Equity Considerations Research Articles

Measuring multi-activities accessibility and equity with accessibility-oriented development strategies

Accessibility-oriented development (AOD) strategies are the extension of transit-oriented development (TOD) strategies but focus more on access to destinations. Adopting AOD strategies can help identify and improve the defects of imperfect TOD construction. Based on AOD strategies, this paper evaluated the comprehensive accessibility to multiple public facilities with the Gaussian-based two-step floating catchment area method (G2SFCA) in the heart area of Chengdu City and further analyzed its equity issues. The comprehensive accessibility analysis proved the efficiency of AOD-based analysis in public resources shortage area determination and TOD level evaluation. The equity analysis indicated that the improvement of equity could not reflect the progress on total accessibility but only rationalize the allocation structure of public resources. Based on the case study, several suggestions for policy-making are given, including the construction of the non-motorized transportation system, adjustment of supply allocation, and comprehensive consideration of equity and accessibility in urban planning.

Economic Evaluations and Equity in the Use of Artificial Intelligence in Imaging Exams for Medical Diagnosis in People With Skin, Neurological, and Pulmonary Diseases: Protocol for a Systematic Review.

Traditional health care systems face long-standing challenges, including patient diversity, geographical disparities, and financial constraints. The emergence of artificial intelligence (AI) in health care offers solutions to these challenges. AI, a multidisciplinary field, enhances clinical decision-making. However, imbalanced AI models may enhance health disparities. This systematic review aims to investigate the economic performance and equity impact of AI in diagnostic imaging for skin, neurological, and pulmonary diseases. The research question is "To what extent does the use of AI in imaging exams for diagnosing skin, neurological, and pulmonary diseases result in improved economic outcomes, and does it promote equity in health care systems?" The study is a systematic review of economic and equity evaluations following PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) and CHEERS (Consolidated Health Economic Evaluation Reporting Standards) guidelines. Eligibility criteria include articles reporting on economic evaluations or equity considerations related to AI-based diagnostic imaging for specified diseases. Data will be collected from PubMed, Embase, Scopus, Web of Science, and reference lists. Data quality and transferability will be assessed according to CHEC (Consensus on Health Economic Criteria), EPHPP (Effective Public Health Practice Project), and Welte checklists. This systematic review began in March 2023. The literature search identified 9,526 publications and, after full-text screening, 9 publications were included in the study. We plan to submit a manuscript to a peer-reviewed journal once it is finalized, with an expected completion date in January 2024. AI in diagnostic imaging offers potential benefits but also raises concerns about equity and economic impact. Bias in algorithms and disparities in access may hinder equitable outcomes. Evaluating the economic viability of AI applications is essential for resource allocation and affordability. Policy makers and health care stakeholders can benefit from this review's insights to make informed decisions. Limitations, including study variability and publication bias, will be considered in the analysis. This systematic review will provide valuable insights into the economic and equity implications of AI in diagnostic imaging. It aims to inform evidence-based decision-making and contribute to more efficient and equitable health care systems. DERR1-10.2196/48544.

Advancing the Science and Application of Implementation Science to Promote Health Equity: Commentary on the Symposium.

There has been an increasing focus on making health equity a more explicit and foundational aspect of the research being conducted in public health and implementation science. This commentary provides an overview of five reviews in this Annual Review of Public Health symposium on Implementation Science and Health Equity. These articles reflect on and advance the application of core implementation science principles and concepts, with a focus on promoting health equity across a diverse range of public health and health care settings. Taken together, the symposium articles highlight critical conceptual, methodological, and empirical advances in the study designs, frameworks, and approaches that can help address equity considerations in the use of implementation science in both domestic and global contexts. Finally, this commentary highlights how work featured in this symposium can help inform future directions for rapidly taking public health to scale, particularly among systemically marginalized populations and communities.

