Access to health care and social protection

In France, the access to healthcare has been conceived as a social right and is mainly managed through the coverage of the population by the National Health Insurance, which is a part of the whole French social security scheme. This system was based on the so-called Bismarckian model, which implies that it requires full employment and solid family links, as the insured persons are the workers and their dependents. This paper examines the typical problems that this system has to face as far as the right to healthcare is concerned. First, it addresses the need to introduce some universal coverage programs, in order to integrate the excluded population. Then, it addresses the issue of financial sustainability as the structural weakness of the French system--in which healthcare is still mainly provided by private practice physicians and governed by the principle of freedom--leads to conceive and implement complex forms of regulations between the State, the Social security institutions and the healthcare providers.     

The Head,the Heart,and the Community: Piloting a Brief Home-Based Mindfulness Intervention for Couples With Low Income

Although mindfulness is documented to reduce both individual and relationship stress and has the flexibility to be taught anywhere (e.g., at home, clinic setting, etc.), research examining mindfulness interventions among individuals with low income and economic marginalization (LIEM; APA, 2019), or persons whose economic position negatively impacts their health or well-being due to factors such as access to healthcare, is limited. To address this gap, the author and colleagues used Community Based Participatory Research methods to develop a brief, couple-based, mindfulness intervention tailored for communities with LIEM (see Lenger et al., 2022). The present study tested this newly developed brief, couple-based, mindfulness intervention's effectiveness in improving individual and relationship health through 1- and 2-months post-intervention. The intervention was piloted on a sample of 39 couples with an overrepresentation of couples with LIEM. To improve access to care, couples could participate in their home or a variety of local clinics. Thirty-nine couples received the intervention and completed assessments on mindfulness, depression, anxiety, stress, relationship satisfaction, and communication at baseline, 1-month, and 2-months post-intervention. Results revealed that mindfulness, depression, and relationship satisfaction improved from baseline to 1-month post-intervention. Mindfulness improved at a greater rate for couples with LIEM relative to couples with higher incomes. From baseline to 2-months post-intervention, depression and stress significantly improved at similar rates for couples with higher income and couples with LIEM. Thus, this study indicates that mindfulness can be taught in a brief, two-session format, and can have favorable outcomes on individual and relationship functioning.     

Dismantling institutional racism: theory and action

Despite a strong commitment to promoting social change and liberation, there are few community psychology models for creating systems change to address oppression. Given how embedded racism is in institutions such as healthcare, a significant shift in the system's policies, practices, and procedures is required to address institutional racism and create organizational and institutional change. This paper describes a systemic intervention to address racial inequities in healthcare quality called dismantling racism. The dismantling racism approach assumes healthcare disparities are the result of the intersection of a complex system (healthcare) and a complex problem (racism). Thus, dismantling racism is a systemic and systematic intervention designed to illuminate where and how to intervene in a given healthcare system to address proximal and distal factors associated with healthcare disparities. This paper describes the theory behind dismantling racism, the elements of the intervention strategy, and the strengths and limitations of this systems change approach.     

Water Crisis Adaptation: Defending a Strong Right Against Displacement from the Home

This essay defends a strong right against displacement as part of a basic individual right to secure access to one’s home. The analysis is purposefully situated within the difficult context of climate change adaptation policies. Under increasing environmental pressures, especially regarding water security, there are weighty reasons motivating the forced displacement of persons—to safeguard water resources or prevent water-related disasters. Even in these pressing circumstances, I argue, individuals have weighty rights to secure access to their homes. I explain how the home provides a functional context for conditions of autonomous agency. Being coerced from the home disrupts and subverts the conditions necessary for autonomous processes. I conclude by suggesting that the right to the home could be a foundational element of territorial rights.     

Hobbesian Right to Healthcare

Over the last few years we have had a debate regarding the role of government in providing healthcare. There has been a question as to whether or not the state's proper role requires protection of its subjects from the calamities associated with a lack of healthcare. In this article, I will argue that straightforward Hobbesian principles require the state to provide healthcare. It might seem odd (or, at the very least, anachronistic) that such a positive right can be justified by a philosopher who famously conceives of individuals as motivated by self‐interest. Nonetheless, Hobbes's political theory provides the framework for such a right.     

