text:
The At-Large Advisory Committee (ALAC) is an advisory committee to ICANN, the organization that administers the Internet's Domain Name System and addressing system. According to ICANN Bylaw XI.4.a, "ALAC is the primary organizational home within ICANN for individual Internet users", with a mandate to "consider and provide advice on the activities of ICANN, insofar as they relate to the interests of individual Internet users".

Structure and mission
The ALAC is composed by fifteen members, three from each of the five geographic regions used by ICANN for geographical diversity requirements.

As a part of its mission, the ALAC reaches out for groups of individual Internet users all around the world - identified as At-Large Structures (ALSes) - and encourages them to apply for accreditation by ICANN. Once accredited, these groups can participate in the five Regional At-Large Organizations (RALOs), regional groupings that host discussions at a regional level. In turn, each RALO appoints two members of the ALAC (for a total of ten members out of fifteen). This builds an open, bottom-up mechanism to select the ALAC members. The remaining five members of the ALAC are appointed by ICANN's Nominating Committee.

The ALAC appoints one non-voting representative to the councils of the Generic Names Supporting Organization and to the Country Code Names Supporting Organization, and liaisons to ICANN working groups and task forces. It also appoints five members (one per geographic region) of ICANN's Nominating Committee. It has some statutory authority, though limited, to influence ICANN's policy making activities. However, it usually shares its opinions through non-binding advisory statements sent to the ICANN Board.

Originally the ALAC appointed a liaison to the ICANN Board; however, that position was abolished in 2010 when an additional, fully voting position on the ICANN Board was designated to be selected by the At-Large community. The first person selected by this process, joining the ICANN Board in October 2012, was former ALAC member Sébastien Bachollet.

History

The ALAC was created in 2002, as one of the changes introduced in the so-called "ICANN 2.0" reform, with the purpose of providing a viable mechanism for participation by a significant number of active individual users of the Internet from around the world. Its structure was studied through the At-Large Advisory Committee Assistance Group, which made a proposal that was then approved by the ICANN Board.

The first ALAC was appointed in January 2003. Since the Regional At-Large Organizations did not exist yet, the committee was marked as "interim" and the ten regional members were appointed by the ICANN Board instead. The initial membership included the former ICANN Chairman Esther Dyson. The initial Chairman was Vittorio Bertola, and the first appointed liaison to the ICANN Board was Roberto Gaetano, and Thomas Roessler to the GNSO, who in December 2004 left his position to Bret Fausett. In March 2006, Bertola left the Chairmanship to Annette Muehlberg; in December 2006, Bertola was appointed as the new Board liaison, Alan Greenberg as GNSO liaison, and Siavash Shahshahani as CCNSO liaison.

Initially, there was widespread concern that the ALAC would fail as a result of a perception of disenfranchisement common to many Internet rights groups - especially the North American ones - that followed the demise by ICANN of the original At-Large election plan. However, the number of accredited At-Large Structures grew slowly but steadily, reaching 100 in the first months of 2007. In December 2006, the first Regional At-Large Organization, the Latin American RALO, was formally accredited by ICANN. Further RALOs for Europe, Africa and Asia-Pacific were expected to be accredited in the first half of 2007.

Membership

2021 membership
 Maureen Hilyard (Asia Pacific)
 Jonathan Zuck (North America)
 Joanna Kulesza (Europe)
 Humberto Carrasco (Latin America)
 Tijani Ben Jemaa (Africa)
 Dave Kissoondoyal (Africa)
 Abdulkarim Oloyede (Africa)
 Holly Raiche (Asia Pacific)
 Justine Chew (Asia Pacific)
 Bastiaan Gosling (Europe)
 Matthias Hudobnik (Europe)
 Pari Esfandiari (Europe)
 Carlos Raul Gutierrez (Latin America)
 Sylvia Herlein Leite (Latin America)
 Marita Moll (North America)
 Javier Rua-Jovet (North America)

EURALO Individual Members
 Alastair Strachan (Netherlands)
 Amali De Silva-Mitchell (United Kingdom)
 Ana Kakalashvili (Germany)
 Andrei Kolesnikov (Russian Federation)
 Anna Romandash (Ukraine)
 Auke Pals (Netherlands)
 Carole Sunderland (Switzerland)
 Christel Dahlskjaer (United Kingdom)
 Cisse Kane (Switzerland)
 Clement Genty (France)
 Daniel Leuenberger (Switzerland)
 Danko Jevtovic (Serbia)
 Desara Dushi (Albania)
 Desiree Miloshevic (United Kingdom)
 Desislava Atanasova (Bulgaria)
 Dina Solveig Jalkanen (Finland)
 Dušan Popovic (Serbia)
 Eric Tomson (Belgium)
 Fotjon Kosta (Albania)
 Gerhard Landauf (Austria)
 Helén Palm (Sweden)
 Ioana Stupariu (Hungary)
 Jacqueline Eggenschwiler (Switzerland)
 James Gannon (Ireland)
 Jean-Jacques Subrenat (France)
 Joanna Kulesza (Poland)
 John McCormac (Ireland)
 José Alberto Barrueto Rodríguez (Spain)
 Julian Ludlow (United Kingdom)
 Laurin Weissinger (United Kingdom)
 Leena Romppainen (Switzerland)
 Lousewies van der Laan (Netherlands)
 Maria Kolesnikova (Russian Federation)
 Maria Korniiets (Ukraine)
 Máté Mester (Hungary)
 Mathias Challend de Cevins (France)
 Matthias Hudobnik (Austria)
 Michael Oghia (Serbia)
 Michele Neylon (Ireland)
 Muhammad Farhan (Ireland)
 Narine Khachatryan (Armenia), observer
 Natalia Filina (Russian Federation)
 Nertil Berdufi (Albania)
 Nicolas Koray Namer (France)
 Pablo Mazurier (Spain)
 Pantelis Kassotis (Greece)
 Pari Esfandiari (United Kingdom)
 Raza Qureshi (Denmark)
 Remo Hardeman (Netherlands)
 Ricardo Holmquist (Spain)
 Rim Hayat Chaif (Denmark)
 Robert Baskerville (United Kingdom)
 Roberto Gaetano (Austria)
 Shwetal Shah (United Kingdom)
 Stuart Clark (United Kingdom)
 Sylwia Marcinkowska (Poland)
 Tapani Tarvainen (Finland)
 Tatiana Tropina (Germany)
 Thierry Piette-Coudol (France)
 Veronica Cretu (Moldova)
 Wale Shakiru Bakare (United Kingdom)
 Zaneta Vinopalova (Czech Republic)

ALAC Executive Committee (ExCom) 2020
 Chair - Maureen Hilyard (Asia Pacific)
 Vice-Chairs - Jonathan Zuck (North America) and Joanna Kulesza (Europe)
 Executive Members - Tijani Ben Jemaa (Africa) and Humberto Carrasco (Latin America)

ALAC Liaisons
 ccNSO - Barrack Otieno (Africa)
 GNSO - Cheryl Langdon-Orr (Asia Pacific)
 SSAC - Andrei Kolesnikov (Europe)
 GAC - Yrjo Lansipuro (Europe)

Former ALAC Liaisons
 Board - Vanda Scartezini (Latin America) and Wendy Seltzer (North America)
 ccNSO - Maureen Hilyard (Asia Pacific), Cheryl Langdon-Orr (Asia Pacific), Rudi Vansnick (Europe)
 IDN Policy - Edmon Chung (Asia Pacific), James Seng (Asia/Pacific) and Sivasubramanian Muthusamy (Asia/Pacific)

