This chapter contains sections titled: Distributive Justice Nanotechnology and the Developing World Water Purification Solar Energy Medicine Nanotechnology, the Developing World, and Distributive Justice.

In lieu of an abstract, here is a brief excerpt of the content:502 Feminist Studies 46, no. 2. © 2020 by Feminist Studies, Inc. Jaime Madden Teaching Online: Issues of Equity and Access in Writing-centric Formats The COVID-19 pandemic has turned us all into online teachers. In the context of this crisis, we have quickly learned new technologies and the affordances of asynchronous and synchronous delivery. We have grappled with the challenges of building community and supporting active engagement, (...) and we have turned to adapting our assessment methods for the remote environment. We have done this work at traditional colleges and universities, where online teaching was formerly the purview of graduate students and adjunct instructors. Online learning can no longer be associated with those who struggle to access traditional classrooms, such as disabled students and those who attend for-profit colleges. Instead, access to online learning can now be associated with access to wealth and to health—specifically as relates to avoiding contact with the virus. In K-12 education, we have seen districts that largely enroll white students make the decision to continue online or go hybrid for the fall 2020 semester, whereas those that largely enroll students of color are returning to the classroom.1 Inequalities pervade the teaching landscape as well. Teaching is not a job usually marked as high risk, but within this environment, some 1. The work of activist and artist @bmore_radical shows how these decisions are being made in Baltimore, Maryland. See https://www.instagram.com /bmore_radical/?hl=en. Jaime Madden 503 bodies suffer at higher rates. In a recent article published in this journal, coauthors writing as the Brocher Foundation Feminist Collective describe their experience and knowledge “of the ways that academia produces sickness.”2 The authors are white and cisgender women at Anglo-American and European universities, and even though they acknowledge that they did not experience high levels of racism, classism, linguistic marginalization, and/or illness, they still found themselves—at different stages of their careers—“worn thin” in a system where “bodies are disposable.”3 Commenting on this problem in another context, disability studies scholar Alison Kafer notes that disability is “more fundamental, more inevitable, for some than others.”4 The pandemic has made this much clear: able-bodied people are “temporarily able-bodied,” and those who experience racism and classism are among the most frequently and intensely sickened. In attending to how teachers and students transition online en masse, we need to consider how we are differently positioned within institutions governed by the logics of racialized capitalism. It is important to recognize not only which students can access these online spaces but also which skills such spaces tend to reward. It is also important to ask which teachers are disproportionately impacted by the transition online. In this piece, I describe the challenges of assessment and then wrestle with broader questions of access as a scholar invested in feminist studies and disability studies. The tension in online education between its promise of access and its methods of assessment is, I argue, worthy of urgent attention. The Challenges of Assessment I have taught online courses at four institutions: two private colleges and two public universities. Good teaching and learning can undoubtedly happen across a range of spaces. In online environments, I have found that my best teaching happens in the feedback I give students. 2. Laura Bisaillon, Alana Cattapan, Annelieke Driessen, Esther van Duin, Shannon Spruit, Lorena Anton, and Nancy S. Jecker, “Doing Academia Differently: ‘I Needed Self-Help Less Than I Needed a Fair Society,” Feminist Studies 46, no. 1 (2020): 132. 3. Bisaillon, et al., “Doing Academia Differently,” 136, 140. 4. Alison Kafer, Feminist, Queer, Crip (Bloomington: Indiana University Press, 2013), 26. 504 Jaime Madden This is understandable since assessment practices are important teaching opportunities in all contexts. In online environments, and particularly in asynchronous teaching, I have found that it is while carrying out assessments of student work that my most intense teaching occurs. It is through grading and offering comments on papers and assignments that I am most directly in communication with students as their teacher. When I mark student work, I ask questions of students, I prompt them to consider how our course materials may be placed... (shrink)

