With growing public health and health equity challenges brought to the forefront — following racialized health inequities resulting from COVID-19 and a national reckoning around the deaths of unarmed Black victims at the hands of police — an antiracist health equity agenda has emerged naming racism a public health crisis.

Corruption involves greed, money, and risky decision-making. We explore the love of money, pay satisfaction, probability of risk, and dishonesty across cultures. Avaricious monetary aspiration breeds unethicality. Prospect theory frames decisions in the gains-losses domain and high-low probability. Pay dissatisfaction (in the losses domain) incites dishonesty in the name of justice at the individual level. The Corruption Perceptions Index, CPI, signals a high-low probability of getting caught for dishonesty at the country level. We theorize that decision-makers adopt avaricious love-of-money aspiration (...) as a lens and frame dishonesty in the gains-losses domain (pay satisfaction-dissatisfaction, Level 1) and high-low probability (CPI, Level 2) to maximize expected utility and ultimate serenity. We challenge the myth: Pay satisfaction mitigates dishonesty across nations consistently. Based on 6500 managers in 32 countries, our cross-level three-dimensional visualization offers the following discoveries. Under high aspiration conditions, pay dissatisfaction excites the highest- (third-highest) avaricious justice-seeking dishonesty in high (medium) CPI nations, supporting the certainty effect. However, pay satisfaction provokes the second-highest avaricious opportunity-seizing dishonesty in low CPI entities, sustaining the possibility effect—maximizing expected utility. Under low aspiration conditions, high pay satisfaction consistently leads to low dishonesty, demonstrating risk aversion—achieving ultimate serenity. We expand prospect theory from a micro and individual-level theory to a cross-level theory of monetary wisdom across 32 nations. We enhance the S-shaped Curve to three 3-D corruption surfaces across three levels of the global economic pyramid, providing novel insights into behavioral economics, business ethics, the environment, and responsibility. (shrink)

Law and racism are intertwined, with legal tools bearing the potential to serve as instruments of oppression or equity. This Special Issue explores this dual nature of health law, with attention to policing in the context of mental health, schools, and substance use disorders; industry and the environment in the context of food advertising, tobacco regulation, worker safety, and environmental racism; health care and research in the context of infant mortality, bias in medical applications of (...) AI, and diverse inclusion in research; and anti-racist teaching and practice in the context of building an interprofessional curriculum and medical-legal partnerships. (shrink)

There is consistent and strong empirical evidence for social inequalities in health, as a vast and fast growing literature shows. In recent years, these findings have helped to move health equity high on international research and policy agendas. This paper examines how the empirical identification of social inequalities in health relates to a normative judgment about health inequities and puts forward an approach which embeds the pursuit of health equity within the general pursuit (...) of social justice. It defends an indirect approach to health equity, which views social inequalities in health as unjust in so far as they are the result of an unjust basic structure of society in Rawls’ sense. (shrink)

Whereas using artificial intelligence (AI) to predict natural hazards is promising, applying a predictive policing algorithm (PPA) to predict human threats to others continues to be debated. Whereas PPAs were reported to be initially successful in Germany and Japan, the killing of Black Americans by police in the US has sparked a call to dismantle AI in law enforcement. However, although PPAs may statistically associate suspects with economically disadvantaged classes and ethnic minorities, the targeted groups they aim to protect (...) are often vulnerable populations as well (e.g., victims of human trafficking, kidnapping, domestic violence, or drug abuse). Thus, determining how to enhance the benefits of PPA while reducing bias through better management is important. In this paper, we propose a policy schema to address this issue. First, after clarifying relevant concepts, we examine major criticisms of PPAs and argue that some of them should be addressed. If banning AI or making it taboo is an unrealistic solution, we must learn from our errors to improve AI. We next identify additional challenges of PPAs and offer recommendations from a policy viewpoint. We conclude that the employment of PPAs should be merged into broader governance of the social safety net and audited publicly by parliament and civic society so that the unjust social structure that breeds bias can be revised. (shrink)

Racially disparate policing, prosecution, and punishment harm individuals, families, and communities. These practices must be understood within the context of the development of the criminal legal system as a means of racialized social control. This context permits a critical examination of the way criminalization has been and is still deployed to subject poor and racialized communities to systemic injustices. This commentary frames a call for interventions to integrate a health justice approach to ensure that they advance racial and (...) health equity to promote the well-being of individuals, families, and communities. (shrink)

Sabatello et al. make a compelling case for structural racism as the root cause of the health inequities experienced by communities of color during the COVID-19 pandemic. As public health pr...