AGE-FRIENDLY CITIES AND COMMUNITIES: RESEARCH ON LOCAL PRACTICE TO STRENGTHEN THE MOVEMENT’S FUTURE

Abstract The age-friendly cities and communities (AFCC) movement has accelerated a major paradigmatic shift for the field of aging in the 21st century. Launched and spurred by high-profile government agencies and organizations across the globe, this ambitious movement highlights the transformative potential of deliberate, cross-sectoral efforts to improve built, social, and service environments of localities in response to population aging. This presentation will provide a brief overview of the development of a global program of policy and practice on AFCCs, with an emphasis on its emergence in the United States. It will then present insights regarding challenges and opportunities for the future based on findings from an ongoing, longitudinal study of a regional network of AFCC initiatives. The study, designed as a developmental evaluation, explores the perspectives of on-the-ground AFCC leaders on their practice as part of a private philanthropic grantmaking initiative to spur AFCCs in New Jersey. Reflecting on our years of engaged research with this network, the presentation will highlight issues concerning multi-level systems alignment, the promises and pitfalls of public sector leadership, the need for additional practice theories, and greater incorporation of considerations of aging equity and racial justice. The presentation will demonstrate the importance of continuing to leverage the strengths of community-engaged research to better ensure the movement’s relevance, reach, and equitable impact across diverse community, organizational, and broader systems contexts.

Early Intervention Programs for Adolescents and Young Adults With Eating Disorders

What Is the Problem? How Might Early Intervention Help Fix the Problem?
 
 The number of adolescents and young adults living with eating disorders is on the rise. This increase was especially noticeable during the height of the COVID-19 pandemic, with more than a 50% increase in the number of young women being hospitalized with an eating disorder.
 Early intervention programs are those delivered by community or health care–based organizations that offer interventions to treat adolescents and young adults living with eating disorders within the first 3 years of diagnosable disorder, with the intention of providing earlier access and preventing disease progression.
 
 What Did We Do?
 
 Advisors with lived experience of eating disorders shared their perspectives and priorities to help reviewers contextualize the evidence and interpret the findings in the literature. Advisors highlighted their treatment experiences and priorities for early intervention, highlighting equity considerations and challenges.
 We conducted a literature search to identify, gather, synthesize, and summarize relevant evidence to inform our understanding of the clinical effectiveness and clinical harms of early intervention programs.
 A search of the economic literature was conducted to identify economic evaluations of early intervention programs to treat adolescents and young adults living with eating disorders. Based on an assessment of the clinical evidence, the uncertainty and heterogeneity of the information precluded a de novo cost-effectiveness analysis (CEA). As such, a narrative summary of the health care resources required to implement an early intervention program for adolescents and young adults living with eating disorders was conducted.
 
 What Did We Find?
 
 Advisors with lived experience of eating disorders described a need for greater access to specialized services focused on eating disorder treatment, equity, capacity building, and culture change. Specific treatment approaches mentioned included family-based treatment, cognitive behavioural therapy, peer support, and group therapy.
 We identified 14 studies related to the clinical effectiveness of early intervention programs. We did not identify any studies evaluating clinical harms.
 The findings from included studies suggest that earlier engagement and access to eating disorder support could have clinical benefits; however, interpretation of these findings are uncertain due to various factors.
 No evidence was identified in the search for information on the cost-effectiveness of early intervention programs for the treatment of adolescents and young adults living with an eating disorder.
 The resources needed to run early intervention programs (or other similar interventional programs) to treat eating disorders may include administration, staffing, training, IT support and infrastructure, and other overhead costs related to the location in which the service is provided.
 
 What Does This Mean?
 
 The clinical evidence suggests that investment of health care resources into early intervention programs shows potential for overall benefit and may help address challenges with access to treatment, which was identified as an issue by those with lived experience.
 The human and financial resources required to implement early intervention programs will vary depending on the treatment options and treatment frequency chosen.
 The demands on an already limited pool of specialized health care resources in eating disorder care are important considerations when choosing whether to implement any new eating disorder treatment programs. Training and recruiting of specialized health care providers will be a key implementation consideration for any new early intervention program for the treatment of eating disorders.
 Further consultation with a diverse group of adolescents and young adults with lived experience with eating disorders might be beneficial to inform implementation of early intervention programs within the Canadian context.

