Equity Problems Research Articles

OP79 Experimenting HTAi Patient Group Submission Template To Involve Patients

INTRODUCTION:The Health Technology Assessment International (HTAi) community recognises the importance of including patients’ views from published research and systematically obtaining input from patient organizations (POs). The HTAi's Patients and Public Involvement Subgroup has elaborated the Patient Group Submission Template for HTA (HTA Template) to facilitate the collection of evidence from patients via POs involvement. In 2015 AGENAS outlined a procedure to involve POs and tested the HTA Template within a Health Technology Assessment (HTA) report on dialysis.METHODS:The HTAi template was translated into Italian and adapted to the HTA report's specific information needs: to understand patients’ experiences with different dialysis modalities and any delivery problems at the regional level. Some questions were reformulated, others were cut and two different versions of the template were used. One was tailored to POs representatives and the other to individual patients selected with a purposive sampling procedure. We provided the HTA Template to POs appointed by an umbrella organization, Cittadinanzattiva, for their input and to identify other relevant POs to be involved. We identified a list of four associations, based on geographical location and typology of patients. Each POs representative completed the first template and administered the second one to, at least one patient for each five dialysis modalities. AGENAS staff provided support on a cascade basis POs collected and returned all templates.RESULTS:Researchers performed a thematic analysis of the answers received and this input was introduced in the HTA report within the chapter on Patients Aspects. Patients’ experiences closely corresponded to the ones in our qualitative literature's systematic review. However, PO representatives templates revealed an important problem of equity in access to different dialysis modalities across regions that we highlighted in the HTA report's recommendations.CONCLUSIONS:One of the template's limitations was related to self-administration. In some cases, a lack of familiarity with communicating one's views in writing may have affected the survey's informative power. This pilot also demonstrated the need for a more inclusive involvement procedure, as some important POs were not initially represented by the umbrella organization.

Unequal Thailand: Aspects of Income, Wealth and Power ed. by Pasuk Phongpaichit and Chris Baker

Reviewed by: Unequal Thailand: Aspects of Income, Wealth and Power ed. by Pasuk Phongpaichit and Chris Baker Thanet Aphornsuvan1 Unequal Thailand: Aspects of Income, Wealth and Power Pasuk Phongpaichit and Chris Baker (eds) Singapore: NUS Press, 2016. 208pp. ISBN: 978-981-4722-00-1 This is a book about the political economy of Thailand in the globalized era, focusing especially on the sensitive and much concerned issue plaguing the nation for a long time: inequality. What makes Thailand so conspicuous on this issue is the central theme of the book. The authors studied sources of money income and the social structure, which generate a kind of power that enables the privileged to be richer and more powerful while spelling an unfortunate future [End Page 161] for the working population. The book chapters are the fruits of a research project on ‘Towards a More Equitable Thailand: A study of Wealth, Power, and Reform’. In the tumultuous years during which the nation was divided into two colours of yellow and red with sharp differences in political ideologies, the authors of these chapters were moved to take a more serious look at the phenomenon of inequality in Thai society. Unequal Thailand persuasively argues that the increase in inequality is a product of oligarchy, the rule of the few, one that involves the political system as well as the driving of economic forces creating a new and modern society in which people’s lives have improved in many ways. Yet the small elite were, and are, in control of the vision and reality of the future of the country. In this timely and much-needed book on the sensitive issue of inequality in Thailand, the authors analyse unequal practices and the policies and politics that reproduce the Thai oligarchy. The editors of Unequal Thailand, Chris Baker and Pasuk Phongpaichit are well-known scholars of Thai political economy and political history. Their meticulous approach to the study of political economy and careful analyses of the connections between economy and politics in Thailand are evident here in the first chapter. The introductory chapter gives the volume cohesion and persuasively argues that the increase in inequality has been a product of oligarchy, the rule of the few. Based upon the Gini index (a measure of income distribution in which a higher figure means greater inequality), Thailand became one of the most unequal countries in thirty years of economic development from the 1969s to 1990s with the index rising from 0.413 to 0.536. The prominent factors which contributed to this trend included government policies that favoured capital while repressing working people, the concentration of growth mainly in and around Bangkok, the prices, profits, and salaries for some adjusted towards international levels as well as the increase in value of property as globalization enveloped Thailand. From the mid-1970s onwards, world agricultural prices fell relentlessly, bringing down farmers’ income. On top of these factors Thailand lacked strong political will to resolve this growing problem of inequality among the country’s political and bureaucratic leaders. The rest of the book has eight chapters, which make use of government data to show how inequality in economics, politics, and education is sustained in Thailand. The second chapter by Duangmanee Laovakul on ‘Concentration of Land and Other Wealth in Thailand’ is a revelation about the main problem of equity and social justice in a country where agriculture has dominated the economy for so long. Land has been the most fundamental means of production in Thai society since at least the beginning of the formation of the Bangkok Empire under the Chakri dynasty in the late eighteenth and early nineteenth centuries. Historically, the Ayutthaya king was the ‘lord of the land’ and ‘lord of people’s lives’ to whom all land in the kingdom belonged; no individual ownerships were ever granted to the nobility and phrai (commoners) of the kingdom except usufruct rights or use rights over designated land. The fact that the researcher of the chapter accessed data from the Land Department, a first in the study of land ownership, also tells us about the nature of politics and power involving the management of land in Thailand. The study clearly...

