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The article explores how the COVID-19 pandemic revived discussions on the importance of local pharmaceutical production for promoting health security and resilient health systems. It examines the World Health Organization's hub and spoke mRNA vaccine production model (mRNA hub), a global initiative that aims to establish sustainable, local mRNA manufacturing capabilities in low- and middle-income countries in response to the inequities in access to COVID-19 vaccines and the trade disruptions during the pandemic. Using the mRNA hub as case study, the paper discusses how the tectonic shift towards local production implicates supply and license agreements, and thus IPRs. The paper maps the intellectual property challenges that might impact the mRNA hub's sustainability and provides recommendations on how to enhance the initiative's chances of success and foster a more equitable pharmaceutical sector in the future.
Conventional benefit–cost analysis is well-established and widely used to assess interventions designed to improve public health and welfare. While it has many advantages, it has well-known limitations. Chief among these is its inattention to the distributional equity of the impacts. To measure individual well-being, the conventional approach relies on individuals’ willingness to exchange their own income for the outcomes they experience. To measure societal welfare, it relies on simple aggregation of these values across individuals. This approach reflects a relatively narrow conception of welfare and ignores how impacts are distributed across advantaged and disadvantaged individuals. Social welfare analysis has been proposed as an alternative approach to address these limitations, but real-world applications are rare due largely to the complexity of the calculations. This article provides a pragmatic approach for conducting equity-sensitive benefit–cost analysis globally that addresses data limitations and other challenges, illustrated with example applications. It formally develops and implements equity weights that adjust for the decreasing marginal value of money and for additional moral considerations, prioritizing increases in welfare for those who are worse off.
In response to our critics, we clarify and defend key ideas in the report Open and Inclusive: Fair Processes for Financing Universal Health Coverage. First, we argue that procedural fairness has greater value than Dan Hausman allows. Second, we argue that the Report aligns with John Kinuthia's view that a knowledgeable public and a capable civil society, alongside good facilitation, are important for effective public deliberation. Moreover, we agree with Kinuthia that the Report's framework for procedural fairness applies not merely within the health sector, but also to the wider budget process. Third, we argue that while Dheepa Rajan and Benjamin Rouffy-Ly are right that robust processes for equal participation are often central to a fair process, sometimes improvements in other aspects of procedural fairness, such as transparency, can take priority over strengthening participation. Fourth, while we welcome Sara Bennett and Maria Merritt's fascinating use of the Report's principles of procedural fairness to assess the US President's Emergency Plan for AIDS Relief, we argue that their application of the Report's principle of equality to development partners' decision-making requires further justification.
Several concepts are introduced and defined: measurement invariance, structural bias, weak measurement invariance, strong factorial invariance, and strict factorial invariance. It is shown that factorial invariance has implications for (weak) measurement invariance. Definitions of fairness in employment/admissions testing and salary equity are provided and it is argued that strict factorial invariance is required for fairness/equity to exist. Implications for item and test bias are developed and it is argued that item or test bias probably depends on the existence of latent variables that are irrelevant to the primary goal of test constructers.
The relevance of education and outreach (E&O) activities about the Antarctic Treaty has been recognized at the Antarctic Treaty Consultative Meetings (ATCM) and at the Committee for Environmental Protection (CEP). This study examines the key topics and the target audiences detailed in papers submitted to the ATCM on E&O. Since the Antarctic Treaty entered into force in 1961, a total of 216 ATCM papers on E&O have been produced. The number of papers has increased substantially since the mid-1990s. ‘Science’ (76.9%) and ‘Wildlife/Biodiversity/Environment’ (75.5%) were the most addressed topics in these papers, while the ‘Public’ (81.0%) and those attending ‘Schools’ (69.0%) are the main target audiences. ‘Science’ in ATCM papers increased ~120-fold from 1961–1997 to 2015–2023, while ATCM papers discussing engagement with the ‘Public’ increased ~40-fold during the same period. ‘Climate change’ was first mentioned in 2006, and the number of papers per year increased fourfold by 2015–2023. This study shows the increasing interest in E&O through time, addressing key topics to relevant audiences related to the Antarctic region. From an educational perspective, attention should be paid to emerging topics (e.g. equity, diversity and inclusion), and the engagement of early-career professionals and educators should be made a priority.
