Issues and Challenges: The Development of Fair and Equitable Health Policy

Public health policy/law is a discipline that seeks to identify opportunities and implement mechanisms to achieve justice in the public health sector. Several public health policies and programs have been implemented by virtue of the Affordable Care Act (ACA), and these policies and programs seek to decrease America’s “paradox of excess and deprivation” and address socioeconomic barriers that exist in the U.S. healthcare system. Private healthcare market interests have accused the ACA of intruding heavily into the professional autonomy of the medical profession, eroding healthcare market competition, and driving up national healthcare spending. Counter-arguments defending the ACA state that the law exposes the limitations to such professional autonomy of the medical profession, primarily because the U.S. healthcare system is currently ridden with excess, waste, and social injustice. This review article outlines the types of policies and laws governing healthcare, unique healthcare issues faced by particularly vulnerable populations, and future challenges and opportunities under the ACA. Lastly, the article provides recommendations to address future challenges and opportunities under the ACA, so as to balance the scales between private market interests and public health equity

Reducing the Rate of Late Stage Breast Cancer Through Effective Health Communication: An Opinion Piece

Purpose: Health and illness are traditionally characterized and treated differently across various ethnic groups, which encourages American health systems serving these diverse populations to explore culturally competent and safe ways to effectively reduce illness within such populations. Certain ethnic groups of women in the United States (US) bear greater risk of late stage breast cancer because of various circumstances, which include but are not limited to a lack of insurance or underinsurance and discomfort with and/or resentment toward the US healthcare system. The dominant culture and the social aspects of the modern American health system often and most favorably serve the European American population as compared to the non-European American population. When non- European American female patients are given the opportunity to understand, afford, and adhere to breast cancer prevention techniques, as a result of culturally competent and safe health communication, there is greater potential to control healthcare spending and costs, improve breast cancer outcomes and risks, and produce healthier female populations. This narrative explores communication routes that practice cultural sensitivity and foster cultural safety whilst providing healthcare to non- European American populations, so as to help reduce the rate of late-stage female breast cancer in the US

Evaluating Bulk Carbon and Nitrogen Isotope Compositions of Acidic Hydrothermal Sediments on Earth– Implications for Mars Astrobiology

Carbon isotopes have been widely used as unique biosignatures because biologic processes commonly result in distinctive negative delta 13C values (-35 to -10 ‰) within organic material on Earth. However, the bulk delta 13C analysis in Gale crater sediments on Mars revealed a wider range of values, from -25 to +56 ‰ (Franz et al., 2020), which suggests a more complex origin. To determine if bulk isotope analysis can be successfully used to detect a microbial signature in a martian analog environment, we analyzed concentrations and isotope compositions of C within hydrothermal sediments in Iceland (Námafjall, Krýsuvík, Hveragerdi) and the United States (Lassen, Valles Caldera, Yellowstone). The measured bulk delta 13C of the hot spring and mud pot sediments was higher in barren Icelandic sites (-25.6 to -14.5 ‰) compared to lower values in more forested sites of the United States (-26 to -21 ‰). These corresponded to lower C concentration in Iceland (0.13 to 0.55 wt.%) and higher C concentrations in the United States (0.04 to 4.78 wt.%). The distinctive ranges of bulk delta 13C values observed in the studied sites were indicative of life processes occurring in-situ (microbial activity) and in the surrounding area (production of plant biomass), wherein more negative bulk delta 13C values corresponded to increasing input of allochthonous plant matter in United States. By contrast, the higher delta 13C of the Icelandic sediments were consistent with smaller C isotope fractionations associated with microbial activity. Bulk delta 15N results were less useful in differentiating biosignatures because of overlapping delta 15N values between the various N sources, such as allochthonous plant matter, volcanic/hydrothermal gases, and microbial processes. The larger variability of bulk delta 13C values observed in Gale crater is to some extent controlled by carbonate minerals present with significantly higher delta 13C, which were not present in our analog sites. Consequently, future bulk delta 13C analysis on Mars may consider analysis of acidic sediments (with no carbonate present) as they have the highest potential of displaying a distinctive C isotope biosignature associated with possible martian life

An Assessment of Hybrid Poplar Biomass Plantations for Ontario

The search for an alternative to oil dominated political and economic thinking during the 1970’s and continues in this decade. In Ontario, one such alternative is methanol, which could possibly be supplied in large quantities from hybrid poplar biomass plantations. While the nature of these plantations has been debated at greath length, the exact quantity and location of land that could be available for plantations in Ontario has not been identified. Using the Land Evaluation Model (LEM 2) developed at the University of Guelph an inventory of the land resources and the resulting land use patterns is determined. Throughout the province, there are approximately 4.2 million hectares of land that are economically capable of supporting hybrid poplar plantations, yielding enough energy to meet 145& of 1983 liquid fuel requirements. When the land that is currently cleared is quantified, the total land resource becomes 3.1 million hectares, equivalent 108& of 1983 requirements. However, most of this land is currently being used for agricultural production, and the amount of cleared land remaining totals just .846 million hectares. When both agricultural and poplar production requirements are given consideration, a linear programming evaluation by LEM 2 concludes that 2 million hectares could meet 71.1& of liquid fuel needs while decreasing overall agricultural production by 28.9&. Because the magnitude of the resource base required for any of these scenarios is so great, the distribution of the land resourcecs and the potential land-use and economic impacts are reviewed

