Equity Goals Research Articles

Decolonising global health evaluation: Synthesis from a scoping review.

As decolonisation awareness and activism amplifies in the mainstream masses and within academic realms across a variety of fields, the time is right to converge parallel movements to decolonise the fields of global health and evaluation by restructuring relations of dependency and domination reified through the "foreign gaze"1 or "white gaze." We conducted a review of relevant records with the following inclusion criteria-they define or advocate for the decolonisation of global health evaluation or explicate methods, policies or interventions to decolonise global health evaluation published by advocates of the decolonisation movement from both fields. These records were derived following a systematic article search by the lead autthor on Google, Google Scholar, NewsBank, and PubMed using the following keywords: "decolonising" and "global health," "evaluation," or "global health evaluation" replicating a digital search strategy utilized by scoping reviews across a variety of topics. Because the topic of interest is nascent and still emerging, the date range was not restricted. The lead author screened abstracts retrieved from the search. In total, 57 records, ranging in publication date from 1994 to 2020, were selected and charted for this review. We reviewed these records to identify socio-ecological factors that influence the decolonisation of global health evaluation, such as decolonising minds; reorienting funders and reforming funding mechanisms; and investing in sustainable capacity exchange. In doing so, we reflected on our positionality as well as our internalisation and potential reinforcement of colonial relations in the process of reporting our results. In the context of turmoil and transition due to the COVID-19 pandemic, our scoping review offers a starting point to embark on a journey first to transform and decolonise global health evaluation and then to achieve the greater goal of equity and justice.

Using measures of quality of care to assess equity in health care funding for primary care: analysis of Indonesian household data

BackgroundMany countries implementing pro-poor reforms to expand subsidized health care, especially for the poor, recognize that high-quality healthcare, and not just access alone, is necessary to meet the Sustainable Development Goals. As the poor are more likely to use low quality health services, measures to improve access to health care need to emphasise quality as the cornerstone to achieving equity goals. Current methods to evaluate health systems financing equity fail to take into account measures of quality. This paper aims to provide a worked example of how to adapt a popular quantitative approach, Benefit Incidence Analysis (BIA), to incorporate a quality weighting into the computation of public subsidies for health care.MethodsWe used a dataset consisting of a sample of households surveyed in 10 provinces of Indonesia in early-2018. In parallel, a survey of public health facilities was conducted in the same geographical areas, and information about health facility infrastructure and basic equipment was collected. In each facility, an index of service readiness was computed as a measure of quality. Individuals who reported visiting a primary health care facility in the month before the interview were matched to their chosen facility. Standard BIA and an extended BIA that adjusts for service quality were conducted.ResultsQuality scores were relatively high across all facilities, with an average of 82%. Scores for basic equipment were highest, with an average score of 99% compared to essential medicines with an average score of 60%. Our findings from the quality-weighted BIA show that the distribution of subsidies for public primary health care facilities became less ‘pro-poor’ while private clinics became more ‘pro-rich’ after accounting for quality of care. Overall the distribution of subsidies became significantly pro-rich (CI = 0.037).ConclusionsRoutine collection of quality indicators that can be linked to individuals is needed to enable a comprehensive understanding of individuals’ pathways of care. From a policy perspective, accounting for quality of care in health financing assessment is crucial in a context where quality of care is a nationwide issue. In such a context, any health financing performance assessment is likely to be biased if quality is not accounted for.

Analysis of deprivation distribution in New Zealand by ethnicity, 1991-2013.

To compare the distribution of Māori and New Zealand (NZ) European populations in Aotearoa New Zealand by neighbourhood deprivation, for the five censuses between 1991 and 2013, and to identify changes in the distribution pattern over time. Geographical meshblock data from the 1991-2013 New Zealand censuses, by NZDep Index deprivation score, and by prioritised ethnic group population, were combined to analyse ethnic population counts by deprivation decile and deprivation score. Trends over time were analysed. Māori were over-represented in the more deprived NZDep deciles and under-represented in the least deprived deciles for all census periods. The NZ European population were over-represented in the least deprived deciles, and under-represented in the more deprived deciles. In each census, over 40% of the Māori population have been living in the two most deprived deciles, compared to less than 15% for NZ European. The patterns of inequity in socio-economic deprivation between Māori and NZ Europeans have remained virtually unchanged since 1991, despite various Government commitments to reduce inequity. Socio-economic deprivation for Māori is a key determinant of health inequity, and bolder Government measures prioritised for Māori are needed to change this socio-economic gradient if health equity goals are to be met.

