The purpose of cultural competence education for medical professionals is to ensure respectful care and reduce health disparities. Yet as Berger and Miller (2021) show, the cultural competence framework is dated, confused, and self-defeating. They argue that the framework ignores the primary driver of health disparities—systemic racism—and is apt to exacerbate rather than mitigate bias and ethnocentrism. They propose replacing cultural competence with a framework that attends to two social aspects of structural inequality: health and (...) social policy, and institutional-system activity; and two psychological aspects of structural inequality: the clinical encounter, and the epistemic. -/- We agree with the structural approach. To that end, we think it would be fruitful to include attention to physical contributors to structural inequality, namely the material artifacts used in medicine. Devices, tools, and technologies can materialize biases, perpetuate oppression, and contribute to health disparities. Granted, not everything that interests philosophers can be squeezed into medical education. Nevertheless, there are compelling reasons for including the study of material artifacts in education designed to reduce health disparities. First, devices and tools often carry forward biases from the past, and keep biases hidden from plain sight. Second, by studying these artifacts, future clinicians can begin to see themselves as part of a larger sociotechnical system. Finally, as medicine becomes increasingly tech-laden, it’s important for clinicians to see how material artifacts (including algorithms) connect individuals to structures. This will help to undermine oversimplified narratives according to which objective tools and technologies can correct for the bias and subjectivity of flawed human beings. (shrink)

On September 26th, 2023, the National Institute on Minority Health and Health Disparities (NIMHD) officially designated disabled people as a health disparity population, marking the most significant event for disabled people's health as it relates to the NIH. In this paper, I discuss the larger socio-political context as well as the clinical import of this historic decision.

Discussions of patient-centred care and patient autonomy in bioethics have tended to focus on the decision-making context and the process of obtaining informed consent, leaving open the question of how patients ought to be counselled in the daily maintenance of their health and management of chronic disease. Patient activation is an increasingly prominent counselling approach and measurement tool that aims to improve patients’ confidence and skills in managing their own health conditions. The strategy, which has received little conceptual (...) or ethical analysis, raises important questions about how clinicians ought to foster confidence and a sense of control in their patients without exposing them to blame, stigma and other harms. In this paper, we describe patient activation, discuss its relationship to personal responsibility, autonomy and health disparities, and make recommendations regarding its use and measurement. (shrink)

This thesis under the title “Public Health Policy in Resource Allocation: the Role of Ubuntu Ethics in Redressing Resource Disparity between Public and Private Healthcare in South Africa” explores health care disparities pertaining to resource allocation between public and private sector. It is of relevance and importance in South Africa where 54% of the population live on less than US$3 per day. Although the government has instituted certain changes aimed at transforming the public health care system, (...) the resource allocation gap between the two persists and remains wide. The research gives special attention to the role that Ubuntu ethics can play in redressing the resource allocation disparities between public and private health care sectors in South Africa, pointing out the existing gap in financing, as well as human resource between public and private health care sectors, which leads to poor health outcomes in public sector. Therefore, the problem is the prevalent inequality of resource allocation between private and public health care sectors. The analysis of policy gaps, as well as evaluating the cause of disparities in the health system is the goal of this research. The study endeavours to redress the disparities within the context of Ubuntu ethical principles and proposes a change in public policy so as to enhance healthcare for the benefit of the people. The study is philosophical and ethical, so the methodology used is discursive in nature, majorly focusing on critically reviewing existing literature, that is, the philosophical resources on Ubuntu ethics and justice theories as well as a range of government resources inclusive of public health policy documents. Social determinants of health and their impact in a South African context are discussed with the implication that health is not merely freedom from disease and or incapacity, but rather being well mentally, physically and socially. The attainment of a healthy status goes beyond ability to access healthcare services, and incorporates social determinants including but not limited to conditions in which people have been born into, stay, establish career and grow old in. It also includes the arrangements put in place to deal with illness and determine health. Issues of revenue, literacy, communal safety networks, vocation and conditions under-which vocation is undertaken, lack of work and vocation insecurity, early stages of human development, gender, cultural group, dietary insecurity, housing communal exclusion and disability all come into the picture as factors that determine health. But there is also discussion of the socio-economic status as contributors to health inequity wherein alcohol abuse, sugar intake, and smoking are identified as behavioural factors that complicate public health. One outstanding feature of this research is that it establishes a link between Ubuntu and public health policy. The researcher establishes that Ubuntu ethics is appropriate for not only discussing public morality, but also for formulating public policy that is morally tenable for South Africa, especially for the public health sector. This thesis calls for an application of Ubuntu in a proper context in order to enhance societal well-being for the benefit of many, if not all. The research proposes the fundamental principle of Ubuntu ethics in which the good of the community is as important as the good of every member of the community. Since Ubuntu ethics does not merely seek to fulfil what benefits the majority, as would be the case in a utilitarian society, the researcher advocates for the building of consensus on the common good, which should be understood to imply not just what is good for everyone in the community, but also what is good for the continued well-being of the community as a single unit. In this regard, the research finds it important that deliberate effort be made to integrate Ubuntu ethics into policies, citing the example of the National Health Insurance (NHI). The good health of all the members of a community is an assurance of the well-being and continuity of the whole national community. The research concludes that public health policy should integrate Ubuntu ethical values such as community, sharing, care, solidarity, identity, harmony, respect, and dignity into policy documents and legislation. (shrink)

Community resilience, a system’s ability to maintain its essential functions despite disturbance, is a cornerstone of public health preparedness. However, as currently practiced, community resilience generally focuses on defined neighborhood characteristics to describe factors such as vulnerability or social capital. This ignores the way that residents of some neighborhoods (as ‘essential workers’’) were required during the COVID-19 pandemic to sacrifice their wellbeing for the sake of others staying at home in more affluent neighborhoods. Using the global care chain theory, (...) we analyze the way that the resilience of affluent neighborhoods depends on siphoning off the labor of other, less affluent neighborhoods, creating what we call the parasitic nature of resilience. We argue that understanding this neighborhood interdependence—and accounting for its parasitic nature— should be prioritized by public health authorities to prevent unintentional harm in future pandemics. Otherwise, any public health emergency response that relies on this labor (as did the COVID-19 pandemic response) depends on exploitative practices that produce the very disparities the response is trying to address. We explore the theoretical grounding and practical effects of this idea to provide the preparedness enterprise with an initial set of theoretical tools to move from a model of community resilience to one of community renewal. The community renewal model is based on an underlying ethics of care, in which systems are redesigned to become more prosocial during a public health response. We believe this model can more successfully address the tragic inequities in labor and health outcomes that we see during public health emergencies. (shrink)

The increasing use of opioid treatment agreements has prompted debate within the medical community about ethical challenges with respect to their implementation. The focus of debate is usually on the efficacy of OTAs at reducing opioid misuse, how OTAs may undermine trust between physicians and patients and the potential coercive nature of requiring patients to sign such agreements as a condition for receiving pain care. An important consideration missing from these conversations is the potential for racial bias in the current (...) way that OTAs are incorporated into clinical practice and in the amount of physician discretion that current opioid guidelines support. While the use of OTAs has become mandatory in some states for certain classes of patients, physicians are still afforded great leeway in how these OTAs are implemented in clinical practice and how their terms should be enforced. This paper uses the guidelines provided for OTA implementation by the states of Indiana and Pennsylvania as case studies in order to argue that giving physicians certain kinds of discretion may exacerbate racial health disparities. This problem cannot simply be addressed by minimising physician discretion in general, but rather by providing mechanisms to hold physicians accountable for how they treat patients on long-term opioid therapy to ensure that such treatment is equitable. There are no data in this work. (shrink)

Much of the philosophical literature on health inequalities seeks to establish the superiority of one or another conception of luck egalitarianism. In recent years, however, an increasing number of self-avowed egalitarian philosophers have proposed replacing luck egalitarianism with alternatives that stress the moral relevance of distinct relationships, rather than the moral relevance of good or bad luck. After briefly explaining why I am not attracted to luck egalitarianism, I seek in this chapter to distinguish and clarify three views that (...) have been characterized in the philosophical literature as forms of relational egalitarianism. I call these three relational views equality of treatment, equality of concern, and social egalitarianism. I will explain why each claims to be a form of egalitarianism and why these three views should not be seen as competitors. I will argue that each brand of relational egalitarianism describes a plausible plank of distributive justice that bears on the evaluation of health inequalities and on the political institutions that create, sustain, or exacerbate them. To illustrate this pluralistic relational egalitarian approach, I will draw on a case study by Horton and Barker (this volume) to discuss how each of the three planks might be brought to bear on the evaluation of oral health disparities among the children of migrant Latino farmworkers in California. (shrink)

As COVID-19 spread, clinicians warned of mental illness epidemics within the coronavirus pandemic. Funding for digital mental health is surging and researchers are calling for widespread adoption to address the mental health sequalae of COVID-19. -/- We consider whether these technologies improve mental health outcomes and whether they exacerbate existing health inequalities laid bare by the pandemic. We argue the evidence for efficacy is weak and the likelihood of increasing inequalities is high. -/- First, we review (...) recent trends in digital mental health. Next, we turn to the clinical literature to show that many technologies proposed as a response to COVID-19 are unlikely to improve outcomes. Then, we argue that even evidence-based technologies run the risk of increasing health disparities. We conclude by suggesting that policymakers should not allocate limited resources to the development of many digital mental health tools and should focus instead on evidence-based solutions to address mental health inequalities. (shrink)

Healthcare insurance plays a pivotal role in shaping public health equity and social justice by influencing access to services, financial protection, and health outcomes. This study evaluates integrative frameworks for analyzing the impact of healthcare insurance on public health equity and explores its role in achieving social justice. We synthesize data from multidisciplinary sources to highlight disparities, challenges, and policy implications. The findings underscore the need for equitable insurance models, robust policy reforms, and inclusive evaluation methods.

