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Paper short abstract:

This article provides a reading of the diaries of a medical doctor from a capability approach and sociological theory perspective. The educational system built around the training of medical doctors is reconstructed. Learning takes place, not only related to medical knowledge (treatments and diagnostics), but also attitudes, emotions and behaviors from interactions in the hospital scenery.

Paper long abstract:

This article seeks to make a reading of the diaries of medical doctor from a capabilities approach and sociological theory perspective related to educational processes (in this case, training of medical doctors). What is proposed is to reconstruct, through different testimonies, the functioning of the educational system built around the training of medical doctors, especially in a crucial period such as the internship and medical residency, in which learning takes place in the scenery of the hospital. It is in this enviroment that learning takes place, not only related to medical knowledge (treatments and diagnostics of diseases) but also attitudes, emotions and behaviors that come from interactions between patients, doctors, residents and interns that introduce how medicine is practiced and taught in Peru. What type of education do the medical students have? What do you learn of this type of education? And what kind of doctors emerge from this educational system? To resolve these unknowns, the article will be presented in three sections.

In the first section, the theoretical and methodological frameworks that are used to analize the testimonies will be presented. The scope will be placed on contributions that the capabilities approach, educational sociological theory and emotions can provide to analyze this testimony, mainly in the capability to go about life without shame. Also the related sociological theory regarding educational processes from a critical perspective will be mentioned. The second part will show the most important findings from the analysis made to the testimony with the framework presented. Based on the testimonies, the medical education system will be characterized and the effects on the professional training of future medical doctors will be analized, as well as in the quality of the health attention that these professionals give to their patients. Finally, the conclusions will present the kind of professionals that this educational medical system provides: individuals that, in a context of inequialities and lack of resources of the Peruvian healthcare public system, reproduce those inequalities in the healthcare attention and relationship with the patients.

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Health equity is essential for individuals, serving as both a means and an end in their lives, providing fair and just opportunities to access healthcare. This paper aims to explore and analyze health equity through Sen's capability approach among the people of Baramulla District, situated on the Line of Control between India and Pakistan.

Paper long abstract:

Health is both the means and ends to a quality life for a human being. It serves as a gateway to accessing other opportunities, including quality education and progress in economic and social aspects. Therefore, it's crucial to assess the extent to which health equity has been provided to the community and its agencies. This paper aims to explore and analyze the scope of health equity in the borderland district of Baramulla, Jammu and Kashmir.

The paper uses the capability approach to examine the significance of health equity through Sen’s capability framework, which revolves around two claims: the freedom to achieve well-being and agency. Freedom stands as the pivotal component in this framework. However, Martha Nussbaum presents a list of central human capabilities necessary for a life of human dignity, differing from Amartya Sen’s approach, which focuses on expanding human capability without a specific list. This difference can be seen as an attempt to address life's subjective and uncertain aspects. Nussbaum's suggestive list cannot universally define human capabilities.

The capability approach retains its significance in providing health equity, which is central to human development. Especially during the COVID-19 pandemic, amid public health crises and social injustices, achieving health equity becomes a fundamental goal for policymakers, health establishments, and communities. Health equity implies fair and just opportunities to achieve highest level of health. Achieving equitable health requires a collaborative effort from individuals and institutions over a longer period. The process of expanding human capability should not be solely viewed as the government's responsibility but also involves social institutions. Here, the role of agency becomes crucial in how agencies respond to the community's health needs and how the community accesses health through these agencies.

Freedom, central to Sen’s capability approach, plays a pivotal role in India's diverse demographics, where inequality persists in society. Inequality obstructs access to healthcare services in remote areas, exacerbating the burden of healthcare costs and potentially intensifying poverty. Thomas Piketty's work on inequality underscores the challenge of reducing inequality in development, as individuals play a central role in this process. However, addressing inequality extends beyond income inequality alone. Unequal access to opportunities in personal and social spheres poses a threat to human well-being. Institutional frameworks that facilitate these opportunities are influenced by people's exercise of freedom, enabling them to participate in social decision-making processes that promote the advancement of these opportunities.

However, the notion of equality as a solution to inequality is subject to debate, raising several questions. One such question pertains to the diversity among individuals and the diverse aspects of equality and inequality. Differences among people extend beyond external factors such as entitlement, natural or social environment, encompassing internal factors like age, gender, and physical and mental abilities. It is important to acknowledge and address this human diversity instead of dismissing it, to effectively address and rectify inequality, ensuring a sustainable existence for all. These factors significantly influence people's ability to exercise health equity.

India, with its wide range of diversity in geography, social, and economic status, experiences both inherent and constructed inequalities. Baramulla, situated on the Line of Control between India and Pakistan, presents a distinct scenario. Here, the local health department has achieved 100 percent immunization coverage and notably reduced infant and maternal mortality rates. This case exemplifies health equity at the last mile, highlighting successful efforts to address healthcare disparities in challenging circumstances.

