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 (DCU) 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)

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)

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 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)

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)

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)

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)

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.

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)

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...

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)

At the beginning of his essay ‘Philosophies of the Transindividual: Spinoza, Marx, Freud’, Balibar [2018] hints at some reasons why he will not be dealing with Simondon, despite agreeing with the latter’s program of going beyond ‘the metaphysics of the subject and of substance’ and towards an ‘ontology of relations’. In what follows I would like to outline Simondon’s concept of transindividuality and spell out more clearly why Balibar cannot follow Simondon’s trajectory. At the same time, I suggest a number (...) of socio-political approaches that a specifically Simondonian concept of transindividuality opens up. (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)

American universities have long treated racial underrepresentation in academic programs as a problem to be solved at the point of admission. Race-conscious selection, whether explicit or concealed, rests on the assumption that disparities in outcomes reflect systemic exclusion and can be corrected by relaxing formal thresholds based on merit. With medicine as the focus, this essay challenges that assumption by shifting attention to earlier in the pipeline, where preparation and performance are first measured at scale. Advanced Placement (AP) exam participation (...) and performance—such as in AP Chemistry—are early meritocratic filters, and we document persistent gaps in both. We trace these disparities along the “success sequence” to medicine and demonstrate how conclusions about underrepresentation depend entirely on the denominator chosen. Relative to the general population, Blacks are underrepresented among medical school graduates; relative to AP examinees, they are neither under nor overrepresented among medical school graduates; relative to top AP performers, they are strongly overrepresented among medical school graduates. The same data tell three different stories, only one of which respects the structure of a meritorious pipeline. We argue that treating disparity as prima facie evidence of discrimination obscures the real problem: unequal preparation. A post-progressive research agenda should abandon the reflex to equate disparity with racism and instead confront the upstream factors that shape academic readiness. If the aim is durable representation in medicine and other selective professions, lowering standards at the end mistakes symptoms for causes. (shrink)

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)

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)

When do laws and policies that do not explicitly treat people differently on the basis of legally protected traits like race and sex nonetheless constitute disparate treatment on these bases? According to U.S. constitutional law, they do so when “facially neutral” laws are both enacted for impermissible reasons and also produce a discriminatory effect. To date, the first element of this claim – impermissible intention – has attracted significant attention. However, its second element – discriminatory effect – has been largely (...) ignored. Yet it is critical that we better understand what discriminatory effect requires, as competing tests animate debates in Circuit court cases and the issue has recently been flagged by Justice Alito. This Article takes up the task. It explores the normative disagreement that underlies the controversy regarding how to assess whether discriminatory effect is present and diagnoses the genuine moral conflict that any test for discriminatory harm must navigate. (shrink)

Repetitive transcranial magnetic stimulation (rTMS) is an FDA approved treatment for depression but may not be equitably accessible. Anecdotally, rTMS research enrolls few racialized participants. We assessed disparities and contributing factors through (1) systematic review of reported demographics in U.S. rTMS clinical trials for depression (n = 24 studies); (2) a nationwide, representatively sampled survey of potential patients and psychiatrists examining willingness to seek rTMS and perceived barriers (n = 603). Racialized non-white populations are underrepresented in rTMS clinical trials for (...) depression in the USA. Survey data suggests this is not due to the lack of acceptance of rTMS; there was no difference in willingness to seek rTMS based on respondent race (p = 0.18). Potential patients’ perceived barriers to rTMS care were similar regardless of race. Potential patients reported the primary barrier was lack of sufficient scientific evidence, while psychiatrists predicted that patients’ primary barriers to care were financial. Many publications did not report demographic data. Survey methodology is limited in predicting technology adoption behavior from stated attitudes. This work quantifies racial disparities within rTMS. Because access to care is the final step of translational research, increasing research participation in racialized groups should be a priority for the field. (shrink)

