Medicine is a significant and integral part of my personal and professional life. I always strive to learn something new, be involved in all processes, and develop. I have been trying and still try to participate in all kinds of practices to gain experience, and there have been many complicated and unexpected cases in my practice. However, I believe that each of them granted me valuable experience to be applied in further practice, so I do not consider these events as negatively affecting my disposition towards medicine.
Personal Case Study
I was doing an internship in a hospital and faced a completely unexpected discovery in medical practice. At that time, we had a large queue of patients waiting for an appointment with a doctor because of the flood accident. During this incident, I conducted initial examinations and identified the priority of visiting based on the received information. However, after some time, the queue ceased to represent a specific order due to the considerable congestion of people. At that moment, I clearly defined my task, that those who are in poorer health should go to the doctor first. However, my supervisor presented a different solution which was mandatory for me to use.
Cultural Differences
The supervisor decided to start by nationality, serving dark-skinned people at the end as they will have fewer claims. He supported his reasoning by stating that if we do not accept light-skinned people promptly, they can leave complaints, be dissatisfied with the service, or cause scandals. Sim et al. (2021) provide arguments such as a lack of empathy for patients with different skin colors from the medical staff due to the cultural difference, which leads to inadequate attitudes. Therefore, the attitudes vary depending on the cultural factors.
Challenges of the Case
At that moment, being under the guidance of an experienced supervisor, I decided not to argue and followed his instructions. In some ways, he was right, and dark-skinned people showed fewer signs of dissatisfaction with the service. However, it was an absolutely unethical and incorrect decision since we returned to social inequality. At that moment, I only performed actions I did not agree with but carried out due to my inexperience and immaturity. Additionally, it was difficult for me to find concrete arguments for my position. However, I believe that no personal, national, or religious matters should influence equal attention and care for anyone. Therefore, if I could return to this scenario, I would not comply with these requirements and oppose my supervisor, claiming that it is unethical and inconsiderate to determine the need for medical assistance by personal attributes.
Social Inequality
Social inequality seems to have existed long ago, but if such decisions were repeated by different people on an ongoing basis, we would again return to full-fledged social inequality, when people are treated differently depending on their nationality, skin color, and other criteria on which people have no direct influence. Further, I began to study in detail the materials on the topic of inequality in society and in medicine.
As Yearby (2021) says, in the 21st century, in many medical institutions, as well as in scientific materials, it is confirmed that the races of people still influence how they are treated, including medical care. Williams and Ovbiagele (2020), in turn, confirmed my conjecture that such cases of unequal treatment require an integrated approach, starting with educating people about the historical and contemporary importance of equality. This research helped me form a strong personal position and argumentation regarding this issue, which I will apply in practice if I meet such a case again.
Conclusion
In conclusion, the topic of equity should be discussed during training and shared with all future healthcare professionals. If this topic is not brought up for awareness, anyone can get into the same situation without understanding the importance of their own actions or the possibility of arguing a position. Such actions should be unacceptable in the 21st century, and all people should be treated equally.
Affordable Care Act is one source that provides healthcare organizations with primary help related to existing patients. However, many companies did not test the concept, and the efficiency is not approved. Nevertheless, the Centre for Medicare and Medicaid Innovation faces and mentions all challenges provided by the Act and increases the awareness of the technique (Peikes et al., 2020). The main mission of the Affordable Care Act is to provide healthcare equity and make medicine affordable for everyone (Gaffney & McCormick, 2017). Peikes et al. (2020) showed the implementation results, and they stated that there was a significant breakthrough in helping related to people of different cultural backgrounds and races. However, the reduction in costs was inefficient as more resources were required, and there was not enough funding to cover all costs. Consequently, the impact of the Act is positive as more people receive primary help even though the cost reduction process was not significant.
The implementation of the Hospital Readmissions Reduction Program is one of the massive influencers on the medical industry as it aims to increase the efficiency of healthcare. The concept includes penalties that might be related to those workers who do not provide their patients with the needed treatment or exceed authorities (Julnes & Choi, 2020). Even though disadvantaged populations have received high-quality medical service, there was no significant difference in deaths because of the Hospital Readmissions Reduction Program. Discriminated people by race or sex do not attend specialists often, and even if they control their chronic health issues, 30-day and one-year mortality possibility exist (Julnes & Choi, 2020). The introduction of the program became beneficial for people with high social status as they have a chance to pay an extra charge for the healthcare service. However, the disadvantaged population cannot receive repeated surgeries or consultations due to the cost reduction program as a part of the CMS. The Hospital Readmissions Reduction Program has both positive and negative sides, and to ensure the concept’s success, industry specialists should make sacrifices.
The programs help nurses return to their favorite working responsibilities quicker as they receive an increased salary and pay their educational loans sufficiently. Nurse practitioners become more motivated, and their general performance increases (HHS Action Plan to Reduce Racial and Ethnic Health Disparities, n.d.). The response time is crucial in the nurse practice as many illnesses can be successfully treated in the early stages without returning patients to the hospitals (Mileski et al., 2020). Moreover, specialists in this industry provide patients with psychological support that should not be underestimated to ensure that the level of paranoia is not significant. Experts define the main sources of hospitalization and what groups of people are at higher risk. This strategy helps understand what aspects require more effort and what solutions can be adjusted. According to Mileski et al. (2020), nursing home residents are more subjected to hospitalizations, and it is important to provide them with medical assistance to ensure no relapse.
Every person should be eligible to receive medical help when needed, and workers in this industry should consider civil rights before building specific relationships with their current patients. Many healthcare companies follow the rules provided by one of the massive organizations called the World Health Organization. WHO aims to decrease the discrimination rate and ensure that everyone in the world is treated equally. The corporation’s Constitution states that attainable health is a fundamental right of every person. Moreover, WHO (2017) explains that the right of civilians is to receive all resources needed for positive life conditions. For instance, safety, drinking water, food, shelter, education, and equality in different areas like race or gender. Healthcare is a priority in this list of needs, and every person can defend their rights if they do not receive a high-quality service. In many countries, this regulation provided by the WHO is included in the domestic laws and constitutions, and governmental authorities make a lot of investments to control this industry and maintain a general level of healthcare.
The article provides clear information regarding the healthcare industry and what new interventions are being made to increase performance in many developed and developing countries in the world. I agree with the information provided in the paper as the world is changing, but some people continue discriminating against others, and insignificant changes are made. It is true that every person understands their rights and can defend themselves in case of a discrimination act. Consequently, the help of different social programs is crucial as they state clear rules for society and can change routines. I also agree that workers who do not want to provide the disadvantaged population with efficient services should be fined for abusing the company’s standards and governmental policies. I share the idea that people’s rights are the most important aspect of the provision of medical help. WHO is a common example of the defender of civil privileges that makes other people more aware of their responsibilities.
I chose the above picture, found on the Internet, as it depicts the realities of the inequities in healthcare, amongst other areas of life. In the picture, various vulnerable groups are represented, such as those with disabilities. Furthermore, it draws attention to the unfair differences in treatment by professionals that one’s race, ethnicity, gender, socio-economic status, sexual orientation, and place of living might cause. In order to convey this message, the image shows the different people at different heights, using the pedestals as a metaphor for different advantage points. In this example, the vulnerability causes inequity in treatment and healthcare.
Health inequities must not be confused with inequalities, since the former are concerned not simply with offering the same opportunities and treatment to everyone but taking into consideration the background of the individuals. According to Sossauer et al. (2019), vulnerability is defined as “the likelihood of having one’s interests unjustly considered,” which leads to inequity. This phenomenon is dangerous as it can lead to a decrease in the level of healthcare services. There are various causes for the inequities but vulnerability, as illustrated by the picture, is a major reason.
The picture is very accessible and has a great reach to the masses. Since it is a simple cartoon, it is easy to understand, and invites further conversation and research of the topic. Therefore, it is incredibly useful in raising awareness for the issue of inequity in healthcare. While it is not a problem that can be easily fixed, raising awareness and introducing the issue to people. One of the most important parts of solving the problem is identifying it and making sure that it is prevented at the core. In the case of vulnerability and inequity, this means knowing which groups are at risk of being mistreated, so that they can be protected.
