Conceptualising fairness: three pillars for medical algorithms and health equity

ObjectivesFairness is a core concept meant to grapple with different forms of discrimination and bias that emerge with advances in Artificial Intelligence (eg, machine learning, ML). Yet, claims to fairness in ML discourses are often vague and contradictory. The response to these issues within the scientific community has been technocratic. Studies either measure (mathematically) competing definitions of fairness, and/or recommend a range of governance tools (eg, fairness checklists or guiding principles). To advance efforts to operationalise fairness in medicine, we synthesised a broad range of literature.MethodsWe conducted an environmental scan of English language literature on fairness from 1960-July 31, 2021. Electronic databases Medline, PubMed and Google Scholar were searched, supplemented by additional hand searches. Data from 213 selected publications were analysed using rapid framework analysis. Search and analysis were completed in two rounds: to explore previously identified issues (a priori), as well as those emerging from the analysis (de novo).ResultsOur synthesis identified ‘Three Pillars for Fairness’: transparency, impartiality and inclusion. We draw on these insights to propose a multidimensional conceptual framework to guide empirical research on the operationalisation of fairness in healthcare.DiscussionWe apply the conceptual framework generated by our synthesis to risk assessment in psychiatry as a case study. We argue that any claim to fairness must reflect critical assessment and ongoing social and political deliberation around these three pillars with a range of stakeholders, including patients.ConclusionWe conclude by outlining areas for further research that would bolster ongoing commitments to fairness and health equity in healthcare.

The Challenge of Sustainability of High-Cost Oncological Drugs: A Budgeting Model in an Italian Cancer Center

In Italy, drug expenditure governance is achieved by setting caps based on the percentage increase in hospital spending compared to the previous year. This method is ineffective in identifying issues and opportunities as it does not consider an analysis of the number of treated cases and per capita consumption in local and regional settings. The IRCCS (Scientific hospitalization and treatment institute) Istituto Romagnolo per lo Studio dei Tumori (IRST) “Dino Amadori” in Meldola, has developed and adopted an effective management model designed to oversee pharmaceutical expenditure, guarantee prescription appropriateness and quality of care to patients. The budget setting follows a structured process which evaluates determining factors of the expenditure such as expected patients calculated according to the epidemiology and to national and regional indications of appropriateness, mean cost per patient calculated on the average period of demonstrated efficacy of the drug and use of drugs with the best cost-effectiveness ratio. Strict monitoring and integrated purchasing processes allow for immediate corrective actions on expenditures, as well as a continuous dialogue with the region in order to guarantee consistent funding of IRST activities. The model, presented in this article is efficient and implements concepts beyond the conventional “silos” approach and national and regional governance tools, in terms of patient centricity.

The Role of Public Art in Solar Commons Institution-Building: Community Voices from an Essential Partnership among Artists, Community Solar Researchers, and Activists

In this urgent decade when American democracy faces the challenge of decarbonizing the U.S. electric grid and assuring that the economic benefits of our energy transition are equitably shared, many solar energy researchers and activists are searching for new ways to partner with the civic sector. Instead of treating energy users as passive customers, experts understand the importance of engaging community as active decision-makers, beneficiaries, and communicators for a just energy transition. Distributed solar technology offers more democratic potential than small savings on individuals’ electric bills. Energy experts working on the Solar CommonsÔ community solar model at the University of Minnesota are piloting demonstration projects with community partners in Arizona and Minnesota. These solar commons aggregate savings through power purchase agreements that create 25-year peer-governed revenue streams to support mutual aid and reparative justice work in neighborhoods. This article describes a Solar Commons research project in Arizona, with a conversation among the public artists who partnered with the legal research team to co-create communication and peer governance tools that will allow DIY Solar Commons to iterate throughout the US as a new institution in our civic sector. Images of the Solar Commons public art demonstrate how the artists helped expand the vision of solar energy from the iconic individual solar panel to a technology embedded in community justice and in a complex human-more-than-human environment.