The study employs vulnerability analysis, utilizing three key indicators, to assess health equity. In Baramulla district, various factors contribute to vulnerability regarding health issues, such as geographical accessibility, proximity to health facilities, community mobility, distance from the district headquarters, and the socio-economic conditions of the community. While two pregnant women with a haemoglobin (HB) level of 6 may be medically categorized at the same vulnerability level, these indicators can significantly impact their overall vulnerability. For example, a woman residing in a remote and inaccessible area, far from health facilities, will face higher vulnerability compared to a woman with the same HB level residing in Baramulla town. Furthermore, including more indicators can further amplify vulnerability. Based on this rationale, our findings indicate that Boniyar, situated near the Line of Control (LoC), exhibits heightened vulnerability. This vulnerability serves as a hotspot according to the analysis and underscores the importance of ensuring health equity in immunization. The paper will conclude by presenting a framework to ensure health equity in similar areas, with a focus on localizing the framework to suit specific contexts.

References:

Piketty, T. (2017). Capital in the Twenty-First Century. USA: Harvard University Press.

Sai Ma, S. A. (2023). Distinguishing Health Equity and Health Care Equity: A Framework for Measurement . Massachusetts: NEJM Catalyst.

Sen, A. (2000). Development As Freedom. New Delhi: Oxford University Press.

Sen, A. (1999). Inequality reexamined. New Delhi: OXFORD University Press.

Sen, A. (1985). Well-Being, Agency and Freedom: The Dewey Lectures 1984. The Journal of Philosophy, 82, 169-221.

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Covid-19 pandemic outbreak in India was very well managed in India with a lesser loss of life and prevalence of the virus than was anticipated and predicted due to the unpredictable nature of the virus and the response of a majority of public that has low level of education, poor health systems, loss of income due to isolation and lockdown. This is examined from Capability Approach perspective.

Paper long abstract:

This paper presents a study of the public policy designed and implemented to manage the Covid-19 pandemic in India. The data comes from an analysis of a mainstream English newspaper’s Delhi edition, which is the capital city of India. It is also where the central government is based and could implement the policy strongly because of its control over the Delhi police. The analysis is being carried out in NVivo 14 and Python 3.12. Preliminary analysis shows that the achievement of better health capability outcomes was possible with a lower percentage of loss of life compared to the total population of India, versus the populations of some developed countries, by a) controlling the health agency and individual agency through state or governmental actors, b) the agency of health professionals in public sector, and the mandates to private health sector with some freedom given to them to plan their Covid strategy, c) the agency and paternalistic control of the police force with absolute power to implement the guidelines issued by Ministry of Home Affairs, and the Disaster Management Act of India, 2005. It is argued in this paper that health freedom and health functioning or health agency can be properly utilized as a freedom by an individual when it relates to their personal health concerns, needs and priorities. But in the face of a pandemic, governmental control, monitoring, action and control of individual agency led to better health capability outcomes and strengthening of healthcare sector, both public and private and with private public partnerships, there was lesser loss of life and spread of the pandemic in India. This analysis seems to contradict the conceptualization of health capability in the literature (Ruger, 2010).

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The UK Coronavirus Job Retention scheme (CJRS) was a temporary scheme designed to protect the economy supporting jobs and avoiding the social fallout of the COVID 19 crisis. Using April-July 2020 UKHLS data, we investigate whether the CJRS is able to mitigate individuals’ psychological distress, especially for individual experiencing neighbourhood social cohesion deprivation

Paper long abstract:

The COVID-19 pandemic, discovered in Whuan in December 2019, led to a global pandemic that have had an impact on the economy in the United Kingdom and around the world. Nations all over the world called for measures to combat the disease within their own countries. Lockdown policies, confinement measures and social distancing led to elevated levels of loneliness and social isolation, which in turn produce mental-health related repercussions (Moreno et al., 2020; Miao et al., 2021; Breedvelt et al., 2022; Ferber et al., 2022). In the UK, the first lockdown started on 23 March 2020 and by mid-April 2020 the peak of the first wave was reached and restrictions were gradually eased. During the lockdown periods, non-essential activities, leisure facilities and schools were closed. Some individuals were furloughed, and others lost their job. Greater financial strains and smaller reserves of coping resources contribute in varying degrees to heightened levels of distress found among displaced workers (Scarpetta et al., 2021; Günay, 2021; Grace, 2023).

The UK Coronavirus Job Retention scheme (CJRS), set up in March 2020, was a temporary scheme designed to protect the economy by helping employers’ firms affected by the pandemic to retain their employees and pay workers’ wages . Thus, despite the temporary cessation of work, employees maintained a substantial portion of their income. In other words, the CJRS supported the incomes of workers, mitigated their financial hardship and presumably decreasing workers’ psychological distress (OECD, 2020). However, some furloughed workers reported more depressive symptoms and anger than the stably employed people (Wilson and Finch, 2021). Furloughed workers were also concerned about the future: they were worried that the CJRS would only delay inevitable layoffs or hour reductions if they return to work. This concerns might create anxiety. Therefore, the impact of furlough (under the CJRS) on distress is not so straightful and need to be empirically tested.

