I wanted to raise the fact
that health inequities at the top,
in the term that's used in non-U.S.
contexts, and disparities use in the U.S.
context.
So does the difference in the definitions
reflect anything about how the U.S.
sees health disparities
in the rest of the world?
Yeah.
So it's this is consistent with the,
the terms are used in the United States.
So it's interesting over
the past, like a decades, many people
started to use
even in the United States, inequities are used.
And and so ethical part is more explicit.
I think in the early on, people thought people,
scientists think health researchers
thought that
when you start to say inequity, it sounds like not science,
because you're talking about morality
and ethics, that's not science.
So people start that, then it's just kind of like, well, and
scientist.
I want to talk about numbers and so them maybe disparity
sounds better
like a kind of bypass because it's a bit ambiguous.
So that's how it started.
And the disparities are actually it was going between cost
around between inequality and inequities for a long time.
And then now I think on it becoming a people are more
comfortable
to say when we say health,
disparities in social disadvantage.
Yeah.
So ethics is front and center in a way of mine.
So it's a kind of interesting history.
It is. Yeah.
Yeah. Thank you.
Thank you. Here is the question from Jake.
Could you give an example of a health inequity
that is not a health disparity.
So he's asking, right.
You have a green and then an olive
are there what's in that green circle versus what's in that
olive circle.
Yeah. So that's interesting. Good question.
So the
They're different.
Philosophical perspectives to define health inequity.
So I give you just 1 or 2.
So one is that,
equal opportunity for philosophers in the, realm?
La la land is an there.
What's wrong about it is that the,
those factors beyond individual control,
those are inequity,
but something within your control
and something that happens.
So a typical example I gave is that you don't need to.
But you insisted and you did the bungee jumping
without safety precaution.
And, you really didn't need to.
It's your choice.
And you happened to you just broke your leg.
Then to that.
I'm sorry that happens, but maybe society's not
responsible
for what you did.
So that that health is.
Okay.
So something like that.
So then you could think about it.
So in that view the distinction is not
so much which group it is.
So you can imagine that then that,
you know, even low income people
within them, those people who did the bungee
jumping and, you know, bungee jumping,
you know, there's some differences.
So it doesn't neatly fit into that groups. So,
so that's one example,
of that and how the theories are broader.
And then often people think about the goods
and then that's the poor part.
I hope that we'll find out.
So Jake, let us know if you have a follow
up.
NRMA. Hi.
Thank you for your talk.
So I have a question sort of broadly
about intersectionality because I think,
it seems like in the past 10 or 20 years,
like we've, you know, started
to talk more about the ways that people,
can be a part of more than one group.
So when researchers are doing a study,
about the effects of,
income on, you know, some other thing,
it seems like in addition to,
sort of grouping by low income, middle income
and high income, they should have
some sort of understanding,
of the fact that
gender influences income or maybe disability influences
income.
So how are researchers teasing apart,
those sorts of issues and how are they like mapping on
like a maybe like looking back like
those sorts of complex interactions
between groups.
Yeah. So that's a very good question.
And I.
Get different ways to answer it.
So the,
Who are the researchers we're talking about.
So those are the ones I know who are interested in the
empirical work,
like trials.
As I said,
the the choice of groups are often
just intriguing.
So that and I'm very interested in gender.
I'm interested in race.
And let's do that.
And nothing wrong about it, but.
And how about this, this this, this, this.
It's not like a there's almost all things
you can consider and then sit down
and come up with the theory and pick the most important one.
It doesn't work that way. Right. So that's one.
And then also it's just in the how if it is measured.
So for example,
even now
measuring sex, it's getting very complex
how to measure.
And so the do we have the data or do we know how to measure.
So that becomes the consideration.
So the also typically people have their own ism.
So I'm interested in sexism, I'm interested in racism.
I'm interested in capitalism.
You know.
So they just go into one.
And then it's very difficult to say,
well everything is important.
I know which one to choose.
And that is like not the way
they, empirical work goes.
I would like to have that conversation
going more.
But anyway, there is a gap that then we have to have that
question.
Thank you.
Go ahead. Hi.
Thanks again for your talk.
My question is about, so I can
you like the reasons why you conduct like a study,
right.
So it's like in terms of practice
of patient
or biological differences or social differences.
And my question is how do you really study,
like when, like there's conflict conflating between biology
in social issues, like how we think of the history of
science.
In many ways, problems is conflating things
between biology and social history,
for example.
