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PubMed2004

Housing and wealth inequality: racial-ethnic differences in home equity in the United States.

In our study, we took a first step toward broadening our understanding of the sources of both housing and wealth inequality by studying differences in housing equity among blacks, Hispanics, Asians, and non-Hispanic whites in the United States. Using data from the American Housing Survey, we found substantial and significant gaps in housing equity for blacks and Hispanics (but not for Asians) compared with whites, even after we controlled for a wide range of locational, life-cycle, socioeconomic, family, immigrant, and mortgage characteristics. Furthermore, the payoffs to many factors are notably weaker for minority than for white households. This finding is especially consistent across groups for the effects of age, socioeconomic status, and housing-market value. Blacks and Hispanics also uniformly receive less benefit from mortgage and housing characteristics than do whites. These findings lend credence to the burgeoning stratification perspective on wealth and housing inequality that acknowledges the importance of broader social and institutional processes of racial-ethnic stratification that advantage some groups, whites in this case, over others.

Adult↗

PubMed2006

Sickle cell disease: a question of equity and quality.

Thirty years ago, the first major federal legislation concerning sickle cell disease treatment was passed, resulting in the development of comprehensive sickle cell centers. We are now at another watershed moment in the treatment of this illness with the passage in October 2004 of the Sickle Cell Treatment Act, designed to substantially expand specialized sickle cell treatment programs. This legislation offers a remarkable opportunity to significantly improve health outcomes for individuals with sickle cell disease if it is implemented with a specific focus on the distinct but related issues of equity and quality. Despite major advances in sickle cell disease treatment that have occurred over the past 3 decades, important gaps exist both in the equity of government and private philanthropic support for research and in the uniform provision of high quality clinical care. This article assesses the current gaps in funding support and in the implementation of improvements in clinical care in order to suggest strategies for making optimal use of the opportunity that the new legislation presents to improve the health of all individuals affected by this disease.

Anemia, Sickle Cell↗

PubMed2005

[Social equity in the health domain].

In the European debate on equity in health and health care a crucial question has received scant consideration. It concerns the precise specification of a health system's objectives and the manner by which they can be suitably interpreted to permit monitoring of implemented policies. This article is an attempt to review actual and potential contributions to this area of study. It adopts the view that the meaning of equity in the health domain depends crucially on how social justice is defined and that this in turn depends on value judgements or the views of society held by individuals, groups or governments. Such an approach allows one to choose principles of distribution which are in agreement with a society's value set and subsequently to apply them as the correct yardstick for measuring the success of policy. Following an initial exposition of the approach, the main body of the article discusses the question of competing theories of society - Libertarian, Liberal and Democratic Socialist - and appraises the various distribution principles, to be found in the economic and philosophical literature, which they imply. The final section offers some brief conclusions and avenues for further research.

English Abstract↗

PubMedDate not supplied

[Equity and health systems reform in Latin America].

The aim of any health care system is to help improve the people's health, and to do so as efficiently as possible. In order to improve the efficiency and equity of health services provision, many countries around the world have implemented reforms, including several Latin American nations. However similar the objectives may appear, the various ways societies implement such reforms reflect different values and concepts. This article analyzes the egalitarian and neoliberal values underlying different concepts of equity in health care. The authors develop criteria to interpret selected health services funding and provision strategies in Latin American health system reforms. These criteria are then applied to health care financing and delivery policies under the reforms currently being implemented in Colombia and Costa Rica.

Colombia↗

PubMedDate not supplied

[Equity and geographic distribution of financial resources in health systems].

This study focuses on equity in health and specifically the geographic distribution of financial resources. The author reviews the main contemporary theories of social justice and discusses the concept of equity in general and specifically in the health field. Based on the discussion of selected international experiences (United Kingdom, Spain, and Italy), the Resource Allocation Working Party (RAWP) formula used in the United Kingdom is identified as the most adequate distributive methodology, sizing the relative needs based on the population's demographic and epidemiological profiles. Finally, the results are presented from a simulation performed for the Brazilian case, showing that a more equitable geographic distribution of financial resources would require a redistribution favoring the States of the North and Northeast. The article concludes by highlighting that a comparison of actual fund outlays by the Ministry of Health in 1994 and the results of the simulation with the RAWP methodology for the Brazilian case show that the principles written into Brazilian legislation were absent from the geographic distribution of financial resources.