The sheer gamut of issues impacting transgender health equity may seem overwhelming. This article seeks to introduce readers to the breadth of topics addressed in this symposium edition, exemplifying that transgender health equity is a global issue that demands an interdisciplinary approach.

In the last fifty years, average overall health status has increased more or less in parallel with a much celebrated decline in mortality, attributed mostly to poverty reduction, sanitation, nutrition, housing, immunization, and improved medical care. It is becoming increasingly clear, however, that these achievements were not equally distributed. In most countries, while some social groups have benefited significantly, the situation of others has stagnated or may even have worsened.If health is a prerequisite to a person functioning as (...) an agent, inequalities in health constitute inequalities in people's capability to function -- a denial of equality of opportunity. So why should a concern with health equity be singled out from the pursuit of social justice more generally? Can existing theories of justice provide an adequate account of health equity? And what ethical problems arise in evaluating health inequalities? These are some of the important questions that this book addresses in building an interdisciplinary understanding of health equity. With contributions from distinguished philosophers, anthropologists, economists, and public-health specialists, it centres on five major themes: what is health equity?; health equity and social justice; responsibilities for health; ethical issues in health evaluation; and anthropological perspectives. (shrink)

Bioethics' traditional focus on clinical relationships and exotic technologies has led the field away from population health, health disparities, and issues of justice. The result: a myopic view that misses the institutional context in which clinical relationships operate and can overlook factors that affect health more broadly than do exotic technologies. A broader bioethics agenda would take up unresolved questions about the distribution of health and the development of fair policies that affect health distribution.

Since 1984, the idea of health equity has proliferated throughout public health discourse with little mainstream critique for its variability and distance from its original articulation signifying social transformation and a commitment to social justice. In the years since health equity’s emergence and proliferation, it has taken on a seemingly endless range of invocations and deployments, but it most often translates into proactive and apolitical discourse and practice. In Margaret Whitehead’s influential characterization, achieving health (...) equity requires determining what is inequitable by examining and judging the causes of inequalities in the context of what is going on in the rest of society. However, it also remains unclear how or if public health actors examine and judge the causes of health inequality. In this article, we take the concept of health equity itself as an object of study and consider the ways in which its widespread deployment has entailed a considerable emptying of its semantic and political content. We point toward equity’s own discursive productivity as well as the quantifying imperative embedded within evidentiary norms that govern knowledge making, and performance management regimes that govern public health practices. Under current conditions of knowledge making and performance evaluation, a range of legitimate action and inaction is produced at the same time that more socially transformative action is legitimately curtailed—not merely by politics, but by the rules of the field in which public health actors work. Ultimately, meaningful progress on a normative ethical idea like health equity will require both substantial philosophical content and an analysis of what is going on in the rest of society. (shrink)

Bonuses, as incentives or rewards for health -related behavior, feature prominently in German social health insurance. Their goal is centered around promoting personal responsibility, but reducing overall health -care expenditure and enabling competition between sickness funds also play a role. The central position of personal responsibility in German health -care policy is described, and a framework is offered for an analysis of the ethical issues raised by policies seeking to promote responsibility. The framework entails seven tests (...) relating to: solidarity; equality and equity; intrusiveness; attributability and opportunity of choice; evidence, rationale, and feasibility; affected third parties; and coherence. It is contended that a focus on tests, in particular from within contractualism, is the most appropriate way of addressing the question of health responsibility in pluralistic societies. However, taken by themselves, the tests also allow an identification of the key ethical issues by particular policies, which are illustrated by applying the framework to particular bonus polices. (shrink)

