Health inequities

Consider the distinct journeys of Patient X and Patient Y who are on the brink of death with only one solution that can save their lives: an organ transplant. Patient X works two jobs to provide for her five children, maintain her one-bedroom apartment, and save up money for her liver transplant. She contracted hepatitis B which has ultimately caused the formation of hepatic tumors. She does not have enough money to pay for a liver transplant, and her wait time on the national waitlist for her region is over a year. Meanwhile, her liver function is drastically decreasing with every day that passes.

Patient Y is a successful business owner with a beautiful family of her own. She contracted a rare autoimmune disease that detrimentally impacts her liver function. Although she was taking medication to keep her healthy for a while, she suddenly felt a sharp pain one day, and the doctors found that she might need a liver transplant very soon. Because her region had a high demand for liver transplants, her doctors gave her the option to get listed in a less liver-demanding area given that she had the economic stability necessary to do so. In just 10 days of moving to this area, a liver was finally available for her, and her surgery would take place as soon as she wanted.

Unfortunately, there are a plethora of potential organ recipients stuck in Patient X’s position. Although there is a national database, which means there is a wait time for all organ recipients, loopholes that enable affluent patients to travel to regions with shorter wait times still exist. There are also patients with time-dependent diseases that simply cannot wait over a year to finally get an organtransplant and end up dying. This is thereason some have proposed an “organ market” where patients who need an organ urgently can buy it without having to wait so long. This “market” does not sit well with too many people and is already illegal in the United States; people believe it could put the more vulnerable and less affluent part of the population at risk of even longer wait times for an organ transplant. Perhaps, there is a way to ensure equal access to organ transplants with lower wait times that will benefit the most people- but what would that look like?

Health inequalities and inequities in healthcare are among the most significant problems in health systems and in today’s societies as a whole. They exist between and within countries, even in the most developed. Clarification of the concepts and fundamental principles is essential for studying the nature of inequalities and inequities and for establishing of adequate measures and policies to deal with them. This article aims to present the basic concepts of the essence of health inequalities and inequities in healthcare and to put the principles of health policy for solving these problems.

The state of Maharashtra has registered a growth of more than 7.5% to 8% in the recent past establishing itself as a strong growth driver for the country. The performance of the State of Maharashtra in on economic parameters has been always impressive compared to other states in India. Maharashtra in many respects, has historically been a leading state and hence the expected level of achievements and performance are commensurately higher. Though in social sectors like health and education also it has performed better than many other states in India, it has been criticised for its failure to tackle the problems of under nutrition among children and rising health inequalities across regions and across various social groups. As a result of which, contrary to its top rank in economic indicator, it does not hold the top rank in health and educational indicators. In fact the state has come under severe criticism for the slippages it has suffered on various counts and in the extreme, has been characterized as a ‘failed state. This might seem to be an extreme criticism for it but the failures on under nutrition and health inequity are absolutely unjustifiable.

Thailand's public health system is lauded globally for its broad access and coverage. However, significant gaps in health outcomes persist for diverse highland Indigenous and ethnic minority communities that have historically resided along the country's northern and northwestern border region. Yet, Thailand's census data do not tabulate ethnicity, and therefore preclude assessments of health barriers and progress among ethnic minority groups anywhere in the country. Moreover, state surveys of highlanders, often undertaken for surveillance purposes in the mid-to-late 20th century, never included measures of health, educational attainment, wealth, or other indices of inequality. Beginning in 2005, UNESCO undertook a sequential, mixedmethodological research program in the highlands to assess progress and barriers in citizenship acquisition and inequalities related thereto. In the Highland Peoples Survey (HPS) I, more than 60,000 people in nearly 200 villages in 3 provinces were surveyed, and in the HPS II, more than 70,000 people representing 18 ethnic groups in over 300 villages in 5 provinces were surveyed. In addition to providing a detailed overview of the unique utility of the UNESCO Highland Peoples Surveys for ascertaining complex dynamics of ethnicity, legal status, wealth, and health care availability for highlanders, this article presents a broad exploration of health access detected in the 2010 survey, and thus provides a baseline of health inequalities among highlanders from which future comparative analyses may be drawn.

