In Chapter 9, the final example of the legal exile of humanity is provided, where toxicity in the environment from industry has been legally permitted to accumulate. Tort litigation in the US, using the example of oil and chemical spills, is discussed, noting the decline in strict liability for industrial defendants over the last century.

In evidence law, a privilege can prevent the discovery or evidentiary use of certain sensitive information. Many privileges apply to communication with specified persons such as lawyers, doctors, psychologists, accountants, clergy, or spouses. A major shortcoming of current privilege law is that it tends to protect relationships that are more common in higher economic strata. Low-income people do not benefit equally from privileges because their relationships are less likely to meet the requirements set forth in statutes and case law. The time has come to level the playing field and extend the valuable protections of evidentiary privileges more uniformly throughout society. Evidentiary privilege should not depend on economic privilege.

In this chapter, we define health system reform as “changes produced out of explicit intention on the part of government or political groups to transform, for the better, the health sector.” We identify four levels where changes can be made: systemic, where the main goal is equity; programmatic, where the main objective is allocational efficiency; organizational, where the objective is technical efficiency; and instrumental, where institutional intelligence is developed for better system performance. Valuable change can happen at any of these four levels, but true reform must address all of them. We examine reform challenges in each of the five health system functions. We also analyze several key policy transitions and larger societal transformations that are shaping the future of health systems. Finally, we use the example of the Seguro Popular in Mexico to illustrate how these ideas come together in the actual design and implementation of a comprehensive health system reform.

This chapter focuses on how to evaluate and improve the performance of health systems. It frames performance as a relative concept: how well a system attains its goals compared to what is achievable under given circumstances. It examines how health system architecture, including vertical and horizontal integration, influences performance. We also argue that improving performance requires strengthening key system components and propose four priority areas (the “LIST” elements): leadership, institutions, systems design, and technologies. Finally, the chapter argues that health systems must be accountable for determinants they can influence, even if external, and stresses the importance of rigorous assessment methods to inform evidence-based policy and effective reforms.

This chapter provides a conceptual framework to organize the complex relationships between multiple determinants that underlie changes in the health conditions of a population. Specific relationships of determination take place within a basic frame comprised of the population, its genetic constitution, the physical environment within which it resides and its forms of social organization. It distinguishes between five organized levels – systemic, societal, institutional, household and individual, organizing them hierarchically to show how upper levels constrain lower ones. The model emphasizes the dynamic concept of risk, which operates at the population level, and susceptibility, which manifests at the individual level. Finally, the chapter stresses that health inequities often result from unfair distribution of determinants.

A brand new chapter to this Edition of the Course Manual. Ethnicity and social background adversely affect maternal and perinatal outcomes. This chapter focuses primarily on the inequalities experienced by those of black, Asian and mixed ethnicity as well as those experiencing social deprivation. We explore the impacts of inequity and inequality, as well as strategic action and central support for local improvement. Key learning points: There is an immediate need to act and address inequalities and inequity within maternity services. Non-white ethnicity and social deprivation adversely affect maternal and perinatal outcomes. It is important for individuals and wider society, that women are healthy, educated, and feel safe in their environment. Equality and equity are not the same, both need to be provided for fair and inclusive maternity care. Unacceptable differences in perinatal mortality related to levels of deprivation and ethnicity have increased. Microaggressions and stereotypical assumptions are examples of inequalities that have been reported to contribute to substandard care for women. Research inequalities, and staff representation associated with non-white ethnicity and deprivation, impact clinical care. There are national recommendations to increase research in this area, provide education for staff and women, as well as a call for action to ensure that the quality of maternity care is improved for all.

Initially it may seem odd to many people to learn that a large proportion of our laws were not made by parliaments, but rather by judges. However the doctrine of precedent, combined with a commitment to judicial restraint, and combined also with the capacity of judges to rule in equity if the common law was inadequate, developed over time a consistent and sophisticated body of law which was that exported around the world during the period of colonial empires. Many of the characteristics of our legal system have their beginning in this gradual, incremental process under which judges took their lead from other judges in order to develop a coherent legal system. As we will note in this Chapter, the common law has advantages and disadvantages, but it was exported around the world by England during the age of colonialism, and has stood the test of time as a legal methodology. It remains in use in a range of nations as distinct as Australia, the United States, the Philippines, Kenya, India, the Cook Islands, and Canada. It is one of the world’s great legal systems.

