Incorporating diverse values of nature in decision-making-theory and practice

Values play a significant role in decision-making, especially regarding nature. Decisions impact people and nature in complex ways and understanding which values are prioritised, and which are left out is an important task for improving the equity and effectiveness of decision-making. Based on work done for the IPBES Values Assessment, this paper develops a framework to support analyses of how decision-making influences nature as well as whose values get prioritised. The framework is used to analyse key areas of environmental policy: a) the present model for nature protection in market economies, b) the role of valuation in bringing nature values into decisions, and c) values embedded in environmental policy instruments, exemplified by protected areas for nature conservation and payments for ecosystem services. The analyses show that environmental policies have been established as mere additions to decision-making structures that foster economic expansion, which undermines a wide range of nature's values. Moreover, environmental policies themselves are also focused on a limited set of nature's diverse values. This article is part of the theme issue 'Bringing nature into decision-making'.

Three Arguments Against Institutional Conscientious Objection, and Why They Are (Metaphysically) Unconvincing

The past decade has seen a burgeoning of scholarly interest in conscientious objection in healthcare. While the literature to date has focused primarily on individual healthcare practitioners who object to participation in morally controversial procedures, in this article we consider a different albeit related issue, namely, whether publicly funded healthcare institutions should be required to provide morally controversial services such as abortions, emergency contraception, voluntary sterilizations, and voluntary euthanasia. Substantive debates about institutional responsibility have remained largely at the level of first-order ethical debate over medical practices which institutions have refused to offer; in this article, we argue that more fundamental questions about the metaphysics of institutions provide a neglected avenue for understanding the basis of institutional conscientious objection. To do so, we articulate a metaphysical model of institutional conscience, and consider three well-known arguments for undermining institutional conscientious objection in light of this model. We show how our metaphysical analysis of institutions creates difficulties for justifying sanctions on institutions that conscientiously object. Thus, we argue, questions about the metaphysics of institutions are deserving of serious attention from both critics and defenders of institutional conscientious objection.

A Multidisciplinary Assessment of ChatGPT's Knowledge of Amyloidosis: Observational Study

BACKGROUND

Amyloidosis, a rare multisystem condition, often requires complex, multidisciplinary care. Its low prevalence underscores the importance of efforts to ensure the availability of high-quality patient education materials for better outcomes. ChatGPT (OpenAI) is a large language model powered by artificial intelligence that offers a potential avenue for disseminating accurate, reliable, and accessible educational resources for both patients and providers. Its user-friendly interface, engaging conversational responses, and the capability for users to ask follow-up questions make it a promising future tool in delivering accurate and tailored information to patients.

OBJECTIVE

We performed a multidisciplinary assessment of the accuracy, reproducibility, and readability of ChatGPT in answering questions related to amyloidosis.

METHODS

In total, 98 amyloidosis questions related to cardiology, gastroenterology, and neurology were curated from medical societies, institutions, and amyloidosis Facebook support groups and inputted into ChatGPT-3.5 and ChatGPT-4. Cardiology- and gastroenterology-related responses were independently graded by a board-certified cardiologist and gastroenterologist, respectively, who specialize in amyloidosis. These 2 reviewers (RG and DCK) also graded general questions for which disagreements were resolved with discussion. Neurology-related responses were graded by a board-certified neurologist (AAH) who specializes in amyloidosis. Reviewers used the following grading scale: (1) comprehensive, (2) correct but inadequate, (3) some correct and some incorrect, and (4) completely incorrect. Questions were stratified by categories for further analysis. Reproducibility was assessed by inputting each question twice into each model. The readability of ChatGPT-4 responses was also evaluated using the Textstat library in Python (Python Software Foundation) and the Textstat readability package in R software (R Foundation for Statistical Computing).

RESULTS

ChatGPT-4 (n=98) provided 93 (95%) responses with accurate information, and 82 (84%) were comprehensive. ChatGPT-3.5 (n=83) provided 74 (89%) responses with accurate information, and 66 (79%) were comprehensive. When examined by question category, ChatGTP-4 and ChatGPT-3.5 provided 53 (95%) and 48 (86%) comprehensive responses, respectively, to "general questions" (n=56). When examined by subject, ChatGPT-4 and ChatGPT-3.5 performed best in response to cardiology questions (n=12) with both models producing 10 (83%) comprehensive responses. For gastroenterology (n=15), ChatGPT-4 received comprehensive grades for 9 (60%) responses, and ChatGPT-3.5 provided 8 (53%) responses. Overall, 96 of 98 (98%) responses for ChatGPT-4 and 73 of 83 (88%) for ChatGPT-3.5 were reproducible. The readability of ChatGPT-4's responses ranged from 10th to beyond graduate US grade levels with an average of 15.5 (SD 1.9).

CONCLUSIONS

Large language models are a promising tool for accurate and reliable health information for patients living with amyloidosis. However, ChatGPT's responses exceeded the American Medical Association's recommended fifth- to sixth-grade reading level. Future studies focusing on improving response accuracy and readability are warranted. Prior to widespread implementation, the technology's limitations and ethical implications must be further explored to ensure patient safety and equitable implementation.

Highly pathogenic avian influenza A(H5N1) virus in a common bottlenose dolphin (Tursiops truncatus) in Florida

Since late 2021, highly pathogenic avian influenza (HPAI) viruses of A/goose/Guangdong/1/1996 (H5N1) lineage have caused widespread mortality in wild birds and poultry in the United States. Concomitant with the spread of HPAI viruses in birds are increasing numbers of mammalian infections, including wild and captive mesocarnivores and carnivores with central nervous system involvement. Here we report HPAI, A(H5N1) of clade 2.3.4.4b, in a common bottlenose dolphin (Tursiops truncatus) from Florida, United States. Pathological findings include neuronal necrosis and inflammation of the brain and meninges, and quantitative real time RT-PCR reveal the brain carried the highest viral load. Virus isolated from the brain contains a S246N neuraminidase substitution which leads to reduced inhibition by neuraminidase inhibitor oseltamivir. The increased prevalence of A(H5N1) viruses in atypical avian hosts and its cross-species transmission into mammalian species highlights the public health importance of continued disease surveillance and biosecurity protocols.

Women's representation in Indian academia and conferences

Documentation of women’s inclusion in Indian academia and conferences by BiasWatchIndia reveals the scale of underrepresentation of women across science, technology, engineering and mathematics.

