Health Care in the U.S. Compared to Other High-Income Countries: Worst Outcomes

The Commonwealth Fund

Mirror, Mirror 2021: Reflecting Poorly

Originally posted 4 Aug 21

Introduction

No two nations are alike when it comes to health care. Over time, each country has settled on a unique mix of policies, service delivery systems, and financing models that work within its resource constraints. Even among high-income nations that have the option to spend more on health care, approaches often vary substantially. These choices affect health system performance in terms of access to care, patients’ experiences with health care, and people’s health outcomes. In this report, we compare the health systems of 11 high-income countries as a means to generate insights about the policies and practices that are associated with superior performance.

With the COVID-19 pandemic imposing an unprecedented stress test on the health care and public health systems of all nations, such a comparison is especially germane. Success in controlling and preventing infection and disease has varied greatly. The same is true of countries’ ability to address the challenges that the pandemic has presented to the workforce, operations, and financial stability of the organizations delivering care. And while the comparisons we draw are based on data collected prior to the pandemic or during the earliest months of the crisis, the prepandemic strengths and weaknesses of each country’s preexisting arrangements for health care and public health have undoubtedly been shaping its experience throughout the crisis.

For our assessment of health care system performance in Australia, Canada, France, Germany, the Netherlands, New Zealand, Norway, Sweden, Switzerland, the United Kingdom, and the United States, we used indicators available across five domains:

• Access to care
• Care process
• Administrative efficiency
• Equity
• Health care outcomes

For more information on these performance domains and their component measures, see How We Measured Performance. Most of the data were drawn from surveys examining how members of the public and primary care physicians experience health care in their respective countries. These Commonwealth Fund surveys were conducted by SSRS in collaboration with partner organizations in the 10 other countries. Additional data were drawn from the Organisation for Economic Co-operation and Development (OECD) and the World Health Organization (WHO).

The info is here.

Science Skepticism Across 24 Countries

Rutjens, B. T., et al., (2021). 

Social Psychological and Personality Science. 

https://doi.org/10.1177/19485506211001329

Abstract

Efforts to understand and remedy the rejection of science are impeded by lack of insight into how it varies in degree and in kind around the world. The current work investigates science skepticism in 24 countries (N = 5,973). Results show that while some countries stand out as generally high or low in skepticism, predictors of science skepticism are relatively similar across countries. One notable effect was consistent across countries though stronger in Western, Educated, Industrialized, Rich, and Democratic (WEIRD) nations: General faith in science was predicted by spirituality, suggesting that it, more than religiosity, may be the ‘enemy’ of science acceptance. Climate change skepticism was mainly associated with political conservatism especially in North America. Other findings were observed across WEIRD and non-WEIRD nations: Vaccine skepticism was associated with spirituality and scientific literacy, genetic modification skepticism with scientific literacy, and evolution skepticism with religious orthodoxy. Levels of science skepticism are heterogeneous across countries, but predictors of science skepticism are heterogeneous across domains.

From the Discussion

Indeed, confirming previous results obtained in the Netherlands (Rutjens & van der Lee, 2020)—and providing strong support for Hypothesis 6—the current data speak to the crucial role of spirituality in fostering low faith in science, more generally, beyond its domain-specific effects on vaccine skepticism. This indicates that the negative impact of spirituality on faith in science represents a cross-national phenomenon that is more generalizable than might be expected based on the large variety (Muthukrishna et al., 2020) of countries included here. A possible explanation for the robustness of this effect may lie in the inherent irreconcilability of the intuitive epistemology of a spiritual belief system with science (Rutjens & van der Lee, 2020). (If so, then we might look at a potentially much larger problem that extends beyond spirituality and applies more generally to “post-truth” society, in which truth and perceptions of reality may be based on feelings rather than facts; Martel et al., 2020; Rutjens & Brandt, 2018.) However, these results do not mean that traditional religiosity as a predictor of science skepticism (McPhetres & Zuckermann, 2018; Rutjens, Heine, et al., 2018; Rutjens, Sutton, & van der Lee, 2018) has now become irrelevant: Not only did religious orthodoxy significantly contribute to low faith in science, it was also found to be a very consistent cross-national predictor of evolution skepticism (but not of other forms of science skepticism included in the study).

The research is here.