Modeling the Potential Impact of Missing Race and Ethnicity Data in Infectious Disease Surveillance Systems on Disparity Measures: Scenario Analysis of Different Imputation Strategies.

Monitoring progress toward population health equity goals requires developing robust disparity indicators. However, surveillance data gaps that result in undercounting racial and ethnic minority groups might influence the observed disparity measures. This study aimed to assess the impact of missing race and ethnicity data in surveillance systems on disparity measures. We explored variations in missing race and ethnicity information in reported annual chlamydia and gonorrhea diagnoses in the United States from 2007 to 2018 by state, year, reported sex, and infection. For diagnoses with incomplete demographic information in 2018, we estimated disparity measures (relative rate ratio and rate difference) with 5 imputation scenarios compared with the base case (no adjustments). The 5 scenarios used the racial and ethnic distribution of chlamydia or gonorrhea diagnoses in the same state, chlamydia or gonorrhea diagnoses in neighboring states, chlamydia or gonorrhea diagnoses within the geographic region, HIV diagnoses, and syphilis diagnoses. In 2018, a total of 31.93% (560,551/1,755,510) of chlamydia and 22.11% (128,790/582,475) of gonorrhea diagnoses had missing race and ethnicity information. Missingness differed by infection type but not by reported sex. Missing race and ethnicity information varied widely across states and times (range across state-years: from 0.0% to 96.2%). The rate ratio remained similar in the imputation scenarios, although the rate difference differed nationally and in some states. We found that missing race and ethnicity information affects measured disparities, which is important to consider when interpreting disparity metrics. Addressing missing information in surveillance systems requires system-level solutions, such as collecting more complete laboratory data, improving the linkage of data systems, and designing more efficient data collection procedures. As a short-term solution, local public health agencies can adapt these imputation scenarios to their aggregate data to adjust surveillance data for use in population indicators of health equity.

The Opportunity of Now: Adopting Open Educational Resources in the Sociology Classroom and Beyond

There is no better time than now for sociologists to adopt open educational resources (OER), and sociology as a discipline is well positioned to lead. Adopting OER takes seriously the well-documented financial challenges faced by many students, supports classroom and campus goals of equity and inclusion, and allows for increased instructor flexibility. However, OER are not without their difficulties and limitations. This conversation article suggests four ways for instructors to begin or advance their utilization of OER: Ask your librarian, start with an open textbook, join the existing OER conversation, and incorporate OER within one’s broader commitment to inclusive and empathetic pedagogy.

A New Hybrid Model for Mapping Spatial Accessibility to Healthcare Services Using Machine Learning Methods

The unequal distribution of healthcare services is the main obstacle to achieving health equity and sustainable development goals. Spatial accessibility to healthcare services is an area of interest for health planners and policymakers. In this study, we focus on the spatial accessibility to four different types of healthcare services, including hospitals, pharmacies, clinics, and medical laboratories at Isfahan’s census blocks level, in a multivariate study. Regarding the nature of spatial accessibility, machine learning unsupervised clustering methods are utilized to analyze the spatial accessibility in the city. Initially, the study area was grouped into five clusters using three unsupervised clustering methods: K-Means, agglomerative, and bisecting K-Means. Then, the intersection of the results of the methods is considered to be conclusive evidence. Finally, using the conclusive evidence, a supervised clustering method, KNN, was applied to generate the map of the spatial accessibility situation in the study area. The findings of this study show that 47%, 22%, and 31% of city blocks in the study area have rich, medium, and poor spatial accessibility, respectively. Additionally, according to the study results, the healthcare services development is structured in a linear pattern along a historical avenue, Chaharbagh. Although the scope of this study was limited in terms of the supply and demand rates, this work gives more information and spatial insights for researchers, planners, and policymakers aiming to improve accessibility to healthcare and sustainable urban development. As a recommendation for further research work, it is suggested that other influencing factors, such as the demand and supply rates, should be integrated into the method.

