35.1: Introducing Health Care Economics
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Defining Health, Health Care, and Medical Care
Health care economics is a segment of economic study pertaining to the value, effectiveness, and efficiency in health care services.
learning objectives
- List the parties involved in the healthcare system in the United States
Health care economics is a segment of economic study pertaining to the value, effectiveness, and efficiency in medical care and health care services and issues. The study of health care, from an economic perspective, requires taking a broad lens on a complex system with a wide variety of stakeholders. In 1963, Kenneth Arrow differentiated health care economics from other economics due to the wide range of unique considerations involved. Health care, due to the severity of the need/demand, wide variety of externalities, government intervention, and role of doctors as third-parties (making critical purchasing decisions for other people), cannot be considered from the same perspective as other industries.
Defining Health Care
Health care is a significant concern for patients, insurance companies, governments, businesses, health care providers, researchers, and non-profits. It is a vast economic system with many internal players and externalities. Understanding the basic factors involved, both logistically and economically, will provide useful context in defining health care and the medical care services.
The chart below outlines who is involved, and in what fashion.
Health Care System Flow Chart : This flow chart does an excellent job of outlining the various stakeholders and influences in the broader health care system context.
- Health (Box B): Health metrics for health attributes from a value of life and overall utility-based perspective.
- Demand for Health Care (Box C): The overall health care demand, which is a complex array of inputs that can be summarized as health care seeking behaviors, and what factors influence them (i.e. externalities, price, time, perspectives, etc.).
- Supply of Health Care Costs (Box D):The supply of health care in most systems is quite complex, inclusive of direct inputs such as drugs, medical suppliers, and diagnostics to insurance companies (third parties) to health care professionals (doctors, nurses, etc.) to research.
- Evaluation of the Whole System (Box F): This is where the government factors in, particularly in countries with a more socialized system for health care, alongside the comparisons both internally and externally.
This process flow is what defines health care and the medical industry from an economic standpoint, and the relative influence of each of these components, and the interdependence between them, is worth studying to determine where higher degrees of efficiency and efficacy can be found.
Health Care System in the U.S.
With this in mind, it is useful to also outline the inputs and outputs of the U.S. health care system, particularly during this transitional time. At the time of this writing (2013), the Affordable Care Act (often referred to as ‘Obamacare’) will be coming into play shortly. While the details and implications of this are beyond the scope of this discussion, it is useful to understand what the basic construct that exists in the United States currently.
At the moment, health care is largely privatized with the exception of medicaid and medicare, the former being for low income groups and the latter for retirees. For most of us, health care insurance is generally purchased on a capital market by a policy-holder (who may be a company the beneficiary works for or the beneficiary themselves, depending upon the profession and contractual obligations of an employer). This health insurance plan offers a construct for what will be covered under an umbrella of monthly health care payments, and what is considered outside of the plan. There are many large health care insurance providers out there, offering this service to prospective beneficiaries.
Now, either the insurance company, the government (medicaid and medicare), or the individual (if they are not covered or if their particular procedure is not covered) is the direct client of the hospitals, pharmacies, and doctor’s offices. These institutions are also quite complicated, and require their own insurances against liability due to the high consequences in the field. Doctors and nurses provide a service, either actively performing a recommended approach (e.g. surgery) or recommending a treatment (e.g drugs). These medical professionals are largely overseen by the government from a quality control perspective (various standardized test and degree requirements), adding an additional line of complexity to the operation.
Overall, this system of healthcare in the U.S. is quite convoluted. There are many players involved and the stakes are extremely high. Picture a demand curve for a treatment for a deadly disease, what would the price point be? Considering the consequences, healthcare services often fall outside of standard macroeconomic concepts, defying supply and demand frameworks due to the nature of the business (i.e. life and death, the well-being of people). This underlines a social issue: how can we improve healthcare economics to maximize value and minimize costs?
Where a Dollar Spent on Health Care Goes: Introducing the Inputs to Health Care
Health care has many inputs and a variety of incumbents, namely insurance providers, administrators, governments, and pharmaceuticals.
learning objectives
- Discuss the factors that affect the cost of and access to healthcare
Healthcare has many inputs and a wide variety of interested parties profiteering. Understanding what drives the need for health care (and what prevents it), what is included in the cost, and the overall accessibility of this essential service is critical to understanding economics issues in healthcare. A dollar spent on health care can find it’s way to insurance providers, medical service providers, pharmaceutical companies, governments, administrative bodies (managing these businesses), and laboratories. Understanding what individuals pay for and why, alongside what is available, is important data for navigating this market.
Where the Money Goes
While a percentage breakdown of who procures the largest capital gains from health care is difficult to ascertain across such a complex system, it is safe to say that quite a few players contribute to the constantly rising price of even simple procedures and doctor’s visits. A breakdown of the critical players illuminates this further:
- Health Care Providers: On the surface, this is who a beneficiary feels like they are paying. This is their doctors, nurses, psychologists, dietitians, technologists, chiropractors, surgeons, and a wide range of other hands on and customer facing roles. These individuals are further differentiated by the fact that they often act as references as opposed to direct suppliers, making them both a direct to consumer provider and a third party provider.
- Pharmaceutical Companies: Drugs are playing an increasingly large role in health care, and likely will continue to do so in the future. The constant development of new drugs, alongside the distribution of established medications, is an enormous part of the market.
- Insurance Providers: There is a divider between most medical service consumers and their providers, and this is the insurance company. For those who are covered by their full-time jobs (or dependents of these individuals), this is largely a matter of who their business purchases from. For others not covered, insurance issues are a complex and highly expensive issue, and getting coverage is quite difficult (this is being addressed in the U.S. by new legislation, and is not an issue in most other developed nations). The insurance companies command a huge profit and represent a substantial part of the medical price tag.
- Government: The role of government in health care is fiercely debated in the United States, but in most of the developed world the government is essentially the provider of health care plans (using social services models to consolidate tax revenues to be allocated for this service). In the U.S., this is only done for medicaid and medicare. The government also takes tax revenues from involved parties in this industry, driving prices up further.
- Administration: This is the hospital itself, or the doctors office, where the management team attempts to run a largely profitable business in the medical industry. Administration pays the health care providers and the government, taking income from direct consumers, the government, and the insurance companies to cover the cost of business (and often turn substantial profits).
With these group of incumbents in mind, it becomes quite clear why the costs are rising exponentially and are so unsustainable. The constant struggle between these large and powerful players coupled with an essentially infinite demand has left the consumer as an extremely weak player in the market. Indeed, with this in mind, the graph displays the trajectory of health care spending due to excess costs in the long term.
Health Care Costs : This graph illustrates the danger of continuing down path of using the excessively high cost-structure U.S. health care incumbents have dictated in the context of spending as a % of GDP.
Accessibility
One of the most discussed topics in health care is accessibility. Due to the fact that health care represents the ability for an individual to maintain a healthy and happy life, it seems intuitive that accessibility must as unlimited as possible. Of course, in a capitalistic system, this will not be the case. Economics dictates that price points will be determined based on supply and demand, and the demand in this industry is often essentially infinite. As a result, accessibility and profitability do not always align from an economic perspective. The U.S. employs medicaid and medicare to provide for low-income and elderly citizens that would otherwise be excluded from the market, while other countries have healthcare systems with more government intervention to address market failure.
One of the larger issues in accessibility is nations without the infrastructure required to support health care industries. Developing nations often do not have access to the skills or suppliers required to run modern hospitals and doctors offices, nor the ability to act preventatively (i.e. eating healthy, getting exercise, check ups, etc.). This creates enormous inefficiency in the system and reduces the economic viability of operating in these countries for insurance providers. Addressing this concern is one of the central issues for the United Nations (UN) and other nongovernmental organizations.
Different Health Care Systems Around the World
Health care systems differ from nation to nation depending upon the level of economic development and the political system in place.
learning objectives
- Identify different types of healthcare systems
Health care differs from nation to nation, sometimes substantially depending upon the level of economic development and the political system in place. Health care systems, on the global scale, is best defined via the World Health Organization’s definition: “A health system consists of all organizations, people and actions whose primary intent is to promote, restore or maintain health. This includes efforts to influence determinants of health as well as more direct health-improving activities. A health system is therefore more than the pyramid of publicly owned facilities that deliver personal health services. ” This definition is important when observing international health care systems, as it captures both developed and developing nations within this context.
