Eren Vural, Ipek
The 2007-2008 global financial crisis revived interest in the impacts of financial markets and actors on our social and economic life. Nevertheless, research on health care financialisation remains scant. This article presents findings from research on one modality of financial investments in health care: global private equity funds' investments in private hospitals. Adopting a political economy approach, it analyses the drivers and impacts of the upsurge of global private equity investments in the Turkish private hospital sector amid the global financial crisis. The analysis derives from review of research and archival literature, as well as six in-depth interviews held with owners/executive board directors/general managers of the largest private hospital chains in Turkey and the general partners of their PE investors. The interviewing process took place between January and November 2016. All interviews were conducted by the author in Istanbul. The findings point to a mutually reinforcing relationship between neoliberal policies and financialisation processes in health care. The article shows that neoliberal healthcare reforms, introduced under consecutive Justice and Development Party (JDP) governments in Turkey, have been important precursors of private equity investments in healthcare services. These private equity investments, in turn, intensified and broadened the process of marketisation in health care services. Four impacts are identified, through which private equity investments hasten the marketisation of health care services. These relate to the impacts of private equity investments on a) advancing the process of chain formation by large hospital groups, b) spreading financial imperatives into the operations of private hospitals c) fostering internationalisation of capital, and d) augmenting inequities in access to health care services and standards. Copyright © 2017 Elsevier Ltd. All rights reserved.
Gözde Ünal; Ömer Faruk Tan
.... A total of 14 equity fund managers' performances are analyzed. The study can be guiding especially for investors who are interested in Polish equity fund performances in a period where emerging stock markets outperformed with QE.
La Rosa-Salas, Virginia; Tricas-Sauras, Sandra
It has long been known that a segment of the population enjoys distinctly better health status and higher quality of health care than others. To solve this problem, prioritization is unavoidable, and the question is how priorities should be set. Rational priority setting would seek equity amongst the whole population, the extent to which people receive equal care for equal needs. Equity in health care is an ethical imperative not only because of the intrinsic worth of good health, or the value that society places on good health, but because, without good health, people would be unable to enjoy life's other sources of happiness. This paper also argues the importance of the health care's efficiency, but at the same time, it highlights how any innovation and rationalization undertaken in the provision of the health system should be achieved from the consideration of human dignity, making the person prevail over economic criteria. Therefore, the underlying principles on which this health care equity paper is based are fundamental human rights. The main aim is to ensure the implementation of these essential rights by those carrying out public duties. Viewed from this angle, equity in health care means equality: equality in access to services and treatment, and equality in the quality of care provided. As a result, this paper attempts to address both human dignity and efficiency through the context of equity to reconcile them in the middle ground.
ömer faruk tan
Full Text Available Abstract: Purpose of the article: The main purpose of the paper is empirically evaluating selectivity skills and market timing ability of Polish fund managers during the period from January 2009 to November 2014. After the global financial crisis of 2008, in this period of quantitative easing (QE, thanks to an increase in the money supply, a capital flow from developed countries to developing countries was observed. In this study, we try to analyse that although the financial market in Poland made an incredible progress, whether fund managers show better or worse performance than the market. Methodology/Methods: In order to evaluate fund manager performances, Jensen alpha (1968 is computed, which depicts selectivity skills of fund managers. For determining market timing ability of fund managers, Treynor&Mazuy (1966 regression analysis and Henriksson&Merton (1981 regression analysis are applied. Fund performances are evaluated using Warsaw Stock Exchange Index as the benchmark index. Scientific aim: In this study, we have tried to evaluate selectivity skills and market timing ability of Polish fund managers. A total of 14 equity fund managers’ performances are analysed. The study can be guiding especially for investors who are interested in Polish equity fund performances in a period where emerging stock markets outperformed with quantitative easing. Findings: Jensen (1968 alphas indicate that over this period fund managers did not have selective ability, as none of the 14 funds had statistically significant positive alphas. Furthermore, Treynor&Mazuy (1966 and Henriksson&Merton (1981 regression analysis indicate that over the same period fund managers did not also have market timing ability, as again none of the 14 funds had statistically significant positive coefficients. Conclusion: In this work, we can detect that in the era of quantitative easing, although the financial market in Poland made an incredible progress, the fund returns were
Tabatadze, Shalva; Gorgadze, Natia
The aim of this research is to study the effectiveness of general education funding system from the perspective of equal and equal educational opportunities for all in Georgia. Following the objective, the research aimed to respond three main research questions: 1. is the school financing formula effective and efficient enough to be administrated…
Full Text Available This study examines the phenomenon of performance persistence of equity funds in Hungary in two time perspectives: 1-year and 6-month perspectives. The empirical results confirm the occurrence of performance dependence in consecutive periods. There is also a strong evidence of short-term persistence in the total horizon of the study (from the beginning of 2000 to the end of 2009, and in several sub-periods. The 1-year persistence was also found in the tested sample and, in general, depended on the measure applied. Furthermore, I observed performance reversal, which can be partly explained by trend changes in the financial markets. The persistence of equity funds performance in Hungary is shaped by market factors rather than the diversity of managerial characteristics.
Full Text Available This study focuses on open-ended equity mutual funds in Thailand. The funds’ performances were examined whether the returns significantly and persistently out-perform the market; whether the use of different measures leads funds with similar rankings. The analyses use various metrics: the traditional fund performance evaluation measures and Data Envelopment Analysis (DEA technique; Pearson’s correlation coefficients, and cover six different investment horizons. The results suggest that open-ended equity mutual funds analyzed in this study significantly out-perform the market, and the funds’ positive performance sustains for 3-month time-period of investment, at least. The top five funds managed by the Aberdeen, Bangkok Bank and Siam Commercial Bank Asset Management Companies out-perform the bottom five funds between 0.1912 and 1.3187 for six time-periods of investment from 1-month to 5-year. Finally, it is concluded that for individual investors, the results provided by this study can be guidelines for selecting mutual funds for investment.
Glenn, William J.; Picus, Lawrence O.; Odden, Allan; Aportela, Anabel
While there is an extensive literature analyzing the relative equity of state funding systems for current operating revenues, there is a dearth of research on capital funding systems. This article presents an analysis of the school capital funding system in Kentucky since 1990, using the operating-revenue analysis concepts of horizontal equity,…
Klein, Susan S.; Goodman, Melanie A.
This publication discusses federal funds which are available for research and development in sex equity in education. A major objective is to identify specific Federal funding opportunities for projects focusing on sex equity. Another objective is to help individuals understand the overall Federal pattern of support for activities to promote sex…
Eduardo Pozzi Lucchesi
Full Text Available The disposition effect predicts that investors tend to sell winning stocks too soon and ride losing stocks too long. Despite the wide range of research evidence about this issue, the reasons that lead investors to act this way are still subject to much controversy between rational and behavioral explanations. In this article, the main goal was to test two competing behavioral motivations to justify the disposition effect: prospect theory and mean reversion bias. To achieve it, an analysis of monthly transactions for a sample of 51 Brazilian equity funds from 2002 to 2008 was conducted and regression models with qualitative dependent variables were estimated in order to set the probability of a manager to realize a capital gain or loss as a function of the stock return. The results brought evidence that prospect theory seems to guide the decision-making process of the managers, but the hypothesis that the disposition effect is due to mean reversion bias could not be confirmed.
Our framework for evaluating and investing in mutual funds combines observed returns on funds and passive assets with prior beliefs that distinguish pricing-model inaccuracy from managerial skill. A fund's alpha' is defined using passive benchmarks. We show that returns on non-benchmark passive assets help estimate that alpha more precisely for most funds. The resulting estimates generally vary less than standard estimates across alternative benchmark specifications. Optimal portfolios constr...
Angerer, Martin; Brem, Alexander; Kraus, Sascha
Entrepreneurs often struggle to find sufficient funding for their start-ups. A relatively new way for companies to attract capital is via an internet platform, locating investors who in return receive something in return for their ventures. Equity crowdfunding is one of several types of crowdfund......Entrepreneurs often struggle to find sufficient funding for their start-ups. A relatively new way for companies to attract capital is via an internet platform, locating investors who in return receive something in return for their ventures. Equity crowdfunding is one of several types...... of crowdfunding, and is also known as crowdinvesting in the German-speaking realm. This article predominantly advances the scientific knowledge regarding the success factors of equity crowdfunding for German start-ups. The study conducted nine qualitative interviews with start-ups and crowdinvesting platforms...
Scheele, Christian Elling; Little, Ingvild; Diderichsen, Finn
to health equity goals outside of the health sector and inadequate economic prioritization budget curbs implementation. Concerning evidence, there is a lack of epidemiological data, detailed evidence of health equity interventions as well as indicators relevant for monitoring implementation. Concerted......AIMS: Local governments in the Scandinavian countries are increasingly committed to reduce health inequity through 'health equity in all policies' (HEiAP) governance. There exists, however, only very sporadic implementation evidence concerning municipal HEiAP governance, which is the focus...
Braveman, Paula; Gruskin, Sofia
Those concerned with poverty and health have sometimes viewed equity and human rights as abstract concepts with little practical application, and links between health, equity and human rights have not been examined systematically. Examination of the concepts of poverty, equity, and human rights in relation to health and to each other demonstrates that they are closely linked conceptually and operationally and that each provides valuable, unique guidance for health institutions' work. Equity and human rights perspectives can contribute concretely to health institutions' efforts to tackle poverty and health, and focusing on poverty is essential to operationalizing those commitments. Both equity and human rights principles dictate the necessity to strive for equal opportunity for health for groups of people who have suffered marginalization or discrimination. Health institutions can deal with poverty and health within a framework encompassing equity and human rights concerns in five general ways: (1) institutionalizing the systematic and routine application of equity and human rights perspectives to all health sector actions; (2) strengthening and extending the public health functions, other than health care, that create the conditions necessary for health; (3) implementing equitable health care financing, which should help reduce poverty while increasing access for the poor; (4) ensuring that health services respond effectively to the major causes of preventable ill-health among the poor and disadvantaged; and (5) monitoring, advocating and taking action to address the potential health equity and human rights implications of policies in all sectors affecting health, not only the health sector.
Sach Tracey H; Whynes David K; Yu Chai
Abstract Background Equitable financing is a key objective of health care systems. Its importance is evidenced in policy documents, policy statements, the work of health economists and policy analysts. The conventional categorisations of finance sources for health care are taxation, social health insurance, private health insurance and out-of-pocket payments. There are nonetheless increasing variations in the finance sources used to fund health care. An understanding of the equity implication...
Kjellstrom, Tord; Friel, Sharon; Dixon, Jane; Corvalan, Carlos; Rehfuess, Eva; Campbell-Lendrum, Diarmid; Gore, Fiona; Bartram, Jamie
This paper outlines briefly how the living environment can affect health. It explains the links between social and environmental determinants of health in urban settings. Interventions to improve health equity through the environment include actions and policies that deal with proximal risk factors in deprived urban areas, such as safe drinking water supply, reduced air pollution from household cooking and heating as well as from vehicles and industry, reduced traffic injury hazards and noise, improved working environment, and reduced heat stress because of global climate change. The urban environment involves health hazards with an inequitable distribution of exposures and vulnerabilities, but it also involves opportunities for implementing interventions for health equity. The high population density in many poor urban areas means that interventions at a small scale level can assist many people, and existing infrastructure can sometimes be upgraded to meet health demands. Interventions at higher policy levels that will create more sustainable and equitable living conditions and environments include improved city planning and policies that take health aspects into account in every sector. Health equity also implies policies and actions that improve the global living environment, for instance, limiting greenhouse gas emissions. In a global equity perspective, improving the living environment and health of the poor in developing country cities requires actions to be taken in the most affluent urban areas of the world. This includes making financial and technical resources available from high-income countries to be applied in low-income countries for urgent interventions for health equity. This is an abbreviated version of a paper on "Improving the living environment" prepared for the World Health Organization Commission on Social Determinants of Health, Knowledge Network on Urban Settings.
Angerer, Martin; Brem, Alexander; Kraus, Sascha
Entrepreneurs often struggle to find sufficient funding for their start-ups. A relatively new way for companies to attract capital is via an internet platform, locating investors who in return receive something in return for their ventures. Equity crowdfunding is one of several types...... of crowdfunding, and is also known as crowdinvesting in the German-speaking realm. This article predominantly advances the scientific knowledge regarding the success factors of equity crowdfunding for German start-ups. The study conducted nine qualitative interviews with start-ups and crowdinvesting platforms....... Its first result is that German start-ups select crowdinvesting because (1) it is a funding opportunity and (2) it has an expected marketing effect. To organize the results of relevant success factors, the Crowdinvesting Success Model was designed by the researchers. This supports German entrepreneurs...
... ``hedge fund'' and ``private equity fund'' as an issuer that would be an investment company, as defined... prohibited proprietary trading in the securities of U.S. companies if such trades were booked outside of the... investments in, or relationships with, hedge funds and private equity funds. The Board also consulted with...
Petkovic, Jennifer; Epstein, Jonathan; Buchbinder, Rachelle
: The English, Dutch, French, and Turkish Health Assessment Questionnaires and English and French Osteoarthritis Knee and Hip Quality of Life questionnaires were evaluated by applying 3 readability formulas: Flesch Reading Ease, Flesch-Kincaid grade level, and Simple Measure of Gobbledygook; and a new tool...... abstained, 1 no). Twenty-two participants agreed that cultural equivalency of PROM should be assessed and suitable methods used (7 abstained, 2 no). Special interest group participants identified challenges with cross-cultural adaptation including resources required, and suggested patient involvement...... for improving translation and adaptation. CONCLUSION: Future work will include consensus exercises on what methods are required to ensure PROM are appropriate for people with low literacy and different cultures....
Corburn, Jason; Sverdlik, Alice
Informal settlement upgrading is widely recognized for enhancing shelter and promoting economic development, yet its potential to improve health equity is usually overlooked. Almost one in seven people on the planet are expected to reside in urban informal settlements, or slums, by 2030. Slum upgrading is the process of delivering place-based environmental and social improvements to the urban poor, including land tenure, housing, infrastructure, employment, health services and political and social inclusion. The processes and products of slum upgrading can address multiple environmental determinants of health. This paper reviewed urban slum upgrading evaluations from cities across Asia, Africa and Latin America and found that few captured the multiple health benefits of upgrading. With the Sustainable Development Goals (SDGs) focused on improving well-being for billions of city-dwellers, slum upgrading should be viewed as a key strategy to promote health, equitable development and reduce climate change vulnerabilities. We conclude with suggestions for how slum upgrading might more explicitly capture its health benefits, such as through the use of health impact assessment (HIA) and adopting an urban health in all policies (HiAP) framework. Urban slum upgrading must be more explicitly designed, implemented and evaluated to capture its multiple global environmental health benefits.
Full Text Available The existing literature finds conflicting results on the magnitude of price linkages between equity mutual funds and the stock market. The study contends that in an optimal lagged model, the expectations of future prices using knowledge of past price behaviour in a particular equity mutual fund category will improve forecasts of prices of other equity mutual fund categories and the stock market index. The evidence shows that the long-run pricing of equity mutual funds is cointegrated with the stock market index. In the short run, the results indicate that some equity mutual fund categories possess both long-run and short-run exogeneity with the stock market. Therefore, the short-run dynamic indicates short-run Granger causal links running between different equity mutual fund categories.
Northridge, Mary Evelyn; Freeman, Lance
Although the fields of urban planning and public health share a common origin in the efforts of reformers to tame the ravages of early industrialization in the 19th century, the 2 disciplines parted ways in the early 20th century as planners increasingly focused on the built environment while public health professionals narrowed in on biomedical causes of disease and disability. Among the unfortunate results of this divergence was a tendency to discount the public health implications of planning decisions. Given increasingly complex urban environments and grave health disparities in cities worldwide, urban planners and public health professionals have once again become convinced of the need for inclusive approaches to improve population health and achieve health equity. To make substantive progress, intersectoral collaboration utilizing ecological and systems science perspectives will be crucial as the solutions lie well beyond the control of any single authority. Grounded in the social determinants of health, and with a renewed sense of interconnectedness, dedicated and talented people in government agencies and communities who recognize that our future depends on cultivating local change and evaluating the results can come to grips with the enormous challenge that lies ahead to create more equitable, sustainable, and healthier cities worldwide.
Full Text Available With the plethora of schemes available in the Indian markets, aninvestors needs to evaluate and consider various factors beforemaking an investment decision. The present investigation is aimedto examine the performance of safest investment instrument in thesecurity market in the eyes of investors i.e., mutual funds byspecially focusing on equity-diversified schemes. Eight mutual fundschemes have been selected for this purpose. The examination isachieved by assessing various financial tests like Sharpe Ratio,Standard Deviation, Alpha, Beta (b and Coefficient ofDetermination (R2. Furthermore, in-depth analysis also has beendone by considering return over the period of last five years onvarious basis, expenses ratio, corpus-size etc. the data has beentaken from various websites of mutual fund schemes and from www.amfiindia.com. Calculated results are in the favor of RelianceRegular Savings Equity in terms of returns over the last five yearsand Birla Sun Life Dividend Yield Plus in terms of maximum returns by taking minimum risks. The study will be helpful for the researchers and financial analysts to analyze various securities orfunds while selecting the best investment alternative out of thegalaxy of investment alternatives.
Vargas, Ingrid; Vazquez, Maria Luisa; Jane, Elisabet
The aim of any health care system is to help improve the people's health, and to do so as efficiently as possible. In order to improve the efficiency and equity of health services provision, many countries around the world have implemented reforms, including several Latin American nations. However similar the objectives may appear, the various ways societies implement such reforms reflect different values and concepts. This article analyzes the egalitarian and neoliberal values underlying different concepts of equity in health care. The authors develop criteria to interpret selected health services funding and provision strategies in Latin American health system reforms. These criteria are then applied to health care financing and delivery policies under the reforms currently being implemented in Colombia and Costa Rica.
J.A. McCahery; E.P.M. Vermeulen
Hedge funds and private equity increasingly play an important role in the financial services industry and corporate governance in Europe and the United States. Activist hedge funds and private equity firms have developed similar investment strategies that are designed to influence the corporate gove
Full Text Available Equity is a core value of Health Impact Assessment (HIA. Many compelling moral, economic, and health arguments exist for prioritizing and incorporating equity considerations in HIA practice. Decision-makers, stakeholders, and HIA practitioners see the value of HIAs in uncovering the impacts of policy and planning decisions on various population subgroups, developing and prioritizing specific actions that promote or protect health equity, and using the process to empower marginalized communities. There have been several HIA frameworks developed to guide the inclusion of equity considerations. However, the field lacks clear indicators for measuring whether an HIA advanced equity. This article describes the development of a set of equity metrics that aim to guide and evaluate progress toward equity in HIA practice. These metrics also intend to further push the field to deepen its practice and commitment to equity in each phase of an HIA. Over the course of a year, the Society of Practitioners of Health Impact Assessment (SOPHIA Equity Working Group took part in a consensus process to develop these process and outcome metrics. The metrics were piloted, reviewed, and refined based on feedback from reviewers. The Equity Metrics are comprised of 23 measures of equity organized into four outcomes: (1 the HIA process and products focused on equity; (2 the HIA process built the capacity and ability of communities facing health inequities to engage in future HIAs and in decision-making more generally; (3 the HIA resulted in a shift in power benefiting communities facing inequities; and (4 the HIA contributed to changes that reduced health inequities and inequities in the social and environmental determinants of health. The metrics are comprised of a measurement scale, examples of high scoring activities, potential data sources, and example interview questions to gather data and guide evaluators on scoring each metric.
This article examines the mid-twentieth-century transformation of U.K. pension fund investment policy known as the “cult of equity.” It focuses on the influence exercised by the Association of Superannuation and Pension Funds over actuarial and corporate governance standards, through actuaries who were members of its council. This intervention led to increasingly permissive actuarial valuations that reduced contributions for sponsors of pension funds investing in equities. Increased demand fo...
Gagnon, Anita J; Small, Rhonda; Sarasua, Irene; Lang, Carly
An international research collaboration answered, "Can equity in perinatal health for migrant women be measured for comparison across countries?" In nine countries, perinatal databases were assessed for the availability of equity indicators. Equity data were also sought from women and health records. Optimal sources of data differed depending on the migrant perinatal health equity indicator. Health and migration data, required to capture equity, were often not reported in the same location. Migration indicators other than country of birth were underreported. Perinatal health equity can be measured for international comparisons, although a standardized protocol is required to capture all indicators.
Full Text Available This paper investigates the performance and persistence in performance of equity funds in China. We apply the capital asset pricing model (CAPM and the Carhart four-factor model to examine 520 equity funds for an eleven-year period with 39,449 observations. To investigate persistence, the entire sample is divided into ten portfolios (deciles on the basis of lagged one-year performance and then observed over the next 12 months. We find that equity funds in China outperform their benchmark market but do not find any evidence of persistence in the performance of equity funds. Top-performing (worst-performing funds do not continue to perform well (worse in the following year. Top-performing funds are younger and have lower expense ratios than the worst-performing funds. However, the size of the top-performing funds and the worst-performing funds show no significant difference. Our results suggest that past performance of equity funds is not predictive of future fund performance.
paper, proposes a framework for monitoring equity in access and health .... get additional data through in—depth and qualitative studies. Equity and health .... characteristics of HIV infected patients seeking care in relation to access to the Drug ...
