The value of other people's health: individual models and motives for helping

This thesis was motivated by a wish to understand the slow response to HIV/AIDS and so seeks to address the questions of why and when people help others. The questions are important, as typically it is others who decide who among those most in need receive help. To narrow the focus to motives of help, the discussions consider the helping of distant others, as typically such actions do not involve material gain to the helper. Related literature exists on charitable behaviour but tends towards a marketing approach. This limits its use in providing specific input regarding motives. The economics literature is far more specific and a review identifies four groups of models. These models have a number of weaknesses, so an alternative is suggested: the balance model, and a responsibility formulation, is proposed for this and existing models, which, it is argued, assist in addressing the questions. Following on from the identification and development of alternative theoretical frameworks, these options are taken through a process of attrition. They are contrasted with evidence and theory from the psychology literature - first on helping and then on harming. This exercise suggests the relative strength of the balance model and the maintenance of a responsible self-image model. Both deal well with explaining how help differs according to context and how individuals might avoid or deliberately misinterpret information. The balance model is used to examine individual helping behaviour, by way of an economic experiment. The model is then expanded to consider the social context, which allows for the consideration of the HIV response. The theoretical discussions and the experimental results suggest that individuals feel a responsibility to help. They can, however, try to avoid information which may prompt such feelings and manipulate themselves to reduce the pressure such feelings place on them to help

Desmond Chris- Callison College One Pager

https://scholarlycommons.pacific.edu/callison-college-sis/1024/thumbnail.jp

The dual role of income in the spread of HIV in Africa.

Thesis (M.Com.)-University of Natal, Durban, 2002.Every day more people in Africa are infected with HIV despite prevention efforts. These new infections and those already infected are not evenly spread throughout the continent. Substantial variations in HIV prevalence exist within and between countries. Understanding these variations helps understand what is driving the epidemic and this understanding in turn helps in the design of more appropriate interventions to prevent its further spread. This thesis builds on existing work by attempting to develop a more comprehensive theory of what role income plays in the spread of HIV. To this end the Theory of the Dual Role of Income in the Spread of HIV is outlined and explained. It uses the concepts of relative and absolute income, borrowed from elsewhere in the health economics literature, to separate the different effects income has on individual and group risk of HIV infection. The theory hypothesises that, while higher levels of absolute income (income independent of others) offer protection against infection via better access to health care and information, higher relative income (the income of an individual relative to other members of their social or reference group) increases risk of infection either as a result of more sexual partners or higher risk partners. The theory in no way argues that HIV infections are not related to poverty, but rather that the relationship is, somewhat more complicated and non-linear than often suggested. The explanatory power of the theory is examined with the use primarily of two data sets: firstly using data collected from antenatal clinics in two South African provinces linked with census data and secondly with data on a large South African company. While these data are not ideal, the results from the analysis are in line with the expectations based on the theory. The theory and the results of the analysis presented in this thesis support the argument that environments in which decisions are made and actions taken are important in determining risk of HIV infection. This argument suggests that prevention efforts need to do more then provide information

Decision-making strategies: ignored to the detriment of healthcare training and delivery?

Context: People do not always make health-related decisions which reflect their best interest – best interest being defined as the decision they would make if they carefully considered the options and fully understood the information available. A substantial literature has developed in behavioral economics and social psychology that seeks to elucidate the patterns in individual decision-making. While this is particularly relevant to healthcare, the insights from these fields have only been applied in a limited way. To address the health challenges of the twenty-first century, healthcare providers and healthcare systems designers need to more fully understand how individuals are making decisions. Methods:: We provide an overview of the theories of behavioral economics and social psychology that relate to how individuals make health-related decisions. The concentration on health-related decisions leads to a focus on three topics: (1) mental shortcuts and motivated reasoning; (2) implications of time; and (3) implications of affect. The first topic is relevant because health-related decisions are often made in a hurry without a full appreciation of the implications and the deliberation they warrant. The second topic is included because the link between a decision and its health-related outcomes can involve a significant time lag. The final topic is included because health and affect are so often linked. Findings:: The literature reviewed has implications for healthcare training and delivery. Selection for medical training must consider the skills necessary to understand and adapt to how patients make decisions. Training on the insights garnered from behavioral economics and social psychology would better prepare healthcare providers to effectively support their clients to lead healthy lives. Healthcare delivery should be structured to respond to the way in which decisions are made. Conclusions:: These patterns in decision-making call into question basic assumptions our healthcare system makes about the best way to treat patients and deliver care. This literature has implications for the way we train physicians and deliver care