Comparisons: Developed Nations
The World Health Organization has been actively measuring a variety of performance indicators to determine an overall ranking system for health care on a global scale. While this has seen some objections, primarily due to the selection of attributes which weigh into this ranking, it is designed to measure critical success factors which are easily comparably across borders (apples to apples). These measured attributes include health of the population, fair financial contributions, responsiveness of the system, preventable deaths, affordability and a range of other considerations.
The countries which perform the highest on these metrics are primarily located in Europe (generally northern Europe, see ), where social systems are well designed at a governmental level to ensure prices remain accessible and care remain available. Interestingly, the U.S. has consistently ranked poorly and continues to perform substantially below European counterparts deemed developed at similar economic levels. Two good examples are provided in the media relative to the overall capital costs and the subsequent returns on these costs, on being costs to hospital beds per capita and the other costs to physicians per capita. By these measures, European nations capture more value and efficiency within their systems. The most notable difference between these systems is that the US is that, of these countries, the US is the only country without universal healthcare.
Capital Costs and Physicians : Similar to the graph representing costs vs. beds, this chart illustrates the number of physicians available (relative to the population) in the context of capital expenditures. Once again the United States is a clear outlier, where the number of physicians is low and the cost quite high.
Capital Costs and Hospital Beds : This graph demonstrates the apparent correlation between beds (per 1000 people) and the costs involved in healthcare overall. This demonstrates that, on a per capita basis, the U.S. is spending a great deal without capturing much in return relative to available space for patients.
Economic Efficiency of Global Health Care Systems : Healthcare spending per capita is on the left y-axis and life expectancy is on the right. Country differences are apparent, especially when comparing the US to others.
Let us explore further through an example of health care in German (though not all European countries are the same). Germany has consistently demonstrated reductions in cost of health care per capita relative to GDP growth. German health care is regulated by the Federal Joint Commission, a public health organization which leverages governmental health reform bills to generate new regulations. This system also includes a total of 85% of the population on the government offered standardized health care plan, which covers a variety of health care needs across the board. The remaining 15% of the population has opted for private health insurance options, which provide unique niche benefits for specific groups. This system has been highly effective and affordable in providing health care to German citizens.
Developing Nations
With fewer resources, developing nations struggle to compete provide the same access to health care as do developed nations.
China is an interesting case study. China has a great deal of variance in quality and accessibility, with hospital wait times for the poor (depending on severity) taking many hours (sometimes days) compared to the rich, who are admitted immediately. Transitioning towards a system that provides care to the rich and the poor alike is the primary challenge in these developing regions.
Externalities in the Health Care Market
Health care can impact people beyond the person receiving and the person providing the care, causing positive and negative externalities.
learning objectives
- Describe externalities in the healthcare market
Defining Externalities
An externality is any impact, be it positive or negative, on individuals or groups not involved in a given economic transaction. That is to say, an externality is something that affects other people outside of the particular parties involved in an exchange.
Externalities : The basic premise of an externality is captured in this diagram, where external factors affect the internal economic system for a product or service.
A classic example of externalities is the automobile. Cars consistently produce air pollution whenever they are driven, slowly eroding the health of our ecosystem. This cost is shouldered not only by the driver of the vehicle, but also by every living thing on the planet. This is an example of parties not involved in the transaction (selling or buying the vehicle) being impacted, in this case negatively.
Health Care Externalities
In health care, the critical externality in most systems is the care provided to others. You benefit from others being healthy because it reduces the likelihood of you catching their illness (assuming it’s contagious). You benefit from a positive externality of others receiving health care.
Your health care costs are also affected by others choosing to purchase health care. The healthy pay more to the insurance company than they receive in treatment, while the opposite is true for the sick. Insurance fundamentally operates by taking the money from healthy people to pay for the procedures required by sick people.
Taxpayers should also be concerned with the state of the healthcare system not only because they pay for Medicare and Medicaid, but also because healthcare is a huge part of the US economy. In 2011, the US spent 17.2% of GDP on healthcare, more than any other country. Reducing the cost of health care can clearly increase the amount that the US can consume or invest.
Other negative externalities include:
- Infectious Disease: One of the largest reasons why health care is so critical is the fact that disease are infectious. Untreated disease will result higher population vulnerability to that disease due to increased exposure.
- Environmental Degradation: Health care produces a great deal of chemical waste, requires a great deal of emissions (ambulances, etc.) and alters the natural ecological environment of bacteria.
- Antibiotic Resistance: An interesting byproduct of the newer solutions to medical dilemmas is the slowly growing resistance of antibiotics in bacteria. Due to the way in which the health care industry has been operating, bacteria are dramatically altering to resist our solutions.
Positive externalities include:
- Health Affects Wealth: Healthy workers are absent from work less and are more productive workers. A health care market that effectively helps workers can lead to positive economic gains.
- Technology and Information: The study of health care, and the research involved in generating new solutions, has dramatically increased the knowledge and technological capacity of society in general. This has affected other industries, as research and development in health care affects the technological efficacy in other markets.
- Vaccinations: An interesting new development in health care is the advent of vaccines. Vaccination results in herd immunity, or essentially the fact that many individuals will become immune and thus reduce the likelihood that everyone in the population will contract certain diseases.
Current Issues in Health Care
Current issues in the U.S. health care system largely revolve around the significant policy changes resulting from the Affordable Care Act.
learning objectives
- Explain the main parts of the Affordable Care Act and the current American healthcare system
Current issues in the U.S. health care system largely revolve around the significant policy changes imposed by the Affordable Care Act (ACA, or Obamacare), which attempts to provide health insurance coverage for all citizens. This legislation was designed to respond to many flaws in the current U.S. system of healthcare. It is also important to understand the criticisms of this change, as many voters in the U.S. disagree with proposed changes to the system.
U.S. House Votes for the Affordable Health Care Act : This map outlines the voting distribution in 2009 when the Affordable Health Care Act was brought to the floor.
U.S. Health Care Currently
The U.S., despite having some of the greatest technological advances and medical professionals, has consistently struggled to provide affordable, effective health care to everyone. The costs alone, on a per capita basis, underline the way in which the U.S. system has struggled to meet international standards in providing affordable care. illustrates the costs incurred by each individual in the system based on a country to country comparison. As it illustrates, consumers in the U.S. are faced with much higher (and growing) costs than international counterparts.
Health Costs Per Capita : This chart illustrates the costs incurred by each individual in the system based on a country to country comparison. As is demonstrated, consumers in the U.S. are faced with much higher costs (and consistently growing higher) than international counterparts.
Most Americans with private health insurance have it provided by their employers. There are also social welfare programs such as Medicaid and Medicare. The insurers negotiate rates with hospitals for different procedures. Patients then go into the hospital and get procedures recommended by doctors. The doctors are then paid by hospitals. This is a classic case of moral hazard: the two parties deciding for the transaction to occur- patients and doctors- are not the same two exchanging money.
Healthcare has a demand curve that fluctuates wildly based upon the extent of the issue – consumers who are facing serious health problems will likely demand healthcare at almost any price, allowing medical providers to take advantage of the inelastic demand. Further issues include the fact that doctors represent a third party (recommending drugs and procedures) and that insurance companies have the power to deny coverage to individuals who need it most.
The Affordable Health Care Act
In December of 2009, the Senate passing a bill called Patient Protection and Affordable Care Act. The Affordable Care Act is a complex piece of legislation, but a number of bullets from the bill are highly useful to understand:
- Pre-existing Conditions: Individuals with pre-existing conditions are much more likely to be expensive clients, and thus are not profitable to insure. This results in insurers refusing to insure these patients. The Affordable Care Act addresses this through legislation, saying providers cannot refuse coverage.
- Changing Insurance Rates: As a complement to the analysis above, insurance agencies also cannot alter rates based on pre-existing conditions or gender. This levels the playing field for the consumer, who historically had limited buyer power.
- Antitrust: Previously, insurance companies were immune to antitrust laws. This means they could generate monopolies geographically and exploit consumers. This immunity has been repealed.
- Standards: Obamacare also closes loopholes regarding to quality standards, ensuring that insurance providers do not reduce what is provided to clients in an effort to cut costs.
