IntroductionThere is a significant disparity in the United States between the health care received by children with special health care needs versus physically healthy children.ObjectiveThe objective of the paper is to show that children with special needs receive less than adequate health care overall. This disparity affects the quality of life for these children and influences their ability to live their lives to their full potential.MethodsResearch was conducted by examining multiple studies with a focus on six major factors (...) that play a role in creating this disparity.ResultsThe findings show an alarming trend in the access and delivery of health care to children with special health care needs.ConclusionsSolutions to correcting the disparities are possible, but it will take a full understanding of the issues, perseverance, dedication, and hard work on the part of families, physicians, legislators, and others genuinely interested in creating an equal health care system for all children. (shrink)

There is a growing literature demonstrating a link between lower socioeconomic status (SES) and poorer neuroanatomical health, such as smaller total and regional gray and white matter volumes, as well as greater white matter lesion volumes. Little is known, however, about the relation between SES and white matter integrity. Here we examined the relation between SES and white matter integrity of the brain’s primary cortical regions, and evaluated potential moderating influences of age and self-identified race. Participants were 192 neurologically intact, (...) community-dwelling African American and White adults (mean age = 52 years; 44% male, 60% White, low SES = 52%) from the Healthy Aging in Neighborhoods of Diversity across the Life Span (HANDLS) SCAN study. Participants underwent 3.0-T cranial magnetic resonance imaging. Diffusion tensor imaging was used to estimate regional fractional anisotropy (FA) to quantify the brain’s white matter integrity and trace to capture diffusivity. Multiple regression analyses examined independent and interactive associations of SES, age, and race with FA of the frontal, temporal, parietal, and occipital lobes bilaterally. Sensitivity analyses assessed the influence of several biopsychosocial risk factors on these associations. Exploratory analyses examined these relations with trace and using additional SES indicators. Results indicated there were no significant interactions of SES, age, and race for any region. Individuals with low SES had lower FA in all regions, and higher trace in the right and left frontal, right and left temporal, and left occipital lobes. Findings remained largely unchanged after inclusion of sensitivity variables. Older age was associated with lower FA and greater trace for all regions, except for the right temporal lobe with FA. No main effects were found for race in FA, and Whites had higher trace values in the parietal lobes. Novel findings of this study indicate that relative to the high SES group, low SES was associated with poorer white matter integrity and greater diffusivity. These results may, in part, reflect exposures to various biopsychosocial risk factors experienced by those of lower SES across the lifespan, and may help explain the preponderance of cognitive and functional disparities between socioeconomic groups. (shrink)

The concept of disparity has long been a topic of obsession and argument for philosophers but Slavoj Žižek would argue that what disparity and negativity could mean, might mean and should mean for us and our lives has never been more hotly debated. Disparities explores contemporary 'negative' philosophies from Catherine Malabou's plasticity, Julia Kristeva's abjection and Robert Pippin's self-consciousness to the God of negative theology, new realisms and post-humanism and draws a radical line under them. Instead of establishing (...) a dialogue with these other ideas of disparity, Slavoj Žižek wants to establish a definite departure, a totally different idea of disparity based on an imaginative dialectical materialism. This notion of rupturing what has gone before is based on a provocative reading of how philosophers can, if they're honest, engage with each other. Slavoj Žižek borrows Alain Badiou's notion that a true idea is the one that divides. Radically departing from previous formulations of negativity and disparity, Žižek employs a new kind of negativity: namely positing that when a philosopher deals with another philosopher, his or her stance is never one of dialogue, but one of division, of drawing a line that separates truth from falsity. (shrink)

Health disparities are primarily driven by structural inequality including systemic racism. Medical educators, led by the AAMC, have tended to minimize these core drivers of health disparities. Ins...

