Equitable System Research Articles

Ending Race-Conscious College Admissions and Its Potential Impact on the Infectious Disease Workforce.

On 29 June 2023, the Supreme Court of the United States ruled that race-conscious consideration for college admission is unconstitutional. We discuss the consequences of this ruling on the delivery of equitable care and health system readiness to combat current and emerging pandemics. We propose strategies to mitigate the negative impact of this ruling on diversifying the infectious disease (ID) workforce.

Strengthening primary health care in low- and middle-income countries: furthering structural changes in the post-pandemic era.

Strengthening primary health care (PHC) is the most cost-effective approach in low- and middle-income countries (LMICs) to achieve sustainable universal health coverage (UHC), protect against health shocks, and promote health and wellbeing for all people. It has been 45 years since PHC was put on the global agenda followed by multiple efforts to advocate for more funding and improved performance of PHC. Yet, investment in PHC is still insufficient and overall performance of PHC systems is weak in LMICs, resulting in increased vulnerability and poor health outcomes especially among marginalized populations. As countries recover from the COVID-19 pandemic, which exposed the fragility of PHC platforms, it is imperative to go beyond advocacy for PHC investments and make systemic changes to strengthen PHC as the foundation of resilient and equitable health systems. We propose five gamechangers to facilitate structural changes for strengthening PHC through a focused health systems approach: (i) integration of client-centered health services at PHC level; (ii) digitization of PHC services; (iii) efficiency gains invested in essential health services; (iv) strengthening management practices for PHC at district and facility levels; and (v) advancing community engagement for PHC. To be successful, the implementation of the gamechangers must be contextualized and focus on achieving sustainable health outcomes, and therefore use implementation approaches that link essential health services to health outcomes. Through this way countries will maximize the possibility of achieving UHC and attaining the ambitious health targets of the Sustainable Development Goals (SDGs) by 2030.

Criminal Law Reform to Increase the Effectiveness of the Justice System in Overcoming Crime

This study explores the imperative need for comprehensive criminal law reform to enhance the efficacy of the justice system in combating crime. As societies evolve, so do the complexities of criminal activities, necessitating a reevaluation of legal frameworks to address emerging challenges. The current legal landscape often proves inadequate in addressing the dynamic nature of criminal behavior, resulting in inefficiencies in crime prevention, investigation, and prosecution. The research investigates key areas of reform, including the modernization of outdated statutes, the incorporation of advanced technologies in crime detection and evidence gathering, and the implementation of evidence-based sentencing practices. By examining successful models from jurisdictions that have already undergone significant legal reforms, this study aims to identify best practices that can be adapted and integrated into existing legal systems. Furthermore, the research considers the socio-economic factors influencing criminal behavior, advocating for a holistic approach that combines legal reforms with social interventions. Such an approach seeks to address root causes of criminality, offering a more sustainable and effective strategy for crime reduction. Through a comprehensive analysis of existing legal frameworks, case studies, and sociological data, this study contributes valuable insights to the ongoing discourse on criminal justice reform. The findings aim to inform policymakers, legal practitioners, and the public, fostering a nuanced understanding of the multifaceted challenges associated with contemporary crime and the necessary steps for a more effective and equitable justice system.

Contexts for integrating classical music in vulnerable educational environments

Intersectional intervention on educational policies in 21st century society is noted as a viable alternative in disadvantaged educational settings. In this direction, a well-reasoned educational policy facilitates access to education and knowledge for a significant number of students. The vision of each teacher, and in general of an educator, must be aimed at comprehensive educational policies, consistent with educational ideals and the agreed school curriculum, the skills of each educator being evident in the way they can adapt and apply classical or modern educational strategies or concepts, capable of producing much needed change in the evolution and school performance of the beneficiaries of this social service. The involvement of music education in the formation of the modern pupil's personality can be the foundation on which to build an equitable and inclusive education system, providing pupils with valuable opportunities to develop cognitive, social and emotional skills.