Health equity can be defined as the absence of disadvantage to individuals and communities in health outcomes, access to health care, and quality of health care regardless of one’s race, gender, nationality, age, ethnicity, religion, and socioeconomic status. Health equity concerns those disparities in public health that can be traced to unequal, systemic economic, and social conditions. Despite significant improvements in the health of the overall population, health inequities in America (...) persist. Racial and ethnic minorities continue to experience higher rates of morbidity and mortality than non-minorities across a range of health issues. For example, African-American children with asthma have a seven times greater mortality rate than Non-Hispanic white children with the illness. While cancer is the second leading cause of death among all populations in the U.S., ethnic minorities are especially burdened with the disease. (shrink)

Health equity can be defined as the absence of disadvantage to individuals and communities in health outcomes, access to health care, and quality of health care regardless of one’s race, gender, nationality, age, ethnicity, religion, and socioeconomic status. Health equity concerns those disparities in public health that can be traced to unequal, systemic economic, and social conditions. Despite significant improvements in the health of the overall population, health inequities in America (...) persist. Racial and ethnic minorities continue to experience higher rates of morbidity and mortality than non-minorities across a range of health issues. For example, African-American children with asthma have a seven times greater mortality rate than Non-Hispanic white children with the illness. While cancer is the second leading cause of death among all populations in the U.S., ethnic minorities are especially burdened with the disease. (shrink)

The Chinese public medical care system was established after the 1949 revolution. However, there is no necessary connection between Marxism and the public medical care system; and although the current system may be reasonable from an historical point of view, it can no longer be justified ethically as an all-embracing medical system, since it does not provide equitable health care for the people. Keywords: Marxism-Leninism, Chinese health care, People's Republic of China, equitable health care, public health (...) care, bioethics CiteULike Connotea Del.icio.us What's this? (shrink)

Inequities in health and health care are one of the greatest challenges facing the international community today. This problem raises serious questions for health care planners, politicians and ethicists alike. The major world religions can play an important role in this discussion. Therefore, interreligious dialogue on this topic between ethicists and health care professionals is of increasing relevance and urgency. This article gives an overview on the positions of Islam and Christianity on equity and the (...) distribution of resources in health care. It has been written in close collaboration and constant dialogue between the two authors coming from the two religions. Although there is no specific concept for the modern term equity in either of the two religions, several areas of agreement have been identified: All human beings share the same values and status, which constitutes the basis for an equitable distribution of rights and benefits. Special provisions need to be made for the most needy and disadvantaged. The obligation to provide equitable health services extends beyond national and religious boundaries. Several areas require intensified research and further dialogue: the relationship between the individual and the community interms of rights and responsibilities, how to operationalize the moral duty to decrease global inequalities in health, and the understanding and interpretation of human rights in regard to social services. (shrink)

Modern health care rhetoric promotes choice and individual patient rights as dominant values. Yet we also accept that in any regime constrained by finite resources, difficult choices between patients are inevitable. How can we balance rights to liberty, on the one hand, with equity in the allocation of scarce resources on the other? For example, the duty of health authorities to allocate resources is a duty owed to the community as a whole, rather than to specific individuals. (...) Macro-duties of this nature are founded on the notion of equity and fairness amongst individuals rather than personal liberty. They presume that if hard choices have to be made, they will be resolved according to fair and consistent principles which treat equal cases equally, and unequal cases unequally.In this paper, we argue for greater clarity and candour in the health care rights debate. With this in mind, we discuss (1) private and public rights, (2) negative and positive rights, (3) procedural and substantive rights, (4) sustainable health care rights and (5) the New Zealand booking system for prioritising access to elective services. This system aims to consider: individual need and ability to benefit alongside the resources made available to elective health services in an attempt to give the principles of equity practical effect. We describe a continuum on which the merits of those, sometimes competing, values—liberty and equity—can be evaluated and assessed. (shrink)

The current debate on health care resource allocation in the Netherlands is characterized by a social context in which two values are generally and traditionally accepted as being equally fundamental: solidarity and equity. We will present an outline of the distinctive features of the Dutch health care system, and analyze the present state of affairs in the resource allocation debate. The presuppositions of the political call for constraint and (renewed) government supervision and the role of the specific (...) value context in recent proposals for reconstruction of the Dutch health care system will be evaluated. (shrink)