- Healthcare.gov: This is a way to enable consumers in finding health care insurers in a way that promotes capitalistic competition between providers. Previously, discussing pricing and plans with insurers was highly complex for many individuals (designed for businesses, not individual consumers).
- Medicaid and Medicare: Overall, medicare has been reduced while medicaid has been expanded. Medicare spending has been increasing dramatically. This has been cut by $400 billion, which is a source of discontent for many individuals. Medicaid has been expanded to 133% of the poverty level, covering more people.
Criticisms
The ACA will only work if both healthy and sick people alike buy insurance: if the healthy choose to pay the fine for not having insurance and only the sick buy insurance, then costs will increase. There is also a political critique of the ACA. Some feel that the government should not mandate that private citizens purchase insurance in the first place. They feel that the government is overstepping its bounds.
Many individuals also believe that this new legislation will increase costs for small businesses that are now required to buy insurance for their employees, and will motivate ‘freeloaders’, or individuals who take government handouts. Overall, while the goal is to enable more people to health care more affordably, many people believe this new approach will do not accomplish that.
Key Points
- Kenneth Arrow, in 1963, differentiated health care economics from other economics due to the wide range of unique considerations involved (i.e. infinite demand, wide range of stakeholders, etc. ).
- Health care is a significant concern for patients, insurance companies, governments, businesses, health care providers, researchers, and non-profits. These parties determine the supply, demand, oversight, and externalities of the system.
- Currently, U.S. health care is largely privatized with the exception of medicaid and medicare, the former being for low income groups and the latter for retirees. This is unlike many developed nations, who have socialized support in place.
- The insurance company, the government (medicaid and medicare), or the individual (if they are not covered or if their particular procedure is not covered) is the direct client of the hospitals, pharmacies, and doctor’s offices.
- Overall, this system of health care in the U.S. is quite convoluted. There are many players involved and the stakes are extremely high.
- While a percentage breakdown of who procures the largest capital gains from health care is difficult to ascertain across such a complex system, it is safe to say that quite a few players contribute to the constantly rising price.
- In short, the dollar value of health care is largely provided by beneficiaries to insurance companies (or governments), and paid out to administrative systems who employ and pay health care providers.
- One of the most discussed topics in health care is accessibility. Governments and insurers provide economics means for this in developed nations.
- One of the larger issues in accessibility is nations without the infrastructure required to support health care industries. Developing nations often do not have access to the skills or suppliers required.
- A health system consists of all organizations, people and actions whose primary intent is to promote, restore or maintain health. This includes efforts to influence determinants of health as well as more direct health-improving activities.
- The World Health Organization has been actively measuring a variety of performance indicators to determine an overall ranking system for health care on a global scale.
- The countries which perform the highest on these metrics are primarily located in Europe, where social systems are well designed at a governmental level to ensure prices remain accessible and care remain available.
- The U.S. has consistently ranked poorly and continues to perform substantially below European counterparts deemed developed at similar economic levels.
- Developing nations struggle to compete and compare apples to apples to developed nations, primarily due to the required infrastructure and capital requirements.
- An externality is any impact, be it positive or negative, on individuals or groups not involved in a given economic transaction.
- Negative externalities include tax costs, infectious disease, anti-biotic resistance and environmental degradation. The negative components impact others despite their participation in the system.
- Positive externalities include increases in wealth due to increased health, vaccinations to limit disease exposures and increases in technology and knowledge.
- Positive externalities include increases in wealth due to increased health, vaccinations to limit disease exposures and increases in technology and knowledge.
- U.S. citizens pay substantially more per capita for health care than do residents of other countries, and many people lack access to affordable health care.
- Patients have procedures performed by doctors, by the actual exchange of money occurs between the patient’s insurance provider and the doctor’s employer.
- The Affordable Care Act addresses issues like pre-existing conditions, anti-trust, unfair rates based on gender, universal standards and a range of other considerations.
- Many individuals believe that this new legislation will increase costs for small businesses, and will motivate ‘freeloaders’, or individuals who take government handouts.
Key Items
- Health care : The prevention, treatment, and management of illness or the preservation of mental and physical well-being through the services offered by the medical, nursing, and allied health professions.
- Medicare : The system of government subsidies for health care for the elderly and disabled.
- Medicaid : U.S. government system for providing medical assistance to persons unable to afford medical treatments.
- Beneficiary : One who benefits or receives an advantage.
- World Health Organization : The World Health Organization (WHO) is a specialized agency of the United Nations (UN) that is concerned with international public health.
- Universal healthcare : A system where every citizen is guaranteed access to a certain basic level of health services.
- Determinants : A determining factor; an element that determines the nature of something
- externality : An impact, positive or negative, on any party not involved in a given economic transaction or act.
- Vaccinations : Inoculation with a vaccine in order to protect a particular disease or strain of disease
- Affordable Care Act : The ACA was enacted with the goals of increasing the quality and affordability of health insurance.
- Pre-existing Conditions : A pre-existing condition is a risk with extant causes that is not readily compensated by standard, affordable insurance premiums.
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- Economic policy of Barack Obama. Provided by : Wikipedia. Located at : en.Wikipedia.org/wiki/Economic_policy_of_Barack_Obama%23Health_care . License : CC BY-SA: Attribution-ShareAlike
- Affordable Health Care for America Act. Provided by : Wikipedia. Located at : en.Wikipedia.org/wiki/Affordable_Health_Care_for_America_Act . License : CC BY-SA: Attribution-ShareAlike
- Health economics. Provided by : Wikipedia. Located at : en.Wikipedia.org/wiki/Health_economics . License : CC BY-SA: Attribution-ShareAlike
- Health care in comparison. Provided by : Wikipedia. Located at : en.Wikipedia.org/wiki/Health_care_in_comparison%23International_comparisons . License : CC BY-SA: Attribution-ShareAlike
- Health insurance in the United States. Provided by : Wikipedia. Located at : en.Wikipedia.org/wiki/Health_insurance_in_the_United_States . License : CC BY-SA: Attribution-ShareAlike
- Moral hazard. Provided by : Wikipedia. Located at : en.Wikipedia.org/wiki/Moral_hazard . License : CC BY-SA: Attribution-ShareAlike
- Boundless. Provided by : Boundless Learning. Located at : www.boundless.com//political-science/definition/affordable-care-act . License : CC BY-SA: Attribution-ShareAlike
- Pre-existing Conditions. Provided by : Wikipedia. Located at : en.Wikipedia.org/wiki/Pre-exi...g%20Conditions . License : CC BY-SA: Attribution-ShareAlike
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9.8: References
Alvarez, A. (2011, April 19). Native American tribes and economic development. Urbanland. https://urbanland.uli.org/development-business/native-american-tribes-and-economic-development/
Barwick-Snell, K., & Walker, V. (2017). Becoming aware: A text/workbook for human relations and personal adjustment . Kendall Hunt.
Brewer, N., Mitchell, P., & Weber, N. (2002). Gender role, organizational status, and conflict management styles. International journal of conflict manageme nt, 13 (1), 78-94.
Clayton, R. B., Nagurney, A., & Smith, J. R. (2013). Cheating, breakup, and divorce: Is Facebook use to blame? Cyberpsychology, Behavior, and Social Networking , 16 (10), 717-720.
Conerly, K., & Tripathi, A. (2004). What is your conflict style? Understanding and dealing with your conflict style. Journal for Quality and Participation , 27 (2), 16-20.
Cramer, D. (2000) Relationship satisfaction and conflict style in romantic relationships, The Journal of Psychology, 134 (3), 337-341. doi.org/10.1080/00223980009600873
Cupach, W. R., Canary, D.J., & Spitzberg, B. H. (2010). Competence in interpersonal conflict (2nd ed.). Waveland Press, Inc.
Fisher, R., Ury, W. L., & Patton, B. (2011). Getting to yes: Negotiating agreement without giving in . Penguin.
Gottman, J. M. (1994). What predicts divorce? The relationship between marital processes and marital outcomes . Lawrence Erlbaum Associates.
Gottman, J. M., & Driver, J. L. (2005). Dysfunctional marital conflict and everyday marital interaction. Journal of Divorce & Remarriage , 43 (3-4), 63-77.
Gross, M. A., & Guerrero, L.K. (2000). Managing conflict appropriately and effectively: An application of the competence model to Rahim’s organizational conflict styles. International Journal of Conflict Management , 11 (3), 200-226.