Participant representation, including the Good Participatory Practice guidelines, in the design and execution of clinical research can profoundly affect research structure and process. Early in the COVID-19 pandemic, an online registry called the Healthcare Worker Exposure Response and Outcomes (HERO) Registry, was launched to capture the experiences of healthcare workers (HCWs) on the pandemic frontlines. It evolved into a program that distributed COVID-19-related information and connected participants with COVID-19-related research opportunities. Furthermore, a subcommittee of HCWs was created to inform the COVID-19-related clinical research, engagement, and communication efforts. This paper, coauthored by the HERO HCW subcommittee, describes how it was formed, the impact of community participation on the HERO Registry and Research Program, reflections on lessons learned, and implications for future research. Engagement of the HCW Subcommittee resulted in representing their lived experience and ensured that their perspectives as HCWs were incorporated into the HERO Research. The strategies not only supported recruitment and retention efforts but also influenced the HERO research team in framing research questions and data collection pertinent to the participant community. This experience demonstrated the importance of having participants’ input as expert advisors to an investigative team in their research efforts during a global health emergency.
Edited by
Daniel Benoliel, University of Haifa, Israel,Peter K. Yu, Texas A & M University School of Law,Francis Gurry, World Intellectual Property Organization,Keun Lee, Seoul National University
This chapter explores the impact of intellectual property on increasing income and wealth inequality internationally and domestically, with a focus on law and legal methodology. It begins by setting the scene and background of international intellectual property protection. The chapter then examines the potential of taking into account considerations of income and wealth distribution in the process of interpreting intellectual property rules and explores the potential of the principle of equity. It turns to the overall balance of rights and obligations from an angle of fostering investment in innovation and proposes to recognize creative imitation in the overall equation. It also suggests recalibrating rules on the duration of patents, copyright, trademarks, and trade secret protection. The latter is not subject to limitation and time and may thus contribute to unjustified economic rents detrimental to human investment. This chapter suggests to introduce ceilings of protection and refer to the principle of unjust enrichment in conceptualizing these concerns.
This chapter focuses on the barriers that LGBTIQ people continue to experience across a range of sectors, including the workplace, schools, healthcare and social care provision, and counselling and psychological services. Whilst some positive changes have occurred, this chapter highlights the ongoing (and renewed) resistance to the inclusion of LGBTIQ people. An overview of research on resistance to the inclusion of LGBTIQ people within foster care services and sports and resistance to the inclusion of certain LGBTIQ people (e.g., LGBTIQ refugees, disabled LGBTIQ people) within services is also provided. The chapter highlights the importance of both equity and liberatory practices in the removal of barriers to inclusion.
A screening test for more than 50 cancers at earlier stages would strike many as a godsend. Such a test would promise, prima facie, to save 160,000 lives annually from a premature death from cancer, reduce the intensity of medical treatment, and reduce social costs. In brief, this is what is promised by the Galleri test. We will delineate those claims in greater detail and critically assess them from medical, economic, and ethical perspectives. We conclude, with many others, that this test lacks clinical validity and clinical utility. In addition, annual public funding of $100 billion for this test would be socially unaffordable; the opportunity costs would be unacceptable for both ethical and economic reasons. Further, the least well off with respect to cancer care would be made worse off if this test were publicly funded for everyone over the age of fifty.
This chapter is concerned with coordinating the immediate global response to future pandemics – on which there has been very little focus – as opposed to long-term arrangements on prevention and preparedness where recent efforts by the WHO, the Coalition for Epidemic Preparedness Innovations (CEPI), and the Pandemic Fund seem to be moving in the right direction, even if a lot more needs to be done. This chapter does not purport to provide all the answers on global governance on pandemic response but attempts to at least raise the right questions that the international community needs to ask itself.