The aim of this paper is to explore whether individuals’ mental health depends on labour market status. In particular, we investigate the association between being on furlough (under the CJRS) and psychological distress. We also explore this association in a specific case: individuals perceiving neighbourhood social cohesion deprivation. A neighbourhood low in cohesion refers to a neighbourhood where residents report feeling a weak sense of community, report engaging in rare (or none) acts of neighbouring and are poorly attracted to live in and remain residents of the neighbourhood (Buckner, 1988). Low levels of social cohesion mean limited capacities of supporting the needs of all in the community during the acute phase of the COVID-19 crisis and in recovery planning. The reasons for this are the following. First, social cohesion encourages closer adherence to public health guidelines through care for the collective (Jewett et al., 2021). Second, social cohesion includes the provision of social support, practical help, interpersonal reciprocity, and the sharing of information across social networks. And third, social cohesion promotes trust and creates a sense of belonging to the state (OECD, 2012). As results, low levels of social cohesion are associated with worst health outcomes, less engagement with positive health behaviours, and lower resilience and emotional wellbeing (Long et al., 2022; Ware, 2023; Zangger, 2023). Lack of social cohesion increases distress and depression during periods of high infection rates and restrictions on social activity (Best et al., 2021; O’Donnell et al., 2022; Zangger, 2023). Our hypothesis is that the CJRS is the main instrument for making ends meet for furlough workers living in social cohesion deprived neighbourhoods. These are often low-income areas where individuals do not benefit from social support, reciprocity, and practical help from other community members. Thus, being eligible for the CJRS represents for them a strong relief that could decrease stress. For individuals that can rely on social resources (that are individuals living in cohesive neighbourhoods) the psychological contribution of the CJRS could be smaller. We empirically test this hypothesis.

Using April-July 2020 data from the UK Understanding Society COVID-19 survey, we find that a continuous employment status is associated with better mental health outcomes. The Coronavirus Job Retention Scheme is able to mitigate distress. In particular, individuals perceiving neighbourhood social cohesion deprivation appear to benefit more (in terms of distress reduction) from the CJRS than individuals living in more cohesive neighbourhoods. We also find that individuals living in deprived neighbourhoods appear to experience, on average, higher level of distress.

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Paper short abstract:

Despite high disease burden and mortality, cervical cancer remains low priority for the health systems especially for low income, rural women in remote areas. CAPED partnered with ACS to address these issues with local and community centered interventions. CA is a useful framework to study this intervention since it’s a setting with multiple inequities related to gender, income and religion/caste.

Paper long abstract:

Despite high disease burden and mortality (India loses one woman to cervical cancer every eight minutes), cervical cancer remains low priority for the health systems. Screening is simple and inexpensive and treatment is effective. Still efforts at disease elimination runs into several challenges including low income for remote, rural and vulnerable communities, women’s health being low in priority, lack of access and affordability for screening and treatment, and stigmas surrounding an STI.

According to the WHO India Cervical Cancer Profile crude cervical cancer incidence per 100,000 women in 2020 was 18.7 with 45,300 cervical cancer deaths recorded (2019). According to latest Lancet report out of the 6,04,127 new cases and 3,41,831 deaths from cervical cancer, 21% of the cases and 23% of the deaths occurred in India. Cervical cancer remains one of the leading case of cancer deaths among women in India and 1 Indian woman dies of cervical cancer every eight minutes. At the moment less than one percent of girls are vaccinated and National Family Health Survey estimates that less than 4% of women are screened. Most screening is concentrated in the urban areas.

Thus cervical cancer screening for rural women in Haryana becomes a health equity issue. Haryana is a largely agrarian and an extremely patriarchal state with one of the poorest sex ratios in India. Haryana also has poor indicators for mother and child health. The health and well being of women, especially in remote rural areas continue to suffer. Women remain at high risk for cervical cancer yet screening is almost non existent. Cervical cancer screening comes under the NPCDCS (National Programme for Prevention and Control of Cancer, Diabetes, Cardiovascular Diseases and Stroke) and is offered through PHCs and government hospitals. It is clubbed with breast and oral cancer screening. It is also offered in private hospitals. In rural areas government camps are held but screening uptake is low. Women are often unaware of the issue or avoid due to apathy and mistreatment by the health staff. Nurses and health personnel are also often untrained to convince or even facilitate.

CAPED an NGO working on cancer partnered with American Cancer Society to address these issues with local and community centered interventions. They implemented a Cervical Cancer Awareness & Screening project in rural, low performing areas of Gurugram district, Haryana with the ASHAs (Accredited Social Health Activists) being the lynchpin of community mobilization. ASHAs are local women sharing good connect with women and were effective in bringing into focus women’s health issues besides maternal and child care (most of India’s health policies for women are focused on her pregnancy and delivery – neglecting large cohort of adolescent girls and middle aged women).

Through supporting the leadership at District Health Centers and local Public Health Centers (PHCs) and CHCs, and training/capacity building of ASHAs to increase their knowledge for better community outreach, the number of women seeking screening test and following up on diagnostics increased significantly. The proposed project’s implementation plan is adopted from the INSPIRE (Integrative Systems Praxis for Implementation Research) model of participatory design and implementation of a sustainable and effective cervical cancer screening project.

The areas for intervention were identified with the help of district administration to target the villages that were weakest in terms of cervical cancer screening and awareness. Then training was administered to all the ASHAs in the selected areas. Post surveys short qualitative interviews were also done. The project is now in second phase and key informant and longer focus groups are planned.

