Introductory Chapter: Social Inequality – Global Perspectives

1. Introduction

Social inequality means more than difficulties in accessing health, education, transportation, recreation, rest, work, peace, food, clothing, technology, among others; means the perennial and hegemonic persistence of unequal relations of power and subalternity that reproduce a mercantilist system that has socially and historically segregated vulnerable social groups in relation to gender, ethnicity, age group, socioeconomic condition, religious beliefs, and so on. This geopolitical, economic, and sociocultural system also reveals inadequate public health, education, and labor policies, their ineffective execution, and the lack of correspondence with true social needs. Public policies aimed at addressing the social needs and problems of the population are not always executable due to multiple problems, for example, insufficient budgets and difficulty in making budget allocations effective, for example, in health and education programs, budget cuts, among others. The result of unequal relations of power and subordination is undoubtedly social inequity and injustice in relation to the satisfaction of basic needs (subsistence (health, food, etc.), protection (security and prevention systems, housing, etc.), affection (family, friends, privacy, etc.) understanding (education, communication, etc.), participation (rights, responsibilities, work, etc.), leisure (games and shows), creation (skills), identity (groups of reference, sexuality, and values), and freedom (equal rights)) [1] and exercise of fundamental human rights, evidence of this represents more than 700 million people who continue to live in conditions of extreme poverty and struggle to satisfy their most basic needs, such as health, education, and access to water and sanitation, to name a few; 30 million children who grow up poor in the richest countries in the world according to the United Nations (UN) [2].

In this work, we carry out a review and in-depth analysis of different dimensions of the human population that are affected in relation to their detriment or limiting access to: land, education, health, technology, and wages in relation to gender. The restructuring of subjectivities around the empathy due to the prevailing economic system and its repercussions on the individualization of the life path are discussed.

2. Sociocultural factors and social inequality

The social inequality is determined by different socio-cultural, ecomic, politic, religious, ethnic, gender, parental education level, geographic location, state political structure, religious system, among others. One example of structural power that determines social inequality is the hegemonic medical model (MMH). The MMH of health prevailing at a global level constitutes a tool of social control and inexorable exploitation, and this model represents an unquestionable tool that produces, reproduces, and perpetuates social inequity in relation to health, as it includes the private corporate model, responsible for deepening cost inequalities, and causes weaker sectors of society to assume their own costs with limited expectations in general terms and radically unequal in comparative terms [3]. It is especially characterized by a constant increase in the cost of care for the disease, but also a clear proletarianization of doctors: precariousness of working conditions [4]. Depending on the country, it operates as a private, official, or mixed system and as a market-based system, and, therefore, it is markedly characterized by inequality [4], so that it has high costs, which are prohibitive for a large part of the world population [4]. The MMH prevails in almost all the countries of the world; unfortunately, and despite the fact that alternative and popular medicines exist, it is not possible to say that they are recognized and respected in the health systems that are the translation of the MMH, as they work outside of this Western hegemonic model and public policies, in addition to being considered illegal.

Access to medicines is highly restricted due to the system based on commercial supply and demand imposed by the MMH through the pharmaceutical industry worldwide. This access becomes impossible in many cases of catastrophic pathologies such as cancer, as drugs such as abraxane, whose net sales worldwide increased by 9% between 2016 (973 million dollars) and 2018 ($1062 million dollars) (1866) [5], represent an impossible luxury for the common denominator of people with cancer. Abraxane® was approved for the treatment of breast cancer in 2005 and for the treatment of non-small cell lung cancer, in October 2012. Abraxane® sales for the first 9 months of 2012 were $320 million, a small percentage of Celgene’s earnings for that period, estimated at 4.1 trillion dollars. It was developed by Abraxis BioScience, and Celgene had acquired this company in 2010 for 2.9 billion dollars. In the agreement, Abraxis shareholders received a commitment to an additional profit settlement if Abraxane® managed to be licensed for the treatment of pancreatic cancer, as has been the case [6].