Past membership
 Hadia Elminiawi (Africa)
 Titi Akinsanmi (Africa)
 Yaovi Atohoun (Africa)
 Edmon Chung (Asia/Pacific)
 Salanieta Tamanikaiwaimaro (Asia/Pacific)
 Rinalia Abdul Rahim (Asia/Pacific)
 Olivier Crépin-Leblond (Europe)
 Jean-Jacques Subrenat (Europe)
 Sandra Hoferichter (Europe)
 Natalia Enciso (Latin America)
 Carlton Samuels (Latin America)
 Sergio Salinas Porto (Latin America)
 Eduardo Diaz (North America)
 Evan Leibovitch (North America)
 Ganesh Kumar (North America)
 Gareth Shearman (North America)
 Chery Langdon-Orr (Asia/Pacific)
 James Seng (Asia/Pacific)
 Mohammed El Bashir (Africa)
 Adam Peake (Europe)
 Dr. V. C.Vivekanandan (Asia/Pacific)
 Patrick Vande Walle (Europe)
 Alan Greenberg (North America)
 Carlos Aquirre ( (Latin America)
 Sébastien Bachollet (Europe)
 Beau Brendler (United States)
 Hawa Diakite (Africa)
 Erick Iriarte Ahon (Latin America) (January 2003 – December 2006)
 Izumi Aizu (Asia/Pacific)
 Vittorio Bertola (Europe) (January 2003 – May 2007)
 Veronica Cretu (Europe)
 Pierre Dandjinou (Africa)
 Esther Dyson (North America) (January 2003 – December 2004)
 Clement Dzidonu (Africa)
 Bret Fausett (North America)
 Sunday Folayan (Africa) (June 2003 – December 2005)
 Roberto Gaetano (Europe) (June 2003 – December 2006)
 Robert Guerra (North America)
 Kenneth Hamma (North America) (June 2003 – December 2004)
 Xue Hong (Asia/Pacific)
 Nguyen Thu Hue (Asia/Pacific)
 John Levine (North America) (February 2005 – March 2007)
 Toshifumi Matsumoto (Asia/Pacific) (June 2003 – December 2005)
 Jacqueline Morris (Latin America)
 Annette Muehlberg (Europe)
 Jean Armour Polly (North America) (December 2004 – December 2006)
 José Ovidio Salgueiro(Latin America)
 Sebastian Ricciardi (Latin America) (January 2003 – December 2006)
 Thomas Roessler (Europe) (January 2003 – December 2004)
 Josè-Ovidio Salgueiro (Latin America)
 Vanda Scartezini (Latin America)
 Sylvia Herlein-Leite (Latin America)
 Wendy Seltzer (North America)
 Siavash Shahshahani(Asia/Pacific)
 Fatimata Seye Sylla (Africa)
 Tadao Takahashi (Latin America) (June 2003 – December 2005)
 Alice Wanjira-Munyua (Africa)

References

External links
 ICANN At-Large Community website
 Official ALAC page at ICANN
 ALAC Assistance Group

Domain Name System
Internet governance organizations
Organizations established in 2002

redpajama_set_name: RedPajamaWikipedia


text:
Q: How do I set what port Eclipse uses for local help server? Is there a way to set what port Eclipse uses for its local help server (e.g. localhost:64219/help/index.jsp)? I would like to bookmark specific pages, but I obviously can't since the port changes each time it runs.
I personally think its crazy they don't just try a common port # and then work up from there so there is consistency not just for a given user, but across users. That would make it possible to share local help links with coworkers.
I found this help article on running a standalone Information Center that says you can -port, but that doesn't seem to work with Eclipse itself (I tried adding it to eclipse.ini).

A: In current Kepler release it can be changed by adding
-vmargs
-Dserver_port=8089

in config.ini

redpajama_set_name: RedPajamaStackExchange


I used to date a guy, (emphasis on 'used') who broke a bargain buy Portmeirion plate my mum gave me. His response was not "sorry", but "it's only a cheap plate"! My response soon after was "goodbye". I realised this man thought he knew the price of everything and obviously the value of nothing, including me! As replacing the plate was definitely not cheap, and I'm priceless!!!
So today be aware of what or whom you shed your tears over. Some things are just not worth it.
Value what has great worth to your heart, not your wallet, as that is where the best treasures are kept.
This entry was posted in Card of the day and tagged heart, love, money, pentacles, perspective, tarot, treasure, value, wallet. Bookmark the permalink.


