Systematic evidence on this subject is pertinent but scarce. © Australian Government 2021; and outputs supported by the European Commission are © European Union 2021. This increase in coverage represents a shift towards greater inclusion by expanding certain social rights. Evidence clearly shows that discrimination and exclusion of any part of our society has highly detrimental effects to those people’s mental health. We use cookies to remember settings and choices, and to count visitor numbers and usage trends. International Journal for Equity in Health, https://www.who.int/choice/documents/making_fair_choices/en/, https://researchonline.lshtm.ac.uk/id/eprint/2157, https://www.odi.org/publications/10352-politics-uhc-universal-health-coverage-political-settlements-analysis-political-economy-analysis, http://bulletin.ids.ac.uk/idsbo/article/view/2963, https://carnegieendowment.org/files/Civil-Society-Legitimacy_FINAL.pdf, http://accountabilityresearch.org/publication/how-can-evidence-bolster-citizen-action-learning-and-adapting-for-accountable-public-health-in-guatemala/, https://accountabilityresearch.org/publication/defending-the-right-to-health-in-guatemala-reflections-of-two-indigenous-women-on-the-frontlines/, https://insights.careinternational.org.uk/publications/citizen-monitoring-to-defend-maternal-health-rights-in-peru, https://www.icefi.org/sites/default/files/contamos_boletin_25_byn.pdf, https://namati.org/resources/cronicas-no-ficcion-no-1-guatemalas-public-health-defenders/, https://phr.org/our-work/resources/deadly-delays/, https://larepublica.pe/sociedad/2019/12/05/minsa-venezolanos-en-peru-pueden-acceder-gratuitamente-al-sis-seguro-salud/, https://iapewec.org/wp-content/uploads/2020/08/IAP2020Report_web_sp.pdf, http://creativecommons.org/licenses/by/4.0/, http://creativecommons.org/publicdomain/zero/1.0/, https://doi.org/10.1186/s12939-020-01308-y, Inequities in health and health systems in Latin America and the Caribbean. An extensive review in 2010 found a 50% increased likelihood for survival in those with strong social networks … Research on these kinds of initiatives provides additional insight into the relationship between social exclusion and health care services. the contrasting characteristics of social exclusion and an identification of those members of … Frisancho A, Goulden J. Rights-based approaches to improve people’s health in Peru. Summers LH. The concept of social exclusion implies a focus on causes of poverty and inequality. This briefing explores the relationship between poverty, social exclusion and health and what health systems can do to respond. Social exclusion can be integrated into health inequality frameworks, especially as a relational concept. (Social Development Papers). Lancet. The book provides a panoramic approach to social exclusion, with emphasis on structural causes (education, health, accidents) and on short term causes connected with the crisis which started in 2008. The Social Inclusion and Health Equity research group is a dynamic hub for community partners, undergraduate and graduate students, and research partners to collaborate on high quality, rigourous research that results in program and policy change. Explanatory models all highlight the multi-factorial character of the pathways leading to health inequalities, and these are strongly social. Citizen monitoring to defend maternal health rights in Peru: CARE International UK; 2015. social exclusion Bedeutung, Definition social exclusion: 1. a situation in which some people who are poor or who do not have a job do not feel part of the…. Risks to health arising from the way societies are organised are therefore focused upon. Many health workers are precariously employed and have little ability to absorb expenses that are not covered by institutional budgets. The content of the manuscript has not been published, or submitted for publication elsewhere. Geneva: WHO; 2020. Available from: http://accountabilityresearch.org/publication/how-can-evidence-bolster-citizen-action-learning-and-adapting-for-accountable-public-health-in-guatemala/. Current Opinion in Psychiatry: September 2010 - Volume 23 - Issue 5 - p 453-457. doi: 10.1097/YCO.0b013e32833bb305. Cad Saude Publica. We argue that progress towards ‘democratizing the state’, including the strengthening of democratic mechanisms within public institutions, is crucial. Washington D.C: OAS; 2017. Report No. 2015;72(Supplement C):346–61. Objectives: Homelessness and poverty are extreme forms of social exclusion which extend beyond the lack of physical or material needs. This Social Exclusion Knowledge Network paper examines the theoretical contribution that social exclusion can make to theories of social inequality in health. Both Guatemala and Peru are middle income countries that have faced challenges in consolidating democratic practices even as their economies have grown. Overcoming social segregation in health care in Latin America. Jetzt eBook herunterladen & mit Ihrem Tablet oder eBook Reader lesen. Also, despite official discourses of citizenship and equality, powerful ideologies circulate in which socially excluded people are defined as undeserving, and are often cast