The current study is conducted to examine the following research questions: 1) How are the enjoyment of and connection to the coastal environment associated with the perceived health outcomes during the previous year’s coastal visits? 2) How are the perceived health outcomes during the previous year’s coastal visits associated with visitors’ mental health and perceived general health? 3) Do the perceived health outcomes during the previous year’s coastal visits mediate the relationships between (...) the enjoyment of and connection to the coastal environment and the visitors’ mental health and perceived general health? (shrink)

The current study is conducted to examine the following research questions: 1) How is the relationship between general coastal activities enabling close connections and mental health in the previous year conditional on the nature connectedness? 2) How is the relationship between general coastal activities enabling close connections and perceived general health in the previous year conditional on the nature connectedness?

The current study is conducted to examine the following research questions: 1) How are coastal activities enabling close connections to nature associated with the mental health condition of the visitors in the previous year? 2) How are coastal activities that have close connections to nature associated with the perceived general health condition of the visitors in the previous year?

The current study is conducted to examine the following research questions: 1) Is the relationship between the enjoyment of and connection to the coastal environment and the visitors’ mental health and perceived general health conditional on the duration of daily visits to the coast in the previous year? 2) Is the relationship between the enjoyment of and connection to the coastal environment and the visitors’ mental health and perceived general health conditional on the duration of stay (...) visits to the coast in the previous year? (shrink)

Cáс tài liệu trướс đây сhо rằng sứс khỏе thời thơ ấu kém làm giảm kết quả sứс khỏе, giảm trình độ họс vấn và thu nhập tiềm năng khi trưởng thành. Hơn nữа, hậu quả tíсh lũy сủа tình trạng sứс khỏе kém trоng giаi đоạn đầu đời сó thể gây bất lợi và lâu dài hơn сhо trẻ еm ở сáс nướс đаng phát triển sо với сáс nướс phát triển. Dо đó, phát hiện сủа сhúng tôi nhấn (...) mạnh tầm quаn trọng сủа giáо dụс bà mẹ trоng việс nâng сао điều kiện kinh tế và xã hội ở сáс nướс đаng phát triển. (shrink)

Background: Previous studies assessing students’ learning outcomes and identifying contributing factors have often dwelt on the cognitive domain. Furthermore, school evaluation decisions are often made using scores from cognitive-based tests to rank students. This practice often skews evaluation results, given that education aims to improve the three learning domains. This study addresses this gap by assessing the contributions of four students’ input to their cognitive, affective and psychomotor skills (CAPs). Methods: A cross-section of senior secondary class II students (n (...) = 870), sampled through the multistage procedure, participated in a physical survey. Students’ Inputs Questionnaire (STIQ) and Learning Outcomes Questionnaire (LOQ) were used for data collection. Based on data obtained from a pilot sample (n = 412), principal axis factoring (PAF) was performed to assess the internal structure of the instruments following an oblique rotation. The KMO value of sampling adequacy were 0.88 and 0.94, while the Bartlett’s test of sphericity were significant χ2 (253) = 5,010; p < 0.001 and χ2 (105) = 3693.38, p < 0.001 for the STIQ and LOQ, respectively. Confirmatory factor analysis was used to assess the models’ acceptability based on the maximum likelihood estimation technique. The main study used hierarchical linear regression for data analysis. Results: Findings indicated that innate ability, health, motivation and social capital relatively and cumulatively predicted students’ overall, cognitive, affective and psychomotor learning outcomes. The proportion of variance explained by the predictors increased at different levels of the models with the addition of new variables. Students’ social capital reduced the effect of students’ innate ability regardless of their motivation and health status. Conclusion/implication: This study has provided evidence that the four students’ inputs are crucial predictors of their learning outcomes in the three domains. This result is helpful for school management to provide services aimed at improving the school climate for students’ motivation and social capital. The result can provide policymakers with a proper understanding of the constituents of learning outcomes and how policies can be aligned to secure quality student inputs for maximum productivity in education. (shrink)

There are a number of important links and similarities between public health and safety. In this extended essay, Gregg D. Caruso defends and expands his public health-quarantine model, which is a non-retributive alternative for addressing criminal behavior that draws on the public health framework and prioritizes prevention and social justice. In developing his account, he explores the relationship between public health and safety, focusing on how social inequalities and systemic injustices affect health outcomes and (...) crime rates, how poverty affects brain development, how offenders often have pre-existing medical conditions (especially mental health issues), how involvement in the criminal justice system itself can lead to or worsen health and cognitive problems, how treatment and rehabilitation methods can best be employed to reduce recidivism and reintegrate offenders back into society, and how a public health approach could be successfully applied within the criminal justice system. Caruso's approach draws on research from the health sciences, social sciences, public policy, law, psychiatry, medical ethics, neuroscience, and philosophy, and he delivers a set of ethically defensible and practically workable proposals for implementing the public health-quarantine model. The essay begins by discussing recent empirical findings in psychology, neuroscience, and the social sciences that provide us with an increased understanding of the social and neurological determinants of health and criminal behavior. It then turns to Caruso's public health-quarantine model and argues that the model provides the most justified, humane, and effective approach for addressing criminal behavior. Caruso concludes by proposing a capability approach to social justice grounded in six key features of human well-being. He argues that we cannot successfully address concerns over public health and safety without simultaneously addressing issues of social justice—including the social determinants of health (SDH) and the social determinants of criminal behavior (SDCB)—and he recommends eight general policy proposals consistent with his model. (shrink)

