Equity Criteria Research Articles

Achieving Sustainable Development Goals (SDGs) in Sub-Saharan Africa (SSA): A Conceptual Review of Normative Economics Frameworks

Background: The health status of the Sub-Saharan African (SSA) countries is well below that of the rest of the world. Coupled with low per capita income, these countries have agreed and committed themselves to raising their health status equitable standard by addressing United Nations (UN) Sustainability Development Goal number 3 (SDG3) by 2030. Addressing SDG3 requires increased and equitable funding for universal health coverage, healthcare infrastructure, efficient resource allocation, improved priority setting, reduction in corruption, and other strategies. However, what is urgently needed to improve priority setting processes or meaningful health system reform, among other things. There is therefore a need for the exploration of the economic and non-economic (which includes social justice) explicit criteria that ought to form the normative framework for Decision Making. These explicit criteria include efficiency, burden of disease, equality (strict egalitarianism), equity, and explicit criteria.Methods: The ultimate aim was to identify explicit values/principles/criteria that can be used to formulate an ideal normative framework to be used to guide decision Making so as to improve SDG3 in SSA. We synthesized selected literature on the normative frameworks for priority setting processes in health in SSA was undertaken, and the explicit criteria which, ought to guide these frameworks were identified. The form of the Social Welfare function and its principles was identified.Results and Conclusions: The framework and its explicit criteria for priority setting in the SSA countries that ought to be adopted in order to improve their SDG3 was identified—Non-Welfarist framework. This framework allows utility, health and other important social values/attributes/principles to enter the normative SWF. It is argued that such a framework ought to be specified empirically and concurrently by the decision-makers and members of the community representatives. Community representatives ought to be recognized as legitimate claimants of the resources determined, and should therefore be allowed to have a role in specifying the arguments in the SWF and what weights to be attached to the stated arguments. This implies that the selection of options in decision-making should focus on maximizing benefit and minimizing the opportunities forgone as stated in the framework.

Benefit Allocation in Shared Water-Saving Management Contract Projects Based on Modified Expected Shapley Value

Water-Saving Management Contract (WSMC) is an innovative business model to reduce water consumption and improve water-use efficiency. The Shared Water-Saving Model, as a primary operating model in WSMC projects, is relatively widely used compared with other patterns. However, the lack of a water-saving benefit allocation scheme is one of the critical obstacles frustrating the implementation and promotion of the Shared Water-Saving Model. To correct this deficiency, a modified expected Shapley value method is developed, in which alliance revenues are characterized as uncertain variables due to the lack of historical data. Firstly, risk, input and effort are identified as key influencing factors to improve the deficiencies in the distribution of benefits based on the contribution. Secondly, equity criteria, including symmetry, efficiency and additivity, are redefined based on correction factors to measure the fairness of the allocation scheme. Thirdly, we prove that the allocation result obtained by the proposed method satisfies the equity criteria and is unique. Finally, a water-saving project launched by Handan City located in North China is studied to illustrate the applicability of the proposed method. The result shows that the modified expected Shapley value method significantly enhances the cooperative relationship and can therefore be used as an effective tool for the fair and reasonable distribution of benefits in Shared WSMC projects.

Perceived quality assessment of the health services offered to riverine communities in Brazilian Amazon

In line with the UN Agenda 2030 Sustainable Development Goals, Public Health Policies follow in Brazil criteria of universality, completeness, and equity formulated to ensure access to health services in adequate quantity and quality for the entire population. To evaluate the quality of services provided in health units, it is essential, however, to make methodological considerations to concern the use of proper instruments and techniques to achieve accuracy and precision regarding their effectiveness for the user population. Mainly where health care is precarious or in need of adjustment, properly constructed indicators can become excellent management tools. This paper aims to analyze the specificities of the perception of the quality of health services offered to residents of the riverside communities of the Tupé Sustainable Development Reserve (SDR), Manaus, Amazonas, Brazil. The methodological approach is from a descriptive and ecological case study, based on field research with original data collection of fixed residents, aged over 18 years, by applying structured questionnaires and analyzing the results according to the SERVQUAL methodology. In the present study, it observed the impact of previous experiences of attending on the quality of health service. In the case of SDR of Tupé, there were positive evaluations with above 70% in all items. Still, when analyzing the data set and cut, considering the existence or not of previous experience, a different pattern of perception was detected. Based on these results, we suggest that the quality perception of health has to do with competitiveness, associated with the performance standard on the offer available to the customer.