The author posits some ethical concerns and theories of distribution in order to gain some insight into the meaning of equity in health, as referred to in WHO documents. It is pointed out that the lack of clarity in the WHO positions is evidenced by examining 1) the European strategy document, which focuses on giving equal health to all and equity access to health care, and 2) the Global Strategy for Health, which talks about reducing inequality and health as a human right. The question raised in document 1 is whether more equal sharing of health might mean less health for the available quantity of resources. The question raised in document 2 is whether there is a right to health per se. The question is how does one measure health policy effects. Health effects are different for an 8-year-old girl and an octogenarian. How does one measure the fairness of access to health care in remote mountain villages versus an urban area? Is equal utilization which is more easily measured comparable to equal need as a measure? How does one distribute doctors equitably? The author espouses the determinant of health as Aday's illness and health promotion, which is not biased by class and controversy. The Aday definition embraces both demand and need, although his definition is still open to question. Concepts of health with distinction between need and demand are made. Theories of Veatch which relate to distributive justice and equity in health care are provided as entitlement theory (market forces determine allocation of resources), utilitarianism (greatest good for the greatest number regardless of redistribution issues), maximum theory (maximize the minimum position or giver priority to the least well off), and equality (fairness in distribution). Different organizational and financing structures will influence the approach to equity. The conclusion is that equity is a value laden concept which has no uniquely correct definition. 5 theories of equity in distribution of health
One of the most extensive Chilean health care reforms occurred in July 2005, when the Regime of Explicit Health Guarantees (AUGE) became effective. This reform guarantees coverage for a specific set of health conditions. Thus, the purpose of this study is to provide timely evidence for policy makers to understand the current distribution and equity of health care utilization in Chile. The authors analyzed secondary data from the National Socioeconomic Survey (CASEN) for the years 1992–2009 and the 2006 Satisfaction and Out-of-Pocket Payment Survey to assess equity in health care utilization using two different approaches. First, we used a two-part model to estimate factors associated with the utilization of health care. Second, we decomposed income-related inequalities in medical care use into contributions of need and non-need factors and estimated a horizontal inequity index. Findings of this empirical study include evidence of inequities in the Chilean health care system that are beneficial to the better-off. We also identified some key factors, including education and health care payment, which affect the utilization of health care services. Results of this study could help researchers and policy makers identify targets for improving equity in health care utilization and strengthening availability of health care services accordingly. PMID:23937894
In this article,several cases are cited to demonstrate how foreign private equity firms circumvent Chinese government restrictions on capital flows and investing in strategic and sensitive sectors. Speci cally,private equities investing in Chinese companies to be listed abroad can use the Red-chip,Sheng Da or overseas option models. Private equities investing in domestically-listed Chinese companies can resort to foreign-funded banks,underground banking,stock-holder borrowing,stocks held by the third party,equity bonds or local investment company purchases.
Yu, Chai Ping; Whynes, David K; Sach, Tracey H
Equitable financing is a key objective of health care systems. Its importance is evidenced in policy documents, policy statements, the work of health economists and policy analysts. The conventional categorisations of finance sources for health care are taxation, social health insurance, private health insurance and out-of-pocket payments. There are nonetheless increasing variations in the finance sources used to fund health care. An understanding of the equity implications would help policy makers in achieving equitable financing. The primary purpose of this paper was to comprehensively assess the equity of health care financing in Malaysia, which represents a new country context for the quantitative techniques used. The paper evaluated each of the five financing sources (direct taxes, indirect taxes, contributions to Employee Provident Fund and Social Security Organization, private insurance and out-of-pocket payments) independently, and subsequently by combined the financing sources to evaluate the whole financing system. Cross-sectional analyses were performed on the Household Expenditure Survey Malaysia 1998/99, using Stata statistical software package. In order to assess inequality, progressivity of each finance sources and the whole financing system was measured by Kakwani's progressivity index. Results showed that Malaysia's predominantly tax-financed system was slightly progressive with a Kakwani's progressivity index of 0.186. The net progressive effect was produced by four progressive finance sources (in the decreasing order of direct taxes, private insurance premiums, out-of-pocket payments, contributions to EPF and SOCSO) and a regressive finance source (indirect taxes). Malaysia's two tier health system, of a heavily subsidised public sector and a user charged private sector, has produced a progressive health financing system. The case of Malaysia exemplifies that policy makers can gain an in depth understanding of the equity impact, in order to help
Sach Tracey H
Full Text Available Abstract Background Equitable financing is a key objective of health care systems. Its importance is evidenced in policy documents, policy statements, the work of health economists and policy analysts. The conventional categorisations of finance sources for health care are taxation, social health insurance, private health insurance and out-of-pocket payments. There are nonetheless increasing variations in the finance sources used to fund health care. An understanding of the equity implications would help policy makers in achieving equitable financing. Objective The primary purpose of this paper was to comprehensively assess the equity of health care financing in Malaysia, which represents a new country context for the quantitative techniques used. The paper evaluated each of the five financing sources (direct taxes, indirect taxes, contributions to Employee Provident Fund and Social Security Organization, private insurance and out-of-pocket payments independently, and subsequently by combined the financing sources to evaluate the whole financing system. Methods Cross-sectional analyses were performed on the Household Expenditure Survey Malaysia 1998/99, using Stata statistical software package. In order to assess inequality, progressivity of each finance sources and the whole financing system was measured by Kakwani's progressivity index. Results Results showed that Malaysia's predominantly tax-financed system was slightly progressive with a Kakwani's progressivity index of 0.186. The net progressive effect was produced by four progressive finance sources (in the decreasing order of direct taxes, private insurance premiums, out-of-pocket payments, contributions to EPF and SOCSO and a regressive finance source (indirect taxes. Conclusion Malaysia's two tier health system, of a heavily subsidised public sector and a user charged private sector, has produced a progressive health financing system. The case of Malaysia exemplifies that policy makers
Yu, Chai Ping; Whynes, David K; Sach, Tracey H
Background Equitable financing is a key objective of health care systems. Its importance is evidenced in policy documents, policy statements, the work of health economists and policy analysts. The conventional categorisations of finance sources for health care are taxation, social health insurance, private health insurance and out-of-pocket payments. There are nonetheless increasing variations in the finance sources used to fund health care. An understanding of the equity implications would help policy makers in achieving equitable financing. Objective The primary purpose of this paper was to comprehensively assess the equity of health care financing in Malaysia, which represents a new country context for the quantitative techniques used. The paper evaluated each of the five financing sources (direct taxes, indirect taxes, contributions to Employee Provident Fund and Social Security Organization, private insurance and out-of-pocket payments) independently, and subsequently by combined the financing sources to evaluate the whole financing system. Methods Cross-sectional analyses were performed on the Household Expenditure Survey Malaysia 1998/99, using Stata statistical software package. In order to assess inequality, progressivity of each finance sources and the whole financing system was measured by Kakwani's progressivity index. Results Results showed that Malaysia's predominantly tax-financed system was slightly progressive with a Kakwani's progressivity index of 0.186. The net progressive effect was produced by four progressive finance sources (in the decreasing order of direct taxes, private insurance premiums, out-of-pocket payments, contributions to EPF and SOCSO) and a regressive finance source (indirect taxes). Conclusion Malaysia's two tier health system, of a heavily subsidised public sector and a user charged private sector, has produced a progressive health financing system. The case of Malaysia exemplifies that policy makers can gain an in depth
Full Text Available Mutual funds are one of the key suppliers of liquidity in Romanian capital market. This paper uses quarterly data on Romanian open-end funds starting with 2006 until 2010. We find that significant negative flows (outflows were registered beginning with the end of 2007 (equity funds, during 2008 (equity funds, balanced funds, other funds and bond funds in the last 2 quarters of the year and from 2009 to 2010 (in the case of money market funds. There is evidence that the changing market conditions attract differently the incoming flows in these mutual funds. This is the reason why such perturbations affect investors’ confidence for these investment vehicles and impose the reorientation of the investment funds and of their investors to other alternatives in order to preserve their capital.
Donald Trump's rhetoric and leadership are destroying the "culture of community" necessary for progress on health equity. His one-line promises to provide "quality health care at a fraction of the cost" smack of neoliberal nostrums that shifted ever more costs onto patients, thereby preventing many people from getting care. The dangers of Trump go far beyond health policy, however; Trump's presidency threatens the political and cultural institutions that make any good policy possible. Copyright © 2017 by Duke University Press.
Full Text Available Abstract Background The health sector in Lebanon suffers from high levels of spending and is acknowledged to be a source of fiscal waste. Lebanon initiated a series of health sector reforms which aim at containing the fiscal waste caused by high and inefficient public health expenditures. Yet these reforms do not address the issues of health equity in use and coverage of healthcare services, which appear to be acute. This paper takes a closer look at the micro-level inequities in the use of healthcare, in access, in ability to pay, and in some health outcomes. Methods We use data from the 2004/2005 Multi Purpose Survey of Households in Lebanon to conduct health equity analysis, including equity in need, access and outcomes. We briefly describe the data and explain some of its limitations. We examine, in turn, and using standardization techniques, the equity in health care utilization, the impact of catastrophic health payments on household wellbeing, the effect of health payment on household impoverishment, the equity implications of existing health financing methods, and health characteristics by geographical region. Results We find that the incidence of disability decreases steadily across expenditure quintiles, whereas the incidence of chronic disease shows the opposite pattern, which may be an indication of better diagnostics for higher quintiles. The presence of any health-related expenditure is regressive while the magnitude of out-of-pocket expenditures on health is progressive. Spending on health is found to be "normal" and income-elastic. Catastrophic health payments are likelier among disadvantaged groups (in terms of income, geography and gender. However, the cash amounts of catastrophic payments are progressive. Poverty is associated with lower insurance coverage for both private and public insurance. While the insured seem to spend an average of almost LL93,000 ($62 on health a year in excess of the uninsured, they devote a smaller
G.J. de Zwart (Gerben); B. Frieser (Brian); D.J.C. van Dijk (Dick)
textabstractThis paper develops a reinvestment strategy for private equity which aims to keep its portfolio weight equal to a desired strategic allocation, while taking into account the illiquid nature of private equity. Historical simulations (1980-2005) show that our dynamic strategy is capable of
Full Text Available Abstract Introduction In all countries people experience different social circumstances that result in avoidable differences in health. In New Zealand, Māori, Pacific peoples, and those with lower socioeconomic status experience higher levels of chronic illness, which is the leading cause of mortality, morbidity and inequitable health outcomes. Whilst the health system can enable a fairer distribution of good health, limited national data is available to measure health equity. Therefore, we sought to find out whether health services in New Zealand were equitable by measuring the level of development of components of chronic care management systems across district health boards. Variation in provision by geography, condition or ethnicity can be interpreted as inequitable. Methods A national survey of district health boards (DHBs was undertaken on macro approaches to chronic condition management with detail on cardiovascular disease, chronic obstructive pulmonary disease, congestive heart failure, stroke and diabetes. Additional data from expert informant interviews on program reach and the cultural needs of Māori and Pacific peoples was sought. Survey data were analyzed on dimensions of health equity relevant to strategic planning and program delivery. Results are presented as descriptive statistics and free text. Interviews were transcribed and NVivo 8 software supported a general inductive approach to identify common themes. Results Survey responses were received from the majority of DHBs (15/21, some PHOs (21/84 and 31 expert informants. Measuring, monitoring and targeting equity is not systematically undertaken. The Health Equity Assessment Tool is used in strategic planning but not in decisions about implementing or monitoring disease programs. Variable implementation of evidence-based practices in disease management and multiple funding streams made program implementation difficult. Equity for Māori is embedded in policy, this is not so
Full Text Available Equity isone of the basic principles of health systems and features explicitly in theNigerian health financing policy. Despite acclaimed commitment to theimplementation of this policy through various pro-poor health programmes andinterventions, the level of inequity in health status and access to basichealth care interventions remain high. This paper examines the equity of healthcare expenditure by individuals in Nigeria. The paper evaluated equity in out-of-pocketspending( OOP for the country and separately for the six geopolitical zones ofthe country.The methodological framework rests onKakwani Progressivity Indices (KPIs, ReynoldSmolensky indices andconcentration indices (CIs using data from the 2004 Nigerian National LivingStandard Survey( NLSS collected by the National Bureau of Statistics. .The results reveal that health financing isregressive with the incidence disproportionately rest on poor households withabout 70% of the total expenditure on health is through out-of-pocket paymentsby households. Poor households are prone to bear most of the expenses in theevent of any health shock. The catastrophic consequences thus push some intopoverty, and aggravate the poverty of others.The paper therefore suggests that thecountry’s health financingsystems must be designed not only to allow people to access services when theyare needed, but must also protect household, from financial catastrophe, byreducing OOP spending through risk pooling and prepayment schemes within thehealth system.Keywords: Equity, Health careexpenditure, Kakwani progressivity index, Nigeria.
Chang, Wei-Ching; Fraser, Joy H
The role of competition and cooperation in relation to the goal of health equity is examined in this paper. The authors explain why the win-lose mentality associated with avoidable competition is ethically questionable and less effective than cooperation in achieving positive outcomes, particularly as it relates to health and health equity. Competition, which differentiates winners from losers, often with the winner-takes-all reward system, inevitably leads to a few winners and many losers, resulting in social inequality, which, in turn, engenders and perpetuates health inequity.Competitive market-driven approaches to healthcare-brought about by capitalism, neo-liberalization, and globalization, based primarily on a competitive framework-are shown to have contributed to growing inequities with respect to the social determinants of health, and have undermined equal opportunity to access health care and achieve health equity. It is possible to redistribute income and wealth to reduce social inequality, but globalization poses increasing challenges to policy makers. John Stuart Mill provided a passionate, philosophical defense of cooperatives, followed by Karl Polanyi who offered an insightful critique of both state socialism and especially the self-regulating market, thereby opening up the cooperative way of shaping the future. We cite Hannah Arendt's "the banality of evil" to characterize the tragic concept of "ethical fading" witnessed in business and everyday life all over the world, often committed (without thinking and reflecting) by ordinary people under competitive pressures.To promote equity in health for all, we recommend the adoption of a radically new cooperation paradigm, applied whenever possible, to everything in our daily lives.
Dahlgren, G; Diderichsen, Finn
In recent years the Swedish debate on health policy has been focusing on resource allocation between primary care versus secondary care, private care versus public care, and prevention versus care. The National Commission on the "Swedish Health Services in the 1990s" brought attention to the prev...... to the prevailing inequalities in health. The Health Policy Bill of 1985 defines the reduction of inequalities in health as a major target of national health policy. The health policy measures discussed are mainly outside the health care sector....
... Advantage and Premium Opportunity Fund (``IGA''); ING Global Equity Dividend and Premium Opportunity Fund..., each applicant was able to rely on the exemptive order granted in the Matter of ING Clarion Real Estate... (since as a practical matter excess gains must be distributed and accordingly would not be available...
Samuel Kristianto Utomo
Full Text Available We extend the persistence and pervasiveness of the presence of value effect to Indonesian stock returns in the last two decades by utilizing data set that is relatively free of survivor bias and selection bias. Our finding shows that value portfolios have been able to outperform growth portfolios. Furthermore, the presence of the effect as an asset pricing factor, along with the size effect, can significantly explain the returns of the aggregate equity mutual funds in Indonesia and unveil that the equity mutual fund industry does not provide sufficient risk-adjusted return to cover trading costs and fund expenses. Our proposition is that the equity mutual fund valuation will be better off to apply simpler model shown in this paper to capture the value premium as opposed to the general application of traditional valuation method.
Stapleton, G; Schröder-Bäck, P; Townend, D
Evidence emerging from the study of epigenetics and epigenomics challenges notions of health by enhancing understanding of disease etiologies and improving awareness of new health risks. New paradigms arising from epigenetic and epigenomic research present challenging cases through which to debate theories of justice in health because they expand the concept of health and, controversially, place value on what was previously assumed to be 'healthy' individual variance. Discoveries of the dynamic nature of the epigenome and its variable sensitivity towards change in numerous phenomena add further complexity to the assessment of health inequalities. Such evidence can cast doubt on perceptions of justice in health, which in turn raises questions over the suitability of actions taken in pursuit of equity. This article discusses how recent developments in epigenetics and epigenomics may impact upon assessments of equity in health. A review of literature discussing possible health risks associated with acquired yet heritable epigenetic variance is used to highlight the diversity of possible pathways through which health may be influenced. From this context, the consideration of health risk with respect to epigenetics, it is argued, demands a more inclusive concept of health when used in discussions of inequities. Copyright © 2013 S. Karger AG, Basel.
Cookson, Richard; Mirelman, Andrew J; Griffin, Susan; Asaria, Miqdad; Dawkins, Bryony; Norheim, Ole Frithjof; Verguet, Stéphane; J Culyer, Anthony
This articles serves as a guide to using cost-effectiveness analysis (CEA) to address health equity concerns. We first introduce the "equity impact plane," a tool for considering trade-offs between improving total health-the objective underpinning conventional CEA-and equity objectives, such as reducing social inequality in health or prioritizing the severely ill. Improving total health may clash with reducing social inequality in health, for example, when effective delivery of services to disadvantaged communities requires additional costs. Who gains and who loses from a cost-increasing health program depends on differences among people in terms of health risks, uptake, quality, adherence, capacity to benefit, and-crucially-who bears the opportunity costs of diverting scarce resources from other uses. We describe two main ways of using CEA to address health equity concerns: 1) equity impact analysis, which quantifies the distribution of costs and effects by equity-relevant variables, such as socioeconomic status, location, ethnicity, sex, and severity of illness; and 2) equity trade-off analysis, which quantifies trade-offs between improving total health and other equity objectives. One way to analyze equity trade-offs is to count the cost of fairer but less cost-effective options in terms of health forgone. Another method is to explore how much concern for equity is required to choose fairer but less cost-effective options using equity weights or parameters. We hope this article will help the health technology assessment community navigate the practical options now available for conducting equity-informative CEA that gives policymakers a better understanding of equity impacts and trade-offs.
Gender equity is increasingly cited as a goal of health policy but there is considerable confusion about what this could mean either in theory or in practice. If policies for the promotion of gender equity are to be realisable their goal must be the equitable distribution of health related resources. This requires careful identification of the similarities and differences in the health needs of men and women. It also necessitates an analysis of the gendered obstacles that currently prevent men and women from realising their potential for health. This article explores the impact of gender divisions on the health and the health care of both women and men and draws out some of the policy implications of this analysis. It outlines a three point agenda for change. This includes policies to ensure universal access to reproductive health care, to reduce gender inequalities in access to resources and to relax the constraints of rigidly defined gender roles. The article concludes with a brief overview of the practical and political dilemmas that the implementation of such policies would impose.
Chomi, Eunice Nahyuha; Mujinja, Phares Gamba; Enemark, Ulrika
cross-subsidisation across the funds. This paper analyses whether the risk distribution varies across the Community Health Fund (CHF) and National Health Insurance Fund (NHIF) in two districts in Tanzania. Specifically we aim to 1) identify risk factors associated with increased utilisation of health......INTRODUCTION: Multiple insurance funds serving different population groups may compromise equity due to differential revenue raising capacity and an unequal distribution of high risk members among the funds. This occurs when the funds exist without mechanisms in place to promote income and risk...... services and 2) compare the distribution of identified risk factors among the CHF, NHIF and non-member households. METHODS: Data was collected from a survey of 695 households. A multivariate logisitic regression model was used to identify risk factors for increased health care utilisation. Chi-square tests...
Shi, Yishao; Chen, Huajie; Chen, Yongjian
Assuring equitable health service is an important factor for promoting sustainable development and constructing harmonious society. Its concept is very necessary for policy makers and health planners. Recent advances in the field of health geography have greatly improved our understanding of the role played by equitable geographic distribution of health services. But equity is difficult to operationalize because it is influenced by lots of non-spatial factors. This paper presents a notion that analyzes spatial equity of health service integrating theories and techniques of spatial accessibility and GIS. By means of modified spatial accessibility index, the authors analyze relative equity status of each subdistrict based on geo-referenced and socio-demographic census exemplified by Minhang District of Shanghai. Due to the demand of residents and using efficiency of every health service are added in the method of accessibility, it makes equity research more valid. The paper also discusses the influence of floating population on spatial equity of health service.
