 , 34 , 37 , 45 , 57 – 64 ]. Many of these studies demonstrate that patterns of adoption and use of innovative health technologies at the level of the health care institution may significantly influence the potential of these innovations to benefit the health of end users regardless of individual choice or intent.

“Patients admitted to non-minority-serving hospitals were more likely to receive carotid artery imaging than patients admitted to minority-serving hospitals…the predicted probabilities of receiving carotid artery imaging were similar between white patients and black patients at non-minority-serving hospitals…However, the predicted probabilities among white patients and black patients at minority-serving hospitals were both significantly lower than white patients at non-minority-serving hospitals.”[ 34 ]

Furthermore, a study by Lang and Mertes [ 62 ] demonstrated that the prevailing orientation of dominating political parties can influence how innovative health technologies are accessed and used at the State level, resulting in variations in the distribution of these resources. In a similar discussion, Han et al. [ 60 ] refer explicitly to the social determinants of health theory, which describes the unequal distribution of health as a result of socioeconomic conditions that are largely constructed by social policy [ 65 ], to stress the significance of a geographical patterning of health influencing variations in access and use of innovative health technologies.

Due to a focus on single technologies, however, many of the perspectives discussed above fail to address the potential influence that the rapid, uninterrupted development of new technologies may have on the reduction or (re)production of social inequalities in health. It could be suggested that the cumulative effects of multiple technologies adopted over time is itself a mechanism for (re)producing health disparities. In this case, potential mechanisms could be related to windfall benefits [ 13 ], which are benefits afforded by early adopters (high SES individuals) that accumulate over time, or Bourdieu’s theories of capital and symbolic violence [ 66 ], where the development and implementation of innovative technologies by high SES groups may reinforce social stratification. Baum et al. [ 41 ] demonstrate that Bourdieu’s social theories are a relevant addition to a discussion of innovative health technologies and social inequalities in health, drawing attention to the ways that innovative health technologies potentially influence the interaction of social, cultural, and economic capital to reproduce inequalities in health. They conclude that “some people are being caught in a vicious cycle whereby the inability to make beneficial use [of innovative health technologies] reinforces and amplifies existing disadvantage” [ 41 ].

The results of this study, therefore, seem to suggest that understanding the pathways through which various innovative health technologies reduce or (re)produce social inequalities in health is context dependent. Theories focused on the dependency of individual resources, such as fundamental cause theory, may therefore be most appropriate for understanding socially stratified variations in the access and use of direct end-user (type 1) technologies. Interestingly enough however, studies referring to these theories generally address direct and indirect-use gatekeeper (types 2 and 3) technologies, allowing one to question the merit of these explanations. Conversely, mechanisms at the institutional and political levels would thus seem most appropriate in explaining direct and indirect-use gatekeeper (types 2 and 3) technologies, where the advantages of these technologies are often poorly recognized by individuals of lower social status or where access is limited by gatekeepers (for example, political or institutional agents). In order to better understand social inequalities in health, these contextual variations draw attention to the need for critical distinctions between technologies based on how, and in what context, these various technologies are accessed and used. This may include a stronger focus on understanding the role of institutions and accompanying theories that explain complex mechanisms influencing the distribution of population health [ 1 ].

Limitations

Some limitations not addressed earlier in this study are worth discussing. First, although the choice of search terms was purposefully broad and systematically identified using relevant literature, it is possible that the ability to collect relevant literature from a larger breadth of research fields and traditions could have been limited. This is due to the possibility that the researchers’ previous relation to the fields of sociology and health limit the familiarity, and therefore inclusion, of relevant terms or language used in the fields of technology and innovation. Second, the decision to exclude grey literature, including books, reports, etc., may have led to the exclusion of relevant literature, which could have possibly been used to widen or further support perspectives presented in the results. However, this choice was made with consideration for a purposeful selection of empirical, peer-reviewed studies using original data analyses. The goal here was to increase the probabilities of including relatively high quality research and excluding the possibility of grey material that is lower in quality and neither peer-reviewed nor includes original analyses. Furthermore, as grey literature includes reports and documents often drafted by order of political or special interest organizations, it is more difficult to assess underlying biases that would negatively bias our results. Third, the decision to exclude studies focused on treatment techniques within health services may have excluded some relevant literature. Very often, treatment techniques are dependent on the use of a specific technology. However, had the current study included literature focused on treatment techniques, without a specific focus on the technology used in this treatment, it would have been up to the authors to investigate whether or not each treatment technique included the use of an innovative technology, introducing bias as well as a very problematic assessment process. Furthermore, the inclusion of such studies would have shifted the focus of the current study from that of one focused on novel perspectives related to technology and public health to one focused on the relatively well established field of social inequalities in treatment and health services. The authors, therefore, felt that the inclusion of such studies was out of the scope of the current study and would have fundamentally transformed the current study’s aims and contribution to the scientific literature.

Conclusions

This review was interested in systematically investigating existing literature that explores the influence of innovative technologies on social inequalities in health. The results of this study offer interesting perspectives worth consideration, with implications for further investigation of the influence of innovative health technologies on social inequalities in health. This study questions established scientific measures of social inequality, where various measurements (such as race/ethnicity, income, education, geography, etc.) are often used interchangeably to investigate variations in access and use of innovative health technologies. Results illustrate that the choice of measurement has the potential to bias findings and, therefore, significantly influence the understanding of complex relationships between innovative health technologies and social inequalities in health. Furthermore, this study proposes that a social inequalities perspective may benefit from an understanding, and differentiation, of technologies based on how these technologies are accessed and used by end users. Factors and mechanisms that influence access, for example, may differ from factors and mechanisms that influence use. It is clear that it is not enough to solely focus on the factors and mechanisms that influence unequal access and therefore ignore how variations in use importantly shape social inequalities in health. It is, moreover, not enough to focus attention solely on health care services technologies but, importantly, to investigate emerging technologies in lifestyle health, genomics, and the increased use of personalized devices in health. Furthermore, a deeper understanding of social inequalities in health and innovative health technologies is dependent on distinguishing between a perspective focused on individual resource use, which often draws a questionable causal relationships between SES, technology access/use, and health outcomes, and a perspective focused on mechanisms that are more dependent on social and institutional structure than on individual agency. Although the studies included in our results generally suggest that the implementation and adoption of new technologies (re)produce SES and class-based social inequalities in health, some results indicate that these technologies can, in fact, reduce inequalities over time. Additional research, based on the findings discussed in this study, are needed, however, to reliably establish these conclusions. As much of the current research is dominated by the use of quantitative methods of social epidemiology, additional research may benefit from an increased use of qualitative, sociological methods in order to further investigate mechanisms and pathways leading to the (re)production of social inequalities in health as a result of innovative technologies [ 8 , 30 ]. It is, nevertheless, becoming increasingly important to investigate the social implications and consequences of a society increasingly influenced by technological innovations, including the ways in which these technologies may influence the unequal distribution of health as a human right.

Supporting information

S1 prisma checklist, funding statement.

This research received funding from the strategic research area NTNU Health in 2016/17 at NTNU, Norwegian University of Science and Technology. The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript.

Data Availability

RVHS GP Prelims paper 1 2017

• Is being innovative more desirable than keeping the status quo?
• ‘The promise of science and technology cannot be realised without the humanities.’ Do you agree?
• Is politics today nothing but a series of empty promises?
• ‘Education perpetuates rather than fights inequality.’ Comment.
• ‘Men only need to be good, but women have to be exceptional.’ To what extent is this true in the workplace today?
• Is increased military spending justifiable when countries are not at war?
• Should we always be compassionate?
• To what extent is renewable energy the solution for the world’s increasing need for energy?
• Consider the relevance of patriotism in your society today.
• Given that the global population is growing rapidly, should people be having more children?
• To what extent are the needs of the marginalised met in your society?
• ‘There is no such thing as bad art.’ Discuss

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2023 General Paper (GP) A-Level Essay Questions and Commentary

Just got the list of questions for this year’s A-Level GP exam from my students!

2023 A-Level Essay Questions (Paper 1)

1. How realistic is it for countries to implement a national minimum wage for all their workers?

2. ‘Fossil fuels should no longer have a part in the production of energy.’ Discuss.

3. Consider the view that spending money on space travel cannot be justified in today’s world.

4. Consider the argument that there should be no censorship of the arts in modern society.

5. ‘People who undertake voluntary work do so more for their own benefit than for the benefit of others.’ Discuss.

6. Assess the extent to which all people in your society have the opportunity to achieve their full potential.

7. ‘The quality of human interaction is diminished by modern communication devices.’ How far do you agree?

8. To what extent are festivals and national holidays effective in promoting unity in your society?

9. ‘Regret for past actions is vital for progress.’ What is your view?

10. Evaluate the claim that sports personalities make good role models for young people.

11. Assess the view that accurate translation between languages is always necessary.

12. ‘Young people want to change the world because they do not know it is impossible.’ How far do you agree?

Every year, a substantial number of students fail their A-Level GP exam because they are unprepared for it. Some of these students will make the excuse that the paper was especially difficult or that the questions were especially surprising. I have even heard this excuse from the owner of one large tuition centre chain! Alas, these are all poor excuses. Every GP paper that I’ve seen for the last twenty years have been completely doable with the 2-year curriculum that we follow.

The examination is not the problem. The problem lies with the way students prepare for and approach the examination. From my conversations with private candidates who finally come to me for help with GP the second time around (retaking their A-Level exam), a few common themes have emerged.

(Note: These are the pitfalls that these students fell into before, not after, they come to me for help. They failed the last time because they received poor help or no help at all.)

Misguided question analysis: missing the forest for the trees!