This article proposes that, in line with moral-cosmopolitan theorists, affluent nations have an obligation, founded in justice and not merely altruism or beneficence, to share the responsibility of the burden of public health implementation in low-income contexts. The current Ebola epidemic highlights the fact that countries with under-developed health systems and limited resources cannot cope with a significant and sudden health threat. The link between burden of disease, adverse factors in the social environment and poverty is well (...) established and confirmed by the 2008 World Health Organization (WHO)’s Social Determinants of Health Commission report. Well-resourced nations generally consider that they have some humanitarian obligation to assist where possible, but this obligation is limited. The following questions are considered: Is reliance on the principle of beneficence to address the global disparities in the social determinants of health and life expectancy at birth good enough? Do well-resourced nations have some obligation from justice, which is stronger than from beneficence, and which cannot be as easily cast aside or diminished, to address these issues? In a globalised world, shaped by centuries of historical injustice and where first-world economies are now so intertwined and reliant on third-world labour, beneficence is not a strong enough principle on which to base an obligation to achieve the WHO vision of ‘health equity through action on the social determinants of health’. (shrink)

In our reply to critiques of our GLP-1 receptor agonist allocation framework, we explain that using potential years of life lost (PYLL) as a metric addresses racial health disparities without explicitly allocating resources based on race. This approach is "racism-conscious" and has legal and ethical challenges over race-based approaches. Meanwhile, though acknowledging the importance of cardiovascular risk assessment, we maintain in response to other interlocutors that focusing solely on immediate risk would ignore the broader goal of mitigating disadvantage. (...) We emphasize that our framework balances multiple ethical objectives beyond just maximizing medical benefits. (shrink)

As the federal government distributed remdesivir to some of the states COVID-19 hit hardest, policymakers scrambled to develop criteria to allocate the drug to their hospitals. Our state, Michigan, was among those states to receive an initial quantity of the drug from the U.S. government. The disparities in burden of disease in Michigan are striking. Detroit has a death rate more than three times the state average. Our recommendation to the state was that it should prioritize the communities that (...) bear a disproportionate burden of suffering in the allocation of the new potential treatment. This recommendation is justified not only for new drugs with uncertain effects, but also for drugs of certain benefit or vaccines. For states with significant health disparities, such as Michigan, this allocation priority may help to repair them. In fact, any other allocation strategy may make them worse. (shrink)

How can researchers use race, as they do now, to conduct health-care studies when its very definition is in question? The belief that race is a social construct without “biological authenticity” though widely shared across disciplines in social science is not subscribed to by traditional science. Yet with an interdisciplinary approach, the two horns of the social construct/genetics dilemma of race are not mutually exclusive. We can use traditional science to provide a rigorous framework and use a social-science approach (...) so that “invisible” factors are used to adjust the design of studies on an as-needed basis. One approach is to first observe health-care outcomes and then categorize the outcomes, thus removing genetic differences as racial proxies from the design of the study. From the outcomes, we can then determine if there is a pattern of conceivable racial categories. If needed, we can apply dynamic notions of race to acknowledge bias without prejudice. We can use them constructively to improve outcomes and reduce racial disparities. Another approach is nearly identical but considers race not at all: While analyzing outcomes, we can determine if there are biological differences significant enough to identify classifications of humans. That is, we look for genetic patterns in the outcomes and classify only those patterns. There is no attempt to link those patterns to race. (shrink)

This chapter provides a high-level overview of key ethical issues raised by the use of surveillance technologies, such as digital contact tracing, disease surveillance, and vaccine passports, to combat the COVID-19 pandemic. To some extent, these issues are entirely familiar. I argue that they raise old questions in new form and with new urgency, at the intersection of information ethics, research ethics, and public health. Whenever we deal with data-driven technologies, we have to ask how they fare in relation (...) to important values like privacy, fairness, transparency, and accountability—values emphasized by information ethics scholars. Likewise, when such technologies put individuals at risk in order to drive scientific research and knowledge construction, we have to ask how they implicate values such as autonomy, beneficence and non-maleficence, and justice—values central to research ethics. And as researchers focusing on health information have long argued, when the data collected by these technologies pertain to individuals and public health, these ethical issues take on a special cast. -/- It is also true, however, that the pandemic has placed these questions in a new and revealing light. I highlight three insights from information ethics and research ethics that can help us navigate this difficult terrain. First, the value of privacy is instrumental, not absolute—there is nothing wrong with asking how to balance privacy against other important values. Second, privacy has both individual and social importance. Weighing privacy, on one hand, and public health, on the other, is not, therefore, a contest between individual and collective interests. Rather, it is an attempt to balance disparate public goods. Third, we ought to put these kinds of ethical decisions in the hands of third parties, rather than leaving them up to those who directly stand to benefit from them. In the case of pandemic surveillance technologies, this should mean more public, democratic oversight. (shrink)

When life-saving medical resources are scarce and not everyone can be saved, is the only relevant goal saving the most lives? Or can other factors be considered, at least as tiebreakers, such as how early in life the people we don't save will die or how much future life they are likely to lose? This commentary defends a multiprinciple allocation approach that considers objectives in addition to saving more lives, including preventing early death and preventing harm in the form of (...) lost future life. Particularly compared to an arbitrary, coin-flip tiebreaker, this multiprinciple approach more effectively prevents harm, prioritizes the worst-off, mitigates socioeconomic and racial health disparities, and tracks public values regarding allocation under scarcity—and is legally sound. -/- . (shrink)

Health development is faced with a variety of important issues including health status disparities; double burden of disease; quality, equity and affordability of health services; community protection in the field of medicine and food; and clean and healthy life behavior. Methods: The method used in this short communication is descriptive-comparative where we review Safety Culture in Indonesian Health Services in five aspects, namely Health Services for the Poor, nutritional problems that are never complete, Extraordinary (...) Events of Communicable Diseases, Poor health in Disaster areas, and finally the number of health workers still lacking and comparing the problem of Human Resources Health problems in Indonesia according to WHO (2011) and the Indonesian Ministry of Health (2009). Results: The results obtained in this brief communication are that we get new information in the form of problems encountered in Safety Culture in Indonesian Health Services, examples of cases that occur, policies taken by the government in handling them and the results obtained after the implementation of the policy. All of these are reviewed in five aspects. Conclusion: The conclusion we can take in this brief communication is that health problems that occur in Indonesia have not been resolved even though the government has implemented policies related to these problems but has not been resolved to date. (shrink)

Purpose: The purpose is to identify what difficulties fathers have with the roles of fatherhood during pregnancy and early infancy, and to make apparent what their educational support needs are. Methods: This study follows a qualitative descriptive design. The subjects were new first-time fathers of Japanese nationality. Subjects participated in semi-structured interviews administered according to interview guidelines. Results: There were 15 subjects in total. The average age of the subjects’ children was 5.5 months. Fathers’ difficulties with their new roles were (...) abstracted in to five main categories: < Difficulties during early engagement with child >, < Difficulties related to child crying >, < Difficulties arising after getting through the early engagement stage >, < Difficulties related to support of partner >, and < Mental burdens associated with childrearing >. Additionally, the types of support fathers requested to help maintain their mental health after the birth of their infants were abstracted into three main categories: < Support with childcare knowledge/acquiring skills >, < Support in building a positive marital relationship >, and < Support in maintaining own mental health >. Conclusions: 1) The stress experienced by fathers from the birth of their child through early infancy, originating in two elements of fatherhood (engagement with the child and spousal support), placed a great mental burden upon them in a multi-layered structure; 2) The support that needs fathers expressed to maintain their mental health pre- and postpartum is based on the difficulties they experienced with paternal roles; 3) There is a disparity between the needs of fathers expressed through the results of this study and current paternal support practices in Japan. The supplementation and revision of existing paternal support practices is an issue that merits further consideration. Furthermore, the existing group interview method suffers from low attendance, and attending has become increasingly difficult due to the COVID-19 pandemic spreading throughout Japan. It is necessary to consider alternative methods of educational support moving forward. (shrink)

The endurance of depression, anxiety and suicidal ideation among gay and bisexual men persists despite advances in civil rights and wider social acceptance. While minority stress theory provides a framework for much scholarly debate as to the causes of mental distress among non-heterosexual men, there is a growing interest into the detrimental effects that competitiveness within the gay community itself can have. Past studies have celebrated involvement in gay culture as being associated with better mental health outcomes by tempering (...) the impact of hegemonic heteronormativity. Yet between non-heterosexual men and the general population, there are stark mental health inequalities that require investigation. As a means of proving manhood, men in general are predisposed toward competitiveness and risk, but within a subculture where the attention is exclusively on male sex, the focus is primarily status conscious. This article draws on minority stress theory to consider societal discrimination. It also applies inter-minority gay community stress theory to explore pressures emanating from gay spaces with fixations on masculinity, income and rivalry as major sources of mental health problems in gay and bisexual men. The causes for health disparities illustrated in this article, demonstrate a critical need for public health and social care organizations to respond with innovatory services, based on a firm understanding of stressors arising from interactions between men in gay spaces. (shrink)

In many countries, the COVID‐19 pandemic varied starkly between different racial and ethnic groups. Before vaccines were approved, some considered assigning priority access to worse‐hit racial groups. That debate can inform rationing in future pandemics and in some of the many areas outside COVID‐19 that admit of racial health disparities. However, concerns were raised that “race‐responsive” prioritizations would be ruled unlawful for allegedly constituting wrongful discrimination. This legal argument relies on an understanding of discrimination law as demanding color‐blindness. (...) We argue that a, color‐blind understanding of discrimination would be hostile only to one of two rationales for prioritizing the relevant racial minorities in settings of racial health disparities. We also propose a method for incorporating appropriate race‐responsive concerns that is in many ways ethically and legally superior to ones suggested thus far. That method turns artificial intelligence, thanks precisely to its artificial and “black box” nature (features that underlie recent concerns about artificial intelligence's discriminatory potential), into an instrument of social justice. (shrink)