A global comparative analysis of the criteria and equity considerations included in eighty-six national COVID-19 plans

Systematic priority setting (PS), based on explicit criteria, is thought to improve the quality and consistency of the PS decisions. Among the PS criteria, there is increased focus on the importance of equity considerations and vulnerable populations. This paper discusses the PS criteria that were included in the national COVID-19 pandemic plans, with specific focus on equity and on the vulnerable populations considered. Secondary synthesis of data, from a global comparative study that examined the degree to which the COVID-19 plans included PS, was conducted. Only 32 % of the plans identified explicit criteria. Severity of the disease and/or disease burden were the commonly mentioned criteria. With regards to equity considerations and prioritizing vulnerable populations, 22 countries identified people with co-morbidities others mentioned children, women etc. Low social-economic status and internally displaced population were not identified in any of the reviewed national plans. The limited inclusion of explicit criteria and equity considerations highlight a need for policy makers, in all contexts, to consider instituting and equipping PS institutions who can engage diverse stakeholders in identifying the relevant PS criteria during the post pandemic period. While vulnerability will vary with the type of health emergency- awareness of this and having mechanisms for identifying and prioritizing the most vulnerable will support equitable pandemic responses.

PP07 Vaccine Decision-making In Canada: Processes And Guidelines For Using Economic Evidence

IntroductionCanada’s National Advisory Committee on Immunization (NACI) makes recommendations on the use of human vaccines. Provinces and territories subsequently use the advice to make decisions on public funding and program implementation. Traditionally, NACI reviewed vaccine characteristics and burden of illness.With its recent expanded mandate, NACI now considers cost-effectiveness via economic evaluations, among other decision determinants. As such, new processes and guidelines were needed to formalize the incorporation of economic evidence into federal vaccine decision-making.MethodsTwo task groups were convened respectively to develop NACI’s “Economic Process” and “Guidelines for the Economic Evaluation of Vaccination Programs in Canada”. The groups conducted environmental scans to inform their work, as well as engaged with government partners, decision-makers, academics, national immunization technical advisory groups from other countries, health technology assessment agencies, industry, patient groups, among others.ResultsThe Economic Process outlines when and how NACI incorporates economic evidence for vaccine recommendation. For instance, it describes how policy questions are prioritized given institutional capacity constraints for generating economic evidence. It also describes how policy questions are assessed to determine the appropriate type of economic evidence required (i.e., systematic review, economic evaluation, multi-model comparison of external models).The Economic Guidelines provide recommendations in 15 chapters on how to conduct economic evaluations (i.e., from defining the decision problem to reporting). Unlike other health technologies, vaccines have the potential to affect both vaccinated and unvaccinated individuals. Hence, the Guidelines consider population-level impacts such as externalities (e.g., herd immunity, age-shifting of disease) and spillover effects. They also discuss equity considerations and non-health impacts of vaccines such as to productivity, consumption and education.ConclusionsThe Economic Process and Economic Guidelines promote the generation and use of credible and standardized economic evidence. They advocate for transparency, allowing evidence to be used across jurisdictions beyond Canada. Next steps include documentation of user feedback, incorporation of Indigenous considerations, and formal evaluations.

HPR15 Review and Evaluation of Health Equity Considerations in Health Technology Assessments in Cystic Fibrosis

HPR15 Review and Evaluation of Health Equity Considerations in Health Technology Assessments in Cystic Fibrosis

Health equity consideration in cochrane systematic reviews and their primary studies about add-on therapy for refractory focal epilepsy treatment

Health equity consideration in cochrane systematic reviews and their primary studies about add-on therapy for refractory focal epilepsy treatment

Machine Learning and Artificial Intelligence Applications to Epilepsy: a Review for the Practicing Epileptologist.