Deinstitutionalisation and the move to community care: comparing the changing dimensions of mental healthcare after 1922 in the Republic of Ireland and England

The advent of deinstitutionalisation and the introduction of community care in the latter part of the twentieth century have revolutionised mental-health service provision across Europe, although implementation, timing and services have varied widely in different countries. This article compares the changing dimensions of mental-health provision in post-independence Ireland with that in England, and will shed light on the current state of mental healthcare in both countries. The article calls for more research into the impact of deinstitutionalisation, such as the challenges faced in the community for those in need of continuing care.

Simulating institutional heterogeneity in sustainability science

Sustainability outcomes are influenced by the laws and configurations of natural and engineered systems as well as activities in socio-economic systems. An important subset of human activity is the creation and implementation of institutions, formal and informal rules shaping a wide range of human behavior. Understanding these rules and codifying them in computational models can provide important missing insights into why systems function the way they do (static) as well as the pace and structure of transitions required to improve sustainability (dynamic). Here, we conduct a comparative synthesis of three modeling approaches- integrated assessment modeling, engineering-economic optimization, and agent-based modeling-with underexplored potential to represent institutions. We first perform modeling experiments on climate mitigation systems that represent specific aspects of heterogeneous institutions, including formal policies and institutional coordination, and informal attitudes and norms. We find measurable but uneven aggregate impacts, while more politically meaningful distributional impacts are large across various actors. Our results show that omitting institutions can influence the costs of climate mitigation and miss opportunities to leverage institutional forces to speed up emissions reduction. These experiments allow us to explore the capacity of each modeling approach to represent insitutions and to lay out a vision for the next frontier of endogenizing institutional change in sustainability science models. To bridge the gap between modeling, theories, and empirical evidence on social institutions, this research agenda calls for joint efforts between sustainability modelers who wish to explore and incorporate institutional detail, and social scientists studying the socio-political and economic foundations for sustainability transitions.

Unmasking imposter syndrome: individual responsibility or repercussions of systemic oppression?

In contemporary and popular discourse, imposter syndrome is frequently outlined as an individual problem that can be overcome. Rather than the locus of responsibility being placed on the individual, we posit that neoliberal academic institutions contribute to imposter syndrome by (de)legitimising certain forms of knowledge.

How Public Health Organizational Structure Affected the Response to the COVID-19 Pandemic: A Case Study in British Columbia, Canada

Objectives: This study sought to examine how public health organizational structures affected decision-making and provides recommendations to strengthen future public health crisis preparedness. Methods: The Institutions-Politics-Organizations-Governance (IPOG) framework and an organizational lens was applied to the analysis of COVID-19 governance within British Columbia (BC). Organizational charts detailing the structure of public health systems were compiled using available data and supplemented with data collected through key informant interviews. Results: In response to the COVID-19 pandemic, BC initiated several changes in its public health organization. BC's COVID-19 response attempted to utilize a centralized command structure within a decentralized health system. Four key themes were identified pertaining to the 1) locus of decision-making and action; 2) role of emergency structures; 3) challenges in organizational structure; and 4) balance between authority and participation in decision-making. Conclusion: The organizational adaptations enabled a substantively effective response. However, our findings also illustrate deficiencies in organizational structure in the current public health system. Two recommendations for consideration are: 1) a more formal vertical organizational structure; and 2) developing new mechanisms to link health and general emergency response structures.

'Vaccines are for children only'? Some institutional roots of popular scepticism about vaccines for COVID-19 in Sierra Leone

Vaccines for COVID-19 began to be available in Africa from mid-2021. This paper reports on local reactions to the possibility of vaccination in one West African country, Sierra Leone. We show that the history of institutionalisation of vaccine is highly relevant to understanding these reactions. Given lack of testing for the disease, medical authorities could not be sure whether there was a hidden epidemic. In addition, many people associate vaccination with care of children under 5 years, and not adults, and an emphasis on vaccinating the old at first seemed strange and worrying. This paper examines evidence from ethnographic studies in two rural areas selected for varying exposure to Ebola Virus Disease (EVD), supplemented by some interviews in two provincial urban centres, Bo and Kenema. We describe local ideas about vaccination (maklet) and body marking with leaf medicine (tεwi). We asked about attitudes to the idea of COVID-19 vaccination both before and after vaccines were available. A number of reasons were given for scepticism and hesitation. These included lack of experience with vaccines for adults and lack of experience of COVID-19 as a severe disease. Medical evidence suggests the vaccination protects against serious illness, but local people had their own views about control of infection, based both recent experience (notably EVD) and the history and institutionalisation of vaccination and public health measures in Sierra Leone more broadly.

Investigating the Culture Around Sexual Harassment in First-Generation Universities in Southwestern Nigeria: Protocol for a Mixed Methods Study

BACKGROUND

The phenomenon of sexual harassment (SH) is a complex issue with multiple prongs that concerns all members of academia and raises serious challenges, particularly regarding prevention and response. SH in tertiary institutions remains a huge problem worldwide, leading to severe emotional, academic, and career difficulties, as well as undue suffering. Institutions have responded in various ways to alleviate the burden of SH with little success, especially in Nigeria. The prevalence is high but reportage is low because of the culture of silence around SH in most educational institutions. This study aims to identify factors associated with SH in tertiary institutions in Nigeria and explore factors surrounding reportage or nonreportage following the experience of SH, the institutional mechanisms to prevent and respond to SH, and the lived experience of survivors of SH.

OBJECTIVE

The objective of this study was to present a study protocol that is designed to identify factors associated with the experience of SH in tertiary institutions in Nigeria, the institutional mechanisms to prevent and respond to SH, and the lived experience of survivors of SH.

METHODS

A mixed (quantitative and qualitative) methods approach is used consisting of a policy review of existing antisexual harassment policies in the selected universities, a quantitative survey to determine the correlates of SH, focus group discussions to explore the perspectives of the university community concerning SH, in-depth interviews to explore the lived experiences of survivors of SH, and key informant interviews to understand the perspectives of people who provide interventions to survivors.

RESULTS

This study was funded in July 2022 by the Consortium for Advanced Research Training in Africa, and data collection started in November 2022. The SH policies were comprehensive, with clear policy statements and definitions, and recognized a wide range of survivors and perpetrators. However, there was no clear mention of prevention and response to same-sex SH. Lived experiences showed negative psychological and social sequelae and little institutional support.

CONCLUSIONS

This is the first study that has a component investigating same-sex SH in tertiary institutions in Nigeria. This is also one of the first studies to explore the lived experiences of survivors of SH in Nigerian universities. The findings from this study suggest that periodic evaluation of SH policy implementation will improve institutional support, thus creating safe spaces for survivors and will thereby encourage reportage and support; prevention and response strategies need to be more inclusive; and more interventions should focus on strengthening prosocial skills and healthy, equitable relationships.

INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID)

DERR1-10.2196/49126.

Racism, early psychosis, and institutional contact: A qualitative study of Indigenous experiences

BACKGROUND

There is evidence of Indigenous and ethnic minority inequities in the incidence and outcomes of early psychosis. Racism has been implicated as having an important role.

AIM

To use Indigenous experiences to develop a more detailed understanding of how racism operates to impact early psychosis outcomes.

METHODS

Critical Race Theory informed the methodology used. Twenty-three Indigenous participants participated in four family focus group interviews and thirteen individual interviews, comprising of 9 Māori youth with early psychosis, 10 family members and 4 Māori mental health professionals. An analysis of the data was undertaken using deductive structural coding to identify descriptions of racism, followed by inductive descriptive and pattern coding.

RESULTS

Participant experiences revealed how racism operates as a socio-cultural phenomenon that interacts with institutional policy and culture across systems pertaining to social responsiveness, risk discourse, and mental health service structures. This is described across three major themes: 1) selective responses based on racial stereotypes, 2) race related risk assessment bias and 3) institutional racism in the mental health workforce. The impacts of racism were reported as inaction in the face of social need, increased use of coercive practices and an under resourced Indigenous mental health workforce.

CONCLUSION

The study illustrated the inter-related nature of interpersonal, institutional and structural racism with examples of interpersonal racism in the form of negative stereotypes interacting with organizational, socio-cultural and political priorities. These findings indicate that organizational cultures may differentially impact Indigenous and minority people and that social responsiveness, risk discourse and the distribution of workforce expenditure are important targets for anti-racism efforts.

Food and Power in Protracted Crisis: How Systems and Institutions Influence Livelihoods, Food Security, and Nutrition

This article examines how systems and institutions influence the distribution of resources in society and, as such, affect livelihoods, food security, and nutrition. It draws on research on the political economy of food, and the governance effects of food aid practices, conducted in Sudan and Somalia and on the role of a social approach to nutrition in situations of famine and mass starvation. This article argues first for the importance of examining political structures as basic causes of malnutrition as they influence whether and how institutions function (in relation to land, markets, employment, aid, or justice). Second, this article illustrates how, in situations of crisis, the manipulation of institutions can create power for some and vulnerability to malnutrition in others. Third, it argues that a focus on treatment of malnutrition and behavior (hygiene and feeding practices) has drawn attention away from systems and institutions and feeds into discrimination as a basic cause.

Transforming the grid for a more environmentally and socially sustainable electricity system in Great Britain is a slow and uneven process

Electricity system decarbonization is key for environmental sustainability. From a consumption-production perspective, much attention has been paid to changes in how electricity is generated and used, but electricity systems also rely on a grid infrastructure that connects and integrates production and consumption, and which will also need to transform. At the same time, new technologies in the electricity system, including the grid, offer the potential for more socially sustainable ways of producing and consuming energy. However, in practice, change has been slow, uneven, and often dysfunctional. A socio-technical transitions approach offers insights into why this is so, seeing electricity system change not simply in technical and economic terms, but also as the outcomes of interactions between technology and social and political processes. The approach draws attention to the particular challenges of achieving rapid transitions in complex critical infrastructures like electricity with strong institutional logics of security. This article applies this approach to the case of Great Britain, where despite strong commitments to sustainability in the form of high-level climate policy, the electricity grid has often been a constraint on the pace of change. The nature of the British transition is explained partly by weak links between these high-level goals on the one hand and the detailed rules and practices in the electricity system on the other. It is also explained by patterns of ownership and grid regulation in the British case that protect incumbents and make it difficult for new actors to develop the system in more socially sustainable directions.

One Health approach at the heart of the French Committee for monitoring and anticipating health risks

Following the COVID-19 pandemic, the French government established a committee for monitoring and anticipating health risks. In this Comment, the authors describe the One Health approach taken by the committee, and outline its aims, composition, and initial actions.

Governing beyond the project: Refocusing innovation governance in emerging science and technology funding

This article analyses how a recent idiom of innovation governance, 'responsible innovation', is enacted in practice, how this shapes innovation processes, and what aspects of innovation are left untouched. Within this idiom, funders typically focus on one point in an innovation system: researchers in projects. However, the more transformational aspirations of responsible innovation are circumscribed by this context. Adopting a mode of critique that assembles, this article considers some alternative approaches to governing the shared trajectories of science, technology, and society. Using the idea of institutional invention to focus innovation governance on four inflection points-agendas, calls, spaces, evaluation-would allow funding organizations and researchers to look 'beyond the project', developing new methods to unpack and reflect on assumed purposes of science, technology, and innovation, and to potentially reconfigure the institutions that condition scientific practice.

Naming and shaming as a strategy for enforcing the Paris Agreement: The role of political institutions and public concern

Enforcement is a challenge for effective international cooperation. In human rights and environmental law, along with many other domains of international cooperation, "naming and shaming" is often used as an enforcement mechanism in the absence of stronger alternatives. Naming and shaming hinges on the ability to identify countries whose efforts are inadequate and effectively shame them toward better behavior. Research on this approach has struggled to identify factors that explain when it influences state behavior in ways that lead to more cooperation. Via survey of a large (N = 910) novel sample of experienced diplomats involved in the design of the Paris Agreement, we find support for the proposition that naming and shaming is most accepted and effective in influencing the behavior of countries that have high-quality political institutions, strong internal concern about climate change, and ambitious and credible international climate commitments. Naming and shaming appears less effective in other countries, so further enforcement mechanisms will be needed for truly global cooperation. We also find that the climate diplomacy experts favor a process of naming and shaming that relies on official intergovernmental actors, in contrast with studies suggesting that NGOs, media, and other private actors are more effective at naming and shaming. We suggest that these tensions-the inability for naming and shaming to work effectively within the countries least motivated for climate action and the preference for namers and shamers that seem least likely to be effective-will become central policy debates around making cooperation on climate change more enforceable.

Blinding to Circumvent Human Biases: Deliberate Ignorance in Humans, Institutions, and Machines

Inequalities and injustices are thorny issues in liberal societies, manifesting in forms such as the gender-pay gap; sentencing discrepancies among Black, Hispanic, and White defendants; and unequal medical-resource distribution across ethnicities. One cause of these inequalities is implicit social bias-unconsciously formed associations between social groups and attributions such as "nurturing," "lazy," or "uneducated." One strategy to counteract implicit and explicit human biases is delegating crucial decisions, such as how to allocate benefits, resources, or opportunities, to algorithms. Algorithms, however, are not necessarily impartial and objective. Although they can detect and mitigate human biases, they can also perpetuate and even amplify existing inequalities and injustices. We explore how a philosophical thought experiment, Rawls's "veil of ignorance," and a psychological phenomenon, deliberate ignorance, can help shield individuals, institutions, and algorithms from biases. We discuss the benefits and drawbacks of methods for shielding human and artificial decision makers from potentially biasing information. We then broaden our discussion beyond the issues of bias and fairness and turn to a research agenda aimed at improving human judgment accuracy with the assistance of algorithms that conceal information that has the potential to undermine performance. Finally, we propose interdisciplinary research questions.