In this article, we examine the relationship between the World Health Organization International Health Regulations (IHR) and human rights and its implications for IHR reform, considering the evolution of human rights in the 2005 IHR, the role of human rights in IHR reforms and the implications of these reforms in key domains including equity and solidarity, medical countermeasures, core capacities, travel restrictions, vaccine certificates, social measures, accountability, and financing.
Achieving equitable healthcare access is a global challenge. Improving whole-population mental health and reducing the global burden of mental disorders is a key recommendation of the 2018 Lancet Global Mental Health Commission, which proposed monitoring national indicators, including the proportion of people with severe mental disorders who are service-users. This study aims to derive an equity indicator from national datasets integrating need, service utilisation and socioeconomic status, and demonstrate its utility in identifying gaps in mental health service use amongst those with the greatest need, thereby guiding equitable healthcare delivery.
Methods
We present a case study of a universal health insurance scheme (Medicare) in Australia. We developed the equity indicator using three national datasets. Geographic areas were linked to an area-based socioeconomic deprivation quintile (Census 2016). Per geographic area, we estimated the number with a mental healthcare need using scores ≥30 on the Kessler-10 (Australian National Health Surveys 2015 and 2018), and obtained the number of services used, defined as mental health-related contacts with general practitioners and mental health professionals (Medicare administrative data 2015–2019). We divided the number of services by the population with an estimated mental healthcare need and averaged these use-rates across each socioeconomic deprivation quintile. The equity indicator is the ratio of the use-rates in the least versus most deprived quintiles.
Results
Those estimated to have the greatest need for mental healthcare in 2019 ranged between 8.2% in the most disadvantaged area quintile (Q1) and 2.4% in the least (Q5), corresponding to a proportional increase of 27.7% in Q1 and 19.5% in Q5 since 2015. Equity-indicator-adjusted service rates of 4.2 (3.8–4.6) and 23.9 (22.4–25.4) showed that individuals with the highest need for care residing in Q1 areas received a stark 6 times fewer services compared to their Q5 counterparts, producing an equity indicator of 6.
Conclusions
As the global prevalence of common mental disorders may be increasing, it is crucial to calculate robust indicators evaluating the equity of mental health service use. In this Australian case study, we developed an equity indicator enabling the direct comparison of geographic areas with different need profiles. The results revealed striking inequities that persisted despite publicly-funded universal healthcare, recent service reforms and being a high-income country. This study demonstrates the importance and feasibility of generating such an indicator to inform and empower communities, healthcare providers and policymakers to pursue equitable service provision.
This chapter begins by distinguishing among prevention, intervention, and promotion efforts, giving particular attention to how these processes operate in the context of schools. One example of a school-based, evidence-based practice – City Connects – is used to illustrate how prevention, promotion, and intervention can be operationalized in the contexts of schools and their local communities. As a clinical/public health model, City Connects is responsive to every child in the school, without an exclusive focus on either the subset of students who are in severe crisis or those who are highest performing. The authors argue that prevention-in-action requires working across polarities, such as intervening at both the individual and group levels, targeting challenges while fostering strengths and interests, and promoting healthy development while simultaneously intervening in existing difficulties. The chapter concludes with a summary of challenges and possibilities in implementing high-quality prevention and promotion approaches, such as developing a theory of change based on developmental science that includes measurable outcomes.
This perspective article addresses the critical issue of equitable access to sustainable healthcare services for children with autism spectrum disorder (ASD). Despite the increasing prevalence of ASD globally, significant disparities persist in accessing appropriate healthcare services. The lack of comprehensive data on autism prevalence and incidence in many regions further exacerbates this challenge, hindering the development of targeted interventions and equitable resource allocation. This paper sheds light on barriers to equitable access, including geographical disparities, cultural stigma, communication barriers and inadequate training of healthcare providers. Strategies for achieving sustainable solutions are proposed, including the expansion of telehealth services, financial assistance programmes, competency training, community-based support programmes and investment in high-quality research. By addressing these challenges and implementing evidence-based interventions, we can work towards ensuring that all children with autism have access to the healthcare services they need for optimal development and well-being.
