Health Equity: 03/05/08

Wednesday, March 5, 2008

[EQ] Concepts and Measures of Agency

Concepts and Measures of Agency

Sabine Alkire, Director of the Oxford Poverty & Human Development Initiative
Department of International Development - Queen Elizabeth House, University of Oxford

Working paper No.9 January 2008

Identifies five aspects of agency and scrutinises which of these are routinely measured

Available online as PDF file [23p.] at: http://www.ophi.org.uk/pubs/Alkire_Agency_WP9.pdf

Agency is inescapable plural in both concept and measurement. In Sen’s account of agency:

1) agency is exercised with respect to goals the person values;

2) agency includes effective power as well as direct control;

3) agency may advance wellbeing or may address other-regarding goals;

4) to identify agency also entails an assessment of the value of the agent’s goals;

5) the agent’s responsibility for a state of affairs should be incorporated into his or her evaluation of it.

This chapter refracts the literature on agency measurement through the first four of these characteristics, showing how particular survey-based measures of individual agency elucidate or obscure each distinction. It also observes that existing measures used in development tend to focus on control but not effective freedom…

The literature on measurement also raises a number of very relevant issues for the conceptual approach….”

….Agency is an assessment of “what a person can do in line with his or her conception of the good” (Sen 1985b,p.206). People who enjoy high levels of agency are engaged in actions that are congruent with their values….”

Content:

I. Motivation

II. Agency

III. Measures of agency

IV. Proxy measures of agency

V. Global and Multidimensional

VI. Effective Power and control

VII. Advancing well-being freedom and other Regarding Commitments

VIII. Autonomy and Ability

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This message from the Pan American Health Organization, PAHO/WHO, is part of an effort to disseminate
information Related to: Equity; Health inequality; Socioeconomic inequality in health; Socioeconomic
health differentials; Gender; Violence; Poverty; Health Economics; Health Legislation; Ethnicity; Ethics;
Information Technology - Virtual libraries; Research & Science issues. [DD/ KMS Area]

“Materials provided in this electronic list are provided "as is". Unless expressly stated otherwise, the findings
and interpretations included in the Materials are those of the authors and not necessarily of The Pan American
Health Organization PAHO/WHO or its country members”.
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[EQ] Report on Health and Health-Influencing Behaviors Among Urban Indians

Reported Health and Health-influencing Behaviors Among Urban American Indians and Alaska Natives

An Analysis of Data Collected by the Behavioral Risk Factor Surveillance System

The Urban Indian Health Institute, March 2008

Available online as PDF file [40p.] at:
http://www.uihi.org/wp-content/uploads/2008/03/health_health-influencing_behaviors_among_urban_indians.pdf

On March 5^th, 2008, the Urban Indian Health Institute releases their ground breaking report titled: Reported Health and Health-Influencing Behaviors Among Urban American Indians and Alaska Natives. The report was released at a Native Symposium titled, Through Native Eyes: Identity, Perception and Recognition.

“…..The report finds additional evidence that American Indians and Alaska Natives living in urban areas face major hurdles in reaching health status similar to their fellow Americans. Findings from the Behavioral Risk Factor Surveillance System, a national telephone survey conducted yearly and coordinated by the Center for Disease Control and Prevention (CDC), show America Indians and Alaska Natives living in selected urban areas were more likely to report difficulty accessing health care, had higher rates of risk behavior, and experienced worse health outcomes than the general population. Income differences were shown to play a role in explaining some of the health disparities, but differences in some reported health indicators were not income dependent….”