This brief commentary reappraises the issue of emigration of physicians from developing countries to developed countries. A methodological framework is developed for assessing the impact of physician emigration on population health outcomes. The evidence from macro and micro studies suggest that developing countries especially in sub-Saharan Africa would benefit from regulating physician emigration because the loss of physicians can lower quality of healthcare services and lead to worse health outcomes. Further discussion is contained in an e-letter: (...) http://jme.bmj.com/content/early/2013/05/30/medethics-2013-101409/reply. (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)

One of the lessons of the COVID-19 pandemic is that the lay public relies immensely on the knowledge of public health officials. At every phase of the pandemic, the testimony of public health officials has been crucial for guiding public policy and individual behavior. The reason is simple: public health officials know a lot more than you and I do about public health. As lay people, we rely on experts. This seems straightforward. But the COVID-19 pandemic (...) has shown that public health officials seem undecided as to what, precisely, their role is; are they providing the public information as it presents itself, or are they informing the public in a way that produces a desired or optimal outcome? In this article, I answer the following question: what are public health officials morally obligated to tell the public? As I see it, these are the main options: (1) public health officials should tell the full truth, regardless of outcome; or (2) they should tell partial truths or lies that are aimed to promote a socially optimal outcome. My answer to this question is that public health officials are only allowed to lie under very narrow and rare conditions. -/- . (shrink)

Common mental health disorders are rising globally, creating a strain on public healthcare systems. This has led to a renewed interest in the role that digital technologies may have for improving mental health outcomes. One result of this interest is the development and use of artificial intelligence for assessing, diagnosing, and treating mental health issues, which we refer to as ‘digital psychiatry’. This article focuses on the increasing use of digital psychiatry outside of clinical settings, in (...) the following sectors: education, employment, financial services, social media, and the digital well-being industry. We analyse the ethical risks of deploying digital psychiatry in these sectors, emphasising key problems and opportunities for public health, and offer recommendations for protecting and promoting public health and well-being in information societies. (shrink)

A number of experiences have demonstrated how digital solutions are effective in improving quality of life (QoL) and health outcomes for older adults. Smart Health Age-Friendly Environments (SHAFE) is a new concept introduced in Europe since 2017 that combines the concept of Age-Friendly Environments with Information Technologies, supported by health and community care to improve the health and disease management of older adults and during the life-course. This chapter aims to provide an initial overview of (...) the experiences available not only in Europe, based on the research work of the participants of the International Interdisciplinary Network on Health and Well-being in an Age-Friendly Digital World (NET4Age-Friendly), which could be of interest to preventive, health and social authorities. The chapter reports good practices, pain points, and bottlenecks that may require a collaborative, interdisciplinary research approach to facilitate the transformations towards smart, sustainable, health and age-friendly cities and communities. (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 available resources for global health assistance are far outstripped by need. In the face of such scarcity, many people endorse a principle according to which highest priority should be given to the worst off. However, in order for this prioritarian principle to be useful for allocation decisions, policy-makers need to know what it means to be badly off. In this article, we outline a conception of disadvantage suitable for identifying the worst off for the purpose of making (...) class='Hi'>health resource allocation decisions. According to our total advantage view: the worst off are those who have the greatest total lifetime disadvantage; advantage foregone due to premature death should be treated in the same way as other ways of being disadvantaged at a time; how badly off someone is depends on the actual outcomes that will befall her without intervention, not her prospects at a time; and all significant forms of disadvantage count for determining who is worst off, not just disadvantage relating to health. We conclude by noting two important implications of the total advantage view: first, that those who die young are among the globally worst off, and second, that the epidemiological shift in the global burden of disease from communicable to non-communicable diseases should not lead to a corresponding shift in global health spending priorities. (shrink)

There is an ongoing increase in the use of mobile health technologies that patients can use to monitor health-related outcomes and behaviours. While the dominant narrative around mHealth focuses on patient empowerment, there is potential for mHealth to fit into a growing push for patients to take personal responsibility for their health. I call the first of these uses ‘medical monitoring’, and the second ‘personal health surveillance’. After outlining two problems which the use of mHealth (...) might seem to enable us to overcome—fairness of burdens and reliance on self-reporting—I note that these problems would only really be solved by unacceptably comprehensive forms of personal health surveillance which applies to all of us at all times. A more plausible model is to use personal health surveillance as a last resort for patients who would otherwise independently qualify for responsibility-based penalties. However, I note that there are still a number of ethical and practical problems that such a policy would need to overcome. The prospects of mHealth enabling a fair, genuinely cost-saving policy of patient responsibility are slim. (shrink)

How do people understand the concepts of mental health and disorder? The objective of this paper is to examine the impact of several factors on people’s judgments about whether a condition constitutes a mental disorder or a healthy state. Specifically, this study examines the impact of the source of the condition, its outcome, individual valuation (i.e., the value the individual attaches to the condition), and group valuation (i.e., the value the relevant group attaches to the condition). While we find (...) that people’s health and disorder judgments are driven by perceived dysfunction, we also find that health and disorder judgments are impacted differently by these factors. Health judgements are impacted by outcome and individual valuation, and disorder judgments are impacted by condition source. These results suggest that the folk concept of mental health is positive (i.e., mental health is more than the absence of mental disorder) and normativist (i.e., value judgments play a significant role in determining whether a condition counts as healthy), while the concept of mental disorder aligns with a naturalist perspective, at least to the extent that dysfunction plays an important role in categorizing a condition as a disorder. However, our finding that people’s dysfunction judgments are influenced by individual valuation and outcomes poses a strong challenge to naturalist accounts. To provide access to our supplementary data, an appendix has been included. (shrink)

