There are two methods of business financing. The first is debt financing wherein money is borrowed from external sources such as banks [About, Inc.], finance companies, private corporations, credit card companies or credit unions [Allbusiness.com, Inc.]. Repayment is governed by the terms and conditions of an agreement, and it normally requires paying a monthly sum (part of total principal and part of total interest) over a specific time frame [About, Inc.]. The second method is equity financing wherein a part of the business ownership is traded for money [About, Inc.]. It involves taking on investors and being accountable to them. In case of small businesses, equity is usually raised from relatives, friends and customers as these players are interested in the wellbeing and success of the business. In case of large businesses like American Superconductor Corporation (AMSC), equity finance will come from venture capitalists (individuals, corporations and financial institutions) as these players are professional investors who are not averse to investment in risky new businesses [Allbusiness.com, Inc.].
If AMSC forgoes debt financing and takes on equity financing, it will enjoy five advantages, but will have to struggle against six disadvantages as well.
The first advantage is that equity can be retained permanently [Dynamic Equity Ltd.]. There is no obligation for AMSC to payback equity investment at any specific time, not even if it goes bankrupt. In this connection, AMSC will avoid the disadvantage posed by debt financing which involves prompt repayment of borrowed loans periodically; finance obtained in the form of loans cannot be retained permanently but has to be paid back in periodical instalments [About, Inc.].
The second advantage AMSC will enjoy is the strengthening of its cash flow. This is because cash that would otherwise be earmarked for debt repayment will be now freely available [About, Inc.]. Equity investors are rewarded by dividends, but only out of retained earnings [Dynamic Equity Ltd.]. AMSC will no longer be burdened by debt financings disadvantage of heavy debt repayment whereby its cash profits could be totally consumed in the process with the result that even if AMSC generates profit, there is no tangible form (cash) to show for it [About, Inc.].
The third advantage is that AMSC does not need to put forward any collateral in return for receiving equity contributions. As a result, AMSC will be able to safeguard all its business assets, some of which would have been put forward as collateral if AMSC continued with debt financing because collateral constitutes an important part of loan agreements that entitle the finance lender to legally appropriate those business assets in the event of default in repayment as per agreed terms [About, Inc.].
The fourth advantage is that the image of AMSC will enjoy a great boost because a business that possesses enough equity enjoys a good credit rating in the eyes of investors, lenders and tax authorities. AMSC will no longer be hindered by having to put its business reputation at risk due to debt financings feature of presenting large debts in the business entitys balance sheet, which results in weakening its credit standing and its competence to raise money in time to come [About, Inc.].
The last advantage of equity financing to AMSC is that the new equity investors will be genuinely interested in the wellbeing, progress and future prospects. They will expect returns on their investment only in the long run (usually between 3 to 7 years) [Allbusiness.com, Inc.]. The aggressive nature of equity investors will willingly accommodate downside risks as they take responsibility for the upside risks too. AMSC will no longer have to deal with debt financings conservative money lenders who know they cannot share any upside or profits and therefore seek to remove any possibility of loss or downside risks [Dynamic Equity Ltd.], not caring about the wellbeing or future prospects of AMSC, but being solely interested in getting back their investment in the short term in the form of regular paybacks.
The first disadvantage of equity financing AMSC will encounter is that its ownership will be compromised. The new equity investors will be entitled to a share in the business. AMSC will no longer retain full ownership that was the case with debt financing, where there was no question of giving up a share in business ownership to money lenders [About, Inc.].
The second disadvantage to AMSC will be the risk of interference in business operations and management from equity investors who could have different notions about how the business should be run. Personality conflicts could also add to the problem. In this regard, AMSC will lose the advantage of having no interference whatsoever from money lenders that it enjoyed when opting for debt financing [About, Inc.].
The third disadvantage to AMSC will be that its equity investors will be burdened by taxes, as the financing fees paid by AMSC (dividends) are taxable. This was not the case when AMSC opted for debt financing where the financing fee (loan interest) is allowed by tax authorities as a legitimate expense that is not subject to tax [About, Inc.].
The fourth disadvantage to AMSC will be that the equity investors will share the company profits indefinitely [Allbusiness.com, Inc.]. AMSC will no longer enjoy debt financings feature where leverage of company profits is facilitated, enabling it to utilise external finance to purchase its assets and retain its profits [About, Inc.].
The fifth disadvantage is that equity financing will be more expensive to AMSC as compared to debt financing, because the former involves giving up full business ownership and profit retention rights as compared to the latter scenario, where it had to repay only the loan amount and interest, without compromising business ownership or profit retention [Allbusiness.com, Inc.]
The last disadvantage to AMSC will be the lengthy time period involved. Getting equity finance is a time consuming process, as professional investors tend to scrutinise hundreds of investment possibilities each year before finally investing in very few of them [Allbusiness.com, Inc.]. AMSC will find that obtaining finance by this method is not as quick as debt financing.
In conclusion, it must be pointed out that it is a normal, accepted practice for investments into a business to involve both equity as well as debt financing a harmonious mixture necessitated because hundred percent debt financing involves a tremendous cash drain that will hinder optimal growth, while hundred percent equity financing sends a message that the future business prospects are every bleak and the business is not expected to generate enough profits to benefit from profit leverage [Dynamic Equity Ltd.]. However, as AMSC specialises in energy technology products, solutions and services especially in the field of wind energy, it enjoys the unique advantage of extraordinarily bright future prospects. According to the Global Wind Energy Council, the total installed base of wind power energy globally was 72,184 megawatts in 2006 and is expected to nearly doubt to 134,800 megawatts by 2010 [Superconductor Week], that is 3 years from now. As equity investors do not anticipate short-term but only long-term (3 to 7 years) investment returns [Allbusiness.com, Inc.], and therefore will be heartened by the tremendous future prospects of AMSC, it does appear that AMSC will be taking the right step by opting to forego debt financing and take on equity financing.
References
American Superconductors Power Electronic Systems Division Books $ 4.6 Million in New D-VAR [R] Orders for Wind Farms. Superconductor Week.
Debt vs. Equity? Dynamic Equity Ltd. 2007.
Funding your Business with Loans vs. Equity Capital. Allbusiness.com, Inc. 2007.
Minassian, Mark. Debt vs. Equity Financing. About, Inc. 2007.
