Dignity and development

This paper explores how expanding the notion of informal institutions in the broader institutional framework provides a more complete explanation for development. Specifically, I incorporate McCloskey's notion of ‘dignity and liberty’ as part of the institutional nexus. By doing so, a richer explanation and understanding of the importance of institutions in explaining different economic outcomes is offered. Focusing on bourgeois dignity offers a precise mechanism to explain how institutions matter to support economic growth. In addition, analyzing the changing attitudes toward the bourgeoisie provides a specific example of mechanisms that can lead to institutional change.     

Influence Measures Based on Cressie-Read Divergence Measures in Multivariate Linear Model

We define a new family of influence measures based on the divergence measures, in the multivariate general linear model. Influence measures are obtained by quantifying the divergence between the sample distribution of an estimate obtained with all the observations and the sample distribution of the same estimate obtained without any observation. This approach is applied to best linear unbiased estimates of estimable functions. Therefore, these diagnostics can be applied to every statistical multivariate technique that can be formulated like this kind of model. Some examples are considered to clarify the applicability of the introduced diagnostics.     

The Value of Trust: An Analysis of Social Capital in Natural Areas

This paper defines and analyses the characteristics of social trust that develop in natural areas, examining the connections and interactions between the people and institutions involved. It offers a deeper understanding of the different degrees of trust and the identification of those attributes that affect the generation of this trust at three different levels: strategic, normative and cognitive. The study of the value of trust allows, or at least contributes to, an understanding of different levels of development. The study population consists of local associations, as a sample of existing social structures, and is taken from two areas in Andalusia, Spain. From the application of the proposed method a null hypothesis for the runs and Mann–Whitney tests is accepted at the three levels of trust for both areas. For strategic and cognitive trust, the behaviours of both areas are homogenous, while in the case of normative trust for the Chi square test the alternative hypothesis is accepted. The methodology that is developed demonstrates the interest presented by trust as a study variable in research dealing with social capital and its direct influence on the development of territories. Trust should be considered alongside physical, natural and human capital, since none of these alone is sufficient for complete territorial development.

     

What Defines Quality of Life? The Gap Between Public Policies and Locally Defined Indicators Among Residents of Kodagu, Karnataka (India)

Improving quality of life (QoL) is one of the main goals of many public policies. A useful tool to measure QoL needs to get a good balance between indicators guided by theories (top-down approach) and indicators defined by local people (bottom-up approach). However, QoL measurement tools often neglect to include elements that define the standard of living at local level. In this paper, we analyse the correspondence between human development index, as an indicator adopted by governments to assess QoL, and the elements defined by local people as important in their QoL, called here local means. Using a free-listing technique, we collected information from 114 individuals from Kodagu, Kartanataka (India), to capture local means defining QoL. We then compared local means with the indicators used by Human development report (HDR) of Karnataka, the main measurement tool of QoL in Kodagu. The list of local means included access to basic facilities and many issues related to agriculture and natural resources management as elements locally defining QoL. We also found that HDR does not capture the means defined by people as indicators of QoL. Our findings suggest an important gap between current QoL’s indicators considered by public policies and the means of QoL defined by people. Our study provides insights for a set of plausible local indicators useful to achieve a balance between top-down and bottom-up approaches for the local public policies.     

A Marshall–Olkin family of heavy-tailed distributions which includes the lognormal one

Abstract

A new class of heavy-tailed distribution functions,, containing the lognormal distribution as a particular case is introduced. The class thus obtained depends on a set of three parameters, incorporating an additional distribution to the classical lognormal one. This new class of heavy-tailed distribution is presented as an alternative to other useful heavy-tailed distributions, such as the lognormal, Weibull, and Pareto distributions. The density and distribution functions of this new class are given by a closed expression which allows us to easily compute probabilities, quantiles, moments, and related measurements. Finally, some applications are shown as examples.     

Ethics of resource allocation: instruments for rational decision making in support of a sustainable health care