BackgroundThe current paper follows up on the results of an exploratory quantitative analysis that compared the publication and citation records of men and women researchers affiliated with the Faculty of Computing and Engineering at Dublin City University in Ireland. Quantitative analysis of publications between 2013 and 2018 showed that women researchers had fewer publications, received fewer citations per person, and participated less often in international collaborations. Given the significance of publications for pursuing an academic career, we used qualitative methods to (...) understand these differences and explore factors that, according to women researchers, have contributed to this disparity.MethodsSixteen women researchers from DCU’s Faculty of Computing and Engineering were interviewed using a semi-structured questionnaire. Once interviews were transcribed and anonymised, they were coded by both authors in two rounds using an inductive approach.ResultsInterviewed women believed that their opportunities for research engagement and research funding, collaborations, publications and promotions are negatively impacted by gender roles, implicit gender biases, their own high professional standards, family responsibilities, nationality and negative perceptions of their expertise and accomplishments.ConclusionsOur study has found that women in DCU’s Faculty of Computing and Engineering face challenges that, according to those interviewed, negatively affect their engagement in various research activities, and, therefore, have contributed to their lower publication record. We suggest that while affirmative programmes aiming to correct disparities are necessary, they are more likely to improve organisational culture if they are implemented in parallel with bottom-up initiatives that engage all parties, including men researchers and non-academic partners, to inform and sensitise them about the significance of gender equity. (shrink)

While the domestic effect of structural racism and other social vulnerabilities on Covid‐19 mortality in the United States has received some attention, there has been much less discussion (with some notable exceptions) of how structural global inequalities will further exacerbate Covid‐related health disparity across the world. This may be partially due to the delayed availability of accurate and comparable data from overwhelmed systems, particularly in low‐ and middle‐income countries. However, early methods to procure and develop treatments and vaccines by (...) some high‐income countries reflect ongoing protectionist and nationalistic attitudes that can systemically exclude access for people in regions with weaker health systems. What's needed is a global coordinated effort, based on the principle of solidarity, to foster equitable health care access. (shrink)

Disparities in socioeconomic status correlate closely with health, so that the lower a person's social position, the worse his health, an effect that the epidemiologist Michael Marmot has labeled the status syndrome. Marmot has argued that differences in autonomy, understood in terms of control, underlie the status syndrome. He has, therefore, recommended that the American medical profession champion policies that improve patient autonomy. In this paper, I clarify the kind of control Marmot sees as connecting differences in socioeconomic status to (...) health disparities. I then discuss his use of Amartya Sen's capabilities approach to justice, arguing that he is unsuccessful in relating autonomy as a descriptive property with a normative framework that can adequately explain why and to what extent we should reduce health disparities. (shrink)

The health system is, in particular ways, a microcosm of society and both reflects and contributes to its ills of racism, inequities, and disparities. As such, the house of medicine is obligated to...

When feminist bioethicists express concerns about health‐related gender disparities, they raise considerations about justice and gender that traditional bioethicists have either not raised or raised somewhat weakly. In this article, I first provide a feminist analysis of long‐term healthcare by and for women in the United States and women in Taiwan. Next, I make the case that, on average, elderly US and Taiwanese women fare less well in long‐term care contexts than do elderly US and Taiwanese men. Finally, I explore (...) some suggested practical remedies to reduce gender disparities in long‐term care contexts. (shrink)

The idea of using artificial intelligence as a support system in the sentencing process has attracted increasing attention. For instance, it has been suggested that machine learning algorithms may help in curbing problems concerning inter-judge sentencing disparity. The purpose of the present article is to examine the merits of this possibility. It is argued that, insofar as the unfairness of sentencing disparity is held to reflect a retributivist view of proportionality, it is not necessarily the case that increasing (...) inter-judge uniformity in sentencing is desirable. More generally, it is shown that the idea of introducing machine learning algorithms, that produce sentencing predictions on the ground of a dataset that is built of previous sentencing decisions, faces serious problems if there exists a discrepancy between actual sentencing practice and the sentences that are ideally desirable. (shrink)