Playing the political game: the coevolution of institutions with group size and political inequality

All societies need to form institutional rules to regulate their social interactions. These specify what actions individuals should take in particular situations, and what sanctions will apply if individuals violate these rules. However, forming these institutional rules involves playing a political game-a process of negotiation between individuals that is costly and time-consuming. Intuitively, this cost should be expected to increase as a group becomes larger, which could then select for a transition to hierarchy to keep the cost of playing the political game down as group size increases. However, previous work has lacked a mechanistic yet general model of political games that could formalize this argument and test the conditions under which it holds. We address this by formalizing the political game using a standard consensus formation model. We show that the increasing cost of forming a consensus over institutional rules selects for a transition from egalitarian to hierarchical organization over a wide range of conditions. Playing a political game to form institutional rules in this way captures and unites a previously disparate set of voluntary theories for hierarchy formation, and can explain why the increasing group size in the Neolithic would lead to strong political inequality. This article is part of the theme issue 'Evolutionary ecology of inequality'.

The evolution of economic and political inequality: minding the gap

The extent of economic and political inequality, their change over time, and the forces shaping them have profound implications for the sustainability of a society and the well-being of its members. Here we review the evolution of economic and political inequality broadly, though with particular attention to Europe and the USA. We describe legal/institutional, technological and social forces that have shaped this evolution. We highlight the cumulative effects of inequality across generations as channelled through wealth and inheritance but also through other intergenerational connections. We also review the state of research on the effects of inequality on economic growth, health and societal cohesion. This article is part of the theme issue 'Evolutionary ecology of inequality'.

Introduction. Making work better

From the premise that better work makes for better societies, the challenge, taken up in the introduction to this special issue of Transfer: European Review of Labour and Research, is to explore what makes work better, or worse, and how it can be improved. As a wide variety of experiments shape our economies and communities for the future, a key challenge is to engage in shared learning about these processes in order to stimulate a dialogue between the aspiration for better work and the conditions likely to hinder or facilitate making work better. It is an invitation to move from narrow conceptions of job quality to a broader lens of how world-of-work actors strategise, innovate and incorporate uncertainty into their search for sustainable solutions for better work. Key themes include: why work needs to be better (but is often worse); why better work makes for better societies; how work can be made better; the role of institutions in achieving better work; and, finally, how union strategies are essential to processes of experimentation to make work better.

Introduction : Améliorer le travail

Partant du principe que l’amélioration du travail contribue à l’amélioration des sociétés, le défi qu’entend mettre en évidence l’introduction de ce numéro spécial de Transfer: European Review of Labour and Research , consiste à déterminer ce qui rend le travail meilleur, ou pire, et comment il est possible de l’améliorer. Alors que des expériences très variées contribuent à façonner l’avenir de nos économies et de nos communautés, l’un des principaux enjeux consiste à s’engager dans un apprentissage partagé de ces processus afin de stimuler un dialogue entre l’aspiration à un meilleur travail et les conditions susceptibles de entraver ou de faciliter cette amélioration du travail. Cette démarche veut nous inciter à dépasser une conception étroite de la qualité de l’emploi pour adopter un point de vue plus large sur la manière dont les acteurs du monde du travail élaborent des stratégies, innovent et intègrent l’incertitude dans leur quête de solutions durables pour un travail de meilleure qualité. Les principaux thèmes de discussion sont les suivants : pourquoi le travail doit être meilleur (alors qu’il est souvent pire) ; pourquoi un meilleur travail permet-il d’améliorer les sociétés ; comment améliorer le travail ; quel est le rôle des institutions dans cette amélioration du travail ; comment, enfin, les stratégies syndicales sont-elles essentielles dans les processus d’expérimentation destinés à améliorer le travail.

A democracy built on communicative action: Bahá'í political practice as a prefigurative resource for institutional effectiveness, accountability, and inclusivity

Goal 16 of the UN sustainable development goals, which calls on the global community to "build effective, accountable and inclusive institutions at all levels," can be conceptualized as aiming at fostering communicative action, a concept developed by Jürgen Habermas to describe a mode for coordinating society grounded in deliberation. However, Habermas simultaneously provides an account of the structural transformation of the public sphere that suggests a hard limit on the capacity of mainstream capitalist liberal democracies to foster genuine communicative action in the relationships between institutions, individuals and communities. This paper therefore argues for the critical role of prefigurative politics, in which communities strive to internally embody desired socio-political forms rather than focusing on changing the wider socio-political order, as a vital resource for generating examples to inform institutional progress. The prefigurative example of the Baha'i community demonstrates norms and practices that may illustrate a path out of the dynamic Habermas identifies of system colonizing lifeworld, by fostering and protecting communicative action as the mode of social coordination. The form of communicative action found in the Baha'i community is situated in a context of a telic-organic model of relationships between individuals, communities and institutions. The paper contrasts the conceptual underpinnings of this model with individualistic conceptions of human nature that are argued to undermine liberal democracy's capacity for communicative action. At the core of communicative action within a Baha'i context is a distinctive model of deliberation, known within the community as "consultation". The paper argues that rational-critical consultation can offer a vital nuance to Habermas' ideal of communicative action as rational-critical debate in the public sphere. The formal democratic structures and processes of the Bahá'í community are also explored as an institutional example that arguably meets the challenge of Goal 16. The paper concludes with initial reflections on a process by which the prefigurative example of a Baha'i model might be brought to bear on institutional performance in wider society.

Care and rehabilitation institutions for people with intellectual disabilities during the COVID-19 pandemic: Polish experiences

People with intellectual disabilities benefit from many forms of institutional support, which include residential, rehabilitation, and educational services. Changes caused by the pandemic, especially the introduction of new rules relating to various aspects of life, raised several challenges and problems in the functioning of these institutions and for the people with disabilities during the COVID-19 pandemic. The research concerned facilities providing services for people with intellectual disabilities in Poland during the pandemic. The research goal was to determine what changes took place in the rehabilitation and care institutions during the pandemic in terms of their organization and the functioning of their clients and personnel. An online questionnaire was used. The respondents were institution employees. Data showed a number of preventive, educational, and supportive activities carried out by the institutions. Adverse changes in the psychosocial functioning of people with intellectual disabilities and other problems during the pandemic were reported.

