Health disparities are primarily driven by structural inequality including systemic racism. Medical educators, led by the AAMC, have tended to minimize these core drivers of health disparities. Ins...

The concept of disparity has long been a topic of obsession and argument for philosophers but Slavoj Žižek would argue that what disparity and negativity could mean, might mean and should mean for us and our lives has never been more hotly debated. Disparities explores contemporary 'negative' philosophies from Catherine Malabou's plasticity, Julia Kristeva's abjection and Robert Pippin's self-consciousness to the God of negative theology, new realisms and post-humanism and draws a radical line under them. Instead of establishing a (...) dialogue with these other ideas of disparity, Slavoj Žižek wants to establish a definite departure, a totally different idea of disparity based on an imaginative dialectical materialism. This notion of rupturing what has gone before is based on a provocative reading of how philosophers can, if they're honest, engage with each other. Slavoj Žižek borrows Alain Badiou's notion that a true idea is the one that divides. Radically departing from previous formulations of negativity and disparity, Žižek employs a new kind of negativity: namely positing that when a philosopher deals with another philosopher, his or her stance is never one of dialogue, but one of division, of drawing a line that separates truth from falsity. (shrink)

Disparities in socioeconomic status correlate closely with health, so that the lower a person's social position, the worse his health, an effect that the epidemiologist Michael Marmot has labeled the status syndrome. Marmot has argued that differences in autonomy, understood in terms of control, underlie the status syndrome. He has, therefore, recommended that the American medical profession champion policies that improve patient autonomy. In this paper, I clarify the kind of control Marmot sees as connecting differences in socioeconomic status (...) to health disparities. I then discuss his use of Amartya Sen's capabilities approach to justice, arguing that he is unsuccessful in relating autonomy as a descriptive property with a normative framework that can adequately explain why and to what extent we should reduce health disparities. (shrink)

While the domestic effect of structural racism and other social vulnerabilities on Covid‐19 mortality in the United States has received some attention, there has been much less discussion (with some notable exceptions) of how structural global inequalities will further exacerbate Covid‐related health disparity across the world. This may be partially due to the delayed availability of accurate and comparable data from overwhelmed systems, particularly in low‐ and middle‐income countries. However, early methods to procure and develop treatments and vaccines by some (...) high‐income countries reflect ongoing protectionist and nationalistic attitudes that can systemically exclude access for people in regions with weaker health systems. What's needed is a global coordinated effort, based on the principle of solidarity, to foster equitable health care access. (shrink)

This paper reviews major structural drivers of place-based health disparities in the context of Canada, an industrialized nation with a strong public health system. Likelihood that the COVID-19 pandemic will facilitate rejuvenation of Canada’s northern and remote areas through remote working, advances in online teaching and learning, and the increased use of telemedicine are also examined. The paper concludes by identifying some common themes to address healthcare disparities for northern and remote Canadian residents.

Background Inequities in COVID-19 outcomes in the USA have been clearly documented for sex and race: men are dying at higher rates than women, and Black individuals are dying at higher rates than white individuals. Unexplored, however, is how sex and race interact in COVID-19 outcomes. Objective Use available data to characterize COVID-19 mortality rates within and between race and sex strata in two US states, with the aim of understanding how apparent sex disparities in COVID-19 deaths vary across (...) race. Design and Participants This observational study uses COVID-19 mortality data through September 21, 2020, from Georgia (GA) and Michigan (MI). Main Measures We calculate age-specific rates for each sex-race-age stratum, and age-standardized rates for each race-sex stratum. We investigate the sex disparity within race groups and the race disparity within sex groups using age-standardized rate ratios, and rate differences. Key Results Within race groups, men have a higher COVID-19 mortality rate than women. Black men have the highest rate of all race-sex groups (in MI: 254.6, deaths per 100,000, 95% CI: 241.1–268.2, in GA:128.5, 95% CI: 121.0-135.9). In MI, the COVID-19 mortality rate for Black women (147.1, 95% CI: 138.7–155.4) is higher than the rate for white men (39.1, 95% CI: 37.3–40.9), white women (29.7, 95% CI: 28.3–31.0), and Asian/Pacific Islander men and women. COVID-19 mortality rates in GA followed the same pattern. In MI, the male:female mortality rate ratio among Black individuals is 1.7 (1.5–2.0) while the rate ratio among White individuals is only 1.3 (1.2–1.5). Conclusion While overall, men have higher COVID-19 mortality rates than women, our findings show that this sex disparity does not hold across racial groups. This demonstrates the limitations of unidimensional reporting and analyses and highlights the ways that race and gender intersect to shape COVID-19 outcomes. (shrink)