Statistical evidence is crucial throughout disparate impact’s three-stage analysis: during (1) the plaintiff’s prima facie demonstration of a policy’s disparate impact; (2) the defendant’s job-related business necessity defense of the discriminatory policy; and (3) the plaintiff’s demonstration of an alternative policy without the same discriminatory impact. The circuit courts are split on a vital question about the “practical significance” of statistics at Stage 1: Are “small” impacts legally insignificant? For example, is an employment policy that causes a one percent disparate (...) impact an appropriate policy for redress through disparate impact litigation? This circuit split calls for a comprehensive analysis of practical significance testing across disparate impact’s stages. Importantly, courts and commentators use “practical significance” ambiguously between two aspects of practical significance: the magnitude of an effect and confidence in statistical evidence. For example, at Stage 1 courts might ask whether statistical evidence supports a disparate impact (a confidence inquiry) and whether such an impact is large enough to be legally relevant (a magnitude inquiry). Disparate impact’s texts, purposes, and controlling interpretations are consistent with confidence inquires at all three stages, but not magnitude inquiries. Specifically, magnitude inquiries are inappropriate at Stages 1 and 3—there is no discriminatory impact or reduction too small or subtle for the purposes of the disparate impact analysis. Magnitude inquiries are appropriate at Stage 2, when an employer defends a discriminatory policy on the basis of its job-related business necessity. (shrink)

Explanations of productivity differences between men and women in science tend to focus on the academic sector and the individual level. This article examines how variation in organizational logic affects sex differences in scientists' commercial productivity, as measured by patenting. Using detailed data from a sample of academic and industrial life scientists working in the United States, the authors present multivariate regression models of scientific patenting. The data show that controlling for education- and career-history variables, women are less likely to (...) patent than men. However, in biotechnology firms—industrial settings characterized by flatter, more flexible, network-based organizational structures— women scientists are more likely to become patent-holding inventors than in more hierarchically arranged organizational settings in industry or academia. The authors discuss how the organization of scientists'work settings may influence enduring disparities between men and women in science and the implications of these findings for future work. (shrink)

This paper reviews major structural drivers of place-based health disparities in the context of Canada, an industrialized nation with a strong public health system. Likelihood that the COVID-19 pandemic will facilitate rejuvenation of Canada’s northern and remote areas through remote working, advances in online teaching and learning, and the increased use of telemedicine are also examined. The paper concludes by identifying some common themes to address healthcare disparities for northern and remote Canadian residents.

Digital health includes applications for smartphones and smart speakers as well as more traditional ways to access health information electronically, such as through your health care provider's online web‐based patient portal. As the number of digital health offerings—such as smartphone health trackers and web‐based patient portals—grows, what benefit do ethics, or bioethics, perspectives bring to digital health product development? For starters, the field of bioethics is concerned about issues of social justice, including equitable benefit and minimization and fair distribution of (...) the burden of harms. Researchers who employ user‐centered design methods should consider what digital health applications and products would look like if issues like equity and accessibility were foregrounded throughout design and development. One group whose needs are often neglected in the design of digital health products is older adults. Many people anticipate that the digital divide among older adults will close as the current generation of tech‐savvy consumers ages up. But since technology is constantly evolving, this divide may be constantly recreated. As bioethics moves ever further into the technology era, I want it to be mindful of the creation of digital health care disparities. (shrink)

As disparities and data science researchers, we write in response to Char and colleagues paper on “Identifying Ethical Considerations for Machine Learning Healthcare Applications.” While the...

The concept of substance is considered fundamental in order to understand chemistry and other related concepts, but many problems have been reported about its learning process. Considering the importance of textbooks in the training of chemistry teachers, this study aimed to identify the concepts of substance in general chemistry textbook glossaries. In addition, the study assessed the concepts of substance in relation to other chemical concepts and, when available, compared them with the concepts established by the IUPAC. The methodology employed (...) was content analysis and the results showed that concepts and statements related to the term ‘substance’ are different in the general chemistry textbooks analyzed. They also differ from those stated by IUPAC. Furthermore, it was found that many concepts are dependent on the concept of substance. It is concluded that there must be a greater effort from the community of chemists and the teaching of chemistry in the search for conceptual uniformity to reduce the problems of conceptual understanding. (shrink)