Records the main presentations of an international conference convened to identify the ethical concerns that need to be addressed as WHO renew its health for all policy for the 21st century. The meeting was attended by more than 150 experts in the fields of ethics, human rights, philosophy, medicine, and public health. Their contributions illustrate the many complex issues that need to be addressed when formulating global health policies for the future, particularly in view of striking recent (...) changes in health care, disease patterns, market forces, and political systems. The report opens with a description of the WHO policy framework for achieving four goals in the 21st century: attainment by all of health rights, achievement of global health equity, increase in healthy life expectancy, and access for all to essential quality health services. Against this background, the first section traces the evolution of bioethics to its present concern with the health of populations and identifies some of the most important inequalities that confront contemporary society. Papers in section two discuss key policy issues, including the definition of essential public health functions and their relationship to primary health care, ethical issues raised by the use of Disability-Adjusted Life Years (DALYs) to prioritize health resources, and the potential conflict between policies aimed at reaching vulnerable groups and those seeking to achieve aggregate health benefits. Ethical issues are discussed in subsequent sections, which explore policy implications at global, regional, and national levels. The remaining sections consider the actions needed to ensure that ethical analysis plays a role in the renewal of the health for all strategy and discuss some of the practical requirements for gaining commitment to equity as an essential public health goal for the 21st century. (shrink)

Every day, students from marginalized communities disproportionately face adversity and trauma. It is well documented that exposure to adverse childhood experiences can impact children's ability to focus, learn, and even regulate their emotions. Many schools, rather than providing multi-tiered systems of support to address the root causes of behavior, place these students at greater risk of experiencing health disparities through the use of exclusionary school discipline practices. ESDs not only deny students important educational opportunities, but also can compound existing (...) social, economic, and health inequities. Thus, ESD practices must be understood as more than simply impacting what happens in the classroom. Instead, they should be conceptualized as public health policies with far-reaching impacts on a child's lifelong health and well-being. Even though school discipline has largely been overlooked by the public health community, current reform efforts are one aspect of a holistic health justice framework.This article seeks to begin to bridge current gaps in the literature and public discourse by identifying key linkages between ESD practices and health. It then presents evidence-based design principles to ensure education policy is aligned with a health justice framework. And finally, it explores a specific school-based intervention, restorative justice. (shrink)

Journals have been described as “duty bearers” of upholding fundamental ethical principles that are essential for maintaining the ethical integrity of newly generated and disseminated knowledge. To play our part, we evaluated diversity and inclusion in the leadership and management of global and international health journals. We developed Journal Diversity Index (JDI) to measure three parameters of diversity and representation (gender, geographic, socioeconomic status). Relevant information regarding editorial board members of systematically screened journals was sequentially extracted and job titles (...) were categorized into five editorial roles. Chi-squared test was utilized to study associations between gender and geographic distribution of editors along with the Medline indexing of the journal and its impact factor. Out of 43 journals included, 62.7% were published from two high-income countries. Women comprised 44% of the total editors. Among all the editorial board members, we did not find any information suggesting the representation of non-binary and transgender individuals. Furthermore, 68.2% of editors were based in high-income countries with 67.3% of the editors belonging to the Global North. This disparity in geographic region and socioeconomic level was observed across all five editorial roles. Among all women editors, more than 70% worked in non-Medline and non-impact factor journals. Only two journals scored “excellent” on JDI. Despite the continuous evolution of the definition of global health ethics, marginalized individuals, and their perspectives remain underrepresented in this field. Thus, we call for swift action regarding the decentralization and redistribution of global and international health journal editorial boards. (shrink)

California has focused on health equity in the state’s COVID-19 reopening plan. The Blueprint for a Safer Economy assigns each of California’s 58 counties into 1 of 4 tiers based on 2 metrics: test positivity rate and adjusted case rate. To advance to the next less-restrictive tier, counties must meet that tier’s test positivity and adjusted case rate thresholds. In addition, counties must have a plan for targeted investments within disadvantaged communities, and counties with more than 106 000 (...) residents must meet an equity metric. California's explicit incorporation of health equity into its reopening plan underscores the interrelated fate of its residents during the COVID-19 pandemic and creates incentives for action. This article evaluates the benefits and challenges of this novel health equity focus, and outlines recommendations for other US states to address disparities in their reopening plans. (shrink)