Brazil↗

PubMedDate not supplied

[Equity issues in health care reform in Argentina].

This article analyzes the historical and contemporary development of the Argentine health care system from the viewpoint of equity, a principle which is not explicitly mentioned in the system's founding documents. However, other values can be identified such as universal care, accessibility, and solidarity, which are closely related to equity. Nevertheless, the political dynamics characterizing the development of the country's health care system led to the suppression of more universalistic approaches, with group solidarity the only remaining principle providing structure to the system. The 1980s financial crisis highlighted the relative value of this principle as the basis for an equitable system. The authors illustrate the current situation with data on coverage under the medical social security system.

Argentina↗

PubMed2005

[Latin American science museums and equity].

Latin America and the Caribbean form a region of great variations yet marked by cultural resemblances. The origins of the region's countries, of their wealth, and also of their problems are quite similar. Indeed, there are clear points of contact in the most basic aspects, such as each society's worldview. Throughout the region there is a very strong democratizing trend that seeks more just and more educated societies. Science plays a key role in the development as a powerful weapon for tolerance and equity and therefore should be disseminated among the greatest possible number of Latin Americans. Red POP the network for the Popularization of Science and Technology in Latin America and the Caribbean - was created to help reach this goal. Under the auspices of ORCYT-UNESCO, Red POP is an interactive network of centers and programs that work to bring science and technology to the public at large. It fosters exchange, skill-acquisition, and resource use among its members. Based on the network's experience, we explore to what extent science museums favor equity in their home societies.

Education↗

PubMedDate not supplied

[Information for health equity in Chile].

OBJECTIVES: To estimate the magnitude of geographical health inequalities in Chile through key indicators based on data and information that are routinely collected and easily obtained, and to characterize the current situation with respect to the availability, quality, and access to information on health equity that official sources routinely collect. METHODS: A conceptual framework proposed by the World Health Organization was used to study health equity in terms of four dimensions: 1) state of health, 2) health determinants, 3) resources for and the supply of health system services, and 4) utilization of health system services. For each of these four dimensions, indicators were selected for which there was available information. The information was aggregated according to geographical and administrative units in the country: communes (342 in Chile), sanitary districts called "Health Services" (28), and regions (13). The aggregated information was analyzed using univariate analysis (distribution characteristics), bivariate analysis (correlations and frequency tables), and tabulation of values for selected indicators for the communes. RESULTS: With respect to the first dimension, state of health, we found an inverse relationship between mortality and average family income in the communes (r = -0.24; P < 0.001; n = 191 communes). With health determinants, there were important differences among the communes with regard to average household income, years of schooling, literacy, quality of housing, drinking water supply, and the wastewater disposal system. In terms of resources for and the supply of health system services, the municipal governments of the communes with higher average household incomes tended to contribute more funds per beneficiary (r = 0.19; P = 0.013). The financial contributions from the national government were targeted well, but they only partially compensated for the more limited resources available in poorer communes. With respect to the utilization of health care services per beneficiary in the different sanitary districts, we found some large differences. In terms of the ratio between the highest rate of utilization in any of the districts and the lowest rate in any other district, the ratio for primary-care visits per beneficiary was 2.8, the ratio for emergency-care visits was 3.9, and the ratio for hospitalizations was 2.0. CONCLUSIONS: There are important geographical differences in Chile with respect to mortality and other health outcomes, income and environmental conditions, and the financing and utilization of health care services. The information that is collected regularly and is available to characterize the health-related variables frequently has limitations in terms of quality, sustainability, and access. In Chile it would be pointless to focus the greatest efforts on reorganizing the information systems. The existing indicators showing marked inequalities are adequate to support the planning of interventions aimed at making urgently needed improvements in the situation of the worst-off Chileans.

