International Trade & Health Equity: Have Benefits of Medical Tourism ‘Trickled Down’ to India’s Poor?

This is the final version of the article. Available from the publisher via the link in this record.In the late 20th century, international trade was projected as a tool for development with regard to global, social and political formations. Traditional political economic models claimed wealth generation through ostensibly maximising ‘comparative advantages’. The free market economy model claims that the whole society will receive material welfare from such international trade, as benefits of economic growth ‘trickle down’ either directly through increased income or indirectly as the increased government revenues are spent on infrastructural development, health, education, etc. Convinced by this theoretical claim, India gradually changed its stance from opponent to proponent of international trade in services during the WTO Uruguay round negotiations. Accordingly, the Indian government’s policy shifted towards capitalising India’s ‘comparative advantage’ in medical tourism, while contending that foreign exchange and revenue earned can be used to subsidise the treatment of poor patients. Thus, promotion of trade liberalisation in hospital services has been viewed as a tool to fulfil the mandate of social justice and promote health equity. However, the present paper argues that, instead, the health inequities have only grown throughout the period of neo-liberal globalisation, while there is no empirical evidence to prove the ‘trickling down’ of any material benefit to the poor resulting from opening up the healthcare sector to privatisation and internationalisation. Moreover, while the Indian health policy shift facilitated the burgeoning of a highly variable private sector, the absence of a comprehensive regulatory framework and a just grievance redress system has resulted in dubious quality and unethical practices in healthcare service provision in both the public and private sectors and inflation in healthcare costs. The paper will conclude with reiterating the importance of healthcare as intrinsic to ‘health capabilities’ imperative for enjoying a meaningful life

International Trade & Health Equity: Have Benefits of Medical Tourism ‘Trickled Down’ to India’s Poor?

This is the final version of the article. Available from the publisher via the link in this record.In the late 20th century, international trade was projected as a tool for development with regard to global, social and political formations. Traditional political economic models claimed wealth generation through ostensibly maximising ‘comparative advantages’. The free market economy model claims that the whole society will receive material welfare from such international trade, as benefits of economic growth ‘trickle down’ either directly through increased income or indirectly as the increased government revenues are spent on infrastructural development, health, education, etc. Convinced by this theoretical claim, India gradually changed its stance from opponent to proponent of international trade in services during the WTO Uruguay round negotiations. Accordingly, the Indian government’s policy shifted towards capitalising India’s ‘comparative advantage’ in medical tourism, while contending that foreign exchange and revenue earned can be used to subsidise the treatment of poor patients. Thus, promotion of trade liberalisation in hospital services has been viewed as a tool to fulfil the mandate of social justice and promote health equity. However, the present paper argues that, instead, the health inequities have only grown throughout the period of neo-liberal globalisation, while there is no empirical evidence to prove the ‘trickling down’ of any material benefit to the poor resulting from opening up the healthcare sector to privatisation and internationalisation. Moreover, while the Indian health policy shift facilitated the burgeoning of a highly variable private sector, the absence of a comprehensive regulatory framework and a just grievance redress system has resulted in dubious quality and unethical practices in healthcare service provision in both the public and private sectors and inflation in healthcare costs. The paper will conclude with reiterating the importance of healthcare as intrinsic to ‘health capabilities’ imperative for enjoying a meaningful life

Escherichia coli contamination and health aspects of soil and tomatoes (Solanum lycopersicum L.) subsurface drip irrigated with on-site treated domestic wastewater.

Faecal contamination of soil and tomatoes irrigated by sprinkler as well as surface and subsurface drip irrigation with treated domestic wastewater were compared in 2007 and 2008 at experimental sites in Crete and Italy. Wastewater was treated by Membrane Bio Reactor (MBR) technology, gravel filtration or UV-treatment before used for irrigation. Irrigation water, soil and tomato samples were collected during two cropping seasons and enumerated for the faecal indicator bacterium Escherichia coli and helminth eggs. The study found elevated levels of E. coli in irrigation water (mean: Italy 1753 cell forming unit (cfu) per 100 ml and Crete 488 cfu per 100 ml) and low concentrations of E. coli in soil (mean: Italy 95 cfu g(-1) and Crete 33 cfu g(-1)). Only two out of 84 tomato samples in Crete contained E. coli (mean: 2700 cfu g(-1)) while tomatoes from Italy were free of E. coli. No helminth eggs were found in the irrigation water or on the tomatoes from Crete. Two tomato samples out of 36 from Italy were contaminated by helminth eggs (mean: 0.18 eggs g(-1)) and had been irrigated with treated wastewater and tap water, respectively. Pulsed Field Gel Electrophoresis DNA fingerprints of E. coli collected during 2008 showed no identical pattern between water and soil isolates which indicates contribution from other environmental sources with E. coli, e.g. wildlife. A quantitative microbial risk assessment (QMRA) model with Monte Carlo simulations adopted by the World Health Organization (WHO) found the use of tap water and treated wastewater to be associated with risks that exceed permissible limits as proposed by the WHO (1.0 × 10(-3) disease risk per person per year) for the accidental ingestion of irrigated soil by farmers (Crete: 0.67 pppy and Italy: 1.0 pppy). The QMRA found that the consumption of tomatoes in Italy was deemed to be safe while permissible limits were exceeded in Crete (1.0 pppy). Overall the quality of tomatoes was safe for human consumption since the disease risk found on Crete was based on only two contaminated tomato samples. It is a fundamental limitation of the WHO QMRA model that it is not based on actual pathogen numbers, but rather on numbers of E. coli converted to estimated pathogen numbers, since it is widely accepted that there is poor correlation between E. coli and viral and parasite pathogens. Our findings also stress the importance of the external environment, typically wildlife, as sources of faecal contamination