The problem of equity in health care is always urgent in the context of an ever-expanding cultural diversity, taking into account the process of globalization and international communication only superficially. Progress and technologization were supposed to equalize the world, improving it to an impeccable degree. But in the end, technologies and their development spectrum rather only alienated people from each other. One might even get the impression that the global model of world perception, which has been so popular over the past few decades, has been exhausted. The world situation is such that large states are increasingly moving away from close cooperation with each other throughout the 21st century, and the autonomy of major powers that are not in mutually beneficial communication is only growing. Consequently, these countries, which are engaged in competition in the sphere of economic and political influence, have less time and resources to solve the problems of the third world countries.
Against the background of economic rivalry, the life of an individual person gradually ceased to be perceived as a primary value. Thus, many third world countries may still receive less humanitarian aid. It should be noted that this problem often applies to marginalized segments of the population in the countries of the first world. The current tragic situation has a chance to be revised in the context of a global pandemic.
As a result of the shock experienced by the entire world community, it becomes obvious that nations are not able to completely separate and live autonomously and independently from each other. Many countries that are not economic giants have found themselves in situations of real economic pressure. It is clear that developing countries still face extreme challenges in the areas of health and social services. Scientists emphasize that the outlined widespread crisis economic processes and the following social inequality are only at risk of increasing. At the same time, in those countries where such social problems were previously unclear, the crisis situation inflicted an unexpected double blow on state and medical infrastructures. At the same time, it is not difficult to assume that the pandemic problem only aggravates the situation with massively widespread diseases already existing in many countries, while health systems are losing control over them.
The official position of the international powers in relation to the current global crisis was the declared tactics of solidarity. This term requires consideration in ethical criteria and in terms of its real relation to the provision of assistance internationally. The chosen policy is the principle of rational medical justice, that is, limited due to economic considerations. Theorists believe that strategies for achieving full balance are impossible, while the lack of global equality in receiving medical care is demonstrated by statistics. Looking at the big data, it should be mentioned that of the three hundred vaccine test launches, most are in the United States and China, while the smallest are in Africa (Johnson, 2020). Based on these measurements, it is clear that the principle of relative solidarity only emphasizes the existence of inequality on the global scale.
Moreover, speaking of large international organizations for the protection of health in recent years, only one of them has only one African country, South Africa (Johnson, 2020). This only emphasizes a problem of actual inequity in global healthcare system and calls for an immediate response. Global support during a pandemic is still not reaching those in need on a continent-wide scale. At the same time, the principle of rational solidarity at the moment practically excludes these countries from the dialogue on the international support system. The system of solidarity is thus demonstrated as extremely relative and proceeding primarily from the urgent needs of influential countries.
It follows from the article that European states are striving to unite in international organizations for the protection of health care, which cumulate the forces of doctors and the whole society in the fight against the pandemic. Also in 2020, several transnational funds were organized, the money received from which will go to help weaker health systems. This money is spent on training and improving the skills of doctors, as well as organizing communities that can counteract disease in any way possible. It is logical to assume that for the most part such measures are required if the health care system of a particular state is not able to ensure proper control over the disease. Thus, through such funds, the problem of inequality in health care around the world can be really addressed.
Countries can also team up with large companies and international organizations for a collaborative strategy to provide equal levels of assistance to all countries or sectors of society in need. The largest of these, the General Health Security Agenda, includes a community from 31 countries (Johnson, 2020). At the same time, they are in collaboration with large companies, thus complementing and enhancing financial mutual influence. Based on this, we can conclude that financial support and the concentration of such a large amount of energy may be enough to develop solutions that can truly help the maximum number of people. That being said, it is interesting to note the ethical delivery of the claims of such global organizations to provide assistance. The UNICEF statement calls on this support not to be seen as help, but as a true collaboration for the overall health of the world’s population (Johnson, 2020). It can be concluded that this statement implies that countries with fewer resources should, however, strive to adopt the proposed innovations as much as possible and cooperate in their implementation.
Speaking about assistance to states in crisis, it is important not only to distribute medical supplies and humanitarian aid, which is absolutely necessary. An extremely effective element in the fight against the epidemic is also awareness of it, the ability to maximally protect oneself and the loved ones. To truly move closer to overcoming today’s health problems requires a global network of scientists, legislators, governments.
It is true that the funding provided by transnational organizations and individual states is valuable at the moment. However, based on all of the above, one can conclude that states still need to reconsider many political priorities in order to unite in a more effective consolidation. Only in this way will the system of global connections really live up to its name, creating a situation in which the best minds in the world will not compete in creating a vaccine, but will cooperate with each other in its development. Thus, tackling the global inequality in health care delivery requires a concerted effort and scaling up of support, although at this time this seems to be disadvantageous or impossible.
Work Cited
Johnson, Stephanie B. (2020). Advancing global health equity in the COVID-19 response: Beyond solidarity. Journal of Bioethical Inquiry, vol. 17, no. 4, pp. 703-707. doi: 10.1007/s11673-020-10008-9
Social determinants of health (SDH) are specific conditions of people’s lives, which determine their health and well-being in general (Frank et al., 2020; Lucyk & McLaren, 2017). Examples are education level, socioeconomic status, common problems such as obesity, mental health issues, and environmental settings. Urban health and health equity are other factors, important for modern world. The problem of inequity is widespread; to solve it, progressive health policies are necessary, especially at the local levels. As city population rise everywhere in the world, urban health measures are essential to provide well-being: examples of them are city parks establishment, pollution reducing and providing accessible medicine and education (Astell-Burt & Feng, 2019; Lowe et al., 2020; Paul Rosenberg (Health officer) et al., 2016). City councils create organizations, such as the Alliance for healthy cities, to ensure the usage of progressive health policies (Acuto et al., 2016; Leeuw & Simos, 2018; Lowe et al., 2020).
Literature Search Strategy
Most of the literature was found in PubMed: a good and extensive database of articles related to health, medicine, and biology. Other parts of the literature are reviews, releases, and articles from the World Health Organization website. The one source is used from the Gold Coast City website as an example of an urban health measure (Gold Coast City Council, 2021). The search was conducted based on keywords, such as “urban health,” “health equity,” and “social determinants of health.”
Criteria for the literature search were as follow:
Articles should describe either social determinants of health in general or be focused on one of them, such as health equity, urban health, or environmental settings.
Articles can be either a global review and study of social determinants of health and their policies or be focused on implementing health policies in some particular territory.
WHO resources show current health inequity and urban health issues and the policies intended to solve those issues.
Health equity and urban health are the main topics of the current review; thus, articles focused on them are the priority.
Articles that describe the Australian health policies and SDH are the priority. Those describing other countries, such as Norway and the United States, are also eligible to show the trends
What is Meant by Urban Health, Health Equity, and Social Determinants of Health
Definitions
Social determinants of health (SDH) are the factors that show the current state of health and well-being of the population. They are developing as more factors are researched and determined; some examples are health literacy level, environmental settings, access to the healthcare for the population (Frank et al., 2020; Lawless et al., 2016; Lucyk & McLaren, 2017). They can be presented both as the models and the influential factors, and those concepts, overlapping, can create confusion (Lucyk & McLaren, 2017). Still, it is a valuable instrument to evaluate the population’s health and develop approaches to improve it.
Health equity is the absence of unfair and avoidable differences among people that prevents them from the access to the health services, to fully realize their well-being potential (Health Equity — Global, 2021). Those differences are present worldwide, which creates a huge concern (Urban Health: Major Opportunities for Improving Global Health Outcomes, despite Persistent Health Inequities, 2016; WHO, 2021). For example, in the United States, where 12.1% of the population has diabetes, mortality rates are higher among the people with a low income and significantly higher among the Native American population (Haire-Joshu & Hill-Briggs, 2019; Shah et al., 2015). Similarly, in Australia, Aboriginal populations are more vulnerable to health issues (Backholer et al., 2021; Pearson et al., 2020). In that way, ensuring equity is crucial for public health.