They learnt question analysis techniques that appeared useful but actually harmed them on the day of the examination. In many cases, the techniques they employed encouraged them to take an overly pedantic approach towards examining the questions. Many such students focus excessively on matters like “question type”, on identifying “double-barrelled” questions, and on ensuring that they identify all of the “question requirements”. These are strictures invented by overzealous teachers, a bunch of unqualified undergraduate tutors and overweening tuition centres. They encourage students to apply formulaic approaches that dull the mind and blunt their analysis. Such students end up missing the forest for the trees. From my experience, this is one of the biggest reasons why students do poorly even in spite of substantial effort and a good grasp of the English language. Unfortunately, many such students are lulled into a false sense of security by the good grades they get in school, grades that do not always reflect the reality that Cambridge is more concerned about substance than pedantry.

To be clear, we do cover question analysis techniques as well. The key difference is that the techniques I teach are always rooted in a discussion of the real-world context and designed to actually help students make sense of a question rather than follow a set of arbitrary rules. (Some examples of this below.)

Inflexibility in brainstorming: no good points to write!

A lot of students are simply hopeless at brainstorming, not because they do not know anything, but because they limit their brainstorming to one or two topics per question. Those who do so inevitably find themselves without a sufficient number of points and examples. This is, again, the unfortunate result of a certain pedantry that is characteristic of the Singapore education system and reflected by an obsession with “doing” practice papers (the doing of practice papers has extremely limited pedagogical value since a practice paper is designed to assess, not teach).

Conversely, if students are willing to abandon their preconceived notions about the exam and see the world as I teach it through essential concepts, enduring contentions and interdisciplinary case studies, they will very quickly see that many questions are completely doable, even with just two years of our classes. Quite unfortunately, many students insist on either relying completely on themselves (a recipe for disaster at their age) or on the cram-school style classes they get at various tuition establishments, where the goal is to do as many questions as possible rather than to achieve any kind of meaningful preparation. If this is you, I humbly suggest that you might be better off joining my classes now rather than after you discover that you have to retake your entire A-Level examination because you failed your GP paper.

Trying to spot questions and taking a one-topic approach

Every year, I tell students that I do not and will not spot questions for them. This is not because I am bad at spotting questions nor is it because I am afraid to stand behind the questions that I spot. Rather, it is because the entire premise of spotting questions is flawed. The premise underpinning this entire endeavour is that questions are always about specific topics. For instance, some will say, “this is a politics question” or “this is a technology question”. And when there are no environment questions, as appeared to be the case on the surface for the past few years, they say, “there is no environment question”. But this entire one-topic approach is fundamentally flawed. Cambridge essay questions are never only about one topic and there is often room to discuss topics that one can draw connections to after examining the question more thoroughly, using the approaches that I teach.

This year, there were again many questions seemed to only be about one thing, but that actually touch on many other issues as well. For instance, space travel is not merely about the topic, “Space”, or the topic, “Science and Technology”. It is also about inequality, the environment, ethics, international relations, and even politics! Unfortunately, many students arbitrarily limit their essays because they take the one-topic approach that question spotting is based on. They then lament that “the topics I studied for didn’t come out” and that there were no media or politics questions this year. But that is complete nonsense. These students were simply poorly taught. This is precisely why question spotting is such an odious practice. Put simply, question spotting teaches students to impose arbitrary limits on how they can apply their knowledge. It tells them that other things that they have learnt, on other topics, are not related to the question at hand. The end result is that these students endure a disproportionate amount of suffering for what is really the result of poor guidance.

This temptation to spot questions is so great that every year without fail, students and parents ask me what questions I think will “come out this year”. Alas, the results of even trying are so perverse that I refuse to engage in this odious practice myself. Does this then mean that my students fare worse? By no means! On the contrary, they perform far better because they are trained to try and apply all of the essential concepts, enduring contentions and interdisciplinary case studies that we learn in class to each and every question. And every year, the end result is stunningly positive. Using only what I have taught in class, students are able to answer at least 8 out of 12 questions in any given year. To me, this is what it means to prepare students for an examination. Question spotting is a cop-out, the refuge of laziness and ineptitude. Students must be prepared for all possibilities or they are not prepared at all.

Too much rote memory: memorising points and examples is a recipe for disaster!

Virtually every student who sits for the A-Level GP exam would have done some form of preparation beforehand. Unfortunately, while most students are quite industrious, too many of them focus their efforts on memorising points and examples just as they do for Biology, Physics or Chemistry. Come examination day, they tend to find that a lot of the points and examples they memorised cannot be applied. (They then complain that the paper is difficult. It is not; they are simply ill-prepared.) In other cases, students emerge feeling confident, but it often turns out that they applied their points and examples wrongly. The outcome is what can only be described as a bitter tragedy and an unmitigated disaster. The high number of students having to retake their A-Level examinations because they failed their GP paper is testament to the perils of such stubbornness. All this pain could have been avoided if only students directed their energies towards learning essential concepts, enduring contentions and interdisciplinary case studies.

Memorising points and examples is a recipe for disaster because the GP exam is fundamentally different from the Biology, Physics or Chemistry exam. Cambridge examiners have said time and again that the GP exam is not a test of knowledge. It is a test of a student’s ability to develop arguments systematically, support these arguments with compelling evidence, consider opposing points of view, engage in nuanced analysis and evaluation, write clearly and coherently, and most importantly, persuade and convince.

On top of that, every A-Level examination paper is unique. Every essay question is unique. Cambridge never repeats questions. A student can memorise all of the points and examples for the last 10 years’ worth of questions and he will still fail the examination if he adopts this strategy. Given the heavy emphasis today on genuine understanding, critical thinking and clear communication, it is no surprise that students who only know how to regurgitate points and examples fare poorly.

Instead, what students need to learn is how to develop their own points and draw on their pool of knowledge to craft their own examples. They learn these skills most effectively by exploring concepts, debates over contentious issues, and through interesting case studies. They remember these ideas and learn how to apply them best when they finally accept that the GP examination cannot be defeated through rote memory.

• How realistic is it for countries to implement a national minimum wage for all their workers?

Although we do not believe in spotting topics, we often come quite close to it (unintentionally). In the second last week of our classes, we discussed minimum wage as a policy option. We considered some of the arguments for and against the minimum wage, looked at some of the positions taken on this issue by different prominent figures in Singapore, and discussed the political, economic, and moral dimensions of this contentious issue. We also looked at how Singapore addresses this problem through redistributive policies (such as GST vouchers) and through its progressive wage model.

Apart from that particular class, we have also covered the following applicable concepts over the past two years: meritocracy, political polarisation, inequality, robotic automation and artificial intelligence, ethics and morality, human rights, corruption and fraud, offshoring and outsourcing, reshoring, international trade, immigration, monopsony, gig economy, anti-competitive business practices, corporate social responsibility, labour unions and labour rights.

Over the course of the two years, we also examined the socio-economic context within the following countries: US, China, Iran, Saudi Arabia and Singapore. We looked at issues like inflation, rising property prices, youth unemployment, meritocratic ideals, income inequality, ageing population, debt crisis, and a looming growing property bubble.

Some might object that some of these concepts and case studies are not relevant to the question. That is simply not true. An argument can be made using each and every one of them. We train our students to draw these connections and provide many examples every week.

Interestingly, a number of students suggested on Reddit that this year’s A-Level paper did not contain any politics questions. It always perplexes me when students make such comments. Whether or not to implement a national minimum wage is a deeply contested political question in virtually every country currently suffering from high levels of inequality. To say that politics is irrelevant is like saying that only the economists get to decide whether or not a country should have a minimum wage. Then again, having been brought up in technocratic Singapore, it is little wonder that students might think that way. Alas, this also means that the education system has failed them.

• ‘Fossil fuels should no longer have a part in the production of energy.’ Discuss.

Again, although we do not spot topics, we covered two case studies (COP26 and nuclear power) that were directly pertinent to this question in the week leading up to the exam. This was, again, purely coincidental. Apart from those two case studies, we covered a number of related concepts and case studies over the past two years.

Relevant concepts and contentions: tragedy of the commons and the problem of securing international cooperation, inequality and the ways in which it is perpetuated even through green policies, democracy and the problem of ensuring that successive governments keep commitments made in previous ones, balance of power issues and the opportunism of emerging great powers like China in support green policies, lobbying and the influence of the energy industry, technological ingenuity and the possibilities it can unleash, individual responsibility for making greener choices, greenwashing by an assortment of businesses (including the oil and gas industry), green activism (or alarmism) and its limits, technological determinism and path dependence, techno-optimism and faith in technological developments, the potentially devastating consequences of climate change, and finally, the concept of the tipping point or the point of no return.

Relevant case studies: COP26, nuclear power, 2022 Beijing Winter Olympics, Russia’s invasion of Ukraine, climate geoengineering, Mahsa Amini protests in Iran, China-Taiwan conflict, assassination of Jamal Khashoggi, electric vehicles, Israel-Palestinian conflict

Once again, a number of students avoided this question because they considered it a “Geography” question. At the same time, a number of Geography students chose to attempt this question using their (limited) knowledge of Geography. This is doubly tragic.

First, the question is not merely about how long we have until our fossil fuels run out, about detailing the consequences of climate change, or about explaining how alternative sources of energy work.

This question is also about:

• considering the feasibility of all these different options (there’s a whole debate to be had about whether or not we can actually switch to renewable sources),
• examining the trade-offs (solar power takes up arable land, wind power kills birds and destroys the scenery, nuclear power produces highly dangerous waste and run the risk of melting down),
• looking at why different countries remain dependent on fossil fuels (for reasons that appear foolish now, Germany deepened its commitment to obtaining natural gas for Russia for years until the war with Ukraine broke out),
• considering whether the result would be greater inequality (the poor suffer more when energy prices go up),
• about questions of international cooperation and enforcement (how do you get impoverished countries to give up fossil fuels when they remain the cheapest options, if not through financing provided by other developed countries?),
• and about techno-optimism and hype (the very idea of doing away completely with fossil fuels right now is sheer fantasy).