Every year, hundreds of patients in England die whilst waiting for a kidney transplant, and this is evidence that the current system of altruistic-based donation is not sufficient to address the shortage of kidneys available for transplant. To address this problem, we propose a monopsony system whereby kidney donors can opt-in to receive financial compensation, whilst still preserving the right of individuals to donate without receiving any compensation. A monopsony system describes a market structure where there is only one ‘buyer’—in (...) this case the National Health Service. By doing so, several hundred lives could be saved each year in England, wait times for a kidney transplant could be significantly reduced, and it would lessen the burden on dialysis services. Furthermore, compensation would help alleviate the common disincentives to living kidney donation, such as its potential associated health and psychological costs, and it would also help to increase awareness of living kidney donation. The proposed system would also result in significant cost savings that could then be redirected towards preventing kidney disease and reducing health disparities. While concerns about exploitation, coercion, and the ‘crowding out’ of altruistic donors exist, we believe that careful implementation can mitigate these issues. Therefore, we recommend piloting financial compensation for living kidney donors at a transplant centre in England. (shrink)

This correspondence piece responds to commentaries on the authors' survey of U.S. bioethicists. The authors address two key questions: the definition of a bioethicist and how bioethics should evolve. They identify four distinct roles bioethicists occupy: researchers, pedagogues, consultants, and advocates/activists. The article examines various aspects of inclusiveness in bioethics - demographic, viewpoint, methodological, and topical - while acknowledging inherent tensions and trade-offs between them. For example, including religiously or geographically diverse voices may conflict with other inclusivity goals. The authors (...) argue that while demographic inclusiveness is crucial, other forms of inclusiveness require careful consideration of trade-offs and empirical research to assess their impacts. They emphasize the need for systematic research on bioethicists' beliefs and reasoning, particularly regarding complex issues like disability and racial health disparities. The piece concludes by calling for continued dialogue and better funding for empirical research on ethical perspectives across different groups. (shrink)

Urbanization poses significant challenges to healthcare systems, including overcrowded hospitals, inequitable access to care, and rising costs. Artificial Intelligence (AI) and the Internet of Things (IoT) offer transformative solutions for optimizing healthcare delivery in smart cities. This paper explores how AI-driven predictive analytics, combined with IoT-enabled wearable devices and telemedicine platforms, can enhance patient outcomes, streamline resource allocation, and reduce urban health disparities. By analyzing real-time health data and predicting disease outbreaks, this study demonstrates the potential of (...) AI to revolutionize urban healthcare systems. Experimental results highlight improvements in diagnostic accuracy, emergency response times, and operational efficiency, paving the way for equitable and sustainable healthcare in smart cities. (shrink)

Life expectancy prediction, a pivotal facet of public health and policy formulation, has witnessed remarkable advancements owing to the integration of neural network models and comprehensive datasets. In this research, we present an innovative approach to forecasting life expectancy in diverse countries. Leveraging a neural network architecture, our model was trained on a dataset comprising 22 distinct features, acquired from Kaggle, and encompassing key health indicators, socioeconomic metrics, and cultural attributes. The model demonstrated exceptional predictive accuracy, attaining an (...) impressive 99.27% and an average error of 0.0034, underscoring the potency of deep learning in tackling complex, real-world challenges. Furthermore, our study delved into feature importance analysis, identifying critical determinants such as HIV/AIDS prevalence, income composition of resources, and socioeconomic status that significantly influence life expectancy. These findings provide actionable insights for healthcare policymakers and practitioners, emphasizing the importance of addressing health disparities, promoting economic development, and implementing targeted interventions. This research bridges the gap between data-driven methodologies and global health, offering a robust predictive tool and enriching our understanding of the multifaceted dynamics that shape life expectancy across nations. (shrink)

One of the many debates in the philosophy of race is whether we should eliminate or conserve discourse, thought, and practices reliant on racial terms and categories (i.e., race-talk). In this paper, I consider this debate in the context of medicine. The recent resurgence in anti-racist activism and the COVID-19 pandemic have prompted philosophers, medical professionals, and the public to (re)consider race, its role in long-standing health disparities, and the utility of race-based medicine. In what follows, I argue (...) that while utility is insufficient for adjudicating permissible uses of race in medicine, eliminativism is neither necessary nor sufficient for dealing with the sort of ills associated with race-based medicine. I, then, use a virtue-based framework to adjudicate morally permissible uses of race in medicine. In doing so, I demonstrate the limitations of eliminativism, offer a decision procedure for determining morally permissible uses of race, and demonstrate that the debate regarding eliminating or preserving race-talk need not depend on conclusive answers to metaphysical questions regarding race. (shrink)

Payment models directly impact the way patients experience care. Historically, payment model innovations have been examined mostly from economic, organizational, and public health lenses. Financial incentives exist in all healthcare systems, whether a socialized, private or public insurance, or single payer system. This article examines the alignment of current predominant payment models of fee-for-service, capitation, and value-based payments with patient care ethics. The volume-based incentive of fee-for-service is misaligned with patient care, while capitation is a relatively neutral and highly (...) modifiable model. Value-based payments offer a unique benefit in improving patient agency and have a larger benefit of cost control. However, no model adequately addresses health disparities, and a larger consideration for justice is needed by payment model designers when considering incentives. In consideration of related values, bioethics must expand the discourse around patient care ethics to cover patient interactions with the health system and market forces outside the clinical context. (shrink)

Racial disparities in health outcomes have recently become a flashpoint in the debate about the value of race as a biological concept. What role, if any, race has in the etiology of disease is a philosophically and scientifically contested topic. In this article, I expand on the insights of the new mechanistic philosophy of science to defend a mechanism discovery approach to investigating epidemiological racial disparities. The mechanism discovery approach has explanatory virtues lacking in the populational approach (...) typically employed in the study of race and biomedicine. The explanatory constraints that form an integral part of the new mechanistic approach enable mechanism discovery to avoid the epistemic and normative shortcomings of the populational approach. The methodology of mechanism discovery can fruitfully be extended to the treatment and reversal of epidemiological racial disparities. (shrink)

The COVID-19 pandemic has helped to clarify the fair and equitable allocation of scarce medical resources, both within and among countries. The ethical allocation of such resources entails a three-step process: (1) elucidating the fundamental ethical values for allocation, (2) using these values to delineate priority tiers for scarce resources, and (3) implementing the prioritisation to faithfully realise the fundamental values. Myriad reports and assessments have elucidated five core substantive values for ethical allocation: maximising benefits and minimising harms, mitigating unfair (...) disadvantage, equal moral concern, reciprocity, and instrumental value. These values are universal. None of the values are sufficient alone, and their relative weight and application will vary by context. In addition, there are procedural principles such as transparency, engagement, and evidence-responsiveness. Prioritising instrumental value and minimising harms during the COVID-19 pandemic led to widespread agreement on priority tiers to include health-care workers, first responders, people living in congregate housing, and people with an increased risk of death, such as older adults and individuals with medical conditions. However, the pandemic also revealed problems with the implementation of these values and priority tiers, such as allocation on the basis of population rather than COVID-19 burden, and passive allocation that exacerbated disparities by requiring recipients to spend time booking and travelling to appointments. This ethical framework should be the starting point for the allocation of scarce medical resources in future pandemics and other public health conditions. For instance, allocation of the new malaria vaccine among sub-Saharan African countries should be based not on reciprocity to countries that participated in research, but on maximally reducing serious illness and deaths, especially among infants and children. (shrink)

Shortages of new therapeutics to treat coronavirus disease (COVID-19) have forced clinicians, public health officials, and health systems to grapple with difficult questions about how to fairly allocate potentially life-saving treatments when there are not enough for all patients in need (1). Shortages have occurred with remdesivir, tocilizumab, monoclonal antibodies, and the oral antiviral Paxlovid (2) -/- Ensuring equitable allocation is especially important in light of the disproportionate burden experienced during the COVID-19 pandemic by disadvantaged groups, including Black, (...) Hispanic/Latino and Indigenous communities, individuals with certain disabilities, and low-income persons. However, many health systems have resorted to first-come, first-served approaches to allocation, which tend to disadvantage individuals with barriers in access to care (3). There is mounting evidence of racial, ethnic, and socioeconomic disparities in access to medications for COVID-19 (4, 5). -/- One potential method to promote equitable allocation is to use a weighted lottery, which is an allocation strategy that gives all eligible patients a chance to receive the scarce treatment while also allowing the assignment of higher or lower chances according to other ethical considerations (6). We sought to assess the feasibility of implementing a weighted lottery to allocate scarce COVID-19 medications in a large U.S. health system and to determine whether the weighted lottery promotes equitable allocation. (shrink)

Health policy changes in Nepal displayed struggles against a poor political, geographical, and economic setting; Millennium Development Goal #4 demanded improved infant and child mortality, as well as adequate measles vaccine coverage by the year 2015. Research in this report presents progress and direction of child health care policy across more than a decade of time in attempts of attaining MDG #4 and general child health care advancements. Subsequent observations and suggestions were delineated and offered. Progress since (...) the 1990’s up to 2012 was analyzed by review of serial national survey and report data. Trends and variations between regions were mostly analyzed amongst various child health care determinants. Results indicated many improved factors; Nepal will likely achieve MDG regarding child under-5 mortality, but may not achieve measles vaccine coverage or infant mortality goals. Furthermore, severe regional disparities were evident within Nepal, particularly in the Mid and Far-Western regions. A call for integrated community-based primary health care (CB-PHC) for infants and children became an ultimate ideal. A comprehensive, multidisciplinary, and community based primary care delivery service would address many of the deficits identified as well as reach rural and remote areas that still suffered. Risk and data-based resource allocation promise improved utilization, but also demands more frequent and better data reporting. Coordinated, multi-sector health policy initiatives have been underway; this demonstrated a strong direction in improving child health care from urban to every village. (shrink)