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Eric Terrien, Sonni Honscheid Win The Port Adriano SUP Race In Beautiful Mallorca, Spain (UPDATED RESULTS)
Week #1 of the 2014 NSP Euro Tour started with perfect sunny conditions here on beautiful Mallorca, Spain. With a strong field lining up against a backdrop of sandy beaches, colourful and jagged cliffs, imposing islands and turquoise waters, I knew we were in for a great weekend of racing.
The Port Adriano SUP Race is split in two: Long Distance on Saturday and knockout sprint son Sunday. In Saturday morning's distance race it was France's Eric Terrien who took the victory, ahead of a very determined Leonard Nika from Italy. Leo set the pace for most of the 13km around the islands outside the luxury Port Adriano, however Eric was too strong in the final 500 metres.
Despite the relatively calm ocean conditions making drafting fairly easy, a solid pace at the front split the field early, with the top 15 spread out between four different draft trains. Sitting in the lead group of four alongside Eric and Leo, and eventually coming home for a very impressive third, was former champion Czech marathon canoer, Branislav Sramek, who out-sprinted Austria's Peter Bartl to the line. Local strong man Victor Blanes led the four-man, Tour de France style chase group and took fifth over the line.
Meanwhile over on the women's side Sonni Honscheid showed why she's going to be very tough to beat this year, comfortably winning the women's and beating most of the men in the process. Mallorca local and Sonni's fellow SIC team rider, Laura Quetglas, came home second.
Although Eric had taken the early lead in the overall event standings, Leo's pace was obvious and we all knew he'd be a threat in Sunday's sprints. Sure enough, the Italian blitzed the short course, taking out the win ahead of Eric, Roman Frejo and Peter Bartl. That put Leo and Eric tied on points, however the distance race was the tie-breaker, giving Eric the win and the 2,000 Euro first place prize purse. The prize money was paid out immediately at the awards ceremony (in cash I might add). Good to see a medium sized race getting it right where so many bigger events fall over…
Oh and there was a very interesting battle in the men's 14′ division. The top four placings from Saturday were totally flipped on Sunday, meaning four guys all ended up on five points.
The highlight of the weekend, however, was perhaps the girls' short course race. In fact all the kids from 6-15 made it clear that Spain has a bright future in this short, showing off skills and speed well beyond their years. Over 30% of the 80+ paddlers who competed in this year's Port Adriano were kids – awesome to see!
The only thing better than the racing this weekend was the location. Mallorca is a magic island, with extraordinarily beautiful coastlines dotted with jagged cliffs, islands and blue waters. Great way to start the Euro Tour.
Unfortunately I had to sit out the racing on day two due to veeery unforeseen circumstances, however it was definitely a great weekend of racing all round. Put this race on your 2015 bucket list for sure!!
Port Adriano SUP Race – Overall Results
Men's 12'6
1st: Eric Terrien (1st, 2nd)
2nd: Leonard Nika (2nd, 1st)
3rd: Peter Bartl (4th, 4th)
Women's 12'6
1st: Sonni Honscheid (1st, 1st)
2nd: Laura Quetglas (2nd, 2nd)
3rd: Susak Molinero (3rd, 4th)
1st: Xavi Masdevall (1st, 4th)
2nd: Miguel Martorell (2nd, 3rd)
3rd: Tino Aja (3rd, 2nd)
Here are the full results. "Dia 1" = Day 1 (Distance race), "Dia 2" = Day 2 (Sprints)
Port Adriano SUP Race – Distance Race Results
Course: 13km
Click "Division" to switch between men's and women's / 12'6 and 14′ results
1 Eric Terrien 1:19:52 Men's 12'6 1
2 Leonard Nika 1:19:56 Men's 12'6 2
3 Branislav Sramek 1:20:12 Men's 12'6 3
4 Peter Bartl 1:20:22 Men's 12'6 4
5 Víctor Blanes 1:21:38 Men's 12'6 5
6 Davide Codotto 1:21:53 Men's 12'6 6
7 Paolo Marconi 1:21:54 Men's 12'6 7
8 Xavi Masdevall 1:22:02 Men's 14' 1
9 Miguel Martorell 1:23:16 Men's 14' 2
10 Reza Nasiri 1:23:59 Men's 12'6 8
11 Pepe Oltra 1:24:02 Men's 12'6 9
12 Román Frejo 1:24:05 Men's 12'6 10
13 Christopher Parker 1:24:07 Men's 12'6 11
14 Tino Aja 1:24:08 Men's 14' 3
15 Kiko Borrás 1:24:18 Men's 12'6 12
16 Sonni Hönscheid 1:24:41 Women's 12'6 1
17 Tolo Canellas 1:24:53 Men's 14' 4
18 Saul Viadero 1:26:02 Men's 14' 5
19 Jurgi Zulaika 1:27:52 Men's 12'6 13
20 Laura Quetglas 1:27:59 Women's 12'6 2
21 Jaran Rodríguez 1:29:31 Men's 12'6 14
22 William Doering 1:29:33 Men's 12'6 15
23 Ahmet Senoglu 1:30:25 Men's 14' 6
24 Rom Loopik 1:30:27 Men's 14' 7
25 Dirk Jan Coljee 1:38:28 Men's 14' 8
26 Susak Molinero 1:33:14 Women's 12'6 3
27 Susanne Lier 1:34:37 Women's 12'6 4
28 Siri Schubert 1:35:09 Women's 12'6 5
29 Marcelo Barreto 1:39:53 Men's 12'6 16
30 Sara Gelabert 1:40:08 Women's 12'6 6
31 Marta Abruñedo 1:41:46 Women's 12'6 7
32 Ane Zulaika 1:41:59 Women's 12'6 8
33 Julia Perez 1:57:48 Women's 12'6 9
Course: 5km
Click "Division" to switch between men's and women's results
1 Michel Cardell 0:40:23 Men's Weekend Warriors 1
2 Jose Antonio Roca 0:40:27 Men's Weekend Warriors 2
3 Jose Antonio Pineiro 0:43:08 Men's Weekend Warriors 3
4 Fernando Viadero 0:43:39 Men's Weekend Warriors 4
5 Miguel Delpon 0:43:44 Men's Weekend Warriors 5
6 nicolas Villedieu 0:44:17 Men's Weekend Warriors 6
7 Silvia Canudas 0:48:58 Women's Weekend Warriors 1
8 Sergio Rubio 0:49:19 Men's Weekend Warriors 7
9 Dayana Beancourt 0:50:11 Women's Weekend Warriors 2
10 Angel Gracia 0:50:19 Men's Weekend Warriors 8
11 Tineke Merkus 0:50:29 Women's Weekend Warriors 3
12 Aukje Postma 0:52:31 Women's Weekend Warriors 4
13 Bea Canudas 0:53:12 Women's Weekend Warriors 5
14 Lara Abrunedo 0:57:32 Women's Weekend Warriors 6
15 Ingrid Berger 0:57:32 Women's Weekend Warriors 7
KIDS RACE!
Course: entertaining
Boys under 8
1st: Marc Simoncelli (0:14:12)
1st: Aaron Sanchez (0:13:01)
2nd: Lucas Simoncelli (0:13:32)
3rd: Antonio Serrera (0:16:01)
4th: Aleix Viada (0:16:18)
1st: Adrian Caimari (0:18:37)
2nd: Miguel Angel Cardell (0:19:55)
1st: toni Marti (0:24:03)
2nd: Matias Caimari (0:24:20)
3rd: Pau Ybarra (0:25:13)
4th: Alex Suau (0:25:23)
5th: Enrique Hurtado (0:25:48)
6th: Pedro Nadal (0:29:10)
1st: Daniela Pajaro (0:12:52)
2nd: Duna Gordillo (0:13:03)
3rd: Sonia Caimari (0:14:17)
Girls 12-14
1st: Alba Gordillo (0:13:36)
2nd: Carme Martorell (0:14:00)
3rd: Marta Caimari (0:15:04)
4th: Laura Oliver (0:15:18)
5th: Alejandra Serrera (0:15:20)
6th: Maria Jose Pellicer (0:21:02)
1st: Aylin Rodas (0:20:05)
2nd: Daniela Betan court (0:20:14)
3rd: Ana Bassitta (0:23:07)
Eric, Laura, Sonni and Leo (photo credit: SUPracer.com)
Thanks to Thaissa MDC for snapping the pics from the boat. All photos copyright SUPracer.com, though feel free to swipe them and post them all over Instagram, Facebook or on your bedroom wall.
The Euro Tour is on! Follow the fun and adventures around Europe this summer thanks to NSP and SUPracer.com…
Tags: Eric Terrien, Laura Quetglas, Leonard Nika, Port Adriano SUP Race, Sonni Honscheid, Stand Up Paddle Racing in Europe
[vivafbcomment]

