Universal health coverage (UHC) is at the center of current efforts to strengthen health systems and improve the level and distribution of health and health services. This document is the final report of the WHO Consultative Group on Equity and Universal Health Coverage. The report addresses the key issues of fairness and equity that arise on the path to UHC. As such, the report is relevant for every actor that affects that (...) path and governments in particular, as they are in charge of overseeing and guiding the progress toward UHC. (shrink)

The goal of achieving Universal Health Coverage (UHC) can generally be realized only in stages. Moreover, resource, capacity and political constraints mean governments often face difficult trade-offs on the path to UHC. In a 2014 report, Making fair choices on the path to UHC, the WHO Consultative Group on Equity and Universal Health Coverage articulated principles for making such trade-offs in an equitable manner. We present three case studies which illustrate how these principles can (...) guide practical decision-making. These case studies show how progressive realization of the right to health can be effectively guided by priority-setting principles, including generating the greatest total health gain, priority for the worse off, and financial risk protection. They also demonstrate the value of a fair and accountable process of priority setting. (shrink)

Objective: To assess the relation between autocratisation—substantial decreases in democratic traits (free and fair elections, freedom of civil and political association, and freedom of expression)—and countries’ population health outcomes and progress toward universal health coverage (UHC). -/- Design: Synthetic control analysis. -/- Setting and country selection: Global sample of countries for all years from 1989 to 2019, split into two categories: 17 treatment countries that started autocratising during 2000 to 2010, and 119 control countries that never (...) autocratised from 1989 to 2019. The treatment countries comprised low and middle income nations and represent all world regions except North America and western Europe. A weighted combination of control countries was used to construct synthetic controls for each treatment country. This statistical method is especially well suited to population level studies when random assignment is infeasible and sufficiently similar comparators are not available. The method was originally developed in economics and political science to assess the impact of policies and events, and it is now increasingly used in epidemiology. -/- Main outcome measures: HIV-free life expectancy at age 5 years, UHC effective coverage index (0-100 point scale), and out-of-pocket spending on health per capita. All outcome variables are for the period 1989 to 2019. -/- Results: Autocratising countries underperformed for all three outcome variables in the 10 years after the onset of autocratisation, despite some improvements in life expectancy, UHC effective coverage index, and out-of-pocket spending on health. On average, HIV-free life expectancy at age 5 years increased by 2.2% (from 64.7 to 66.1 years) during the 10 years after the onset of autocratisation. This study estimated that it would have increased by 3.5% (95% confidence interval 3.3% to 3.6%, P<0.001) (from 64.7 to 66.9 years) in the absence of autocratisation. On average, the UHC effective coverage index increased by 11.9% (from 42.5 to 47.6 points) during the 10 years after the onset of autocratisation. This study estimated that it would have increased by 20.2% (95% confidence interval 19.6% to 21.2%, P<0.001) (from 42.5 to 51.1 points) in the absence of autocratisation. Finally, on average, out-of-pocket spending on health per capita increased by 10.0% (from $4.00 (£3.1; €3.4) to $4.4, log transformed) during the 10 years after the onset of autocratisation. This study estimated that it would have increased by only 4.4% (95% confidence interval 3.9% to 4.6%, P<0.001) (from $4.0 to $4.2, log transformed) in the absence of autocratisation. -/- Conclusions: Autocratising countries had worse than estimated life expectancy, effective health service coverage, and levels of out-of-pocket spending on health. These results suggest that the noticeable increase in the number of countries that are experiencing democratic erosion in recent years is hindering population health gains and progress toward UHC. Global health institutions will need to adjust their policy recommendations and activities to obtain the best possible results in those countries with a diminishing democratic incentive to provide quality healthcare to populations. (shrink)

In response to our critics, we clarify and defend key ideas in the report Open and Inclusive: Fair Processes for Financing Universal Health Coverage. First, we argue that procedural fairness has greater value than Dan Hausman allows. Second, we argue that the Report aligns with John Kinuthia’s view that a knowledgeable public and a capable civil society, alongside good facilitation, are important for effective public deliberation. Moreover, we agree with Kinuthia that the Report’s framework for procedural fairness (...) applies not merely within the health sector, but also to the wider budget process. Third, we argue that while Dheepa Rajan and Benjamin Rouffy-Ly are right that robust processes for equal participation are often central to a fair process, sometimes improvements in other aspects of procedural fairness, such as transparency, can take priority over strengthening participation. Fourth, while we welcome Sara Bennett and Maria Merritt’s fascinating use of the Report’s principles of procedural fairness to assess the U.S. President’s Emergency Plan for AIDS Relief, we argue that their application of the Report’s principle of equality to development partners’ decision-making requires further justification. (shrink)

We summarize key messages from the World Bank report Open and Inclusive: Fair Processes for Financing Universal Health Coverage. A central lesson of the Report is that in decision-making on the path to UHC, procedural fairness matters alongside substantive fairness. Decision systems should be assessed using a complete conception of procedural fairness that embodies core commitments to impartial and equal consideration of interests and perspectives. These commitments demand that comprehensive information is gathered and disclosed and that justifications (...) for policies are publicly debated; that participation in decision-making is enabled; and that these characteristics of the decision system are institutionalised rather than up to the good will of decision-makers. Procedural fairness can improve equity in outcomes, raise legitimacy and trust, and can help make reforms last. While improving procedural fairness can be costly and there are barriers to achieving it, the range of instruments that countries at varying levels of income and institutional capacity have used with some success shows that, in many contexts, advances in procedural fairness in health financing are possible and worthwhile. (shrink)

This report by the WHO Consultative Group on Equity and Universal Health Coverage addresses how countries can make fair progress towards the goal of universal coverage. It explains the relevant tradeoffs between different desirable ends and offers guidance on how to make these tradeoffs.