So to me, going further in depth,
like a lot of ways, like race and gender
is one primary consequence of conflating
these two, reasons why we study.
Like, for example, we have a history of attributing
like intelligence, for example, to race or to
gender.
And it could be the consequences can be as
simple as like
stereotyping to something super severe, like eugenics
movement,
which has been based off of the science
of thinking that there's biology,
biological differences between these groups.
So my question is that how do we study
these differences, like knowing if it's
a biological difference or a whole social
and cultural historical difference?
We're comparing two groups and how can we ethically
communicate
these results in a way that's like
uplifting rather than degrading of,
making sure we are conscious of these differences.
That's really good question. And then,
it sounds kind of silly,
but we just have to be very critical and
and careful.
So, If it is like
the way I categorize is not,
Stable in
and then it's you can always say that a
these like, intelligence
each day I believe the biological.
So I'm going to do biology
and then maybe you think that way
but and that could be wrong.
So it's just a different ways you might see.
And then it doesn't give you that license.
You can do it.
You you have to think that's an everyday state.
Good question. And make sense.
And so I really I agree with you.
And At the same time,
right now
we try to include diverse populations
and then do a little bit more careful examination.
Before we didn't,
although the medical studies came from very homogeneous
populations.
And so that is a problem too.
But and at the same time, if you doesn't have an
assumption
and you start to just prove that assumption that are wrong
to.
So I, I know I'm not answering, but I just totally agree with
you.
And then I just have to be very careful.
And so two quick things, right? I think
transparency and as you said, critical.
Right.
So if you're looking at literature, right,
it's important for you to be able to say,
okay, let me think about what
they were interested when they were designing this
study.
And let me critically look at whether or not they're
basing
their hypothesis on a very old and,
you know, incorrect assumptions.
And so if you're doing a meta analysis
or something, right, you would be like,
okay, that's garbage.
I'm just, you know, to be hyperbolic,
I'm not going to include that in my, my,
you know, meta analysis because they weren't asking,
an appropriate question, maybe something.
Like that. Yeah.
So I think that maybe it's helpful
to go back.
Yeah. It's an eight principle.
So one is a variable scientific question.
Yeah.
So and then here the reason why I said that
the equity consideration is not checkbox
is that woven into.
So that's actually a good example
that if if you do this you're fine.
It's not like that.
So you have to think about I could do this.
But then where does this question come
from.
Is a really variable meaning for sure man question.
And then that always needs to be, examined.
Yeah.
Thank you.
So this is another question from Jake.
Can equity considerations
ever justify not carrying out a study due
to limited resources or other feasibility
constraints?
A study that lacks necessary resources
to sufficiently mitigate risk of harm
or obtain adequate informed consent
from participants should not be conducted.
But should we ever stop a study from moving forward
due to equity concerns?
Right.
Like I just have to say that another way, right?
You have let's say you have a great research
question.
You have thought very carefully about what the most appropriate,
valid
scientific methodology is, what groups
you're going to sample from.
But the sample size would be so large
that,
you know, you can't get funding to do that
large a study.
So you might have to compromise.
And you say, okay, yeah.
Yeah.
So that's I'm trying to go back to my slide.
Yeah. So that's happening.
Yeah. So it's a game when I'm, I'm sorry.
It's not like, black and white answers.
And so before I think is that.
It's just impossible because it's so expensive not
feasible.
And and also as I indicated, typically
it's not a small sample size, but
these are pretty populations.
Often that then that for historical
and good reason
they do want to participate in the study
because they're suspicious
and and then who are we to blame because we did so wrong.
So just to get that,
necessary sample,
it just cost more.
You need more effort.
You need more people to go in and, you
know, you need to talk, and it's all that.
So we say that if we don't do it because it's so expensive.
So I think that's not right.
So we have to push it.
So it's very nice that the NIH said
that the net cost is not a concern.
Then you can write the grant and then you justify
we need these people because we have this, you
know, concern, and we need this much money
and they give us money and they should get the money.
So that's good. But then at the same time.
There are many methodological things
you could do.
So here I talked about meta analysis
methods.
So those are the ones that then the each
researcher try but still not sufficient.
But then maybe collectively we could still make some
difference.
So it's not either or I think.
And we have to do everything we could do.
Yeah. Yeah.
And right.
Cost can't be an issue.
But there are finite resources as well. Right.
So if let's say we design a study
that that is going to cost
$5 million, and there are five other studies
that cost $1 million, you know, that kind of stuff.
So I guess just reinforce it's not an easy means easy
answer.