NHS Health Scotland was the Scottish national health education and promotion agency from 2003 to 2020. A Special Health Board of NHS Scotland , its goal was to improve the health of the nation, via research, planning, programme implementation and evaluation.
127-551: NHS Health Scotland provided leadership and helped coordinate the work of other bodies, principally the 14 regional NHS Boards, in improving the health of the population and reducing health inequality . NHS Health Scotland was established on 1 April 2003, by the merger of the Health Education Board for Scotland ( HEBS ) and the Public Health Institute of Scotland ( PHIS ). It was dissolved by
254-403: A right or freedom to do so. It was conceived in the 1980s as an alternative approach to welfare economics . In this approach, Amartya Sen and Martha Nussbaum combine a range of ideas that were previously excluded from (or inadequately formulated in) traditional approaches to welfare economics. The core focus of the capability approach is improving access to the tools people use to live
381-489: A cause of poorer health for a society as a result of "underinvestment in social goods, such as public education and health care; disruption of social cohesion and the erosion of social capital". The role of socioeconomic status in health equity extends beyond simple monetary restrictions on an individual's purchasing power. In fact, social capital plays a significant role in the health of individuals and their communities. It has been shown that those who are better connected to
508-457: A choice may not positively affect physical well-being . Sen explains that a person as an agent need not be guided by a pursuit of well-being; agency achievement considers a person's success in terms of their pursuit of the whole of their goals. For the purposes of the capability approach, agency primarily refers to a person's role as a member of society , with the ability to participate in economic, social, and political actions. Therefore, agency
635-428: A clean environment , the likelihood that the average person will have a right to 10 years or more of education, and lead a comparatively long and healthy life. Well-being will also be increased by institutions that enable citizens to feel that they control their own lives, and that investment of their time and resources will be rewarded. In turn, this will lead to higher incomes in a virtuous circle . Simon Kuznets ,
762-405: A common use of the term " agent " sometimes used in economics and game theory to mean a person acting on someone else's behalf. Agency depends on the ability to personally choose the functionings one values, a choice that may not correlate with personal well-being. For example, when a person chooses to engage in fasting , they are exercising their ability to pursue a goal they value, though such
889-736: A considerable section of these nations (6%, 17%, 3%, 1%, and 6% respectively), this could have significant detrimental effects on the health equity of the nation. In France, an older study noted significant differences in access to healthcare between native French populations, and non-French/migrant populations based upon health expenditure; however this was not fully independent of poorer economic and working conditions experienced by these populations. A 1996 study of race-based health inequity in Australia revealed that Aborigines experienced higher rates of mortality than non-Aborigine populations. Aborigine populations experienced 10 times greater mortality in
1016-461: A country's score in the three areas of the HDI based on perceived gender gaps, and penalizes the score of the country if, indeed, large gender disparities in those areas exist. This index is used in unison with the HDI and therefore also captures the elements of capabilities that the HDI holds. In addition, it considers women's capabilities which has been a focus in much of Sen's and Nussbaum's work (to list
1143-479: A decent standard of living) adjusted for inequalities in the distribution of each dimension across the population. The Gender-related Development Index is defined as a "distribution-sensitive measure that accounts for the human development impact of existing gender gaps in the three components of the HDI" (p. 243). In this way, the GDI accounts for shortcomings in the HDI in terms of gender, because it re-evaluates
1270-634: A deduction in accounting systems (p. 11). Furthermore, natural resources are treated as limitless and negative outputs such as pollution and associated health risks, are not deducted from the measures. Technical and misinterpretation critiques When GNP and GDP were developed, their intended use was not for measuring human well-being; the intended use was as an indicator of economic growth, and that does not necessarily translate into human well-being. Kuznets has often made this point, in his words, "distinctions must be kept in mind between quantity and quality of growth, between costs and returns and between
1397-570: A few: Nussbaum, 2004a; Nussbaum, 2004b; Sen, 2001; Sen, 1990.) The Gender Empowerment Measure (GEM) is considerably more specialized than the GDI. The GEM focuses particularly on the relative empowerment of women in a given country. The empowerment of women is measured by evaluating women's employment in high-ranking economic positions, seats in parliament, and share of household income. Notably this measurement captures more of Nussbaum's 10 Central Capabilities, such as, Senses, Imagination and Thought; Affiliation; and Control Over One's Environment. In
SECTION 10
#17327868523331524-536: A framework to provide funding based upon communal contributions and government subsidies. In its absence, there was a significant decrease in the quantity of healthcare professionals (35.9%), as well as functioning clinics (from 71% to 55% of villages over 14 years) in rural areas, resulting in inequitable healthcare for rural populations. The significant poverty experienced by rural workers (some earning less than US$ 1 per day) further limits access to healthcare, and results in malnutrition and poor general hygiene, compounding
1651-399: A fulfilling life. Sen initially argued for five components to assess capability: Subsequently, in collaboration with political philosopher Martha Nussbaum , development economist Sudhir Anand and economic theorist James Foster , Sen has helped propel the capabilities approach to appear as a policy paradigm in debates concerning human development; his research inspired the creation of
1778-497: A gender identity that diverges from their birth gender. In addition to many of the same barriers as the rest of the LGBT community, globally the transgender individuals often also face a higher disease burden. Transgender people also face significant levels of discrimination. Due to this experience, many transgender people avoid seeking necessary medical care out of fear of discrimination. The stigmatization represented particularly in
1905-561: A general assessment and critique of global human development to shed light on persistent inequality, poverty and other capability deprivations despite high levels of GDP growth. Currently the HDI continues to be used in the Human Development Report in addition to many other measures (based on theoretical perspectives of Capabilities) that have been developed and used by the United Nations. Among these indices are
2032-465: A history of anti-LGBT bias in health care. The Diagnostic and Statistical Manual of Mental Disorders ( DSM ) listed homosexuality as a disorder until 1973; transgender status was listed as a disorder until 2012. This was amended in 2013 with the DSM-5 when "gender identity disorder" was replaced with " gender dysphoria ", reflecting that simply identifying as transgender is not itself pathological and that