Chile↗

PubMedDate not supplied

[Globalization, international trade, and health equity].

Globalization and international trade are having an increasingly evident impact on the day-to-day duties of the health sector, and the phenomenon has aroused a great deal of interest among governments, nongovernmental organizations, international organizations, and the mass media. Up to this point the heated and polemical debate on the subject has seriously hindered objective discourse on the health implications of globalization and international trade. This piece examines the possible impact of the two processes on health in the Region of the Americas, in order to foster policies for equity that are adopted within the framework of public health in the Americas. The piece considers the relationships among globalization, trade, and health in general and then focuses on the special case of trade in health goods and services. The piece looks at the possible impact on health equity of the agreements for integration and free trade that are being negotiated in the Americas. The piece concludes with a summary of the activities that the Pan American Health Organization has been carrying out in this area.

Canada↗

PubMedDate not supplied

[The law and equity in health].

What role does the law play in reducing inequalities in health that are unnecessary, avoidable, and unfair? The question is addressed in this paper, whose purpose is to examine how the legal system, as a regulatory agency of the State, contributes to achieving greater equity in access to and use of health-related goods and services. From the legal viewpoint, health is a public commodity that is critical to human well-being and survival. But in prioritizing health as a human right, the legal system is challenged with finding ways to make health equally accessible to all, while bearing in mind the particular needs of different groups. There are currently important gaps in health legislation in the Region that must be addressed if greater equity in health is to be achieved. Such gaps, along with potential ways to correct them, are discussed throughout the paper.

Bias↗

PubMedDate not supplied

[Equity, gender, and health: challenges for action].

The Governing Bodies of the Pan American Health Organization (PAHO) have mandated that the Organization apply a gender perspective in all aspects of the Organization's activities and its technical cooperation in the area of health with the PAHO Member States. This article points out the need to eradicate unjust gender differences that affect the right and access to health care that is appropriate for women. The piece explains the differences between equity and equality and between gender and sex, and how gender equity should come about in the state of health, in health care, and in all people's efforts to engender health. It is hoped the piece will contribute to a better understanding of the situation, thus helping to eliminate inequities that are due to sex, socioeconomic factors, and the distribution of power.

Adolescent↗

PubMed2002

Allocating HIV-prevention resources: balancing efficiency and equity.

The primary goal of HIV prevention is to prevent as many infections as possible. This requires allocating HIV-prevention resources according to cost effectiveness principles: those activities that prevent more infections per dollar are favored over those that prevent fewer. This is not current practice in the United States, where prevention resources from the federal government to the states flow in proportion to reported AIDS cases. Although such allocations might be considered equitable, more infections could be prevented for the same expenditures were cost-effectiveness principles invoked. The downside of pure cost-effective allocations is that they violate common norms of equity. In this article, we argue for a middle ground that promotes both equity and efficiency in allocating federal HIV-prevention resources.

Acquired Immunodeficiency Syndrome↗

PubMed1986

"Generational equity" and the new victim blaming: an emerging public policy issue.

Recent attempts to frame complex policy issues in terms of "justice between generations" and "intergenerational equity" are based on a series of questionable assumptions and economic calculations concerning the relative financial well-being of the elderly vis-à-vis other groups in U.S. society. On closer inspection, however, these assumptions--e.g., of a homogeneous and financially secure elderly population and of younger cohorts likely to become increasingly resentful of elderly entitlement programs--appear ill-founded. Census data revealing wide disparities in income among the elderly, and national opinion poll data suggestive of a large cross-generational and cross-ethnic group "stake" in Social Security and Medicare, are used to suggest that the intergenerational equity framework may well be an inappropriate one in the public policy arena. Such a framework, moreover, is seen as deflecting attention from more basic inequities in U.S. society and from the need for major policy shifts in response to these more fundamental problems.