Addressing diversity in the physician workforce through social determinants of medical education

Social determinants of medical education are the most impactful aspects of recruiting, retaining, and producing the next generation of a diverse physician workforce. We can use the same framework well known to describe social determinants of health to identify social determinants that impact medical education learners and their ability to enter the workforce and succeed to completion. Efforts aimed at recruitment and retention should not exist in isolation and must be matched with those that continuously assess and evaluate the learning environment. The development of a climate where all can bring their full selves to learn, study, work, and care for patients is critically important in the creation of a learning environment where every participant can grow and thrive. If we are to address the need to diversify the workforce, we must be intentional with strategic plans, which includes addressing the social determinants that are prohibitive for some of our learners.

Wastewater Surveillance to Inform Public Health Decision Making in Residential Institutions

Testing sewage (wastewater-based surveillance, or WBS) for pathogens is an increasingly important tool for monitoring the health of populations. During the COVID-19 pandemic, some residential institutions including colleges, prisons, and skilled nursing facilities used facility-level wastewater data to inform their pandemic responses. To understand how these early adopters used WBS data in decision making, we conducted in-depth, semistructured interviews with multiple decision makers at 6 residential institutions in the United States (universities, prisons, and nursing homes) encompassing a total of more than 70 000 residents and staff about interpretation, uses, and limitations of these data. We found that WBS data were used in extremely diverse ways. WBS combined with clinical surveillance informed a wide range of public health actions at residential institutions, including transmission reduction measures, public health communications, and allocation of resources. WBS also served other institutional purposes, such as maintaining relationships with external stakeholders and helping alleviate decision makers' pervasive stress. Recognizing these diverse ways of using WBS data can inform expansion of this practice among institutions as well as development of community-scale systems.

How have researchers defined institutions, politics, organizations and governance in research related to epidemic and pandemic response? A scoping review to map current concepts

In recent years, the literature on public health interventions and health outcomes in the context of epidemic and pandemic response has grown immensely. However, relatively few of these studies have situated their findings within the institutional, political, organizational and governmental (IPOG) context in which interventions and outcomes exist. This conceptual mapping scoping study synthesized the published literature on the impact of IPOG factors on epidemic and pandemic response and critically examined definitions and uses of the terms IPOG in this literature. This research involved a comprehensive search of four databases across the social, health and biomedical sciences as well as multi-level eligibility screening conducted by two independent reviewers. Data on the temporal, geographic and topical range of studies were extracted, then descriptive statistics were calculated to summarize these data. Hybrid inductive and deductive qualitative analysis of the full-text articles was conducted to critically analyse the definitions and uses of these terms in the literature. The searches retrieved 4918 distinct articles; 65 met the inclusion criteria and were thus reviewed. These articles were published from 2004 to 2022, were mostly written about COVID-19 (61.5%) and most frequently engaged with the concept of governance (36.9%) in relation to epidemic and pandemic response. Emergent themes related to the variable use of the investigated terms, the significant increase in relevant literature published amidst the COVID-19 pandemic, as well as a lack of consistent definitions used across all four terms: institutions, politics, organizations and governance. This study revealed opportunities for health systems researchers to further engage in interdisciplinary work with fields such as law and political science, to become more forthright in defining factors that shape responses to epidemics and pandemics and to develop greater consistency in using these IPOG terms in order to lessen confusion among a rapidly growing body of literature.

Childhood exposure to birth registration laws and old-age mortality

This paper studies the effects of the enactment of birth registration laws, as the official universal and uniform method of recording births, across US states in the first decades of the 20th century on old-age longevity for children affected by these laws. We show that establishing birth registration laws has long-term benefits for old-age health. The benefits are primarily driven by states with an effective child labor policy, suggesting that registering births helps the enforcement of child labor laws which in turn operate as the mechanism channel to improve old-age longevity. A treatment-on-treated calculation suggests an increase of 0.6 years of longevity from not working during childhood due to the birth registration law.

Experiences of midwifery care in English prisons

BACKGROUND

In the United Kingdom (UK), all prisoners must receive healthcare equivalent to that available in the community. However, evidence suggests that equality in healthcare provision for perinatal women in UK prisons is not always achieved. The aim of this research was to examine pregnant women prisoners' and custody staffs' experiences and perceptions of midwifery care in English prisons.

METHODS

A qualitative approach based on institutional ethnography was used to research women's experiences in three English prisons over a period of 10 months. In total, 28 women participated in audio-recorded, semi-structured interviews. Ten staff members were interviewed, including six prison service staff and four health care personnel. Ten months of prison fieldwork enabled observations of everyday prison life. NVivo was used for data organization with an inductive thematic analysis method.

RESULTS

Women's experiences included: disempowerment due to limited choice; fear of birthing alone; and a lack of information about rights, with a sense of not receiving entitlements. Some women reported favorably on the continuity of midwifery care provided. There was confusion around the statutory role of UK midwifery.

DISCUSSION

Experiences of perinatal prisoners contrast starkly with best midwifery practice-women are unable to choose their care provider, their birth companions, or their place of birth. In addition, a reliance upon "good behavior" in return for appropriate treatment may be detrimental to the health, safety, and well-being of the pregnant woman and her unborn baby.

CONCLUSION

Prison is an adverse environment for a pregnant woman. This study provides key insights into imprisoned women's experiences of midwifery care in England and shows that midwives play an essential role in ensuring that perinatal prisoners receive safe, high-quality, respectful care.

Trends in the Number of Authors and Institutions in Papers Published in AJPE 2015-2019

Objective. To investigate the number of authors and unique institutions per paper published in the American Journal of Pharmaceutical Education (AJPE) in 2015 through 2019, and to examine the number of authors and unique institutions for papers that were nominated for the Rufus A. Lyman Award in the same period.Methods. Articles published in AJPE from 2015 through 2019 were reviewed. Data collected for each article included article type, number of authors, and number of institutions.Results. Of the 811 articles published in AJPE during this period, the number of authors increased significantly from a mean (SD) of 3.5 (1.8) to 4.5 (2.2). The number of unique institutions also increased significantly from 1.7 (1.1) to 2.4 (1.8).Conclusion. There is a trend toward a greater number of authors and unique institutions for the publications in one pharmacy education journal. Explanations for this trend may include pressure to publish, increased research complexity, and expanded interprofessional collaboration.