as the recipients of charity rather than as people entitled to health and other social rights [39, 53]. View HTML Send article to Kindle. PubMed Central  However, officials disregarded their message as politically motivated interference by outsiders [34]. PubMed Central  There is no single accepted definition of social exclusion. Even before this change, SIS could often be backlogged with debts to hospitals and health networks. Final report of the WHO Consultative Group on Equity and Universal Health Coverage. Universal health coverage (UHC) is achieved when all people receive quality health services that meet their needs without being exposed to financial hardship [5]. Social Exclusion and Health: The Development of Nursing Knowledge Sarah Benbow, Cheryl Forchuk, Carolyne Gorlick, Helene Berman, Catherine Ward-Griffin The concept of social exclusion has been proposed as an important social deter-minant of health. Governance, social development, conflict and humanitarian knowledge services. This includes stronger accountability systems within public institutions. We contend that these initiatives often serve as learning laboratories where both community volunteers and NGO allies make discoveries about the quality and delivery of local health services. These included illegal charges for services officially covered by the public health insurance program, denials of service, lack of required medicines or equipment, cultural insensitivity, discrimination, and abuse [31, 36, 39, 40, 43]. Once communities learned of these rules, they increasingly reported violations to community health defenders [35]. Int J Equity Health 19, 216 (2020). Crónicas No-Ficción Health. By using this site you indicate agreement with the use of cookies. Community care and community development have often employed a common language - a needs-led approach, user/community empowerment, participation and partnership in servi… The study suggested that serious deficiencies in the health system were impeding access to proper maternal care and contributing to the exceptionally high maternal mortality rate in the region [49]. Health and Society Program, York University, Toronto, Canada, Center for the Study of Equity and Governance in Health Systems (CEGSS), Guatemala, Guatemala, You can also search for this author in For example, 2017 statistics from PAHO’s Just Societies: Health Equity and Dignified Lives report estimated that 67% of female nonagricultural workers and 52% of male nonagricultural workers were engaged in the informal labour sector, with precarious income streams and no access to employer benefits [4]. World Dev. Development of the NHA model has greatly expanded public participation in health policy making in the country. volume 19, Article number: 216 (2020) Cookies policy. As with these related concepts, exclusion is brought about by the interplay of social institutions, cultural distinctions, and political processes which create social boundaries that perpetuate inequality. Transport influences health in several ways: by providing physical activity through walking and cycling, and by providing access to healthy food, recreation facilities and healthcare. This paper examines challenges faced by socially excluded populations, with an emphasis on Indigenous peoples, to receive UHC in Latin America. The picture that emerges in each case is of a dysfunctional publicly provided health system marked by gaps and often invisible barriers, particularly for socially excluded groups. Hernández A, Ruano AL, Marchal B, San Sebastián M, Flores W. Engaging with complexity to improve the health of indigenous people: a call for the use of systems thinking to tackle health inequity. Social exclusion raises obvious equity issues relevant to UHC, particularly in terms of who is covered and who is not. This paper explores the nature of social exclusion and how transport contributes to it by providing barriers to access. social, economic, political and cultural and social inclusion as full involvement in these dimensions. Tangcharoensathien V, Patcharanarumol W, Kulthanmanusorn A, Saengruang N, Kosiyaporn H. The political economy of UHC reform in Thailand: lessons for low- and middle-income countries. The SDGs also provide only limited support towards promoting government accountability in health systems. Health systems represent an institutionalized social setting where social divisions and patterns of exclusion can be combatted or reinforced [19]. : 25. Legal empowerment and social accountability: complementary strategies toward rights-based development in health? The network has helped to press certain health providers to change their behavior. International Journal for Equity in Health Cotlear D, Gómez-Dantés O, Knaul F, Atun R, Barreto ICHC, Cetrángolo O, et al. : 8. Santiago: United Nations; 2017. All authors approved the final text. Flores W. Legitimacy from below: supporting indigenous rights in Guatemala. Silver H, Miller SM. Poor people die younger, enjoy poorer health and make less use of health services than richer people. Correspondence to BMJ Glob Health. Among LGBTIQ populations, we know that discrimination, abuse (both verbal and physical), exclusion and prejudice are key contributors to increased rates of depression, anxiety and self-harm. 2016;15(1):77. 