Access, equity and the role of rights in health care

Modern health care rhetoric promotes choice and individual patient rights as dominant values. Yet we also accept that in any regime constrained by finite resources, difficult choices between patients are inevitable. How can we balance rights to liberty, on the one hand, with equity in the allocation of scarce resources on the other? For example, the duty of health authorities to allocate resources is a duty owed to the community as a whole, rather than to specific individuals. Macro-duties of this nature are founded on the notion of equity and fairness amongst individuals rather than personal liberty. They presume that if hard choices have to be made, they will be resolved according to fair and consistent principles which treat equal cases equally, and unequal cases unequally. In this paper, we argue for greater clarity and candour in the health care rights debate. With this in mind, we discuss (1) private and public rights, (2) negative and positive rights, (3) procedural and substantive rights, (4) sustainable health care rights and (5) the New Zealand booking system for prioritising access to elective services. This system aims to consider: individual need and ability to benefit alongside the resources made available to elective health services in an attempt to give the principles of equity practical effect. We describe a continuum on which the merits of those, sometimes competing, values-liberty and equity-can be evaluated and assessed.

Envy, facts and justice: a critique of the treatment of envy in justice as fairness

A common anti-egalitarian argument is that equality is motivated by envy, or the desire to placate envy. In order to avoid this charge, John Rawls explicitly banishes envy from his original position. This article argues that this is an inconsistent and untenable position for Rawls, as he treats envy as if it were a fact of human psychology and believes that principles of justice should be based on such facts. Therefore envy should be known about in the original position. The consequences for Rawlsian theory—both substantive and methodological—are discussed.

Inequality, intergenerational mobility and redistributive policies under endogenous information

This paper presents a dynamic model to study how different levels of information about the root determinants of wealth (luck versus effort) can impact inequality and intergenerational mobility through societal beliefs, individual choices and redistributive policies. To my knowledge, the model presented is the first dynamicmodel in which skills are stochastic and both beliefs and voted redistribution are determined endogenously. The model is able to explain a number of empirical facts. Large empirical evidence shows that the difference in the political support for redistribution appears to reflect differences in the social perceptions regarding the determinants of individual wealth and the underlying sources of income inequality. Moreover the beliefs about the determinants of wealth impact individual choices of effort and therefore the beliefs about the determinants of wealth impact inequality and mobility both through choices of effort and redistributive policies. The model generates multiple equilibria (US versus Europe-type) which may account for the observed features not only in terms of societal beliefs and redistribution but also in terms of perceived versus real mobility and inequality.

Victory, peace, and justice : the neglected trinity

The assumption that the most important aim of war is to create a better peace than existed before the war, i.e. a peace with justice, was self-evident for writers prior to Clausewitz. This does not mean that princes saw this as their priority, but theoreticians did. This changed dramatically with the Napoleonic Wars: Clausewitz initiated an era where writers on strategy paid no heed to what would come after military victory, now seen as the be-all and end-all of war. Terrible consequences flowed from this, and a series of ephemeral victories leading to new wars. It was only around the Second World War, to some in itself the consequence of this obsession with victory and not with peace, that it began to dawn on writers that peace, not military victory must be the ultimate aim to be kept in sight.

Parental death as a vital conjuncture? Intergenerational care and responsibility following bereavement in Senegal

This article explores the ways that parental death represents a 'vital conjuncture' for Serer young people that reconfigures and potentially transforms intergenerational caring responsibilities in different spatial and temporal contexts. Drawing on semi-structured interviews with young people (aged 15-27), family members, religious and community leaders and professionals in rural and urban Senegal, I explore young people's responses to parental death. 'Continuing bonds' with the deceased were expressed through memories evoked in homespace, shared family practices and gendered responsibilities to 'take care of' bereaved family members, to cultivate inherited farmland and to fulfil the wishes of the deceased. Parental death could reconfigure intergenerational care and lead to shifts in power dynamics, as eldest sons asserted their position of authority. While care-giving roles were associated with agency, the low social status accorded to young women's paid and unpaid domestic work undermined their efforts. The research contributes to understandings of gendered nuances in the experience of bereavement and continuing bonds and provides insight into intra-household decision-making processes, ownership and control of assets. Analysis of the culturally specific meanings of relationships and a young person's social location within hierarchies of gender, age, sibling birth order and wider socio-cultural norms and practices is needed.

Conceptualising and measuring the equity of online brands

Although brand equity is an important source of competitive advantage online, previous conceptualisations and measures overlook the unique characteristics of the internet that render consumers co-creators of brand value. In view of this, a threephased research programme was undertaken to identify the facets of online retail/service (ORS) brand equity and then develop and validate a scale for its measurement. ORS brand equity was found to be a second order construct with five correlated yet distinct dimensions: emotional connection, online experience, responsive service nature, trust, and fulfilment. A series of tests showed that the ensuing 12-item scale has strong psychometric properties. The implications of this research for marketing researchers and practitioners are discussed.