One of the most significant questions in the theory of health inequalities and inequity concerns their identification and measurement in relation to the leading causes. The results have to assure evidence based foundation for health policy decisions about reducing of health inequalities. With regard to research and measurement methods there are two leadings debates in the scientific literature – the first is about which aspect of inequity have to be measured and the second how to be measured. The aim of this paper is to analyze the different methods and approaches for measurement of health inequalities and inequity in health care. Their main advantages and disadvantages are discussed, as well as opportunities and restrictions of their implementation. The paper presents literature review of scientific publication in Scopus and Science Direct.

Въведение: Равнопоставеността в достъпа до здравни услуги зависи от това, доколко гражданите трябва да заплащат директно за тях. Целта на изследването е да се анализира финансовата тежест на здравните разходи върху домакинствата в България и на тази основа да се направи оценка за неравенствата в достъпа до здравни услуги, причинени от неравенства в доходите на населението.
Материал и методи: В изследването са представени данни за разходите за здравеопазване в България и е анализирано влиянието на частните разходи върху достъпа на населението до здравни услуги. Използвани са данни от Националния статистически институт, Световната здравна организация, Евростат и други, както и резултати от различни проучвания.
Резултати и дискусия: През последните години разходите за здравеопазване в България постоянно нарастват, но финансовата тежест се измества не към публичните фондове, а към домакинствата. Съотношението публични – частни разходи е изключително неблагоприятно, като делът на последните се движи между 41 и 48%. Относителната финансова тежест на здравните разходи на домакинствата и лицата е по-висока за хората с по-ниски доходи. Редица проучвания показват, че разходите за здравеопазване създават сериозни бариери в достъпа до здравни услуги, особено за по-бедните домакинства, неосигурените лица и другите уязвими групи.
Заключение: Резултатите потвърждават извода, че системата на финансиране на здравеопазването в България не почива на принципите на солидарност и равнопоставеност. Здравната система в България не предлага голяма финансова защита. Плащанията със собствени средства са значително високи според международните стандартни и създават бариери пред достъпа на
населението до здравни услуги.

Introduction: Health and health-related behaviours in childhood, adolescence and youth are crucial for health and behavioural patterns in adulthood. The purpose of this study was to examine the levels, distribution and socio-demographic determinants of health outcomes among Slovenian youth using three subjective health indicators.
Methods: We used national survey samples of Slovenian youth from studies in 2010 and 2013 and analyzed three single-item indicators: self-rated health, self-reported chronic health problems (illness, disability, mental health problems) and perceived stress.
Results: In 2013 16.8 % of respondents rated their health as excellent, 71.6 % as (very) good, and 11.5 % as poor/fair – the latter more often by women and respondents with less educated mothers. On average about every tenth respondent reported chronic health problems in six surveys covering the period 2002–2013. In 2013, 40.2 % of Slovenian youth experienced stress “at least weekly”, a slightly smaller proportion than in 2011 (41.1 %). The frequency of perceived stress was higher among women and older youth.
Discussion and conclusions: In the 2010–2013 period there were no significant changes in subjective health status of Slovenian youth, despite the unfavourable macro-conditions in Slovenia and Europe, which had especially negative impact on the objective situation of young people (e.g., increases in the youth unemployment rates, etc.). Our study aimed to partially fill the research gap, since there is a lack of studies on health of Slovenian post-adolescent youth and young adults.
Key words: self-rated health, perceived stress, chronic health problems, inequalities in health, determinants of health, youth.