Travelling internationally to acquire medical treatments otherwise unavailable or inaccessible in one’s home country is not a novel concept. Conventionally, such medical travel largely entailed patients from developed countries or wealthy patients from the developing world seeking care in Western facilities like the Mayo Clinic in the U.S. and myriad private clinics along Harley Street in London, England. What is different about the topical phenomenon known as “medical tourism” is the growing trend of health services export in the opposite direction. (...) The number of patients travelling from the developed world to low- and middle-income countries for treatments has ballooned in recent years, primarily driven by difficulties with accessing affordable care at home. According to a liberal estimate by the Deloitte Center for Health Solutions, the number of Americans travelling abroad for care rose from 750,000 in 2007 to 1.6 million in 2012. On the flip side, Thailand reportedly treated a total of 1.3 million foreign nationals in 2007, which represented a 16% leap from 2001. (shrink)

There is currently an evidentiary gap in the scholarship concerning medical tourism's impact on low- and middle-income destination countries (LMICs). This article reviews relevant evidence that exists and concludes that there are signs of correlation between medical tourism and the expansion of private, technology- intensive health care in LMICs, which has largely remained out of reach for the majority of the local patients. In light of this health care inequity between local residents and medical tourists in LMICs, we argue that (...) the presumption should not be in favor of medical tourism and that governments have a legitimate interest in seeking to regulate this industry to ensure that the net effects for their citizens is positive. Moreover, sending countries, particularly those in the developed world, have the responsibility to adopt public policies to diminish demand on the part of their citizens for medical tourism and to work with LMICs to ensure that the growth of medical tourism does not occur at the expense of the poorest of the poor. (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)

No progress has been made over the past decade in improving equity of access to higher education for young people from low socio-economic backgrounds. New evidence indicates that both family income and cultural factors explain this situation. The cultural factor is particularly strong for boys from blue collar backgrounds. Current Government equity policy ignores these findings.

In this age of information technology, it is morally imperative that equal access to information via computer systems be afforded to people with disabilities. This paper addresses the problems that computer technology poses for students with disabilities and discusses what is needed to ensure equity of access. particularly in a university environment.

We examine ethical considerations in access to facial transplantation (FT), with implications for promoting health equity. As a form of vascularised composite allotransplantation, FT is still considered innovative with a relatively low volume of procedures performed to date by a small number of active FT programmes worldwide. However, as numbers continue to increase and institutions look to establish new FT programmes, we anticipate that attention will shift from feasibility towards ensuring the benefits of FT are equitably available to (...) those in need. This manuscript assesses barriers to care and their ethical implications across a number of considerations, with the intent of mapping various factors relating to health equity and fair access to FT. Evidence is drawn from an evolving clinical experience as well as published scholarship addressing several dimensions of access to FT. We also explore novel concerns that have yet to be mentioned in the literature. (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)

ABSTRACT:In this response, I reiterate my argument that price gouging undercuts the goal of equity in access to essential goods whereas Zwolinski emphasizes the importance of the efficient provision of essential goods above all other goals. I agree that the efficient provision of essential goods is important as I argue for the goal of equitable access to sufficient of the goods essential to living a minimally flourishing human life. However, efficiency is a means to this goal rather (...) than the end itself. Finally, I offer additional arguments against the non-worseness claim. (shrink)

In the context of long waiting time to access rehabilitation services, a large majority of settings use referral prioritization to help manage waiting lists. Prioritization practices vary greatly between settings and there is little consensus on how best to prioritize referrals. This paper describes the prioritization processes for physiotherapy services in Québec and its potential implications in terms of equity in access to services. This is a secondary analysis of a survey of outpatient physiotherapy departments (n=98; proportion (...) of participation was 99%) conducted in 2015 across publicly funded hospitals in Québec. In many settings, persons with acute orthopaedic conditions were prioritized while chronic conditions were given a lower priority. There were 72 different combinations of prioritization criteria used in outpatient physiotherapy departments. Variability was also observed in the type of personnel involved in the prioritization process, the number of priority levels used to rank the referrals and the source of information used to prioritize referrals. These results highlight potential issues regarding equity in access to physiotherapy services: the prioritization of persons with acute conditions to the detriment of those with chronic conditions, the lack of consensus on a fair prioritization process and the importance to adequately assess patients’ needs for treatment. Further research and interventions on prioritization criteria and processes are needed to ensure equitable access to physiotherapy services, especially in the public sector. (shrink)