Urban health includes a set of measures used to provide a healthy life in the cities. In Australia, there is evidence that people exposed to the green canopy are less likely to feel distressed, anxiety and other mental issues (Astell-Burt & Feng, 2019). Governments also create policies to promote physical activities, a lack of which is typical for city populations and worsens their health. (Candio et al., 2021; Durham et al., 2019; Leeuw & Simos, 2018; Paul Rosenberg (Health officer) et al., 2016). According to the article, it also improves health equity, as all population obtains access to sports grounds.
Environmental and social issues are closely connected with urban health issues. For example, there is evidence that Australian supermarkets promote unhealthy food (Grigsby-Duffy et al., 2020). Alcohol consumption is widespread and dangerous: 13.5 % of all deaths in 20-39 are connected with alcohol consumption (WHO, 2018). In that way, governments can increase public health by establishing and promoting healthy diets, similar to promoting physical activity (Barbour et al., 2021). Air pollution is another issue: worldwide, approximately 7 million deaths in the year are connected to pollution (Health Benefits Far Outweigh the Costs of Meeting Climate Change Goals, 2018). Health equities is a challenge for cities: according to the analysis of city households in 97 countries, the wealthiest 20% have access to clean water 2.7 times more likely than the poorest 20% (Urban Health: Major Opportunities for Improving Global Health Outcomes, despite Persistent Health Inequities, 2016).
Measurements and Policies
To measure health equity, researchers should first define the inequity and search for its examples. Health Inequalities Assessment Toolkit (HIAT) uses interviews, focus groups, and workshops to gather information and evaluate the level of inequity in different societies (Porroche-Escudero & Popay, 2019). To create a model, researchers can use the health equity measurement framework: it includes the social, economic, and cultural context of the population, social stratification, environmental settings, and general healthcare quality (Dover & Belon, 2019). The Urban Health Index can be used for urban health, as recommended by the WHO: it uses the parameters of health indicators, health determinants, area boundaries, and demographic base (Leeuw & Simos, 2018; Weaver et al., 2014). Those measures are used to evaluate the situation with healthcare in the population and see how to improve it.
Policies directed on improving health equity are different and treat the problem from different sides. One of them is providing and maintaining social equity: gender, racial, national (Centers of Disease Control, 2017; WHO, 2021; Woodruff, 2021). It ensures that all classes of the population will have access to education and health services and will be able to maintain their health. In Australia, research policy advisory groups (PAGs) conduct research and stimulate the population’s knowledge flow, improving its health literacy (van Eyk et al., 2020). Health literacy is essential, as the population with high literacy care more about themselves and are more critical to health issues (Nutbeam & Lloyd, 2021). To solve health inequalities, researchers produced a plan to eliminate them by the 2030 year (Backholer et al., 2021). The methods are implementing the policies that promote collaboration, address social inequalities between white and Aboriginal populations, and use technologies to solve environmental problems and digitalize the public health field.
The Alliance for Healthy Cities
The Alliance for healthy cities was formed to address urban health issues and develop and implement policies that can efficiently solve them. Gold Coast City is a member of the Alliance: its website shows healthcare and environmental policies, such as regular water monitoring (Alliance for healthy cities; Gold Coast City Council, 2021). City networking is the process of communication between city governments, both on national and international levels, and the Alliance is an example of such city networks (Acuto & Morissette, 2016). Its full members can be city governments and governing units such as municipality organizations. Individuals and other organizations can be admitted as associate members.
The Healthy Cities programme is developed with the WHO and aims to increase the networking between cities, improving its quality (A. Lee & Nakamura, 2021; Leeuw & Simos, 2018). According to the research, there is a problem with the low quality of the networking: city governments talk about the opportunities but not about specific strategies (Acuto & Morissette, 2016). This programme tends to solve that problem and ensure high-level communication about urban health issues. The Alliance for healthy cities developed the SPIRIT framework, ensuring the holistic approach to urban health (A. Lee & Nakamura, 2021). SPIRIT stands for Setting and Sustainability, Political commitment and Policy, Information and Innovation, Research and Resources, Infrastructure and Intersectoral, and Training. The framework aims to evaluate and address all social determinants of health connected with city populations: environmental, social, cultural issues, inequalities, behaviour typical for the particular city (A. Lee & Nakamura, 2021; Redman et al., 2015). Then, the Alliance engages key stakeholders from the healthcare industry to launch various health-improving programs to solve identified issues (Acuto & Morissette, 2016; Alliance for healthy cities; Leeuw & Simos, 2018). In that way, the Alliance helps to improve the urban health of its city members.
Diplomacy between cities is an important element of urban health: they can share their best policies and the experience of their implementation, which will improve the public health in all cities engaged (Acuto et al., 2016; WHO Team: Air quality and health, 2021). According to research, Australia lacks policies to establish a healthy city environment, despite the general aspiration to liveability (Lowe et al., 2020). The country solves those issues at the local level: for example, in the state of Victoria, the implementation of initiatives such as public gardens, community kitchens, and bicycle recycling helped reduce health inequity (Kay & Livingstone, 2020). Those initiatives positively impact the public health level in the state and promote health equity.
Barriers and Obstacles to Health Equity
COVID-19 pandemic exposed a lot of the existing problems in the public health area. According to the research conducted in Hong Kong, more than 60% of people experience high stress during the quarantine lockdown (A. Lee & Nakamura, 2021). The pandemic clearly showed that poor people are more vulnerable to illness and other diseases (Deslatte et al., 2020). The WHO has created and promoted a strategy to implement health equity worldwide (WHO, 2021). Solving the inequity problems is one of the most critical challenges for the modern world, but there are many barriers to doing this.
The main obstacle to health equity is that poor populations with insufficient resources usually cannot create better conditions for themselves. They are usually heavily exposed to the air and other pollutions and often work in an unhealthy environment (WHO Team: Air quality and health, 2021). This further worsens their state and leads to diseases, which crop the opportunities for them. Non-communicable diseases, which are especially typical for the cities, are results of the wrong environmental influences, such as pollution and stress; approximately 68% of deaths worldwide are connected with them (Paul Rosenberg (Health officer) et al., 2016). Examples of such diseases are cancer, diabetes, and mental illnesses. Personalization of the medicine, while promoting a better service and the usage of technologies, deepens the health inequalities if no policies are implemented to prevent it (Malbon et al., 2019). In that way, a lack of social mobility worsens the health of the population.
Lack of communication and health literacy is another barrier to health equality: those who do not know how to access healthcare and care for themselves are more likely to face health issues. In Australia, there is a lack of communication between local governments and public health organizations, negatively impacting the decision-making connected with health issues (Javanparast et al., 2018). There is an initiative to provide multisectoral policy implementation, reduce that lack of communication, and provide better decision-making (Baum et al., 2017). In general, improving health literacy among the population improves their health (Nutbeam & Lloyd, 2021). Another example is the position of the public health coordinator in Norway: it is a person who manages the distribution of public health facilities in a city or other community (Hagen et al., 2019). Such a policy positively influences the decision-making at the local government level. In that way, to ensure health equality, local governments should implement policies that improve public health literacy and initiate communications between different organizations and communities.
Conclusion and Gaps in the Research
There are many social determinants of health, and not all of them are presented equally in the researches. There are many studies and WHO reports connected with health equity problems, but they are mostly connected with Western countries, such as Europe, the U.S., and Australia, or with general health inequity issues in the world (Baum et al., 2018; Farrer et al., 2015; Haire-Joshu & Hill-Briggs, 2019; Hall et al., 2016; Harris et al., 2020; Malbon et al., 2019; Woodruff, 2021). Researches which studies health equity in the context of the COVID-19 pandemic are popular in modern days, despite only one of them being mentioned in this research (Deslatte et al., 2020). Urban health themes are popular and well-presented in the literature, from the WHO books and reports to research articles in different countries (Astell-Burt & Feng, 2019; Leeuw & Simos, 2018; Paul Rosenberg (Health officer) et al., 2016; WHO Team: Air quality and health, 2021). Environmental issues and social issues, which are also deeply connected with health issues, are well-presented and studied, as they are critical and well-recognized modern problems (Barbour et al., 2021; Baum et al., 2018; Grigsby-Duffy et al., 2020; Kay & Livingstone, 2020; Nutbeam & Lloyd, 2021; Health Benefits Far Outweigh the Costs of Meeting Climate Change Goals, 2018).