Obstetric Violence in Spain (Part I): Women's Perception and Interterritorial Differences.

The decentralization of health systems can have direct repercussions on maternity care. Some inequalities can be noted in outcomes, like neonatal and child mortality in Spain. This study aimed to make the presence of obstetric violence in Spain visible as an interterritorial equity criterion. A descriptive, restrospective and cross-sectional study was conducted between January 2018 and June 2019. The sample comprised 17,541 questionnaires, which represented all Spanish Autonomous Communities. Of our sample, 38.3% perceived having suffered obstetric violence; 44.4% perceived that they had undergone unnecessary and/or painful procedures, of whom 83.4% were not requested to provide informed consent. The mean satisfaction with the attention women received obtained 6.94 points in the general sample and 4.85 points for those women who viewed themselves as victims of obstetric violence. Spain seems to have a serious problem with public health and respecting human rights in obstetric violence. Offering information to women and requesting their informed consent are barely practiced in the healthcare system, so it is necessary to profoundly reflect on obstetric practices with, and request informed consent from, women in Spain.

Efforts-sharing to achieve the Paris goals: Ratcheting-up of NDCs and taking full advantage of international carbon market

Aggregated mitigation efforts represented by current Nationally Determined Contributions (NDCs) fall far short of meeting the 2 °C and 1.5 °C Paris goals, and Parties should enhance their mitigation targets through a ratcheting-up mechanism to close the large gap. The paper first assesses the stringency of major emitters’ NDCs based on a comparison with the seven equity allocations. Then, it proposes a novel ratcheting-up scheme which distributes the mitigation gap between aggregated NDCs and the Paris goals based on key equity criteria and calculates the additional emission reduction rates for countries with insufficient ambitions. To fully consider different ambition levels of NDCs and also avoid overambitious outcomes, lower and upper limits are set for individual country’s reduction rate, thus improving the equity and feasibility of the scheme. The results indicate that most countries should strengthen current efforts. By 2030, countries with insufficient NDCs need to reduce their aggregated emissions by 23% and 36% respectively to achieve the 2 °C and 1.5 °C goals. Most developed countries should undertake reduction rates which are above the global average level. Under the 1.5 °C pathway, many developed countries need to reduce their NDC emissions by about 50% in 2030. The mitigation costs of achieving the Paris goals as well as the benefits of international emissions trading have been evaluated. The results show that global GDP losses in 2030 for achieving 2 °C and 1.5 °C could decrease by 69% and 50% respectively through permits trading, and regional GDP losses would also be reduced, highlighting the importance of an effective global carbon market for meeting the Paris goals.

Evaluating the impacts of HSR stations on the creation of firms

Justified on territorial equity criteria, Spain has developed one of the largest high-speed rail (HSR) network in the world. This research evaluates how the opening of a new station affects the number of firms created at provincial level. We estimate differential impacts on firm creation across four different types of activities: service, tourism, knowledge intensive and manufacturing. The use of panel data makes it possible both to test for the dynamic structure in the data and to provide new insights on the territorial impact of HSR effects. Moreover, we develop a methodological procedure to improve the accuracy of small but positive effects. The results point out that being connected to a HSR network may promote firm creation, but this is not always the case. It has a larger effect in the service, tourism and knowledge intensive activities, whereas in the manufacturing sector the impact is almost null. Regarding the territorial impact, we find that the HSR can reinforce the concentration of firm creation in the biggest cities. Additionally, improving short-distance connections can strengthen agglomeration benefits by enlarging metropolitan areas. Finally, HSR would contribute to increasing the level of divergence in terms of firm creation across provinces. Therefore, our work calls for a rethinking of the strategy of basing investment decisions on territorial equity criteria.