Wearable devices are increasingly present in the health context, as tools for biomedical research and clinical care. In this context, wearables are considered key tools for a more digital, personalised, preventive medicine. At the same time, wearables have also been associated with issues and risks, such as those connected to privacy and data sharing. Yet, discussions in the literature have mostly focused on either technical or ethical considerations, framing these as largely separate areas of discussion, and the contribution of (...) wearables to the collection, development, application of biomedical knowledge has only partially been discussed. To fill in these gaps, in this article we provide an epistemic (knowledgerelated) overview of the main functions of wearable technology for health: monitoring, screening, detection, and prediction. On this basis, we identify 4 areas of concern in the application of wearables for these functions: data quality, balanced estimations, health equity, and fairness. To move the field forward in an effective and beneficial direction, we present recommendations for the 4 areas: local standards of quality, interoperability, access, and representativity. (shrink)

Using the example of Black people’s inequitable COVID-19 outcomes and their health outcomes prior to the pandemic, I argue that the pandemic has forever changed how we should think about the conceptual and practical nature of health equity. From here on, we can no longer think of health equity without the concept of intersectionality. In particular, we must acknowledge that discrimination (e.g. sexism, ableism, racism, classism, etc.) within our social institutions intersect to withhold resources needed (...) for health from people who themselves have intersecting identities that make them vulnerable to the effects of discrimination. To ignore intersectionality in our work on health equity would mean ignoring a great injustice imposed on some of the most overlooked people in our communities, which would also be a great disserve to bioethics’ professional longevity. (shrink)

Health equity is increasingly identified as a principal goal to be achieved through public health policies and activities. However, what is to be measured in the assessment of health equity and how inequities in health ought to be redressed are among the pressing questions that must be answered if health equity is to serve as a meaningful and consistent ethical guide for measurement and intervention in public health. In this article I (...) argue that the concept of health equity, in the form it is predominantly found in public health, suffers from normative indeterminacy and is therefore unlikely to provide actionable normative guidance to public health policy-makers, practitioners and researchers. I argue that the concept of health equity, as it is commonly defined in public health, ultimately rests upon assumptions of a more fundamental, yet tacit, conception of justice to do its normative work. In this vein, I expand upon a critique of Margaret Whitehead’s oft-cited definition of health equity made by James Wilson to raise additional reasons not explored by Wilson, or others, as to why Whitehead’s definition remains inadequate in providing normative guidance to policy-makers, practitioners and researchers in public health. (shrink)

Nurses play a crucial role in reducing health disparities and advancing health equity for individuals and communities. The future nursing workforce relies on their nursing education to prepare them to promote health equity. Nursing educators prepare students through a variety of andragogical learning strategies in the classroom and in clinical experiences and by intentionally updating and revising curricular content to address knowledge and competency gaps. This critical review aimed to determine the extent to which (...) class='Hi'>health equity concepts are explicitly present in prelicensure undergraduate nursing curricula globally. Of 434 articles screened, 22 articles describing 20 studies met inclusion criteria. Frequency and quantity of health equity content, concepts and topics, teaching strategies, evaluation strategies, and the overall extent of integration varied widely. Notably, only two articles described overall well‐integrated explicit health equity content, and there was little attention to whether students transfer this learning into practice. A focus on individualism rather than population and community was noted, highlighting the presence of whiteness in nursing. Results from this review confirm that nursing education has room to improve with respect to health equity in the curricula. (shrink)

There is much discourse and focus on the social determinants of health, but undergirding these multiple intersecting and interacting determinants are legal and political determinants that have operated at every level and impact the entire life continuum. The United States has long grappled with advancing health equity via public law and policy. Seventy years after the country was founded, lawmakers finally succeeded in passing the first comprehensive and inclusive law aimed at tackling the social determinants of (...) class='Hi'>health, but that effort was short-lived. Today the United States is faced with another fork in the road relative to the advancement of health equity. This article draws on lessons from history and law to argue that researchers, providers, payers, lawmakers and the legal community have a moral, economic and national security imperative to address not only the negative outcomes of health disparities, but also the imbalance of inputs resulting from laws and policies which fail to employ an equity lens. (shrink)

Julian Le Grand's case for saying that it would be equitable if smokers and smokers alone were to pay the costs of smoking-related health care is considered and found to be deficient.