More can also be said about the role that businesses play in lobbying against efforts to reduce our reliance on fossil fuels, about the concept of the tipping point or the point of no return, and finally about

Second, the subject known as “Geography” is not as limited in scope as these students think. Many of what I’ve mentioned is covered by Geography courses in university.

In other words, the non-Geography students who skipped this question because it was a Geography question were just as wrong as the Geography students who did this question because they thought it was only about Geography.

But perhaps the most perplexing remark I’ve heard about this question is this: “if you do not compare past and present in every paragraph, your content score will be capped at 18 marks”. (18 marks for content is around 50%) In other words, if you do not follow some inane made-up rule, you cannot get anything above a D. Notwithstanding the fact that Cambridge has never laid down such rules, the reasoning that leads one to such a conclusion is so flawed I can only pity the student who believes it unquestioningly.

This claim that one must compare past and present is made on the basis of nothing more than the question’s use of the phrase, “no longer”. The seemingly inevitable conclusion then is that one must go beyond merely making arguments for and against the use of fossil fuels in energy production today, one must also argue that fossil fuels used to be the dominant source of energy but should no longer be used today (and one must perform this comparison in every paragraph). Unfortunately, this then turns every paragraph into a convoluted exercise in stating the obvious. Such an essay would almost certainly be a shallow, lacking in substance, and far more likely to result in a failing grade.

Quite unfortunately, this is not the first time I’ve seen students engage in pointless pedantry and formalism. It is sad enough when students fail. But to fail because you dutifully applied nonsense; that is simply tragic.

• Consider the view that spending money on space travel cannot be justified in today’s world.

When a student does not study for the exam and does poorly for it, he has only himself to blame. But who does one blame when he studies for a topic, then refuses to do the very question that is related to that topic? This year, a number of students lamented the absence of “Science and Technology” questions (presumably because they studied very hard for this particular topic). This was very puzzling. Is not space travel precisely about science and technology? Or must a question contain the words “science” and “technology” to be considered a “Science and Technology” question? Surely not! In this case, it is clear that excessive pedantry and formalism has blinded poorly trained students from seeing the obvious.

A better approach would be to treat this as an interdisciplinary question involving a discussion of not only science and technology, but also issues of inequality, democracy and climate change.

Relevant concepts and contentions: dual-use nature of technologies, techno-optimism and the belief that advances in technologies will always produce positive results, technological determinism and the belief that technologies follow a predetermined trajectory of their own, tragedy of the commons and the problem of governing access to shared resources, sovereignty, international relations, corporate social responsibility, anticompetitive business practices, lobbying and regulatory capture, income and wealth inequality within and between nations, climate change and escapism, philanthropy and democratic control.

• Consider the argument that there should be no censorship of the arts in modern society.

The term “the arts” can be interpreted broadly to include all three types of arts: visual arts (photography, painting and sculpting), literary arts (prose, drama and poetry), and the performing arts (dance, music and theatre). The term “censorship” is pretty straightforward. In this context, the censorship of the arts is the suppression of artistic self-expression and criticism. The issues raised here are issues that students ought to have discussed when exploring topics like politics and media.

Relevant concepts: freedom of speech, censorship, authoritarianism, democracy, human rights, media, subjectivity in art, racial and religious tolerance, hate speech and the assassin’s veto.

There is no need to make too much of the term “modern society”. The term “modern” is itself deeply contested and this essay is not the place to discuss what counts as modern and what does not. Obviously, examples should not be taken from the medieval period, but this does not mean that examples dating slightly further back, say to 1990s, cannot be used. What matters is that these examples remain relevant today and are relevant to the point being made.

Some students suggested that this is an absolute question and that the only possible position to take here is to disagree. This is complete nonsense. The only reason for saying so is if there are no rational grounds for agreeing with the view that there should be no censorship of the arts. But there are. In fact, to write a balanced essay, one must consider those very views. I sometimes wonder where these students get these ridiculous notions from and who has been teaching them all these absurd rules. The view that there should never be any censorship of the arts is, in fact, a reasonable view with many strong arguments for it. To reject it out of hand is an act of sheer ignorance. It is this ignorance that makes it highly probable that such a student would have missed the opportunity to consider some of these arguments. For instance, one argument for never engaging in censorship is that censorship is far more likely than not to be abused by those in power for their own gain. Since there is no way to ensure that acts of censorship are always only done for the good of all, it is better not to censor the arts at all.

• ‘People who undertake voluntary work do so more for their own benefit than for the benefit of others.’ Discuss.

We discussed this topic in our classes on philanthropy (particularly the philanthropy of Bill Gates, Jeff Bezos and Mark Zuckerberg) and on the question of altruism, kin selection and reciprocity. In one of these classes, we considered the argument that evolution can explain altruistic behaviour. In particular, we looked at the idea of kin selection, the idea that people engage in self-sacrificial behaviour because it benefits one’s kin, allowing one’s genes to survive through relatives. We also examined the notion of reciprocity, which is the simple idea that humans understand that cooperative behaviour enables them to increase their odds of survival as a group.

In our discussion of religion, we also examined how religiosity is strongly correlated with volunteer work, looking at the evidence in the United States and the United Kingdom. We discussed some of the reasons why this might be so, and considered the role that religious beliefs play in motivating people to put others first. We also considered some possible objections to the evidence presented.

Finally, in our discussion of quiet quitting, we considered the question of whether workers should go above and beyond the call of duty or whether it was justifiable to only what they were paid to do.

This question was not very popular, either because students were not exposed to these ideas or because they were unable to draw connections to them. Those that did do this question run the risk of misinterpreting the question. To be clear, the question is not about whether people should be altruistic when they undertake voluntary work. The question is whether they are altruistic. This means that students must engage with the idea of altruism and the arguments associated with it.

What students most certainly should not do is split hairs over the term “voluntary work” and waste time agonising over it. The term “voluntary work” can be taken to refer broadly to any kind of work that people do voluntarily. This includes volunteer work as well as work that they do voluntarily rather than because they are paid to or legally obligated to. There is no need to clearly distinguish volunteer work from voluntary work, and most certainly no need to exclude all forms of volunteer work from the essay simply because the question uses the term “voluntary work”. To do so would be to make yourself a victim of your own mindless pedantry and sophisticated ignorance.

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The Gender Gap in STEM: Still Gaping in 2023

Despite progress in gender equity and growing interest over the last decade in computer science, engineering, math, and statistics among both men and women, the underrepresentation of women in the Science, Technology, Engineering, and Mathematics (STEM) fields continues to persist. In 2023, the gender gap in STEM remains significant, with women making up only 28% of the STEM workforce. i

If we look at places worldwide where we might hope to find better news, the statistics give us pause. The figure stands at 24% in the United States, ii 17% in the European Union, iii 16% in Japan, iv and 14% in India. v

This disparity is concerning, as it leads to a lack of diversity and inclusion, and ultimately limits the potential of the STEM industry. Addressing existing underrepresentation is critical as the world grapples with economic, environmental, geopolitical, societal, and technological risks. Closing the gender gap will not only bolster sustainable tech-enabled growth and innovation but is also deemed an economic necessity. vi

Examining the Stumbling Blocks: Factors Contributing to the Gender Gap in STEM

The gender gap in STEM has been attributed to several long-standing and deeply entrenched realities, including the following:

Stereotypes: Many individuals still associate STEM fields with masculine qualities, leading to stereotypes that can discourage girls and women from pursuing STEM education and careers.

Lack of role models: Women remain underrepresented in STEM leadership positions, which makes it harder for girls and women to find role models and mentors in the field.

Unconscious bias: Unconscious biases in hiring, promotion, and grant funding can disadvantage women and lead to their disproportionately low representation in STEM.

Work-life balance imbalance: STEM careers can be demanding, and some women may opt out or choose to work part-time to handle family responsibilities, which can impact career advancement.

Implementing Strategies: Closing the Gap from Childhood to Career Advancement

There are various strategies that can be implemented to close the gender gap in STEM. These include:

Encouraging girls to pursue STEM education: It is essential to introduce girls to STEM subjects early on to help dispel the stereotypes associated with STEM and provide them with role models. Programs like Girls Who Can Code , Black Girls Code , and Million Women Mentors have been successful in inspiring girls to pursue STEM education.

Creating inclusive workplaces: Companies and institutions can work toward creating inclusive workplaces by identifying and addressing unconscious biases and fostering a culture of inclusivity. This can be achieved by implementing diversity and inclusion policies, offering mentorship and sponsorship programs, and providing flexible work arrangements.

Promoting female role models: Having visible female role models in STEM is crucial to inspiring and encouraging girls and women to pursue STEM careers. Organizations should prioritize diversity in their hiring and promotion practices to increase representation at all levels of leadership.

Providing professional development opportunities: Initiatives that include training, mentorship, and networking events can help women develop the skills and confidence needed to succeed in STEM fields.

Addressing structural barriers: Breaking down structural obstacles, such as the gender pay gap, lack of family-friendly policies, and gender bias in grant funding is crucial in closing the gender gap in STEM. Companies and institutions should work toward creating policies that address these issues and promote gender equity.

Encouraging women to stay in STEM careers: It is important to create a supportive environment that spurs women to remain in STEM careers. This can be accomplished by offering mentorship and sponsorship programs, providing opportunities for career advancement, and creating flexible work arrangements.

