EDITORIAL
THE ETHICAL IMPLICATIONS OF THE
SOCIAL DETERMINANTS OF HEALTH:
A GLOBAL RENAISSANCE FOR
BIOETHICS
In this special issue, Bioethics explores the ethical issues
that relate to the social determinants of health. As the
articles demonstrate, the recognition that social factors
help to determine a population’s health offers bioethics
new challenges and new opportunities. With this recog-
nition, fundamental bioethical concepts, such as cau-
sation, autonomy, rights, and justice, take on new
meanings. Likewise, mainstay bioethical issues, including
the equitable distribution of resources, the duties of pro-
fessionals, and the conflict between paternalism and
autonomy, become amenable to new perspectives.
The realization that social forces help to determine
health is hardly new. For millennia people have recog-
nized a relationship between the social environment
and disease. In the 19th century, sanitarians blamed the
rampant filth of growing cities for the incessant outbreaks
of disease. Later progressive reformers lambasted both
poverty and poor working conditions for disease and
premature death. The pioneers of epidemiology docu-
mented these relationships.
The field of bioethics has never been closed to such
concerns. Since its inception in the 1960s and 1970s,
however, bioethics has deployed much of its intellectual
energy on the moral issues that relate to the development,
distribution, and delivery of health care services. In so
doing, the field reflected medicine’s eclipse of public
health in the 20th century. As medicine became predomi-
nant and illness became more and more amenable to
individualized medical treatment, ethical discourse came
to emphasize clinical encounters. At the same time, as
disease and health increasingly came to be seen as result-
ing from individual factors, individuals began to be
viewed as morally culpable for both their illnesses and the
impact of those illnesses on others.
Not surprisingly, given the importance that bioethics
placed upon individual patients and providers, autonomy
surfaced as a key concern. In the early years bioethicists
focused on the autonomy of patients. Following the lead
of John Stuart Mill, bioethicists revealed the dangers of
medical paternalism and explained why and how patient
autonomy should be respected. In this they were highly
successful, as informed consent became both widely
regarded and legally established.
Individual autonomy remained of paramount interest
in the 1990s. By then, however, the concern widened to
include the autonomy of physicians. At least within the
USA, physicians criticized managed care for interfering
with their ability to make decisions for their patients
and infringing upon their professional autonomy. And
throughout the developed world, as health care costs rose,
market solutions were debated. Patients began to be
viewed as ‘consumers’ of medical care instead of as
patients in need of treatment and care. Not surprisingly,
once patients were.
From diagnosis to social diagnosisAuthor Phil Brown Mercedes Lys.docxshericehewat
From diagnosis to social diagnosis
Author Phil Brown Mercedes Lyson, Tania Jenkins
Abstract
In the past two decades, research on the sociology of diagnosis has attained considerable influence within medical sociology. Analyzing the process and factors that contribute to making a diagnosis amidst uncertainty and contestation, as well as the diagnostic encounter itself, are topics rich for sociological investigation. This paper provides a reformulation of the sociology of diagnosis by proposing the concept of ‘social diagnosis’ which helps us recognize the interplay between larger social structures and individual or community illness manifestations. By outlining a conceptual frame, exploring how social scientists, medical professionals and laypeople contribute to social diagnosis, and providing a case study of how the North American Mohawk Akwesasne reservation dealt with rising obesity prevalence to further illustrate the social diagnosis idea, we embark on developing a cohesive and updated framework for a sociology of diagnosis. This approach is useful not just for sociological research, but has direct implications for the fields of medicine and public health. Approaching diagnosis from this integrated perspective potentially provides a broader context for practitioners and researchers to understand extra-medical factors, which in turn has consequences for patient care and health outcomes.
Highlights
► “Social diagnosis” recognizes interplay between social structures and illness manifestations. ► Case study shows how Mohawk Akwesasne dealt with rising obesity. ► Provides broad context for practitioners and researchers to understand extra-medical factors.
· Previous article in issue
· Next article in issue
Keywords
Diagnosis
Risk
Social movements
Environment
Public health
USA
Canada
Reservations
Introduction
Sociological analysis of diagnosis has achieved considerable influence in the last two decades, providing important insight into how we understand health, disease, and illness. It has also expanded how we view the social and cultural influences that shape our knowledge and practice on health and illness. This includes studies of diagnosis that have gone beyond the interaction between physician and patient, to take into account the larger social, structural, and temporal forces that shape diagnosis (see, for example, the categorization of homosexuality as a mental disorder and the role of gay rights activists in the American Psychiatric Association’s deliberations) (Cooksey & Brown, 1998).
Recently we have also seen the emergence of diseases whose etiologies, symptoms, and, therefore, diagnoses, are often contested or uncertain. This combination of medical and social uncertainty leads us to propose a reformulation of the concept social diagnosis as a new way of thinking about the sociology of diagnosis. This paper explores social diagnosis by first, outlining a conceptual framework of social diagnosis; second, discussing the different acto ...
1Identifying the VulnerableLearning ObjectivesAfteEttaBenton28
1
Identifying the Vulnerable
Learning Objectives
After reading this chapter, you should be able to:
• Explain the concept of vulnerable populations.
• Discuss how the theories of common good and individual rights contribute to the cre-
ation of public policy in health care.
• Determine how the concept of resource availability relates to one’s health.
• Examine the aggregate statistical data on the number and growth of identified vulnerable
populations.
• Identify the vulnerable populations in the United States.
Courtesy of Chris Bett/fotolia
bur25613_01_c01_001-038.indd 1 11/26/12 10:32 AM
CHAPTER 1Introduction
Introduction
Two women enter the hospital with pneumonia. They are similar in age, but of dif-ferent races. One patient has private health insurance; the other is on Medicaid. One patient recovers quickly while the other languishes. What can be surmised from the
differences in the two patients? Thinking on this and asking the right questions allows
health care providers to create patient care plans that better meet each patient’s needs.
Providing better health care to all patients requires awareness of environmental factors
that may prohibit timely recovery and put the patient at risk for secondary and repeat
infections.
Environmental factors such as finances, family, and education all affect a person’s vulner-
ability, or risk level. Understanding statistical data on vulnerable populations will help
you interpret patient information. This allows easier identification of those who are at
risk, so that providers may plan care accordingly. Addressing the needs of at-risk popula-
tions leads to faster patient recovery, thereby lowering the cost of patient care.
Lowering health care costs is important for the patient, the care provider, and the whole
country. Nonprofit organizations and government agencies work to identify and help
at-risk groups. This activity affects both government and organizational policy among
health care providers.
This text investigates the statistical data and indicators of vulnerable populations in
American health care. It also covers the causes of vulnerability and the prevailing ideolo-
gies on dealing with at-risk populations. We will also discuss what is currently being done
through policymaking and program implementation to address the needs of vulnerable
populations and what the future looks like for at-risk groups. This chapter focuses on
identifying vulnerable populations. The relationship between resource availability and
health is an important part of recognizing at-risk groups. Finally, we will look at statistical
data concerning the at-risk groups identified in the book.
Critical Thinking
The text states, “Addressing the needs of at-risk populations leads to faster patient recovery, thereby
lowering the cost of patient care.” How does addressing the needs of at-risk populations lead to faster
patient recovery?
bur25613_01_c01_001-038.indd 2 11/26/12 ...
1Identifying the VulnerableLearning ObjectivesAfte.docxaulasnilda
1
Identifying the Vulnerable
Learning Objectives
After reading this chapter, you should be able to:
• Explain the concept of vulnerable populations.
• Discuss how the theories of common good and individual rights contribute to the cre-
ation of public policy in health care.
• Determine how the concept of resource availability relates to one’s health.
• Examine the aggregate statistical data on the number and growth of identified vulnerable
populations.
• Identify the vulnerable populations in the United States.
Courtesy of Chris Bett/fotolia
bur25613_01_c01_001-038.indd 1 11/26/12 10:32 AM
CHAPTER 1Introduction
Introduction
Two women enter the hospital with pneumonia. They are similar in age, but of dif-ferent races. One patient has private health insurance; the other is on Medicaid. One patient recovers quickly while the other languishes. What can be surmised from the
differences in the two patients? Thinking on this and asking the right questions allows
health care providers to create patient care plans that better meet each patient’s needs.
Providing better health care to all patients requires awareness of environmental factors
that may prohibit timely recovery and put the patient at risk for secondary and repeat
infections.
Environmental factors such as finances, family, and education all affect a person’s vulner-
ability, or risk level. Understanding statistical data on vulnerable populations will help
you interpret patient information. This allows easier identification of those who are at
risk, so that providers may plan care accordingly. Addressing the needs of at-risk popula-
tions leads to faster patient recovery, thereby lowering the cost of patient care.
Lowering health care costs is important for the patient, the care provider, and the whole
country. Nonprofit organizations and government agencies work to identify and help
at-risk groups. This activity affects both government and organizational policy among
health care providers.
This text investigates the statistical data and indicators of vulnerable populations in
American health care. It also covers the causes of vulnerability and the prevailing ideolo-
gies on dealing with at-risk populations. We will also discuss what is currently being done
through policymaking and program implementation to address the needs of vulnerable
populations and what the future looks like for at-risk groups. This chapter focuses on
identifying vulnerable populations. The relationship between resource availability and
health is an important part of recognizing at-risk groups. Finally, we will look at statistical
data concerning the at-risk groups identified in the book.
Critical Thinking
The text states, “Addressing the needs of at-risk populations leads to faster patient recovery, thereby
lowering the cost of patient care.” How does addressing the needs of at-risk populations lead to faster
patient recovery?
bur25613_01_c01_001-038.indd 2 11/26/12 ...
1Identifying the VulnerableLearning ObjectivesAfte.docxfelicidaddinwoodie
1
Identifying the Vulnerable
Learning Objectives
After reading this chapter, you should be able to:
• Explain the concept of vulnerable populations.
• Discuss how the theories of common good and individual rights contribute to the cre-
ation of public policy in health care.
• Determine how the concept of resource availability relates to one’s health.
• Examine the aggregate statistical data on the number and growth of identified vulnerable
populations.
• Identify the vulnerable populations in the United States.
Courtesy of Chris Bett/fotolia
bur25613_01_c01_001-038.indd 1 11/26/12 10:32 AM
CHAPTER 1Introduction
Introduction
Two women enter the hospital with pneumonia. They are similar in age, but of dif-ferent races. One patient has private health insurance; the other is on Medicaid. One patient recovers quickly while the other languishes. What can be surmised from the
differences in the two patients? Thinking on this and asking the right questions allows
health care providers to create patient care plans that better meet each patient’s needs.
Providing better health care to all patients requires awareness of environmental factors
that may prohibit timely recovery and put the patient at risk for secondary and repeat
infections.
Environmental factors such as finances, family, and education all affect a person’s vulner-
ability, or risk level. Understanding statistical data on vulnerable populations will help
you interpret patient information. This allows easier identification of those who are at
risk, so that providers may plan care accordingly. Addressing the needs of at-risk popula-
tions leads to faster patient recovery, thereby lowering the cost of patient care.
Lowering health care costs is important for the patient, the care provider, and the whole
country. Nonprofit organizations and government agencies work to identify and help
at-risk groups. This activity affects both government and organizational policy among
health care providers.
This text investigates the statistical data and indicators of vulnerable populations in
American health care. It also covers the causes of vulnerability and the prevailing ideolo-
gies on dealing with at-risk populations. We will also discuss what is currently being done
through policymaking and program implementation to address the needs of vulnerable
populations and what the future looks like for at-risk groups. This chapter focuses on
identifying vulnerable populations. The relationship between resource availability and
health is an important part of recognizing at-risk groups. Finally, we will look at statistical
data concerning the at-risk groups identified in the book.
Critical Thinking
The text states, “Addressing the needs of at-risk populations leads to faster patient recovery, thereby
lowering the cost of patient care.” How does addressing the needs of at-risk populations lead to faster
patient recovery?
bur25613_01_c01_001-038.indd 2 11/26/12 ...
Medicalization of SocietyThe social construction of .docxbuffydtesurina
Medicalization of Society
The social construction of medical knowledge
*
Medicalization of SocietyDescribes a process whereby previously non-medical problems become defined and treated as medical problems, usually in terms of illness, disorders, and conditions. Some suggest that the growth of medical jurisdiction is one of the most significant transformations of the last half of the 20th century.
*
DefinitionThe term refers to the process by which certain events or characteristics of everyday life become medical issues, and thus come within the purview of doctors and other health professionals to engage with, study, and treat. The process of medicalization typically involves changes in social attitudes and terminology, and usually accompanies (or is driven by) the availability of treatments.
*
The prevalence of medicalization
Indicators:
percentage of gross national income increased from 4.5% in 1950 to 16% in 2006
# of physicians per population has doubled in that time frame, extending medical capacity
Jurisdiction of medicine has grown to encompass new problems not previously deemed ‘medical’
Examples: ADHD, eating disorders, CFS,PTSD, panic disorder, fetal alcohol syndrome, PMS, SIDS, obesity, alcoholism
*
Medicalization concerns itself with deviance and ‘normal life events’.Behaviors once defined as immoral, sinful, or criminal have been given medical meaning moving them from badness to sickness.Common life processes have been medicalized: including aging, anxiety and mood, menstruation, birth control, fertility, childbirth, menopause, and death.
*
Increasing MedicalizationNew categories of disease and drug therapies.Expanding/contracting medical categories.Elastic categories: Alzheimer Disease (AD) and the removal of age criteria led to AD encompassing senile dementia sufferers, sharply increasing the number of AD cases (now a top 5 cause of death in the US).Demedicalization whereby a problem is no longer defined as medical problem worthy of medical intervention (e.g. masturbation, homosexuality). Unsuccessful attempts include childbirth. Partial success includes disability.
*
Beyond Sociology…Numerous articles on medicalization in Medline search.British Medical Journal (2002) special issue on medicalization.PLoS Medicine (2006) devoted to ‘disease mongering’.President’s council on Bioethics dedicated session (2003).Seattle Times (2005) Suddenly Sick series.
*
Medicalization has gained attention beyond the social sciences.
Increased medicalizationNew epidemic of medical problems? Or,Is medicine better able to understand and identify and treat existing problems? Or, Are life’s problems increasingly defined as medical problems despite dubious evidence of their medical nature?
*
We’re not interested ncessarily in whether conditions are really medical or not, rather, we’re going to think of medical knowledge and the conditions which come to be understood as medical - as .
This week we will begin by reviewing the course content and evaluation procedures. The opening remarks will include an examination of the biomedical and social models of health.
From diagnosis to social diagnosisAuthor Phil Brown Mercedes Lys.docxshericehewat
From diagnosis to social diagnosis
Author Phil Brown Mercedes Lyson, Tania Jenkins
Abstract
In the past two decades, research on the sociology of diagnosis has attained considerable influence within medical sociology. Analyzing the process and factors that contribute to making a diagnosis amidst uncertainty and contestation, as well as the diagnostic encounter itself, are topics rich for sociological investigation. This paper provides a reformulation of the sociology of diagnosis by proposing the concept of ‘social diagnosis’ which helps us recognize the interplay between larger social structures and individual or community illness manifestations. By outlining a conceptual frame, exploring how social scientists, medical professionals and laypeople contribute to social diagnosis, and providing a case study of how the North American Mohawk Akwesasne reservation dealt with rising obesity prevalence to further illustrate the social diagnosis idea, we embark on developing a cohesive and updated framework for a sociology of diagnosis. This approach is useful not just for sociological research, but has direct implications for the fields of medicine and public health. Approaching diagnosis from this integrated perspective potentially provides a broader context for practitioners and researchers to understand extra-medical factors, which in turn has consequences for patient care and health outcomes.
Highlights
► “Social diagnosis” recognizes interplay between social structures and illness manifestations. ► Case study shows how Mohawk Akwesasne dealt with rising obesity. ► Provides broad context for practitioners and researchers to understand extra-medical factors.
· Previous article in issue
· Next article in issue
Keywords
Diagnosis
Risk
Social movements
Environment
Public health
USA
Canada
Reservations
Introduction
Sociological analysis of diagnosis has achieved considerable influence in the last two decades, providing important insight into how we understand health, disease, and illness. It has also expanded how we view the social and cultural influences that shape our knowledge and practice on health and illness. This includes studies of diagnosis that have gone beyond the interaction between physician and patient, to take into account the larger social, structural, and temporal forces that shape diagnosis (see, for example, the categorization of homosexuality as a mental disorder and the role of gay rights activists in the American Psychiatric Association’s deliberations) (Cooksey & Brown, 1998).
Recently we have also seen the emergence of diseases whose etiologies, symptoms, and, therefore, diagnoses, are often contested or uncertain. This combination of medical and social uncertainty leads us to propose a reformulation of the concept social diagnosis as a new way of thinking about the sociology of diagnosis. This paper explores social diagnosis by first, outlining a conceptual framework of social diagnosis; second, discussing the different acto ...
1Identifying the VulnerableLearning ObjectivesAfteEttaBenton28
1
Identifying the Vulnerable
Learning Objectives
After reading this chapter, you should be able to:
• Explain the concept of vulnerable populations.
• Discuss how the theories of common good and individual rights contribute to the cre-
ation of public policy in health care.
• Determine how the concept of resource availability relates to one’s health.
• Examine the aggregate statistical data on the number and growth of identified vulnerable
populations.
• Identify the vulnerable populations in the United States.
Courtesy of Chris Bett/fotolia
bur25613_01_c01_001-038.indd 1 11/26/12 10:32 AM
CHAPTER 1Introduction
Introduction
Two women enter the hospital with pneumonia. They are similar in age, but of dif-ferent races. One patient has private health insurance; the other is on Medicaid. One patient recovers quickly while the other languishes. What can be surmised from the
differences in the two patients? Thinking on this and asking the right questions allows
health care providers to create patient care plans that better meet each patient’s needs.
Providing better health care to all patients requires awareness of environmental factors
that may prohibit timely recovery and put the patient at risk for secondary and repeat
infections.
Environmental factors such as finances, family, and education all affect a person’s vulner-
ability, or risk level. Understanding statistical data on vulnerable populations will help
you interpret patient information. This allows easier identification of those who are at
risk, so that providers may plan care accordingly. Addressing the needs of at-risk popula-
tions leads to faster patient recovery, thereby lowering the cost of patient care.
Lowering health care costs is important for the patient, the care provider, and the whole
country. Nonprofit organizations and government agencies work to identify and help
at-risk groups. This activity affects both government and organizational policy among
health care providers.
This text investigates the statistical data and indicators of vulnerable populations in
American health care. It also covers the causes of vulnerability and the prevailing ideolo-
gies on dealing with at-risk populations. We will also discuss what is currently being done
through policymaking and program implementation to address the needs of vulnerable
populations and what the future looks like for at-risk groups. This chapter focuses on
identifying vulnerable populations. The relationship between resource availability and
health is an important part of recognizing at-risk groups. Finally, we will look at statistical
data concerning the at-risk groups identified in the book.
Critical Thinking
The text states, “Addressing the needs of at-risk populations leads to faster patient recovery, thereby
lowering the cost of patient care.” How does addressing the needs of at-risk populations lead to faster
patient recovery?
bur25613_01_c01_001-038.indd 2 11/26/12 ...
1Identifying the VulnerableLearning ObjectivesAfte.docxaulasnilda
1
Identifying the Vulnerable
Learning Objectives
After reading this chapter, you should be able to:
• Explain the concept of vulnerable populations.
• Discuss how the theories of common good and individual rights contribute to the cre-
ation of public policy in health care.
• Determine how the concept of resource availability relates to one’s health.
• Examine the aggregate statistical data on the number and growth of identified vulnerable
populations.
• Identify the vulnerable populations in the United States.
Courtesy of Chris Bett/fotolia
bur25613_01_c01_001-038.indd 1 11/26/12 10:32 AM
CHAPTER 1Introduction
Introduction
Two women enter the hospital with pneumonia. They are similar in age, but of dif-ferent races. One patient has private health insurance; the other is on Medicaid. One patient recovers quickly while the other languishes. What can be surmised from the
differences in the two patients? Thinking on this and asking the right questions allows
health care providers to create patient care plans that better meet each patient’s needs.
Providing better health care to all patients requires awareness of environmental factors
that may prohibit timely recovery and put the patient at risk for secondary and repeat
infections.
Environmental factors such as finances, family, and education all affect a person’s vulner-
ability, or risk level. Understanding statistical data on vulnerable populations will help
you interpret patient information. This allows easier identification of those who are at
risk, so that providers may plan care accordingly. Addressing the needs of at-risk popula-
tions leads to faster patient recovery, thereby lowering the cost of patient care.
Lowering health care costs is important for the patient, the care provider, and the whole
country. Nonprofit organizations and government agencies work to identify and help
at-risk groups. This activity affects both government and organizational policy among
health care providers.
This text investigates the statistical data and indicators of vulnerable populations in
American health care. It also covers the causes of vulnerability and the prevailing ideolo-
gies on dealing with at-risk populations. We will also discuss what is currently being done
through policymaking and program implementation to address the needs of vulnerable
populations and what the future looks like for at-risk groups. This chapter focuses on
identifying vulnerable populations. The relationship between resource availability and
health is an important part of recognizing at-risk groups. Finally, we will look at statistical
data concerning the at-risk groups identified in the book.
