Equity Agenda Research Articles

Critical Chinese as an Additional Language education in Australia: A journey to voices, courage and hope

This article addresses key topics of Chinese as an Additional Language (CAL) education and classroom pedagogical practices. It reports on a 3‐year ethnographic study within Australian schools to discuss dialogic pedagogical practices and students’ aspirations. Based on Freire’s conceptualisation of conscientização and banking education, the purpose of this article is therefore to unpack a journey to voices, courage and hope of a cohort of socially, linguistically and economically disadvantaged students in Western Sydney, one of the most culturally diverse regions in the country. Their experiences, responses, dreams and understanding of CAL education in multicultural Australia were thus captured. Our data shows that critical CAL education might point to some avenues for the educational equity agenda. By arguing that emancipatory and critical practices could enhance students to achieve consciousness and collective self‐transformation, we aim to make a contribution to the literature on CAL and languages education, which all too often isolates from broader issues in educational theory. The article also adds to the limited research that engages with CAL classroom data. Our critical approach to CAL education illuminates the intersections between language and social inclusion. Considering the worldwide growing upheaval and scepticism around CAL education, we call for writing inclusive languages education and related pedagogical practices into the social inclusion agenda in Australia and internationally, for the teaching and learning of all additional languages.

Informing the GRADE evidence to decision process with health equity considerations: demonstration from the Canadian rheumatoid arthritis care context

ObjectivesHealth equity is a priority for clinical and public health practice and promoted in GRADE's Evidence to Decision (EtD) Framework, yet there is still limited integration of specific equity considerations in chronic disease guideline development and implementation. Our objective was to embed equity considerations for upcoming Canadian Rheumatoid Arthritis treatment guidelines. Study Design and SettingIn parallel with the Guidelines Committee process, considerations for six population groups (rural and remote residents, Indigenous Peoples, elderly persons with frailty, minority populations of first-generation immigrants and refugees, persons with low socioeconomic status or who are vulnerably housed, and sex and gender populations) based on literature reviews and key informant interviews were identified and contextualized to each step in the GRADE EtD framework. ResultsThe EtD Framework domains relevant to rheumatoid arthritis treatment and management were analyzed through patient-centric, social determinant and economic lenses, while considering implementation feasibility. This determined tailored considerations relevant to recommendations for the priority populations to mitigate potential intervention-generated inequities. ConclusionThis approach provides a demonstration of the process of incorporating equity in the evidence to decision process and can be applied in future rheumatic disease guidelines while also informing a research agenda for equity in rheumatology outcomes.

First, Do No Harm: From Diversity and Inclusion to Equity and Anti-racism in Interpersonal Violence Research and Scholarship.

This article aims to support interpersonal violence (IPV) researchers in promoting diversity and inclusion in their research and scholarship and urges the IPV field to advance a racial equity, anti-oppressive, and justice-driven research agenda. The article discusses a range of factors to consider at each stage of the research process as researchers seek to be inclusive, responsive to diversity concerns, and seek equity. The researcher's perspective and positionality are discussed and the importance of critical self-examination of one's position in relation to the research is emphasized. Participatory and collaborative research processes are recommended, to engage with community partners, strengthen the validity of the findings, and help ensure that the research benefits the participants. Examples illustrate ways researchers might support diversity and inclusion with respect to sampling and measurement, cultural validity, and the conceptualization and operationalization of race. Recommendations are offered to promote diversity, equity, and inclusion when analyzing data, interpreting results, and writing up the study. The importance of a strengths-based approach and structural level analysis is emphasized. This article goes beyond discussion of the minimum, "do no harm" standard that researchers should meet in attending to diversity and inclusion in research and urges the pursuit of equity, anti-racism, and justice toward dismantling those structures that perpetuate violence in its many forms. Researchers are encouraged to ask themselves: Where would I situate my research? Is it racist, not racist, or anti-racist? Not all IPV research has the goal of dismantling inequities, but we should aspire that it do so.