The aspect of equity in organizational total compensation plans primarily entails fairness and competitiveness of salaries and rewards that employers pay employees (Martocchio, 2009). Internal equity and external equity are the main forms of employee-centered compensation systems. The two reward systems are implemented by organizations depending on the nature of their activities, their required employee skill sets, and their overall human resources management strategies.
Internal equity involves the comparisons of employee rewards allocations in an organization. External equity, on the other hand, refers to the ways an organizations compensation packages compare to those of other organizations. The choice of a particular compensation system is usually informed by the need to optimize employee retention and work performance while remaining attractive to prospective employees at the same time (Martocchio, 2009). This essay analyses the fundamental aspects of internal and external equity, with reference to two organizations that have in place either of the compensation systems.
Internal Equity at American Institutes for Research
American Institutes for Research (AIR) is one good example of an organization that implements a total compensation structure that is focused on internal equity. AIRs work environment demonstrates team empowerment and encourages assertiveness in the bid to observe motivational strategies that promote efficiency and continuity within the internal environment of the organization. These employee compensation characteristics are evident in AIRs total compensation package whereby it is designed to attract and retain the best talent through competitive salary rewards, comprehensive employee benefits, and a supportive work environment.
As such, it observes internal equity by rewarding its entire talented workforce proportionately (American Institutes for Research). The organization has in place performance-based bonus programs, well-defined systems for propagating employee promotions, and clear criteria for determining salary increments and benefits that come with promotions (American Institutes for Research). This enables the organization to avoid discriminative salary discrepancies and other pitfalls in its internal environment.
One advantage of internal equity is that it encourages individual employees to exercise creativity and innovations because of the satisfaction they get from their compensation rewards, but also from their ambition to rise through the ranks. It also promotes teamwork among employees in similar and different pay scales because of the absence of discontent that usually arises from salary discrepancies among employees in similar job scales. Organizational employees also motivated when their designated job responsibilities and actual workloads are taken into account in their respective total compensation packages (Martocchio, 2009).
However, internal equity compensation plans may fail to take into account the individual skills, talents, and work performance capabilities of employees especially when uniform scales compensation is offered to workers in similar job groups.
External Equity at Novartis Pharmaceuticals Corporation
Novartis Pharmaceuticals Corporation is one good example of an organization that has in place a total compensation structure that is focused on external equity. The companys external equity aims at ensuring that its total compensation plan matches or even exceeds the prevalent pay rate scales in the market. To this end, the Novartis Annual Incentive Plan offers employees lucrative reward packages along with a string of benefits that are in tandem with the prevailing industry trends (Novartis Pharmaceuticals Corporation, 2012).
The companys external equity-focused benefits programs include: overall health and overall well-being benefits, work and life benefits, financial protection benefits, financial and retirement planning benefits that include 401k plans (Novartis Pharmaceuticals Corporation, 2012).
The total compensation plan for Novartis Pharmaceuticals Corporation compares well with the other industry players such as Sanofi Aventis, Pfizer, Inc., and Bristol-Myers Squibb Company. For example, in addition to offering an extensive employee benefits portfolio, Sanofi Aventis provides its employees with 401k retirement plans that are accompanied by matching contributions of the company (Sanofi, 2012).
Bristol-Myers Squibb similarly ensures that its total compensation packages match the offers of other industry players (Bristol-Myers Squibb Company, 2012). This means that the employees of Novartis Pharmaceuticals Corporation are not likely to exit the company in favor of its competitors on grounds of compensation because all the companies provide relatively similar lucrative total compensation plans.
External equity poses the advantage of stemming employee turnover rates because it ensures that the organization matches or even exceeds offers in the industry-wide compensation systems. It also enables the organization to attract employees with the best qualifications and desired skill sets that enhance output performance and product competitiveness (Martocchio, 2009). However, the external equity compensation system has the disadvantage of added costs for the organization, especially when the organizations income potential does not match the income potentials of other organizations in the industry offering comparatively lucrative compensation packages to their employees. Moreover, external equity is a force of the external organizational environment. External forces are considered to pose significant challenges to organizational management because of their uncontrollable nature.
Conclusion
Organizational needs are generally determined by the diversity management strategies that involve planned and systematic commitment of the organization to recruiting and retaining employees with diversified skills from diversified backgrounds (Kirton, Mary, & Greene, 2009). Indeed, employees with diversified professional backgrounds are beneficial to the organization because they can freely multitask and eliminate the need for expanded support staff. Diversified qualifications broaden management approach options for managers by way of mainstreaming operations through individual skills and affiliations (Kirton, Mary, & Greene, 2009).
Kirton, G., Mary, Q., & Greene, A. (2009). The costs and opportunities of doing diversity work in mainstream organizations. Human Resources Management Journal, 19(2): 159-175.
Martocchio, J. J. (2009). Strategic compensation: A human resource management approach, (5th ed.). Prentice Hall, Pearson Education Inc.
Novartis Pharmaceuticals Corporation. (2012). Compensation and benefits. Web.
One of the important aspects of defining the implications of earnings management concerns the association between stock-based compensations of managers, their equity rates and the degree to which earnings are managed. In such a way, stock ownerships can affect directly or indirectly the compensation and benefits of a manager, which is why such a situation creates certain incentives that induce earnings management.
Naturally, in the modern business context, there are several various mechanisms and techniques aimed at controlling and remedying such processes. They include a hypothetical linkage between stock prices and managerial ownership, as well as stock-based compensations, to the interests of managers in the companys performance, and therefore, benefits not only for the executives but also for all stakeholders.
However, there is also a strongly supported possibility that, in such a scenario, managers will only pay attention to the stock prices and the companys performance on a short-term basis, which is why they will gain the majority of their benefits while they are managing a particular company. Moreover, the easiest way to achieve such a short-term increase in the companys performance and the price of stocks includes the elements of earnings management. Because the current earnings of the company will be managed and will appear higher than its actual performance is, it will also harm the overall performance of the company in the long run because the future analysts predictions about it will be made on the basis of currently managed earnings.
Hypothesis development
One of the patterns observed in managers behavior is that executives with higher equity rates are more likely to sell their stocks after they finish their contracts. For that reason, the main hypothesis is that there is a direct linkage between the effects of the managerial actions to improve the companys performance solely on a short-term basis and earnings management incentives. One of the motivations of managers, in such a situation, is, of course, the fact that managers are looking for a personal benefit, in the first place, affects their decisions concerning earnings management.