Parking Spaces in the Age of Shared Autonomous Vehicles: How Much Parking Will We Need and Where?

The world is on the cusp of a new era in mobility given that the enabling technologies for autonomous vehicles (AVs) are almost ready for deployment and testing. Although the technological frontiers for deploying AVs are being crossed, transportation planners and engineers know far less about the potential impact of such technologies on urban form and land use patterns. This paper attempts to address those issues by simulating the operation of shared AVs (SAVs) in the city of Atlanta, Georgia, by using the real transportation network with calibrated link-level travel speeds and a travel demand origin–destination matrix. The model results suggest that the SAV system can reduce parking land by 4.5% in Atlanta at a 5% market penetration level. In charged-parking scenarios, parking demand will move from downtown to adjacent low-income neighborhoods. The results also reveal that policy makers may consider combining charged-parking policies with additional regulations to curb excessive vehicle miles traveled and alleviate potential social equity problems.

Inequity in access to childhood immunization in Enugu urban, Southeast Nigeria.

The Nigerian National Programme on Immunization aims at increasing the immunization coverage of children under 1 year of age. However, there is still a gap between the national immunization targets and the immunization coverage rates, and data are rarely disaggregated according to socioeconomic status. As a result, there is a dearth of information about the coverage of subgroups, especially at the local level. This study determined the socioeconomic differentials in immunization coverage for children under 5 years and under 1 year in Enugu urban, Southeast Nigeria. This was a community-based, descriptive cross-sectional study in Enugu urban of Southeast Nigeria. A modified 30 × 7 cluster sampling design was adopted as the sampling method to select and interview 462 mothers of 685 children under the age of 5 years on their sociodemographic and economic characteristics and immunization status of their children. Principal components analysis in STATA software was used to characterize socioeconomic inequity. Immunization coverage was as follows: Diphtheria, pertussis, tetanus third dose(DPT3), 3, 65.3%; oral polio vaccine 3, 78.0%; hepatitis B3, 65.2%; and measles, 55.8%. The full immunization rates for children 1-5 years and st year of life was selected as the reference group, the immunization rates in all other age groups decreased significantly. Using the same logistic regression model for children under 1 year of age, every added month of the child's life increased the full immunization coverage, and this was statistically significant (OR 2.752, 95% CI 2.304-3.418). Full immunization coverage for children aged < 1 year was lower than the national target of 95%. There are differences in immunization coverage rates between different wealth quartiles in the area with the least poor benefiting more than the poorest, thus creating equity problems. Health managers need such community-based information about the vaccination status of their target population to plan and implement interventions that aim to improve immunization coverage in these areas.

Future food.