Kinship intensity and the use of mental states in moral judgment across societies

C. M. Curtain and others

Evolution and Human Behavior
Volume 41, Issue 5, September 2020, Pages 415-429

Abstract

Decades of research conducted in Western, Educated, Industrialized, Rich, & Democratic (WEIRD) societies have led many scholars to conclude that the use of mental states in moral judgment is a human cognitive universal, perhaps an adaptive strategy for selecting optimal social partners from a large pool of candidates. However, recent work from a more diverse array of societies suggests there may be important variation in how much people rely on mental states, with people in some societies judging accidental harms just as harshly as intentional ones. To explain this variation, we develop and test a novel cultural evolutionary theory proposing that the intensity of kin-based institutions will favor less attention to mental states when judging moral violations. First, to better illuminate the historical distribution of the use of intentions in moral judgment, we code and analyze anthropological observations from the Human Area Relations Files. This analysis shows that notions of strict liability—wherein the role for mental states is reduced—were common across diverse societies around the globe. Then, by expanding an existing vignette-based experimental dataset containing observations from 321 people in a diverse sample of 10 societies, we show that the intensity of a society's kin-based institutions can explain a substantial portion of the population-level variation in people's reliance on intentions in three different kinds of moral judgments. Together, these lines of evidence suggest that people's use of mental states has coevolved culturally to fit their local kin-based institutions. We suggest that although reliance on mental states has likely been a feature of moral judgment in human communities over historical and evolutionary time, the relational fluidity and weak kin ties of today's WEIRD societies position these populations' psychology at the extreme end of the global and historical spectrum.

General Discussion

We have argued that some of the variation in the use of mental states in moral judgment can be explained as a psychological calibration to the social incentives, informational constraints, and cognitive demands of kin-based institutions, which we have assessed using our construct of kinship intensity. Our examination of ethnographic accounts of norms that diminish the importance of mental states reveals that these are likely common across the ethnographic record, while our analysis of data on moral judgments of hypothetical violations from a diverse sample of ten societies indicates that kinship intensity is associated with a reduced tendency to rely on intentions in moral judgment. Together, these lines of ethnographic and psychological inquiry provide evidence that (i) the heavy reliance of contemporary, WEIRD populations on intentions is likely neither globally nor historically representative, and (ii) kinship intensity may explain some of the population-level variation in the use of mental-state reasoning in moral judgment.

The research is here.

For whom does determinism undermine moral responsibility? Surveying the conditions for free will across cultures

Ivar Hannikainen and others
PsyArXiv Preprints
Originally published October 15, 2019

Abstract

Philosophers have long debated whether, if determinism is true, we should hold people morally responsible for their actions since in a deterministic universe, people are arguably not the ultimate source of their actions nor could they have done otherwise if initial conditions and the laws of nature are held fixed. To reveal how non-philosophers ordinarily reason about the conditions for free will, we conducted a cross-cultural and cross-linguistic survey (N = 5,268) spanning twenty countries and sixteen languages. Overall, participants tended to ascribe moral responsibility whether the perpetrator lacked sourcehood or alternate possibilities. However, for American, European, and Middle Eastern participants, being the ultimate source of one’s actions promoted perceptions of free will and control as well as ascriptions of blame and punishment. By contrast, being the source of one’s actions was not particularly salient to Asian participants. Finally, across cultures, participants exhibiting greater cognitive reflection were more likely to view free will as incompatible with causal determinism. We discuss these findings in light of documented cultural differences in the tendency toward dispositional versus situational attributions.

The research is here.

You can’t characterize human nature if studies overlook 85 percent of people on Earth

Daniel Hruschka
The Conversation
Originally posted November 16, 2108

Here is an excerpt:

To illustrate the extent of this bias, consider that more than 90 percent of studies recently published in psychological science’s flagship journal come from countries representing less than 15 percent of the world’s population.

If people thought and behaved in basically the same ways worldwide, selective attention to these typical participants would not be a problem. Unfortunately, in those rare cases where researchers have reached out to a broader range of humanity, they frequently find that the “usual suspects” most often included as participants in psychology studies are actually outliers. They stand apart from the vast majority of humanity in things like how they divvy up windfalls with strangers, how they reason about moral dilemmas and how they perceive optical illusions.