Aged↗

PubMed1999

Benchmarks of fairness: a moral framework for assessing equity.

The health care systems of most advanced industrialized countries are currently undergoing extensive reforms. In Europe, in addition to economic and political issues, issues of "equity" and "solidarity" are very much on the minds of some health care reformers. Elsewhere in Europe, economics and politics dominate health care reform, and concerns about fairness are either absent or of secondary importance. Similarly, the recent health care debates in the United States were largely carried out in terms of payment schemes, cost-containment and outcome measures, campaign strategies, and political concessions. Issues of fairness were either hidden in the many features of the competing proposals and the debates about them, or totally ignored. In both cases, there has been no practical way to gauge how a given change would alter the equity or fairness of existing health care services. This article addresses that void by presenting ten scorable benchmarks of fairness.

Benchmarking↗

PubMed1990

Generational equity and the politics of the welfare state.

The concept of generational equity--that the nation is squandering its wealth on entitlements to the elderly while children remain impoverished--has received considerable media attention. The author traces the source of that message to an organization, Americans for Generational Equity, which is dedicated to restructuring the Social Security system along the lines of a social assistance program: reduced benefits available at later ages only to those who qualify through means tests. The impact of this agenda would be to increase the labor force participation of older people, particularly women and minorities, those presently without private pension coverage and already heavily represented in that sector of the economy where labor shortage is developing. Defining national spending priorities in terms of intergenerational conflict obscures the fact that Social Security is the only U.S. welfare program that has been successful in reducing poverty levels.

Age Factors↗

PubMed2006

Setting the stage for equity-sensitive monitoring of the maternal and child health Millennium Development Goals.

OBJECTIVE: This analysis seeks to set the stage for equity-sensitive monitoring of the health-related Millennium Development Goals (MDGs). METHODS: We use data from international household-level surveys (Demographic and Health Surveys (DHS) and Multiple Indicator Cluster Surveys (MICS)) to demonstrate that establishing an equity baseline is necessary and feasible, even in low-income and data-poor countries. We assess data from six countries using 11 health indicators and six social stratifiers. Simple bivariate stratification is complemented by simultaneous stratification to expose the compound effect of multiple forms of vulnerability. FINDINGS: The data reveal that inequities are complex and interactive: inferences cannot be drawn about the nature or extent of inequities in health outcomes from a single stratifier or indicator. CONCLUSION: The MDGs and other development initiatives must become more comprehensive and explicit in their analysis and tracking of inequities. The design of policies to narrow health gaps must take into account country-specific inequities.

Data Collection↗

PubMed2004

Organ allocation for transplantation in the USA and Korea: the changing roles of equity and utility.

Realizing the promise and managing the success of organ transplantation requires the creation of unique institutions. An Organ Procurement and Transplant Network (OPTN) must be capable of increasing the supply of cadaver donor organs, of allocating those organs properly to recipients with due consideration for equity and utility, and of using scientific data to improve the system for the good of society. The OPTN should answer to the public and should expect public support. Both in the United States and in Korea major changes in deceased donor organ procurement and allocation are in progress. In the United States change takes the form of a renewed emphasis on achieving equity in kidney allocation without significantly sacrificing transplant graft or patient survival and the first ever use of purely objective, statistically evaluated criteria for liver allocation. In Korea where the OPTN is only four years old, change takes the form of a new brain death law and the creation of that country's first organ procurement organizations. In both countries, success in meeting the transplant needs of their populations will ultimately depend on the support of society and the cooperation of the entire medical community.

Health Care Rationing↗

PubMed1992

An immodest proposal: pay equity for nursing faculty who do clinical teaching.

Pay equity, the concept of equal pay for equal or comparable work, will continue to be of paramount importance to women as the 20th century draws to a close. While it might have been anticipated that women in academic settings would enjoy pay equity, clinical teaching in nursing education provides a model for gender discrimination as related to women's work. Elements of proposal development and a case study for contesting pay inequity are presented.

Faculty, Nursing↗