In the context of long waiting time to access rehabilitation services, a large majority of settings use referral prioritization to help manage waiting lists. Prioritization practices vary greatly between settings and there is little consensus on how best to prioritize referrals. This paper describes the prioritization processes for physiotherapy services in Québec and its potential implications in terms of equity in access to services. This is a secondary analysis of a survey of outpatient physiotherapy departments conducted in (...) 2015 across publicly funded hospitals in Québec. In many settings, persons with acute orthopaedic conditions were prioritized while chronic conditions were given a lower priority. There were 72 different combinations of prioritization criteria used in outpatient physiotherapy departments. Variability was also observed in the type of personnel involved in the prioritization process, the number of priority levels used to rank the referrals and the source of information used to prioritize referrals. These results highlight potential issues regarding equity in access to physiotherapy services: the prioritization of persons with acute conditions to the detriment of those with chronic conditions, the lack of consensus on a fair prioritization process and the importance to adequately assess patients’ needs for treatment. Further research and interventions on prioritization criteria and processes are needed to ensure equitable access to physiotherapy services, especially in the public sector. (shrink)

In Australia and other countries, certain groups of women have traditionally been denied access to assisted reproductive technologies . These typically are single heterosexual women, lesbians, poor women, and those whose ability to rear children is questioned, particularly women with certain disabilities or who are older. The arguments used to justify selection of women for ARTs are most often based on issues such as scarcity of resources, and absence of infertility , or on social concerns: that it “goes against (...) nature”; particular women might not make good mothers; unconventional families are not socially acceptable; or that children of older mothers might be orphaned at an early age. The social, medical, legal, and ethical reasoning that has traditionally promoted this lack of equity in access to ARTs, and whether the criteria used for client deselection are ethically appropriate in any particular case, are explored by this review. In addition, the issues of distribution and just “gatekeeping” practices associated with these sensitive medical services are examined. (shrink)

In this response, I reiterate my argument that price gouging undercuts the goal of equity in access to essential goods whereas Zwolinski emphasizes the importance of the efficient provision of essential goods above all other goals. I agree that the efficient provision of essential goods is important as I argue for the goal of equitable access to sufficient of the goods essential to living a minimally flourishing human life. However, efficiency is a means to this goal rather (...) than the end itself. Finally, I offer additional arguments against the non-worseness claim. (shrink)

Local food systems can have economic and social benefits by providing income for producers and improving community connections. Ongoing global climate change and the acute COVID-19 pandemic crisis have shown the importance of building equity and resilience in local food systems. We interviewed ten stakeholders from organizations and institutions in a U.S. midwestern city exploring views on past, current, and future conditions to address the following two objectives: 1) Assess how local food system equity and resilience were impacted (...) by the COVID-19 pandemic, and 2) Examine how policy and behavior changes could support greater equity and resilience within urban local food systems. We used the Community Capitals Framework to organize interviewees’ responses for qualitative analyses of equity and resilience. Four types of community capital were emphasized by stakeholders: cultural and social, natural, and political capital. Participants stated that the local food system in this city is small; more weaknesses in food access, land access, and governance were described than were strengths in both pre- and post-pandemic conditions. Stakeholder responses also reflected lack of equity and resilience in the local food system, which was most pronounced for cultural and social, natural and political capitals. However, local producers’ resilience during the pandemic, which we categorized as human capital, was a notable strength. An improved future food system could incorporate changes in infrastructure (e.g., food processing), markets (e.g., values-based markets) and cultural values (e.g., valuing local food through connections between local producers and consumers). These insights could inform policy and enhance community initiatives and behavior changes to build more equitable and resilient local food systems in urban areas throughout the U.S. Midwest. (shrink)

Assistive technology has great potential to contribute to health, functioning, and quality of life. To date, as exemplified in the Canadian context, variations and inequities in access to assistive technology are evident; the development of legislation, policies, and programs has not kept up with the increasing use of assistive technology. In this article, we apply ;Daniels’s (2008) theory of just health to argue that equitable access to assistive technology funding and services is necessary for justice. In doing so, (...) we offer theoretical guidance for the development of legislation, policies, and programs to guide such access in health and social services. (shrink)