The proposition that digital innovations can put people in charge of their health has been accompanied by prolific talk of empowerment. In this paper we consider ethical challenges and opportunities of trying to achieve justice and empowerment using digital health initiatives. The language of empowerment can misleadingly suggest that by using technology, people can control their health and take responsibility for health outcomes to a greater degree than is realistic or fair. Also, digital health (...) empowerment often primarily reaches people who already have high technological and health literacy, leaving others behind. We critically investigate whether the concept of health empowerment could be re-engineered to mean something different, namely the process of improving the health literacy and access of those who least possess it, in line with recent proposals for conceptual engineering in the service of justice. We settle on the weaker conclusion that underlying ethical values including justice should be used to interpret the existing concept of empowerment. To conclude, we take a high-level view of various strategies for achieving the ethical value associated with digital health empowerment. (shrink)

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

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)

Some bioethicists and political philosophers argue that rich states should restrict the immigration of health workers from poor countries in order to prevent harm to people in these countries. In this essay, I argue that restrictions on the immigration of health workers are unjust, even if this immigration results in bad health outcomes for people in poor countries. I contend that negative duties to refrain from interfering with the occupational liberties of health workers outweighs rich (...) states' positive duties to prevent harm to people in sending countries. Furthermore, I defend this claim against the objection that health workers in poor countries acquire special duties to their compatriots that render them liable to coercive interference. (shrink)

Moralization is a social-psychological process through which morally neutral issues take on moral significance. Often linked to health and disease, moralization may sometimes lead to good outcomes; yet moralization is often detrimental to individuals and to society as a whole. It is therefore important to be able to identify when moralization is inappropriate. In this paper, we offer a systematic normative approach to the evaluation of moralization. We introduce and develop the concept of ‘mismoralization’, which is when moralization (...) is metaethically unjustified. In order to identify mismoralization, we argue that one must engage in metaethical analysis of moralization processes while paying close attention to the relevant facts. We briefly discuss one historical example and two contemporary cases related to COVID-19 that we contend to have been mismoralized in public health. We propose a remedy of de-moralization that begins by identifying mismoralization and that proceeds by neutralizing inapt moral content. De-moralization calls for epistemic and moral humility. It should lead us to pull away from our tendency to moralize—as individuals and as social groups—whenever and wherever moralization is unjustified. (shrink)

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

Patients’ knowledge of hypertension and treatment has been found to affect health outcomes of hypertension. This study aimed to assess the impact of therapeutic patients’ education on knowledge of hypertension and lifestyle/dietary modification among hypertensive patients in Nigeria. The study was conducted among 317 hypertensive patients randomized into controlled and intervention groups (158 vs 159, respectively) between March 2021 and February 2022. Baseline knowledge of the patients was assessed and intervention was provided for the intervention group with a (...) structured educational program at a baseline and six months. Descriptive data were presented with a frequency table in percentage while the chi-square test and univariate logistic regression were used to determine the association between categorical variables. Out of the total 318 patients, 275 completed the study (response rate: 86.8%) with 136 in the control group and 139 in the intervention group. The mean age of the patients was 59.5 (±12.5) and patients >60 years (49.5%) were the most frequent age category. The baseline knowledge score of hypertension was 9.8 (±2.6) and 9.3 (±2.6) on a scale of 16 points in the control group and intervention group, respectively (P=0.060) while at six months 11.9 (±2.3) vs 10.8 (±2.4) (P<0.001) and 12 months 12.6 (±2.5) vs 9.5 (±2.0) (P<0.001), respectively. Knowledge of lifestyle/dietary modification in the control group and intervention group at baseline was 7.0 (±2.1) and 6.6 (±2.0), respectively, while at six months 7.5 (±1.5) vs 9.9 (±1.3) (P<0.001) and at 12 months 7.2 (±1.5) vs 10.4 (±1.2), respectively. Marital status, body mass index, and family history of hypertension were associated with knowledge of hypertension and lifestyle/dietary modification (P<0.001). The educational intervention provided was associated with a significant improvement in knowledge of hypertension and lifestyle/dietary modification. The marital status of the patients, body mass index and family history of hypertension influenced patients’ level of knowledge. (shrink)

It is natural to think that there is a tight connection between whether someone is responsible for some outcome and whether it is appropriate to hold her accountable for that outcome. And this natural thought naturally extends to health: if someone is responsible for her health, then, all else being equal, she is accountable for it. Given this, some have thought that responsibility for health has an important role to play in distributing the benefits and burdens of (...) healthcare. But there is a reason for caution. That health is influenced by social, economic, and environmental factors is a matter of consensus. And some have argued that in light of these social determinants of health, individuals are not typically responsible for their health, rendering inappropriate policies that employ a responsibility‐for‐health criterion. This debate implicates a number of overlapping concepts and questions that are often difficult to pull apart. And I worry that those who maintain that social determinants undermine responsibility for health have latched on to the wrong target. The social determinants of health are relevant to such policies, but, I argue, not by globally undermining responsibility. Rather, social determinants are sometimes responsibility‐undermining, sometimes responsibility‐preserving, and often relevant to whether we should hold individuals accountable for their health regardless of their responsibility. This calls for a more nuanced appraisal of the ways in which the social determinants of health are relevant to such policies. And here I attempt to provide one. (shrink)