The literature which considers the Alliance for healthy cities is scarce: there are only indirect mentions of the Alliance in most of the literature. It is mostly mentioned as an example of a successful city network organization (Acuto et al., 2016). The SPIRIT framework, designed by the Alliance and used for improving urban health, is described in several articles, but similar approaches are underrepresented in the literature (A. Lee & Nakamura, 2021; Redman et al., 2015). There are much more literature examples considering the Healthy Cities approach in general, and present the Alliance as the part of successful implementation of this approach (Acuto et al., 2016; Leeuw & Simos, 2018; Paul Rosenberg (Health officer) et al., 2016).
The health studies in Australia can be considered as well-developed: there are many articles where the situation with urban health and health equity in Australian cities and states is studied (Astell-Burt & Feng, 2019; Baum et al., 2018; Delany-Crowe et al., 2019; Grigsby-Duffy et al., 2020). The Gold Coast City is not well-represented in studies, despite there being studies of the healthcare situation in the state of Queensland in general (Durham et al., 2019). For other countries, there are many articles exploring the Norwegian and Swedish situation with health equity and the initiatives and policies connected with it (Hagen et al., 2019; Hagen et al., 2016; van Vliet, 2018). There is much literature studying the health equality issues in the United States (Deslatte et al., 2020; Shah et al., 2015; Haire-Joshu & Hill-Briggs, 2019).
Health equity and urban health have big importance due to the rapid growth of city populations and the necessity to provide their healthcare. There is a need for policies to ensure high security, a clean environment, and a good healthcare level with equal access in cities. Successful experiences, such as public initiatives in Victoria state or health coordinators in Norway, should be used. City networks, such as the Alliance for Healthy Cities, help share the best policies and improve health in their populations. Communication between researchers measuring health inequity, local governments, and communities is crucial for improving health literacy and equity.
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Sepúlveda-Loyola et al. (2020) examine the effects of social exclusion on the psychological and physical well-being of the elderly throughout the COVID-19 epidemic and provide suggestions to patients and care providers. Sadarangani et al. (2022) outline the COVID-19 pandemic’s overwhelming but little-understood consequences on elderly people receiving care at Adult Day Services Centers (ADSCs).
Considering that older persons are at a greater risk for negative impacts of social isolation, like deteriorating physical problems, cognitive dysfunction, depressed mood, injuries, and growing fragility, this prolonged isolation is particularly troubling. Widespread epidemics of COVID-19 were recorded in care facilities across the globe, impacting not just the patients, but also the care personnel and guests. Because of their older age and the prevalence of underlying conditions, the residents at long-term care institutions constitute a disadvantaged population that might benefit from further anti-contamination efforts.
Several suggestions have been made to help manage disease transmission in long-term care centers based on analyses of past influenza outbreaks and their effects on nursing homes. Even if substantial measures have been taken to safeguard citizens, the responsiveness to this healthcare problem must be enhanced to prevent future loss of life. A lack of formal guidelines and rules in the event of natural catastrophes for senior shelters across the globe contributed to the tragic results within nursing care facilities. Adoption of a screening strategy for inhabitants, including continuous monitoring for signs and regular tests and screening of employees who provide care services for residents on a routine basis. Whenever a reported case of COVID-19 is found, urgent infection control and prevention actions must be taken (Sepúlveda-Loyola et al., 2020). Every nursing home must gather facility-based information, preferably using an integrated computerized system for monitoring and tracking the health condition of the residents and staff.
To prevent excursions to the food store or drugstore, the elderly may stock up on non-perishable foodstuffs, personal care items, and prescriptions that will last a long time. Elderly folks or those with underlying problems must be urged to minimize interaction with others, particularly avoiding grocery shops, communal spaces like the kitchen and shared restrooms in the home, and, if feasible, abstaining from sharing a bed with other family members. Even though these approaches minimize the spread of COVID-19 among older persons, they simultaneously increase loneliness and distress. Additionally, nursing facilities must be pushed to offer paid sick leave so that workers do not attend work when ill out of fear of being fired or wages (Sadarangani et al., 2022). Staff members who report to work when unwell represent a significant danger to elderly patients.
These research articles are relevant to the advocacy for equality in nursing homes, and the COVID-19 pandemic clearly indicates that this area requires improvement. As an economically and socially deprived population, elderly adults face more challenges to receiving health care services; inequities like poor income and absence of insurance are deciding forces in limiting the elderly’s health care utilization. U.S. older individuals who have encountered prejudice in a healthcare environment are more prone to have lower general health, endure economic challenges, and are unhappy with their treatment compared to people who are not subjected to inequality. Older adults with low socioeconomic levels are likely to be at risk of not obtaining health care and experiencing unfulfilled health requirements, particularly those residing in healthcare resource-limited situations. In addition to being exceedingly expensive, nursing homes frequently have a reputation for providing subpar services. Most nursing facilities deal with staffing shortages that might lead to patient maltreatment or neglect. Since residents generally have poor psychological or physical states, they cannot assist themselves when treated unfairly.
Evidence-based nursing practice is an emerging field that aims to improve the efficiency and quality of nurses’ work. Every year the number of responsibilities and the influence of nurses on healthcare change. In the work of each medical institution, such criteria as accountability, emotional stability of nurses and equal treatment of patients are important. Therefore, it is important for nurses to adhere to a fair attitude to all patients and try not to be at work in a state of emotional burnout.
It was found out from the National Academy of Medicine’s 2021 report that nurses work at the intersection of healthcare, education, and society. They are the first people with whom patients of different races, nationalities, and religions interact (Flaubert et al., 2021). Consequently, nurses play one of the main roles in achieving equality and fair treatment of all in health care. The report notes that the next decade will be important for nurses, as the main goal will be to create equal conditions for hospital patients.
Social determinants of health are the environmental conditions in which people are born, live, study, work and lead daily lives, which directly affects their health. These conditions are the cause of many property inequalities (Flaubert et al., 2021). The social determinants of health considered at the societal level include unequal living conditions in early childhood, different educational opportunities, social security and access to health care. One of the most important social determinants of health is financial well-being (Flaubert et al., 2021). The principle of justice in healthcare today is directly related to the human right to health protection within the framework of the social institute of healthcare. In order to ensure fair treatment in the field of health care in accordance with the determinant of health, it is necessary to inform patients about possible budgetary medical programs. The need to address issues related to the social determinants of health means that the activities of nurses should extend to areas such as finance, agriculture, education, transport, energy and housing.
The International Council of Nurses (ICM) considers the human right to equity in the availability of medical services as an integral part of nursing ethics. This is enshrined in the MSM Code of Ethics preamble, which states that nursing is characterized by respect for human rights, including the right to life, dignity, and respect (Flaubert et al., 2021). The availability of nursing care is not affected by the patient’s age, skin color, beliefs, culture, disability, or illness. Nurses must constantly improve their skills to ensure equitable access to medical services.
The cultural competence of employees is an important condition for ensuring fair access to services. It helps improve service quality by developing communication between medical professionals and patients (Flaubert et al., 2021). Nurses play an important role in developing strategies, actively participating in political activities, and conducting scientific research, especially in medical care (Oldland et al., 2020). The ability to adapt to a new situation is an important strategy for improving access to medical services. Increasing the function of nurses demonstrated the possibility of improving the quality of service and reducing organizational costs.
Introducing appropriate new personnel is an effective way to reduce costs without compromising the quality of service. It is important that managers, including nurse managers and employers, provide their employees with information about the possibility of training on issues related to the needs and preferences of the local population (Flaubert et al., 2021). The recruitment of employees from among persons belonging to national minorities and their support in the workplace affect the receipt by minority representatives of medical care of the same quality as the majority (De Groot et al., 2019). Nurses, with their experience of direct patient care, should ensure that patients have the most reliable information and that research protocols are designed in such a way as to ensure proper representation and participation in research of all population groups.
In current conditions, a person meets on his way with a sufficiently large number of stressful factors that undoubtedly affect his personality and professional activity. It is especially important to study the syndrome of emotional burnout in the professional activity of a nurse during the period of reforms that lead to the intensification of the professional activity of a specialist. To prevent the syndrome, it is advisable to conduct psychological training, which masters the exercises of auto-training – the main method of mental self-regulation. It is emphasized that the prevention of emotional burnout should be comprehensive, considering the individual personality characteristics of each health worker (Flaubert et al., 2021). The class of physical methods is often used because it is simple and accessible: exposure to the body through different temperatures and light therapy. To combat emotional burnout, pharmaceuticals, herbal remedies, and aromatherapy are used.