Critical Thinking
The text states, “Addressing the needs of at-risk populations leads to faster patient recovery, thereby
lowering the cost of patient care.” How does addressing the needs of at-risk populations lead to faster
patient recovery?
bur25613_01_c01_001-038.indd 2 11/26/12 ...
1Identifying the VulnerableLearning ObjectivesAfte.docxfelicidaddinwoodie
1
Identifying the Vulnerable
Learning Objectives
After reading this chapter, you should be able to:
• Explain the concept of vulnerable populations.
• Discuss how the theories of common good and individual rights contribute to the cre-
ation of public policy in health care.
• Determine how the concept of resource availability relates to one’s health.
• Examine the aggregate statistical data on the number and growth of identified vulnerable
populations.
• Identify the vulnerable populations in the United States.
Courtesy of Chris Bett/fotolia
bur25613_01_c01_001-038.indd 1 11/26/12 10:32 AM
CHAPTER 1Introduction
Introduction
Two women enter the hospital with pneumonia. They are similar in age, but of dif-ferent races. One patient has private health insurance; the other is on Medicaid. One patient recovers quickly while the other languishes. What can be surmised from the
differences in the two patients? Thinking on this and asking the right questions allows
health care providers to create patient care plans that better meet each patient’s needs.
Providing better health care to all patients requires awareness of environmental factors
that may prohibit timely recovery and put the patient at risk for secondary and repeat
infections.
Environmental factors such as finances, family, and education all affect a person’s vulner-
ability, or risk level. Understanding statistical data on vulnerable populations will help
you interpret patient information. This allows easier identification of those who are at
risk, so that providers may plan care accordingly. Addressing the needs of at-risk popula-
tions leads to faster patient recovery, thereby lowering the cost of patient care.
Lowering health care costs is important for the patient, the care provider, and the whole
country. Nonprofit organizations and government agencies work to identify and help
at-risk groups. This activity affects both government and organizational policy among
health care providers.
This text investigates the statistical data and indicators of vulnerable populations in
American health care. It also covers the causes of vulnerability and the prevailing ideolo-
gies on dealing with at-risk populations. We will also discuss what is currently being done
through policymaking and program implementation to address the needs of vulnerable
populations and what the future looks like for at-risk groups. This chapter focuses on
identifying vulnerable populations. The relationship between resource availability and
health is an important part of recognizing at-risk groups. Finally, we will look at statistical
data concerning the at-risk groups identified in the book.
Critical Thinking
The text states, “Addressing the needs of at-risk populations leads to faster patient recovery, thereby
lowering the cost of patient care.” How does addressing the needs of at-risk populations lead to faster
patient recovery?
bur25613_01_c01_001-038.indd 2 11/26/12 ...
Medicalization of SocietyThe social construction of .docxbuffydtesurina
Medicalization of Society
The social construction of medical knowledge
*
Medicalization of SocietyDescribes a process whereby previously non-medical problems become defined and treated as medical problems, usually in terms of illness, disorders, and conditions. Some suggest that the growth of medical jurisdiction is one of the most significant transformations of the last half of the 20th century.
*
DefinitionThe term refers to the process by which certain events or characteristics of everyday life become medical issues, and thus come within the purview of doctors and other health professionals to engage with, study, and treat. The process of medicalization typically involves changes in social attitudes and terminology, and usually accompanies (or is driven by) the availability of treatments.
*
The prevalence of medicalization
Indicators:
percentage of gross national income increased from 4.5% in 1950 to 16% in 2006
# of physicians per population has doubled in that time frame, extending medical capacity
Jurisdiction of medicine has grown to encompass new problems not previously deemed ‘medical’
Examples: ADHD, eating disorders, CFS,PTSD, panic disorder, fetal alcohol syndrome, PMS, SIDS, obesity, alcoholism
*
Medicalization concerns itself with deviance and ‘normal life events’.Behaviors once defined as immoral, sinful, or criminal have been given medical meaning moving them from badness to sickness.Common life processes have been medicalized: including aging, anxiety and mood, menstruation, birth control, fertility, childbirth, menopause, and death.
*
Increasing MedicalizationNew categories of disease and drug therapies.Expanding/contracting medical categories.Elastic categories: Alzheimer Disease (AD) and the removal of age criteria led to AD encompassing senile dementia sufferers, sharply increasing the number of AD cases (now a top 5 cause of death in the US).Demedicalization whereby a problem is no longer defined as medical problem worthy of medical intervention (e.g. masturbation, homosexuality). Unsuccessful attempts include childbirth. Partial success includes disability.
*
Beyond Sociology…Numerous articles on medicalization in Medline search.British Medical Journal (2002) special issue on medicalization.PLoS Medicine (2006) devoted to ‘disease mongering’.President’s council on Bioethics dedicated session (2003).Seattle Times (2005) Suddenly Sick series.
*
Medicalization has gained attention beyond the social sciences.
Increased medicalizationNew epidemic of medical problems? Or,Is medicine better able to understand and identify and treat existing problems? Or, Are life’s problems increasingly defined as medical problems despite dubious evidence of their medical nature?
*
We’re not interested ncessarily in whether conditions are really medical or not, rather, we’re going to think of medical knowledge and the conditions which come to be understood as medical - as .
This week we will begin by reviewing the course content and evaluation procedures. The opening remarks will include an examination of the biomedical and social models of health.
Promoting Health Equity A Resource to Help Communities Add.docxbriancrawford30935
Promoting Health Equity
A Resource to Help Communities Address
Social Determinants of Health
Cover art is based on original art by Chris Ree developed for the Literacy for Environmental Justice/Youth
Envision Good Neighbor program, which addresses links between food security and the activities of
transnational tobacco companies in low-income communities and communities of color in San Francisco. In
partnership with city government, community-based organizations, and others, Good Neighbor provides
incentives to inner-city retailers to increase their stocks of fresh and nutritious foods and to reduce tobacco
and alcohol advertising in their stores (see Case Study # 6 on page 24. Adapted and used with permission.).
Promoting Health Equity
A Resource to Help Communities Address
Social Determinants of Health
Laura K. Brennan Ramirez, PhD, MPH
Transtria L.L.C.
Elizabeth A. Baker, PhD, MPH
Saint Louis University School of Public Health
Marilyn Metzler, RN
Centers for Disease Control and Prevention
This document is published in partnership
with the Social Determinants of Health
Work Group at the Centers for Disease
Control and Prevention, U.S. Department of
Health and Human Services.
1
Suggested Citation
Brennan Ramirez LK, Baker EA, Metzler M. Promoting Health Equity: A Resource
to Help Communities Address Social Determinants of Health. Atlanta: U.S.
Department of Health and Human Services, Centers for Disease Control and
Prevention; 2008.
For More Information
E-mail: [email protected]
Mail: Community Health and Program Services Branch
Division of Adult and Community Health
National Center for Chronic Disease Prevention and Health Promotion
Centers for Disease Control and Prevention
4770 Buford Highway, Mail Stop K–30
Atlanta, GA 30041
E-mail: [email protected]
Mail: Laura Brennan Ramirez, Transtria L.L.C.
6514 Lansdowne Avenue
Saint Louis, MO 63109
Online: This publication is available at
http://www.cdc.gov/nccdphp/dach/chaps
and http://www.transtria.com.
Acknowledgements
The authors would like to thank the following people for their valuable contributions to
the publication of this resource: the workshop participants (listed on page 5), Lynda
Andersen, Ellen Barnidge, Adam Becker, Joe Benitez, Julie Claus, Sandy Ciske, Tonie
Covelli, Gail Gentling, Wayne Giles, Melissa Hall, Donna Higgins, Bethany Young
Holt, Jim Holt, Bill Jenkins, Margaret Kaniewski, Joe Karolczak, Leandris Liburd, Jim
Mercy, Eveliz Metellus, Amanda Navarro, Geraldine Perry, Amy Schulz, Eduardo
Simoes, Kristine Suozzi and Karen Voetsch. A special thanks to Innovative Graphic
Services for the design and layout of this book.
This resource was developed with support from:
> National Center for Chronic Disease Prevention and Health Promotion
Division of Adult and Community Health
Prevention Research Centers
Community Health and Program Services Branch
> National Center f.
Ch. 1 Identifying the VulnerableLearning ObjectivesAfter rea.docxcravennichole326
Ch. 1 Identifying the Vulnerable
Learning Objectives
After reading this chapter, you should be able to:
Explain the concept of vulnerable populations.
Discuss how the theories of common good and individual rights contribute to the creation of public policy in health care.
Determine how the concept of resource availability relates to one's health.
Examine the aggregate statistical data on the number and growth of identified vulnerable populations.
Identify the vulnerable populations in the United States.
Introduction
Two women enter the hospital with pneumonia. They are similar in age, but of different races. One patient has private health insurance; the other is on Medicaid. One patient recovers quickly while the other languishes. What can be surmised from the differences in the two patients? Thinking on this and asking the right questions allows health care providers to create patient care plans that better meet each patient's needs. Providing better health care to all patients requires awareness of environmental factors that may prohibit timely recovery and put the patient at risk for secondary and repeat infections.
Environmental factors such as finances, family, and education all affect a person's vulnerability, or risk level. Understanding statistical data on vulnerable populations will help you interpret patient information. This allows easier identification of those who are at risk, so that providers may plan care accordingly. Addressing the needs of at-risk populations leads to faster patient recovery, thereby lowering the cost of patient care.
Lowering health care costs is important for the patient, the care provider, and the whole country. Nonprofit organizations and government agencies work to identify and help at-risk groups. This activity affects both government and organizational policy among health care providers.
This text investigates the statistical data and indicators of vulnerable populations in American health care. It also covers the causes of vulnerability and the prevailing ideologies on dealing with at-risk populations. We will also discuss what is currently being done through policymaking and program implementation to address the needs of vulnerable populations and what the future looks like for at-risk groups. This chapter focuses on identifying vulnerable populations. The relationship between resource availability and health is an important part of recognizing at-risk groups. Finally, we will look at statistical data concerning the at-risk groups identified in the book.
Critical Thinking
The text states, "Addressing the needs of at-risk populations leads to faster patient recovery, thereby lowering the cost of patient care." How does addressing the needs of at-risk populations lead to faster patient recovery?
1.1 Social Theory and Public Policy in Health Care
Courtesy of iStockphoto/Thinkstock
Prohibiting smoking in public places exemplifies the social theory of the common good, bec ...
Social work is an integral component of the U.S. health care system. The emergence of professional social work in Indian hospitals is a attributed to Bhore committee who recommended training and placement of hospital social workers. Social work in healthcare is performed in a medical context that is, the medical social worker needs to collaborate with the medical professionals who usually treat patients. Social work in healthcare is also regulated by healthcare legislation and not solely by social laws. Social work in healthcare in India accomplished by medical social workers trained in crisis treatment, psychosocial treatment, counselling, law, how to handle traumas and how to provide social assistance, emotional support, and instrumental support. Social worker in present settings across the health care continuum, providing services to individuals and families throughout the lifespan, and addressing the full range of bio psychosocial issues that impact well being. The presents article an overview of the Social Work, Health Care Settings and Social Work in Health Care Settings. Dr. Gouri Manik Manas "Social Work in Health Care Setting" Published in International Journal of Trend in Scientific Research and Development (ijtsrd), ISSN: 2456-6470, Volume-6 | Issue-1 , December 2021, URL: https://www.ijtsrd.com/papers/ijtsrd49098.pdf Paper URL: https://www.ijtsrd.com/humanities-and-the-arts/social-science/49098/social-work-in-health-care-setting/dr-gouri-manik-manas
On July 1, 1665, the lordmayor and aldermen of thecity of Lo.docxvannagoforth
On July 1, 1665, the lordmayor and aldermen of the
city of London put into place a set
of orders “concerning the infec-
tion of the plague,” which was
then sweeping through the popula-
tion. He intended that these
actions would be “very expedient
for preventing and avoiding of
infection of sickness” (1).
At that time, London faced a
public health crisis, with an inade-
quate scientific base in that the
role of rats and their fleas in dis-
ease transmission was unknown.
Nonetheless, this crisis was faced
with good intentions by the top
medical and political figures of
the community.
Daniel Defoe made an observation that could apply to
many public health interventions then and today, “This
shutting up of houses was at first counted a very cruel and
unchristian method… but it was a public good that justi-
fied a private mischief” (1). Then, just as today, a complex
relationship existed between the science of public health
and the practice of public health and politics. We address
the relationship between science, public health, and poli-
tics, with a particular emphasis on infectious diseases.
Science, public health, and politics are not only com-
patible, but all three are necessary to improve the public’s
health. The progress of each area of public health is relat-
ed to the strength of the other areas. The effect of politics
in public health becomes dangerous when policy is dictat-
ed by ideology. Policy is also threatened when it is solely
determined by science, devoid of considerations of social
condition, culture, economics, and public will.
When using the word “politics,” we refer not simply to
partisan politics but to the broader set of policies and sys-
tems. Although ideology is used in many different ways, in
this case, it refers to individual systems of belief that may
color a person’s attitudes and actions and that are not nec-
essarily based on scientific evidence (2).
Public Health Achievements
Science influences public health decisions and conclu-
sions, and politics delivers its programs and messages.
This pattern is obvious in many of public health’s greatest
triumphs of the 20th century, 10 of which were chronicled
in 1999 by the Centers for Disease Control and Prevention
(CDC) as great public health achievements, and several of
which are presented below as examples of policy affecting
successes (3). These achievements remind us of what can
be accomplished when innovation, persistence, and luck
converge, along with political will and public policy.
Vaccination
Childhood vaccinations have largely eliminated once-
common, terrible diseases, such as polio, diphtheria,
measles, mumps, and pertussis (4). Polio is being eradicat-
ed worldwide. The current collaboration between the
World Health Organization, the United Nations Children’s
Fund, CDC, and Rotary International is a political as well
as biological “tour de force,” and eradication of polio in
Nigeria has been threatened by local political struggles and
decisions. ...
KAFKAS ÜNİVERSİTESİ/KAFKAS UNIVERSITY
SOCIOLOGY
Course
LECTURE NOTES AND POWER POINT PRESENTATIONS
Prof.Dr. Halit Hami ÖZ
Kars, TURKEY
hamioz@yahoo.com
EDUC 742EDUC 742Reading Summary and Reflective Comments .docxtidwellveronique
EDUC 742
EDUC 742
Reading Summary and Reflective Comments Form & Instructions
For each assigned reading, summarize the main principles and reflect on these principles in order to make the content meaningful to you. This will ensure that you understand the reading and understand its relationship to daily life experiences within your educational setting or work environment. The reflective statements may draw on previous experiences or future plans to use the information from the reading. You are also encouraged to critique ideas in light of a biblical worldview. Summaries will be 100-125 words and will be in paragraph form, and the reflections will be 150-200 words. (Submit the Reading Summary by 11:59 p.m. (ET) on Sunday in Modules/Weeks 1, 3, 4, 5, and on Friday in Module/Week 8, adding the new entries each time.)
STUDENT NAME:
Bridget Pruitt
Reading
Assignment
Main Principles
Reflective Comments
Reading Summary 1
Razik and Swanson
Data within the United States is processed based on four assessments. The assessments are reading, math, science, and other subjects. They are based on 4th, 8th, and 12th graders. They are also broken up into different ethnic groups. There are a lot of data that is alarming within the U.S. Data is based on household characteristics, family and peer influences, and student achievement. Also in this chapter it reaches on the education reform movement. Global forces and the specific causes that are concerning within the U.S. education system. What are the causes of failure within the U.S. school system and what changes can be implemented to improve the rapid downfall of our education system.
When all of the assessments were implemented on the different groups that provided data that broke up the groups that is when I feel our education system had been broken. Ways of instruction as well as curriculum has not changed much, however, all of the testing data is what has changed and the ways that the data is being implemented. Schools have become all about the numbers instead of the importance of what is being taught to our children. If the U.S. school systems were not all about the numbers and teaching our children how to read and write I feel that our schools would be more successful in all the data assessments that are being implemented. The problem is that special attention is given to achievement gaps among ethnic and economic groups instead of teaching everyone the same way that was taught years and years ago. With all the changes within the school systems and how they are wanting teachers to teach their children has caused a lot of confusion as well as stress upon the teachers as well as the children.
Van
Brummelen
First of all, I love this book. It goes into practices and prospective within the interaction between theory and practice. It explains why in public schools that God cannot be taught and how the Christian schools central theme is focused in the teachings of Jesus Christ. In this chapter it.
EDUC 380 Blog Post Samples Module 1 The Brain Below .docxtidwellveronique
EDUC 380 Blog Post Samples
Module 1: The Brain
Below are some student examples that are excellent blog posts for the first two prompts in Module 1
(The Brain). The goal for the discussion posts is to engage in the module materials directly and explore
some of the questions and issues in each module more deeply. The posts are very important for your
learning. Below you will find comments to help you understand how these students met the rubric
requirements. The rubric for blog posts is posted in the end of this document and is in the course
syllabus.
Blog Post # 1:
● Describe a time when you engaged in something adults might consider risky and/or thoughtless:
● How old were you?
● Why did you do it?
● What were you thinking at the time?
Think back to the article on risk-taking you read and to the video you watched on the teen brain. What
connections can you make between the lecture, the article, and/or the video?
Growing up, my family would take annual trips to the river in Laughlin, Nevada. We
would go with our family friends who had kids with a wide range of ages. I was 13 years
old at the time within the middle age range. A big activity at the river is jumping off of
rocks. My parents did not want my sisters and me to engage in this activity. During one
of the annual trips, I joined the older teenagers on a boat ride to the “jumping rock.”
Depending on how much risk they wanted to take, there are different levels for people
to jump off of. All of the older teens were jumping off of the highest level. I decided to
join the older teens and jump from the tallest rock. At the time, I wanted to do it
because all of the older teenagers were doing it. I wanted to be like them. This was not
an impulsive decision. I had thought about doing this activity the whole trip and decided
to go on the boat ride, knowing they were going to jump off the tallest rock. The article,
“Beautiful Brains,” explains, “Seeking sensation isn’t necessarily impulsive. You might
plan a sensation-seeking experience- a skydive or a fast car…” (Dobbs, 2011, p. 49).
By jumping off the rock with them, I thought this would change their view of me as an
older and more mature teenager. When they changed their opinion about me, it would
allow me to hang out with them all the time. I was taking more risks because I would get
a higher reward. This relates to the article, “Beautiful Brains,” which states, “Teens take
more risks not because they don’t understand the dangers but because they weigh risk
versus reward differently. In situations where risk can get them something they want,
they value the reward more heavily than adults do” (Dobbs, 2011, p. 54). By jumping off
the tallest rock, it gave me the reward of spending more time with the older teenagers.
If I had jumped off the shorter rock, I could have not been accepted into the group
because they did not view me as mature as themselves. Therefore, I would have been
penalized for not.
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Promoting Health Equity A Resource to Help Communities Add.docxbriancrawford30935
Promoting Health Equity
A Resource to Help Communities Address
Social Determinants of Health
Cover art is based on original art by Chris Ree developed for the Literacy for Environmental Justice/Youth
Envision Good Neighbor program, which addresses links between food security and the activities of
transnational tobacco companies in low-income communities and communities of color in San Francisco. In
partnership with city government, community-based organizations, and others, Good Neighbor provides
incentives to inner-city retailers to increase their stocks of fresh and nutritious foods and to reduce tobacco
and alcohol advertising in their stores (see Case Study # 6 on page 24. Adapted and used with permission.).
Promoting Health Equity
A Resource to Help Communities Address
Social Determinants of Health
Laura K. Brennan Ramirez, PhD, MPH
Transtria L.L.C.
Elizabeth A. Baker, PhD, MPH
Saint Louis University School of Public Health
Marilyn Metzler, RN
Centers for Disease Control and Prevention
This document is published in partnership
with the Social Determinants of Health
Work Group at the Centers for Disease
Control and Prevention, U.S. Department of
Health and Human Services.
1
Suggested Citation
Brennan Ramirez LK, Baker EA, Metzler M. Promoting Health Equity: A Resource
to Help Communities Address Social Determinants of Health. Atlanta: U.S.
Department of Health and Human Services, Centers for Disease Control and
Prevention; 2008.
For More Information
E-mail: [email protected]
Mail: Community Health and Program Services Branch
Division of Adult and Community Health
National Center for Chronic Disease Prevention and Health Promotion
Centers for Disease Control and Prevention
4770 Buford Highway, Mail Stop K–30
Atlanta, GA 30041
E-mail: [email protected]
Mail: Laura Brennan Ramirez, Transtria L.L.C.
6514 Lansdowne Avenue
Saint Louis, MO 63109
Online: This publication is available at
http://www.cdc.gov/nccdphp/dach/chaps
and http://www.transtria.com.
Acknowledgements
The authors would like to thank the following people for their valuable contributions to
the publication of this resource: the workshop participants (listed on page 5), Lynda
Andersen, Ellen Barnidge, Adam Becker, Joe Benitez, Julie Claus, Sandy Ciske, Tonie
Covelli, Gail Gentling, Wayne Giles, Melissa Hall, Donna Higgins, Bethany Young
Holt, Jim Holt, Bill Jenkins, Margaret Kaniewski, Joe Karolczak, Leandris Liburd, Jim
Mercy, Eveliz Metellus, Amanda Navarro, Geraldine Perry, Amy Schulz, Eduardo
Simoes, Kristine Suozzi and Karen Voetsch. A special thanks to Innovative Graphic
Services for the design and layout of this book.