After the first phase preliminary analysis indicated that ASHAs knowledge base was impacted and their capacity building led to increase in their confidence in terms of addressing the issue and convincing the women of their community. The women also reported better overall satisfaction at the health centre and felt their voice and bodily autonomy was respected. The project also had the additional impact of spreading awareness about HPV infection at a time when an indigenously produced HPV vaccine is on the verge of nationwide introduction through the public Universal Immunisation Programme (imported HPV vaccine is privately available, optional and expensive).

Capability Approach is a useful framework to study this intervention since it’s a setting with multiple deprivations and inequities related to gender, income and religion/caste. Sen notes that diversity is no secondary complication, rather a fundamental aspect of our interest in equality. Using CA, vulnerabilities at the individual and community level can be recognised and addressed. The women at the risk of cervical cancer and HPV infections are marginalized at an individual level (middle aged, non-earning, low levels of awareness or decision making, primary caretaker of household and children, suffering other health issues due to neglect, and holding poor bargaining power within the household) and face structural causes of disempowerment (living in rural areas, facing discrimination from the public health system etc.)

Thus using quantifiable measures to understand low screening is not sufficient. Using CA functionings can be CAPED’s training of health workers, support provided to women to access screening safely and confidently, access to information to understand test results, and other medical information, and access to logistics like transport, camps etc. Capabilities are the freedoms in the larger connect that make this possible – and this depends on institutional and structural support provided by the NGO in partnership with the state. This has great implications for women's health in a setting where their health is marginalised, they have low bodily autonomy, and routinely and unjustly succumb to preventable diseases.

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The study focuses on intersectionality and brings to fore that women with disability can face double deprivation of capabilities at a micro, mezzo and macro levels based on primary data collected through in-depth interview of ten women with disability. It was found that there is non-encouragement from a micro and mezzo levels leading to poor conversion of capabilities.

Paper long abstract:

With approximately 2.21 percentage of population from India facing some kind of disability, it has become increasingly important to discuss enhancing capabilities for empowerment through employment. From about 2.68 crore persons with disability, 20 percent have disability in movement, 19 percent are with disability in seeing, while 19 percent are with disability in hearing and 8 percent have multiple disabilities. It has been historically seen that people with disability find it difficult to find productive employment particularly women find it harder and are therefore treated as mostly dependent on someone who is supposedly a wholly-abled near one. The current approach to development defy the norms of human development from a Capabilities approach and does not lead to any kind of independent functioning for the person with disability. The UNHRO (1975) has declared that “Disabled persons have the right to economic and social security and to a decent level of living. They have the right, according to their capabilities, to secure and retain employment or to engage in a useful, productive and remunerative occupation and to join trade unions”. However, the major question comes to the commitment of the implementing members from a human development perspective. Out of 2.68 crore persons with disability, 1.18 crore are women, which accounts for almost 44.03 percent. As discussed above women bear the double burden of disparity being female and disabled. The current study focuses on this intersectionality and proposes to highlight that women with disability face double deprivation of capabilities in terms of commitment at a micro, mezzo and macro levels. As we rapidly progress with technology advancement and more so the intent to have inclusive development, it has to be accepted and explored how a majority of this section of population with disability can attain the functioning through the right set of capabilities offered.

The study is based on primary data collected from the persons with disability. It is an in-depth qualitative study through the interview of ten women with disability with a view to investigate the gaps in capabilities that may lead to a discouraged worker situation for many among them. Utilising the unique stories of the 10 women the study tries to answer following questions.

RO1: To understand the capabilities failure of women with disability in getting any kind of employment.

RO2: To investigate the gaps in capabilities that may be leading to a discouraged worker situation for the disabled persons.

RO4: To understand the disempowering impact of due to capabilities failure and lack of employment.

The study found that employment opportunities are far and few for the women with disability whether sustainable productive self-employment or a remunerative wage-employment. Vocational training and support are there as a result of various policy initiatives at macro levels, however, accessibility to these trainings centres and other ancillary support systems like access to funding is constrained due to non-encouragement from a micro – within the family unit and mezzo levels and subsequently, leads to poor conversion of capabilities in to attainments of value. Therefore, the study proposes that there should be policy measures that create very strong support for women with disability that would convert the inertia of the family as a unit into encouragement through affirmative actions like monetary or other incentives. Post pandemic, it is realised that technology also offers a lot of solutions in this direction.

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The paper discusses three issues: (a) the role of the private sector in medical education, particularly its growth and regional distribution; (b) the availability and distribution of doctors in India, with a special focus on inter-state variations and rural-urban disparity; (c) mapping out the regional variations in the availability of doctors and COVID-19 death and infection rate.