Thus, the National Academy of Medicine’s 2021 report made clear the key responsibilities of a nurse and the importance of this profession in ensuring equality in the field of health care. The criterion for evaluating the effectiveness of nursing care is the improvement of the patient’s health indicators and earlier rehabilitation, which is achieved through compliance with the standards of nursing practice. Nurses today should have deep theoretical knowledge about the application of innovative techniques and manipulations in accordance with the standards of medical practice. Nurses play an essential function in achieving health equity and defining strategies for the health sector’s impact on reducing inequities in this area. For effective work, nurses should monitor their emotional state and consult a doctor during emotional burnout.
Margaret Cahalan is a brilliant writer and researcher who focuses on the improvement of the quality of higher education and the necessity to increase its equity through effective leadership practices. Regarding my knowledge of and experience in educational leadership, I find many strategies introduced by Cahalan (2015) helpful as they are based on clear statistical data, as well as the personal and academic needs of students and teachers.
However, at this stage of learning, I want to underline the importance of an understanding of how to combine learning processes and work. Students have to be engaged in choosing their careers at the early stages of their education in college. As soon as they set their career and learning goals and are provided with certain guarantees, they will be eager to continue their education and be guided with a meaning.
Equity of participation in higher education can be valuable when students realize what they strive for. Still, it is not enough to have one or two goals and try to do everything possible to achieve positive results. I already observed several situations when students established goals and tried to do their best to have the highest grades and introduce the strongest projects. In the end, they were assessed, and a portion of gratitude was shown.
Unfortunately, it was the only result achieved. No job opportunities were offered. Therefore, to make sure that students want to stay in college and continue their education in universities, educational leaders have to think about the increased integration of work and learning. This method can inspire students, open new partnerships for leaders, and guide teachers concerning the skills and knowledge that may be crucial for their students.
Reference
Cahalan, M. (2015). Sixteen strategies for widening equity of participation in higher education in the United States: Reflections from international comparisons. In the Pell Institute for the Study of Opportunity in Higher Education (Ed.), Indicators of Higher Education Equity in the United States (pp. 43-52). Philadelphia, PA: The Pell Institute.
The educational sector of Canada expects “knowledge economy” to be fulfilled only with “post secondary education” for presently Canadian higher education is witnessing revolution (Davies & Hammack, 2005). The reason for a revolutionary post secondary education is none other than the realisation that Canada cannot rely upon its traditional activities for acquiring natural resources as natural resources are going through exploitation. Now, it has no other option than to look upon its educated younger generation for a prosperous economy. It is this generation that uphold the required ‘qualified workforce’ (Madore, 1992).
According to a World Bank report, more than half of the students enrolled in higher education worldwide belong to developing countries (World Bank, 2000). Research and assumption also reveals that among 65 million students who enrolled in colleges and universities in 1991 will grow to 97 million by 2015 (World Bank, 2000). With such an enormous educational market, it is little wonder that how come despite extending access and strengthening the quality of higher education as key national priorities of governments across much of the developing world, international students ratio is increasing gradually in developed countries. This intensified interest in higher education is driven by demographics, politics, economic challenges, the changing nature of the workplace, and national pride. Yet, at the same time, many governments are facing serious economic constraints and intensified competition for public funds from other sectors that are limiting their ability to respond solely by investing more money in campus construction, faculty salaries, and student stipends. Government and education leaders across much of the developing world are intensively engaged in a search for more creative and at the same time less expensive ways to extend and improve post secondary higher education (Chapman & Austin, 2002, p. 3). This is for two reasons: First, the Government supporting post secondary higher education in developing countries does not want their share of revenue to be acquired by the developed nations. Secondly, they are aware of the educational market potential. Therefore all they want is to provide the best while utilising the least resources.
Present Role of Higher Education Institutions in the Developing World
Higher education reform has always depended on the Governmental support for how much and to what extent improvement the Government takes in order to manage capacity within the institutions. This has led not only the citizens but also the institutions to think an array of partnering arrangements between institutions in different parts of the world. Though globalisation has revolutionised post-secondary education in different forms, either in the form of university linkage online projects or by conducting administrative training workshops and tutorials, but still there is a need for strengthening the management and instructional functions of the participating institutions of the developing world (Chapman & Claffey, 1998). These efforts where on one hand has tended to concentrate on helping colleges and universities develop stronger budgeting systems, enrolment management systems, student and facilities tracking systems, course credit policies, and procedures for systematic curriculum design, on the other hand it has made the Institutions to think in what ways they can manage to shape their external relationship with Government.
While many of these efforts have been successful and will continue to be needed in the developing countries, the main challenge of the next decade centres on how institutions define their relationship with Governments as well as with citizens. Unravelling factors that account for the apparently intractable problems in widening access to higher education among disadvantaged developing nations has preoccupied the national educational press in recent times. Many comments have pointed to the deterrent effects of the changes in funding support for students and the introduction of tuition fees. With more emphasis on ways and means of supporting higher education, low participation has been noticed in contributing towards those factors responsible for identifying the solution.
According to the National Audit Office (NAO) report (2002), higher education institutions do not make their conditions for funding and support strong. Instead they blame low entry rates from non-traditional groups on relatively poor examination performance at A level or equivalent among working class pupils. The NAO report (2002) has shown that a significant proportion of universities in England make discrimination on the basis of students from working class and disadvantaged backgrounds. The report also suggest that qualified working class applicants were 30 per cent less likely to be offered a place at some universities than their counterparts from higher socioeconomic groups. Correlation with social class is very rare and social class differences became apparent again at the end of higher education, in the form of disparities in the earning power of people with equivalent qualifications on entering the labour market. Graduates from social classes IV and V earned on average 7 per cent less than graduates from social class I (Hayton & Paczuska, 2002, p. 40).
The debate makes us to think that does post secondary education allows the students to contribute to the local and global market? as access to affordable higher education is not granted to every one.
Setting up a target area of 50 percent of young people participating in post-secondary education before the age of 30 is simply not enough. It requires a framework of policy which should primarily focus on four strands:
Initiatives to expand the overall supply of higher education places;
To provide adequate funds for updating higher education institutions so that non-traditional learners find it easier to participate;
Introducing all non-traditional learners with all initiatives to apply for higher education
This would encourage them to bring in a new two-year foundation degree.
The Challenges
Among the major challenges in areas of post-compulsory education, is the expansion of education centres and institutions. No doubt, the Government is committing itself primarily to a ‘supply-side’ strategy which is focusing broadly on the supply of provision to stimulate learner demand, but still the historical analysis of student participation reveals that trends in higher education sustain expansion when effective demand for learning has been generated (Hodgson and Spours, 2000). Up till now, the largest rise in higher educational participation is seen in UK in the late 1980s and early 1990s and that was due to large rises in post-16 participation and achievement. It was also due to the changes in occupational structure leading to increased demand for post graduate degrees (HEFCE, 2001).
In the present scenario, universities and institutions are experiencing a shortfall of demand for places. This make us think seriously about the future prospects of success for supply-side approaches. The reason for experiencing high ‘drop-out’ rates is largely due to the fact that universities expect from their students to attain high level grades as a pre requirement for entering the universities. As a result where the students with relatively low previous levels of attainment and from more diverse social groups should go? Such students from developing countries have no option left than to live at home or to get involve in the local labour market. In this case they would face a range of external pressures but without clear signals from employers that they value higher education qualifications (HEFCE, 2001).