This resource was developed with support from:
> National Center for Chronic Disease Prevention and Health Promotion
Division of Adult and Community Health
Prevention Research Centers
Community Health and Program Services Branch
> National Center f.
Ch. 1 Identifying the VulnerableLearning ObjectivesAfter rea.docxcravennichole326
Ch. 1 Identifying the Vulnerable
Learning Objectives
After reading this chapter, you should be able to:
Explain the concept of vulnerable populations.
Discuss how the theories of common good and individual rights contribute to the creation of public policy in health care.
Determine how the concept of resource availability relates to one's health.
Examine the aggregate statistical data on the number and growth of identified vulnerable populations.
Identify the vulnerable populations in the United States.
Introduction
Two women enter the hospital with pneumonia. They are similar in age, but of different races. One patient has private health insurance; the other is on Medicaid. One patient recovers quickly while the other languishes. What can be surmised from the differences in the two patients? Thinking on this and asking the right questions allows health care providers to create patient care plans that better meet each patient's needs. Providing better health care to all patients requires awareness of environmental factors that may prohibit timely recovery and put the patient at risk for secondary and repeat infections.
Environmental factors such as finances, family, and education all affect a person's vulnerability, or risk level. Understanding statistical data on vulnerable populations will help you interpret patient information. This allows easier identification of those who are at risk, so that providers may plan care accordingly. Addressing the needs of at-risk populations leads to faster patient recovery, thereby lowering the cost of patient care.
Lowering health care costs is important for the patient, the care provider, and the whole country. Nonprofit organizations and government agencies work to identify and help at-risk groups. This activity affects both government and organizational policy among health care providers.
This text investigates the statistical data and indicators of vulnerable populations in American health care. It also covers the causes of vulnerability and the prevailing ideologies on dealing with at-risk populations. We will also discuss what is currently being done through policymaking and program implementation to address the needs of vulnerable populations and what the future looks like for at-risk groups. This chapter focuses on identifying vulnerable populations. The relationship between resource availability and health is an important part of recognizing at-risk groups. Finally, we will look at statistical data concerning the at-risk groups identified in the book.
Critical Thinking
The text states, "Addressing the needs of at-risk populations leads to faster patient recovery, thereby lowering the cost of patient care." How does addressing the needs of at-risk populations lead to faster patient recovery?
1.1 Social Theory and Public Policy in Health Care
Courtesy of iStockphoto/Thinkstock
Prohibiting smoking in public places exemplifies the social theory of the common good, bec ...
Social work is an integral component of the U.S. health care system. The emergence of professional social work in Indian hospitals is a attributed to Bhore committee who recommended training and placement of hospital social workers. Social work in healthcare is performed in a medical context that is, the medical social worker needs to collaborate with the medical professionals who usually treat patients. Social work in healthcare is also regulated by healthcare legislation and not solely by social laws. Social work in healthcare in India accomplished by medical social workers trained in crisis treatment, psychosocial treatment, counselling, law, how to handle traumas and how to provide social assistance, emotional support, and instrumental support. Social worker in present settings across the health care continuum, providing services to individuals and families throughout the lifespan, and addressing the full range of bio psychosocial issues that impact well being. The presents article an overview of the Social Work, Health Care Settings and Social Work in Health Care Settings. Dr. Gouri Manik Manas "Social Work in Health Care Setting" Published in International Journal of Trend in Scientific Research and Development (ijtsrd), ISSN: 2456-6470, Volume-6 | Issue-1 , December 2021, URL: https://www.ijtsrd.com/papers/ijtsrd49098.pdf Paper URL: https://www.ijtsrd.com/humanities-and-the-arts/social-science/49098/social-work-in-health-care-setting/dr-gouri-manik-manas
On July 1, 1665, the lordmayor and aldermen of thecity of Lo.docxvannagoforth
On July 1, 1665, the lordmayor and aldermen of the
city of London put into place a set
of orders “concerning the infec-
tion of the plague,” which was
then sweeping through the popula-
tion. He intended that these
actions would be “very expedient
for preventing and avoiding of
infection of sickness” (1).
At that time, London faced a
public health crisis, with an inade-
quate scientific base in that the
role of rats and their fleas in dis-
ease transmission was unknown.
Nonetheless, this crisis was faced
with good intentions by the top
medical and political figures of
the community.
Daniel Defoe made an observation that could apply to
many public health interventions then and today, “This
shutting up of houses was at first counted a very cruel and
unchristian method… but it was a public good that justi-
fied a private mischief” (1). Then, just as today, a complex
relationship existed between the science of public health
and the practice of public health and politics. We address
the relationship between science, public health, and poli-
tics, with a particular emphasis on infectious diseases.
Science, public health, and politics are not only com-
patible, but all three are necessary to improve the public’s
health. The progress of each area of public health is relat-
ed to the strength of the other areas. The effect of politics
in public health becomes dangerous when policy is dictat-
ed by ideology. Policy is also threatened when it is solely
determined by science, devoid of considerations of social
condition, culture, economics, and public will.
When using the word “politics,” we refer not simply to
partisan politics but to the broader set of policies and sys-
tems. Although ideology is used in many different ways, in
this case, it refers to individual systems of belief that may
color a person’s attitudes and actions and that are not nec-
essarily based on scientific evidence (2).
Public Health Achievements
Science influences public health decisions and conclu-
sions, and politics delivers its programs and messages.
This pattern is obvious in many of public health’s greatest
triumphs of the 20th century, 10 of which were chronicled
in 1999 by the Centers for Disease Control and Prevention
(CDC) as great public health achievements, and several of
which are presented below as examples of policy affecting
successes (3). These achievements remind us of what can
be accomplished when innovation, persistence, and luck
converge, along with political will and public policy.
Vaccination
Childhood vaccinations have largely eliminated once-
common, terrible diseases, such as polio, diphtheria,
measles, mumps, and pertussis (4). Polio is being eradicat-
ed worldwide. The current collaboration between the
World Health Organization, the United Nations Children’s
Fund, CDC, and Rotary International is a political as well
as biological “tour de force,” and eradication of polio in
Nigeria has been threatened by local political struggles and
decisions. ...
KAFKAS ÜNİVERSİTESİ/KAFKAS UNIVERSITY
SOCIOLOGY
Course
LECTURE NOTES AND POWER POINT PRESENTATIONS
Prof.Dr. Halit Hami ÖZ
Kars, TURKEY
hamioz@yahoo.com
EDUC 742EDUC 742Reading Summary and Reflective Comments .docxtidwellveronique
EDUC 742
EDUC 742
Reading Summary and Reflective Comments Form & Instructions
For each assigned reading, summarize the main principles and reflect on these principles in order to make the content meaningful to you. This will ensure that you understand the reading and understand its relationship to daily life experiences within your educational setting or work environment. The reflective statements may draw on previous experiences or future plans to use the information from the reading. You are also encouraged to critique ideas in light of a biblical worldview. Summaries will be 100-125 words and will be in paragraph form, and the reflections will be 150-200 words. (Submit the Reading Summary by 11:59 p.m. (ET) on Sunday in Modules/Weeks 1, 3, 4, 5, and on Friday in Module/Week 8, adding the new entries each time.)
STUDENT NAME:
Bridget Pruitt
Reading
Assignment
Main Principles
Reflective Comments
Reading Summary 1
Razik and Swanson
Data within the United States is processed based on four assessments. The assessments are reading, math, science, and other subjects. They are based on 4th, 8th, and 12th graders. They are also broken up into different ethnic groups. There are a lot of data that is alarming within the U.S. Data is based on household characteristics, family and peer influences, and student achievement. Also in this chapter it reaches on the education reform movement. Global forces and the specific causes that are concerning within the U.S. education system. What are the causes of failure within the U.S. school system and what changes can be implemented to improve the rapid downfall of our education system.
When all of the assessments were implemented on the different groups that provided data that broke up the groups that is when I feel our education system had been broken. Ways of instruction as well as curriculum has not changed much, however, all of the testing data is what has changed and the ways that the data is being implemented. Schools have become all about the numbers instead of the importance of what is being taught to our children. If the U.S. school systems were not all about the numbers and teaching our children how to read and write I feel that our schools would be more successful in all the data assessments that are being implemented. The problem is that special attention is given to achievement gaps among ethnic and economic groups instead of teaching everyone the same way that was taught years and years ago. With all the changes within the school systems and how they are wanting teachers to teach their children has caused a lot of confusion as well as stress upon the teachers as well as the children.
Van
Brummelen
First of all, I love this book. It goes into practices and prospective within the interaction between theory and practice. It explains why in public schools that God cannot be taught and how the Christian schools central theme is focused in the teachings of Jesus Christ. In this chapter it.
EDUC 380 Blog Post Samples Module 1 The Brain Below .docxtidwellveronique
EDUC 380 Blog Post Samples
Module 1: The Brain
Below are some student examples that are excellent blog posts for the first two prompts in Module 1
(The Brain). The goal for the discussion posts is to engage in the module materials directly and explore
some of the questions and issues in each module more deeply. The posts are very important for your
learning. Below you will find comments to help you understand how these students met the rubric
requirements. The rubric for blog posts is posted in the end of this document and is in the course
syllabus.
Blog Post # 1:
● Describe a time when you engaged in something adults might consider risky and/or thoughtless:
● How old were you?
● Why did you do it?
● What were you thinking at the time?
Think back to the article on risk-taking you read and to the video you watched on the teen brain. What
connections can you make between the lecture, the article, and/or the video?
Growing up, my family would take annual trips to the river in Laughlin, Nevada. We
would go with our family friends who had kids with a wide range of ages. I was 13 years
old at the time within the middle age range. A big activity at the river is jumping off of
rocks. My parents did not want my sisters and me to engage in this activity. During one
of the annual trips, I joined the older teenagers on a boat ride to the “jumping rock.”
Depending on how much risk they wanted to take, there are different levels for people
to jump off of. All of the older teens were jumping off of the highest level. I decided to
join the older teens and jump from the tallest rock. At the time, I wanted to do it
because all of the older teenagers were doing it. I wanted to be like them. This was not
an impulsive decision. I had thought about doing this activity the whole trip and decided
to go on the boat ride, knowing they were going to jump off the tallest rock. The article,
“Beautiful Brains,” explains, “Seeking sensation isn’t necessarily impulsive. You might
plan a sensation-seeking experience- a skydive or a fast car…” (Dobbs, 2011, p. 49).
By jumping off the rock with them, I thought this would change their view of me as an
older and more mature teenager. When they changed their opinion about me, it would
allow me to hang out with them all the time. I was taking more risks because I would get
a higher reward. This relates to the article, “Beautiful Brains,” which states, “Teens take
more risks not because they don’t understand the dangers but because they weigh risk
versus reward differently. In situations where risk can get them something they want,
they value the reward more heavily than adults do” (Dobbs, 2011, p. 54). By jumping off
the tallest rock, it gave me the reward of spending more time with the older teenagers.
If I had jumped off the shorter rock, I could have not been accepted into the group
because they did not view me as mature as themselves. Therefore, I would have been
penalized for not.
EDUC 741Course Project Part 1 Grading RubricCriteriaLevels .docxtidwellveronique
EDUC 741
Course Project: Part 1 Grading Rubric
Criteria
Levels of Achievement
Content 70%
Advanced
Proficient
Developing
Not Present
Analysis
13 to 14 points
The analysis thoroughly interprets and examines at least three referred journal articles for perspective, validity, and significance of the findings.
12 points
The analysis partially interprets and examines at least three referred journal articles for perspective, validity, and significance of the findings.
1 to 11 points
The analysis attempts of some aspects of analysis and interpretation of journal articles in a limited way. The review is more descriptive than analytical.
0 points
Not present
Use of Evidence and Relevant Outside Information
13 points
The analysis is thoroughly supported with relevant facts, arguments, examples, and details. Information outside the subject articles is often incorporated into the analysis.
11 to 12 points
The analysis is generally supported with relevant facts, arguments, and details. Information outside the subject articles is occasionally incorporated into the analysis.
1 to 10 points
The analysis is thoroughly supported with some facts, arguments, examples, and details. Information outside the subject articles is incorporated in a limited way into the analysis.
0 points
Not present
Organization and Development
13 points
The analysis is quite well-reasoned, indicating substantial breath and depth of thinking. The summary of each article is thorough and meaningful.
11 to 12 points
The analysis is generally well-reasoned, indicating some breath and depth of thinking. The summary of each article is generally sound.
1 to 10 points
The analysis has limited reasoning, indicating a surface understanding of the articles. The summary of each article is limited.
0 points
Not present
Body – Biblical Worldview
13 points
A biblical worldview perspective is clearly articulated and is supported by appropriate Scripture references, course requirements, and application.
11 to 12 points
A biblical worldview perspective is articulated but is not supported by Scripture or is not appropriate, and somewhat applies to course requirements and application.
1 to 10 points
A biblical worldview perspective is poorly articulated and is not supported by Scripture or is not appropriate, and does not apply to course requirements and application.
0 points
Not present
Structure 30%
Advanced
Proficient
Developing
Not Present
Grammar and Spelling
6 points
Correct spelling and grammar are used throughout the essay. There are 0–2 errors in grammar or spelling that distract the reader from the content.
5 points
There are 3–5 errors in grammar or spelling that distract the reader from the content.
1 to 4 points
There are 6–10 errors in grammar or spelling that distract the reader from the content.
0 points
There are more than 10 errors in the grammar or spelling that distract the reader from the content.
Sentence Structure and Mechanics
6 points
Sentences are well-phrased and varied in lengt.
EDUC 740
Prayer Reflection Report Grading Rubric
Criteria
Levels of Achievement
Content 70%
Advanced
Proficient
Developing
Not present
Structure & Organization
33 to 35 points
The paper has a clearly constructed introduction that builds the foundation for further reflection. The structure is clear, logical, and easy to follow. Each paragraph is focused and uses excellent transitions from previous paragraphs. The paper has a clear conclusion. Overall writing style is appropriate for a graduate-level course.
30 to 32 points
The paper has a constructed introduction that builds the foundation for further reflection. The structure is clear, logical, and easy to follow. Each paragraph is focused and uses transitions from previous paragraphs. The paper has a conclusion. Overall writing style is appropriate for a graduate-level course.
1 to 29 points
The paper has a constructed introduction that is beginning to build the foundation for further reflection. The structure is vague and difficult to follow. Not all paragraphs are focused and don’t always use transitions from previous paragraphs. The paper has a conclusion. Overall writing style is not appropriate for a graduate-level course.
0 points
Not present
Analysis
19 to 20 points
The content reflects higher-level thinking through critical self-evaluation and application of principles learned. Includes a discussion of your reflections based on your personal prayer journal, including any changes and/or positive things that you have seen occur in the lives of the leaders you have chosen. Includes specific examples of ways that you have seen changes in the lives of the leaders you have chosen. Includes specific examples of the impact of the assignment on your own life.
17 to 18 points
The content reflects thinking through self-evaluation and application of principles learned. Includes a discussion of your reflections based on your personal prayer journal, including any changes and/or positive things that you have seen occur in the lives of the leaders you have chosen. Includes examples of ways that you have seen changes in the lives of the leaders you have chosen. Includes examples of the impact of the assignment on your own life.
1 to 16 points
The content does not reflect higher-level thinking through critical self-evaluation and application of principles learned. Includes a vague discussion of your reflections based on your personal prayer journal, including any changes and/or positive things that you have seen occur in the lives of the leaders you have chosen. Includes minimal examples of ways that you have seen changes in the lives of the leaders you have chosen. Includes ambiguous examples of the impact of the assignment on your own life.
0 points
Not present
Support
14 to 15 points
Biblical references and principles are integrated into the paper appropriately, demonstrating an excellent understanding of biblical leadership principles.
13 points
Biblical references and principles are integrated.
EDUC 6733 Action Research for EducatorsReading LiteracyDraft.docxtidwellveronique
EDUC 6733 Action Research for Educators
Reading Literacy
Draft
Part A
The context of the classroom setting
In the first section of this action research project I will address the context of classroom setting. Although, it is as important as the teaching itself and understand it is essential in creating learning environments in which every student can thrive. According to Pallardy, context is a classroom’s characteristics such as the composition of the student body, classroom structures and resources. Furthermore, by establishing that context is dependent on student learning we are able to come up with an action research question that will be discussed in this essay. The action research will be on the reading workshop; Is motivation among students a big challenge when it comes to reading literacy?
In addition, a reading workshop is one way to structure a class. Developing strong reading skills in students is one of the key goals in an educational program. Reading workshops encourages the students to become better readers. To accommodate the children’s variability, I assess the children through instructing them to write journals on what they have read and giving them vocabulary tests on that week’s reading. This helps when it comes to identifying student with a reading problem and can be able to tailor lessons to individuals.
One of the concerns that I have experienced in this classroom setting of reading workshops is children’s motivation to read books that they have selected. Their ability to choose the right book and their commitment to stay with the book until they finished is also a concern when it comes to their motivation when reading books. These findings were drawn from the data of the journals and vocabulary test that I had assigned to them. The journals that they wrote the boys in the class performed poorly more than the girls. There is also the fact that the boys in the class didn’t find satisfaction in reading unlike the girls. The boys also were not reading books of their own accord unlike the girls in the class who spent hours with ‘series’ books and other chapter books.
The classroom has 24 students; 52% are boys and 48% are girls. The last two tests on vocabulary showed that girls performed more than the boys. Also, the literature review was discouraging: the boys were lagging the girls. This concerns may be a product of the independent reading workshop and of the freedom of children to choose their own books during that session.
Through observation and interaction with the boys that excelled in the literature reviews I noted that families had a strong impact and the boys that saw their fathers at home read were more likely to choose to read. Therefore, having spoken with the school administration I invited some of the male role models for the boys. I invited teachers, some of their fathers, other school male employees to visit the class and talk about their reading habits. Some of them were frank about their discovery about.
EDUC 637
Technology Portfolio InstructionsGeneral Overview
For this assignment, you will identify forms of and applications for technology for use in a middle school social studies classroom. You will be required to describe the general applications of these technologies, specific applied activities in the general social studies arena, and provide an evaluation.Learning Objective
You will develop a portfolio of technologies that could be used in a middle school social studies classroom, identifying general uses, aligned appropriate national social studies standards, potential activities, and good and bad points to that technology’s use.Assignment Process
1. Select 10 technologies (defined below) that can be used in an educational setting/environment for each of the categories listed below. Notice that I did not say educational or instructional technologies. This is to not restrict you to that search parameter, but rather to allow you to explore critically any technology that might have a pedagogical use. Select technologies representing:
a. Hardware devices
b. Business/productivity software (i.e., Microsoft Office)
c. Web-based technologies (delivered via the Internet)
d. Multimedia software (audio, video, graphical)
e. Games/entertainment
2. Then review each technology answering the following questions in 1–2 paragraphs for each question (best recorded in a word-processing program like Microsoft Word as a multi-page document). Questions to answer include:
a. What are the general functions and purposes of this technology?
b. What types of social studies objectives/goals could be met by this technology and how? Please relate to an NCSS main theme (or more than 1 if appropriate).
c. What, in your opinion, are the good and bad points of using this technology in a pedagogical setting? Consider this a risk analysis.
3. Turn in the completed assignment by 11:59 p.m. (ET) on Sunday of Module/Week 2.
EDUC 637
Literature Review InstructionsGeneral Overview
Please read the instructions and rubric for the Literature Review assignment BEFORE you sign-up for a topic. You will want to select a topic wisely so you will be able to identify 5 trends in your research.
For this assignment, you will select a topic in the general area of social studies instruction in middle grade education and examine accompanying literature related to that topic to identify the latest trends and issues. Ultimately, you will compile these results into a PowerPoint presentation of around 10 slides to identify these trends.Learning Objective
You will develop a presentation identifying general trends in middle-grade social studies education associated with a set of articles in the content area.Assignment Process
1. Begin classifying and compiling articles and sub-topics into groups of information for presentation (note 5 trends).
2. You should have scanned at least 30 articles in the process, which then need to be provided as part of this assignment in an attached bi.
EDUC 364 The Role of Cultural Diversity in Schooling A dialecti.docxtidwellveronique
EDUC 364: The Role of Cultural Diversity in Schooling
A dialectical journal is one in which you engage in conversation with the text. This involves pulling quotes from the text, and providing your reaction, thoughts, analysis and/or questions about what you’ve read. When reading a chapter from Spring(chapter2 and 3), choose 3-5 short passages/selections from each assigned chapter on which to reflect. See the example below. You can format your DJ in a chart format (see next page for template), or you can format it simply as a question/answer format like below. The goal is to use the DJ to think through your reactions and prepare for discussion. Submit your DJ to Cougar Courses prior to class, and if you don’t have your computer with you in class, print it out so you have it with you for a class discussion
Example
Quote: “Faced with the world’s migration of people’s, some countries, such as Singapore, have maintained cultural pluralism by providing public schools that use the child’s home language and reflect the cultural values of the child’s home. Through the use of educational methods that promote cultural pluralism, Singapore has been able to maintain Chinese, Malay, and Indian cultures and languages. Therefore, there have been different educational approaches to the intersection of cultures resulting from globalization...Minority cultures in the United State have primarily experienced cultural genocide, deculturalization, and denial of education. Immigrant groups have mostly experienced assimilation and hybridity.” (Chapter 1).