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

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

A better understanding of the factors that mitigate the consequences of nutrition-related hazards and encourage resilience is required to prevent against or improve poor development outcomes. This study included a review of the literature. Dietary adequacy is essential for growth and development, but current data suggests that nutrition supplements alone is insufficient to generate resilience to defend against, alleviate, and recover from nutritional stressors, as well as to promote healthy development. It is vital to combine nutrition therapy with stimulation (...) and responsive care. Combined nutrition and psychosocial stimulation treatments may be successful in promoting protective factors and mitigating risks for impaired cognitive, motor, social, and affective functioning, hence assisting children in adapting to adversity. (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)

Healthcare systems across the globe are struggling with increasing costs and worsening outcomes. This presents those responsible for overseeing healthcare with a challenge. Increasingly, policymakers, politicians, clinical entrepreneurs and computer and data scientists argue that a key part of the solution will be ‘Artificial Intelligence’ (AI) – particularly Machine Learning (ML). This argument stems not from the belief that all healthcare needs will soon be taken care of by “robot doctors.” Instead, it is an argument that rests on the (...) classic counterfactual definition of AI as an umbrella term for a range of techniques that can be used to make machines complete tasks in a way that would be considered intelligent were they to be completed by a human. Automation of this nature could offer great opportunities for the improvement of healthcare services and ultimately patients’ health by significantly improving human clinical capabilities in diagnosis, drug discovery, epidemiology, personalised medicine, and operational efficiency. However, if these AI solutions are to be embedded in clinical practice, then at least three issues need to be considered: the technical possibilities and limitations; the ethical, regulatory and legal framework; and the governance framework. In this article, we report on the results of a systematic analysis designed to provide a clear overview of the second of these elements: the ethical, regulatory and legal framework. We find that ethical issues arise at six levels of abstraction (individual, interpersonal, group, institutional, sectoral, and societal) and can be categorised as epistemic, normative, or overarching. We conclude by stressing how important it is that the ethical challenges raised by implementing AI in healthcare settings are tackled proactively rather than reactively and map the key considerations for policymakers to each of the ethical concerns highlighted. (shrink)

The purpose of this study is to find out that whether the jobs of nurses in Pakistan are fulfilling their necessary requirements or not. This issue is being analyzed by the relation of Person-Job (P-J) Fit with three different JobBehaviors and the whole relation is being tested under the moderation of Agreeableness, which is a personality trait of the Big5 Model. A survey method is deployed, questionnaires are used to obtain data. 120 Nurses were accessed from different hospitals of Islamabad/Rawalpindi. (...) Data were analyzed through statistical tests and regression analysis. Findings of the study highlight that P-J fit is related positively to job satisfaction of nurses and negatively to their Turnover Intentions.Where no significant impact of agreeableness as a moderator is found for this study. The Sample size was too small (120participants). This may restrict the generalizability of the studies. In the Pakistani context, only a limited study has been conducted on nurses. Thus, this piece of research will play a significant role in enhancing and boosting the confidence of deprived nurses of Pakistan by identifying the causes of negative job outcomes and help in mitigating those triggers. (shrink)

Gallbladder disease commonly affects the general population of Western developed nations and the standard surgical treatment of laparoscopic cholecystectomy normally follows severe cases of this condition. However, the negative health and life quality consequences of this standard line of treatment are lesser known and stand the chance of being taken lightly by healthcare professionals. Complications include bile duct injury, dropped gallstones and a second open invasive surgery, of which could be life threatening for some rare cases. It is, therefore, (...) necessary to highlight the limitations of such a procedure and the need for improvement and widening of the range of treatment options for vulnerable members of the patient population. Additionally, here is a brief overview introduction of a new procedure called endoscopic ultrasound guided gallbladder drainage with promising success rates that can be a potentially feasible alternative to traditional surgical procedures to offer gallbladder disease patients. (shrink)

Background The purpose of this study was to examine whether extended use of a variety of screen-based devices, in addition to television, was associated with poor dietary habits and other health-related characteristics and behaviors among US adults. The recent phenomenon of binge-watching was also explored. -/- Methods A survey to assess screen time across multiple devices, dietary habits, sleep duration and quality, perceived stress, self-rated health, physical activity, and body mass index, was administered to a sample of US (...) adults using the Qualtrics platform and distributed via Amazon Mechanical Turk (MTurk). Participants were adults 18 years of age and older, English speakers, current US residents, and owners of a television and at least one other device with a screen. Three different screen time categories (heavy, moderate, and light) were created for total screen time, and separately for screen time by type of screen, based on distribution tertiles. Kruskal-Wallis tests were conducted to examine differences in dietary habits and health-related characteristics between screen time categories. -/- Results Aggregate screen time across all devices totaled 17.5 h per day for heavy users. Heavy users reported the least healthful dietary patterns and the poorest health-related characteristics – including self-rated health – compared to moderate and light users. Moreover, unique dietary habits emerged when examining dietary patterns by type of screen separately, such that heavy users of TV and smartphone displayed the least healthful dietary patterns compared to heavy users of TV-connected devices, laptop, and tablet. Binge-watching was also significantly associated with less healthy dietary patterns, including frequency of fast-food consumption as well as eating family meals in front of a television, and perceived stress. -/- Conclusions The present study found that poorer dietary choices, as well as other negative health-related impacts, occurred more often as the viewing time of a variety of different screen-based devices increased in a sample of US adults. Future research is needed to better understand what factors among different screen-based devices might affect health behaviors and in turn health-related outcomes. Research is also required to better understand how binge-watching behavior contributes impacts health-related behaviors and characteristics. (shrink)