Food systems have changed markedly with human settlement and agriculture, industrialisation, trade, migration and now the digital age. Throughout these transitions, there has been a progressive population explosion and net ecosystem loss and degradation. Climate change now gathers pace, exacerbated by ecological dysfunction. Our health status has been challenged by a developing people-environment mismatch. We have regarded ecological conquest and innovative technology as solutions, but have not understood how ecologically dependent and integrated we are. We are ecological creatures interfaced by our sensoriness, microbiomes, shared regulatory (endocrine) mechanisms, immune system, biorhythms and nutritional pathways. Many of us are 'nature-deprived'. We now suffer what might be termed ecological health disorders (EHD). If there were less of us, nature's resilience might cope, but more than 9 billion people by 2050 is probably an intolerable demand on the planet. Future food must increasingly take into account the pressures on ecosystem-dependent food systems, with foods probably less biodiverse, although eating in this way allows optimal health; energy dysequilibrium with less physical activity and foods inappropriately energy dense; and less socially-conducive food habits. 'Personalised Nutrition', with extensive and resource-demanding nutrigenomic, metabolomic and microbiomic data may provide partial health solutions in clinical settings, but not be justified for ethical, risk management or sustainability reasons in public health. The globally prevalent multidimensional malnutritional problems of food insecurity, quality and equity require local, regional and global action to prevent further ecosystem degradation as well as to educate, provide sustainable livelihoods and encourage respectful social discourse and practice about the role of food.

Supplemental Material for A Multilevel Examination of Racial Disparities in High School Discipline: Black and White Adolescents’ Perceived Equity, School Belonging, and Adjustment Problems

Supplemental Material for A Multilevel Examination of Racial Disparities in High School Discipline: Black and White Adolescents’ Perceived Equity, School Belonging, and Adjustment Problems

Il governo dell’innovazione farmaceutica in Italia: quali strumenti di governance regionale proporre?

Managing pharmaceutical innovation in Italy: which regional governance tools can be adopted? Within the Italian federalist framework, national and regional governance tools for pharmaceutical care have been developed in recent years. From a financial perspective, the pharmaceutical outpatient expenditure has already been put under control and this has markedly contributed to reducing the overall costs. The hospital pharmaceutical expenses instead have grown. On this last element bears how innovative and expensive drugs are introduced and managed; among these drugs, cancer drugs have a decisive role.&#x0D; In the last years the AIFA (Agenzia Italiana del Farmaco – Italian Drugs Agency) policies regarding the adoption process of new drugs have stressed the concept of value for money: any innovative and expensive drug is linked to a webbased control register in order to monitor outcomes. The aim is to relate the drug price to the obtained results (payment by result and risk-sharing) or at least to institute simple financial agreements (cost-sharing) that can be defined as managed entry agreements (MEA). The critical point that can cause equity problems is the way these national governance tools are applied in different regional contexts. There are in fact marked differences among Italian regions. Most regions are aware that the only way to rule the system, and in particular the use of innovative drugs, is to have stronger evidence-based management tools able to connect different systems of oncological prescriptions. The aim is to follow patients in different care settings in order to measure the pathway phases in terms of consumption, costs and quality outcomes and therefore evaluate in actual practice the value for money of innovative drugs.

Health promotion and diabetes care in developing countries

Once considered as a disease of the rich, diabetes is now sweeping the whole world with 80% of diabetics living in developing countries. The costly and prolonged treatment of diabetes raises the equity problem between and within countries. Diabetes care goes beyond simply injecting insulin or swallowing oral tablets. The treatment of diabetes assumes availability, accessibility and affordability not only of/to insulin or oral tablets but also of/to all means of blood control (glycemic monitoring, urine tests, biological analyses, healthy diet, etc.). Besides the need for efficient health systems, good control of diabetes depends on other social determinants of health such as education and income. Consequently, there is a requirement of good participation from individuals and communities in order to support and complement medical treatments suggested by doctors and qualified medical staff. In this paper, we consider prevention and care of diabetes as an example of health promotion in developing countries. Health promotion was considered in eight Global WHO Conferences (Ottawa Charter, 1986; Adelaide Statement, Australia, 1988; Sundsvall, Sweden, 1991; Jakarta, 1997; Mexico City, 2000; Bangkok, 2005; Nairobi Call for Action, 2009 and Helsinki, 2013). All the conferences followed and tried to implement the five action areas for health promotion defined in the Ottawa Charter, namely: – building healthy public policy; – creating supportive environments; – strengthening community action; – developing personal skills; – re-orienting health care services toward prevention of illness and promotion of health. Unfortunately, thirty years after the launch of Ottawa Charter, very few developing countries have implemented the charter actions in terms of diabetes care. Struggling to get the minimal subsistence in terms of insulin and oral drugs, poor, rural and non-educated people with diabetes can neither afford the (out-of-pocket) cost of a regular blood control neither the access to a healthy diet. More generally, all people with diabetes are in need of personal skills especially with the help of community. Last but not least and more than ever, developing countries must re-orient health care services toward prevention of illness and promotion of health by acting on risk factors like obesity, lack of physical exercise, smoking, alcohol, etc.