2159-439: A list of central human capabilities. On the other hand, Sen refuses to supply a specific list of capabilities. Sen argues that an exact list and weights would be too difficult to define. For one, it requires specifying the context of use of capabilities, which could vary. Also, Sen argues that part of the richness of the capabilities approach is its insistence on the need for open valuational scrutiny for making social judgments. He
2286-864: A much higher risk of maternal death than those in developed countries. The highest risk of dying during childbirth is 1 in 6 in Afghanistan and Sierra Leone, compared to nearly 1 in 30,000 in Sweden—a disparity that is much greater than that for neonatal or child mortality . Women are generally are of lower socioeconomic status (SES) in USA and have more barriers to accessing healthcare, and higher rates of depression and chronic stress and negative impact health. In Europe, women who grew up in poverty are more likely to have lower muscle strength and higher disability in old age. Women are also more likely than men to suffer from sexual or intimate-partner violence both in
2413-581: A number of countries. The Pygmies of Congo, for instance, are excluded from government health programs, discriminated against during public health campaigns, and receive poorer overall healthcare. In a survey of five European countries (Sweden, Switzerland, the UK, Italy, and France), a 1995 survey noted that only Sweden provided access to translators for 100% of those who needed it, while the other countries lacked this service potentially compromising healthcare to non-native populations. Given that non-natives composed
2540-465: A number of development and well-being factors that are not taken into account in the calculation of GDP and GNP. The Human Development Index is calculated using the indicators of life expectancy, adult literacy, school enrollment, and logarithmic transformations of per-capita income. Moreover, it is noted that the HDI "is a weighted average of income adjusted for distributions and purchasing power, life expectancy, literacy and health" (p. 16) The HDI
2667-419: A paradigm in development. The programme of work operationalising the capability approach by Anand and colleagues draws heavily on Nussbaum's list as a relatively comprehensive, high-level account of the space in which human well-being or life quality is experienced. This work argues that the subitems on Nussbaum's list are too distinct to be monitored by single question and that a dashboard of some 40-50 indicators
SECTION 20
#17327868523332794-484: A picture of quality of life and deprivation in the UK. Subsequently, Anand and colleagues have developed datasets for the US, UK and Italy in which all the elements of Sen's framework are reflected in data which permits all three key equations, for functionings, experience and capabilities, to be estimated. In a series of papers, they have shown that both their primary data and some secondary datasets can be used to shed light on
2921-400: A political economist and activist for women's rights, elaborates on the example of a mother engaged in child care, domestic care and producing few goods for the informal market, all of which are usually done simultaneously. These activities provide economic benefits, but are not valued in national accounting systems; this suggests that the definition of unemployment used in output-based measures
3048-407: A political order can only be considered as being decent if this order secures at least a threshold level of these 10 capabilities to all inhabitants. Nussbaum's capabilities approach is centered around the notion of individual human dignity. Nussbaum emphasizes that this approach is necessary since even individuals within a family unit can have vastly different needs. Given Nussbaum's contention that
3175-582: A range of insights. In 1990, the UN Human Development report published the first such exercise which focused on health, education and income which were equally weighted to generate the Human Development Index . At the same time, and subsequently, researchers recognizing that these three areas covered only certain elements of life quality have sought to develop more comprehensive measures. A major project in this area has been
3302-565: A result receive less regular medical care. The level of insurance coverage is directly correlated with access to healthcare including preventive and ambulatory care. A 2010 study on racial and ethnic disparities in health done by the Institute of Medicine has shown that the aforementioned disparities cannot solely be accounted for in terms of certain demographic characteristics like: insurance status, household income, education, age, geographic location and quality of living conditions. Even when
3429-495: A result; this trend is also observed in regard to other substances, such as marijuana, in Jamaica, where the rate of use is 2–3 times more for men than women. Men are also more likely to have severe chronic conditions. In developing countries, males tend to have a health advantage over women due to gender discrimination, evidenced by infanticide, early marriage, and domestic abuse for females. Women in developing countries have
3556-481: A strong preventative measure that can be taken to decrease levels of illness and increase levels of visiting healthcare providers. The lack of health education can contribute to worsened health outcomes in these areas. Education inequities are also closely associated with health inequities. Individuals with lower levels of education are more likely to incur greater health risks such as substance abuse, obesity, and injuries both intentional and unintentional. Education
3683-427: Is a stub . You can help Misplaced Pages by expanding it . Health inequality Health equity arises from access to the social determinants of health , specifically from wealth, power and prestige. Individuals who have consistently been deprived of these three determinants are significantly disadvantaged from health inequities, and face worse health outcomes than those who are able to access certain resources. It
3810-570: Is a basis of health discrimination and inequity throughout the world. Homosexual , bisexual , transgender , and gender-variant populations around the world experience a range of health problems related to their sexuality and gender identity , some of which are complicated further by limited research. In spite of recent advances, LGBT populations in China, India, and Chile continue to face significant discrimination and barriers to care. The World Health Organization (WHO) recognizes that there
3937-404: Is a non-remediable/controllable factor, the situation would be classified as a health inequality. Conversely, if a population has a lower life expectancy due to lack of access to medications, the situation would be classified as a health inequity. These inequities may include differences in the "presence of disease, health outcomes, or access to health care". Although, it is important to recognize
NHS Health Scotland - Misplaced Pages Continue
4064-416: Is a positive correlation between developed countries with high economic equality and longevity. This is unrelated to average income per capita in wealthy nations. Economic gain only impacts life expectancy to a great degree in countries in which the mean per capita annual income is less than approximately $ 25,000. The United States shows exceptionally low health outcomes for a developed country, despite having
4191-707: Is also associated with greater comprehension of health information and services necessary to make the right health decisions, as well as being associated with a longer lifespan. Individuals with high grades have been observed to display better levels of protective health behavior and lower levels of risky health behaviors than their less academically gifted counterparts. Factors such as poor diets, inadequate physical activity, physical and emotional abuse, and teenage pregnancy all have significant impacts on students' academic performance and these factors tend to manifest themselves more frequently in lower-income individuals. For some populations, access to healthcare and health resources