This World Bank Report offers a new conception of fair decision processes in health financing. It argues that such procedural fairness can contribute to fairer outcomes, strengthen the legitimacy of decision processes, build trust in authorities, and promote the sustainability of reforms on the path to health coverage for all.

We offer a summary of the WHO Report "Making Fair Choices on the Path to Universal Health Coverage".

In a context of imperfect risk protection, households may protect against the impact of a health shock by employing various financial and non-financial coping mechanisms, such as foregoing or reducing needed medical care, labor substitution, consumption reduction, borrowing money, dissaving, and selling assets. However, leveraging certain coping mechanisms may reduce future productivity, potentially trapping households in chronic or persistent poverty. Resources and risk are not necessarily shared equitably within a household; the ability and willingness of the household to leverage (...) coping mechanisms, or the choice of coping mechanism may depend on the social protection policy context, household socioeconomic status, and type of intrahousehold risk sharing. Vietnam has been making policy changes aimed towards achieving Universal Health Coverage for the past several decades, culminating in a 2015 change mandating universal insurance coverage. This can potentially influence both providers in making decisions around service delivery and households around financing care. This research aims to contribute to the literature exploring the relationships among direct and indirect health care costs, potentially maladaptive coping mechanisms, and household living standards, within the particular health financing and social protection environment in Vietnam. (shrink)

Most people are completely oblivious to the danger that their medical data undergoes as soon as it goes out into the burgeoning world of big data. Medical data is financially valuable, and your sensitive data may be shared or sold by doctors, hospitals, clinical laboratories, and pharmacies—without your knowledge or consent. Medical data can also be found in your browsing history, the smartphone applications you use, data from wearables, your shopping list, and more. At best, data about your health (...) might end up in the hands of researchers on whose good will we depend to avoid abuses of power.2 Most likely, it will end up with data brokers who might sell it to a future employer, or an insurance company, or the government. At worst, your medical data may end up in the hands of criminals eager to commit extortion or identity theft. In addition to data harms related to exposure and discrimination, the collection of sensitive data by powerful corporations risks the creation of data monopolies that can dominate and condition access to health care. -/- This chapter aims to explore the challenge that big data brings to medical privacy. Section I offers a brief overview of the role of privacy in medical settings. I define privacy as having one’s personal information and one’s personal sensorial space (what I call autotopos) unaccessed. Section II discusses how the challenge of big data differs from other risks to medical privacy. Section III is about what can be done to minimise those risks. I argue that the most effective way of protecting people from suffering unfair medical consequences is by having a public universal healthcare system in which coverage is not influenced by personal data (e.g., genetic predisposition, exercise habits, eating habits, etc.). (shrink)

This chapter explores two questions in detail: How should we determine the threshold for costs that individuals are asked to bear through insurance premiums or care-related out-of-pocket costs, including user fees and copayments? and What is an adequate relationship between costs and benefits? This chapter argues that preventing impoverishment is a morally more urgent priority than protecting households against income fluctuations, and that many health insurance plans may not adequately protect individuals from health care costs that threaten to (...) drop their financial status below a decent minimum. A design that places greater emphasis on preventing impoverishment and finances the achievement of that goal by reducing unnecessary subsidies to better-off households would better accord with a sufficientarian approach to health care. -/- . (shrink)

Introduction: Universal health coverage (UHC) was introduced in Iran in 2014. The aim of this study was to evaluate the usage rate of health services by human immunodeficiency virus (HIV)/acquired immunodeficiency syndrome (AIDS) patients after UHC implementation. Material and methods: In 2018, in a cross-sectional study, we evaluated the outpatients’ needs (within its previous month) and inpatients’ needs (within its previous 6 months) of HIV/AIDS patients in Isfahan province (the center of Iran). Concurrently, we estimated the (...) essential health care services that HIV/AIDS patients have to receive regularly, including vaccination for hepatitis B, measurement of CD4, tuberculosis (TB) assessments and TB treatment, anti-retroviral therapy, examination of viral load, treatment approach, and drug side effects counseling. Two checklists were used for assessing the utilization of health services and essential health cares for HIV/AIDS patients, validated by the Ministry of Health and Medical Education of Iran. Data were analyzed by χ2 test, Pearson’s correlation coefficient, and Spearman’s correlation test. Results: Two hundred and thirteen HIV/AIDS patients completed the questionnaires. The mean age of participants was 41.14 ± 9.23. The outpatient service utilization rate was 31.94% in the previous month and the rate of hospitalization was 126 per 1,000 HIV/AIDS patients in the previous 6 months. The majority of HIV/AIDS patients received essential health services more often than the national standard goals estimation. Conclusions: After UHC implementation, the utilization rate of outpatients and inpatients services in HIV/AIDS patients was more than similar indices in the general population. In addition, HIV/AIDS patients received essential health services adequately. (shrink)

Offers a commentary on the Report 'A Fair Path to Universal Health Coverage' from the perspective of the Director of the Ethiopian Ministry of Health.

We reply to critics of the World Health Organisation's Report "Making Fair Choices on the Path to Universal Health Coverage". We clarify and defend the report's key moral commitments. We also explain its role in guiding policy in the face of both financial and political constraints on making fair choices.

This report from the WHO Consultative Group on Equity and Universal Health Coverage offers advice on how to make progress fairly towards universal health coverage.