Fish stocks, as common pool resources, are more and more managed by giving fishermen exclusive access rights as Individual Transferable Quotas (ITQ). These have been widely discussed, with focus on social, economic and ecological issues. While equity aspects have been of great concern, there is very limited analysis about how to assess issues of equity and fair distribution when introducing ITQs. This paper applies an existing framework for assessing equity in resource use systems to tradable quota (...) systems in fisheries. The framework defines the perspectives of distributive fairness, the stakeholders who are bound by fair practice rules, and instruments of fairness, and identifies metrics to assess equity in practice. We assess if the framework provides practical guidance for evaluating whether a given ITQ system operates under an equitable framework programme. (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)

_Higher Education and the Color Line_ examines the role of higher education in opening up equal opportunity for mobility in American society--or in reinforcing the segregation between white and nonwhite America. In the wake of the U.S. Supreme Court's landmark decision upholding affirmative action, this comprehensive and timely book outlines the agenda for achieving racial justice in higher education in the next generation. Weaving together current research and a discussion of overarching demographic, legal, and political issues, the book focuses on (...) the racial transformation of higher education and the structural barriers that perpetuate racial stratification at the postsecondary level. _Higher Education and the Color Line_ includes chapters that outline the demographic changes in elementary, secondary, and postsecondary school enrollment; the evolving role of law and policy; the barriers faced by minority college students; and the kinds of programs that best serve them. Topics addressed include financial aid; the role of community colleges; nontraditional paths to postsecondary education; and the role of higher education in social and economic mobility. In addition to providing a thorough and up-to-date assessment of the state of racial integration in higher education, the book goes beyond the usual black-and-white analysis to provide a multiethnic perspective supported by extensive new data. Taken together, these discussions examine the role of higher education in opening up equal opportunity for mobility in American society--or in reinforcing the segregation between white and nonwhite America. It provides insight for how institutions, states, and the country should be thinking about U.S. Supreme Court Justice Sandra Day O’Connor’s hope that affirmative action will no longer be needed in 25 years. (shrink)

Civic agriculture is an approach to agriculture and food production that—in contrast with the industrial food system—is embedded in local environmental, social, and economic contexts. Alongside proliferation of the alternative food projects that characterize civic agriculture, growing literature critiques how their implementation runs counter to the ideal of civic agriculture. This study assesses the relevance of three such critiques to urban farming, aiming to understand how different farming models balance civic and economic exchange, prioritize food justice, and create socially inclusive (...) spaces. Using a case study approach that incorporated interviews, participant observation, and document review, I compare two urban farms in Baltimore, Maryland—a “community farm” that emphasizes community engagement, and a “commercial farm” that focuses on job creation. Findings reveal the community farm prioritizes civic participation and food access for low-income residents, and strives to create socially inclusive space. However, the farmers’ “outsider” status challenges community engagement efforts. The commercial farm focuses on financial sustainability rather than participatory processes or food equity, reflecting the use of food production as a means toward community development rather than propagation of a food citizenry. Both farms meet authentic needs that contribute to neighborhood improvement, though findings suggest a lack of interest by residents in obtaining urban farm food, raising concerns about its appeal and accessibility to diverse consumers. Though not equally participatory, equitable, or social inclusive, both farms exemplify projects physically and philosophically rooted in the local social context, necessary characteristics for promoting civic engagement with the food system. (shrink)

Access to education for undocumented migrant children in South Africa remains a significant challenge. While the difficulties related to their inability to access education within the country have been highlighted elsewhere, there remains a lack of clarity on an approach to how this basic human right can be achieved. In this conceptual paper, we draw on the distinction between equality and equity, and describe the various ways in which education has been conceptualised in the South African Constitution (...) – which in part contributes to the existing confusion on education for various groups, including undocumented migrant children. In this paper, we critically reflects on the need to develop an integrated approach for creating a platform that allows all undocumented migrant children access to education in South Africa. We argue that an integrated approach – which entails ways through which access to education can be delivered through the lens of equity – will enhance the right to education for undocumented migrant children in South Africa. We conclude that the South African government must urgently consider this integrated approach to enable access to education for undocumented migrant children, so that they can achieve their full educational potential. (shrink)