Porto, Silvia Marta
This study focuses on equity in health and specifically the geographic distribution of financial resources. The author reviews the main contemporary theories of social justice and discusses the concept of equity in general and specifically in the health field. Based on the discussion of selected international experiences (United Kingdom, Spain, and Italy), the Resource Allocation Working Party (RAWP) formula used in the United Kingdom is identified as the most adequate distributive methodology, sizing the relative needs based on the population's demographic and epidemiological profiles. Finally, the results are presented from a simulation performed for the Brazilian case, showing that a more equitable geographic distribution of financial resources would require a redistribution favoring the States of the North and Northeast. The article concludes by highlighting that a comparison of actual fund outlays by the Ministry of Health in 1994 and the results of the simulation with the RAWP methodology for the Brazilian case show that the principles written into Brazilian legislation were absent from the geographic distribution of financial resources.
This paper examines diversification as a source of value creation and destruction in private equity. The literature has focused on the `diversification discount' in corporations. It has not analyzed diversification in PE-funds, where diversification might increase value by ameliorating managerial
The present paper starts by discussing the principles of public funding of universities. The size of the social returns to investment in education gives an indication regarding the most efficient use of resources, while the difference between the private and the social rates relates to issues of equity. The available evidence is contrasted to…
This paper examines diversification as a source of value creation and destruction in private equity. The literature has focused on the `diversification discount' in corporations. It has not analyzed diversification in PE-funds, where diversification might increase value by ameliorating managerial ri
Leaning, Jennifer; Spiegel, Paul; Crisp, Jeff
Addressing increasing concerns about public health equity in the context of violent conflict and the consequent forced displacement of populations is complex. Important operational questions now faced by humanitarian agencies can to some extent be clarified by reference to relevant ethical theory. Priorities of service delivery, the allocation choices, and the processes by which they are arrived at are now coming under renewed scrutiny in the light of the estimated two million refugees who fled from Iraq since 2003.Operational questions that need to be addressed include health as a relative priority, allocations between and within different populations, and transition and exit strategies. Public health equity issues faced by the humanitarian community can be framed as issues of resource allocation and issues of decision-making. The ethical approach to resource allocation in health requires taking adequate steps to reduce suffering and promote wellbeing, with the upper bound being to avoid harming those at the lower end of the welfare continuum. Deliberations in the realm of international justice have not provided a legal or implementation platform for reducing health disparities across the world, although norms and expectations, including within the humanitarian community, may be moving in that direction.Despite the limitations of applying ethical theory in the fluid, complex and highly political environment of refugee settings, this article explores how this theory could be used in these contexts and provides practical examples. The intent is to encourage professionals in the field, such as aid workers, health care providers, policy makers, and academics, to consider these ethical principles when making decisions.
Full Text Available Abstract Addressing increasing concerns about public health equity in the context of violent conflict and the consequent forced displacement of populations is complex. Important operational questions now faced by humanitarian agencies can to some extent be clarified by reference to relevant ethical theory. Priorities of service delivery, the allocation choices, and the processes by which they are arrived at are now coming under renewed scrutiny in the light of the estimated two million refugees who fled from Iraq since 2003. Operational questions that need to be addressed include health as a relative priority, allocations between and within different populations, and transition and exit strategies. Public health equity issues faced by the humanitarian community can be framed as issues of resource allocation and issues of decision-making. The ethical approach to resource allocation in health requires taking adequate steps to reduce suffering and promote wellbeing, with the upper bound being to avoid harming those at the lower end of the welfare continuum. Deliberations in the realm of international justice have not provided a legal or implementation platform for reducing health disparities across the world, although norms and expectations, including within the humanitarian community, may be moving in that direction. Despite the limitations of applying ethical theory in the fluid, complex and highly political environment of refugee settings, this article explores how this theory could be used in these contexts and provides practical examples. The intent is to encourage professionals in the field, such as aid workers, health care providers, policy makers, and academics, to consider these ethical principles when making decisions.
Stolk, Elly A; van Donselaar, Gijs; Brouwer, Werner B F; Busschbach, Jan J V
Economic evaluations have become an important and much used tool in aiding decision makers in deciding on reimbursement or implementation of new healthcare technologies. Nevertheless, the impact of economic evaluations on reimbursement decisions has been modest; results of economic evaluations do not have a good record in predicting funding decisions. This is usually explained in terms of fairness; there is increasing awareness that valuations of QALYs may differ when the QALYs accrue to different patients. The problem, however, is that these equity concerns often remain implicit, and therefore frustrate explicitness and transparency in evidence-based decision making. It has been suggested that a so-called equity adjustment procedure may (partially) solve this problem. Typically this would involve the application of so-called equity weights, which can be used to recalculate the value of QALY gains for different patients. This paper explores such an equity adjustment procedure, using the equity concept of proportional shortfall. Proportional shortfall assumes that measurement of inequalities in health should concentrate on the fraction of QALYs that people lose relative to their remaining life expectancy, and not on the absolute number of QALYs lost or gained. It is the ratio of QALYs lost over the QALYs remaining. This equity concept combines elements of two popular but conflicting notions of equity: fair innings and severity-of-illness. We applied the concept of proportional shortfall to ten conditions and tentatively explored how an equity adjustment procedure using proportional shortfall might affect priority setting. Our equity adjustment procedure lowered the cost-effectiveness threshold when a condition was relatively mild. Because the proportional shortfall caused by the ten conditions differed considerably, the equity-adjustment procedure discriminated strongly between the ten conditions, and this experiment provided a good opportunity to explore the impact
Ömer Faruk Tan
Full Text Available This study aims to evaluate the performance of Indian equity funds between January 2009 and October 2014. This study period coincides with the period of quantitative easing during which the developing economies in financial markets have been influenced. After the global financial crisis of 2008 came a period of quantitative easing (QE, creating an increase in the money supply and leading to a capital flow from developed countries to developing countries. During this 5-year 10-month period, in which the relevant quantitative easing continued, Indian CNX500 price index yielded approximately 21% compounded on average, per annum. In this study, Indian equity funds are examined in order to compare these funds’ performance within this period. Within this scope, 12 Indian equity funds are chosen. In order to measure these funds’ performances, the Sharpe ratio (1966, Treynor ratio (1965, Jensen’s alpha (1968 methods are used. Jensen’s alpha is also used in identifying selectivity skills of fund managers. Additionally, the Treynor & Mazuy (1966 regression analysis method is applied to show the market timing ability of fund managers.
Pratt, Bridget; Hyder, Adnan A
Global health research partnerships are increasingly taking the form of consortia of institutions from high-income countries and low- and middle-income countries that undertake programs of research. These partnerships differ from collaborations that carry out single projects in the multiplicity of their goals, scope of their activities, and nature of their management. Although such consortia typically aim to reduce health disparities between and within countries, what is required for them to do so has not been clearly defined. This article takes a conceptual approach to explore how the governance of transnational global health research consortia should be structured to advance health equity. To do so, it applies an account called shared health governance to derive procedural and substantive guidance. A checklist based on this guidance is proposed to assist research consortia determine where their governance practices strongly promote equity and where they may fall short.
Griffith, Derek M; Shelton, Rachel C; Kegler, Michelle
Qualitative methods have long been a part of health education research, but how qualitative approaches advance health equity has not been well described. Qualitative research is an increasingly important methodologic tool to use in efforts to understand, inform, and advance health equity. Qualitative research provides critical insight into the subjective meaning and context of health that can be essential for understanding where and how to intervene to inform health equity research and practice. We describe the larger context for this special theme issue of Health Education & Behavior, provide brief overviews of the 15 articles that comprise the issue, and discuss the promise of qualitative research that seeks to contextualize and illuminate answers to research questions in efforts to promote health equity. We highlight the critical role that qualitative research can play in considering and incorporating a diverse array of contextual information that is difficult to capture in quantitative research.
Johan, S.A.; Knill, A.M.; Mauck, N.
This paper examines investment patterns of 50 sovereign wealth funds (SWFs) in nations around the world. We study investment by SWFs in 903 public and private firms over the period 1984-2009. As expected, we observe SWFs investments are more often in private firms when the market returns of target
Johan, S.A.; Knill, A.M.; Mauck, N.
This paper examines investment patterns of 50 sovereign wealth funds (SWFs) in nations around the world. We study investment by SWFs in 903 public and private firms over the period 1984-2009. As expected, we observe SWFs investments are more often in private firms when the market returns of target n
Full Text Available Background: Health equity audit, as an alternative solution, is a process by which local partners systematically review inequalities in the patients` health, their access to appropriate services and health system outputs. Then, necessary activities needed in order to have more equitable services are agreed on and these concurrences become the executive scheme and action initiates. Therefore, it is pivotal for health care organizations to pay special attention to this important topic. The objective of the current study was to review the health equity audit model in different countries to gather viewpoints of various involved groups in health sector, particularly health experts, and to offer a practical and appropriate model for health equity audit in Iran. Methods: This study adopted applied research approach in two phases. In the first step, this study conducted theoretical health equity audit models in the texts; the experiences of other countries were studied and the most appropriate model for Iranian health system was selected. In the second step, this study employed the Delphi technique. According to the Delphi technique the questionnaire applied in order to gather data and then, the final model was extracted. Results: Agreeable topics, performing agencies, 6 equity audit stages, and equity indicators under 3 main parts with 16 sub-sections were elaborated and viewpoints of Iranian experts in the above fields were gathered and presented as the proposed health equity audit model for Iran. Conclusions: This study reviewed the model of health equity audit for UK and provided a comparative model for health system of Iran with respect to the opinions of academic experts.
Construct the investment strategy for the New-State Capital Hedge Fund. Identify profit making opportunities in Foreign Exchange (Forex) & Equities using both conventional and non-conventional indicators. The author is to articulate and document his current knowledge in the chosen area in order to stimuate ideas in creating potential investment strategies. Justify knowledge with actual results in a genuine live investment. Critique and evluate the effectiveness of the proposed investment ...
Liaropoulos, L; Tragakes, E
The 1983 health reforms in Greece were indirectly aimed at increasing equity in financing through expansion of the role of the public sector and restriction of the private sector. However, the rigid application of certain measures, the failure to change health care financing mechanisms, as well as growing dissatisfaction with publicly provided services actually increased the private share of health care financing relative to that of the public share. The greatest portion of this increase involved out-of-pocket payments, which constitute the most regressive form of financing, and hence resulted in reduced equity. The growing share of private insurance financing, though as yet quite small, has also contributed to reducing equity. Within public funding, while a small shift has occurred in favor of tax financing, it is questionable whether this has contributed to increased equity in view of widespread tax evasion. On balance, it is most unlikely that the 1983 health care reforms have led to increased equity; it is rather more likely that the system in operation today is more inequitable from the point of view of financing than the highly inequitable system that was in place in the early 1980s.
Chin, Marshall H
Health care organizations have increasingly acknowledged the presence of health care disparities across race/ethnicity and socioeconomic status, but significantly fewer have made health equity for diverse patients a true priority. Lack of financial incentives is a major barrier to achieving health equity. To create a business case for equity, governmental and private payors can: 1) Require health care organizations to report clinical performance data stratified by race, ethnicity, and socioeconomic status. 2) Incentivize preventive care and primary care. Implement more aggressive shared savings plans, update physician relative value unit fee schedules, and encourage partnerships across clinical and non-clinical sectors. 3) Incentivize the reduction of health disparities with equity accountability measures in payment programs. 4) Align equity accountability measures across public and private payors. 5) Assist safety-net organizations. Provide adequate Medicaid reimbursement, risk-adjust clinical performance scores for sociodemographic characteristics of patients, provide support for quality improvement efforts, and calibrate cuts to Disproportionate Share Hospital (DSH) payments to the pace of health insurance expansion. 6) Conduct demonstration projects to test payment and delivery system reform interventions to reduce disparities. Commitment to social justice is essential to achieve health equity, but insufficient without a strong business case that makes interventions financially feasible.
Hahn, Robert A.; Truman, Benedict I.
This article describes a framework and empirical evidence to support the argument that educational programs and policies are crucial public health interventions. Concepts of education and health are developed and linked, and we review a wide range of empirical studies to clarify pathways of linkage and explore implications. Basic educational expertise and skills, including fundamental knowledge, reasoning ability, emotional self-regulation, and interactional abilities, are critical components of health. Moreover, education is a fundamental social determinant of health – an upstream cause of health. Programs that close gaps in educational outcomes between low-income or racial and ethnic minority populations and higher-income or majority populations are needed to promote health equity. Public health policy makers, health practitioners and educators, and departments of health and education can collaborate to implement educational programs and policies for which systematic evidence indicates clear public health benefits. PMID:25995305
Chen, Rui; Zhao, Yali; Du, Juan; Wu, Tao; Huang, Yafang; Guo, Aimin
To reveal the equity of health workforce distribution in urban community health service (CHS), and to provide evidence for further development of community health service in China. A community-based, cross-sectional study was conducted in China from September to December 2011. In the study, 190 CHS centers were selected from 10 provinces of China via stratified multistage cluster sampling. Human resources profiles and basic characteristics of each CHS centers were collected. Lorenz curves and Gini Coefficient were used to measure the inequality in the distribution of health workforce in community health service centers by population size and geographical area. Wilcoxon rank test for paired samples was used to analyze the differences in equity between different health indicators. On average, there were 7.37 health workers, including 3.25 doctors and 2.32 nurses per 10,000 population ratio. Significant differences were found in all indicators across the samples, while Beijing, Shandong and Zhejiang ranked the highest among these provinces. The Gini coefficients for health workers, doctors and nurses per 10,000 population ratio were 0.39, 0.44, and 0.48, respectively. The equity of doctors per 10,000 population ratio (G = 0.39) was better than that of doctors per square kilometer (G = 0.44) (P = 0.005). Among the total 6,573 health workers, 1,755(26.7%) had undergraduate degree or above, 2,722(41.4%)had junior college degree and 215(3.3%) had high school education. Significant inequity was found in the distribution of workers with undergraduate degree or above (G = 0.52), which was worse than that of health works per 10000 population (Purban CHS centers.
Full Text Available OBJECTIVES: To reveal the equity of health workforce distribution in urban community health service (CHS, and to provide evidence for further development of community health service in China. METHODS: A community-based, cross-sectional study was conducted in China from September to December 2011. In the study, 190 CHS centers were selected from 10 provinces of China via stratified multistage cluster sampling. Human resources profiles and basic characteristics of each CHS centers were collected. Lorenz curves and Gini Coefficient were used to measure the inequality in the distribution of health workforce in community health service centers by population size and geographical area. Wilcoxon rank test for paired samples was used to analyze the differences in equity between different health indicators. RESULTS: On average, there were 7.37 health workers, including 3.25 doctors and 2.32 nurses per 10,000 population ratio. Significant differences were found in all indicators across the samples, while Beijing, Shandong and Zhejiang ranked the highest among these provinces. The Gini coefficients for health workers, doctors and nurses per 10,000 population ratio were 0.39, 0.44, and 0.48, respectively. The equity of doctors per 10,000 population ratio (G = 0.39 was better than that of doctors per square kilometer (G = 0.44 (P = 0.005. Among the total 6,573 health workers, 1,755(26.7% had undergraduate degree or above, 2,722(41.4%had junior college degree and 215(3.3% had high school education. Significant inequity was found in the distribution of workers with undergraduate degree or above (G = 0.52, which was worse than that of health works per 10000 population (P<0.001. CONCLUSIONS: Health workforce inequity was found in this study, especially in quality and geographic distribution. These findings suggest a need for more innovative policies to improve health equity in Chinese urban CHS centers.
... request an order to permit a registered closed-end investment company to make periodic distributions of... companies to such Fund during the year. Under the Distribution Policy of a Fund, such Fund would distribute... companies to make periodic distributions of long-term capital gains with respect to their outstanding...
Neagu, Oana Maria; Michelsen, Kai; Watson, Jonathan; Dowdeswell, Barrie; Brand, Helmut
Making up a third of the EU budget, Structural and Investment Funds can provide important opportunities for investing in policies that tackle inequalities in health. This article looks back and forward at the 2007-2013 and 2014-2020 financial periods in an attempt to inform the development of health equity as a strand of policy intervention under regional development. It combines evidence from health projects funded through Structural Funds and a document analyses that locates interventions for health equity under the new regulations. The map of opportunities has changed considerably since the last programming period, creating more visibility for vulnerable groups, social determinants of health and health systems sustainability. As the current programming period is progressing, this paper contributes to maximizing this potential but also identifying challenges and implementation gaps for prospective health system engagement in pursuing health equity as part of Structural Funds projects. The austerity measures and their impact on public spending, building political support for investments as well as the difficulties around pursuing health gains as an objective of other policy areas are some of the challenges to overcome. European Structural and Investment Funds could be a window of opportunity that triggers engagement for health equity if sectors adopt a transformative approach and overcome barriers, cooperate for common goals and make better use of the availability of these resources.
Chomi, Eunice Nahyuha; Mujinja, Phares Gamba; Enemark, Ulrika; Hansen, Kristian; Kiwara, Angwara Dennis
Multiple insurance funds serving different population groups may compromise equity due to differential revenue raising capacity and an unequal distribution of high risk members among the funds. This occurs when the funds exist without mechanisms in place to promote income and risk cross-subsidisation across the funds. This paper analyses whether the risk distribution varies across the Community Health Fund (CHF) and National Health Insurance Fund (NHIF) in two districts in Tanzania. Specifically we aim to 1) identify risk factors associated with increased utilisation of health services and 2) compare the distribution of identified risk factors among the CHF, NHIF and non-member households. Data was collected from a survey of 695 households. A multivariate logisitic regression model was used to identify risk factors for increased health care utilisation. Chi-square tests were performed to test whether the distribution of identified risk factors varied across the CHF, NHIF and non-member households. There was a higher concentration of identified risk factors among CHF households compared to those of the NHIF. Non-member households have a similar wealth status to CHF households, but a lower concentration of identified risk factors. Mechanisms for broader risk spreading and cross-subsidisation across the funds are necessary for the promotion of equity. These include risk equalisation to adjust for differential risk distribution and revenue raising capacity of the funds. Expansion of CHF coverage is equally important, by addressing non-financial barriers to CHF enrolment to encourage wealthy non-members to join, as well as subsidised membership for the poorest.
Full Text Available Indian health system is characterized by a vast public health infrastructure which lies underutilized, and a largely unregulated private market which caters to greater need for curative treatment. High out-of-pocket (OOP health expenditures poses barrier to access for healthcare. Among those who get hospitalized, nearly 25% are pushed below poverty line by catastrophic impact of OOP healthcare expenditure. Moreover, healthcare costs are spiraling due to epidemiologic, demographic, and social transition. Hence, the need for risk pooling is imperative. The present article applies economic theories to various possibilities for providing risk pooling mechanism with the objective of ensuring equity, efficiency, and quality care. Asymmetry of information leads to failure of actuarially administered private health insurance (PHI. Large proportion of informal sector labor in India′s workforce prevents major upscaling of social health insurance (SHI. Community health insurance schemes are difficult to replicate on a large scale. We strongly recommend institutionalization of tax-funded Universal Health Insurance Scheme (UHIS, with complementary role of PHI. The contextual factors for development of UHIS are favorable. SHI schemes should be merged with UHIS. Benefit package of this scheme should include preventive and in-patient curative care to begin with, and gradually include out-patient care. State-specific priorities should be incorporated in benefit package. Application of such an insurance system besides being essential to the goals of an effective health system provides opportunity to regulate private market, negotiate costs, and plan health services efficiently. Purchaser-provider split provides an opportunity to strengthen public sector by allowing providers to compete.
Full Text Available The impact of performance funding on community college student outcomes is a contested issue. Performance funding policies in most U.S. states involve too small a proportion of funding to change college behavior. English further education colleges are similar to U.S. community colleges. 1992 policy reforms in England centralized policy control, and implemented a per-pupil funding formula; 10% of all funding is based on student success but other components of the funding formula pay colleges more money for enrolling disadvantaged students. This research uses five years of student level data to test the impact of these policies. Overall student success rates rose by 10% during the five-year period, with the largest gains made by ethnic minorities, adult basic education students, and students from disadvantaged neighborhoods. Although the English system depends on regulatory agencies that do not exist in the U.S., the major assertion of this research is that market-based funding policies˜if properly designed˜can promote equity in educational achievement.
Mason, Chris; Barraket, Jo; Friel, Sharon; O'Rourke, Kerryn; Stenta, Christian-Paul
The role of social innovations in transforming the lives of individuals and communities has been a source of popular attention in recent years. This article systematically reviews the available evidence of the relationship between social innovation and its promotion of health equity. Guided by Fair Foundations: The VicHealth framework for health equity and examining four types of social innovation--social movements, service-related social innovations, social enterprise and digital social innovations--we find a growing literature on social innovation activities, but inconsistent evaluative evidence of their impacts on health equities, particularly at the socio-economic, political and cultural level of the framework. Distinctive characteristics of social innovations related to the promotion of health equity include the mobilization of latent or unrealised value through new combinations of (social, cultural and material) resources; growing bridging social capital and purposeful approaches to linking individual knowledge and experience to institutional change. These have implications for health promotion practice and for research about social innovation and health equity. © The Author 2015. Published by Oxford University Press. All rights reserved. For Permissions, please email: email@example.com.