Izhodišča: Zdravje in z zdravjem povezana vedenja v obdobju otroštva, adolescence in mladosti so ključnega pomena za zdravje in vedenjske vzorce v odraslosti in poznejši starosti. Namen pričujoče raziskave je bil preučiti stopnje, distribucijo in sociodemografske dejavnike zdravstvenih izidov slovenske mladine na treh subjektivnih indikatorji zdravja.
Metode: Uporabljeni so bili nacionalni anketni vzorci slovenske mladine iz let 2010 in 2013, analizirali pa smo indikatorje: samoocenjeno zdravje, samoporočane kronične zdravstvene težave (bolezen, invalidnost, psihične težave) in pogostost samozaznanega stresa. 
Rezultati: V 2013 je 16,8 % respondentov svoje zdravje ocenilo kot odlično, 71,6 % kot (zelo) dobro, 11,5 % pa kot slabo/zadovoljivo – slednje pogosteje ženske in respondenti z manj izobraženimi materami. V povprečju približno vsaki desetih mladi v Sloveniji poroča kronične zdravstvene težave; v obdobju 2002–2013 je bil trend relativno stabilen. V letu 2013 je 40,2 % slovenske mladine doživljalo stres »vsaj tedensko«, nekoliko manjši delež kot v letu 2011 (41,1 %). Pogostost samozaznanega stresa je višja med ženskami in starejšo mladino.
Diskusija in zaključki: V obdobju 2010–2013 ni prišlo do bistvenih sprememb subjektivnega zdravstvenega stanja slovenske mladine, kljub neugodnim makrorazmeram v Sloveniji in Evropi, ki še posebej slabo vplivajo na položaj mladih (npr. naraščanje stopnje brezposelnosti mladih). Z raziskavo smo poskušali deloma zapolniti raziskovalno vrzel, saj v Sloveniji primanjkuje raziskav o zdravju postadolescentne mladine in mladih na prehodu v odraslost.
Ključne besede: samoocenjeno zdravje, samozaznan stres, kronične zdravstvene težave, neenakosti v zdravju, dejavniki zdravja, zdravje slovenske mladine.

The region can be considered as a factor influencing health inequalities because it creates the context for work, education and income of individuals. The aim of the study is to analyse the importance of the region and regional development for the arising, deepening and reduction of health inequalities. Different studies addressing the geographical area as a determinant of health and health inequalities are summarised. Theories and models explaining how socio-economic factors interact and influence on health at the individual and regional level are presented.

Health and health-related behaviours in childhood, adolescence and youth are crucial for health and behavioural patterns in adulthood. The purpose of this study was to examine the levels, distribution and socio-demographic determinants of health outcomes among Slovenian youth using three subjective health indicators. We used national survey samples of Slovenian youth from studies in 2010 and 2013 and analyzed three single-item indicators: self-rated health, self-reported chronic health problems (illness, disability, mental health problems) and perceived stress. In 2013 16.8 % of respondents rated their health as excellent, 71.6 % as (very) good, and 11.5 % as poor/fair – the latter more often by women and respondents with less educated mothers. On average about every tenth respondent reported chronic health problems in six surveys covering the period 2002–2013. In 2013, 40.2 % of Slovenian youth experienced stress “at least weekly”, a slightly smaller proportion than in 2011 (41.1 %...

The COVID-19 pandemic has shed light on the norms, patterns, and power structures in the United States that privilege certain groups of people over others. This manuscript describes COVID-19 as an unprecedented catalyst for social transformation that underscores the need for multi-level and cross-sectoral solutions to address systemic changes to improve health equity for all. The authors propose that the American Psychological Association and its membership can initiate systemic change, in part, by: (a) supporting mutual aid organizations that prioritize the needs of vulnerable communities; (b) leveraging the efforts and strides APA psychologists have already made within the association, in the profession, and in policymaking to attend to the health equity and the needs of marginalized communities; (c) building capacity for collaboration between a broad coalition of health associations, health experts, and policymakers to address the physio-psycho-socioeconomic needs of disadvantaged communities, and (d) increasing APA’s participation in the formulation and implementation of an advocacy agenda that prioritizes the physical and psychological health of the communities whose lives are most endangered by COVID-19.