Developing Ethics and Equity Principles, Terms and Engagement Tools

Background: Artificial intelligence (AI) and machine learning (ML) technology design and development continues to be rapid, despite major limitations in its current form as a practice and discipline to address all sociohumanitarian issues and complexities. From these limitations emerges an imperative to strengthen AI and ML literacy in underserved communities and build a more diverse AI and ML design and development workforce engaged in health research. Objective: AI and ML has the potential to account for and assess a variety of factors that contribute to health and disease and to improve prevention, diagnosis, and therapy. Here, we describe recent activities within the Artificial Intelligence/Machine Learning Consortium to Advance Health Equity and Researcher Diversity (AIM-AHEAD) Ethics and Equity Workgroup (EEWG) that led to the development of deliverables that will help put ethics and fairness at the forefront of AI and ML applications to build equity in biomedical research, education, and health care. Methods: The AIM-AHEAD EEWG was created in 2021 with 3 cochairs and 51 members in year 1 and 2 cochairs and ~40 members in year 2. Members in both years included AIM-AHEAD principal investigators, coinvestigators, leadership fellows, and research fellows. The EEWG used a modified Delphi approach using polling, ranking, and other exercises to facilitate discussions around tangible steps, key terms, and definitions needed to ensure that ethics and fairness are at the forefront of AI and ML applications to build equity in biomedical research, education, and health care. Results: The EEWG developed a set of ethics and equity principles, a glossary, and an interview guide. The ethics and equity principles comprise 5 core principles, each with subparts, which articulate best practices for working with stakeholders from historically and presently underrepresented communities. The glossary contains 12 terms and definitions, with particular emphasis on optimal development, refinement, and implementation of AI and ML in health equity research. To accompany the glossary, the EEWG developed a concept relationship diagram that describes the logical flow of and relationship between the definitional concepts. Lastly, the interview guide provides questions that can be used or adapted to garner stakeholder and community perspectives on the principles and glossary. Conclusions: Ongoing engagement is needed around our principles and glossary to identify and predict potential limitations in their uses in AI and ML research settings, especially for institutions with limited resources. This requires time, careful consideration, and honest discussions around what classifies an engagement incentive as meaningful to support and sustain their full engagement. By slowing down to meet historically and presently underresourced institutions and communities where they are and where they are capable of engaging and competing, there is higher potential to achieve needed diversity, ethics, and equity in AI and ML implementation in health research

A new framework for global data regulation

Under the current regulatory framework for data protections, the protection of human rights writ large and the corresponding outcomes are regulated largely independently from the data and tools that both threaten those rights and are needed to protect them. This separation between tools and the outcomes they generate risks overregulation of the data and tools themselves when not linked to sensitive use cases. In parallel, separation risks under-regulation if the data can be collected and processed under a less-restrictive framework, but used to drive an outcome that requires additional sensitivity and restrictions. A new approach is needed to support differential protections based on the genuinely high-risk use cases within each sector. Here, we propose a regulatory framework designed to apply not to specific data or tools themselves, but to the outcomes and rights that are linked to the use of these data and tools in context. This framework is designed to recognize, address, and protect a broad range of human rights, including privacy, and suggests a more flexible approach to policy making that is aligned with current engineering tools and practices. We test this framework in the context of open banking and describe how current privacy-enhancing technologies and other engineering strategies can be applied in this context and that of contract tracing applications. This approach for data protection regulations more effectively builds on existing engineering tools and protects the wide range of human rights defined by legislation and constitutions around the globe.Comment: 15 pages, 2 figure

Applying an ELSI lens to real-world data and novel genomic insights for personalized mental healthcare

Improving the understanding of the complex relationship between genetic predispositions, environmental influences, and sociocultural factors in the development and progression of mental illness is crucial for optimizing treatment efficacy and addressing longstanding health disparities. This paper discusses the ethical, legal, and social implications (ELSI) of recent advancements in biomedical research, particularly in genome-wide association studies (GWAS), phenome-wide association studies (PheWAS), and genome-wide environment interaction studies (GWEIS). Despite recent scientific progresses, challenges such as inadequate study methodology (e.g., correlational studies) and lack of diversity within study samples persist. Recent discoveries of several genetic variants of diseases, could augment and improve, or even challenge, existing understanding of the onset and management of mental illness. Leveraging real-world data (RWD), including electronic health record data (EHRs) focused on social determinant of health alongside biobank data, offers further opportunities to enhance the understanding of gene-environment interactions and inform efforts for reducing disparities in mental healthcare. Increased knowledge can support timely, holistic, evidence-based, and personalized care. Addressing ELSI considerations and maximizing the use of RWD is essential for advancing ethical and inclusive psychiatric genetics research, ultimately improving patient outcomes and promoting equitable access to evidence-based treatments

Addressing Ethical Issues in Healthcare Artificial Intelligence Using a Lifecycle-Informed Process

OBJECTIVES: Artificial intelligence (AI) proceeds through an iterative and evaluative process of development, use, and refinement which may be characterized as a lifecycle. Within this context, stakeholders can vary in their interests and perceptions of the ethical issues associated with this rapidly evolving technology in ways that can fail to identify and avert adverse outcomes. Identifying issues throughout the AI lifecycle in a systematic manner can facilitate better-informed ethical deliberation. MATERIALS AND METHODS: We analyzed existing lifecycles from within the current literature for ethical issues of AI in healthcare to identify themes, which we relied upon to create a lifecycle that consolidates these themes into a more comprehensive lifecycle. We then considered the potential benefits and harms of AI through this lifecycle to identify ethical questions that can arise at each step and to identify where conflicts and errors could arise in ethical analysis. We illustrated the approach in 3 case studies that highlight how different ethical dilemmas arise at different points in the lifecycle. RESULTS DISCUSSION AND CONCLUSION: Through case studies, we show how a systematic lifecycle-informed approach to the ethical analysis of AI enables mapping of the effects of AI onto different steps to guide deliberations on benefits and harms. The lifecycle-informed approach has broad applicability to different stakeholders and can facilitate communication on ethical issues for patients, healthcare professionals, research participants, and other stakeholders