Reaping the Benefits: The Advantages of Bridging the STEM Divide

Closing the gender gap in STEM fields can have numerous benefits for the global community:

Promoting diversity and inclusion: Gender equity can foster diversity and inclusion, leading to more innovative solutions to societal challenges.

Economic growth: Losing the gender gap in STEM can help address the skills gap in the STEM workforce, leading to economic growth and job creation.

Improved research: Increasing gender diversity in STEM fields can lead to improved research outcomes, as diverse perspectives can provide unique insights into research questions.

Improved products and services: Greater gender diversity in STEM fields can lead to the development of products and services that better meet the needs of all consumers.

Social progress: Narrowing the gender gap in STEM can contribute to broader social progress, as greater gender equity can lead to a more just and equitable society.

Closing the gender gap in STEM is a complex issue that requires a multifaceted approach—from instilling confidence in girls within families to creating incentives for women to join and stay in STEM. We have the collective opportunity to elevate human endeavor by empowering women with the freedom of choice in educational tracks and career trajectories. Ultimately, through a more inclusive economy, we can unlock the full potential of STEM-related industries and tackle the world’s most pressing challenges.

i UNESCO Institute for Statistics. 2021. Women in Science. https://en.unesco.org/themes/women-science/women-data ii National Science Board. 2020. Science and Engineering Indicators 2020. https://ncses-nsf.gov/pubs/nsb20201/ iii European Commission. 2019. She Figures 2018. https://op.europa.eu/en/publication-detail/-/publication/5e7c5d3a.fb7a-11e9-8c5a-01aa75ed71a1/language-en iv Ministry of Education, Culture, Sports, Science and Technology. 2020. Women and Science and Technology in Japan. http://www.mext.go.jp/content/20200508-mxt_gakujutu03-100004652_1.pdf v National Science and Technology Management Information System. 2019. Women in Science and Technology. http://dst.gov.in/sites/default/files/WM%20in%20S%26T%202019%20Final%20_0.pdf vi “Here’s Why We Need More Women and Girls in STEM.” February 11, 2023. McKinsey and Company. https://www.mckinsey.com/featured-insights/themes/heres-why-we-need-more-women-and-girls-in-stem

Clara Piloto Director of Global Programs, Director of Digital Plus Programs MIT Professional Education Massachusetts Institute of Technology professional.mit.edu

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• Shattering Glass Ceilings: Women in Leadership Positions 07/03/2023
• Defining Sustainability: Clean Energy Solutions to Achieve Sustainability 03/03/2023
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2020 A-Level General Paper (GP) Paper 1 Essay Questions

The 2020 A Level GP essay questions was seen by students as unusual: there were quite a number of miscellaneous questions and questions that were a hybrid of multiple themes. We predicted several topics accurately for our students this year, including sports, science and morality, democracy and technology as well as free speech.

1. How reliable are statistics as a guide for planning the future?

2. To what extent is human life in general about the survival of the fittest?

3. ‘Individuals achieve sporting success, not nations’. Discuss.

4. ‘We shape our buildings, but then our buildings shape us.’ To what extent is this true of your society?

5. To what extent can any society claim to be great?

6. Examine the view that the scientist is concerned only with knowledge, not morality.

7. Given greater levels of international cooperation, how necessary is it for countries to engage in the arms trade?

8. Should politicians pursue the popular viewpoint or their own convictions, if they conflict?

9. Is modern technology a benefit or a threat to democracy?

10. ‘An appreciation of music is vital for a fully rounded education.’ How true is this of your society?

11. ‘In a free society, there should be no restrictions on freedom of speech.’ Discuss.

12. How far can prosperity and uncontrolled population growth go hand in hand?

Later dont say never Jio

Essay Questions on Science and Technology

GP Essay Questions on Science and Technology. Have a look at these GP Essay Questions on Science and Technology from A-Level past papers and address these essay questions taken from past exam papers.

• Does modern technology always improve the quality of people’s lives?
• Examine the claim that the world is too dependent on oil.
• Should research into expensive medical treatments be allowed when only a few can afford them?
• How far is it possible to ensure that all producers of food and goods are fairly rewarded?
• To what extent has technology had an impact on both privacy and security in your country?
• ‘The key to good health is a lifestyle rather than medicine.’ How far do you agree with this statement?
• To what extent has technology had a negative impact on the skill levels of people?
• In the digital age do newspapers still have a role in your society?
• Can space research be justified nowadays?
• Consider the view that mathematics possesses not only truth but supreme beauty.
• Should people be allowed to have children by artificial means?
• How far is it acceptable for technology to be used only for financial benefit?
• Consider the view that most work these days could, and should, be done from home.

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• Published: 10 July 2024

Using social and behavioral science to address achievement inequality

• Eddie Brummelman   ORCID: orcid.org/0000-0001-7695-5135 1 ,
• Nienke van Atteveldt   ORCID: orcid.org/0000-0002-3387-6151 2 ,
• Sharon Wolf   ORCID: orcid.org/0000-0002-8076-8399 3 &
• Jellie Sierksma   ORCID: orcid.org/0000-0002-1690-5811 4  

npj Science of Learning volume  9 , Article number:  44 ( 2024 ) Cite this article

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Achievement inequality has been on the rise. Globally, students from disadvantaged backgrounds perform worse academically than their peers, even with equal ability. This represents a significant loss of potential and perpetuates inequality. We organized this interdisciplinary Special Collection to uncover experiences that contribute to achievement inequality, identify interventions that reduce it, and sketch a research agenda. We hope it inspires scholars committed to addressing social problems through basic research.

Achievement inequality is a defining challenge of our time. Around the world, students from disadvantaged backgrounds perform worse academically than their more advantaged peers, even if their ability is the same 1 , 2 . This represents a significant loss of potential and perpetuates inequality across generations 3 . The achievement gap emerges early in development and widens with age 4 . At age 15, the gap equals three full years of schooling 5 , 6 . This is a global problem, occurring across high-, middle-, and low-income countries 7 . Despite large-scale efforts to combat inequality, it has increased steadily over the past 60 years 8 , 9 .

We believe that the social and behavioral sciences are well positioned to address achievement inequality. They have theories and methods that are needed to better understand—and eventually address through intervention—the types of experiences that cause, maintain, or reinforce achievement inequality. Unfortunately, however, much social and behavioral research occurs in disciplinary silos, which prevents scholars from identifying and studying novel questions that cut across disciplines. We organized this Special Collection to bring together insights across the social and behavioral sciences in addressing achievement inequality. Here, we integrate the insights gained from this collection along three guiding questions: (1) What kinds of experiences contribute to achievement inequality? (2) How can interventions address these experiences to reduce achievement inequality? (3) How can scholars bring together their diverse theories and methods across disciplinary borders to spearhead the next generation of research on achievement inequality? We adopt a developmental perspective, focusing on children from preschool through primary and secondary school. This allows us to identify early sources of inequality and to evaluate developmentally tailored solutions. We hope this collection will serve as an inspiration for scholars who are committed to using basic social and behavioral science to address social problems.

Experiences that contribute to achievement inequality

The first set of studies in our collection examines how children from low socioeconomic status (SES) backgrounds see themselves and how they are seen by others. These perceptions can have serious downstream consequences, from limiting participation in classroom discussions to undermining academic achievement.

In this collection, Hofer et al. 10 —a collaboration between psychologists and educational scientists—investigated children’s self-views as mechanisms of achievement inequality. Children from low-SES backgrounds are often exposed to denigrating messages about their academic abilities. For example, their teachers perceive them as less intelligent, believe their intelligence is fixed and cannot be developed, and disproportionally assign them to lower educational tracks—even when these children perform as well as their peers 1 . Consequently, children from low-SES backgrounds may develop more negative views of their academic abilities, which can stifle motivation and undermine achievement. Using data from the 2018 Programme for International Student Assessment (PISA), including 520,729 15-year-old students from 70 countries, Hofer et al. demonstrated that those from low-SES backgrounds indeed had more negative self-views: They had lower self-perceived ability, lower self-efficacy, more of a fixed mindset, and a reduced sense of belonging. These self-views, in turn, predicted poorer academic achievement. Self-views partially mediated the association between SES and achievement, thus perpetuating achievement inequality. By investigating this across 70 countries, the authors were able to demonstrate that the effects differed meaningfully between countries, depending on a country’s level of social mobility and income inequality.

Although Hofer et al. demonstrated socioeconomic disparities in children’s self-views, with downstream consequences for achievement, their research does not speak to the origins of these disparities. What experiences cause children from low-SES backgrounds to develop negative beliefs about their academic abilities? Some of these experiences might occur in classrooms. Classrooms embody an ideal of meritocracy: By providing all students with the same desk, the same teacher, and the same materials, they create an illusion of a level playing field, suggesting that any difference in achievement is due to effort or ability 2 , 11 . Yet, even in classrooms, children might be treated differently based on their SES. Three studies in our collection—Renoux et al. 12 , Schoneveld and Brummelman 13 , and Sierksma 14 —address this possibility. They demonstrate that children from low-SES backgrounds may face unequal treatment in the classroom, often at the hands of well-intentioned teachers or peers, with serious repercussions.

First, teachers may provide fewer opportunities to children from low-SES backgrounds to participate in whole-class discussions. For example, preschoolers from low-SES backgrounds are called on less by the teacher and speak less without being called on, regardless of their language ability 15 . Combining insights from social psychology and sociology, Renoux et al. 12 conducted preregistered research showing that the reduced participation of preschoolers from low-SES backgrounds affects how they are seen by their peers. When preschoolers saw that a classmate participated less in class, they explained this primarily in terms of inherent factors—revealing a so-called inherence bias 16 . For example, they were more likely to think that the classmate is not smart (i.e., an intrinsic factor) than to think the classmate has reduced access to educational resources (i.e., an extrinsic factor). Over time, these inferences may turn attention away from extrinsic factors and perpetuate the idea that children from low-SES backgrounds are simply less competent than their peers.