A centralized directional distance model for efficient and horizontally equitable grants allocation to local governments

This paper proposes a directional distance model for efficient resource allocation when there is a centralized decision maker who oversees all units. The model is designed to allocate grants from an upper-tier government to the municipalities under its jurisdiction. Local governments employ the grants together with levied local taxes to provide services to their citizens. The objective of our formulation is to optimize grants allocation across municipalities taking into account efficiency, effectiveness and horizontal fiscal equity criteria. The model easily allows the setting of alternative priorities of the central decision maker, thus permitting quantification of the trade-off between the potential increase in the provision of local services and its associated cost. The model is applied to the allocation of current grants in the autonomous community of Navarre in northern Spain.

The Meaning of Value in “Person-centred” approaches to Healthcare

In health economics, value has usually been understood within the framework of the production and consumption of healthcare. Two tools of measurement, efficiency and equity, have been used to make decisions on healthcare resources. However, the healthcare system is also not a market like others, and applying the criteria of efficiency and equity to the field of health calls for significant adaptation. In addition, even when epistemologically informed and technically equipped, care is also attention and an engagement toward the person for whom the care is directed. Current models fail to take into consideration the individual, qualitative nature of individual patient experience, but also the wider environment affecting the patient’s health outcomes. Therefore tensions continue to exist between value as understood in a health economics perspective and the relational values promoted in proposals of person-centered care. Healthcare values are plural and explain what one commits to in terms of actions and relationships with others. Taking into account this plurality reminds us both of the ethical dimension of care but also how it is made possible through financing. Person-centered care therefore calls for new models of evaluation, ones which will understand the values of care for the person in their personal and professional contexts.

Asymmetric Benefit Compensation Model for Resolving Transboundary Water Management Conflicts

This paper proposes an asymmetric benefit compensation model for stimulating rational agents, who often have disparate geography, hydrology, climate, and socio-economies, to participate in cooperative transboundary water management. A social planner model is initially developed to maximize the total water benefit of a river system under the assumption of perfect cooperation among the agents. Subsequently, a Stackelberg game-theoretical model is used to derive the agents’ disagreement utility based on considering their spatial heterogeneity in water accessibility. Based on the agents’ bargaining weights produced by several multi-attribute decision analysis methods, the aggregate water benefit is then redistributed among the agents by adopting the asymmetric Nash bargaining solution. The possible benefit compensation solutions are finally compared by using a composite index that can synthetically consider optimality, equity and stability criteria. The Qujiang River Basin in China is used to demonstrate the applicability of the suggested model. The results show that this integrated model can offer useful insights for conflict resolution in river sharing problems.

Equidad, pertinencia y relevancia educativa mediante arte, solar y lengua maya

El artículo analiza cómo la pertinencia, la relevancia y la equidad pueden construirse en un proyecto colaborativo, cuyo centro es el arte, el solar y la lengua maya para transformar la educación primaria desde el ámbito comunitario, implementado en dos comunidades en el estado de Yucatán, en articulación con sus escuelas primarias. Mediante entrevistas con los coordinadores del proyecto, sus talleristas, los docentes de las escuelas y las madres y los padres de familia, así como dibujos-entrevistas con los estudiantes y observación no participante, se obtuvieron los datos cualitativos que son analizados a la luz de las categorías mencionadas. El proyecto ha detonado procesos educativos pertinentes a partir de aprendizajes situados sumados al fortalecimiento de la lengua maya, la reconexión de los niños y las niñas con la tierra, así como mayor vinculación entre las escuelas y las comunidades; también ha propiciado una educación más relevante al contribuir positivamente al logro de los aprendizajes escolares y a una mayor equidad educativa, que ha generado nuevas expectativas sobre la educación de los niños y las niñas, así como aprendizajes in-esperados en el imaginario de las comunidades por asumirse como contextos vulnerados.

A policy framework for social sustainability: Social cohesion, equity and safety

AbstractThe purpose of our paper is to characterize the social pillar using the three criteria of social cohesion, equity and safety. Alongside this characterization we develop a policy framework to promote social sustainability, which has been the subject of much academic interest in recent years. In addition, we demonstrate that the social sustainability policies we advocate are capable of embracing environmental sustainability. Our work therefore provides a fresh perspective on sustainable development policies by emphasizing the importance of the social pillar to the policy making process.