Community-based participatory research (CBPR) and community engaged research (CEnR) are key to promoting community and patient engagement in actionable evidence-based strategies to improve research for health equity. Rapid growth of CBPR/CEnR research projects have led to the broad adoption of partnering principles in community-academic partnerships and among some health and academic organizations. Yet, transformation of principles into best practices that foster trust, shared power, and equity outcomes still remain fragmented, are dependent on individuals with long term projects, (...) or are non-existent. This paper describes how we designed our Engage for Equity PLUS intervention that leverages the leadership and membership of champion teams (including community-engaged faculty, community partners and patient advocates) to improve organizational policies and practices to support equity based CBPR/CEnR. (shrink)

COVID-19 demonstrated a global catastrophe that touched everybody, including the scientific community. As we respond and recover rapidly from this pandemic, there is an opportunity to guarantee that the fabric of our society includes sustainability, fairness, and care. However, approaches to environmental health attempt to decrease the population burden of COVID-19, toward saving patients from becoming ill along with preserving the allocation of clinical resources and public safety standards. This paper explores environmental and public health evidence-based practices toward (...) responding to Covid-19. A literature review tried to do a deep dive through the use of various search engines such as Mendeley, Research Gate, CAB Abstract, Google Scholar, Summon, PubMed, Scopus, Hinari, Dimension, OARE Abstract, SSRN, Academia search strategy toward reretrieving research publications, “grey literature” as well as reports from expert working groups. To achieve enhanced population health, it is recommended to adopt widespread evidence-based strategies, particularly in this uncertain time. As only together can evidence-informed decision-making (EIDM) can become a reality which includes effective policies and practices, transparency and accountability of decisions, and equity outcomes; these are all more relevant in resource-constrained contexts, such as Nigeria. Effective and ethical EIDM though requires the production as well as use of high-quality evidence that are timely, appropriate and structured. One way to do so is through co-production. Co-production (or co-creation or co-design) of environmental/public health evidence considered as a key tool for addressing complex global crises such as the high risk of severe COVID-19 in different nations. A significant evidence-based component of environmental/public health (EBEPH) consist of decisions making based on best accessible, evidence that is peer-reviewed; using data as well as systematic information systems; community engagement in policy making; conducting sound evaluation; do thorough program-planning frameworks; as well as disseminating what is being learned. As researchers, scientists, statisticians, journal editors, practitioners, as well as decision-makers strive to improve population health, having a natural tendency toward scrutinizing the scientific literature aimed at novel research findings serving as the foundation for intervention as well as prevention programs. The main inspiration behind conducting research ought to be toward stimulating and collaborating appropriately on public/environmental health action. Hence, there is need for a “Plan B” of effective behavioural, environmental, social as well as systems interventions (BESSI) toward reducing transmission. (shrink)

Local participation is always beneficial for sustainable action and environmental problems resulting from urban implementation due to the failure of social and institutional change necessary for a successful transformation of rural life to urban life ahead of the rapid movement of the population. Despite good legal practice and comprehensive guidelines, evidence suggests that Environmental Impact Assessment (EIA) or more broadly Environmental, Social and Health Impact Assessment (ESHIA) have not yet been found satisfactory in Nigeria, as the current system amounts (...) to duplication of efforts and cost. However, ESHIA has been developed and integrated to help manage project activities, facilities, and operations sustainably, so that both economic and ecological profits are accrued (sustainable development) or ensure that any development project does not result in excessive deterioration of and/or the irreversible adverse effect on any component of the environment – a recite for sustainable development. A literature review was done by using a variety of search engines including Research Gate, Google Scholar, Academia, Mendeley, SSRN search strategy to retrieve research publications, “grey literature” and expert working group reports. The thrust of this study is to evaluate the potential benefits of ESHIA as a tool for sustainable environmental development. The evaluation and implementation of EIA are one of the strengths of these tools. Indeed, EIA is the first and foremost management tool employed to help mitigate adverse, potential, and associated impacts of proposed major developments in our environment. EIA is a regulatory requirement that is efficiently used to improve performance, project design, enhancing decision-making, and facilitating policy programs in a sustainable environment. An evaluation of the EIA systems reveals several weaknesses of the EIA system. These include the inadequate capacity of EIA approval authorities, deficiencies in screening and scoping, poor EIA quality, insufficient public participation, and weak monitoring, and erratic government policies. Overall, most EIA study rarely meets the objectives of being a project planning tool to contribute to achieving sustainable development and mitigate the impact of the development project. The study recommends some directions for the future to ensure that entire content of the EIA are religiously implemented, review the existing EIA act, increase the expertise of EIA consultants, create a liaison office with an international organisation and with sister agency, ESHIA must enjoy Improved budgetary provision, time latitude, spatial contexts and methodological improvements for outcome measures to achieve results that are relevant to sustainable development by improving project design, enhancing decision making and facilitating policy programs. (shrink)