Hocker, J., & Wilmot, W. (2018). Interpersonal conflict (10th ed.). McGraw-Hill.
Hofstede, G. (2001). Culture’s consequences: Comparing values, behaviors, institutions, and organizations across nations (2nd ed.). Sage Publications.
Kilman, R. & Thomas, K. (1977). Developing a forced-choice measure of conflict-handling behavior: The MODE instrument. Educational and Psychological Measure, 37, 309-325.
Lenhart, A., Smith, A., Anderson, M., Duggan, M., & Perrin, A. (2020). Teens, technology and friendships. Pew Research Center. 2015.
McCullough, M. E. (2001). Forgiveness: Who does it and how do they do it? Current directions in psychological science , 10 (6), 194-197.
North, J. (1987). Wrongdoing and forgiveness. Philosophy , 62 (242), 499-508.
Oetzel, J. G., & Ting-Toomey, S. (2003). Face concerns in interpersonal conflict: A cross-cultural empirical test of the face negotiation theory. Communication Research , 30 (6), 599-624.
Parker, K., & Barroso, A. (2021). In Vice President Kamala Harris, we can see how America has changed. Pew Research Center. https://www.pewresearch.org/fact-tank/2021/02/25/in-vice-president-kamala-harris-we-can-see-how-america-has-changed/
Rahim, M. A. (2000) Empirical studies on managing conflict. The International Journal of Conflict Management, 11 (1), 5-9.
Rahim, M. A., & Katz, J. P. (2019). Forty years of conflict: the effects of gender and generation on conflict-management strategies. International Journal of Conflict Management , 31 (1), 1-16. https://doi.org/10.1108/IJCMA-03-2019-0045
Rahim, M. A., Kaufman, S., & Psenicka, C. (2004). A model of the styles of handling conflict, marital satisfaction, and instability. SSRN . dx.doi.org/10.2139/ssrn.602765
Smith, S. G., Zhang, X., Basile, K. C., Merrick, M. T., Wang, J., Kresnow, M. J., & Chen, J. (2018). The national intimate partner and sexual violence survey: 2015 data brief–updated release.
Spangler, B. (2003, June). Win-win, win-lose, and lose-lose situations . Beyond intractability . Burgess, G. & Burgess, H. (Eds). Conflict Information Consortium, University of Colorado, Boulder. http://www.beyondintractability.org/essay/win-lose .
Suler, J. (2004). The online disinhibition effect. Cyberpsychology & Behavior , 7 (3), 321-326.
Ting-Toomey, S. (1988). Intercultural conflict styles: A face-negotiation theory. In Y. Kim & W. Gudykunst (Eds.), Theories in intercultural communication (pp. 213-235). Sage Publications.
Ting-Toomey, S. (2009). Intercultural conflict competence as a facet of intercultural competence development. In D. Deardoff (Ed.), The Sage handbook of intercultural competence , (pp.100-120). Sage Publications.
Ting-Toomey, S. & Oetzel, (2001). Managing intercultural conflict effectively. Sage Publications.
Vogel, E. A. & Anderson, M. (2020). Dating and relationships in the digital age. Pew Research Center. pewresearch.org/internet/2020/05/08/dating-and-relationships-in-the-digital-age/
Watzlawich, P., Beavin, J., & Jackson, D. (1967). The pragmatics of human communication. Norton.


6.2.4: Materials and Procedures
Materials
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Organisms used from the Student Stock Cultures(TSB):
- Proteus vulgaris
- Escherichia coli
- Alcaligenes faecalis
- Lactobacillus acidophilus
- 4 tubes: TSB pH 4.0
- 4 tubes: TSB pH 6.0
- 4 tubes: TSB pH 8.0
- 4 tubes: TSB pH 10.0
Procedures
Each Group :
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Use a sterile transfer pipette to inoculate each of the 4 organisms into each pH tube:
- add 1 drop of broth culture to each pH broth tube.
- Staphylococcus saprophyticus → TSB pH 4.0, pH 6.0, pH 8.0, pH 10.0
- Escherichia coli → TSB pH 4.0, pH 6.0, pH 8.0, pH 10.0
- Alcaligenes viscolactis → TSB pH 4.0, pH 6.0, pH 8.0, pH 10.0
- Lactococcus lactis → TSB pH 4.0, pH 6.0, pH 8.0, pH 10.0
- Place the tubes in buckets and incubate in your classroom incubator.
Results
Enter your ratings for each bacterium/pH and give the pH classification for bacterium.
|
Organism |
pH 4 |
pH 6 |
pH 8 |
pH 10 |
Optimum pH |
pH Classification |
|---|---|---|---|---|---|---|


7.3: Parameters vs. Statistics
Learning Objectives
- Describe the sampling distribution for sample proportions and use it to identify unusual (and more common) sample results.
- Distinguish between a sample statistic and a population parameter.
One of the goals of inference is to draw a conclusion about a population on the basis of a random sample from the population. Obviously, random samples vary, so we need to understand how much they vary and how they relate to the population. Our ultimate goal is to create a probability model that describes the long-run behavior of sample measurements. We use this model to make inferences about the population.
We begin our investigation with a simplified and artificial situation.
Example
Proportions from Random Samples Vary
Imagine a small college with only 200 students, and suppose that 60% of these students are eligible for financial aid.
In this simplified situation, we can identify the population, the variable, and the population proportion.
- Population: 200 students at the college.
- Variable: Eligibility for financial aid is a categorical variable, so we use a proportion as a summary.
- Population proportion: 0.60 of the population is eligible for financial aid.
Note: Populations are usually much larger than 200 people. Also, in real situations, we do not know the population proportion. We are using a simplified situation to investigate how random samples relate to the population. This is the first step in creating a probability model that will be useful in inference.
How accurate are random samples at predicting this population proportion of 0.60?
To answer this question, we randomly select 8 students and determine the proportion who are eligible for financial aid. We repeat this process several times. Here are the results for 3 random samples:
Notice the following about these random samples:
- Each random sample came from a population in which the proportion eligible for financial aid is 0.60, but sample proportions vary. Each random sample has a different proportion who are eligible for financial aid.
- Some sample proportions are larger than the population proportion of 0.60; some sample proportions are smaller than the population proportion.
- Some samples give good estimates of the population proportion. Some do not. In this case, 0.625 is a much better estimate than 0.375.
- A lot of variability occurs in these sample proportions. It is not surprising, therefore, that a sample of 8 students may give an inaccurate estimate for the proportion of those eligible for financial aid in the population. It makes sense that small samples of only 8 students may not represent the population accurately. Later we investigate the effect of increasing the size of the sample.
- The variability we see in proportions from random samples is due to chance.
Try It
In these activites, we use the following simulation to select a random sample of 8 students from the small college in the previous example. At the college, 60% of the students are eligible for financial aid. For each sample, the simulation calculates the proportion in the sample who are eligible for financial aid. Repeat the sampling process many times to observe how the sample proportions vary, then answer the questions.
https://assessments.lumenlearning.co...sessments/3582
Click here to open this simulation in its own window.
Example
Means from Random Samples Vary
Now let’s consider a quantitative variable with this same population of 200 students at a small college. Let’s also suppose that the mean amount of financial aid received by students at the college is $1,500.
In this simplified situation, we have
- Population: 200 students at the college.
- Variable: Financial aid amount ($) is a quantitative variable, so we use a mean as a summary.
- Population mean: $1,500.
How accurate are random samples at predicting this population mean of $1,500?
To answer this question, we randomly select 8 students and determine the mean amount of financial aid received by the students. We repeat this process several times. Here are the results for 3 random samples:
Notice that observations we made earlier about sample proportions are true for sample means.
- Each random sample came from a population for which the mean amount of financial aid received by individual students is $1,500. But the sample means vary: Each random sample has a different mean.
- Some sample means are larger than the population mean of $1,500. Some sample means are smaller than the population mean.
- Some samples give better estimates of the population mean than others. For example, $1,325.00 is a much better estimate than $687.50.
- A lot of variability occurs in the sample means. It is not surprising, therefore, that a sample of 8 students may give an inaccurate estimate of the mean amount of financial aid received by the population. Again, it makes sense that small samples of only 8 students may not represent the population accurately. We investigate the factors that affect the variability of means from random samples in the module Inference for Means .