In addition to representing a main source of data in linguistic research, example sentences are a core vehicle for linguists in teaching a wide range of phenomena to our students. However, the content of these sentences often reflects the biases of the researchers who construct them: referents are typically given Anglocentric proper names like John and Mary, reflecting (at least implicitly) dominant white culture and conformity to heteronormative gender roles. To support linguists in shifting these practices, we present the Diverse Names Database, a database of 78 names from a variety of languages and cultures, confirmed with native speakers. We outline the goals for the project, introduce our process of developing and adjusting the design, and present some additional issues and reflections for consideration, such as how to use the database as one component of an affirming, anti-racist, and gender-equitable linguistics pedagogy. We aim to generate meta-level discussions about disciplinary conventions and canons, and to challenge the idea that underlying linguistic structures are, or should be, the only things of relevance when constructing example sentences. How we teach linguistics is part of how we practise it, and how we do both matters to the composition and direction of the field.
The All-Affected Principle (AAP) expresses a basic intuition about what democracy is good for: I should want to have a say in decisions that significantly affect my life. Here I sketch an approach to the AAP that responds to this normative ideal, as well as to the issues of organizing these ideals into institutions and practices beyond state-based constituencies. First, I interpret the AAP a normative specification of social justice as it relates to democratic inclusion. Second, I comment on the most three common objections to the AAP principle. Third, I contrast the AAP to a common alternative, the All-Subjected Principle. Fourth, I argue that the normative force of the AAP should be derived from social justice. Fifth, specifying the AAP in this way produces a distinction between democratic equalities and democratic equities. Sixth, this approach to the AAP helps to identify constituencies—actual or latent—defined by essential interests, challenging use to find new ways and means of democratic inclusion for essential interests. Finally, I look at the question as to whether the AAP is workable in practice, noting that we already use the AAP extensively but implicitly and unevenly.
Australian courts may grant ‘reasonable fee’ awards where defendants have used certain property or infringed certain rights in a tortious manner. ‘Reasonable fee’ refers to a method of calculating a monetary award for a wrong; namely, where the court awards the objectively ascertained fee that the parties would have agreed upon for permitting the defendant’s conduct. Reasonable fee awards may be made in various forms, including through an award of compensation, in an action for money had and received through ‘waiver of tort’, as ‘restitutionary damages’, or under Lord Cairns’ Act in lieu of an injunction. They are generally awarded for common law causes of action. As discussed in this chapter, the rationale for reasonable fee damages is highly contested. In previous editions of this book, we conceptualised reasonable fee awards as being gain-based and discussed them in the chapter on gain-based relief. The latest cases from the apex courts of the United Kingdom and Singapore suggest that reasonable fee awards are an instance of ‘substitutive compensation’. It remains to be seen whether Australian courts will adopt this approach.
The law of civil remedies has frequently been described as a ‘capstone’ private law subject. In other words, it is the culmination of a student’s knowledge of private law, and it is intended to assist all the disparate strands from previously studied private law subjects to come together.
It is for this reason that we will take a generally ‘functional’ approach to the organisation of this book, grouping remedies from across different areas according to the broad functions they perform so that parallels and contrasts can be made.
This chapter introduces the politics and policy of urban nature and nature-based solutions, stemming from a diversity of flexible governance modes and novel financial arrangements with a strong involvement of local communities. It opens with a discussion of the different visions of nature that are present in cities, followed by a more detailed examination of two particularly conflicting visions: the extent to which nature is to be mobilised as a tool for public welfare versus one for private profit. Then the chapter situates nature-based solutions in the context of three specific debates that illustrate their political and contested nature. First, the extent to which the drive for multi-functionality of urban nature can be a double-edged sword. Second, the tensions between green growth and gentrification and the pitfalls of greening exclusionary urban change. And finally, the need to consider issues of justice and equity within nature-based solutions. Through case studies of innovative park management in Newcastle, the United Kingdom, and East-Boston rail-to-trail Greenway in Boston, the United States, the chapter highlights enabling conditions that can drive systemic, just, ecologically sustainable and genuine integration of nature into urban life and policy.