redpajama_set_name: RedPajamaCommonCrawl


— Forty years ago today, Stephen B. Clemmons was assigned to Launch Complex 34 at Cape Canaveral, Florida. The events that would unfold on Jan. 27, 1967, would forever change the course of the United States' space program and Clemmons' life.
The crew of the first Apollo mission, scheduled to launch on February 21, 1967, were at the pad to run a test inside the spacecraft that would take them to orbit, kick starting the nation's efforts to land a man on the Moon before the Soviets. With less than three years left in the decade set by the late President John F. Kennedy to accomplish the lunar landing, NASA was under pressure to launch Apollo 1. Virgil 'Gus' Grissom, Edward White and Roger Chaffee were already strapped and sealed inside Apollo 204 for a "plugs-out" test when Clemmons arrived at Pad 34.
collectSPACE spoke with Clemmons about that ill-fated January day.
SC: This was to be the last major test of the spacecraft called the "Plugs Out Test," which would simulate the liftoff of the spacecraft during an actual launch. The umbilicals, the only connection between the spacecraft and the ground control systems would jettison or drop away from the spacecraft, cutting off all ground control signals and the spacecraft would go on its own internal power and control systems.
SC: There was a slight pause, we could hear some cross chatter in the blockhouse, then we heard, "We have a fire in here, get us out!" No one has really been able to tell what was said, it was followed by "there's a fire in here," then a few seconds later, we heard a piercing scream and then silence.
cS: What did you and your coworkers do?
SC: All hell broke loose as Jim Gleaves, Jerry Hawkins and Donald Babbitt scrambled from the clean room out to the catwalk that led into the White Room. Then the whole floor erupted in fire and bits of burning debris as the spacecraft seemed to explode. Heavy biting black smoke began to fill both floors, blocking out all light sources except for the flames coming from the spacecraft. Burning bits of insulation were flying into every corner.
I attempted to contact anyone in the blockhouse, particularly the ECS engineer to see if they wanted the [oxygen] panel shut down or left on. If there was a chance that the crew had survived, I would be shutting off their O2. If I left it on, I would be feeding the fire.
About sixty seconds later, the fire in the clean room drove me out onto the catwalk. I left [the panel] on and ran out to help the crew that was fighting to get into the craft.
cS: What did you find at the White Room?
SC: Those that had made it to the White Room, a small room that provided access to the spacecraft were driven out by flames and smoke, making it impossible to get to the hatch. They backed off to regroup. They didn't have any type of firefighting equipment, or gas masks and were wearing clean room nylon gloves which by now had melted and were discarded, along with their nylon shop coats which had melted in the first few seconds. They went back in seconds later just as another blast of hot smoke and burning bits of insulation rained down on them.
They couldn't wait for firemen and would take turns to go into the fire and smoke, holding their breath as long as they could.
LD Reese, a NAA Quality Control Inspector and I joined them and together, taking turns after gulping fresh air went into the White Room for short periods to unlatch the hatches.
Four minutes later, Jerry [Hawkins] and I were on the last relay, the last hatch fell inside. I was able to get just inside the burned out hulk because the hatch had only fallen a foot or so to look for survivors and get a look at what was inside.
cS: What did you see inside the spacecraft?
SC: That first look has always been a haunting reminder that we had lost our crew that day and remains as clear today as it did 40 years ago.
I yelled for anyone to answer, just hoping that someone had survived, but it was just silence, just the crackling noise of cooling aluminum and a gentle squeal of oxygen coming from where the ECU [environmental control unit] had been. Jerry followed, going in just a bit further, then LD went in all the way, but the spacecraft was silent. LD thought that he heard voices but it was just the squealing noise of the venting oxygen.
We had lost our crew, spacecraft and almost our lives.
cS: What happened in the weeks and months afterwards?
SC: There was a three month lull in all activities except those required on the disassembly of the spacecraft. After the investigation ended, we [NAA] went through a complete reorganization of men and management and new training was mandated. This went on for many months as new procedures were worked out.
In order to work on the tower, now everyone connected to the spacecraft and ground support went through a rigid training program that involved firefighting, ground and flight crew rescue, pad safety, and schooling on the new spacecraft and its systems. We trained on how to get off the pad, either by the elevators or cable car within a certain time frame.
Each man had to go before a review board to certify on each system and all safety procedures. Over four hundred NAA and NASA technicians and engineers were certified during the next 18 months. Some men were sent back to Downey [California] to work as well as train on the new Block II vehicles which were going through a complete shake down and overhaul.
I've often said that they re-invented the wheel, but in this case a new moon program. Under the threat of having the program cancelled by Congress, they went back to basics. It was a complete 180 degree turnaround and for us, we welcomed the new changes.
cS: How did the period before the fire differ from the time afterwards?
SC: I think the days before the fire and after the fire were as different as day and night in the overall operations.
Before the fire, there was utter chaos. When Apollo 7 arrived, same crews, but a very different attitude. Now the professionalism in each of us came out and it made a big difference. With the memories of Apollo 1 still fresh in our minds, we were determined that it wouldn't happen again. No longer would we accept someone's word that something wouldn't happen, we had to make sure it didn't.
cS: In your opinion, would we have successfully reached the moon had Apollo 1 not occurred?
SC: No, because there were too many things wrong, both with the spacecraft and NASA operations, which were discovered during the investigation of the fire. There were fatal errors, most hidden from view that would have surfaced if we had continued. It's very possible that we would have had a catastrophe on the ground, possibly the destruction of the Saturn V with many deaths or we could have left men on the moon and in orbit.
cS: What do you remember of the day of the fire that the public may not know?
SC: I remember we had discussions that afternoon on the way up to the spacecraft level that no one was prepared for any type of accident. It was being treated as a routine test and we all knew that it was dangerous because of the pure oxygen atmosphere and the fact that it was in the top of a 220-foot tower, many minutes away from anyone that could help us.
We wondered why the rescue teams that were used in the [earlier] altitude chamber were not being used today.
But most of all, we were wondering who or what group of idiots had determined that the test was not hazardous, because in all the years at Cape Canaveral, any time oxygen was involved it was considered highly dangerous.
cS: What similarities and differences did you see between the Apollo 1 fire and the loss of Columbia and Challenger?
SC: One factor that all three accidents had in common was the shortage of funds and a lack of quality control and safety requirements. Lackadaisical attitudes and apathy among the workers added to the overall problems.
NASA had the money, but it was being spent elsewhere to maintain their worldwide operations, provide grants to colleges, hospitals, universities and to increase the size of NASA. They were running the flight programs on bare bone budgets and the needed safety improvements were ignored because it would take important time out of the schedule.
They violated every known rule [with regards to] crew safety: manual hatch, open wiring, flammable material inside the cabin, incomplete testing requirements, but most of all, added modifications right up to the day of the test.
All professional opinions about the dangers which had been studied, hashed and rehashed, had been ignored.
The same problems came up on the Challenger. They ignored ground safety data, flight equipment test data and violated flight safety rules to make rigid flight schedules set by Congress. The needed changes were ignored, or put off because of a lack of funding. The problem with the solid rocket boosters' seals were well known for at least 18 months before Challenger, even to many of us outside the program, but they wanted to get one more flight. It would be too expensive to make the changes and hold to the flight schedules.
Both shuttle disasters were the result of the same overall root problems. A rush to flight without consideration of flight safety rules, a shortage of funds to keep the fleet going, with many serious problems that needed correcting being signed off as insignificant and a business as usual mental attitude.
cS: What are you feelings about displaying the Apollo 1 spacecraft today? It's currently hidden from public view at Langley Research Center in Virginia.
SC: I feel that it should be displayed at Kennedy Space Center in a special section apart from the astronaut memorial and not on Pad 34 as a reminder to America that it must never happen again.
The story of Apollo 1 should be told over and over again because it's not just about three men who were killed, but it is more about the conditions that created the fire. We must always be reminded that it can happen again. Men and women who go to space deserve the best and nothing must be left to chance. This display would tell the world that there is danger in all aspects of rocketry.
cS: How did the loss of Apollo 1 change your life?
It has remained a constant reminder over the years that nothing can be taken for granted. We must remain ever vigilant. I spent the next thirty years after Apollo 13 in the new construction industry, the second most dangerous business in the world and as a manager, I put safety of the men foremost. I never had a fatal accident and never had to tell a wife or family that their husband or son would not be coming home.
Many have asked me over the years "Why were you so strict on safety?"
My answer, "Because I lost one crew when it could have been prevented during Apollo and it will never happen again."