This paper provides a conceptual framework to explain why disparities may exist in food safety code compliance by food stores in different neighborhoods. Explanations include market dynamics, community characteristics, retailer attributes, inspector characteristics, and enforcement approaches, and interactions among the factors. A preliminary and limited empirical test of some of these relationships in Detroit, Michigan shows a higher rate of food safety violations by stores in poorer neighborhoods and in neighborhoods with higher concentrations of African-American residents. Stores inspected by female (...) inspectors also scored higher numbers of critical violations, suggesting a need for greater examination of the social relations associated with enforcement interactions in food safety studies. (shrink)

Multidimensional concepts are everywhere, and they are important. Examples include moral value, welfare, scientific confirmation, democracy, and biodiversity. How, if at all, can we aggregate the underlying dimensions of a multidimensional concept F to yield verdicts about which things are Fer than which overall? Social choice theory can be used to model and investigate this aggregation problem. Here, we focus on a particularly thorny problem made salient by this social choice-theoretic framework: the underlying dimensions of a given concept might be (...) measurable on different types of scales—e.g., some ordinal and some cardinal. An underappreciated impossibility theorem due to Anna Khmelnitskaya shows that seemingly plausible constraints on aggregation across scale types are inconsistent. This impossibility threatens to render the notion of overall Fness incoherent. We attempt to defuse this threat, arguing that the impossibility depends on an overly restrictive conception of measurement and of how measurement constrains aggregation. Adopting a more flexible—and, we think, more perspicuous—conception of measurement opens an array of possibilities for aggregation across disparate scale types. (shrink)

This paper describes the significance of key empirical findings from the recent and landmark study Caring and Aging with Pride: The National Health, Aging and Sexuality Study (with Karen I. Fredriksen‐Goldsen as the principal investigator), on lesbian, gay, bisexual, and transgender aging and health disparities. We will illustrate these findings with select quotations from study participants and show how nonconscious bias (i.e., activation of negative stereotypes outside conscious awareness) in the clinical encounter and health care setting can threaten shared decision‐making (...) and perpetuate health disparities among LGBT older adults. We recognize that clinical ethicists are not immune from nonconscious bias but maintain that they are well situated to recognize bias and resulting injustice by virtue of their training. Further, we discuss how clinical ethicists can influence the organization's ethical culture and environment to improve the quality and acceptability of health care for LGBT older adults. (shrink)

Personalized medicine with its promise of developing interventions tailored to an individual's health need and genetically related response to treatment might seem a promising antidote to the documented underutilization of standard depression treatments by African Americans. In addition, understanding depression not merely in biochemical terms but also in genetic terms might seem to counter cultural beliefs and stigma that attach to depression when conceived as a mood or behavioral problem under an individual's control. After all, if there is one thing (...) for which a person is not responsible and cannot be blamed, it is her genes. Nevertheless, for multiple reasons, a personalized medical approach to depression treatment, and its attendant conceptualization of depression and treatment response as genetically influenced, present the risk of exacerbating well-documented disparities in access to, and utilization of, treatment for depression among African-American and Caucasian elderly adults. (shrink)

Compensation for research related injuries is a subject that is increasingly gaining traction in developing countries which are burgeoning destinations of multi center research. However, the existence of disparate compensation rules violates the ethical principle of fairness. The current paper presents a comparison of the policies of Brazil, Russia, India, China and South Africa. A systematic search of good clinical practice guidelines was conducted employing search strategies modeled in line with the recommendations of ADPTE Collaboration. The search focused on three (...) main areas namely bibliographic data bases, clinical practice guidelines data bases and a restricted internet search. A manual search of references cited in relevant guideline documents was also conducted. The search terms, Medical Subject Headings and key words were developed for a PubMed platform and then adapted for all other data bases. The search terms were kept constant for each country with the only difference being the country name. The documents so obtained were subjected to systematic content analysis. The study revealed that there is vast panoply of regulations which exist on a continuum. On one extreme is India with comprehensive regulations that are codified into law, and on the other end there is China which does not have specific laws regulating research related injuries. There are a number of differences and similarities such as mandatory insurance requirements, existence of no fault compensation, compensable injuries and the role of research ethics committees. It is imperative to enact legislations that protect participants without stifling the research enterprise. There is need for consistency and ideally harmonization of such regulations at a global level. A model policy on compensation for research related injuries should borrow from the best aspects of the different country policies and should be informed by the cardinal ethics principles of autonomy, justice and beneficence. (shrink)