Given that these typical participants are often outliers, many scholars now describe them and the findings associated with them using the acronym WEIRD, for Western, educated, industrialized, rich and democratic.

The info is here.

Toward a psychology of Homo sapiens: Making psychological science more representative of the human population

Mostafa Salari Rad, Alison Jane Martingano, and Jeremy Ginges
PNAS November 6, 2018 115 (45) 11401-11405; published ahead of print November 6, 2018 https://doi.org/10.1073/pnas.1721165115

Abstract

Two primary goals of psychological science should be to understand what aspects of human psychology are universal and the way that context and culture produce variability. This requires that we take into account the importance of culture and context in the way that we write our papers and in the types of populations that we sample. However, most research published in our leading journals has relied on sampling WEIRD (Western, educated, industrialized, rich, and democratic) populations. One might expect that our scholarly work and editorial choices would by now reflect the knowledge that Western populations may not be representative of humans generally with respect to any given psychological phenomenon. However, as we show here, almost all research published by one of our leading journals, Psychological Science, relies on Western samples and uses these data in an unreflective way to make inferences about humans in general. To take us forward, we offer a set of concrete proposals for authors, journal editors, and reviewers that may lead to a psychological science that is more representative of the human condition.

Philosophy of Multicultures

Owen Flanagan
Philosophers Magazine
Originally published August 19, 2018

Here is an excerpt:

First, as I have been insisting, we live increasingly in multicultural, multiethnic, cosmopolitan worlds. Depending on one’s perspective these worlds are grand experiments in tolerant living, worlds in which prejudices break down; or they are fractured, wary, tense ethnic and religious cohousing projects; or they are melting pots where differences are thinned out and homogenised over time; or they are admixtures or collages of the best values, norms, and practices, the sociomoral equivalent of fine fusion cuisine or excellent world music that creates flavours or sounds from multiple fine sources; or on the other side, a blend of the worst of incommensurable value systems and practices, clunky and degenerate. It is good for ethicists to know more about people who are not from the North Atlantic (or its outposts). Or even if they are from the North Atlantic are not from elites or are not from “around here”. It matters how members of original displaced communities or people who were brought here or came here as chattel slaves or indentured workers or political refugees or for economic opportunity, have thought about virtues, values, moral psychology, normative ethics, and good human lives.

Second, most work in empirical moral psychology has been done on WEIRD people (Western Educated Industrialised Rich Democratic) and there is every reason to think WEIRD people are unrepresentative, possibly the most unrepresentative group imaginable, less representative than our ancestors when the ice melted at the end of the Pleistocene. It may be the assumptions we make about the nature of persons and the human good in the footnotes to Plato lineage and which seem secure are in fact parochial and worth re-examining.

Third, the methods of genetics, empirical psychology, evolutionary psychology, and neuroscience get lots of attention recently in moral psychology, as if they can ground an entirely secular and neutral form of common life. But it would be a mistake to think that these sciences are superior to the wisdom of the ages in gaining deep knowledge about human nature and the human good or that they are robust enough to provide a picture of a good life.

The info is here.

The WEIRD Science of Culture, Values, and Behavior

Kim Armstrong
Psychological Science
Originally posted April 2018

Here is an excerpt:

While the dominant norms of a society may shape our behavior, children first experience the influence of those cultural values through the attitudes and beliefs of their parents, which can significantly impact their psychological development, said Heidi Keller, a professor of psychology at the University of Osnabrueck, Germany.

Until recently, research within the field of psychology focused mainly on WEIRD (Western, educated, industrialized, rich, and democratic) populations, Keller said, limiting the understanding of the influence of culture on childhood development.

“The WEIRD group represents maximally 5% of the world’s population, but probably more than 90% of the researchers and scientists producing the knowledge that is represented in our textbooks work with participants from that particular context,” Keller explained.

Keller and colleagues’ research on the ecocultural model of development, which accounts for the interaction of socioeconomic and cultural factors throughout a child’s upbringing, explores this gap in the research by comparing the caretaking styles of rural and urban families throughout India, Cameroon, and Germany. The experiences of these groups can differ significantly from the WEIRD context, Keller notes, with rural farmers — who make up 30% to 40% of the world’s population — tending to live in extended family households while having more children at a younger age after an average of just 7 years of education.

The information is here.