text:
This piece is featured in our book, Essays and Conversations from the First Ten Years. Order your copy now!
Parent-Artist Advocacy
Parents of Color and the Need For Anti-Racist Theatre Practices
I'm at a theatre conference, and I hear the children before I see them. Bubbly giggles erupt from their bodies as they take flight, running for the pure joy of the experience. For a moment I'm lost in thought as I measure the emotional cost of me being here—which is time away from my own children—and what it would mean for them to accompany me into these highly problematic, racist spaces. Confident I made the right decision to leave them at home, I return to the reality of the conference.
In another instance, I'm part of a convening planning committee for an organization that lives the justice it teaches others to fight for. During the planning process, we learn there will be two infants present. My reaction was: "We're child friendly, the more the merrier!" But that thought was the extent of my support around their presence. Though my intention was to be inclusive, I mistook the term "child friendly" as sufficient, which resulted in an exclusive gathering with no tangible plan for parental support and childcare, including having things like mats in the space and plush toys for the kids. Only when a parent spoke out during the gathering about the lack of support did any of us organizers realize our misstep. As a parent myself, I was dismayed I had upheld the narrative "parenthood is an independent issue for parents to overcome," especially because my lived experience has been shaped by systemic inequities.
Cast, directors, and stage manager of Cry It Out by Simpatico Theatre, a production that created comprehensive support centered on work by artists of color, women, and parents—especially those at the intersection of all three. (L to R) Newton Buchanan, Anita Holland, Brandi Burgess, Angelica Jackson, Tamanya Garza (director), Monica Flory (assistant director), and Noelle Johnson (stage manager). Photo by Daniel Kontz.
Parenthood and Race
Dr. Robin DiAngelo, author of White Fragility, says, "You cannot talk about any other issue without talking about how race informs that issue." When we don't view systematic inequity through the lens of race and racism, our anti-oppression practice remains rooted in oppressive values and inactive language.
The term "child friendly," as I understand it, is an abstract noun, which is something that exists in thought without being concrete and, in many instances, operates to protect white supremacy culture through generality and vague, unofficial policy. Due to the indeterminate nature of the conference's family-friendly policy, I had intuited the space as inhospitable for my children to attend, which was further fortified by seeing only white children present.
When we don't view systematic inequity through the lens of race and racism, our anti-oppression practice remains rooted in oppressive values and inactive language.
For the convening I helped plan, "child friendly" functioned as a demonstrative expression lacking application, which resulted in my failure to advocate for parent support. My personal lack of interrogation of the term is in part due to how normalized my experience of not being supported is, paired with the toxic "exceptional Black womxn" myth that reinforces that I should be able to carry the weight of everyone's needs before attending to my own.
Certainly if the issue of parent support was reconstructed as an issue of race and racism, my response would have been activated to right the imbalance of superficial resources enacted to support parents of color in the arts.
Going Big to Go Small
Looking first at issues that parents of color face can provide a more holistic and deeper understanding of the obstacles in front of them, which informs what resources they may need in order to feel supported. For example, my gender and race make me susceptible to lower pay; people like me earn roughly $0.74 for every dollar a white man earns. Womxn are more likely to be penalized for taking time off work to care for children or aging family members than men. Black womxn stagnate in their careers and are less likely than white women to make it to executive level positions; when they do, they are often put in charge of organizations that are in disrepair. Black womxn are also more likely to be watched over by their white counterparts, which leads to lower performance reviews.
Knowing that the roots of the theatre industrial complex are overwhelmingly capitalist, racist, patriarchal, and ableist—a sentinel of white feminism and staunch advocate of meritocracy—provides a wider framework for organizations to begin to effect the necessary long-lasting change that will have considerable impact for parent-artists. Enacting anti-racist policies and practices, which function to create equitable workplaces and events, changes the way we perceive the world and generates a ripple effect on the decisions we make. The task of uprooting oppression is for all of us to do and is more effective when we prioritize anti-racist and anti-oppressive ideology in our decision-making.
The task of uprooting oppression is for all of us to do and is more effective when we prioritize anti-racist and anti-oppressive ideology in our decision-making.
Steps to Supporting Parent-Artists with an Anti-Racist Lens
There is such a long history of mistrust between white people and Black, Indigenous, and people of color communities, which cannot be remedied by a generic "family friendly" invitation to a conference. It's difficult to repair trust when communication is not clear around whose experience and comfort is being prioritized.
In terms of parent-artist support, there needs to be an active acknowledgement and commitment through written policy about harm reduction, harm prevention, and relationship repair. These tenets provide the foundation of transparency, accountability, and admission, acknowledging both how American society utilizes policies to destabilize families of color and what is being done to counter those policies.
Angelica Jackson (Jessie) and Newton Buchanan (Mitchell) in Cry It Out at Simpatico Theatre, a production that created comprehensive support centered on work by artists of color, women, and parents—especially those at the intersection of all three. Photo by Daniel Kontz.
Here are some ways organizers and organizations can work to recognize, address, and counter bias and racism to standardize equitable support systems for parent-artists of color:
Make sure the historically invisible communities have a say and a stake in the resources provided for parents and caregivers.
Implement institutional-wide policy. The problem with case-by-case parent support is that it allows bias to influence language used to describe working parents, which in turn determines an institution's willingness or reluctance to grant parent support. For instance, bias in language ascribes negative or positive words to different parents for doing the same action, e.g. a white mother who brings her infant to work is "hardworking" and a mother of color who brings her school-age child to work is "unprofessional"; a father who brings his children to work is "a good dad" but a mother who does the same is "a mess." Rachel Spencer Hewitt, founder of the Parent Artist Advocacy League (PAAL), shares, "Without intentional parent support and protocol, implicit bias will always dictate the words we choose to describe contributors who are caregivers."
Develop a written public anti-racist ethos outlining your commitment to anti-racist and anti-oppression parent-support work. Be honest about your institution's past and present bias, prejudice, and racist behavior toward parents and create pathways of accountability that ensure those oppressive values don't resurface.
Sustain child-positive practices rather than child- or family-friendly practices. "Child positive" is a term I use to refer to the purposeful inclusion of children in any space by accounting for their needs, abilities, and limitations. All of these factors impact how children, parents, and non-parental people function in a space and determine whether or not the needs of all participants are being met, valued, and centered. "Child friendly," on the other hand, is akin to tolerating the presence of children with minimal attention given to how they impact others and the space.
Invest in anti-bias training that provides people with resources to address and mitigate microaggressions to children from adults and from children to children.
Apply principles of restorative justice to how you integrate parent-support policies.
Recently, both my children and I were invited to the national PAAL Summit—me to present on anti-racist principles and my children to engage with other children of parent-artists via provided childcare. The invitation to do my heart's works without leaving behind my heartbeats was a rare moment and one worth fighting to have again. It is now on us to decide where we are going from here, letting go of all that is unnecessary to cultivate embodied liberation for everyone. It is my hope us artists will be guided by, as theatre artist Douglas Turner Ward puts it, the desire to construct anew "not out of negative need, but positive potential," leaving for the next generation a more transformed and just society for all.
This series covers challenges faced by parent artists and builds on the work of the Parent Artist Advocacy League for the Performing Arts (PAAL), a national resource hub and all-parent, all-discipline league advocating for a national standard of best practices for parents in the performing arts.
The Wildcard Workbook: Why Forum Theatre and Why Now?
LeoNimm
Theatremakers Sulu LeoNimm, Liz Morgan, and Katy Rubin discuss the process of co-authoring The Wildcard Workbook, a guide designed to help others in the field delve into Theatre of the Oppressed practices and devised theatre processes.
Are You Really a Parent-Friendly Workplace?
Ashley Walden
Michelle Ramos sits down with Ashley Davis, founder and director of the social enterprise Unlock Creative, to discuss Ashley's experience being a mom in the field and how she works to make her own organization more accommodating of parents and caregivers.
Intimacy and Equity: A Balancing Act
Ann James introduces the Rebuilding for the Future: A Convergence of Thought Leaders in Intimacy Practice series with this call for intimacy professionals to build a foundation of equity in the industry by interrogating available mentorship and training structures. This essay begins that work by highlighting the need for a diverse pool of training ideologies and methods; and the interview-based series that follows takes up that need by highlighting the perspectives of eight practitioners who navigate the intimacy industry in a variety of ways.
Anti-Racist Theatre
Parenting and Caregiving


