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Since India had been controlled by the British, it regressed to a lower stage. Poverty had been a lived reality for Indians, including for some of the Indian economists, since the late seventeenth century. International trade networks were disrupted by economic crisis and wars. Meanwhile, the Indian subcontinent was experiencing some of the most severe famines in its history. The Indian economists felt these crises sweeping their cities and villages. In particular, Dadabhai Naoroji and Romesh Chunder Dutt would spend most of their adult lives examining the regress that they saw in India. They would explore how it could be measured, how it varied from region to region, and its causes.
The COVID-19 pandemic and Black Lives Matter movement have brought ethnic and racial inequalities to the forefront of public conversation on both sides of the Atlantic. However, research shows that people routinely overestimate the progress made towards equality and underestimate disparities between racial and ethnic majority and minority groups. Common among the American public is a naive belief in equal opportunity that stands in sharp contrast to the reality of structural racial inequity. Across the Atlantic, Dutch people’s self-perception of a tolerant, progressive, and egalitarian society means that racism and discrimination are topics often avoided, rendering invisible the stigmatization of ethnic and racial minorities. The result is racism of omission: ethnic and racial disparities are minimized and attributed to factors other than discrimination, which leads to legitimize inequities and justify non-intervention. Against this background, we field an internationally comparative randomized survey experiment to study whether (willful) ignorance about racial and ethnic inequality can be addressed through the provision of information. We find that facts about ethnic and racial inequality, on the whole, (1) have the greatest impact on people’s perceptions of inequality as compared to their explanations of inequality and policy attitudes, (2) register most strongly with majority-group White participants as compared to participants from minority groups, (3) cut across partisan lines, and (4) effect belief change most consistently in the Netherlands, as compared to the United States. We make sense of these findings through the lens of how ‘shocking’ the information provided was to different groups of participants.
To describe variation in task shifting from GPs to practice assistants/nurses in 34 countries and to explain differences by analysing associations with characteristics of the GPs and their practices and features of the health care systems.
Background:
Redistribution of tasks and responsibilities in primary care are driven by changes in demand, such as the growing number of patients with chronic conditions, and workforce developments, including staff shortage. The need to manage an expanding range of services has led to adaptations in the skill-mix of primary care teams. These developments are hampered by barriers between professional domains.
Methods:
Data were collected between 2011 and 2013 through a cross-sectional survey among approximately 7,200 general practitioners (GPs) in 34 countries. Task shifting is measured through a composite score of GPs’ self-reported shifting of tasks. Independent variables at GP and practice level are as follows: innovativeness; part-time working; availability of staff; location and population of the practice. Country-level independent variables are as follows: demand for and supply of care, nurse prescribing, and professionalisation of practice assistants/nurses. Multilevel analysis is used to account for clustering of GPs in countries.
Findings:
Countries vary in the degree of task shifting. Regarding GP and practice characteristics, use of electronic health records and availability of support staff in the practice are positively associated with task shifting and GPs’ working hours negatively, in line with our hypotheses. Age of the GPs is, contrary to our hypothesis, positively related to task shifting. These variables explain 11% of the variance at GP level. Two country variables are related to task shifting: a lower percentage of practices without support staff in a country and nurse prescribing rights coincide with more task shifting. The percentage of practices without support staff has the strongest relationship, explaining 73% of the country variation.
To inform the primary care community about priorities for research in primary care as came up from the European project TO-REACH and to discuss transferability of service and policy innovations between countries.
Background:
TO-REACH stands for Transfer of Organizational innovations for Resilient, Effective, equitable, Accessible, sustainable and Comprehensive Health services and systems. This EU-funded project has put health systems and services research higher on the European agenda and has led to the current development of a European ‘Partnership Transforming Health and Care Systems’.
Methods:
To identify research priorities, both qualitative and quantitative approaches were used. Policy documents and strategic roadmaps were searched, and priorities were mapped. Stakeholders were involved through national roundtable consultations and online consultations. Regarding transferability, we carried out a review of the literature, guided by a conceptual framework, and using a snowballing approach.