Machine Learning (ML) and Artificial Intelligence (AI) are data-driven techniques to translate raw data into applicable and interpretable insights that can assist in clinical decision making. Some of these tools have extremely promising initial results, earning both great excitement and creating hype. This non-technical article reviews recent developments in ML/AI in epilepsy to assist the current practicing epileptologist in understanding both the benefits and limitations of integrating ML/AI tools into their clinical practice. ML/AI tools have been developed to assist clinicians in almost every clinical decision including (1) predicting future epilepsy in people at risk, (2) detecting and monitoring for seizures, (3) differentiating epilepsy from mimics, (4) using data to improve neuroanatomic localization and lateralization, and (5) tracking and predicting response to medical and surgical treatments. We also discuss practical, ethical, and equity considerations in the development and application of ML/AI tools including chatbots based on Large Language Models (e.g., ChatGPT). ML/AI tools will change how clinical medicine is practiced, but, with rare exceptions, the transferability to other centers, effectiveness, and safety of these approaches have not yet been established rigorously. In the future, ML/AI will not replace epileptologists, but epileptologists with ML/AI will replace epileptologists without ML/AI.

Employing Mixed-Methods Citation Analysis to Investigate Transnational Influence in Evaluation Theory

Mixed-methods citation analysis can be used to conduct research on evaluation (RoE) studies with a cross-country focus. In particular, this RoE study employs mixed-methods citation analysis to investigate the influence of an evaluation theorist’s concepts transnationally. We use Jennifer Greene’s program evaluation theories as a case example for observing the imprint of a theorists’ concepts on evaluators theorizing and practicing outside of the United States. Conducting this case analysis highlights the methodological affordances and shortcomings of citation analysis. The article addresses equity and diversity considerations in using citation analysis, particularly for investigating multidirectional transnational influences in evaluation theory.

Revision of Malawi’s Health Benefits Package: A Critical Analysis of Policy Formulation and Implementation

ObjectivesHealth benefits packages (HBPs), which define specific health services that can be offered for free or at a reduced cost to fit within public revenues, have been recommended for over 30 years to maximize population health in resource-limited settings. However, there remain gaps in defining and operationalizing HBPs. We propose a combination of design and prioritization methods along with practical strategies to improve the implementation of future iterations of the HBP in Malawi. MethodsFor HBP development for Malawi’s Third Health Sector Strategic Plan, we combined cost-effectiveness analysis with a quantitative, consultative multicriteria decision analysis. Throughout the process of development, we documented challenges and opportunities to improve HBP design and application. ResultsThe primary and secondary HBP included 115 interventions. However, the definition of an HBP is just one step toward focusing limited resources, with functional operationalization as the most critical component. Full implementation of previous HBPs has been limited by challenges in aid coordination with the misalignment of nonfungible vertical donor funding for the HBP without accounting for the complexity and interconnectedness of the health system. Opportunities for improved application include creation of a complementary minimum health service package to guide overall resource inputs through an integrative approach. ConclusionsWe believe that expanded participatory HBP methods that consider value, equity, and social considerations, along with a shift to providing integrated health service packages at all levels of care, will improve the efficiency of using scarce resources along the journey to universal health coverage.

THE INTERSECTION OF TECHNOLOGY AND SOCIAL SERVICE: CURRENT TRENDS, CHALLENGES, AND OPPORTUNITIES

This research paper explores the dynamic relationship between technology and social service, shedding light on current trends, challenges, and opportunities in this rapidly evolving field. As technology continues to transform the way society operates, the social service sector is no exception. This paper provides an in-depth analysis of how technology is being leveraged to enhance social services, with a focus on key trends, including the adoption of artificial intelligence, the growth of telehealth, and the impact of data analytics on decision-making in social service organizations. It also delves into the ethical and equity considerations associated with these technological advancements.

Ovarian Cancer: From Precursor Lesion Identification to Population-Based Prevention Programs.

Epithelial ovarian cancer (EOC) is a heterogeneous group of malignancies, including high-grade serous ovarian cancer (HGSC). HGSC is often diagnosed at advanced stages and is linked to TP53 variants. While BRCA variants elevate risk, most HGSC cases occur in individuals without known genetic variants, necessitating prevention strategies for people without known high-risk genetic variants. Effective prevention programs are also needed due to the lack of traditional screening options. An emerging primary prevention strategy is opportunistic salpingectomy, which involves removing fallopian tubes during another planned pelvic surgery. Opportunistic salpingectomy offers a safe and cost-effective preventative option that is gaining global adoption. With the publication of the first cohort study of patients who underwent salpingectomy, specifically for cancer prevention, attention has turned to broadening opportunities for salpingectomy in addition to more targeted approaches. Prevention opportunities are promising with increasing adoption of salpingectomy and the increased understanding of the etiology of the distinct histotypes of ovarian cancer. Yet, further research on targeted risk-reducing salpingectomy with thoughtful consideration of equity is necessary to reduce death and suffering from ovarian cancer.