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Saturday, Oct. 15: Swing Dance
We're excited to offer a fun evening of music, dance, friends, fun – and raising funds for the Bethlehem Food Co-Op! All are welcome – no partners (or experience) necessary!
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Equity and justice in healthcare payment form an integral part of health policy and planning. In the majority of low and middle-income countries (LMICs), healthcare inequalities are further aggravated by Out of Pocket Expenditure (OOPE). This paper examines the pattern of health equity and regional disparities in healthcare spending among Indian states by applying Andersen's behavioural model of healthcare utilization.
The present study uses data from the 66th quinquennial round of Consumer Expenditure Survey, of the National Sample Survey Organization (NSSO), conducted in 2009–10 by Ministry of Statistics and Programme Implementation (MoSPI), Government of India (GoI). To measure equity and regional disparities in healthcare expenditure, states have been categorized under three heads on the basis of monthly OOPE i.e., Category A (OOPE > =INR 100); Category B (OOPE between INR 50 to 99) and Category C (OOPE < INR 50). Multiple Generalised Linear Regression Model (GLRM) has been employed to explore the effect of various socio-economic covariates on the level of OOPE.
The gap in the ratio of average healthcare spending between the poorest and richest households was maximum in Category A states (richest/poorest = 14.60), followed by Category B (richest/poorest 11.70) and Category C (richest/poorest 11.40). Results also indicate geographical concentration of lower level healthcare spending among Indian states (e.g., Odisha, Chhattisgarh and all the north-eastern states). Results from the multivariate analysis suggest that people residing in urban areas, having higher economic status, belonging to non-Muslim communities, non-Scheduled Tribes (STs), and non-poor households spend more on healthcare than their counterparts.
In spite of various efforts by the government to reduce the burden of healthcare spending, widespread inequalities in healthcare expenditure are prevalent. Households with high healthcare needs (SCs/STs, and the poor) are in a more disadvantaged position in terms of spending on health care. It has also been observed that spending on healthcare was comparatively lower among backward or isolated states. No doubt, the overall social security measures should be enhanced, but at the same time, looking at the regional differences, more priority should be assigned to the disadvantaged states to reduce the burden of OOPE. It is proposed that there is need to increase government spending, especially for the disadvantaged states and population, to minimise the burden of OOPE.
Health equity has been an important policy issue since the Alma-Ata Declaration of the World Health Organization (WHO). Since then all countries have been making efforts to reduce health inequities. Concerns have been expressed regarding the quality and availability of healthcare services in low and middle-income countries (LMICs) [1, 2]. Accessibility and affordability of healthcare services are among the major healthcare challenges faced by developing countries [3–5]. Financial barriers are key limitations to access healthcare services in LMICs since Out-of-Pocket Expenditure (OOPE)1 constitutes a significant proportion of healthcare expenditure [6–8]. Globally, about 1.3 billion people are deprived of access to effective and affordable health care. Majority of households spend more than 40% of their household income on medical treatment [9, 10].
Possibilities are high of many households residing in LMICs being pushed into poverty when faced with high medical expenses, especially when it is combined with loss of income due to adverse health outcomes [11, 12]. Measures to promote financial protection through universal health coverage (UHC) strategize to ensure that people would have access to health services without risking financial impoverishment [13–15]. Health systems in many LMICs are financed through key sources such as, taxation, social security schemes, private health insurance and OOPE .
More than half of the world's population does not have access to formal social protection schemes [16, 17]. Majority of the households who are unable to pay for using healthcare services either do not seek care or resort to short-term coping strategies such as minimizing food expenses, using past savings, and removing children from school to manage the financial shortfall [18–20]. Short-term coping strategies may result in higher cost in the long run, leading to impoverishment and poverty. These households are not captured in poverty estimates, as high healthcare cost raises their expense above the threshold level and they are considered non-poor .
Literature shows that the level of health payments also differs significantly with variations in certain specific characteristics of the households. Poor and disadvantaged sections of the population face more financial risks and need better financial mechanisms to avail healthcare services [21, 22]. Literature also indicates differentials in healthcare spending among various regions as well as segments of population [23, 24].
Equity and justice in healthcare payment are integral parts of health policy draft in India [25, 26]. Healthcare system in India is highly privatized and the main source of financing is OOPE [27, 28]. OOPE does not provide any financial protection; as a result, such households incur heavy expenses in availing healthcare services . Expenditure on healthcare pushes a large number of families into poverty in India as they do not have sufficient spending power due to low level of income or sometimes, no fixed source of income [30–32].
In India, more than 90% of the workforce, especially people who belong to socially and economically underprivileged sections of society, is engaged in informal economic activities.2 As insurance facilities are available only to the workforce in the formal sector, majority of such households are not covered under any social protection scheme [33, 34]. In the case of ill health, these households have to spend from their own pockets. Inadequate provisioning of health care facilities, coupled with a highly privatized health sector, further worsens the financial status of the poor and marginalized groups of the population [35, 36]. It leads them into financial catastrophe and further deepens existing poverty [36–39].
Level and pattern of OOPE are determined on the basis of socio-economic affiliations in India. Differences also prevail in the health spending and level of socio-economic inequalities among different Indian states. Different variables such as, socio-economic status, class, religious affiliation, place of residence, gender and age are used to classify the population [35, 40, 41]. Among all these factors, economic status and caste affiliation are considered most important classificatory variables for analyzing socio-economic inequalities in health and health care expenditure in India [42–45]. Socio-economic inequalities are highly unfavourable for healthcare, especially when society is more diversified, multi-ethnic, overpopulated and undergoing significant but unequal economic growth .
There is evidence of wider inter-state differentials in public spending and health infrastructure across Indian states. The level of public spending on health in few of the backward states such as, Bihar, Jharkhand, and Odisha, is very low in comparison to Kerala, Punjab and other developed states . Studies also indicate increasing interstate inequalities in health spending in recent years. The difference between per capita OOPE among developed states such as, Kerala and Punjab, and backward states such as, Jharkhand, Chhattisgarh and Orissa, has increased, leading to greater divergence between these states [48, 49].
Only a limited number of studies are available in the Indian contexts which have tried to examine the level of equity and regional variations in healthcare spending, by categorizing Indian states. We have classified the states on the basis of OOPE into three categories i.e., high, medium and low level of OOPE, and examined the pattern of inequalities in health spending among these states. This paper makes an effort to examine the pattern of health equity and regional disparities in healthcare spending among the Indian states by applying Andersen's behavioural model of healthcare utilization.
Data is used from the 66th quinquennial round of the Consumer Expenditure Survey (CES), National Sample Survey Organisation (NSSO), conducted by the Government of India (GoI) in 2009–10. The present study uses schedule type-1 questionnaire, which covers 100,855 households, of which nearly 59% are located in rural areas. We have taken into consideration consumption expenditure as a measure of healthcare spending. As there are noticeable differences between developed and developing countries regarding the nature and extent of formal employment, level of poverty and health indicators, consumption is used as the standard measure of overall material well-being among developing countries. In developing countries, only a limited segment of the population is employed in the formal sector while a majority of the population is engaged in the informal sector without any fixed source of income. Under such circumstances, consumption is better measured than income for poor families, and is less vulnerable to under-reporting bias. There are also conceptual and economic reasons to prefer consumption measure rather than income because consumption is a more direct measure of material well-being. Spending on healthcare not only depends on income but also on sources such as, savings, borrowings and other sources. Available literature tends to support the consumption method, signifying that consumption should be used to assess spending on healthcare and to set other benefit criteria [6, 8, 40, 50].