American Cyber Insecurity: The growing danger of cyber attacks

This paper aims to advise American policy makers on a correct course of action regarding the advent of cyber warfare. Cyber-attacks have become ubiquitous in the 21st century and pose a direct threat to the safety of American interests abroad and domestically. Beginning with an analysis of the history and lessons from past cyber conflicts this paper moves on to proscribe a set of actions to protect American security in the 21st century. We conclude that the current legal framework for evaluating cyber-attacks needs to be re-framed in a manner more conducive to American interests.Winner of the 2014 Alona E. Evans Prize, a Duke Political Science award for the undergraduate or graduate student(s) whose paper on international law best reflects excellence in scholarshi

Universal molecular screening does not effectively detect Lynch syndrome in clinical practice

Background: Lynch syndrome (LS) due to an inherited damaging mutation in mismatch repair (MMR) genes comprises 3% of all incident colorectal cancer (CRC). Molecular testing using immunohistochemistry (IHC) for MMR proteins is a recommended screening tool to identify LS in incident CRC. This study assessed outcomes of population-based routine molecular screening for diagnosis of LS in a regional center. Methods: We conducted a prospective, consecutive case series study of universal IHC testing on cases of resected CRC from September 2004–December 2013. Referred cases with abnormal IHC results that attended a familial cancer clinic were assessed according to modified Bethesda criteria (until 2009) or molecular criteria (from 2009). Results: 1612 individuals underwent resection for CRC in the study period and had MMR testing by IHC. Of these, 274 cases (16.9%) exhibited loss of expression of MMR genes. The mean age at CRC diagnosis was 68.1 years (± standard deviation 12.7) and the mean age of those with an IHC abnormality was 71.6 (± 11.8). A total of 82 (29.9%) patients with an abnormal result were seen in a subspecialty familial cancer clinic. Patients aged under 50 (p = 0.009) and those with loss of MSH6 staining (p = 0.027) were more likely to be referred and to attend. After germ-line sequencing, 0.6% (10 of 82) were identified as having a clinically significant abnormality. A further eight probands with pathogenic germ-line mutations were identified from other referrals to the service over the same time period. Conclusions: While technically accurate, the yield of ‘universal’ IHC in detecting new Lynch probands is limited by real-world factors that reduce referrals and genetic testing. We propose an alternative approach for universal, incident case detection of Lynch syndrome with ‘one-stop’ MMR testing and sequencing.This work was supported by a grant from the Canberra Hospital Private Practice Fund (to DT)

Does foreign aid crowd out government investments? Evidence from rural health centres in Rwanda

Background: Rural healthcare facilities in low-income countries play a major role in providing primary care to rural populations. We examined the link of foreign aid with government investments and medical service provision in rural health centres in Rwanda. Methods: Using the District Health System Strengthening Tool, a web-based database built by the Ministry of Health in Rwanda, we constructed two composite indices representing provision of (1) child and maternal care and (2) HIV, tuberculosis (TB) and malaria services in 330 rural health centres between 2009 and 2011. Financing variables in a healthcare centre included received funds from various sources, including foreign donors and government. We used multilevel random-effects model in regression analyses and examined the robustness of results to a range of alternative specification, including scale of dependent variables, estimation methods and timing of aid effects. Findings: Both government and foreign donors increased their direct investments in the 330 rural healthcare centres during the period. Foreign aid was positively associated with government investments (0.13, 95% CI 0.06 to 0.19) in rural health centres. Aid in the previous year was positively associated with service provision for child and maternal health (0.008, 95% CI 0.002 to 0.014) and service provision for HIV, TB and malaria (0.014, 95% CI 0.004 to 0.022) in the current year. The results are robust when using fixed-effects models. Conclusions: These findings suggest that foreign aid did not crowd out government investments in the rural healthcare centres. Foreign aid programmes, conducted in addition to government investments, could benefit rural residents in low-income countries through increased service provision in rural healthcare facilities