This article attempts to describe the rationale that has led to the development of information sources dealing with equity, health, and human development in countries of Latin America and the Caribbean within the context of the Virtual Health Library (Biblioteca Virtual en Salud, BVS). Such information sources include the scientific literature, databases in printed and electronic format, institutional directories and lists of specialists, lists of events and courses, distance education programs, specialty journals and bulletins, as well as other means of disseminating health information. The pages that follow deal with the development of a Virtual Library in Equity, Health, and Human Development, an effort rooted in the conviction that decision-making and policy geared toward achieving greater equity in health must, of necessity, be based on coherent, well-organized, and readily accessible first-rate scientific information. Information is useless unless it is converted into knowledge that benefits society. The Virtual Library in Equity, Health, and Human Development is a coordinated effort to develop a decentralized regional network of scientific information sources, with strict quality control, from which public officials can draw data and practical examples that can help them set health and development policies geared toward achieving greater equity for all.
Snyder, Jeremy, E-mail: firstname.lastname@example.org [Faculty of Health Sciences, Simon Fraser University, 8888 University Drive, Burnaby, BC, V5A 1S6 (Canada); Wagler, Meghan, E-mail: email@example.com [Department of Health, Enkhtaivan Street, Building 13b, Suukhbaatar District, First Khoroo, Ulaanbaatar (Mongolia); Lkhagvasuren, Oyun, E-mail: firstname.lastname@example.org [Department of Health, Enkhtaivan Street, Building 13b, Suukhbaatar District, First Khoroo, Ulaanbaatar (Mongolia); Laing, Lory, E-mail: email@example.com [School of Public Health, University of Alberta, 3-50E University Terrace, Edmonton, AB, T6G 2T4 (Canada); Davison, Colleen, E-mail: firstname.lastname@example.org [Department of Community Health and Epidemiology, 2nd and 3rd Floors, Carruthers Hall, Queen& #x27; s University Kingston, ON, K7L 3N6 (Canada); Janes, Craig, E-mail: email@example.com [Faculty of Health Sciences, Simon Fraser University, 8888 University Drive, Burnaby, BC, V5A 1S6 (Canada)
A health impact assessment (HIA) is a tool for assessing the potential effects of a project or policy on a population's health. In this paper, we discuss a tool for successfully integrating equity concerns into HIAs. This discussion is the product of collaboration by Mongolian and Canadian experts, and it incorporates comments and suggestions of participants of a workshop on equity focused HIAs that took place in Mongolia in October, 2010. Our motivation for discussing this tool is based on the observation that existing HIAs tend either to fail to define equity or use problematic accounts of this concept. In this paper we give an overview of socio-demographic and health indicators in Mongolia and briefly discuss its mining industry. We then review three accounts of equity and argue for the importance of developing a consensus understanding of this concept when integrating considerations of equity into an HIA. Finally, we present findings from the workshop in Mongolia and outline a tool, derived from lessons from this workshop, for critically considering and integrating the concept of equity into an HIA.
Sergio Antonio Clavijo Clavijo
Full Text Available The world health should be considered a social welfareof human beings, since this is a prerequisite for thedevelopment of humanity. In the context of human rights,health equity is an inherent principle based on social justice,looking for all individuals regardless of their social, entitledto the same opportunities. Historically, have developedhealth services that provide social welfare to individuals, butthe concept has prevailed mercantilist, which has reducedhealth systems to simple utilities, ignoring the underlyingproblems of the population. It is proposed Primary HealthCare as an alternative, speaking as population includes theresponsibility to ensure health services accessibility and apossible response to the inequalities inherent in a systemfocused on health insurance. For this study was conductedreflects on the concept of equity, carrying out searches withthe terms equity, health, equity in health, health economics,quality health, public health, public health policy, healthhistory, primary health care with the aim of being able tocollect partial abstracts or full text. Additional to search forelectronic journals, books that will argue the importance ofequity in the companies were consulted, different economicmodels, the history of health and disease; nature relatingbills that argument on these definitions were consulted.
D.P. Budiono (Diana)
textabstractWe study the mutual fund performance for about 45 years. There are several key points that we can withdraw from this dissertation. First, to study the persistence of mutual fund performance, it is important to consider time-varying exposures because when they are ignored, the persistence
Full Text Available Urban places and health equity are two of the most challenging concepts for 21st century environmental health. More people live in cities than at any other time in human history and health inequities are increasing. Health inequities are avoidable differences in the social, environmental and political conditions that shape morbidity and mortality, and disproportionately burden the poor, racial, ethnic and religious minorities and migrants. By linking urban place and health inequities, research and action brings into sharp relief the challenges of achieving urban environmental justice. This article briefly reviews the complex definitions of urban places and how they can shape health equity in cities. I suggest that a more relational or integrated approach to defining urban places and acting on health equity can complement other approaches and improve the ability of public health to meet 21st century challenges. I close with suggestions for research and practice that might focus environmental public health on healthy urban place making. The practices include community driven map making, Health in All Policies (HiAP, promoting urban ecosystem services for health, and participatory and integrated approaches to urban slum upgrading. I conclude that if the global community is serious about the sustainable development goals (SDGs, greater attention must be paid to understanding and acting to improve urban places, living conditions and the social and economic conditions that can promote health equity.
Urban places and health equity are two of the most challenging concepts for 21st century environmental health. More people live in cities than at any other time in human history and health inequities are increasing. Health inequities are avoidable differences in the social, environmental and political conditions that shape morbidity and mortality, and disproportionately burden the poor, racial, ethnic and religious minorities and migrants. By linking urban place and health inequities, research and action brings into sharp relief the challenges of achieving urban environmental justice. This article briefly reviews the complex definitions of urban places and how they can shape health equity in cities. I suggest that a more relational or integrated approach to defining urban places and acting on health equity can complement other approaches and improve the ability of public health to meet 21st century challenges. I close with suggestions for research and practice that might focus environmental public health on healthy urban place making. The practices include community driven map making, Health in All Policies (HiAP), promoting urban ecosystem services for health, and participatory and integrated approaches to urban slum upgrading. I conclude that if the global community is serious about the sustainable development goals (SDGs), greater attention must be paid to understanding and acting to improve urban places, living conditions and the social and economic conditions that can promote health equity.
Many children in the United States fail to reach their full health and developmental potential. Disparities in their health and well-being result from the complex interplay of multiple social and environmental determinants that are not adequately addressed by current standards of pediatric practice or public policy. Integrating the principles and practice of child health equity-children's rights, social justice, human capital investment, and health equity ethics-into pediatrics will address the root causes of child health disparities. Promoting the principles and practice of equity-based clinical care, child advocacy, and child- and family-centered public policy will help to ensure that social and environmental determinants contribute positively to the health and well-being of children. The American Academy of Pediatrics and pediatricians can move the national focus from documenting child health disparities to advancing the principles and practice of child health equity and, in so doing, influence the worldwide practice of pediatrics and child health. All pediatricians, including primary care practitioners and medical and surgical subspecialists, can incorporate these principles into their practice of pediatrics and child health. Integration of these principles into competency-based training and board certification will secure their assimilation into all levels of pediatric practice.
Introduction International evidence shows that enhancement of primary health care (PHC) services for disadvantaged populations is essential to reducing health and health care inequities. However, little is known about how to enhance equity at the organizational level within the PHC sector. Drawing on research conducted at two PHC Centres in Canada whose explicit mandates are to provide services to marginalized populations, the purpose of this paper is to discuss (a) the key dimensions of equity-oriented services to guide PHC organizations, and (b) strategies for operationalizing equity-oriented PHC services, particularly for marginalized populations. Methods The PHC Centres are located in two cities within urban neighborhoods recognized as among the poorest in Canada. Using a mixed methods ethnographic design, data were collected through intensive immersion in the Centres, and included: (a) in-depth interviews with a total of 114 participants (73 patients; 41 staff), (b) over 900 hours of participant observation, and (c) an analysis of key organizational documents, which shed light on the policy and funding environments. Results Through our analysis, we identified four key dimensions of equity-oriented PHC services: inequity-responsive care; trauma- and violence-informed care; contextually-tailored care; and culturally-competent care. The operationalization of these key dimensions are identified as 10 strategies that intersect to optimize the effectiveness of PHC services, particularly through improvements in the quality of care, an improved 'fit' between people's needs and services, enhanced trust and engagement by patients, and a shift from crisis-oriented care to continuity of care. Using illustrative examples from the data, these strategies are discussed to illuminate their relevance at three inter-related levels: organizational, clinical programming, and patient-provider interactions. Conclusions These evidence- and theoretically-informed key dimensions and
Browne Annette J
Full Text Available Abstract Introduction International evidence shows that enhancement of primary health care (PHC services for disadvantaged populations is essential to reducing health and health care inequities. However, little is known about how to enhance equity at the organizational level within the PHC sector. Drawing on research conducted at two PHC Centres in Canada whose explicit mandates are to provide services to marginalized populations, the purpose of this paper is to discuss (a the key dimensions of equity-oriented services to guide PHC organizations, and (b strategies for operationalizing equity-oriented PHC services, particularly for marginalized populations. Methods The PHC Centres are located in two cities within urban neighborhoods recognized as among the poorest in Canada. Using a mixed methods ethnographic design, data were collected through intensive immersion in the Centres, and included: (a in-depth interviews with a total of 114 participants (73 patients; 41 staff, (b over 900 hours of participant observation, and (c an analysis of key organizational documents, which shed light on the policy and funding environments. Results Through our analysis, we identified four key dimensions of equity-oriented PHC services: inequity-responsive care; trauma- and violence-informed care; contextually-tailored care; and culturally-competent care. The operationalization of these key dimensions are identified as 10 strategies that intersect to optimize the effectiveness of PHC services, particularly through improvements in the quality of care, an improved 'fit' between people's needs and services, enhanced trust and engagement by patients, and a shift from crisis-oriented care to continuity of care. Using illustrative examples from the data, these strategies are discussed to illuminate their relevance at three inter-related levels: organizational, clinical programming, and patient-provider interactions. Conclusions These evidence- and theoretically
Holden, Kisha; Charles, Lisa; King, Stephen; McGregor, Brian; Satcher, David; Belton, Allyson
St. Lucia is an island nation in the Eastern Caribbean, with a population of 179,000 people, where chronic health conditions, such as hypertension and diabetes, are significant. The purpose of this pilot study is to create a model for community health education, tracking, and monitoring of these health conditions, research training, and policy interventions in St. Lucia, which may apply to other Caribbean populations, including those in the U.S. This paper reports on phase one of the study, which utilized a mixed method analytic approach. Adult clients at risk for, or diagnosed with, diabetes (n = 157), and health care providers/clinic administrators (n = 42), were recruited from five healthcare facilities in St. Lucia to assess their views on health status, health services, and improving health equity. Preliminary content analyses indicated that patients and providers acknowledge the relatively high prevalence of diabetes and other chronic illnesses, recognize the impact that socioeconomic status has on health outcomes, and desire improved access to healthcare and improvements to healthcare infrastructures. These findings could inform strategies, such as community education and workforce development, which may help improve health outcomes among St. Lucians with chronic health conditions, and inform similar efforts among other selected populations. PMID:26703647
Full Text Available St. Lucia is an island nation in the Eastern Caribbean, with a population of 179,000 people, where chronic health conditions, such as hypertension and diabetes, are significant. The purpose of this pilot study is to create a model for community health education, tracking, and monitoring of these health conditions, research training, and policy interventions in St. Lucia, which may apply to other Caribbean populations, including those in the U.S. This paper reports on phase one of the study, which utilized a mixed method analytic approach. Adult clients at risk for, or diagnosed with, diabetes (n = 157, and health care providers/clinic administrators (n = 42, were recruited from five healthcare facilities in St. Lucia to assess their views on health status, health services, and improving health equity. Preliminary content analyses indicated that patients and providers acknowledge the relatively high prevalence of diabetes and other chronic illnesses, recognize the impact that socioeconomic status has on health outcomes, and desire improved access to healthcare and improvements to healthcare infrastructures. These findings could inform strategies, such as community education and workforce development, which may help improve health outcomes among St. Lucians with chronic health conditions, and inform similar efforts among other selected populations.
Holden, Kisha; Charles, Lisa; King, Stephen; McGregor, Brian; Satcher, David; Belton, Allyson
St. Lucia is an island nation in the Eastern Caribbean, with a population of 179,000 people, where chronic health conditions, such as hypertension and diabetes, are significant. The purpose of this pilot study is to create a model for community health education, tracking, and monitoring of these health conditions, research training, and policy interventions in St. Lucia, which may apply to other Caribbean populations, including those in the U.S. This paper reports on phase one of the study, which utilized a mixed method analytic approach. Adult clients at risk for, or diagnosed with, diabetes (n = 157), and health care providers/clinic administrators (n = 42), were recruited from five healthcare facilities in St. Lucia to assess their views on health status, health services, and improving health equity. Preliminary content analyses indicated that patients and providers acknowledge the relatively high prevalence of diabetes and other chronic illnesses, recognize the impact that socioeconomic status has on health outcomes, and desire improved access to healthcare and improvements to healthcare infrastructures. These findings could inform strategies, such as community education and workforce development, which may help improve health outcomes among St. Lucians with chronic health conditions, and inform similar efforts among other selected populations.
Anselmi, Laura; Lagarde, Mylène; Hanson, Kara
In contexts where health services are mostly publicly provided and access is still limited, health financing systems require some mechanism for distributing financial resources across geographic areas according to population need. Equity in public health expenditure has been evaluated either by comparing allocations across spending units to equitable shares established using resource allocation formulae, or by using benefit incidence analysis to look at the distribution of expenditure across individual service users. In the latter case, the distribution across individuals has typically not been linked to the mechanisms that determine the allocation across geographic areas, and to the utilization of specific services by individuals. In this paper, we apply benefit incidence analysis in an innovative way to assess horizontal and vertical equity in the geographic allocation of recurrent expenditure for outpatient health care across districts in Mozambique. We compare the actual distribution of expenditure with horizontal and vertical equity benchmarks, set according to measures of economic status and need for health care. We quantify the observed inequities and the relative contributions of service use and resource allocation. We analyse government and donor expenditure separately and combined, for the years 2008-2011 to compare changes over time and funding source. We use data from a number of national routine sources. Results show improvements in both horizontal and vertical equity, along with the gradual alignment of government and donor resources over time, which resulted in almost horizontally and vertically equitable resource allocation in 2011. However, inequities in the distribution of expenditure across beneficiaries persisted and were driven by inequities in service use. The discrepancy between economic and need indicators highlighted initial differences in government and donor expenditure targets, raising questions about the purpose of public health
© 2017 by the authors; licensee MDPI, Basel, Switzerland. Urban places and health equity are two of the most challenging concepts for 21st century environmental health. More people live in cities than at any other time in human history and health inequities are increasing. Health inequities are avoidable differences in the social, environmental and political conditions that shape morbidity and mortality, and disproportionately burden the poor, racial, ethnic and religious minorities and migra...
Baker, Peter A
In 1994, the African National Congress (ANC) won South Africa's first ever democratic election. It inherited a health service that was indelibly marked with the inequities of the apartheid era, highly privatized and distorted toward the hospital needs of urban Whites. The ANC's manifesto promised major improvements, but this study finds only two significant health equity improvements: (1) primary care had funding increased by 83 percent and was better staffed; and (2) health care workers became significantly more race-representative of the population. These improvements, however, were outweighed by equity losses in the deteriorating public-private mix. Policy analysis of the elite actors attributes this failure to the dominance of the Treasury's neoliberal macroeconomic policy (GEAR), which severely limited any increases in public spending. The ANC's nationalist ideology underpinned GEAR and many of the health equity decisions. It united the ANC, international capital, African elites, and White capital in a desire for an African economic renaissance. And it swept the population along with it, becoming the new hegemonic ideology. As this study finds, the successful policies were those that could be made a part of this active hegemonic reformation, symbolically celebrating African nationalism, and did not challenge the interests of the major actors.
Spiegel, Jerry M; Breilh, Jaime
To improve the governance needed to create Healthy Cities, it is essential that policy processes directly engage marginalized populations and address the forces that affect health equity. Framings such as that provided by the Latin American collective health/social medicine/critical epidemiology orientation to critical processes of social determination of health enables a move beyond a reductionist focus to challenge the drivers that undermine health, and are consistent with policy directives such as the Shanghai Declaration on promoting health in the 2030 Agenda for Sustainable Development.
Systems change is necessary for improving health care in the United States, especially for populations suffering from health disparities. Theoretical and methodological contributions of anthropology to health care design and delivery can inform systems change by providing a window into provider and patient perceptions and practices. Our community-engaged research teams conduct in-depth investigations of provider perceptions of patients, often uncovering gaps between patient and provider perceptions resulting in the degradation of health equity. We present examples of projects where collaborations between anthropologists and health professionals resulted in actionable data on functioning and malfunctioning systemic momentum toward efforts to eliminate disparities and support wellness. PMID:27158189
Hagan, Teresa L; Cohen, Susan M
Females' experiences of identity, health, and equity share similar features around the world. This literary analysis describes the narratives of 4 female protagonists from popular fiction novels to identify similarities between their personal and contextualized experiences. The impact these private realities and public structures have on female health will be used to demonstrate the universal ecological threats to women's health. In conclusion, we offer suggestions on how to incorporate the shared female movement from domination and separation toward liberation and connection into modern health care practices that emphasize shared decision making, open communication, and social activism.
Equity in health has been the underlying value of the World Health Organization's (WHO) Health for All policy for 30 years. This article examines how cities have translated this principle into action. Using information designed to help evaluate phase IV (2003-2008) of the WHO European Healthy Cities Network (WHO-EHCN) plus documentation from city programs and websites, an attempt is made to assess how far the concept of equity in health is understood, the political will to tackle the issue, and types of action taken. Results show that although cities continue to focus considerable support on vulnerable groups, rather than the full social gradient, most are now making the necessary shift towards more upstream policies to tackle determinants of health such as poverty, unemployment, education, housing, and the environment, without neglecting access to care. Although local level data reflecting inequalities in health is improving, there is still a long way to go in some cities. The Healthy Cities Project is becoming an integral part of structures for long-term planning and intersectoral action for health in cities, and Health Impact Assessment is gradually being developed. Participation in the WHO-EHCN appears to allow new members to leap-frog ahead established cities. However, this evaluation also exposes barriers to effective local policies and processes to reduce health inequalities. Armed with locally generated evidence of critical success factors, the WHO-EHCN has embarked on a more rigorous and determined effort to achieve the prerequisites for equity in health. More attention will be given to evaluating the effectiveness of action taken and to dealing not only with the most vulnerable but a greater part of the gradient in socioeconomic health inequalities.
Chauvin, James; Perera, Yoshith; Clarke, Michael
Digital technology (DT) plays an increasingly important role in the health sector. This study explores how national public health associations (PHAs) use DT to achieve their mandate. The World Federation of Public Health Associations canvassed and conducted a semi-structured interview with its national public health association members about their use of DT, the challenges they encounter in using it, and their experiences and thoughts as to how to assess its impact, both organizationally as well as on population health and health equity. The study found that digital technology plays an important role in some PHAs, principally those in higher income countries. PHAs want to broaden their use within PHAs and to assess how DT enables PHAs to achieve their organizational mandates and goals, including improved public health and health equity.
Eklund Karlsson, Leena; Saleh, Faten; Azam, Shadi
health and to explore whether the documents include an equity perspective, and whether the suggested measures in these documents communicate a clear focus on promoting equity and/or on addressing the social gradient (the term refers to, that health improves with income throughout the income distribution...... was not explicitly used in these documents but the idea of equity was implicitly communicated by addressing objectives for tackling poverty and guaranteeing that all social groups share the benefits of growth and improvement of quality of life. Conclusions: The state’s role to protect health and provide health care...... to every citizen was emphasised. However, there is a need for an in-depth analysis on the concrete policy measures and implementation addressing health equity in KSA....
Ahmad Reza Hosseinpoor
Full Text Available Background: Health equity is a priority in the post-2015 sustainable development agenda and other major health initiatives. The World Health Organization (WHO has a history of promoting actions to achieve equity in health, including efforts to encourage the practice of health inequality monitoring. Health inequality monitoring systems use disaggregated data to identify disadvantaged subgroups within populations and inform equity-oriented health policies, programs, and practices. Objective: This paper provides an overview of a number of recent and current WHO initiatives related to health inequality monitoring at the global and/or national level. Design: We outline the scope, content, and intended uses/application of the following: Health Equity Monitor database and theme page; State of inequality: reproductive, maternal, newborn, and child health report; Handbook on health inequality monitoring: with a focus on low- and middle-income countries; Health inequality monitoring eLearning module; Monitoring health inequality: an essential step for achieving health equity advocacy booklet and accompanying video series; and capacity building workshops conducted in WHO Member States and Regions. Conclusions: The paper concludes by considering how the work of the WHO can be expanded upon to promote the establishment of sustainable and robust inequality monitoring systems across a variety of health topics among Member States and at the global level.