Background: The World Health Organization has endorsed a community-based health insurance scheme (CBHIS) as a shared financing plan to improve access to health services and ensure universal coverage of the healthcare delivery system. Such a contributory scheme is the most likely option to provide health insurance coverage when governments cannot offer direct health care support. Despite improvements in access to current healthcare services, Ethiopia’s healthcare delivery remained low, owing to the country’s underdeveloped (...) healthcare finance system. As a result, the present study assessed CBHIS coverage and its predictors in Ethiopia at the individual and community level. Methods: The availability of CBHIS was checked via a criterion: at least one of the cluster respondents had to be enrolled in CBHIS. This study was based on secondary data from the Ethiopia Mini Demography and Health Survey (EMDHS) 2019 and included 7724 respondents. The study population was described using percentage and frequency. Four multilevel mixed-effects logistic regression modelling stages were performed to control for variations due to heterogeneity across clusters, and determinant predictors of CBHIS enrollment were outplayed. Results: The prevalence of CBHIS enrollment in Ethiopia was 33.13%. Rural residents were 3.218 times (AOR = 3.218; 95% CI: 1.521, 6.809), male household heads were 1.574 times (AOR = 1.574, 95% CI: 1.105, 2.241), getting funds from the safety net program were times 2.062 (AOR = 2.062, 95% CI: 1.297, 3.279), attending the primary educational level was 1.686 times (AOR = 1.686, 95% CI: 1.007, 2.821), bank accounts were 1.373 times (AOR = 1.373, 95% CI: 1.052, 1.792), and wealth index was 1.356 times (AOR = 1.356, 95% CI: 1.001, 1.838) more likely associated with CBHIS coverage, whereas the regions, the other religions, and women aged 20– 24 had lower odds of CBHIS coverage. Conclusion: In Ethiopia, regional healthcare expenditure per capital, religious affiliation, women age range, residents, sex of household head, funds from the safety net program, formal educational level, and having bank accounts were associated with community-based health insurance scheme coverage. (shrink)

Background: The World Health Organization has endorsed a community-based health insurance scheme (CBHIS) as a shared financing plan to improve access to health services and ensure universal coverage of the healthcare delivery system. Such a contributory scheme is the most likely option to provide health insurance coverage when governments cannot offer direct health care support. Despite improvements in access to current healthcare services, Ethiopia’s healthcare delivery remained low, owing to the country’s underdeveloped (...) healthcare finance system. As a result, the present study assessed CBHIS coverage and its predictors in Ethiopia at the individual and community level. (shrink)

The major objective of this study was to investigate whether visual impairments (VI) impact mental health literacy among first-generation university students (FGUS). A descriptive survey research method was used to examine the mental health literacy of 132 purposive sample of FGUS with and without VI from three federal universities in Southern Nigeria. A 35-item MHL Scale (MHLS) for university students (Crobach’s α=0.83) with 5-point response was used for data collection. Questionnaire distribution was achieved through the help of two (...) research assistants. Means, standard deviations, analysis of variance and regression plot were employed to analyze the research data. Participants’ mean age was 24.96±3.86 years. Results showed a higher level of mental health literacy across seven domains of the MHL Scale among students with VI compared to those without this disability. The students identified mental health literacy they possess including the ability to recognize specific disorders, the ability to seek mental health information, the ability to identify risk factors and causes, the ability to understand self-treatment options, the ability to access professional assistance, and positive behaviors that promote awareness and help-seeking. VI did not significantly impact the mental health literacy of FGUS with VI. VI explained only 6.31% of the variation in MHL among FGUS with VI. Accordingly, mental health literacy is an essential skill that should be acquired by everyone, including those who suffer from specific disorders and professionals who care for them. Further effort is required in order to improve the mental literacy of FGUS without VI in Nigerian universities. (shrink)

We discuss the role of prior authorization (PA) in supporting patient-centered care (PCC) by directing health system resources and thus the ability to better meet the needs of individual patients. We begin with an account of PCC as a standard that should be aimed for in patient care. In order to achieve widespread PCC, appropriate resource management is essential in a healthcare system. This brings us to PA, and we present an idealized view of PA in order to argue (...) how at its best, it can contribute to the provision of PCC. PA is a means of cost saving and as such it has mixed success. The example of the US demonstrates how implementation of PA has increased health inequalities whereas best practice has the potential to reduce them. In contrast, systems of universal coverage, like those in Europe, may use the cost savings of PA to better address individuals' care and PCC. The conclusion we offer therefore is an optimistic one, pointing towards areas of supportive overlap between PCC and PA where usually the incongruities are most evident. (shrink)

Transnational, global trades, investments, and travels, amongst other drivers of globalization, helps to reverberate the deadly coronavirus pandemic from Wuhan, China, across the world like whirl fire. In order to contain the infectious spread of the pandemic, and mitigate its negative effects on macro-economic variables, the World Health Organization, (WHO) designed Covid-19 protocols that are being enforced by governments and people of the world. Based on the above account, the study examined the Second wave effect of Covid’19 pandemic on (...) transportation business: Keke-napep and Motorcycle transport systems in Asaba metropolis, Nigeria. The main objective is to empirically determine the real impact of the pandemic on rural land transport business. The study employed structured questionnaire and interview methods to generate data from the 250 respondents selected using the census sampling technique. Out of the 250 sets of questionnaires administered, 235 (94%) were retrieved while 15 (6%) were rejected. The statistical tools used for analyzing data were correlation and multiple regression techniques. Findings were that covid’19 pandemic negatively affected rural land transport business. The study concludes that, the coronavirus pandemic caused a contraction in transport business. It is therefore recommended that, there is a need for government to relax the stringent covid’19 protocols to allow economic activities to resume again. Campaigns on safety and hygiene should be intensified so that the populace will imbibe the culture of general cleanliness and personal hygiene, amongst others. (shrink)

Drawing on an analysis of the distinction between perfect and imperfect duties suggested by The Metaphysics of Morals, I argue that Kant’s Categorical Imperative (CI) requires that maxims be universalizable in the sense that they can be regarded as universal laws consistent with the integrity and effective exercise of rational agency. This account, I claim, has a number of advantages over Korsgaard’s practical contradic-tion interpretation of the CI both in terms of the criteria of assessment that Korsgaard uses and (...) in those of broader textual considerations. (shrink)