Evaluation for equity: reclaiming evaluation by striving towards counter-hegemonic democratic practices

ABSTRACT Formal evaluation of policies, programmes and people has become ubiquitous in contemporary western contexts. This is the case for equity and widening participation (WP) agendas in higher education, for which evaluation is often required to measure ‘what works’. Although evaluation has a ‘fundamentally social, political, and value-oriented character’ (Guba and Lincoln. 1989. Fourth Generation Evaluation. Newbury Park, CA: Sage, 7), an experimental approach, situated within hegemonic positivist epistemologies, has tended to prevail. In this paper, we argue that it is misguided to pursue evaluation with an apolitical pretext of independence and objectivity. Drawing on Butler’s concept of performativity, we explore how hegemonic anti-democratic evaluation practices can potentially re-inscribe and reproduce the very inequalities that WP seeks to address. By critiquing the technologies of evaluation, we lay out one way of understanding how democratic evaluation practices can reclaim evaluation to make possible more diverse and socially just worlds.

Seeing Isn’t Always Believing: Gender, Academic STEM, and Women Scientists’ Perceptions of Career Opportunities

Studies about women’s underrepresentation in the U.S. science, technology, engineering, and mathematics (STEM) academic workforce have flourished in the past decade. Much of this research focuses on institutionalized gender barriers and implicit biases, consistent with theorizing about how work organizations disproportionately benefit men, white people, and other systemically advantaged groups. But to what extent do faculty most likely disadvantaged by systematic inequities actually perceive “barriers” to equity in the context of their own work lives? What might the repercussions associated with variation in perceptions about inequity be, especially within institutions of higher education actively pursuing equity agendas under such programs as the National Science Foundation’s ADVANCE program? Using interview data from 53 STEM women faculty working at a university that received a 5-year NSF ADVANCE IT award, we examine the range of views held among women scientists about the extent to which opportunity and success are a function of meritocratic versus nonmeritocratic processes. Findings show that almost a third of participants held the view that opportunities and advancement are primarily a function of meritocratic processes. We discuss implications of these findings for broader institutional efforts to reduce inequities in academic STEM.

An Implementation Research Approach to Re-orient Health Supply Chains Toward an Equity Agenda in the COVID-19 Era.

The Covid-19 pandemic has exposed critical inequities in global healthcare supply chains and the need for these systems to be analyzed and reoriented with an equity lens. Implementation research methodology can guide the use of evidence-based interventions to re-orient health supply chains towards equity and optimize health outcomes. Using this approach, private and public sector entities can adapt their strategies to focus not just on efficiency and cost savings but ensuring that vulnerable populations have access to essential medications, vaccines, and supplies. Findings can inform regulations that address supply chain inequities at the global level, strengthen existing systems to fill structural gaps at the national level, and address contextual challenges at the subnational level. This methodology can help account for historical practices from prior health initiatives, identify contemporary barriers and facilitators for positive change, and have applicability to the Covid-19 pandemic and ongoing vaccine distribution efforts. An implementation research approach is critical in equipping health supply chains with a path for more resilient and equitable distribution of necessary supplies, vaccines, and delivery of care.

A losing battle? Women’s sport pre- and post-COVID-19

ABSTRACT Research question In 2019, women’s sport was reported as being on the rise. Increased participation rates, media coverage, investment and support were evident. Following the spread of COVID-19 across the globe, which halted most forms of competitive sport, there were repeated concerns about the future of women’s sport. This research aims to document elite sportswomen’s perceptions of the state of women’s sport pre-COVID-19 and the possible impact moving forwards. Research methods Ninety five responses from an online, anonymous, qualitative questionnaire completed by elite sportswomen mainly based, in the UK, on the impact of COVID-19 on women’s sport were collected. Data were subject to a thematic analysis, to determine key concerns, and the frequency data of responses were quantitatively recorded. Results and findings Most sportswomen felt that women’s sport was on an upward trajectory, but many juxtaposed that against inequality compared to men’s sport in terms of media coverage and finance. There were concerns that the subordinate position women’s sport, with less resources and support, will have severe implications post-COVID-19. However, there were considerations that a pause in sport would allow for personal development, increased participation upon sports return and space for a reconfiguration of sport. Implications Those involved in sport are encouraged to think more critically about progress narratives in women’s sport. We caution that these hide perpetual, structural and symbolic inequalities and propose that they are positioned more coherently within wider gender equity agenda. This is a process that will require widespread cultural change.