Efficient or Fair? Operationalizing Ethical Principles in Flood Risk Management: A Case Study on the Dutch-German Rhine.

Flood risk management decisions in many countries are based on decision‐support frameworks which rely on cost‐benefit analyses. Such frameworks are seldom informative about the geographical distribution of risk, raising questions on the fairness of the proposed policies. In the present work, we propose a new decision criterion that accounts for the distribution of risk reduction and apply it to support flood risk management decisions on a transboundary stretch of the Rhine River. Three types of interventions are considered: embankment heightening, making Room for the River, and changing the discharge distribution of the river branches. The analysis involves solving a flood risk management problem according to four alternative formulations, based on different ethical principles. Formulations based on cost optimization lead to very poor performances in some areas for the sake of reducing the overall aggregated costs. Formulations that also include equity criteria have different results depending on how these are defined. When risk reduction is distributed equally, very poor economic performance is achieved. When risk is distributed equally, results are in line with formulations based on cost optimization, while a fairer risk distribution is achieved. Risk reduction measures also differ, with the cost optimization approach strongly favoring the leverage of changing the discharge distribution and the alternative formulations spending more on embankment heightening and Room for the River, to rebalance inequalities in risk levels. The proposed method advances risk‐based decision‐making by allowing to consider risk distribution aspects and their impacts on the choice of risk reduction measures.

Assessing the youth-friendliness of youth clinics in northern Sweden: a survey analyzing the perspective of the youth

BackgroundSweden has nearly 300 youth clinics that have been offering services since the 1970s. However, no evaluation has been done to assess their youth-friendliness. This study aims to assess: i) to what extent youth clinics are perceived as youth-friendly by the young people using them; and ii) if the level of youth friendliness is equally perceived across different sociodemographic groups of users.MethodsThe four northernmost counties of Sweden were included in the study. Of the total identified 22 youth clinics, 20 participated by giving out questionnaires to the youth after their visits to the respective youth clinics. In total 1110 youth participated in the study and answered questions according to the World Health Organization’s criteria of accessibility, equity, respect, privacy and confidentiality, no judgement, and quality. Means and frequencies were calculated, and t-test and ANOVA were used to compare means by sociodemographic variables.ResultsParticipants perceived the youth clinics as very youth friendly across the measured domains, with scores as high as 4.8 and 4.9 (of a maximum of 5). Youth clinics were perceived in a similar way regardless of gender, but other sociodemographic factors influenced some of the domains, especially ethnic background.ConclusionsThe perception of youth friendliness in youth clinics was very high. Nonetheless, younger users; users who did not categorize themselves as either heterosexual, homosexual, or bisexual; users with trans-experiences; and users with non-Swedish backgrounds gave youth clinics lower scores for certain domains.

Moving to a More "Certain" Test for Tax Residence in Australia: Lessons for Canada?

Canada and Australia have superficially similar tests for determining the tax residence of individuals. Both have a common-law residence (or resides) test, "continuing attachment" rules (a statutory test in Australia), a 183-day type of test, and provisions focused on government officials. A key difference between the countries in this regard, despite broadly similar residence tests, is that litigation in Canada is rare whereas Australia, over the last decade, has seen at least 43 administrative tribunal, Federal Court, and High Court decisions with respect to tax residence. In response to the high levels of litigation resulting from concentrated Australian Taxation Office compliance programs, the Board of Taxation commenced a self-initiated review of the income tax residence rules for individuals in May 2016. The report subsequently submitted to government noted that the current rules were no longer appropriate and needed to be updated and simplified. Although the Australian government has not endorsed the board's recommendations, the board was directed to undertake further consultation in order to ensure that the proposed residence rules are appropriately designed and targeted, with a particular focus on integrity (that is, anti-avoidance) issues. A final report, sent to the government in April/May 2019, proposed a number of bright-line tests. These proposed tests are based in part on the approach adopted in the NZ and 2013 UK residence rules. In this paper, the author considers the similarities and shortcomings of the Canadian and Australian rules on individual tax residence according to the criteria of equity, simplicity, and efficiency (integrity), and then reviews the Board of Taxation's recommendations with an eye to whether the proposed Australian changes could provide guidance for any future Canadian reform, should the political circumstances so dictate in the future.