The CES rounds contain information on household consumption expenditure for both food and non-food items. Healthcare expenses are covered under non-food section and can be broadly classified into institutional and non-institutional health expenditure. The recall period is 365 days for institutional expenses and 30 days for non-institutional expenses. This study uses data on OOPE for both institutional (inpatient)3 and non-institutional (outpatient)4 expenditure by using a 30-day recall period. Institutional expenditure was available for a 365-day recall period; so, for the purpose of the study, it has been converted into 30-day recall period (see Appendix). The approach to measure OOPE for healthcare payments has been adopted from Wagstaff and Doorslaer . In addition to medical expenditure, information is also available on socio-economic and demographic characteristics of the households. The questionnaire contains information about individuals and households such as, place of residence (urban/rural), religious affiliation (Hinduism, Islam, Christianity, Sikhism, Jainism, Buddhism, Zoroastrianism and others), social group5 (Scheduled Caste (SC)6, Scheduled Tribe (ST),7 Other Backward Caste (OBC)8and Others).
States has been classified into three categories i.e., Category A (Higher OOPE), Category B (Middle-level OOPE) and Category C (lower OOPE) states. Though it is ideal to categorize the states on the basis of mean/median values of OOPE, our objective was to look into the equity and efficiency aspects among the states with higher, lower and middle levels of OOPE. First, we categorized the states on the basis of the level of monthly OOPE in three categories i.e., Category A (OOPE > =INR 100); Category B (OOPE between INR 50 to 99) and Category C (OOPE < INR 50). Next, mean OOPE was calculated for the three categories of states (A, B, and C), by selected socio-economic covariates. Lastly, we employed multiple Generalized Linear Regression Model (GLRM) to explore the effect of various socio-economic covariates on the level of OOPE. Our outcome variable OOPE was usually non-parametric and positively skewed with influential outliers. Traditional Ordinary Least Square (OLS) regressions with log-transformation cannot accurately capture the skewness in the data. It can provide inferences in the natural units of average healthcare expenditure. . GLRM can flexibly handle the skewed datasets and reduce the problem of outcome transformation [52, 53]. We have employed GLRM with gamma distribution and log link function to examine the various determinants of OOPE .
The dependent variable for the study is OOPE among all Indian states and UTs (both rural and urban).
The independent variables are: residence (Rural /Urban), economic status (wealth quintile), religious group (Muslims and others), and social group (Scheduled Tribe and others). For measurement of the economic status, we have used the households quintile based ranking on MPCE, separately for both urban and rural areas. In the Indian social setup, caste is broadly divided into different groups such as, SCs, STs, OBCs and others category. We have re-classified the caste groups into two i.e., STs and Others (Including SCs, OBCs and others), and religious categories, into Muslims and non-Muslims, (Non-Muslims include Hindus, Christians, Sikhs, Buddhism, Jainism, Zoroastrianism and other smaller religious communities).
This paper also tries to apply Andersen's behavioural model of healthcare utilization which was initially developed in the late1960s [55, 56]. As per this model, use of healthcare services by the households is a function of their predisposition to use services, factors which allow them to use these services and their need to use these services. This model categorizes the use of health care services as a function of three elements - predisposing, enabling and need factors. Predisposing factors include demographic variables such as, residence and socioeconomic status (social and religious group). Enabling factors include the wealth or economic status of the population; level and pattern of OOPE, which is an indicator of health status, are considered need factors.
Based on Andersen's model, we have also classified the factors determining the use of healthcare services in three categories: predisposing, enabling and need factors (Fig. 1). We have included place of residence, religious and social affiliation as predisposing factors; economic status has been considered an enabling factor while the level of health spending has been taken into consideration as a need factor.
Out of 100,855 households, 16,887 (16.74%) are in Category A states, 57,829 (57.34%) are in Category B and 26,139 (25.92%) are in Category C. States have been categorized into three groups on the basis of average monthly OOPE i.e., low, medium and high OOPE (Table 1).
Figure 2 shows that average monthly per capita healthcare expenditure was the highest in states such as, Punjab, Chandigarh, Maharashtra, Goa, Kerala and Pondicherry (Category A). Category B states are more concentrated towards southern India such as, Karnataka, Andhra Pradesh, Tamil Nadu, Andaman and Nicobar, Lakshadweep as well as northern states such as, Jammu and Kashmir (J&K), Delhi, Uttarakhand, Haryana, Himachal Pradesh, Rajasthan and Uttar Pradesh; states such as, Madhya Pradesh, Gujarat, Tripura and West Bengal are exceptions. Category C states are located in the north-eastern, central and southern eastern regions such as, Dadra Nagar Haveli, Daman & Diu, Sikkim, Nagaland, Assam, Manipur, Meghalaya, Mizoram, Arunachal Pradesh, Bihar, Jharkhand, Chhattisgarh and Orissa.
Majority of the north-eastern states fall in Category C and their average monthly expenditure on healthcare is less than INR 50. Results also indicate geographical concentration of lower level of health spending among these states (e.g., Odisha, Chhattisgarh and all the north-eastern states). The gap in terms of average monthly healthcare spending between the richest and the poorest households was the highest in Category A (Richest/Poorest = 14.60) states, followed by Category B (Richest/Poorest =11.70) and Category C (Richest/Poorest =11.40) (Table 2). Similarly, in Category C states, there was marginally higher gap among Muslims and Non-Muslims (Non-Muslims/Muslims =1.53) households in terms of healthcare spending followed by Category A (Non-Muslims/Muslims =1.13) and Category B (Non-Muslims/Muslims =1.13).As far as social group affiliation is concerned, the inequalities in terms of OOPE was nearly the same in both Category A (Others/ST = 2.58) and B (Others/ST = 2.34) states, and comparatively lower in Category C states (Others/ST = 1.17). The gap between urban and rural households in terms of healthcare spending was marginally higher in the Category C states (Urban/Rural =1.92), followed by Category B (Urban/Rural =1.62) and Category A states (Urban/Rural =1.26). Overall, in the Indian context, inequalities in terms of average monthly healthcare spending were observed between the richest and the poorest (Richest/Poorest =13.19), STs and Others (Others/ST = 2.50), rural and urban (Urban/Rural =1.49) households, and between Muslims and Non-Muslims (Non-Muslims/Muslims =1.11).
The result of the multivariate analysis is presented in Table 3. In Category A states, the level of OOPE is significantly lower for households that belong to the lowest wealth quintile (β = -1.501, ρ = 0.001), as compared to their counterparts in Category B and C states. The impact of economic status on the level of OOPE was similar in the other two categories of states i.e., Category B (β = -1.419, ρ = 0.000) and C (β = -1.139, ρ = 0.000) states. Similarly, as far as social group affiliation is concerned, the level of OOPE was the lowest among ST population as compared to their counterparts in all the categories of the states i.e., Category A (β = -2.97, ρ = 0.001), B (β = -0.386, ρ = 0.000), and C (β = -1.281, ρ = 0.000). Category C states recorded lower level of spending among Muslims (β = -0.220, ρ = 0.000), and rural communities (β = -0.158, ρ = 0.000). Place of residence and religious affiliation are important predictors of healthcare spending among the Category C states. However, these factors do not play any significant role in determining the level of OOPE among Category A and B states.
As per the Andersen's model, in the Indian context, predisposing factors such as, residence, religion and social group affiliation have a significant impact on the pattern of healthcare spending among households. Households in rural areas (β = -0.102, ρ = 0.00), belonging to the Muslims community (β = -0.101, ρ = 0.00), and ST social group (β = -0.634, ρ = 0.00) have recorded significantly lower level of OOPE than their counterparts. Enabling factors indicate that spending on healthcare among population belonging to the lowest economic status was significantly lower (β = -1.273, ρ = 0.00) as compared to other economic categories.
Equity in healthcare is one of the important and most desired goals to be achieved for any society. Inequalities in healthcare are measured on the basis of health outcome, utilization pattern and level of OOPE, between the Non-poor/Poor, Urban/Rural, Advantaged/Disadvantaged and other socio-economic groups of the population. Healthcare financing system should focus on achieving vertical equity (households of unequal ability should be treated unequally), horizontal equity (households of the same ability should be treated equally) and progressivity in healthcare expenditure [55–57]. This paper focuses on the equity and regional perspective of healthcare expenditure among Indian states to uncover the linkages and the burden in the form of OOPE. Results indicate that burden of OOPE is not proportional among different subgroups of the population.
People residing in the urban areas, having higher economic status, belonging to non-Muslim and non-ST groups were spending significantly higher on healthcare than their counterparts. Literature also indicates that households that belong to the lower socio-economic status (Rural, STs, Muslims and lowest wealth quintile) were constantly experiencing poor health outcomes. This may be due to the fact that these people have minimum access to healthcare facilities or they were not in a position to pay for the use of healthcare services [30, 58, 59].
There is also evidence of regional disparity in terms of healthcare spending among Indian states. It is evident from the results that in Category A states (Kerala, Punjab, Maharashtra, Goa and Chandigarh), the average monthly expenditure on healthcare was highest followed by Category B and C. Findings from available literature also supports the fact that Category A states are more affluent with higher per capita income as compared to the other categories of states (B and C). Category C states constitute a higher share of tribal population as compared to the other two categories of states. Due to geographical isolation and inaccessibility, these states are more deprived in terms of availability of healthcare facilities [25, 48, 49].