Response: This is always what I come back to when thinking about American education. We could have chosen a different path, a different approach educating the various groups of children that have come through the school system. But instead of seeing schooling primarily as a democratizing tool, the founders and those in government who came after them saw schooling as a tool for deculturalization, for imposing hegemony. What is most frustrating is how to tease out how our current system still contains the legacy of those oppressive institutional choices. Seeing those remnants for what they are--clearly--is the only way to change the system to truly benefit all kids.
.
EDUC 144 Writing Tips The writing assignments in this cla.docxtidwellveronique
EDUC 144 Writing Tips
The writing assignments in this class require students to engage in critical thinking and analysis,
producing papers that go beyond simple summaries of course readings by utilizing concepts, ideas, and
findings in course readings to critically analyze contemporary schooling and academic achievement in
the United States. Below is a list of suggestions to help you write strong papers that are critical and
analytical.
The introductory paragraph should briefly mention the topic and purpose/focus of your paper and state
your thesis in clear, specific terms (i.e. “In this paper, I will argue…” or “I will contend...,” or “I will
demonstrate…”).
Each paragraph in the body of the paper should be tightly organized around one main idea. Each
paragraph should build on previous ones and provide concrete examples/findings from the week’s
readings that serve as data that support your analysis, or examples from your own experiences and
observations of schooling that serve as evidence in support of your analysis. If you are drawing on a
specific theoretical concept(s) or idea(s) in your analysis, remember to clearly define and explain the
concept(s) or idea(s) before using that concept(s) or idea(s) to investigate and analyze particular aspects
of contemporary schooling.
The concluding paragraph needs to restate the thesis and main points addressed in the paper.
Sometimes writers do not know what their argument is until they have reached the end of the paper—or
the thesis has changed by the end. If either of these happens to you, be sure to put your thesis in the first
paragraph as well and/or make sure that you are making the same argument throughout the paper.
Things to keep in mind, at the level of the paragraph:
Make sure your comments are relevant to the topic at hand: one way to do this is to make an outline of
each paragraph’s main idea; each one should clearly relate to the topic and focus/purpose or thesis of
your paper. It is writer’s responsibility to select relevant concepts or ideas, examples of research
findings from the week’s readings, and/or personal experiences and observations that relate directly to
the topic and purpose/focus of the paper. It is not appropriate to expect the reader to do this instead.
Remember, examples/research findings and personal experiences and observations are not “obviously”
evidence in support of your analysis until you explicitly explain how these examples/findings/
experiences/observations support the claims in your analysis.
Make sure each paragraph’s main idea is clearly connected to your thesis.
*Smoothly transition between paragraphs: connect first line of new paragraph with main idea of
previous paragraph.
*Stick to the facts at hand—do not overstate your case.
Things to keep in mind, at the level of the sentence:
*Tighten sentence structure: combine sentences when possible by eliminating redundant information.
*Employ p.
EDUC 1300- LEARNING FRAMEWORK
Portfolio Page Prompts
INTRODUCTION
This page introduces, not you, but your portfolio. . Invite people into the portfolio and give them a reason for
exploring further Convey your purpose in creating the portfolio. Include a picture of yourself, and a quote
that is meaningful to you. No attachment is needed on this page. (10 points)
ABOUT ME
This page introduces you. Share information about yourself – your family, hobbies, work, and what you enjoy.
Don’t just TELL people, SHOW who you are, too. Things you might include: photos, images, or video/links
that interest you. Attach your Quality World Essay or another paper about yourself to this page. (10 points)
GOALS
List your long-term goals: personal, education, career. Identify the short-term and intermediate goals that will
help you progress toward these long-term goals. Include images that help you and your viewer visualize your
goals. Attach your degree plan/Timeline assignment to show your academic plans/goals. (10 points)
LEARNING
This page showcases what you’ve learned about your learning. Collect information you’ve gathered about
yourself and how you learn, such as learning styles inventories, personality type indicators, and your
Strengthsquest assessment. Interpret those results and draw conclusions about yourself from this evidence and
write about it. Attach your Insight Report from Strengthsquest so your viewer can learn more about your top
5 strengths or another assessment report which have helped you identify how you learn. (15 points)
THINKING
What have you learned this semester about critical thinking? What have you created that demonstrates the
quality of your thinking? Select examples and identify these qualities in your reflection. Attach an
assignment/paper from this class or another that show your thinking abilities. (15 points)
RESEARCH
On this page, post a question that you’ve selected to research and write what you found. What did you learn
about using the online databases? How will that help you in future classes? Attach your annotated
bibliography/research organizers and/or a research paper from another course. (15 points)
REFLECTION:
Your Introduction page described the purpose of the portfolio. On this page, provide a conclusion. Reflect on
your experience in the course and semester in creating this portfolio. Consider the following prompts:
What expectations or assumptions did you have before the course began? Were they valid or invalid?
How has the course contributed to your understanding of yourself and others?
What impact did the course have on your understanding of your quality world?
How do you now assume responsibility for your learning? What thinking and behaviors will you further
develop on your journey to becoming an autonomous learner?
(15 points)
EDUC 1300 Learning Framework Grading Rubric
Page Unsatisfactory
.
EDU734 Teaching and Learning Environment Week 5.docxtidwellveronique
EDU734: Teaching and
Learning Environment
Week 5: Curriculum
Development
Topic goals
To gain an understanding of the concept of
curriculum development and its importance
To gain an understanding of how curriculum
is implemented in different cultural contexts
Task – Forum
Do you think that the current school curriculum needs
to be adapted more to the modern culture? If so, in
what ways do you think it can be done?
What do you consider to be the implications for the
nature of valid knowledge in the future school curriculum?
EDU734: Teaching and Learning Environment Page 1
EDU734: Teaching and
Learning Environment
5.1 Introduction
Curriculum lies at the heart of educational policies and practices.
They are are highly political documents which convey ideological positions about
the type of education that should be given in different cultural contexts and the
citizenship values that can be shared by the citizen of a state (Apple, 2004).
Each society has its own values and beliefs which they want to be translated into
educational objectives via the curriculum.
“Curriculum is a comprehensive plan for an educational programme/institute/
course to offer new or improved manpower to accomplish the rising needs of a
dynamic society” (Pillai, 2015).
5.1.1 Orientations to curriculum
Child-centred
Society-centred
Knowledge-centred
Eclectic
5.1.2 Determinants of the curriculum
Basic needs
Social aspects
Cultural factors
Individual talents
Ideals: intellectual, moral, aesthetic, religious
Tradition
(Pillai, 2015)
EDU734: Teaching and Learning Environment Page 2
EDU734: Teaching and
Learning Environment
5.2 Definition of Curriculum Development
Curriculum development is defined as the process which is planned, purposeful,
progressive, and systematic in order to create positive improvements in the
educational system.
The curriculum is affected by any changes or developments that affect society
(Alvior, 2014).
It needs to correspond to those changes but at the same time to respect all
people despite of gender, ethnicity, disability, religion etc. (Symeonidou and
Mavrou, 2014).
2. How can
1. What learning 3. How can
4. How can the
educational experiences learning
effectiveness of
purposes that are likely to experiences be
learning
should the be useful in organised for
experiences be
school seek to attaining these effective
evaluated?
attain? objectives be instruction?
selected?
Diagram 5.1: Four questions for the organization and development of the
curriculum (Tyler, 1949, cited in Howard, 2007)
EDU734: Teaching and Learning Environment Page 3
EDU734: Teaching and
Learning Environment
5.2.1 Four principles for the development of any curriculum:
Def.
EDU 505 – Contemporary Issues in EducationCOURSE DESCRIPTION.docxtidwellveronique
EDU 505 – Contemporary Issues in Education
COURSE DESCRIPTION
Examines theory, research, and practices relating to critical issues faced by educators today. Discusses contemporary concerns in American and global education: National and local initiatives in education, the evolving relationship between schools and communities, impacts of public policy on the educational enterprise, and current social, political, economic, and legal issues influencing schools are explored from American and global perspectives. Evaluates the future of education in both industrial and developing countries, including growth of learning needs and inequities both within and between countries. Emphasizes problem identification, analysis, and remediation, with the latter focusing on “best of breed” innovative practices.
INSTRUCTIONAL MATERIALS
Required Resources – Textbook
Tozer, S. E., Senese, G., & Violas, P. C. (2013). School and society: Historical and contemporary perspectives (7th ed.). New York, NY: McGraw-Hill.
Required Resources – Articles
Baker, B., Sciarra, D., & Farrie, D. (2014). Is School Funding Fair? A National Report Card. Retrieved from http://www.schoolfundingfairness.org/National_Report_Card_2014.pdf
Baker, B., & Corcoran, S. (2012). The Stealth Inequities of School Funding: How State and Local School Finance Systems Perpetuate Inequitable Student Spending. Center for American Progress. Retrieved from https://www.americanprogress.org/issues/education/report/2012/09/19/38189/the-stealth-inequities-of-school-funding/
Brackemyre, T. (2012). Education to the Masses: The Rise of Public Education in Early America. History Scene. Retrieved from http://www.ushistoryscene.com/uncategorized/riseofpubliceducation/
Cobb, N. (2014). Climate, Culture and Collaboration: The Key to Creating Safe and Supportive Schools. Techniques: Connecting Education and Careers. Retrieved from: http://eds.b.ebscohost.com/eds/pdfviewer/pdfviewer?sid=1bde4a76-6090-47af-8294-13f37c6936c7%40sessionmgr110&vid=16&hid=112
Gardner, H. (2011). To improve U.S. education, it’s time to treat teachers as professionals. The Washington Post. Retrieved from http://www.washingtonpost.com/national/on-leadership/to-improve-us-education-its-time-to-treat-teachers-as-professionals/2011/07/18/gIQA8oh2LI_story.html
Garrity, C., & Jens, K. (1997). Bully Proofing Your School: Creating a Positive Climate. Intervention in School & Clinic. Retrieved from http://eds.b.ebscohost.com/eds/detail/detail?vid=2&sid=1bde4a76-6090-47af-8294-13f37c6936c7%40sessionmgr110&hid=112&bdata=JnNpdGU9ZWRzLWxpdmUmc2NvcGU9c2l0ZQ%3d%3d#db=a9h&AN=9703123351
Hiler, T., & Hatalsky, L.(2014). TEACH Grant Trap: Program to Encourage Young People to Teach Falls Short. Third Way. Retrieved from http://www.thirdway.org/memo/teach-grant-trap-program-to-encourage-young-people-to-teach-falls-short
Hinduja, S., & Patchin, J. (2015). Cyberbullying Legislation and Case Law: Implications for School Policy and Practice. Retrieved from.
EDU 3338 Lesson Plan TemplateCandidate NameCooperatin.docxtidwellveronique
EDU 3338 Lesson Plan Template
Candidate Name:
Cooperating Teacher Name:
Placement Site:
Grade Level:
Subject:
Length of Lesson:
Lesson Title:
Date of Lesson:
Learning Central Focus
Central Focus
What is the central focus for the content in the learning segment?
Content Standard
What standard(s) are most relevant to the learning goals?
Student Learning Goal(s)/ Objective(s)
Skills/procedures
What are the specific learning goal(s) for student in this lesson?
Concepts and reasoning/problem solving/thinking/strategies[footnoteRef:1] [1: The prompt provided here should be modified to reflect subject specific aspects of learning. Language here is mathematics related. See candidate edTPA handbooks for the “Making Good Choices” resource for subject specific components. ]
What are the specific learning goal(s) for students in this lesson?
Prior Academic Knowledge and Conceptions
What knowledge, skills, and concepts must students already know to be successful with this lesson?
What prior knowledge and/or gaps in knowledge do these students have that are necessary to support the learning of the skills and concepts for this lesson?
Theoretical Principles and/or Research–Based Best Practices
Why are the learning tasks for this lesson appropriate for your students?
Materials
What materials does the teacher need for this lesson?
What materials do the students need for this lesson?
Assessments, Instructional Strategies, and Learning Tasks
Description of what the teacher (you) will be doing and/or what the students will be doing.
Launch
__________ Minutes
How will you start the lesson to engage and motivate students in learning?
Pre-Assessment
How will you find out what students already know about the lesson objective?
What tangible pre-assessments will you administer?
How will you evaluate student performance on the pre-assessment?
Instruction
__________ Minutes
What will you do to engage students in developing understanding of the lesson objective(s)?
How will you link the new content (skills and concepts) to students’ prior academic learning and their personal/cultural and community assets?
What will you say and do? What questions will you ask?
How will you engage students to help them understand the concepts?
What will students do?
How will you determine if students are meeting the intended learning objectives?
Structured Practice and
Application
__________ Minutes
How will you give students the opportunity to practice so you can provide feedback?
How will students apply what they have learned?
How will you structure opportunities for students to work with partners or in groups? What criteria will you use when forming groups?
Formative Assessment
What formative assessment techniques will you utilize to determine if students are meeting the intended learning objectives?
Differentiation/ Planned Support
How will you provide students access to learning based on individual and group need.
EDU 3215 Lesson Plan Template & Elements Name Andres Rod.docxtidwellveronique
EDU 3215 Lesson Plan Template & Elements
Name: Andres Rodriguez
Email address: [email protected]
Content Areas: English Language Arts and Social Studies
Common Core Standard(s): (list and write all applicable)
ELA CCSS:
RI 7.1 - Cite several pieces of textual evidence to support analysis of what the text says explicitly
as well as inferences drawn from the text.
RI 7.3 - Analyze the interactions between individuals, events, and ideas in a text (e.g., how ideas
influence individuals or events, or how individuals influence ideas or events).
RI 7. 4 - Determine the meaning of words and phrases as they are used in a text, including
figurative, connotative, and technical meanings; analyze the impact of a specific word choice on
meaning and tone.
CCSS: RH.6–8.1: Cite specific textual evidence to support analysis of primary and secondary
sources.
RH.6–8.2: Determine the central ideas or information of a primary or secondary source; provide
an accurate summary of the source distinct from prior knowledge or opinions.
Essential Question(s): How did colonists, African Americans, and Native Americans choose
sides during the Revolutionary War?
Introduction and Lesson Objective (outline the purpose for the lesson in 50 -100 words)
E.g., This lesson is focused on the role of the Native Americans during the American
Revolution. Students explored the roles of the Patriots and the Red Coats and will synthesize this
information with the roles of Native Americans during the American Revolution. The purpose is
for students to understand the variety of people and reasons who were involved in the American
Revolution.
Resources/Materials/Technology Utilized:
E.g., Computer, Smartboard, NewsELA article, Reading about Mohawk Mary Molly Bryant,
Notebooks, Pens, Pencils, Index cards, looseleaf
Instructional Sequence (x amount of minutes/ how many days will this lesson cover).
Include evidence of Explicit Instruction within the tasks/activity:
ortliebe
Highlight
ortliebe
Highlight
Time Allocation Objective Activity
Assessment/Evaluatio
n
7-9 minutes
This will help
the teacher
gauge what
knowledge the
students are
coming into the
lesson with.
Do Now - Answer the
following question:
Who do you think the
Native Americans fought
with/along side during the
American Revolution?
Why do you believe they
chose this side.
Teacher will walk
around and take note
of how many students
choose Patriots or Red
Coats. This will help
with grouping in
future lessons.
10 minutes
Reading a
document about
Mohawk Mary
Molly Bryant as
a class to help
students with
annotating
relevant facts
and details that
will help them
answer critical
thinking
questions later
on.
Reading a document about
a Native American woman,
Mohawk Mary Molly
Bryant as a class. Teacher
asks the following
questions during the
reading and students
underline/annotate the
answers based on t.
EDST 1100R SITUATED LEARNING EDST 1100 N Situated Learning .docxtidwellveronique
EDST 1100R: SITUATED LEARNING
EDST 1100 N: Situated Learning
Thursdays, 2.30 – 5.30
Keele Campus, Mac 050B
Winter, 2020
Instructor: Dr. Lorin Schwarz
Email: [email protected]
Office Hours: ½ hour after class, or by appointment
*
Learning is intentional and contextual, and it involves developing systems and structures that not only allow but also encourage organization members to learn and grow together –to develop “communities of practice.”
-Preskill and Torres
The idea of a subject that calls to us is more than metaphor. In the community of truth, the knower is not the only active agent –the subject itself participates in the dialectic of knowing...geologists are people who hear rocks speak, historians are people who hear the voices of the long dead, writers are people who hear the music of words. The things of the world call to us, and we are drawn to them –each of us to different things, as each is drawn to different friends.
--Parker J. Palmer
Teaching is a complex, relational, and creative event. When I teach, I am simultaneously involved in several dynamic relations: with myself, with my everyday world, with my subject matter, and with my students. I cannot really teach if I am not engaged with my students or if my students are not involved with me.
--Carol S. Becker
The relationship between our physical constraints and the assertion of our freedom is not a 'problem' requiring a solution. It is simply the way human beings are. Our condition is to be ambiguous to the core, and our task is to learn to manage the movement and uncertainty in our existence, not banish it...the ambiguous human condition means tirelessly trying to take control of things. We have to do two near-impossible things at once: understand ourselves as limited by circumstances, and yet continue to pursue our projects as though we are truly in control.
--Sarah Bakewell
Course Description
Welcome to EDST 1100: “Situated Learning.” As described in the university calendar, the aims of this seminar are as follows:
“This course is framed around situated learning theories in relation to the provisioning of educational experiences in a variety of contexts (e.g., early familial experiences, formal educational experiences, cultural educational experiences, employment educational experiences). Students are first introduced to the major principles of families of learning theories (e.g., behaviourism, cognitivism, social learning theory, social constructivism). This introduction is followed by in-depth study of situated learning theory drawing from Lave and Wenger (1991) a seminal text in the field. Students engage in exploring exemplars of situated learning drawing from theory to understand the factors at play in the exemplars because, as situated learning theory would suggest, the representations of situated learning theory must be situated in relation to reference points. Given any particular learning engagement’s situational parameters, stu.
EDU 151 Thematic Unit Required ComponentsThematic Unit Requireme.docxtidwellveronique
EDU 151 Thematic Unit Required Components
Thematic Unit Requirements
Component Parts of Selected Thematic Unit
A) Study Topic - Select a specific appropriate topic reflecting children’s interests and experiences. Topics that are too broad or not developmentally applicable will not be considered. Examples of this type of topic include Ocean, Rain Forest, Outer Space. Examples of specific appropriate topics are shoes, worms, rocks.
A)
B) Age Level –“Birth through Second Grade” Select an age or grade level.
B)
C) Focus - Develop a one-sentence focus statement that summarizes the direction and intent of the unit.
C)
D) Objectives - Identify three or four specific objectives you wish children to master by the completion of the unit, use the appropriate NC Early Learning Standards for the age of the child.
D)
E) Resources - You will need to cite all resources used throughout the study topic. For example: Internet resources (specific web site), printed resources, magazines, newspaper, journals, audio/visual resources, field trips, etc.
E)
F) Extensions Activities - Complete the attached Lesson Plan Forms in detail. You should also include two extension activities (extended activities or enrichment activities).
F)
G) Discussion Questions – Include at least three open-ended questions that will help children think about the topic in varied and divergent ways.
G)
H) Literature Selections - Select children’s books that relate to the theme and are developmentally appropriate for the children you will be working with
H)
I) Culminating activity - The culminating activity is a project or activity that engages children in a meaningful summarization of their discoveries and leads to new ideas, understandings and connections.
J) Evaluation - Devise appropriate means of evaluating children’s progress throughout the unit based on the objectives chosen above.
Student Name: _________ Date: _________
Assessment Name: Study Topic Unit
This assessment is used in every section of EDU 151
This assessment is designed to focus on Standards #4 and #5
This assessment is designed to focus on Supportive Skill # 3, #4, and #5
D/F
C
B
A
100
Unsatisfactory
Average
Good
Very Good
Standard or
Supportive Skill
Key Elements
Basic Knowledge
Comprehension
Application
Synthesis
Comments
Standard 4: Using Developmentally Effective Approaches to Connect with Children and Families
(Attach Weekly Planning Form to Standard 4c in School Chapters)
4c. Using a broad repertoire of developmentally appropriate teaching/learning approaches
Activities are not developmentally appropriate and do not incorporate a range of teaching approaches
0 – 12
Activities are mostly developmentally appropriate and incorporate a few teaching approaches
13
Activities are developmentally appropriate and incorporate varied teaching approaches
14
Activities are developmentally appropriate and incorporate a wide array of teaching approache.
EDSP 429
Differentiated Instruction PowerPoint Instructions
The purpose of this assignment is to produce a PowerPoint presentation that demonstrates your ability to apply course concepts and vocabulary to the topic of differentiated instruction.
Differentiated instruction is a form of instruction that seeks to maximize each student’s growth by recognizing that students have different ways of learning, different interests, and different ways of responding to instruction. In practice, it involves offering several different learning experiences in response to students’ varied needs. You will use theories, vocabulary, and models to construct a PowerPoint presentation that gives an overview of differentiated instruction.
1. Construct the PowerPoint presentation as if you were addressing peers in an in-service training on differentiated instruction.
2. The PowerPoint presentation must be 7–12 slides.
3. The PowerPoint presentation must address the following topics:
· Definition of differentiated instruction
· Advantages to students with special needs
· At least 3 specific examples of differentiated instruction
· References page
The Differentiated Instruction PowerPoint is due by 11:59 p.m. (ET) on Monday of Module/Week 5.