This chapter represents a report of corporate social responsibility (CSR)-related government policies and regulations from Austria, Czechia, France, Germany, Ireland, Italy, the Netherlands, Romania, and Spain. It highlights the significant influence of both EU directives and national initiatives in fostering sustainable business practices, as well as the national governments compliance with the United Nations Guiding Principles for Business and Human Rights through National Plans on Business and Human Rights, which have been implemented by seven of the nine analyzed countries. This (...) chapter’s objective is to present and discuss the importance of aligning national policies with EU and UN regulations to ensure coherence and effectiveness. Our findings reveal significant regional disparities in the implementation of CSR policies across nine European countries, shaped by economic maturity, cultural attitudes, and alignment with EU and UN directives. While Western nations often lead with robust frameworks and initiatives, emerging markets face challenges in harmonizing domestic priorities with international standards, highlighting the need for cohesive, adaptive approaches to CSR. Future researchers should broaden its scope and incorporate primary data to enhance the understanding of CSR policies, while public authorities should update and refine their CSR regulations to address evolving challenges. (shrink)

Contemporary work in bioethics presupposes a monistic view of race and a structuralist or polysemous view of racism. We aim to show that these received views are mistaken if the aim is to solve the racial health disparities problem. We argue that the theories that best enable us to solve the racial health disparities problem are a pluralist race theory and a virtue-theoretic account of racism because these theories are the best in terms of providing relevant accuracy and scope, causal (...) explanatory power, nonsuperfluous ontological complexity, and practical utility for the task at hand. (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)

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)

A key problem in conservation biology is how to measure biological diversity. Taxic diversity (the number of species in a community or in a local biota) is not necessarily the most important aspect, if what most matters is to evaluate how the loss of the different species may impact on the future of the surviving species and communities. Alternative approaches focus on functional diversity (a measure of the distribution of the species among the different ‘jobs’ in the ecosystem), others on (...) morphological disparity, still others on phylogenetic diversity. There are three major reasons to prioritize the survival of species which provide the largest contributions to the overall phylogenetic diversity. First, evolutionarily isolated lineages are frequently characterized by unique traits. Second, conserving phylogenetically diverse sets of taxa is valuable because it conserves some sort of trait diversity, itself important in so far as it helps maintain ecosystem functioning, although a strict relationships between phylogenetic diversity and functional diversity cannot be taken for granted. Third, in this way we maximize the “evolutionary potential” depending on the evolvability of the survivors. This suggests an approach to conservation problems focussed on evolvability, robustness and phenotypic plasticity of developmental systems in the face of natural selection: in other terms, an approach based on evolutionary developmental biology. (shrink)

In this chapter Robert Audi argues that cognitive diversity is inherent in the human condition. People differ greatly in what they believe even when they do not disagree. But most of us also disagree with many others on various important matters. Nor are cognitive disparities limited to what is _believed_: we also differ in what we presuppose, presume, accept, suspect, and surmise. Even where we agree, and thereby coincide in the _content_ of certain cognitions, we may differ in our degrees (...) of _conviction_ regarding the mutually accepted propositions. This paper considers the kinds of cognitive disparities—_intrapersonal_ as well as _interpersonal_—of major interest for epistemology. These include rational disagreements even on self-evident propositions, which some have thought obvious in a way that precludes rationally rejecting them. On the basis of the account of cognitive diversity and several distinctions within that category, the paper indicates a number of ways both to understand rational disagreement and to resolve it when possible. (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)

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...