- The variability we see in the means from random samples is due to chance.
Definitions
Before we continue our discussion of sampling variability, we introduce some vocabulary.
A parameter is a number that describes a population. A statistic is a number that we calculate from a sample.
Let’s use this new vocabulary to rephrase what we already know at this point:
- When we do inference, the parameter is not known because it is impossible or impractical to gather data from everyone in the population. (Note: In each example on this page, we assumed we knew the parameter so that we could investigate how statistics relate to the parameter. This is the first step in creating a probability model. However, when we do inference, we use a statistic to draw a conclusion about an unknown parameter.)
- We make an inference about the population parameter on the basis of a sample statistic.
- Statistics from samples vary.
In this course, if the variable is categorical, the parameter and the statistic are both proportions. If the variable is quantitative, the parameter and statistic are both means.
From our first example:
- Parameter: A population proportion. For this population of students at a small college, 0.60 are eligible for financial aid.
- Statistics: Sample proportions that vary. In the example, 0.75, 0.625, and 0.375 are all statistics that describe the proportion eligible for financial aid in a sample of 8 students.
From our second example:
- Parameter: A population mean. For this population of students at a small college, the mean amount of financial aid is $1,500.
- Statistics: Sample means that vary. In the example, $2,087.50, $1,325.00, and $687.50 are all statistics that describe the mean amount of financial aid received by a sample of 8 students.
We use different notation for parameters and statistics:
| (Population) Parameter | (Sample) Statistic | |
|---|---|---|
| Proportion | ||
| Mean | ||
| Standard Deviation |
Sometimes we refer to the sample statistics as “p-hat” and “x-bar.”
Here we use this notation for the information from our examples.
For our first example:
- For the population of college students, p = 0.60.
- For the 3 random samples of 8 students, we have p-hats
For our second example:
- For the population of college students, µ = $1,500.
- For the 3 random samples of 8 students, we have x-bars
Important Comments about Notation
Many statistics packages and introductory statistics textbooks use the notation shown in the table. The notation for means and standard deviations is common in the field of statistics. However, you will occasionally see other notation for proportions. In some statistical material, the Greek letter π represents the population proportion and p represents the sample proportion. This can be particularly confusing because p is used in some statistical material for the population proportion and in other statistical material for a sample proportion. Whenever you work with symbols, always be sure you understand what the symbol represents. You should be able to interpret the symbol from the context of the material.
Contributors and Attributions
- Concepts in Statistics. Provided by : Open Learning Initiative. Located at : http://oli.cmu.edu . License : CC BY: Attribution


6.15: Introduction to Discrete Probability Distribution
What you’ll learn to do: Use probability distributions for discrete and continuous random variables to estimate probabilities and identify unusual events.
In studying a probability experiment, it is often useful to work with quantitative values to represent outcomes. These quantitative values associated to outcomes are called random variables. In this section, we explore random variables that take on numeric values that can be listed. For example, number of books is a discrete random variable. On the other hand, hair color is not a random variable because hair color is not numeric. Also, any decimal between 0 and 1 is not discrete because we cannot list out all the decimals. In analyzing real life data, we will apply fundamental concepts about discrete probability distributions to estimate likelihoods and draw inferences.
Contributors and Attributions
- Concepts in Statistics. Provided by : Open Learning Initiative. Located at : http://oli.cmu.edu . License : CC BY: Attribution


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12.1: The Spinal Cord
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This page discusses the central nervous system (CNS), focusing on the brain and spinal cord. It describes the tubular structure of the spinal cord, detailing its anatomical features like the anterior median fissure and posterior median sulcus. The gray matter's organization into posterior, anterior, and lateral horns is explained, highlighting their roles in sensory processing, motor signals, and sympathetic functions.
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12.2: Exercises
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This page provides exercises on spinal cord anatomy, including labeling structures like the dura mater and nerve components, matching spinal cord regions to their enlargements, and identifying peripheral nerves. It also encourages the creation of a study sheet for cranial nerves, featuring a mnemonic for easier memorization.
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12.3: MODELS" Spinal Cord, Spinal Columns (Flat), Spinal Cord in Vertebral Column, Blank Brain Picture
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This page provides a comprehensive overview of spinal cord anatomy, detailing the meningeal layers (dura, arachnoid, pia mater), spinal cord structures (conus medullaris, cauda equina, cervical/lumbar enlargements), and cross-sectional anatomy (dorsal, lateral, ventral horns).


13: Instructional Assessment- Involving Students in the Assessment Process Last updated Save as PDF Page ID 122562 Jennfer Kidd, Jamie Kaufman, Peter Baker, Patrick O'Shea, Dwight Allen, & Old Dominion U students Old Dominion University 13.1: What is locus of control? How is it related to student achievement and assessment? 13.2: What are the benefits of students as self-regulated learners? 13.3: How can we help students set goals and monitor their own learning? 13.4: How can early elementary students be involved in the assessment process? 13.5: How can upper elementary students be involved in the assessment process? 13.6: How can secondary students be involved in the assessment process? 13.7: When is peer reviewing effective? 13.8: Can and should students grade each other?


21.3: Carbon Dioxide, pH, and Ocean Acidification
The anthropogenic addition of carbon dioxide into the atmosphere has an additional effect on ocean chemistry. About 30% of the carbon dioxide that is added to the atmosphere is absorbed by the oceans. This additional carbon dioxide affects the pH of the ocean. We previously learned the following:
When CO 2 gas dissolves in the ocean, it interacts with the water to produce a number of different compounds according to the reaction below:
CO 2 + H 2 O ↔ H 2 CO 3 ↔ H + + HCO 3 – ↔ 2H + + CO 3 2-
CO 2 reacts with water to produce carbonic acid (H 2 CO 3 ), which then dissociates into bicarbonate (HCO 3 – ) and hydrogen ions (H + ). The bicarbonate ions can further dissociate into carbonate (CO 3 2- ) and additional hydrogen ions (Figure \(\PageIndex{2}\)).
Carbon dioxide and the other carbon compounds listed above play an important role in buffering the pH of the ocean. Currently, the average pH for the global ocean is about 8.1, meaning seawater is slightly basic. Because most of the inorganic carbon dissolved in the ocean exists in the form of bicarbonate, bicarbonate can respond to disturbances in pH by releasing or incorporating hydrogen ions into the various carbon compounds. If pH rises (low [H + ]), bicarbonate may dissociate into carbonate, and release more H + ions, thus lowering pH. Conversely, if pH gets too low (high [H + ]), bicarbonate and carbonate may incorporate some of those H + ions and produce bicarbonate, carbonic acid, or CO 2 to remove H + ions and raise the pH. By shuttling H + ions back and forth between the various compounds in this equation, the pH of the ocean is regulated and conditions remain favorable for life.
CO 2 and Ocean Acidification
In recent years there has been rising concern about the phenomenon of ocean acidification . As described in the processes above, the addition of CO 2 to seawater lowers the pH of the water. As anthropogenic sources of atmospheric CO 2 have increased since the Industrial Revolution, the oceans have been absorbing an increasing amount of CO 2 , and researchers have documented a decline in ocean pH from about 8.2 to 8.1 in the last century. This may not appear to be much of a change, but remember that since pH is on a logarithmic scale, this decline represents a 30% increase in acidity. It should be noted that even at a pH of 8.1 the ocean is not actually acidic; the term “acidification” refers to the fact that the pH is becoming lower, i.e. the water is moving towards more acidic conditions.
Figure \(\PageIndex{3}\) presents data from observation stations in and around the Hawaiian Islands. As atmospheric levels of CO 2 have increased, the CO 2 content of the ocean water has also increased, leading to a reduction in seawater pH. Some models suggest that at the current rate of CO 2 addition to the atmosphere, by 2100 ocean pH may be further reduced to around 7.8, which would represent more than a 120% increase in ocean acidity since the Industrial Revolution.
Why is this important? Declining pH can impact many biological systems. Of particular concern are organisms that secrete calcium carbonate shells or skeletons, such as corals, shellfish, and may planktonic organisms. At lower pH levels, calcium carbonate dissolves, eroding the shells and skeletons of these organisms (Figure \(\PageIndex{4}\)).