This essay defends the controversial and indeed counterintuitive claim that there is a good argument to be made from a Lockean perspective for government action to guarantee access to health care. The essay maintains that this argument is in some regards more robust than the well-known argument in defense of universal health care spelled out by Norman Daniels, which this essay also examines in some detail. Locke's view that government should protect people's lives, property, and freedom–where freedom (...) is understood as independence and self-determination–justifies government action to ensure access to health care, because (roughly), just as individuals cannot protect themselves from crime and foreign invasion, so individuals are unable to provide for their own health care. Defense from disease is as important as defense from crime, and–although this is arguable–government action to guarantee access to health care does not itself undermine freedom. (shrink)

Background. The COVID-19 pandemic necessitated drastic changes to undergraduate medical training at the University of Botswana (UB). To save the academic year when campus was locked down, the Department of Medical Education conducted a needs assessment to determine the readiness for emergency remote teaching (ERT) of the Faculty of Medicine, UB. Objectives. To report on the findings of needs assessment surveys to assess learner and teaching staff preparedness for fair and just ERT, as defined by philosopher John Rawls. Methods. Needs (...) assessment surveys were conducted using Office 365 Forms distributed via WhatsApp, targeting medical students and teaching staff during the 5 undergraduate years. Data were analysed quantitatively and qualitatively. Results. Ninety-two percent (266/289) of students and 73.5% (62/84) of teaching staff responded. Surveys revealed a high penetration of smartphones among students, but poor internet accessibility and affordability in homes. Some teaching staff also reported internet and device insufficiencies. Only WhatsApp was accessible to students and teaching staff. Conclusions. For equitable access to ERT in the future, the surveys revealed infrastructural improvement needs, including wider, stronger, affordable WiFi coverage within Botswana and enhanced digital infrastructures in educational institutions, with increased support for students. (shrink)

Evidence shows that the COVID-19 pandemic has increased stress and despair levels. During the outbreak, everyone’s health and safety are given high importance. The only practical option at this time is for schools and institutions all around the world to switch to online classes. Students, parents, professors, and teachers in the Philippines are aware of the long-term difficulties of online learning, notably their effects on college student’s mental health. This hasn't, however, been adequately documented. The challenges and consequences (...) of online learning on the mental health of students taking up the Hospitality Management program at Romblon State University were investigated in this study. It would add to the body of knowledge regarding mental health, especially for Filipino students. The descriptive quantitative research was employed in the study, and purposive sampling was used to choose the respondents. A researcher-modified instrument with a Perceived Stress Scale (PSS-10) was translated into a Google form and it was used as the standard tool to collect data. The online survey was carried out and data analysis was done using frequency and percentage distribution as well as weighted mean. According to the results, the respondent’s 3-5 hours weekly online activity demonstrates their lack of involvement. Home distractions, a lack of engaging online teaching techniques, procrastination, increased workload, depression, and anxiety are a few of the difficulties encountered. The effect on the HM students is a perceived stress scale interpreted as stressed sometimes. (shrink)

Child health inequalities violate children’s rights to optimal wellbeing. Different issues worldwide affect children’s physical and mental health as well as their development, influencing their future as adults. Inequities are avoidable inequalities. Despite improvements in the past two decades, the ambitious goals of global agendas have, for the most part, remained as expectations with regard to childhood rights, social justice, and health equity in practice. The concept of social determinants of health has become part of the (...) common language in certain settings, but this is still too little to improve health in practice on a global scale, particularly for underprivileged subgroups of the community, as children and adolescents often are. Pediatric health professionals and their organizations are also responsible for guaranteeing children’s and adolescents’ right to health and better wellbeing, helping to reduce health inequalities. (shrink)

Human nature, values, and human existence and development are all intertwined in the notion of Maqāṣid al-Sharīʽah, which supports the well-being of humans, including those with mental health concerns. The high degree of mental health difficulties among students, such as severe stress and depressive symptoms, not only impact their academic performance but also lead to self-injurious behaviour and suicidal attempts. With the COVID-19 pandemic affecting Malaysian university students’ mental health, this article aims to explore the situation from (...) a Maqāṣid al-Sharīʽah perspective and positive psychology. The study employed a mixed-method approach. Firstly, a quantitative descriptive analysis was done to assess students’ overall mental health symptoms to provide a rudimentary assessment of their core psychological problems. Questionnaires were accompanied by an open-ended question to triangulate respondents’ experiences and were analysed qualitatively through a thematic analysis. A DASS-21 survey was given to 87 undergraduate IIUM students (n = 81) aged 19 to 27 years. Based on the maqāṣid framework, the study could be utilised to prioritise strategies to treat mental health concerns at various levels that will ensure the preservation of human life. The ultimate purpose of this research is to provide future implications for a multidimensional framework of psychological well-being based on Maqāṣid al-Sharīʽah principles. This is consistent with the Sustainable Development Goals (SDG) that calls for action to protect humanity and to ensure that all individuals are living in peace and prosperity. (shrink)

In this paper, I distinguish two conceptions of solidarity, which I call solidarity as beneficence and solidarity as mutual advantage. I argue that only the latter is capable of providing a complete foundation for national universal health care programs. On the mutual advantage account, the rationale for universal insurance is parallel to the rationale for a labor union’s “closed shop” policy. In both cases, mandatory participation is necessary in order to stop individuals free-riding on an ongoing system (...) of mutually advantageous cooperation. (shrink)