In ‘Does zero-COVID neglect health disparities?’ we made the case that strict zero-COVID policies implemented during the coronavirus 2019 disease (COVID-19) pandemic raise health equity concerns so serious that these policies are not ethically sustainable.1 Zero-COVID, which has dominated many Pacific Rim societies, sets zero deaths from COVID-19 as a goal, and aims to reach it by forcefully containing transmission through short-term lockdowns, followed by stringent find, test, trace and isolate methods. Since the paper appeared in 2021, the Omicron variant (...) and subvariants took hold, making a strict zero goal unattainable and leading many countries to abandon it. Careful ethical analysis of zero-COVID’s impact remains crucially important, however, not only because the novel coronavirus continues to surprise us, but also to ensure lessons learnt from this pandemic are carried forward to future pandemics. In ‘Zero-COVID and health inequities’,2 Schaefer argues that it is possible to pursue zero-COVID yet offset any negative impacts on disadvantaged groups. Citing Singapore, where zero-COVID led to outbreaks in crowded and unsanitary migrant workers dormitories, Schaefer notes the government offset these effects, setting up less densely populated ‘quick build dormitories’ that caused daily case counts to drop, even while zero-COVID remained …. (shrink)

Empirical evidence demonstrates that minority and marginalized populations receive less and lower quality healthcare than more advantaged groups. Ethical analyses of these disparities explain their injustice. That disparities exist and constitute a moral wrong are uncontroversial views. Less clear are the exact causes of healthcare disparities.

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)

This article examines the responsibilities of researchers who conduct exploratory research to provide a service to vulnerable respondents. The term “service” is used to denote the provision of a tangible benefit in relation to the research question that is apart from the altruistic research benefits. This article explores what this “service” could look like, who might be responsible for providing it, and the challenges associated with such a service. The article argues that not providing a tangible benefit to vulnerable research (...) participants is inconsistent with the principle of social justice that undergirds much of the rationale for conducting health disparities research. (shrink)

ABSTRACT 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)

We consider a panel of experts asked to assign probabilities to events, both logically simple and complex. The events evaluated by different experts are based on overlapping sets of variables but may otherwise be distinct. The union of all the judgments will likely be probabilistic incoherent. We address the problem of revising the probability estimates of the panel so as to produce a coherent set that best represents the group’s expertise.

The government recognizes that social factors cause racial inequalities in access to resources and opportunities that result in racial health disparities. However, this recognition fails to acknowledge the root cause of these racial inequalities: structural racism. As a result, racial health disparities persist.

This article advocates a new interpretation ofinner experience– the experience that one has of one’s empirical-psychological features ‘from within’ – in Kant. It argues that for Kant inner experience is the empirical cognition of mental states, but not that of a persistent mental substance. The schema of persistence is thereby substituted with the regulative idea of the soul. This view is shown to be superior to two opposed interpretations: the parity view that regards inner experience as empirical cognition of a (...) mental object on a par with outer experience and the disparity view that denies altogether that inner experience is empirical cognition. (shrink)

The paper summarizes recently published data and recommendations about healthcare disparities experienced by African Americans who have Medicare or other healthcare coverage. Against this background the paper addresses the ethics of such disparities and how disadvantages of vulnerable populations like African Americans are typically maintained indecision making about how to respond to such disparities. Considering how to respond to disparities reveals much that vulnerable populations would bring to the policy-making table, if they can also be heard when they get there. (...) The paper argues that vulnerable populations like African Americans need fair representation in bodies deciding what to do about such disparities and that fairness requires proportional representation at all levels of decisions that affect healthcare – a radical change. In this decision setting, howto provide adequate protection of minorities needs much further attention. The most attractive decision-making model is deliberative democracy. The paper shows that in deliberation, fair representation requires not only having a voice in decisions, but a fair hearing of those voices. Achieving a fair hearing requires changes in norms of communication and training of all to give importance to greetings and other measures of civility and trust building, and to be open to diverse forms of expression. Decisions about how to respond to healthcare disparities would include what programs to initiate for whom, howto evaluate the programs, and what to do in response to such evaluations. Conclusions are that achieving such goals will take a sea change in how healthcare institutions and providers do their business, and that social activism at every level will be needed to effect these changes. The discussion highlights many ethical issues that need much greater attention. (shrink)