Analytical Formulation of the Jacobian Matrix for Non-linear Calculation of the Forced Response of Turbine Blade Assemblies with Wedge Friction Dampers

A fundamental issue in turbomachinery design is the dynamical stress assessment of turbine blades. In order to reduce stress peaks in the turbine blades at engine orders corresponding to blade natural frequencies, friction dampers are employed. Blade response calculation requires the solution of a set of non-linear equations originated by the introduction of friction damping. Such a set of non-linear equations is solved using the iterative numerical Newton-Raphson method. However, calculation of the Jacobian matrix of the system using classical numerical finite difference schemes makes frequency domain solver prohibitively expensive for structures with many contact points. Large computation time results from the evaluation of partial derivatives of the non-linear equations with respect to the displacements. In this work a methodology to compute efficiently the Jacobian matrix of a dynamic system having wedge dampers is presented. It is exact and completely analytical. The proposed methods have been successfully applied to a real intermediate pressure turbine (IPT) blade under cyclic symmetry boundary conditions with underplatform wedge dampers. Its implementation showed to be very effective, and allowed to achieve relevant time savings without loss of precision

Right to Health in GATS: Can The Public Health Exception Pave the Way for Complementarity?

This is the final version. Available on open access from Pace Law School via the link in this recordTrade in health-related services, such as hospital, medical professional and sanitation, have potential to improve health outcomes for Countries. Yet, health-related services are least liberalised services sector under GATS. Reluctance of WTO members can be attributed to the scepticism that GATS restricts the public health policies and their ability to protect, promote and fulfil their right to health obligation as signatory to ICESCR. Examining the specific interaction between the right to health and public health exception in GATS, this paper demonstrates that WTO members can raise public health exception to justify trade-restrictive public health policies aimed at fulfilling the right to health. It argues that good faith and harmonious interpretation of the public health exception in GATS taking into account the right to health not only brings complementarity between international human rights and international trade law regimes but further advances systemic integration and (de)fragmentation of public international law

One step forward or one step back? Autonomy, agency and surrogates in the Indian Surrogacy (Regulation) Bill 2019

This is the final version. Available on open access from Cambridge University Press via the DOI in this recordThe Indian government has recently introduced legislation to regulate ‘altruistic’ surrogacy while banning ‘commercial’ surrogacy amidst the criticism that India has become the ‘baby factory’. In the past decade, academic discourse has raised socioethical and legal issues that surfaced in the unrestricted transnational commercial-surrogacy industry. Most of the literature and ethnographic studies centred on the issues of informed consent, autonomy, decision-making and exploitation. With the proposed legislation, the Indian government has shown its will to regulate surrogacy, including the medical intermediaries as well as the contract between the intending parents and the surrogate mother-to-be. The present paper addresses the legal and socioethical context in which India introduced the Surrogacy (Regulation) Bill 2019. It examines the extent to which the proposed law responds to the legal challenges and socioethical concerns that surfaced in the course of unregulated transnational commercial-surrogacy arrangements in India. It argues that, even though the proposed legislation addresses and responds to some of the legal and ethical concerns such as informed consent and legal parentage, it stops short of ensuring the welfare and well-being of the surrogate. Second, the legal certainty of parentage and the child's rights comes at the cost of the physical and psychological well-being of the surrogate. Finally, it argues that, by presupposing the surrogate as an autonomous agent and yet imposing the requirement of marriage, the Bill overlooks the sociocultural realities of patriarchal hierarchies entrenched in Indian society – that, in its conception of ‘family’, the focus on the ‘traditional’ family not only presents a narrow view of the heteronormative family and perpetuates the patriarchal notions of gender roles, but also fails to take into consideration maternal pluralism in surrogacy arrangements, undermines the modern family and, above all, discriminates against the single person's and lesbian, gay, bisexual, transgender, and queer (LGBTQ) communities’ right to found a family. Since many countries that served as centres for international commercial-surrogacy arrangement (such as Cambodia, Thailand and Nepal) have recently started to take steps to prohibit or limit transnational surrogacy arrangements, the analysis of Indian law in the present paper will provide a useful context within which these countries can effectively regulate surrogacy while safeguarding the surrogate's rights and interests