PURPOSE—A substantial fraction of the observations made by clinicians and entered into patient records are expressed by means of negation or by using terms which contain negative qualifiers (as in “absence of pulse” or “surgical procedure not performed”). This seems at first sight to present problems for ontologies, terminologies and data repositories that adhere to a realist view and thus reject any reference to putative non-existing entities. Basic Formal Ontology (BFO) and Referent Tracking (RT) are examples of such paradigms. The (...) purpose of the research here described was to test a proposal to capture negative findings in electronic health record systems based on BFO and RT. METHODS—We analysed a series of negative findings encountered in 748 sentences taken from 41 patient charts. We classified the phenomena described in terms of the various top-level categories and relations defined in BFO, taking into account the role of negation in the corresponding descriptions. We also studied terms from SNOMED-CT containing one or other form of negation. We then explored ways to represent the described phenomena by means of the types of representational units available to realist ontologies such as BFO. RESULTS—We introduced a new family of ‘lacks’ relations into the OBO Relation Ontology. The relation lacks_part, for example, defined in terms of the positive relation part_of, holds between a particular p and a universal U when p has no instance of U as part. Since p and U both exist, assertions involving ‘lacks_part’ and its cognates meet the requirements of positivity. CONCLUSION—By expanding the OBO Relation Ontology, we were able to accommodate nearly all occurrences of negative findings in the sample studied. (shrink)

This article makes a moral argument for universal access to health care and for the legitimate function of government to guarantee that access. Constructed as a reply to the libertarian argument against universal access, this article utilizes the moral and political theory of John Locke, favored by libertarianism, to develop a Lockean argument for a view contrary to the libertarian philosophy. In particular, the argument here shows how libertarianism’s neglect of a crucial element of the natural-law tradition, (...) to which Locke adhered, not only undercuts the libertarian objection to universal access to health care but also underwrites an alternative argument in favor of such. (shrink)

Access to students’ perspectives on substance abuse is essential for effective youth intervention projects development. This study aimed to explore students’ perspectives on abuse of drugs and alcohol with probable development of student-led intervention strategies. The study was conducted at public universities in Zambia. Student’s perspectives on drugs and alcohol abuse were documented using a mixed method design that employed purposive and snowball sampling to select 200 respondents to questionnaires and 10 to in-depth interviews. A humanistic theory approach was applied (...) in the interpretation and analysis of the data collected. The findings showed that cannabis (30%) and codeine contained in Benylin (17%) were commonly abused. Further findings showed that students’ academic pressure was the leading cause of substance abuse (27%), followed by peer pressure (20%). Students knew that abuse of drugs and alcohol led to low academic performance, violence and theft, risks of contracting sexually transmitted infections (STIs), and other social maladjustments. The study recommends that institutions of learning increase student-led awareness campaigns, security surveillance on campus, and collaboration with government drug enforcement agencies. Institutions of learning should involve students in the planning of programmes to deal with drug and alcohol abuse. Contribution: The study will inform amendment of drug and alcohol abuse policies in institutions of learning. The study will contribute towards the UNESCO O3 PLUS project goal of making campuses safe and inclusive, and overall, the Sustainable Development Goal 3 and 4. The study serves as basis for scholars in the field of biblical theology engaged with justice, health and human development. The article is a contribution to the research project Biblical Theology and Hermeneutics. The results of this research can especially be utilised by scholars in the field of psychology of religion, the sociology of religion and practical theologians focusing on youth ministry. (shrink)

This study, by using 142 groups of data from 1990 to 2007 and the method of cross-temporal meta-analysis, researched the changing trend of status of mental health of 108736 members of the Chinese Army along with the change of years. All the data came from 94 related research reports, and all the research reports used SCL-90 (the Symptom Checklist 90) as the testing tool of mental health. The study found that: (1) mental health of members of the (...) Chinese Army steadily improved between 1990 and 2007; (2) during those 18 years, the Interpersonal Sensitivity factor of SCL-90 of Chinese Army members changed most significantly, and the least significantly changed factor was Somatization; (3) Chinese Army members showed evidence of fewest problems on the Photic Anxiety factor, in contrast to the consistent problems indicated by scores on the Obsessive-Compulsive and Interpersonal Sensitivity scales; (4) Chinese Army members from single-child families (N =1,944) showed significant lower evidence of positive mental health than soldiers from multiple child families (N =2,649); (5) The mental health of soldiers from non-agricultural backgrounds (N =7,808) was less positive than that of soldiers from agricultural households(N =11,459); (6) Chinese Army members with senior high school education level (N = 10,189) had less positive mental health than those with junior high school (N = 8,407) or university education (N = 863). (shrink)

Objectives The study aims to evaluate the impact of the Revised Health Insurance Law 2014 on the utilisation of outpatient and inpatient care services, healthcare services utilisation at different levels of providers, types of providers and types of visits across different entitlement groups. Design/setting Secondary data from two waves of the Vietnam Household Living Standard Survey (VHLSS) 2016, VHLSS 2014 were used. A cross-sectional study applying propensity score matching was conducted. Participants A total of 4900 individuals who reported using (...) healthcare services are analysed. Outcomes measure Numbers of outpatient and inpatient visits, frequency of healthcare service utilisation at commune health stations, district hospitals, provincial hospitals, public and private health facilities, number of visits at health facility for medical treatment and health checks per year. Results The result indicates that health insurance (HI) policy increased the number of outpatient visits for the enrolled between 0.87 and 1.29. The greatest impact was found on participants of heavily subsidised health insurance (HSHI) programmes with 1.29 visits per person per year. Similarly, an increase between 0.08 and 0.16 in the number of inpatient admissions was because of participation in HI. With regard to type of healthcare providers, the study found that participation in HI has the most effect on the use of healthcare services at district hospitals. However, the study demonstrated that the impacts of HI on the increase in the frequency of visiting commune health stations, number of visits at the provincial hospital for HSHI groups, and number of visits at health facilities for health check and consultation were sensitive to unobserved characteristics. Conclusion Our findings imply that policy-makers in Vietnam could continue expanding health insurance coverage to increase access to healthcare services for citizens, especially vulnerable groups. In addition, the government should draw more attention to primary healthcare level. (shrink)

