Equity Problems Research Articles

The Problem of Access, Quality and Equity in South African Higher Education and Strategies for Revitalisation

The assumption that higher education (HE) is the engine behind social and economic development as well as an agent for human emancipation has led to massive investment in HE development. Consequently, nation states, policy makers, and educational planners have made the equitable provision and delivery of HE their top agenda and vision. In the South African context, this gave rise to the enactment of a number of policy initiatives at both government and institutional level so as to translate this vision into reality. While significant milestones were achieved in the quantitative aspects of equity as encapsulated in widened access to higher education, there are persistent challenges that threaten the overall quality and performance of the HE system. These include but are not limited to issues such as student funding, student level of unpreparedness, academic development programmes, pedagogy and the language issue. If these and other challenges are not addressed, they may render the equity vision elusive, however well-intentioned. This paper sought to explore critical challenges experienced by HE institutions in South Africa in their efforts to embrace the equity imperative. The focus of the paper transcend mere exploration by articulating strategies that are meant to revitalise the HE system so as to make it more responsive and relevant to a massified student population.

Problems of priority change in kidney allocation and beyond

Standardized and transparent priority setting in medicine, desirable as it is, will generally exacerbate inter-temporal equity problems arising from changes in treatment priorities: when can it be fair that the treatment of already waiting patients who would have had priority under an established system should be postponed (withheld) for an extended period of time to advance the treatment of others under a reformed system? The reform of the Eurotransplant system of priority setting in kidney allocation (ETKAS), which is in many respects ideal, is a case in point. To give due weight to new medical knowledge, waiting time after the onset of end state renal failure should change from a priority-enhancing to a priority-reducing factor. Since those who have gained in priority by waiting under the present system would be set back under the new, severe problems of transitional justice must be overcome when responding to advances in medical knowledge. The paper explores conceptually some possible ways of rule change and indicates their general relevance from an ethical and a practical point of view for future problems of medical resource allocation under transparent, standardized priority-setting rules.

Challenges of bioethics in twenty-first century medicine

In order to propose possible challenges of bioethics in the twenty-first century medicine, it is necessary to consider that there were some past challenges (at the origin of this new discipline called bioethics), that the challenges have been modified with scientific, biomedical and humanistic breakthroughs, considering at the same time that challenges that may arise in the future will be, in different ways, a result of this historical evolution. The major challenges would be in the future: the unsolved problems of justice, equity and poverty; the challenges posed by the introduction of new technologies with the nanomedicine paradigm; and finally, the challenges driven by breakthroughs in neurosciences with the neuroethics paradigm.

Patient socioeconomic determinants for the choice of the cheapest molecule within a cluster: evidence from Belgian prescription data

Reference pricing is a common cost-sharing mechanism, with the financial penalty for the use of costly drugs shifted from the third-party payer to the patient. Unintended distributional consequences might arise, if the weakest socioeconomic groups face a relatively higher financial burden. This study analyzed for a sample of Belgian individual prescription data for 4 clusters of commonly used drugs (proton pump inhibitors, statins and two groups of antihypertensives [drugs acting on renin-angiotensin system and dihydropyridine derivatives]) whether the probability to receive the least expensive molecule within a cluster was linked to the socioeconomic status of the patient. Logistic regression models included individual demographic, working, chronic illness and financial status and small area education data for 906,543 prescriptions from 1,280 prescribing general practitioners and specialists. For the 4 clusters, results show that patients with lower socioeconomic status consistently use slightly more the least expensive drugs than other patients. Larger effects are observed for patients residing in a nursing home for the elderly, patients entitled to increased reimbursement of co-payments, unemployed, patients treated in a primary care center financed per capita (and not fee-for-service) and patients having a chronic illness. Also, patients residing in neighborhoods with low education status use more less expensive drugs. The findings of the study suggest that although equity considerations were not explicitly taken into account in the design of the reference price system, there is no real equity problem, as the costly drugs with supplement are not prescribed more often in patients from lower socioeconomic classes.