Approximately 30% of unsubsidized patients in the US were unable to purchase prescriptions for cancer drugs, as they do not qualify for low-income subsidies, and therefore do not obtain prescriptions for specialized and highly expensive drugs of this nature according to one study from the Vanderbilt University Medical Center (USA), in which the prescription records of 17,076 prescriptions for expensive drugs used to treat cancer, hepatitis C, immune system disorders, and high cholesterol were analyzed. The prescriptions were written to Medicare patients in 11 US health systems between 2012 and 2018 [7]. Therefore, it can be said that, from pathologies such as cancer, industries profit exponentially from human frailty.

Social inequality not only prevails in the sphere of health but has also permeated socioeconomic aspects at a global level, and as today, the economic gap between rich and poor has increased. The latter, as an inequity beyond all logic, is presented as the persistence of 86 million people in Latin America who still live in extreme poverty, and the Economic Commission for Latin America and the Caribbean (ECLAC) [8] estimates that the number of people in extreme poverty increased by around 5 million between 2020 and 2021, while the richest 10% in Latin America and the Caribbean own 71% of the wealth and only pay 5.4% of their income. The richest 10% of the world population currently earns 52% of world income, while the poorest half obtains 6.5% of it [9]. Between 2002 and 2015, the fortunes of Latin American billionaires grew by an average of 21% per year, that is, an increase six times higher than the region's GDP. Much of this wealth is kept tax-exempt or in tax havens. It is shameful that, in most of the countries of the region, the progressive increase in the rate and goods that pay VAT continues, instead of attacking tax evasion and reducing the exemptions received by those who have more [10]. Less than 100 people accumulate the wealth of 3,500 million. The lack of access to basic services widens the gap, and the result is called inequality [11]

The economic inequality and global development also is especially marked in Latin America and the Caribbean, as even economically, it continues to be the most unequal region in the world [12]. Belonging to an indigenous ethnic group or one of its Original Peoples, being Afro-descendant, or Asian, makes access to education, employment, and health care processes more complex, among others; as it is more than known that, in developing or Latin American countries, for example, Ecuador, it is associated with stigma or ethnic labeling and translates into poor or reduced access to education, job access, access to care in health, among others. The Original Peoples (indigenous) represent 10% of the population of Latin America, and their income levels, as well as their human development indicators, such as education and health conditions, have systematically lagged behind those of the rest of the population [13].

Being indigenous increases an individual’s chances of being poor, a roughly identical relationship at the beginning and end of the decade. Controlling for basic factors known to be associated with poverty, such as age, education, employment status, and region within a country, indigenous origin still significantly increases an individual’s chances of being poor. Being indigenous increases these probabilities between 13% and 30% for countries such as Bolivia, Ecuador, Guatemala, Mexico, and Peru. These results are very similar to those obtained in 1994, suggesting that this relationship has remained fairly stable over the decade [13]; indigenous people have fewer years of schooling, economic income, less access to health care services, and lower scores in school tests, among others [13]. Therefore, economic, social, and cultural inequality is inextricably linked to ethnicity, a factor that determines poverty and a decrease in the enjoyment of basic rights. The indigenous ethnic groups of Latin America, especially in Ecuador and other developing countries, have been historically, socially, and culturally behind, and segregated because without idealizing, but trying to demarcate reality, they have been the object of economic exploitation by the elites that own the land. “Huasipungo” refers to the plot of land that the latifundistas gave to the indigenous people (generally on the less fertile land) for them to cultivate. In exchange for these lands, the indigenous people (considered the property of the landowners) had to work on the haciendas [14].

For their part, the large estates and smallholdings refer to sources of exploitation that currently would not exist in theory; however, the reality is different, and it is enough to visit rural parishes in the Andean regions such as Ecuador; for example, in the province of Azuay, there are some such as Tarqui, Victoria del Portete, Chilcatotora, Totorillas, and Cumbe, in which forms of exploitation and labor precariousness will still be observed under which small farmers work in conditions of exploitation by families of ancestry. In spite of this, it is currently important to indicate that new forms of land appropriation have been created, such as timeshare, new forms of land grabbing, and new production relationships, such as contract farming that prefers the name of “business inclusive,” or the impacts of massive emigration abroad, which results in the feminization of certain rural areas. Large properties in the name of a legal and even natural person persist, with the largest registered property reaching 24,900 hectares. These large properties are concentrated in some areas of Ecuador, such as Santa Elena, Guayas, Azuay, and certain cantons of Pichincha [15].