Vulnerability and Health Care. Law and Medical Protocols

The article deals with the analysis of the criteria for the allocation of scarce health resources during the pandemic produced by the COVID 19 virus in Spain. It critically analyses the absence of a legal-constitutional perspective in the elaboration of such criteria and suggests the incorporation of the criterion of equity as a guarantee of the effective exercise of the constitutional right to health protection by vulnerable persons.

An interdisciplinary mixed-methods approach to developing antimicrobial stewardship interventions: Protocol for the Preserving Antibiotics through Safe Stewardship (PASS) Research Programme

Behaviour change is key to combating antimicrobial resistance. Antimicrobial stewardship (AMS) programmes promote and monitor judicious antibiotic use, but there is little consideration of behavioural and social influences when designing interventions. We outline a programme of research which aims to co-design AMS interventions across healthcare settings, by integrating data-science, evidence- synthesis, behavioural-science and user-centred design. The project includes three work-packages (WP): WP1 (Identifying patterns of prescribing): analysis of electronic health-records to identify prescribing patterns in care-homes, primary-care, and secondary-care. An online survey will investigate consulting/antibiotic-seeking behaviours in members of the public. WP2 (Barriers and enablers to prescribing in practice): Semi-structured interviews and observations of practice to identify barriers/enablers to prescribing, influences on antibiotic-seeking behaviour and the social/contextual factors underpinning prescribing. Systematic reviews of AMS interventions to identify the components of existing interventions associated with effectiveness. Design workshops to identify constraints influencing the form of the intervention. Interviews conducted with healthcare-professionals in community pharmacies, care-homes, primary-, and secondary-care and with members of the public. Topic guides and analysis based on the Theoretical Domains Framework. Observations conducted in care-homes, primary and secondary-care with analysis drawing on grounded theory. Systematic reviews of interventions in each setting will be conducted, and interventions described using the Behaviour Change Technique taxonomy v1. Design workshops in care-homes, primary-, and secondary care. WP3 (Co-production of interventions and dissemination). Findings will be integrated to identify opportunities for interventions, and assess whether existing interventions target influences on antibiotic use. Stakeholder panels will be assembled to co-design and refine interventions in each setting, applying the Affordability, Practicability, Effectiveness, Acceptability, Side-effects and Equity (APEASE) criteria to prioritise candidate interventions. Outputs will inform development of new AMS interventions and/or optimisation of existing interventions. We will also develop web-resources for stakeholders providing analyses of antibiotic prescribing patterns, prescribing behaviours, and evidence reviews.

Fundamental utilitarianism and intergenerational equity with extinction discounting

Ramsey famously condemned discounting “future enjoyments” as “ethically indefensible”. Suppes enunciated an equity criterion which, when social choice is utilitarian, implies giving equal weight to all individuals’ utilities. By contrast, Arrow (Contemporary economic issues. International Economic Association Series. Palgrave Macmillan, London, 1999a; Discounting and Intergenerational Effects, Resources for the Future Press, Washington DC, 1999b) accepted, perhaps reluctantly, what he called Koopmans’ (Econometrica 28(2):287–309, 1960) “strong argument” implying that no equitable preference ordering exists for a sufficiently unrestricted domain of infinite utility streams. Here we derive an equitable utilitarian objective for a finite population based on a version of the Vickrey–Harsanyi original position, where there is an equal probability of becoming each person. For a potentially infinite population facing an exogenous stochastic process of extinction, an equitable extinction biased original position requires equal conditional probabilities, given that the individual’s generation survives the extinction process. Such a position is well-defined if and only if survival probabilities decline fast enough for the expected total number of individuals who can ever live to be finite. Then, provided that each individual’s utility is bounded both above and below, maximizing expected “extinction discounted” total utility—as advocated, inter alia, by the Stern Review on climate change—provides a coherent and dynamically consistent equitable objective, even when the population size of each generation can be chosen.

An interdisciplinary mixed-methods approach to developing antimicrobial stewardship interventions: Protocol for the Preserving Antibiotics through Safe Stewardship (PASS) Research Programme.