The Shadows of Future Generations

This Note addresses the twin problems of political short-termism and intergenerational equity. Although scholars have discussed these concerns extensively, few scholars have developed proposals to modify democratic institutions - particularly legislatures - to better consider posterity's interests. This Note critiques one such proposal by several environmental ethicists for including posterity-oriented legislators in present-generation legislatures. It then proposes a system that ties the long-term outcomes of legislators' policy preferences to their pension plans by creating a new commodities market that values the decisions legislators make and their effect on posterity.

Sharing the Cost of Global Warming*

AbstractFor meteorological reasons, the distribution of climate‐change damage bears no relationship to the distribution of emissions across the globe. We argue in favor of offsetting this discrepancy. We propose a global insurance scheme of sorts, to be financed according to countries’ responsibilities in the matter. We analyze this horizontal equity problem using a responsibility/compensation framework, which we have adapted to a context of externalities. We characterize new versions of two well‐known cost‐sharing schemes.

Comparing Single Sex and Reformed Coeducation: A Constitutional Analysis

One of the most enduring educational debates of the past three decades has dealt with the legality and advisability of sex-segregated education. This debate can often look confusing, given a large number of debaters and the diversity of their perspectives and agendas. More than this diversity, however, the debate is confusing because the debate has been structured as a contest between the “innovation” of sex-segregated education and status quo coeducation. Missing from the debate is a comparison between reformed coeducation and a single-sex alternative; a comparison that is markedly more useful in determining what ought to be done about the problems animating the debate, particularly problems of gender equity in education and society. Also missing from the debate are comprehensive constitutional analyses applying the U.S. Supreme Court’s equal protection “intermediate scruitiny” test to sex-segregated education, a test characterized by much debate as to its application and consistency. These two gaps ultimately come together because the comparison between reformed coeducation and sex-segregated education is also the proper one for analyzing the constitutionality of single-sex education. Therefore, this Article seeks both to address the lack of comprehensive analyses regarding the constitutionality of sex-segregated K-12 public education and to untangle the underlying debate regarding the Court’s application of the intermediate scrutiny test. In undertaking this analysis, it posits a new way to look at the Court’s jurisprudence regarding legislation that facially classifies based on sex, one that suggests that the Court’s jurisprudence may be more consistent and predictable than most commentators have suggested up to this point. It then applies this jurisprudence to sex-segregated, K-12 public education. In doing so, it pays particular attention to the reformed coeducation and sex-segregated education comparison as the proper one for analyzing the constitutionality of single-sex education. It concludes that, when assessing whether a sex classification substantially advances an important government objective, under the Supreme Court’s thirty-year-plus line of cases, it is extremely useful and possibly necessary to compare the sex classification with sex-neutral alternatives for advancing that objective.

Subjective Well-being as a Measure of Welfare and Equity: The Case of Choice Policies in Health Care

Choice and competition policies in public services are popular reform strategies in many European countries. Using the case of health care in the UK, this article analyses the effects of choice and competition policies by using subjective well-being (SWB) as an indicator of welfare and equity. Existing literature on welfare effects is focused on measuring efficiency and quality and it is here that SWB offers an alternative perspective. In this article, I use SWB to assess the welfare effects of the choice of hospital policy in the English NHS. Choice preferences are then analysed with a particular focus on the views of different social groups and the results are related to the overall welfare effects of choice with the purpose of capturing equity effects. Results indicate overall positive welfare effects of choice and competition with marked differences between social groups. While it is groups with lower income and lower education that state a higher demand choice, the positive welfare effects I identify are felt most strongly by high income and high education groups. The results highlight the previously debated equity problem arising from choice and competition policies in health care.