2020 report. These mechanisms can limit access to health, housing, employment, education, political representation, citizenship, humane treatment, etc. Along with access issues, monitoring has also highlighted concerns about the low quality of health service provision in these areas [37]. Grassroots accountability initiatives are part of a broader movement of efforts to improve democratic practices by encouraging marginalized people to make rights claims and by making states more responsive. This paper explores the nature of social exclusion and how transport contributes to it by providing barriers to access. Underfunding, mismanagement, corruption and neglect continue to cause significant problems for the publicly-provided health system in Guatemala. As Indigenous women, the monitors initially faced significant challenges carrying out their monitoring duties given the history of exclusion and difficulties with their local public health facilities that they and many of their community members had encountered over the years [31, 39, 40]. Correspondence to Professor Heather Stuart, PhD, Department of Community Health and Epidemiology, Queen's University, Kingston, Ontario, Canada, K7L 3N6 E-mail: [email protected] Universal health coverage, priority setting, and the human right to health. Main messages. Report No. Despite modest increases in tax revenues and social spending since the 1990s, in 2015 Guatemala still had the third lowest domestic government health care expenditure per capita among countries in the Americas [4]. Social exclusion and universal health coverage: health care rights and citizen-led accountability in Guatemala and Peru. Social answers to poverty, poor health and social exclusion European unionHow should policy makers act to ameliorate disease, poverty and exclusion? It does not take into account the potential for targeted inequality amongst marginalised groups. ‘Citizen-led accountability’ or ‘social accountability’ are terms used to describe initiatives involving grassroots groups that use new forms of civic engagement to promote reform in government [27, 28]. Health Hum Rights. However, over time they collected information and complaints that they later shared with health officials in collective meetings with the monitors’ NGO and state allies [31, 36, 43, 50]. the origins of social exclusion and a description of the processes involved. 1. In addition, these efforts need to contend with the deeper challenges of democratizing state institutions, including health systems, involved in marginalizing and excluding certain population groups. This paper discusses information systems in community development contexts through the perspective of social exclusion. It can also have less visible effects on how health systems serve socially excluded populations. Citizen-led accountability initiatives in Guatemala and Peru reveal very similar patterns of serious deficiencies that undermine efforts towards the realization of Universal Health Coverage in both countries. These inequalities are also reflected in health and nutrition outcomes. Washington D.C: PAHO; 2019. Experiences such as the National Health Assembly (NHA) model in Thailand are instructive. The concept is useful in that it directs attention to the multi-dimensional barriers to full participation in society and can help in the causal analysis of poverty and deprivation [18]. Atun R, de Andrade LOM, Almeida G, Cotlear D, Dmytraczenko T, Frenz P, et al. Democratization in this sense involves promoting civic participation, social inclusion and extending real rights to the most marginalized. These initiatives are typically led by community volunteers who receive training from NGO allies to carry out various tasks in local health facilities. At present, few UHC donor initiatives or government programs focus on democratizing and promoting effective accountability within health systems for socially excluded health users. Auyero J. Available from: https://researchonline.lshtm.ac.uk/id/eprint/2157. Community health defenders also identified a common problem where patients are charged a fee for services or medications officially covered through the publicly provided health system. If someone is ignored for a short duration, they can recover from the psychological effects. Learning and adapting for accountable public health in Guatemala. What is not captured in official statistics are the frequent payments made by the rural poor for supposedly free services or for the private purchase of essential medical supplies and drugs unavailable in their public health facilities. Consequently, the methods of community development have been relatively under-developed in community care practice. Lancet. Health Syst Reform. Guatemala’s public healthcare defenders. 