Health equity and health system strengthening – Time for a WHO re-think

ABSTRACT The pursuit of health equity is foundational to the global health enterprise. But while moral concerns over health inequities can galvanise political commitment, how such concerns can or should translate into practice remains less clear. This paper reviews evolving ways that equity goals have featured in key World Health Organization (WHO)-related policy documents, before discussing the heuristic value and empirical traction that the concept of equity can bring to the health system strengthening (HSS) agenda. We argue that while health equity is often presented as the overarching goal of HSS, in practice this is typically circumscribed to the provision of healthcare services. Although healthcare equity is important, we suggest that this narrow focus risks losing sight of the structural political, social and economic drivers of health and health inequities, as well as the broader contexts of care and complex socio-political mechanisms through which health systems are strengthened. Drawing on new lines of empirical inquiry, we propose that broadening the equity lens for HSS ­offers exciting opportunities to put health systems at the heart of a more ambitious equity agenda in global health.

Assessing burden, risk factors, and perceived impact of uterine fibroids on women\u2019s lives in rural Haiti: implications for advancing a health equity agenda, a mixed methods study

BackgroundUterine fibroids, the most common cause of gynecologic surgery, have a reported cumulative incidence of 59% among Black women in the U.S. Uterine fibroids negatively impact the quality of women’s lives. No study has been found in the literature about fibroids in Haiti. We conducted a mixed methods study to assess the burden and risk factors of uterine fibroids, as well as their effects on women’s quality of life.MethodsA convergent mixed methods study was conducted between October 1, 2019 and January 31, 2020 at MUH’s (Mirebalais University Hospital) OB-GYN outpatient department. Quantitatively, in a cross-sectional study 211 women completed consecutively a structured questionnaire. In-depth interviews with 17 women with fibroids and 7 family members were implemented for the qualitative component. Descriptive statistics were calculated for clinical and social demographic variables. Logistic regression was performed to examine associations between fibroids and related risk factors. An inductive thematic process was used to analyze the qualitative data. A joint display technique was used to integrate the results.ResultsOf 193 women analyzed 116 had fibroids (60.1%). The mean age was 41.3. Anemia was the most frequent complication— 61 (52.6%). Compared to women without uterine fibroids, factors associated with uterine fibroids included income decline (AOR = 4.7, 95% CI: 2.1–10.9, p = < 0.001), excessive expenses for transport (AOR = 4.4, 95% CI: 1.6–12.4, p = 0.005), and family history with uterine fibroids (AOR = 4.6, 95% CI: 1.6–13.6, p = 0.005). In contrast, higher level of education and micro polycystic ovarian syndrome were associated with lower prevalence (AOR = 0.3, 95% CI: 0.1–0.9, p = 0.021) and (AOR = 0.2, 95% CI: 0.1–0.97, p = 0.044), respectively. The qualitative findings delineate how contextual factors such as health system failures, long wait times, gender inequality and poverty negatively affect the quality of women’s lives. The poverty cycle of uterine fibroids emerged.ConclusionsA vicious cycle of poverty negatively impacts access to care for uterine fibroids in Haiti. Health insurance, social support, and income generating activities may be keys to promote social justice through access to adequate care for women with uterine fibroids in Haiti.

Hispanic Identity and Its Inclusion in the Race Discrimination Discourse in the United States.

As protests against racism occur all over the United States and medical institutions face calls to incorporate antiracism and health equity curricula into professional training and patient care, the antiracism discourse has largely occurred through a Black/African American and White lens. Hispanics, an umbrella category created by the U.S. government to include all people of Spanish-speaking descent, are the largest minority group in the country. Hispanics are considered an ethnic rather than a racial group, although some Hispanics self-identify their race in terms of their ethnicity and/or country of origin while other Hispanics self-identify with any of the 5 racial categories used by the U.S. government (White, Black/African American, American Indian or Alaska Native, Asian, or Native Hawaiian or Other Pacific Islander). Expanding the antiracism discourse in medicine to include Hispanic perspectives and the diversity of histories and health outcomes among Hispanic groups is crucial to addressing inequities and disparities in health and medical training. A lack of inclusion of Hispanics has contributed to a growing shortage of Hispanic physicians and medical school faculty in the United States as well as discrimination against Hispanic physicians, trainees, and patients. To reverse this negative trend and advance a health care equity and antiracist agenda, the authors offer steps that medical schools, academic medical centers, and medical accreditation and licensing bodies must take to increase the representation of Hispanics and foster their engagement in this evolving antiracism discourse.