EDSP 429
D
IFFERENTIATED
I
NSTRUCTION
P
OWER
P
OINT
I
NSTRUCTIONS
The purpose of
this assignment is to produce a
PowerPoint
p
resentation that demonstrates
your
ability to apply course concepts and vocabulary to the topic of
d
ifferentiated
i
nstruction
.
Differentiated
instruction is a form of instruction that seeks to maximize each student
’
s growth
by recognizing that students have different ways of learning, different interests, and different
ways of responding to instruction. In practice, it involves offering several
different learning
experiences in response to students
’
varied needs.
You will
use theories, vocabulary, and models
to construct a
PowerPoint
p
resentation that gives an overview of differentiated
instruction
.
1.
Construct the
PowerPoint
presentation as if yo
u were addressing peers in an in
-
service
training on differentiated instruction.
2.
The
PowerPoint
presentation
must
be 7
–
12
slides
.
3.
The
PowerPoint
presentation
must
address the following topics:
·
Definition of differentiated
i
nstruction
·
Advantages to student
s with special needs
·
At least 3
specific examples
of differentiated instruction
·
References
page
The
Differentiated Instruction
PowerPoint
is due by 11:59 p.m. (ET) on Monday of
M
odule/
W
eek
5
.
EDSP 429
DIFFERENTIATED INSTRUCTION POWERPOINT INSTRUCTIONS
The purpose of this assignment is to produce a PowerPoint presentation that demonstrates your
ability to apply course concepts and vocabulary to the topic of differentiated instruction.
Differentiated instruction is a form of instruction that seeks to maximize each student’s growth
by recognizing that students have different ways of learning, different interests,.
EDSP 429Fact Sheet on Disability Categories InstructionsThe pu.docxtidwellveronique
EDSP 429
Fact Sheet on Disability Categories Instructions
The purpose of this assignment is to produce a Fact Sheet that demonstrates your ability to articulate the characteristics of each of the IDEA recognized categories of disabilities.
The Individuals with Disabilities Education Act guarantees a free appropriate public education to eligible children with disabilities. It specifically identifies 13 categories of disabilities that are entitled to special education services. Using relevant reliable websites and your text, you are to construct a Fact Sheet that explains each of the disability categories in terms that are understandable for the general public.
1. Develop the Fact Sheet as if it would be used to educate parents or others in the general public about disabilities that receive special education services.
2. Include an introduction stating the purpose of the fact sheet and the information provided.
3. Each disability category must be fully defined.
4. A minimum of 3 sources should be cited and referenced, one of which should be the textbook.
5. A reference page must be included.
The Fact Sheet on Disability Categories is due by 11:59 p.m. (ET) on Monday of Module/Week 2.
EDSP 429
F
ACT
S
HEET ON
D
ISABILITY
C
ATEGORIES
I
NSTRUCTIONS
The purpose of
this assignment is to produce a
Fact Sheet
that demonstrates
your
ability to
articulate the charac
teristics of each of the IDEA
recognized categories of disabilities.
The Individuals with Disabilities Education Act guarantees a free appropriate public education to
eligible children with disabilities. It specifically identifies 13 categories of disabilities that are
entitled to special education services. Using
relevan
t reliable websites and your text, you are to
construct a Fact Sheet that explains each of the disability categories in terms that are
understandable for the general public.
1.
Develop the Fact Sheet as if it would be used to educate parents or others in th
e general
public about disabilities that receive special education services.
2.
Include an introduction stating the purpose of the fact sheet and the information provided.
3.
Each disability category must be fully defined
.
4.
A minimum of 3 sources should be cited
and referenced, one of which should be the
textbook.
5.
A reference page must be included.
The
Fact Sheet on Disability Categories
is due by 11:59 p.m. (ET) on Monday of
M
odule/
W
eek
2
.
EDSP 429
FACT SHEET ON DISABILITY CATEGORIES INSTRUCTIONS
The purpose of this assignment is to produce a Fact Sheet that demonstrates your ability to
articulate the characteristics of each of the IDEA recognized categories of disabilities.
The Individuals with Disabilities Education Act guarantees a free appropriate public education to
eligible children with disabilities. It specifically identifies 13 categories of disabilities that are
entitled to special education services. Using relevant reliable websites and your.
EDSP 370Individualized Education Plan (IEP) InstructionsThe .docxtidwellveronique
EDSP 370
Individualized Education Plan (IEP) Instructions
The purpose of this assignment is to provide a means of practice in IEP development. You will be expected to produce an IEP – full in its overall scope but not in-depth. This will allow you to apply the knowledge learned within the course as a whole. The IEP will be written in three phases in order to provide assistance and feedback as well as allow for improvements. ONLY DO PHASE 1. STOP WORKING WHEN YOU SEE THIS:
THIS IS THE END OF THE WEEK 3 ASSIGNMENT.
· Phase 1
You will complete the following components of the IEP:
Notice
Cover Page
Factors
Present Level of Performance (PLOP)
Diploma Status
Phase 11 and 111 will get competed in weeks to follow (DO NOT COMPLETE THIS PORTION).
· Phase II
You will revise IEP 1 based on instructor comments and complete the
following additional components:
Goals
Objectives
Accommodations/Modifications
Participation in State Accountability and Assessment System
· Phase III
You will revise IEP II based on instructor comments and complete the
following additional components:
Least Restrictive Environment (LRE)
Transition
Extended School Year (ESY)
Parent Consent
You will be using the Michael Jones case study which has been provided with the instucstions to this. All portions of the IEP will pertain to Michael. It is understood that it will be difficult to fully consider the development of an IEP without more exhaustive details considering Michael’s educational and functional strengths and weaknesses.
To complete the IEP, it will be necessary to review all of the assigned reading and presentations. You may also research current information on Virginia Department of Education’s website. These resources provide valuable information and examples to help create the IEP. You will use the IEP template that is a sample created from the VA DOE’s sample IEP, also located in the Assignment Instruction folder for Module/Week 3.
Page 1 of 1
SAMPLE
School Division Letterhead
IEP MEETING NOTICE
Date:
To:
Susie and Robert Jones________________
and
Michael______________________________________
Parent(s)/Adult Student Student (if appropriate or if transition will be discussed)
You are invited to attend an IEP meeting regarding Michael Jones
Student’s Name
PURPOSE OF MEETING (check all that apply):
· IEP Development or Review
· IEP Amendment
· Transition: Postsecondary Goals, Transition Services
· Manifestation Determination
· Other: ________________________________________________________________________________
The meeting has been scheduled for:
Date Time Location
Meetings are scheduled at a mutually agreed upon place and time by y.
EDSP 377
Scenario Instructions
Scenario 2: Teaching communication skills
Scenario assignments are designed to help the candidate synthesize and apply course content to real-world situations involving individuals with ASD. In Scenario #2, candidates will create a lesson plan for a pre-K student with autism who has communication needs.
Scenario: You are a pre-K teacher for a 4-year-old student with autism named Johnsaan. Johnsaan has difficulty asking for help when he needs something. Instead of asking for help using words, he grunts and waves his hands until he gets a response and engages in challenging behaviors. As Johnsaan's teacher, you need to teach him to use words to ask for help, which should decrease his challenging behavior. What components need to be included in your lesson plan?
Assignment: Drawing on the lesson planning and delivery techniques discussed in Chapter 5, create a lesson plan that could be used to teach Johnsaan to ask for help. Be sure your lesson plan includes the 5 major components of a lesson plan, outlined in Chapter 5, that will enhance your student's ability to express himself when he needs help. The final assignment should be a completed lesson plan, approximately 2 pages (Times New Roman, 12-point font) and an additional 1-page candidate reflection.
Step 1: Identify the main components of the lesson including the goal and/or objective, specific information related to the conditions for responding, types of reinforcers and reinforcement schedule, mastery criteria and evaluation methods.
Step 2: Develop a formal lesson incorporating at least 1 specified presentation style outlined in Chapter 5: Direct Instruction (DI), Discreet Trial Training (DTT), Milieu Teaching (MU), Grouping, or Embedded ABA Teaching Strategies. The formal lesson plan must include an opportunity for guided practice and independent practice. Opportunities for generalization and maintenance should be outlined.
Step 3: Reflect upon the lesson planning process. The reflection should integrate course materials and a biblical world-view, including at least 2 in-text citations and reference list following APA formatting. The following considerations should be addressed within the reflection:
· Rationale for the identification of selected target skill and presentation style(s).
· Review of the lesson planning process including consideration of pre-requisite skills and next steps after lesson implementation.
· Identification of possible challenges with implementation and how these potential challenges will be addressed prior to and during instruction.
EDSP 377
S
CENARIO
I
NSTRUCTIONS
S
CENARIO
2
:
T
EACHING COMMUNICATIO
N SKILLS
Scenario assignments are design
ed
to help the candidate synthesize and apply course
content
to
real
-
world situations involving individuals with ASD.
In
Scenario #2
, candidates will
create
a
lesson plan for a pre
-
K student with aut
ism who has communication needs.
Scenario:
You are a pre.
EDSP 377
Autism Interventions
1. Applied Behavior Analysis (ABA)
2. Auditory Integration Training (AIT)
3. Biochemical Therapies
4. Circle of Friends
5. Computer Aided Instruction
6. Dietary Restrictions and/or Supplements (including enzymes and vitamins)
7. DIR/Floortime Approach (Greenspan)
8. Discrete Trial Training (DTT)
9. Early Intervention Behavioral Intervention (EIBI)
10. Early Start Denver Model (ESDM), for young children with autism
11. Functional Communication Training (FCT)
12. Holding Therapies
13. Hyperbaric Oxygen Chamber Treatments
14. Joint Attention Interventions
15. Music Therapy
16. Naturalistic Intervention
17. Options Therapy (Son Rise)
18. Peer Mediated Instruction and Intervention
19. Pharmacological Approaches
20. Picture Exchange Communication System (PECS)
21. Pivotal Response Training (PRT)
22. Play Groups
23. Power Cards
24. Relationship Development Intervention (RDI)
25. Research on Connection with Mercury and the MMR to autism
26. Research on Siblings of Children with Autism
27. Research on Transition Services for Employment
28. Research on Transition to the Adult World
29. Research on Twin Studies
30. SCERTS Model (Social Communication, Emotional Regulation, and Transactional Support)
31. Sensory Integration
32. Sign Language
33. Social Stories
34. TEACCH (Treatment and Education of Autistic and related Communication-handicapped Children)
35. Visual Strategies and Supports
36. Video Modeling
A
UTISM
I
NTERVENTIONS
1.
Applied Behavior Analysis (ABA)
2.
Aud
itory Integration Training (AIT)
3.
Biochemical Therapies
4.
Circle of Friends
5.
Computer Aided Instruction
6.
Dietary
R
estrictions and/or
S
upplements (including enzymes and vitamins)
7.
DIR/Floortime Approach (Greenspan)
8.
Discrete Trial Training
(DTT)
9.
Early Intervention Behavioral Intervention (EIBI)
10.
Early Start Denver Model (ESDM)
,
for young children with autism
11.
Functional Communication Training (FCT)
12.
Holding Therapies
13.
Hyperbaric Oxygen C
hamber Treatments
14.
Joint
Attention Interventions
15.
Music Therapy
16.
Naturalistic Intervention
17.
Options Therapy (Son Rise)
18.
Peer
M
ediated
I
nstruction and
I
ntervention
19.
Pharmacological
A
pproaches
20.
Picture Exchange Communication System (PECS)
21.
Pivotal Response Training
(PRT)
22.
Play Groups
23.
Power Cards
24.
Relationship Development Intervention (RDI)
25.
Research on
C
onnection with
M
ercury and the MMR to autism
26.
Research on
S
iblings of
C
hildren with
A
utism
27.
Research on
T
ransition
S
ervices for
E
mployment
28.
Research on
T
ransition to the
A
dult
W
orld
29.
Research on
T
win
S
tudies
30.
SCERTS Model (Social
Communication
,
Emotional Regulation
, and
Transactional Support)
31.
Sensory Integration
32.
Sign
L
anguage
33.
Social Stories
34.
TEACCH (Treatment and Education of Autistic and related
Communication
-
handicapped C
h
ildren)
35.
Visual Strategies
and .
Acetabularia Information For Class 9 .docxvaibhavrinwa19
Acetabularia acetabulum is a single-celled green alga that in its vegetative state is morphologically differentiated into a basal rhizoid and an axially elongated stalk, which bears whorls of branching hairs. The single diploid nucleus resides in the rhizoid.
Honest Reviews of Tim Han LMA Course Program.pptxtimhan337
Personal development courses are widely available today, with each one promising life-changing outcomes. Tim Han’s Life Mastery Achievers (LMA) Course has drawn a lot of interest. In addition to offering my frank assessment of Success Insider’s LMA Course, this piece examines the course’s effects via a variety of Tim Han LMA course reviews and Success Insider comments.
Welcome to TechSoup New Member Orientation and Q&A (May 2024).pdfTechSoup
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Palestine last event orientationfvgnh .pptxRaedMohamed3
An EFL lesson about the current events in Palestine. It is intended to be for intermediate students who wish to increase their listening skills through a short lesson in power point.
The French Revolution, which began in 1789, was a period of radical social and political upheaval in France. It marked the decline of absolute monarchies, the rise of secular and democratic republics, and the eventual rise of Napoleon Bonaparte. This revolutionary period is crucial in understanding the transition from feudalism to modernity in Europe.
For more information, visit-www.vavaclasses.com
Operation “Blue Star” is the only event in the history of Independent India where the state went into war with its own people. Even after about 40 years it is not clear if it was culmination of states anger over people of the region, a political game of power or start of dictatorial chapter in the democratic setup.
The people of Punjab felt alienated from main stream due to denial of their just demands during a long democratic struggle since independence. As it happen all over the word, it led to militant struggle with great loss of lives of military, police and civilian personnel. Killing of Indira Gandhi and massacre of innocent Sikhs in Delhi and other India cities was also associated with this movement.
Macroeconomics- Movie Location
This will be used as part of your Personal Professional Portfolio once graded.
Objective:
Prepare a presentation or a paper using research, basic comparative analysis, data organization and application of economic information. You will make an informed assessment of an economic climate outside of the United States to accomplish an entertainment industry objective.
Model Attribute Check Company Auto PropertyCeline George
In Odoo, the multi-company feature allows you to manage multiple companies within a single Odoo database instance. Each company can have its own configurations while still sharing common resources such as products, customers, and suppliers.
A Strategic Approach: GenAI in EducationPeter Windle
Artificial Intelligence (AI) technologies such as Generative AI, Image Generators and Large Language Models have had a dramatic impact on teaching, learning and assessment over the past 18 months. The most immediate threat AI posed was to Academic Integrity with Higher Education Institutes (HEIs) focusing their efforts on combating the use of GenAI in assessment. Guidelines were developed for staff and students, policies put in place too. Innovative educators have forged paths in the use of Generative AI for teaching, learning and assessments leading to pockets of transformation springing up across HEIs, often with little or no top-down guidance, support or direction.
This Gasta posits a strategic approach to integrating AI into HEIs to prepare staff, students and the curriculum for an evolving world and workplace. We will highlight the advantages of working with these technologies beyond the realm of teaching, learning and assessment by considering prompt engineering skills, industry impact, curriculum changes, and the need for staff upskilling. In contrast, not engaging strategically with Generative AI poses risks, including falling behind peers, missed opportunities and failing to ensure our graduates remain employable. The rapid evolution of AI technologies necessitates a proactive and strategic approach if we are to remain relevant.
Biological screening of herbal drugs: Introduction and Need for
Phyto-Pharmacological Screening, New Strategies for evaluating
Natural Products, In vitro evaluation techniques for Antioxidants, Antimicrobial and Anticancer drugs. In vivo evaluation techniques
for Anti-inflammatory, Antiulcer, Anticancer, Wound healing, Antidiabetic, Hepatoprotective, Cardio protective, Diuretics and
Antifertility, Toxicity studies as per OECD guidelines
The Roman Empire A Historical Colossus.pdfkaushalkr1407
The Roman Empire, a vast and enduring power, stands as one of history's most remarkable civilizations, leaving an indelible imprint on the world. It emerged from the Roman Republic, transitioning into an imperial powerhouse under the leadership of Augustus Caesar in 27 BCE. This transformation marked the beginning of an era defined by unprecedented territorial expansion, architectural marvels, and profound cultural influence.
The empire's roots lie in the city of Rome, founded, according to legend, by Romulus in 753 BCE. Over centuries, Rome evolved from a small settlement to a formidable republic, characterized by a complex political system with elected officials and checks on power. However, internal strife, class conflicts, and military ambitions paved the way for the end of the Republic. Julius Caesar’s dictatorship and subsequent assassination in 44 BCE created a power vacuum, leading to a civil war. Octavian, later Augustus, emerged victorious, heralding the Roman Empire’s birth.
Under Augustus, the empire experienced the Pax Romana, a 200-year period of relative peace and stability. Augustus reformed the military, established efficient administrative systems, and initiated grand construction projects. The empire's borders expanded, encompassing territories from Britain to Egypt and from Spain to the Euphrates. Roman legions, renowned for their discipline and engineering prowess, secured and maintained these vast territories, building roads, fortifications, and cities that facilitated control and integration.
The Roman Empire’s society was hierarchical, with a rigid class system. At the top were the patricians, wealthy elites who held significant political power. Below them were the plebeians, free citizens with limited political influence, and the vast numbers of slaves who formed the backbone of the economy. The family unit was central, governed by the paterfamilias, the male head who held absolute authority.
Culturally, the Romans were eclectic, absorbing and adapting elements from the civilizations they encountered, particularly the Greeks. Roman art, literature, and philosophy reflected this synthesis, creating a rich cultural tapestry. Latin, the Roman language, became the lingua franca of the Western world, influencing numerous modern languages.
Roman architecture and engineering achievements were monumental. They perfected the arch, vault, and dome, constructing enduring structures like the Colosseum, Pantheon, and aqueducts. These engineering marvels not only showcased Roman ingenuity but also served practical purposes, from public entertainment to water supply.
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EDITORIALTHE ETHICAL IMPLICATIONS OF THESOCIAL DETERMINA.docx
1. EDITORIAL
THE ETHICAL IMPLICATIONS OF THE
SOCIAL DETERMINANTS OF HEALTH:
A GLOBAL RENAISSANCE FOR
BIOETHICS
In this special issue, Bioethics explores the ethical issues
that relate to the social determinants of health. As the
articles demonstrate, the recognition that social factors
help to determine a population’s health offers bioethics
new challenges and new opportunities. With this recog-
nition, fundamental bioethical concepts, such as cau-
sation, autonomy, rights, and justice, take on new
meanings. Likewise, mainstay bioethical issues, including
the equitable distribution of resources, the duties of pro-
fessionals, and the conflict between paternalism and
autonomy, become amenable to new perspectives.
The realization that social forces help to determine
health is hardly new. For millennia people have recog-
nized a relationship between the social environment
and disease. In the 19th century, sanitarians blamed the
rampant filth of growing cities for the incessant outbreaks
of disease. Later progressive reformers lambasted both
poverty and poor working conditions for disease and
premature death. The pioneers of epidemiology docu-
mented these relationships.
The field of bioethics has never been closed to such
concerns. Since its inception in the 1960s and 1970s,
however, bioethics has deployed much of its intellectual
2. energy on the moral issues that relate to the development,
distribution, and delivery of health care services. In so
doing, the field reflected medicine’s eclipse of public
health in the 20th century. As medicine became predomi-
nant and illness became more and more amenable to
individualized medical treatment, ethical discourse came
to emphasize clinical encounters. At the same time, as
disease and health increasingly came to be seen as result-
ing from individual factors, individuals began to be
viewed as morally culpable for both their illnesses and the
impact of those illnesses on others.
Not surprisingly, given the importance that bioethics
placed upon individual patients and providers, autonomy
surfaced as a key concern. In the early years bioethicists
focused on the autonomy of patients. Following the lead
of John Stuart Mill, bioethicists revealed the dangers of
medical paternalism and explained why and how patient
autonomy should be respected. In this they were highly
successful, as informed consent became both widely
regarded and legally established.
Individual autonomy remained of paramount interest
in the 1990s. By then, however, the concern widened to
include the autonomy of physicians. At least within the
USA, physicians criticized managed care for interfering
with their ability to make decisions for their patients
and infringing upon their professional autonomy. And
throughout the developed world, as health care costs rose,
market solutions were debated. Patients began to be
viewed as ‘consumers’ of medical care instead of as
patients in need of treatment and care. Not surprisingly,
once patients were seen as consumers responsible for
selecting their own healthcare in market transactions,
some ethicists were apt to disavow physicians’ fiduciary
duties. Caveat emptor replaced the duty of beneficence as
3. the invisible hand of the market was viewed as the source
of just outcomes. Frequently neglected in mainstream
bioethical discourse of this era – although well noted by
bioethicists working from feminist and communitarian
traditions – was the fact that individuals are never simply
self-determined but are selves nestled in relationships with
other individuals, communities, and the wider world.