Given its subject matter, biological psychiatry is uniquely poised to lead STEM DEI initiatives related to disability. Drawing on literatures in science, philosophy, psychiatry, and disability studies, we outline how that leadership might be undertaken. We first review existing opportunities for the advancement of DEI in biological psychiatry around axes of gender and race. We then explore the expansion of biological psychiatry’s DEI efforts to disability, especially along the lines of representation and access, community accountability, first person testimony, and (...) revised theoretical frameworks for pathology. We close with concrete recommendations for scholarship and practice going forward. By tackling head-on the challenge of disability inclusion, biological psychiatry has the opportunity to be a force of transformation in the biological sciences and beyond. (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)

Equity is a foundational concept for the new World Health Organization (WHO) Pandemic Treaty. WHO Member States are currently negotiating to turn this undefined concept into tangible outcomes by borrowing a policy mechanism from international environmental law: “access and benefit-sharing” (ABS).

There is evidence of persistent inequalities in household financial protection of health and drugs spending in Latin America. Despite the expansion of coverage, strong inequalities persist in access to health and family spending on drugs in the region. Out-of-pocket spending in medicines is regressive in greater need for affordable medicines.

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)

This publication features the stories and experiences of pharmacy professionals who identify as members of historically underrepresented groups. This collection of personal essays presents significant events in the lives of those in the pharmacy community whose experiences have been shaped by their race, ethnicity, gender or gender presentation, sexual orientation, ability, language, mental health, or other factors. The perspectives from the narratives highlight the importance of diversity, equity, and inclusion in the healthcare sector. The authors of the narratives also (...) reflect on their experience to consider what they wish would have happened in the experience, to offer advice for others that may be faced with similar situations. Access to these stories will deepen the collective understanding among pharmacy colleagues, patients, and society of the experiences that individuals from historically underrepresented groups within pharmacy have experienced. (shrink)

_CHOICE Outstanding Academic Title 2022__ In this thought-provoking volume, editors Rebecca M. Taylor and Ashley Floyd Kuntz invite readers to explore the many facets of on-campus ethical dilemmas and the careful, nuanced decision-making processes required to address them._ Taylor and Kuntz demonstrate how to apply collaborative, multidisciplinary, philosophical inquiry to deeply complex issues. They present seven normative case studies focusing on a variety of campus quandaries, from urgent matters such as Title IX violations and free speech in social media policy (...) to long-simmering concerns such as admissions and access and the future of historically Black colleges and universities. The editors then bring together a diverse group of scholars and practitioners with a broad array of disciplinary and personal backgrounds to offer their commentary and insight on the cases. Leaders in higher education are under immense pressure to respond to campus crises quickly, to quell controversy, and to avoid the backlash of public scrutiny in an ever-shifting sociopolitical terrain. Yet, in tension with such pressures, adequate responses to these dilemmas require leaders to make ethical, contextual choices that effectively foster inclusion, respect individual and institutional freedoms, and promote equity. Expanding the scope of inquiry, the contributors challenge underlying assumptions, raise points that had been omitted from the original cases, and imagine alternative solutions. _Ethics in Higher Education_ appeals to readers to do the same, in the interest of advancing ethical decision-making on campuses. (shrink)

Nanomedicine applications are an extension of traditional pharmaceutical drug development that are targeting the most pressing health concerns through improvements to diagnostics, drug delivery systems, therapeutics, equipment, surgery and prosthetics. The benefits and risks to the individual have been extrapolated to include broader societal impacts of nanomedicine with concerns extending to inequitable distribution of benefits accruing to developed, or North countries, rather than developing, or South countries. Analysis reveals a great deal of overlap between the North and South's most serious (...) health priorities which kill millions each year. A significant amount of nanomedicine research activity is also underway for the most pressing South country-specific health concerns. Nanomedicine development promises profound breakthroughs for both North and South countries; however, the existing inequities in pharmaceutical drug development, patenting, access and delivery remain significant barriers for South countries. (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)

Watson begins with two questions: “Should the need for abortion care be considered a health disparity? and, “If yes, would framing it this way increase the ability of poor women and women of color...