The Research Centers in Minority Institu­tions (RCMI) program was established by the US Congress to support the develop­ment of biomedical research infrastructure at minority-serving institutions granting doctoral degrees in the health professions or in a health-related science. RCMI institu­tions also conduct research on diseases that disproportionately affect racial and ethnic minorities (ie, African Americans/Blacks, American Indians and Alaska Natives, His­panics, Native Hawaiians and Other Pacific Islanders), those of low socioeconomic sta­tus, and rural persons. Quantitative metrics, including the numbers of doctoral science degrees granted to underrepresented stu­dents, NIH peer-reviewed research funding, peer-reviewed publications, and numbers of racial and ethnic minorities participat­ing in sponsored research, demonstrate that RCMI grantee institutions have made substantial progress toward the intent of the Congressional legislation, as well as the NIH/NIMHD-linked goals o...

The adoption of the WHO Global Code of Practice on the International Recruitment of Health Personnel in May, 2010, ostensibly heralded a new era of accountability in the migration of health-care workers.1 Global health advocates lauded its unanimous adoption by all 193 WHO member states convening at the 63rd World Health Assembly as a sign of changing social expectations for human health resources, foreshadowing an imminent end to the brain drain of skilled health professionals from resource-constrained countries. But, has the Code been effective?

Social epidemiology, medical sociology and other social sciences are systematically identifying and mapping out the specific causal pathways that demonstrate what oppressed people feel and know as lived experience-that violations of respect, in forms such as discrimination, are bad for one's health. In the US, for example, much research has been conducted on how racial discrimination against people of color impacts negatively on their health. Included is research that demonstrates evidence for psychosocial determinants of health-discrimination functions not only to skew access to resources such as healthcare and opportunities for healthy living, it also creates stress and negative emotional states such as psychological distress which can in and of themselves be manifestations of ill-health, e.g. in the form of psychological ill-health, or they can increase the risk of physiological disease and impairment, or both. A model of the way in which discrimination can affect emotions and in turn health can be called the discrimination-emotion-health model. Identifying the causal pathways for specific health outcomes provides essential information for better understanding the bad consequences of what are already manifest injustices-wrongful discrimination-as well as for intervening to improve health outcomes. In this paper, however, I identify an unrecognized and troubling problem; that the way in which the relationship between discrimination, emotion and health can be presented will actually reinforce inequities, for example by reinforcing stereotypes, by prescribing how the disadvantaged should feel and behave, and by presenting the emotional life of the privileged as 'normal'. In the first and second sections of the paper, I identify the discrimination-emotion-health model and its implications. This model appears to underlie much public health literature on discrimination as a psychosocial determinant of health but is not made explicit. In the third section I argue that an appreciation of the political dimensions of emotions, indicates that the model can have troubling implications. I will provide a critique focusing on six concerns: the reinforcement, agency, respectability, dissidence, fragility of privilege and object of emotions critiques. In the final section, I will demonstrate how this political critique helps us to develop the features required of a theory of health equity in order for it to best represent discrimination as a psychosocial determinant of health. I highlight six implications of the critique for theories of health equity, including the recognition that health policies have expressive value, and that oppressive systems can damage the privileged, as well as the oppressed. Thinking about the model and its critique according to such a theory will provide health policy-makers and practitioners with a nuanced way of thinking about the role of emotions in health disparities, which can help with the development of suitable policies and guidance for health equity.

Renata Schiavo, Gretchen Van Wye & Erma Manoncourt (2022) COVID-19 and health inequities: the case for embracing complexity and investing in equity- and community-driven approaches to communication, Journal of Communication in Healthcare, 15:1, 1-6, DOI: 10.1080/17538068.2022.2037349