Findings:
Primary care emerged as an important priority from the inventory, as are areas that are conducive to strengthening primary care, such as workforce policies. The large variation in service organisation and policy around primary care in Europe is a huge potential for cross-country learning. However, the simple transfer of primary care service and policy arrangements from one health system to another has a big chance to fail, unless known conditions for successful transfer are taken into account and gaps in our knowledge about transfer are resolved.
The chapter will cover possible ways to ensure universal health access for people with psychosis, primarily through a comparison between the USA and Denmark healthcare systems. The chapter will discuss the utility of employing national clinical treatment guidelines, treatment rights, treatment packages, supervision, and fidelity rating when ensuring high quality treatment for psychosis. Denmark is one of many developed nations whose healthcare and sociopolitical contingencies support a completely different approach to psychosis compared to the USA. Incarceration, barriers to care, and health outcomes in the USA demonstrate an inarguably inadequate approach to psychosis. Based on the same evidence, other nations built imperfect but substantially more effective approaches. By illustrating a Scandinavian approach to psychosis and its successes and pitfalls, we highlight the feasibility of effective support and recovery for people with psychosis, as well as the necessity of long-term investments in citizens’ health and learning from successes and failures.
To describe variation in task shifting from general practitioners (GPs) to practice assistants/nurses in 34 countries, and to explain differences by analysing associations with characteristics of the GPs, their practices and features of the health care systems.
Background:
Redistribution of tasks and responsibilities in primary care are driven by changes in demand for care, such as the growing number of patients with chronic conditions, and workforce developments, including staff shortage. The need to manage an expanding range of services has led to adaptations in the skill mix of primary care teams. However, these developments are hampered by barriers between professional domains, which can be rigid as a result of strict regulation, traditional attitudes and lack of trust.
Methods:
Data were collected between 2011 and 2013 through a cross-sectional survey among approximately 7200 GPs in 34 countries. The dependent variable ‘task shifting’ is measured through a composite score of GPs’ self-reported shifting of tasks. Independent variables at GP and practice level are: innovativeness; part-time working; availability of staff; location and population of the practice. Country-level independent variables are: institutional development of primary care; demand for and supply of care; nurse prescribing as an indicator for professional boundaries; professionalisation of practice assistants/nurses (indicated by professional training, professional associations and journals). Multilevel analysis is used to account for the clustering of GPs in countries.
Findings:
Countries vary in the degree of task shifting by GPs. Regarding GP and practice characteristics, use of electronic health record applications (as an indicator for innovativeness) and age of the GPs are significantly related to task shifting. These variables explain only little variance at the level of GPs. Two country variables are positively related to task shifting: nurse prescribing and professionalisation of primary care nursing. Professionalisation has the strongest relationship, explaining 21% of the country variation.
Greenland and the Canadian territory of Nunavut appear to have a different prevalence of forensic psychiatric patients, despite their comparable population and landmass sizes. Both are mainly inhabited by Inuit with a similar cultural and social background. Both have a universal health care system. They differ, however, concerning the supply of mental health services and legislation concerning forensic psychiatric patients.
Objectives
To compare the prevalence and clinical characteristics of forensic psychiatric patients in Greenland and Nunavut.
Methods
Data is obtained from health records, forensic psychiatric evaluations and court acts from all forensic psychiatric patients 18 years or older living in Greenland or admitted to the University Hospital Aarhus (N≈100). Data extracted from Nunavut Review Board hospital reports will be used to describe the patient population from Nunavut (N≈15). Patient characteristics include gender, age, marital status, education, diagnosis of mental illness, medical treatment, family history of mental illness and serious adverse childhood experiences. Public documents concerning health systems and legislation will be identified through literature search.
Results
Patient characteristics from the two patient populations, as well as visualizations of the differences and similarities between the respective health care and legislative systems will be presented at the conference.
Conclusions
This study provides a comprehensive clinical, socio-demographic and forensic comparison of the forensic psychiatric populations in Greenland and Nunavut, Canada. To our knowledge, it will be the first to describe and compare forensic psychiatric populations in the Arctic.