In order to reach the target for achieving higher education expansion, Government has to rely both on stimulating participation and achievement in secondary phase of higher education. Increasing the demand among those in their early-20s in the workplace is another way to undertake a form of part-time higher education. By considering the above mentioned approaches, the Government will not only reach its target but would also encourage participants in higher education in all social compositions. Institutions have had to trim budgets, reduce program offerings, and hire additional staff to meet these increasing state-based accountability measures. The mixed funding past and uncertain futures which juxtapose to create increased accountability have caused many institutions to agree to and participate in ‘quid pro quo’ relationships with their state legislatures. Many institutions have agreed to ‘incentive’ funding programs if certain state goals are met. These quid pro quo relationships seem to be a way for developing states and institutions to keep the forces of tighter budgets and increased accountability from colliding. In many states, examples of more stringent accountability measures, such as increased efficiency and effectiveness and graduation policies reducing time to completion are now common reporting requirements in today’s higher-education environment (Losco, 2000, p. 110).
Equity
Improving post secondary educational outcomes uphold two approaches: equity and efficiency. Equity is all about the educational concern, whether the distribution of educational outcomes would be able to spread widely among the poor students with a low or middle class or it would end up with fewer qualifications resulting in lower incomes. Equity in terms of educational opportunities could be defined as ‘equality of opportunity’. Now, equality of opportunity does not simply mean that a lower class student has the opportunity to go to university; it does not even mean that anyone who wishes can go to university (Barr & Crawford, 2005, p. 212). It indicates that if two students have identical capabilities and educational ranking, they receive the same education irrespective of factors which are regarded as irrelevant such as parental income and financial status.
On the other hand ‘Allocative or external efficiency’ is concerned with producing the types of educational activities which equip individuals to survive better while earning a decent livelihood in terms of economical, social, political and cultural conditions of their countries or countries to which they belong. This efficiency at least possesses the advantage for those who are not financially stable and want to receive higher education.
Although progress has been made in terms of forming interdisciplinary units within universities and this has remained a feature of research universities in the 1980s and 1990s (Geiger, 1996) and the faster growing research universities conduct more research in centres and institutes than do the slower growing research universities (Stahler and Tash, 1994) but the concern is about the working or lower class. Federal agencies that fund research have contributed to this pattern: for example, in the 1980s, an increasingly large proportion of NSF funds went to teams and centers, and a declining proportion (though still the majority) went to individual investigators (Losco, 2000, p. 41).
England may appear to have been doing at least its share in enrolling minority students. With 1.8 percent of the nation’s blacks, New England has 2.5 percent of all black enrolments in higher education; and with 2 percent of the nation’s Hispanics, it has 2.5 percent of the nation’s postsecondary Hispanic enrolments. Furthermore, those percentages of minority enrolments have been increasing slightly but steadily since 1976, while national figures have recently begun to decline. New England also has mostly ‘non-resident aliens’, or foreign students but if one looks at the enrolment of minority students-blacks, for example in relation to total enrolments, the record is less impressive.
In 1984 in the nation as a whole, 11.7 percent of the total population but only 8.5 percent of college students were black. In New England 3.8 percent of residents were black, but only 3.2 percent of college enrolments were so reported. Among the New England states, Connecticut had the highest percentage (7 percent) of blacks in its total state population but only 4.4 percent in its colleges, a figure that nevertheless led those of the other New England states. Similarly, in America Massachusetts public colleges, by contrast, with 43.7 percent of the states total enrolments, have only 38.4 percent of the state’s black enrolments in higher education and only 40.2 percent of the Hispanic. (Cronin & Simmons, 1987, p. 80) This clearly indicates the contribution of foreign nationals in acquiring higher education.
Practical Solutions to the Educational Problems
Funding
Many nations are undergoing a dramatic transition in their higher education systems. Previously reliant almost entirely on their governments, colleges and universities in many countries now face declining government funding and are being encouraged to develop alternative sources of support. At the same time, strengthening higher education is viewed as a critical national strategy for growth in a global economy based on information technology. Educational fund raising is required by all the developing nations so that the programs and activities by which the college or university seeks grants from private sources support its programs and build long-term strength through improvements to its facilities and additions to its endowment (Worth, 2002, p. 6).
In general, fees for liberal arts schools and teachers colleges are low in public institutions, and clearly much below costs for divinity students in private ones. Charges for technological students are high, though far below costs in public institutions. Not only do students in other independent professional schools pay high fees in both public and private institutions, but the charge is two-thirds as high in public as in private institutions. For all fees public charges are but 30 per cent of those in private institutions. High fees in the other independent professional schools reflect not only an association of private gain for this kind of education but also the high costs involved in the instruction.
It is often assumed that the competition of the public institution is the dominant factor everywhere but in the Northeast, where public tuition is high. But actually the tuition differential between public and private institutions is higher in the Northeast than in the rest of the country. Students will often select higher-priced rather than lower-priced institutions because of product differentiation, an item not easy to define or measure. Obviously the main interest is in what the college contributes. Another factor that seems to influence tuition rates is the social product contributed. There is a tendency to charge less when social gains are highest, e.g., divinity and education, and more when the private gains are great, even though in some instances social gains are also relevant, e.g., medicine, engineering.
In short, there is a long tradition of low tuition rates, for many years strongly supported by private institutions but gradually being weakened by economic pressures. Public institutions with tax resources behind them are even more firmly attached to this low-tuition tradition. In an interesting analysis Riesman writes: “These public institutions help spread the ethos that even wealthy students need not pay the full cost of their education and that desirable students (not only athletes but sometimes debaters, scholars, and ‘all-around’ types) need not borrow more than the token amounts that present loan services can proffer” (Harris, 1962, p. 116).
It is likely that tuition will continue to rise both absolutely and in relation to the costs of higher education. The primary reason for this is the difficulty of increasing gifts, capital income, or tax receipts for higher education as rapidly as costs rise. Without additional state support, the university cannot provide our youth with an educational opportunity equal to that enjoyed by young people elsewhere in the nation, or cannot provide the research and services which we have come to expect. However, the charges by the university upon the student should be increased so as to share the added costs and that scholarships should also be increased, in numbers and perhaps in amounts, so that those students whose financial inability is clearly demonstrated can receive the help they deserve. Over the years private college administrators have supported higher tuition both on the ground that alternative resources for meeting rising costs and turning out a good product are not available and because (in the view of some) the public institutions are maintaining unfair competition.
Student Loans
Student indebtedness is one of today’s more complicated higher education problems. While everyone agrees that students and parents need access to the funds that loan programs provide, there is concern about the increasing debt burden on our nation’s youth. Between 25 and 50 percent of all postsecondary students seek loan assistance to finance college costs.
As with other complicated issues of our time, there are lingering misconceptions about student indebtedness. It is time to examine the myths about student loans in light of the realities of higher education finance. Citizens, educators, lenders all taxpayers need to place in perspective what is happening in the student loan programs. Students who drop out, who do not qualify for an average or above average salary, or who borrow and then work in low-paying jobs may have trouble–as may the person in debt who heads a family and supports many dependents. This segment may range from 5 to 10 percent of the borrowing students, but not as high as 25 percent of the 25 percent who do borrow. We should worry about this population, however, as we should about debt burdens for social workers, divinity students, public health workers, and teachers, most of whom may need either loan assistance, a longer repayment period, or most essential-more adequate pay.
Student Loan Counselling
An increasingly important area of focus for financial aid practitioners is effective student loan counselling. In its simplest terms, loan counselling is plain required disclosure making sure the prospective borrower knows that the loan has to be paid back and on what terms and conditions. Canadian Higher Education describes loan counselling as not a single event but rather the process of credit education. We conceive of it as taking place at multiple times during a student’s pre-borrowing, borrowing, and repayment life and as covering a broad range of steps (Cronin & Simmons, 1987, p. 50).
Task Force is a group of lenders, schools, community agencies, the high school, and the guarantee agency. Both lender representation and school representation are diverse. As a task force research suggest certain ethnic, income, or psychological characteristics as a means to identify a potential student loan defaulter, but we found little empirical evidence to support any such generalisations. We concluded that there is no definitive profile of a defaulter; instead, we found that the single most frequent feature of importance was borrower attitude. We have come to describe the successful loan re-payer as one who fully understands his/ her financial obligations and who is willing to accept whatever lifestyle restrictions the loan obligation may impose. The research suggested that borrowers using 10 percent or more of income to repay student loans experience an impact on other lifestyle choices. But most borrowers repay because they are committed to doing so.