For over 30 years I have argued, in and out of print that, for both intellectual and humanitarian reasons, we urgently need a revolution in the aims and methods of academic inquiry. Instead of giving priority to the search for knowledge, academia needs to devote itself to seeking and promoting wisdom by rational means, wisdom being the capacity to realize what is of value in life, for oneself and others. Wisdom thus includes knowledge but much else besides. A basic task (...) of academia would be to help humanity learn how to create a better world. Now I find the revolution is underway – entirely independent of my own efforts to promote it. During the last ten to twenty years, all sorts of changes have taken place in academia that amount to putting aspects of wisdom-inquiry into practice – even if in complete ignorance of my work. Perhaps the most significant steps are the creation of departments, institutions and research centres concerned with social policy, with problems of environmental degradation, climate change, poverty, injustice and war, and with such matters as medical ethics and community health. Nevertheless, the revolution is happening with agonizing slowness, in a dreadfully muddled and piecemeal way. It needs academics and non-academics to wake up to what is going on – or what needs to go on – to help give direction, coherence and a rationale to this nascent revolution from knowledge to wisdom. (shrink)

Aim: The aim of this study is to reveal the convergence of public health ethics, institutional, collective, and individual ethics obligation during the COVID-19 pandemic and give some explanations with online media reports. Method: The study method is qualitative content analysis; this method was chosen as it would suit best the purpose of the study. The Turkish Medical Association, Turkish Public Health Association, and online newspaper articles and videos have been scanned using keywords. After that, related online reports (...) and interviews have been classified and analyzed according to the context in between May 22, 2020 and November 16, 2020. No official ethical permission was obtained as the study was conducted through open access internet news sites. Results: The COVID-19 scientific committee and the Ministry of Health has suggested a new way of normal life called controlled social life for all places in Turkey. In the frame of these recommendations, with the Google research engine, many articles of online media including some announcements of medical and legal associations, interviews, and calls made by the authorities were selected and analyzed. These articles and interviews containing each problem and pieces of information provided for the common understandings of the society were selected and evaluated at three topics individual, collective and state and institutional responsibility and obligations. Conclusion: Although the warnings of associations, health authorities, and scientists are mostly about personal-civil responsibility, some occurring practices have caused violations. In addition, the level of education, perception capacity, and habits that include existing social-cultural and religious rituals have prevented people from adapting to this new style of life, in other words, controlled social life. Therefore, besides the original national culture and customs, universal ethical responsibilities and obligations should teach starting from primary school and should consist of whole life understanding as a higher perspective. (shrink)

This study was designed to determine effects of peer-health-education on sexual health knowledge and attitudes of tertiary institution students in Imo State Nigeria by determining the mean gain scores of sexual health knowledge and attitudes after peer health education. Quasi-experimental (pre-test-post-test) research design was employed. Two hundred students drawn from the University, Polytechnic and College of Education, using a multi-stage sampling technique participated in the peer sessions which were facilitated by trained peer educators. Data were analyzed (...) using ANCOVA and Z-test. Findings revealed improved knowledge and attitudes on sexual health, as depicted by positive mean gain scores. Age group 16 - 20 years had the highest mean gain score ( X = 22.31) of sexual health knowledge than the rest, while age group 26 - 30 years had the highest mean gain score ( X = 10.59) of sexual health attitudes. Males had higher mean gain score ( X = 26.05) of sexual health knowledge, while females had higher mean gain score ( X = 9.77) of sexual health attitudes. The first years (100 level students) had the highest mean gain score ( X = 25.71) of sexual health knowledge and also had the highest mean gain score ( X = 14.12) of sexual health attitudes. Level of study was significant both for knowledge and attitudes (P < 0.01). It is recommended that peer-health-education be explored further as a method of communicating sexual health issues to tertiary institution students and youths generally. (shrink)

Discussions concerning whether there is a natural right to health care may occur in various forms, resulting in policy recommendations for how to implement any such right in a given society. But health care policies may be judged by international standards including the UN Universal Declaration of Human Rights. The rights enumerated in the UDHR are grounded in traditions of moral theory, a philosophical analysis of which is necessary in order to adjudicate the value of specific policies (...) designed to enshrine rights such as a right to health care. We begin with an overview of the drafting of the UDHR and highlight the primary influence of natural law theory in validating the rights contained therein. We then provide an explication of natural law theory by reference to the writings of Thomas Aquinas, as well as elucidate the complementary “capabilities approach” of Martha Nussbaum. We conclude that a right to health care ought to be guaranteed by the state. (shrink)

The 2010 Patient Protection and Affordable Care Act was designed to increase health insurance coverage in the United States. Its most controversial feature is the requirement that US residents purchase health insurance. Opponents of the mandate argue that requiring people to contribute to the collective good is inconsistent with respect for individual liberty. Rather than appeal to the collective good, this Viewpoint argues for a duty to buy health insurance based on the moral duty individuals have (...) to reduce certain burdens they pose on others. When some people have a duty to rescue, others may have a duty to take rescue precautions, in this case, to purchase health insurance to cover acute and emergency care needs. Requiring that individuals meet this obligation is consistent with respect of individual liberty. (shrink)

Lieto’s Minimal Cognitive Grid (MCG) for assessing artificial agents, augmented as the method MCG+, has two implications: (1) MCG+ can advance the mathematical science of universal intelligence/cognition. (2) (a) pre-Lieto, this science lacks of coverage of perception; (b) heralded artificial agents of today are devoid of human-level perceptual intelligence.