Universal access to antiretroviral treatment (ART) in Chad was officially declared in December 2006. This presidential initiative was and is still funded 100% by the country’s budget and external donors’ financial support. Many factors have triggered the spread of AIDS. Some of these factors include the existence of norms and beliefs that create or increase exposure, the low-level education that precludes access to health information, social unrest, and population migration to areas of high economic opportunities and gender-based discrimination. (...) Social forces that influence the distribution of dimensions of well-being and shape risks for infection also determine the persistence of access barriers to ART. The universal access policy is quite revolutionary but should be informed by the systemic barriers to access so as to promote equity. It is not enough to distribute ARVs and provide health services when health systems are poorly organized and managed. Comprehensive access to ART raises many organizational, ethical and policy problems that need to be solved to achieve equity in access. This paper argues that the persistence of access barriers is due to weak health systems and a poor public health leadership. AIDS has challenged health systems in a manner that is essentially different from other health problems. (shrink)

The United States' pursuit of increasingly TRIPS-Plus levels of intellectual property protection for medicines in bilateral and regional trade agreements is well recognized. Less so, however, are U.S. efforts through these agreements to influence and constrain the pharmaceutical coverage programs of its trading partners. Although arguably unsuccessful in the Australia- U.S. Free Trade Agreement (AUSFTA), the U.S. nevertheless succeeded in its bilateral FTA with South Korea (KORUS) in establishing prescriptive provisions pertaining to the operation of coverage and reimbursement programs for (...) medicines and medical devices, which have the potential to adversely impact future access in that country. More recently, draft texts leaked from the current Trans Pacific Partnership Agreement (TPPA) negotiations show that U.S. objectives include not only AUSFTA-Plus and KORUS-Plus IP provisions but also ambitious inroads into the domestic health programs of its TPPA partners. This highlights the apparent conflict between trade goals — pursued through multilateral legal instruments to promote economic “health”— and public health objectives, such as the development of treatments for neglected diseases, the pursuit of efficiency and equity in priority setting, and the procurement of medicines at prices that reflect their therapeutic value and facilitate affordable access. (shrink)

The number of people in immediate need of anti‐retroviral treatment (ART) in the southern African region continues to significantly exceed the capacity of health systems there to provide it. Approaches to this complex rationing dilemma have evolved in different directions. The ethical concepts of fairness and equity have been suggested as a basis to guide the development of approaches to select patients for ART. This article reports the results of a case study on patient selection at a rural ART (...) clinic in Lesotho. The purpose of the study was to examine whether or not such concepts had relevance or operative value for a treatment team providing ART in rural Lesotho. The study found that while concepts of fairness and equity were relevant to the work of the treatment team, patient selection practices did not necessarily reflect what these concepts entail. The idea of fairness as a structured, formalized selection process did not figure in the approach to ART provision at the site. A less formal, ‘first‐come‐first‐served’ approach was adopted. While there was knowledge among some team members that social, economic or geographic conditions inhibit individuals and groups from gaining access to ART and that this was inequitable, it was felt that there was little they could do to try to mediate the impact of these conditions. The study's findings pose importance questions about the approach to ART programming in resource constrained settings. The findings also question the relevance of trying to achieve fairness and equity when the gap between need for care and capacity to provide it remains so large. (shrink)

There is no cure or vaccine for HIV/AIDS. The only life-prolonging treatment available is antiretroviral (ARV) therapy. WHO estimates, however, that less than 5 percent of those who require treatment in developing countries currently enjoy access to these medicines. In Africa fewer than 50,000 people–less than 2 percent of the people in need–currently receive ARV therapy. These facts have elicited strongly divergent reactions, and views about the appropriate response to this crisis have varied widely.The intensity of the debate concerning (...) access to life-prolonging medicines for the treatment of HIV/AIDS, and the heated rhetoric with which they are often conducted, suggest that these disagreements may be rooted in deeper disagreements of value. It is not obvious, however, what disagreements of value are at stake in this debate. By analyzing the statements of scholars, public officials, activist organizations, and private sector representatives, each of whom may endorse very different policy recommendations on access to HIV/AIDS drugs, we have identified and created a typology of the different sources of disagreement in the debate. We conclude that the central disagreements concerning access to medicines arise from competing understandings of how responsibilities for bringing remedy to hardships should be allocated to different agents and institutions. A central lesson that emerges from our analysis is that thinking about “health equity” must extend beyond the explanation and justification of goals, values, and ideals, and engage more honestly with the difficult question of how responsibilities for bringing remedy to health crises should be allocated in complex social contexts. (shrink)