4318-543: Is also evidence for a correlation between socioeconomic status and health literacy; one study showed that wealthier Tanzanian families were more likely to recognize disease in their children than those that were coming from lower income backgrounds. Social inequities are a key barrier to accessing health-related educational resources. Patients in lower socioeconomic areas will have less access to information about health in general, leading to less awareness of different diseases and health issues. Health education has proven to be
4445-506: Is also true of the difference between mortality across all occupational classes in highly equal Sweden as compared to less-equal England. Unconditional cash transfers for reducing poverty used by some programs in the developing world appear to lead to a reduction in the likelihood of being sick. Such evidence can guide resource allocations to effective interventions. The quality of health care varies among different socioeconomic groups. Children in families of low socioeconomic status are
4572-769: Is an expression of behavior and lifestyle choices. Both sex and gender inform each other, and differences between genders influence disease manifestation and associated healthcare approaches. Understanding how the interaction of sex and gender contributes to disparity in the context of health allows providers to ensure quality outcomes for patients. This interaction is complicated by the difficulty of distinguishing between sex and gender given their intertwined nature; sex modifies gender, and gender can modify sex, thereby impacting health. Sex and gender can both be considered sources of health disparity; both contribute to susceptibility to various health conditions, including cardiovascular disease and autoimmune disorders. In most regions of
4699-494: Is an important, yet underrepresented, factor in health inequities research and prevention efforts. There are many ways that a job can affect one's health, such as the job's physical demands, exposure to hazards, mechanisms of employment, compensation and benefits, and availability of health and safety programs. In addition, those who are in steady jobs are less likely to face poverty and its implications and more likely to have access to health care. Maintenance of good health through
4826-578: Is calculated for individual countries with a value between 0 and 1 and is "interpreted...as the ultimate development that has been attained by that nation" (p. 17). Currently, the 2011 Human Development Report also includes the Inequality-adjusted Human Development Index which accounts for exactly the same things that the HDI considers however the IHDI has all three dimensions (long and healthy life, knowledge and
4953-400: Is capable of doing and their resulting current state due to the nature of the options available to them. Consequently, the capability set outlined by this approach is not merely concerned with achievements; rather, freedom of choice , in and of itself, is of direct importance to a person's quality of life . For example, the difference between fasting and starving , on person's well-being,
5080-416: Is closely associated with the social justice movement, with good health considered a fundamental human right. These inequities may include differences in the "presence of disease, health outcomes, or access to health care" between populations with a different race , ethnicity , gender , sexual orientation , disability , or socioeconomic status. Health inequity differs from health inequality in that
5207-444: Is crucial in assessing one's capabilities and any economic, social, or political barriers to one's achieving substantive freedoms. Concern for agency stresses that participation , public debate, democratic practice, and empowerment , should be fostered alongside well-being. Alkire and Deneulin pointed out that agency goes together with the expansion of valuable freedoms. That is, in order to be agents of their lives, people need
NHS Health Scotland - Misplaced Pages Continue
5334-839: Is difficult to know the worldwide extent of this practice. While generally thought of as a Sub-Saharan African practice, it may have roots in the Middle East as well. The estimated 3 million girls who are subjected to FGM each year potentially suffer both immediate and lifelong negative effects. Immediately following FGM, girls commonly experience excessive bleeding and urine retention . Long-term consequences include urinary tract infections , bacterial vaginosis , pain during intercourse , and difficulties in childbirth that include prolonged labor, vaginal tears, and excessive bleeding. Women who have undergone FGM also have higher rates of post-traumatic stress disorder (PTSD) and herpes simplex virus 2 (HSV2) than women who have not. Sexuality
5461-400: Is disinclined to in any way devalue the domain of reasoning in the public sphere . Instead, Sen argues that the task of weighing various capabilities should be left to the ethical and political considerations of each society based on public reasoning. Along with concerns raised about Nussbaum's list, Alkire and Black also argue that Nussbaum's methodology "runs counter to an essential thrust of
5588-490: Is distributed among economic and social status in a society can provide insight into the level of development within that society. Health is a basic human right and human need, and all human rights are interconnected. Thus, health must be discussed along with all other basic human rights. Health equity is defined by the CDC as "the state in which everyone has a fair and just opportunity to attain their highest level of health". It
5715-500: Is inadequate research data about the effects of LGBT discrimination on morbidity and mortality rates in the patient population. In addition, retrospective epidemiological studies on LGBT populations are difficult to conduct as a result of the practice that sexual orientation is not noted on death certificates. WHO has proposed that more research about the LGBT patient population is needed for improved understanding of its unique health needs and barriers to accessing care. One of
5842-440: Is inappropriate. (See the article on Feminist economics, section "Well-being" ). Environmental critiques Another critique by Waring is that the output-based measures ignore negative effects of economic growth and so commodities that lower social welfare, such as nuclear weapons, and oil extraction which causes spills, are considered a good input. The "anti-bads" or the defensive expenditures to fight "bads" are not counted as
5969-567: Is inherently tied together with an understanding of capabilities, as defined by this approach. Capabilities are the alternative combinations of functionings that are feasible for a person to achieve. Formulations of capability have two parts: functionings and opportunity freedom — the substantive freedom to pursue different functioning combinations. Ultimately, capabilities denote a person's opportunity and ability to generate valuable outcomes, taking into account relevant personal characteristics and external factors. The important part of this definition
6096-400: Is likely that the quality of that care is not highly sufficient. Education is an important factor in healthcare utilization, though it is closely intertwined with economic status. An individual may not go to a medical professional or seek care if they do not know the ills of their failure to do so, or the value of proper treatment. In Tajikistan , since the nation gained its independence,