Purpose Prescription stimulant use as “cognitive enhancers” has been described among undergraduate college students. However, the use of prescription stimulants among future health care professionals is not well characterized. This study was designed to determine the prevalence of prescription stimulant misuse among students at an academic health sciences center. -/- Method Electronic surveys were e-mailed to 621 medical, pharmacy, and respiratory therapy students at East Tennessee State University for four consecutive weeks in fall 2011. Completing the survey was (...) voluntary and anonymous. Surveys asked about reasons for, frequency of, and side effects of nonprescription misuse of prescription stimulants. Given the sensitive material, an opportunity to win one of ten $50 gift cards was used as an incentive. -/- Results Three hundred seventy-two (59.9%) students completed the survey from three disciplines (47.6% medical, 70.5% pharmacy, and 57.6% respiratory therapy). Overall, 11.3% of responders admitted to misusing prescription stimulants. There was more misuse by respiratory therapy students, although this was not statistically significant (10.9% medicine, 9.7% pharmacy, 26.3% respiratory therapy; P = .087). Reasons for prescription stimulant misuse included to enhance alertness/ energy (65.9%), to improve academic performance (56.7%), to experiment (18.2%), and to use recreationally/get high (4.5%). -/- Conclusions Prescription stimulant misuse was prevalent among participating students, but further research is needed to describe prevalence among future health care workers more generally. The implications and consequences of such misuse require further study across professions with emphasis on investigating issues of academic dishonesty (e.g., “cognitive enhancement”), educational quality, and patient safety or health care quality. (shrink)

There have recently been novel applications of medical systematic review guidelines to economic policy interventions which contain controversial methodological assumptions that require further scrutiny. A landmark 2017 Cochrane review of unconditional cash transfer (UCT) studies, based on the Grading of Recommendations Assessment, Development and Evaluation (GRADE), exemplifies both the possibilities and limitations of applying medical systematic review guidelines to UCT and universal basic income (UBI) studies. Recognizing the need to upgrade GRADE to incorporate the differences between medical and policy (...) interventions, the GRADE Public Health Project Group (PHPG) was convened to enumerate and address these methodological challenges. However, in light of our analysis of additional methodological challenges that arise for UCT and UBI studies, we argue that the adaptation of medical systematic review guidelines to economic methodology is far from straightforward and is in fact more challenging than claimed by the PHPG. (shrink)

ABSTRACT This essay focuses on two underlying presumptions that impinge on the effort of UNESCO to engender universal agreement on a set of bioethical norms: the conception of universality that pervades much of the document, and its disregard of structural inequalities that significantly impact health. Drawing on other UN system documents and recent feminist bioethics scholarship, we argue that the formulation of universal principles should not rely solely on shared ethical values, as the draft document affirms, but (...) also on differences in ethical values that obtain across cultures. UNESCO's earlier work on gender mainstreaming illustrates the necessity of thinking from multiple perspectives in generating universal norms. The declaration asserts the ‘fundamental equality of all human beings in dignity and rights’1 and insists that ‘the highest attainable standard of health is one of the fundamental rights of every human being without distinction of race, religion, political belief, economic or social condition’2 yet it does not explicitly recognize disparities of power and wealth that deny equal dignity and rights to many. Without attention to structural (as opposed to merely accidental) inequities, UNESCO's invocation of rights is so abstract as to be incompatible with its avowed intention. (shrink)

This dissertation aimed to examine the consequence of health-induced poverty and two policy responses to address this issue among older adults in the United States and China. Specifically, Paper I investigates whether public transfers crowded out private transfers among rural and urban Chinese older families and if this dynamic would change when health care expenses were high. Paper II examines the effect of New Rural Cooperative Medical Insurance, a national health insurance program for rural residents in China, (...) on changing the incidence of health-induced poverty among middle-aged and older beneficiaries. Paper III tests the effects of closing the Medicare Part D donut hole (coverage gap) through the Affordable Care Act (ACA) on changing prescription drug cost-induced poverty. Overall, the findings obtained from these three papers provide empirical evidence that health-induced poverty is prevalent among older adults in both China and the United States and the current public transfers and health policies are either ineffective or insufficient to reduce health-induced poverty as intended. (shrink)

The objective of the research is to carry out a review of the literature about suicide risk factors in young university students. The methodology used is quantitative descriptive with a bibliometric approach, under the PRISMA method. The search was carried out in three databases: Clarivate Web of Science, MDPI and Taylor and Francis that had the variables of suicide risk factors. Inclusion criteria were used such as: study variables, years 2019 to 2022, published in Spanish and English,scientific reports research results, (...) research with clinical and non-clinical population. After the application of the Boolean operators, the total sample is (n=10360) and after screening with the PRISMA method (n=45). Results: The United States, followed by China and Bangladesh, are the countries that produce the most on the subject. The most frequent risk factors are: depression, anxiety, stress, academic commitments, lack of opportunities, low income and race. The students with the highest suicide rates are in the health area such as medicine and nursing, in addition, there is more suicide intent in women than in men. (shrink)

Chewing Khat is one of the leading causes of mental disorders in Ethiopia. An alarming increase in Khat chewing among adults since the early 1990s was reported. Studies have shown that starting chewing Khat early in life is associated with an increased risk of adverse health effects. The objective of the study: This study was conducted to measure the increase in Khat chewing among students at Dire Dawa University students in Dire Dawa City, identify the natural causes of the (...) problem, and demonstrate students' knowledge of the effects of Khat chewing. Material and Methods: The study was separate. Dated February 2021. Students during study time (n = 302) were included. The information was collected through personal interviews and completed a list of questions prepared after reviewing. RESULTS: Male (88.2%) of responding students chewed Khat with a significant difference (P <0.001) between males and females in terms of chewing. The year of student study, academic achievement, and family history of chewing Khat had a significant impact (P <0.05) on chewer students. Of the Khat chewer students who read 35.6% reported chewing both morning and afternoon. 66.7% of students who chewed reported that they had intentions to stop chewing and 82.4% considered chewing to be dangerous. CONCLUSION: Khat chewing gum among students is considered a problem and efforts are needed to help students stop chewing and this is considered a way to prevent Khat chewing among students. (shrink)

