NSW health and equity statement - In all fairness - increasing equity in health across NSW

In All Fairness is a point of reference for the NSW Health system to gauge current strategic directions, policies and programs in terms of reducing health inequalities.

Designing a health system for equity

The key discussions about the relationship between health and equity have understandably concerned the causal relationship between various social, economic, cultural and environmental determinants of health and the health status of populations by socioeconomic status, class or other divisions that may be used to illustrate health inequalities. (Acheson (1998); "Bringing Britain together" (1998); Kawachi et al (1997); Canada (1997); Dixon (1999); Marmot (1998); Wilkinson (1996); RACP (1999); WHO (1998), Cochrane/Campbell (2000))

Similarly, there has been key discussion about the nature of organizations and their ability to affect and/or respond to change. We know quite a deal about organizations and their structures. And we now have (as we be shown below) an understanding from both practice and theory of the changes needed for organizations to evolve successfully.

General practice : contribution to health and equity

The evidence that a primary health approach enhances health outcomes, increases system effectiveness and is cost effective gives a new impetus for general practice within the continuum of health services. At the same time, in Australia the establishment of the Divisions of General Practice and their continued support has led to a new found confidence in general practice.

Best practice for prevention and treatment of cardiovascular disease through an equity lens : a review

Background Despite declining rates of cardiovascular disease (CVD) mortality in developed countries, lower socioeconomic groups continue to experience a greater burden of the disease. There are now many evidence-based treatments and prevention strategies for the management of CVD and it is essential that their impact on the more disadvantaged group is understood if socioeconomic inequalities in CVD are to be reduced.

Aims To determine whether key interventions for CVD prevention and treatment are effective among lower socioeconomic groups, to describe barriers to their effectiveness and the potential or actual impact of these interventions on the socioeconomic gradient in CVD.

Methods Interventions were selected from four stages of the CVD continuum. These included smoking reduction strategies, absolute risk assessment, cardiac rehabilitation, secondary prevention medications, and heart failure self-management programmes. Electronic searches were conducted using terms for each intervention combined with terms for socioeconomic status (SES).

Results Only limited evidence was found for the effectiveness of the selected interventions among lower SES groups and there was little exploration of socioeconomic-related barriers to their uptake. Some broad themes and key messages were identified. In the majority of findings examined, it was clear that the underlying material, social and environmental factors associated with disadvantage are a significant barrier to the effectiveness of interventions.

Conclusion Opportunities to reduce socioeconomic inequalities occur at all stages of the CVD continuum. Despite this, current treatment and prevention strategies may be contributing to the widening socioeconomic-CVD gradient. Further research into the impact of best-practice interventions for CVD upon lower SES groups is required.

The direct costs of raising external equity capital for US REIT IPOs

Purpose – The purpose of this paper is to investigate the total direct costs of raising external equity capital for US real estate investment trust (REIT) initial public offerings (IPOs).

Design/methodology/approach – The study provides recent evidence on total direct costs for a comprehensive dataset of 125 US REIT IPOs from 1996 until June 2010. A multivariate OLS regression is performed to determine significant factors influencing the level of total direct costs and also underwriting fees and non-underwriting direct expenses.

Findings – The study finds economies of scale in total direct costs, underwriting fees and non-underwriting expenses. The equally (value) weighted average total direct costs are 8.33 percent (7.52 percent), consisting of 6.49 percent (6.30 percent) underwriting fees and 1.87 percent (1.22 percent) non-underwriting direct expenses. The study finds a declining trend of total direct costs for post 2000 IPOs which is attributed to the declining trend in both underwriting fees and non-underwriting direct expenses. Offer size is a critical determinant for both total direct costs and their individual components and inversely affects these costs. The total direct costs are found significantly higher for equity REITs than for mortgage REITs and are also significantly higher for offers listed in New York Stock Exchange (NYSE). Underwriting fees appear to be negatively influenced by the offer price, the number of representative underwriters involved in the issue, industry return volatility and the number of potential specific risk factors but positively influenced by prior quarter industry dividend yield and ownership limit identified in the prospectus. After controlling for time trend, the paper finds REIT IPOs incur higher non-underwriting direct expenses in response to higher industry return volatility prior to the offer.

Originality/value – This paper adds to the international REIT IPO literature by exploring a number of new influencing factors behind total direct costs, underwriting fees and non-underwriting direct expenses. The study includes data during the recent GFC period.

Understanding equity as an asset to national interest: developing a social contract analysis of policy

Alongside the influence of market-based reforms in education policy has been the growth of policy that has largely been overlooked – those that outline social contracts. This paper draws on policies that connect with equity as a way of illustrating this social contract turn in policy and develops a conceptualisation of social contracts as they apply to education policy. The argument provides three principles that underpin social contracts, including informed consent, negotiation and accountability. This paper applies these principles to three levels of social contract. At the first level are broad social contracts, which are associated with debates about the kinds of things that states should expect from its citizens, and the things that citizens could expect from governments and the state. The second level of social contract is an institutional or field-based social contract, which spells out the obligations and connections between a specific field and other fields. This level names a kind of social contract that is often exemplified in policies or statements by specific institutions. The third level of social contract deals with contract-like mechanisms embedded in fields that make tangible the obligations and expectations of citizens in fulfilling the expectations of fields.

Striving for educational equity and ‘world-class quality’ schools in Mauritius in global times

Concerns that the education system in Mauritius has not been adequately preparing students for work and life, and unsatisfactory academic achievement in schools, have fuelled the government’s drive to improve the quality of schools. These concerns exist within education structures that systematically segregate students into ‘star’ schools and less desirable schools that curtail the education experience of the majority of Mauritian children. Within this context, Mauritian education authorities have attempted various educational reforms aiming at ‘World Class Quality Education’ so as to contribute to an efficient and dynamic workforce and to meet the needs of an increasingly competitive, knowledge-based and globalised economy. Reflecting the Mauritian government’s ‘quality’ agenda and its focus on the work of school leaders, this article reports the findings of research exploring Mauritian principals’ views about the usefulness or otherwise of Total Quality Management (TQM) principles in raising educational standards. It focuses specifically on whether and how principals are addressing the mounting challenges brought about by globalisation. The findings indicate that, despite the government’s efforts at reforms, the education system detracts from ambitions to adequately prepare all Mauritian children for work and life in a globalised and networked world. The article argues that school leaders need to take proactive responsibility for ensuring that all Mauritian children have access to an education system that cultivates their participation as active citizens of the global community.

Towards a southern theory of student equity in Australian higher education : enlarging the rationale for expansion

Student equity in Australian higher education is a numbers game. While university student recruitment departments focus on ‘bums on seats’, equity advocates draw attention to which bums, in what proportions and, more to the point, which seats, where. But if the counting of ‘bums’ is crude, so is the differentiation of seats. Just distinguishing between courses and universities and scrutinizing the distribution of groups is a limited view of equity. This paper proposes an expanded conception for student equity and an enlarged regard for what is being accessed by students who gain entry to university. Drawing on Connell’s notion of ‘southern theory’, the paper highlights power/knowledge relations in higher education and particularly for ‘southerners’: those under-represented in universities, often located south of cut-off scores, and whose cultural capital is similarly marginalised and discounted. The paper concludes that taking account of marginalized forms of knowledge requires thinking differently about what higher education is and how it gets done.