6223-493: Is not equity to simply provide every individual with the same resources; that would be equality. In order to achieve health equity, resources must be allocated based on an individual need-based principle. According to the World Health Organization , "Health is a state of complete physical, mental and social well-being and not merely the absence of disease or infirmity". The quality of health and how health
6350-643: Is physically limited, resulting in health inequities. For instance, an individual might be physically incapable of traveling the distances required to reach healthcare services, or long distances can make seeking regular care unappealing despite the potential benefits. In 2019, the federal government identified nearly 80 percent of rural America as "medically underserved," lacking in skilled nursing facilities, as well as rehabilitation, psychiatric and intensive care units. In rural areas, there are approximately 68 primary care doctors per 100,000 people, whereas there are 84 doctors per 100,000 in urban centers. According to
6477-634: Is representative of the general population of the United States. On the other hand, a woman's access to healthcare in rural communities has recently become a matter of concern. Access to maternal obstetric care has decreased in rural communities due to the increase in both hospital closers and labor & delivery center closures that have placed an increased burden on families living in these areas. Burdens faced by women in these rural communities include financial burdens on traveling to receive adequate care. Millions of individuals living in rural areas in
SECTION 50
#17327868523336604-401: Is required to inform the development of empirical work. The measurement of capabilities was previously thought to be a particular barrier to the implementation and use of the approach. However, two particular lines of work, in research and policy have sought to show that meaningful indicators of what individuals (and in some cases governments) are able to do can be developed and used to generate
6731-402: Is the "freedom to achieve", because if freedom had only instrumental value (valuable as a means to achieve an end) and no intrinsic value (valuable in and of itself) to a person's well-being, then the value of the capability set as a whole would simply be defined by the value of a person's actual combination of functionings. Such a definition would not acknowledge the entirety of what a person
6858-605: Is whether the person is choosing not to eat. In this example, the functioning is starving but the capability to obtain an adequate amount of food is the key element in evaluating well-being between individuals in the two states. In sum, having a lifestyle is not the same as choosing it; well-being depends on how that lifestyle came to be. More formally, while the combination of a person's functionings represents their actual achievements, their capability set represents their opportunity freedom — their freedom to choose between alternative combinations of functionings. In addition to being
6985-586: The Gender-related Development Index (GDI), the Gender Empowerment Measure (GEM), introduced in 1995, and the more recent Gender Inequality Index (GII) and the Inequality-adjusted Human Development Index (IHDI), both adopted in 2010. The following are a few of the major indices that were created based on the theoretical grounds of Capabilities Approach. The Human Development Index takes into consideration
7112-538: The National Rural Health Association , almost 10% of rural counties had no doctors in 2017. Rural communities face lower life expectancies and increased rates of diabetes, chronic disease, and obesity. There is a physical difference in access healthcare as well, for emergency instances or even therapies, where patients are to travel excessive distances to receive necessary care. These health disparities in rural areas are major problems. Over
7239-448: The pandemic , however, efforts were present to make healthcare more universal. In doing so, more awareness was given to rural populations. There are still things that need to be done, though, underlying health disparities in region are still prominent. Costa Rica , for example, has demonstrable health spatial inequities with 12–14% of the population living in areas where healthcare is inaccessible. Inequity has decreased in some areas of
7366-479: The 'capabilities measurement project' in which Anand has led teams of philosophers, economists and social scientists to generate that gives a full and direct implement of the approach drawing particular on the key relations and concepts developed in Sen (1985) but also on work to do with the content of the approach. The earliest work in this project developed a set of around 50 capability indicators which were used to develop
7493-528: The 2013 Human Development Report the Gender Inequality Index, which was introduced in 2011, continues to adjust the GDI and the GEM. This composite measurement uses three dimensions: reproductive health , empowerment, and labor force participation. When constructing the index the following criteria were key: conceptual relevance to definitions of human development and theory; Non-ambiguity so that
7620-468: The 30–40 age range; 2.5 times greater infant mortality rate, and 3 times greater age standardized mortality rate. Rates of diarrheal diseases and tuberculosis are also significantly greater in this population (16 and 15 times greater respectively), which is indicative of the poor healthcare of this ethnic group. At this point in time, the parities in life expectancy at birth between indigenous and non-indigenous peoples were highest in Australia, when compared to
7747-437: The LGBT community contend with health care disparities due, in part, to lack of provider training and awareness of the population's healthcare needs. Transgender individuals believe that there is a higher importance of providing gender identity (GI) information more than sexual orientation (SO) to providers to help inform them of better care and safe treatment for these patients. Studies regarding patient-provider communication in
SECTION 60
#17327868523337874-835: The LGBT patient community show that providers themselves report a significant lack of awareness regarding the health issues LGBT-identifying patients face. As a component of this fact, medical schools do not focus much attention on LGBT health issues in their curriculum; the LGBT-related topics that are discussed tend to be limited to HIV/AIDS, sexual orientation, and gender identity. Among LGBT-identifying individuals, transgender individuals face especially significant barriers to treatment. Many countries still do not have legal recognition of transgender or non-binary gender individuals leading to placement in misgendered hospital wards and medical discrimination. Seventeen European states mandate sterilization of individuals who seek recognition of
8001-515: The UN's Human Development Index (a popular measure of human development that captures capabilities in health, education, and income). Additionally, the approach has been operationalized to have a high income country focus by Paul Anand and colleagues. Sen also founded the Human Development and Capability Association in 2004 in order to further promote discussion, education, and research on
8128-670: The UNDP introduced the Human Poverty Index (HPI), which is aimed at measuring poverty in both industrialized and developing countries. The HPI is a "nonincome-based" measure of poverty (p. 100) which focuses on "human outcomes in terms of choices and opportunities that a person faces" (p. 99). In support of this index, Sakiko Fukuda-Parr —a development economist and past Director of The Human Development Report Office—differentiates between income poverty and human poverty. Human poverty can be interpreted as deprivations to lead