Paper long abstract:

Human resource availability is critical for effectively providing and delivering quality health care to India’s vast population. It drives health outputs and outcomes, including immunisation levels, the outreach of primary care, and infant, child and maternal survival (WHO 2006; Anand and Barnighausen 2007; Mitchell et al. 2008; Rao et al. 2012). Also, India’s mandate for universal health coverage (UHC) — developing a framework for providing easily accessible and affordable health care to all Indians — depends, to a large extent, on an adequate and effective health workforce providing care at primary, secondary and tertiary levels. Likewise, to achieve the Sustainable Development Goal (SDG) 3, which aims to ensure health and well-being for all, India needs to improve the availability of human resources for health. More importantly, healthcare workers play a vital role in the fight against COVID-19 Pandemic. However, even with the recognition of the importance of the health workforce for delivering better health care, more so in the recent Pandemic, there is an acute shortage of health and care workers in India. The World Health Statistics Report (WHO 2022) reveals that in India, between 2012 and 2020, there were 24.9 health workers per 10,000 population (7.4 doctors and 17.5 nurses and midwives)—more than half of the global average of 55.9 workers per 10,000 population (16.4 doctors and 39.5 nursing and midwifery personnel). Even after two decades, the availability of human resources (doctors, nurses and midwives) in India is less than the threshold of 25 health workers per 10,000 population as established by the Joint Learning Initiative (JLI) of the World Health Organisation (WHO) in 2004.

Health and care workers (HCWs) are part of the frontline facing the Pandemic. The Pandemic has affected their physical, mental and social well-being (Nguyen, Drew, Graham, et al. 2020). There has been a significant death of health workers during COVID-19. In India, as per the Indian Medical Association (IMA) data, around 1342 doctors have died in the line of duty ever since the Pandemic began in March 2020, and this figure is likely at the lower bound. Many health workers continue to work in under-resourced and fragile health systems, with inadequate personal protective equipment, dealing with a situation that was unprecedented consequences (Essex & Weldon 2021). Health and care workers in India have faced grave concerns where their density is low, and they need to serve many patients, for instance, in rural and semi-urban areas.

How does India address the issue of human resources for health, a critical factor to the human development and well-being of the Indians? Mainly, what are the post-pandemic strategies to address this concern? It is argued that states in India are struggling with the complexities of escalating human resource costs, additional demand for the health workforce, uneven distribution, and skill-mix imbalances, and the intervention of the private sector is suggested as a potential alternative in solving these issues (Jilani et al 2008; Davey et al 2014). Thus, in the past several decades, the private sector has grown participation in building up the health workforce in India, particularly by establishing many medical and nursing colleges (Mahal and Mohanan 2006). For instance, in the last three decades (1990 to 2020), private medical colleges increased by 540%, whereas government-run medical colleges grew up only by 174% (Kumar, 2022).

In this context, the paper discusses three issues: (a) the role of the private sector in medical education, particularly its growth and regional distribution; (b) the availability and distribution of doctors in India, with a special focus on inter-state variations and rural-urban disparity; (c) mapping out the regional variations in the availability of doctors and COVID-19 death and infection rate. Specific questions raised in the paper are:

1. How has the private sector intervention in medical education resulted in regional inequality in the availability of health and care workers in India?

2. Is the availability of doctors in a specific state/region linked to patient infection and death in India?

3. How to improve the coping strategies and dynamic capabilities among doctors to serve patients during pandemics like COVID-19?

The paper uses data from the National Medical Commission, National Health Profile and Rural Health Statistics published by the Ministry of Health and Family Welfare, COVID-19 statistics of the Government of India, and the World Health Organisation. Descriptive statistics and multi-variate regression techniques are used to analyse the data.

This study finds that one of the most dominant features of Indian medical education is the rapid expansion of the private sector (especially after the 1990s), which has led to regional inequality in the production and distribution of doctors. Interestingly, this growth has occurred primarily in the more developed states with better health outcomes, while the low-income states with poor health indicators have lagged. This unequal distribution of medical colleges has impacted the availability of medical services and has also resulted in regional differences in access to doctors (in some cases, access to quality doctors) in the country. For example, there is considerable variation in the density of doctors between rural and urban areas, which indicates the difficulty rural Indians face in accessing healthcare. We find a robust negative relationship between the availability of doctors and COVID-19 death rate i.e. states with less availability of doctors have high COVID deaths, and vice versa. But we did not find a clear relationship between doctor availability and COVID infection rate. The findings of the study call for minimising regional inequality in the production and distribution of human resources for health in India and also suggest developing coping strategies and dynamic capabilities among doctors to serve patients during pandemics like COVID-19. This work is an initial effort to understand the role of private sector in producing doctors in India and connecting with the Pandemic context, which is extremely important for health workforce planning in India. The findings of this study underline some potential areas for future investigation.

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People with disabilities are a marginalized and vulnerable segment of the population in Bangladesh. Most of them are isolated from mainstream society, stigmatized, and mistreated. They experience poor health compared to their non-disabled counterpart in Bangladesh. The present paper intends to understand the health care service utilization by parents of children with disabilities in Bangladesh.

Paper long abstract:

People with disabilities are a marginalized and vulnerable segment of the population in Bangladesh. Most of them are isolated from mainstream society, stigmatized, and mistreated. They experience poor health compared to their non-disabled counterpart in Bangladesh. They even face challenges in accessing the health and rehabilitation services. Parents of children with disabilities had to incur additional health care expenditure and encounter stigma and negative attitudes from healthcare professionals and community people. They live in an unfriendly and hostile environment and are often subject to a negative attitude, non-cooperation, ill-treatment, neglect, and hostility in Bangladesh. However, the inclusion of people from all segments of society including people with disabilities in mainstream development activities is necessary for minimizing inequalities and ensuring sustainable development.