As the technology for ectogenesis continues to advance, the ethical implications of such developments should be thoroughly and proactively explored. The possibility of full ectogenesis remains hypothetical at present, and myriad concerns regarding the safety and efficacy of the technology must be evaluated and addressed, while pressing moral considerations should be fully deliberated. However, it is conceivable that the technology may become sufficiently well established in the future and that eventually full ectogenesis might be deemed ethically acceptable as a reproductive (...) alternative to gestation within a human womb under certain circumstances. If the safety and efficacy of full ectogenesis are established, if ethical dilemmas are sufficiently well addressed, and if the technology is offered as a reproductive option to cisgender heterosexual individuals or couples desiring to become parents, there is a moral obligation grounded in social justice to ensure that full ectogenesis be made available to individuals or couples identifying as members of sexual‐ or gender‐minority groups who likewise seek to pursue parenthood. We examine the history of access to current family‐building options, including assisted reproductive technology, surrogacy and adoption, for these populations and conclude that in the absence of robust empirical evidence suggesting an increased risk of harm to children of individuals and couples who identify as members of sexual‐ or gender‐minority groups, equitable access to ectogenesis as a pathway to parenthood for sexual and gender minorities must be assured as a matter of reproductive justice. (shrink)

Biodiversity and genetic resources have become the focal point of major national and international biological and political debates regarding control, ownership, access, and erosion of critical resources. While these issues are key to environmental sustainability and food security, biodiversity and genetic resources must be seen in the broader context of their inextricable relationship to cultural diversity and to humans' view of nature. Nature is assumed to be constituted socially through a wide variety of human processes described collectively as culture. (...) Three significant cultural factors, technology, science, and capitalism, are largely responsible for the secularization and homogenization of food and agriculture and the remaking of nature. These processes and forces may simultaneously and unwittingly create the problems of declines in biodiversity, cultural diversity, and food equity. Indeed, it may well be that the only way to conserve cultural biodiversity in the field is to conserve cultural diversity among peoples. This reunification of biodiversity and cultural diversity and food and agriculture will require new paradigms and institutional mechanisms that allow us to show our care for each other through our reverence for nature. (shrink)

I Several years ago, when the Carter administration announced that it would support congressional action to end the public fund ing of abortions, the President was asked at a press conference whether he thought that such a policy was unfair; he responded, "Life is unfair." His remarks provoked a storm of controversy. For other than those who, for principled reasons, opposed abor tion on any grounds, it seemed that the President's comments were cruel, violating what was thought to be an (...) American com mitment to providing equal access to health services to all citi zens, regardless of their capacity to pay. Those sentiments had, in fact, been reflected in public opinion polls that had, for at least three decades, indicated that Americans supported the propo sition that the government should guarantee health care to all. Ultimately, those beliefs had been translated into the oft-ex 1 pressed political demand for a one-class system of health care. This commitment to equality is rather remarkable. American society evidences a striking willingness to tolerate vast inequal ities with regard to income and wealth. While it guarantees ed ucation to all children, there is not even a pretense that the children of the wealthy and the children of the poor ought to get precisely the same kind of schooling. While some commitment 'Hazel Erskine. "The Polls: Health Insurance," Public Opinion Quarterly, XXXIX (Spring, 1975), 128-143. (shrink)

Most of the estimated 855 million people in the world (one sixth of the population) without access to schooling are women and girls. Two thirds of the 110 million school age children not in school are girls (UNGEI, 2002). This injustice has been a focus of attempts at coordinated international policy interventions since the 1990s, sometimes loosely referred to as the Education for All (EFA) movement. The first of the millennium development targets - gender equity in education - (...) is supposed to be reached by 2005, but it is widely acknowledged that it will be missed. A number of different social theories underpin the EFA policies. By the late 1990s a widespread consensus was emerging that the concept of rights provided a fruitful theoretical, political and policy way forward on this issues. Policy documents and declarations took on a language of rights, which supplanted earlier ideas of basic needs and gender interests. In these documents rights appeared isomorphic with the more philosophically developed versions of basic needs and gender interests in the work on capabilities undertaken by Amartya Sen and Martha Nussbaum. (shrink)