This chapter uses the film _John Q_ (2002) to set the stage for a discussion of the issues of organ transplantation and the ethics of health disparities and economic health policy. The film tells the story of John Q. Archibald (Denzel Washington), an African American factory worker, whose son requires a heart transplant. Upon discovering that their insurance will not cover the surgery, the couple realizes that they still lack sufficient funds to pay the hospital for the surgery. Growing desperate, (...) John holds the patients and staff of the hospital emergency room as hostages, demanding surgery for his son, while police negotiators and media attention gather and grow outside the walls of the hospital. (shrink)

On September 26th, 2023, the National Institute on Minority Health and Health Disparities (NIMHD) officially designated disabled people as a health disparity population, marking the most significant event for disabled people's health as it relates to the NIH. In this paper, I discuss the larger socio-political context as well as the clinical import of this historic decision.

This article examines how people of color can biologically inherit the deleterious effects of white racism. Drawing primarily on the field of epigenetics, I demonstrate how transgenerational racial disparities are in fact racist disparities that can be manifest physiologically, helping constitute the chemicals, hormones, cells, and fibers of the human body. Epigenetics can be used to demonstrate how white racism can have durable effects on the biological constitution of human beings that are not limited to the specific person who is (...) the target of white racism, but instead extend to that person's offspring. In this way, the field of epigenetics can help philosophers and others understand the transgenerational biological impact of social forces such as white racism. It reveals that the damage done by white racism is more extensive than critical philosophers of race might have realized, and also that interventions against white racism must address not just the economic, geographical, social, and psychological, but also the biological aspects of human existence. In particular, the article examines racist disparities in preterm birth rates and argues that the scope and significance of prenatal care for African American women must be expanded intergenerationally and include wide-scale forms of racial justice. (shrink)

For a little more than a decade, professional organizations and healthcare institutions have attempted to develop guidelines and policies to deal with seemingly intractable conflicts that arise between clinicians and patients (or their proxies) over appropriate use of aggressive life-sustaining therapies in the face of low expectations of medical benefit. This article suggests that, although such efforts at conflict resolution are commendable on many levels, inadequate attention has been given to their potential negative effects upon particular groups of patients/proxies. Based (...) on the well-documented tendency among many African Americans to prefer more aggressive end-of-life medical interventions, it is proposed that the use of institutional policy to break decision making impasse in cases for which aggressive treatment is deemed "medically inappropriate" will fall disproportionately on that group. Finally, it is suggested that the development and application of institutional conflict-resolution policies should be evaluated in the context of historical and current experiences of marginalization and disempowerment, lest such policies exacerbate that experience. (shrink)

Enthusiasm about the use of artificial intelligence (AI) in medicine has been tempered by concern that algorithmic systems can be unfairly biased against racially minoritized populations. This article uses work on racial disparities in knee osteoarthritis diagnoses to underline that achieving justice in the use of AI in medical imaging requires attention to the entire sociotechnical system within which it operates, rather than isolated properties of algorithms. Using AI to make current diagnostic procedures more efficient risks entrenching existing disparities; a (...) recent algorithm points to some of the problems in current procedures while highlighting systemic normative issues that need to be addressed while designing further AI systems. The article thus contributes to a literature arguing that bias and fairness issues in AI be considered as aspects of structural inequality and injustice and to highlighting ways that AI can be helpful in making progress on these. (shrink)