Second, teachers may send seemingly well-intentioned but discouraging messages to children from low-SES backgrounds. Working at the intersection of developmental psychology and educational science, Schoneveld and Brummelman 13 show that teachers may sometimes behave in ways that are superficially positive but undermine the perceived competence of children from low-SES backgrounds. A preregistered experiment showed that when a child from a low-SES (vs. high-SES) background succeeded in school, teachers delivered more inflated praise, such as “You did incredibly well!” Teachers probably gave more inflated praise because they inferred that the child from a low-SES background had to work harder to achieve their success. Another preregistered experiment showed that when children learned that another child received inflated praise (while an equally performing classmate did not), they perceived this child as more hardworking but less smart. Thus, teachers’ inflated praise may inadvertently reinforce the view of children from low-SES backgrounds as less smart.

Third, once children are stereotyped as being less smart, they may be treated by classmates in ways that perpetuate their presumed lack of smartness. Integrating theories from social and developmental psychology, Sierksma 14 demonstrated that children might perpetuate competence-based inequality by offering disempowering help (i.e., help that does not offer recipients an opportunity to practice and improve their skills, such as providing the right answer rather than a hint). In two preregistered experiments, children were introduced to two peers whom they later overheard were either good or not so good at a task. Children then had an opportunity to help those peers. Children provided more empowering help (e.g., hints) to peers portrayed as competent and more disempowering help (e.g., right answers) to peers portrayed as incompetent. Thus, once stereotypes have been formed, interactions between children in a classroom can perpetuate them.

In addition to the unequal treatment of children from low-SES backgrounds within classrooms, there are regional and national policies that perpetuate achievement inequality. One such policy is ability tracking 17 , where children from lower SES backgrounds are assigned disproportionately to lower, vocational tracks, even when their academic achievement is on par 18 . In this collection, Bardach et al. 19 linked research on ability tracking to insights from educational science and psychology. Specifically, they examined a mechanism through which ability tracking might perpetuate achievement inequality: track-related stereotypes —generalized beliefs about students belonging to a certain track. In their study, 3,880 secondary school students rated how they thought others perceive students attending their own track (e.g., to what extent others perceive these students as stupid, dumb, unmotivated, and lazy). Preregistered analyses confirmed the presence of such stereotypes, showing that students from lower, vocational tracks believed that others had relatively negative perceptions of students in their track, while students from higher, academic tracks believed that others had relatively positive perceptions of students in their track. Students from mixed tracks were in-between. However, changes in such stereotypes over time were not consistently related to changes in engagement, self-perceived ability, or academic achievement over time. That is, even when children became more aware of the negative stereotypes about their track, they did not suffer academically. One possible explanation is that stereotypes are most consequential when they are held by others (rather than the self), leading to biased treatment that perpetuates inequality, even if students are not aware of the biased treatment 1 .

In some cases, being the subject of negative stereotypes can compel students to work harder in school, even when this has long-term mental and physical health costs 20 . Black American youth face racial stereotyping, especially in the domain of mathematics, which can undermine their academic achievement 21 . Students become aware of these stereotypes in elementary school and begin endorsing them in secondary school 22 . Black students may develop strategies to cope with the stereotypes they face. Some students may distance themselves from their racial identity, whereas others may distance themselves from academics. In this collection, Wilson and Matthews 23 combined insights from psychology and educational science to argue that one group of students has long been overlooked: those who resist pejorative racial ideologies by persistently pursuing academic success. A ninth-grade student remarked: “Like it’s not a bad thing being Black, it’s not. That’s one of the best things to be in life. Like it’s good, but you realize that you have to work ten times harder, because people is judging you off of what they think like a stereotype or a statistic…” (p. 1). In a sample of secondary school students, Wilson and Matthews measured students’ self-beliefs and identified a small group of Black American students showing a so-called resistors profile. These students viewed both their race and the domain of mathematics as important reflections of who they are, and they experienced a strong drive for school success as a way to resist discrimination, stigma, and stereotypes against their racial group.

After secondary school, many students from low-SES backgrounds enter vocational education. In this collection, Finkenauer et al. 24 —a team of interdisciplinary social scientists—discovered that vocational-education students who experience financial scarcity (e.g., who often worry about money) are at risk of dropout. Why are these students at risk? One explanation is that adolescents who experience financial scarcity lose trust in institutions. For example, they may see authority figures in school as dishonest, unreliable, and incompetent. Reduced institutional trust, in turn, may lead adolescents to disengage from school. Indeed, preregistered analyses demonstrated that reduced institutional trust partly explained why adolescents who experienced financial scarcity dropped out. This can have serious consequences, as students who drop out have worse economic prospects, including a higher likelihood of ending up in poverty 25 .

Collectively, the papers in this collection identify crucial experiences that reinforce achievement inequality. Children from low-SES backgrounds are treated differently by teachers and peers, irrespective of their actual abilities and achievements. For example, they receive fewer opportunities to participate in whole-class discussions and receive more superficially positive feedback and unsolicited disempowering help. Over time, such treatment can lead to them being perceived as less competent, feeling less competent, and losing trust in institutions, including educational institutions. This erosion of confidence can hinder academic achievement and increase the likelihood of dropout. While some children resist the negative stereotypes they encounter, the long-term consequences of this coping strategy can be detrimental.

Interventions that reduce achievement inequality

As the first set of studies has uncovered experiences that contribute to achievement inequality, the second set focuses on intervention strategies—how to develop, design, and deliver interventions in ways that reduce achievement inequality. While some interventions target individual students, others target classrooms, schools, or even national policies.

Connecting insights across neuroscience and psychology, Harms and Garrett-Ruffin 26 discuss in this collection how growing up in poverty contributes to cumulative risk exposure, resulting in chronic stress that impacts neurocognitive development. Over time, this may undermine academic achievement and perpetuate the intergenerational cycle of poverty. The authors call for two types of intervention strategies to lessen the harmful effects of poverty: (1) neuroscience-based educational practices that reduce the impact of poverty on educational achievement, such as by removing sources of stress from the curriculum; and (2) policies at the national, state, and district levels that eradicate poverty and address negative stereotypes about those living in poverty, including anti-racism policies.

Some scholars have suggested that personalized learning —embracing students’ individual differences in the classroom by personalizing their learning experiences, often with the help of technology—could help address achievement inequality. In this collection, Dumont and Ready 27 reviewed literature from the learning sciences, philosophy, psychology, and sociology to identify the conditions under which personalized learning can be beneficial. They argue that personalized learning is unlikely to create equality of outcomes . It could, however, contribute to adequacy , “[equipping] all students with the basic competencies to participate in society as active members and to live meaningful lives” (p. 1).

Achievement inequality is a pressing issue worldwide, but its causes and consequences differ across regions. In sub-Saharan Africa, an increasing number of children enroll in primary school, but their learning outcomes remain low 28 . One barrier to learning is child labor. Worldwide, approximately 160 million children engage in child labor 29 . In this collection, Wolf and Lichand 30 developed an intervention with the aim of reducing child labor and improving learning in Cote d’Ivoire, the largest producer of cocoa in the world, where child labor is common 31 . Building on insights from economics, applied developmental psychology, and educational science, they developed an SMS-based nudge intervention and tested it through a preregistered randomized controlled trial. The intervention delivered nudges via SMS and audio messages to parents, teachers, or both, with the aim of raising parental engagement and teacher motivation. The messages included reminders, encouragement, and activities. Parents received messages like: “School is a space for everyone, including families. You are invited to come to school next week. See you there!” Teachers received messages like: “Ask every child in your classroom to write on the board what they would like to learn. Then, ask them to choose another student to help them, by working in pairs.” Overall, the intervention did not reduce child labor and did not raise learning outcomes, regardless of whether the intervention targeted parents, teachers, or both. Among children who had started off with low learning levels, however, the parent-focused intervention raised learning outcomes and, seemingly paradoxically, also raised child labor. Specifically, the intervention raised children’s domestic work (e.g., cleaning the house), but not their cocoa farming activities. Together, these findings suggest that raising parents’ or teachers’ motivation—without alleviating the systemic barriers they face—might not be sufficient for generating broad improvements in children’s learning outcomes.

Most approaches to reducing achievement inequality target students, teachers, or school-based policies. Rarely, however, do they target the content of the curriculum or tests. In this collection, Muskens et al. 32 asked: Can achievement inequality be reduced by making tests more relevant to the everyday lives of children from low-SES backgrounds? They adopted a hidden talents approach—rooted in insights from biology, psychology, and anthropology—to theorize that some social and cognitive abilities are enhanced, rather than impaired, through adversity 33 . Extending this notion, the authors hypothesized that children from low-SES backgrounds would perform better on mathematics items if these items reflected topics of real-world importance to them (e.g., money, food, and social relationships). They tested this preregistered hypothesis using cross-sectional data from Trends in International Mathematics and Science Studies (TIMSS), including data from 5501,165 4 th and 8 th grade students from 58 countries. Contrary to the authors’ hypothesis, children from low-SES backgrounds scored 18% lower on items of real-world importance. One possible explanation is that these items were so salient to them that their attention was diverted away from the task. This suggests that well-intentioned attempts to make questions more relevant to children’s everyday lives could, in some cases, backfire for children from low-SES backgrounds.