The idea of using artificial intelligence as a support system in the sentencing process has attracted increasing attention. For instance, it has been suggested that machine learning algorithms may help in curbing problems concerning inter-judge sentencing disparity. The purpose of the present article is to examine the merits of this possibility. It is argued that, insofar as the unfairness of sentencing disparity is held to reflect a retributivist view of proportionality, it is not necessarily the case that increasing inter-judge uniformity (...) in sentencing is desirable. More generally, it is shown that the idea of introducing machine learning algorithms, that produce sentencing predictions on the ground of a dataset that is built of previous sentencing decisions, faces serious problems if there exists a discrepancy between actual sentencing practice and the sentences that are ideally desirable. (shrink)

Statistical evidence is crucial throughout disparate impact’s three-stage analysis: during (1) the plaintiff’s prima facie demonstration of a policy’s disparate impact; (2) the defendant’s job-related business necessity defense of the discriminatory policy; and (3) the plaintiff’s demonstration of an alternative policy without the same discriminatory impact. The circuit courts are split on a vital question about the “practical significance” of statistics at Stage 1: Are “small” impacts legally insignificant? For example, is an employment policy that causes a one percent disparate (...) impact an appropriate policy for redress through disparate impact litigation? This circuit split calls for a comprehensive analysis of practical significance testing across disparate impact’s stages. Importantly, courts and commentators use “practical significance” ambiguously between two aspects of practical significance: the magnitude of an effect and confidence in statistical evidence. For example, at Stage 1 courts might ask whether statistical evidence supports a disparate impact (a confidence inquiry) and whether such an impact is large enough to be legally relevant (a magnitude inquiry). Disparate impact’s texts, purposes, and controlling interpretations are consistent with confidence inquires at all three stages, but not magnitude inquiries. Specifically, magnitude inquiries are inappropriate at Stages 1 and 3—there is no discriminatory impact or reduction too small or subtle for the purposes of the disparate impact analysis. Magnitude inquiries are appropriate at Stage 2, when an employer defends a discriminatory policy on the basis of its job-related business necessity. (shrink)

Public health emergencies expose social injustice and health disparities, resulting in calls to address their structural causes once the acute crisis has passed. The COVID-19 pandemic is highlighting and exacerbating global, national, and regional disparities in relation to the benefits and burdens of undertaking critical basic public health mitigation measures such as physical distancing. In the United States, attempts to address the COVID-19 pandemic are complicated by striking racial, economic, and geographic inequities. These synergistic inequities exist in both (...) urban and rural areas but take on a particular character and impact in areas of rural poverty. Rural areas face a diverse set of structural challenges, including inadequate public health, clinical, and other infrastructure and economic precarity, hampering the ability of communities and individuals to implement mitigation measures. Public health ethics demands that personnel address both the tactical, real-time adjustment of typical mitigation tools to improve their effectiveness among the rural poor as well as the strategic, longer-term structural causes of health and social injustice that continue to disadvantage this population. (shrink)

In “Should We Impose Quotas? Evaluating the ‘Disparate Impact’ Argument Against Legalization of Assisted Suicide,” Ronald Lindsay argues that it should make no difference to the debate over legalizing assisted suicide whether the risks associated with legalization would fall disproportionately on the poor, people with disabilities, racial minorities, or any other especially vulnerable social group. Even assuming such an inequitable distribution of risks would occur, he maintains, attempting to avoid such an outcome is not a good reason to deny assisted (...) suicide to “competent persons who truly voluntarily choose it.”Those of us who worry that legalization will differentially burden already disadvantaged segments of society have generally taken it for granted that the possibility of such disparities raises significant public policy concerns. By insisting on an explanation of this assumption — and, in so doing, making explicit the tension between autonomy and equality that underlies the assisted suicide debate — Lindsay has significantly advanced the ongoing conversation. While I disagree with his analysis, I commend him for a thoughtful, provocative, and important contribution to the literature. (shrink)

Volume 20, Issue 7, July 2020, Page 182-184.