Urban transport social needs in China: Quantification with central government transit grant

Social inclusion requires suitable measures to improve public transport, thus satisfying the needs of socially disadvantaged groups (SDGs). Although numerous measures are available in principle, in practice, however, financial problems hinder the implementation of these measures. This study addresses an important issue in China—how to finance a socially inclusive public transport system given the incomplete nature of fiscal reforms at local government level. Central government grants are required to achieve a more equitable distribution of public transport resources. To calculate the demand for central government grants, an approach was developed to quantify transport social needs (TSNs). A primary component regression model was established to identify the factors that affect the SDGs using public transport. Further, a need-based method is proposed for the allocation of central government grants. The allocation procedure was designed with the categorization of cities to avoid distorted incentives, and a two-step formula was used to address the funding allocation equity problems. The data obtained from 252 municipal cities in China in 2010 show that the TSNs were 37.63 billion trip-kilometers. The corresponding central government grant was ¥18.82 billion. The results of the proposed allocation show that more funding was provided to small and low-density cities had unfavorable situations due to local public transport investment. This investigation would help in a more equitable distribution of public transport funding.

Intended and Unintended Consequences of Educational Technology on Social Inequality

While much has been written in the field of educational technology regarding educational excellence and efficiency, less attention has been paid to issues of equity. Along these lines, the field of educational technology often does not address key equity problems such as academic achievement and attainment gaps, and inequality of educational access and opportunity. In this paper, we survey research regarding persistent inequality issues related to (a) educational access and (b) educational opportunity in the U.S. education system. Furthermore, we discuss intended and unintended consequences of educational technology on social equality. We then conclude with a discussion of how educational technology researchers and practitioners should consider the broader social context in which their work is conducted and the intended and unintended consequences it might have on social inequality.

A Payback Approach to Generational Inequity

The payback approach to capital budgeting is proposed as a clear and intuitive way to think about fiscal policy and the normative problem of generational equity. Payback has been an enduring tool of corporate capital budgeting decisions and the home mortgage industry. As a clear and resonant conceptual tool, payback measures thus have the potential to mobilize political will for overcoming difficult fiscal policy problems, when they arise. Numerical examples calibrated to U.S. federal budget history illustrate how payback measures can be used in practice.

Finding Pathways to More Equitable and Meaningful Public-Scientist Partnerships

For many, citizen science is exciting because of the possibility for more diverse, equitable partnerships in scientific research with outcomes considered meaningful and useful by all, including public participants. This was the focus of a symposium we organized at the 2015 conference of the Citizen Science Association. Here we synthesize points made by symposium participants and our own reflections. Professional science has a participation problem that is part of a larger equity problem in society. Inequity in science has negative consequences including a failure to address the needs and goals arising from diverse human and social experiences, for example, lack of attention to issues such as environmental contamination that disproportionately impact under-represented populations, and a failure to recognize the pervasive effects of structural racism. Inequity also encourages mistrust of science and scientists. A perception that science is practiced for the sole benefit of dominant social groups is reinforced when investigations of urgent community concerns such as hydraulic fracturing are questioned as being biased endeavors. Defined broadly, citizen science can challenge and change this inequity and mistrust, but only if it reflects the diversity of publics, and if it doesn’t reinforce existing inequities in science and society. Key will be the way that science is portrayed: Acknowledging the presence of bias in all scientific research and the tools available for minimizing this, and demonstrating the utility of science for local problem solving and policy change. Symposium participants called for reflexive research, mutual learning, and other methods for supporting more equitable engagement in practice and in the activities of the Citizen Science Association.

The problem of equity in the philosophy of the age of enlightenment in the context of growing of european states and the formation of civil society

It is researched the evolution of equity issues in the European philosophy of the Age of Enlightenment. It`s analyzed the social andphilosophical aspects of equity in T. Hobbes, John. Locke, K. Helvetius, D. Diderot, D. Hume. It`s discovered the common and differencesin their views.