U.S. decarbonization impacts on air quality and environmental justice

As policy organizations consider strategies to mitigate climate change, decarbonization initiatives can also reduce health-impacting air pollutants and may affect the associated racial disparities of adverse effects. With the U.S. Environmental Protection Agency CO-Benefits Risk Assessment Health Impacts Screening Tool (COBRA), we compare three decarbonization scenarios and their impacts at the regional and county scales. COBRA calculates changes in county-level ambient fine particulate matter (PM2.5), and associated mortality impacts, for each decarbonization scenario. We compare these patterns with demographic data to evaluate the relative exposure reduction benefit across race and ethnicity. Carbon-free electricity would reduce national average ambient PM2.5 concentrations by 0.21 μg m−3, compared with a 0.19 μg m−3 reduction associated with carbon-free industrial activity, and a 0.08 μg m−3 reduction associated with carbon-free light duty vehicle (LDV) transportation. Decarbonization strategies also vary in terms of the racial groups most benefitting from each scenario, due to regional and urban/rural patterns in emission sources and population demographics. Black populations are the only group to experience relative exposure reduction benefits compared to the total population in every scenario, with industrial decarbonization yielding 23% greater reductions in ambient PM2.5 concentrations for Black populations than for the total U.S. population. The largest relative reduction in PM2.5 exposure was found for Asian populations in the carbon-free LDV transportation scenario (53%). The magnitudes of total air quality improvements by scenario vary across regions of the U.S., and generally do not align with the decarbonization policy that achieves the largest equity goal. Only the transportation decarbonization scenario meets the criteria of the Justice40 Initiative nationwide, fulfilling the 2021 commitment by U.S. President Biden that federal investments in clean energy are designed to allocate at least 40% of benefits to disadvantaged communities.

The role of income in the lives of people with long-term disabilities: A multi-country analysis

Abstract Background Health is a fundamental human right. Yet, people become ill and die because they do not have enough money to access the necessary healthcare. Studies confirm that on average, more income translates to better health status. The magnitude of this relationship and its consequences beyond health like reintegration or spillovers are not widely understood but are expected to be significantly different among countries. This is especially the case in vulnerable populations like those with a spinal cord injury (SCI). This study aims to better understand the role that income plays in promoting health in people with SCI and their differences across countries. Methods The research focus on three aspects, one, the estimation of the health income gap using years after the injury and a comorbidity index, two, the decomposition of different factors of this inequality with a special interest in the unmet healthcare needs, and three, their consequences in their social participation measured by the reasons of unemployment. Results There are significant differences in health status by income and between countries. On average, the poorest income groups with SCI are up to 40 times more likely to be ill than people in the richest groups and live 4-6 years less after the injury. The working conditions and the unmet health care needs are important factors that explain that differences. In addition, the health status, the lack of sustainable employment opportunities, and workplace accessibility issues are the main issues to reintegrating into the labor market. Conclusions Health inequalities are a global problem that affects people with long-term health conditions disproportionately to others without. Even in more equal and high-income countries with a universal health system, there are different realities for the people according to their income, where the estimations and solutions for the ‘average’ individual do not target the needs of people in the extremes. Key messages • This study generates evidence about the role of income in health, lack of health services, and consequences in people with SCI across and within countries. • To achieve the goal of health equity, it is important to target the different realities focusing on the needs of people who most need which goes beyond the health system and changes by income level.

“We’re Not Going to Overcome Institutional Bias by Doing Nothing”: Latinx/a/o Student Affairs Professionals as Advocates for Equity

Higher education institutions continue to be contested environments where the goals of equity and inclusion are often at odds with the permanence of institutional racism. Through a multi-case study of 19 Latinx/a/o mid-level administrators who worked at 16 predominantly white, private four-year universities, the authors uncovered the ways that (a) private universities grant agency to Latinx/a/o mid-level administrators to serve student needs but restrict agency to address the inequitable organizational structures; (b) constituent groups within private universities, namely faculty, mark the racialized boundaries of power and decision-making through credentialing; and (c) private universities use silence as a means of controlling Latinx/a/o mid-level professionals administrators’ equity work. Although Latinx/a/o mid-level administrators have a significant role to play in advancing equity work inside higher education institutions, these racialized organizations will create barriers that maintain whiteness and white interests. Without addressing power structures and the bureaucracy of decision-making at private institutions, progress on equity throughout the organizational structure may be limited. Implications for research and practice for Latinx/a/o/ administrators are discussed.

A Tale of 2 Countries: Implementation of the Cold Chain Equipment Optimization Platform in Guinea and Kenya.

In 2016, the Gavi Cold Chain Equipment Optimization Platform (CCEOP) was approved and launched in recognition of the fact that functional cold chain equipment (CCE) is essential to strengthening vaccine supply chains and ultimately achieving Gavi's immunization equity and coverage goals. Through CCEOP, Gavi committed to investing US$250 million between 2016 and 2021 to commission CCE in more than 63,000 facilities to upgrade and expand their CCE footprint while stimulating the market to provide affordable, technologically advanced, and accessible equipment. We present case studies from Guinea and Kenya, both of which received CCEOP support, that highlight 2 ways for countries to prioritize investments and implement activities through a large funding and support mechanism. The studies explore the different ways that each country implemented CCEOP and consider how aspects of leadership and technical capacity influence country priorities and results. They also uncover key lessons on sustainability of a large immunization supply chain effort. The experiences of Guinea and Kenya can help other countries embarking on similarly large health system interventions, especially related to supply chain strengthening and immunization programs. In particular, these experiences offer important lessons in leadership, processes and systems, country ownership, technical capacity, and sustainability.