Not only does a declining pH lead to increased rates of dissolution of calcium carbonate, it also diminishes the amount of free carbonate ions in the water. The relative proportions of the different carbon compounds in seawater is dependent on pH (Figure \(\PageIndex{6}\)). As pH declines, the amount of carbonate declines, so there is less available for organisms to incorporate into their shells and skeletons. So ocean acidification both dissolves existing shells and makes it harder for shell formation to occur.
Additional links for more information:
- NOAA Ocean Acidification Program website http://oceanacidification.noaa.gov/


11.4A: The Complement System
- Illustrate the key points of the complement system
The complement system helps or “complements” the ability of antibodies and phagocytic cells to clear pathogens from an organism. It is part of the immune system called the ” innate immune system ” that is not adaptable and does not change over the course of an individual’s lifetime. However, it can be recruited and brought into action by the adaptive immune system.
The complement system consists of a number of small proteins found in the blood, generally synthesized by the liver, and normally circulating as inactive precursors (pro-proteins). When stimulated by one of several triggers, proteases in the system cleave specific proteins to release cytokines and initiate an amplifying cascade of further cleavages. The end result of this activation cascade is massive amplification of the response and activation of the cell-killing membrane attack complex. Over 25 proteins and protein fragments make up the complement system, including serum proteins, serosal proteins, and cell membrane receptors. They account for about 5% of the globulin fraction of blood serum.
Three biochemical pathways activate the complement system: the classical complement pathway, the alternative complement pathway, and the lectin pathway. The following are the basic functions of the complement: opsonization (enhancing phagocytosis of antigens); chemotaxis (attracting macrophages and neutrophils); cell lysis (rupturing membranes of foreign cells); and clumping (antigen-bearing agents).
The proteins and glycoproteins that constitute the complement system are synthesized by the liver hepatocytes. But significant amounts are also produced by tissue macrophages, blood monocytes, and epithelial cells of the genitourinal tract and gastrointestinal tract. The three pathways of activation all generate homologous variants of the protease C3-convertase. The classical complement pathway typically requires antigen, antibody complexes for activation (specific immune response), whereas the alternative and mannose-binding lectin pathways can be activated by C3 hydrolysis or antigens without the presence of antibodies (non-specific immune response). In all three pathways, C3-convertase cleaves and activates component C3, creating C3a and C3b, and causing a cascade of further cleavage and activation events. C3b binds to the surface of pathogens, leading to greater internalization by phagocytic cells by opsonization. C5a is an important chemotactic protein, helping recruit inflammatory cells.
C3a is the precursor of an important cytokine (adipokine) named ASP and is usually rapidly cleaved by carboxypeptidase B. Both C3a and C5a have anaphylatoxin activity, directly triggering degranulation of mast cells, as well as increasing vascular permeability and smooth muscle contraction. C5b initiates the membrane attack pathway, which results in the membrane attack complex (MAC), consisting of C5b, C6, C7, C8, and polymeric C9. MAC is the cytolytic endproduct of the complement cascade; it forms a transmembrane channel, which causes osmotic lysis of the target cell. Kupffer cells and other macrophage cell types help clear complement-coated pathogens. As part of the innate immune system, elements of the complement cascade can be found in species earlier than vertebrates, most recently in the protostome horseshoe crab species, putting the origins of the system back further than was previously thought.
n the classical pathway, C1 binds with its C1q subunits to Fc fragments (made of CH2 region) of IgG or IgM, which forms a complex with antigens. C4b and C3b are also able to bind to antigen-associated IgG or IgM, to its Fc portion.
Such immunoglobulin-mediated binding of the complement may be interpreted, as that the complement uses the ability of the immunoglobulin to detect and bind to non-self antigens as its guiding stick. The complement itself is able to bind non-self pathogens after detecting their pathogen-associated molecular patterns (PAMPs); however, utilizing specificity of antibody, complements are able to detect non-self enemies much more specifically. There must be mechanisms that complements bind to Ig but would not focus its function to Ig but to the antigen.
shows the classical and the alternative pathways with the late steps of complement activation schematically. Some components have a variety of binding sites. In the classical pathway, C4 binds to Ig-associated C1q and C1r2s2 enzyme cleaves C4 to C4b and 4a. C4b binds to C1q, antigen-associated Ig (specifically to its Fc portion), and even to the microbe surface. C3b binds to antigen-associated Ig and to the microbe surface. The ability of C3b to bind to antigen-associated Ig would work effectively against antigen-antibody immune complexes to make them soluble. In the figure, C2b refers to the larger of the C2 fragments.
Key Points
- Three biochemical pathways activate the complement system–the classical complement pathway, the alternative complement pathway, and the lectin pathway.
- The following are the basic functions of the complement: Opsonization (enhancing phagocytosis of antigens ); chemotaxis (attracting macrophages and neutrophils); cell lysis (rupturing membranes of foreign cells); and clumping (antigen-bearing agents).
- The complement system consists of a number of small proteins found in the blood, generally synthesized by the liver, and normally circulating as inactive precursors (pro-proteins).
Key Terms
- antibodies : An antibody (Ab), also known as an immunoglobulin (Ig), is a large Y-shaped protein produced by B-cells that is used by the immune system to identify and neutralize foreign objects, such as bacteria and viruses. The antibody recognizes a unique part of the foreign target, called an “antigen. “
- phagocytic : Phagocytosis, meaning “cell,” and -osis, meaning “process,” is the cellular process of engulfing solid particles by the cell membrane to form an internal phagosome by phagocytes and protists.
- pathogens : A pathogen or infectious agent (colloquially known as a germ) is a microorganism (in the widest sense, such as a virus, bacterium, prion, or fungus) that causes disease in its host. The host may be an animal (including humans), a plant, or even another microorganism.
- classical pathway : a group of blood proteins that mediate the specific antibody response


11.2: Ethical Considerat ions in Making and Using Art
11.2.1 Appropriation
Artists have always been inspired by the work of other artists; they have borrowed composi- tional devices, adopted stylistic elements, and taken up narrative details. In such cases, the artist incorporates these aspects of another’s work into their own distinct creative endeavor. Appropriation , on the other hand, means taking existing objects or images and, with little or no change to them, using them in or as one’s own artwork. Throughout the twentieth century and to the present day, appropriation of an object or image has come to be considered a legitimate role for art and artists to play. In the new context, the object or image is re-contextualized. This allows the artist to comment on the work’s original meaning and bring new meaning to it. The viewer, rec- ognizing the original work, layers additional meanings and associations. Thus, the work becomes different, in large part based on the artist’s intent.
Sherrie Levine (b. 1947, USA) has spent her career prompting viewers to ask questions about what changes take place when she reproduces or makes slight alterations to a well-known work of art. For example, in 1981 Levine photographed images created by Walker Evans (1903-1975, USA) that had been reproduced in an exhibition catalogue. ( After Walker Evans: 4 , Sherrie Levine: http://www.metmuseum.org/collection/.../search/267214 ) She titled her series After Walker Evans , freely acknowledging Evans as the creator of the “original” photographic works. And, she openly stated, the catalogue—containing reproductions of Evans’s photographs— was the source for her own “reproductions.” Levine created her photographs by photographing the reproduced photographs in the exhibition catalogue; the photographs in the catalogue were reproductions of the photographs in the exhibition.
Visitors to the exhibition who were familiar with Evans’s depictions of Alabama sharecropper families struggling to make a living during the Great Depression were being challenged to view Levine’s photographs, such as this one of Allie Mae Burroughs titled After Walker Evans: 4 , in- dependent of their historical, intellectual, and emotional significance. Without those connections, what story did the photograph tell? Did the photograph itself having meaning, or is its message the sum of what meanings the viewer ascribes to it? Levine’s work in the 1980s was part of the postmodern art movement that questioned cultural meaning over individual significance: was it possible to consider art in such broad categories any longer, or is there such a thing as one, agreed-upon, universal meaning? She was also questioning notions of “originality,” “creativity,” and “reproduction.” What product can truly be attributed to one individual’s thought processes and efforts, with no contribution from a collective of influences? If none exists, then we cannot state something is an original work of art, springing from a single source of creativity, after which all subsequent works are reproductions. One is not more authentic or valuable than the other.