Risk,Uncertainty, and Gender Stereotypes in Healthcare Decisions

Disparities in healthcare access, treatment, and outcomes are widely prevalent for women and minorities. At the same time, healthcare choices have become increasingly intricate and correspondingly uncertain. We review contemporary issues in healthcare for women, with emphasis on access to care and on healthcare disparities. In the belief that forewarned is forearmed, we review the role of sexism and the psychology of decision making in producing health disparities. In the face of this complexity, therapists can help women seek sound healthcare and make informed choices. Implications for feminist therapy are suggested that emphasize client empowerment and agency.     

Why Hope is not a Moral Virtue: Aquinas's Insight

There is a growing consensus among philosophers that hope is a moral virtue: the virtuously hopeful person experiences the right amount of hope for the right things. This moralization of hope presents us with a puzzle. The historical consensus is that hope is a passion and hope is a theological virtue, not a moral virtue. Thomas Aquinas, the philosopher who wrote most extensively on hope, offers an explanation for why hope is not a moral virtue. The aim of this paper is argue that Aquinas is right in thinking that hope is not a moral virtue. 1     

Revisiting the God/World Difference

On what basis do we distinguish God from the world? I argue that the doctrine of creation, more specifically the analogical notion of causa , supplies a salutary foundation. My conversation partners are Karl Barth and Thomas Aquinas. I take up the former's five conditions for a right theological use of causa , demonstrating that despite his basic misreading of Thomas, both theologians share some basic convictions regarding God's independence. I argue, moreover, that Thomas provides a more theologically satisfying anchor for what distinguishes God from what is not God. I conclude by reflecting on the importance of experience in articulating the distinction.     

We are not a Healthcare Business: Our Inadvertent Vow of Poverty

Psychology has been fractionated from mainstream healthcare delivery and this schism has resulted in huge costs to psychologists and our intended customers. Psychology has also been naïve economically. The authors suggest three revolutions: (1) for clinical psychology to be better integrated into the healthcare delivery system; (2) for psychologists to better understand healthcare economics and business; and (3) for psychologists to become more entrepreneurial, i.e., see needs in healthcare (such as those of the elderly, obesity, improved access and value through ehealth) and systematically fill these. We note high quality businesses help many individuals (customers, family members, employees) not typically recognized by anti-business psychologists.     

Reducing Youth Access to Alcohol: Findings from a Community-Based Randomized Trial

Underage drinking continues to be an important public health problem and a challenge to the substance abuse prevention field. Community-based interventions designed to more rigorously control underage access to alcohol through retailer education and greater enforcement of underage drinking laws have been advocated as potentially effective strategies to help address this problem, but studies designed to evaluate such interventions are sparse. To address this issue we conducted a randomized trial involving 36 communities to test the combined effectiveness of five interrelated intervention components designed to reduce underage access to alcohol. The intervention was found to be effective in reducing the likelihood that retail clerks would sell alcohol to underage-looking buyers, but did not reduce underage drinking or the perceived availability of alcohol among high school students. Post hoc analyses, however, revealed significant associations between the level of underage drinking law enforcement in the intervention communities and reductions in both 30-day use of alcohol and binge drinking. The findings highlight the difficulty in reducing youth drinking even when efforts to curtail retail access are successful. Study findings also suggest that high intensity implementation of underage drinking law enforcement can reduce underage drinking. Any such effects of enhanced enforcement on underage drinking appear to be more directly attributable to an increase in perceived likelihood of enforcement and the resultant perceived inconveniences and/or sanctions to potential drinkers, than to a reduction in access to alcohol per se.     

Examining the initial usability,acceptability and feasibility of a digital mental health intervention for college students in India

Generalised anxiety disorder (GAD) is prevalent among college students in India; however, barriers like stigma, treatment accessibility and cost prevent engagement in treatment. Web- and mobile-based, or digital, mental health interventions have been proposed as a potential solution to increasing treatment access. With the ultimate goal of developing an engaging digital mental health intervention for university students in India, the current study sought to understand students' reactions to a culturally and digitally adapted evidence-based cognitive behavioural therapy (CBT) for GAD intervention. Specifically, through theatre testing and focus groups with a non-clinical sample of 15 college students in India, the present study examined initial usability, acceptability and feasibility of the “Mana Maali Digital Anxiety Program.” Secondary objectives comprised identifying students' perceived barriers to using the program and eliciting recommendations. Results indicated high usability, with the average usability rating ranking in the top 10% of general usability scores. Participants offered actionable changes to improve usability and perceived acceptability among peers struggling with mental health issues. Findings highlight the benefits of offering digital resources that circumvent barriers associated with accessing traditional services. Results build on existing evidence that digital interventions can be a viable means of delivering mental healthcare to large, defined populations.     