Can Homes Affect Well-Being? A Scoping Review among Housing Conditions, Indoor Environmental Quality, and Mental Health Outcomes

The purpose of the scoping review is to explore the relationship between housing conditions, indoor environmental quality (IEQ), and mental health implications on human well-being. In fact, time spent at home increased due to the recent COVID-19 lockdown period, and social-sanitary emergencies are expected to grow due to the urbanization phenomenon. Thus, the role of the physical environment in which we live, study, and work, has become of crucial importance, as the literature has recently highlighted. This scoping review, conducted on the electronic database Scopus, led to the identification of 366 articles. This, after the screening processes based on the inclusion criteria, led to the final inclusion of 31 papers related specifically to the OECD area. The review allowed the identification of five housing conditions [house type, age, and floor level; housing qualities; household composition; neighborhood; green spaces] that, by influencing the IEQ parameters, had impacts on the mental health outcomes addressed. By synthesizing the contributions of the review, a list of design recommendations has been provided. These will serve as a basis for future researchers, from which to develop measures to reduce inequalities in housing by making them healthier, more resilient, and salutogenic

Design considerations for a new generation of SiPMs with unprecedented timing resolution

The potential of photon detectors to achieve precise timing information is of increasing importance in many domains, PET and CT scanners in medical imaging and particle physics detectors, amongst others. The goal to increase by an order of magnitude the sensitivity of PET scanners and to deliver, via time-of-flight (TOF), true space points for each event, as well as the constraints set by future particle accelerators require a further leap in time resolution of scintillator-based ionizing radiation detectors, reaching eventually a few picoseconds resolution for sub MeV energy deposits. In spite of the impressive progress made in the last decade by several manufacturers, the Single Photon Time Resolution (SPTR) of SiPMs is still in the range of 70-120ps FWHM, whereas a value of 10ps or even less would be desirable. Such a step requires a break with traditional methods and the development of novel technologies. The possibility of combining the extraordinary potential of nanophotonics with new approaches offered by modern microelectronics and 3D electronic integration opens novel perspectives for the development of a new generation of metamaterial-based SiPMs with unprecedented photodetection efficiency and timing resolution.Comment: 16 pages, 6 figures, submitted to JINS

Challenges in IAQ for Indoor Spaces: A Comparison of the Reference Guideline Values of Indoor Air Pollutants from the Governments and International Institutions

Since people spend most of their time inside buildings, indoor air quality (IAQ) remains a highlighted topic to ensure in the built environment to improve public health, especially for vulnerable users. To achieve a better indoor environment quality (IEQ), some countries’ governments or regional institutions have developed and published reference guideline values of various air pollutants to prevent the IAQ from becoming adverse to occupants. Beyond guidelines by World Health Organization (WHO), in some countries, there are specific institutional requirements on the IAQ, and others integrated it into the building regulation for the built environment. This paper is based on the literature research, summarized from previously conducted works by the authors, on the chemical reference values of IAQ-related regulations and guidelines published by several Governments or related institutions from various regions around the World. Despite these efforts at standardization and legislation, many indoor air quality monitoring activities conducted in several countries still fall short of the main indications produced. By comparing the reference values of 35 pollutants, both physical and chemical ones, which are proposed in documents from 23 regions included so far, the IAQ research and prevention actions on progress in different regions should be included in monitoring plans with guidelines/reference values in their current state. The outcome of the paper is to define the current trends and suggest some perspectives on the field of interest for improving the indoor air quality of generic spaces at an international level. It becomes evident that, at the global level, IAQ represents a complex political, social, and health challenge, which still suffers from the absence of a systematic and harmonized approach. This is not a new situation; the issue was raised more than 40 years ago, and despite efforts and a pandemic, the situation has not changed

Disk wakes in nonlinear stratification

Nonlinearity of density stratification modulates buoyancy effects. We report results from a body-inclusive large eddy simulation (LES) of a wake in nonlinear stratification, specifically for a circular disk at diameter-based Reynolds number ($Re$) of $5000$. Five density profiles are considered; the benchmark has linear stratification and the other four have hyperbolic tangent profiles to model a pycnocline. The disk moves inside the central core of the pycnocline in two of those four cases and, in the other two cases with {a} shifted density profile, the disk moves partially/completely outside the pycnocline. The maximum buoyancy frequency ($N_{max}$) for all the profiles is the same. The first part of the study investigates the centered cases. Nonuniform stratification results in increasing wake turbulence relative to the benchmark owing to reduced suppression of turbulence production as well as the wave trapping in the pycnocline. Steady lee waves are also quantified to understand limitations of linear theory. The second part pays attention to the effect of a relative shift between the pycnocline and the disk. The wake defect velocity decays faster in the cases with a shift. The effect of disk location on the Kelvin wake waves (a family of steady waves within the pycnocline) and its modal form is obtained and explained by solving the Taylor-Goldstein equation. The family of unsteady internal gravity waves that are generated by the wake is also studied and the effect of disk shift is quantified.Comment: 23 pages, 15 plots, submitted to Journal of Fluid Mechanic