8255-594: The US, Canada and New Zealand. In South America, indigenous populations faced similarly poor health outcomes with maternal and infant mortality rates that were significantly higher (up to 3 to 4 times greater) than the national average. The same pattern of poor indigenous healthcare continues in India, where indigenous groups were shown to experience greater mortality at most stages of life, even when corrected for environmental effects. Due to systemic health and social inequities people from racial and ethnic minority groups in
8382-608: The United States and worldwide. Women have better access to healthcare in the United States than they do in many other places in the world, yet having sufficient health insurance to afford the care, such as related to postpartum treatment and care, may help to avoid additional preventable hospital readmission and emergency department visits. In one population study conducted in Harlem, New York, 86% of women reported having privatized or publicly assisted health insurance, while only 74% of men reported having any health insurance. This trend
8509-587: The United States are disproportionately affected by COVID-19 . On February 5, 2021, the head of the World Health Organization (WHO), Tedros Adhanom Ghebreyesus , noted regarding the global inequity in the access to COVID-19 vaccines , that almost 130 countries had not yet given a single dose. In early April 2021, the WHO reported that 87% of existing vaccines had been distributed to the wealthiest countries, while only 0.2% had been distributed to
8636-553: The United States are more at risk of having decreased access to maternal health care facilities if the community is low-income. These women are more at risk of experiencing adverse maternal outcomes like a higher risk of having postpartum depression , having an out-of-hospital birth, and on the extreme end, maternal morbidity and mortality . In addition, women's pain tends to be treated less seriously and initially ignored by clinicians when compared to their treatment of men's pain complaints. Historically, women have not been included in
8763-461: The United States, that is, more equal states show more desirable health outcomes. Importantly, inequality can have a negative health impact on members of lower echelons of institutions. The Whitehall I and II studies looked at the rates of cardiovascular disease and other health risks in British civil servants and found that, even when lifestyle factors were controlled for, members of lower status in
8890-480: The University of Southampton noted that physical access to healthcare was one of the primary factors influencing quality of maternal healthcare. Further, many women in rural areas of the country did not have adequate access to healthcare resources, resulting in poor maternal and neonatal care. These rural women were, for instance, far more likely to give birth in their homes without medical oversight. Along with
9017-775: The approach has been criticized for being grounded in the liberal notion of freedom: This is a fundamentally reductive view of the human condition. Moreover, the emphasis on freedom betrays a profoundly modern orientation. The compound problem is that freedom in Nussbaum's hands is both given an intrinsic and primary value (a reductive claim), and, at the same time, the list is treated as a contingent negotiated relation in tension with other virtues such as justice, equality and rights. Both propositions cannot hold. The core capabilities Nussbaum argues should be supported by all democracies are: Although Nussbaum did not claim her list as definite and unchanging, she strongly advocated for outlining
9144-466: The capabilities approach in a critical form. In particular, it considers freedom in relation to responsibility, that is, the capacity of people to apply moral constraints to themselves. By contrast, Sen's capability approach considers freedom as a purely functional rationality of choice. Amartya Sen defines an agent as someone who acts and brings about change, whose achievement can be evaluated in terms of his or her own values and goals. This differs from
9271-407: The capabilities approach which has been the attempt to redirect development theory away from a reductive focus on a minimally decent life towards a more holistic account of human well-being for all people." That said, applications to development are discussed in Sen (1999), Nussbaum (2000), and Clark (2002, 2005), and are now numerous to the point where the capabilities approach is widely accepted as
9398-426: The capability approach; capability is conceptualized as a reflection of the freedom to achieve valuable functionings. In other words, functionings are the subjects of the capabilities referred to in the approach: what we are capable of, want to be capable of, or should be capable of being and/or do. Therefore, a person's chosen combination of functionings, what they are and do, is part of their overall capability set —
9525-427: The capacity to profoundly limit the capabilities of an individual or population, manifesting itself through deficiencies in both financial and social capital . It is clear how a lack of financial capital can compromise the capacity to maintain good health. Income is an important determinant of access to healthcare resources. Because one's job or career is a primary conduit for both financial and social capital, work
9652-538: The conclusion of Capabilities Approach is that people do not just value monetary income, and that development is linked to various indicators of life satisfaction and hence are important in measuring well-being. Development policies strive to create an environment for people to live long, healthy creative lives. Feminist critiques Nussbaum highlights some of the problematic assumptions and conclusions of output-based approaches to development. First, she notes that GNP and GDP do not consider special requirements to help
9779-564: The cultural phenomenon of preference for male children. Recently, gender-based disparities have decreased as females have begun to receive higher-quality care. Additionally, a girl's chances of survival are impacted by the presence of a male sibling; while girls do have the same chance of survival as boys if they are the oldest girl, they have a higher probability of being aborted or dying young if they have an older sister. In India , gender-based health inequities are apparent in early childhood. Many families provide better nutrition for boys in
9906-656: The design or practice of clinical trials , which has slowed the understanding of women's reactions to medications and created a research gap. This has led to post-approval adverse events among women, resulting in several drugs being pulled from the market. However, the clinical research industry is aware of the problem, and has made progress in correcting it. Health disparities are also due in part to cultural factors that involve practices based not only on sex, but also gender status. For example, in China , health disparities have distinguished medical treatment for men and women due to
10033-410: The developer of GNP, cautioned against using the measure as an indicator of overall welfare, which speaks to the unintended use of output-based measures as indicators of human welfare. The use of GDP and GNP as an approximation of well-being and development have been critiqued widely, because they are often misused as indicators of well-being and human development when in fact they are only telling about
10160-433: The diagnosis is instead for the distress a transgender person may experience as a result of the discordance between assigned gender and gender identity. LGBT health issues have received disproportionately low levels of medical research, leading to difficulties in assessing appropriate strategies for LGBT treatment. For instance, a review of medical literature regarding LGBT patients revealed that there are significant gaps in