Resaland, Sjur; Riis, Luca Alexander
As Norway possesses a large petroleum wealth, there has been calls for a change regarding the Government Pension Fund Global´s (GPFG´s) investments in petroleum equities based on diversification considerations. This subject has been debated by the Ministry of Finance in White Paper nr. 19, where the conclusion was not to alter the GPFG´s investment strategy as no long-term relationship between the oil price and oil and gas stocks was discovered. Evaluating the investment strate...
Full Text Available Contextualisation This research note describes a proposed study which aims to examine the issue of how higher education in Rwanda might be funded. The amount the government spends on one student at university equals that of 150 students in a primary school. Research carried out in other countries suggests that loans are more effective, and equitable, as a form of financial aid. The implications of this, for the Rwandan context are discussed. Abstract: This research note describes the background to and plans for, a study to examine whether, in the context of higher education in Rwanda, the provision of loans, instead of grants/scholarships as a means of financial support to students in university, is likely to enhance equity and efficiency. It also aims to examine whether the current system is effective in meeting the manpower and employment needs of Rwanda. The participants of the proposed study include Rectors, Vice-Rectors, and student leaders in public and private universities: participant perceptions will be collected through questionnaires and interviews. Those interviewed will also include the Minister of Finance and Education. Quantitative methods will also be used to analyse the relative efficiency of loans compared to scholarships. It is hoped that the results of the study will indicate whether loans are a more efficient and equitable financing method compared to scholarships.
..., Emerging Markets Equity Fund, Emerging Markets Equity Index Fund, Enhanced International Equity Index Fund... Fund, Emerging Markets Equity Fund, Emerging Markets Equity Index Fund, Enhanced International Equity... Market Fund, Real Estate Securities Fund, Short-Term Bond Fund, Small-Cap Equity Fund; Teachers...
Salter, Katherine; Salvaterra, Rosana; Antonello, Deborah; Cohen, Benita E; Kothari, Anita; LeBer, Marlene Janzen; LeMieux, Suzanne; Moran, Kathy; Rizzi, Katherine; Robson, Jordan; Wai, Caroline
To determine what organizational level indicators exist that could be used by local Ontario public health agencies to monitor and guide their progress in addressing health equity. This scoping review employed Arksey and O'Malley's (2005) six-stage framework. Multiple online databases and grey literature sources were searched using a comprehensive strategy. Studies were included if they described or used indicators to assess an organization's health equity activity. Abstracted indicator descriptions were classified using the roles for public health action identified by the Canadian National Collaborating Centre for Determinants of Health (NCCDH). Health equity experts participated in a consultation phase to examine items extracted from the literature. Eighteen peer-reviewed studies and 30 grey literature reports were included. Abstracted indicators were considered for 1) relevance for organizational assessment, 2) ability to highlight equity-seeking populations, and 3) potential feasibility for application. Twenty-eight items formed the basis for consultation with 13 selected health equity experts. Items considered for retention were all noted to require significant clarification, definition and development. Those eliminated were often redundant or not an organizational level indicator. Few evidence-based, validated indicators to monitor and guide progress to address health inequities at the level of the local public health organization were identified. There is a need for continued development of identified indicator items, including careful operationalization of concepts and establishing clear definitions for key terms.
Hall, Mark A
United States' courts have played a limited, yet key, role in shaping health equity in three areas of law: racial discrimination, disability discrimination, and constitutional rights. Executive and administrative action has been much more instrumental than judicial decisions in advancing racial equality in health care. Courts have been reluctant to intervene on racial justice because overt discrimination has largely disappeared, and the Supreme Court has interpreted civil rights laws in a fashion that restricts judicial authority to address more subtle or diffused forms of disparate impact. In contrast, courts have been more active in limiting disability discrimination by expanding the conditions that are considered disabling and by articulating and applying the operative concepts "reasonable accommodation" and "other qualified" in the context of both treatment and insurance coverage decisions. Finally, regarding constitutional rights, courts have had limited opportunity to intervene because, outside of specially protected arenas such as reproduction, constitutional law gives government wide discretion to define health and safety goals and methods. Thus, courts have had only a limited role in shaping health equity in the United States. It remains to be seen whether this will change under the Affordable Care Act or whatever health reform measure might replace it. Copyright © 2017 by Duke University Press.
Rashad, Hoda; Khadr, Zeinab
This paper proposes measurement tracks of health equity (HE) and presents practical illustrations to influence, inform and guide the uptake of equity-sensitive policies. It discusses the basic requirements that allow the effective use of the proposed measurement tracks. Egypt is used as a demonstration of this practice. The paper differentiates between the policy needs of two groups of countries. The first set of measurement tracks are specifically tailored to countries at the early stages of considering health equity, requiring support in placing HE on the policy agenda. Key messages for this group of countries are that the policy influence of measurement can be strengthened through the implementation of four self-reinforcing tracks that recognize the need to effectively use the available current databases prior to engaging in new data collection, emphasize the importance of a social justice reframing of the documented health inequities, present health inequity facts in simple visual messages and move beyond the why to what needs to be done and how. The tracks also recognizes that placing an issue on the policy agenda is a complex matter requiring reinforcement from many actors and navigation among competing forces and policy circles. For the second group of countries the paper discusses the monitoring framework. The key messages include the importance of moving toward a more comprehensive system that sustains the monitoring system which is embedded within affective participatory accountability mechanisms. The paper discusses the basic requirements and the institutional, financial, technical and human capacity-building considerations for implementing the proposed measurement tracks.
Full Text Available This paper tackles the difficult and often not openly discussed This paper tackles the difficult and often not openly discussed topic of access and equity in higher education for people with mental health difficulties. Recent legislative and policy developments in mental health, disability, anti-discrimination and education mean that all students who disclose a mental health condition can expect fair and equitable treatment. However the findings of an exploratory study at an Australian university reveal that just under two thirds of the 54 students who reported mental health difficulties did not disclose this to staff due to fears of discrimination at university and in future employment. Students who did disclose felt supported when staff displayed a respectful attitude and provided appropriate advice and useful strategies for them to remain engaged in university studies when experiencing mental health difficulties.
Full Text Available The EBRD is the largest investor in private equity funds, mainly focusing on growth and expansion in countries of operation. The significant support to its private equity fund managers accelerates the development and institutionalisation of the private equity industry in the region. For EBRD, equity investments are made indirectly through regional and sector funds. These funds are created by groups of investors, mostly private, to which the EBRD participates with capital.
Povlsen, Lene; Eklund Karlsson, Leena; Regber, Susann;
Aims: To explore if the term equity was applied and how measures for addressing social inequalities in health and reducing inequity were communicated in selected Nordic documents concerning public health. Methods: Documents from Denmark, Finland, Norway, and Sweden were collected and analysed...... by Nordic authors. Data included material from websites of ministries and authorities responsible for public health issues, with primary focus on steering documents, action programmes, and reports from 2001 until spring 2013. Results: Most strategies applied in Danish, Finnish, and Swedish documents focused...... on the population in general but paid special attention to vulnerable groups. The latest Danish and Finnish documents communicate a clearer commitment to address social inequalities in health. They emphasise the social gradient and the need to address the social determinants in order to improve the position...
... Health Parity and Addiction Equity Act of 2008 AGENCY: Internal Revenue Service (IRS), Treasury. ACTION... regulations under the Paul Wellstone and Pete Domenici Mental Health Parity and Addiction Equity Act of 2008...
Rooddehghan, Zahra; Nasrabadi, Alireza Nikbakht; Parsa Yekta, Zohreh
Equity in health is one of key objectives in health care systems world wide. This study aimed to explain the perspective of Iranian nurses about equity in the health care system. A qualitative exploratory design with thematic analysis approach was used to collect and analyze data. Using a purposeful sampling helped the researchers to recruit 16 eligible participants. Data were collected via in-depth semi-structured interviews. Five main categories were extracted through data analysis process including (1) inequity against the nurse, (2) the recommended patient, (3) no claim for equity-oriented care in health system, (4) physicians' dominancy system; and (5) the need to define criteria to measure equity-oriented care. All health care systems around the world struggle to establish equity-oriented care. In perspective of Iranian nurses, the reform of structures in the health system is possible through providing the context of equitable care for caregivers and care recipients. Health system should commit the flow of equity at all of its levels. It should utilize policies to claim equity and consider the interests of all beneficiaries. Furthermore, certain criteria should be defined for equity-oriented care in the health care system, and also provides the possibility to measure and monitor it.
In 1979, when the Frente Sandinista de Liberacion Nacional (FSLN), a popular revolutionary front, deposed Nicaragua's ruling Somoza family, the Nicaraguan population's health status ranked with that of Bolivia and Honduras as the worst in Latin America. The Sandinista government committed itself to improving health services and health status such that in 1982, the World Health Organization commended the major advances in health care made in the government's first few years. That progress, however, has not been maintained as Sandinista health, nutrition, literacy, and agrarian programs have been abandoned by the government under pressure from the International Monetary Fund (IMF) and the US government to privatize and cut public spending. The progress made over the past decade is now being undone by an imposed structural adjustment policy and the burden of international debt. The IMF has disregarded social equity as a criterion for its programs. Under current conditions, the health and well-being of the Nicaraguan people will continue to deteriorate. Until the Nicaraguan debt situation is resolved, there is no hope for sustainable growth and development.
Full Text Available In 2014, a series of reforms, called as the Health Sector Evolution Plan (HSEP, was launched in the health system of Iran in a stepwise process. HSEP was mainly based on the fifth 5-year health development national strategies (2011-2016. It included different interventions to: increase population coverage of basic health insurance, increase quality of care in the Ministry of Health and Medical Education (MoHME affiliated hospitals, reduce out-of-pocket (OOP payments for inpatient services, increase quality of primary healthcare, launch updated relative value units (RVUs of clinical services, and update tariffs to more realistic values. The reforms resulted in extensive social reaction and different professional feedback. The official monitoring program shows general public satisfaction. However, there are some concerns for sustainability of the programs and equity of financing. Securing financial sources and fairness of the financial contribution to the new programs are the main concerns of policy-makers. Healthcare providers’ concerns (as powerful and influential stakeholders potentially threat the sustainability and efficiency of HSEP. Previous experiences on extending health insurance coverage show that they can lead to a regressive healthcare financing and threat financial equity. To secure financial sources and to increase fairness, the contributions of people to new interventions should be progressive by their income and wealth. A specific progressive tax would be the best source, however, since it is not immediately feasible, a stepwise increase in the progressivity of financing must be followed. Technical concerns of healthcare providers (such as nonplausible RVUs for specific procedures or nonefficient insurance-provider processes should be addressed through proper revision(s while nontechnical concerns (which are derived from conflicting interests must be responded through clarification and providing transparent information. The
Moradi-Lakeh, Maziar; Vosoogh-Moghaddam, Abbas
In 2014, a series of reforms, called as the Health Sector Evolution Plan (HSEP), was launched in the health system of Iran in a stepwise process. HSEP was mainly based on the fifth 5-year health development national strategies (2011-2016). It included different interventions to: increase population coverage of basic health insurance, increase quality of care in the Ministry of Health and Medical Education (MoHME) affiliated hospitals, reduce out-of-pocket (OOP) payments for inpatient services, increase quality of primary healthcare, launch updated relative value units (RVUs) of clinical services, and update tariffs to more realistic values. The reforms resulted in extensive social reaction and different professional feedback. The official monitoring program shows general public satisfaction. However, there are some concerns for sustainability of the programs and equity of financing. Securing financial sources and fairness of the financial contribution to the new programs are the main concerns of policy-makers. Healthcare providers' concerns (as powerful and influential stakeholders) potentially threat the sustainability and efficiency of HSEP. Previous experiences on extending health insurance coverage show that they can lead to a regressive healthcare financing and threat financial equity. To secure financial sources and to increase fairness, the contributions of people to new interventions should be progressive by their income and wealth. A specific progressive tax would be the best source, however, since it is not immediately feasible, a stepwise increase in the progressivity of financing must be followed. Technical concerns of healthcare providers (such as nonplausible RVUs for specific procedures or nonefficient insurance-provider processes) should be addressed through proper revision(s) while nontechnical concerns (which are derived from conflicting interests) must be responded through clarification and providing transparent information. The requirements of
Eslava-Schmalbach, Javier; Barón, Gilberto; Gaitán-Duarte, Hernando; Alfonso, Helman; Agudelo, Carlos; Sánchez, Carolina
An economic analysis of cost-equity (from society's viewpoint) for evaluating the impact of Law 100/93 in Colombia between 1998 and 2005. An economic analysis compared costs and equity in health in Colombia between 1998 and 2005. Data was taken from the Colombian Statistics' Administration Department ( Departamento Administrativo Nacional de Estadistica - DANE) and from national demographic and health surveys carried out in 2000 and 2005. Information regarding costs was taken from the National Health Accounts' System. Inequity in Health was considered in line with the Inequity in Health Index (IHI). Incremental and average cost-equity analysis covered three sub-periods; 1998-1999 (during which time per capita gross internal product became reduced in Colombia ), 2000-2001 (during which time total health expense became reduced) and 2001 -2005. An unstable tendency for inequity in health becoming reduced during the period was revealed. There was an inverse relationship between IHI and public health spending and a direct relationship between out-of-pocket spending on health and equity in health (Spearman, p<0.05). The second period had the best incremental cost-equity ratio. Fluctuations in IHI and marginal cost-equity during the periods being analysed suggested that health spending depended on equity in health in Colombia during the period being studied.
Gunning-Schepers, L J; Stronks, K
In discussions about equity there is a tendency to focus on the inequalities in health status that appear to be the result of the material and immaterial consequences of a lower income, professional or social status in society. If we look at publications such as the Black Report in the UK or Ongelijke gezondheid in The Netherlands, we have to accept that despite our universal access to healthcare and the existence in many Western countries of social security measures that preclude 'real' poverty, considerable differences in health continue to exist between socioeconomic groups. This is corroborated for many other European countries in the research carried out by a concerted action led by Mackenbach. These inequalities in health have been referred to in many countries as inequities, meaning that society finds them unjust and expects them to be 'avoidable' or amenable to policy interventions. However, the research on the causal networks underlying the occurrence and the avoidability of inequalities in health remains sparse and intervention studies seem to focus on policy measures that can be evaluated, but which will most likely have a limited impact on the inequalities measured at the population level. Thus the research community leaves policymakers with very little evidence on which to build policy initiatives that are nevertheless requested by many governments. The third element, which needs to be addressed in this context, is the ominous inequality in access to healthcare. Since the debate on equity in health has rightly been initiated in the context of a broader, more intersectoral approach to health policy, very little attention has been paid, so far, to the issue of universal access to quality healthcare services. This is because in the second half of this century most Western (European) countries have created a healthcare system with universal access, financed either through taxation or through social insurance schemes. It is these financing systems that will
Weiler, Anelyse M; Hergesheimer, Chris; Brisbois, Ben; Wittman, Hannah; Yassi, Annalee; Spiegel, Jerry M
There has been growing policy interest in social justice issues related to both health and food. We sought to understand the state of knowledge on relationships between health equity--i.e. health inequalities that are socially produced--and food systems, where the concepts of 'food security' and 'food sovereignty' are prominent. We undertook exploratory scoping and mapping stages of a 'meta-narrative synthesis' on pathways from global food systems to health equity outcomes. The review was oriented by a conceptual framework delineating eight pathways to health (in)equity through the food system: 1--Multi-Scalar Environmental, Social Context; 2--Occupational Exposures; 3--Environmental Change; 4--Traditional Livelihoods, Cultural Continuity; 5--Intake of Contaminants; 6--Nutrition; 7--Social Determinants of Health and 8--Political, Economic and Regulatory context. The terms 'food security' and 'food sovereignty' were, respectively, paired with a series of health equity-related terms. Combinations of health equity and food security (1414 citations) greatly outnumbered pairings with food sovereignty (18 citations). Prominent crosscutting themes that were observed included climate change, biotechnology, gender, racialization, indigeneity, poverty, citizenship and HIV as well as institutional barriers to reducing health inequities in the food system. The literature indicates that food sovereignty-based approaches to health in specific contexts, such as advancing healthy school food systems, promoting soil fertility, gender equity and nutrition, and addressing structural racism, can complement the longer-term socio-political restructuring processes that health equity requires. Our conceptual model offers a useful starting point for identifying interventions with strong potential to promote health equity. A research agenda to explore project-based interventions in the food system along these pathways can support the identification of ways to strengthen both food
Shah, Koonal K; Cookson, Richard; Culyer, Anthony J; Littlejohns, Peter
The National Institute for Health and Clinical Excellence (NICE) routinely publishes details of the evidence and reasoning underpinning its recommendations, including its social value judgements (SVJs). To date, however, NICE's SVJs relating to equity in the distribution of health and health care have been less specific and systematic than those relating to cost-effectiveness in the pursuit of improved total population health. NICE takes a pragmatic, case-based approach to developing its principles of SVJ, drawing on the cumulative experience of its advisory bodies in making decisions that command respect among its broad range of stakeholders. This paper aims to describe the SVJs about equity in health and health care that NICE has hitherto used to guide its decision making. To do this, we review both the general SVJs reported in NICE guidance on methodology and the case-specific SVJs reported in NICE guidance about particular health care technologies and public health interventions.
Yonas, Michael A; Jones, Nora; Eng, Eugenia; Vines, Anissa I; Aronson, Robert; Griffith, Derek M; White, Brandolyn; DuBose, Melvin
In this nation, the unequal burden of disease among People of Color has been well documented. One starting point to eliminating health disparities is recognizing the existence of inequities in health care delivery and identifying the complexities of how institutional racism may operate within the health care system. In this paper, we explore the integration of community-based participatory research (CBPR) principles with an Undoing Racism process to conceptualize, design, apply for, and secure National Institutes of Health (NIH) funding to investigate the complexities of racial equity in the system of breast cancer care. Additionally, we describe the sequence of activities and "necessary conflicts" managed by our Health Disparities Collaborative to design and submit an application for NIH funding. This process of integrating CBPR principles with anti-racist community organizing presented unique challenges that were negotiated only by creating a strong foundation of trusting relationships that viewed conflict as being necessary. The process of developing a successful NIH grant proposal illustrated a variety of important lessons associated with the concepts of cultural humility and cultural safety. For successfully conducting CBPR, major challenges have included: assembling and mobilizing a partnership; the difficulty of establishing a shared vision and purpose for the group; the problem of maintaining trust; and the willingness to address differences in institutional cultures. Expectation, acceptance and negotiation of conflict were essential in the process of developing, preparing and submitting our NIH application. Central to negotiating these and other challenges has been the utilization of a CBPR approach.
McMichael, Celia; Healy, Judith
ABSTRACT Background: Migrant health is receiving increasing international attention, reflecting recognition of the health inequities experienced among many migrant populations and the need for health systems to adapt to diverse migrant populations. In the Greater Mekong Subregion (GMS) there is increasing migration associated with uneven economic integration and growth, socio-economic vulnerabilities, and disparities between countries. There has been limited progress, however, in improving migrant access to health services in the Subregion. This paper examines the health needs, access barriers, and policy responses to cross-border migrants in five GMS countries. Methods: A review of published literature and research was conducted on migrant health and health service access in Cambodia, Lao People’s Democratic Republic, Myanmar, Thailand, and Viet Nam, as well as analysis of current migration trends and universal health coverage (UHC) indicators in the Subregion. The review included different migrant types: i.e. migrant workers, irregular migrants, victims of trafficking, refugees and asylum seekers, and casual cross-border migrants. Results: There is substantial diversity in the capacity of GMS health systems to address migrant populations. Thailand has sought to enhance migrant health coverage, including development of migrant health policies/programs, bilateral migrant worker agreements, and migrant health insurance schemes; Viet Nam provides health protection for emigrant workers. Overall, however, access to good quality health care remains weak for many citizens in GMS countries let alone migrants. Migrant workers – and irregular migrants in particular – face elevated health risks yet are not adequately covered and incur high out-of-pocket (OOP) payments for health services. Conclusions: UHC implies equity: UHC is only achieved when everyone has the opportunity to access and use good-quality health care. Efforts to achieve UHC in the GMS require
Montagu, Dominic; Graff, Maura
National and international decisions on financing for sexual and reproductive health (SRH) services have profound effects on the type, unit costs and distribution of SRH commodities and services produced, and on their availability and consumption. Much international and national funding is politically driven and is doing little for equity and quality improvement. Financing remains a significant challenge in most developing countries and demands creative responses. While no "one-size-fits-all" solution exists, there are numerous ongoing examples of successful innovations, many of which are focusing on resource pooling and on purchasing or subsidising SRH services. In this article we have used interviews, grey literature and presentations made at a range of recent public fora to identify new and innovative ways of financing SRH services so as to increase equity in developing countries. Because SRH services are often of low value as a personal good but high value as a public good, we summarise the issues from a societal perspective, highlighting the importance of financing and policy decisions for SRH services. We provide a structured overview of what novel approaches to financing appear to have positive effects in a range of developing countries. Targeting, government payment mechanisms, subsidy delivery and co-financing for sustainability are highlighted as showing particular promise. Examples are used throughout the article to illustrate innovative strategies.