This study intends to understand the health care service utilization by parents of children with disabilities in Bangladesh. The research design incorporates both qualitative and quantitative approaches. A multistage sampling procedure was used to recruit an appropriate sample for the study. Parents who participated in the study highlight the multiple disadvantageous conditions in access to healthcare services and experiences of neglect, abuse, and discrimination from healthcare providers. The results of the study also revealed that most parents do not utilize available healthcare services because of the issue of accessibility, financial constraints, physical distance, lack of information about the services, lack of staff in the service centers, and dependency of some parents on the traditional healing systems. The study advocates for disability-friendly support services for strengthening the capabilities of families with children with disabilities, expediting their access to healthcare services, and promoting the well-being of children with disabilities and their families in Bangladesh.

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This study tried to capture health in a multi-dimensional way, using the novel index of computing 'Years of Good Life' (YoGL). Here, healthy is defined as being out of poverty, out of physical limitation, without cognitive disability, and with positive life satisfaction simultaneously. Inequality in terms of gender, place of residence, as well as among states of India is computed in the study.

Paper long abstract:

With unprecedented rise in life expectancy, research on counting life years spent in different health condition (i.e., ‘good’ health and ‘less than good’ health) gained significant global importance. Though rising life expectancy itself, is an indicator of development, healthy life expectancy brings in the ‘quality of life’ dimension to it. The study investigates the heterogeneities in healthy life among older-adults in India, using a novel concept of counting ‘expected years of good life’. Whether the there is convergence between the states or states are diverging in terms of 'healthy longevity?

Methodology

Grounded in Desai and Sen's ‘capable longevity’ approach, the index of YoGL (Years of Good Life) is an amalgamation of objective and subjective dimensions of health. A year is counted as ‘good’ one if a person is simultaneously out of poverty, free from severe activity limitations and cognitive impairments, i.e., objective capabilities, and experiences positive life satisfaction, i.e., subjective health. The study used demographic methods to quantify the healthy life years within the life expectancy using Sullivan's method of life table construction. It is a prevalence based method where the age-specific proportion of population having a 'good life' is used to divide the life expectancy at a particular age into two sections - 'the healthy years' and 'unhealthy years'. The information regarding the proportion of 'good life' is calculated using the Longitudinal Ageing Study in India, 2017-18 (LASI wave-I) dataset. The survey provides sub-nationally representative data for the population aged 45 years and above in India, regarding different measures of health, well-being, health care utilisation, health expenditure, etc. Information regarding life expectancy are collected from Sample Registration System (SRS) Abridged Life Tables, 2015-19, Registrar General of India. To calculate the threshold of the four dimensions, different cutoff points are set and sensitivity analysis of those cut off are also done as a robustness check. Using household level consumption expenditure data the bottom 20th quintile of the population is identified as poor; for cognitive performance the data uses a a battery comprising different aspects of cognitions, such as, memory (immediate word recall and delayed word recall), orientation (date, time, place), retrieval fluency (verbal fluency), arithmetic, executive functioning and object naming etc. The cut of is set at bottom 10th quintile (score 19 out of 43) for cognitive impairment which is sensitive for both literate as well as illiterate population. People who does not have any difficulty in Daily life activities (ADL) such as, limitations in dressing, walking across the room, bathing, eating, getting out of bed and using toilet etc. are considered to be out of physical limitation. For positive life satisfaction, a likert scale comprising of 7 dimensions - 1) In most ways, my life is close to ideal; 2) the conditions of my life are excellent; 3) I am satisfied with my life; 4) so far, I have got the important things I want in life; and 5) if I could live my life again, I would change almost nothing, are avaiable in the dataset. Having a score between 5-10 is considered to have negative or low life satisfaction.

Analysis

As mentioned previously, the demographic construction of healthy longevity is done using life table construction method. Years of good life is separately calculated for both the genders, rural and urban population and for major states of India separately. To capture the relative contribution of different factors, regression based decomposition after Shorrocks (1982) & Fields (2003) is applied here. The control variables in the regression model are Education, percentage population working, female population, percentage population widowed, etc.

Conclusion

The results show, at age 50, YoGL for male is 13.9 years (55.6% of remaining life expectancy) and for females, 11.3 years (41.7% of remaining life expectancy). Supporting the ‘gender-health-mortality paradox’, results reveal that women’s advantage in life expectancy doesn’t translate into equal advantage in ‘good-years’ for all older age-groups. AMong the states, the inequality is diverging in terms of healthy longevity. Inter-state variability is higher in terms of YoGL, than in life expectancy; from 64% years counts as ‘good life’ in Punjab to 34% of remaining years as ‘good life’ in Odisha. Regression decomposition indicates functional limitations contributes 32%, cognitive impairment 20% and birth-cohorts contributes around 18% in explaining the regional heterogeneity. The take away policy formulation from this study would be to reduce the inequality in terms of health among regions of India.

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Paper short abstract:

Despite centuries of rapid economic and social progress worldwide, societies across the world remain steeped in gender inequality. It stands to reason, therefore, that the impact of any adverse situations, including those brought on by climate change will be intersectional and multidimensional for women and other marginalized members of society. This study aims to examine the same.