매입임대주택 공급의 문제점과 개선 방안: 서울을 중심으로

본 연구에서는 임대주택에 대한 수요가 많은 서울을 중심으로, 최저소득계층을 대상으로 하는 매입임대주택의 공급 현황과 문제점을 구체적으로 파악함으로써 이에 대한 개선 방안을 제시하고자 한다. 주거비 부담 문제의 심화로 매입임대주택의 공급 확대가 필요함에도 불구하고, LH공사와 SH공사에 의해 서울에 공급되는 신규 매입임대주택 호수는 2009년 이후 감소 추세를 보이고 있다. 매입임대주택은 지역 거주민을 입주 대상으로 하기 때문에, 지역별 공급 규모가 주거복지 수혜의 형평성 문제를 야기하게 되는데, 전반적으로 저소득층이 많이 거주하는 도심에 공급이 적고, 서울 외곽의 특정구에 공급이 편중되어 있다. 이와 같은 신규 공급 정체와 지역 편중 문제의 원인은 정부의 낮은 지원 기준단가로 인해 재원 구조가 취약하기 때문이다. 따라서 실거래가 기준으로 정부 기준단가를 인상하고, 실거래가 변동률과 정부 기준단가를 연계하는 것이 필요하다. 수요에 기반한 공급물량 배분을 위한 종합계획이 수립되어야 하며, 매입임대주택을 비롯한 저렴임대주택 공급이 많은 지역들에서는 차상위계층 및 저소득 청년으로 입주 대상이 확대되어야 한다. This research suggests improvement strategies for the problems of 'public housing supplied through the purchase of existing house' by understanding the situation of supply to lowest income class in Seoul where there are many demands. Due to the heavy housing expenditure burden, in spite of the fact that the needs for affordable housings are increasing, the number of 'public housing supplied through the purchase of existing house' which has been supplied to Seoul by LH & SH has decreased since 2009. It is caused by the low standard purchasing price set by government especially Seoul. Since 'the public housing supplied through the purchase of existing house' is targeted for indigenous inhabitants, different supply stocks among different regions cause equity problem. Generally regions with low income class are in short supply, on the contrary the supply is especially concentrated specific regions in outskirts of Seoul. The main reason of such new supply stagnation and regional concentration is the low standard purchasing price. Therefore, it is necessary to increase the government's standard price according to the actual transaction price. Also it is needed to associate actual transaction price's increasing rate with the government's standard price. The housing supply based on demands must be established. In addition, the provision of 'public housing supplied through the purchase of existing house' should be expanded to low-middle income inhabitants and low income youth in the regions where the supply of the affordable housing excess demands.

Challenging fundraising, challenging inequity: contextual constraints on advocacy groups’ policy influence

ABSTRACTSchool fundraising is known to reproduce inequities in schools, yet it remains common practice in Ontario, Canada; findings from a critical policy analysis of an advocacy group’s efforts to change fundraising policy help explain why this is the case. Adopting a discursive understanding of policy, the study used rhetorical analysis to identify how the group has engaged in a decades-long struggle over the meaning of fundraising policy. The findings of the rhetorical analysis were examined in light of an historical narrative of Ontario’s social context to understand how the policy’s contexts have constrained the group’s influence. The study’s findings demonstrate that challenging school fundraising by defining the policy as a problem of equity is not strong enough to overcome neoliberalism’s pressure on parents to provide their children with educational advantages, a trend toward privatization in public education, neoconservative interests in reduced government spending, Canadians’ belief in meritocracy, and historical fundraising practices and dominant meanings. Further, the continuance of school fundraising even after Ontario’s government introduced policy that explicitly addressed the group’s concerns about equity and aimed to limit the practice challenges traditional notional of group influence and success in policy processes.

Are Asymmetrically Informed Individuals Irremediably Envious?

AbstractIn most economies, in particular in presence of uncertainty, a fair allocation does not exist. The main focus of this paper is on possibility of simultaneously resolving the equity and efficiency problems in economies with asymmetrically informed agents. We prove that if a cautious attitude towards uncertainty is socially accepted, then it is possible to have equitable and efficient allocations via a competitive equilibrium mechanism.