As disparities and data science researchers, we write in response to Char and colleagues paper on “Identifying Ethical Considerations for Machine Learning Healthcare Applications.” While the...

Compensation for research related injuries is a subject that is increasingly gaining traction in developing countries which are burgeoning destinations of multi center research. However, the existence of disparate compensation rules violates the ethical principle of fairness. The current paper presents a comparison of the policies of Brazil, Russia, India, China and South Africa. A systematic search of good clinical practice guidelines was conducted employing search strategies modeled in line with the recommendations of ADPTE Collaboration. The search focused on three (...) main areas namely bibliographic data bases, clinical practice guidelines data bases and a restricted internet search. A manual search of references cited in relevant guideline documents was also conducted. The search terms, Medical Subject Headings and key words were developed for a PubMed platform and then adapted for all other data bases. The search terms were kept constant for each country with the only difference being the country name. The documents so obtained were subjected to systematic content analysis. The study revealed that there is vast panoply of regulations which exist on a continuum. On one extreme is India with comprehensive regulations that are codified into law, and on the other end there is China which does not have specific laws regulating research related injuries. There are a number of differences and similarities such as mandatory insurance requirements, existence of no fault compensation, compensable injuries and the role of research ethics committees. It is imperative to enact legislations that protect participants without stifling the research enterprise. There is need for consistency and ideally harmonization of such regulations at a global level. A model policy on compensation for research related injuries should borrow from the best aspects of the different country policies and should be informed by the cardinal ethics principles of autonomy, justice and beneficence. (shrink)

The health system is, in particular ways, a microcosm of society and both reflects and contributes to its ills of racism, inequities, and disparities. As such, the house of medicine is obligated to...

The concept of disparity has long been a topic of obsession and argument for philosophers but Slavoj Žižek would argue that what disparity and negativity could mean, might mean and should mean for us and our lives has never been more hotly debated. Disparities explores contemporary 'negative' philosophies from Catherine Malabou's plasticity, Julia Kristeva's abjection and Robert Pippin's self-consciousness to the God of negative theology, new realisms and post-humanism and draws a radical line under them. Instead of establishing a (...) dialogue with these other ideas of disparity, Slavoj Žižek wants to establish a definite departure, a totally different idea of disparity based on an imaginative dialectical materialism. This notion of rupturing what has gone before is based on a provocative reading of how philosophers can, if they're honest, engage with each other. Slavoj Žižek borrows Alain Badiou's notion that a true idea is the one that divides. Radically departing from previous formulations of negativity and disparity, Žižek employs a new kind of negativity: namely positing that when a philosopher deals with another philosopher, his or her stance is never one of dialogue, but one of division, of drawing a line that separates truth from falsity. (shrink)

This paper describes the significance of key empirical findings from the recent and landmark study Caring and Aging with Pride: The National Health, Aging and Sexuality Study (with Karen I. Fredriksen‐Goldsen as the principal investigator), on lesbian, gay, bisexual, and transgender aging and health disparities. We will illustrate these findings with select quotations from study participants and show how nonconscious bias (i.e., activation of negative stereotypes outside conscious awareness) in the clinical encounter and health care setting can threaten shared (...) decision‐making and perpetuate health disparities among LGBT older adults. We recognize that clinical ethicists are not immune from nonconscious bias but maintain that they are well situated to recognize bias and resulting injustice by virtue of their training. Further, we discuss how clinical ethicists can influence the organization's ethical culture and environment to improve the quality and acceptability of health care for LGBT older adults. (shrink)

In “Should We Impose Quotas? Evaluating the ‘Disparate Impact’ Argument Against Legalization of Assisted Suicide,” Ronald Lindsay argues that it should make no difference to the debate over legalizing assisted suicide whether the risks associated with legalization would fall disproportionately on the poor, people with disabilities, racial minorities, or any other especially vulnerable social group. Even assuming such an inequitable distribution of risks would occur, he maintains, attempting to avoid such an outcome is not a good reason to deny assisted (...) suicide to “competent persons who truly voluntarily choose it.”Those of us who worry that legalization will differentially burden already disadvantaged segments of society have generally taken it for granted that the possibility of such disparities raises significant public policy concerns. By insisting on an explanation of this assumption — and, in so doing, making explicit the tension between autonomy and equality that underlies the assisted suicide debate — Lindsay has significantly advanced the ongoing conversation. While I disagree with his analysis, I commend him for a thoughtful, provocative, and important contribution to the literature. (shrink)