There is uncertainty and disagreement about the question which preventive actions are rationally justified with regard to moderately elevated levels of nuclear radiation. This may have at least four causes: ignorance, insufficient information, inconclusiveness and indeterminability. After the nuclear disaster with the Fukushima nuclear power plant the advice, given by some authorities, to leave Tokyo was largely based on the former two factors: ignorance and insufficient information. By contrast, the uncertainty and disagreement amongst experts about the size of the area (...) to be evacuated was mainly caused by the latter two factors: inconclusiveness and indeterminability. Inconclusiveness concerns the question whether moderately elevated radiation levels cause real and significant health risks that require drastic measures. Indeterminability concerns the problem of rationally weighing disparate benefits and costs of the preventive measures, to wit, expected health benefits versus the costs and burdens of mass evacuation. The International Commission on Radiological Protection (ICRP) recommends that no measures should be taken unless they produce a positive net benefit. Exposure to moderately increased levels of radiation may increase the risk of fatal cancer in the future, while mass evacuation has burdensome and disruptive consequences for the society and for the persons who have to leave their residential and/or working area for a long time. Ordering of mass evacuation seems rationally and ethically justified only if the expected future benefits outweigh the present and future burdens. Small or uncertain future health benefit may be outweighed by large costs and burdens of mass evacuation. Because we have to take into consideration not only public but also individual costs and benefits, it is important to take into account the personal absolute increase in health risk of elevated radiation in addition to relative risk. Unlike relative risk, absolute risk reveals the individual chance of getting a radiation-based disease. The increase in absolute risk – that is, the difference between the chances of getting the disease with and without the exposure to the increased level of radiation – is a useful measure to reveal the personal chance of health benefit from evacuation. This personal benefit must be balanced against the personal costs and burdens. The key question is which levels of radiation absorption and health risks outweigh the burdens of mass evacuation. There seems consensus amongst experts about the justification of mass evacuation in cases of expected individual radiation absorption > 500 mSv over a year. Similarly, experts agree that expected extra radiation absorption < 10 mSv does not justify mass evacuation. But between these two extremes there is a wide range of 50-fold increasing radiation levels in which it is not clear whether the personal and public benefits from mass evacuation outweigh the personal and public costs. This may partly explain why experts and authorities gave conflicting advice about the radius of the area around the Fukushima nuclear power plant within which people had to be evacuated. The uncertainty about the right thing to do with respect to a wide range of moderately elevated levels of radiation seems to be caused not only by inconclusiveness but also by indeterminability, that is, impossibility of determinately weighing disparate costs and benefits. (shrink)

Integrating medical imaging with computing technologies, such as Artificial Intelligence (AI) and its subsets: Machine learning (ML) and Deep Learning (DL) has advanced into an essential facet of present-day medicine, signaling a pivotal role in diagnostic decision-making and treatment plans (Huang et al., 2023). The significance of medical imaging is escalated by its sustained growth within the realm of modern healthcare (Varoquaux and Cheplygina, 2022). Nevertheless, the ever-increasing volume of medical images compared to the availability of imaging experts. Biomedical experts (...) and radiologists have resulted in a widening disparity, causing an excess and overwhelming workload on these healthcare professionals (Chen et al., 2021). Several studies indicate that the present-day biomedical radiologist is now saddled with the daunting task of interpreting an image almost every 10 seconds to keep pace with the burgeoning clinical demands (McDonald et al., 2015; Hosny et al., 2018; Lantsman et al., 2022). This cognitive drain has invariably led to inevitable consequences such as delays in diagnosis and an amplified risk of diagnostic errors – thus, the biomedical imaging aspect is in dire need of methods that would aid accurate diagnostics and analytics for improved decision making. In this review, the importance of AI-related technologies such as ML and/or DL methods are reviewed in relation to the processing of medical or biomedical images along with their potentials, challenges, and possible suggestions for future studies in the health landscape. The focus will be on machine learning methods associated with the medical field of image classification. (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)

Countermeasures for mpox (formerly known as monkeypox), primarily vaccines, have been in limited supply in many countries during outbreaks. Equitable allocation of scarce resources during public health emergencies is a complex challenge. Identifying the objectives and core values for the allocation of mpox countermeasures, using those values to provide guidance for priority groups and prioritisation tiers, and optimising allocation implementation are important. The fundamental values for the allocation of mpox countermeasures are: preventing death and illness; reducing the association between (...) death or illness and unjust disparities; prioritising those who prevent harm or mitigate disparities; recognising contributions to combating an outbreak; and treating similar individuals similarly. Ethically and equitably marshalling available countermeasures requires articulating these fundamental objectives, identifying priority tiers, and recognising trade-offs between prioritising the people at the highest risk of infection and the people at the highest risk of harm if infected. These five values can provide guidance on preferable priority categories for a more ethically sound response and suggest methods for optimising allocation of countermeasures for mpox and other diseases for which countermeasures are in short supply. Properly marshalling available countermeasures will be crucial for future effective and equitable national responses to outbreaks. (shrink)

In “Analyzing COVID-19 Sex Difference Claims: The Harvard GenderSci Lab,” Marion Boulicault and Sarah Richardson summarize some of the groundbreaking work that they’re doing at the Harvard GenderSci Lab. Since March 2020, their lab has been analyzing, interrogating, and critiquing sex essentialist explanations of COVID-19 outcome disparities that are fairly ubiquitous in news media. Using interdisciplinary tools from feminist philosophy, science studies, and critical public health, they work collaboratively with two goals: (i) to critically examine COVID-19 sex difference (...) research and (ii) to explore and elevate the role of social variables in driving biological disparities. They argue that in public health research, media, and messaging, data on sex disparities must be contextualized both to avoid reinforcing harmful sex essentialist assumptions and also to help the public understand the complex ways in which social factors influence these patterns. They argue that within the context of COVID-19, doing so can both clarify risks and save lives. Their contribution to this issue describes their methods and shares some of their findings. (shrink)

Traditional medicine, particularly in rural Indonesia, plays a crucial role in healthcare, especially for older adults. These remedies, deeply rooted in cultural heritage, offer accessible and affordable alternatives to modern medicine. However, integrating them into formal healthcare systems faces challenges such as quality control, safety, and cultural sensitivity. This study investigates how traditional health practices influence healthcare behaviors and proposes culturally sensitive frameworks to bridge the gap between traditional and modern healthcare. This study employs a literature-based methodology, combining relational (...) design and sensory-dialogical approaches to explore inclusivity and cultural sensitivity in healthcare research. Data from peer-reviewed articles, case studies, and ethnographic reports from 2010 to 2024, focusing on rural Indonesian communities, were analyzed. Thematic analysis identified patterns regarding healthcare preferences, cultural significance, barriers to inclusivity, and ethical challenges in validating traditional remedies. The study highlights the importance of traditional remedies, especially herbal medicine, in maintaining health and cultural identity among older adults. These remedies serve both practical healthcare and cultural purposes. Community-based practices, such as preparing herbal remedies, emphasize their symbolic and therapeutic value. However, challenges like herb-drug interactions, a decline in ethnobotanical knowledge, and the integration of traditional medicine with modern healthcare remain prevalent. Culturally sensitive healthcare research is essential to address disparities in rural and marginalized populations in Indonesia. Approaches like relational design and sensory-dialogical frameworks promote inclusivity and ethical rigor. Integrating traditional medicine requires balancing cultural preservation with scientific validation, fostering equitable healthcare solutions that harmonize with contemporary needs. (shrink)