The concluding chapter focuses on two questions. The first is whether Britain is unique in its identity conflicts. While no other EU member state looks likely to repeat Britain’s EU exit adventure in the near future, the demographic trends driving the emergence of identity conflicts – educational expansion and rising diversity through globalisation and mass migration – are common to most wealthier democracies. The effects of these changes are being felt everywhere – educational and ethnic divides are becoming stronger predictors of political choices in many countries, with ethnocentric ‘us against them’ conflicts over issues such as immigration, national identity, diversity pitting identity conservative white school leavers against identity liberal graduates and ethnic minorities. In the United States, which like the UK uses a first-past-the-post electoral system, similar identity divides have reinforced and deepened longstanding party divisions on race and identity. The second question is what impact identity politics can have outside party and electoral politics. Many policies involve decisions about the distribution of resources between groups, and as such public views of such policies may be radically changed by the mobilisation of identity conflicts. We discuss welfare, equal opportunity and immigration policies to illustrate this disruptive potential.
This paper offers a framework for measuring global growth and inflation, built on standard index number theory, national accounts principles, and the concepts and methods for international macro-economic comparisons. Our approach provides a sound basis for purchasing power parity (PPP)- and exchange rate (XR)-based global growth and inflation measures. The Sato–Vartia index number system advocated here offers very similar results to a Fisher system but has the added advantage of allowing a complete decomposition with PPP or XR effects. For illustrative purposes, we present estimates of global growth and inflation for 141 countries over the years 2005 and 2011. The contribution of movements in XRs and PPPs to global inflation are presented. The aggregation properties of the method are also discussed.
Despite its benefits for prolonging careers, participation in training is far lower among older employees (age 50+) than among younger employees. This study analyses gender differences in older employees’ training participation. To investigate the predictors of training intensity, we examine two forms of training: formal educational programmes and on-the-job training. The study draws on a novel data-set, the European Sustainable Workforce Survey, carried out in nine European countries in 2015 and 2016, analysing 2,517 older employees and their managers, spread over 228 organisations. We concentrate on the interplay between employees’ gender, managers’ gender and managers’ ageism in shaping older employees’ training participation. Our findings indicate comparable training participation of older men and women in both forms of training, yet older women more often pay for enrolment in educational programmes themselves. Also, predictors of training participation are different. In line with the tenet of ‘gendered ageism’, we find that managerial ageism primarily targets older women, excluding female employees from the training opportunities available to their comparable male colleagues. Finally, female managers are associated with higher training participation rates for older employees, but only for older men. This result supports ‘queen bee’ arguments and runs counter to ‘homophily’ arguments. Overall, the study demonstrates that workplace dynamics and managerial decisions contribute to the reproduction of traditional gender divides in the late career.
Twin pairs discordant for disease may help elucidate the epigenetic mechanisms and causal environmental factors in disease development and progression. To obtain the numbers of pairs, especially monozygotic (MZ) twin pairs, necessary for in-depth studies while also allowing for replication, twin studies worldwide need to pool their resources. The Discordant Twin (DISCOTWIN) consortium was established for this goal. Here, we describe the DISCOTWIN Consortium and present an analysis of type 2 diabetes (T2D) data in nearly 35,000 twin pairs. Seven twin cohorts from Europe (Denmark, Finland, Norway, the Netherlands, Spain, Sweden, and the United Kingdom) and one from Australia investigated the rate of discordance for T2D in same-sex twin pairs aged 45 years and older. Data were available for 34,166 same-sex twin pairs, of which 13,970 were MZ, with T2D diagnosis based on self-reported diagnosis and medication use, fasting glucose and insulin measures, or medical records. The prevalence of T2D ranged from 2.6% to 12.3% across the cohorts depending on age, body mass index (BMI), and national diabetes prevalence. T2D discordance rate was lower for MZ (5.1%, range 2.9–11.2%) than for same-sex dizygotic (DZ) (8.0%, range 4.9–13.5%) pairs. Across DISCOTWIN, 720 discordant MZ pairs were identified. Except for the oldest of the Danish cohorts (mean age 79), heritability estimates based on contingency tables were moderate to high (0.47–0.77). From a meta-analysis of all data, the heritability was estimated at 72% (95% confidence interval 61–78%). This study demonstrated high T2D prevalence and high heritability for T2D liability across twin cohorts. Therefore, the number of discordant MZ pairs for T2D is limited. By combining national resources, the DISCOTWIN Consortium maximizes the number of discordant MZ pairs needed for in-depth genotyping, multi-omics, and phenotyping studies, which may provide unique insights into the pathways linking genes to the development of many diseases.