Prevention of Older Adult Infantilization by Nursing Home Professionals: An Intervention Program

This study analyzes the efficacy of a brief psychoeducational program aimed at preventing older adult infantilization by nursing home professionals. We examined whether an experimental group of professionals reported less infantilization than those of a control group. Changes in stereotypes and humanization were regarded as sub-targets. The sample comprised 154 staff members. Infantilization, humanization, and negative stereotypes toward older adults were assessed before and after the intervention, and repeated measures of ANOVA and one-way ANCOVAs were conducted. Infantilization and negative stereotypes decreased in the experimental group. Significant post-intervention differences were found between the experimental and control groups both in infantilization and negative stereotypes but not in humanization. Results reflect the relevance of developing specific interventions focused on preventing infantilization as well as the need for professionals' training and education to generate a culture of change.

Sustaining productivity gains in the face of climate change: A research agenda for US wheat

Wheat is a globally important crop and one of the "big three" US field crops. But unlike the other two (maize and soybean), in the United States its development is commercially unattractive, and so its breeding takes place primarily in public universities. Troublingly, the incentive structures within these universities may be hindering genetic improvement just as climate change is complicating breeding efforts. "Business as usual" in the US public wheat-breeding infrastructure may not sustain productivity increases. To address this concern, we held a multidisciplinary conference in which researchers from 12 US (public) universities and one European university shared the current state of knowledge in their disciplines, aired concerns, and proposed initiatives that could facilitate maintaining genetic improvement of wheat in the face of climate change. We discovered that climate-change-oriented breeding efforts are currently considered too risky and/or costly for most university wheat breeders to undertake, leading to a relative lack of breeding efforts that focus on abiotic stressors such as drought and heat. We hypothesize that this risk/cost burden can be reduced through the development of appropriate germplasm, relevant screening mechanisms, consistent germplasm characterization, and innovative models predicting the performance of germplasm under projected future climate conditions. However, doing so will require coordinated, longer-term, inter-regional efforts to generate phenotype data, and the modification of incentive structures to consistently reward such efforts.

Externalities, scarcity, and abundance

Introduction

Do externalities work and matter differently in a world of scarcity vs. a world of abundance? In this article, we critically examine the economic phenomena of externalities. The concept of externality, an important idea in economics and law, is useful in exploring the complex and dynamic relationships between resource supply and human flourishing within various sociotechnical systems.

Methods

First, we define the basic concept and explain why it is fundamental to economic analysis of complex social environments Second, we briefly survey the intellectual history of externalities with the goal of tying together a few different strands of economic theory and providing a roadmap for a general theory of externalities. This discussion highlights a latent conflict between those who pursue and those who resist perfectibility (optimization) of social systems by internalizing externalities. Third, we compare externalities in worlds of scarcity and abundance.

Results

This article develops the theoretical framework, including a brief intellectual history and notes toward the development of a general theory of externalities. As a conceptual tool, externalities enable one to identify and examine social interdependencies and to map their causes and consequences. Externalities provide evidence of social demand for governance institutions. This descriptive utility can and should inform normative analysis, the design of governance institutions, and comparative institutional analysis. We also raise a series of (mostly empirical) questions that should frame comparative institutional analysis and evaluation of different externalities in the digital networked world.

Discussion

We focus on the scarcity and abundance of knowledge resources and the (technological) means for participating in the production, dissemination, and modification of such resources. In the real, necessarily imperfect world where abundance and scarcity vary across resources, people, and contexts, externalities persist, indicate social demand for governance, and inform comparative analysis and design of governance institutions.

JEL classification

D62, B52, D02.

Adoption and scale-up of the cardiovascular Polypill: a realist institutional analysis

Efforts to promote the adoption and scale-up of health system innovations must contend with the existing institutional context. But there are no commonly used frameworks to ensure that the insights of actors involved in such institutional efforts connect to one another. To test and modify a potential framework-the 'four-by-four' framework-we interviewed researcher-entrepreneurs involved in the unfolding story of the cardiovascular Polypill. The framework has four types/levels of institutions that affect adoption and scale-up: (1) informal institutions (L1, e.g. social norms), (2) formal institutions (L2, e.g. government policies and regulation), (3) organizational structures (L3, e.g. organizational boards and mission) and (4) everyday exchange (L4, e.g. service delivery), vis-à-vis four potential entrepreneurial strategies in response: (1) abide by existing institutions, (2) evade them, (3) alter them and/or (4) exit entrepreneurial action. Using this framework, we conducted a realist-informed analysis to understand how context (i.e. institutions) and mechanism (i.e. entrepreneurial strategies) influence each other to shape outcomes (i.e. adoption and scale-up). We found that researcher-entrepreneurs began with efforts to abide with existing institutions but encountered institutional obstacles at each level. Efforts to abide were followed by seeking to evade and/or alter unfavourable institutions, with greater success evading and/or altering lower (L3 and L4) than upper (L1 and L2) institutions. Exit considerations followed the failure of the evade or alter strategy. Shifts between strategies were propelled by 'learning'. The 'four-by-four' framework can be used as a scaffold to generate narratives of adoption or scale-up efforts, a sensitizing tool to prospectively map out contingencies and a matrix to synthesize narratives and experiences across multiple innovations or settings. Used in these ways, the 'four-by-four' framework can help to optimize the transferability and cumulation of insights on how to promote the adoption and scale-up of health system innovations.

Indigenous institutions as adaptive measures to environmental dynamics: an ethnographic study of Loba Community of Upper Mustang, Nepal

This paper investigates how different institutions of Loba communities of the Upper Mustang work together and facilitate the community to cope with the environmental dynamics in the region. The indigenous institutions are place-based, and their evolution is concerned with reducing vulnerability and enhancing the resilience capacity of place-based communities to cope with and adapt to local natural and socio-cultural environmental dynamics. The paper is based on anthropological fieldwork. Qualitative data were collected by applying observation and interviews. The paper presents the role of the galbo, (Lo King), ghenba (Village Chief), Lama (Monk), and dhongba (Household) as local institutions that act in close relation and make community-level decisions. The findings reveal that the King is seen as the leader whose governance best suited to the local natural environment, cultural practices, and economy. The Lama plays a major role in reinforcing local rules, while the Ghenba is an agent who mediates the Lo King and people in materializing rules and operationalizing institutional mechanisms. The Dhongbas are units of production of the local social-ecosystem that are entitled to use local resources within the context of the institution’s agreed rules, norms, and values. These local institutions are cooperating well, successfully regulating, managing, and protecting agricultural, forest, and pasture lands, and maintaining the monuments in Lo-manthang for centuries. However, recent social-environmental dynamics such as climate change, migration, and modernization are reducing the relevancies of traditional norms and practices. Nevertheless, the institutions are working hard to continue their existence by frequently modifying their rules and norms.