Gender Variations and Inequity in Health Care Financing: Evidence from Southeast Nigeria.

Health care is central to sustainable development, but it is underfunded in many developing countries such as Nigeria. This study empirically examined gender variations and inequity in health care financing in Southeast Nigeria. To decompose the Gini coefficient and analyze inequity by gender and differences in health care financing among states in the region, Dagum's approach for decomposition of the Gini coefficient is used. Empirical results showed that gender inequity exists in health care financing in Southeast Nigeria. In addition, variations in health care financing inequity among states in the Southeast region were found. Based on the foregoing, the study recommends that when implementing health care financing reforms, different population groups be covered in order to achieve the broader equity and effectiveness goals. Furthermore, governments in various states should step up efforts to assist disadvantaged and oppressed communities, such as poor indigenous people, in terms of health care utilization, which could reduce the health care financing burden.

Climate change, society, and health inequities.

Climate change, society, and health inequities.

A design framework for considering spatial equity in sustainable urban drainage infrastructure

• Traditional design methods may lead to inequity in water infrastructure services. • A trade-off between spatial equity and other goals may exist. • A multi-criteria design framework addressing spatial equity is proposed. The design of urban drainage systems has traditionally aimed for cost and service objectives without considering broader socio-economic implications of design decisions. This can result in designs with unequal distributions of infrastructure services among urban communities. In this paper, we propose a design approach for multi-criteria design of urban drainage systems which combines traditional design objectives, such as reliability and cost-effectiveness, with social goals like reducing inequality in the spatial distribution of infrastructure benefits. A multi-dimensional search algorithm is linked to an urban rainfall-runoff simulation model to identify portfolios of efficient (Pareto-optimal) and spatially equitable drainage infrastructure developments. A measure of the difference in flood damage between different subregions is also considered as a decision-making aide along with other criteria. An illustrative case study shows how the design framework can help planners make trade-offs, for example between spatial equity and cost-effectiveness, when selecting future interventions in urban water systems. The results imply that traditional optimisation models can lead to inequity in spatial distribution of urban drainage infrastructure services and that equality in spatial distribution of green drainage assets does not necessarily entail fair spatial distribution of flood damage between different urban neighbourhoods.

THE SHARED SISTERHOOD PHILOSOPHY FOR EQUITY IN ORGANIZATIONAL LEADERSHIP

AbstractThe authors, in trying for better approaches to racial and gender equity, discuss what they call the “Shared Sisterhood” philosophy and approach on “how to achieve equity across genders and racioethnicity (i.e., race + culture combined) grounded in deep introspection and authentic interpersonal connection. In the workplace, equity is achieved via collective action, which means that you work with your coworkers to attain a common goal of equity.” They also note problems that the DEI/diversity, equity, and inclusion industry has had in organizations, even in today’s landscape where we have greater overall awareness of these topics. “With Shared Sisterhood,” they write, “we ask whether the power to change lies in growing and connecting with others and using those connections to foment the dismantling of systemic inequities.” They outline various steps individuals can take, each of which is described in more detail in the article. Some are, in their words: Keep reading; Follow people from different racioethnic groups on social media; and engage with different news sources. These are followed by interpersonal steps, such as Create book clubs or discussion circles to practice Shared Sisterhood exercises, and Create partnerships with other people to hold each other accountable for working toward equity.

Operationalizing Urban Climate Justice: A Case Study of Sunset Park, Brooklyn, New York City

Cities are increasingly incorporating climate resiliency goals into planning, development, and sustainability efforts. Such efforts are often touted as opportunities to promote climate justice that will not only support adaptation and mitigation efforts but also improve local environmental quality and bring higher paying, green jobs to frontline communities. Yet many local community leaders and residents remain skeptical of the promised benefits of climate-resilient development in their neighborhoods, fearing that new investments will attract higher income earners, intensify real estate pressures, and contribute to green gentrification. This study investigates the synergies and tensions that are emerging as cities develop policy responses to address climate change, implement resiliency projects, and meet economic, equity and social justice goals. Through a case study of Sunset Park, Brooklyn, a low-income working waterfront community in New York City, the paper explores community efforts to exert influence over two large-scale, climate resiliency-focused development projects. Data sources for the study include interviews with city officials, private sector representatives, community leaders and residents, participation in community events and workshops, and analysis of planning and policy documents. The study finds that an extensive legacy of community-led planning, the presence of proactive community champions, and grassroots mobilizations were critical factors that strengthened local influence over urban resiliency planning processes. It offers lessons and strategies for empowering local voices in community-based adaptation and resiliency efforts and for achieving climate justice objectives.