Executives operate a variety of different elements that relate to their stock-based compensations and equity rates. Those forms of holdings include various options for managing stock grants and types of ownership. Therefore, there is a theoretical relationship between equity incentives, including all the options from exercisable ones to the stock ownership, the earnings management in terms of the need to meet analysts expectations, and the future selling of the stocks. In such a way, another hypothesis is that occurrence of earnings management is related to equity incentives.
In the ideal business environment maintained in a particular company, there should be an equilibrium among those three aspects. However, the dominance of two of them is likely to result in higher levels of earnings management and a decline in the companys performance in the long run.
Sample and data
For the study, Chang and Warfield used the data collected from the financial documents related to the stock-based compensations and their implications and effects on the companies long-term performance. The included data was obtained from the Execu-Comp databases, and it concerned the provided data from the 1993 2000.
Empirical results
Given the scope of Chang and Warfields study and the developed hypothesis, the results suggested that stock ownership and stock-based compensations for managers as a part of the equity model can create specific incentives for earnings management. The primary empirical results concerned the analysis of equity-related incentives and future selling of the managers stocks, based on comparing the rates of option grants, unexercisable options, exercisable options, cash flow, the companys size and growth, and the level of stock returns. The results were also analyzed in the sphere of correlations between the earnings management and the levels of various options for the managerial equity-based compensation, as well as the linkage between the degree to which earnings management is incorporated in the companys daily operation and the number of stocks that managers trade after they leave the company.
Additional analysis
In addition to the initial results of the study, it is also important to point out the fact that the additional analysis in the study revealed a correlation between analysts expectations, earnings management incentives, and the possibility of trading the stocks by managers. In particular, boosting the companys performance by managing both real earnings, such as cash flow, and financial accruals of different kinds can result in managers gaining more profit using selling stocks and shares after they registered the earnings in financial reporting in such a way that they would largely exceed analysts expectations. On the other hand, there is another scenario including trading their stocks after they managed the abnormal accruals that would boost the income.
Conclusion and implications
Overall, high equity incentives create for the executives some motivation to exercise earnings smoothing because of the possibility of personal benefits via trading stocks in the future. Moreover, there is also a relationship between analysts forecasts and managers desire to boost the companys performance by means of earnings management.
With the opening of international trade routes and globalization of movement of goods, services and utilities, spawned by technological advancement and the internet, global equity markets have been receiving wide attention in recent years, thanks to the opening up of global economies. Therefore, it is now possible for an investor sitting in Mumbai or New Delhi to transact in the London or New York stock exchange, through the process of global equity market schemes.
The main aspects of global equity trading, beside being more profitable for investors is that it provides a higher assessment expertise from given levels of market rules. Further, it reduces price fluctuations through market inefficiencies and also considerably enhances the improvement in macro economics and financial essentials. Higher returns envisage higher risks for investors and this applies to global markets too, where the capricious tendencies of stock markets are fully manifest.
Again the apparent anonymity of global investors could camouflage illegal and fraudulent transactions, and therefore need to have maximum control, security and transparency. However, it is widely believed that Global equity markets, in essence safe and predictable only to those few who truly understand them, are capable to provide sophisticated investors and traders alike with plenty of rewards. (Global equity markets, (n.d)).
It is now necessary to conduct Strength/Weaknesses/Opportunities &Threats (SWOT) Analysis to determine efficiency from investors perspective.
Strengths
The innate fluctuations and vicissitudes in Stock Exchanges worldwide need to be arrested through diversifying the application of funds in different kinds of investment activities like FDI, public and private placements of debts and institutional financing. Besides this, a primary tool could also be through global equity issues
Again, it is seen that domestic equity issues may be subject to government rigours and stiff conditional ties, which could be avoided through global equity placements. It is also important that major companies, who may be keen to enter foreign markets through public issues, need to have their shares traded in foreign stock exchanges. It is very important that the financial system should stabilize and companies need to provide sound financials.
Equity markets will not find solid footing until the financial system stabilizes, says Pierre Lapointe, market strategist at National Bank Financial. One thing we have noticed is that the latest market rally is different from previous ones. This time around, investors have bought into financials. This is good news, because equities have never rebounded from a recession without a strong contribution from financials. (Pett, 2009).
Global equity trading facilitates new sources of financing and helps broaden capital base of equity while also bringing wide cross culture of investors.
Weaknesses
There have been many instances of unscrupulous traders conducting fraudulent activities for personal gains. Again, since backgrounds of global communities may not be easily gained, there are possibilities of losing heavily in global stock activities. Country specific rules and regulations are also present that may curb, or restrict trading. Political influences, cornering of shares and insider trading are major weaknesses that beset global equity trading.
Opportunities
That being said, it is quite possible that the investing public and the companies may stand to gain immensely by high performance of global equity markets that may cause phenomenal share growth and earnings, and also declare handsome and consistent dividends. As a global trading facilitator, global equity markets serve to enhance the worth of economies also through a process of safeguarding the assets of corporate of different parts of the globe. Besides, it improves the trading technologies between countries.
Threats
By far one of the major threats is insider trading, by which large individual profits may pro-offer to unscrupulous traders, perhaps at the cost of the company whose shares are being so traded. Again, it is possible for frauds, misrepresentations and illegal transactions to be perpetrated that may not be easily visible, or detected. Economic meltdowns, wide ranging economic debacles, currency fluctuations, political and economic crises do also influence movements of global equity markets. The markets now will have to readjust to the fact that US consumers not only will restrain the apathy for goods and services, they will also look for domestic US products. (Adelton, 2006).
Conclusions
It is seen that in the present economic meltdown in US, and other advanced economies, these could record dismal performance for individual stockholders. However, it is believed that by 2010, the global equity market would stabilize once again, as it is already on the road to stability.
By 2010, all the policy implementations for injections of equity into the economy, impacts of banking and trading reforms and various institutional measures would show results, which would also be most promising for the global equity markets.
Reference
Adelton, Sam. (2006). World equity markets surprised with US dollar drop- underestimated the weakness of the US economy. India Daily. Web.
Global equity markets. (n.d). Bulls Versus Bears. Web.
Pett, David. (2009). New found resilience in global equity markets. Calgary Hearld: Division of CanWest Publishing Inc. Web.