Making Lemonade out of Lemons: Dialectical Behavior Therapy via Telehealth During a Pandemic

The COVID-19 pandemic has created a burden on healthcare systems and increased demand for mental healthcare at a time when in-person services are limited. Many programs offering dialectical behavior therapy (DBT) for complex clients have pivoted to telehealth in order to increase access to critical mental healthcare. There is, however, limited research on the provision of telehealth treatment for clients with complex psychopathology more broadly, or the telehealth implementation of DBT more specifically. The aim of this study was to examine the use of telehealth services and related clinician attitudes and experiences in the context of DBT. We examined the degree of telehealth platform adoption among DBT clinicians, as well as changes in stress and self-care strategies. A supplemental aim was to gather clinicians’ recommendations for providing DBT via telehealth. Participants included N = 99 DBT practitioners (79.8% female; 20.2% male). Qualitative and quantitative methods were used for data analysis. Findings show that telehealth DBT has been widely adopted among DBT clinicians, and that clinicians’ attitudes to telehealth DBT are cautiously optimistic. Participants described three main areas of stress associated with DBT via telehealth provision, as well as lost and novel self-care strategies.     

Why Philosophy Abides for Aquinas

In Truth in Aquinas Catherine Pickstock and John Milbank continue Radical Orthodoxy's 'reinterpretation' of the history of philosophy and theology by evaluating philosophy as metaphysics so that 'metaphysics collapses into sacra doctrina ' in Thomas Aquinas. Their strategy for saving Aquinas from Heideggerian 'onto-theology' is the opposite of that Jean-Luc Marion who in 'Saint Thomas d'Aquin et l'onto-théo-logie' keeps philosophy and metaphysics distinct from sacred teaching. The article examines some of the questions involved by reconsidering the nature of philosophy as textual commentary in late Antiquity and in the Middle Ages. It goes on to examine what Aquinas means by 'the truth of things', and concludes by looking at how he treats the aspects of metaphysics and the relation of metaphysics and sacra doctrina . Hankey judges that Marion is right on this question. The author suggests that what is involved with Milbank and Pickstock is not a reinterpretation of Aquinas. What they have written depends on mistakes and misrepresentations of basic points in his teaching, e.g, participation, intellectual intuition and abstractions, God's being and his existence in things, with the result that Thomas looks more like Descartes or Spinoza than himself.     

Implementing a Virtual Health Telemedicine Program in a Community Setting

Aurora Health Care in eastern Wisconsin has a clinical genetics program driven by genetic counselors in the cancer/adult and prenatal genetics settings. In 2015, the workforce shortage of genetic counselors left us with 4 open positions for genetic counselors that we were unable to fill. We explored many models of alternative service delivery, and determined virtual health (VH) via telemedicine to be the best option for our system. Historically, telemedicine technologies have been used to provide access to healthcare services to patients in remote areas. We, however, were struggling to find genetics counselors to staff both our remote clinics and urban clinics. To solve this problem, we recruited genetic counselors from across the country to work remotely from their current home or home office utilizing VH to staff our clinics. We then created clinical workflows and an implementation process of virtual health for 9 prenatal and cancer clinics across the eastern Wisconsin footprint of our healthcare system over the course of 12 months. Here we provide our experience and process in establishing a VH program in order to help other institutions that have been affected by the workforce shortage of clinical genetics professionals.     

Equality,Bias, and the Right to an Equal Say

Philosophia - Thomas Christiano argues that democracies acquire a right to rule by being the unique embodiment of publicly accessible rules. Justice requires the equal advancement of the interests...     