Given the unprecedented novel nature and scale of coronavirus and the global nature of this public health crisis, which upended many public/environmental research norms almost overnight. However, with further waves of the virus expected and more pandemics anticipated. The COVID-19 pandemic of 2020 opened our eyes to the ever-changing conditions and uncertainty that exists in our world today, particularly with regards to environmental and public health practices disruption. This paper explores environmental and public health evidence-based practices toward (...) responding to Covid-19. A literature review tried to do a deep dive through the use of various search engines such as Mendeley, Research Gate, CAB Abstract, Google Scholar, Summon, PubMed, Scopus, Hinari, Dimension, OARE Abstract, SSRN, Academia search strategy toward retrieving research publications, “gray literature” as well as reports from expert working groups. To achieve enhanced population health, it is recommended to adopt widespread evidence-based strategies, particularly in this uncertain time. As only together can evidence-informed decision-making (EIDM) can become a reality which include effective policies and practices, transparency and accountability of decisions, and equity outcomes; these are all more relevant in resource-constrained contexts, such as Nigeria. Effective and ethical EIDM though requires the production as well as use of high-quality evidence that are timely, appropriate and structured. One way to do so is through co-production. Co-production (or co-creation or co-design) of environmental/public health evidence considered as a key tool for addressing complex global crises such as the high risk of severe COVID-19 in different nations. A significant evidence-based component of environmental/public health (EBEPH) consist of decisions making based on best accessible, evidence that is peer-reviewed; using data as well as systematic information systems; community engagement in policy-making; conducting sound evaluation; do a thorough program-planning frameworks; as well as disseminating what is being learned. As researchers, scientists, statisticians, journal editors, practitioners, as well as decision makers strive to improve population health, having a natural tendency toward scrutinizing the scientific literature aimed at novel research findings serving as the foundation for intervention as well as prevention programs. The main inspiration behind conducting research ought to be toward stimulating and collaborating appropriately on public/environmental health action. Hence, there is need for a “Plan B” of effective behavioral, environmental, social as well as systems interventions (BESSI) toward reducing transmission. (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)

Objectives. The purpose of this study was to conduct the first randomized controlled trial (RCT) to evaluate the effectiveness of a second-generation mindfulness-based intervention (SG-MBI) for treating fibromyalgia syndrome (FMS). Compared to first generation mindfulness-based interventions, SG-MBIs are more acknowledging of the spiritual aspect of mindfulness. Design. A RCT employing intent-to-treat analysis. Methods. Adults with FMS received an 8-week SG-MBI known as meditation awareness training (MAT; n = 74) or an active control intervention known as cognitive behaviour theory for groups (...) (n = 74). Assessments were performed at pre-, post-, and 6-month follow-up phases. Results. Meditation awareness training participants demonstrated significant and sustained improvements over control group participants in FMS symptomatology, pain perception, sleep quality, psychological distress, non-attachment (to self, symptoms, and environment), and civic engagement. A mediation analysis found that (1) civic engagement partially mediated treatment effects for all outcome variables, (2) non-attachment partially mediated treatment effects for psychological distress and sleep quality, and (3) non-attachment almost fully mediated treatment effects for FMS symptomatology and pain perception. Average daily time spent in meditation was found to be a significant predictor of changes in all outcome variables. Conclusions. Meditation awareness training may be a suitable treatment for adults with FMS and appears to ameliorate FMS symptomatology and pain perception by reducing attachment to self. (shrink)

Estimates of the burden of disease assess the mortality and morbidity that affect a population by producing summary measures of health such as quality-adjusted life years and disability-adjusted life years. These measures typically do not include stillbirths among the negative health outcomes they count. Priority-setting decisions that rely on these measures are therefore likely to place little value on preventing the more than three million stillbirths that occur annually worldwide. In contrast, neonatal deaths, which occur in comparable (...) numbers, have a substantial impact on burden of disease estimates and are commonly seen as a pressing health concern. In this article we argue in favor of incorporating unintended fetal deaths that occur late in pregnancy into estimates of the burden of disease. Our argument is based on the similarity between late-term fetuses and newborn infants and the assumption that protecting newborns is important. We respond to four objections to counting stillbirths: that fetuses are not yet part of the population and so their deaths should not be included in measures of population health; that valuing the prevention of stillbirths will undermine women's reproductive rights; that including stillbirths implies that miscarriages should also be included; and that birth itself is in fact ethically significant. We conclude that our proposal is ethically preferable to current practice and, if adopted, is likely to lead to improved decisions about health spending. (shrink)

According to recent approaches in the philosophy of medicine, biomedicine should be replaced or complemented by a humanistic medical model. Two humanistic approaches, narrative medicine and the phenomenology of medicine, have grown particularly popular in recent decades. This paper first suggests that these humanistic criticisms of biomedicine are insufficient. A central problem is that both approaches seem to offer a straw man definition of biomedicine. It then argues that the subsequent definition of humanism found in these approaches is problematically reduced (...) to a compassionate or psychological understanding. My main claims are that humanism cannot be sought in the patient–physician relationship alone and that a broad definition of medicine should help to revisit humanism. With this end in view, I defend what I call an outcomes-oriented approach to humanistic medicine, where humanism is set upon the capacity for a health system to produce good health outcomes. (shrink)

Policies that require male-female sex comparisons in all areas of biomedical research conflict with the goal of improving health outcomes through context-sensitive individualization of medical care. Sex, like race, requires a rigorous, contextual approach in precision medicine. A “sex contextualist” approach to gender-inclusive medicine better aligns with this aim.