Embracing equitable learning in managing the physical and financial resources in South-African-schools: A social justice perspective

In this article I report on the findings of an empirical study conducted to show the merits of integrating equitable learning by members of the South African School Governing bodies (SGBs) in managing the physical and financial resources. Within the interpretivist paradigm and utilising a qualitative descriptive phenomenological design, the data generation followed the use of an unstructured questionnaire administered to a sample of 30 participants purposefully sampled. Adopting a social justice perspective as the lens, we unpack the necessity of learning equity in the SGB’s dealing of school resources. The study was guided by the following key research question; How can South African schools embrace the learning equity agenda in managing their physical and financial resources? The findings show that adopting such principles of equity in learning as integrating diversity in the equitable deployment of the physical and financial resources goes a long way towards entrenching social justice in managing the resources. The key conclusion was that unless members of the SGBs adopt an equitable mechanism for allocating these resources in the face of competing priorities, real equitable learning remains elusive. The recommendations include the need for adopting policies designed to deal with the complex relationships between concerned stakeholders in the provision of guidelines for public-school funding – most of which come from public budgets.

Celebrating the Last 10 Years of Community College Internationalization

Celebrating the Last 10 Years of Community College Internationalization

Discursive constructions of equity in Australian higher education: Imagined worlds and the case of people seeking asylum

There is a strong rationale for people seeking asylum and refugees given temporary protection to be key beneficiaries of Australian higher education equity practices. However, despite the extreme precarity they face, this group remains among the most educationally disadvantaged populations in Australia. Here, we use critical discourse analysis to examine the publicly available statements of 38 Australian universities to identify discursive representations of equity practices and connections, with our analytic gaze focused through the lens of people seeking asylum. Using a three‐part analytic heuristic examining ‘statements’, ‘practices’ and ‘connections’, we offer a critical discourse analysis of how each public university expresses its commitment to the equity agenda in powerful stakeholder‐facing documents—such as annual reports, strategic plans and media releases—and we compare this analysis against institutional stated practices with regard to people seeking asylum. In identifying misalignments between equity statements and stated practices, we suggest that institutional equity narratives articulate ‘imagined worlds’, in which all marginalised groups can access higher education. We argue that now is the time to move beyond these ‘imagined worlds’, to enact stated commitments to universal education, by instituting real and effective practices to facilitate equitable access to Australian higher education for people seeking asylum.

Advancing a health equity agenda across multiple policy domains: a qualitative policy analysis of social, trade and welfare policy

ObjectiveWhile there is urgent need for policymaking that prioritises health equity, successful strategies for advancing such an agenda across multiple policy sectors are not well known. This study aims to...

Leadership at all levels: system alignment through empowerment in Scottish education?

ABSTRACT This article examines the policy construction of leadership at all levels in Scottish education. In the current reforms ‘leadership at all levels’ is being used to mobilise support around changes to the role of the headteacher and of the local authorities (LAs) to bring about greater system alignment. From a critical policy analysis six themes are reported on: (1) Social Justice Ideology and the Equity Agenda – Perception Versus Reality?; (2) Mobilising Support for Reform – Managing Perceptions of the Public?; (3) Mobilising Support for New Governance – Managing Perceptions of the Teaching Profession?; (4) Mobilising Support for Restructuring – Managing the Middle Tier?; (5) Mobilising Support for Empowerment and Collaboration – Leadership at all Levels?; (6) Policy Rhetoric Versus Practice Realities – System Alignment through Empowerment?

Namibia's way to Marine Spatial Planning – Using existing practices or instigating its own approach?