Objective: In all western countries health care budgets are under considerable constraint and therefore a reflection process has started on how to gain the most health benefit for the population within limited resource boundaries. The field of “ethics of resource allocation” has evolved only recently in order to bring some objectivity and rationality in the discussion. In this article it is argued that priority setting is the prerequisite of ethical resource allocation and that for purposes of operationalization, instruments such as “need assessment” and “health technology assessment (HTA)” are essential worktools for making more rational decisions. Thresholds (deduced from the need assessment and HTA) are—within this context—guiding but not binding principles. Method: Discussion of theoretical concepts of not only priority setting, need assessment and HTA complemented by practical examples for showing the challenges and the need, but also the chances of a more explicit and transparent policy of resource allocation in health care. Results: Priority setting in health care is based on the values of equity, justice and solidarity. Health packages decisions are determined from medical need (the severity of the condition) and/or the appropriateness of medical interventions (their cost-effectiveness). With growing awareness that originally effective and cost-effective services and programmes are eventually provided inappropriately, the focus is shifting towards the organisational aspects of provision and application. Therefore, need assessment is based on the distinction of health care needs from demand, supply, or actual care. Additionally HTA provides the evidence on health care interventions in a way that it becomes obvious who benefits from an intervention and who definitely does not benefit, but eventually is harmed. Conclusions: Health services research on effective and cost-effective interventions and research/monitoring of performance that the effective and cost-effective services are provided appropriately are of increasing importance for guiding the decision-making process on priority setting and need assessment. Effective healthcare for all is sustainable, if we start to put expenditures in perspective and focus health policies and research strategies on managing expectations through patient information and a more realistic notion of medical advancements and, on the other hand, on encouraging need-based and cost-effective innovations.

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Zusammenfassung Ziel: In allen Ländern des Westens ist die Haushaltslage im Gesundheitswesen heute äußerst angespannt, weshalb nun ein Reflexionsprozess begonnen hat, wie mit begrenzten Haushaltsmitteln der größtmögliche gesundheitliche Nutzen für die Bevölkerung erzielt werden kann. Erst in jüngster Zeit ist die “Ethik der Mittelzuweisung” als Arbeitsgebiet entwickelt worden, mit dem Ziel, eine gewisse Objektivität und Rationalität in die Diskussion zu bringen. In diesem Artikel argumentieren wir, dass eine ethische Mittelzuweisung Prioritätssetzungen erfordert und dass Instrumente wie Bedarfeinschätzung (Need Assessment) und Bewertung medizinischer Verfahren [Health Technology Assessment (HTA)] wesentliche Arbeitswerkzeuge zur Erzielung rationaler Entscheidungen sind. Schwellenwerte (abgeleitet aus Need Assessment und HTA) dienen in diesem Zusammenhang als leitende, jedoch nicht bindende Prinzipien. Methode: Diskussion theoretischer Begriffe der Prioritätssetzung, Bedarfeinschätzung und HTA, ergänzt durch praktische Beispiele zur Darstellung der Herausforderungen des Bedarfs nach, aber auch der Chancen für eine explizitere und transparentere Politik der Mittelzuweisung im Gesundheitswesen. Ergebnisse: Prioritätssetzung im Gesundheitswesen basiert auf den Werten Gleichheit, Gerechtigkeit und Solidarität. Entscheidungen über Versorgungspakete richten sich nach der medizinischen Bedarfslage (Schwere der Erkrankung) und/oder der Angemessenheit medizinischer Eingriffe (Kosteneffektivität). Mit der wachsenden Erkenntnis, dass ursprünglich effektive und kosteneffektive Leistungen und Programme am Ende unangemessen bereitgestellt werden, richtet sich die Aufmerksamkeit mehr auf Organisationsaspekte der Bereitstellung und Anwendung. Need Assessment basiert daher auf der Unterscheidung zwischen Bedarf im Gesundheitswesen und Nachfrage, Angebot oder tatsächlicher Versorgung. HTA fasst dann die Evidenz zu Eingriffen seitens des Gesundheitswesens zusammen, sodass offenbar wird, wem ein Eingriff nützt und wem er mit Sicherheit nicht nützt, sondern am Ende schadet. Schlussfolgerungen: Forschungen der Gesundheitsdienste zu effektiven und kosteneffektiven Eingriffen sowie die Erforschung/Erfolgskontrolle einer angemessenen Bereitstellung effektiver und kosteneffektiver Dienste sind von wachsender Bedeutung für die Information des Entscheidungsprozesses zur Prioritätssetzung und Bedarfseinschätzung. Eine effektive Gesundheitsversorgung für alle bleibt tragbar, sofern wir beginnen, Ausgaben in Perspektive zu setzen und gesundheitspolitische Entscheidungen und Forschungsstrategien darauf ausrichten, Erwartungen zu lenken, indem wir die Patienten informieren und eine realistischere Einschätzung medizinischer Fortschritte fördern, und uns zugleich auf bedarfsorientierte und kosteneffektive Innovationen konzentrieren.