Loud Silence ‐ Performing the Research Interview, Listening to Black Women’s Stories in the Academy and Beyond

This article (originally written as a performance piece) focuses on the lessons learned while conducting qualitative research on Black women in the academy, in particular the lessons learned from Dr Vivi South. Theoretical insights from Critical Race Theory, Queer Theory, Black Feminist Thought, and Narrative Inquiry inform the piece to create an engaging and educational experience that blurs boundaries between traditional modes of academic demonstration, performance, and storytelling. Blurring boundaries between research and practice, theory and method, social science and humanities, community and university creates a space for scholars to rethink the traditional qualitative research interview and the problems of equity in the academy.

서울시 주택정책의 문제점과 향후 과제

The purpose of this study was to find new policy task and solution by examining and arranging the problem of housing policy in Seoul. In order to achieve this goal, we studied the situation of housing policy in Seoul. For example, we arranged the supply situation of public rental housing, and we examined the dictionary meaning between house and housing, house policy and housing welfare policy. We found the problem of housing policy in Seoul. The problem of housing policy in Seoul are ①the boundary problem of housing policy ② the housing problem which the people live in unusual housing ③the housing problem of homeless ④ the social equity problem between beneficiaries and non-beneficiaries ⑤ the target problem of housing policy in Seoul. Therefore, we proposed future tasks that ①the change of housing welfare policy ② the establishment of master plan in housing welfare policy ③the target definiteness of housing policy ④ the support of independent will ⑤ the establishment of governance system with welfare system.

Real investigative journalism in a virtual world

Commentary: Dumbing down media content undermines democracy. News media need to unleash the full power of investigative journalism. Every investigative story that goes in-depth and behind the scenes will actually strengthen democracy and the free press. The hope was that information technology would level the playing field and bridge the digital divide existing globally and within our countries. But, this commentary argues, technology alone is never the answer. Information technology is not value-free either and is not, by itself, going to provide answers to deep-seated structural problems of governance, social justice and equity.

Equity and Distributional Implications of Climate Change

This paper looks at the climate change problem from an equity perspective. It compares utilitarian approaches with ones based on rights or capabilities. It argues that few of the proposals that have been discussed in the literature have an ethical basis, while those that do have a number of problems. The paper looks at the practicalities of addressing the equity problem in international negotiations. Two specific dimensions of the equity problem in the context of climate change are explored further in the paper: those relating to uncertainty and those relating to discounting.

Priorización y análisis de problemas de salud con una mirada desde la equidad: experiencia en el nivel local en Venezuela

This article analyzes the application of the explanatory moment of the Strategic Situational Planning (SSP) and the Analysis of the Situation of Health (ASIS), as approaches that together, allow to prioritize with a look from the equity problems of health in the local level feasible of intervention. By using the case study developed in the parish Zuata of Aragua State, Venezuela, it can be observed the application of both approaches The main actors of the above mentioned parish prioritized the low coverage of drinkable water, like a health problem. On having analyzed the problem, the following causes were selected to prepare the proposed action: scarce community participation, weakness of governmental plans, absence of political town-planning, inadequate administration of the public resources and lack of conscience in the rational use of water. At the end one concludes that the joint PES-ASIS allows to generate inputs that concretized for the actors in an action plan, they can contribute in the reduction of inequities. Also, the active participation of the actors allows to demonstrate the real problems of the population and to construct a plan of demands.

The Target Efficiency Problem in Italy's Housing Policy. The Case of Tuscany

In Italian housing policy there has recently been a huge shift in competences from national to regional governments. The work to formulate a General Social Housing Law for Tuscany has provided the opportunity for an accurate analysis of how the current housing policy tools work. The main goal of this paper is not to demonstrate whether new tools, i.e. demand-side subsidies, are more or less efficient than traditional ones, i.e. bricks and mortar subsidies in the form of public houses for social rent. Instead, the aim is to point out that new and traditional tools use different eligibility criteria, thereby creating a problem of target efficiency and equity. By simulating some simple changes to the recipient selection criteria and recalculating the amount of public aid assigned to each family, there is an improvement in target efficiency and therefore in equity, while keeping the current total amount of public expenditure unchanged.