At the beginning of his essay ‘Philosophies of the Transindividual: Spinoza, Marx, Freud’, Balibar [2018] hints at some reasons why he will not be dealing with Simondon, despite agreeing with the latter’s program of going beyond ‘the metaphysics of the subject and of substance’ and towards an ‘ontology of relations’. In what follows I would like to outline Simondon’s concept of transindividuality and spell out more clearly why Balibar cannot follow Simondon’s trajectory. At the same time, I suggest a number (...) of socio-political approaches that a specifically Simondonian concept of transindividuality opens up. (shrink)

While political blackness seems to be making quite a comeback, this resurgence has also met with frustration and ambivalence. This paper aims to make sense of why this mobilising concept is accepted in some contemporary black feminist circles and outright rejected in others. It unpicks the diasporic dimensions of political blackness, reflecting on the issues that converged to foreground ‘black’ as the basis for mobilising women of African and Asian decent to engage in collective activism. Attention is given to the (...) Organisation of Women of Asian and African Descent, a national network that linked black women's organisations and expressed and projected what the author defines as gendered political blackness. Interrogating its implications and the tendency towards ideological policing, the author argues that political blackness must be viewed as a politics of solidarity. If it is to maintain its viability, political blackness needs reframing, contextualising and further analysis. A retelling of its ideological underpinnings, and crucially the tensions and contradictions inherent in political blackness, offers a critical lens through which to rethink how we use it as a mobilising tactic in the present. (shrink)

We consider a panel of experts asked to assign probabilities to events, both logically simple and complex. The events evaluated by different experts are based on overlapping sets of variables but may otherwise be distinct. The union of all the judgments will likely be probabilistic incoherent. We address the problem of revising the probability estimates of the panel so as to produce a coherent set that best represents the group’s expertise.

Is it possible to derive the outlines of a thinking of politics from the writings of Gilbert Simondon ? We will sketch an affirmative response by focusing our attention on three aspects of Simondon’s philosophy: 1. The manner in which the concept of Nature or the pre-individual displaces the debates over the relationship between political action, human nature and biological capacity; 2. The importance of the excess of « subject,) over « individual o as the matrix of a politics of (...) the transindividual; 3. The possibility of envisaging the notion of disparation, especially through its Deleuzian reading, as an essential contribution to a political philosophy of difference, that is, to a non-dialectical thinking of construction and conflict. We will end with a consideration of the limits of Simondon, limits in our view concentrated in the equivocal and irenic notion of « culture » or « technical culture. ». (shrink)

This paper examines the consistency of parent selection procedures, focusing on adoption and embryo donation. It outlines the current methods of selection and their disparities, and considers reasons for these disparities; namely, the intentionality of the parents, the gestational experience, and the technological imperative. This discussion is followed by an analysis of the ethical validity of these reasons, in terms of their consistency and how well they meet standards of equity and justice. The paper concludes that current approaches (...) to parent selection are unsystematic and inadequate, and discusses the implications of this assessment. (shrink)

IntroductionThere is a significant disparity in the United States between the health care received by children with special health care needs versus physically healthy children.ObjectiveThe objective of the paper is to show that children with special needs receive less than adequate health care overall. This disparity affects the quality of life for these children and influences their ability to live their lives to their full potential.MethodsResearch was conducted by examining multiple studies with a focus on six major factors that play (...) a role in creating this disparity.ResultsThe findings show an alarming trend in the access and delivery of health care to children with special health care needs.ConclusionsSolutions to correcting the disparities are possible, but it will take a full understanding of the issues, perseverance, dedication, and hard work on the part of families, physicians, legislators, and others genuinely interested in creating an equal health care system for all children. (shrink)

Cultural disparity—the variation across cultural traits such as knowledge, skill, and belief—is a complex phenomenon, studied by a number of researchers with an expanding empirical toolkit. While there is a growing consensus as to the processes that generate cultural variation and change, general explanatory frameworks require additional tools for identifying, organising, and relating the complex causes that underpin the production of cultural disparity. Here I develop a case study in the cognitive science of religion, and demonstrate how concepts and distinctions (...) drawn from work on contrastive explanation and manipulationist accounts of causation provide such tools for distinguishing explanatory levels, organising causal narratives, and accounting for cross-cultural patterns. (shrink)

Empirical evidence demonstrates that minority and marginalized populations receive less and lower quality healthcare than more advantaged groups. Ethical analyses of these disparities explain their injustice. That disparities exist and constitute a moral wrong are uncontroversial views. Less clear are the exact causes of healthcare disparities.