Having reached the conclusion that willingness to repay is even more important than ability to repay; the Task Force asked the question, “How can we influence the willingness of borrowers to repay student loans?” Our response was to determine that credit education and loan counselling must take place at multiple times and with different emphases during a student borrower’s developmental life. The Task Force developed a comprehensive loan counselling model which involves the schools, the lenders, and the guarantor. Each of these groups has a share in the opportunity and obligation to counsel and is involved at different times.
Loans, of course, are only the best means to finance higher education. We want students to understand both the consequences of borrowing and the alternatives to borrowing. We want students who are already in higher education to make the most informed choice possible about how much to borrow, to understand the terms of each of their loans, and to be prepared for repayment. And we also want to be of service to those borrowers who have already left higher education and are bewildered by the loan repayment process. Our target groups, therefore, include: junior high and high school students, borrowers in school, borrowers in repayment, borrowers in default, and the general public.
A critical concept that we believe all loan counselling must include is how debt relates to future income and lifestyle choices. This element is crucial to all of the target groups. Students can be helped to understand that their education is a valuable investment and that obtaining an education is worthwhile, even though they may have to rearrange future priorities.
Besides the major target groups there are certain categories of borrowers, such as adult borrowers and students who have withdrawn from universities. Although the model is for the most part generic, we do not want to ignore groups with special needs. The message which underlies our program is that responsibility to avoid default rests with the borrower. But, all of our investigations support our understanding that students are usually inexperienced borrowers whose first form of credit is the student loan, and that we frequently make mistakes the first time we do something. The Task Force aims to help students become experienced re-payers. In addition, our intent is to help student loan providers and school administrators respond to the dilemmas of loan counselling.
The dilemmas that face adult and female borrowers are a special concern in loan counselling. These are difficult categories even to describe generally because there are so many different breeds. Some individuals are in post secondary schools or borrowing for graduate or professional school; some adults are resuming their education after being away from school, and some are starting higher education for the first time. Some adult borrowers are working full-time and going to school part-time. The capacity of the adult borrower to handle loan responsibility also depends on a number of other factors such as a person’s previous work experience and the level of income one can predict on the basis of that experience. Obviously, the more work experience a person has, the greater the income he or she will generate once working, unless a big career change is involved. The other financial responsibilities the adult borrower may have such as mortgages and car payments are factors. The career the person is planning to go into and the level of income to be expected in that career are important factors as well. And finally, prior experience with borrowing and the kind of confidence people have in their capacity to borrow to juggle priorities, to figure out how to manage money, to manage repayments must be considered.
One specific category of borrower is the adult female undergraduate borrower. First of all, whether married, divorced, or single, the majority of women in this category often have responsibilities for dependent children. The primary motivating factor for them to go to college or resume education is their desire to improve their job opportunities, make more money, and be better prepared to help support their families. In many instances these women are single parents; often, they are the sole support of their children or have limited child support to supplement what they can generate themselves (Chapman & Austin, 2002, p. 28).
Women have much more difficulty than their male counterparts in obtaining well-paying jobs. Women with four year college degrees earn an average of 63 percent of what men with high school diplomas earn. And, there is about a 50 percent differential between the expected lifetime earnings of men and of women (Cronin & Simmons, 1987, p. 55). The implications for women’s capacity to handle loans are obvious. Another factor to be considered is that adult women who have completed their undergraduate education, even though they have many more financial responsibilities than younger women just coming out of college, are still entry level people in the labour market. That is to say, a 35-yearold woman with a bachelor’s degree will begin at the same salary level as a 22-year-old woman. This is true even though the 35-year-old may have two children, higher rent, and many more expenses than the 22-year-old, as well as limited mobility in terms of being able to move to new places to work (Simma, 2004).
The female adult borrower must consider, even when she gets out of school, that she is already living close to the margin; she does not have a lot of flexibility. She may have heavy costs, and most of the money to which she has access may be needed to cover very basic expenses. Women comprise two-thirds of the borrowers who have to commit more than 10 percent of their income to student loans. Some studies have shown that of the borrowers who had to commit 10 percent of income, 80 percent were single, and many of those single borrowers had dependent children. It obviously is much more stressful to carry the responsibility of a loan with these responsibilities. Under such circumstances, what is required from the Educational perspective of Government is to make conveniences for the students, particularly who come to study from developing or under developed nations (Hodgson & Sprouse, 2000).
Despite the difficulties listed above, the borrower should assume primary responsibility for loan repayment. We need to be more aware; however, of how very hard it is for adults, particularly adults with limited borrowing experience, to know exactly where to go for information. Therefore, it is very important that lenders and schools provide such information. Schools are the first choice because adult borrowers with limited experience or limited resources are somewhat intimidated by bankers. Many people are afraid to ask too many questions for fear they will reveal something about themselves that will make it impossible for them to get the loan.
Schools should emphasise the alternatives to borrowing and help students think of other ways they can manage besides borrowing. Before time comes for repayment, students will benefit from career counselling. They need to think early in their educational career about the kind of job they want after graduation. They can be preparing as freshmen, sophomores, and juniors for those kinds of jobs by participating in internships, coops, and work-study jobs as a way to build a reservoir of job experience that will help them get into the labour market. Obviously, there are potentially many different kinds of help. Ideally, the school will play a role by providing students with instruction in financial management and planning by experts by people who have both some ideas and some solutions.
In the repayment stage, lifestyle adjustments and compromises are very important characteristics, but an adult woman returning to school because she needs to be able to earn more money may be quite limited in terms of making lifestyle adjustments. She cannot take her children and find a roommate with whom to share an apartment the way a single person can. If she takes a second job at night, she has to pay for a babysitter. She has a whole set of monthly financial obligations that are fundamental parts of life the utilities, rent, telephone. In short, she is limited in her capacity to make lifestyle adjustments even though that, theoretically, is what needs to be done (Chapman & Austin, 2002, p. 43).
Although there is always a need for help with financial management and career counselling, it is not always easy to get this kind of help in institutions. The congruence between student needs for counselling and other kinds of support services on the one hand, and the availability of such services on the other hand, suggests that post secondary institutions and colleges have many support services available and the students have many needs for them, but students indicate that they do not use them to any great extent. This is a problem for which the institution must take responsibility. The ways in which these services are organised at most postsecondary institutions make it very difficult for them to deliver coherently the kind of advice and assistance that people need. Financial aid officers are not career counsellors, career counsellors are not student employment people, student employment people are not internship coordinators, internship coordinators are not co-op people, and co-op people are not job placement people. In short, the services are unorganised and widely dispersed.
The concerns, for example, of the adult female borrower are interlocking problems that require an integrated solution. Yet, most student affairs and financial aid people do not interact much except over coffee and lunch; they fail to see the overall problem. The fact that many of the students involved are commuters with off-campus responsibilities adds to the problem; they simply do not have time to run around to several different offices. Subsequently, these students often do not make their needs known, and they do not receive the benefit of institutional resources.
This problem for adult and female students is also a problem for the schools. It is in the interest of postsecondary institutions to help students and to counsel them so that they will repay their loans conscientiously. After all, postsecondary institutions depend heavily on the availability of student loans for attendance (Doyle, 2000). Responsible borrowing, moreover, is congruent with the lofty and admirable philosophy of many postsecondary institutions that people should be prepared for life in practical terms. Certainly it is important for everyone to know how to be financially responsible. By helping students understand the responsibility for repaying loans and by encouraging them to do so in a conscientious way, educators can perform a real and lasting service.
The majority of students attending post secondary institutions are from economically disadvantaged backgrounds. Fifty percent of their federal aid resources come from loans, primarily because of the diminishing number of grant programs. In the light of the above research it is evident that the issue of how to convey higher education information to low-income adults is, one of the most challenging problems in any culture. For example, how can higher education recruiters convince a student living in a public housing project that a better life is a probable result of attendance at a community college, a technical school, or a university?
In this context Canada’s post secondary education institutions are liable along with the Government policymakers to design a framework on how to integrate education loan policy with scholarships and with public service and career planning in a more thoughtful and constructive fashion. Education loan programs are complex and, like any vehicle, require fine-tuning and adjustment to travel any distance. One of the best strategies for helping students attend post secondary education is supporting them through the complex process of applying for admission and financial aid, including loans but with such an ease that repaying the debt remains no big deal for them. Another strategy for colleges is to sponsor Upward Bound programs enabling high school students to visit colleges, then spend a summer on a campus to taste college life, and to get considerable adult and peer group support in preparing for college. Talent Search represents an effort to locate gifted and talented students, many of whom do not realise that some colleges are looking for applicants exactly like themselves.