This study reviews international comparative studies investigating people’s views on inequality. These studies are classified using a framework consisting of three types of conceptions of inequality and two dimensions of inequality. Four perspectives are discussed explaining cross-national differences in views on inequality: the modernist, the culturalist, the micro and the macro perspective. The findings of studies comparing views on inequalities in post-communist and Western states provide more support for the modernist than for the culturalist perspective. Few comparative studies appear to investigate views on inequalities as independent variables impacting on other social attitudes and behaviours. It is argued that the social relevance of the field will be enhanced if more studies can show that views on inequality have an effect on social outcomes complementary to that of objective inequalities.
The OECD International Network on Financial Education has addressed the demand for an internationally comparable measure of financial literacy by developing a financial literacy questionnaire that can be used across a diverse range of countries. This questionnaire takes into account knowledge, behaviours, and attitudes related to personal finance and is designed to identify similarities and differences in levels of financial literacy around the world. It is currently being piloted in 12 countries, with the expectation that the final survey instrument will become a useful tool for policy-makers, academics, and financial education programme designers seeking to identify robust questions to assess financial literacy.
This paper discusses an integrated approach to mental health studies on Financing of Illness (FoI) and health accounting, Cost of Illness (CoI) and Burden of Disease (BoD). In order to expand the mental health policies, the following are suggested: (a) an international consensus on the standard scope, methods to collect and to analyse mental health data, as well as to report comparative information; (b) mathematical models are also to be validated and tested in an integrated approach, (c) a better knowledge transfer between clinicians and knowledge engineers, and between researchers and policy makers to translate economic analysis into practice and health planning.
When developing accessible, affordable and effective mental health systems, exchange of data between countries is an important moving force towards better mental health care. Unfortunately, health information systems in most countries are weak in the field of mental health, and comparability of data is low.
Special international data collection exercises, such as the World Health Organization (WHO) Atlas Project and the WHO Baseline Project have provided valuable insights in the state of mental health systems in countries, but such single-standing data collections are not sustainable solutions. Improvements in routine data collection are urgently needed. The European Commission has initiated major improvements to ensure harmonized and comprehensive health data collection, by introducing the European Community Health Indicators set and the European Health Interview Survey. However, both of these initiatives lack strength in the field of mental health. The neglect of the need for relevant and valid comparable data on mental health systems is in conflict with the importance of mental health for European countries and the objectives of the ‘Europe 2020’ strategy.
The need for valid and comparable mental health services data is today addressed only by single initiatives, such as the Organisation for Economic Co-operation and Development work to establish quality indicators for mental health care. Real leadership in developing harmonized mental health data across Europe is lacking. A European Mental Health Observatory is urgently needed to lead development and implementation of monitoring of mental health and mental health service provision in Europe.
Currently in Australia there is much activity and expenditure in a field broadly defined as ‘Indigenous education’. However, there is little by way of rigorous research that has compared and evaluated different approaches. This article draws together the existing international evidence to develop a set of best-practice components for Indigenous education. The author intends for these components to provide practical guidance for program developers who may currently be developing programs without the benefit of an existing evidence base, while also acknowledging the need to expand the evidence base and continue to refine this set of components to maximise their utility.
Objectives: The aim of this study was to present and illustrate an instrument to measure the level of innovation at country level.
Methods: The data used are the Organisation for Economic Co-operation and Development (OECD) health data 2009, in particular the information on use of medical technology. Two composite scales expressing a relative level of adoption of innovations in health care are regressed, using multilevel regression analysis, on country characteristics. The country characteristics are selected as proxies on availability or scarcity of resources in a country. We expect that scarcity will promote adoption of innovations that enhance efficiency, and that availability of resources will promote advanced, expensive innovations.