As in previous studies in the Indian context, our study also indicates progressivity in healthcare financing among Indian states. The incidence of OOPE was higher among Category A states such as, Kerala, Punjab, Maharashtra, Goa, and Chandigarh. However, Category A states face higher burdens of Non-communicable diseases (NCDs), causing them to spend more on healthcare, and resulting into a higher level of OOPE than their counterparts [60–63].
There were noticeable differences in healthcare spending on the basis of economic status (richest /poorest) and social group affiliation (others /STs) among Category A states. In Category B states, inequalities are moderate among the above mentioned socio-economic groups. All these states (Karnataka, Andhra Pradesh, Tamil Nadu, Andaman and Nicobar, Lakshadweep, J&K, Delhi, Uttarakhand, Haryana, Himachal Pradesh, Rajasthan, Uttar Pradesh, Madhya Pradesh, Gujarat, Tripura and West Bengal) are middle-income states [11, 63, 64].
Economic status and social group affiliation were important determinants of healthcare spending among Category A and B states [35, 55, 64]. Among Category C states (Dadra Nagar Haveli, Daman & Diu, Sikkim, Nagaland, Assam, Manipur, Meghalaya, Mizoram, Arunachal Pradesh, Bihar, Jharkhand, Chhattisgarh and Orissa) the gap between the rich and the poor, and the disadvantaged social groups and others, is comparatively lower than it was in other categories of states . In the Indian context, income, class, caste and wealth quintile are considered the most powerful stratification variables in assessing socio-economic inequalities .
Multivariate GLRM analysis shows that in Category A and B states, the role of religious affiliation and caste system is comparatively less important, while economic status is considered an important determinant of OOPE. Opposite trends have been observed in Category C states where the role of caste system continues to be a predominating factor and significantly influences the spending pattern on health. This study brings into focus that even in the 21st century, with all medical advancements and institutional reforms, social institutions still have a significant influence on the healthcare seeking behaviour and spending patterns of households [66, 67]. In the Indian context, religion and caste significantly influence spending pattern among households. Results indicate significant variations in household expenditure on the basis of caste, especially among the STs [33, 34].
Similar observations have been recorded for Category B states where again economic status and social group affiliation are very important contributing factors of OOPE. Here also class concept (Economic status) is more dominant than caste but place of residence does not play an important role [27, 68]. In Category C states, religious affiliation and economic status both are considered equally important determinants of spending on health. Also, social group and place of residence are important determinants of OOPE among Category C states.
In line with the Anderson model, our study also highlights the importance of predisposing, enabling and need factors. As per the categorization of states, the role of these factors in determining the level of OOPE varies significantly in the Indian context. Among Category A states, enabling factors play a more dominant role than predisposing and need variables. A similar pattern was also observed among Category B states. In Category C states, predisposition to use the services such as, caste and residence, still play a major role in the determination of the level of OOPE on healthcare than other factors such as, enabling and need factors .
There is also evidence of the geographical concentration of the states on the basis of socio-economic inequalities and OOPE. Especially, Category C states are geographically concentrated more either on the north-eastern or southern eastern side of the country. All these states, which fall in Category C on the basis of OOPE, are backward states in terms of per capita income as well [70–72]. While examining healthcare spending pattern and level of OOPE as per geographic concentration, it is not easy to state whether these variations are due to geographical factors or not. These variations may be due to differences in health-seeking behaviour among the population, and to some extent, the accessibility and availability of services. Instead, socioeconomic factors affect the need for health care and are more accountable for the variations in the level of OOPE .
In this study, we have assessed the level of OOPE, and the socio-economic and regional variations, among all Indian states and UTs. In a developing country like India, where majority of the population spends on healthcare services from their own pockets, higher government spending on health is essential. This study brings into focus healthcare inequalities in India that are based on caste and social groups. The pattern of healthcare expenditure shows large variations in access to quality healthcare by the diverse socio-religious groups in the country. Special focus must be given to financing the health care needs of the disadvantaged sections of the population, as health expenses can push these households into greater risk of poverty through mobilizing funds to cater their healthcare needs. However, designing a financial protection mechanism requires a deeper understanding of both the absolute and relative amounts of the financial burden of OOPE on the households.
There is evidence of regional disparities in terms of the level of OOPE among Indian states. Developed states are spending more on healthcare and backward states are spending less. There is a need to look into why these backward states lag behind their counterparts. Our study brings into focus the issue of inter-state differentials in OOPE causing geographic variation and concentration in healthcare spending. It has been observed that the spending on healthcare was comparatively lower among all the backward or isolated states. Overall social security measures should be enhanced, but at the same time, more priority should be assigned to these disadvantaged states to reduce the burden of OOPE, looking at the regional differences. However, geographical differences cannot explain the OOPE differentials properly and more research is needed to understand why such variation occurs and what efforts are required to address these issues.
Any resulting policy changes should reflect the needs of the backward states and local communities. It was observed that there was an association between the prevalence of socio-economic inequalities and average monthly OOPE. Policy interventions are required from both centre and the states to increase budget allocation for health spending and for reducing the level of OOPE. We hope the findings of our study will be useful for policy makers, researchers and other stakeholders to formulate appropriate strategies for removing regional imbalances in terms of health spending among Indian states.
This study tries to analyse only the absolute burden of healthcare spending by taking into consideration various socio-economic covariates. A limited number of indicators have been taken into consideration due to data limitation, as the source data does not provide information on other important covariates. If other variables are also taken into consideration then results may vary.
OOPE are non-reimbursable fees which a patient or family is responsible for paying directly to health practitioners or suppliers, without intervention of a third party.
Informal sector economic activities include all forms of non-standard atypical, alternative, irregular and precarious forms of work, and includes all persons in employment who, by law or in practice, are not subject to national labour legislation, income taxation, social protection or entitlement to employment benefits (International Labour Organization (ILO), 2012).
Inpatient expenditure comprises of health care services delivered to patients who are formally admitted to hospitals, ambulatory premises or self-standing centers.
Outpatient expenditure includes expenses on physician's private office, hospital outpatient center or ambulatory-care center. Patient does not stay overnight.
The Scheduled Castes (SCs), Scheduled Tribes (STs) and Other Backward Class (OBC) indicate constitutional classification of various groups of historically disadvantaged indigenous people in India. Various provisions are made by the Constitution of India, to provide reservation, protection and safeguards, in public employment in respect of the persons belonging to the SCs/STs and OBCs.
The Scheduled Castes are sometimes referred to as lower caste or Dalits, and are officially regarded as the socially disadvantaged group of population.
Scheduled Tribes is used as an official term for Adivasi or indigenous people, mainly residing in the hilly, forest or other inaccessible areas. In the Indian context, these people are mainly the indigenous people who are officially regarded as socially disadvantaged.
Other Backward Class (OBC) is a collective term used by the Constitution of India to categorize castes which are socially and educationally disadvantaged.
The authors are grateful to the Department of Humanities and Social Sciences, National Institute of Technology (NIT), Rourkela for their support and encouragement, which has helped in improving this paper. The authors also thank the journal editor and reviewers for their insightful comments which greatly helped improve this paper.
We received no funding support to undertake this study.
This paper uses data from the unit level information from 66th quinquennial CES round of the NSSO, conducted under the aegis of the Ministry of Statistics and Programme Implementation, Government of India. For more details see the report "Level and Pattern of Consumer Expenditure" 2009–10, by NSSO, Ministry of Statistics and Programme Implementation, Government of India, New Delhi: http://164.100.34.62/index.php/catalog/20/related_materials.
Design of the study: RD, JP. Wrote the Paper: RD. Analysed the data: RD with the help of JP. Finalising the article: RD, JP. All authors read and approved the final manuscript.
RD is Senior Research Fellow (SRF), and JP is assistant professor in Health Economics with the Department of Humanities and Social Sciences, National Institute of Technology (NIT), Rourkela, Odisha. Their research interests include healthcare financing, specifically health equity and inequality perspective in health economics.
We have bought this data from NSSO to use in our research. This data is also available in public domain for research purpose.
N.A. As this study uses secondary data so no consent to participate is required by the authors.
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