Full Text Available Air pollution is an important public health problem in Europe and there is evidence that it exacerbates health inequities. This calls for effective strategies and targeted interventions. In this study, we conducted a systematic review to evaluate the effectiveness of strategies relating to air pollution control on public health and health equity in Europe. Three databases, Web of Science, PubMed, and Trials Register of Promoting Health Interventions (TRoPHI, were searched for scientific publications investigating the effectiveness of strategies on outdoor air pollution control, public health and health equity in Europe from 1995 to 2015. A total of 15 scientific papers were included in the review after screening 1626 articles. Four groups of strategy types, namely, general regulations on air quality control, road traffic related emission control interventions, energy generation related emission control interventions and greenhouse gas emission control interventions for climate change mitigation were identified. All of the strategies reviewed reported some improvement in air quality and subsequently in public health. The reduction of the air pollutant concentrations and the reported subsequent health benefits were more significant within the geographic areas affected by traffic related interventions. Among the various traffic related interventions, low emission zones appeared to be more effective in reducing ambient nitrogen dioxide (NO2 and particulate matter levels. Only few studies considered implications for health equity, three out of 15, and no consistent results were found indicating that these strategies could reduce health inequity associated with air pollution. Particulate matter (particularly fine particulate matter and NO2 were the dominant outdoor air pollutants examined in the studies in Europe in recent years. Health benefits were gained either as a direct, intended objective or as a co-benefit from all of the strategies examined
Wang, Li; Zhong, Buqing; Vardoulakis, Sotiris; Zhang, Fengying; Pilot, Eva; Li, Yonghua; Yang, Linsheng; Wang, Wuyi; Krafft, Thomas
Air pollution is an important public health problem in Europe and there is evidence that it exacerbates health inequities. This calls for effective strategies and targeted interventions. In this study, we conducted a systematic review to evaluate the effectiveness of strategies relating to air pollution control on public health and health equity in Europe. Three databases, Web of Science, PubMed, and Trials Register of Promoting Health Interventions (TRoPHI), were searched for scientific publications investigating the effectiveness of strategies on outdoor air pollution control, public health and health equity in Europe from 1995 to 2015. A total of 15 scientific papers were included in the review after screening 1626 articles. Four groups of strategy types, namely, general regulations on air quality control, road traffic related emission control interventions, energy generation related emission control interventions and greenhouse gas emission control interventions for climate change mitigation were identified. All of the strategies reviewed reported some improvement in air quality and subsequently in public health. The reduction of the air pollutant concentrations and the reported subsequent health benefits were more significant within the geographic areas affected by traffic related interventions. Among the various traffic related interventions, low emission zones appeared to be more effective in reducing ambient nitrogen dioxide (NO₂) and particulate matter levels. Only few studies considered implications for health equity, three out of 15, and no consistent results were found indicating that these strategies could reduce health inequity associated with air pollution. Particulate matter (particularly fine particulate matter) and NO₂ were the dominant outdoor air pollutants examined in the studies in Europe in recent years. Health benefits were gained either as a direct, intended objective or as a co-benefit from all of the strategies examined, but no
Wang, Li; Zhong, Buqing; Vardoulakis, Sotiris; Zhang, Fengying; Pilot, Eva; Li, Yonghua; Yang, Linsheng; Wang, Wuyi; Krafft, Thomas
Air pollution is an important public health problem in Europe and there is evidence that it exacerbates health inequities. This calls for effective strategies and targeted interventions. In this study, we conducted a systematic review to evaluate the effectiveness of strategies relating to air pollution control on public health and health equity in Europe. Three databases, Web of Science, PubMed, and Trials Register of Promoting Health Interventions (TRoPHI), were searched for scientific publications investigating the effectiveness of strategies on outdoor air pollution control, public health and health equity in Europe from 1995 to 2015. A total of 15 scientific papers were included in the review after screening 1626 articles. Four groups of strategy types, namely, general regulations on air quality control, road traffic related emission control interventions, energy generation related emission control interventions and greenhouse gas emission control interventions for climate change mitigation were identified. All of the strategies reviewed reported some improvement in air quality and subsequently in public health. The reduction of the air pollutant concentrations and the reported subsequent health benefits were more significant within the geographic areas affected by traffic related interventions. Among the various traffic related interventions, low emission zones appeared to be more effective in reducing ambient nitrogen dioxide (NO2) and particulate matter levels. Only few studies considered implications for health equity, three out of 15, and no consistent results were found indicating that these strategies could reduce health inequity associated with air pollution. Particulate matter (particularly fine particulate matter) and NO2 were the dominant outdoor air pollutants examined in the studies in Europe in recent years. Health benefits were gained either as a direct, intended objective or as a co-benefit from all of the strategies examined, but no consistent
Pedro Campos Bias Fortes
Full Text Available The study evaluated the importance of Private Equity in the performance of medium-term (three years of 89 companies between 2004 and 2007. The hypothesis tests for differences in means of cumulative abnormal returns showed a lower underpricing in companies with PE, especially in the sectors of transport and services, construction and industries in general. Additionally, the results of the multiple linear regression estimation showed a statistically significant (at 10% level and positive relationship between the presence of PE funds and cumulative abnormal returns. Therefore, the companies that had PE funds as shareholders at the time of the IPO showed superior performance compared to other corporations. In this way, the study pointed out evidence that, by participating actively in the management of companies in their portfolios, PE funds reduce information asymmetry, certifying the business quality, solidity and good management of the companies in which they invest. In addition, the better medium-term performance in the companies with presence of PE funds can be a sign that these funds provide more effective management.
Weiler, Anelyse M.; Hergesheimer, Chris; Brisbois, Ben; Wittman, Hannah; Yassi, Annalee; Spiegel, Jerry M.
There has been growing policy interest in social justice issues related to both health and food. We sought to understand the state of knowledge on relationships between health equity—i.e. health inequalities that are socially produced—and food systems, where the concepts of ‘food security’ and ‘food sovereignty’ are prominent. We undertook exploratory scoping and mapping stages of a ‘meta-narrative synthesis’ on pathways from global food systems to health equity outcomes. The review was oriented by a conceptual framework delineating eight pathways to health (in)equity through the food system: 1—Multi-Scalar Environmental, Social Context; 2—Occupational Exposures; 3—Environmental Change; 4—Traditional Livelihoods, Cultural Continuity; 5—Intake of Contaminants; 6—Nutrition; 7—Social Determinants of Health and 8—Political, Economic and Regulatory context. The terms ‘food security’ and ‘food sovereignty’ were, respectively, paired with a series of health equity-related terms. Combinations of health equity and food security (1414 citations) greatly outnumbered pairings with food sovereignty (18 citations). Prominent crosscutting themes that were observed included climate change, biotechnology, gender, racialization, indigeneity, poverty, citizenship and HIV as well as institutional barriers to reducing health inequities in the food system. The literature indicates that food sovereignty-based approaches to health in specific contexts, such as advancing healthy school food systems, promoting soil fertility, gender equity and nutrition, and addressing structural racism, can complement the longer-term socio-political restructuring processes that health equity requires. Our conceptual model offers a useful starting point for identifying interventions with strong potential to promote health equity. A research agenda to explore project-based interventions in the food system along these pathways can support the identification of ways to
Karim, F; Tripura, A; Gani, M S; Chowdhury, A M R
Many studies have examined the health inequities between different social groups, often measured by individual independent variables, such as education, gender, ethnicity, geography, rich, poor, etc. Although inequities are increasingly widening, a few studies have looked at the health inequity between different poverty groups within the poor. The present study, using equity terms, examined the use of health services in two rural areas of Bangladesh. Using a multistage sampling method, a total of 80 villages were selected from the Bogra and Dinajpur sadar thanas (subdistricts) for the study. A total of 4003 households in these villages were visited for data collection on mortality and fertility, while data related to use of health services was collected from a subsample of 1032 households. A poverty index, constructed using three variables (household landholding, education level of head of household, and self-rated categorization of household's annual food security), categorized the households into three groups: extreme poor, moderate poor and non-poor. Overall, the data revealed considerable inequities in many study indicators between the poor and the non-poor. However, inequities of varying degrees were also found between the extreme poor and the moderate poor. Lower levels of inequities were found between the poor and the non-poor in the use of health services, which were easily accessible and free of charge (immunization, vitamin A capsule, etc.). On the whole, the extreme poor were less likely to use health services than the moderate poor and the non-poor, suggesting the need for a more appropriate programme to address their pressing health needs.
Johnston, R; Crooks, V A
Medical tourism, which is the intentional travel by private-paying patients across international borders for medical treatment, is a sector that has been targeted for growth in many Caribbean countries. The international development of this industry has raised a core set of proposed health equity benefits and drawbacks for host countries. These benefits centre on the potential investment in health infrastructure and opportunities for health labour force development while drawbacks focus on the potential for reduced access to healthcare for locals and inefficient use of limited public resources to support the growth of the medical tourism industry. The development of the medical tourism sector in Caribbean countries raises additional health equity questions that have received little attention in existing international debates, specifically in regard to environmental health equity. In this viewpoint, we introduce questions of environmental health equity that clearly emerge in relation to the developing Caribbean medical tourism sector These questions acknowledge that the growth of this sector will have impacts on the social and physical environments, resources, and waste management infrastructure in countries. We contend that in addition to addressing the wider health equity concerns that have been consistently raised in existing debates surrounding the growth of medical tourism, planning for growth in this sector in the Caribbean must take environmental health equity into account in order to ensure that local populations, environments, and ecosystems are not harmed by facilities catering to international patients.
Friel, Sharon; Akerman, Marco; Hancock, Trevor; Kumaresan, Jacob; Marmot, Michael; Melin, Thomas; Vlahov, David
Urban living is the new reality for the majority of the world's population. Urban change is taking place in a context of other global challenges--economic globalization, climate change, financial crises, energy and food insecurity, old and emerging armed conflicts, as well as the changing patterns of communicable and noncommunicable diseases. These health and social problems, in countries with different levels of infrastructure and health system preparedness, pose significant development challenges in the 21st century. In all countries, rich and poor, the move to urban living has been both good and bad for population health, and has contributed to the unequal distribution of health both within countries (the urban-rural divide) and within cities (the rich-poor divide). In this series of papers, we demonstrate that urban planning and design and urban social conditions can be good or bad for human health and health equity depending on how they are set up. We argue that climate change mitigation and adaptation need to go hand-in-hand with efforts to achieve health equity through action in the social determinants. And we highlight how different forms of governance can shape agendas, policies, and programs in ways that are inclusive and health-promoting or perpetuate social exclusion, inequitable distribution of resources, and the inequities in health associated with that. While today we can describe many of the features of a healthy and sustainable city, and the governance and planning processes needed to achieve these ends, there is still much to learn, especially with respect to tailoring these concepts and applying them in the cities of lower- and middle-income countries. By outlining an integrated research agenda, we aim to assist researchers, policy makers, service providers, and funding bodies/donors to better support, coordinate, and undertake research that is organized around a conceptual framework that positions health, equity, and sustainability as central
Rifkin, Susan B
This paper presents a framework to explore the relationship between health equity and community empowerment. It traces the progression of the concept of participation to the present term of empowerment and the links among empowerment, equity, and health outcomes. It argues that the relationship can best be described by using the acronym CHOICE (Capacity-building, Human rights, Organizational sustainability, Institutional accountability, Contribution, and Enabling environment). Based on the concept of development as freedom put forward by Nobel Laureate Amartya Sen, the paper describes how each factor illustrates the relationship between equity and empowerment in positive health outcomes, giving appropriate examples. In conclusion, it is suggested that these factors might form the basis of a tool to assess the relationship between equity and empowerment and its impact on health outcomes.
Carney, Timothy Jay; Kong, Amanda Y
Informaticians are challenged to design health information technology (IT) solutions for complex problems, such as health disparities, but are achieving mixed results in demonstrating a direct impact on health outcomes. This presentation of collective intelligence and the corresponding terms of smart health, knowledge ecosystem, enhanced health disparities informatics capacities, knowledge exchange, big-data, and situational awareness are a means of demonstrating the complex challenges informatics professionals face in trying to model, measure, and manage an intelligent and smart systems response to health disparities. A critical piece in our understanding of collective intelligence for public and population health rests in our understanding of public and population health as a living and evolving network of individuals, organizations, and resources. This discussion represents a step in advancing the conversation of what a smart response to health disparities should represent and how informatics can drive the design of intelligent systems to assist in eliminating health disparities and achieving health equity. Copyright © 2017. Published by Elsevier Inc.
Coelho, Ivan Batista
This paper aims to evaluate the nineteen years of the National Health System in Brazil, under the prism of equity. It takes into account the current political context in Brazil in the 80s, that the democratization of the country and the health sector could, per se, lead to a more equitable situation regarding the access to health services. Democracy and equity concepts are here discussed; analyzing which situations may facilitate or make it difficult its association in a theoretical plan, applying them to the Brazilian context in a more general form and, to emphasizing practical implications to the National Health System and to groups of activism related to health reforms. It also seeks to show the limits and possibilities of these groups with regards to the reduction of inequality, in relation to the access to health services, which still remain. To conclude, the author points out the need for other movements to be established which seek the reduction of such and other inequalities, such as access to education, housing, etc, drawing special attention to the role played by the State, which is questioned regarding its incapacity of promoting equity, once it presents itself as being powerful when approaching other matters.
Palmer, G R
An important goal of health services research is to improve the efficiency and effectiveness of health services through a quantitative and evidence-based approach. There are many limitations to the use of evidence in health policy-making, such as differences in what counts as evidence between the various disciplines involved, and a heavy reliance on theory in social science disciplines. Community and interest group values, ideological positions and political assessments inevitably intrude into government health policy-making. The importance of these factors is accentuated by the current absence of evidence on the impact of policy options for improving the health status of the community, and ensuring that efficiency and equity objectives for health services are also met. Analysis of recent hospital funding and private health insurance initiatives shows the limited role of evidence in the making of these decisions. Decision-making about health policy might be improved in the future by initiatives such as greater exposure of health professionals to educational inputs with a policy focus; increased contribution of doctors to health services research via special postgraduate programs; and establishing a national, multidisciplinary centre for health policy research and evaluation.
Victor B. Penchaszadeh
Full Text Available The modern health system of Argentina was developed in 1945-1955, a period of economic bonanza characterized by industrialization, rapid urbanization and activist labor organizations. During the ensuing years it evolved in three sectors: public, social security and private, with separate services, population coverage and funding. While the national Ministry of Health is nominally responsible for general health policies and regulations, overseeing the general operation of health services, designing preventive medicine programs and negotiating the coverage and fees of health insurance plans, it has in fact very low leverage to enforce decisions in the provinces, which are autonomous, as well as in the social security and private sectors, which are weakly regulated if at all. While the health workforce, medical facilities and level of spending are acceptable, the fragmentation and segmentation of the system render it highly inequitable and inefficient. During the 1980s and 1990s, the health system has experienced further transformations, as neoliberal policies took hold in the country and dictated a reduction of state involvement in social services in favor of privatization and decentralization of health care. The result has been increased fragmentation, inequity and inefficacy, as health care is increasingly prey to the economic interests of private corporations (insurance and pharmaceutical industries, trade union bureaucracies and the medical professional and technology establishments. The expectation of popular sectors of society are that progressive polices recently enacted by Congress, and being implemented in the fields of education, retirement pensions and the media, will be followed with much needed public health policies based on equity and efficiency.
Driessen, J.; Lin, T.-C.; Phalippou, L.
We develop a new GMM-style methodology with good small-sample properties to assess the abnormal performance and risk exposure of a non-traded asset from a cross-section of cash flow data. We apply this method to a sample of 958 mature private equity funds spanning 24 years. Our methodology uses actu
Poots, Alan J.; Green, Stuart A.; Honeybourne, Emmi; Green, John; Woodcock, Thomas; Barnes, Ruth; Bell, Derek
Objective To investigate equity of patient outcomes in a psychological therapy service, following increased access achieved by a quality improvement (QI) initiative. Design Retrospective service evaluation of health outcomes; data analysed by ANOVA, chi-squared and Statistical Process Control. Setting A psychological therapy service in Westminster, London, UK. Participants People living in the Borough of Westminster, London, attending the service (from either healthcare professional or self-referral) between February 2009 and May 2012. Intervention(s) Social marketing interventions were used to increase referrals, including the promotion of the service through local media and through existing social networks. Main Outcome Measure(s) (i) Severity of depression on entry using Patient Health Questionnaire-9 (PHQ9). (ii) Changes to severity of depression following treatment (ΔPHQ9). (iii) Changes in attainment of a meaningful improvement in condition assessed by a key performance indicator. Results Patients from areas of high deprivation entered the service with more severe depression (M = 15.47, SD = 6.75), compared with patients from areas of low (M = 13.20, SD = 6.75) and medium (M = 14.44, SD = 6.64) deprivation. Patients in low, medium and high deprivation areas attained similar changes in depression score (ΔPHQ9: M = −6.60, SD = 6.41). Similar proportions of patients achieved the key performance indicator across initiative phase and deprivation categories. Conclusions QI methods improved access to mental health services; this paper finds no evidence for differences in clinical outcomes in patients, regardless of level of deprivation, interpreted as no evidence of inequity in the service with respect to this outcome. PMID:24521701
AR Olyaee Manesh
Full Text Available Objective: This abstract focuses on theoretical background for the notion of “equity in health care” and on the implications of applying these theories to the health care of developed and developing countries. Equity Principals and the Implications: There are different theories about the principle of Equity or Justice such as Altruism, Utilitarians, Marxists, Rawls’ theory and Nazick’s entitlement. Among these theories, some of them are applicable to health care such as Libertarianism and Egalitarianism. The focus of the Libertarians is on the extent to which people are free to purchase the health care that they want. The Libertarians’ principle is the main equity base for private health systems. In contrast, Egalitarians suggest that finance of the health care should be according to the ability to pay and distribution of health care should be according to the need (ill health. It seems that policy makers in most developed countries such as European countries accept the Egalitarians’ principle and application of this equity principle by their health systems has significantly reduced health inequities and inequalities in these countries. There are a limited number of studies to look at equity in the health care of developing countries. A common equity principle for these countries is “equal access for everyone” and different mechanisms are applied to attain this target. Despite the overall improvements in health care in recent years, evidence indicates that many of developing countries have failed to provide equal access to health care for all in need. The financial limitations of the governments, spending about 70% of the health care resources on hospital-based care, unequal access to hospital services in favour of urban population, income inequalities among population, and lack of consistent and up-to-date information of inequalities, make developing countries unable to monitor and prevent inequities and inequalities of health
Stolk, Elly A; Pickee, Stefan J; Ament, André H J A; Busschbach, Jan J V
The value of QALY gains for different patients may be recalculated using equity weights, but it is unclear which interpretation of equity should be used: severity of illness, fair innings or proportional shortfall. We set up an experiment to analyze which of these equity concepts best reflects people's distributional preferences. Sixty respondents assigned a priority rank to the treatment of 10 conditions using the paired comparison technique. We described these real-life conditions by their actual QALY profiles, i.e. in terms of age, disease free period, duration of disease, quality of life, and life years lost. Next we determined the priority rank order of the 10 conditions by the three equity concepts, using the weights that each equity concept attributes to the different units of the QALY profile describing the 10 conditions. To explore the social interpretation of equity, we compared the observed and theoretical rank orderings using Spearman correlations. All correlations were significant at a 0.05 level. Fair innings best predicted the observed rank order of the 10 conditions (r=0.95). Weaker correlations were found for proportional shortfall (r=0.82) and severity of illness (r=-0.65). This result calls attention to health policy, because actual health care decisions often reflect concerns of severity of illness. This raises the question if health care decision makers evaluate the claims of different patients for health care by appropriate criteria.
Mehdipanah, R; Schulz, A J; Israel, B A; Gamboa, C; Rowe, Z; Khan, M; Allen, A
The Urban Health Equity Assessment Response Tool (Urban HEART) combines statistical evidence and community knowledge to address urban health inequities. This paper describes the process of adopting and implementing this tool for Detroit, Michigan, the first city in the USA to use it. The six steps of Urban HEART were implemented by the Healthy Environments Partnership, a community-based participatory research partnership made up of community-based organizations, health service providers, and researchers based in academic institutions. Local indicators and benchmarks were identified and criteria established to prioritize a response plan. We examine how principles of CBPR influenced this process, including the development of a collaborative and equitable process that offered learning opportunities and capacity building among all partners. For the health equity matrix, 15 indicators were chosen within the Urban HEART five policy domains: physical environment and infrastructure, social and human development, economics, governance, and population health. Partners defined the criteria and ranked them for use in assessing and prioritizing health equity gaps. Subsequently, partners generated a series of potential actions for indicators prioritized in this process. Engagement of community partners contributed to benchmark selection and modification, and provided opportunities for dialog and co-learning throughout the process. Application of a CBPR approach provided a foundation for engagement of partners in the Urban HEART process of identifying health equity gaps. This approach offered multiple opportunities for discussion that shaped interpretation and development of strategies to address identified issues to achieve health equity.