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Résumé Objectif : Dans tous les pays occidentaux, les budgets de santé publique sont soumis à de fortes contraintes, ce pourquoi un processus de réflexion a commencé sur la question de savoir comment obtenir avec des moyens limités la plus grande utilité possible pour la population en termes de santé. Ce n’est que récemment que « l’éthique de l’allocation des ressources » a été développée pour apporter une certaine part d’objectivité et de rationalisme dans la discussion. Le présent article soutient que l’attribution de priorités est la condition préalable indispensable à l’allocation des ressources et que des instruments tels que l’évaluation des besoins (need assessment) et l’évaluation des technologies de la santé (ETS/HTA) sont des outils essentiels pour parvenir à des décisions plus rationnelles. Les valeurs seuils (déduites de l’évaluation des besoins et de l’ETS) servent dans ce contexte de principes directeurs, mais non contraignants. Méthode : Discussion sur les notions théoriques d’attribution de priorités, d’évaluation des besoins et d’ETS, complétée par des exemples pratiques mettant en évidence les défis et les besoins, mais aussi les chances d’une politique d’allocation des ressources de santé plus explicite et transparente. Résultats : L’attribution des priorités dans le domaine de la santé se base sur les valeurs d’équité, de justice et de solidarité. Les décisions relatives à des ensembles thérapeutiques sont déterminées par le besoin médical (gravité de la maladie) et/ou le caractère opportun des interventions médicales (efficacité des coûts). Avec la prise de conscience que des services et des programmes initialement opérationnels et efficaces en termes de coûts sont appliqués de manière inappropriée, l’attention se porte sur les aspects organisationnels de l’attribution et de l’application. L’évaluation des besoins se base par conséquent sur la distinction entre les besoins de santé provenant de la demande, de l’offre et de l’approvisionnement effectivement fourni. L’évaluation des technologies de la santé procède à une synthèse des preuves faisant apparaître qu’une intervention de santé est utile à un patient, lui est en toute certitude inutile, voire préjudiciable. Conclusions : Les recherches des services de santé sur les interventions efficaces en termes de thérapie et de coûts, de même que la recherche/le suivi des performances sur une fourniture appropriée de services efficaces en termes de thérapie et de coûts revêtent une importance croissante pour guider le processus décisionnel sur l’attribution des priorités et l’évaluation des besoins. Une couverture de santé efficace pour tous n’est viable que si nous commençons à mettre les dépenses en perspective et à concentrer les politiques de la santé et les stratégies de recherche sur la gestion des attentes, en informant les patients et en promouvant une estimation plus réaliste des progrès médicaux, et d’autre part en encourageant les innovations fondées sur les besoins et sur le rendement des coûts.

     

Metropolitan Governance: Which Policies for Globalizing Cities?

Today, for the first time in history, half the world’s people live in cities. This puts metropolitan areas to the test, especially in developing countries, where the greatest part of urban growth is occurring. In order to meet the new challenges linked to urbanization, today’s growing cities need appropriate metropolitan governance. The present paper wants to investigate this issue, through the definition of a general model of metropolitan governance, which can be adapted to every urbanization context according to its own specificities. Considerable emphasis will be given to concrete examples to test the consistency of our model. In particular, since water and sanitation supply is one of the key challenges affecting metropolitan areas, we will apply our model to urban water management. Furthermore, an important focus will be given to the contribution that Information and Communication Technologies can provide to the implementation of the model.     

RDELA—a Delaunay-triangulation-based, location and covariance estimator with high breakdown point

We propose an approach that utilizes the Delaunay triangulation to identify a robust/outlier-free subsample. Given that the data structure of the non-outlying points is convex (e.g. of elliptical shape), this subsample can then be used to give a robust estimation of location and scatter (by applying the classical mean and covariance). The estimators derived from our approach are shown to have a high breakdown point. In addition, we provide a diagnostic plot to expand the initial subset in a data-driven way, further increasing the estimators’ efficiency.     

Contested memories: efforts of the powerful to silence former inmates' histories of life in an institution for 'mental defectives'

This paper discusses the barriers encountered in undertaking an oral history project with survivors of a total institution for 'mental defectives' in the province of Alberta, Canada. Powerful social actors were able to bar access to survivors through legal guardianship orders, and to make access to the institution and its grounds and to publicly archived materials quite prohibitive to the researcher. In addition to overt efforts on the part of powerful social actors to block the project, concerns about the potential to discredit survivor narratives led to changes in the research design. Specifically, research and literature about the 'acquiescence' of intellectuals with intellectual impairments led the researcher to broaden the sources for this history as a preemptive strategy. Despite these barriers, survivors of the institution provided a rich and powerful testimony to the brutality of institutionalization, and provide us with an emancipatory history from the perspectives of those most oppressed by disability policies and practices.