The world is remarkably diverse, and peoples communities are becoming increasingly multicultural, multilingual, and multiracial. By developing intercultural understanding in children and adults, people strive to create inclusive communities and instill in everyone a sense of connection and belonging. People welcome their diversity and embrace the differences, commonalities, and shared values. Diversity refers to political beliefs, race, culture, sexual orientation, religion, class, and differences in gender identity. Inclusion means that everyone in diversity feels included, valued, respected, treated fairly, and embedded in the culture. Equity ensures that all society members have access to the same treatment, opportunities, and promotion; it aims to identify and remove the existing barriers to the full participation of certain groups. All aspects are important: diversity without inclusion can result in a toxic culture, and inclusion without diversity can make a community stagnant. This is a natural development of a society striving to be more diverse in its perceptions of people with different backgrounds and experiences. Differences become strengths in joint efforts, and cooperation is the way to achieve peace. And it should be something people truly need to celebrate.
From my point of view, celebrating diversity, equality and inclusion is very important from a social perspective. Firstly, participants of such events can get a new look at life and the people around them because knowledge is the key to tolerance. The celebration of diversity usually includes a wide range of local and international music, eclectic dancing, delicious food, and creative crafts: it may be interesting for all community members. Secondly, cultural celebrations foster respect and open-mindedness towards other cultures. Understanding people and their backgrounds are critical to personal and community growth. Thirdly, through the understanding of diversity, people are able to become more aware of themselves; the key to understanding yourself lies in the ability to understand others. Finally, due to such celebration, we can explain the important fact: the differences define people and how they treat others concerning these differences.
The main reason why celebrating equality, inclusion, and diversity is important to me is its societal significance, as outlined above. I want to live in a society that accepts and understands the diversity of its members, in a society where there is no place for discrimination. Such celebrations are needed to form such a progressive society. The importance lies not only in the exchange of intercultural experience but also in teaching people tolerance and norms of behavior in raising awareness about the problems of oppressed minorities. The existence of a culture of such celebrations and participation in them has made me an understanding and sensitive person myself. Thanks to such events, people may finally understand that our cultural, racial, ethnic, gender, and other differences make us human beings.
By creating a diverse and inclusive environment, all members of society can benefit, especially those who belong to traditionally marginalized groups. Using culturally sensitive strategies will help recognize that people may have more options and opportunities than they considered. Diversity, equity, and inclusiveness open up a much broader perspective for solving problems and developing creative solutions for competitive advantage and greater success. A celebration dedicated to such important social aspects is important because it aims to bring people together, exchange cultural experiences and inform about social issues. With the help of such events, people learn to accept the peculiarities of other people and better understand who they really are.
In addition to medical and genetic factors that affect human health, social determinants of health (SDOH) exist. They may be related to socioeconomic circumstances, the environment, the populations education, and governmental social and medical programs. Moreover, social determinants significantly affect access to proper medical care and cause health equity issues. Health equity implies recognizing that some population groups need additional assistance to receive equal health services. Recognition of this fact contributes to the reduction of the influence of the SDOH and the promotion of equity. Therefore, this paper will analyze the impact of social determinants on health and opportunities to improve equity in health care.
Social Determinants of Health
Social determinants of health are non-medical factors that can significantly affect the incidence of the population. These factors include education, employment, health systems and services, housing, income and wealth, the physical environment, public safety, the social environment, and transportation (National Academies of Sciences, Engineering, and Medicine, 2021, p. 32). SDOH can have both positive and negative effects on peoples health. However, in most cases, they have a negative effect, causing severe diseases and generating health inequalities.
One of the most common social determinants is the level of income and wealth of people. People with lower incomes are primarily concerned with meeting their basic needs, such as food and shelter, and often do not have enough money for regular medical examinations and treatment. It leads people with higher incomes to experience lower mortality, higher life expectancy, and slower declines in physical functioning (National Academies of Sciences, Engineering, and Medicine, 2021, p. 42). In addition, wealth determines the environment in which a person lives, his predisposition to smoking, alcohol and drug use, and malnutrition.
Another significant outcome for the health of people with lower incomes is the opportunity to access social services, education, and healthcare. First, the lack of quality education causes a low level of health literacy (Hill-Briggs et al., 2021). As a result, people pay less attention to their health and not seeking medical help on time. Second, the lack of education determines the possibility of employment and earnings at an older age (Hill-Briggs et al., 2021). In addition, poorer neighborhoods often have limited access to proper health care. Thus, a persons socioeconomic status is one of the leading causes of health inequity.
Improving Health Equity
Healthcare equity is necessary to ensure the proper health of all citizens and prevent serious diseases. Hill-Briggs et al. (2021) define equity as the absence of avoidable, unfair, or remedial differences among groups of people (p. 259). That means everyone should receive the same high-quality health care regardless of social, economic, demographic, or geographic characteristics. At the same time, the task of nurses is to reduce the impact of social determinants of health and provide equal healthcare services to all patients.
Since nurses interact most with patients and their families, their role in improving health equity is very significant. First, nurses can engage in patient information and education, increasing health literacy among the population. It makes patients more likely to follow instructions and change their behavior as directed by their doctor (National Academies of Sciences, Engineering, and Medicine, 2021). In addition, they may work with community services and organizations to promote public health. Secondly, improving health equity requires a change in the attitude toward patients and increased attention to emerging equity issues. Therefore, nurses can lead teams to improve the care and reduce the costs of high-need, high-cost patients and coordinate with other nurses (National Academies of Sciences, Engineering, and Medicine, 2021, p. 102). In addition, nurses can provide primary care to people who do not have access to medical facilities through telehealth or by visiting patients at their homes.
Self-Care for Nurses
The work of nurses is aimed at meeting the complex needs of patients, so there are often physical, psychological, and emotional challenges. Therefore, self-care is necessary to ensure nurses general well-being and prevent professional burnout. Moreover, nurses well-being improves their ability to address SDOH and improve health equity (National Academies of Sciences, Engineering, and Medicine, 2021). Often the stress and tension associated with work cause burnout and deterioration in the physical health of nurses, so it is necessary to use self-care strategies to improve their condition.
One strategy for improving mental health and preventing burnout is mindfulness. Horn and Johnston (2020) define it as the act of focusing on the present moment (p. 565). This practice helps assess mental state and reduce stress and anxiety. In addition, a critical strategy for improving nurses well-being is maintaining high-quality sleep and reducing caffeine intake. Nurses work schedules can often be hectic with heavy workloads, so sleep and recuperation are essential. Furthermore, Horn and Johnston (2020) note the impact of diet and exercise on nurses health. It helps maintain physical well-being and affects stress levels and mental health, reducing the risk of burnout.