Exploring settler-Indigenous engagement in food systems governance

Within food systems governance spaces, civil society organizations (CSOs) play important roles in addressing power structures and shaping decisions. In Canada, CSO food systems actors increasingly understand the importance of building relationships among settler and Indigenous peoples in their work. Efforts to make food systems more sustainable and just necessarily mean confronting the realities that most of what is known as Canada is unceded Indigenous territory, stolen land, land acquired through coercive means, and/or land bound by treaty between specific Indigenous groups and the Crown. CSOs that aim to build more equitable food systems must thus engage with the ongoing impacts of settler colonialism, learn/unlearn colonial histories, and build meaningful relationships with Indigenous peoples. This paper explores how settler-led CSOs engage with Indigenous communities and organizations in their food systems governance work. The research draws on 71 semi-structured interviews with CSO leaders engaged in food systems work from across Canada. Our analysis presents an illustrative snapshot of the complex and ongoing processes of settler-Indigenous engagement, where many settler-led CSOs aim to work more closely with Indigenous communities and organizations. However, participants also recognize that most existing engagements remain insufficient. We share CSOs’ practices, tensions, and lessons learned as reflections for scholars and practitioners interested in the continuous journey of building settler-Indigenous partnerships and reimagining more just and sustainable food systems, work which requires iterative and critically reflexive learning.

Effect of supplementary private health insurance on out-of-pocket inpatient medical expenditure: evidence from Malaysia.

The vital role of healthcare financing in achieving universal health coverage is indisputable. However, most countries, including Malaysia, face challenges in establishing an equitable and sustainable healthcare financing system due to escalating healthcare costs, an ageing population and a growing disease burden. With desirable pre-payment and risk pooling features, private health insurance (PHI) is considered an alternative financing option to reduce out-of-pocket (OOP) medical expenditure. However, ongoing theoretical and empirical debates persist regarding the adequacy of financial risk protection provided by PHI largely because it depends on its role, the benefit design and the regulations in place. Our study aimed to investigate the effect of supplementary PHI on OOP inpatient medical expenditure in Malaysia. Secondary data analysis was conducted using the Malaysian National Health and Morbidity Survey 2019 dataset. A total of 983 respondents with a history of inpatient hospitalization in the past 12 months were included in the study. Instrumental variable analysis using a two-stage residual inclusion was performed to address endogeneity bias, with wealth status and education level as the instrumental variables. Tobit regression model was used in the second stage considering the censored distribution of the outcome variable. Missing data were handled using multiple imputation. About one-fifth of the respondents had PHI. In this study, we found that having PHI significantly increased OOP inpatient medical expenditure in all three marginal effects. Additionally, age, residential location, ethnicity (citizenship), being covered by government guarantee letter, government funding and employer-sponsored health insurance were other significant factors associated with OOP inpatient medical expenditure. Our findings undermine a key justification to advocate PHI uptake among the population, with a need for the Malaysian government to reassess the role of PHI in healthcare financing and reconsider PHI subsidization policy. Regulations should also be strengthened to enhance the financial risk protection provided by PHI.

A review of advanced wastewater treatment technologies: USA vs. Africa

This research paper conducts a comprehensive comparative analysis of advanced wastewater treatment technologies in the USA and Africa, emphasizing infrastructure, regulatory frameworks, and socio-economic factors. The USA exhibits robust infrastructure, supportive regulations, and technological awareness, fostering the adoption of advanced solutions. In contrast, Africa faces limited resources and diverse regulatory landscapes. Affordability, accessibility, public awareness, and education are critical socio-economic factors influencing technology adoption. Prospects include innovations like AI integration and circular economy principles. Policy recommendations stress adaptive frameworks and international collaborations. The conclusion underscores the importance of inclusive strategies for global sustainable wastewater management, recognizing each region's unique socio-economic diversity. This research contributes valuable insights for policymakers, researchers, and practitioners working towards resilient and equitable wastewater treatment systems.