Counsellor-delivered HIV risk reduction intervention addresses safer sex barriers of people living with HIV in KwaZulu-Natal, South Africa

This study developed an HIV risk reduction intervention for people living with HIV (PLWH) obtaining care at primary healthcare clinics in KwaZulu-Natal, South Africa by (1) conducting elicitation research to understand the dynamics of risk behaviour among PLWH, (2) modifying an existing HIV risk reduction intervention based on research findings and (3) conducting a pilot study to evaluate feasibility, acceptability and fidelity of the modified intervention implemented by trained lay counsellors at a rural clinic in KwaZulu-Natal. A total of 61 healthcare providers and 77 HIV+ patients from four primary healthcare clinics participated in 14 focus groups and 20 individual interviews to identify informational, motivational and behavioural skills (IMB) factors contributing to PLWH's sexual risk behaviour. Elicitation research findings were incorporated into a revised version of Options for Health, an evidence-based risk reduction intervention for PLWH in clinical care. In a 5-day training, lay counsellors learned strategies to address IMB barriers to safer sex identified in elicitation research. The revised intervention, which was implemented by six counsellors with 39 patients, was feasible to implement, acceptable to patients and counsellors, and implemented with good fidelity. This study makes an important contribution towards development of a theory-based HIV risk reduction intervention for PLWH linking prevention with treatment in South Africa.     

Effectiveness of virtual reality distraction during a painful medical procedure in pediatric oncology patients

The effectiveness of virtual reality (VR) as a behavioral intervention designed to decrease distress during port access procedure was examined in 20 7- to 14-year-old pediatric oncology patients. Children were randomized to either engage in an immersive VR environment during the procedure or to a no VR control condition. Children's distress was assessed through subjective self-ratings and objective physiological and behavioral ratings. Narrative accounts of the experience were used as a measure of how well the child coped with the procedure. VR was effective in reducing children's distress on all measures. Implications of these findings for intervention are discussed.     

Counsellor-delivered HIV risk reduction intervention addresses safer sex barriers of people living with HIV in KwaZulu-Natal,South Africa

This study developed an HIV risk reduction intervention for people living with HIV (PLWH) obtaining care at primary healthcare clinics in KwaZulu-Natal, South Africa by (1) conducting elicitation research to understand the dynamics of risk behaviour among PLWH, (2) modifying an existing HIV risk reduction intervention based on research findings and (3) conducting a pilot study to evaluate feasibility, acceptability and fidelity of the modified intervention implemented by trained lay counsellors at a rural clinic in KwaZulu-Natal. A total of 61 healthcare providers and 77 HIV+ patients from four primary healthcare clinics participated in 14 focus groups and 20 individual interviews to identify informational, motivational and behavioural skills (IMB) factors contributing to PLWH's sexual risk behaviour. Elicitation research findings were incorporated into a revised version of Options for Health, an evidence-based risk reduction intervention for PLWH in clinical care. In a 5-day training, lay counsellors learned strategies to address IMB barriers to safer sex identified in elicitation research. The revised intervention, which was implemented by six counsellors with 39 patients, was feasible to implement, acceptable to patients and counsellors, and implemented with good fidelity. This study makes an important contribution towards development of a theory-based HIV risk reduction intervention for PLWH linking prevention with treatment in South Africa.     

A randomised controlled trial of a brief online mindfulness-based intervention

ObjectivesThere is growing evidence that mindfulness has positive consequences for both psychological and physical health in both clinical and non-clinical populations. The potential benefits of mindfulness underpin a range of therapeutic intervention approaches designed to increase mindfulness in both clinical and community contexts. Self-guided mindfulness-based interventions may be a way to increase access to the benefits of mindfulness. This study explored whether a brief, online, mindfulness-based intervention can increase mindfulness and reduce perceived stress and anxiety/depression symptoms within a student population.MethodOne hundred and four students were randomly allocated to either immediately start a two-week, self-guided, online, mindfulness-based intervention or a wait-list control. Measures of mindfulness, perceived stress and anxiety/depression were administered before and after the intervention period.ResultsIntention to treat analysis identified significant group by time interactions for mindfulness skills, perceived stress and anxiety/depression symptoms. Participation in the intervention was associated with significant improvements in all measured domains, where no significant changes on these measures were found for the control group.ConclusionsThis provides evidence in support of the feasibility and effectiveness of shorter self-guided mindfulness-based interventions. The limitations and implications of this study for clinical practice are discussed.