Conclusion
Thus, social determinants are one of the critical determinants of the level of population health. They cause health inequity, as a result of which some groups of people do not receive the necessary medical services. Improving health equity should be one of the main areas for changing the health system. In addition, health professionals, particularly nurses, significantly influence the equality of healthcare services provided. However, nurses ability to address equity issues and reduce the impact of SDOH depends on several factors, particularly their physical and mental health.
The given article review will primarily focus on two main domains, which are access and national quality strategy informed by research. The healthcare system in the United States is among one of the most expensive and unaffordable ones across the globe. In addition, it is evident that the access aspect is comprised of two key factors, such as cost and insurance, which are determinants of availability.
In the case of access, the direct strategy needs to revolve around reducing barrier costs and expanding coverage. The author claims that such reforms will cover up to 32 million uninsured individuals and eliminate co-payments (Fiscella, 2011). It adheres to the biblical worldview of public and community health. The Gospel of John states: But if anyone has the worlds goods and sees his brother in need, yet closes his heart against him, how does Gods love abide in him? (as cited in Health care, 2020, 3:17). Christianity supports aiding others and providing for others at the cost of ones own sacrifice.
The article also states the main prescriptions and pitfalls of the given approaches. The major ramifications of the reform are that 23 million people will still remain uninsured and primary care might experience certain challenges without robust measures (Fiscella, 2011). The prescription of the accessibility increase is in line with the biblical perspective, where the researchers suggest to implement universal coverage and expand Medicare. The Book of Deuteronomy states: For there will never cease to be poor in the land. Therefore I command you, You shall open wide your hand to your brother, to the needy and to the poor, in your land (as cited in Health care, 2020, 15:11). In other words, the Bible supports the notion of the wealthy helping the ones in need, and healthcare access is the direct example of the case.
Moreover, it is important to improve the overall quality of healthcare through a national quality strategy. The article suggests that improved accountability is the central promise of the reform, whereas the primary pitfall is the negligence of the physician-patient relationship (Fiscella, 2011). In addition, the recommended prescription for the change is to preserve the patients at the center of the issue (Fiscella, 2011). It also goes in accordance with the biblical view of community and public health. The Gospel of James states: Is anyone among you sick? Let him call for the elders of the church, and let them pray over him, anointing him with oil in the name of the Lord (as cited in Health care, 2020, 5:14). The Bible keeps sick or patient at the heart of the problem.
In conclusion, it is evident that the articles propositions and analysis statements are in tune with biblical interpretations of healthcare. The lack of access and quality assurance are among several major issues of the American healthcare system. The Bible supports the notions of expanding coverage for the uninsured and focusing on the patient only as the center of the care. In addition, accountability and performance can be improved through national reforms.
References
Fiscella, K. (2011). Health care reform and equity: Promise, pitfalls, and prescriptions. The Annals of Family Medicine, 9(1), 78-84. Web.
It has been acknowledged that several social determinants influence peoples health. These social factors include income, race, unemployment, social support, and education, among others (Coughlin, 2019). Although multiple factors shape peoples behaviors and their health outcomes, education is one of the central domains that require specific attention as it can become an opportunity rather than a challenge. Education, as one of the social determinants, often has lifelong and far-reaching effects. The major outcomes associated with this social determinant are the prevalence of chronic illness, health behaviors, and shorter life expectancy in people with a low level of education (Alderwick & Gottlieb, 2019). This paper includes a detailed analysis of the impact of education access and quality on health equality and patient outcomes, as well as recommendations to improve the current situation.
Link Between Education and Health Equity and Patient Outcomes
The relationship between education and health equality and patient outcomes has been identified in numerous studies. For instance, the prevalence of diabetes in people with less than high school education is 12.6%, while the incidence rate is 7.2% among people with more than high-school education (Hill-Briggs et al., 2020). The diabetes-related mortality rate is twice higher in people with less than high-school education compared to those with a college education. Education is associated with the mortality rate, which is evident on the global level (see Figure 1).
Coughlin (2019) states that fewer African Americans gain high-school education as compared to non-Hispanic whites, 72.5% and 87.2%, respectively, which affects their income, employment, and access to quality health care. Coughlin (2019) notes that, as a result, the level of education predicts the survival rate of people with cancer. Other studies are consistent with these conclusions as, for example, it is found that individuals with less than a high-school education are at a higher risk (42% in men and 120% in women) of higher colorectal cancer mortality (Singh et al., 2017). Other chronic diseases are also more common in people with lower levels of education.
Figure 1. The link between enrollment rate (and adult education levels) and infant mortality rate per 1,000 globally. Source: Raghupathi and Raghupathi (2020)
The prevalence of chronic diseases among people with lower levels of education is associated with health behaviors. It has been acknowledged that people with less than high-school education are more likely to have unhealthy behavioral patterns. Singh et al. (2017) note that approximately a quarter of people with such level of education are current smokers, while only 5.8% of those with a college degree smoke regularly. Medvedyuk et al. (2017) claim that the level of education is associated with such health conditions as obesity. The researchers state that education can be an effective platform to address the problem, which has been proved in various studies.
In addition to quite direct effects on patient outcomes, the social determinant in question affects healthcare accessibility. People with lower levels of education tend to have lower income, which, in its turn, makes quality healthcare services less attainable. These groups can hardly pay for their housing and daily expenses, so they tend to skip medical checkups that are critical for proper health management. Early diagnosis cannot be made if a person addresses a doctor when severe symptoms of an issue appear and their health has deteriorated substantially. The recent evidence of the role education may play in healthcare equity and patient outcomes have become the ground for the development and implementation of various incentives aimed at addressing the problem.
Reducing Health Disparities and Improving Health Equity by Addressing Education as a Social Determinant of Health
Numerous educational projects and initiatives have been implemented across the country. Harrington et al. (2020) claim that a two-fold approach can be instrumental in addressing the problem of health disparity and health equity. On the one hand, the increase in the number of healthcare professionals trained to provide high-quality healthcare services and advocate for vulnerable populations is necessary. The lack of nurses, as well as other practitioners, reduces health equity as people with higher income have higher access to health care. Underprivileged groups have to wait a long period before they can see a doctor or receive limited care due to the lack of time since healthcare professionals provide care to a large pool of patients.