A harmonized immunization schedule for Canada: A call to action

In Canada, the National Advisory Committee on Immunization systematically reviews the evidence for the effectiveness and safety of new and old vaccines, and sets a 'minimum' recommended schedule. However, in contrast to other industrialized countries where single, harmonized countrywide immunization schedules are de rigeur, Canada has a confusing system, with each province and territory defining its own schedule - and none are the same. The time has come to rectify this decades-old patient equity and safety problem. The Canadian Paediatric Society calls for a harmonized schedule to improve the health and safety of Canadian children and youth.

Beyond the Inner City

In this study the job accessibility of low-income job seekers was compared with that of the affluent majority in a polycentric urban structure. Kain's spatial mismatch hypothesis was extended not only to examine where and why low-income job seekers have lower job accessibility than high-income job seekers but also to compare changes from 1990 to 2000 in the Los Angeles, California, metropolitan area. The job accessibility measure applied in this research captured travel impedance and both job supply and demand. The results suggested that spatial mismatch still existed and that it continued to increase over time. However, the spatial pattern of mismatch had changed. Low-income job seekers were more disadvantaged in the inner-ring suburbs, mainly because of the lag in the residential suburbanization of low-income job seekers. This research contributed to the understanding of the extent and consequences of urban spatial transformation and suggested that social equity problems be addressed from a broader spatial perspective.

Value and Cancer Care: Toward an Equitable Future

Health care expenses in the United States are increasing inexorably. At the current rate of growth, it is anticipated that 20% of the gross national product will consist of health-related expenditures within the next decade. Cancer is the second leading cause of death in the United States, and it is increasing in prevalence because of the aging of the population and the limited number of successful prevention strategies. As the biological characteristics of cancer come into sharper focus, targeted therapies are being developed that offer the promise of increased clinical benefit with fewer toxicities than are associated with conventional treatment. Although spectacular successes are infrequent with this approach, to date, the majority of targeted therapies are modestly effective at best, and extremely costly. This observation suggests that a broadly acceptable definition of value in a cancer therapeutic agent is not at hand, but is sorely needed from the vantage points of the patient and society. A corollary issue of enormous import is how to equitably distribute the health care dollar in the service of achieving the greatest good for the greatest number. Although cancer is responsible for only 5% of the health care budget, its cost is increasing and it can be viewed as paradigmatic when contemplating the problem of equity in health care. Here, a number of concepts are discussed that focus on this goal and its implications for the cancer patient and society at large.

Retrospective cost analysis of breast cancer patients treated in a Brazilian outpatient cancer center (OCC).

e11026 Background: Public health data indicate that the global burden of breast cancer in women, measured by incidence and mortality, is substantial. The associated treatment costs increase steadly above economic growth, leading to substantial financial, equity and access problems. However, the economic impact of management costs in Brazilian clinical practice has not been documented yet. Information about patients' quality of life associated with the introduction of new drugs and procedures is also lacking. Methods: This is a retrospective study of women with breast cancer treated at a private practice OCC in Rio de Janeiro, Brazil. All the patients were covered by Amil, a Brazilian HMO. Direct costs (DC) of 199 patients diagnosed since 2002 and followed to the end of 2009 were analyzed and correlated to clinical stage. Results: 48% of women were diagnosed in stage I, 34% patients in stage II, and only 2.5% were diagnosed in stage IV, similar numbers to those seen in developed countries. The average DC of their medical care per patient was US$21,658.94 (mean 2.48 yrs ± SD 1.66) for stage I compared to US$48,295.29 (mean 2.76 yrs ± SD 1.67) for stage II, and were US$63,662.06 (mean 2.34 yrs ± SD 1.56) for stage III and US$63,697.33 (mean 1.77 yrs ± SD 0.80) for stage IV. We also observed that DC per patient-year increased according to clinical stage. In the first year, average cost was US$15,183.85 for stage I, while it was US$ 44,160.74 for stage IV. Those DC decreased along the years in all stages. For example, in the seventh year of follow-up, the average DC was only US$ 467.27 for stage I (2005 purchasing power parity index 1 USD = 1.4 BRL). Conclusions: Breast cancer accounts for a significant part of the health insurance budget. Later stage at diagnosis is associated with higher DC per patient-year of treatment, and known lower probability of 5-year survival. No significant financial relationships to disclose.