A Feminist View of American Elder Law

ANY discussion of contemporary American elder law must consider gender issues. A number of gender concerns are readily discernible, including workplace and family issues. Significantly, sex-based disparities are increasing within the elderly population. In turn, these disparities exacerbate problems of fairness and equity in meeting intergenerational family needs and expectations.As with childrearing, in contemporary American society, the major caregiving responsibility for the growing number of frail elderly falls largely on women rather than men. With an increasing number of women working outside the family home, the intersection of work and family issues is receiving considerable attention both in academic circles and in the popular media. Recently, for example, twenty-nine colleges and universities were identified as having workplace policies sensitive to employee family care responsibilities. Regrettably, such workplaces are the exceptions in American society. This article examines these significant elder law issues from a feminist perspective, particularly the feminist jurisprudence of care. Feminism has much to teach traditional American law and jurisprudence, including elder law. Feminist jurisprudential approaches have provided valuable critiques of traditional legal topics, including tort law, family law, corporate law, tax law, commercial law, labor law, and international law. This article applies similar feminist sensibilities and methodologies to elder law concerns.In general, American elder law is traditional in approach. Traditional or classical American jurisprudence, like elder law, promotes autonomy, personal responsibility, rationality, and individualism. On the other hand, feminism, especially the feminist “ethic of care” associated with the work of Carol Gilligan, rejects these traditional concepts in favor of solidarity, empathy, and community responsibility. This article argues that the feminist ethic of care should displace the traditional American approach to elder law.

Modelling the relationship between counter‐knowledge and open‐mindedness for policy development

Counter‐knowledge refers to flaws in citizens' mental models arising from utilization of rumours, inappropriate knowledge structures, outdated routines or procedures. When counter‐knowledge is applied to civil servants, it may result in problems of efficiency, equity and motivation. This paper examines the relationship between counter‐knowledge and open‐mindedness to model a framework for improving city marketing and policy development. This study tested two measurement models. While the theoretical model represents the effect of counter‐knowledge on city marketing and that the latter has a negative effect on open‐mindedness, the alternative model involves that counter‐knowledge has a positive indirect impact on open‐mindedness. These relationships are examined through an empirical investigation of 203 Spanish city halls. The results show a potential positive indirect effect of counter‐knowledge on open‐mindedness through city marketing programmes. This paper clarifies the existing literature, which tries to contribute to the discussion of city marketing, and helps us to obtain meaning out of the relationship between counter‐knowledge, city marketing and open‐mindedness. Copyright © 2016 John Wiley &amp; Sons, Ltd.

The Taxation of Internationally Portable Pensions: Fiscal Issues and Policy Options

Pension policy reforms across the world in recent decades are a reaction to the changing demographic and socioeconomic environment. While pension scheme redesign has received much attention, the tax treatment of contributions, returns, and benefits of retirement savings remains mostly unattended and the taxation of internationally portable pensions is terra incognita for economists. This paper focuses on the huge differences in old-age pension taxation within and across OECD countries and highlights fiscal equity and efficiency issues that emerge in a world of internationally mobile workers and pensioners. It highlights that pension taxation differs widely not only across countries but also across pension pillars within a country, creating savings and mobility distortions and fiscal equity problems at individual and country level. The paper offers explanations for this heterogeneity and proposes a switch from deferred taxation towards front-loaded taxation of retirement savings to meet the demographic challenges of a globalized world. Three policy options presented differ in the way taxes are paid, but all of them are claimed superior to single-country measures taken to uphold deferred pension taxation or to rely on renegotiations of bilateral double taxation treaties. JEL-codes: H200, H240, H550.

A Fair Go? A Response to the Independent Local Government Review Panel's Assessment of Municipal Taxation in NSW

The Independent Local Government Review Panel (ILGRP) recently handed down its final report on the financial sustainability of New South Wales (NSW) councils. The report identifies a number of problems in relation to local government rating practice and recommends that the NSW Government consider replacing the present rate‑pegging regime, changing the base from which council rates are levied for high‑density unit complexes and reducing the number of exemptions and concessions currently available. At the heart of the recommendations is an empirically untested contention that the current system of council rates in NSW is inherently inequitable in terms of both inter‑municipal equity and capacity to pay. We begin our assessment of the ILGRP claims by reviewing the theoretical foundations of council property taxes. We then provide a synoptic account of NSW municipal rating before empirically assessing equity under the current arrangements. Finally, we propose a set of public policy responses which address the equity problems identified in our analysis.