EDITORIAL

Здравните неравенства и неравнопоставеността в здравеопазването са едни от най-значимите съвременни проблеми на здравните системи и обществата в цяла Европа. В тази връзка изключително значение придобива политиката по разпределение на ресурсите в здравеопазването - като основа за намаляване на неравния достъп до здравни услуги в различните региони.
Целта на дисертацията е да се изследват неравенствата в достъпа до здравната мрежа в България и на тази основа да се разработи модел за регионално разпределение на ресурсите. За постигането й са изяснени основните теоретико-методологически постановки относно същността на здравните неравенства и концепцията за равнопоставеност, техните детерминанти, както и методите за тяхното измерване. Извършен е анализ на диференциациите в здравния статус на населението с акцент върху регионалните различия, здравно-политически анализ и анализ на финансовата равнопоставеност, като са изследвани факторите, влияещи върху неравнопоставеността в здравеопазването в България. Изследвана е осигуреността с ресурси на здравната система в отделните райони и области на страната и е направена оценка на равномерността на тяхното разпределение. Осъществени са две социологически проучвания – сред гражданите на Североизточния район на планиране и сред експерти в сферата на здравеопазването.
Изводите от направените анализи на теоретичните модели и емпиричните данни стоят в основата на предложения модел за разпределение на ресурсите в здравната система, включващ разпределение между регионите и такова между видовете здравни услуги и дейности. Крайната цел на модела е намаляване на регионалните различия в достъпа до здравната мрежа и на здравните неравенства.

Epidemiological evidence on the social determinants of health inequity is well-advanced, but considerably less attention has been given to evaluating the impact of public policies addressing those social determinants. Methodological challenges to produce evidence on policy outcomes present a significant barrier to mobilising policy actions for health equities. This review aims to examine methodological approaches to policy evaluation of health equity outcomes and identify promising approaches for future research. We conducted a systematic narrative review of literature critically evaluating policy impact on health equity, synthesizing information on the methodological approaches used. We searched and screened records from five electronic databases, using pre-defined protocols resulting in a total of 50 studies included for review. We coded the studies according to (1) type of policy analysed; (2) research design; (3) analytical techniques; (4) health outcomes; and (5) equity dimensi...

What do we mean by health? Why are billions of people still affected by disease? How do we promote well-being? I’ve tried to answer these questions in my latest paper.

The research challenges the current neo-liberal framework of health in international relations and defines the concept of dis-ease as a political issue. Drawing from post-colonial and Neo-Marxist theories, I apply Paulo Freire’s critical pedagogy as a problem-posing method to contrast and combat the persistency of neglected tropical diseases (NTDs) in today’s world.

The paper has been written for the Environment, Geopolitics & the Human research seminar, part of the MA in International Relations, at the Rijksuniversiteit Groningen.

On 8 October 2014, Liberian citizen Thomas Eric Duncan, died from the Ebola Virus Disease (EVD) in Dallas, Texas. Following his untimely death, concerns about the spread of Ebola in the United States reached a fever pitch, and the word Ebola itself became a subtext for stigmatization and alienation of an entire continent and group of people.

The article is aimed to assess trends in wealth-related inequalities in coverage of reproductive, maternal, neonatal and child health (RMNCH) interventions using delivery channels framework in Indian context, at national level as well as at state level-Tamil Nadu (TN) and Chhattisgarh (CG)-a better off and poorer state, respectively. We used National Family Health Survey-3rd (2005-2006) and 4th (2015-2016) to study the trends and differentials of inequalities in the RMNCH coverage. We have used two summary indices-absolute inequalities using the slope index of inequality (SII) and relative inequalities using the concentration index (CIX). Culturally driven interventions had pro-poor inequalities in TN, CG and in India, but the coverage has improved significantly for the women from wealthier households recently. Environmental interventions were highly inequal in distribution, particularly for the 'use of clean fuels'. Inequalities in the coverage of health facilities-based interventions has reduced in TN, CG and overall India, but more so in TN. The inequalities in coverage of community-based interventions have reduced over the period of ten years in TN, CG as well as at national level. Adopting RMNCH delivery channel framework could be useful for assessing and monitoring the progress of public health programmes. Policy makers can gain insights from the success of coverage of various interventions and determine specific implementation strategies to reduce inequalities in the coverage and its effectiveness.