Introduction to the Special Issue: Changing Conceptions of Special Education

After a long history of exclusion, litigation and legislation now ensure access to a free, appropriate education for students with disabilities. The legal safeguards and processes that have been used to identify and place students in special education were designed to provide access, but they do not guarantee excellence of educational services and outcomes for students with disabilities. As a result, the alignment of the Individuals With Disabilities Education Improvement Act (IDEA) and the No Child Left Behind Act of 2001 (NCLB) now mandates the inclusion of students with disabilities in high-stakes assessments of academic achievement and meaningful participation in the general education curriculum. These changes in policy, which were meant to address persistent problems of educational equity, have profound practical implications for the delivery of educational services to all students. Meanwhile, scholarly inquiry into the education of students with disabilities continues to raise exciting possibilities as well as practical challenges for both general and special educators. The University of Delaware's (UD) School of Education invited nationally prominent scholars-six speakers and five policy experts--to present and discuss their perspectives on changing conceptions of special education. The 2-day symposium attracted over 100 practitioners, scholars, and policy makers. Speakers presented papers that explored the theoretical, policy, and/or practice perspectives that shape the experience and structure of education for students with disabilities; lines of inquiry that inform current thinking about special education; challenging areas for future inquiry into the education of students with disabilities; and the future relationship between general and special education. These papers are featured in this special issue. McLaughlin considers views of equity that have emerged in K-12 education practice as a result of intersecting interpretations of civil rights statutes, social science research, and education accountability policies. She traces important shifts in how educational equity is defined, from notions of equal access to equal opportunity to equal outcomes, noting the tension that has resulted from competing concerns for group versus individual equity. She raises the question of whether students with unique needs can ever be treated justly when held to universal standards. She concludes with a proposal that embraces accountability for both group and individual equity. Artiles, Kozleski, Trent, Osher, and Ortiz analyze traditional explanations for the disproportional representation of historically underserved groups in special education. These explanations fail to consider the complicated historical and cultural influences on policies and practices that result in disproportionality. Further, traditional explanations may have the unintended effect of reinforcing the assumption that achievement deficits are a defining feature of underserved students. The authors argue for a view of culture that recognizes its regulative, interpretative, and instrumental properties. They recommend critically analyzing the theoretical foundations of research and embracing a multidimensional conception of culture that recognizes the centrality of practice to teachers' professional development. Fuchs, Fuchs, and Stecker describe contrasting perspectives about the response-to-intervention (RTI) initiative, which has engendered considerable interest among policy makers and practitioners. The authors argue that these perspectives, which they associate with IDEA and NCLB, differ in significant ways despite agreement about the importance of early intervention, early identification, and strengthening general education. Among these differences include the role of special education in a multitiered system of service delivery and the use of validated instructional protocols. The authors are especially concerned that the implementation of the NCLB perspective will blur the difference between special and general education, and promote the use of nonstandard and ineffective interventions. …

Statistical Note #1: Negative Equity and Mortgage Affordability Problems: 1985 Versus 2005

This paper utilizes data from the Panel Study of Income Dynamics (PSID) to assess changes in housing equity and mortgage affordability across age groups between 1985 and 2005. The tabulations presented here indicate the share of the population with negative equity and the share of the population with potentially unaffordable mortgages both increased over this time frame. Changes in equity were more severe for younger households while changes in payment issues were more severe for older age groups. The tabulations from the PSID indicate approximately one-third of households (household head 55-years old or over) with a mortgage have a remaining mortgage balance greater than three times income.