In “Should We Impose Quotas? Evaluating the ‘Disparate Impact’ Argument Against Legalization of Assisted Suicide,” Ronald Lindsay argues that it should make no difference to the debate over legalizing assisted suicide whether the risks associated with legalization would fall disproportionately on the poor, people with disabilities, racial minorities, or any other especially vulnerable social group. Even assuming such an inequitable distribution of risks would occur, he maintains, attempting to avoid such an outcome is not a good reason to deny assisted (...) suicide to “competent persons who truly voluntarily choose it.”Those of us who worry that legalization will differentially burden already disadvantaged segments of society have generally taken it for granted that the possibility of such disparities raises significant public policy concerns. By insisting on an explanation of this assumption — and, in so doing, making explicit the tension between autonomy and equality that underlies the assisted suicide debate — Lindsay has significantly advanced the ongoing conversation. While I disagree with his analysis, I commend him for a thoughtful, provocative, and important contribution to the literature. (shrink)

Background Inequities in COVID-19 outcomes in the USA have been clearly documented for sex and race: men are dying at higher rates than women, and Black individuals are dying at higher rates than white individuals. Unexplored, however, is how sex and race interact in COVID-19 outcomes. Objective Use available data to characterize COVID-19 mortality rates within and between race and sex strata in two US states, with the aim of understanding how apparent sex disparities in COVID-19 deaths vary across race. (...) Design and Participants This observational study uses COVID-19 mortality data through September 21, 2020, from Georgia (GA) and Michigan (MI). Main Measures We calculate age-specific rates for each sex-race-age stratum, and age-standardized rates for each race-sex stratum. We investigate the sex disparity within race groups and the race disparity within sex groups using age-standardized rate ratios, and rate differences. Key Results Within race groups, men have a higher COVID-19 mortality rate than women. Black men have the highest rate of all race-sex groups (in MI: 254.6, deaths per 100,000, 95% CI: 241.1–268.2, in GA:128.5, 95% CI: 121.0-135.9). In MI, the COVID-19 mortality rate for Black women (147.1, 95% CI: 138.7–155.4) is higher than the rate for white men (39.1, 95% CI: 37.3–40.9), white women (29.7, 95% CI: 28.3–31.0), and Asian/Pacific Islander men and women. COVID-19 mortality rates in GA followed the same pattern. In MI, the male:female mortality rate ratio among Black individuals is 1.7 (1.5–2.0) while the rate ratio among White individuals is only 1.3 (1.2–1.5). Conclusion While overall, men have higher COVID-19 mortality rates than women, our findings show that this sex disparity does not hold across racial groups. This demonstrates the limitations of unidimensional reporting and analyses and highlights the ways that race and gender intersect to shape COVID-19 outcomes. (shrink)

Is it possible to derive the outlines of a thinking of politics from the writings of Gilbert Simondon ? We will sketch an affirmative response by focusing our attention on three aspects of Simondon’s philosophy: 1. The manner in which the concept of Nature or the pre-individual displaces the debates over the relationship between political action, human nature and biological capacity; 2. The importance of the excess of « subject,) over « individual o as the matrix of a politics of (...) the transindividual; 3. The possibility of envisaging the notion of disparation, especially through its Deleuzian reading, as an essential contribution to a political philosophy of difference, that is, to a non-dialectical thinking of construction and conflict. We will end with a consideration of the limits of Simondon, limits in our view concentrated in the equivocal and irenic notion of « culture » or « technical culture. ». (shrink)