Individuals' actions are blamed for being at highest risk for ill health, even when their choices have
been constrained by public policies and corporate practices. Whereas, there is a relationship between
lifestyle and health inequities which is be briefly explored in this paper. It also covers the emergence
of lifestyle as a concept and concludes that instead of just targeting individuals to change lifestyle,
strategies should also be employed to improve their social determinants of health.

Thailand’s public health system is lauded globally for its broad access and coverage. However, significant gaps in health outcomes persist for diverse highland Indigenous and ethnic minority communities that have historically resided along the country’s northern and northwestern border region. Yet, Thailand’s census data do not tabulate ethnicity, and therefore preclude assessments of health barriers and progress among ethnic minority groups anywhere in the country. Moreover, state surveys of highlanders, often undertaken for surveillance purposes in the mid-to-late 20th century, never included measures of health, educational attainment, wealth, or other indices of inequality. Beginning in 2005, UNESCO undertook a sequential, mixed-methodological research program in the highlands to assess progress and barriers in citizenship acquisition and inequalities related thereto. In the Highland Peoples Survey (HPS) I, more than 60,000 people in nearly 200 villages in 3 provinces were surveyed, and in the HPS II, more than 70,000 people representing 18 ethnic groups in over 300 villages in 5 provinces were surveyed. In addition to providing a detailed overview of the unique utility of the UNESCO Highland Peoples Surveys for ascertaining complex dynamics of ethnicity, legal status, wealth, and health care availability for highlanders, this article presents a broad exploration of health access detected in the 2010 survey, and thus provides a baseline of health inequalities among highlanders from which future comparative analyses may be drawn. Keywords: Indigenous health, Ethnic minority health, Legal Status, Wealth, Health Disparities, Thailand

Thailand’s public health system is lauded globally for its broad access and coverage. However, significant gaps in health outcomes persist for diverse highland Indigenous and ethnic minority communities that have historically resided along the country’s northern and northwestern border region. Yet, Thailand’s census data do not tabulate ethnicity, and therefore preclude assessments of health barriers and progress among ethnic minority groups anywhere in the country. Moreover, state surveys of highlanders, often undertaken for surveillance purposes in the mid-to-late 20th century, never included measures of health, educational attainment, wealth, or other indices of inequality. Beginning in 2005, UNESCO undertook a sequential, mixed-methodological research program in the highlands to assess progress and barriers in citizenship acquisition and inequalities related thereto. In the Highland Peoples Survey (HPS) I, more than 60,000 people in nearly 200 villages in 3 provinces were surveyed, and in the HPS II, more than 70,000 people representing 18 ethnic groups in over 300 villages in 5 provinces were surveyed. In addition to providing a detailed overview of the unique utility of the UNESCO Highland Peoples Surveys for ascertaining complex dynamics of ethnicity, legal status, wealth, and health care availability for highlanders, this article presents a broad exploration of health access detected in the 2010 survey, and thus provides a baseline of health inequalities among highlanders from which future comparative analyses may be drawn. Keywords: Indigenous health, Ethnic minority health, Legal Status, Wealth, Health Disparities, Thailand

Въведение: Населеното място и регионът формират контекста за възможностите за работа, образование и доходи на индивидите. Регионът може да се разглежда и като детерминант на здравето, както и на здравните неравенства. Целта на настоящото изследване е да се проучат и анализират различията в използването на здравни услуги между жителите на отделните видове населени места в Североизточния район на България.
Материал и методи: В изследването са използвани данни от социологическо проучване чрез анкета. Проучването е проведено в периода март-юни 2014 г. сред 618 граждани на Североизточния район, живеещи в областни градове, малки градове и села.
Резултати и обсъждане: В трите вида населени места с най-голяма честота на посещенията са тези при общопрактикуващите лекари. Разглеждана по типове населени места, средната използваемост е най-висока в малките градове, с изключение на медико-диагностичните изследвания. В селата използваемостта, както при първичната, така и при специализираната медицинска помощ, е по-ниска от средната общо за извадката, което се дължи предимно на затрудненията в достъпа до здравни услуги. Статистически значими различия според типа населено място има в използването на стоматологична и болнична помощ.
Заключение: Изводите показват, че са налице различия в използването на здравни услуги и достъпа до здравната мрежа, зависещи от местоживеенето, които са пример за неравнопоставеност в здравеопазването.