Rigenerazione urbana e paesaggio. Il caso di San Severo

The Municipality of San Severo has implemented the Regional Territorial Landscape Plan of Apulia at local level through a participatory process that, with the contribution of literature (poetry in particular), has involved experts, designers, teenagers, as well as associations operating in cultural, social, environmental and productive fields. Through the adaptation of the General Urban Plan to the PPTR, the implementation at local level of the Territorial Projects constituting the Strategic Scenario of the Regional Plan and the improvement of the governance tools aimed at involving the city and the territory, the contents and the methodology of the Mosaic Charter emerged as a strategy of protection and valorisation of the “Mosaic of San Severo”, that aims at identifying the territory.

“Force Majeure”: The Transformation of Cultural Strategy as a Result of Urban Shrinkage and Economic Crisis. The Case of Riga, Latvia

Cultural strategies have been commonly used to address the consequences of urban shrinkage, particularly in a post-industrial context. Proliferated growth-oriented models, such as “creative city,” have threatened the sustainable development of shrinking cities. Alternative cultural models that prioritize social inclusion, local sensitivity, and affordability are thus urgently needed. Using Riga as a case study, this paper explores the process of transformation to an alternative cultural strategy in a post-socialist shrinking city and identifies planning and governance tools that stimulate its development. Employing qualitative interviews and document analysis, the relations between emergent and deliberate cultural strategies are investigated. The results show how the organization of the European Capital of Culture 2014 during the severe shrinkage and economic crisis led to five elements of an alternative cultural strategy: (1) a shift from investing in cultural “hardware” to “software,” (2) a locally sensitive approach, (3) cultural decentralization, (4) strengthened civic engagement, and (5) inclusiveness. These elements of an emergent strategy were recognized by local authorities and stimulated changes in the deliberate cultural strategy. This study supports the idea that urban shrinkage offers municipalities an opportunity to reimagine traditional planning practices and emphasizes the important role of civic actors’ participation in coproducing public services and governance strategies.

A Business Model Fast Track on Energy Communities—Key Lessons Learned from H2020 EU Projects

Developing business models for energy communities means that community-based values and goals are to be taken seriously. This paper presents how several European Horizon projects attempt to do so, highlighting the key issues and challenges encountered. The various projects also show diverse ways to support energy community BMs, developing and demonstrating both technological as well as governance tools and support. What all projects point out is that energy communities lack (financial, knowledge, relational) resources, and that the current local, regional and national market and policy frameworks are not conducive for energy community BMs.

An Introduction to Climate-Smart Forestry in Mountain Regions

The goal to limit the increase in global temperature below 2 °C requires reaching a balance between anthropogenic emissions and reductions (sinks) in the second half of this century. As carbon sinks, forests can potentially play an important role in carbon capture. The Paris Agreement (2015) requires signatory countries to reduce deforestation, while conserving and enhancing carbon sinks. Innovative approaches may help foresters take up climate-smart management methods and identify measures for scaling purposes. The EU’s funding instrument COST has supported the Action CLIMO (Climate-Smart Forestry in Mountain Regions – CA15226), with the aim of reorienting forestry in mountain areas to challenge the adverse impacts of climate change.Funded by the EU’s Horizon 2020, CLIMO has brought together scientists and experts in continental and regional focus assessments through a cross-sectoral approach, facilitating the implementation of climate objectives. CLIMO has provided scientific analysis on issues including criteria and indicators, growth dynamics, management prescriptions, long-term perspectives, monitoring technologies, economic impacts, and governance tools. This book addresses different combinations of CLIMO’s driving/primary objectives and discusses smarter ways to develop forestry and monitor forests under current environmental changes, affecting forest ecosystems.

Sustainable Supply Chain Management: Insights from Australia’s Firms

While the sustainable supply chain is an emergent area of interest, the literature provides little guidance on how best to carry out sustainable supply chain management. The purpose of this paper is to provide hints to businesses on how best to approach the challenge of developing a sustainable supply chain. Hence, the case studies method is undertaken to explore how Australia’s companies that are prominent worldwide for their sustainability performance have approached the challenge of managing sustainability in their supply chain. This study finds that sustainability action plans and governance tools that rightly reflect requisites for suppliers, diverse evaluation means to measure the suppliers’ performance, and regular reviews of sustainable supply chain management practices and policies enable businesses to manage sustainability in their supply chain. The study contributes to the literature by providing a best practice model from the findings to provide practical guidance to businesses.