Another approach to reducing achievement inequality targets mindsets: beliefs about the malleability of intellectual abilities. A growth mindset is the belief that students can develop their abilities through effort and education, whereas a fixed mindset is the belief that students’ abilities are set in stone. In this collection, Hecht et al. 34 brought together a large team of psychologists and educational scientists to review literature on how cultivating a growth mindset culture can reduce achievement inequality. They argue that mindsets do not just reside within teachers’ and students’ minds; they exist within a classroom, representing shared beliefs about what it means to be a learner in that classroom. Teachers can create growth-mindset cultures by conveying that all students can learn and improve, such as by expressing high expectations for all students, treating mistakes as opportunities for learning, allowing students to take ownership of their learning process while being a source of support, and providing feedback on the process rather than on ability 35 . This set of practices has been shown to reduce achievement inequality. An intervention that encouraged teachers to adopt growth-mindset practices improved students’ achievement, especially in classes with a higher proportion of students from low-SES backgrounds 36 .

Together, the papers in this collection demonstrate the promises and perils of psychological interventions for reducing achievement inequality. Most existing psychological interventions target students individually, which could convey to students that the onus of change is on them 37 , 38 . Challenging this approach, several interventions in this collection target those in positions of power, such as teachers or policy makers, which can create fertile soil for psychological change in students. Sustainable change requires both “good seeds” (a psychologically wise intervention) and “fertile soil” (a context that affords the way of thinking offered by the intervention) 39 . For example, teaching children a growth mindset is unlikely to improve their academic achievement if their teachers continue to endorse a fixed mindset 40 . Thus, achievement inequality cannot be solved through individual psychological intervention alone; psychological interventions must be supplemented by structural changes—at the classroom, school, and national policy level—that create a fertile soil that enables students to put their new ways of thinking into practice.

The next generation of research on achievement inequality

Looking into the future, what types of research do we need to advance our understanding of achievement inequality? Based on the promising examples showcased in our collection, we outline a roadmap for future research.

First, we call for research that challenges deficit perspectives on achievement inequality. According to these perspectives, children from low-SES backgrounds have deficits in their individual attributes—such as their intelligence, executive functions, self-regulation, or motivation—that lead them to underperform in school 41 . Such deficit perspectives may be fueled by society’s firm belief in meritocracy, which assumes that students’ achievements in school are reflections of their efforts and abilities. In our collection, Zengilowski et al. 42 formed a unique team of educational, developmental, and cognitive psychologists to challenge deficit perspectives. They argue convincingly that overemphasizing individual attributes may lead one to overlook the actual structural causes of achievement inequality and may inspire individual interventions that put an increased burden on children from low-SES backgrounds. Thus, over time, a deficit perspective may both justify and perpetuate existing inequalities in education.

Several studies in our collection challenge the deficit perspective. One line of work, described by Muskens et al. 32 , is based on the premise that children from low-SES backgrounds develop skills that enable them to contend with the challenges of growing up in low-SES environments (e.g., detecting threats, finding creative solutions in times of scarcity, reading others’ intentions). That is, growing up in low-SES backgrounds does not invariably lead to deficits; it leads to a specialized set of skills that is often underappreciated in academic contexts. Another line of work, exemplified by Renoux et al. 12 and Schoneveld and Brummelman 13 , shows that teachers treat children from low-SES backgrounds unfairly, even when their abilities and achievements are on par. Why? One explanation is that teachers perceive a mismatch between the tendencies of children from low-SES backgrounds and those that are valued in academic contexts 43 . For example, children from low-SES backgrounds may prefer working together, eschewing competition, being modest, and deferring to adults and peers, while academic contexts value working individually, embracing competition, being assertive, and challenging others. In other words, the attributes of children from low-SES backgrounds are not inferior to those valued in academic contexts—“they just happen to be different , and this difference should not be mistaken for a deficit” 43 . Yet, teachers may explain this mismatch in terms of deficits (e.g., perceiving children from low-SES backgrounds as less smart). Such inherent explanations may lead teachers to treat children from low-SES backgrounds in ways that exacerbate existing inequalities (e.g., excluding them from whole-class discussions and lavishing them with inflated praise for average achievements).

Together, these two lines of work suggest that solutions to achievement inequality should not attempt to fix the apparent deficiencies of children from low-SES backgrounds; rather, they should create environments that allow all children, regardless of their socioeconomic backgrounds, to fulfill their potential. Consistent with this approach, Hecht et al. 34 show how creating a growth mindset classroom culture can reduce achievement inequality.

Second, we call for research at the intersection of disciplines. Achievement inequality is a multifaceted problem with many underlying causes. Only by working across the borders of disciplines can we fully comprehend and address these causes. In this collection, educational scientists Elffers et al. 44 argue that, when forming such interdisciplinary collaborations, it is critical to establish a shared understanding by considering one’s implicit—and often discipline-specific—theories of achievement inequality. Are all forms of achievement inequality problematic, or are some forms acceptable or even desirable? Should teachers strive to provide children with equal opportunities, even if this results in unequal outcomes, or should they provide some children with more opportunities than they do others? Can educational institutions eventually reduce achievement inequality, or are they social sorting machines that are designed to maintain or even exacerbate existing inequalities? Asking these questions will help researchers align and sharpen their theories and methods, and, importantly, inform when and for whom interventions are most needed.

By collaborating across disciplinary borders, researchers can develop shared research infrastructure that will allow them to conduct the same study or test the same intervention in different contexts. This is critical for understanding heterogeneity : what works for whom under what conditions 45 . Without such a shared infrastructure, researchers are limited to meta-analyses that integrate studies with different designs, different measures, and different sampling strategies after they have been conducted. With a shared infrastructure, researchers can coordinate designs, measures, and sampling strategies in advance. And by pooling resources, they can purposefully recruit samples that are heterogeneous and generalizable. For example, rather than limiting themselves to children from high-SES backgrounds, they can target children from a wide range of SES backgrounds; or rather than limiting themselves to high-income countries, they can target low-, middle-, and high-income countries. Several papers in our collection set an example. Hecht et al. 34 discuss the importance of large heterogeneous samples and multi-site studies for identifying the conditions under which growth-mindset interventions work. Hofer et al. 10 used the PISA 2018 data to examine antecedents and consequences of socioeconomic disparities in self-views across 70 countries, allowing them to identify differences between countries. Lichand and Wolf 30 tested their intervention in 100 schools in Cote d’Ivoire, including a total of 2246 students, which allowed them to compare intervention effects across child- and family-level characteristics. To create the necessary infrastructure, they established a collaboration with Movva, a Brazilian social enterprise, and partnered with the Ministry of Education and local schools. We hope to see more international multi-site research that explores the best contextualized solutions to achievement inequality globally.

Third, we call for research that develops and implements inclusive research methods. In this collection, a group of neuroscientists, educational scientists, and psychologists, Adams et al. 46 , describe a case in point. Over the past decades, findings from neuroscience have been used increasingly to inform theory and policy in the field of education. Electroencephalography (EEG) is an important tool in this field, given its high temporal resolution, its ability to be used outside of traditional lab settings, and its suitability for use with young children, even infants 47 . However, it is difficult to collect high-quality EEG data from participants with thick, voluminous, and curly hair types and certain hairstyles. Adams et al. describe how this has led to unintended systemic racism, as certain minority populations—such as Black and Latinx students—have been excluded disproportionally from EEG research. The authors provide a substantial list of recommendations for conducting EEG research with these populations, thereby making EEG research more inclusive.

How can researchers make sure that their research methods are inclusive? They can do so by engaging with and learning from the populations they study. They can involve the populations they study in every step of their research—from conceptualizing the research questions and developing the materials to interpreting the findings and identifying new research directions. This approach turns the populations into co-constructors of knowledge rather than mere objects of study, helping researchers avoid the deficit perspectives and exclusionary research methods that are still dominant in many fields 48 . Of course, the populations need to be properly compensated and credited for these efforts. Unfortunately, such an inclusive approach is often discouraged, because it is believed to interfere with objectivity and can be mistaken for bias, especially if the researcher is part of the population they study 49 . We hope that scholars can correct this misunderstanding by demonstrating that research can be both inclusive and rigorous.

Concluding remarks

What kinds of experiences contribute to achievement inequality? And how can we address these experiences through intervention? Our special collection has attempted to address these questions by bringing together insights from different fields, including developmental psychology, social psychology, educational science, neuroscience, sociology, economics, and interdisciplinary social sciences. Each of these fields has a history of studying important social problems, and each field brings unique tools, from rich theories to rigorous methods. Yet, incentive structures in academia have discouraged some of the high-risk high-gain research that is needed to answer big questions. Our collection demonstrates that a commitment to social problems can reinvigorate our work 50 . It connects researchers across disciplinary boundaries, which enables them to look beyond their own theoretical borders, to engage in transformative interdisciplinary projects, and to build a shared research infrastructure. We hope this collection serves as an inspiration for a new era of research that addresses interdisciplinary, big, and bold questions.

Reporting summary

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Acknowledgements

The Special Collection was developed during an interdisciplinary symposium on educational inequality funded by an KNAW Early Career Partnership 2020 (Royal Netherlands Academy of Arts and Sciences) to Eddie Brummelman. All editors of this collection participated in the symposium. During the writing of the editorial, Eddie Brummelman was supported by a Jacobs Foundation Research Fellowship (2020-1362-02), a Jacobs Foundation COVID-19 Education Challenge Grant (2020-1399-00), and an NWO Talent Programme Vidi grant (VI.Vidi.211.181). Jellie Sierksma was supported by an NWO Talent Programme Veni Grant (VI.Veni.191 G.052). We thank Viki Hurst for her help in editing this collection.