In 1993, Levine was invited by the Philadelphia Museum of Art to be the first artist to participate in Museum Studies , a series of contemporary projects: “new works and installations created by artists specifically for the museum.” Levine created six translucent white glass “reproductions” of a 1915 marble sculpture by Constantine Brancusi (1876-1957, Romania), titled Newborn I . ( Crystal Newborn , Sherrie Levine: s3.amazonaws.com/classconnec...cards/7114093/ jpg/thenewborn1334629599199-14C4CC989054F51F15F.jpg) She titled her 1993 work Crystal Newborn ; it is shown here along with Black Newborn of 1994. ( Crystal Newborn and Black Newborn , Sherrie Levine: api.whitney.org/uploads/image...ge_8._crystal_ newborn_1993_black_newborn_1994.jpg) Both works are cast glass, which in the case of Black Newborn , has been sandblasted. ( Black Newborn , Sherrie Levine: http://www.moma.org/ collection/works/89955?locale=en)
Similar to her 1981 photograph After Walker Evans: 4 , these works are meant to examine notions about something being an original or, instead, being a reproduction. Just as her earlier photographic reproductions of Evans’s work themselves could be reproduced, so also were these glass works part of a series; Levine cast a total of twelve versions from one (original?) mold. In addition, although sculpture such as Brancusi’s Newborn I , is generally displayed on a pedestal or stand that elevates the work to a comfortable viewing height and separates it from its surround- ings, Levine had her work displayed on a grand piano. Doing so changed the setting from a more conventional, expected, but consciously neutral mode of display, the pedestal, to the more nu- anced, domesticated, yet sophisticated tone of a polished piano top. She wanted the difference to register in the viewer’s mind and influence the viewer’s response to the work, including thinking of the contrast: the typical museum display is masculine, that is, part of the male world of wealthy collectors and museum board members. The piano, on the other hand, brings to mind the femi- nine world of the comforting and comfortable home it is a sculpture of a newborn, after all. But the cool, smooth, hard surface of Levine’s glass, as was the case of Brancusi’s marble, does not allow the infant head to descend to the level of maternal sentimentality.
Levine maintains tremendous similarities to the works preceding hers that she appropriates from, but she opens up their accumulated meanings to even more, new ones.
11.2.2 Use of Materials
The materials artists use to create their art throughout history have generally contributed to the value of the work. Using silver or ivory or gems or paint made from a rare mineral or numerous other materials that are costly and difficult to obtain literally raised the monetary value of the work produced. If the artwork was made for a political or religious leader, the cultural value of the work increased because it was associated with and owned by those of high status in society. On the other hand, using materials at odds with social values raises questions in the viewer’s mind. For example, ivory was and still is a desirable material for carving, but it is illegal to trade in elephant ivory within the United States as African elephants are now an endangered species. Viewers’ awareness of and sensitivity to the plant and animal life impacted in the production of art is increasing, and may actually be a factor in the materials an artist chooses to use.
Damien Hirst (b. 1965, England) began his career in the late 1980s associated with the Young British Artists (YBA). Hirst, along with others in the group, was known for his controversial subjects and approaches in his art. Much of his art from that time to the present has been concerned with spirituality Hirst was raised Catholic and with death as an end and a beginning, a boundary and a portal. One of the motifs he has returned to throughout his career is the butterfly. With its transformative life cycle, from egg to caterpillar to chrysalis to adult, the butterfly serves for Hirst as a “universal trigger.” That is, the symbolism associated with the butterfly’s life cycle, linked by the ancient Greeks to the psyche, or soul, by early Christians to resurrection, and by many to this day to innocence and freedom, is so deeply imbedded in human consciousness that it springs to the viewer’s mind automatically. In his art, those associations are the foundation upon which Hirst builds.
Hirst began his experimentations with butterflies in 1991 when he created a dual installation and exhibition, In and Out of Love (White Paintings and Live Butterflies) and In and Out of Love (Butterfly Paintings and Ashtrays) . Both contained living butterflies that were intended to and did die over the course of the five-week display. ( http://www.damienhirst.com/exhibitions/ solo/1991/in-out-love) His first solo show, In and Out of Love , set the stage for Hirst’s career and reputation as an artist who confronts definitions of art and provokes the viewer to explain how art helps us to grapple with boundaries between and intersections of life and death, reason and faith, hope and despair.
Touching upon his interests in religion and science, including lepidoptery, the study of butterflies, Hirst often makes biblical references in the titles of his artwork, and he mimics aspects of how butterflies have traditionally been displayed in his compositions. He began the Kaleidoscope series in 2001, not using entire living or dead butterflies, but using only their wings, symbolizing for him a separation from the unavoidable ugliness and unpleasantness of life—the butterfly’s hairy body—to preserve only the fleeting beauty of the wings and their associations with the swift passing of time. The Kingdom of the Father is a later work in the series, dating to 2007. ( Kingdom of the Father , Damien Hirst: broadmuseum.msu.edu/sites/def...rst-Kingdom%20 of%20the%20Father_72.jpg?width=90%25&height=90%25) The title, compositional elements, and overall shape of the mixed-media work are directly linked to the artist’s absorption with religion: here, as with a number of works in the Kaleidoscope series, the work looks like a stained glass window found in the Gothic cathedrals that fascinated Hirst as a child.
Despite the splendid effect of their vivid colors, energized compositions, and iridescent glow, some viewers object to the materials Hirst uses: the beauty and luminosity is derived from thou- sands of butterflies killed so that their wings could be used in his work. In 2012, the Tate Modern in London mounted a retrospective of Hirst’s art, the first major exhibition in England to review work from his entire career. His 1991 installation, In and Out of Love, was recreated as part of the show. ( http://www.damienhirst.com/exhibitions/solo/2012/tate ) Some critics and animal rights activists lodged complaints about the estimated 9,000 butterflies that died over the course of the twenty-three week event. For example, a spokesperson for the Royal Society for the Prevention of Cruelty to Animals (RSPCA) stated, “There would be national outcry if the exhibition involved any other animal, such as a dog. Just because it is butterflies, that does not mean they do not de- serve to be treated with kindness.” The Tate Modern issued a statement that the butterflies were “sourced from reputable UK butterfly houses.” They also defended their use as integral to Hirst’s art, stating, “the themes of life and death as well as beauty and horror are highlighted, dualities that are prevalent in much of the artist’s work.”
In essence, the museum, along with many other individuals and institutions over the course of Hirst’s career, acknowledged the complaints, but accepted the artist’s actions as an acceptable part of his creative process, and determined his artistic intentions were of greater importance than any issues of morality raised. Simply, the butterflies were the means to a higher end, his artwork.
11.2.3 Digital Manipulation
Digital manipulation of photographs through the use of Adobe Photoshop and other computer software is so commonplace today it generally goes unnoticed or without comment. Digital manipulation is used by amateur and professional photographers alike, and can be a helpful, con- structive tool. When photographs are manipulated with the aim of altering factual information, however, an ethical line has been crossed.
In 2006, freelance photographer Adnan Hajj made changes to a photograph, carried by Reuters Group, a news agency, of smoke rising in the midst of buildings in Beirut following an Israeli attack during the Israel-Lebanon conflict. (The Adnan Hajj photographs controversy revolving around digitally manipulated photographs: https://upload.wikimedia.org/wikiped...comparison.jpg ) A blogger commented that the photograph showed signs of manipulation. Comparing the unaltered photograph on the left to the published image on the right reveals that the smoke is obviously darker; in addition, the spreading smoke at the top of the photograph shows the telltale patterning, known as cloning , which indicates a digital effect that has been repeatedly duplicated. Reuters immediately retracted the photograph and issued the statement, “Reuters takes such matters extremely seriously as it is strictly against company editorial policy to alter pictures.”
The ethical premise is that photojournalists are expected to conform to accepted professional standards of conduct. In fact, the National Press Photographers Association has established a Code of Ethics that addresses the issue: “Editing should maintain the integrity of the photographic images’ content and context. Do not manipulate images or add or alter sound in any way that can mislead viewers or misrepresent subjects.” Of importance here is that, as news, these images must remain factual, and must represent the events and people truthfully and faithfully. When a photograph is manipulated with the intent to deceive the viewer, as was the case with Hajj’s enhancement of the damage done by an Israeli strike against the Lebanese, it changes the historical record; it is unethical.
