This paper explores whether constitutional litigation contributes to sustaining the equity element of the right to health. Equity entails a fair distribution of the burden of healthcare financing across the different socio-economic groups of the population. A shift towards uncontrolled private healthcare provision and financing raises equity challenges by disproportionately benefitting those who are able to afford such services. The extent to which equity is enforced is an indicator of the strength of the right to health. However, do domestic constitutional courts second-guess, based on equity, policy decisions that impact on healthcare financing? Is it the task of constitutional courts to scrutinize such policy decisions? Under what conditions are courts more likely to do so? The paper addresses these questions by focusing on the case of Hungary, where the right to health has been present in the Fundamental Law adopted in 2010 and the Constitutions preceding it. While the Hungarian Constitutional Court has been traditionally cautious to review policy decisions pertaining to healthcare financing, the system has been struggling with equity issues and successive government coalitions have had limited success in tackling these. The paper discusses the role of constitutional litigation in addressing such equity concerns. In doing so, it contributes to the discussion on the role of domestic constitutional courts in the protection of social and economic rights.
MULTIFILE
Reducing social inequalities in physical activity (PA) has become a priority for public health. However, evidence concerning the impact of interventions on inequalities in PA is scarce. This study aims to develop and test the application of a strategy for re-analyzing equity-specific effects of existing PA intervention studies in middle-aged and older adults, as part of an international interdisciplinary collaboration. This article aims to describe (1) the establishment and characteristics of the collaboration; and (2) the jointly developed equity-specific re-analysis strategy as a first result of the collaboration. To develop the strategy, a collaboration based on a convenience sample of eight published studies of individual-level PA interventions among the general population of adults aged ≥45 years was initiated (UK, n = 3; The Netherlands, n = 3; Belgium, n = 1; Germany, n = 1). Researchers from these studies participated in a workshop and subsequent e-mail correspondence. The developed strategy will be used to investigate social inequalities in intervention adherence, dropout, and efficacy. This will allow for a comprehensive assessment of social inequalities within intervention benefits. The application of the strategy within and beyond the collaboration will help to extend the limited evidence regarding the effects of interventions on social inequalities in PA among middle-aged and older adults.
DOCUMENT
BACKGROUND: Reducing inequalities in physical activity (PA) and PA-associated health outcomes is a priority for public health. Interventions to promote PA may reduce inequalities, but may also unintentionally increase them. Thus, there is a need to analyze equity-specific intervention effects. However, the potential for analyzing equity-specific effects of PA interventions has not yet been sufficiently exploited. The aim of this study was to set out a novel equity-specific re-analysis strategy tried out in an international interdisciplinary collaboration.METHODS: The re-analysis strategy comprised harmonizing choice and definition of outcomes, exposures, socio-demographic indicators, and statistical analysis strategies across studies, as well as synthesizing results. It was applied in a collaboration of a convenience sample of eight European PA intervention studies in adults aged ≥45 years. Weekly minutes of moderate-to-vigorous PA was harmonized as outcome. Any versus no intervention was harmonized as exposure. Gender, education, income, area deprivation, and marital status were harmonized as socio-demographic indicators. Interactions between the intervention and socio-demographic indicators on moderate-to-vigorous PA were analyzed using multivariable linear regression and random-effects meta-analysis.RESULTS: The collaborative experience shows that the novel re-analysis strategy can be applied to investigate equity-specific effects of existing PA interventions. Across our convenience sample of studies, no consistent pattern of equity-specific intervention effects was found. Pooled estimates suggested that intervention effects did not differ by gender, education, income, area deprivation, and marital status.CONCLUSIONS: To exploit the potential for equity-specific effect analysis, we encourage future studies to apply the strategy to representative samples of existing study data. Ensuring sufficient representation of 'hard to reach' groups such as the most disadvantaged in study samples is of particular importance. This will help to extend the limited evidence required for the design and prioritization of future interventions that are most likely to reduce health inequalities.
DOCUMENT
With this “invitation for action”, the Diversity, Inclusion & Gender Equality (DIGE) Working Group of the AEC - Empowering Artists as Makers in Society project (hereafter, ARTEMIS) welcomes all the AEC member institutions to explore, discuss and implement practices fostering Diversity, Equity and Inclusion (DEI) in Higher Music Education (HME). We invite our colleagues to collectively dream up possible futures for HME through DEI work, which responds to the need to accommodate the plurality of backgrounds, artistic paradigms, access capabilities, identities and aspirations amongst current as well as future students and staff. Through this publication we wish to encourage the AEC memberinstitutions to grasp this simultaneously evident and complex task and to explore what diversity, equity and inclusion could mean if musicians are seen as “makers in, for and of society” (Gaunt et al. 2021). For us as a Working Group, this proactive view has been central to our work from the beginning, as we asked ourselves whether HME institutions find themselves predominantly adapting (or not) to inevitable local and global changes and pressures, and whether the HMEinstitutions could see themselves as part of a network of change makers in society. Focusing on the latter, we see DEI work as being directly connected to the core artistic practices of the institutions. As reflections from many of our colleagues in various AEC member institutions illustrate, the commitment to DEI work nurtures artistic imagination, widens pedagogical approaches, and expands the scope of professional practice.