While a plethora of studies has been conducted to examine stress and its impact on mental health in western countries, research is scarce investigating the relationship between student challenge stress and health illness in the context of Chinese colleges. No studies examined the moderating effect of self-efficacy on the relationship between challenge stress and health illness. This study attempted to investigate the relationships between these three variables among Chinese college students. Especially, this study focused on examining whether (...) self-efficacy moderated the effect of perceived challenge stress on students’ mental health. Also, the differences were tested between male and female students in terms of these three variables. A sample of 578 Chinese college students was recruited over an approximately 12-week period from 7 Chinese universities. An online survey link was distributed through WeChat. The SPSS version 26 software was used to analyze the data. Results showed that there is no significant difference between genders in terms of perceived challenge stress, self-efficacy, and students’ mental health. In addition, challenge stress was positively related to the students’ mental health (β = 0.35, p < 0.01) while there was a negative association between self-efficacy and mental health (β = -0.41, p < 0.01). Furthermore, self-efficacy plays a moderating role in the relationship between challenge stress and mental health (β = -0.11, p = 0.02). Students with low self-efficacy tend to experience more mental health issues. It is suggested that Chinese colleges and universities pay more attention to students with low self-efficacy, either through faculty/staff interventions or peer counseling. Professors consider reducing students’ academic stress to improve their mental health. (shrink)

La cobertura universal de salud está en el centro de la acción actual para fortalecer los sistemas de salud y mejorar el nivel y la distribución de la salud y los servicios de salud. Este documento es el informe fi nal del Grupo Consultivo de la OMS sobre la Equidad y Cobertura Universal de Salud. Aquí se abordan los temas clave de la justicia (fairness) y la equidad que surgen en el camino hacia la cobertura universal de (...) salud. Por lo tanto, el informe es pertinente para cada agente que infl uye en ese camino y en particular para los gobiernos, ya que se encargan de supervisar y guiar el progreso hacia la cobertura universal de salud. (shrink)

The ethical question is whether university mask mandates should be relaxed. I argue that the use of face masks by healthy individuals has uncertain benefits, which potential harms may outweigh, and should therefore be voluntary. Systematic reviews by the World Health Organization (WHO) and Cochrane Acute Respiratory Infections concluded that the use of face masks by healthy individuals in the community lacks effectiveness in reducing viral transmission based on moderate-quality evidence. The only two randomized controlled trials of face masks (...) published during the pandemic found little to no benefit. Without high-quality evidence, it is difficult to justify a requirement rather than a recommendation. Notwithstanding, one might argue that the precautionary principle justifies mask mandates. If the precautionary principle can justify implementing mask mandates due to the risk of forgoing possible benefit, then it might also be able to justify not implementing mask mandates due to the risk of potential harm caused by the intervention. It is commonly thought that there is little to lose from the use of face masks, but this is not necessarily true. It is possible that masks have done more harm than good. (shrink)

One of the primary goals of Higher Education Institutions (HEIs) is to ensure that all students develop the skills necessary to respond to rapidly changing labor market requirements and conditions. Universities must consider how they train their students to be employable graduates. This study determined how Bachelor of Science in Medical Technology/Medical Laboratory Science (BSMT/BSMLS) and BS Physical Therapy (BSPT) programs prepared the graduates for employment in the Philippines. The study employed a descriptive-correlational research design to establish a relationship between (...) the graduates’ level of satisfaction with their education and the level of adequacy of the BSMLS and BSPT programs. An alumni survey was distributed to all Academic Year 2014-2018 program graduates via e-mail and Messenger. The survey revealed that the preparation for the board examination is the most common influencing factor in the transition from graduation to employment. The vast majority of graduates were employed locally and in positions that were relevant to their programs. The survey also revealed that the University adequately prepared graduates for jobs related to their degrees, and that graduates are satisfied with their education due to high-quality instruction and well-established student internship programs. Pearson correlation revealed that there is a moderate and positive relationship between the level of adequacy of the programs and the level of satisfaction. The study concludes that that graduates’ high employability both locally and globally is a result of the adequate academic preparation they received at the University. (shrink)

As in other branches of social sciences, many studies on altruism have been conducted in the field of psychology. Altruism, which is at the intersection point of social psychology, positive psychology and the psychology of religion, is based on the prioritization of the other rather than oneself. Providing a roadmap for social relations, religions glorifies altruistic behavior. For this reason, it has been accepted that there is a natural relationship between altruism and religious attachment. In this article, the relationship between (...) altruism and religious attitude is examined through university students from different departments. The study, which involves 334 undergraduate students, uses The Altruism Scale developed by Ümmet, Ekşi and Otrar (2013) and the Religious Attitude Scale developed by Ok (2011). As a result of the research, it is determined that there is a positive significant correlation (r =, 360, p <, 001) between the level of religiousness and altruism. When comparing the departments, the lowest level of altruism is found to be psychology (3.76), and the highest level to be theology (4.08). The field of health (3.98) and social and humanities (3.93) follow theology, respectively. According to the LSD test results, the differences between psychology and theology, health and social and humanities are significant. When analyzed in terms of sub-dimensions, a significant difference is found between the departments in "participation in voluntary activities", "financial assistance", "assistance in traumatic situations" and "assistance based on physical strength". There is no such difference in the other three sub-dimensions. While the highest score in the sub-dimension of "help in traumatic situations" belongs to the field of social sciences and humanities, the highest score in all other sub-dimensions belongs to the field of theology. (shrink)