Paper long abstract:

Gender inequality is a prevalent social evil that has persisted for centuries despite rapid economic and social progress. The multidimensional nature of this phenomenon is a relatively under-explored subject. Women and other marginalized members of society are largely seen to be deprived in the most basic dimensions, although the extent differs according to context. This includes basic facets of life such as health. The present paper aims to first establish the gendered nature of health inequality in developing countries, with South Asian and South-East Asian countries. The Alkire-Foster measure will be used to create a composite measure of health deprivation. Principal Component Analysis will be used to narrow down the exact determinants of access to and quality of healthcare received - including but not limited to, emergency care, general healthcare, treatment of chronic and acute illnesses, antenatal care, and other sexual and reproductive healthcare. Sub-group analysis by income, place of residence, and region/sub-region will also be conducted. The next section of the paper proposes to probe further into the gendered impacts of adverse climate events. The South Asian subcontinent and a few countries in the South-East Asian belt specifically suffer from quite a huge range of adverse climate events such as wildfires, droughts, flooding, landslides and so on. These are often brought on by larger climatic phenomena such as El Nino Southern Oscillation (ENSO) and the Indian Ocean Dipole (IOD), and so on. To establish a causal relationship between these adverse climate events and gendered health inequality, the paper proposes to use a mix of quantitative methods. As before, PCA will be used to construct the composite health deprivation measure through the Alkire-Foster method, to determine that health inequality exists. Since climate data is most likely to be found as time-series country/region data, we would need to get a health deprivation measure for each point in time the adverse climate event has happened. A multivariable regression will then be used to establish the causal relationship between climate change and health inequality. It is important to note here, that these climate events often result in the stoppage of services and bottlenecks in the delivery of relief. Therefore, a separate note as to whether these climate events have deepened inequality in access, delivery, or quality of healthcare services will also be included. As we would be limiting our country focus to South Asian and South-East Asian countries, the creation of this measure will be more feasible. In the remaining sections, the paper aims to provide a more qualitative report of climate change mitigation measures taken in these countries. This qualitative coverage would aim to also examine whether these programs, policies, or measures are gender-responsive and inclusive - i.e. have equity considerations been incorporated, and were the panel of decision-makers inclusive by nature? Finally, this paper also aims to provide policy recommendations based on the findings - the impact of climate change on already-persistent health inequalities and the gendered nature of the same would help make mitigation and rebuilding policies and programs more inclusive. On the other hand, the qualitative coverage of the existing climate change mitigation policies and the possible lacunae in their inclusivity would make the case for further use of the capabilities approach in policy-making and health research.

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Paper short abstract:

The impact of sport on the quality of life of individuals with disabilities. Barriers of sports participation.

Paper long abstract:

the benefits of physical activity or sport in general are well known in reducing the health consequences of a sedentary lifestyle in the general population. However, there are still few studies on the impact of sport on the quality of life of disabled people, despite the fact that regular participation in leisure and sports activities is positively linked to improving the quality of life of disabled people. However, individuals with disabilities participate less frequently in physical activity than those without disabilities. In Italy, according to istat data (2023), 15% of people who practice sports have a disability, compared to 57.5% of the population who practice sport does not have disabilities. There are therefore many "barriers" that hinder the participation in sport, individual but especially environmental, social and cultural (accessibility, transport, prejudice, lack of skills ...).

Therefore, it is necessary to analyze the barriers to the sports participation of disabled people. They limit the expansion of people’s choices and freedoms. The reference approach is the capability approach, according to which disability is not environment independent. Different environments have different impacts on the same individual.

The aim of this study is to provide an overview of the literature focusing on the effects of sports participation on the quality of life of people with disabilities and to obtain information on environmental barriers to sports participation that hinder the full participation of people in society.

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Paper short abstract:

Despite centuries of rapid economic and social progress worldwide, societies across the world remain steeped in gender inequality. It stands to reason, therefore, that the impact of any adverse situations, including those brought on by climate change will be intersectional and multidimensional for women and other marginalized members of society. This study aims to examine the same.

Paper long abstract:

Gender inequality is a prevalent social evil that has persisted for centuries despite rapid economic and social progress. The multidimensional nature of this phenomenon is a relatively under-explored subject. Women and other marginalized members of society are largely seen to be deprived in the most basic dimensions, although the extent differs according to context. This includes basic facets of life such as health. The present paper aims to first establish the gendered nature of health inequality in developing countries, with South Asian and South-East Asian countries. The Alkire-Foster measure will be used to create a composite measure of health deprivation. Principal Component Analysis will be used to narrow down the exact determinants of access to and quality of healthcare received - including but not limited to, emergency care, general healthcare, treatment of chronic and acute illnesses, antenatal care, and other sexual and reproductive healthcare. Sub-group analysis by income, place of residence, and region/sub-region will also be conducted. The next section of the paper proposes to probe further into the gendered impacts of adverse climate events. The South Asian subcontinent and a few countries in the South-East Asian belt specifically suffer from quite a huge range of adverse climate events such as wildfires, droughts, flooding, landslides and so on. These are often brought on by larger climatic phenomena such as El Nino Southern Oscillation (ENSO) and the Indian Ocean Dipole (IOD), and so on. To establish a causal relationship between these adverse climate events and gendered health inequality, the paper proposes to use a mix of quantitative methods. As before, PCA will be used to construct the composite health deprivation measure through the Alkire-Foster method, to determine that health inequality exists. Since climate data is most likely to be found as time-series country/region data, we would need to get a health deprivation measure for each point in time the adverse climate event has happened. A multivariable regression will then be used to establish the causal relationship between climate change and health inequality. It is important to note here, that these climate events often result in the stoppage of services and bottlenecks in the delivery of relief. Therefore, a separate note as to whether these climate events have deepened inequality in access, delivery, or quality of healthcare services will also be included. As we would be limiting our country focus to South Asian and South-East Asian countries, the creation of this measure will be more feasible. In the remaining sections, the paper aims to provide a more qualitative report of climate change mitigation measures taken in these countries. This qualitative coverage would aim to also examine whether these programs, policies, or measures are gender-responsive and inclusive - i.e. have equity considerations been incorporated, and were the panel of decision-makers inclusive by nature? Finally, this paper also aims to provide policy recommendations based on the findings - the impact of climate change on already-persistent health inequalities and the gendered nature of the same would help make mitigation and rebuilding policies and programs more inclusive. On the other hand, the qualitative coverage of the existing climate change mitigation policies and the possible lacunae in their inclusivity would make the case for further use of the capabilities approach in policy-making and health research.

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Paper short abstract:

This completed graduate thesis explores the unequal distribution of resources linked to instances of design disablement resulting from standardized architectural practices. Through an ethnographic investigation of the spatial experiences of mobility aid users, it analyzes the extent to which the built environment may either hinder or enhance the capabilities of people with disabilities.

Paper long abstract:

Historically, our society has demonstrated tendencies of exclusion towards those who misfit the norms. While there may be innumerable factors that come into play in these scenarios, such tendencies of marginalization seem to hold a strong connection to aspects of the built environment. As one of the many standardized systems in our world, design and architecture follow guidelines that commonly comply with a ‘one size fits all’ approach, catering toa mainstream majority while disregarding individuals who misfit such standards. Such scenario of design disablement is commonly true for users of assistive technology, whose scope of devices are rarely considered within traditional design practices.Although such technologies may be partially accounted for through codes and regulations regarding wheelchair access, the usability of other forms of mobility assistance - such as walkers, crutches, canes, scooters and adaptive limbs - remain absent in such guidelines. With architectural practices focusing on the needs of non-disabled bodies, the needs of mobility aid users seem to go unrecognized, leading to disadvantageous spatial conditions that restrict their capabilities. Taking that perspective into consideration, it’s possible to say that the ambulation restraints of individuals who rely on mobility aids is less about their physical capabilities and more about architecture’s lack of receptiveness towards their reliance on the use of assistive devices. Bringing to light the complexities between the built environment and the use of mobility devices, this investigation seeks to recognize the joint influence between the demands imposed by spatial design and the ranging capacities of those who may use it. Although other minorities may also face barriers of flawed design, the primary concern to be addressed within this framework is the capability limitations imposed specifically on individuals who face reduced mobility and rely on assistive ambulation devices.

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Paper short abstract:

he dissolution of traditional extended families in India is led to rising economic inequality, urbanization, modernization, growing individualism, and a greater emphasis on consumption. The rise in nuclear families and longer life expectancies has led to an increase in the cost of caring for the old, which puts older people at greater risk of experiencing disadvantages or falling into poverty.

Paper long abstract:

Background: As the number of older people in India's population continues to rise, it is becoming more and more important to improve their economic stability. Factors like migration from rural to urban areas and the shifting labor force distribution across different economic sectors also have an impact on this requirement. When it comes to determining health choices and providing financial support for healthcare, the traditional family structure is crucial. A vital factor in guaranteeing the financial security of the elderly is the involvement of family members in the workforce. The dissolution of traditional extended families in India is closely related to the above-described issues, which also lead to rising economic inequality, urbanization, modernization, growing individualism, and a greater emphasis on consumption. The rise in nuclear families and longer life expectancies has led to an increase in the cost of caring for the old, which puts older people at greater risk of experiencing disadvantages or falling into poverty.

The purpose of this study is to examine the demographic segment that depends on family members for financial support. It also looks at how the aging population prefers to stay healthy and how they use money to pay for medical care.

Methodology: The research uses information gathered from 72,250 people 45 years of age and older during the 2017–2019 Longitudinal Ageing Study in India (LASI). The early and late aging population and older individuals make up the two main cohorts into which the data is divided. The latter specifically addresses the 31,646 senior population, which consists of 16,366 senior women and 15,098 senior men.

Results: The data point to a significant gap in the economy's coverage of financial security. In particular, one out of every five senior citizens is enrolled in an organized sector pension plan. Notably, a sizable share (20.65%) of the aged population is covered by federal and state pension programs. In contrast, only a small percentage of India's old population (2.1%) is covered by private pension systems, especially employer-funded pension schemes. Just 7% of senior citizens believe their family's financial situation is adequate, whereas 53% say they are middle class.