Data science in public health: A review of predictive analytics for disease control in the USA and Africa

This scholarly paper delves into the realm of data science in public health, with a specific focus on the transformative role of predictive analytics in disease control across the United States and Africa. Set against a backdrop of rapidly evolving healthcare challenges, the study aims to dissect and synthesize the advancements, applications, and hurdles associated with data-driven health strategies in these diverse geographical contexts. Employing a qualitative analysis of peer-reviewed literature, the paper meticulously examines the evolution of predictive analytics, comparing public health structures, and scrutinizing key diseases and health challenges prevalent in both regions. The scope of the study extends to exploring the ethical considerations and technological advancements in health data utilization, offering a panoramic view of the current and potential landscape of data science in public health. The findings reveal a significant surge in the application of predictive analytics, particularly in the USA for chronic disease management and in Africa for infectious disease control. The study highlights the successes and challenges in implementing data-driven health policies, emphasizing the need for a balanced approach that addresses technological, ethical, and cultural barriers. The future of AI and machine learning in disease control is identified as a promising domain, with potential for further innovation and integration into healthcare and public policy. Conclusively, the paper recommends continued investment in data science applications in public health, advocating for collaborative efforts to overcome implementation challenges and ethical considerations. The study underscores the transformative potential of data science in enhancing healthcare delivery, advocating for more effective, efficient, and equitable healthcare systems globally.

Developing countries' health policy: A critical review and pathway to effective healthcare systems

This paper provides a concise overview of a comprehensive review exploring the health policies of developing countries, critically assessing their strengths, weaknesses, and proposing pathways towards building effective healthcare systems. In developing countries, health policies play a pivotal role in determining the accessibility, quality, and equity of healthcare services. This critical review examines the current state of health policies in developing nations, acknowledging both achievements and shortcomings. The analysis encompasses key areas such as infrastructure, workforce capacity, disease prevention, and financial sustainability. The review identifies common challenges faced by developing countries, including limited financial resources, inadequate healthcare infrastructure, and disparities in healthcare access among different socio-economic groups. It also sheds light on successful strategies employed by certain nations, emphasizing the importance of community-based healthcare, technology integration, and innovative financing models. Moreover, the review critically assesses the effectiveness of existing health policies in addressing prevalent health issues, such as infectious diseases, maternal and child health, and the growing burden of non-communicable diseases. It delves into the role of governance, political will, and international collaborations in shaping and implementing health policies. In proposing a pathway to effective healthcare systems, the review emphasizes the need for tailored, context-specific approaches that consider the unique challenges of each developing country. It advocates for increased investment in primary healthcare, capacity-building for healthcare professionals, and the harnessing of digital technologies to enhance healthcare delivery. Ultimately, this critical review aims to inform policymakers, healthcare professionals, and stakeholders in developing countries, providing insights to shape evidence-based health policies that lead to resilient, accessible, and equitable healthcare systems. By learning from both successes and failures, these countries can pave the way for transformative changes in their health policies, ensuring the well-being of their populations and contributing to global health advancement.

Review of smart water management: IoT and AI in water and wastewater treatment

Integrating the Internet of Things (IoT) and Artificial Intelligence (AI) in smart water management revolutionizes sustainable water resource utilization. This comprehensive review explores these technologies' benefits, challenges, regulatory implications, and future trends. Smart water management enhances operational efficiency, predictive maintenance, and resource conservation while addressing data security and infrastructure investment challenges. Regulatory frameworks play a pivotal role in shaping the responsible deployment of AI and IoT, ensuring data privacy and ethical use. Future trends include advanced sensors, decentralized systems, quantum computing, and blockchain for enhanced water data security. The alignment with Sustainable Development Goals (SDGs) underscores the transformative potential of smart water management in achieving universal access to clean water, climate resilience, and inclusive, sustainable development. As we embrace these technologies, collaboration, public awareness, and ethical considerations will guide the evolution of intelligent and equitable water management systems.

