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Socioeconomic inequality and access to emergency care: understanding the pathways to the emergency department in the UK
Get PDFObjective To examine how socioeconomic deprivation influences referral pathways to emergency departments (EDs) and to assess how these pathways affect subsequent hospital outcomes. Design Retrospective observational study. Setting Emergency department of a large teaching hospital in the East of England, providing secondary and tertiary care. Participants 482787 ED attendances by patients aged 16 years and over, recorded between January 2019 and December 2023. Patients were assigned Index of Multiple Deprivation (IMD) deciles based on residential postcode. Main outcome measures Referral source (general practitioner (GP), National Health Service (NHS) 111, ambulance, self-referral, other), total ED time, 4-hour breach, hospital admission and unplanned return within 72 hours. Results Substantial socioeconomic inequalities were observed in referral pathways. Patients from the most deprived areas were significantly less likely to be referred by a GP (4.7%) than those from the least deprived areas (14.7%) and more likely to arrive via ambulance (32% vs 24%). These differences persisted after adjusting for demographic, clinical and contextual variables. Ambulance referrals showed the longest ED stays, ranging from 347 to 351 min across IMD deciles (overall 95%CI 343 to 363) and the highest probability of 4-hour breaches (51%; 95%CI 50% to 53%). Self-referrals had the greatest rates of unplanned returns within 7 days (up to 7.1%; 95%CI 5.5% to 8.7%). In contrast, NHS 111 and GP referrals were associated with shorter stays, lower breach rates and fewer reattendances. Minimal variation in outcomes was observed across deprivation levels once referral source was accounted for. Conclusions Inequalities in how patients access emergency care, particularly reduced GP and NHS 111 referrals among more deprived groups, appear to underpin disparities in ED outcomes. Referral source captures important clinical and system-level factors that influence patient experience and resource use. Interventions to improve equitable access to structured referral pathways, particularly in more deprived areas, may enhance both the efficiency and fairness of emergency care delivery. Further research using national data is needed to assess broader policy implications and economic costs associated with differential access
Delivering an integrated climate finance agenda in support of the Baku to Belém Roadmap to 1.3T: fourth report of the Independent High-Level Expert Group on Climate Finance
Get PDFThe Independent High Level Expert Group (IHLEG) on Climate Finance has been supporting the deliberations on the climate finance agenda under successive COP Presidencies since COP26. The group is co-chaired by Amar Bhattacharya, Vera Songwe and Nicholas Stern. Eléonore Soubeyran serves as Executive Secretary and Head of the Secretariat. The full membership is provided at the end of the report. This independent group was tasked to help develop and put forward policy options and recommendations to encourage and enable the public and private investment and finance necessary for delivery of the commitments, ambition, initiatives and targets of the UNFCCC Paris Agreement, reinforced by the Glasgow Climate Pact, the Sharm el-Sheikh agenda, the COP28 Global Climate Finance Framework and the COP29 Baku Climate Unity Pact. This fourth report of the IHLEG has benefitted enormously from the active and highquality participation, guidance and input of the group’s members, and from engagement with a wide range of stakeholders. We are deeply grateful for the guidance and interactions with the COP30 Presidency team under the leadership of Ambassador André Corrêa do Lago and Ana Toni. The preparation of the report was greatly supported by the close engagement with the team in the Brazilian Ministry of Finance led by Vice Minister Tatiana Rosito and Ivan Oliveira and the extensive work that was undertaken in the preparation of the Circle of Finance Ministers report on the Baku to Belém Roadmap. Our report therefore is closely aligned with the Circle of Finance Ministers report
Predicting accelerated and delayed aging in global settings: biobehavioral age gaps and the role of global exposomes
Get PDFBackground: Global health challenges like aging and dementia are shaped by socioeconomic disparities, environmental factors, and social determinants of health. We developed a behavioral age gap (BAG), measuring the difference between expected behavioral age and chronological age Method: We utilized a cross‐sectional sample (n = 161,981) comprising countries from Latin America, Europe, Asia, and Africa. Behavioral age was estimated using a Gradient Boosting Regressor with 10‐fold cross‐validation, incorporating multiple risk factors (hypertension, diabetes, heart disease, female sex, visual impairment and hearing impairment) and protective factors (cognition, functional ability, education) associated with healthy aging. BAG was calculated as the difference between predicted and chronological age, and adjusted gaps were derived from the residuals of regressing BAG on chronological age. Result: Chronological age was accurately estimated using biobehavioral predictors. Key protective predictors were functional ability, education, and cognition, while main risks were hearing impairment, heart disease, and hypertension. Participants were categorized into delayed or accelerated aging groups to explore biobehavioral factors in aging. Both models demonstrated high predictive accuracy, especially for accelerated aging. BAGs varied significantly across regions and income levels, increasing from Europe to Asia, LA, and Africa. Participants from LIC displayed accelerated aging compared to HIC. Adverse exposomes were linked to accelerated aging with large effect sizes. Conclusion: This work positions BAGs as markers of aging disparities, emphasizing the influence of inequalities and exposomes, while providing measures for targeted interventions and research
The role of financial mathematics in data protection and fairness in technology: based in a case study of Te Hiku Media
Get PDFThis analysis explores how Te Hiku Media, a Mori-led non-profit organization, integrates interdisciplinary strategies to protect and revitalize the Mori language while actively resisting the forces of data colonization driven by large technology corporations. Central to their approach is the development of in-house machine learning models that leverage semi-supervised learning methods, which significantly reduce the need for extensive labeled datasets. By adopting this strategy, Te Hiku maintains linguistic sovereignty, safeguards cultural heritage, and minimizes reliance on external corporate infrastructures. Beyond the technical dimension, the organization applies financial tools such as cost-benefit analysis, Bayesian probability, and multivariate regression to support risk-aware decision-making in areas of data ownership, potential commercialization, and the long-term preservation of cultural value. The initiative also foregrounds critical ethical considerations, including the avoidance of algorithmic bias, the prevention of price discrimination in educational access, and the enforcement of strict community-led governance structures to ensure data privacy and cultural accountability. Te Hiku Medias work demonstrates how localized, ethical applications of artificial intelligence can simultaneously promote cultural continuity and advance social equity. Their model provides a replicable pathway for other Indigenous communities navigating similar technological, cultural, and geopolitical challenges in the rapidly evolving digital age