Content:

Executive Summary

Introduction

Urban American Indians and Alaska Natives

BRFSS background, limitations, and benefits

Report Structure

Methods and Definitions

Selected urban areas

Race classification

Income definitions

Healthy People 2010 Targets

Statistical methods

Results - Respondent Demographics

Results - Part I: Initial Comparison

Results - Part II: Income Analysis

Conclusion

References

Appendices

Appendix A: UIHO Service Areas

Appendix B: BRFSS Health Indicators and Associated Questions

Appendix C: Represented States by Year

Appendix D: Rates and confidence intervals - Initial Comparison

Appendix E: Rates and confidence intervals - Income Analysis

Maile Taualii, MPH, Scientific Director Urban Indian Health Institute

Seattle Indian Health Board PO BOX 3364

Seattle, WA 98114 Phone: 206-812-3030 Email: MaileT@uihi.org

* * * *

“Materials provided in this electronic list are provided "as is".Unless expressly stated otherwise, the findings
and interpretations included in the Materials are those of the authors and not necessarily of The Pan American
Health Organization PAHO/WHO or its country members”.
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[EQ] Report on Health Systems and the right to the highest attainable standard of Health

PROMOTION AND PROTECTION OF ALL HUMAN RIGHTS, CIVIL, POLITICAL, ECONOMIC, SOCIAL AND CULTURAL RIGHTS

Report of the Special Rapporteur on the right of everyone to the enjoyment of the highest attainable standard of physical and mental health

Paul Hunt, The Human Rights Centre, University of Essex, United Kingdom

Report on health systems and the right to the highest attainable standard of health. This report (A/HRC/7/11)
was submitted to the Human Rights Council on 31 January 2008.

Available online [25p.] at: http://www2.essex.ac.uk/human_rights_centre/rth/docs/A-HRC-7-11.doc

“……At the heart of the right to the highest attainable standard of health lies an effective and integrated health system, encompassing health care and the underlying determinants of health, responsive to national and local priorities, and accessible to all.

The Human Rights Council, in its decision 2/108, requested the Special Rapporteur on the right of everyone to the enjoyment of the highest attainable standard of physical and mental health to identify and explore the key features of an effective, integrated and accessible health system from the perspective of the right to health, bearing in mind the level of development of countries. This report is a response to that request.

There is a growing recognition that a strong health system is an essential element of a healthy and equitable society. In any society, an effective health system is a core social institution, no less than a fair justice system or democratic political system. However, according to a recent publication of the World Health Organization, health systems in many countries are failing and collapsing.

The report briefly identifies some of the historical landmarks in the development of health systems, such as the Declaration of Alma-Ata on primary health care (1978). Taking into account health good practices, as well as the right to the highest attainable standard of health, the report identifies a general approach to strengthening health systems (chap. II, sect. C). This general approach should be applied, consistently and systematically, across the numerous elements - or “building blocks” - that together constitute a functioning health system. By way of illustration, the report takes the general approach outlined in the report and begins to apply it to two of the health system “building blocks” (chap. II, sect. E).

Section F signals how the right to a fair trial has helped to strengthen court systems and argues that, in a similar way, the right to the highest attainable standard of health can help to strengthen health systems….: “

Content:

I. INTRODUCTION

II. HEALTH SYSTEMS AND THE RIGHT TO THE HIGHEST ATTAINABLE STANDARD OF HEALTH

A. Health systems: some historical landmarks

B. Definitions

C. In general terms, a right-to-health approach to strengthening health systems

D. The “building blocks” of a health system

E. Applying the general approach: some specific measures for health system strengthening

F. The right to health helps to establish a health system in the same way as the right to a fair trial helps to establish a
court system

III. CONCLUSIONS

* * * *

“Materials provided in this electronic list are provided "as is".Unless expressly stated otherwise, the findings
and interpretations included in the Materials are those of the authors and not necessarily of The Pan American
Health Organization PAHO/WHO or its country members”.
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    IMPORTANT: This transmission is for use by the intended recipient and it may contain privileged, proprietary or confidential information. If you are not the intended recipient or a person responsible for delivering this transmission to the intended recipient, you may not disclose, copy or distribute this transmission or take any action in reliance on it. If you received this transmission in error, please notify us immediately by email to infosec@paho.org, and please dispose of and delete this transmission. Thank you.