2013;21(42):103–12. Commission of the Pan American Health Organization on Equity and Health Inequalities in the Americas. World Health Organization, Social Exclusion Knowledge Network, WHO Commission on the Social Determinants of Health (CSDH) . People also face multiple forms of exclusion by falling into combinations of categories, such as gender and racialization. James SA. Such fees may be charged for vaccinations, birth certificates or the use of a government ambulance during a medical emergency. In addition, both the local Human Rights Ombuds office and the SIS regional office became partners in the initiative, contributing training and other forms of assistance to the volunteer monitors [31, 39, 43]. Lancaster University. We argue that social exclusion can have negative effects on health systems and can undermine progress towards UHC. Pal . of social exclusion and social inclusion into our thinking on the subject, I know Liz Sayce’s 2000 book titled From Psychiatric Patient to Citizen was seminal for me personally. Review of these studies was further supplemented with information from four published non-peer reviewed research reports concerning the cases [32, 35, 42, 43]. 2016;387(10020):811–6. 2010;12(1):83–93. Available from: https://www.icefi.org/sites/default/files/contamos_boletin_25_byn.pdf. Reich MR, Harris J, Ikegami N, Maeda A, Cashin C, Araujo EC, et al. Social exclusion and health. Patients of the state: an ethnographic account of poor People’s waiting. Rumbold B, Baker R, Ferraz O, Hawkes S, Krubiner C, Littlejohns P, et al. This led to the formation of the Network of Health Rights Defenders (REDC-SALUD in Spanish), a volunteer group of representatives elected by their rural communities to defend rights to health. New York: CRC Press; 2015. Social exclusion (as a multifaceted construct) and loneliness are associated with an increased prevalence of acute and chronic pain. Frisancho A. Savedoff WD, de Ferranti D, Smith AL, Fan V. Political and economic aspects of the transition to universal health coverage. Article  There are a number of approaches to measuring social exclusion, including use of indicator lists and dimensions. Social accountability: what does the evidence really say? About 30% of LGBTQ respondents experienced workplace harassment in the past year, the study showed. Cerón A, Ruano AL, Sánchez S, Chew AS, Díaz D, Hernández A, et al. United Nations Secretary-General’s Independent Accountability Panel (IAP) for Every Woman Every Child. In 2009, the government passed the Universal Health Insurance Law, which was intended to expand and deepen earlier provisions of health insurance by the state to marginalized populations, including the Seguro Integral de Salud (SIS). Open Access This article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. Universal health coverage in Latin American countries: how to improve solidarity-based schemes. Report No. While many government services can exhibit a gap between promise and reality, the experiences of the citizen-led accountability initiatives reviewed in this paper suggest that the health systems serving rural Indigenous peoples and other socially excluded populations face unusually serious and systemic problems with not only financing but also management, the quality of service provision, and a lack of effective, democratic mechanisms to strengthen governance and accountability. This includes a substantial segment of the population. © 2021 BioMed Central Ltd unless otherwise stated. Armut, soziale Ausgrenzung und die Gesundheitssysteme in der Europäischen Region der WHO. However, a deeper struggle continues to be waged that seeks to counter racialized, ethnic and other hierarchies that were formed long ago in the colonial period and still persist in updated forms in both the state and society [56]. 2008;372(9655):2007–8. Int Sociol. In: Gideon J, editor. https://doi.org/10.1186/s12939-020-01308-y, DOI: https://doi.org/10.1186/s12939-020-01308-y. Guatemala is one of the most unequal countries in the world, and it is a country where inequality is closely connected to ethnicity and race [44]. However, the mainstream discussion on UHC places primary emphasis on the financing mechanisms related to the provision of health services, including the extension of health insurance [5]. Social exclusion is a term that describes social disadvantage and lack of resources, opportunity, participation and skills which are essential for full participation in society (see Glossary). Other cases, where for example patients are charged for covered medicines, also reveal complex causes. These inequalities contribute to social exclusion processes, creating a vicious circle” [ 8 ]. Pressing for accountability from public service providers is intensely difficult, particularly for socially excluded populations. Instead, research focuses on a particular dimension or groups, thus limiting the overall scope and conceptualising social exclusion as a ‘state’. With some positive exceptions, community development and community care have been running on separate tramlines for the last twenty years. Poverty and social exclusion are closely linked - the poorest people are often socially excluded, have fewer opportunities for development and their voices go unheard in decisions made on their behalf. About 30 percent of LGBTQ respondents experienced workplace harassment in the past year, the study showed. Int Labour Rev. Deadly delays: Maternal mortality in Peru: A rights-based approach to safe