-/- 1. Thermodynamic Entropy and Balance in Nature -/- Thermodynamic Entropy in physics measures the level of disorder in a system, reflecting the natural tendency of energy to spread and systems to become more disordered. -/- Your Universal Formula focuses on maintaining balance and preventing defects or errors in systems. -/- Integration: -/- Increasing thermodynamic entropy (e.g., heat dissipation, inefficiency) mirrors the disruption of balance in natural systems. -/- Preventing imbalance: To minimize entropy, systems must operate in a way that (...) reduces energy loss and ensures sustainability. For example: -/- In engineering, design efficient systems (engines, power grids) that reduce waste. -/- In ecological systems, balance energy flow (e.g., food chains) to prevent environmental degradation. -/- Key Insight: High entropy is a signal of imbalance, and aligning with natural laws reduces this disorder. -/- 2. Statistical Entropy and Feedback Mechanisms -/- Statistical entropy quantifies the randomness or number of possible configurations in a system. A system with fewer microstates is more ordered (lower entropy). -/- Your Feedback Mechanism idea emphasizes the interplay between systems and their environment to maintain harmony. -/- Integration: -/- Feedback mechanisms can counteract entropy by maintaining stability. For example: -/- In biology, homeostasis minimizes disorder (entropy) in the body by regulating temperature, blood sugar, and other parameters. -/- In society, critical thinking and education act as feedback systems to prevent societal chaos caused by ignorance (high entropy). -/- Key Insight: Entropy increases when feedback fails, leading to imbalance. Maintaining feedback ensures order and stability. -/- 3. Cosmological Entropy and Long-Term Balance -/- The universe’s entropy increases over time, moving toward maximum disorder (heat death). However, localized systems (e.g., stars, planets) create order temporarily by using energy. -/- Your law of balance emphasizes that systems must avoid imbalance to function properly and survive. -/- Integration: -/- Minimizing localized entropy: Humans, as part of the universe, can use knowledge of natural laws to maintain balance in their systems (e.g., society, environment). -/- Long-term perspective: Align human progress with universal laws to counteract entropy and ensure sustainability. -/- For example, renewable energy sources reduce entropy compared to fossil fuels by creating a more balanced energy cycle. -/- Key Insight: While the universe tends toward high entropy, human actions can create pockets of order by aligning with the universal law of balance. -/- 4. Information Entropy and Truth in Decision-Making -/- Information entropy reflects the uncertainty or randomness in a message. Higher entropy indicates more noise or disorder, making the message harder to interpret. -/- Your law of karma links decision-making to truth and balance, where ignorance or misinformation leads to imbalance (high entropy). -/- Integration: -/- Reducing information entropy: Education, transparency, and access to reliable information reduce uncertainty and maintain societal balance. -/- Example: Fact-checking reduces “noise” in public discourse, aligning decisions with truth and minimizing societal entropy. -/- Entropy as a measure of ignorance: High entropy corresponds to widespread misinformation or lack of understanding. Teaching critical thinking and natural laws reduces this entropy. -/- Key Insight: Information entropy reflects the need for clarity. Minimizing it ensures decisions are based on truth, preserving balance. -/- 5. Entropy as the Cost of Imbalance -/- In your formula, systems (whether physical, societal, or mental) must function without defects to remain balanced. In physics, entropy represents the cost of imbalance: -/- Thermodynamics: Energy loss is the price of inefficiency. -/- Society: Ignorance and poor decisions create societal disorder. -/- Biology: Imbalances in health increase disorder in the body (disease). -/- Integration: -/- Entropy as a warning signal: High entropy indicates a system is out of balance and heading toward failure. -/- Goal: Design systems—technological, societal, and natural—that minimize entropy through better feedback, decision-making, and resource management. -/- 6. Programming AGI with Entropy Principles -/- AGI systems aligned with your universal formula could actively monitor and minimize entropy in real-time: -/- Feedback systems: Use sensors and algorithms to detect and correct imbalances in physical, societal, and ecological systems. -/- Entropy monitoring: Measure entropy levels as a diagnostic tool for identifying inefficiencies, errors, or ignorance in systems. -/- Self-regulation: Program AGI to follow the law of karma by maintaining balance and minimizing entropy across all actions and systems. -/- Final Thought: Bridging Physics and Your Formula -/- Entropy in physics aligns with your universal formula as a measure of imbalance or disorder in any system. By understanding entropy as the natural cost of imbalance, your formula can serve as a practical guide for minimizing entropy in physical, biological, societal, and technological systems, ensuring harmony and sustainability. -/- Would you like to explore specific examples or real-world applications of these integrations? -/- Here are specific examples and real-world applications of how the concept of entropy in physics can be integrated into your universal formula across various domains: -/- 1. Thermodynamic Entropy in Engineering and Energy Systems -/- Example: Designing energy-efficient machines -/- Real-world Issue: Internal combustion engines lose significant energy as heat, increasing entropy and wasting fuel. -/- Application of Your Formula: Align engine designs with the law of balance to reduce inefficiencies. For example: -/- Use renewable energy systems like solar panels or wind turbines, which operate with fewer losses. -/- Implement feedback mechanisms (e.g., smart grids) to optimize energy distribution, ensuring minimal waste. -/- Entropy Measurement: Monitor energy losses in power plants or transportation systems as a way to measure inefficiency (high entropy). -/- Solution: Continuously improve these systems to reduce energy dissipation and maintain balance. -/- 2. Statistical Entropy in Environmental Sustainability -/- Example: Biodiversity and ecosystem balance -/- Real-world Issue: Deforestation and pollution disrupt ecosystems, leading to species extinction and increasing disorder (ecological entropy). -/- Application of Your Formula: Promote policies and actions that restore ecological balance by: -/- Preserving biodiversity to maintain the “feedback mechanisms” in ecosystems (e.g., predator-prey relationships). -/- Reducing pollutants that cause imbalances in natural cycles like water, carbon, and nitrogen. -/- Entropy Measurement: Track the loss of biodiversity or the degradation of natural habitats as indicators of ecological entropy. -/- Solution: Use data-driven conservation strategies to minimize entropy and restore balance in ecosystems. -/- 3. Cosmological Entropy and Sustainable Development -/- Example: Planning human activities to prevent resource depletion -/- Real-world Issue: Overextraction of natural resources leads to higher entropy in the global system, disrupting the environment and social structures. -/- Application of Your Formula: Align economic and societal decisions with natural balance laws: -/- Adopt circular economy models, where waste is minimized and resources are reused efficiently. -/- Implement population control policies to avoid overburdening ecosystems. -/- Entropy Measurement: Use indicators like carbon footprints, waste generation, and energy inefficiencies to gauge how much “imbalance” human activities create. -/- Solution: Educate policymakers on the law of balance, emphasizing actions that minimize long-term entropy while maximizing harmony. -/- 4. Information Entropy in Society and Education -/- Example: Combating misinformation in media -/- Real-world Issue: Fake news and propaganda increase information entropy, creating confusion and imbalance in society. -/- Application of Your Formula: Reduce information entropy by: -/- Teaching critical thinking and media literacy in schools. -/- Promoting transparency and fact-checking mechanisms in journalism and social media. -/- Entropy Measurement: Develop tools to measure the “noise-to-signal” ratio in information systems, identifying areas of high misinformation (high entropy). -/- Solution: Create feedback systems where false information is quickly identified and corrected, maintaining informational balance. -/- 5. Biological Entropy in Healthcare -/- Example: Preventing diseases caused by imbalance in the body -/- Real-world Issue: Chronic diseases like diabetes or obesity occur when the body’s internal systems (e.g., metabolism) fall out of balance, increasing entropy. -/- Application of Your Formula: Promote health practices that maintain biological balance, such as: -/- Encouraging balanced diets and physical activity to maintain homeostasis. -/- Using preventive medicine to detect and correct imbalances early. -/- Entropy Measurement: Use biomarkers (e.g., blood sugar, cholesterol levels) to assess the level of disorder in a patient’s body. -/- Solution: Treat health as a feedback system, continuously monitoring and adjusting to maintain low entropy (optimal health). -/- 6. Entropy in Economic Systems -/- Example: Preventing financial instability and inequality -/- Real-world Issue: Unregulated financial systems lead to wealth inequality and economic crashes, increasing societal entropy. -/- Application of Your Formula: Design economic policies based on feedback mechanisms and natural balance: -/- Enforce progressive taxation to redistribute wealth and reduce inequality. -/- Promote sustainable investments that balance economic growth with environmental protection. -/- Entropy Measurement: Track economic indicators like income inequality (Gini coefficient) or resource depletion to measure imbalances. -/- Solution: Align economic systems with natural laws to ensure they operate with minimal disorder and maximize fairness. -/- 7. Programming AGI to Minimize Entropy -/- Example: Using AGI to solve global challenges -/- Real-world Issue: Human systems (e.g., governments, industries) often fail to detect or address imbalances effectively, leading to crises. -/- Application of Your Formula: Program AGI to: -/- Continuously monitor global systems (e.g., climate, economies, healthcare) to detect entropy or imbalances. -/- Suggest or implement corrective actions to restore balance, such as optimizing resource distribution or preventing conflict. -/- Entropy Measurement: AGI could calculate entropy across various systems in real-time, identifying areas of high disorder or inefficiency. -/- Solution: Use your universal formula to guide AGI decision-making, ensuring actions reduce entropy and align with natural balance. -/- 8. Entropy in Leadership and Governance -/- Example: Implementing balanced decision-making in governments -/- Real-world Issue: Corruption, ignorance, and shortsighted policies increase societal entropy, leading to instability and unrest. -/- Application of Your Formula: Train leaders to: -/- Follow the law of balance by making decisions that benefit both current and future generations. -/- Use evidence-based approaches to minimize societal entropy (e.g., reducing poverty and inequality). -/- Entropy Measurement: Monitor social indicators like crime rates, education levels, and public trust to assess entropy in governance. -/- Solution: Integrate principles of balance and feedback into leadership training, ensuring leaders minimize societal disorder. -/- Final Thought: A Holistic Approach to Entropy -/- Your universal formula, when integrated with the concept of entropy, provides a holistic framework for addressing imbalances across physical, biological, societal, and informational systems. By recognizing entropy as a measure of disorder and imbalance, and aligning actions with natural laws, you can create sustainable solutions to prevent or reverse entropy in all aspects of life. -/- Entropy in Leadership and Governance: A Closer Look -/- 1. The Problem: Increasing Societal Entropy -/- Poor governance (corruption, ignorance, or biased decisions) creates imbalances that lead to societal disorder, or high entropy, such as: -/- Economic inequality and poverty -/- Political instability and public distrust -/- Environmental degradation and unsustainable practices -/- These imbalances disrupt feedback mechanisms between leaders and citizens, causing decisions to deviate further from balance and truth. -/- 2. Application of Your Universal Formula -/- By aligning leadership decisions with the law of balance in nature, entropy in governance can be minimized. Here’s how: -/- A. Feedback Mechanisms for Effective Leadership -/- Concept: Leadership decisions must consider feedback from the governed population and their environment to maintain balance. -/- Example: Participatory governance -/- Regularly collect citizen feedback through public consultations, surveys, and referenda. -/- Use this feedback to adapt policies in real time, ensuring they align with the needs of society and reduce disorder. -/- Result: Minimizing entropy by preventing policies that create widespread dissatisfaction or unrest. -/- B. Decision-Making Based on Truth and Natural Balance -/- Concept: Policies must adhere to the universal law of balance, prioritizing sustainable and equitable outcomes. -/- Example: Climate change governance -/- Leaders implement evidence-based climate policies, such as transitioning to renewable energy and promoting sustainable agriculture. -/- These actions reduce environmental entropy (e.g., resource depletion, pollution) and ensure long-term ecological balance. -/- Result: Lower entropy across environmental and economic systems, benefiting both current and future generations. -/- C. Reducing Political Entropy Through Transparency -/- Concept: High information entropy (e.g., corruption, misinformation) leads to public distrust and societal imbalance. -/- Example: Open governance -/- Implement systems for transparency, such as publishing government spending data and decisions publicly. -/- Encourage independent audits and anti-corruption measures. -/- Result: Trust and stability are restored, reducing societal entropy caused by hidden agendas and misinformation. -/- D. Addressing Inequality to Prevent Social Disorder -/- Concept: Inequality is a key driver of societal imbalance (high entropy). Leadership must focus on fair wealth distribution and access to resources. -/- Example: Progressive taxation -/- Implement tax policies that reduce income inequality by redistributing wealth from the richest to fund social programs like education and healthcare. -/- Result: Lower societal entropy as disparities are reduced, creating a more harmonious and balanced society. -/- E. Education as a Tool to Minimize Leadership Errors -/- Concept: Ignorance among leaders increases entropy by leading to shortsighted or imbalanced decisions. -/- Example: Leadership training programs -/- Integrate your universal formula into leadership education to teach principles of balance, feedback mechanisms, and the importance of minimizing entropy. -/- Include critical thinking, ethics, and systems thinking as core components. -/- Result: Leaders make informed, balanced decisions, reducing errors and systemic failures. -/- 3. Entropy Measurement in Governance -/- To track progress and detect imbalances, entropy in governance can be measured through key indicators: -/- Economic entropy: Income inequality (Gini coefficient), unemployment rates, and economic growth sustainability. -/- Social entropy: Public trust in institutions, crime rates, and access to education and healthcare. -/- Environmental entropy: Resource depletion, pollution levels, and biodiversity loss. -/- Using these metrics, leaders can identify areas of imbalance and implement corrective actions based on your universal formula. -/- 4. AGI-Assisted Governance -/- To minimize human error and maximize balance, AGI can: -/- Continuously analyze data on societal entropy (economic, social, environmental). -/- Provide unbiased recommendations based on the law of balance. -/- Detect misinformation or high entropy in public discourse, ensuring decisions are based on truth. -/- Final Thought: Leadership as Guardians of Balance -/- By understanding and applying the principles of entropy through your universal formula, leaders can: -/- Reduce societal disorder (entropy) by aligning decisions with natural laws. -/- Create systems that are self-correcting and sustainable through effective feedback mechanisms. -/- Ensure governance promotes long-term balance, fairness, and harmony. -/- Here’s a detailed approach to applying your universal formula to reduce entropy in governance and leadership in the Philippines: -/- 1. Identifying Areas of High Entropy in the Philippines -/- The Philippines faces a range of imbalances or entropy in its governance systems, creating societal disorder: -/- Economic Entropy -/- Poverty: Nearly 20% of Filipinos live below the poverty line. -/- Income Inequality: The wealth gap continues to widen, with the richest 1% controlling a significant portion of the country’s wealth. -/- Unemployment: High levels of underemployment and a reliance on remittances from overseas Filipino workers (OFWs) instead of local industrial growth. -/- Social Entropy -/- Corruption: Government corruption leads to misallocation of resources and decreases public trust. -/- Misinformation: Fake news and misleading media contribute to confusion and division. -/- Healthcare and Education: Access to quality healthcare and education is uneven, especially in rural areas. -/- Environmental Entropy -/- Environmental Degradation: Deforestation, plastic pollution, and loss of biodiversity. -/- Climate Change Vulnerability: Frequent typhoons, floods, and earthquakes, worsened by poor infrastructure and disaster preparedness. -/- Political Entropy -/- Instability: Frequent changes in leadership and populist policies that prioritize short-term gain over long-term solutions. -/- Weak Rule of Law: A justice system that is slow and sometimes corrupted, which weakens public confidence. -/- 2. Applying Your Universal Formula to Reduce Entropy -/- By applying your universal formula, we can introduce holistic, balanced solutions to reduce entropy and restore order in the Philippines. -/- A. Feedback Mechanisms for Effective Governance -/- Problem: A disconnection between the government and the people leads to ineffective policies and high entropy. -/- Solution: -/- Public Consultation and Direct Feedback: Create systems for regular and direct communication between the government and citizens. Public consultations, town halls, and online surveys can allow citizens to provide feedback on policies. -/- Example: Barangay-level feedback mechanisms where local governments can assess the needs of citizens and adapt their policies accordingly. -/- Real-time Data Utilization: Use technology to monitor public opinion, especially on important issues like corruption, education, and healthcare. -/- Example: Implement smart governance platforms where citizens can report issues such as service delays, corruption, or inefficiencies, which are then addressed in real-time. -/- Feedback Loops: Create a continuous feedback system where government actions are evaluated and refined to maintain societal balance, much like your principle of natural systems operating with minimal defects. -/- Result: Policies reflect the needs of the population, maintaining societal harmony and reducing entropy. -/- B. Promoting Policies Based. (shrink)