11.2.4 As an Observer
Photojournalists are expected to follow the National Press Photographers Association (NPPA) Code of Ethics not only when it comes to the manipulation of news images, but also in the acquisi- tion of those images. In times of war, political unrest, or natural disasters, for example, they may be in the midst of events that unfold in unexpected and disturbing ways. The photojournalist is an observer whose role is to make a record of the events, but as a fellow human being, should the photographer become involved or offer aid?
In 1993, photojournalist Kevin Carter (1960-1994, South Africa) photographed a starving young girl being watched by a vulture during a time of famine in Sudan. ( Vulture , Kevin Carter: http://theunsolicitedopinion.com/wp-...er-vulture.jpg ) The photograph was sold to The New York Times and was featured in that newspaper and numerous others worldwide, generating tremendous concern about the fate of the child and commentary on the ethics of taking the photograph, especially as the scene was described as a toddler having collapsed on her way to a relief station for food. But, guidelines in the NPPA Code of Ethics state: “While photographing subjects do not intentionally contribute to, alter, or seek to alter or influence events.” Many felt, however, that in light of the child’s condition and helplessness, the photographer had the responsibility to take action.
According to Carter and Joao Silva, a friend and fellow photographer, the situation and Car- ter’s responses were more nuanced than it may appear in the photograph. Carter and Silva arrived by airplane in the village of Ayod with United Nations personnel bringing provisions to the local feeding center. As women and children began gathering at the center, Carter photographed them. The child was a short distance away in the bush, approaching the center with difficulty on her own; as Carter watched, the vulture landed. As recounted later in Time magazine:
Careful not to disturb the bird, he positioned himself for the best possible image. He would later say he waited about 20 minutes, hoping the vulture would spread its wings. It did not, and after he took his photographs, he chased the bird away and watched as the little girl resumed her struggle. Afterward he sat under a tree, lit a cigarette, talked to God and cried. “He was depressed afterward,” Silva recalls. “He kept saying he wanted to hug his daughter.” 1
So while Carter did not otherwise aid the child, he did remove a source of immediate danger to her by waving away the vulture. He expressed regret he did not, and felt he could not, further help the girl and the many other victims he saw while on assignments. The unrelenting suffering he witnessed contributed to the depression he was subject to for years. A little more than a year after the photograph of the starving child was published, in April 1994, Carter received the Pulitzer Prize for the controversial image. A week later, Ken Oosterbroek, another friend and fellow photojournalist, was killed during a violent conflict they were photographing in their native South Africa. Haunted by sorrow, regret, atrocities he had witnessed, and the pain he felt, Carter committed suicide three months later.


6.1: Philosophy of Religion
Philosophy of religion according to the Stanford Encyclopedia of Philosophy is, "the philosophical examination of the central themes and concepts involved in religious traditions." It is an ancient discipline, being found in the earliest known manuscripts concerning philosophy, and relates to many other branches of philosophy, including metaphysics, epistemology, and ethics.
The philosophy of religion differs from religious philosophy in that it seeks to discuss questions regarding the nature of religion as a whole, rather than examining the problems brought forth by a particular belief system. It is designed such that it can be carried out dispassionately by those who identify as believers or non-believers.
Field of study
Philosophy of religion covers alternative beliefs about God, the varieties of religious experience, the interplay between science and religion, the nature and scope of good and evil, and religious treatments of birth, history, and death. The field also includes the ethical implications of religious commitments, the relation between faith, reason, experience and tradition, concepts of the miraculous, the sacred revelation, mysticism, power, and salvation.
The philosophy of religion has been distinguished from theology by pointing out that, for theology, "its critical reflections are based on religious convictions". Also, "theology is responsible to an authority that initiates its thinking, speaking, and witnessing ... [while] philosophy bases its arguments on the ground of timeless evidence."
Basic themes and problems
Three considerations that are basic to the philosophy of religion concerning deities are: the existence of God, the nature of God, and the knowledge of God.
Existence of God
There are several main positions with regard to the existence of God that one might take:
- Theism - the belief in the existence of one or more divinities or deities.
- Pantheism - the belief that God exists as all things of the cosmos, that God is one and all is God; God is immanent.
- Panentheism - the belief that God encompasses all things of the cosmos but that God is greater than the cosmos; God is both immanent and transcendent.
- Deism - the belief that God does exist but does not interfere with human life and the laws of the universe; God is transcendent.
- Monotheism - the belief that a single deity exists which rules the universe as a separate and individual entity.
- Polytheism - the belief that multiple deities exist which rule the universe as separate and individual entities.
- Henotheism - the belief that multiple deities may or may not exist, though there is a single supreme deity.
- Henology - believing that multiple avatars of a deity exist, which represent unique aspects of the ultimate deity.
- Agnosticism - (literally, not knowing or without knowledge ) the belief that the existence or non-existence of deities or God is currently unknown or unknowable and cannot be proven. A weaker form of this might be defined as simply a lack of certainty about gods' existence or nonexistence. []
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Atheism - the rejection of belief in the existence of deities.
- Weak atheism is simply the absence of belief that any deities exist.
- Strong atheism is specifically the position that there are no deities.
- Apatheism - a complete disinterest in, or lack of caring for, whether or not any deity or deities exists.
- Possibilianism
These are not mutually exclusive positions. For example, agnostic theists choose to believe God exists while asserting that knowledge of God's existence is inherently unknowable. Similarly, agnostic atheists reject belief in the existence of all deities, while asserting that whether any such entities exist or not is inherently unknowable.
Natural theology
The attempt to provide proofs or arguments for the existence of God is one aspect of what is known as natural theology or the natural theistic project. This strand of natural theology attempts to justify belief in God by independent grounds. There is plenty of philosophical literature on faith (especially fideism) and other subjects generally considered to be outside the realm of natural theology. Perhaps most of philosophy of religion is predicated on natural theology's assumption that the existence of God can be justified or warranted on rational grounds. There has been considerable philosophical and theological debate about the kinds of proofs, justifications and arguments that are appropriate for this discourse.
The philosopher Alvin Plantinga has shifted his focus to justifying belief in God (that is, those who believe in God, for whatever reasons, are rational in doing so) through Reformed epistemology, in the context of a theory of warrant and proper cognitive function.
Other reactions to natural theology are those of Wittgensteinian philosophers of religion, most notably D. Z. Phillips. Phillips rejects "natural theology" and its evidentialist approach as confused, in favor of a grammatical approach which investigates the meaning of belief in God. For Phillips, belief in God is not a proposition with a particular truth value, but a form of life. Consequently, the question of whether God exists confuses the logical categories which govern theistic language with those that govern other forms of discourse (most notably, scientific discourse). According to Phillips, the question of whether or not God exists cannot be "objectively" answered by philosophy because the categories of truth and falsity, which are necessary for asking the question, have no application in the religious contexts wherein religious belief has its sense and meaning. In other words, the question cannot be answered because it cannot be asked without entering into confusion. As Phillips sees things, the job of the philosopher is not to investigate the "rationality" of belief in God but to elucidate its meaning.
Problem of evil
Main articles: Problem of evil and Theodicy
The problem of evil is the question of how to reconcile the existence of evil with that of a deity who is, in either absolute or relative terms, omnipotent, omniscient, and omnibenevolent. An argument from evil attempts to show that the co-existence of evil and such a deity is unlikely or impossible if placed in absolute terms. Attempts to show the contrary have traditionally been discussed under the heading of theodicy.
The nature of God
There exists many understandings of the term "God". It typically differs not only from religion to religion, but also from person to person who share the same religious beliefs. It is therefore hard to define "God" or list a complete array of characteristics (nature) of God that is applicable to all religions.
For the sake of simplicity, the concept of "God" is often described by philosophers of religion to be an " 1. Omniscient, 2. Omnipotent, 3. Omnibenevolent 4. Being". Any "God" that is referred to in most contexts of philosophy of religion must have the above four characteristics, including being a "Being". Note that this list is not exhaustive. There exists other characteristics of certain "God"s that are not included, for example, "omnipresent".
Above all, a simple "if" relationship exists between "God" and those four characteristics. That is to say. if X is a "God", X must possess all four characteristics. Yet, according to the above statement, the existence of those four characteristics together on Y might not be sufficient to lead to the conclusion that Y is a "God". However, the non-existence of one or more of the four characteristics on an object Z is sufficient to lead to the argument that Z is not a "God" that we have defined above.