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Eddie Brummelman

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Nienke van Atteveldt

Graduate School of Education, University of Pennsylvania, Philadelphia, PA, USA

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E.B. developed the idea for this special collection. E.B. and N.v.A. set up the special issue together. J.S. and S.W. joined them as co-editors and helped editing papers. E.B. wrote the first version of this manuscript. N.v.A., J.S., and S.W. provided input and revisions. E.B. acquired funding for this project. All authors approved the complete version of this manuscript for submission.

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Correspondence to Eddie Brummelman .

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E.B., J.S., and S.W. are Guest Editors of npj Science of Learning . N.v.A. is Editor-in-Chief of npj Science of Learning . E.B., N.v.A., S.W., and J.S. were not involved in the journal’s review of, or decisions related to, this manuscript. The authors declare no competing financial or non-financial interests.

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Brummelman, E., van Atteveldt, N., Wolf, S. et al. Using social and behavioral science to address achievement inequality. npj Sci. Learn. 9 , 44 (2024). https://doi.org/10.1038/s41539-024-00259-1

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DOI : https://doi.org/10.1038/s41539-024-00259-1

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‘Education is a solution to social inequality.’ Do you agree?

Education is often naively thought to be the holy grail of meritocracy. Observers from the outside view the system as a metaphorical social ladder, where all students start at the same point, and their final outcome is a function of only how far they are willing to climb. However, digging below the surface would leave these idealists sorely disillusioned. Underneath the facade of equal competition lies a reality where students are seen not as seeds to grow, but as investments to pump money into so that the rich can secure their status in the upper class. In today’s world, education is a perpetuator of, not a solution to social inequality.

In most societies around the world, financial capital from wealthy students’ parents gives them a massive leg-up in the educational rat race. This is because even though politicians who preach the value of education in tackling social inequality point to the equality of opportunity provided to students in school, what truly matters is the enrichment that students receive outside the classroom. In Singapore, for example, there is a bustling tuition industry, as parents scramble to find their children an elusive academic edge. In fact, the Straits Times reported that the average Singaporean parent spends $500 every month on tuition or enrichment classes outside of school. These tuition agencies promise excellent academic results, with some even guaranteeing an ‘A’ or ‘B’ grade for their students – and they deliver. Such after school programs are also commonplace in other pressure cooker education systems such as South Korea. While $500 a month might seem like a worthy investment for more affluent parents, it forms a large proportion of poorer families’ household income, entailing a huge opportunity cost that less well-to-do parents simply cannot afford. From this, it is clear that education perpetuates income inequality, rather than enabling social mobility. Unless the education system is restructured in such a way that financial capital does not give students as much of an advantage, education is not and can never be a solution to social inequality.

Other than financial capital, students from higher social classes also advantaged by the cultural capital that many of their peers do not have access to. In a survey by the Institute of Policy Studies, researchers found that while more affluent parents treat education as a top priority for their children, it ranks much lower on the list for parents from lower social classes. This is because for these families, the need to attain a good education conflicts with their more basic needs such as caring for younger children and maintaining their financial stability. In tangible terms, this low priority for education manifests in less enriching or stimulating environments devoid of books and educational games that richer students have access to. Poorer parents’ lower emphasis on education also often translates to their children putting less effort into their school work, making it more difficult for them to do well in school. This insidious source of inequality is nearly omnipresent, deepening the hold of social inequality on poorer families. This situation has become so dire that even America, the country that takes the greatest pride in its meritocracy, has 45% of its Harvard students coming from families earning USD$200,000 a year or more. The fact that students in higher social classes have such a clear advantage in attaining top scores in standardised examinations, proves any claims of education being a solution to social inequality to be nothing more than empty rhetoric.

Even when looking beyond the role of individual parents, education can still be said to be a poor solution to social inequality, as there are systemic biases that perpetuate inequality, rather than addressing it. It is true that governments have tried to develop their education systems into true solutions to social inequality. For instance, the Scholastic Aptitude Test (SAT) that American students take at the end of high school takes into account ethnographic factors of students while calculating scores, giving additional points to students that come from disadvantaged backgrounds. Firm believers of education latch onto these examples to propose education as the panacea to social inequality. However, such measures inevitably fall short as they merely target the symptoms of systemic biases; not the root cause. To be a true solution of social inequality, education systems should not base students’ future opportunities on their past performance, as this prevents substantial improvements from being made. For example, students who are able to enter an elite school after their Primary School Leaving Examinations in Singapore have access to opportunities to stretch their mind, while those studying in neighbourhood schools do not. Similarly, in Finland, students posted to vocational schools have many lower-income jobs cut off from them, regardless of how well they perform in class. This is a problem for the education system as early performance is largely hinged on parental support. It is only when students become older that their academic results become more reflective of their own hard work. This means that education currently judges students largely based on parental factors, leaving students little chance to prove themselves as they get older. Considering this, it is clear that the education system exacerbates social inequality rather than solving it.

Overall, it might not be wrong to think of education as a ladder. However, we must be aware that the ladder that each student receives can wildly differ. While come students receive sturdy metal ladders that they can easily scale, others receive shoddy ones with shaky legs and broken rungs. Consequently, it is crucial that the government does not simply throw every child ladder, expecting them to eventually ascend to the same place. The ladder’s quality is just far too contingent on parents financial and cultural capital, and too inflicted by systematic biases for this to be effective. For the education system to even endeavour to address social inequality, it has to be majorly reformed to stand alone. School should provide additional assistance to lower-income families, before their children enter primary school to negate richer students’ headstart; more resources should be dedicated to pull-out programmes to reduce the need for tuition; and standardised examinations should be rethought to require more on-the-spot thinking and less drilling. Only then can education truly be a solution to social inequality.

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GP Essay (Technology)

‘Technology makes our lives easier but at the same time more complicated.’ Do you agree?

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INTRODUCTION

Technologies address the basic needs of humans and are the fundamentals which set us apart from animals. Man has evolved to be able to use his intelligence to question and investigate his environment and from what he has learnt, apply his knowledge to create tools that give him an advantage over his environment. While technology has no doubt brought about great convenience to our lives, it is incontrovertible that it has fueled extremist activities, destroyed Mother Nature as well as enabled the development of nuclear weapons.

ANTI-THESIS 1

Technology is the panacea for the proliferation of people’s proclivity to indolence.

ELABORATION:

Science is able to identify problems while technology is able to translate these problems into practical solutions for the betterment of mankind. The power of technology has brought about great convenience and it is evident in the average home.

Roomba is a series of autonomous robotic vacuum cleaners sold by iRobot and named one of the best inventions of 2002 by the Times. Introduced in September 2002, Roomba features a set of sensors that enable it to perform its tasks. Running on rechargeable batteries, Roomba roams your house entirely on its own, swooping up dust bunnies and zipping under beds and couches where mere humans can’t reach. Its sensors keep it from bumping into walls and furniture or falling off staircases. When it finishes a room, Roomba beeps proudly and turns itself off.

EVALUATION OF EXAMPLE 1:

Such ease provided by the advancement of technology has indubitably brought about much comfort to our lives. With a click of a button, the Roomba can easily do the tedious household chores for you. Moreover, with a price tag of under $200, it is affordable and can be easily acquired by households.

Nanyang Technological University in Singapore uses driverless shuttles at its campus. The minibus, which is fully enclosed and air-conditioned, can take up to 15 people, with 11 seated and four standing.

EVALUATION OF EXAMPLE 2:

Densely-populated Singapore hopes driverless technology will help the country manage its land constraints and manpower shortages. “The autonomous vehicles will greatly enhance the accessibility and connectivity of our public transport system, particularly for the elderly, families with young children and the less mobile,” Transport Minister Khaw Boon Wan said.

All these appliances and tech gadgets that have made life easier for us are all products of science.

ANTI-THESIS 2

In less than two decades, the development of technology like wireless Internet, text messaging and smartphones have wildly transformed the way we communicate with one another.

Efficiency in communication brought about by technology can be seen in a practical sense. Technology has definitely made us better communicators in utilizing the resources available to us to communicate with one another in a faster and more concise manner. Gone are the days where lack of an efficient means of communication had brought about inconvenience to our lives.

Prior to the advent of the use of telegraph and radio in warfare, dispatch riders on horseback and runners were used to convey and deliver orders and battle updates to and from unit commanders and headquarters. This provided a slow and inefficient means of communication, causing units whose lines of communication were compromised to be vulnerable to becoming isolated and defeated, as the means for requesting reinforcements and resupply is lost.

EVALUATION OF EXAMPLE:

Today, emails and text messaging made possible by state-of-the-art technology have become a staple and inexpensive means of long-distance communication where messages are delivered to the intended recipient with just a single click or touch of a button.

Time is no longer a constraint in communication, and people no longer have to worry about being separated by geographical boundaries. Be it disseminating information, broadcasting news, or sharing knowledge, technology has unequivocally made it faster, easier, and smarter.

THESIS 1 (REBUTTAL TO AT 1)

More often than not, technology complicates our lives more than simplifies it. The deleterious consequences on the environment as a result of technological advancement is taking a toll on Mother Earth and inflicting serious damages on our lives.

Allan M. Eddison once famously said that “Modern technology owes ecology an apology”. This is true as the advancements in technology have no doubt brought about the deterioration of the environment, complicating our lives.

Our lives today are made more comfortable and convenient with the advancements in technology in producing electrical appliances like refrigerators, fans, air conditioners etc.

However, the increased consumption of power and electricity has led to the depletion of Earth’s natural resources and brought about pernicious consequences. Global warming, which came to widespread attention after Al Gore’s “An Inconvenient Truth”, is a crisis borne out of greenhouse gases being released into the atmosphere; the increased rate of its release being the byproduct of the Industrial Revolution and mankind’s subsequent revolutionary lifestyle with factories being continuously built to satisfy man’s desire.