DOCUMENT
BACKGROUND: The INHERIT (INtersectoral Health and Environment Research for InnovaTion) project has evaluated intersectoral cooperation (IC) in 12 European case studies attempting to promote health, environmental sustainability, and equity through behavior and lifestyle changes. These factors are the concerns of multiple sectors of government and society. Cooperation of health and environmental sectors with other sectors is needed to enable effective action. IC is thus essential to promote a triple win of health, sustainability, and equity.OBJECTIVE: This paper describes the design of a qualitative study to gain insights into successful organization of IC, facilitators and barriers, and how future steps can be taken to improve IC in the evaluated case studies.METHODS: Each case study was assessed qualitatively through a focus group. A total of 12 focus groups in 10 different European countries with stakeholders, implementers, policymakers, and/or citizens were held between October 2018 and March 2019. Five to eight participants attended each focus group. The focus group method was based on appreciative inquiry, which is an asset-based approach focusing on what works well, why it is working well, and how to strengthen assets in the future. A stepped approach was used, with central coordination and analysis, and local implementation and reporting. Local teams were trained to apply a common protocol using a webinar and handbook on organizing, conducting, and reporting focus groups. Data were gathered in each country in the local language. Translated data were analyzed centrally using deductive thematic analysis, with consideration of further emerging themes. Analyses involved the capability, opportunity, motivation-behavior (COM-b) system to categorize facilitators and barriers into capability, motivation, or opportunity-related themes, as these factors influence the behaviors of individuals and groups. Web-based review sessions with representatives from all local research teams were held to check data analysis results and evaluate the stepped approach.RESULTS: Data collection has been completed. A total of 76 individuals participated in 12 focus groups. In December 2019, data analysis was nearly complete, and the results are expected to be published in fall 2020.CONCLUSIONS: This study proposes a stepped approach that allows cross-country focus group research using a strict protocol while dealing with language and cultural differences. The study generates insights into IC processes and facilitators in different countries and case studies to filter out which facilitators are essential to include. Simultaneously, the approach can strengthen cooperation among stakeholders by looking at future cooperation possibilities. By providing knowledge on how to plan for, improve, and sustain IC successfully to deal with today's multisectoral challenges, this study can contribute to better intersectoral action for the triple win of better health, sustainability, and equity. This protocol can serve as a tool for other researchers who plan to conduct cross-country qualitative research.INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID): RR1-10.2196/17323.
DOCUMENT
Introduction: Learning is essential for sustainable employability. However, various factors make work-related learning more difficult for certain groups of workers, who are consequently at a disadvantage in the labour market. In the long term, that in turn can have adverse health implications and can make those groups vulnerable. With a view to encouraging workers to continue learning, the Netherlands has a policy on work-related learning, which forms part of the 'Vitality Package'.Aim: A Health Impact Assessment with equity focus (HIAef) was undertaken to determine whether the policy on work-related learning affected certain groups of workers and their health in different ways, and whether the differences were avoidable.Methods: The HIAef method involved the standard phases: screening, scoping, appraisal and recommendations. Equity was the core principle in this method. Data were collected by means of both literature searches (e.g., Scopus, Medline) and interviews with experts and stakeholders (e.g., expertise regarding work, training and/or health).Results: The HIAef identified the following groups as potentially vulnerable in the field of work-related learning: the chronically sick, older people, less educated people, flexi-workers/the self-employed and lay carers (e.g., thresholds to learning). Published literature indicates that work-related learning may have a positive influence on health through (work-related) factors such as pay, employability, longer employment rate and training-participation. According to experts and stakeholders, work-related learning policy could be adapted to take more account of vulnerable groups through alignment with their particular needs, such as early support, informal learning and e-learning.Conclusion: With a view to reducing avoidable inequalities in work-related learning, it is recommended that early, low-threshold, accessible opportunities are made available to identified vulnerable groups. Making such opportunities available may have a positive effect on (continued) participation in the labour market and thus on the health of the relevant groups.
DOCUMENT
Research about equity through Musical Engagement with People with Dementia
DOCUMENT
This paper examines a co-production arrangement between private actors, households, and community actors occurring within the framework of scheme of commercialised spring water in peri-urban Bandung, Indonesia. We argue that the provision of spring water in Ujungberung District is a form of co-production, characterised by: (1) any one, or the elements, of the service production process being shared; (2) the presence of a fundamental shift in the balance of power between the primary producers and users/communities, and (3) the existence of mutual support and relationship networks, rather than a clearly defined delineation between providers and clients. Actor contributions defined as inputs along the value chain of spring water production were examined. We describe interactions between local private actors and community members in planning, service delivery, and conflict management with respect to disruption of water supplies, free-riding behaviour, and the geographical distribution of services. This paper identifies several institutional innovations that may yield a safer and more affordable water supply and nurture equity in the sense of: (1) improved access to water for the previously unserved people by piped water and boreholes; (2) the opportunity to negotiate from below; and (3) transparency and accountability.
LINK
This paper explores how a Bildung-making approach underpinned by embodied pedagogy and didactics can contribute to a learner becoming a person and a teacher’s development of artistry. We argue that the existing Cartesian divide between mind and body can explain the fundamental differences in how teachers and learners perceive Bildung within the Dutch educational system: either as an ‘academic’ phenomenon (for ‘the head’) or as vocational (for ‘the hand’). In this study, Dutch (pre)vocational teachers designed and co-created Bildung prototypes in professional learning communities (PLCs) and classrooms. The teachers used ‘real life’ questions from their teaching practices as their departure point to develop Bildung-making. The results of the study show that when Bildung education becomes an embodied maker’s process, it enables learners to transcend barriers to educational equity. Co-created enjoyment and social emotional learning come to the foreground during Bildung-making, thus fostering inclusive education.
LINK