This neglect is vanishing. With globalization and the
rise of pandemics including, HIV/AIDS, and new global
threats, such as global warming, the deep connections
between individuals, communities, and the wider world
can no longer be overlooked. Moreover, although many
empirical questions remain unanswered, voluminous
research has now firmly demonstrated the existence of
significant disparities in health between the rich and poor,
across the globe and within nations. As the World Health
Organization’s Commission on Social Determinants of
Health recently stated: ‘These inequities in health, avoid-
able health inequalities, arise because of the circum-
stances in which people grow, live, work, and age, and the
systems put in place to deal with illness. The conditions in
which people live and die are, in turn, shaped by political,
social, and economic forces.’1 In response, bioethics must
expand its horizons and consider the ethical issues that
arise from the social forces that help to determine health,
as well as the ethical problems that result from interven-
tions that target those forces.2
1 WHO. Commission on Social Determinants of Health. 2008.
Closing
a Gap in a Generation: Health Equity Through Act on the Social
Deter-
minants of Health, Final Report on the Commission on Social
Determi-
nants of Health. Geneva: WHO. Available at:
5. requiring individuals to wear seatbelts, that limit indi-
vidual autonomy in order to improve a population’s
health.5 While such discussions seldom consider the role
of social determinants explicitly, these debates arise from
a discontent with the atomistic assumptions that social
determinants dissolve.
In recent years, bioethicists have also paid attention to
the ethics of public health interventions directed at ill-
nesses which are linked to social determinants. In this
issue, the articles by Paula Boddington and David Shaw
exemplify different ways of addressing such questions.
Each article is written with a firm appreciation of social
determinants. And each moves bioethics away from the
clinical encounter to a broader social setting.
In Heart Disease and Social Inequality: Ethical Issues
in the Aetiology, Prevention and Treatment of Health
Disease, Paula Boddington analyzes the ethics of prevent-
ing and treating heart disease. In contrast to traditional
bioethical discussions, which generally focus on the ethics
of clinical research and treatment, Boddington analyses
the ethical issues that arise from broad public health
policies. Her piece begins with two critical observations:
heart disease is distributed unequally and its etiology is
complex and multi-causal. With these observations, she
establishes that a discussion of the ethics of heart disease
prevention and treatment must move not only beyond
clinical medicine, but beyond individually-oriented
solutions. It must consider the possibility, and ethical
implications, of broader social changes. As Boddington
notes, ‘Distributive justice is embedded in debate about
strategies for treatment and prevention.’ (123) Common
interventions, such as those that warn individuals about
‘risk factors’ may help prevent some cases of disease.
6. They may also respect or even facilitate the choices of
individuals. At the same time, however, they result in an
inappropriate attribution of responsibility to individuals
and may increase distributive inequities, both because
some populations may be in a better position to heed such
warnings and because such interventions decrease the
visibility of socially-determined causal factors.
David Shaw’s paper, Tackling Socially Determined
Dental Inequalities: Ethical Aspects of Childsmile, The
The National Child Oral Health Demonstration Pro-
gramme in Scotland, also engages the ethical dilemmas
that arise from public health interventions. Childsmile is
a multifaceted intervention designed to reduce both the
incidence of and disparities of dental caries among chil-
dren. The program includes both broadly-based and
narrowly targeted arms. By examining Childsmile from a
Rawlsian perspective, Shaw illuminates the tensions that
exist between population-based and more targeted mea-
sures, as well as the tensions between maximizing health
and reducing disparities, prevention and treatment, and
ultimately utility and justice. According to Shaw, by
incorporating both population-wide and high-risk strat-
egies, Childsmile may mitigate some of these tensions,
though only ‘time will tell.’ (131) In so concluding, Shaw
demonstrates fidelity to both context and empiricism,
showing that while a bioethical analysis informed by
social determinants may grapple with broad, population-
wide issues, its conclusions remain contingent upon the
particulars of social facts and very specific programs.
In Justice, Stigma, and the New Epidemiology of Health
Disparities, Andrew Courtwright illustrates how the rec-
ognition of social determinants can raise new questions
about old issues. Bioethicists have long criticized stigma-
tization. But for the most part, they have focused on its
8. The close nexus between bioethics and political and
moral theory becomes even more pronounced once we
recognize the global dimension of social determinants.
The medical perspective is naturally bounded by the
human body; the same is not true of social determinants.
They have no simple boundary. So when we look at the
social determinants of health, our focus necessarily
becomes global. In making that shift, we leave behind not
only bioethics’ traditional emphasis on autonomy and
the moral responsibilities of individuals, but also domes-
tic law and well-entrenched norms. We enter less familiar
territory, where political and moral philosophy – and
perhaps human rights – serve as our primary guideposts.7
The global dimension of social disparities is striking.
As Audrey R. Chapman points out in Globalization,
Health, and Human Rights, at the end of the 20th century,
1.2 billion people in the world lived on less than $1 dollar
a day and half the world’s population lived on 2 dollars a
day. Because of the connection between absolute poverty
and poor health, poverty is an international determinant
of health. With additional resources, developing coun-
tries could improve the health of their people.
Chapman argues that, unlike the individual right to
health, the right to development is a collective right that
could address the impact of poverty as a social determi-
nant in a way that individual rights cannot. A United
Nations Declaration recognized the human right to
development in 1986. In the following words:
The right to development is an inalienable human right
by virtue of which every person and all peoples are
entitled to participate in and contribute to and enjoy
economic, social cultural and political development, in
9. which all rights and fundamental freedoms can be fully
realized.8
In this way the duty to fulfill the right to development, a
positive right, is imposed on all peoples for all peoples, a
vision that moves away from the particularism of nation-
alism, and embraces a more cosmopolitan stance. There
is little question that this collective right, if realized,
would go a long way in changing the social, political, and
economic conditions that are responsible for the diseases
of poverty.
In Globalization, Human Rights and the Social Deter-
minants of Health, Ashley M. Fox and Benjamin Mason
Meir cover similar terrain but make a different argument.
They contend that globalization, understood as the inter-
dependence of the world’s people, involving the integra-
tion of economies, culture, technologies, and governance,
and under the influence of neoliberal ideology, has ben-
efitted rich countries much more than poor countries. As
globalization has spread, global injustice has followed.
Fox and Meir argue that a human rights approach would
do a better job of improving health and welfare, globally,
but especially for the global poor. Nonetheless, Fox and
Meir point out that in order for the right to the highest
attainable standard of health to be as effective as it can
be, it must be understood by the legal community as well
as human rights activists to incorporate the social deter-
minants of health. They are also concerned that many of
those who are involved in the creation of government
policy have a narrow understanding of the right to health,
and their country’s commitment to the highest attainable
standard of health globally.
Both of these rights-based approaches to poverty,
10. global disease, and avoidable deaths offer compelling
accounts because they assign responsibility for health and
development to identifiable others. Still, as Fox and Meir
suggest, we are a long way away from a time when such
rights are in fact widely respected and fulfilled. The
source of the problem may be that, even though there is a
universal right to the highest attainable standard of
health and a collective right to development, without a
widely adopted cosmopolitan ethic, few will funnel into
the global social order the resources that are needed to
meet these rights.
Nonetheless, without the help of scientific data about
the causes of disease, including the social determinants, a
cosmopolitan ethic on its own has little chance of having
a significant impact on global health. In Epidemiology
and Social Justice in Light of Social Determinants of
Health Research, Sridhar Venkatapuram and Sir Michael
Marmot underscore the importance of collaboration
between ethics and epidemiology in a bioethics commit-
ted to global social justice. Unless the bioethics conver-
sation includes both epidemiologists and ethicists, neither
can be confident that their work will be as effective as it
could be. Importantly, Venkatapuram and Marmot note
that epidemiology is informed by the moral concern with
human health and its role in social justice. By the same
token, the fact that bioethics is informed by the data of
epidemiology ensures that its insights are not cast away as
mere irrelevant postulations, but help to realize the
7 J. Mann. Medicine and Public Health, Ethics and Human
Rights.
Hastings Cent Rep 1997; 27: 6–13.
8 Declaration on the Right to Development. GA Res/128
adopted 4
Dec. 1986. UN GAOR. 41 Sess. Annex UN Doc. A/Res/41128:
13. a field of study from before 1960 to the present. What
historical event do you think has the most important impact on
the current business environment? (150 Words)
Essay Question # 2 - Define business ethics, analyzes the
benefits of business ethics and the development of business
ethics. (250-500 Words)
Essay Question # 3 – Select a recent ethical breach at a
company. Briefly describe what happened, and the effects on
stakeholders. Why do you think it is noteworthy? (150 Words)
Essay Question # 4 – Why is ethical misconduct more difficult
for a business to overcome than poor financial performance?
(150 Words)
Essay Question # 5 – Discuss how one goes about recognizing
an ethical issue? How do companies respond to ethical issues?
(150 Words)
Essay Question # 6 – List 5 different ethical issues in the
workplace. Then briefly reflect on how they could be prevent.
(150 Words)
Essay Question # 7 - How has the concept of social
responsibility changed? Select an area you think will change
over the next 10 years and speculate on why and what might
happen? (150 Words)
Essay Question # 8 - How do you think managers and business
executives should display ethical principles. Give an example.
(150 Words)
Essay Question # 9 - How can companies secure stakeholder
input during an ethics audit? Why do you think it is important
to do so? (150 Words)
Essay Question # 10 - How do you think ethical actions of
business leaders (positive or negative) effect the actions of
their subordinates. (150 Words)
Essay Question # 11 - What is the Global Reporting Initiative?
What is its goal? Why do you think it has grown in importance?
(150 Words)
Essay Question # 12 - How can differences in two countries'
cultures create opportunities for learning about ethical
14. differences? (150 Words)
Essay Question # 13 - List five aspects of an ethics programs
that you think should considered successful. What do you think
is the most important feature of that program? (150 Words)
Essay Question # 14 - How do you
think sustainability relates to ethical decision making and social
responsibility? (150 Words)
Critical Public Health
Vol. 22, No. 3, September 2012, 267–279
The global financial crisis and health equity: toward a
conceptual
framework
Arne Ruckert* and Ronald Labonté
Department of Epidemiology and Community Medicine,
Institute of Population Health,
University of Ottawa, Ontario, Canada
(Received 5 April 2012; final version received 7 April 2012)
In this article, we identify pathways that link the global
financial crisis to
health equity. We distinguish between direct and indirect
channels of
influence, and develop a conceptual model that builds on the
literature
analyzing the impacts of globalization on social determinants of
health.
The most pertinent direct pathways discussed are economic
contraction,
15. health budget cutbacks, rise in unemployment, and qualitative
transfor-
mations of health systems. We also outline how other indirect
channels of
influence are likely to affect health equity, including cutbacks
to welfare
programs, labor market transformations, the emergence of an
ideological
climate conducive to austerity politics, and reductions in
official develop-
ment assistance. We conclude by suggesting that the current
intensification
of neoliberal policy implementation is likely to undermine
health equity,
and that a different path toward economic recovery is required
to ensure
equitable access to health care.
Keywords: health equity; global financial crisis; population
health; social
determinants of health; health governance
Introduction
Health equity is becoming a central concern in health research
(Östlin et al. 2011),
with the tenacity of health disparities in countries around the
world identified as one
of the most serious public health threats of the twenty-first
century (Edwards and Di
Ruggiero 2011). The WHO defines health equity as the absence
of systematic
differences in health, between and within countries, that are
avoidable by reasonable
action (CSDH 2008, p. 1). Health equity research starts from the
assumption that
16. many of the differences in health outcomes between different
segments of the
population are directly traceable to inequalities in the
underlying social and
economic conditions that are essential for health, or what
recently came to be called
‘social determinants of health’ (SDH) (Labonté et al. 2009). A
rapidly growing body
of literature on SDH surfaced in the 1990, and has gained
momentum with the WHO
Commission on Social Determinants of Health (CSDH 2008)
and subse-
quent national and regional reviews (for a good overview, see
Navarro 2009,
Raphael 2011).
*Corresponding author. Email: [email protected]
ISSN 0958–1596 print/ISSN 1469–3682 online
� 2012 Taylor & Francis
http://dx.doi.org/10.1080/09581596.2012.685053
http://www.tandfonline.com
As a part of this literature, a small branch is focusing on how
global factors and
forces are shaping SDH domestically (e.g. Labonte and
Torgerson 2005, Labonte
and Schrecker 2007a, b, c, Edwards and Di Ruggiero 2011).
However, recent global
developments, in particular the on-going global financial crisis
and the concomitant
austerity drive that it unleashed, present a new set of challenges
for understanding
17. the links between global macro-structural developments and
health equity that
remain largely unaddressed in the literature. There have been
multiple warnings that
the financial crisis will negatively impact on health outcomes
(e.g. Banoob 2009,
Blakey and McLeod 2009, Labonté 2009, Marmot and Bell
2009, WHO 2009; Gill
and Baker 2011, Kentikelenis et al. 2011), with a Lancet
commentary calling the
financial crisis an ‘acute threat’ to population health (Horton
2009). Some studies
have started to analyze the ways in which the financial crisis is
percolating down to
the level of health policy making (e.g. Mladovsky et al. 2011,
WHO 2011). But there
has been little effort to explicitly assess the health equity
implications of the global
financial crisis and subsequent changes to health policy and
governance, and little
emphasis placed in the literature on the indirect health equity
effects of financial
crises. This article attempts to fill this research gap.
This article unfolds as follows: First, we review the existing
literature on the
impact of global forces, in general, and the financial crisis, in
particular, on health
equity, linking the financial crisis conceptually back to the
macro-structural process
of neoliberal globalization. We next develop a generic
framework of the linkages
between the current financial crisis and health equity,
distinguishing between direct
and indirect channels of influence (Figure 1). We then discuss
the most pertinent
18. direct channels of influence, with a focus on economic
contraction with its associated
decline in the tax base, health budget cutbacks, rise in
unemployment, and
qualitative transformations of health systems. We then outline
how other indirect
channels of influence are likely to affect health equity,
including cutbacks to welfare
programs, labor market transformations, the emergence of an
ideological climate
conducive to austerity politics, and reductions in official
development
Figure 1. Health equity-relevant pathways of global financial
crisis.
268 A. Ruckert and R. Labonté
assistance (ODA). This article selectively draws on some of the
early experiences with
and effects of the financial crisis on SDH in a range of different
countries
representing developed, transition, and developing economies.
The article concludes
by suggesting that a different path to that of deep austerity is
required to insure that
health equity goals will not be undermined further in the policy
response to the
global financial crisis.
Globalization, the global financial crisis, and health equity
Financial crises have been a central characteristic of neoliberal
globalization since
19. the beginning of the deregulation of finance in the early 1980s,
with more than
20 financial crises occurring annually since 1986 (Mohindra et
al. 2011). Most of
these financial crises have been contained domestically, with
the exception of the
Asian financial crisis (in the late 1990s) and the global financial
crisis (2007/2008 and
ongoing). All have strongly affected health and wider social
living conditions in the
countries in which they transpired. The wider health equity
impacts of the current
global financial crisis must be situated within the context of the
globalization of
production and finance that has been a key feature of the world
economy over the
past three decades. The liberalization of financial markets has
been identified as one
of the key pillars of neoliberal globalization, with strong
implications for health
equity and SDH (Labonté and Schrecker 2007b). Financial
liberalization refers to
the global integration of financial markets and predominantly
consists of the
deregulation of the foreign sector capital account, the domestic
financial sector, and
the stock market (Arestis 2004). A central element of financial
liberalization since the
early 2000s has been the self-regulation of banking entities,
with risk assessments
performed internally through models developed and controlled
by banks themselves.
The loosening of financial capital from the regulatory
constraints of the nation state
has ushered in a new era of market discipline with concomitant
loss of policy space in
20. the health domain (Bakker and Gill 2006).
1
Loss of policy space is related to the
ways in which investor decisions can influence the policy
making process. Under
globally integrated financial markets, governments require the
confidence of large
international institutional investors to fund their operations
through sovereign debt
markets (borrowing). In the realm of health, this implies that
even governments
committed to improving access to better and more equitable
health care are reluctant
to risk the effects of displeasing financial markets.
Governments may also be
reluctant to implement policies that might be viewed negatively
by sources of foreign
direct investment or foreign sovereign bond investors (Labonte
et al. 2009, p. 118).
This tendency has been intensified with the onset of the global
financial crisis, as
rating agencies have become private actors whose embrace or
rejection of
government policies can have far-reaching consequences. Any
downgrading of a
country’s public (government) bond issues can dramatically
increase the cost of
borrowing in international markets. The higher interest rates
governments pay on
their bonds decrease revenues available for public service
spending and potentially
increase debt, risking a cycle of further bond-rating downgrades
and higher
borrowing costs.
21. Despite the conceptual challenge of connecting the macro-
structural phenomena
of globalization to individual health outcomes, a body of
scholarship has developed
that assesses the health equity implications of globalization. A
comprehensive
Critical Public Health 269
conceptual framework linking globalization to health equity was
presented by
Labonté and Schrecker (2007a, b, c) in their work funded
through the WHO
Globalization Knowledge Network of the CSDH. They propose
seven clusters of
pathways that link various aspects of globalization with SDH
and health equity:
trade liberalization, reorganization of labor markets, debt crises,
financial liberal-
ization, restructuring of cities, environmental impacts of
globalization, and market-
ization of health systems (Labonté and Schrecker 2007b).
Building on this
framework, the financial crisis could be considered a novel
health equity-relevant
pathway, which is linked to previous financial liberalization
efforts, and which
directly impacts the SDH and health equity through the channels
specified below.
22. The global financial crisis and health equity: direct channels of
influence
Economic decline and health budget cuts
The most direct link between financial crises and health equity
is the steep decline in
overall economic activity that financial crises induce. The
opportunity costs of
financial crises, understood in terms of lost or forgone output,
are much higher than
those for normal economic recessions (Gill and Bakker 2011),
as financial crises
produce more significant declines in overall economic activity
than ‘normal’
recessions (Reinhart and Rogoff 2009). This puts constraints on
the government’s
ability to maintain social spending, notably but not exclusively
in public health. The
International Monetary Fund (IMF) recently estimated that after
a financially
induced recession, output is about 10% below its previous trend
in the medium term,
which it defines as seven years (Gill and Bakker 2011). This
implies a deeper and
longer economic contraction with more pronounced challenges
to government
budgeting. Such a steep decline in economic activity leads to a
decline in the tax base
and associated cuts in government spending, as the crisis
23. response thus far has
focused on spending cuts and tax increases, mostly by way of
socially regressive taxes
(such as value added and sales taxes), which have the potential
to significantly
undermine SDH. However, if revenues from such taxes are used
to finance
universally accessible health and social programs, they can
function in a redistrib-
utive way; but not in the absence of progressivity in other tax
measures. At the same
time, previous experiences with the impact of financial crises
on health suggest that
health equity impacts can materialize more rapidly than during a
mild recession
(Marmot and Bell 2009).
A WHO commissioned study on the health policy response to
the financial crisis
provides a preliminary picture of how the crisis has affected
health care spending in a
wide range of European countries (Mladovsky et al. 2011).
Although the response
has varied across health systems in Europe, some of the findings
are disturbing and
suggest that health equity impacts of the financial crisis will not
only be felt widely
but will also likely persist over time in many countries. Several
countries reported
24. that steep health budget cuts, in some cases by over 20%,
including in Bulgaria,
Romania, the Czech Republic, Estonia, Ireland, Latvia, Spain,
and Portugal. The
most dramatic case is clearly Greece, where the hospital budget
has been cut by more
than 40%, while demand (partly due to the health hardships
induced by austerity
measures) increased by approximately 25% (Kentikelenis et al.
2011), leading to a
comeback of diseases such as HIV and malaria (Henlay 2012).
It increasingly looks
270 A. Ruckert and R. Labonté
like Greece will represent a blue-print for steep austerity
measure to come in other
parts of Europe, especially the Southern periphery.
Similarly, while most developing countries did not immediately
contract health
spending in response to the global financial crisis, by now, they
have started to follow
the path toward austerity. A comprehensive review of IMF
agreements with low-
income countries commissioned by UNICEF has fueled
criticisms of excessive
austerity in recent IMF programming with low-income
countries, especially
programs agreed upon since 2010 (Ortitz et al. 2011). Although
the IMF initially
showed some flexibility in its crisis response, and allowed
25. marginally higher fiscal
deficits than in past episodes of financial upheaval, by 2010 it
has been back on its
austerity path. The above-mentioned study found that most
governments initially
introduced small fiscal stimuli to buffer their populations from
the impacts of the
crisis during 2008–2009; but that expenditure contraction
became widespread
beginning in 2010 despite vulnerable populations’ urgent and
significant need of
public assistance. The scope of austerity is becoming severe and
widening quickly,
with 70 developing countries (or 55% of the study’s sample)
reducing total
expenditures by nearly 3% of GDP, on average, during 2010,
and 91 developing
countries (or more than 70% of the sample) expected to reduce
annual expenditures
in 2012. The biggest cuts are anticipated in North Africa, the
Middle East, and sub-
Saharan Africa. What is particularly disconcerting is that,
comparing the 2010–2012
and 2005–2007 periods, nearly one-quarter of developing
countries appear to be
undergoing excessive contraction, defined in the study as
cutting expenditures below
pre-crisis levels in terms of GDP (Ortiz et al. 2011, p. v).
