Equity is one of the pillars of Brazil's Unified Health System (SUS). However, analysis of the scientific literature shows that the concept of equity is polysemic and open to many interpretations. ...The scope of this article is to identify the meanings conferred upon equity in the discourse of SUS managers. Semi-structured interviews were conducted with individuals in three municipalities in the state of Sao Paulo, namely Marilia, Sao Carlos and Santos. The interviews were recorded, transcribed and organized using the Discourse of the Collective Subject method. In the analysis of the results, three core categories were identified: Treat everyone in an egalitarian manner; treat the unequal in an unequal manner, prioritizing the most needy in accordance with their social and economic status; and treating the unequal in an unequal manner, prioritizing specific groups in accordance with risk criteria. The managers acknowledge equity as being a SUS principle and seek prudent clinical and epidemiological criteria to justify their choices in allocating resources. There is a need for further research into the concept and operationalization of equity and the need to hear the other actors of SUS who are involved in the actions and are jointly responsible for decisions on healthcare.
Advocates for improved equity in kidney transplants in the United States have recently focused their efforts on initiatives to increase referral for transplant evaluation. However, because donor ...kidneys remain scarce, increased referrals are likely to result in an increasing number of patients proceeding through the evaluation process without ultimately receiving a kidney. Unfortunately, the process of referral and evaluation can be highly resource-intensive for patients, families, transplant programs, and payers. Patients and families may incur out-of-pocket expenses and be required to complete testing and treatments that they might not have chosen in the course of routine clinical care. Kidney transplant programs may struggle with insufficient capacity, inefficient workflow, and challenging programmatic finances, and payers will need to absorb the increased expenses of upfront pretransplant costs. Increased referral in isolation may risk simply transmitting system stress and resulting disparities to downstream processes in this complex system. We argue that success in efforts to improve access through increased referrals hinges on adaptations to the pretransplant process more broadly. We call for an urgent re-evaluation and redesign at multiple levels of the pretransplant system in order to achieve the aim of equitable access to kidney transplantation for all patients with kidney failure.
Few reports include more than 1-2 social identities when examining organized sport and physical activity (PA) participation among adolescents. We used a quantitative intersectional approach to ...examine disparities in adolescent sport and PA lesson participation.PURPOSEFew reports include more than 1-2 social identities when examining organized sport and physical activity (PA) participation among adolescents. We used a quantitative intersectional approach to examine disparities in adolescent sport and PA lesson participation.Ninth and 11th grade 2022 Minnesota Student Survey participants (N = 62,940) self-reported social identities and team sport and PA lessons. Social identities included sex assigned at birth, gender modality, sexual identity, racial and ethnic identity, access to resources (i.e., economic status), weight status, and mental health/behavioral/emotional problems. We used Exhaustive Chi-square Automatic Interaction Detection to identify prevalence of participation among adolescents with different intersecting social identities.METHODSNinth and 11th grade 2022 Minnesota Student Survey participants (N = 62,940) self-reported social identities and team sport and PA lessons. Social identities included sex assigned at birth, gender modality, sexual identity, racial and ethnic identity, access to resources (i.e., economic status), weight status, and mental health/behavioral/emotional problems. We used Exhaustive Chi-square Automatic Interaction Detection to identify prevalence of participation among adolescents with different intersecting social identities.Half of the sample played sports and one-quarter participated in PA lessons. Participation varied substantially at the intersections of social identities. Whereas participants in the highest prevalence sports participation groups were predominantly White, heterosexual, and had high resource access, participants in the lowest prevalence groups held multiple marginalized social identities: only 12.8% of adolescents with least access to resources who were questioning their gender identity and sexual identity, or who reported a sexual identity not listed, participated in sports. Regarding PA lessons, youth in the highest prevalence groups were predominantly heterosexual, had highest access to resources, and were youth of color; by comparison, most of the lowest prevalence groups comprised youth who had medium/low resource access and/or high body mass index, and often a diverse sexual, gender, or racial/ethnic identity.RESULTSHalf of the sample played sports and one-quarter participated in PA lessons. Participation varied substantially at the intersections of social identities. Whereas participants in the highest prevalence sports participation groups were predominantly White, heterosexual, and had high resource access, participants in the lowest prevalence groups held multiple marginalized social identities: only 12.8% of adolescents with least access to resources who were questioning their gender identity and sexual identity, or who reported a sexual identity not listed, participated in sports. Regarding PA lessons, youth in the highest prevalence groups were predominantly heterosexual, had highest access to resources, and were youth of color; by comparison, most of the lowest prevalence groups comprised youth who had medium/low resource access and/or high body mass index, and often a diverse sexual, gender, or racial/ethnic identity.Multiply marginalized adolescents are under-represented in sports and PA lessons. Organizations should address interlocking barriers to participation.DISCUSSIONMultiply marginalized adolescents are under-represented in sports and PA lessons. Organizations should address interlocking barriers to participation.
This paper compares how recent waves of private equity real estate investment have reshaped the rental housing markets in New York and Berlin. Through secondary analysis of separate primary research ...projects, we explore financialisation's impact on tenants, neighbourhoods, and urban space. Despite their contrasting market contexts and investor strategies, financialisation heightened existing inequalities in housing affordability and stability, and rearranged spaces of abandonment and gentrification in both cities. Conversely cities themselves also shaped the process of financialisation, with weakened rental protections providing an opening to transform affordable housing into a new global asset class. We also show how financialisation's adaptability in the face of changing market conditions entails ongoing, but shifting processes of uneven development. Comparative studies of financialisation can help highlight geographically disparate, but similar exposures to this global process, thus contributing to a critical urban politics of finance that crosses boundaries of space, sector and scale.
We examine how corporate environmental responsibility (CER) affects the cost of equity capital for manufacturing firms in 30 countries. Using several approaches to estimate firms' ex ante equity ...financing costs, we find in regressions that control for firm-level characteristics as well as industry, year, and country effects that the cost of equity capital is lower when firms have higher CER. This finding is robust to addressing endogeneity through instrumental variables, to using alternative specifications and proxies for the cost of equity capital, and to accounting for noise in analyst forecasts. We conclude that investment in CER reduces firms' equity financing costs worldwide.
Past research has shown that new firms can facilitate resource mobilization by signaling their unobservable quality to prospective resource providers. However, we know less about situations in which ...firms convey multiple signals of different strengths-that is, signals that are more- or less-correlated with unobservable firm quality. Building on a sociocognitive perspective, we propose that prospective resource providers respond differently to signals of different strengths and that the effectiveness of signals, especially weak signals, will be contingent on the media attention new firms receive. Empirically, we conduct a longitudinal analysis examining the ability of new private equity firms to raise a follow-on fund. Consistent with our theory, we find that unrealized performance, a relatively weak signal, positively influences fundraising. However, we fail to find statistical evidence that its effect is weaker than that of realized performance, a relatively strong signal. Further, media attention strengthens the relationship between unrealized performance and fundraising, but media attention exerts less impact on the relationship between realized performance and fundraising. Taken together, our findings deepen our understanding of how new firms can mobilize resources with signals of different strengths and of how the media-as a key information intermediary-differently impacts their effectiveness.
PDF