Some programs aimed at addressing the shortage of medical staff have been introduced, and the practice is gaining momentum in rural areas. Federal and state budgets, as well as communities, fund projects that encompass the provision of scholarships to students of medical schools (Harrington et al., 2020). New healthcare practitioners, who choose to work in rural areas, receive additional benefits, including on-the-job training, which leads to the improvement of the quality of provided care. Alcaraz et al. (2019) claim that various policies addressing this issue have been launched and led to positive outcomes. In addition to popularizing medical professions, federal and state budgets allocate funds to provide scholarships to low-income students. By obtaining higher levels of education, these groups will be able to improve their socioeconomic status, which will make healthcare services more affordable for them.
On the other hand, more educational incentives in terms of the countrys educational system should be introduced. Educational facilities are seen as a favorable platform that ensures the coverage of a considerable population (Harrington et al., 2020). Therefore, healthcare professionals are involved in different programs launched in schools, colleges, and other educational facilities. A considerable bulk of evidence regarding different approaches and particular programs exists.
Researchers have developed guidelines and identified effective strategies and pitfalls to be avoided when creating projects aimed at addressing the social determinant in question. For instance, Alcaraz et al. (2019) state that targeted incentives should be implemented as they are instrumental in achieving clear and attainable goals. These projects are also cost-effective, which is critical for low-income communities. Students are trained to cook healthy meals, be more active physically, and maintain their mental health through the development of social ties. It has also been acknowledged that further research is needed to facilitate the development of the healthcare system and mitigate the negative effects of all social determinants, including education (Alcaraz et al., 2019; Harrington et al., 2020). Evidence-based initiatives should be carried out in different communities across the country with a focus on their peculiarities.
How Effective Quality Management Programs on Education Can Improve Health Equity and Patient Outcomes
Public health is one of the priorities of the American government, so diverse measures have been undertaken to address numerous issues in this area. As mentioned above, the implementation of projects aimed at addressing social determinants results in considerable improvement and reduced health inequality. Effective quality management programs are instrumental in achieving positive results and addressing the negative impact of such social determinants as education (Alcaraz et al., 2019). The inadequate access to healthcare services of people with low levels of education is associated with their insufficient income. People with no high-school education tend to have low-paid jobs, so health care services are often unaffordable for them. Limited resources also make people address medical staff when their health deteriorates substantially instead of having regular check-ups.
One of the areas to consider is the use of technological advances with a focus on information technologies. The implementation of projects encompassing the use of electronic medical records helps healthcare professionals to screen patients for the social determinants affecting their conditions (Hill-Briggs et al., 2020). Screening is the first step in helping patients to access resources available to them. It has been found that people are often unaware of opportunities they have, which prevents them from accessing quality care (Hill-Briggs et al., 2020). To ensure effective screening and informing, healthcare professionals should have the necessary skills to manage electronic medical records effectively. Hence, quality management programs at healthcare facilities can lead to direct effects and the improvement of health equity and positive patient outcomes.
Other quality management programs can be useful in addressing the social determinant under consideration as well. For instance, projects aimed at improving the work of interdisciplinary teams can bring positive results through the provision of high-quality care, shorter waiting time, fewer medical errors, and lower readmission rates (Hill-Briggs et al., 2020). By providing quality services, healthcare practitioners can attend to more patients, which will improve peoples access to care and make the problem of the personnels shortage, less burning. The use of technology is again beneficial in this respect as it helps to provide healthcare services more effectively. Advanced equipment and devices can help in diagnosing and treating various health conditions.
At that, one of the most far-reaching types of programs that have lifelong effects involves educating people (young populations) regarding healthy behaviors. Hill-Briggs et al. (2020) note that significant attention should be paid to mental health as low-income communities where people with low levels of education reside are vulnerable to such public health issues as alcoholism and other types of addiction. These populations tend to have unhealthy diets and insufficient physical activity. Therefore, numerous projects aimed at raising peoples awareness on the most relevant aspects are conducted. Medical staff, in collaboration with educators, informs people about the negative effects of unhealthy behaviors, ways to maintain healthy lifestyles, and steps to be undertaken to access quality care. Such projects are implemented in diverse settings, including clinical, educational, and community-based. Social support is an important component of such interventions and programs (Alcaraz et al., 2019). People are encouraged to shape their behavioral patterns, which is achieved through the involvement of families and community members.
Quality Improvement Project to Address Education with the Goals of Improving Health Equity and Patient Outcomes
It is possible to implement a quality improvement project addressing education to reach health equality and better patient outcomes. The program will involve such stakeholders as healthcare practitioners (mainly public nurses), educators, children and their parents, and communities. The initiative will encompass the provision of training to children and their parents within the educational setting, with several sessions held in the community. The project may be launched in a community characterized by the prevalence of a low-income population. After the evaluation of the outcomes, similar projects can be initiated on the state or even federal level. This incentive will be held based on public educational facilities to reach the most vulnerable populations.
The program will consist of regular educational sessions for children and their parents with lectures and workshops on a range of health-related topics. The areas to be addressed include a healthy lifestyle and diet, major health concerns, their negative effects, and associated risk factors, available resources to maintain an appropriate way of life. Public nurses will deliver lectures and run the workshops based on the mentioned domains. The program will be developed in close collaboration among healthcare professionals, educators, and community members. Educators will help in creating workshops and running the training sessions.
Community members may provide resources for the implementation of the project (spaces for community-based sessions, materials, investment). Local non-profit organizations aiming at improving public health or addressing specific health issues will be the most engaged actors as far as the community is concerned. Community members and companies can donate to increase the number of nurses in local public hospitals. They can also become advocates, who will address policymakers to allocate more funds to medical schools to invest in scholarships in similar initiatives. To be effective advocates, they will need certain training, so the educational sessions will involve workshops for building the necessary skills.
Conclusion
To sum up, it is necessary to note that education is one of the social determinants of health that have multiple lifelong effects. People with lower levels of education tend to be at a higher risk of the development of chronic diseases and higher mortality rates. People with a low-level education are likely to have lower income and limited access to health care. They are also less likely to maintain a healthy lifestyle and keep to a proper diet due to the lack of resources. Hence, education is one of the areas to be addressed to reduce health disparity and improve health equity in the United States.
Numerous projects and initiatives have been implemented on different levels. Some projects entail the provision of healthcare services within the contexts of educational facilities (this is specifically common when it comes to mental health). Physical activity is another aspect that has received significant attention, and numerous projects encompass encouraging students (and their parents) to be more physically active. At that, the major focus is on educating people to make them aware of health risks and ways to improve their health.