The relationships between age and the life-supporting treatments use, and between gender and the life-supporting treatments use are still controversial. Using extracorporeal membrane oxygenation as an example of life-supporting treatments, the objectives of this study were: to examine the relationship between age and the extracorporeal membrane oxygenation use; to examine the relationship between age and the extracorporeal membrane oxygenation use; and to deliberate the ethical and societal implications of age and gender disparities in the initiation of extracorporeal membrane oxygenation. This (...) is a population-based, retrospective cohort study. Taiwan’s extracorporeal membrane oxygenation cases from 2000 to 2010 were collected. The annual incidence rate of extracorporeal membrane oxygenation use adjusting for both age and gender distribution for each year from 2000 to 2010 was derived using the population of 2000 as the reference population. The trend of extracorporeal membrane oxygenation use was examined using time-series linear regression analysis. We conducted joinpoint regression for estimating the trend change of extracorporeal membrane oxygenation use. The trends of extracorporeal membrane oxygenation use both for different gender groups, and for different age groups have been significantly increasing over time. Men were more likely to be supported by extracorporeal membrane oxygenation than women. Women’s perspectives toward life and death, and women’s perception of well-being may be associated with the phenomenon. In addition, the patients at the age of 65 or older were more likely to be supported by extracorporeal membrane oxygenation than those younger than 65. Family autonomy/family-determination, and the Confucian tradition of filial piety and respecting elders may account for this phenomenon. This study showed gender and age disparities in the initiation of extracorporeal membrane oxygenation use in Taiwan, which may be accounted for by the cultural and societal values in Taiwan. For a healthcare professional who deals with patients’/family members’ medical decision-making to initiate life-supporting treatments, he/she should be sensitive not only to the legality, but also the societal and ethical issues involved. (shrink)

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 engineering applications require management of ever larger volumes of data, ontologies offer the potential to capture, manage, and augment data with the capability for automated reasoning and semantic querying. Unfortunately, considerable barriers hinder wider deployment of ontologies in engineering. Key among these is lack of a shared top-level ontology to unify and organise disparate aspects of the field and coordinate co-development of orthogonal ontologies. As a result, many engineering ontologies are limited to their scope, and functionally difficult to extend (...) or interoperate with other engineering ontologies. This paper demonstrates how the use of a top-level ontology, specifically the Basic Formal Ontology (BFO), greatly facilitates interoperability of multiple engineering-related ontologies. We constructed a system of formal linked ontologies by re-engineering legacy ontologies to be conformant with BFO and developing new BFO-conformant ontologies to capture knowledge in the engineering design, enterprise, human factors, manufacturing, and application domain of additive manufacturing. The resulting Integrated Framework for Additively Manufactured Products (IFAMP), including the body knowledge instantiated on its basis, serve as the basis for a proposed Design with Additive Manufacturing Method (DWAM), which we believe can support the design of innovative products with semantically enhanced ideation tools and enhanced access to application domain knowledge. The method and its facilitation through the ontological framework are demonstrated using a case study in medicine. (shrink)

While political blackness seems to be making quite a comeback, this resurgence has also met with frustration and ambivalence. This paper aims to make sense of why this mobilising concept is accepted in some contemporary black feminist circles and outright rejected in others. It unpicks the diasporic dimensions of political blackness, reflecting on the issues that converged to foreground ‘black’ as the basis for mobilising women of African and Asian decent to engage in collective activism. Attention is given to the (...) Organisation of Women of Asian and African Descent, a national network that linked black women's organisations and expressed and projected what the author defines as gendered political blackness. Interrogating its implications and the tendency towards ideological policing, the author argues that political blackness must be viewed as a politics of solidarity. If it is to maintain its viability, political blackness needs reframing, contextualising and further analysis. A retelling of its ideological underpinnings, and crucially the tensions and contradictions inherent in political blackness, offers a critical lens through which to rethink how we use it as a mobilising tactic in the present. (shrink)

Healthcare disparities, characterized by systematic differences in health outcomes among demographic groups, are often driven by bias, both explicit and implicit. Electronic Health Records (EHRs), integral to modern healthcare, pose unique bias and equity risks in healthcare delivery, which arise through EHR design, data entry, management practices, and clinical decision support tools. This chapter explores these risks and opportunities, identifying the “Four D’s of a Bias-D EHR” system—design, data, documentation, and care delivery. It offers strategies to mitigate bias and emphasizes (...) the importance of addressing these issues to promote health equity. Ensuring that EHR systems support fair, unbiased care is essential to improving outcomes across minoritized patient populations. (shrink)