This paper examines the consistency of parent selection procedures, focusing on adoption and embryo donation. It outlines the current methods of selection and their disparities, and considers reasons for these disparities; namely, the intentionality of the parents, the gestational experience, and the technological imperative. This discussion is followed by an analysis of the ethical validity of these reasons, in terms of their consistency and how well they meet standards of equity and justice. The paper concludes that current approaches to parent (...) selection are unsystematic and inadequate, and discusses the implications of this assessment. (shrink)

ABSTRACT Objective: To contrast relief efforts for the 26 December 2004 tsunami with current global HIV/aids relief efforts and analyse possible reasons for the disparity. Methods: Literature review and ethical analysis. Results: Just over 273,000 people died in the tsunami, resulting in relief efforts of more than US$10 bn, which is sufficient to achieve the United Nation’s long‐term recovery plan for South East Asia. In contrast, 14 times more people died from HIV/aids in 2004, with UNAIDS predicting a US$8 (...) bn funding gap for HIV/aids in developing nations between now and 2007. This disparity raises two important ethical questions. First, what is it that motivates a more empathic response to the victims of the tsunami than to those affected by HIV/AIDS? Second, is there a morally relevant difference between the two tragedies that justifies the difference in the international response? The principle of justice requires that two cases similarly situated be treated similarly. For the difference in the international response to the tsunami and HIV/aids to be justified, the tragedies have to be shown to be dissimilar in some relevant respect. Are the tragedies of the tsunami disaster and the HIV/aids pandemic sufficiently different, in relevant respects, to justify the difference in scope of the response by the international community? Conclusion: We detected no morally relevant distinction between the tsunami and the HIV/aids pandemic that justifies the disparity. Therefore, we must conclude that the international response to HIV/aids violates the fundamental principles of justice and fairness. (shrink)

Public health emergencies expose social injustice and health disparities, resulting in calls to address their structural causes once the acute crisis has passed. The COVID-19 pandemic is highlighting and exacerbating global, national, and regional disparities in relation to the benefits and burdens of undertaking critical basic public health mitigation measures such as physical distancing. In the United States, attempts to address the COVID-19 pandemic are complicated by striking racial, economic, and geographic inequities. These synergistic inequities exist in both urban and (...) rural areas but take on a particular character and impact in areas of rural poverty. Rural areas face a diverse set of structural challenges, including inadequate public health, clinical, and other infrastructure and economic precarity, hampering the ability of communities and individuals to implement mitigation measures. Public health ethics demands that personnel address both the tactical, real-time adjustment of typical mitigation tools to improve their effectiveness among the rural poor as well as the strategic, longer-term structural causes of health and social injustice that continue to disadvantage this population. (shrink)

Recently, an increasing number of countries have been allowing voluntary active euthanasia (VAE) and physician-assisted suicide (PAS) as part of palliative care. Japan stands out as the most aged country in the developed world, and while the need for palliative care for older adults with dementia has been noted, there has been reluctance to openly address VAE and PAS. We conducted an online questionnaire survey using a vignette case to investigate the attitudes of Japanese physicians and the general public towards (...) VAE and PAS, and the factors influencing these attitudes. The findings revealed that Japanese physicians did not display support for euthanasia (2%) and assisted suicide (1%); however, the general public supported euthanasia (33%) and assisted suicide (34%). Notably, among the general public, males exhibited significantly higher support for PAS than females. Japanese physicians and the general public expressed a more negative stance towards VAE and PAS compared with their counterparts in Western countries. This disparity may be attributed to the influence of the Buddhist view of life and death and family-centeredness in the Japanese culture, which affects people’s attitudes towards assisted dying. The gap between physicians and the general public could potentially lead to challenges in medical practice, thereby, necessitating the need for open discussions in the future. (shrink)