It is plausible to say, then, that the smallholding is one of the most widespread forms of access to land in Ecuador, countries in Latin America, Asia, and the East that are in conditions of poverty and development paths. For example, in Ecuador, it is estimated that at least 230,000 families are in this situation, according to the 2000 Agricultural Census (we still do not have an updated census). The smallholding allows the production of food for the family, thus subsisting with very low wages (for this reason, some authors affirm that the smallholding subsidizes the agribusiness that uses cheap labor) [15], that is, a precarious and exploitative way that causes detriment of living conditions and consequently of human rights. The survival of these capitalist forms of production is not unusual, as countries in Asia, the Middle East, and Eurasia, among others, is a symbol of extreme poverty [16, 17], as the peasants and indigenous people are subjected to processes of exploitation and receive very little pay. An unavoidable sample of social inequality is based on asymmetry, subaltern power relations, social segregation, reproduction of economic capital, among others. Therefore, the owners of these plots continue to enrich themselves, while the peasants, farmers, and indigenous people who work are subjected to conditions of precariousness and labor exploitation and see limited conditions of economic access to basic services, basic basket, education, health, recreation, sport, among others.

Traditional indigenous communities survived in practice, even when outside the law [18]. We see, then, how injustice and social inequity continue in smallholdings and large estates as a symbol of poverty and exploitation today, but conditions in which smallholdings have been treated as “inclusive agricultural and livestock exploitation areas.” In reality, this reproduces the unequal relations of power and subordination, and the status quo is perpetuated; many families cannot access education, work under better conditions, decent remuneration, and access to health. A problem that afflicts the world population is begging, a phenomenon that prevails and increases until today. It is understood as a measure of oppression and hopelessness of those who decide to carry out this activity, that is, at first sight, it can be considered a lawful activity proper to those who assume it when asking for alms, and it can be framed within said criminal offense when there is exploitation of others, that is, when the trafficker, for his own profit, forces the victim to ask for alms [19]. It is common in developing countries, such as Ecuador, to observe begging, as the multiplicity of social, economic, cultural, educational, and health conditions have conditioned the lives of many Ecuadorian children, which has forced them to beg in streets. Children who beg do not always live outside the family nucleus, but rather, in many cases, they are coerced by the family itself to carry out this activity [20]. According to the National Survey of Child Labor (ENTI) 2012 of the National Institute of Statistics and Censuses (INEC), there are 360,000 boys and girls under 18 years of age in child labor, which is equivalent to 8.6%; in the case of boys and girls under 15 years of age, this incidence is higher in boys, with a labor participation of 10.6%, compared to girls whose participation is 6.5% [21].

Begging, as a phenomenon that represents extreme and forced survival measures in the face of the lack of job opportunities and a form of vulnerability exploitation, is observed as an institutionalized phenomenon in Ecuador, especially in vulnerable groups that we already mentioned. One of these constitute Original Peoples, as the “normal” thing beyond any rationalization under the loss of empathy is begging in the ethnic groups of Ecuador, as the most frequent thing is that indigenous people, Afro-Ecuadorians, and only in the end, mestizos, beg for alms in the streets. According to UNICEF [21] in Ecuador, the indigenous population, boys and girls between 5 and 14 years of age, the incidence of child labor reaches 26%, and in the case of the adolescent population, 39%; while for the same age of the Afro-Ecuadorian population, child labor reaches 4%. Contrary to the mestizo ethnic group of this same age group, there is an incidence of child labor of 5%, and in the case of the adolescent population, 13%. Additionally, we can indicate that begging scourges the most vulnerable populations, and such is the case of people with disabilities (PDF). In Latin America, it is estimated that 82% of the population with disabilities live in conditions of extreme poverty, between 80 and 90% are unemployed, and most do not have access to a minimum level of this life as social security does not cover the amounts to guarantee it [22].

World hunger, a serious problem that has not yet been resolved, translates the injustice of a classist and mercantilist world economic system, as today, it is observed that more than 820 million people go hungry every day, affecting the right to food [23]. Hunger is increasing in almost all African sub-regions, making Africa the region with the highest prevalence of undernourishment, at almost 20%. Hunger is also slowly increasing in Latin America and the Caribbean, although its prevalence is still below 7%. In Asia, western Asia has shown a continuous increase since 2010, and currently more than 12% of its population is undernourished. In addition to hunger, there is a problem that prevents ending hunger (2nd Sustainable Development Goal) [23]. While a significant percentage of food is wasted worldwide, because according to data presented by the FAO, 931 million tons or 17% of the food produced in 2019 ended up in the household trash, retail stores, restaurants, and other actors in the food industry [24].