10287-497: The difference in health equity and equality, as having equality in health is essential to begin achieving health equity. The importance of equitable access to healthcare has been cited as crucial to achieving many of the Millennium Development Goals . Socioeconomic status is both a strong predictor of health, and a key factor underlying health inequities across populations. Poor socioeconomic status has
10414-413: The economic capacity of a country or an average income level when expressed on a per person basis. In particular, feminist economics and environmental economics offer a number of critiques. Critics in these fields typically discuss gender inequalities , insufficient representation of environmental costs of productions and general issues of misusing an output-based measure for unintended purposes. In sum,
10541-765: The elements of human well-being . Monetary and non-monetary measures of well-being are ideal when used to complement each other. Understanding the various aspects of economic development process not only helps address issues of inequality and lags in human development, but also helps to pinpoint where countries lag, which once addressed can further promote well-being and advancement. As the Organisation for Economic Co-operation and Development (OECD) (2006) notes: Well-being has several dimensions of which monetary factors are only one. They are nevertheless an important one, since richer economies are better placed to create and maintain other well-being-enhancing conditions, such as
10668-542: The establishment of Public Health Scotland on 1 April 2020. It employed about 280 staff. The work of the agency was focussed on: NHS Health Scotland was dissolved and succeeded by Public Health Scotland on 1 April 2020. This new national Special Health Board is a collaborative approach by both the Scottish Government and COSLA to give effect to the recommendations of the 2015 Review of Public Health . This National Health Service -related article
10795-451: The freedom to be educated, speak in public without fear, express themselves, associate, etc.; conversely, people can establish such an environment by being agents. In summary, the agency aspect is important in assessing what a person can do in line with his or her conception of the good. Nussbaum (2000) frames these basic principles in terms of 10 capabilities, i.e. real opportunities based on personal and social circumstance. She claims that
10922-480: The functionings they were able to do. Yet, functionings can also be conceptualized in a way that signifies an individual's capabilities. Eating , starving , and fasting would all be considered functionings, but the functioning of fasting differs significantly from that of starving because fasting, unlike starving, involves a choice and is understood as choosing to fast despite the presence of other options. Consequently, an understanding of what constitutes functionings
11049-435: The goal of the capabilities approach is to produce capabilities for each and every person, the capabilities below belong to individual persons, rather than to groups. The capabilities approach has been very influential in development policy where it has shaped the evolution of the human development index ( HDI ), has been much discussed in philosophy, and is increasingly influential in a range of social sciences. More recently,
11176-458: The highest national healthcare expenditure in the world. The US ranks 31st in life expectancy. Americans have a lower life expectancy than their European counterparts, even when factors such as race, income, diet, smoking, and education are controlled for. Relative inequality negatively affects health on an international, national, and institutional levels. The patterns seen internationally hold true between more and less economically equal states in
11303-450: The human development and capability approach. Since then, the approach has been much discussed by political theorists, philosophers, and a range of social scientists, including those with a particular interest in human health. The approach emphasizes functional capabilities ("substantive freedoms", such as the ability to live to old age, engage in economic transactions, or participate in political activities); these are construed in terms of
11430-418: The importance of freedom of choice, individual heterogeneity and the multi-dimensional nature of welfare . In significant respects, the approach is consistent with the handling of choice within conventional microeconomics consumer theory , although its conceptual foundations enable it to acknowledge the existence of claims, like rights , which normatively dominate utility-based claims (see Sen 1979 ). In
11557-497: The index is easily interpreted; Reliability of data that is standardized and collected/processed by a trustworthy organization; No redundancy found in other indicators; and lastly Power of discrimination, where distribution is well distinguished among countries and there is no "bunching" among top and bottom countries (p. 10). This index also captures some of Nussbaum's 10 Central Capabilities (Senses, Imagination and Thought; Affiliation; and Control Over Ones Environment). In 1997,
11684-424: The institution showed increased mortality and morbidity on a sliding downward scale from their higher status counterparts. The negative aspects of inequality are spread across the population. For example, when comparing the United States (a more unequal nation) to England (a less unequal nation), the US shows higher rates of diabetes, hypertension, cancer, lung disease, and heart disease across all income levels. This
11811-443: The interconnected concepts of person, responsibility and freedom in economics, moral philosophy and politics. It tries to reconcile the rationality and morality of individuals. It presents a methodological reflection (phenomenology versus Kantian thought) with the aim to re-humanise the person, through actions, and through the values and norms that lead to corresponding rights and obligations that must be ordered. The book extends
11938-409: The interest of maximizing future productivity given that boys are generally seen as breadwinners . In addition, boys receive better care than girls and are hospitalized at a greater rate. The magnitude of these disparities increases with the severity of poverty in a given population. Additionally, the cultural practice of female genital mutilation (FGM) is known to impact women's health , though
12065-487: The latter term is used in a number of countries to refer to those instances whereby the health of two demographic groups (not necessarily ethnic or racial groups) differs despite similar access to health care services. It can be further described as differences in health that are avoidable, unfair, and unjust, and cannot be explained by natural causes, such as biology, or differences in choice. Thus, if one population dies younger than another because of genetic differences, which
12192-416: The likelihood of giving birth at home has increased rapidly among women with lower educational status. Education also has a significant impact on the quality of prenatal and maternal healthcare. Mothers with primary education consulted a doctor during pregnancy at significantly lower rates (72%) when compared to those with a secondary education (77%), technical training (88%) or a higher education (100%). There