The government recognizes that social factors cause racial inequalities in access to resources and opportunities that result in racial health disparities. However, this recognition fails to acknowledge the root cause of these racial inequalities: structural racism. As a result, racial health disparities persist.

ABSTRACT Objective: To contrast relief efforts for the 26 December 2004 tsunami with current global HIV/aids relief efforts and analyse possible reasons for the disparity. Methods: Literature review and ethical analysis. Results: Just over 273,000 people died in the tsunami, resulting in relief efforts of more than US$10 bn, which is sufficient to achieve the United Nation’s long‐term recovery plan for South East Asia. In contrast, 14 times more people died from HIV/aids in 2004, with UNAIDS predicting a US$8 bn (...) funding gap for HIV/aids in developing nations between now and 2007. This disparity raises two important ethical questions. First, what is it that motivates a more empathic response to the victims of the tsunami than to those affected by HIV/AIDS? Second, is there a morally relevant difference between the two tragedies that justifies the difference in the international response? The principle of justice requires that two cases similarly situated be treated similarly. For the difference in the international response to the tsunami and HIV/aids to be justified, the tragedies have to be shown to be dissimilar in some relevant respect. Are the tragedies of the tsunami disaster and the HIV/aids pandemic sufficiently different, in relevant respects, to justify the difference in scope of the response by the international community? Conclusion: We detected no morally relevant distinction between the tsunami and the HIV/aids pandemic that justifies the disparity. Therefore, we must conclude that the international response to HIV/aids violates the fundamental principles of justice and fairness. (shrink)

Rawls' Difference Principle asserts that a basic economic structure is just if it makes the worst off people as well off as is feasible. How well off someone is is to be measured by an ‘index’ of ‘primary social goods’. It is this index that gives content to the principle, and Rawls gives no adequate directions for constructing it. In this essay a version of the difference principle is proposed that fits much of what Rawls says, but that makes use (...) of no index. Instead of invoking an index of primary social goods, the principle formulated here invokes a partial ordering of prospects for opportunities. (shrink)

BackgroundThe current paper follows up on the results of an exploratory quantitative analysis that compared the publication and citation records of men and women researchers affiliated with the Faculty of Computing and Engineering at Dublin City University in Ireland. Quantitative analysis of publications between 2013 and 2018 showed that women researchers had fewer publications, received fewer citations per person, and participated less often in international collaborations. Given the significance of publications for pursuing an academic career, we used qualitative methods to (...) understand these differences and explore factors that, according to women researchers, have contributed to this disparity.MethodsSixteen women researchers from DCU’s Faculty of Computing and Engineering were interviewed using a semi-structured questionnaire. Once interviews were transcribed and anonymised, they were coded by both authors in two rounds using an inductive approach.ResultsInterviewed women believed that their opportunities for research engagement and research funding, collaborations, publications and promotions are negatively impacted by gender roles, implicit gender biases, their own high professional standards, family responsibilities, nationality and negative perceptions of their expertise and accomplishments.ConclusionsOur study has found that women in DCU’s Faculty of Computing and Engineering face challenges that, according to those interviewed, negatively affect their engagement in various research activities, and, therefore, have contributed to their lower publication record. We suggest that while affirmative programmes aiming to correct disparities are necessary, they are more likely to improve organisational culture if they are implemented in parallel with bottom-up initiatives that engage all parties, including men researchers and non-academic partners, to inform and sensitise them about the significance of gender equity. (shrink)

Multidimensional concepts are everywhere, and they are important. Examples include moral value, welfare, scientific confirmation, democracy, and biodiversity. How, if at all, can we aggregate the underlying dimensions of a multidimensional concept F to yield verdicts about which things are Fer than which overall? Social choice theory can be used to model and investigate this aggregation problem. Here, we focus on a particularly thorny problem made salient by this social choice-theoretic framework: the underlying dimensions of a given concept might be (...) measurable on different types of scales—e.g., some ordinal and some cardinal. An underappreciated impossibility theorem due to Anna Khmelnitskaya shows that seemingly plausible constraints on aggregation across scale types are inconsistent. This impossibility threatens to render the notion of overall Fness incoherent. We attempt to defuse this threat, arguing that the impossibility depends on an overly restrictive conception of measurement and of how measurement constrains aggregation. Adopting a more flexible—and, we think, more perspicuous—conception of measurement opens an array of possibilities for aggregation across disparate scale types. (shrink)