Hedging strategies of China Eastern Airlines in 2022: navigating the dual shocks of COVID-19 and the Russia-Ukraine war
Get PDFIn this paper, the hedging strategy of China Eastern Airlines (CEA) in 2022, which is affected by the dual crises of COVID-19 pandemic and Russia-Ukraine war will be examined. Meanwhile, how these external shocks affect the effectiveness of the CEA's hedging will be described. Specifically, the results of the study show that the pandemic weakened the value of hedging. Global oil prices have been in position due to the decline in passenger demand. the CEA hedges lead to realized losses and deterioration of the firm's financial performance. In contrast, the Russia-Ukraine war triggered a significant increase in fuel prices. However, low hedging ratios and poor timing limited its effectiveness. Worse economic scenarios followed. Additionally, this article highlights the dual nature of hedging by analyzing the financial, managerial and policy dimensions. The research shows that it is not seen as an insurance policy only. Different scenarios of demand-side and supply-side shocks can also determine its value. The CEA experience consequently emphasizes the need for more flexible and adaptive risk management frameworks combined with operational strategies to better protect against risks with high future uncertainty. It also provides inspiration for global airlines and policymakers who are seeking to increase corporate resilience in an era of heightened volatility
HTA82 Comparing HTA outcomes and rationale for decision making between countries with mature vs. newly founded HTA systems: evidence from England, France, and Greece
No full textObjectives To review and compare HTA outcomes, reimbursement decisions and suggested clinical restrictions on a set of originator drugs reimbursed in Greece and assessed in England and France, in order to analyze country differences in the rationale for decision-making. Methods Our sample consists of all drug-indication pairs, which were assessed and ultimately approved for reimbursement in Greece between 2019 and 2023. These were matched with assessments of the same drug-indication pairs in France (HAS), and England (NICE). HTA outcomes (L=List; LWCR=List-with-Clinical-Restrictions; R=Rejected, NA=Not Assessed) and the rationale for decision-making were extracted from publicly available English and French HTA reports and reimbursement approvals in Greece. Results Of the 169 drug-indication pairs, the following HTA outcomes were recorded: Greece (L=70%, LWCR=30%), France (L=56%, LWCR=33%, R=11%), and England (L=38%, LWCR=45%, R=6%, NA=11%). Significant differences were observed in the clinical restrictions recommended between Greece vs France and England. The majority of restrictions recommended in France and England limited use to strictly defined sub-populations based on diagnostic and/or clinical criteria, or to specific circumstances (e.g., failure of prior therapy, unsuitability of alternatives) within the relevant indication. In Greece, the indication perimeter was less frequently regulated, with restrictions often providing more flexibility or relating to aspects such as treatment duration or delivery setting. The same drug-indication pairs were also observed to receive different clinical restrictions between Greece and the comparator settings. Conclusions Differences in HTA outcomes and the rationale for decision-making between mature (England, France) and newly-founded (Greece) HTA systems, indicate a number of inconsistencies in the latter vis-à-vis the former: willingness to accept based on the approved indication and reduced ability or willingness to restrict use to patient sub-groups that are likely to benefit most. Lack of ability or willingness to implement population restrictions carries significant resource implications for newly-founded systems and their ability to reimburse new technologies
The seed and the well: navigating agrarian risk in the Anthropocene
No full textThis chapter examines the entanglements of climatic and agrarian risk against the backdrop of a broader crisis of Indian agriculture. Building on ethnographic research in the Malwa region of central India, the chaper focuses on two major drivers of agrarian change since the 1980s: the introduction of soybean as a primary monsoon crop and the spread of irrigation through private borewells. Specifically, it shows how these capitalist agrarian transformations intersect with climatic change to produce and enhance risk for smallholder farmers. Drawing on the rich traditions of critical agrarian studies and political ecology, the chapter argues that these entwinements reveal that climate change unfolds within and is articulated through specific socio-spatial and historical contexts. Moreover, it demonstrates that the contours of the agrarian present might be discerned in often mundane and minute shifts in everyday practices and processes of cultivation
Liberating economics from ideologies and dystopia
No full textThis perceptive book challenges orthodox and neoliberal approaches to economics, emphasizing the importance of institutions in shaping socio-economic outcomes. George Kararach underscores the need to rethink dominant paradigms in the field of economics and enhance its relevance to public policy
Legal and state efforts to address climate obstruction
No full textIn recent decades, legal and governmental efforts to counteract climate disinformation and obstruction have grown. This chapter summarizes these efforts, including regulation, litigation, and government-led investigations. It discusses specific regulatory tools and how, though they can address obstruction of climate action, obstruction itself can create obstacles to their passage and enforcement. It describes litigation brought to hold corporations—particularly fossil fuel companies—directly responsible for the climate harm their products caused to communities and individuals, as well as detailing government-led investigations of the carbon majors. The chapter also discusses efforts to use the law to impede climate action, including suits against scientists and protestors along with actions against environmental reforms in the financial industry. Its findings suggest that legal and state efforts to address climate obstruction have already made a significant impact and are likely to become an important component of climate action globally