Is the Use of DALYs and QALYs Ethically Permissible in Triage Decisions? COVID-19 and Equity Considerations from a Queer-Crip Perspective

This paper explores the symbolic and material implications of the use of DALYs and QALYs as priority or tie-breaker criteria in triage decisions. It aims to answer the question of their ethical permissibility based on the particular case of the COVID-19 pandemic. For this purpose, theories framed in a queer-crip perspective and ethical frameworks of equity will be used. From a queer-crip perspective, the use of DALYs and QALYs in triage decisions discriminates against and excludes people with disabilities, as it allocates scarce resources based on ableist value judgments about people's quality of life, rather than on evidence. From the point of view of equity, it may imply and reinforce structural injustices involving inequities, that is, avoidable or remediable inequalities. This analysis will argue that the use of DALYs and QALYs categories in triage decisions allocates potentially life-saving resources based on ableist value judgments that lead to an unfair distribution of risks, burdens, and costs. Finally, two objections related to the relevance or necessity of using these or similar categories as criteria will be addressed: the independent cases of structural inequities and the inevitability of setting priorities in the face of a crisis.

Looking ahead: ethical and social challenges of somatic gene therapy for sickle cell disease in Africa.

Somatic gene therapy will be one of the most exciting practices of genetic medicine in Africa and is primed to offer a "new life" for persons living with sickle cell disease (SCD). Recently, successful gene therapy trials for SCD in the USA have sparked a ray of hope within the SCD community in Africa. However, the high cost, estimated to exceed 1.5 million USD, continues to be a major concern for many stakeholders. While affordability is a key global health equity consideration, it is equally important to reflect on other ethical, legal and social issues (ELSIs) that may impact the responsible implementation of gene therapy for SCD in Africa. These include informed consent comprehension, risk of therapeutic misestimation and optimistic bias; priorities for SCD therapy trials; dearth of ethical and regulatory oversight for gene therapy in many African countries; identifying a favourable risk-benefit ratio; criteria for the selection of trial participants; decisional conflict in consent; standards of care; bounded justice; and genetic tourism. Given these ELSIs, we suggest that researchers, pharma, funders, global health agencies, ethics committees, science councils and SCD patient support/advocacy groups shouldwork together to co-develop: (1) patient-centric governance for gene therapy in Africa, (2) public engagement and education materials, and (3) decision making toolkits for trial participants. It is also critical to establish harmonised ethicaland regulatory frameworks for gene therapy in Africa, and for global health agencies to accelerate access to basic care for SCD in Africa, while simultaneously strengthening capacity for gene therapy.

Mountain Biking Tourism Impacts in Rural Michigan

Summary Mountain biking and mountain biking tourism are on the rise. With this increase comes the potential for increased impacts, especially in rural communities promoting their mountain biking trail systems. We present the case of two such trails in Michigan, USA – The Dragon Trail and the DTE Energy Foundation Trail – to exemplify how trail and community managers discuss two areas of tourism impacts and their intersections: economics and equity. Major highlights include economic phrasings of immediate direct impacts and more diffuse community impacts; specifically, equity considerations of barriers to access and representation and safety, and their intersection when discussing local as well as tourist use of these trails. This case serves as insight for communities considering developing mountain biking tourism amenities and identities, as well as how the discussion on impacts may vary across contexts. Information © The Authors 2023

Exploring VR Games for Enhancing Reading Fluency for Students with Reading Disabilities

Virtual reality (VR) has transformed education by providing an immersive and interactive learning experience. This paper explores the introduction of VR games in education, with a focus on supporting students with dyslexia and hyperlexia. It discusses the importance of understanding reading skills and reading disabilities and highlights the current strategies employed by middle school teachers to address these needs. The potential of VR to enhance reading skills and literacy development is then explored, emphasizing the benefits of personalized and targeted interventions. The paper further delves into the design considerations for effective VR-based educational games and simulations that enhance students' reading skills, including interactivity, immersion, and adaptive challenges. Practical considerations, ethical and equity considerations, as well as future directions and emerging trends in this educational game, are also discussed. By leveraging VR technology, educators are more likely to create inclusive and impactful learning experiences that enhance reading skills and foster a love for reading among students.