Conceptualising informal institutions: Drawing on the case of guanxi

Institutions regulate social life through formal rules and sanctions. These are distinguished from another source of social regulation, the informal incentives and constraints inherent in cultural currents and customary practices. Informal practices may be based not simply on cultural forces, though, but expectations regularised by informal rules and sanctions, which may operate as informal institutions. One approach holds that informal institutions arise out of formal institutional voids. Another holds that informal institutions operate in response to situations in which formal institutions frustrate the interests of individuals and groups who engage informal institutions to augment, compromise, or subvert formal institutions. After developing the concept of informal institution, the article goes on to indicate how an informal relationship pervasive in modern China, guanxi, may be understood as an informal institution. It is shown that by drawing on the case of guanxi the scope of the concept informal institution can be extended and also that our understanding of guanxi is enriched when the concept of informal institution is applied to its analysis.

Toward an institution-based paradigm

As part of the broader intellectual movement throughout the social sciences that is centered on new institutionalism, the institution-based view has emerged as a leading perspective in the strategic management literature. This article (1) traces the emergence of the institution-based view, (2) reviews its growth in the last two decades, and (3) responds to three of its major criticisms. We also identify four promising research directions—deglobalization and sanctions, competitive dynamics, hybrid organizations, and corporate social responsibility. Overall, we demonstrate that the thriving research on institutions has culminated in an institution-based paradigm, which has significant potential for future growth.

Regional Intergovernmental Organization Response to COVID-19: The Impact of Neoliberalism on Bureaucratic Autonomy

COVID-19 is a transboundary crisis that crosses political boundaries and affects critical infrastructure. Given the ongoing nature of COVID-19, it is vital to recognize the factors that impact an organization's ability to respond to crises. In this article, we use the concept of bureaucratic autonomy discussed by Bauer and Ege (2016) to examine the response of four regional intergovernmental organizations. We find here that neoliberalism as a dominating global ideology has transformed the autonomy of action dimension into autonomy of finance, with the focus on enabling private firms through adjusting incentive structures, rather than taking direct action. Organizations that lack this autonomy become the benefactors of other dominant neoliberal financing institutions, thus furthering the entrenchment of neoliberalism and neoliberal finance. JEL Classification: F53, F55, P16.

Sociocultural determinants of global mask-wearing behavior

Behavioral responses influence the trajectories of epidemics. During the COVID-19 pandemic, nonpharmaceutical interventions (NPIs) reduced pathogen transmission and mortality worldwide. However, despite the global pandemic threat, there was substantial cross-country variation in the adoption of protective behaviors that is not explained by disease prevalence alone. In particular, many countries show a pattern of slow initial mask adoption followed by sharp transitions to high acceptance rates. These patterns are characteristic of behaviors that depend on social norms or peer influence. We develop a game-theoretic model of mask wearing where the utility of wearing a mask depends on the perceived risk of infection, social norms, and mandates from formal institutions. In this model, increasing pathogen transmission or policy stringency can trigger social tipping points in collective mask wearing. We show that complex social dynamics can emerge from simple individual interactions and that sociocultural variables and local policies are important for recovering cross-country variation in the speed and breadth of mask adoption. These results have implications for public health policy and data collection.

The Link between Democratic Institutions and Population Health in the American States

CONTEXT

This project investigates the role of state-level institutions in explaining variation in population health in the American states. Although cross-national research has established the positive effects of democracy on population health, little attention has been given to subnational units. The authors leverage a new data set to understand how political accountability and a system of checks and balances are associated with state population health.

METHODS

The authors estimate error correction models and two-way fixed effects models to estimate how the strength of state-level democratic institutions is associated with infant mortality rates, life expectancy, and midlife mortality.

FINDINGS

The authors find institutions that promote political accountability are associated with lower infant mortality across the states, while those that promote checks and balances are associated with longer life expectancy. They also find that policy liberalism is associated with better health outcomes.

CONCLUSIONS

Subnational institutions play an important role in population health outcomes, and more research is needed to understand the link between democracy and health. The authors are the first to explore the link between democratic institutions and population health within the United States, contributing to both the social science literature on the positive effects of democracy and the epidemiological literature on subnational health outcomes.

Building Critical Infrastructures: Evaluating the Roles of Governance and Institutions in Infrastructural Developments in Sub-Sahara African Countries

BACKGROUND

The Sub-Saharan African (SSA) region has notably been in the limelight of infrastructural deficit discussions over the decades. Although the region's infrastructural development is gradually improving, the levels and pace of development remain generally poor compared to the rest of the world.

OBJECTIVES

This study thus aims to empirically examine the roles of governance and institutions in infrastructural developments in the Sub-Sahara African (SSA) region toward addressing the pressing needs for critical infrastructures for the region.

RESEARCH DESIGNS

The empirical strategies utilized in the study include the Common Correlated Efficient Mean Group (CCEMG) and Dynamic CCEMG methods among others. These empirical approaches were applied to analyze data on governance and institutional quality proxies for the SSA region to achieve the study's objectives while controlling for the effects of industrial value-added, foreign capital inflow (FDI), and overall economic growth for the understudied period (1990-2019).

RESULTS

The results reflect the essence of governance and institutional quality as these variables significantly boost infrastructural development in SSA. In addition, industrialization and growth also show a favorable impact on the development of infrastructure thus reflecting that the transition from agrarian to industrial economies occurs in parallel with infrastructure development in the SSA. However, FDI inflows were not found to be significantly instrumental to infrastructural development in the region.

CONCLUSIONS

Hence, the SSA must strive to strengthen institutions and harmonize their industrial and economic push with infrastructural developments while encouraging potential foreign investors to diversify investments to infrastructural projects beyond the usual primary sector/resource-based activities.

Religious celibacy brings inclusive fitness benefits

The influence of inclusive fitness interests on the evolution of human institutions remains unclear. Religious celibacy constitutes an especially puzzling institution, often deemed maladaptive. Here, we present sociodemographic data from an agropastoralist Buddhist population in western China, where parents sometimes sent a son to the monastery. We find that men with a monk brother father more children, and grandparents with a monk son have more grandchildren, suggesting that the practice is adaptive. We develop a model of celibacy to elucidate the inclusive fitness costs and benefits associated with this behaviour. We show that a minority of sons being celibate can be favoured if this increases their brothers' reproductive success, but only if the decision is under parental, rather than individual, control. These conditions apply to monks in our study site. Inclusive fitness considerations appear to play a key role in shaping parental preferences to adopt this cultural practice.