Another problem as a prominent representative of social inequality is the lack of access to education, as 70% of 10-year-old children (globally) continue in a situation of learning poverty and cannot read and understand a simple text, especially those who come from lower socioeconomic levels and other disadvantaged groups, as they are suffering greater learning losses. Children with weaker basic literacy prior to school closures are more likely to have suffered more significant learning losses. Without strong foundational skills, children are unlikely to acquire the higher-level and technical skills needed to thrive in increasingly demanding job markets and increasingly complex societies [25]. Likewise, it is important to observe the levels of inequality that prevail today, as nothing more and nothing less than more than 265 million boys and girls are not in school and 22% of these are of primary school age. Likewise, children who attend school lack the basic knowledge of reading and arithmetic [26].

Precarious schooling, less access to it, or in the worst case, the lack of access to it would be worsened by the lack of adequate nutrition in children under 5 years of age, who worldwide are affected by economic precariousness, social, and cultural of their families. Well, according to the United Nations Children’s Fund [27] in its report on nutrition, it specifies that at least 1 in 3 children under 5 years of age –or more than 200 million– is malnourished or overweight. Nearly 2 out of 3 children between 6 months and 2 years of age do not receive foods that support rapid growth in their bodies and brains. This situation can harm their brain development, interfere with their learning, weaken their immune system, and increase their risk of infection and, in many cases, death [28].

Inequity in access to education not only refers to the lack of access to formal education: school, college, university, etc.; well, not only 262 million children and young people who are not in school and have not acquired basic skills in literacy and arithmetic, but also includes 750 million illiterate adults in the world [29]. Therefore, those who have limited access and/or low or no development of skills that allow them to interact in the communication network provided by the use of ICTs become digital illiterates [30]. Digital illiteracy is understood not only as the ignorance of ICTs and their consequent lack of use but also as the process that limits the autonomy of people [31], as among the advantages offered by technology and digital culture is the possibility of improving and achieving autonomy, decreased feelings of loneliness, decreased cognitive impairment, and decreased social isolation, among others [32]. Digital literacy is an instrument of e-inclusion of the elderly. Social prism, (16), 156–204. Older adults, therefore, represent a population vulnerable to structural inequality and all the socio-cultural, economic, and political processes related to it. But in addition to the elderly, there is another population whose right to access the Internet is violated, women [25]. There are 300 million fewer women who use mobile Internet, which represents a gender gap of 20%. These constraints can prevent women from reaping the benefits of new opportunities in services and commerce, such as digital platforms and e-commerce. In low-income countries, 90% of adolescent girls and young women aged 15–24 (almost 65 million people) are offline, compared to 78% of adolescent boys and youth of the same age (almost 57 million) individuals) who do not use the Internet. Furthermore, for every 100 adolescent boys and young men in low-income countries who use the Internet, only 44 adolescent girls and young women do so. Among regions, the largest gap is seen in South Asia, favoring adolescent boys and young men by 27% points [33]. Currently, it is known that half of the world’s population is still not online. While Asia has the highest number of people without access, Africa leads the world in the percentage of the population without connection with 88% [21]. In the case of India, there are more than 103.9 million people over 60 years of age, of whom 56.5% are illiterate or do not have access to information and communication technologies (ICTs) [34].

In relation to the digital divide, the figures are sensitive, as [35] in Latin American countries, it is observed that while 45.7% of the elderly in Uruguay have a computer at home, this number is reduced to 16.6% in Honduras due to gaps in economic and social development in the region. Unfortunately, it is important to indicate that the fact of having access to a computer at home is not equivalent to the use of said tool by the elderly. In countries such as Ecuador, El Salvador, Mexico, Paraguay, and Peru, the percentage of older adults who use computers is lower than the proportion that has a computer at home. This assumes that there is a segment of the older adult population that theoretically has access to a computer, but does not use it. In such a way, the access and use of the Internet is restricted in the regions of the world, which increases the digital divide and digital illiteracy, an issue that reflects the inequity in terms of access to this right.