Readiness Level of Bureaucratic Apparatus and its Impact on Online-Based Community Socio-Economic Development Program Services; Evidence from Tebing Tinggi City, Indonesia

Background: The online-based social-economic development program has emerged as a prevalent bureaucratic service model in Indonesia, particularly at the municipal government level. The model has not been consistent across all service units despite the implementation in several agencies providing bureaucratic service. Therefore, this research aims to analyze the factors affecting the readiness of the community and apparatus in the implementation of the online-based government bureaucracy service model. Method: The research with focus of research on the online-based government bureaucratic service system. This research uses descriptive and explanatory methods with a quantitative approach. Descriptive research is a study to describe in detail a particular phenomenon. Results: The results show that understanding, technology mastery, mental and moral guidance, formal and informal education, as well as material and non-material incentives have a positive and significant impact on the readiness of the community and apparatus in providing online-based bureaucracy service. Furthermore, online-based social-economic development program services can accelerate the role of the community and apparatus in developing urban areas. Conclusion: Tebing Tinggi City government and other similar city governments should focus and increase their attention to efforts to increase mastery of technology and moral development in the bureaucratic service apparatus, as well as build a performance-based equitable material incentive system. Improving the three aspects of apparatus readiness will encourage the realization of better community socio-economic development program services.

Exploring the Influence of Social Class and Sex on Self-Reported Health: Insights from a Representative Population-Based Study.

This study investigates the intricate interplay between social class, sex, and self-reported health (SRH) using data from the European Health Survey of Spain 2020 (EESE2020). Employing a cross-sectional design and a representative sample of 22,072 individuals, the analysis explores the persistence of disparities after adjusting for covariates, focusing on health-related variables. The study employs logistic regression models and directed acyclic graphs (DAGs) to delineate the direct effects of social class and sex on SRH, identifying a minimum adjustment set to control for confounding variables. Results reveal a gradient effect of social class on SRH, emphasizing the enduring impact of socioeconomic factors. Sex-based disparities in SRH diminish after considering additional health-related variables, highlighting the importance of a holistic approach. DAGs serve as transparent tools in disentangling complex relationships, guiding the identification of essential covariates. The study concludes that addressing health inequalities requires comprehensive strategies considering both individual health behaviours and socio-economic contexts. While recognizing limitations, such as the cross-sectional design, the findings contribute to a nuanced understanding of health disparities, informing evidence-based interventions and policies for a more equitable healthcare system.

Preconditions for efficiency and affordability in mixed health systems: are they fulfilled in the Australian public-private mix?

The Australian health system is characterised by high quality care by international standards, produced by a mix of public and private provision and funding of healthcare services. Despite good overall results, three issues are of concern. The first issue relates to the public procurement of healthcare, whose flaws have impacted individuals' access to care, and the high out-of-pocket spending. The second issue concerns the sustainability of the private health insurance market, given the government's goal of relieving cost and capacity from the public scheme, incentivising participation. Third, there are existing inefficiencies and inequities related to the duplication resulting from the interaction between public and private schemes. To ensure a sustainable, efficient and equitable health system, structural reforms are necessary to achieve long-term performance improvements. Using a framework for mixed public-private health systems, we assess the extent to which the Australian healthcare system achieves preconditions for efficiency and affordability in competitive healthcare markets.