12319-1038: The literature found that in studies involving multiracial or multiethnic populations, the incorporation of race or ethnicity variables lacked thoughtful conceptualization and informative analysis concerning their role as indicators of exposure to racialized social disadvantage. Racialized social disadvantage encompasses systemic and structural barriers, discrimination, and social exclusion experienced by individuals and communities based on their race or ethnicity, resulting in disparities in access to resources, opportunities, and health outcomes. Such disparities also prevalently attack indigenous communities. As members of indigenous communities adjust to western lifestyles, they have become more susceptible to developing certain chronic illnesses. There are also considerable racial disparities in access to insurance coverage, with ethnic minorities generally having less insurance coverage than non-ethnic minorities. For example, Hispanic Americans tend to have less insurance coverage than white Americans and as
12446-590: The loss of healthcare resources. It is important to also note what rural areas are composed of. There are many rural counties that have disproportionate rates of minorities living there, a link between the racial issue at play and that of regional status. The loss of the CMS has had noticeable impacts on life expectancy, with rural regions such as areas of Western China experiencing significantly lower life expectancies. Similarly, populations in rural Tajikistan experience spatial health inequities. A study by Jane Falkingham of
12573-503: The main forms of healthcare discrimination LGBT individuals face is discrimination from healthcare workers or institutions themselves. LGBT people often face significant difficulties in accessing care as a result to discrimination and homophobia from healthcare professionals. This discrimination can take the form of verbal abuse, disrespectful conduct, refusal of care, the withholding of health information, inadequate treatment, and outright violence. Additionally, members of
12700-469: The majority of mortality of adolescent males. Men in the United States tend to live longer than women. Physicians tend to offer invasive procedures to male patients more often than to female patients. The 2012 World Development Report (WDR) noted that women in developing nations experience greater mortality rates than men in developing nations. Men are more likely to smoke than women and experience smoking-related health complications later in life as
12827-454: The medical understanding of cervical cancer in lesbian and bisexual individuals it is unclear whether its prevalence in this community is a result of probability or some other preventable cause. For example, LGBT people report poorer cancer care experiences. It is incorrectly assumed that LGBT women have a lower incidence of cervical cancer than their heterosexual counterparts, resulting in lower rates of screening. Such findings illustrate
12954-516: The most basic sense, functionings consist of "beings and doings". As a result, living may be seen as a set of interrelated functions. Essentially, functionings are the states and activities constitutive of a person's being. Examples of functionings can vary from elementary things, such as being healthy, having a good job, and being safe, to more complex states, such as being happy, having self-respect, and being calm. Moreover, Amartya Sen contends that functionings are crucial to an adequate understanding of
13081-581: The most susceptible to health inequities. Children in poor families under 5 years of age are likely to face health disparities because the quality of their health depends on others providing for them; young children are not capable of maintaining good health on their own. In addition, these children have higher mortality rates than those in richer families due to malnutrition. Because of their low socioeconomic status, receiving health care can be challenging. Children in poor families are less likely to receive health care in general, and if they do have access to care, it
13208-426: The most vulnerable, such as women. Specifically, Nussbaum mentions that output-based approaches ignore the distribution of needs for the varying circumstances of people, for example a pregnant woman needs more resources than a non-pregnant woman or a single man. Also, output-based measures ignore unpaid work , which includes child rearing and the societal advantages that result from a mother's work. Marilyn Waring ,
13335-588: The nation as a result of the work of healthcare reform programs, however those regions not served by the programs have experienced a slight increase in inequity. China experienced a serious decrease in spatial health equity following the Chinese economic revolution in the 1980s as a result of the degradation of the Cooperative Medical System (CMS). The CMS provided an infrastructure for the delivery of healthcare to rural locations, as well as
13462-479: The need for continued research focused on the circumstances and needs of LGBT individuals and the inclusion in policy frameworks of sexual orientation and gender identity as social determinants of health. Capability approach#Capabilities The capability approach (also referred to as the capabilities approach ) is a normative approach to human welfare that concentrates on the actual capability of persons to achieve lives they value rather than solely having
13589-485: The poorest countries. As a result, one-quarter of the populations of those wealthy countries had already been vaccinated, while only 1 in 500 residents of the poor countries had been vaccinated. Gender and sex are both components of health disparity. Both gender and sex are significant factors that influence health. Sex is characterized by female and male biological differences in regards to gene expression, hormonal concentration, and anatomical characteristics. Gender
13716-1036: The poverty line. In a 2007 Census Bureau, African American families made an average of $ 33,916, while their white counterparts made an average of $ 54,920. Due to a lack of affordable health care, the African American death rate reveals that African Americans have a higher rate of dying from treatable or preventable causes. According to a study conducted in 2005 by the Office of Minority Health—a U.S. Department of Health—African American men were 30% more likely than white men to die from heart disease. Also African American women were 34% more likely to die from breast cancer than their white counterparts. Additionally, among African American and Latino infants, mortality rates are 2 to 3 times higher than other racial groups. An analysis of more than 2 million pregnancies found that babies born to Black women worldwide had poorer outcomes (such as baby death and stillbirth) than White women. This
13843-433: The production and distribution of life quality for working age adults, those in retirement, very young children, those vulnerable to domestic violence, migrants , excluded traveler communities and the disabled. They use these applications to argue that the capability framework is a particularly good fit for understanding quality of life across the life course and that it provides a relatively universal grammar for understanding
13970-708: The productive process of turning out other goods" (p. 15) These accounting measures also fail to capture all forms of work and only focus on "engagement in work 'for pay or profit ' ", (p. 133) leaving out contributions to a society and economy, like volunteer work and subsistence farming. Kuznets provides the example of the process by which farmers devote time and energy to bringing virgin land into cultivation. Furthermore, GNP and GDP only account for monetary exchanges, and place no value on some important intangibles such as leisure time. Capabilities Approach has been highly influential thus far in human development theories and valuational methods of capturing capabilities,