Background: Tackling inequalities in overweight, obesity and related determinants has become a top priority for the European research and policy agendas. Although it has been established that such inequalities accumulate from early childhood onward, they have not been studied extensively in children. The current article discusses the results of an explorative analysis for the identification of inequalities in behaviours and their determinants between groups with high and low socioeconomic status.

ABSTRACT: In this article I discuss how World Café Dialogues can be used to unveil structural and cultural violence that drive the behaviors that maintain end-of-life care inequalities, especially among minorities, in acute healthcare hospitals. Conflict practitioners are rarely included in conversations of end-of-life care inequalities and when included it is to “solve a problem” through bioethics mediation or provide training in cross-cultural competence. I argue that conflict practitioners need to broaden their approach to conflict and use their skills to surface unequal power structures and implicit beliefs that maintain the unjust status quo in end-of-life care disparities. http://nsuworks.nova.edu/pcs/vol21/iss1/3/

With dilapidated public hospitals, poor-quality public healthcare, widespread corruption, unaffordable private care, and inadequate healthcare coverage, the status of healthcare in Egypt gradually became a major reason for social and political discontent among Egyptians. However, the most prominent voices in the fight for better health in Egypt have rarely been ordinary citizens, patients, patient support groups or advocacy groups, political parties or pressure groups, but, rather consistently, groups of physicians. The Egyptian uprising in January 2011, with its aspirations for “human dignity and social justice,” has only lent momentum to these doctors’ fight to reform the health system.
The paper starts by analyzing the current state of public health in Egypt and problematizing the nature of the mobilization to improve it, reflecting on the extent to which the fight for reforming healthcare in Egypt has been formulated as a fight against inequalities/inequities, as opposed to one for guaranteeing human dignity, attaining social justice, fulfilling a human right to health or even stemming corruption and achieving efficiency. Surely, health inequities exist in Egypt, as the epidemiological outcome of differential access to healthcare, both in quantity and in quality, which in turn is the result of the differential enjoyment of other social determinants of health, and as the corollary of wider socioeconomic inequalities. The paper argues that health inequities in Egypt are the outcome of a complex web of authoritarian politics, crony capitalism, corruption, global economic exploitation, healthcare worker brain drain, and domestic injustices. However, as the paper maintains, the dearth of epidemiological studies documenting inequitable health outcomes across geographic, gender and class lines has prevented the fight for health in Egypt from being, first and foremost, conceived of as a fight against inequality, and has favored other frameworks of resistance, such as those of fighting for human dignity, social justice or a right to health.
Relying on interviews with several doctors and a variety of other sources including statements, press releases and news reports, the paper showcases the mobilization of several groups of Egyptian doctors and their efforts, in different capacities, to reform the health system in Egypt, shedding light on some of their achievements and the challenges they have faced. Some of the groups examined include the board of the Egyptian Medical Syndicate, “Doctors Without Rights,” The Committee for Defending People’s Right to Health, as well as public campaigns such as “What is More Important than Egyptians’ Health?,” NGOs such as “Tahrir Doctors” and The Association for Health and Environmental Development, and charitable organizations such as “Mercy Doctors.” The paper focuses on two major strikes by doctors in 2012 and 2014.
Relying on a historicized analysis of the role assigned to “experts” by the Egyptian state and public sphere, the paper highlights the paradox and limitations of the role of the “activist-expert.” Since doctors are the face of the healthcare system in Egypt, crumbling and predatory as it may be, their calls for reforming it have often been met with suspicion and skepticism from their patients. They have also often been met with hostility from the State which conveniently blames the deterioration of the healthcare system on doctors’ negligence and greed, as a way to let itself off the hook. On the other hand, and paradoxically, doctors’ expert and insider status and their social capital often act to legitimize their claims about the healthcare system, render them more credible, and validate their appeals to reform it.
The paper proposes the notion of the “organic doctor,” along the lines of Gramsci’s “organic intellectual,” to examine and understand these doctors’ mobilization, not as impartial caregivers, but very often as citizens with grievances themselves who see in their fight for the interests of “the people,” an accomplishment of their socio-professional vocation and a realization of their personal and professional value systems. In this context, the paper attempts to explore the moral, political and socioeconomic realities of “activist” doctors in Egypt, the variety of their experiences, the obstacles they face, and how they construe their mission in the face of skeptical patients and successive regimes that chose to remain deaf to their appeals. The paper concludes that unless stakeholders, viz. patients and ordinary citizens, are included, the fight to reform the Egyptian health system will bear little fruit.