Research on the Return of Chinese Migrant Workers Amid Economic Downturn

This research paper investigates the compelling trend of migrant workers in China returning to their hometowns for employment opportunities. Over recent years, this phenomenon has gained prominence due to various factors, including economic shifts, government policies, and evolving social dynamics. This paper analyzes the multifaceted factors driving this trend and highlights its socio-economic implications. The study employs data analysis to examine the number of migrant workers in different regions of China in 2019 and 2021, revealing the trend of workers returning to their home provinces for employment. It delves into the economic pressures pushing individuals towards their hometowns and the government policies aimed at enhancing rural welfare. Additionally, it explores the changing dynamics of urbanized cities, where the rising cost of living has prompted workers to seek opportunities closer to their roots. In conclusion, this research underscores the complexity of the phenomenon and emphasizes the need for collaborative efforts among policymakers, employers, and local communities. To create a more equitable and sustainable system, strategies must be devised, including the establishment of an equitable employment system, improvements in rural living standards, and the strengthening of organizational support for migrant workers. Understanding and addressing this trend is crucial for China's socio-economic development and the well-being of its workforce.

Enabling food system innovation: accelerators for change

It is widely accepted that current food systems are not on a trajectory for achieving the Sustainable Development Goals by the end of the decade. Technological innovation will have a considerable role to play in different parts of the food system; many promising options exist or are in the pipeline, some of which may be highly disruptive to existing value chains. Scaling up the innovations required, at the same time as protecting those who may lose out in the short term, will require a strong enabling environment. Here we apply an existing framework of eight change accelerators to six case studies of historical agricultural innovation. We estimated the degree to which each accelerator had been addressed at some stage in the innovation process, as a measure of the gap between what was needed and what was achieved. For the innovations that are being taken to scale and widely utilized, these accelerator gaps are small. Uptake of other innovations is stalled, and for these we found large gaps for one or more of the eight accelerators. Impactful innovation processes address all eight change accelerators at some point, with different phasing of the accelerators depending on the nature of the technology and on the impact pathway being pursued. This simple framework, when used in combination with narratives of uptake based on theories of change and impact pathways, may provide an effective means of screening future innovation processes to help prioritize and guide investment that can lead to more resilient, sustainable and equitable food systems.

Addressing inequities in medical care

Background: Health disparities and inequities persist globally, significantly affecting marginalized racial and ethnic groups. Medical institutions and educators must address these issues to foster a more equitable healthcare system. Aim: This chapter aims to explore the definitions and implications of health disparities and inequities, emphasizing the need for a comprehensive understanding in medical education to address these challenges effectively. Methods: The chapter reviews definitions from leading health organizations and examines case studies from various countries to highlight the impact of historical, structural, and social determinants of health (SDOH) on health outcomes. Methodologies for measuring these disparities, including quantitative and qualitative approaches, are discussed. Results: Health disparities often arise from systemic and institutional biases, with historical injustices like colonialism and slavery continuing to influence modern health outcomes. Case studies from the United States, Brazil, the United Kingdom, and the Netherlands illustrate ongoing inequities in maternal mortality and other health outcomes. Conclusion: Addressing health disparities requires an understanding of historical contexts, structural factors, and SDOH. Medical education must evolve to incorporate these elements to equip future healthcare professionals with the skills to combat these disparities effectively.

Fair funding for pupils with special educational needs and disability in England?

AbstractSchool funding formulas have been applied across a number of countries for at least the last 50 years. A national funding formula (NFF) was introduced in England in 2018 and aims to provide a platform for fair funding across the country. This study explores the variations in the NFF's high needs block (HNB) funding and examines links with the use of specialist provision by English local authorities (LAs) for children with special educational needs and disability. The findings demonstrate significant and continuing differences in HNB funding between demographically similar LAs, notwithstanding a £3.5 billion (75%) HNB increase in real terms in the decade since 2013, which could have supported a shift towards a more equitable position. Published HNB funding for 2023–24 now varies by up to £49m in comparator LAs. Differences are largely the result of the persistent use of a historical factor in the formula and a ceiling on levels of income growth for lower funded LAs. The research also shows a significant link between HNB funding and the use of specialist provision. The discussion investigates how far the UK government's policy commitment to a more equitable system of HNB funding is matched by the reality, and the degree to which funding is based on need rather than demand or history.