Lessons on Increasing Racial and Health Equity From Accountable Health Communities.

The Accountable Health Communities model (AHC) was developed to test whether systematically screening for health-related social needs and referrals to community-based organizations to resolve unmet needs would affect healthcare use and costs for CMS beneficiaries. Purpose: The AHC model required applicants to develop Disparities Impact Statements (DIS), to increase the model's potential impact on health equity. Authors conducted a thematic analysis of awardees' DISs to identify minority and underserved populations of focus, and the strategies awardees used to increase equitable participation in the model by minority and underserved populations. Most awardees focused on multiple minority and underserved populations and used multipronged innovative strategies to pursue equity goals. Considering recent health equity advancements as Executive Order 13985 and the release of CMS Innovation Center's Strategy Refresh, with highlights of health equity best practices from the AHC model, assessing use of DISs in the AHC model provides valuable lessons. Implications: Given HHS' broadscale promotion of DISs adoption as a viable quality improvement approach to achieving health equity, disseminating how the tool was used by a myriad of organizational types in the AHC model is critically important to improving future efforts to increase equity.

An Analysis of Growth and Pattern of Revenue and Expenditure in the State of Uttarakhand

Abstract: The focus of the paper is to examine trends and growth in state government revenue and expenditures in Uttarakhand. In order to perform its functions i.e. social, economic and general government needs funds that have to be garnered from a variety of sources. Revenue and Expenditure plays a very significant role to achieve the major economic goals of growth, stability, equity and efficiency. The revenue and capital receipts, revenue and capital expenditure of the state determine their ability to deliver services. Weaknesses in revenue and expenditure management could constrain the ability of a state to contribute to poverty reduction and economic development. The importance of public revenue has greatly increased during recent times. This paper reviews key trends in public spending and revenue during this period. The result indicates that the revenue and expenditure of the state government increases from 17% to 23% during study period.

Understanding equity–efficiency interaction in the distribution of global carbon budgets

Equity and efficiency are two important factors guiding the mitigation of anthropogenic emissions to achieve the Paris climate goals. Previous studies have proposed a range of allocations of global carbon budgets, but few have quantified the equity–efficiency interaction. Based on an investigation of the existing allocation literature, this study conducts a novel analysis using a ‘mixed’ allocation ‘big-data’ framework to understand the equity–efficiency interaction in the distribution of global carbon budgets under 2 °C and 1.5 °C warming targets. At a global scale, a carbon Gini coefficient and aggregate abatement costs are used as quantitative metrics to reflect equity and efficiency, respectively. Results show an equity–efficiency frontier that reflects the opportunity for the international community to co-improve equity and efficiency on top of existing allocations. However, the frontier also features strong trade-offs to further improve equity and efficiency if national allocations are to be achieved individually. Our analysis verifies that such trade-offs are sensitively dependent on the level of global connection and integration. Linking national mitigation actions and potentials can help promote equity–efficiency synergies and contribute to the efficient achievement of the Paris Agreement's temperature and equity goals.

Is Section 199A's Qualified Business Income Deduction Good Tax Policy?

ABSTRACT The qualified business income deduction under Section 199A, which was enacted as part of the Tax Cuts and Jobs Act of 2017, was intended to provide a reduction in federal taxes for businesses operating as passthrough entities commensurate with the rate reduction allowed to corporations. While the Section 199A deduction does achieve its intended objective of reducing taxes on passthrough entities, it does so with unnecessary complexity. In this article, we briefly review the rules governing the deduction and evaluate it critically against nine principles of good tax policy. Our evaluation reveals shortcomings in the structure of the deduction that prevent it from achieving the goals of equity, certainty, convenience, administrative effectiveness, simplicity, neutrality, efficiency, compliance, and revenue predictability. However, with respect to the principle of visibility, the deduction succeeds.

Aligning Value-Based Payments With Health Equity

This Viewpoint discusses a potential guiding framework of strategies that align payment model components with equity goals.