Health impacts of poor environmental quality have been identified in studies around the world and in Canada. While many of the studies have identified associations between air pollution and mortality or morbidity, few have focused on the role of health care as a potential moderator of impacts. This study assessed the determinants of health care access and utilization in the context of ambient air pollution in Sarnia, Ontario, Canada. Residents of Sarnia participated in a Community Health Study administered by phone, while several ambient air pollutants including nitrogen dioxide (NO2), sulphur dioxide (SO2) and the volatile organic compounds benzene, toluene, ethylbenzene, mp- and o-xylene (BTEX) were monitored across the city. Land Use Regression models were used to estimate individual exposures to the measured pollutants and logistic regression models were utilized to assess the relative influence of environmental, socioeconomic and health related covariates on general practitione...

... they were not paid a regular wage, the miners preferred to maximize their working hours and increase their chances of getting Tanzanite stones. ... Life in a refugee camp The United Republic of Tanzania is a union between the former Republic of Tanganyika (the mainland) and ...

Course Description: • What does sociology teach us about health and health care? Who pays for, affords, and accesses health care? • Does the COVID19 Pandemic affect the rich and poor in the same way? Can all countries afford the vaccines? • Who is more at risk when it comes to health and lack of access to health care? What about mental health and illness? • How do the unequal power relationships between the Global North and the Global South shape health and illness? How does race, gender or sexuality play a role?
While it is not possible to answer all of these questions, this course will provide a space to explore various aspects of global inequities in health and health care. Particular emphasis will be placed on the role of the COVID19 Pandemic in reproducing these inequities. We will learn about and discuss the systemic health challenges and barriers in access to health care faced by disadvantaged communities and individuals, underlining the sociological processes behind them.
Course Objectives: • Explaining the interaction of health status and access to healthcare with social location from an intersectional lens • Recognizing the systemic health challenges and barriers in access to health care faced by disadvantaged communities and individuals (including refugee, racialized, Indigenous, and LGBTQ+, as well as those living with poverty)

In principle, pharmaceutical producers lack the incentives to develop orphan drugs, i.e. medicines intended to treat rare diseases. Regulation (EC) n. 141/2000 addresses the issue, providing orphan drug producers with accelerated approval, tax benefits, and a ten-year market exclusivity period. Today, orphan drug prices are extremely high and are set independently of ordinary pharmaceutical pricing criteria. Consequently, some scholars suggest that a competition law action for unfair prices under Art. 102, let. a, TFEU may be warranted. This paper claims that the prohibition of abuse of dominant position could play a role in reducing orphan drugs' prices. First, it is shown that market exclusivity provides orphan drug manufacturers with a dominant position in their reference markets. Then, the paper applies and adapts the excessive price test developed by the ECJ to orphan drugs. Civil liability could also play a role, by compensating the damages suffered by NHSs. Finally, recent enforcement developments in the EU concerning excessive prices of medicines confirm the potential role of competition law in curbing orphan drug prices.