Parental Income's Impact on Student Participation in Lesson Activities for Equitable Educational Outcomes

Aims: This study aims to investigate the relationship between parental income and student participation in lesson activities among secondary schoolchildren in Sri Lanka. The primary objectives is identifying potential differences based on parental income levels, and providing valuable insights into the broader implications for educational equity. Study Design: Employing a survey and quantitative research design, this study gathers data from 1350 secondary school students. The research focuses on diverse aspects of student participation, including group work, discussions with teachers and family, experiments, practical activities, and interactions through social media. A Likert Scale with five response options is utilized to measure student engagement, offering a comprehensive view of their involvement. Place and Duration of Study: The study is conducted in secondary schools across Sri Lanka. Data collection spans a specified duration, ensuring a representative sample of participants. The diverse geographical and socio-economic landscape of Sri Lanka enriches the study's scope, allowing for a nuanced understanding of the interplay between parental income and student participation. Methodology: A stratified random sampling technique is employed to select 1350 participants, ensuring a diverse representation of secondary school students. The questionnaire, validated by experts in the sociology of education, comprises two sections: one gathering demographic information and the other assessing students' perceptions of their involvement in lesson activities. Descriptive and inferential statistics, facilitated by the Statistical Package for the Social Sciences (SPSS) Version 23, enable a comprehensive analysis of the data. Results: Descriptive analysis reveals a moderately high overall level of student participation in various lesson activities. Notably, group activities receive the highest mean value, indicating a strong positive correlation with student engagement. The multivariate analysis of variance (MANOVA) demonstrates significant differences based on parental income levels, with upper-middle-class students exhibiting higher participation than their peers from lower-income backgrounds. Conclusion: The study concludes by highlighting the crucial role of parental income in shaping students' educational experiences. Findings underscore the disparities in engagement levels, emphasizing the need for targeted interventions and policy initiatives to promote educational equity. Educators, policymakers, and parents are urged to consider these insights to foster a more inclusive and equitable educational system in Sri Lanka.

Impacts of the COVID-19 pandemic on food systems in Manitoba, Canada and ways forward for resilience: a scoping review

Various studies over the past 3 years have synthesized trends and impacts of the COVID-19 pandemic on Canada’s national food system. However, less research has characterized the effects of COVID-19 within regional and provincial food system contexts. This article presents results from a scoping review of peer-reviewed and grey literature published from March 2020 until end of March 2023 examining the impacts of the COVID-19 pandemic on food systems in the province of Manitoba, Canada. Findings are presented according to the categories of food security funding, policy, and programming; individual and household food security; and food systems. In each area we synthesize key findings and discuss their significance in relation to existing food systems scholarship and national trends. Using review results, we propose priority areas for research and practice to support equitable and resilient food systems in Manitoba, including: (1) undertaking evaluation of food system policies, programs, and funding implemented during the pandemic (2) enhancing food security monitoring for vulnerable populations (3) further exploring community experiences and responses to food security, and (4) examining opportunities for local food systems development.

Progress towards a more sustainable and equitable food system in Brazil?

Introduction: Brazil’s agri-food sector, traditionally being a low productivity sector, has evolved towards significant investment in technology-driven large-scale agribusiness, making Brazil a major food exporter. An increase in intensive large-scale agriculture production, while benefiting Brazil’s economy and export revenues, has also resulted in significant social and environmental externalities. With the aim to improve food security and more equitable access to food, Brazil’s federal government has intervened with a range of policies and initiatives to eliminate hunger and incentivize more sustainable practices for improved environmental outcomes. Objective: The paper provides an overview of the agri-food policy landscape, and policy innovations since the early 2000s intending to drive a transition towards a more sustainable and equitable agri-food system. Results and Discussion: It also highlights the challenges in implementing policies and programmes in the context of Brazil’s agrarian structures, vested interests and political conflicts surrounding the allocation of public assets. Successful implementation will require further innovation, collaboration and inclusive partnerships to foster food system transformation pathways towards the achievement of the Sustainable Development Goals.