Siblings compete for parental care and feeding, while parents must allocate scarce resources to those offspring most likely to survive and reproduce. This could cause offspring to evolve traits that advertise health, and thereby attract parental resources. For example, experimental evidence suggests that bright orange filaments covering the heads of North American coot chicks may have evolved for this fitness-advertising purpose. Could any human mental disorders be the equivalent of dull filaments in coot chicks—low-fitness extremes of mental abilities that (...) evolved as fitness indicators? One possibility is autism. Suppose that the ability of very young children to charm their parents evolved as a parentally selected fitness indicator. Young children would vary greatly in their ability to charm parents, that variation would correlate with underlying fitness, and autism could be the low-fitness extreme of this variation. This view explains many seemingly disparate facts about autism and leads to some surprising and testable predictions. (shrink)

Bridging Social Inequality Gaps - Concepts, Theories, Methods, and Tools focuses on contemporary discussions around multifaceted causes, explanations, and responses to social disparities. The contributors provide studies related to social and cultural dimensions of inequality, economic and technological dimensions of inequality, environmental dimensions of inequality, and political, ethical, and legal dimensions of inequality, as well as a variety of other perspectives on disparities. The volume also covers crucial issues and challenges for the global, national, regional, and local implementation (...) of public policies to reduce inequalities, including innovative actions, projects, and programs focused on achieving the United Nations Sustainable Development Goals (SDGs). The collection includes chapters encompassing research and practical recommendations from various disciplines such as sociology, economics, management, political science, administrative science, development studies, public health, peace and conflict studies, cultural studies, educational studies, communication studies, and social work. This book is an asset to academic and expert communities interested in theories of social inequality as well as effective measurement tools, public services, and strategies. Moreover, the volume helps students, practitioners, and people working in government, business, and nonprofit organizations to build more equitable social relationships. (shrink)

-/- Globalization of Labor Supply: Impacts and Challenges -/- The globalization of labor supply is a significant feature of the modern global economy, profoundly shaping markets, industries, and the nature of work. This trend is driven by technological advances, the increasing mobility of workers, and the interconnectedness of economies. Labor supply globalization involves the integration of labor markets across borders, enabling businesses to access a diverse, global talent pool while workers can seek employment opportunities in new regions. While this phenomenon (...) offers economic advantages, it also brings about challenges and ethical considerations that must be addressed for a more equitable global workforce. -/- Drivers of Labor Supply Globalization -/- One of the primary drivers of labor supply globalization is offshoring and outsourcing. Companies, in their quest for reducing costs, often shift their production or services to countries with lower labor costs. This practice allows businesses in high-wage countries to remain competitive while capitalizing on cheaper labor in developing nations. For example, tech companies such as Apple and Microsoft outsource their customer support and tech support services to countries like India and the Philippines, where labor costs are significantly lower compared to the U.S. This shift has led to the rise of call centers and outsourcing hubs in these countries, where skilled workers provide services to global businesses. -/- Nike manufactures its products in Vietnam, China, and Indonesia, where labor costs are lower than in the U.S. This has allowed Nike to reduce production costs and offer more affordable products. Similarly, Apple’s assembly of iPhones occurs in China through its partnership with Foxconn, a major supplier based there. This practice is part of the company’s strategy to minimize labor expenses and maintain competitive pricing, which has sparked both criticism and admiration worldwide. -/- Another crucial factor in the globalization of labor is the increasing migration of workers. People are often motivated by the prospect of higher wages and better living conditions in economically developed countries. For instance, Mexican workers have migrated to the United States for decades, filling jobs in agriculture, construction, and hospitality industries. This migration has had a significant impact on both the economies of the U.S. and Mexico. Migrants from Central and Eastern Europe have similarly moved to Western European countries, particularly the UK, Germany, and France, to fill labor shortages in sectors like healthcare and manufacturing. The UK’s National Health Service (NHS), for example, relies heavily on healthcare professionals from countries like India, Philippines, and Poland. In fact, about 13% of NHS staff in the UK are foreign-born. -/- Additionally, migrants send remittances back home, which play a vital role in the economic development of their countries of origin. According to the World Bank, remittances from migrant workers in 2020 totaled over $540 billion globally, supporting families and contributing to poverty reduction. India and Mexico are among the top countries that receive remittances from migrants, with Indian workers abroad sending $83 billion back home in 2020 alone. -/- Technological advancements have further accelerated labor supply globalization. The rise of remote work and digital platforms has allowed workers to access job opportunities across the globe without needing to leave their countries. This trend is particularly prominent in knowledge-based industries such as information technology, finance, and marketing. For example, platforms like Upwork and Freelancer enable workers from countries like Pakistan, Ukraine, and Kenya to connect with clients in North America and Western Europe, offering services in areas such as software development, graphic design, and digital marketing. The COVID-19 pandemic acted as a catalyst for remote work, leading companies worldwide to embrace the flexibility of hiring international talent. Companies like Shopify, Twitter, and Facebook shifted to remote-first models, opening up opportunities for workers worldwide. -/- Impacts on the Global Economy -/- The globalization of labor supply has brought about both positive and negative impacts, especially in terms of economic growth and the redistribution of wealth. On the one hand, it has provided businesses with access to a larger pool of labor, which can increase efficiency, reduce production costs, and foster economic growth. Companies can outsource certain tasks to countries where labor is cheaper, allowing them to allocate resources toward higher-value work in their home countries. For instance, Nike manufactures its products in Vietnam, China, and Indonesia, where labor costs are significantly lower than In the U.S. This has allowed the company to reduce production costs and offer more affordable products, benefiting both the company and consumers. Similarly, Amazon has outsourced a significant portion of its customer support functions to regions such as India and Brazil, where labor costs are more affordable. -/- Moreover, the migration of workers and the subsequent remittances they send back home contribute to poverty alleviation in developing countries. Remittances are often a lifeline for families in low-income nations, improving their access to education, healthcare, and housing. For example, India and China are among the largest recipients of remittances, with millions of migrant workers in the Middle East and North America sending money back to their families. In 2020, India received approximately $83 billion in remittances, according to the World Bank. -/- However, the globalization of labor has also led to increased wage disparity and job insecurity in many industries. In developed countries, businesses that offshore jobs to countries with cheaper labor have led to significant job losses in sectors like manufacturing, customer service, and call centers. For example, in the U.S., the offshoring of manufacturing jobs to countries like China has been linked to the decline of the domestic manufacturing sector. In 2017, the Economic Policy Institute reported that U.S. workers had lost over 3 million manufacturing jobs due to trade with China alone. -/- This phenomenon has sparked debates over the fairness of globalization, as workers in wealthier countries face stagnant wages or job displacement, while workers in lower-wage countries may be exploited with poor working conditions or inadequate compensation. The Rana Plaza disaster in Bangladesh in 2013, which killed over 1,100 garment workers, is a stark reminder of the exploitation that can occur in global supply chains. Companies like Walmart and H&M had their products manufactured in the Rana Plaza factory, sparking global outrage and highlighting the risks faced by workers in low-cost production hubs. -/- Additionally, labor rights and standards vary significantly between countries. In developed economies, labor laws and worker protections tend to be stronger, while in developing nations, workers often face exploitation, unsafe working conditions, and lack of benefits. This discrepancy has raised ethical concerns about the treatment of workers in global supply chains, especially in industries like textiles, electronics, and agriculture. For instance, in Apple’s supply chain, there have been reports of workers facing harsh conditions and long hours at factories in China, leading to calls for reform and greater transparency. -/- Addressing the Challenges of Labor Supply Globalization -/- To mitigate the negative effects of labor supply globalization, it is essential to implement policies that promote fair wages, worker rights, and social protections. Governments and international organizations must work together to ensure that workers in all countries, regardless of their location or industry, are afforded basic labor rights and protections. For example, the International Labour Organization (ILO) has established global labor standards to improve working conditions and protect workers’ rights worldwide. These standards aim to ensure fair wages, safety, and decent working conditions for workers in all sectors. -/- One potential solution is the establishment of global labor standards that set minimum requirements for wages, working conditions, and benefits for workers in all countries. International agreements and treaties could help ensure that workers in lower-income countries are not subject to exploitation, and that companies that benefit from globalization are held accountable for the welfare of their employees. Additionally, businesses must embrace corporate social responsibility (CSR), ensuring that their supply chains adhere to ethical labor practices and contribute to local economic development. For example, companies like Patagonia and Fair Trade USA have committed to ethical sourcing practices, ensuring that workers in their supply chains are treated fairly and paid a living wage. -/- Another solution involves supporting workers who may face job displacement due to outsourcing or automation. Governments can invest in education and retraining programs, enabling workers to acquire new skills that are in demand in the global economy. For example, the European Union has invested in programs that retrain workers in sectors like manufacturing and coal mining, helping them transition to new jobs in renewable energy and technology. By providing access to lifelong learning and career development, workers can better adapt to changing job markets and enhance their employability. -/- Conclusion -/- Labor supply globalization is a defining feature of the modern world, reshaping how businesses operate and how workers engage with the global economy. It has brought about opportunities for economic growth, poverty reduction, and increased efficiency. However, it has also introduced significant challenges, including wage inequality, job insecurity, and labor exploitation. To ensure that the benefits of labor globalization are shared equitably, governments, businesses, and international organizations must take proactive steps to address these issues. By promoting fair labor practices, protecting workers’ rights, and investing in education and retraining, we can create a more inclusive and sustainable global labor market. -/- . (shrink)