MAO Ying; XU Fei; ZHANG Ming-jun; LIU Jin-lin; YANG Jie; WANG Mei-juan; ZHANG Si-feng
Background Getting medical treatment is still difficult and expensive in western China.Improving the equity of basic health services is one of the tasks of the new healthcare reform in China.This study aimed to analyze the parallel and vertical equity of health service utilization of urban residents and then find its influencing factors.Methods In August 2011,a household survey was conducted at 18 communities of Baoji City by multi-stage stratified random sampling.Based on the survey data,we calculated a concentration index of health service utilization for different income residents and a difference index of different ages.We then investigated the influencing factors of health service utilization by employing the Logistic regression model and log-linear regression model.Results The two-week morbidity rate of sampled residents was 19.43％,the morbidity rate of chronic diseases was 21.68％,and the required hospitalization rate after medical diagnosis was 11.36％.Among out-patient service utilization,the two-week out-patient rate,number of two-week out-patients,and out-patient expense had good parallel and vertical equity,while out-patient compensation expense had poor parallel and vertical equity.The inpatient service utilization,hospitalization rate,number of inpatients,days stayed in the hospital,and inpatient expense had good parallel equity,while inpatient compensation expense had poor parallel equity.While the hospitalization rate and number of inpatients had vertical equity,the days stayed in hospital,inpatient expense,and inpatient compensation expense had vertical inequity.Conclusions Urban residents' health was at a low level and there was not good health service utilization.There existed rather poor equity of out-patient compensation expense.The equity of inpatient service utilization was quite poor.Income difference and the type of medical insurance had great effects on the equity of health service utilization.
Qualitative methods are not intrinsically progressive. Methods are simply tools to conduct research. Epistemology, the justification of knowledge, shapes methodology and methods, and thus is a vital starting point for a critical health equity research stance, regardless of whether the methods are qualitative, quantitative, or mixed. In line with this premise, I address four themes in this commentary. First, I criticize the ubiquitous and uncritical use of the term health disparities in U.S. public health. Next, I advocate for the increased use of qualitative methodologies-namely, photovoice and critical ethnography-that, pursuant to critical approaches, prioritize dismantling social-structural inequities as a prerequisite to health equity. Thereafter, I discuss epistemological stance and its influence on all aspects of the research process. Finally, I highlight my critical discourse analysis HIV prevention research based on individual interviews and focus groups with Black men, as an example of a critical health equity research approach.
Heredia-Martínez, Henny Luz; Artmann, Elizabeth; Porto, Silvia Marta
The article discusses the results of operationalizing Situational Strategic Planning adapted to the local level in health, considering the communicative approach and equity in a parish in Venezuela. Two innovative criteria were used: estimated health needs and analysis of the actors' potential for participation. The problems identified were compared to the corresponding article on rights in the Venezuelan Constitution. The study measured inequalities using health indicators associated with the selected problems; equity criteria were incorporated into the action proposals and communicative elements. Priority was assigned to the problem of "low case-resolving capacity in the health services network", and five critical points were selected for the action plan, which finally consisted of 6 operations and 21 actions. The article concludes that the combination of epidemiology and planning expands the situational explanation. Incorporation of the communicative approach and the equity dimension into Situational Strategic Planning allows empowering health management and helps decrease the gaps from inequality.
Qin, Xianjing; Luo, Hongye; Feng, Jun; Li, Yanning; Wei, Bo; Feng, Qiming
Healthcare financing should be equitable. Fairness in financial contribution and protection against financial risk is based on the notion that every household should pay a fair share. Health policy makers have long been concerned with protecting people from the possibility that ill health will lead to catastrophic financial payments and subsequent impoverishment. A number of studies on health care financing equity have been conducted in some provinces of China, but in Guangxi, we found such observation is not enough. What is the situation in Guagnxi? A research on rural areas of Guangxi can add knowledge in this field and help improve the equity and efficiency of health financing, particularly in low-income citizens in rural countries, is a major concern in China's medical sector reform. Socio-economic characteristics and healthcare payment data were obtained from two rounds of household surveys conducted in 2009 (4634 respondents) and 2013 (3951 respondents). The contributions of funding sources were determined and a progressivity analysis of government healthcare subsidies was performed. Household consumption expenditure and total healthcare payments were calculated and incidence and intensity of catastrophic health payments were measured. Summary indices (concentration index, Kakwani index and Gini coefficient) were obtained for the sources of healthcare financing: indirect taxes, out of pocket payments, and social insurance contributions. The overall health-care financing system was regressive. In 2013, the Kakwani index was 0.0013, the vertical effect of all the three funding sources was 0.0001, and some values exceeded 100%, indicating that vertical inequity had a large influence on causing total health financing inequity. The headcount of catastrophic health payment declined sharply between 2009 and 2013, using total expenditure (from 7.3% to 1.2%) or non-food expenditure (from 26.1% to 7.5%) as the indicator of household capacity to pay. Our study
Williams, Shanita D; Hansen, Kristen; Smithey, Marian; Burnley, Josepha; Koplitz, Michelle; Koyama, Kirk; Young, Janice; Bakos, Alexis
It is widely accepted that diversifying the nation's health-care workforce is a necessary strategy to increase access to quality health care for all populations, reduce health disparities, and achieve health equity. In this article, we present a conceptual model that utilizes the social determinants of health framework to link nursing workforce diversity and care quality and access to two critical population health indicators-health disparities and health equity. Our proposed model suggests that a diverse nursing workforce can provide increased access to quality health care and health resources for all populations, and is a necessary precursor to reduce health disparities and achieve health equity. With this conceptual model as a foundation, we aim to stimulate the conceptual and analytical work-both within and outside the nursing field-that is necessary to answer these important but largely unanswered questions.
Ratna, Jalpa; Rifkin, Susanb
The purpose of this article is to illustrate how a framework that links equity and empowerment to improved health outcomes for those who live in poverty can be a useful tool for planning and managing health programmes. Using the work of Amartya Sen, Susan Rifkin has developed a framework described in the acronym CHOICE. The article applies the framework to two case studies from Kenya seeking to reduce the disease burdens of malaria and HIV/AIDS. The article examines how the process of pursuing equity and empowerment either supports the positive health outcomes identified as objectives and/or strengthens these outcomes.
Gómez, Elsa Gómez
Gender equity is increasingly being acknowledged as an essential aspect of sustainable development and more specifically, of health development. The Pan American Health Organization's Program for Women, Health, and Development has been piloting for a year now a project known as Equidad de género en las políticas de reforma del sector de salud, whose objective is to promote gender equity in the health sector reform efforts in the Region. The first stage of the project is being conducted in Chile and Peru, along with some activities throughout the Region. The core of the project is the production and use of information as a tool for introducing changes geared toward achieving greater gender equity in health, particularly in connection with malefemale disparities that are unnecessary, avoidable, and unfair in health status, access to health care, and participation in decision-making within the health system. We expect that in three years the project will have brought about changes in the production of information and knowledge, advocacy, and information dissemination, as well as in the development, appropriation, and identification of intersectoral mechanisms that will make it possible for key figures in government and civil society to work together in setting and surveying policy on gender equity in health.
Murphy, Kelly; Fafard, Patrick; O'Campo, Patricia
In 2011, an interdisciplinary symposium was organized in Toronto, Canada to investigate prevailing models of health policy change in the knowledge translation literature and to assess the applicability of these models for equity-focused urban health research. The papers resulting from the symposium have been published together, in the Journal of Urban Health, along with this introductory essay. This essay describes how the different papers grapple in different ways with how to understand and to bridge the gaps between urban health research and action. The breadth of perspectives reflected in the papers (e.g., social epidemiology, public health, political science, sociology, critical labor studies, and educational psychology) shed much light on core tensions in the relationship between KT and health equity. The first tension is whether the content of evidence or the context of decision making is the strong determinate of research impact in relation to health equity policy. The second tension is whether relationships between health equity researchers and decision makers are best viewed in terms of collaboration or of conflict. The third concerns the role that power plays in evidence-based policy making, when the issues at stake are not only empirical but also normative.
... minority group. Though health indicators such as life expectancy and infant mortality have improved for most Americans, ... YouTube Instagram Listen Watch RSS ABOUT About CDC Jobs Funding LEGAL Policies Privacy FOIA No Fear Act ...
Diringer, Joel; Phipps, Kathy R
California has virtually no statewide dental public health infrastructure leaving the state without leadership, a surveillance program, an oral health plan, oral health promotion and disease prevention programs, and federal funding. Based on a literature review and interviews with 15 oral health officials nationally, the paper recommends hiring a state dental director with public health experience, developing a state oral health plan, and seeking federal and private funding to support an office of oral health.
Ahmad Reza Hosseinpoor
Full Text Available Abstract Background It is widely recognised that the pursuit of sustainable development cannot be accomplished without addressing inequality, or observed differences between subgroups of a population. Monitoring health inequalities allows for the identification of health topics where major group differences exist, dimensions of inequality that must be prioritised to effect improvements in multiple health domains, and also population subgroups that are multiply disadvantaged. While availability of data to monitor health inequalities is gradually improving, there is a commensurate need to increase, within countries, the technical capacity for analysis of these data and interpretation of results for decision-making. Prior efforts to build capacity have yielded demand for a toolkit with the computational ability to display disaggregated data and summary measures of inequality in an interactive and customisable fashion that would facilitate interpretation and reporting of health inequality in a given country. Methods To answer this demand, the Health Equity Assessment Toolkit (HEAT, was developed between 2014 and 2016. The software, which contains the World Health Organization’s Health Equity Monitor database, allows the assessment of inequalities within a country using over 30 reproductive, maternal, newborn and child health indicators and five dimensions of inequality (economic status, education, place of residence, subnational region and child’s sex, where applicable. Results/Conclusion HEAT was beta-tested in 2015 as part of ongoing capacity building workshops on health inequality monitoring. This is the first and only application of its kind; further developments are proposed to introduce an upload data feature, translate it into different languages and increase interactivity of the software. This article will present the main features and functionalities of HEAT and discuss its relevance and use for health inequality monitoring.
Full Text Available It is recognized and accepted that social economy has a significant contribution within the area of social inclusion policies. The intervention areas regarded are extremely diverse: professional education and training, employment policies, social and socio‐medical services, social insurances, the banking and cultural environment,leisure activities, proximity services designed for the population with social exclusion risk etc. This study focuses on some of the ways where social economy mechanisms could be introduced in the field of health protection from Romania.Accepting and recognizing the utility of the mutual insurance type structures is desirable for the increase of the preconditions of a real equity within the access tothe health care services, including the vulnerable groups, without endangering social solidarity, focusing on the service needs and guaranteeing the active participation to the formation and management of the funds thus created.
Full Text Available After many reforms of the Polish health care system, the current entity responsible for financing medical services to the insured patients is the National Health Fund. Despite the constantly increasing funds being allocated to the health care system, it still remains underfunded. A tool that facilitates the evaluation and assessment of the viability, stability and profitability of a business is called the financial analysis. The primary source of data necessary for the preparation of the financial analysis comes from the financial statement which includes the balance sheets, profit and loss account, notes, cash flow statement, and statement of changes in equity. On the basis of the information contained in these documents one can understand the structure of assets, earnings, revenues and expenses, as well as the level of indebtedness and liquidity. The National Health Fund has a monopoly on the health insurance market. Therefore, the financial management conducted by this entity should be based on the rationalization of the expenditure in terms of revenue and stable income generation. The financial analysis carried out between 2005 and 2011 showed that the total assets of the entity were dominated by the current assets which can be justified by the nature of the business. The structure of equity relative compared to the foreign capital did not show positive trends. Since 2009, the bad financial situation was manifested by the profit and loss accounts, which reached negative values and costs exceeding the revenue. The ratio analysis showed a high debt rates experienced by the health care payers. At the same time, however, the liquidity has been maintained.
Jehu-Appiah, C.; Aryeetey, G.C.N.O.; Spaan, E.J.A.M.; Hoop, T. de; Agyepong, I.; Baltussen, R.M.P.M.
To improve equity in the provision of health care and provide risk protection to poor households, low-income countries are increasingly moving to social health insurance. Using data from a household survey of 3301 households conducted in 2009 this study aims to evaluate equity in enrollment in the
Two key policy goals in the health sector are equity and financial protection. New methods, data and powerful computers have led to a surge of interest in quantitative analysis that permits monitoring progress toward these objectives, and comparisons across countries. ADePT is a new computer program that streamlines and automates such work, ensuring that results are genuinely comparable and allowing them to be produced with a minimum of programming skills. This book provides a step-by-step guide to the use of ADePT for quantitative analysis of equity and financial protection in the health sect
The environmental determinants of public health and social equity present many challenges to a sustainable urbanism-climate change, water shortages and oil dependency to name a few. There are many pathways from urban environments to human health. Numerous links have been described but some underlying mechanisms behind these relationships are less understood. Combining theory and methods is a way of understanding and explaining how the underlying structures of urban environments relate to public health and social equity. This paper proposes a model for an ecological public health, which can be used to explore these relationships. Four principles of an ecological public health-conviviality, equity, sustainability and global responsibility-are used to derive theoretical concepts that can inform ecological public health thinking, which, among other things, provides a way of exploring the underlying mechanisms that link urban environments to public health and social equity. Theories of more-than-human agency inform ways of living together (conviviality) in urban areas. Political ecology links the equity concerns about environmental and social justice. Resilience thinking offers a better way of coming to grips with sustainability. Integrating ecological ethics into public health considers the global consequences of local urban living and thus attends to global responsibility. This way of looking at the relationships between urban environments, public health and social equity answers the call to craft an ecological public health for the twenty-first century by re-imagining public health in a way that acknowledges humans as part of the ecosystem, not separate from it, though not central to it.
Ruckert, Arne; Labonté,Ronald
Background It is widely acknowledged that austerity measures in the wake of the global financial crisis are starting to undermine population health results. Yet, few research studies have focused on the ways in which the financial crisis and the ensuing ‘Great Recession’ have affected health equity, especially through their impact on social determinants of health; neither has much attention been given to the health consequences of the fiscal austerity regime that quickly followed a brief peri...
Dean, Hazel D; Roberts, George W; Bouye, Karen E; Green, Yvonne; McDonald, Marian
The public health infrastructure required for achieving health equity is multidimensional and complex. The infrastructure should be responsive to current and emerging priorities and capable of providing the foundation for developing, planning, implementing, and evaluating health initiatives. This article discusses these infrastructure requirements by examining how they are operationalized in the organizational infrastructure for promoting health equity at the Centers for Disease Control and Prevention, utilizing the nation's premier public health agency as a lens. Examples from the history of the Centers for Disease Control and Prevention's work in health equity from its centers, institute, and offices are provided to identify those structures and functions that are critical to achieving health equity. Challenges and facilitators to sustaining a health equity organizational infrastructure, as gleaned from the Centers for Disease Control and Prevention's experience, are noted. Finally, we provide additional considerations for expanding and sustaining a health equity infrastructure, which the authors hope will serve as "food for thought" for practitioners in state, tribal, or local health departments, community-based organizations, or nongovernmental organizations striving to create or maintain an impactful infrastructure to achieve health equity.
Fredriksen-Goldsen, Karen I.; Simoni, Jane M.; Kim, Hyun-Jun; Lehavot, Keren; Walters, Karina L.; Yang, Joyce; Hoy-Ellis, Charles P.
National health initiatives emphasize the importance of eliminating health disparities among historically disadvantaged populations. Yet, few studies have examined the range of health outcomes among lesbian, gay, bisexual, and transgender (LGBT) people. To stimulate more inclusive research in the area, we present the Health Equity Promotion Model—a framework oriented toward LGBT people reaching their full mental and physical health potential that considers both positive and adverse health-related circumstances. The model highlights (a) heterogeneity and intersectionality within LGBT communities; (b) the influence of structural and environmental context; and (c) both health-promoting and adverse pathways that encompass behavioral, social, psychological, and biological processes. It also expands upon earlier conceptualizations of sexual minority health by integrating a life course development perspective within the health-promotion model. By explicating the important role of agency and resilience as well as the deleterious effect of social structures on health outcomes, it supports policy and social justice to advance health and well-being in these communities. Important directions for future research as well as implications for health-promotion interventions and policies are offered. PMID:25545433
Marphatia, Akanksha A
Decades of underinvestment in public sectors and in teachers and health workers have adversely affected the health and educational outcomes of women. This is partly explained by a general lack of resources. However, the amount a country can spend on social sectors, including teachers and health workers, is also determined by its macroeconomic framework, which is set in agreement with the International Monetary Fund. There is now ample evidence of how IMF-imposed wage ceilings have constrained the ability of governments to hire adequate numbers of trained professionals and increase investment in social sectors. Though the IMF has recently removed wage ceilings from its basket of conditions, little change has taken place to ensure that women are better supported by macroeconomic policies or, at the least, are less adversely affected. Thus far, the IMF's neoliberal policies have either ignored gender concerns or instrumentalized equity, health, and education to support economic development. Unless macroeconomic policies are more flexible and deliberately take into account the different needs of women and men, social outcomes will continue to be poor and inequitable. Governments must pursue alternative, feminist policies that put the goals of social equity at the center of macroeconomic policy. These policies can facilitate increased investment in education and health care, which are vital measures for achieving gender equality and providing both women and men with the skills and training needed to soften the impact of the current economic crisis.
Kim, Hani; Marks, Florian; Novakovic, Uros; Hotez, Peter J; Black, Robert E
To examine the current partnerships to improve the childhood immunisation programme in the Democratic Peoples' Republic of Korea (DPRK) in the context of the political determinants of health equity. A literature search was conducted to identify public health collaborations with the DPRK government. Based on the amount of publicly accessible data and a shared approach in health system strengthening among the partners in immunisation programmes, the search focused on these partnerships. The efforts by WHO, UNICEF, GAVI and IVI with the DPRK government improved the delivery of childhood vaccines (e.g. pentavalent vaccines, inactivated polio vaccine, two-dose measles vaccine and Japanese encephalitis vaccine) and strengthened the DPRK health system by equipping health centres, and training all levels of public health personnel for VPD surveillance and immunisation service delivery. The VPD-focused programmatic activities in the DPRK have improved the delivery of childhood immunisation and have created dialogue and contact with the people of the DPRK. These efforts are likely to ameliorate the political isolation of the people of the DPRK and potentially improve global health equity. © 2016 The Authors. Tropical Medicine & International Health Published by John Wiley & Sons Ltd.