Internet access is a universal right that should be guaranteed and exercised by everyone, as universal access to the Internet together with the use of this tool should allow the effective enjoyment of the right to freedom of expression. Internet access is also necessary to ensure respect for other rights, such as the right to education, health care and work, the right to assembly and association, and the right to free elections according to the Organization of American States [36].

A global problem that we cannot ignore is the pay gap. Direct pay discrimination occurs when women receive less pay than men for the same job within an organization [37]. The labeling of women as even less qualified beings for access and mastery of work and scientific spaces is the representation of segregating stereotypes. In this way, sex would be a specific criterion for establishing pay differences, underestimating the abilities and work of women. Fortunately, this factor is currently one of the least common, although it is still the cause of many of the gender wage discriminations that we find [37]. Globally, women are 9% less likely than men to have an account at a financial institution or use mobile banking services, and the gap is even larger in the poorest countries. Labor force participation stagnates at around 53% for women compared to 80% for men globally. Unfortunately, this problem of inequality is also reproduced in closed spaces such as the home, where women spend three times more time than men in unpaid care work, and spend between 1 and 5 more hours a day doing domestic chores and care for children and other family members [25]. In all regions, women are paid less than men, with an estimated gender pay gap of around 20% globally. Finally, we can say that women perform at least two and a half times more unpaid domestic and care tasks than men [38].

According to the United Nations Organization [9], there are currently 122 women between the ages of 25 and 34 who live in poverty for every 100 men of the same age group, and more than 160 million children are at risk of continuing to live in poverty. These issues perpetuate unequal power dynamics and subtly incorporate forms of cultural, social, and symbolic violence. Such violence is aimed at defining the realms in which poverty, as well as social, economic, and cultural constraints, are imposed. This, in turn, allows for the exertion of biopower through both anatomopolitics and biopolitics. Consequently, communities most affected by the global economic downturn, which have historically been marginalized, are further isolated and identified as arenas where these power dynamics and states of subjugation are reproduced.

3. Indifference to social suffering and normalization

The constant daily struggle to survive in the midst of a global crisis with less access to basic services and rights prevents the population from stopping to reflect on the unfailing importance of sensitivity and empathy toward the sufferings and problems of others. In turn, moral thought implies moral principles (values and preconceptions that condition behavior) that are directly related to empathy, that is, with emotions (limbic system) toward others; therefore, they have a marked affective charge [39, 40].

Unfortunately, the social perception of values today has been reduced to the instrumentalization of the satisfaction of individualistic needs, for example, self-affirmation in relation to identity and the ethical implications that this entails, for example, the improper use of selfies in sensitive situations such as accidents, deaths, attacks, surgeries, and newborns, in which it is intended to achieve said self-affirmation with a “click” by being positively reinforced in social networks. The instrumentalization mentioned in previous lines is associated with the denaturation of collective values and moral principles to the point of bequeathing a fragile individualism to quickly achieve the satisfaction of personalized needs, as cooperative values have been replaced by individualistic values. This is detrimental to the need for a universal values approach that would allow equality and equity to be achieved in relation to people’s lives, nothing more dehumanized than depersonalization in collective social dynamics.

The human being is a key piece to restructure and improve the socio-cultural, economic, health, political, gender, educational conditions, etc., for their peers; therefore, it has the obligation to empathize with others and the other species and try to improve the reality that is increasingly deconstructed by all the aforementioned processes. But for a global restructuring to take place under dignified living conditions, there must be a nucleus of education in values, mainly in homes and subsequently in schools, universities, etc., that is to say, at all levels related to education, as they will make it possible to sensitize the population in relation to empathy in the face of the pain and suffering of others, not only of their own species but also of others. Education is the key that allows the change of power structures and generations relegated to the worst living conditions. A change is urgently needed in the governmental instances of developing countries, countries where poverty prevails, and where populations live in extreme poverty or below the poverty line. Overcoming the global crisis also implies programs and policies not only directed at the sectors where the States influence but also at the private sectors to avoid hoarding resources such as land and its overexploitation, as well as improving working conditions.