The territorial waters and EEZ of Namibia are part of the Benguela Current Large Marine Ecosystem in the South-East Atlantic. Growing demands and conflicts emerge although the area is not as intensely used as marine areas elsewhere. Namibia has chosen Marine Spatial Planning (MSP) as an integrated approach to facilitate sustainable ocean development and improved ocean governance. The paper explores the reality of the Namibian MSP process to date by investigating two guiding research questions: (1) What makes the Namibian approach to MSP distinct? and (2) What are the opportunities and difficulties of the Namibian MSP process in that particular context? The country's approach to MSP features a series of distinct attributes, not least due to its unique environmental and socio-economic context. Namibian MSP is highly precautionary and forward-looking given the relatively low intensity of current uses, has a strong ecosystem-based perspective due to the fairly pristine environment, is driven by a social equity and distributive justice agenda, and features a strong collaborative process governance. Whilst challenges such as limited financial resources, lacking legislation and weak links to broader ocean governance exist, the MSP process, which was linked to a systematic conservation planning process from the outset, has however resulted in a clear framework for the development of the first marine plan.

Revisiting the social determinants of health agenda from the global South

Abstract Background One of the most marked characteristics of the global social structure is the existence of substantial social inequalities in wealth, which also find expression in health inequalities between and within countries. In an effort to provide an overview of the conceptual debates shaping the mobilisation around social determinants of health and health inequities, two of the most influential approaches in the field are compared: the WHO Commission on Social Determinants of Health approach (CSDH), strongly influenced by European Social Medicine, and the Latin American Social Medicine and Collective Health (LASM-CH) Social determination of the health-disease process approach, hitherto largely invisibilized. Methods A comprehensive literature review was conducted in three databases (Lilacs, Scielo, Medline/Pubmed), reference lists of selected papers, and citations in Google Scholar, including book titles. Results It is argued that the debates shaping the SDH agenda do not merely reflect terminological and conceptual differences, but essentially different ethical-political proposals that define the way health inequities are understood and proposed to be transformed. Conclusions While the health equity and SDH agenda probably also gained momentum due to the broad political alliance it managed to consolidate, it is necessary to make differences explicit as this allows for an increase in the breadth and specificity of the debate, facilitating the recognition of contextually relevant proposals towards the reduction of health inequities. Key messages Debates shaping the SDH agenda do not merely reflect terminological or conceptual differences, but distinct ethical-political proposals. Differences need to be discussed and made explicit to guide the development of contextually relevant efforts to reduce health inequities.

Innovative data analysis approach informing policy action to improve wellbeing and health equity

Abstract Wales is leading the way as one of the first countries supporting the World Health Organization to take forward the work of the Health Equity Status Report Initiative (HESRi) at a national level. The Welsh Health Equity Status Report Initiative (WHESRi) has been established to strengthen this global wellbeing and health equity agenda, applying a cutting-edge HESRi methodology first in Wales, providing valuable lessons and experience, which can enable other countries to take action to address health inequity. WHESRi includes three research streams: a) Health equity data analysis; b) Policy analysis and c) Health economic analysis. The National Survey for Wales (NSW) (cross-sectional study design) is used to 'decompose' the gap in a health outcome using the Blinder-Oaxaca decomposition methodology. The analysis breaks down contributions to the inequitable health outcomes observed between different population groups, by factors that differ systematically between the groups. Factors, which align to the five HESRi health equity conditions (Health Services, Income Security &amp; Social Protection, Living Conditions, Social &amp; Human Capital and Employment &amp; Working Conditions). The work is also exploring how different health outcomes e.g. mental health and life satisfaction, result in different relative contributions to inequities in those outcomes from the five conditions. Analysis of the 2016-17 NSW shows that the prevalence of good health is significantly higher in those who are not materially deprived (75.6% CI 74.5% to 76.6%) compared to those who are (55.3% CI 52.3% to 58.4%). Preliminary data suggests that when decomposing the gap in self-reported health between those who are materially deprived and those who are not, the largest contributing factor to the inequity is systematic differences in the degree of Income Security and Social Protection (39%). The analysis identifies priority policy areas for action and further analysis. Key messages The health gap can be stratified and explained by five essential health equity conditions. Explaining the health gap informs cross-sector policy action and investment prioritisation towards healthy prosperous lives for all.