In ‘Does zero-COVID neglect health disparities?’ we made the case that strict zero-COVID policies implemented during the coronavirus 2019 disease (COVID-19) pandemic raise health equity concerns so serious that these policies are not ethically sustainable.1 Zero-COVID, which has dominated many Pacific Rim societies, sets zero deaths from COVID-19 as a goal, and aims to reach it by forcefully containing transmission through short-term lockdowns, followed by stringent find, test, trace and isolate methods. Since the paper appeared in 2021, the Omicron (...) variant and subvariants took hold, making a strict zero goal unattainable and leading many countries to abandon it. Careful ethical analysis of zero-COVID’s impact remains crucially important, however, not only because the novel coronavirus continues to surprise us, but also to ensure lessons learnt from this pandemic are carried forward to future pandemics. In ‘Zero-COVID and health inequities’,2 Schaefer argues that it is possible to pursue zero-COVID yet offset any negative impacts on disadvantaged groups. Citing Singapore, where zero-COVID led to outbreaks in crowded and unsanitary migrant workers dormitories, Schaefer notes the government offset these effects, setting up less densely populated ‘quick build dormitories’ that caused daily case counts to drop, even while zero-COVID remained …. (shrink)

This article advocates a new interpretation ofinner experience– the experience that one has of one’s empirical-psychological features ‘from within’ – in Kant. It argues that for Kant inner experience is the empirical cognition of mental states, but not that of a persistent mental substance. The schema of persistence is thereby substituted with the regulative idea of the soul. This view is shown to be superior to two opposed interpretations: the parity view that regards inner experience as empirical cognition of a (...) mental object on a par with outer experience and the disparity view that denies altogether that inner experience is empirical cognition. (shrink)

This article examines how people of color can biologically inherit the deleterious effects of white racism. Drawing primarily on the field of epigenetics, I demonstrate how transgenerational racial disparities are in fact racist disparities that can be manifest physiologically, helping constitute the chemicals, hormones, cells, and fibers of the human body. Epigenetics can be used to demonstrate how white racism can have durable effects on the biological constitution of human beings that are not limited to the specific person (...) who is the target of white racism, but instead extend to that person's offspring. In this way, the field of epigenetics can help philosophers and others understand the transgenerational biological impact of social forces such as white racism. It reveals that the damage done by white racism is more extensive than critical philosophers of race might have realized, and also that interventions against white racism must address not just the economic, geographical, social, and psychological, but also the biological aspects of human existence. In particular, the article examines racist disparities in preterm birth rates and argues that the scope and significance of prenatal care for African American women must be expanded intergenerationally and include wide-scale forms of racial justice. (shrink)

Social health disparities are increasing in most countries around the world. During the past two decades, a large amount of evidence has emerged about the health consequences of social inequalities. Despite such evidence, the concept of medical fairness, as traditionally defined by the World Medical Association, has remained unchallenged and even reinforced by some scholars who emphasize that doctors should remain neutral to the socioeconomic status of their patients when providing clinical care. The inconsistency between public health and clinical (...) care perspectives raises tension between a narrow interpretation of the ethics of justice, which stresses the importance of equality and impartiality, and the ethics of care, which highlights the importance of particularity and individuality in clinical practice. This article analyzes the concept of medical fairness using the emerging evidence that demonstrates the impact of social health disparities on clinical care. It proposes a new approach of medical fairness based on equity rather than on equality and provides a consistent ethical framework based on Paul Ricoeur’s three levels of medical judgments. This integrative framework provides a better balance between public health and clinical care in medical practice. (shrink)

The effective solution of environmental problems calls for changes in levels of consumption. Sociologists have described moderation in households of high socio-economic status in affluent countries, and also a type of modesty which cannot be a response to the experience of abundance. However, its essence is not the way of life of a traditional community. Sustainable living based on self-restraint could be considered to be a symptom of the summit of cultural evolution to date. Nevertheless, historical experience warns us against (...) making too much of contemporary cases of moderation. (shrink)