14097-567: The quality of care based on race and overall insurance coverage based on race. A 2002 study in the Journal of the American Medical Association identifies race as a significant determinant in the level of quality of care, with Black people receiving lower quality care than their white counterparts. This is in part because members of ethnic minorities such as African Americans are either earning low incomes, or living below
14224-516: The researchers corrected for these factors, the disparities persist. Slavery has contributed to disparate health outcomes for generations of African Americans in the United States . Ethnic health inequities also appear in nations across the African continent. A survey of the child mortality of major ethnic groups across 11 African nations (Central African Republic, Côte d'Ivoire, Ghana, Kenya, Mali, Namibia, Niger, Rwanda, Senegal, Uganda, and Zambia)
14351-414: The resources provided by the individuals and communities around them (those with more social capital) live longer lives. The segregation of communities on the basis of income occurs in nations worldwide and has a significant impact on quality of health as a result of a decrease in social capital for those trapped in poor neighborhoods. Social interventions, which seek to improve healthcare by enhancing
14478-483: The result of capabilities, some functionings are also a prerequisite for capabilities, i.e., there is a dual role of some functionings as both ends and instruments. Examples of functionings that are a direct requirement for capabilities are good nourishment, mental and physical health, and education. Nussbaum further distinguishes between internal capabilities that are personal abilities, and combined capabilities that are "defined as internal capabilities together with
14605-566: The short and long run. Goals for more growth should specify more growth of what and for what" (p. 9). Nussbaum also points out that GNP and GDP omit income distribution and the opportunity or ability to turn resources into activities (this critique stems directly from Capabilities Approach). Kuznets terms this as a problem of "obtaining an unduplicated total of all output", (p. 15) this suggests that people are only seen as consumers and not as potential producers, hence any products purchased by an individual are not seen as "being consumed in
14732-458: The social resources of a community, are therefore an effective component of campaigns to improve a community's health. Poor health outcomes appear to be an effect of economic inequality across a population. Nations and regions with greater economic inequality show poorer outcomes in life expectancy, mental health, drug abuse, obesity, educational performance, teenage birthrates, and ill health due to violence. On an international level, there
14859-525: The social/political/economic conditions in which functioning can actually be chosen". She points out that the notion of (combined) capability "combines internal preparedness with external opportunity in a complicated way, so that measurement is likely to be no easy task." An extension of the capabilities approach was published in 2013 in Freedom, Responsibility and Economics of the Person . This book explores
14986-406: The socioeconomic factor of health disparities, race is another key factor. The United States historically had large disparities in health and access to adequate healthcare between races, and current evidence supports the notion that these racially centered disparities continue to exist and are a significant social health issue. The disparities in access to adequate healthcare include differences in
15113-799: The substantive freedoms people have reason to value, instead of utility ( happiness , desire-fulfillment or choice ) or access to resources ( income , commodities, assets ). An approach to wellbeing using utility can be found in utilitarianism , while access to resources is advocated by the Rawlsian approach . Poverty is understood as capability-deprivation. It is noteworthy that proponents emphasize not only how humans function, but their access to capabilities "to achieve outcomes that they value and have reason to value". Everyone could be deprived of capabilities in many ways, e.g. by ignorance, government oppression, lack of financial resources, or false consciousness. This approach to human well-being emphasizes
15240-596: The theory has led to the creation of the HDI, IHDI and GII and their uses among international organizations such as the United Nations and others. In companies, capabilities are included in Key Development Indicators , or KDIs as measures of development, including employee development. In 1990 in the Human Development Report (HDR)commissioned by the UNDP set out to create a distribution-sensitive development measure. This measure
15367-524: The transgender population creates a health disparity for LGBT individuals with regard to mental health . The LGBT community is at increased risk for psychosocial distress , mental health complications, suicidality, homelessness, and substance abuse , often complicated by access-based under-utilization or fear of health services. Transgender and gender-variant individuals have been found to experience higher rates of mental health disparity than LGB individuals. These mental health facts are informed by
15494-423: The utilization of proper healthcare resources can be quite costly and therefore unaffordable to certain populations. In China, for instance, the collapse of the Cooperative Medical System left many of the rural poor uninsured and unable to access the resources necessary to maintain good health. Increases in the cost of medical treatment made healthcare increasingly unaffordable for these populations. This issue
15621-431: The world, the mortality rate is higher for adult men than for adult women; for example, adult men develop fatal illnesses with more frequency than females. The list of countries by life expectancy shows the sex gap in life expectancy. The leading causes of the higher male death rate are accidents, injuries, violence, and cardiovascular diseases. In most regions of the world, violence and traffic-related injuries account for
15748-511: Was created to rival the more traditional metrics of GDP and GNP, which had previously been used to measure level of development in a given country, but which did not contain provisions for terms of distribution. The resulting measure was entitled the Human Development Index, created by Mahbub ul Haq in collaboration with Sen and others. The purpose was to create an indicator of human development, especially one that would provide
15875-577: Was further perpetuated by the rising income inequality in the Chinese population. Poor Chinese were often unable to undergo necessary hospitalization and failed to complete treatment regimens, resulting in poorer health outcomes. Similarly, in Tanzania , it was demonstrated that wealthier families were far more likely to bring their children to a healthcare provider: a significant step towards stronger healthcare. Unequal income distribution itself can be
16002-489: Was published in 2000 by the WHO. The study described the presence of significant ethnic parities in the child mortality rates among children younger than 5 years old, as well as in education and vaccine use. In South Africa, the legacy of apartheid still manifests itself as a differential access to social services, including healthcare based upon race and social class, and the resultant health inequities. Further, evidence suggests systematic disregard of indigenous populations in
16129-407: Was true even after controlling for older age and a lower level of education among mothers (an indicator of poorer economic and social status). In the same analysis, Hispanic women were 3 times more likely to experience a baby death than White women and South Asian women had an increased risk of premature birth and having a baby with low birthweight compared with White women. A 2023 scoping review of
#332667