The melting of ice caps due to global warming has also proved to be a worrying issue especially when scientists recently found out that the world’s thickest East Antarctica Ice sheet which contains enough water to raise global sea levels by over 50m, is at risk of melting due to drastic climate changes. Additionally, the fifth Intergovernmental Panel for Climate Change (IPCC) report mentioned that for high emissions IPCC now predicts a global rise by 52-98 cm by the year 2100, which would threaten the survival of coastal cities and entire island nations. But even with aggressive emissions reductions, a rise by 28-61 cm is predicted. Even under this highly optimistic scenario, we might see over half a meter of sea-level rise, with serious impacts on many coastal areas, including coastal erosion and a greatly increased risk of flooding.

The rise in sea levels has already caused some islanders to be displaced from their homes. As many as eight islands in the Pacific Ocean have disappeared entirely due to rising sea levels. The low-lying Micronesia and the Solomon islands have fallen victim to climate change, resulting in islanders facing even more challenges.

THESIS 2   (REBUTTAL TO AT 2)

The argument put forth by detractors sounds specious as they fail to consider the fact that the improved transportation and communication channels are available to extremists as well.

It has heightened the vulnerability of societies by increasing their exposure to threats beyond their own community.

With the availability of air travel, terrorists have been able to target their activities on communities in other countries. This can be seen in the 9/11 attack where Al-Qaeda terrorists hijacked and crashed commercial planes into the two World Trade Towers in America in a bid to fight against the West, leading to widespread devastation across the country.

2005 Bali bombings and the 2013 Boston Marathon Bombing where terrorists were able to carry out attacks around the globe due to the ease of transportation was made probable by technology.

By harnessing the Internet as a tool for communication, the prominent terrorist group ISIS has been successful in spreading its ideology and setting up branches all over the world, which has staged several bombings worldwide. A terrorist planned a Christmas bombing with his girlfriend after he pledged allegiance on Facebook to an Islamic State commander looking for volunteers to carry out lone-wolf attacks, his trial heard. Munir Hassan Mohammed sent messages to the commander in Iraq or Syria and downloaded terrorist publications online, as the couple plotted to make bombs and toxins together.

EVALUATION OF EXAMPLES:

The advancement of communication technology like the Internet has provided an efficacious platform for terrorists to spread their ideologies, thereby expanding their terrorist network. Furthermore, according to a UN report, the US believes that terrorists are now able to share their intelligence with one another and even learn quick ways to make a bomb through videos on the Internet.

Clearly, the advancement of technology has removed precious limitations and opened the door for new threats to enter various countries, thus forming new hazards to the people in their societies.

Technology as weapons of mass destruction fuels a string of complications on people’s lives.

Albert Einstein once said that “I do not know what World War III will be fought with, but I do know that World War IV will be fought with sticks and stones.”

Technology is highly susceptible to human manipulation and can be used as a tool for destructive purposes, often creating a host of problems and dangers of a disastrous magnitude.

Nuclear power, once thought to be the solution to the world’s dwindling power, has taken on a much more insidious appearance after its destructive potential was revealed.

In the Cuban Missile Crisis in the 1960s, the world was nearly embroiled in nuclear warfare when America and the Soviet Union came head to head in Cuba. Also, in spite of treaties such as the Nuclear Non-Proliferation Treaty (NPT) signed in 1968, we have been powerless to stop depraved dictatorships like megalomaniac dictator Kim Jong Un from holding the threat of nuclear weaponry over the heads of many countries in a bid to protect its own security. Not forgetting the deployment of atomic bombs on Nagasaki and Hiroshima which led to the loss of colossal lives and utter destruction.

Governments have also been relentlessly building up stockpiles of increasingly lethal weapons in accordance to their own national interests. Unmanned drones rain down death from above in Pakistan, helicopter gunships massacre unarmed civilians in Syria, and chemical weapons such as nerve gas are deployed to quell the multitude of insurrections in separatist Russian states.

Technology has therefore increased the capability of man to wage war, threatening to disrupt the delicate balance of peace in our world today.

For every advancement that humanity collectively make as a species, there always seems to be accompanying regression. Technology was meant to benefit us all, and yet all it has managed to achieve is seemingly making the world a more dangerous place. At the end of the day however, we must remember this – guns do not kill people, people kill people. Technology by itself is neither benign nor malevolent, it is merely a tool. It is how we use it that determines whether or not it helps to increase our safety or ultimately undermines it. The end goal we should all strive towards now therefore should not be technological advancement, but rather technological enlightenment. We as a species simply should focus first on figuring out how best to utilize the current technology at our disposal, maximising its benefits, while minimising its detriments. Getting everyone to slow down might be unheard of in the name of progress, but given the current context, it is the only way to make things right. Whether we ride the waves of technology or drown in it all depends on how we utilize it.

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GP Essay #22: How far is it possible to have a fair and inclusive society in your country? 

In a meritocratic, pluralistic nation such as Singapore, what does it mean for a society to be ‘fair’ and ‘inclusive’? When there is fairness, the treatment of all individuals is not predicated on indicators which are out of his control, such as race or religion. When a society is inclusive, all members benefit from progress and equality of opportunity, diversity is celebrated instead of shunned, and all individuals are allowed to participate in deciding the creation and direction of social institutions. Singapore is already quite fair and inclusive with the coexistence of diverse racial and religious groups bearing testament to its strong social fabric. That said, however, rampant allegations of micro-aggressions and a society that promotes tolerance instead of genuine acceptance suggest that it is not entirely a completely fair and inclusive one. While it is possible to strive for greater fairness and inclusiveness in Singapore, having one that is entirely equal and accepting is impossible, although this should not stop us from continually striving for one.

            It is possible to have a fair and inclusive society in Singapore as government policies can aid in the creation of such a society. The importance of procedural equality has been enshrined in Singapore’s Constitution, and has been enforced through non-discriminatory policies. For instance, all individuals are treated equally in the court, with no difference in treatment on the basis of race, religion or social status. Hence, this reinforces the understanding that one’s race, religion or indeed other demarcations of social status do not exempt him from the laws of the country, thereby affirming the concept of fairness. The government has also made known its goal for an inclusive society, one where everybody is accepted, and allowed to decide the direction of the country, regardless of race or religion. It has introduced policies such as the Group Representative Constituency, which mandates that political parties are to field at least one minority candidate in the elections. This policy, which ensures some form of minority representation in Parliament, serves to reinforce the fact that all groups are included in the Singapore national fabric, and their interests will be served. The success of these policies that the Singaporean government has already enforced shows that a culture of equality and inclusivity can indeed be cultivated through the actions of the government.

            It is also possible to have a fair and inclusive society in Singapore due to the availability and the quality of our educational system, which functions as an adequate leveller of social mobility. Children from the age of seven to the age of twelve are expected to go to primary school, ensuring that they are literate and have an understanding of the four most basic subjects – English, their own Mother Tongue, Math and Science. School fees are highly subsidized by the government, with most public schools charging less than a hundred Singapore dollars a year. The affordability of education is critical in ensuring a fair and inclusive society, for it equips all children with the knowledge they need to get through life with, such as the ability to read, write and count, regardless of their family background, race or religion. Education also aids in levelling the playing field, for it gives the children an equal opportunity of academic success whether they are from a wealthy or not-so-wealthy families. This often is a direct translation of the amount of effort a child puts into his studies, and so, even a child from a disadvantaged background can get into university with government or corporate scholarships. This therefore aids in creating income mobility within the population, preventing the creation of a single educated group, and hence, social segregation and exclusivity. 

            However, while education may be a means with which one can get out of the poverty cycle, it can also work in the opposite direction – by widening the income gap between the rich and the poor in Singapore. Richer families are easily able to afford tuition, which sets those children from those families up on a more advantageous position. The help rendered to them by their tutors make it easier for them to excel in their studies as compared to the children from poorer families that cannot afford tuition, hence widening the education disparity between the rich and the poor in Singapore. Increasingly, Singaporeans have lost faith in the education system as a leveller, as a representation of social mobility, with many criticising the fact that students in elite schools tend to hail from affluent family backgrounds, and the increased importance of social capital in Singapore.  Given the fact that the education system has traditionally fed into the labour market, there are concerns that the education system only serves to perpetuate the cycle of inequality.

            Lastly, it is possible to have a fair and inclusive society in Singapore through the appeal to the individual. From the age of seven, Singaporean students are made to recite the Pledge in school on a daily basis, subconsciously reminding themselves that differences in race, language, and religion does not make one more, or indeed less, of a Singaporean than anyone else. Singaporeans are taught from when they were young that everyone is equal, and this is hopefully reflected in their dealings with others in the later part of their lives. The creation of a society that welcomes all, despite their differences, can only be done through cooperation of individuals. 

            That said, however, it is ultimately up to individuals to practise being inclusive and non-discriminatory. While Singapore claims to have achieved a ‘harmonious and inclusive’ society, in reality, racial and religious tensions simmer beneath the surface; according to a YouGov survey, 23% of Singaporeans have experienced discrimination while renting properties. Minorities seem to be disproportionately affected, with 49% of Indians surveyed and 34% of Malays reporting such experiences. More than 80% of minorities also report the occurrence of ‘microaggressions’ in their daily lives, suggesting that even a society like Singapore which tries its best to be inclusive has a long way to go. Notwithstanding this, as long as individuals actively strive to correct their biases, the culture of fairness and inclusivity will hopefully grow stronger.

            In conclusion, it is indeed possible to have a highly fair and inclusive society in Singapore, through the implementation of government policies, education, and outreach on an individual level, especially since the framework and guiding policies that have been set down by the leaders of Singapore highlights the importance of those two qualities.