The proposed initiative includes the three areas mentioned above, which can be instrumental in reaching the highest results related to reducing health disparity and improving health equity. The project will be implemented in a local community, but after detailed analysis and evaluation, it can be expanded to other areas or even become a national program. It is also important to continue improving the existing projects aimed at addressing such social determinants of health as education by conducting further research. It is important to explore the ways this social determinant is associated with peoples gender, age, and cultural peculiarities, as well as other specifics. Education should stop being a challenge as it can be an opportunity for helping people and communities choose healthier options and focus on prevention rather than treatment.
Medvedyuk, S., Ali, A., & Raphael, D. (2017). Ideology, obesity and the social determinants of health: A critical analysis of the obesity and health relationship. Critical Public Health, 28(5), 573-585. Web.
The idea of Equity literacy that resonates with my values, thinking, and beliefs are race-related oppression which comprises religion, (dis)ability, gender expression, and identity. Additionally, teachers must integrate this concept in the classroom by reflecting on their thoughts, reducing gender and race biasness and ensuring that these practices are always considered and emphasized. While referring to John, The Dean of Students at a suburban high school, Gorski (2016) says, In addition to his other dean duties, John led the schools diversity efforts at the request of the principal (p.12). This is an example of what educational facilitators need to do in the learning environments. Equity literacy enables educators to make decisions that affect every student similarly. Educational facilitators encounter problems controlling the learning environment since learners bring their identities based on their social group to the learning environment. It is hard to create a classroom climate that is safe and inclusive. Culturally responsive pedagogy and equity literacy are linked as they create a supportive and safe environment by interrupting harmful student behaviours. Besides, culture focuses on academic performance, while equity literacy focuses on the life of an educator as a whole.
Firstly, advancing quality to equity enables one to be able to not only advocate for justice and fairness but also ensure that everyone is treated in the same way. As a teacher, I will advance equality by establishing an environment that equally addresses all students economic, social and cultural aspects. For example, all students might have access to advanced math classes insofar as they are available to anybody who takes the prerequisites, ( Equity Literacy Institute, 2021, para. 3). Another Paradigm Shift for Equitable Educators that I will integrate into my practice is eradicating marginalizing practices among the learners families. &we begin not with a binder full of practical strategies but with a deeper commitment to strengthening our understanding (Gorski, 2016, p.14). I understand that educators should be accommodating. Therefore I will practice this paradigm by accommodating every student and treating them equally without any bias depending on their backgrounds, although it is hard. Besides, Equity literacy reflects a shift in commitment for me as an educator (Gorski, 2014, para.14). Teachers, like anyone else, may not be aware of the biases in their training and upbringing. In addition, they should be able to address such situations most appropriately whenever they arise.
Gender equality means that both men and women have equal opportunities to realise their potential. In the schooling environment, it means that both boys and girls are provided with the same treatment in all areas in a bid to enhance their pursuit for educational targets (Davies & Banks, 1995).
Over the past years, boys have had more opportunities than girls due to various reasons in the society; therefore, civil society groups and other non-governmental organisation have been formed to support education for girls, especially in the developing countries. The trend has gradually changed, and more girls are being given opportunities to realize their full potential in schools and various institutions. Despite all these campaigns, there are still cases of gender disparity in schools and learning institutions, with various measures being put in place to resolve them.
Gender inequality can easily be identified in schools by observing how students tend to micro-interact and aggregate in particular activities or groups. This can be manifested in courses taken by either gender; for example, in mathematics, which is considered a manly course, girls may feel discouraged from pursuing it due to the perceived notion (Koch & Irby, 2005). Inequality can also be expressed in the attention given to either gender by a teacher during teaching.
Research has shown that boys are generally given more opportunities to answer questions than their female counterparts; boys also receive more feedback from their teachers, and when either gender makes a mistake, boys often receive more leniency than girls. These trends have done much in promoting gender inequalities around schools.
Social factors have greatly influenced gender equality in classrooms (Blaise, 2012); these factors are highly interconnected with educational systems to influence it both from within and outside. Poverty and child labour form one of the greatest social obstacles to gender equity. Its influence is far outreaching, considering that nearly 1.4 billion people worldwide live on less than $1.25 a day. Girls from marginalised groups, such as children with disabilities and minority communities, are likely to encounter more challenges if they live far from schools; they may be unable to buy leaning materials, and when they do, they do not get adequate attention in classrooms.
Poorer parents are more likely to withhold their children from attending schools so that they may participate in income-generating activities; in some religions, boys are more valued than girls. Generally, poor families will view formal learning with suspicion and would rather prefer sending boys to schools and leave girls at home. In poverty-stricken homes, girls are left to fend for the family and take care of domestic chores as the parents go to search for daily bread.
Gender norms of a community have a direct influence on the performance of students of either gender in school, whether patriarchal or matrilineal society (Bromley, 2012). The impact of these gender norms can be seen in countries like Samoa and Jamaica, where girls perform better than boys. This fact counters the general global belief that boys do better than girls. It is important to note that cultural factors continue to play a big role in promoting gender inequality in schools. In many societies, girls are expected to be married early in life; for example, statistics from the ministry of education indicated that 28,600 girls left school between 2004 and 2008 due to pregnancy.
Where cultural beliefs are prevalent, parents concentrate more on the abilities of boys and neglect girls due to stereotyping; the result of this action is a scenario where girls end up unnoticed or given little or no opportunity to grow. Moreover, lack of parental support will lead to low self-esteem, a situation that has forced many girls to drop out of schools or end up taking careers that are easy (Yelland, 1998).
Gender inequality is also fostered by school practices and educational systems. The quality of education delivered by a teacher will greatly be influenced by the skills and attention a teacher pays to each gender, as this improves participation and learning. This is true when girls receive more attention than boys in patriarchal societies, and boys receive more recognition in matrilineal societies than girls do. Teachers who have not had gender-sensitive training will normally tend to perceive girls as less intelligent than boys, thereby taking no extra efforts when they fail. Enrolment of girls to schools is also low due to the perception that girls are weaker than boys; they show low participation in class and extra-curricular activities as a result school heads being not eager to enrol them.