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Chapman, D. W., & Claffey, J. (1998). “Higher education and international development: some new opportunities worth taking”. Point of View commentary. Chronicle of Higher Education, p. B6
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Martinez can develop various policy frameworks, in his position as a Budget Director for Chicago Public School (CPS). First of all, he should determine the budgeting framework to be implemented. Therefore, he should come up with a policy framework on whether to use the average or actual teacher salaries; whether to allow schools to employ the teaching staff with little regard to the salary levels or let the schools employ teachers based on a mixed approach that focussed on meeting the schools’ per-pupil budget. In addition, he needs to develop a policy on whether to expand the budgeting system to cover the whole district. There was also an urgent need to develop a policy framework on the formula to be used in determining the student weights (The Electronic Hallway, p. 1).
There are certain characteristics associated with a successful policy framework. A good policy should have an enabling purpose. In this case, the policy’s aims need to be clear and applicable in a general sense. A good policy should also be linked to a wider objective. This helps the concerned individuals to focus on the main goal of the policy. Also, a good policy should have a clear ownership. In this case, the policy is not seen as being imposed on the people against their will. A good policy must also be short and clear. This enables the people concerned to understand the policy and agree with the policy requirements.
Another characteristic of a good policy is that it must emanate from a valid process. In this regard, people should understand the policy process in a clear manner. Another aspect of good policy is that it should work within the restrictions of a certain authority. The authority enables the stakeholders to adopt and abide by the regulations of the policy framework. A good policy needs to be enforceable and adaptable. However, it should be acknowledged that no single policy is perfect and policies may require some adjustments during implementation (“2 Policy”, p. 15-16).
Martinez had various things that he was aiming at achieving in his new role as a Budget Director for CPS. In general, Martinez wanted to initiate an innovative budgeting scheme to be used within the Chicago Public Schools. In achieving his vision, there are certain elements that cannot be possible to achieve. However, there are others that could be realized while implementing the vision.
In this case, it can be argued that Martinez stands to achieve the pupil budgeting scheme, commonly known as the Weighted Student Formula (WSF), in providing a solution to the budgeting issue. However, he should be ready to face spirited opposition on his new formula to be used in budgetary allocation to schools. Although people are opposed to the WSF, Martinez should convince them of the benefits that come with this formula. In this case, he should provide assurances on the fears being raised regarding this formula (The Electronic Hallway, p. 1).
Can the WSF work the way it should if it is not coupled with site-based management?
The WSF can work in the appropriate manner even if it is not coupled with site-based management. As seen in the data from the regions that have already adopted this formula in their budgetary allocation, it can be observed that some schools stood to get more funding than they were used to getting before. On the other hand, other schools would receive less money than before. Veronica Anderson, the editor of Chicago Catalyst, noted that “per-pupil funding will mean less money for schools that enrol better-off kids, unless CPS factors something into the formula to offset that effect” (The Electronic Hallway, p. 10).
It should be noted that the Chicago Public School District is made up of different school categories. This includes the Chartered schools owned by private and non-profit entities but administered by the district. These schools, through the use of the WSF, stand to gain a lot since they are usually underfunded (The Electronic Hallway, p. 10).
The implementation of the WSF was not going to benefit the small schools given their small number of students. In other districts, where WSF was being implemented; such as Houston, Seattle and Edmonton, this disadvantage was addressed through the subsidies that were extended to the small schools, or through the gradual introduction of WSF over the years. The Chicago Public School District intended to use the same criteria in its WSF plan. This approach was not acceptable in some quarters on the argument that it presented a fundamental inequity and undue advantage to small schools. However, this remained to be the most viable means of addressing the disadvantage that was to be experienced by small schools (The Electronic Hallway, p. 10).
Given the worries of the stakeholders in the implementation of the WSF, it was necessary that CPS assured them of the efficiency that would come with the approach. There was a feeling among stakeholders that the subsidies of the small schools promoted inequity and only acted to make the proposed Renaissance 2010 work. Also, the principals of various schools with the Chicago Public School District were sceptical of the new formula.
Therefore, it was important to convince the various stakeholders on the positive aspects that relate to the WSF budgetary formula. Notably, the WSF formula was better than the conventional approaches, in which the schools were rewarded basing on performance gains (The Electronic Hallway, p. 11).
Would it make sense for the Renaissance Schools to introduce school choice along with the WSF?
The aspect of introducing school choice together with the WSF would present some challenges in the CPS. Although some proponents have argued that doing so would enhance accountability of the schools to parents, there is a likelihood of promoting segregation in schools. This is because families would obviously choose to have their children attend schools close to their home. This would promote segregation in the sense that people usually settles in clusters based on race.
Integrating WSF and school choice in the name of promoting local control would be a forum of justifying inequality and segregation. Such a plan would be a gentrification strategy aimed at moving the minority groups from the real estate areas and catering for the interests of the developers. Those opposed to the plan noted “the reality is that the cause of a failed education system is a history of racism, lack of equal opportunity to learn, deindustrialisation, and disinvestment in communities of colour by corporate interest and banks with the support of political leaders” (The Electronic Hallway, p. 9).
Although the CPS administrators made assurances that they were going to ensure that segregation in schools does not occur, this can be quite challenging given the situation. Therefore, it does not make sense for the Renaissance Schools to introduce school choice alongside the WSF budget formula (The Electronic Hallway, p. 9).
What is the best way to implement the WSF? What are the pros and cons of each option?
Deciding on the weights to be used was a major challenge. In choosing the best equity, both horizontal and vertical equities must be applied. The horizontal equity refers to the equal treatment accorded to equals, whereas the vertical treatment refers to the suitable unequal treatment of those who are not equal. The implementation of the WSF was an example of ensuring horizontal equity. The achievement of vertical equity was also necessary to ensure that the general equity had been achieved. This is important, but very contentious to implement (The Electronic Hallway, p. 9).
In achieving vertical equity, the right base of funding rate for every student would be determined. This would be together with the weights determined by the needs of the students. In regard to the basic rates, their weights would be established basing on the amount that each district spends on each category of specific-needs students divided by the number of students in each group. The average numbers from each category would be turned into a ratio basing on the spending average for essential services in order to get the final weights (The Electronic Hallway, p. 9).
Martinez had two ways of implementing the WSF. On one hand, he was to integrate the WSF with the school choice, and this brought a lot of challenges in respect to its implementation. The other way of implementing the WSF was through integration of the aspect of teachers’ salaries during implementation.
The proponents of this approach argued that it was the best in enhancing the schools’ accountability to parents, as opposed to the conventional system that made schools only accountable to the political class. However, this was opposed by those individuals who saw the integration of school choice as meant to promote segregation. In this case, it can be argued that, though the integration of WSF with school choice would bring local control, this will establishes inequality and segregation (The Electronic Hallway, p. 8-9).
The other way of implementing the WSF is by integrating it with the salary consideration of teachers. The bone of contention was on whether to use the average teacher salaries or the actual salaries while implementing the WSF formula. Many stakeholders seemed to agree on the use of average salaries in the implementation of the WSF. This was acceptable among those who subscribed to the WSF system arguing that the use of actual teacher salary would lead to controversies. They argued that if actual salaries were used, the school principals would favour the recruitment of young teachers who are cheap to maintain.
The teachers unions also favoured the use of average salaries. They argued that the use of actual salaries would not be good for senior teachers. This is because the senior teachers had spent a lot of time to enhance their level of compensation. However, those opposed to the use of average teachers’ pay argued that it hid inequalities that were rampant within the Chicago Public School District. Therefore, it can be asserted that the best way of implementing the WSF was to integrate it with the average salary of the teachers in the district (The Electronic Hallway, p. 9).
Works Cited
2 Policy. n.d. Web.
The Electronic Hallway. Defining Equity: Implementing the Weighted Student Formula in Chicago Public Schools. n.d.