In a World Bank analysis of global social spending trends since
the onset of the
financial crisis, Lewis and Verhoeven (2010) confirm that in
developing and
transition economies, social spending levels have declined in
aggregate terms, with
both education and health spending impacted equally. This is
26. not surprising as
developing countries generally display a proclivity toward
procyclical macro-
economic management, especially in the area of public
expenditures for health
(Calvo 2010). This is largely an outcome of the misguided
policy prescriptions and
conditionalities enforced by international financial institutions.
Lewis and
Verhoeven (2010) note that the impacts of the financial crisis
on social spending in
developing and transition economies ‘have generated concern
about continuity of
services when citizens need them most’ (p. 84). However, there
is a notable exception
to this decline as social spending has actually increased in Latin
America (Barcena
2012). Latin American economies have largely been able to
avoid having to rely on
IMF and World Bank lending in the aftermath of the global
financial crisis, which
partly explains the expansionary crisis response compared to
financially dependent
European and African countries.
Rise in unemployment
Another direct health equity pathway is the effect of the
financial crisis on
employment levels, which is itself an after-effect of the steep
decline in economic
output following the rapid (and still ongoing in many countries)
contraction of
credit. The relationship between employment and health
outcomes is well-
established. Employment and working conditions are the origin
27. of many SDH, as
work in its optimal form can provide financial security, social
status, self-esteem,
Critical Public Health 271
personal development, and many other health promoting
attributes (CSDH 2008,
p. 72). Being unemployed is directly associated with various
adverse health
outcomes, as unemployment has been associated with increased
self-harm, suicide,
decreased mental health status, and psycho-social stress (Moser
et al. 1986, Blakely
et al. 2003). Developed and particularly European countries
have seen the steepest
increase in unemployment levels, with some countries reaching
depression-like
unemployment rates exceeding 20%, while most low- and
middle-income economies
were hit less hard. Nevertheless, the International Labor
Organization (ILO 2011a)
has recently noted that unemployment globally has reached
unprecedented propor-
tions, with more than 200 million workers entering the reserve
28. army of unemployed
workers, putting global unemployment at the highest level on
record. In many
countries, a rise in the level of unemployment also has direct
repercussions on the
government’s ability to fund health care expenditure, especially
when government
revenue is generated through social insurance contributions.
Finally, the nature of
the relationship between job loss and health equity is straight-
forward: the health of
people who lose jobs and have poor employment prospects is
affected dispropor-
tionately compared with other population groups in society
(Marmot and Bell 2009,
Suhrcke and Stuckler 2010). Previous experiences with
economic recessions confirm
that the negative distribution of employment impacts is
concentrated amongst those
who are already socioeconomically deprived, and who are part
of ethnic, racial or
other socially disadvantaged minority groups (Blakely and
McLeod 2009,
Phua 2011).
29. Qualitative transformation of health systems
The global financial crisis is also putting pressure on
governments to qualitatively
transform the delivery channels within health systems, arguably
to enhance
efficiency. Such transformations, however, can risk
undermining health equity
goals. Improved efficiency can help reduce the severity of
budget cuts and thus allow
governments to maintain critical health services (WHO 2011).
For example, the
introduction of health technology assessments in several
countries and the
renegotiation of drug prices through public tendering, especially
for generic
medicines, have led to cost savings in a wide range of countries
around the world
(Mladovsky et al. 2011). However, certain qualitative
transformations of health
systems represent formidable challenges for health equity. For
example, several
countries have instituted user charges for specific health
services to address revenue
shortfalls in response to the global financial crisis, including
30. the Czech Republic,
Denmark, Estonia, Finland, France, Greece, Ireland, Latvia, the
Netherlands,
Portugal, Romania, and Turkey (Mladovsky et al. 2011, p. 20).
User charges are
widely known to have negative health equity effects, as low
income groups are
disproportionately affected by them (Gemmill et al. 2008). At
the same time, the
introduction of user charges is likely to worsen overall health
outcomes and can lead
to increased health spending in other areas, such as emergency
care. As the WHO
(2011, p. 34) notes, the poor and less educated population
groups are most likely to
make decisions in response to the introduction of user fees that
lead to delays in
seeking care, which may eventually result in higher costs for the
health system and
worse health outcomes for the individual.
272 A. Ruckert and R. Labonté
Indirect channels of influence
31. Reductions in welfare spending and programs
As is widely acknowledged, individual health, and especially
health equity, is not
solely affected by the prevailing levels of health spending. Two
recent studies have
found a direct link between welfare program expenditure and
health outcomes (e.g.
Stuckler et al. 2010, Bradley et al. 2011). Both studies show
that lower levels of social
expenditure in other areas than health are associated with
deteriorating population
health. Stuckler et al.’s (2010) statistical model demonstrates
that each additional
US$100 in welfare spending is associated with a 1.19% drop in
all cause mortality.
They conclude ‘that the maintenance of social welfare systems
seems to be a key
determinant of future population health’ (p. 77). Similarly,
Bradley et al. (2011)
argue that higher levels of social spending are associated with
improved overall
population health, as the ratio of social expenditure to health
expenditure may
influence health outcomes beyond that which results from health
spending alone.
This implies that cutbacks to welfare programs, even if health
spending is maintained
at pre-crisis levels, are likely to undermine population health.
Given the importance
of social programs for the most vulnerable populations,
cutbacks in social spending
will directly undermine health equity goals.
A recent analysis of the impact of the global financial crisis on
32. welfare spending
globally documents the pressure that the financial crisis has
been exerting over the
welfare state (Busch 2010). In Europe, cuts in services, as well
as tax and
contribution increases, are speeding up the process of
recommodification and state
retrenchment which has been under way for years. This process
is more extreme in
countries with high levels of public debt, such as Greece,
Ireland, and Portugal.
Nevertheless, even countries in a solid fiscal position, such as
Germany and Canada,
have started to further downsize the welfare state, generally by
freezing social
assistance rates. In the realm of pension policy, this rolling
back of the welfare state
finds expression in the introduction of the three-pillar model,
through the transition
from defined-benefit schemes to defined-contribution schemes,
cutbacks in pension
payments, and increases to the retirement age (Busch 2010, p.
7). As Busch (2010)
concludes, ‘reforms of the welfare state in the EU exhibit
considerable convergence
in the East and the West. Given the common objective and the
common socio-
political ideal-model (i.e., neoliberalism), this is not surprising’
(p. 8). A similar
tendency is noted in the revamping of unemployment insurance
schemes. In both
West and East Europe, entitlement conditions have been
tightened up, entitlement
periods cut and wage replacement ratios reduced. While most
developing countries
do not generally have comprehensive welfare states in place,
33. targeted transfer
schemes have come under pressure as well in the aftermath of
the global financial
crisis (Busch 2010, p. 9, Ortitz et al. 2011). Given the
precarious situation of people
relying on such transfers, any cutback will have direct health
consequences for the
most vulnerable populations in developing countries, further
undermining the
equitable delivery of health care.
Changes to aid flows
Another major concern related to the long-term health
consequences of the global
financial crisis is the impact that the crisis will have ODA flows
to low-income
countries. The fact that international assistance in health
already accounts for
Critical Public Health 273
roughly 50% of all public health expenditure in low-income
countries reveals how
crucial the role of international assistance has become
(Taskforce on Innovative
International Financing 2008). In the case of Rwanda, donor
funding represent
almost 100% of the total public health budget (Calvo 2010). In
the period 2008–
2010, overall donor funding in the form of ODA has not been
cut. Organization for
Economic Cooperation and Development (2011) notes that ODA
flows have
34. continued to rise in line with promises made by the
international community, with
aid flows from Development Assistance Committee donor
countries totaling USD
129 billion in 2010, an increase of 6.3% over 2009. However,
given a string of recent
announcements in a wide range of countries to cut back on
ODA, this trend is likely
to be reversed. Previous experiences with financial crises also
suggest that in
countries struggling with budget deficits ODA will likely
plateau and then decline as
countries start addressing large fiscal deficits (World Bank
2009). For example,
Canada just announced a 10% cut to its international assistance
envelope in order to
rein in its budget deficit.
At the same time, a preliminary estimate of health aid flows by
Leach-Kemon
et al. (2012) notes that while development assistance for health
continued to grow in
the aftermath of the financial crisis, growth has slowed down
significantly to around
4% from 2009 to 2011 (p. 228), compared to double digit
growth rates before the
financial crisis, with a growth rate of 17% between 2007 and
2008. Disconcertingly,
this limited growth in international assistance for health was
largely driven by the
World Bank’s increased disbursements to middle income
countries, while World
Bank health funding to low-income countries through the
International Development
Association actually decreased since the onset of the global
financial crisis (Leach-
35. Kemon et al. 2012, p. 231). From a health equity perspective,
this reallocation of
health funding away from low income to middle countries raises
significant concerns.
In addition, some multilateral disbursements have already been
negatively
affected by the global financial crisis, with a high-profile
victim: the Global Fund to
Fight AIDS, Tuberculosis, and Malaria. International donors
have started to
drastically reduce contributions to the Fund, despite a recent
infusion of $750 million
by Bill Gates. As a result, in November 2011, the Global Fund
announced that it
would make no new grants until 2014, in large part because of
depressed donations
attributed to the global financial crisis. More than 70% of life-
saving AIDS medicine
in the developing world, and about 85% of TB programs in
Africa, are financed by
the Global Fund (York 2011). Consequently, the cancelation of
the next round of
grants will negatively impact on tens of thousands of
impoverished people living with
HIV who depend on foreign financing for their medicine.
Finally, development
assistance for health from UN agencies has become stagnant.
Stagnation in UN
funding may pose a challenge to several health focus areas in
which these channels
play an important role, including the areas of maternal and child
health (the United
Nations provided 37% of total development assistance for health
for this area in
2009), noncommunicable diseases (25%), and tuberculosis
36. (16%; Leach-Kemon
et al. 2012, p. 232).
Labor market transformation
Another indirect pathway by which the global financial crisis
has already affected
health equity is through a qualitative transformation of the labor
market.
274 A. Ruckert and R. Labonté
Current policy responses to the global financial crisis
emphasize the importance of
‘modernizing’ labor markets, especially in developed economies
struggling with large
budget deficits. In most cases, this means a dismantling of the
protective measures
that have insulated workers from the vagaries of unregulated
labor markets. These
qualitative transformations of the labor market are not entirely
novel as even before
the financial crisis neoliberal reforms noticeably transformed
working conditions,
with deep implications for SDH (Labonté and Schrecker 2007b).
Increased
‘flexibility’ in the labor market has been a corner stone of
neoliberal globalization
which has lastingly transformed the global landscape for
workers (Vosko 2006). In
this context, flexibility can best be defined as ‘reducing the
constraints on the
movement of workers into and out of jobs previously
constrained by labour laws,
37. union agreements, training systems, or labour markets that
protect workers income
and job security’ (Hadden et al. 2007, p. 6). This flexibilization
resulted in an increase
in various contractual forms, such as temporary, part-time, and
self-employed work.
Previously, standard arrangements generally provided social
benefits, security,
modest income, and various other entitlements. However, the
standard employment
relationship is shifting, so that employers are reducing their
‘commitments’ and
entitlements offered to their workers. The responsibility and
costs for benefits such
as training, extended health care, and pensions are being shifted
away from
employees to workers, creating new burdens for them and their
families, and
undermining SDH in the process. Such changes are under way
in a wide range of
European countries, most prominently Greece, Spain, Italy, and
Portugal. Various
studies show that economic recessions, especially when they are
steep, tend to
exacerbate the deviation from the standard employment
relationship (Vosko 2006,
Perry et al. 2007). Workers in precarious arrangements often
share similar
characteristics with the unemployed, with some evidence
suggesting that chronic
job insecurity may be more damaging to health than actual job
loss. In fact,
dimensions which are typically, but not exclusively, related to
precarious work
arrangements, such as job insecurity, have long been linked to
38. adverse health
outcomes such as psychosocial morbidity (Ferrie et al. 2002,
Virtanen et al. 2005).
Studies suggest that workers that are involuntarily involved in
temporary work
contracts are at an increased risk for mortality (Natti et al.
2009), and that unsecure
employment relationships (where future employment is
unknown) are associated
with overall poorer health indicators.
Conclusion
It has been widely acknowledged that the global financial crisis
of 2008 will have
lasting effects on the health of populations (Horton 2009,
Labonté 2009, Marmot
and Bell 2009). These health effects, however, will not be felt
equally or even
similarly by different population segments, as different socio-
economic positions in
the societal hierarchy will lead to different health outcomes
(Blakey and McLeod
2009, Phua 2011). This article attempted to conceptually
sharpen our understanding
of the transmission channels by which the (ongoing) global
financial crisis will
undermine SDH and challenge health equity goals. We proposed
a number of direct
and indirect channels of influence by which the global financial
crisis has already
begun impacting health equity outcomes. Yet, it likely will take
some time until the
full impact of the crisis on health equity can be
comprehensively assessed, especially
39. Critical Public Health 275
in relation to the indirect channels of influence. In this context,
it is important to
highlight that the most challenging years are still ahead. In
many countries, the initial
response to the financial crisis was counter-cyclical and
expansionary, as few
countries engaged in cutbacks to health budgets and welfare
programs in the
immediate aftermath of the crisis. However, the current
ideological climate of
austerity will make it more likely that further cuts to health and
other social
expenditure will be enacted. This can already be seen in a wide
range of European
countries that have started to make draconian cuts to health and
welfare budgets
(Houston et al. 2011, Mladovsky et al. 2011). But even fiscally
sound countries, such
as Canada, have recently started to wield the axe to cut
government programs in
order to close budget deficits. If access to health and other
social services continues
to decrease, this will more strongly affect those that rely on
40. such services for
maintaining their basic health, i.e., groups within society living
in vulnerable
conditions.
However, there are alternatives to the currently hegemonic
neoliberal austerity
agenda as cracks in its consensus are already appearing. As can
be observed in
Greece, deep cutbacks in government spending can actually be
self-defeating as
budget deficits are likely to remain large due to the economic
decline and associated
revenue contraction that are the logical outcomes of austerity
measures. In
contradistinction to the austerity agenda, the global financial
crisis could be seen
as an opportunity to reinforce commitments to equity,
solidarity, and protection
(WHO 2011); this would require a significant redistribution of
power and wealth, for
example, through more progressive systems of taxation that
would ensure that those
at the top of the income spectrum, currently benefiting from
generous bail-outs of
the banking system, at least contribute a fair share to burden-
sharing within society.
Alternate agendas (e.g. enhanced social protection, expanded
41. universal social
protection, new systems of global taxation) are all part of global
discourse at the
moment (e.g. ILO 2011b), if not yet with the national political
or financial institution
traction needed to move from page to policy. Assuming they do,
even if only because
states will need to accommodate such demands to alleviate
increased domestic strife,
there may still need to be some budgetary cuts in the near- to
mid-term. If budget
cuts in certain areas turn out to be unavoidable, health equity
impact assessments
should be given a priority to determine how cuts can be
implemented in such a
manner that health equity will not be undermined further in the
policy response to
the global financial crisis.
Acknowledgments
Arne Ruckert was supported in this study through the Emerging
Researcher Award by the
Population Health Improvement Research Network (PHIRN),
funded through the Ministry
of Health and Long-Term Care, Province of Ontario. Ronald
Labonté is supported through
the Canada Research Chair Program of the Government of
Canada.
42. Note
1. Policy space can be defined as the freedom, scope, and
mechanisms governments have to
choose, design, and implement public policies to fulfill their
aims (Koivusalo et al. 2008).
276 A. Ruckert and R. Labonté
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Attention to Local Health Burden and the Global
Disparity of Health Research
James A. Evans1*, Jae-Mahn Shim2, John P. A. Ioannidis3
52. 1 Department of Sociology, Computation Institute and Center
for Health and the Social Sciences, University of Chicago,
Chicago, Illinois, United States of America,
2 Department of Sociology, University of Seoul, Seoul, Korea,
3 Departments of Medicine, Health Research and Policy, and
Statistics, Stanford Prevention Research Center,
Stanford University, Stanford, California, United States of
America
Abstract
Most studies on global health inequality consider unequal health
care and socio-economic conditions but neglect inequality
in the production of health knowledge relevant to addressing
disease burden. We demonstrate this inequality and identify
likely causes. Using disability-adjusted life years (DALYs) for
111 prominent medical conditions, assessed globally and
nationally by the World Health Organization, we linked DALYs
with MEDLINE articles for each condition to assess the
influence of DALY-based global disease burden, compared to
the global market for treatment, on the production of relevant
MEDLINE articles, systematic reviews, clinical trials and
research using animal models vs. humans. We then explored
how
DALYs, wealth, and the production of research within countries
correlate with this global pattern. We show that global
DALYs for each condition had a small, significant negative
relationship with the production of each type of MEDLINE
articles
for that condition. Local processes of health research appear to
be behind this. Clinical trials and animal studies but not
systematic reviews produced within countries were strongly
guided by local DALYs. More and less developed countries had
53. very different disease profiles and rich countries publish much
more than poor countries. Accordingly, conditions common
to developed countries garnered more clinical research than
those common to less developed countries. Many of the health
needs in less developed countries do not attract attention among
developed country researchers who produce the vast
majority of global health knowledge—including clinical trials—
in response to their own local needs. This raises concern
about the amount of knowledge relevant to poor populations
deficient in their own research infrastructure. We recommend
measures to address this critical dimension of global health
inequality.
Citation: Evans JA, Shim J-M, Ioannidis JPA (2014) Attention
to Local Health Burden and the Global Disparity of Health
Research. PLoS ONE 9(4): e90147.
doi:10.1371/journal.pone.0090147
Editor: Mohammed Shamji, Toronto Western Hospital, Canada
Received January 2, 2014; Accepted January 29, 2014;
Published April 1, 2014
Copyright: � 2014 Evans et al. This is an open-access article
distributed under the terms of the Creative Commons
Attribution License, which permits
unrestricted use, distribution, and reproduction in any medium,
provided the original author and source are credited.
Funding: This study was funded by a health and health policy
research for disadvantaged populations seed grant, Center for
Health Administration, and by a
Research Opportunity Seed grant, both from the University of
Chicago. The funders had no role in study design, data
collection and analysis, decision to publish,
or preparation of the manuscript.
54. Competing Interests: The authors have declared that no
competing interests exist.
* E-mail: [email protected]
Introduction
Poor and minority persons, as well as those living in resource
restricted regions, are more likely to live shorter, less healthy
lives
[1,2,3]. A long tradition in medicine has sought to reduce these
inequities and realize universal, global health through socio-
economic development, improved public health measures and
affordable health care [4,5,6,7]. Despite successes, there remain
concerns about the relevance and effectiveness of these efforts
for
disadvantaged populations. Target populations are sometimes
resistant and non-adherent to medical intervention. This has
inspired educational projects to enhance the public
understanding
of medicine [8,9] and practitioner understanding of diverse
patient
cultures.
Doubts persist, however, about whether we produce sufficient
55. medical knowledge to provide medical care for certain
conditions
in certain contexts [10,11,12,13]. Counter-intuitive findings
about
emergency care for African children suffering from malaria,
septicemia, meningitis and similar infectious diseases suggest
that
we know much less about diagnosis and treatment for poor
populations [14,15,16]. Moreover, effective therapies for
pandem-
ics such as HIV can create unforeseen knowledge needs like
how
to provide long-term medical care among HIV survivors
[17,18].
Here we examine whether the global research community has
given sufficient attention to medical conditions prevailing in
globally disadvantaged populations. We demonstrate how this
concern follows from the misalignment of global disease burden
and global research attention. Specifically, we reveal the global
inequality of health research by estimating the relationship
between the health burden imposed by many important diseases
56. and subsequent publication of biomedical articles relevant to
those
diseases. We also explore possible causes for this inequality of
health research.
Our findings highlight how poor populations not only face the
greatest burden from disease and disability, but that burden is
given the least medical research attention. We show that this
global inequality of health research follows from two processes.
First, medical research activities are guided by local health
needs
specific to each country rather than global health needs, and
health needs vary greatly across rich and poor populations.
Second, as medical research requires resources, a few developed
countries disproportionately produce the vast majority of
biomed-
ical research. As a result, global research attention to diseases
PLOS ONE | www.plosone.org 1 April 2014 | Volume 9 | Issue
4 | e90147
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http://crossmark.crossref.org/dialog/?doi=10.1371/journal.pone.
0090147&domain=pdf
57. tracks the global market for treatment and the ability of patients
to
pay for care. This has resulted in the current global inequality
of
health research. To reduce this inequality of research, our
analysis
recommends efforts that not only globalize the research
attention
of wealthy countries [19], but also support local research in
those
impoverished contexts where health knowledge is needed most.
Materials and Methods
Study Design and Key Measures
We assessed the total number of biomedical articles and also the
specific number of systematic reviews, randomized controlled
trials
and animal research relevant to a wide range of specific
diseases
and disabilities, and then explored how much of these
distributions
could be explained by 1) the global health burden imposed by
these conditions, 2) the global market for medical treatment,
58. and
3) the local health burden. We investigated these relationships
further by assessing differences in the health profiles of
developed
and less developed countries, and by measuring the association
between a country’s GDP and its production of biomedical
science.