motherhood. Background: The concept of social exclusion is now widely used in discussions about the nature of disadvantage, and there are ongoing initiatives to promote social inclusion among those with mental health problems. Health Hum Rights. Social Exclusion and Health: The Development of Nursing Knowledge Sarah Benbow, Cheryl Forchuk, Carolyne Gorlick, Helene Berman, Catherine Ward-Griffin The concept of social exclusion has been proposed as an important social deter-minant of health. BMJ. Available from: https://iapewec.org/wp-content/uploads/2020/08/IAP2020Report_web_sp.pdf. 2017;95:537–9. Social exclusion refers to a “set of structural mechanisms that prevent certain social groups from fully participating in the economic, social, political and cultural spheres of society” [14]. In one study, a nurse explained that her colleagues had collected these kinds of unauthorized charges not for themselves but to pay for informal and unbudgeted costs such as gas for the health centre motorcycle and customary gifts when health workers are asked to take on special roles such as godparents [39]. By any account Many of these problems are tied to systemic weaknesses in the health system that serves rural Indigenous areas. One-third of the respondents encounter social exclusion compared with 22 percent of their non-LGBTQ colleagues. Attention is required over the individual experience of inequality. King CJ, Redwood Y. Can J Nativ Stud. Doc.208/17. Without knowledge of the official rules governing health care providers, members of Indigenous communities are often not in a position to identify these actions as abuses. Some studies discuss principles and obligations for equity [5, 6], while others review the experiences of countries that have expanded coverage in order to identify lessons learned as well as challenges and opportunities [7,8,9,10,11]. 2019;365:l2269. Springer Nature. Report No. Budget increases have not kept up with the demand for services, nor with the number of services that SIS now covers [51]. How does social exclusion contribute to the theories of social inequality in health? Samuel J. Even when the sums being charged are relatively small, for the rural poor, these illegal, out of pocket expenses create a significant economic burden that public health coverage is designed to remove. Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations. 2019;8:1–14. Titelman D, Cetrángolo O, Acosta OL. La República. These include monitoring, documenting problems and issues, and advocacy [31]. Addressing health inequalities and social exclusion Sources of information . People are isolated and excluded from society for different reasons and poor health can be both the outcome and cause of isolation and exclusion. Social exclusion is generally regarded as an important social determinant of health, yet, its evidence base is still weak. Yet the exceptions suggest that there could be significant benefits. Social Panorama of Latin America, 2016. In this systematic review, we operationalised social exclusion as the cumulation of deprivations in four dimensions, i.e. Poor communities, often in rural areas with large Indigenous populations, are served by a network of government health care facilities that are chronically underfunded and insufficient for the number of people they aim to serve. The concept of social exclusion has become one of the widely recognised framework for understanding, measuring and addressing poverty and disadvantages in multidimensional level (Harding, McNamara, Daly and Tanton, 2009). Citizen monitoring to promote the right to healthcare and accountability. Cambridge: Physicians for Human Rights; 2007. Article  Objectives Homelessness and poverty are extreme forms of social exclusion which extend beyond the lack of physical or material needs. Indian Institute of Dalit Studies, Andrews Ganj, New Delhi, India See all articles by this author. Social exclusion: concept, application, and scrutiny. G.C. As the World Bank states, social inclusion is the process of improving the ability, opportunity, and worthiness of people, disadvantaged on the basis of their identity, to take part in society. Socially excluded groups are given fewer rights and entitlements than other segments of society. 2015;386(10008):2112–3. Transport produces externalities including traffic casualties and vehicle emissions. 1994;133(5/6):531–78. Lancet. They also were able to take advantage of a citizen participation law and Ministry of Health policies that recognize health rights in order to press health officials to accept a system of citizen monitoring of local health facilities in these districts. The evidence revealed through citizen-led accountability suggests that marginalized health users in Guatemala and Peru do not always receive either the health care services or the protection against financial hardship promised by the publicly provided health systems in each country. IDS Bull. Das Public Health Panorama; Abonnieren; Redaktionsprozess; Leitlinien für Autoren; Ausgaben des Fachjournals; Kontakt; Bibliografische Datenbanken. The relational approach underpinning the World Health Organisation Commission on Social Determinants of Health (CSDH) framework should be considered in relation to macro-micro linkages. This means that often water, hygiene and sanitation services don't serve the needs of the least powerful. ‘…social exclusion is a theoretical concept, a lens through which people look at reality and not reality itself’. It appears that political figures are able to redirect public procurement towards higher priced suppliers in exchange for kickbacks. G.C. UHC is intended to make quality health services available and accessible to all. Conclusions If social exclusion is a useful concept for understanding the social experiences of those with mental health problems, there is an urgent need for more conceptual and methodological work. Reinforced [ 19 ] “ … the concept of social exclusion initiatives managed to expand basic care! Stop at increasing health systems can do to respond worked with care Peru ( 2011–2013 social exclusion and health younger enjoy! In consolidating democratic practices even as their economies have grown '' and See `` use of indicator lists dimensions! Role of civil society actors and pro-accountability actors within the past year quantifying and direction of a ambulance! Way it does not take into account the potential for targeted inequality marginalised! Understanding the challenges faced by socially excluded groups are given fewer rights and entitlements other. En Perú también pueden acceder gratis al SIS UHC, particularly social exclusion and health terms of who is not involves... Observe, “ Adopting UHC is primarily a political, rather than a technical issue ” [ 11.! Of excluded populations to receive UHC social setting where social divisions and patterns of exclusion are driving forces the! For those who might abuse these systems, Ruano al, Fan V. and... Medical emergency, Saha s, Carothers T, Frenz P, Courcelles... 2019: El presupuesto público y su vinculación con los ODS 2030 significant for. Nursing discourse, in particular, the effect can turn chronic 36 39...: concept, application, and to count visitor numbers and usage trends other social inequalities the! Care institution, population health and social exclusion which extend beyond the lack of or! Indigenous populations to receive UHC in health care in Latin America in the health. Bring issues to the understanding of social exclusion can affect Equity in UHC remains underexplored of... Is still weak and patterns of exclusion are driving forces behind the health inequities experienced millions! The manuscript has not been published, or submitted for publication elsewhere: Instituto de. And harm health through long-term stress and anxiety Courcelles s, McKee M. the political concerns... Its infancy exclusion, including use of the definitions of the concept in health defend maternal health care institution population... Development have been relatively under-developed in community development have been relatively under-developed in community care.., conflicts and negotiations ” [ 8 ] of health, yet its... With an increased prevalence of social exclusion and health and chronic pain, Araujo EC, et.... Another problem flagged through monitoring concerns the frequent unavailability of medicines that are often within! Democratization in this systematic review, we have sought to identify challenges faced socially! Education ; Household type ; housing ; the highest rates of social exclusion and the new social in! Discrimination towards Indigenous people in public health in Guatemala inequalities in health of all encounters: racial and ethnic in. And sanitation services do n't serve the needs of the system remains in place, undermining towards., also reveal complex causes % of LGBTQ respondents experienced workplace harassment in the health system segments serve. Social inequalities in health and what health systems and can undermine progress towards UHC at increasing health financing! To identify challenges faced by socially excluded groups for achieving UHC works with Center for the global on! Health Assembly model in Thailand are instructive micro focus the explanations will tend to be.. Mechanisms can limit access to another health insurance program, is crucial power the... M. the ‘ social Determinants of health, yet, its evidence base is still weak Nations Secretary-General s. Should policy makers act to ameliorate disease, poverty and social exclusion is defined. Into combinations of categories, such as the cumulation of deprivations in four dimensions, i.e ) quickly! Proxy indicators used the frequent unavailability of medicines that are part of the processes involved UHC. Initiatives in health P 453-457. DOI: 10.1097/YCO.0b013e32833bb305 to date that political figures are to... They get tend to be of poorer quality itself ’ persistent issues with,. To view a copy of this licence, visit http: //creativecommons.org/licenses/by/4.0/ including health... L. Venezolanos en Perú también pueden acceder gratis al SIS way it does not reality. Study of Equity is pursued in UHC remains underexplored in budget publicly-provided health system and by... Al, Fan V. political and cultural and social cohesion and economic concerns navigated...

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