Results: Two scales were constructed. One scale indicates the use of efficiency-enhancing innovations (day case treatment), and the other scale indicates availability of advanced technical innovations. The application of day case treatment is significantly associated with education level (+), the ratio of people aged 15–64 versus younger and older people (+) and the number of hospital beds (−). Availability of advanced medical devices are associated with the expenditure on health (+), demographic dependency (−), number of hospital beds (+), and the annual reduction of hospital beds (−).
Conclusions: Diffusion of innovations is influenced by characteristics of the country and of the healthcare system; fewer resources encourage diffusion of innovations that enhance efficiency and more resources encourage diffusion of complex, expensive devices. This indicates that decisions by healthcare professionals on which innovation to adopt is embedded in a context that is influenced and shaped by the availability of resources on macro level.
Western societies are experiencing a dramatic growth in the population aged 75 and older. Changes in family composition raise questions about who will care for those who need assistance. We compared population projections to the year 2030 of those families aged 75 and older in Canada and France. Over the next 25 years, the pool of potential family carers, (i.e., spouses and children), will broaden from the effect of the baby boom and increased proportion of women with spouses. The populations most dependent on formal care, with no potential support from a child or a spouse, will increase more sharply in Canada (123%) than in France (34%) but at a slower rate than the total population. Policy and programs in both countries will need to prepare for a greater number of elderly spouses providing care and in Canada, at least, a significant increase in the number that will need to rely on formal services.
Two body condition scoring systems were compared for assessing body condition of cows at the Scottish Agricultural College's Crichton Royal Farm. The weekly body condition scores (BCS) were collected for a period of 12 weeks (5 September–21 November). Scores were obtained using the primary systems utilized within the UK and USA. The USBCS were obtained by the same evaluator each week, while the UKBCS were obtained by two different evaluators alternating between weeks. Paired scores (n=2088) between the two systems within week were moderately correlated (r=0·75, P<0·0001). Regression equations to convert scores between the two systems were created using the GLM procedure of SAS (SAS Institute Inc., Cary NC, USA). The simple GLM models to convert from UK to US scores and US to UK scores were USBCS=1·182+0·816 * UKBCS (R2=0·56) and UKBCS=0·131+0·681 (R2=0·56), respectively. These equations may be used to interpret scores within the literature obtained using these two BCS systems, although they must be used with caution.
The aim of this study was to investigate the primary concerns of terminally ill cancer patients in a Short-Term Life Review among Japanese, Koreans, and Americans to develop intervention programs to be tailored to patients in other countries.
Method:
Twenty Japanese, 16 Korean, and 7 American terminally ill cancer patients who were in the hospice wards of general Christian hospitals in each country participated in this study. Medical staff members (nurses, social workers, clinical psychologists) performed Short-Term Life Review Interviews with each patient. Patients reviewed their lives in the first session, the interviewers made simple albums for each patient in the week following the first session, and patients and interviewers then confirmed the contents of the album. The treatment period was 1 week. Measurement instruments included the Functional Assessment Chronic Illness Therapy–Spiritual (FACIT-Sp) and the Hospital Anxiety and Depression Scale (HADS). The contents of each interview session were transcribed, and correspondence analysis and a significance test were conducted on these data to select characteristic words or phrases.
Results:
Using the FACIT-Sp scores, the following concerns were chosen, in descending order of frequency. In Japan, primary concerns consisted of such ideas as “good human relationships and transcendence,” “achievements and satisfaction,” “good memories and important things,” and “bitter memories.” In Korea, “religious life,” “right behavior for living,” “strong consideration for children and will,” and “life for living” were primary concerns. In the United States, “love, pride, will to children,” “good, sweet memories,” and “regret and a feeling of loss” were primary concerns.
Significance of results:
We clarify the differences among the primary concerns from the Short-Term Life Reviews, arguing that we can improve the spiritual well-being of terminally ill cancer patients by focusing on the primary concerns within each country.