Breastfeeding advocates have criticised the phrase ‘breast is best’ as mistakenly representing breastfeeding as a departure from the norm rather than the default for infant feeding. Breastfeeding mothers have an interest in representing breastfeeding as the default, for example, to counteract criticism of breastfeeding outside the home. This connects to an increasing trend to frame feeding babies formula as harmful, which can be seen in research papers, public policy and information presented to parents and prospective parents. Whether we frame infant-feeding (...) decisions in terms of harming or benefit, protection or risk matters because these distinctions are generally morally significant and thus holding that those who decide to use formula ‘harm’, ‘risk harm’ to their babies or describing formula feeding as ‘dangerous’ is likely to contribute to guilt associated with formula feeding and thus to undermine the well-being of vulnerable women. It may undermine attempts to improve breastfeeding rates by leading women to reject information about health outcomes surrounding infant-feeding decisions. However, these distinctions do not apply easily to infant-feeding decisions, in part because of difficulties in determining whether we should treat breastfeeding as the normative baseline for infant feeding. I show that neither the descriptive ‘facts of the matter’ nor moral or pragmatic considerations provide an easy answer before discussing how to respond to these considerations. (shrink)

The paper discusses the possibility that the benefits of pharmacogenomics will not be distributed equally and will create orphan populations. I argue that since these inequalities are not substantially different from those produced by ‘traditional’ drugs and are not generated with the intention to discriminate, their production needs not be unethical. Still, the final result is going against deep-seated moral feelings and intuitions, as well as broadly accepted principles of just distribution of health outcomes and healthcare. I thus (...) propose two provisos that would prevent the most offensive outcomes and moderate the scope of the produced inequalities. The first proviso rejects pharmacogenomics innovations that worsen existing group inequalities and aggravate the disadvantage of communities with a history of discrimination. The second proviso requires that there is a strategy in place to even out as much as possible the distribution of benefits in the future and that a system of compensations is in place for pharmacogenomic orphans. Given that only one moral problem generated by pharmacogenomics has been tackled, the list of provisos might be expanded when other issues are considered. (shrink)

Continued urbanization, along with anthropogenic global warming, has and will increase land surface temperature and air temperature anomalies in urban areas when compared to their rural surroundings, leading to Urban Heat Islands (UHI). UHI poses environmental and health risks, affecting both psychological and physiological aspects of human health. Thus, using a deep learning approach that considers morphological variables, this study predicts UHI intensity in 69 European cities from 2007 to 2021 and projects UHI impacts for 2050 and 2080. (...) The research employs Artificial Neural Networks, Deep Neural Networks, and Gated Recurrent Units, combining high-resolution 3D urban models with environmental data to analyze UHI trends. The results indicate strong associations between urban form, weather patterns, and UHI intensity, highlighting the need for customized urban planning and policy measures to reduce UHI impacts and foster sustainable urban settings. This research enhances understanding of UHI dynamics and serves as a valuable tool for urban planners and policymakers to address the challenges of climate change, urbanization, and air pollution, ultimately aiding in the improvement of health outcomes and building energy consumption. Moreover, the methodology effectively demonstrates the ability of the GRU to link its scores with UHI projections, offering crucial insights into potential health impacts. (shrink)

The Adverse Outcome Pathway (AOP) concept is a knowledge assembly and communication tool to facilitate the transparent translation of mechanistic information into outcomes meaningful to the regulatory assessment of chemicals. The AOP framework and associated knowledgebases (KBs) have received significant attention and use in the regulatory toxicology community. However, it is increasingly apparent that the potential stakeholder community for the AOP concept and AOP KBs is broader than scientists and regulators directly involved in chemical safety assessment. In this paper (...) we identify and describe those stakeholders who currently—or in the future—could benefit from the application of the AOP framework and knowledge to specific problems. We also summarize the challenges faced in implementing pathway-based approaches such as the AOP framework in biological sciences, and provide a series of recommendations to meet critical needs to ensure further progression of the framework as a useful, sustainable and dependable tool supporting assessments of both human health and the environment. Although the AOP concept has the potential to significantly impact the organization and interpretation of biological information in a variety of disciplines/applications, this promise can only be fully realized through the active engagement of, and input from multiple stakeholders, requiring multi-pronged substantive long-term planning and strategies. (shrink)