To measure the amount of disease-specific biomedical research,
we used the total number of articles published on each disease
in
MEDLINE. We also calculated the precise number of systematic
reviews, randomized controlled trials, and research performed
on animal
subjects devoted to those same conditions. Each abstract in
MEDLINE is indexed with NLM Medical Subject Headings
(MeSH) [20,21]. We defined MEDLINE papers as relevant to
one
or more diseases if annotated with related MeSH clinical and
disease terms. We assessed this for each country by linking
MEDLINE with Thomson Reuters’ Web of Science, which
59. provides full institutional information for most MEDLINE
articles.
We then coded the countries of the institutions that hosted each
article author. See File S1 for details.
Number of total research articles is a reasonable indicator of
health research, but an imperfect proxy for biomedical
knowledge
more generally: some diseases are harder to understand,
prevent,
diagnose, and treat than others. For this reason, we also
assessed
the number of different types of articles: systematic reviews,
randomized controlled clinical trials, and animal subjects
research
associated with each disease. The number of systematic reviews
indicates that the biomedical community deems research on a
disease of sufficient size, and relevance that it merits secondary
evaluation and organization. The number of clinical trials is a
marker of organized research assessing the merits of
interventions
for a condition across many patients in one or multiple centers.
60. Finally, the number of research papers performed on animals
suggests an interest at fundamental aspects of each disease.
It should be noted that medical science can possess deep
knowledge of a disease that continues to cause harm because
that
knowledge has not yet disseminated to places where it is needed
most. Nevertheless, recent studies that demonstrate our limited
knowledge about treatment in resource poor environments [22]
suggest that even for diseases about which we have extensive
biological understanding, additional research into their distribu-
tion, acquisition, prevention and treatment among different
populations and in different contexts would likely produce
further,
much needed medical insight. Following this, we believe that
number of total articles provides a useful purchase on relevant
health knowledge as those articles cover the range of health
research, taking biological but also behavioral, social,
economic,
political and cultural factors into account, as many do here.
Number of systematic reviews, randomized control clinical
61. trials,
and disease-relevant research performed on animal models
provide more fine-grained insight about the relationship
between
health burden, research and treatment.
We used World Health Organization (WHO) data to measure
the burden of disease. The WHO introduced global and regional,
but
not country-level, estimates of the disability-adjusted life years
(DALYs) for an array of common conditions through its Global
Burden of Disease (GBD) project in 1990 [23]. In 2002 and
2004,
the WHO re-estimated DALYs for 192 countries as well as
globally [24]. One DALY refers to one healthy life year lost to
disease or disability. By converting time spent in various states
of
health to their ‘‘healthy-year equivalents,’’ [25] DALYs
incorpo-
rate cultural values placed on different aspects of physical,
mental
and social function [26]. The WHO estimates DALYs for 136
62. health conditions. We used 111 of the 136 conditions in our
analysis, excluding residual categories like ‘‘other infectious
diseases.’’ GBD codes for these conditions are organized into
19
categories, and 3 high-level classifications (see Table S1 in File
S1
for all codes).
We matched GBD codes to MeSH terms through the mediation
of ICD-9 (International Statistical Classification of Diseases
and
Related Health Problems) codes. ICD-9 codes are sufficiently
general that we mapped them onto GBD codes with very little
ambiguity. We then linked ICD-9 codes to MeSH through
NLM’s
Unified Medical Language System (UMLS) metathesaurus.
Following this approach, we regrouped MeSH disease terms
according to the 111 GBD codes and so estimated the number of
articles in MEDLINE relevant to a particular disease category
(see
File S1 for alternate linkages).
We measured the global market for treatment associated with
63. each
disease. First, we multiplied the number of disability-adjusted
life
years (DALYs) for each disease in each country by gross
national
income per capita (GNI) at purchasing power parity (PPP) in
that
country. This product equals the value of the revenue that could
be generated if everyone afflicted by the condition in question
was
restored to full health, or the size of a national market for
treatment, if people in that country were willing to spend all
money that could be gained from health on health. With the
same
disease profile, different countries have different markets,
depend-
ing on their GNI. We used the World Bank’s World
Development
Indicators for GNI (PPP) data for each country [27]. By
summing
all national markets for treatment for a given condition, we
computed the global market for treatment for that condition.
The
64. global market for a condition common in developed countries is
much greater than the market for a condition prevalent only
among less developed countries.
Statistical Analysis
We used regression-based analyses to estimate the association
between the burden of disease and the market for treatment on
the
quantity of medical research produced. Counts for each type of
disease-relevant article are not normally distributed: they are
discrete and widely skewed with a few diseases like breast
cancer
and AIDS attracting a disproportionate share of research
attention
while others like Chagas disease and leishmaniasis attracting
little
[19]. This recommended the use of negative binomial regression
models.
First, we analyzed the relationship between the global burden of
disease for 111 diseases and disabilities in one year (2002 and
2004) and the global number of articles published relevant to
those
65. conditions in the subsequent year. We subsequently analyzed
the
relationship of the market for treatment on the quantity of
subsequently published science. This analysis involved
4,703,021
disease and disability assignments to 3,771,604 distinct articles.
Local Health Burden and Global Research Disparity
PLOS ONE | www.plosone.org 2 April 2014 | Volume 9 | Issue
4 | e90147
Our next analysis evaluated the correlation of burden of disease
within countries on the number of subsequently published
medical
articles, systematic reviews, randomized-controlled clinical
trials,
and animal model studies relevant to each disease by
researchers
from those countries. We estimated these models with data from
the 167 countries for which total article information was
complete
and 155 countries for which information about systematic
reviews,
66. randomized-controlled clinical trials and animal models studies
was complete.
Finally, we explored the relationship between poverty, disease
and disease-relevant science revealed by our regression
analyses.
We examined the difference in disease distribution between
developed and less developed countries by calculating the
relative
burden of disease for each country and then graphing and
modeling its relationship with that country’s gross domestic
product (GDP). We also assessed the relationship between
wealth
and the amount of research published by researchers in each
country.
Results
Our world-level analysis reveals that the global burden of
disease accounts for none of the distribution of total health
research
or the controlled trials published in the subsequent year (see
Table 1). For randomized controlled trials and animal model
67. studies, more global need is actually associated with less global
research. Systematic reviews responds positively to global
DALYs,
but only when the 19 broad disease and disability categories are
statistically controlled for. Figure 1 summarizes the alignment
of
health burden with health research, as grouped by broad disease
and disability category. This illustrates how malignant
neoplasms
(cancers), endocrine disorders (including diabetes), and skin
diseases are overrepresented in biomedical research, dispropor-
tionate to the global health burden they exact. In contrast,
infectious parasitic disorders, respiratory infections and
perinatal
conditions are underrepresented in the research relative to their
burden.
In contrast, the global market for treatment significantly
impacts
health research. Table 1 shows that for every $10 billion lost to
a
disease or disability, which might have been put toward care,
68. biomedical articles of all types of controlled trials devoted to
that
disease increased by approximately 3–5% in the subsequent
year,
controlling for health burden. Randomized control trials, which
are most expensive and closest to marketable health products,
increase most—by 5.2% the following year. These statistical
relationships between the number of articles of various types,
the
burden of disease, and the global market for treatment persist
when we controlled for the total cumulative number of articles
relevant to each condition and the proportion of those articles
published in the prior five years, but they attenuate when we
include indicator variables for 19 coarse disease and disability
categories. This means that much of the positive effect of
market
size on published research is attributable to different categories
of
disease, which are associated with larger and smaller markets.
These patterns remained unchanged in a supplementary analysis
69. using global DALY data from 1990 and 2004 (eTable 2). In this
analysis, disease burden remains insignificant, but growth in
market size (by $10 billion) leads to an increase of relevant
articles
by more than 10%, which attenuates when controlling for
disease
categories. These results together show that diseases prevailing
in
poor populations are given less overall research attention than
those common in wealthy populations. Although market forces
appear to be implicated in the publication of research articles of
all
types, in the following analyses we show how they are likely
not the
root cause of unequal health knowledge, but themselves a
consequence of global health and wealth inequality.
Our next analysis shows that within countries, disease burden
has a strong, significant association with many forms of health
research. For each 10 million DALYs lost to a disease within a
country, the number of articles published by researchers in that
country increased by 73.9% (see Table 2). The effect of local
70. burden is highest for randomized controlled clinical trials,
where a
million DALYs lost to a disease results in 367.9% more such
trials
in that year. Only the number of systematic reviews on a disease
do not vary significantly with recent DALYs lost to that disease
within country. Interestingly, systematic reviews do not respond
more to the amount of previous national or global research than
other kinds of research.
Global burden of disease has a small, independent association
with the publication of all research articles within countries,
and
with review articles and all clinical research when controlling
for
broad disease categories. This suggests that whether or not
researchers and funding agencies factor global health needs into
their research, the influence of local needs exerts much more
influence on their work. Alternative specifications of country-
authorship produced the same pattern of results (i.e., all
countries
71. with participating authors are assigned the article versus only
the
wealthiest country, which restricts the measure to indigenous
research; see File S1.
In order to reconcile the presence of a national association
between health burden and health research with the absence of a
global one, we explored how disease profiles and health
research
are correlated with national wealth.
Figure 2 illustrates the striking difference in disease profiles
among populations of rich and poor countries. These are evident
at the level of coarse disease classifications, but the differences
are
much larger at the level of individual conditions (see Table S3
and
Figure S1 in File S1). For example, consider the relative burden
of
infectious and malignant neoplasms (cancers) in rich and poor
countries. Infectious diseases like diarrheal diseases, malaria
and
HIV naturally levy a much higher toll in less developed
countries,
72. while cancers incur a larger burden in more developed countries
with longer life spans. Respiratory infections, perinatal
conditions
and injuries disproportionately afflict less developed countries,
while neuro-psychiatric conditions like depression and
schizophre-
nia and musculoskeletal diseases like arthritis and back pain
represent a greater burden in wealthy countries. Note the
conditions that most afflict poor populations only lightly affect
the rich (e.g., infectious diseases, respiratory infections,
perinatal
conditions), while diseases that most afflict rich populations
also
levy a substantial toll on poor ones (e.g., cancers, neuro-
psychiatric
and musculoskeletal disorders). Figure 2 also shows the
regional
dispersion of these health burden differences. The world’s least
developed countries are located in Africa, and to a lesser extent
South Asia and South America: so also disease burden clusters
regionally, largely correlated with country wealth.
73. There are, however, striking disparities among countries in the
capacity to produce health research. Figure 3 plots the
relationship
between country wealth and the publication of biomedical
research. This figure illustrates how wealthy countries publish
much more biomedical research than less wealthy countries.
National disparities in research are not surprising, as biomedical
research requires substantial resources. Nevertheless, combined
with the responsiveness to local health needs demonstrated
previously, research disparities result in the overrepresentation
of
conditions burdening developed countries and the
underrepresen-
tation of those afflicting less developed countries in the
research
literature. The inequality of research limits current quality of
care
Local Health Burden and Global Research Disparity
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4 | e90147
74. Figure 1. 2004 global disability-adjusted life years (DALYs)
and 2005 research articles categorized by 19 broad WHO
disease and
disability categories. This correspondence suggests the loose
relationship between burden of disease and health knowledge
(see Figure S1 in File
S1 for the distribution of different types of articles by disease).
doi:10.1371/journal.pone.0090147.g001
Table 1. Estimated Association of Global Biomedical Articles
with Global Health Burden (2002, 2004)
a
.
Model 1: All research articles % change 95% C.I. % change
95% C.I. % change 95% C.I.
Global DALYs (10 millions) 25.1 210.7–1.0 23.9 29.3–1.7 3.3
23.1–10.2
Market size ($10 billions) 3.6** 2.2–5.0 3.0** 1.6–4.4 1.3
{
20.1–2.8
Cumulative Global articles (10
thousands)
3.0** 2.2–3.8 10.3** 7.0–13.6
Model 2: Systematic reviews
Global DALYs (10 millions) 20.9 210.3–9.4 0.8 28.6–10.2 11.6
{
75. 21.8–25.1
Market size ($10 billions) 2.7** 0.8–4.6 2.0* 0.1–3.9 0.4 21.8–
2.7
Cumulative Global articles (10
thousands)
23.5** 14.0–33.8 12.5** 5.5–19.9
Model 3: Clinical trials
Global DALYs (10 millions) 211.2* 220.9–20.3 27.1 213.1–8.1
6.6 26.0–20.9
Market size ($10 billions) 5.2** 2.5–7.9 3.2* 21.6–3.0 1.1
21.5–3.8
Cumulative Global articles (10
thousands)
561.8** 275.8–1065.7 341.2** 142.2–703.6
Model 4: Animal subjects
Global DALYs (10 millions) 28.0{ 215.8–0.5 24.7 214.0–3.6
1.1 27.4–10.2
Market size ($10 billions) 3.8** 1.1–6.5 1.9
{
20.4–3.0 1.0 21.3–3.3
Cumulative Global articles (10
thousands)
76. 35.9** 26.7–45.8 29.1** 19.1–39.9
Controlling for disease
`
a
Models in 1A contain 222 cases (111 diseases in 2002 and
2004).
`Models control for the 19 broad disease/disability categories
listed in Figure 2 (including the 2 in the footnote).
{
p ,.10;
* p ,.05;
** p ,.01
doi:10.1371/journal.pone.0090147.t001
Local Health Burden and Global Research Disparity
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4 | e90147
in less developed countries, but it also limits the next
generation of
care there, as the science and technology that could be
transferred
to developing countries are less relevant to their most pressing
health needs.
Discussion
77. Our analysis demonstrates that the production of health
research in the world correlates with the market for treatment
and not the burden of disease. While we expected to find a weak
relationship between global health and medical research, we
find
no relationship. One prior study that found a modest correlation
between the amount of systematic review papers and global
burden of disease [11], our research reveals the fragile nature of
this relationship. Clinical trails and case reports have no
relationship to global burden, and systematic reviews only post
a
small influence when disease categories are held constant. This
means that existing global health research is less relevant to the
needs of poor populations.
More importantly, we show how this global pattern is related to
the local processes of health research: 1) local health needs
within a
country draw the attention of researchers and research resources
of the country more than global health needs [13,19], 2)
developed
78. countries and less developed countries have divergent health
profiles, and 3) developed countries produce much more health
research of all kinds than less developed countries [10]. In
short,
health needs from less developed countries do not attract much
attention among rich country researchers. Ultimately, this
article
stresses that poor populations are in double jeopardy: they
experience the greatest health burdens but their diseases have
been studied least and even researchers from wealthy countries
often lack secure knowledge for context-relevant treatments.
Systematic reviews, which are not driven by local needs, attend
to research slightly more relevant to global health needs, but
this
correction is very small.
These findings have relevance for international development
and health policy. The primary focus of international health
efforts
has been to extend health care innovations from developed
countries to less developed and comparatively less healthy
79. countries. This is good policy: as we demonstrate, conditions
that
incur the highest health burden in wealthy countries like cancers
and musculoskeletal disorders are relevant also to poor
countries.
They are, however, not the most burdensome health challenges
for
those countries. Even global health initiatives, which often
target
specific diseases relevant to less developed countries and have
succeeded in reducing some health inequities, are not always
sufficiently aligned with country priorities or countries’
burdens of
disease [28,29].
Others argue that the biggest health challenges are the result of
inferior environmental contexts (e.g., increased air and water
pollution or sanitation), and so efforts to reduce global health
inequity should focus on economic development and public
health.
This position is not unreasonable, but understates the possibility
that we lack appropriate knowledge to intervene in
impoverished
80. environments or those simply different from rich countries. For
example, recent research demonstrates that child hydration, a
long-promoted emergency care measure for children suffering
from infectious disease in resource poor sub-Saharan Africa
Table 2. Estimated Association of National Biomedical Articles
with National Health Burden (2002, 2004)a.
Model 1: All research articles % change 95% C.I. % change
95% C.I. % change 95% C.I.
National DALYs (10 millions) 73.9** 17.4–130.5 72.4** 18.0–
126.7 68.4** 15.1–121.7
Global DALYs (10 millions) 1.0* 20.9–2.8 0.7** 21.1–2.5
5.0** 3.0–7.0
Cumulative National articles (thousands) 1.1** 0.8–1.3 1.2**
1.0–1.4
Cumulative Global articles (thousands) 0.3** 0.2–0.3 0.3**
0.2–0.3
Model 2: Systematic reviews
National DALYs (10 millions) 27.4 241.6–96.4 23.9 241.4–89.2
23.5 241.7–88.7
Global DALYs (10 millions) 0.2 23.0–3.4 20.1 23.2–3.0 7.5**
3.9–11.1
Cumulative National articles (thousands) 7.3** 5.0–9.5 8.9**
81. 6.6–11.2
Cumulative Global articles (thousands) 2.5** 2.0–2.9 1.7**
1.1–2.3
Model 3: Clinical trials
National DALYs (10 millions) 367.9** 92.3–1038.6 297.6**
80.8–774.6 285.6** 81.7–718.3
Global DALYs (10 millions) 3.1
{
20.1–6.3 1.9 21.1–4.9 7.9** 4.5–11.5
Cumulative National articles (thousands) 57.7** 41.7–75.5
73.9** 56.0–93.8
Cumulative Global articles (thousands) 26.9** 23.2–30.7 16.9**
11.9–22.0
Model 4: Animal subjects
National DALYs (10 millions) 90.8** 242.5–90.4 87.1** 20.3–
190.9 81.1** 17.0–180.3
Global DALYs (10 millions) 0.6 22.9–3.4 0.4 21.8–2.6 1.4
21.1–3.9
Cumulative National articles (thousands) 10.7** 9.3–12.2
11.1** 9.6–12.5
Cumulative Global articles (thousands) 1.4** 1.1–1.7 1.2**
0.7–1.6
Controlling for disease`
82. a
Models in 2B contain 8102 cases (up to 111 diseases and 192
countries in 2002 and/or 2004).
`Models control for the 19 broad disease/disability categories
listed in Figure 2 (including the 2 in the footnote).
{
p,.10;
* p,.05;
** p,.01.
doi:10.1371/journal.pone.0090147.t002
Local Health Burden and Global Research Disparity
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4 | e90147
Figure 2. Broad disease categories, the global DALYs they
exact, and the relationship between country health burden and
wealth
for broad disease categories. Disease subcategories (e.g.,
HIV/AIDS) are listed in order from those that incur the largest
global health burden.
Scatter plots graph country DALY rate (DALYs per 1000
people) of conditions by GDP per capita, plotted on a log scale;
slopes represent this as a
linear relationship (the estimated OLS coefficient of logged
GDP per capita regressed on logged DALY rate). The global
map illustrates country
differences in disease burden by plotting the difference between
DALY rate for infectious diseases and cancers, categories with
the most negative
and positive relationship with country wealth.
83. doi:10.1371/journal.pone.0090147.g002
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4 | e90147
increases short-term mortality [22]. One conclusion voiced by
Ugandan doctor Peter Oluput-Oluput is that ‘‘we need to do
more
research in Africa for Africans.’’ [30] This suggests the
importance
of transferring not only health technology like tertiary care
facilities to the least developed countries, but also helping to
transfer health research technology to impoverished locations
with
health burdens that differ most from wealthy countries. These
recommendations do not presume what less developed countries
should want or how they should spend their limited resources
and
balance urgent with long-term health needs. Neither do they
address the material inequalities that lie behind inequality in
both
84. health and health knowledge. Our research simply highlights the
potential impact of more health research relevant to the needs of
the poorest populations.
Not only environmental but the biological context of disease is
likely to be different in less developed countries. Research
suggesting that treatment for some cancers may be less effective
in certain U.S. minority populations suggests that current
therapies may have been ‘‘overfit’’ to a biased sample of genes
and bodies [31]. A growing collection of related findings have
been
framed as evidence that biological factors play a role in health
disparities [32,33,34,35,36], but they also implicate the
differential
relevance of health knowledge produced by biomedical research
for the health of different groups [37]. In short, the same care
may
not always be equal. In this way, the inequality of biomedical
research that our analysis demonstrates likely understates its
true
inequality.
85. By estimating the particular inequality of health conditions in
relation to national wealth (see Figure S1 in File S1), our study
highlights those most likely to be underserved given the
national
focus and global inequality of research funding. For example,
malaria, tetanus, Chagas disease, measles, Vitamin A
deficiency,
lymphatic filariasis, schistosomiasis, and diphtheria most
dispro-
portionately afflict poor populations. Other conditions also
inflict a
greater burden in less developed countries, including fires,
violence, drowning, and poisoning, as also glaucoma, peptic
ulcers
and ear infections.
Our study has several limitations. The national-level burden of
disease data are only for two years, two years apart, which does
not provide sufficient change to isolate a causal effect of health
burden on research (see File S1). The lag between burden of
disease and disease-relevant publication may also not be long
enough to demonstrate the total influence—we had only one
86. year
of subsequent citation data available to us. Moreover, we did
not
have data on the economic value of diseases within countries,
and
so we were unable to explore to what degree the same dynamic
that occurs across countries occurs inside them. Finally, we
neglect
several other institutions that likely influence health research,
independent of global health needs. These include national
funding priorities, activism in disease communities, the
scientific
maturity or generality of research on some disorders over
others,
etc. Nevertheless, we believe that our analysis sheds light on
the
global inequality of health research and suggests that attention
to
local disease is likely a primary influence. To address global
health
Figure 3. Relationship between the national GDP per capita in
2004 and the quantity of research published by researchers in
2005,
by country, plotted on a logarithmic scale (to spread out