The introduction of co-management is often associated with recognition and allocation of property rights. This chapter therefore provides definitions of the concepts of property, property rights and property regimes. Systems informed by economic theory to provide ‘user rights’ are reviewed in relation to collaborative governance, including Transferable Quota systems and Territorial User Rights for Fishing. Given that rights may be contested and not realised in practice, the chapter goes on to consider the pursuit and realisation of justice through co-management, differentiating between procedural, distribution and recognition justice. Insights from the application of a human rights based approach to natural resource governance and implications for co-management are then identified.

Social justice in psychiatric prescribing necessarily elevates the personhood of the patient, in the context of the relationship with the provider as well as in the larger societal milieu. Grounded in a historical narrative, we offer practical tools to apply a social justice framework to prescribing practices. Simple steps advise the reader to consider practice context, utilize nuance in formulation, and pursue quality improvement in three common scenarios. At the end of the chapter, we offer reflection questions to encourage ongoing social justice in your psychiatric prescribing practice.

Chapter 3 explores children’s digital books as a powerful illustration of what well-designed EdTech can achieve when grounded in learning science. It begins by showcasing diverse examples of digital books and mapping their rapid global expansion, highlighting their growing role in early literacy. The chapter examines evidence demonstrating that digital books, when designed with research-based principles, can enhance vocabulary, comprehension, and engagement, sometimes outperforming print. Connecting this to the science of reading, it explains how features such as responsive narration, sensory supports, and adaptive scaffolding can strengthen foundational literacy skills. The chapter also emphasises the inclusive potential of digital books, offering accessible reading experiences for children with special needs and for families with limited access to print materials. It concludes by reviewing research on effective digital book design and emerging studies on children’s digital libraries, showing how carefully developed platforms can expand reading opportunities at scale.

Māori comprise 17.4 per cent of the total population of Aotearoa New Zealand. They are a relatively young population, with a median age of 25.5 years for males and 27.6 years for females, compared to the national median age of 37.0 years for males and 39.1 years for females. Contemporary Māori, like their pre-colonised counterparts, are diverse in their identity, with many having connections to iwi (tribal nations) or hapū (constellations of whānau, or extended family networks). Today, rather than being defined solely by iwi and hapū differences, Māori are also diverse regarding their histories of colonisation, their levels of disconnection from te ao Māori (Māori world) and their contemporary social experiences. Disconnection from te ao Māori means not all Māori know their whakapapa (genealogical) connections.

Chapter 7 begins with a discussion of how colonialism and the climate issue in the MENA are strongly linked, and how this relationship affects not only development trajectories, but also the status of the climate as a policy area and women’s representation. The second part of the chapter covers Othering, that is, the portrayal of women as vulnerable victims or saviours, focusing on the dangers of feminizing vulnerability and responsibility, whilst also showcasing how Othering of women in the Global South occurs among female parliamentarians in the MENA. In terms of the global climate crisis, this has led to a situation where the climate issue is not prioritized as much as it could be if the female parliamentarians were more accountable to the electorate and identified more strongly with a broader group of women, that is, beyond the narrow elite segment of the population from which they themselves were recruited. At present, those that are the most passionate about combatting the climate crisis are the youth, whereas those who stand to gain the most are marginalized women — two groups that are nothing like the female parliamentarians, who are supposed to act in their interest.

This chapter deals with the question of the sources of international law, that is, how one distinguishes between what is law and what is not. This is governed essentially by art. 38(1) of the Statute of the International Court of Justice. Historically, the first source is custom, which is composed of two elements: the actual conduct of states and the belief that such conduct is carried out in the belief that it is ‘law’. What is counted as state practice is examined, as is the critical belief requirement (opinio juris), which is often harder to ascertain. The process of change is discussed, as is the concept of local or regional custom. The second source, of increasing importance today, is international agreements or treaties, which are binding on all states parties to the particular agreement and is the focus of a later chapter. The third source is termed ‘general principles of law’, which seeks to cover gaps in the law by recourse to accepted principles of the system or of domestic law and includes the notion of equity. Finally, the chapter looks at subsidiary means for the determination of law, including judicial decisions and writings. Other possible sources of law are noted, and the work of the UN International Law Commission is referenced.