This article discusses the ways in which law functions as a determinant of health, historical collaborations between the health and legal professions, the benefits of creating medical-public health-legal collaborations, and how viewing law through a collaborative, population health lens can lead to health equity.

Can the institutional systems that prepare Black nurse researchers question the ways their systemic pathways have impacted health equity knowledge development in nursing? We invite our readers to keep this question in mind and engage with our conversation as Black nurse researchers, scholars, educators, and clinicians. The purpose of our conversation, and this article, is to explore the transactional impact of knowledge development pathways and Black faculty retention pathways on the state of health equity knowledge in (...) nursing today. Over a series of conversations, we discuss the research exploitation of communities of color, deficit research funding, knowledge capitalization, the marginalization of diversity as a continuous process, a lack of sociocultural authority, and our thoughts on solutions. We conclude by using the wisdom of a generation to answer our initial question. (shrink)

People seeking asylum are at risk of receiving poorer quality healthcare due, in part, to racist and discriminatory attitudes, behaviours and policies in the health system. Despite fleeing war and conflict; exposure to torture and traumatic events and living with uncertainty; people seeking asylum are at high‐risk of experiencing long‐term poor physical and mental health outcomes in their host country. This article aims to raise awareness and bring attention to some common issues people seeking asylum face when seeking (...) healthcare in high‐income countries where the health system is dominated by a Western biomedical view of health. Clinical case scenarios are used to highlight instances of racist healthcare policies and practices that create and maintain ongoing health disparities; limited access to culturally and linguistically appropriate health services, and lack of trauma‐informed approaches to care. Nurses and midwives can play an important role in countering racism in healthcare settings; by identifying and calling out discriminatory practice and modelling tolerance, respect and empathy in daily practice. We present recommendations for individuals, organisations and governments that can inform changes to policies and practices that will reduce racism and improve health equity for people seeking asylum. (shrink)

The aims of this paper are threefold. The first aim is to provide a critique of the reform proposal of the Harvard School of Public Health for Hong Kong's health care system through privatization of the public sector services. The second aim is to argue for the duty of society to guarantee every member equal access to a basic level of health care based on the values of equity, care and free choice. The third aim is (...) to explore some suggestions about delivery structures and financial arrangements of a dual sector health care system which will better enable society to provide a basic level of health care that is sustainable and affordable, while being at the same time consistent with the values of care, equity and free choice. (shrink)

In this paper we report findings from a commissioned report to the COVID-19 Clinical Research Coalition on approaches to streamline multinational REC review/approval during public health emergencies. As currently envisioned in the literature, a system of REC mutual recognition is theoretically possible based on shared procedural REC standards, but raises numerous concerns about perceived inequities and mistrust.

Programs, policies, and technologies — particularly those concerned with health equity — are often designed with justice envisioned as the end goal. These policies or interventions, however, frequently fail to recognize how the beneficiaries have historically embodied the cumulative effects of marginalization, which undermines the effectiveness of the intended justice. These well-meaning attempts at justice are bounded by greater socio-historical constraints. Bounded justice suggests that it is impossible to attend to fairness, entitlement, and equity when the basic (...) social and physical infrastructures underlying them have been eroded by racism and other historically entrenched isms. Using the case of Brazil’s National Health Policy for the Black Population, this paper proposes that bounded justice can contribute to justice discourses by serving as a concept, a proffering to a multi-disciplinary conceptual framework, and a potential analytic for those interested in the design of policy, technology, and programmatic interventions towards health equity. (shrink)

Despite good intentions and decades of discussion addressing the need for transformative changes globally to reduce poverty and improve health equity, little progress has been made. A fundamental shift in framing the current conversation is critical to achieve “health for all,” moving away from the traditional approaches that use the more narrowly focused medical model, which is intent on treating and curing disease. A public health framework for action is needed, which recognizes and confronts the complex, (...) and often-times difficult-to-achieve social determinants of health. A restructuring of global health policy development and implementation will be ineffective unless key areas are addressed including primary education and the environment, in addition to economic considerations. A public health framework that embraces a community-based participatory approach would provide a comprehensive platform for identifying critical components that impact health, and for developing effective strategies for change. A participatory approach would encourage dialogue and problem-solving for region-specific issues among those most affected by the broader health and social justice issues, with those who create policy. (shrink)