Association of Timely Outpatient Mental Health Services for Youths After Psychiatric Hospitalization With Risk of Death by Suicide

Timely outpatient follow-up care after psychiatric hospitalization is an established mental health quality indicator and considered an important component of suicide prevention, yet little is known about whether follow-up care is associated with a reduced risk of suicide soon after hospital discharge. To evaluate whether receipt of outpatient care within 7 days of psychiatric hospital discharge is associated with a reduced risk of subsequent suicide among child and adolescent inpatients and examine factors associated with timely follow-up care. This population-based, retrospective, longitudinal cohort study used Medicaid data from 33 states linked with National Death Index data. The study population included all youths aged 10 to 18 years who were admitted to a psychiatric hospital from January 1, 2009, to December 31, 2013. Data analysis was completed from October 9, 2019, through May 15, 2020. Mental health follow-up visits received within 7 days of hospital discharge. Suicides occurring in the 8 to 180 days after hospital discharge. Logistic regression modeled the association between demographic, clinical, and mental health service history factors and receipt of an outpatient visit within 7 days after discharge. Poisson regression estimated the association between suicide risk and outpatient visits within 7 days after discharge, adjusting for confounding using inverse probability of treatment weights from the logistic model. Of the total 139 694 youths admitted to a psychiatric hospital, 51.9% were female, 31.1% were aged 10 to 13 years, and 68.9% were aged 14 to 18 years. A total of 56.5% of the youths received a mental health follow-up visit within 7 days of discharge, and this was associated with a significantly lower odds of suicide (adjusted relative risk, 0.44; 95% CI, 0.23-0.83; P = .01) during the 8 to 180 days postdischarge period. Youths with longer lengths of stay (4-5 days: adjusted odds ratio [AOR], 1.20 [95% CI, 1.17-1.24]; 6-7 days: AOR, 1.47 [95% CI, 1.43-1.52]; 8-12 days AOR, 1.75 [95% CI, 1.69-1.81]; 13-30 days: AOR, 1.71 [95% CI, 1.63-1.78]), prior outpatient mental health care (AOR, 1.58; 95% CI, 1.51-1.65), and foster care placement (AOR, 1.32; 95% CI, 1.28-1.37) were more likely to receive 7-day follow-up, whereas those who were non-Hispanic Black (AOR, 0.82; 95% CI, 0.79-0.84), were older (AOR, 0.82; 95% CI, 0.80-0.84), were medically ill (AOR, 0.77; 95% CI, 0.74-0.81), and had managed care insurance (AOR, 0.88; 95% CI, 0.87-0.91) were less likely to receive follow-up visits. In this cohort study, risk of suicide during the 6 months after psychiatric hospitalization was decreased among youth who had an outpatient mental health visit within 7 days after discharge. Addressing disparities in timely continuity of care may help advance health equity agendas.

Using Implementation Science to Understand Rwanda's Success in Dropping Under‐5 Mortality

Research ObjectiveTo understand how and why Rwanda implemented Evidence‐Based interventions (EBIs) faster than similar countries to reduce amenable U5 mortality (U5M) and contextual factors which facilitated or hindered success.Study DesignExplanatory mixed methods study using an implementation research (IR) framework adapted from existing frameworks (Exploration, Preparation, Implementation, Sustainment expanded include Adaptation (EPAIS), and Consolidated Framework for Implementation Research) to guide literature and document review, and key informant interviews with health care managers and leaders, implementers and policy makers.Population StudiedNot applicable.Principal FindingsRwanda effectively used a 5‐step process to determine the need for and strategies to implement EBIs to address leading causes of death (Table). Critical strategies included rapid uptake of emerging EBIs, stakeholder engagement, donor, and partner coordination based on national plan, data use for decision making, including research when needed, and integrating into and building on existing systems and primary care. Facilitating contextual factors included leadership commitment to health and primary care, existing community health worker program, culture of data use and accountability, donor and partner resources, and national equity agenda. Rwanda was able to implement (feasibility) with high coverage (reach) key EBis including vaccinations, facility delivery, and PMTCT with high acceptability. U5M dropped by 74 percent, from 196 deaths per 1000 live births in 2000 to 50 deaths per 1000 live births in 2015.ConclusionsThrough strategic and stepwise process, Rwanda was able to achieve rapid and broad implementation of life‐saving interventions to reduce U5M. The lesson learned offer transferable knowledge to help other countries accelerate U5M reduction.Implications for Policy or PracticeUsing IR adapted to the study aims is effective in emerging generalizable lessons and knowledge needed for other countries to more effectively implement EBIs and reduce U5M.Primary Funding SourceBMGF and Gates Ventures.