Behaviour change is key to combating antimicrobial resistance. Antimicrobial stewardship (AMS) programmes promote and monitor judicious antibiotic use, but there is little consideration of behavioural and social influences when designing interventions. We outline a programme of research which aims to co-design AMS interventions across healthcare settings, by integrating data-science, evidence- synthesis, behavioural-science and user-centred design. The project includes three work-packages (WP): WP1 (Identifying patterns of prescribing): analysis of electronic health-records to identify prescribing patterns in care-homes, primary-care, and secondary-care. An online survey will investigate consulting/antibiotic-seeking behaviours in members of the public. WP2 (Barriers and enablers to prescribing in practice): Semi-structured interviews and observations of practice to identify barriers/enablers to prescribing, influences on antibiotic-seeking behaviour and the social/contextual factors underpinning prescribing. Systematic reviews of AMS interventions to identify the components of existing interventions associated with effectiveness. Design workshops to identify constraints influencing the form of the intervention. Interviews conducted with healthcare-professionals in community pharmacies, care-homes, primary-, and secondary-care and with members of the public. Topic guides and analysis based on the Theoretical Domains Framework. Observations conducted in care-homes, primary and secondary-care with analysis drawing on grounded theory. Systematic reviews of interventions in each setting will be conducted, and interventions described using the Behaviour Change Technique taxonomy v1. Design workshops in care-homes, primary-, and secondary care. WP3 (Co-production of interventions and dissemination). Findings will be integrated to identify opportunities for interventions, and assess whether existing interventions target influences on antibiotic use. Stakeholder panels will be assembled to co-design and refine interventions in each setting, applying the Affordability, Practicability, Effectiveness, Acceptability, Side-effects and Equity (APEASE) criteria to prioritise candidate interventions. Outputs will inform development of new AMS interventions and/or optimisation of existing interventions. We will also develop web-resources for stakeholders providing analyses of antibiotic prescribing patterns, prescribing behaviours, and evidence reviews.

The allocation of CO2 emissions as a claims problem

In the context of multilateral negotiations on climate change, this paper proposes to use the claims approach as a reasonable and practicable alternative in order to allocate the admissible CO2 emissions per region. The proposed methodology entails analyze the application of a broad group of theoretical solutions through the establishment of equity and stability criteria. To this regard, the empirical analyzing combines several CO2 world endowments from Meinshausen et al. (2009) together with claims forecasts associated with the RCP (Representative Concentration Pathways) scenarios. The results obtained indicate that the constrained equal awards and α-minimal solutions are clearly equity-sensitive. Given that the CO2 emission reduction imposed by the constrained equal awards solution on Asia and the OECD are very important, and considering the better balance between equity and proportionality associated with the α-min solution, it could be that this latter solution would be the most practicable and acceptable.

Three Decades of Learning-by-Doing: The Evolving Climate Change Mitigation Policy of the European Union

This chapter traces the evolution of EU climate change mitigation policy over the past 30 years. It divides the development of EU climate policy into four phases and highlights their links with the international climate policy process under the United Nations Framework Convention on Climate Change (UNFCCC). The chapter also analyses the future prospects of EU climate policy in light of the European Commission’s 2019 proposal for a European Green Deal. The chapter shows that in the past three decades, the EU has developed an extensive climate policy framework that reflects the special nature of the EU as a supranational construct of 27 Member States. The EU framework can offer useful lessons for other jurisdictions on how a group of socially and economically diverse countries can cooperate intensively to mitigate climate change. It also includes many important lessons in terms of the governance structures used and alignment with international climate change treaties. However, the chapter also identifies gaps and important room for improvement. These relate to comprehensiveness (such as providing incentives for negative emissions) and governance (such as a long-term target enshrined in law and the creation of an independent scientific advisory body). Furthermore, while the EU’s climate policy framework can be praised for using internal fairness and equity criteria for allocating responsibilities between the Member States and compensating those with fewer resources or critically affected interests, the EU’s mitigation ambition is not based on any explicit criteria for global fairness and equity, and the bloc’s ambition is arguably not in line with the 1.5/2°C temperature goal included in the Paris Agreement.