Focusing on current efforts to persuade the public to comply with Covid-19 best practices, this essay examines what role appeals to religious reasons should (or should not) play in leaders’ attempts to secure followers’ acceptance of group policies in contexts of religious and moral pluralism. While appeals to followers’ religious commitments can be helpful in promoting desirable public health outcomes, they also raise moral concerns when made in the contexts of secular institutions with religiously diverse participants. In these (...) contexts, leaders who appeal to religious reasons as bases of justification for imposing Covid policies may seem to fail to show respect for the autonomy of those who lack the relevant religious commitments, and—especially when a leader herself rejects the religious commitments she makes reference to to persuade others—her appeals to religious reasons may seem to constitute ethically problematic exercises of manipulation. This essay draws on the resources of contemporary political philosophy to analyze and respond to these concerns and concludes that they are not sufficiently well-founded. To the contrary, it contends that there are good moral grounds for leaders to appeal to religious reasons as (partial) bases of justification for why followers should accept Covid policies. In the course of the argument, this essay also highlights how contemporary political theory can enrich discussions about the distinctions between coercion, manipulation, and leadership, and thereby give insight not only into the ethics of leadership but also—at least by the lights of central theories of leadership like that of James MacGregor Burns (1978)—into whether and how appeals to religious reasons can figure into genuine exercises of leadership, in contrast with mere instances of the wielding of social power. (shrink)

US Senate is considering legislation designed to immunize small businesses from lawsuits brought by customers alleging to have been infected with COVID-19 while on the premises. The legislation seeks to subsidize reopening small businesses by reducing their vulnerability to liability. I argue that the legislation produces worse public health outcomes than existing liability regimes, obliterates claims to redress supported by corrective justice, and unfairly burdens victims by forcing them to become de facto insurers of their injurers. In the (...) US, where health insurance is inextricably linked with employment, and during the pandemic with the consequent loss of employment, the legislation is cruel in addition to being ineffective, unjust, unfair and inappropriate. Since I first uploaded this manuscript to Philpapers, Senate Republicans have in fact introduced specific legislation that is marginally different than the one I discuss in the manuscript. Instead of offering blanket immunity, the current Republican proposal offers a series of substantial barriers both to filing lawsuits and to securing a successful verdict at trial. I discuss these as an addendum to the main paper. In short, though the changes impact some features of my argument, they do not alter any of the conclusions. The current proposal produces worse public health outcomes than would existing tort regime; it leaves the vast majority of those with legitimate claims to repair in corrective justice without a remedy, when providing the opportunity to secure a remedy for wrongs is in large measure, the essential nature of tort liability. Worse still, it continues to render victims the de facto insurers of those who have wronged them; it imposes the burden of spreading risks on victims who are considerably less efficient risk spreaders than are businesses and hospitals; it constitutes an inappropriate response to the challenge it seeks to address, i.e. subsidizing various sectors of the economy by reducing their overall costs; and given the fact that in the US health insurance is too closely linked to employment, it shifts the costs of the pandemic to those who are most at risk of losing their health insurance, rendering the proposal cruel in addition to inefficient, unjust, unfair and inappropriate. For those interested, I am considering a short op-ed piece assessing the particular legislative proposal. If I follow through I will let the readership know where that can be found. (shrink)

The historical relationship between health care professionals and people with disabilities is fraught, a fact all the more troubling in light of the distinctive roles clinicians play in both establishing and responding to that which is considered normal or abnormal by society at large. Those who wish to improve their clinical practice might struggle, however, to keep up with developments across numerous disability communities as well as the ever-growing body of disability studies scholarship. To assist with this goal, I (...) offer an overview of recent disability theory, outline a set of responsibilities clinicians have to disability communities, and provide recommendations for clinicians who hope to justly treat patients with disabilities and improve their care and health outcomes. (shrink)

Mismatch is a prominent concept in evolutionary medicine and a number of philosophers have published analyses of this concept. The word ‘mismatch’ has been used in a diversity of ways across a range of sciences, leading these authors to regard it as a vague concept in need of philosophical clarification. Here, in contrast, we concentrate on the use of mismatch in modelling and experimentation in evolutionary medicine. This reveals a rigorous theory of mismatch within which the term ‘mismatch’ is indeed (...) used in several ways, not because it is ill-defined but because different forms of mismatch are.distinguished within the theory. Contemporary evolutionary medicine has unified the idea of ‘evolutionary mismatch’, derived from the older idea of ‘adaptive lag’ in evolution, with ideas about mismatch in development and physiology derived from the Developmental Origins of Health and Disease (DOHaD) paradigm. A number of publications in evolutionary medicine have tried to make this theoretical framework explicit. We build on these to present the theory in as simple and general a form as possible. We introduce terminology, largely drawn from the existing literature, to distinguish the different forms of mismatch. This integrative theory of mismatch captures how organisms track environments across space and time on multiple scales in order to maintain an adaptive match to the environment, and how failures of adaptive tracking lead to disease. Mismatch is a productive organising concept within this theory which helps researchers articulate how physiology, development and evolution interact with one another and with environmental change to explain health outcomes. (shrink)

Corruption deprives people of access to health care and can lead to the wrong treatments being administered. Drug counterfeiting, facilitated by corruption, kills en masse. Cases are recorded of water being substituted for life-saving adrenaline and of active ingredients being diluted by counterfeiters, triggering drug-resistant strains of malaria, tuberculosis and HIV. The poor are disproportionately affected by corruption in the health sector, and cannot afford to pay for private alternatives where corruption has depleted public health services. Analysis (...) of corruption in the health sector of the UK can redress the information imbalance between UK government and service providers and patients. Health is a major global industry, a key responsibility and budget expense for governments and businesses. Corruption deprives people of access to health care and leads to poor health outcomes. (shrink)