Copyright levies and cloud storage: Ex-ante policy evaluation with a field experiment

Private copying exceptions in copyright law allow individuals to make personal copies without infringing on rights. Copyright levies aim to compensate rightsholders for resulting harm by making devices that enable copying subject to a surcharge. Notwithstanding that the welfare effects of levy schemes remain poorly understood, adaptations are frequently debated. This paper provides an ex-ante evaluation of a policy that would include cloud storage services in the copyright levy system. I study whether the benefits for rightsholders of a levy in the cloud can outweigh its costs for consumers and cloud providers in a static setting. Using a large-scale experiment, I estimate the demand function for cloud storage and quantify welfare changes of various counterfactual policies. I develop a method to determine the level of economic harm caused by private copies in cloud storage, which can be informative for practice. The results show that any realistic copyright levy on cloud storage would be welfare-decreasing. I discuss potential dynamic effects and considerations of efficiency versus equity.

Emergency Department Overcrowding: An Environmental Scan of Contributing Factors and a Summary of Systematic Review Evidence on Interventions


 Emergency department (ED) overcrowding occurs when the demand for health services in the ED exceeds the capacity of the ED, hospital, or community to deliver quality care in a reasonable amount of time. Overcrowding is worsening in jurisdictions across Canada and there is a need to address its many causes and identify potential solutions.
 This report uses a modified version of a conceptual model developed by Asplin et al. (2003) that organizes the emergency care system into 3 interdependent parts: input (arrival to the ED), throughput (flowing through the ED), and output (leaving the ED). We also examined an additional fourth part related to contextual factors and systems that affect overcrowding but lay outside of input, throughout, and output.
 
 Examples of factors include, but are not limited to, increased complexity of needs (input), diagnostic testing and procedures (throughput), boarding (output), and limited resources for mental health and substance use (outside the ED).
 Examples of interventions that were effective in some settings include, but are not limited to, prehospital decision-making by first responders, which reduced ED visits (input); short stay crisis units for people experiencing mental health challenges, which improved emergency department length of stay, wait times, boarding, and patient safety (throughput); ED-based discharge planning, which reduced ED return visits (output); and time-based policy reforms, which reduced ED length of stay (outside the ED).
 
 
 Most of the factors we identified in the published literature existed either outside of the ED or at the interface of the ED and other health care services (input and output), whereas most of the interventions we identified existed within the ED (throughput).
 We heard from participants (during multistakeholder dialogue sessions) and content experts that ED overcrowding is a complex health system issue for which the causes, impacts, and solutions extend beyond the ED. Specifically, the novel insights we heard included:
 
 ED overcrowding is better viewed as a problem of hospital overcrowding and strained resources in the broader social and health care systems. Contributing factors both within and outside the ED influence and interact with each other and are affected by economic, cultural, and institutional realities.
 Solving the issue requires addressing accountability and implementing multifaceted solutions in which several systems and voices work collaboratively.
 Existing technologies and data use and collection are not being used to their full potential; they can be better leveraged to alleviate this issue.
 
 
 In the identified literature, there was a lack of explicit reporting around equity and ethical considerations for factors contributing to, and interventions to alleviate, ED overcrowding. Future work should strive to deliberately and explicitly include ethical considerations inherent in research, planning, and policy-making; considerations of equity-deserving groups; and dedicate the time needed to consider the various facets of this issue.
 This CADTH report and our series of reports on ED overcrowding are a starting point to bridge the literature, stakeholder discussion, and expert opinion to help decision-makers understand the various parts of the issue and consult the relevant updated evidence to inform their work.