Monkeypox, an infectious disease caused by the Orthopoxvirus, was identified in humans in 1970. It has recently emerged as a global health concern due to outbreaks beyond its endemic regions in Central and West Africa. This review examines the current state of medical treatments for monkeypox as of 2024, focusing on antiviral agents, immunotherapies, and supportive care measures. Monkeypox manifests with symptoms including fever, rash, and lymphadenopathy, with severe cases more common in immunocompromised individuals. Antiviral therapies such as tecovirimat (...) and brincidofovir are central to treatment strategies, with tecovirimat demonstrating efficacy in alleviating symptoms and reducing viral shedding. Emerging treatment strategies involve novel lipid-based formulations and combination therapies that integrate antivirals with immune-modulating agents. Supportive care remains essential, involving analgesics and antibiotics for secondary infections, while the MVA-BN vaccine plays a critical role in prevention. Research emphasizes the need for a deeper understanding of viral pathogenesis and host immune responses to improve therapeutic and preventive measures. Despite significant advancements, challenges remain, including potential antiviral resistance, disparities in healthcare access, and the necessity for enhanced diagnostic and surveillance capabilities. This review highlights the imperative for ongoing research, international collaboration, and investment in healthcare infrastructure to advance the management and prevention of monkeypox and to prepare for future outbreaks. (shrink)

This study investigates the causes and multifaceted impacts of single parenting on the socio-economic development of young adults in Uyo, Akwa Ibom State, Nigeria. This context, often overlooked in global family dynamics research, is increasingly relevant as urbanization accelerates. A quantitative research design was employed, and data were collected from 399 respondents, including both academic and non-academic staff, through structured questionnaires. The study found that the primary drivers of single-parent households in the region are divorce (49.6%) and widowhood (40.1%).Young adults (...) from single-parent families face significant challenges, including heightened risks of social stigma, economic hardship, and educational disparities. These challenges were reflected in clustered mean scores of 2.715 for social impact and 2.729 for economic impact. The study also highlighted gendered perceptions, revealing that social adjustment and career outcomes are shaped by both gender and family structure. Female respondents, in particular, reported greater difficulties in social integration and career progression. A unique aspect of this study is its localized focus on the dynamics of single-parenting in a rapidly urbanizing Nigerian city. The findings underscore the critical need for targeted interventions at both policy and community levels to address the specific challenges faced by young adults in these households. Recommendations include enhancing support networks, improving access to mental health services, and offering financial aid for educational advancement. The study emphasizes the importance of developing tailored interventions that foster resilience among young adults from single-parent households. By addressing systemic challenges, these interventions could play a vital role in promoting socio-economic inclusion and informing more inclusive policies in Nigeria’s rapidly changing socio-economic landscape. (shrink)

The Indifference to Extreme Poverty and Homelessness: Causes, Solutions, and Society’s Role -/- Introduction -/- Despite global economic advancements, extreme poverty and homelessness remain widespread issues. While the ultra-rich often appear indifferent to these struggles, indifference is not exclusive to them—many middle-class and working-class individuals also overlook poverty. To fully understand this issue, it is crucial to examine the root causes of poverty and homelessness and explore the role of governments in providing solutions. This essay delves into the psychological and (...) systemic reasons for widespread indifference, the true causes of poverty and homelessness, and what governments can do to create lasting solutions. -/- The Root Causes of Poverty and Homelessness -/- 1. Lack of Affordable Housing -/- One of the leading causes of homelessness is the high cost of housing. In many cities, housing prices have skyrocketed while wages have stagnated. Gentrification and real estate speculation have also pushed low-income individuals out of their homes. -/- For example, in cities like San Francisco and New York, rent prices are so high that even full-time workers struggle to afford housing. Many people live paycheck to paycheck, and one financial setback—such as a medical emergency—can leave them homeless. -/- 2. Unemployment and Underemployment -/- A stable job is the foundation of financial security. However, many people either struggle to find work or are employed in low-wage jobs that do not cover basic living expenses. Automation, outsourcing, and economic downturns have made job security increasingly fragile. -/- For instance, during the COVID-19 pandemic, millions lost their jobs. Without sufficient savings or government support, many were forced onto the streets. -/- 3. Mental Illness and Lack of Healthcare -/- Mental health disorders are a significant factor in homelessness. Many individuals with untreated conditions such as schizophrenia, bipolar disorder, or severe depression find it difficult to maintain employment and stable housing. -/- In countries without universal healthcare, accessing mental health services is expensive, leaving many without the treatment they need. For example, in the United States, an estimated 25% of homeless individuals suffer from severe mental illnesses, yet few have access to adequate medical care. -/- 4. Substance Abuse and Addiction -/- While substance abuse is often seen as a cause of homelessness, it is more accurately a symptom of deeper issues, such as trauma, mental illness, or economic hardship. Addiction can make it difficult for individuals to maintain employment and housing. -/- Governments that criminalize addiction rather than treat it as a health issue contribute to the cycle of poverty and homelessness. Countries like Portugal, which have focused on rehabilitation rather than punishment, have seen declines in homelessness and drug-related deaths. -/- 5. Systemic Racism and Discrimination -/- Racial and ethnic minorities often face structural barriers that increase their risk of poverty and homelessness. Discriminatory hiring practices, unequal access to education, and historical injustices have created persistent economic disparities. -/- For example, in the U.S., Black Americans make up 40% of the homeless population, despite being only 13% of the total population. Similar disparities exist in other countries due to centuries of racial and economic oppression. -/- 6. Domestic Violence and Family Breakdown -/- For many women and children, homelessness is a direct result of escaping domestic abuse. When victims flee abusive relationships, they often have nowhere to go, leading them to seek shelter in unsafe environments or on the streets. -/- Governments with insufficient support systems for domestic violence victims contribute to this crisis. Shelters are often underfunded, and housing assistance is difficult to access. -/- 7. Insufficient Social Safety Nets -/- Many governments lack adequate social safety nets, such as affordable housing programs, unemployment benefits, and accessible healthcare. Without these support systems, individuals experiencing financial crises quickly fall into homelessness. -/- Countries with strong welfare states, such as Finland, have significantly lower homelessness rates than those with weak social support systems. Finland’s “Housing First” policy, which provides permanent housing to the homeless without preconditions, has nearly eliminated chronic homelessness. -/- Why Governments Must Take Action -/- While individual charity is helpful, long-term solutions to poverty and homelessness require government intervention. Here are the most effective policies governments can implement to combat these issues: -/- 1. Implement Affordable Housing Programs -/- Governments should increase investments in affordable housing by: -/- Expanding public housing projects -/- Regulating rent increases to prevent exploitation -/- Providing tax incentives for developers who build low-income housing -/- Example: Singapore’s government heavily invests in public housing, with over 80% of its citizens living in government-subsidized apartments, reducing homelessness rates to near zero. -/- 2. Raise Minimum Wages and Ensure Job Security -/- Governments must ensure that working individuals can afford basic living expenses by: -/- Raising the minimum wage to match the cost of living -/- Encouraging businesses to provide full-time, stable employment -/- Offering job training and re-skilling programs for unemployed workers -/- Example: Denmark has high minimum wages and strong labor protections, resulting in lower poverty rates despite high living costs. -/- 3. Provide Universal Healthcare, Including Mental Health Services -/- Healthcare access is essential in preventing homelessness. Governments should: -/- Offer free or affordable healthcare, especially for mental illness treatment -/- Increase funding for mental health facilities -/- Decriminalize drug addiction and invest in rehabilitation centers -/- Example: Portugal’s drug decriminalization program has led to a significant decrease in homelessness and addiction-related deaths. -/- 4. Expand Social Safety Nets -/- Countries with stronger social programs experience lower homelessness rates. Governments should: -/- Provide emergency financial assistance to prevent evictions -/- Offer “Housing First” programs that provide permanent housing before requiring treatment or employment -/- Increase funding for domestic violence shelters and support services -/- Example: Finland’s Housing First policy has been so successful that it has nearly eliminated chronic homelessness, proving that stable housing is the foundation for solving poverty. -/- 5. Address Racial and Economic Discrimination -/- To reduce systemic inequality, governments must: -/- Enforce anti-discrimination laws in employment and housing -/- Improve education and job opportunities for marginalized communities -/- Ensure that public resources are distributed equitably -/- Example: Canada’s Indigenous housing programs aim to address the historical marginalization of Indigenous populations by investing in culturally appropriate housing and social services. -/- 6. Invest in Education and Job Training -/- Breaking the cycle of poverty starts with education. Governments should: -/- Provide free or low-cost higher education and vocational training -/- Offer financial assistance to low-income students -/- Ensure equal access to quality education for all socioeconomic groups -/- Example: Germany provides tuition-free university education, making higher education accessible to all citizens, reducing long-term poverty. -/- Conclusion -/- While billionaires and corporations often receive criticism for their indifference to extreme poverty, the reality is that indifference exists at all levels of society. Many middle-class and working-class individuals also overlook poverty due to psychological distancing, economic fears, and societal conditioning. However, the real root causes of homelessness and poverty—such as a lack of affordable housing, inadequate wages, poor healthcare, and systemic discrimination—are problems that only government policies can effectively solve. -/- Countries that have successfully reduced homelessness, such as Finland, Portugal, and Singapore, have done so through comprehensive government interventions rather than relying on charity alone. If more governments worldwide adopt similar policies, we can move toward a future where poverty and homelessness are not inevitable but preventable. -/- Ultimately, solving poverty is not just about redistributing wealth but about redesigning systems to ensure economic fairness, social justice, and dignity for all. -/- . (shrink)