Proactive strategies for an inclusive faculty search process

A case study on an inclusive faculty hiring process at Emory University provides advice for institutions creating their own hiring panels and workflows.

Analysis of the Effects of Lockdown on Staff and Students at Universities in Spain and Colombia Using Natural Language Processing Techniques

The aim of this study is to analyze the effects of lockdown using natural language processing techniques, particularly sentiment analysis methods applied at large scale. Further, our work searches to analyze the impact of COVID-19 on the university community, jointly on staff and students, and with a multi-country perspective. The main findings of this work show that the most often related words were "family", "anxiety", "house", and "life". Besides this finding, we also have shown that staff have a slightly less negative perception of the consequences of COVID-19 in their daily life. We have used artificial intelligence models such as swivel embedding and a multilayer perceptron as classification algorithms. The performance that was reached in terms of accuracy metrics was 88.8% and 88.5% for students and staff, respectively. The main conclusion of our study is that higher education institutions and policymakers around the world may benefit from these findings while formulating policy recommendations and strategies to support students during this and any future pandemics.

Champing at the Bit for Improvements: A Review of Equine Welfare in Equestrian Sports in the United Kingdom

Equestrian sports, including racing (e.g., flat, steeple-chasing, harness or donkey derby); show-jumping; cross-country; dressage; polo; polocrosse; endurance; carriage driving; vaulting and hunting; are hugely popular in the UK, and they involve a significant number of people, both as participants and spectators, and tens of thousands of equids. In this paper, we discuss animal welfare as a complex and disputed issue, clarifying what the term means and how it can be measured. We review many aspects of welfare risk to equids used for sport, addressing issues encountered throughout their lives, including housing, feeding, veterinary intervention, shoeing, handling, training, breeding and equipment. This is followed by a unique exploration of the institutions and social processes influencing equine welfare. The institutional components comprise the rules of competition, the equids, attributes of the stakeholders and the space where participants strive to achieve a common purpose. We endeavour to untangle the most significant elements that create barriers or provide opportunities for equine welfare improvement. We expose the challenges faced by a broad range of stakeholders with differing ethics, attitudes and values. Evidently, there are many welfare risks to which equids used in sports continue to be exposed. It is also evident that significant improvements have occurred in recent times, but there remains a barrier to reducing the risks to an acceptable level. We conclude with recommendations regarding a process for change, involvement of stakeholders and management of knowledge to improve equine welfare that involves identifying and prioritising the risk factors and ultimately leading to interventions, further research and/or education.

Trust in the U.S. Government and Its Health Agencies in the Time of COVID-19

This article examines the factors affecting Americans' trust in their federal government and its health agencies during the COVID-19 public health crisis. More specifically, we examine the evolution of Americans' trust in their government and health system and how, in the context of the COVID-19 pandemic response, it has been affected by multiple factors. Several academic journals, government policy recommendations and public health polls were evaluated to understand the public's trust in the federal government and its health institutions. Public trust in institutions during a global pandemic is essential in influencing adherence to a pandemic response (both non-pharmaceutical and medical interventions). Americans' trust in institutions is built and maintained by a variety of factors. We focus on: political polarization and involvement, media influence and health communications, history of systemic racism and socioeconomic inequalities, and pandemic fatigue. Based on the interplay of these factors, we conclude with recommendations for future pandemic response strategies.

Institutions matter: The impact of the covid-19 pandemic on the political trust of young Europeans

In this paper, we study the short-run evolution of political trust during the recent covid-19 pandemic using survey data for a sample of young individuals living in Germany, France, Italy, and Spain. In particular, we analyze whether pre-pandemic perceptions and experiences of citizens about various dimensions of local governments and institutional quality had any mediating effect on the evolution of political trust after the outbreak of the covid-19 pandemic. The results show a relative increase in political trust of about 9% in regions with high institutional quality (75th percentile) compared with regions with low institutional quality (25th percentile) over the period 2019-2020. This divergence can be associated with either a better performance of policymakers in high-quality institutions regions, or to more positive attitudes toward politicians by citizens that, before the pandemic, believed to live in regions with efficient institutions. Overall results are not affected by the inclusion of regional fixed effects or by possible differential evolution of political trust according to a large set of observable regional characteristics.

Source-sink behavioural dynamics limit institutional evolution in a group-structured society

Social change in any society entails changes in both behaviours and institutions. We model a group-structured society in which the transmission of individual behaviour occurs in parallel with the selection of group-level institutions. We consider a cooperative behaviour that generates collective benefits for groups but does not spread between individuals on its own. Groups exhibit institutions that increase the diffusion of the behaviour within the group, but also incur a group cost. Groups adopt institutions in proportion to their fitness. Finally, the behaviour may also spread globally. We find that behaviour and institutions can be mutually reinforcing. But the model also generates behavioural source-sink dynamics when behaviour generated in institutionalized groups spreads to non-institutionalized groups and boosts their fitness. Consequently, the global diffusion of group-beneficial behaviour creates a pattern of institutional free-riding that limits the evolution of group-beneficial institutions. Our model suggests that, in a group-structured society, large-scale beneficial social change can be best achieved when the relevant behaviour and institutions remain correlated.

Can the emergency response be coordinated?

BACKGROUND

In the COVID-19 pandemic, coordination was certainly late, also due to the scarcity of information disseminated at the very beginning of the pandemic, when countries were inevitably taken by surprise. The lack of information, mainly attributable to the country from which everything seems to have started, has produced a huge delay and numerous uncertainties in the feedback of the WHO and international organizations.

OBJECTIVE

The inevitably relevant issue, from a legal point of view, concerns the legitimacy, formal or in any case shared, of the authority in charge of coordinating reactions and policies. The paper analyses the current legislation, soft and hard law, and the undertaken policies concerning emergency responses.

METHODS

International and EU legislation analysis.

RESULTS

The G20 understood that sustainable, flexible and agile funding systems for health emergencies are essential elements of pandemic prevention, preparedness and response. In EU there are many regulations about coordination and response to emergencies in practice in the EU and the Regulation (EU) 2021/522 (EU4Health programme), broadly extends the Union's competence in the field of health and has the objective of strengthening the Union's capacity for prevention, preparedness and rapid response in the event of serious cross-border threats to health.

CONCLUSIONS

It is essential to formalize, within international agreements, the institutionalization of relationships, procedures, and the possible recognition of the reference figure. If in the European Union, at least partially, the protocols are there (even if the COVID-19 emergency has blown them up in principle), certainly in relations with non-EU countries the story is complicated, requiring specific agreements. This is the goal of the path started by the Rome Declaration of 21 May 2021 within the G20 - Global Health Summit.