Female and male role models are also important in ensuring that students enrol and complete their studies. Girls look up to female teachers as their role models; this encourages better performances and completion of their studies. In the case of boys, male teachers serve as role models. A school environment can also cause gender inequality; for example, in an insecure environment prone to drug trafficking and rape, girls will tend to stay away from when compared to their male counterparts. The sanitation of the school will also have a direct influence on gender equality.
Gender-responsive pedagogies encompass both political and cultural dimensions. It is the teaching and learning process that emphasis on certain specific learning needs of boys and girls. There are various methods of addressing school and educational system obstacles such as providing training on gender-friendly teaching methods and also providing the necessary materials needed to increase girls performance in school (Gabel, 2002). The girl child has more needs than a boy child; hence, she requires more support in terms of resource provision. There are various methods employed to reduce gender disparities that occur in schools and institutions and ensure that both boys and girls are treated equally.
The first method is Support of Government Professional Development initiative that improves teacher skills, behaviour and attitude as well as provides training programmes on gender perspective and gender-related issues in teaching supervisors, school teachers and students (Skalli, 2006). Most programmes are normally funded by the government and serve to improve the entire school body through the teaching of necessary skills to address the issue of gender inequality. In the long run, these programmes usually curb the aspects of gender inequality in schools.
Another intervention involves strengthening of both boys and girls club at school to increase their knowledge on sexuality, gender, HIV and AIDS as well career development skills; this would help them avoid negative influences that may ruin their lives. When these issues are addressed at an early age, children mature in a conducive environment where there is success in the fight against such negative attitudes and culture. Boys and girls should also be provided with small grants so that they may be able to improve their school facilities such as toilets. This ensures the fair distribution of resources to both genders, hence helping in curbing issues of gender inequality and exploitation of pupils by teachers (Connell, 2011).
The third intervention involves providing training to regional and district gender officers in a bid to enhance support to headteachers, trainees and supervisors in schools when they send feedback to the national level on various issues that need to be addressed by the government. Gender officers are provided with all necessary equipments by the government to educate and create awareness concerning the effects of gender inequality, including the means of resolving them. Later, they send the reports to the National Government with recommendations on how to eradicate the issue of gender inequality.
Fourth, it is important to support gender mainstreaming in textbooks and curricula systems. This method ensures that gender issues are addressed effectively across various regions of the world where people are literate and can be able to get access to them. Generally, books and curricula systems of all grades should deeply emphasize the effects of gender inequality and provide suitable ways to address them in schools.
Moreover, there is a need for increasing the number of female teachers who are well trained to provide quality education at all levels of education, especially where men have dominated for a long time. This will enrich their school experience in various ways, such as support in teacher training and fairness in the recruitment process at the national level.
Parents and guardians should be convinced on the value of education on girls in school through invitation of female role models who have attained high status in the society to speak regularly on the issue of educating the girl child. This will inspire girls to work hard towards success and help them grow confidence in their abilities towards achieving their education goal. It will also bring the girl child to almost the same level as the boy child, who the society perceives as more privileged in terms of education and needs.
Donors should support the governments projects on gender inequality by increasing training for teachers as well as recruiting female teachers in areas where they are scarce. They should also provide funds to support girls on their basic requirements as well as the development of school infrastructure. This has been a success, especially in geographical areas that lack access to government supplies, hence relying on donors to solve the majority of their problems.
One important intervention that should be promoted involves supporting the process of national policy formulation and implementation frameworks to be more gender-sensitive (Apple, 2004). Boys and girls should be given equal opportunities in schools and places of work, so as to teach both genders in the society on the importance of coexisting without discrimination. With majority leaders of the world being male, the process of implementation may take a few years to be realized, since they perceive that men ought to be given more slots in the society. This has gradually slowed down the implementation process over the past decades but is now coming to effect due to new reforms made by the governments.
Zero tolerance campaigns on violence towards boys or girls should be developed. Government and civil societies should come together and campaign against gender violence and make sure that the perpetrators are brought to justice. In addition, civil society groups should come up with mechanisms such as child protection committees in order to address school-based violence and child abuse. The government, in its position under the law, has the ability to pursue supporters of gender-based violence in communities and impose legal charges against them. These campaigns will help in transforming society and making sure everyone is being treated equally without any kind of discrimination (Leonardo, 2010).
Community-based organisations should help schools in planning and implementing their own solutions that address challenges to gender equality in education (Apple, 2014). These organisations should work hand in hand with teachers to come up with the best strategies to help minimize the issues of gender inequality in schools and implement them to become part of school policies. Other than engaging in schools practices, they should also provide necessary resources in terms of equipment or funds that would see faster implementations of programmes to curb gender inequality.
Financial support should be increased, especially for girls from poor families to enable them to attend schools without having the challenge of dropping out due to lack of fees. This has been a major challenge for girls from rural areas where families cannot be able to sustain themselves and boys are given preference in matters relating to education and knowledge. The government should, therefore provide scholarships and other sponsor programmes to help improve the living standards of societies by educating their children. Apart from the government, donors and well-wishers should come forward to assist boys and girls from needy regions of society.
Finally, the communities should be educated about the effects of negative cultural practices that harm girls; in some cases, they should be banned from engaging in such cultural practices regardless of whether they are part of their cultural beliefs or not.
References
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Apple, M.W. (2004). Ideology and curriculum. NY, USA: Routledge Farmer.
Blaise, M. (2012). Playing It Straight: Uncovering Gender Discourse in the Early Childhood Classroom. London, England: Routledge.
Bromley, V. (2012). Feminisms Matter: Debates, Theories, Activism. Toronto, Canada: University of Toronto Press.
Connell, R. (2011). Confronting equality: Gender, knowledge and global change. Sydney, Australia: Allen & Unwin.
Davies, B. & Banks, C. (1995). The gender trap. In J. Holland, M. Blair, & S. Sheldon, Debates and Issues in Feminist Research and Pedagogy: a Reader. PA, USA: The Open University.
Gabel, S. (2002). Some Conceptual Problems with Critical Pedagogy. Curriculum Inquiry, 32 (2), 177-201.
Koch, J., & Irby, B. (2005). Gender and Schooling in the Early Years. Charlotte, NC, USA: IAP.
Leonardo, Z. (2010). Handbook of Cultural Politics and Education. Rotterdam, The Netherlands: Sense Publishers.
Skalli, L. (2006). Through A Local Prism: Gender, Globalization, and Identity in Moroccan Womens Magazines. Plymouth, England: Lexington Books.
Yelland, N. (2002). Gender in early childhood. London, England: Routledge.