As a worldwide economic crisis emerged at the end of 2008, international health agencies were quick to highlight its predictable impact on health in the poorest of communities. The World Health Organization underscored the need for a multisectoral approach to the crisis, “seeking health gains through demonstrating the importance of health in all policies” and whether current investments in health addressed the broader social determinants of health. However, despite good intentions and decades of (...) discussion addressing the need for transformative changes globally to reduce poverty and improve health equity, little progress has been made.A recent report on progress towards the Millennium Development Goals indicates that many targeted goals have not been met, with some goals lagging many years behind schedule. Although progress towards achieving the MDGs has been made for some specific conditions, where targeted interventions have had an immediate impact, limited progress is reported in more complex areas such as maternal child health. Such complex health issues require structural changes, strong political will, long-term funding, and consideration of other health determinants, such as education and exposure to environmental hazards. (shrink)

Offering a new answer to an age-old problem: the meaning of a just or equitable distribution of resources, Julian Le Grand examines the principal interpretations of equity used by economists and political philosophers. He argues that none captures the essence of the term as well as an alternative conception relating equity to the existence or otherwise of individual choice. Le Grand shows that this conception is not only philosophically well-grounded but is also directly relevant to key areas of (...) distributional policy. His theoretical argument is complemented by detailed discussion of the application of the central idea to specific areas of policy, including the distribution of health and health care, central government grants to local governments and the measurement of income for tax purposes. Equity and Choice is written by an economist, but is intended for political philosophers and social policy analysts as well as economists. Hence the key chapters are written in a non-technical fashion, with specialized material relegated to appendices. This book is a unique combination of philosophical, economic and policy analysis and represents a major contribution in all three areas. (shrink)

ABSTRACT:The relationship between equality and equity has been theorized and described in many ways. Recently, this relationship has been popularly illustrated via a meme depicting three people watching a baseball game while standing on boxes. The meme's analogy, that achieving health equity is the ability to view a spectator sport, is a neoliberal account of health. The analogy defines equality at the expense of equity, characterizes health as individualistic, describes health equity as (...) a static outcome, and implies that the bioethical questions for achieving health equity are about the distribution and redistribution of resources. As the SARS CoV-2 pandemic vividly reminded us, health equity is no spectator sport. Health equity is the intentional removal of obstacles to health and the enabling of human flourishing to assure that everyone has fair and just opportunities for health. That relational and radical account of health equity requires different analogies. This article reimagines and re-illustrates the relationship between equality and equity using an organic analogy of three plants. The analogy calls for bioethics to nurture communal relationships and engage community leaders in pursuit of communal flourishing. (shrink)

BackgroundUnder COVID-19 pandemic, many organizations developed guidelines to deal with the ethical aspects of resources allocation. This study describes the results of an argument-based review of ethical guidelines developed at the European level. It aims to increase knowledge and awareness about the moral relevance of the outbreak, especially as regards the balance of equity and dignity in clinical practice and patient’s care. MethodAccording to the argument-based review framework, we started our research from the following two questions: what are the (...) ethical principles adopted by the ethical guidelines produced at the beginning of the COVID-19 outbreak related to resource allocation? And what are the practical consequences in terms of 'priority' of access, access criteria, management of the decision-making process and patient care?ResultsTwenty-two ethical guidelines met our inclusion criteria and the results of our analysis are organized into 4 ethical concepts and related arguments: the equity principle and emerging ethical theories; triage criteria; respecting patient’s dignity, and decision making and quality of care.ConclusionFurther studies can investigate the practical consequences of the application of the guidelines described, in terms of quality of care and health care professionals’ moral distress. (shrink)

Cultural values influence how people understand illness and dying, and impact their responses to diagnosis and treatment, yet end-of-life care is rooted in white, middle class values. Faith, hope, and belief in God’s healing power are central to most African Americans, yet life-preserving care is considered “aggressive” by the healthcare system, and families are pressured to cease it.