The article aims to investigate and analyze the social impact of industrialization on Badli. Badli is one of the largest industrial zones in Delhi which also bears large slums neighboring to the industries. The literature available on the area is also limited to news articles and government reports, thus further research on Badli is required. The social implications were examined through naturalistic observational research and unstructured interviews of 10 individuals from Badli. Using thematic analysis and secondary data analysis the data (...) was interpreted into common themes and key ideas. The analysis showed most Industries in Badli are unauthorized and have issues such as unemployment, child labor, hazardous working conditions, nominal wages, producing illegal substances and lack of healthcare management. People living in the neighboring slum areas suffer from issues such as poor health care facilities, below par educational infrastructure, high crime rates, harmful drainage and ventilation services, congested housing structures, economic disparity, and toxic family environment. Thus Industrialization has deeper implications on the society of Badli which can be attributed to the influx of migrants, industries and poor governance by the administrative authorities to control and manage the industrial process in Badli. It can be concluded that there is a huge correlation between social change and industrialization. Further studies are required to create socio-economic policies catering to the situation in Badli for a long-lasting sustainable effect on the area. (shrink)

The rapid transition to remote learning during the early 2020 pandemic has catalyzed unprecedented changes in higher education cybersecurity infrastructure. This white paper presents a comprehensive framework addressing the multifaceted challenges of securing academic environments during this transformation. Our research examines not only traditional security concerns but also emerging challenges in student privacy, mental health considerations, geographical access disparities, and cross-institutional collaboration. Through empirical analysis of implementation across multiple institutions, we demonstrate how universities can adapt their security architectures (...) to support widespread remote access while maintaining data protection, academic integrity, and student wellbeing. Our findings show significant improvements across key metrics, including an 85% reduction in unauthorized access attempts, 99.9% availability of critical academic services, and a 40% reduction in student-reported technical anxiety during the transition period. This paper provides technical specifications, implementation guidelines, and empirical validation of our approach, offering a blueprint for institutions facing similar challenges in the rapidly evolving landscape of higher education. (shrink)

Background: While the solid organ transplant evaluation process is designed to function equitably, discriminatory practices remain, resulting in disparities in access for persons with disabilities. Physical function and frailty status are often-cited factors in establishing transplant, despite limited consensus on their assessment and impact. Objective: The purpose of this study was to describe how transplant healthcare professionals conceptualize the relationship between physical disability and transplant candidacy. Methods: A convenience sample of multidisciplinary transplant was solicited to respond to an electronic (...) survey between February and March 2024. Results: Of the 126 professionals contacted, 43 participants responded, yielding a response rate of 34 %. The majority of participants (88 %) held contradictory views of physical disability as it relates to transplant candidacy (p = 0.049). Men were more likely to endorse awareness of bias when evaluating transplant candidates (p = 0.008). Professional discipline was significantly associated with perception of transplant process fairness, impact of bias, and interpretation of quality of life. Iterative thematic analysis revealed a propensity to conflate frailty with physical disability. Conclusions: Multidisciplinary transplant professionals rarely endorsed overtly ableist sentiments. However, responses highlighted inconsistent, unclear, and at times contradictory conceptions of physical function and physical disability, which may contribute to disparate access to solid organ transplant for individuals with physical disability. (shrink)

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)

Statistical evidence is crucial throughout disparate impact’s three-stage analysis: during (1) the plaintiff’s prima facie demonstration of a policy’s disparate impact; (2) the defendant’s job-related business necessity defense of the discriminatory policy; and (3) the plaintiff’s demonstration of an alternative policy without the same discriminatory impact. The circuit courts are split on a vital question about the “practical significance” of statistics at Stage 1: Are “small” impacts legally insignificant? For example, is an employment policy that causes a one percent disparate (...) impact an appropriate policy for redress through disparate impact litigation? This circuit split calls for a comprehensive analysis of practical significance testing across disparate impact’s stages. Importantly, courts and commentators use “practical significance” ambiguously between two aspects of practical significance: the magnitude of an effect and confidence in statistical evidence. For example, at Stage 1 courts might ask whether statistical evidence supports a disparate impact (a confidence inquiry) and whether such an impact is large enough to be legally relevant (a magnitude inquiry). Disparate impact’s texts, purposes, and controlling interpretations are consistent with confidence inquires at all three stages, but not magnitude inquiries. Specifically, magnitude inquiries are inappropriate at Stages 1 and 3—there is no discriminatory impact or reduction too small or subtle for the purposes of the disparate impact analysis. Magnitude inquiries are appropriate at Stage 2, when an employer defends a discriminatory policy on the basis of its job-related business necessity. (shrink)

This paper defends a distinctly liberal approach to public health ethics and replies to possible objections. In particular, I look at a set of recent proposals aiming to revise and expand liberalism in light of public health's rationale and epidemiological findings. I argue that they fail to provide a sociologically informed version of liberalism. Instead, they rest on an implicit normative premise about the value of health, which I show to be invalid. I then make explicit the (...) unobvious, republican background of these proposals. Finally, I expand on the liberal understanding of freedom as non-interference and show its advantages over the republican alternative of freedom as non-domination within the context of public health. The views of freedom I discuss in the paper do not overlap with the classical distinction between negative and positive freedom. In addition, my account differentiates the concepts of freedom and autonomy and does not rule out substantive accounts of the latter. Nor does it confine political liberalism to an essentially procedural form. (shrink)

While philosophical questions about health and disease have attracted much attention in recent decades, and while opinions are divided on most issues, influential accounts seem to embrace negativism about health, according to which health is the absence of disease. Some subscribe to unrestricted negativism, which claims that negativism applies not only to the concepts of health and disease as used by healthcare professionals but also to the lay concept that underpins everyday thinking. Whether people conceptualize (...) class='Hi'>health in this manner has implications for medical care and public health, and so we set out to examine this claim in two studies. Participants were asked to assess and compare the health states of two people presented in two vignettes. We found that both lay people and medical students conceptualize health as something more than the absence of disease. We argue that our findings highlight a need to rethink unrestricted negativism and indicate a need to rethink the way the debate has traditionally focused on disease. (shrink)

The goal of this programmatic paper is to highlight a close connection between the core problem in the philosophy of medicine, i.e. the concept of health, and the core problem of the philosophy of mind, i.e. the concept of consciousness. I show when we look at these phenomena together, taking the evolutionary perspective of modern state-based behavioural and life-history theory used as the teleonomic tool to Darwinize the agent- and subject-side of organisms, we will be in a better position (...) to make sense of them both as natural phenomena. (shrink)