Full Text Available INTRODUCTION: Tackling health inequities both within and between countries remains high on the agenda of international organizations including the World Health Organization and local, regional and national governments. Systematic reviews can be a useful tool to assess effects on equity in health status because they include studies conducted in a variety of settings and populations. This study aims to describe the extent to which the impacts of health interventions on equity in health status are considered in systematic reviews, describe methods used, and assess the implications of their equity related findings for policy, practice and research. METHODS: We conducted a methodology study of equity assessment in systematic reviews. Two independent reviewers extracted information on the reporting and analysis of impacts of health interventions on equity in health status in a group of 300 systematic reviews collected from all systematic reviews indexed in one month of MEDLINE, using a pre-tested data collection form. Any differences in data extraction were resolved by discussion. RESULTS: Of the 300 systematic reviews, 224 assessed the effectiveness of interventions on health outcomes. Of these 224 reviews, 29 systematic reviews assessed effects on equity in health status using subgroup analysis or targeted analyses of vulnerable populations. Of these, seven conducted subgroup analyses related to health equity which were reported in insufficient detail to judge their credibility. Of these 29 reviews, 18 described implications for policy and practice based on assessment of effects on health equity. CONCLUSION: The quality and completeness of reporting should be enhanced as a priority, because without this policymakers and practitioners will continue lack the evidence base they need to inform decision-making about health inequity. Furthermore, there is a need to develop methods to systematically consider impacts on equity in health status that is
Olafsdottir, Anna E; Reidpath, Daniel D; Pokhrel, Subhash; Allotey, Pascale
The literature on health systems focuses largely on the performance of healthcare systems operationalised around indicators such as hospital beds, maternity care and immunisation coverage. A broader definition of health systems however, needs to include the wider determinants of health including, possibly, governance and its relationship to health and health equity. The aim of this study was to examine the relationship between health systems outcomes and equity, and governance as a part of a process to extend the range of indicators used to assess health systems performance. Using cross sectional data from 46 countries in the African region of the World Health Organization, an ecological analysis was conducted to examine the relationship between governance and health systems performance. The data were analysed using multiple linear regression and a standard progressive modelling procedure. The under-five mortality rate (U5MR) was used as the health outcome measure and the ratio of U5MR in the wealthiest and poorest quintiles was used as the measure of health equity. Governance was measured using two contextually relevant indices developed by the Mo Ibrahim Foundation. Governance was strongly associated with U5MR and moderately associated with the U5MR quintile ratio. After controlling for possible confounding by healthcare, finance, education, and water and sanitation, governance remained significantly associated with U5MR. Governance was not, however, significantly associated with equity in U5MR outcomes. This study suggests that the quality of governance may be an important structural determinant of health systems performance, and could be an indicator to be monitored. The association suggests there might be a causal relationship. However, the cross-sectional design, the level of missing data, and the small sample size, forces tentative conclusions. Further research will be needed to assess the causal relationship, and its generalizability beyond U5MR as a health
Full Text Available Abstract Background The literature on health systems focuses largely on the performance of healthcare systems operationalised around indicators such as hospital beds, maternity care and immunisation coverage. A broader definition of health systems however, needs to include the wider determinants of health including, possibly, governance and its relationship to health and health equity. The aim of this study was to examine the relationship between health systems outcomes and equity, and governance as a part of a process to extend the range of indicators used to assess health systems performance. Methods Using cross sectional data from 46 countries in the African region of the World Health Organization, an ecological analysis was conducted to examine the relationship between governance and health systems performance. The data were analysed using multiple linear regression and a standard progressive modelling procedure. The under-five mortality rate (U5MR was used as the health outcome measure and the ratio of U5MR in the wealthiest and poorest quintiles was used as the measure of health equity. Governance was measured using two contextually relevant indices developed by the Mo Ibrahim Foundation. Results Governance was strongly associated with U5MR and moderately associated with the U5MR quintile ratio. After controlling for possible confounding by healthcare, finance, education, and water and sanitation, governance remained significantly associated with U5MR. Governance was not, however, significantly associated with equity in U5MR outcomes. Conclusion This study suggests that the quality of governance may be an important structural determinant of health systems performance, and could be an indicator to be monitored. The association suggests there might be a causal relationship. However, the cross-sectional design, the level of missing data, and the small sample size, forces tentative conclusions. Further research will be needed to assess the
Shiffman, Jeremy; Berlan, David; Hafner, Tamara
Global health analysts have debated whether donor prioritization of HIV/AIDS control has lifted all boats, raising attention and funding levels for health issues aside from HIV/AIDS. We investigate this question, considering donor funding for 4 historically prominent health agendas-HIV/AIDS, health systems strengthening, population and reproductive health, and infectious disease control-over the decade 1998-2007. We employ funding data from the Development Assistance Committee of the Organization for Economic Cooperation and Development, which tracks donor aid. The data indicate that HIV/AIDS may have helped to increase funding for the control of other infectious diseases; however, there is no firm evidence that other health issues beyond the control of infectious diseases have benefited. Between 1998 and 2007, funding for HIV/AIDS control rose from just 5.5% to nearly half of all aid for health. Over the same period, funding for health systems strengthening declined from 62.3% to 23.9% of total health aid and that for population and reproductive health declined from 26.4% to 12.3%. Also, even as total aid for health tripled during this decade, aid for health systems strengthening largely stagnated. Overall, the data indicate little support for the contention that donor funding for HIV/AIDS has lifted all boats.
A. Wagstaff (Adam); E.K.A. van Doorslaer (Eddy)
textabstractThis paper employs the method of Aronson et al. (1994) to decompose the redistributive effect of the Dutch health care financing system into three components: a progressivity component, a classical horizontal equity component and a reranking component. Results are presented for the
Xiao, Lily Dongxia
The aim of this study was to evaluate the mandatory continuing nursing education (MCNE) policy in China and to examine whether or not the policy addresses health equity. MCNE was instituted in 1996 in China to support healthcare reform was to include producing greater equity in health-care. However, the literature increasingly reports inequity in participation in MCNE, which is likely to have had a detrimental effect on the pre-existing discrepancies of education in the nursing workforce, and thereby failing to really address health equity. Despite a growing appeal for change, there is lack of critical reflection on the issues of MCNE policy. Critical ethnography underpinned by Habermas' Communicative Action Theory and Giddens' Structuration Theory were used to guide this study. Findings are presented in four themes: (i) inaccessibility of learning programs for nurses; (ii) undervaluation of workplace-based learning; (iii) inequality of the allocation of resources; and (iv) demands for additional support in MCNE from non-tertiary hospitals. The findings strongly suggest the need for an MCNE policy review based on rational consensus with stakeholders while reflecting the principles of health equity.
Sepehri, Ardeshir; Chernomas, Robert; Akram-Lodhi, A Haroon
The transition from a centrally planned economy in the 1980s and the implementation of a series of neoliberal health policy reform measures in 1989 affected the delivery and financing of Vietnam's health care services. More specifically, legalization of private medical practice, liberalization of the pharmaceutical industry, and introduction of user charges at public health facilities have effectively transformed Vietnam's near universal, publicly funded and provided health services into a highly unregulated private-public mix system, with serious consequences for Vietnam's health system. Using Vietnam's most recent household survey data and published facility-based data, this article examines some of the problems faced by Vietnam's health sector, with particular reference to efficiency, access, and equity. The data reveal four important findings: self-treatment is the dominant mode of treatment for both the poor and nonpoor; there is little or no regulation to protect patients from financial abuse by private medical providers, pharmacies, and drug vendors; in the face of a dwindling share of the state health budget in public hospital revenues and low salaries, hospitals increasingly rely on user charges and insurance premiums to finance services, including generous staff bonuses; and health care costs, especially hospital costs, are substantial for many low- and middle-income households.
Ferrelli, Rita Maria
EUROsociAL is a European Union program for social cohesion in Latin America. The main objective of this essay is to present the conceptual elements underpinning the activities of the EUROsociAL program in the health thematic area, with special attention to their equity aspects. It considers the concepts of social cohesion, equity in health, and the relationship between the two in EUROsociAL, and addresses monitoring of equity in health as a basis of action toward improvement focusing on social determinants of health.
Geronimus, Arline T; James, Sherman A; Destin, Mesmin; Graham, Louis A; Hatzenbuehler, Mark; Murphy, Mary; Pearson, Jay A; Omari, Amel; Thompson, James Phillip
The extent to which socially-assigned and culturally mediated social identity affects health depends on contingencies of social identity that vary across and within populations in day-to-day life. These contingencies are structurally rooted and health damaging inasmuch as they activate physiological stress responses. They also have adverse effects on cognition and emotion, undermining self-confidence and diminishing academic performance. This impact reduces opportunities for social mobility, while ensuring those who "beat the odds" pay a physical price for their positive efforts. Recent applications of social identity theory toward closing racial, ethnic, and gender academic achievement gaps through changing features of educational settings, rather than individual students, have proved fruitful. We sought to integrate this evidence with growing social epidemiological evidence that structurally-rooted biopsychosocial processes have population health effects. We explicate an emergent framework, Jedi Public Health (JPH). JPH focuses on changing features of settings in everyday life, rather than individuals, to promote population health equity, a high priority, yet, elusive national public health objective. We call for an expansion and, in some ways, a re-orienting of efforts to eliminate population health inequity. Policies and interventions to remove and replace discrediting cues in everyday settings hold promise for disrupting the repeated physiological stress process activation that fuels population health inequities with potentially wide application.
Full Text Available background:Poverty in urban area triggered new problem related with their access to health care services. Heavy burden of life in urban makes health, especially reproductive health, never become first priority for urban poor community. This study is aimed to analyzed equity of urban poor community when accessing the reproductive health care. Methods:This is descriptive study with cross sectional design applied. There were 78 women residents of Penjaringansari II Flats in Surabaya selected by simple random sampling (α=10% as respondents. Penjaringansari II Flats was choosen because it is a slum area that residence by unskilled labours and odd employees. The need fulfillment of respondents in reproductive health care was analyzed by spider web analysis. result: Most of respondents (55.1% were first married before 20 years old. There were 60.5% of them gave birth before 20 years old also, so it belongs to high risk pregnant women. Spider web area for health care of under age married was less than ideal age married which means that under age married urban poor experienced inequity for ANC health services. Approximately 10.3% of respondents had never use contraceptives because they fear of side effects and inhibiton of their husband. conclutions:Better equity shown in the prevention of cervical cancer. Being perceived as the poor who need assistance, free pap smear was often held by Penjaringansari II residents. Poor conditions experienced by a group not only can promote health care inequity, but also promote health care equity. recomendation:Health care equity for urban poor can be pursued through both aid schemes provided by the community or the government.
Ford, Chandra L; Airhihenbuwa, Collins O
Racial scholars argue that racism produces rates of morbidity, mortality, and overall well-being that vary depending on socially assigned race. Eliminating racism is therefore central to achieving health equity, but this requires new paradigms that are responsive to structural racism's contemporary influence on health, health inequities, and research. Critical Race Theory is an emerging transdisciplinary, race-equity methodology that originated in legal studies and is grounded in social justice. Critical Race Theory's tools for conducting research and practice are intended to elucidate contemporary racial phenomena, expand the vocabulary with which to discuss complex racial concepts, and challenge racial hierarchies. We introduce Critical Race Theory to the public health community, highlight key Critical Race Theory characteristics (race consciousness, emphases on contemporary societal dynamics and socially marginalized groups, and praxis between research and practice) and describe Critical Race Theory's contribution to a study on racism and HIV testing among African Americans.
Alcaraz, Kassandra I; Sly, Jamilia; Ashing, Kimlin; Fleisher, Linda; Gil-Rivas, Virginia; Ford, Sabrina; Yi, Jean C; Lu, Qian; Meade, Cathy D; Menon, Usha; Gwede, Clement K
Health disparities persist despite ongoing efforts. Given the United States' rapidly changing demography and socio-cultural diversity, a paradigm shift in behavioral medicine is needed to advance research and interventions focused on health equity. This paper introduces the ConNECT Framework as a model to link the sciences of behavioral medicine and health equity with the goal of achieving equitable health and outcomes in the twenty-first century. We first evaluate the state of health equity efforts in behavioral medicine science and identify key opportunities to advance the field. We then discuss and present actionable recommendations related to ConNECT's five broad and synergistic principles: (1) Integrating Context; (2) Fostering a Norm of Inclusion; (3) Ensuring Equitable Diffusion of Innovations; (4) Harnessing Communication Technology; and (5) Prioritizing Specialized Training. The framework holds significant promise for furthering health equity and ushering in a new and refreshing era of behavioral medicine science and practice.
近几年，资本市场的需求使得我国私募股权投资基金呈现良好的发展势头，基于独特的组织形式制度优势，有限合伙制在我国私募股权投资基金领域得到更广泛的应用。但实践中，公司制法人作为有限合伙制私募股权投资基金的普通合伙人的常态化，可能会给其经营管理的运行带来消极影响。对于此类“组织形式有限合伙制、治理结构半公司制”的基金，本文将通过分析其内部构成，内部关系，发现其内部缺陷，从而提出激励和约束机制并存的治理方案。%In recent years, the demand of capital market makes the private equity investment funds in China enjoy a sound development momentum, based on the strengths of unique organization form system, limited partnership is widely used in the field of private equity investment funds in China. But in practice, as the normality of general partner of limited partnership of private equity investment fund, company legal person may bring negative impact on its management and operation. This paper will analyze the internal structure and internal relations to find its internal defect, thus proposing the governance programmes with coexistence of incentive and restraint mechanisms for the fund of"organization form limited partnership and half-company governance structure".
Ndumbe-Eyoh, Sume; Mazzucco, Agnes
The growth of social media presents opportunities for public health to increase its influence and impact on the social determinants of health and health equity. The National Collaborating Centre for Determinants of Health at St. Francis Xavier University conducted a survey during the first half of 2016 to assess how public health used social media for knowledge translation, relationship building, and specific public health roles to advance health equity. Respondents reported that social media had an important role in public health. Uptake of social media, while relatively high for personal use, was less present in professional settings and varied for different platforms. Over 20 per cent of those surveyed used Twitter or Facebook at least weekly for knowledge exchange. A lesser number used social media for specific health equity action. Opportunities to enhance the use of social media in public health persist. Capacity building and organizational policies that support social media use may help achieve this.
Ruckert, Arne; Labonté, Ronald
It is widely acknowledged that austerity measures in the wake of the global financial crisis are starting to undermine population health results. Yet, few research studies have focused on the ways in which the financial crisis and the ensuing 'Great Recession' have affected health equity, especially through their impact on social determinants of health; neither has much attention been given to the health consequences of the fiscal austerity regime that quickly followed a brief period of counter-cyclical government spending for bank bailouts and economic stimulus. Canada has not remained insulated from these developments, despite its relative success in maneuvering the global financial crisis. The study draws on three sources of evidence: A series of semi-structured interviews in Ottawa and Toronto, with key informants selected on the basis of their expertise (n = 12); an analysis of recent (2012) Canadian and Ontario budgetary impacts on social determinants of health; and documentation of trend data on key social health determinants pre- and post the financial crisis. The findings suggest that health equity is primarily impacted through two main pathways related to the global financial crisis: austerity budgets and associated program cutbacks in areas crucial to addressing the inequitable distribution of social determinants of health, including social assistance, housing, and education; and the qualitative transformation of labor markets, with precarious forms of employment expanding rapidly in the aftermath of the global financial crisis. Preliminary evidence suggests that these tendencies will lead to a further deepening of existing health inequities, unless counter-acted through a change in policy direction. This article documents some of the effects of financial crisis and severe economic decline on health equity in Canada. However, more research is necessary to study policy choices that could mitigate this effect. Since the policy response to a similar set of
Xiao-Xiong Xin; Liang Zhao; Xiao-Dong Guan; Lu-Wen Shi
Background:China has not established social security system for rare diseases.Rare diseases could easily impoverish patients and their families.Little research has studied the equity and accessibility of health services for patients with rare diseases in China.This study aimed to explore the factors that influence health expenditure of rare diseases and evaluate its equity.Methods:Questionnaire survey about living conditions and cost burden of patients with rare diseases was conducted.Individual and family information,health expenditure and reimbursement in 2014 of 982 patients were collected.The impact of medical insurance,individual sociodemographic characteristics,family characteristics,and healthcare need on total and out-of-pocket (OOP) health expenditures was analyzed through the generalized linear model.Equity of health expenditure was evaluated by both concentration index and Lorenz curve.Results:Of all the surveyed patients,11.41％ had no medical insurance and 92.10％ spent money to seek medical treatment in 2014.It was suggested female (P =0.048),over 50 years of age (P =0.062),high-income group (P =0.021),hospitalization (P =0.000),and reimbursement ratio (RR) (P =0.000) were positively correlated with total health expenditure.Diseases not needing long-term treatment (P =0.000) was negatively correlated with total health expenditure.Over 50 years of age (P =0.065),high-income group (P =0.018),hospitalization (P =0.000) and having Urban Employee Basic Medical Insurance (UEBMI) (P =0.022) were positively correlated with OOP health expenditure.Patient or the head of the household having received higher education (P =0.044 and P =0.081) and reimbursement ratio (P =0.078) were negatively correlated with OOP health expenditure.The equity evaluation found concentration indexes of health expenditure before and after reimbursement were 0.0550 and 0.0539,respectively.Conclusions:OOP health expenditure of patients with UEBMI was significantly more than that of
Background This article considers how health services access and equity documents represent the problem of access to health services and what the effects of that representation might be for lesbian, gay, bisexual and transgender (LGBT) communities. We conducted a critical discourse analysis on selected access and equity documents using a gender-based diversity framework as determined by two objectives: 1) to identify dominant and counter discourses in health services access and equity literature; and 2) to develop understanding of how particular discourses impact the inclusion, or not, of LGBT communities in health services access and equity frameworks.The analysis was conducted in response to public health and clinical research that has documented barriers to health services access for LGBT communities including institutionalized heterosexism, biphobia, and transphobia, invisibility and lack of health provider knowledge and comfort. The analysis was also conducted as the first step of exploring LGBT access issues in home care services for LGBT populations in Ontario, Canada. Methods A critical discourse analysis of selected health services access and equity documents, using a gender-based diversity framework, was conducted to offer insight into dominant and counter discourses underlying health services access and equity initiatives. Results A continuum of five discourses that characterize the health services access and equity literature were identified including two dominant discourses: 1) multicultural discourse, and 2) diversity discourse; and three counter discourses: 3) social determinants of health (SDOH) discourse; 4) anti-oppression (AOP) discourse; and 5) citizen/social rights discourse. Conclusions The analysis offers a continuum of dominant and counter discourses on health services access and equity as determined from a gender-based diversity perspective. The continuum of discourses offers a framework to identify and redress organizational assumptions
Daley, Andrea E; Macdonnell, Judith A
This article considers how health services access and equity documents represent the problem of access to health services and what the effects of that representation might be for lesbian, gay, bisexual and transgender (LGBT) communities. We conducted a critical discourse analysis on selected access and equity documents using a gender-based diversity framework as determined by two objectives: 1) to identify dominant and counter discourses in health services access and equity literature; and 2) to develop understanding of how particular discourses impact the inclusion, or not, of LGBT communities in health services access and equity frameworks.The analysis was conducted in response to public health and clinical research that has documented barriers to health services access for LGBT communities including institutionalized heterosexism, biphobia, and transphobia, invisibility and lack of health provider knowledge and comfort. The analysis was also conducted as the first step of exploring LGBT access issues in home care services for LGBT populations in Ontario, Canada. A critical discourse analysis of selected health services access and equity documents, using a gender-based diversity framework, was conducted to offer insight into dominant and counter discourses underlying health services access and equity initiatives. A continuum of five discourses that characterize the health services access and equity literature were identified including two dominant discourses: 1) multicultural discourse, and 2) diversity discourse; and three counter discourses: 3) social determinants of health (SDOH) discourse; 4) anti-oppression (AOP) discourse; and 5) citizen/social rights discourse. The analysis offers a continuum of dominant and counter discourses on health services access and equity as determined from a gender-based diversity perspective. The continuum of discourses offers a framework to identify and redress organizational assumptions about, and ideological commitments to
MacDonnell Judith A
Full Text Available Abstract Background This article considers how health services access and equity documents represent the problem of access to health services and what the effects of that representation might be for lesbian, gay, bisexual and transgender (LGBT communities. We conducted a critical discourse analysis on selected access and equity documents using a gender-based diversity framework as determined by two objectives: 1 to identify dominant and counter discourses in health services access and equity literature; and 2 to develop understanding of how particular discourses impact the inclusion, or not, of LGBT communities in health services access and equity frameworks.The analysis was conducted in response to public health and clinical research that has documented barriers to health services access for LGBT communities including institutionalized heterosexism, biphobia, and transphobia, invisibility and lack of health provider knowledge and comfort. The analysis was also conducted as the first step of exploring LGBT access issues in home care services for LGBT populations in Ontario, Canada. Methods A critical discourse analysis of selected health services access and equity documents, using a gender-based diversity framework, was conducted to offer insight into dominant and counter discourses underlying health services access and equity initiatives. Results A continuum of five discourses that characterize the health services access and equity literature were identified including two dominant discourses: 1 multicultural discourse, and 2 diversity discourse; and three counter discourses: 3 social determinants of health (SDOH discourse; 4 anti-oppression (AOP discourse; and 5 citizen/social rights discourse. Conclusions The analysis offers a continuum of dominant and counter discourses on health services access and equity as determined from a gender-based diversity perspective. The continuum of discourses offers a framework to identify and redress
Keating, Daniel P
The conceptual framework for this chapter focuses on outcomes in developmental health as a key indicator of equity. Not all disparities in developmental health are indicators of a failure of equity and justice, but those that are clearly linked to social patterns in theoretically coherent and empirically substantial ways serve as a powerful diagnostic tool. They are especially diagnostic when they point to social factors that are remediable, especially in comparison to societies in which such social disparities are sharply lower (Keating, Siddiqi, & Nguyen, 2013). In this chapter, I review the theoretical links and empirical evidence supporting this central claim and propose that there is strong evidence for the following critical links: (a) there is a compelling empirical connection between disparities in social circumstances and disparities in developmental health outcomes, characterized as a social gradient effect; (b) "drilling down" reveals the core biodevelopmental mechanisms that yield the social disparities that emerge across the life course; (c) in turn, life course effects on developmental health have an impact on societies and populations that are revealed by "ramping up" the research to consider international comparisons of population developmental health; and (d) viewing this integrated evidence through the lens of equity and justice helps to break the vicious cycle that reproduces social inequality in a distressingly recurring fashion.
Payne, Gayle Holmes; James, Stephen D; Hawley, Lisa; Corrigan, Bethany; Kramer, Rachel E; Overton, Samantha N; Farris, Rosanne P; Wasilewski, Yvonne
Obesity has been on the rise in the United States over the past three decades, and is high. In addition to population-wide trends, it is clear that obesity affects some groups more than others and can be associated with age, income, education, gender, race and ethnicity, and geographic region. To reverse the obesity epidemic, the Centers for Disease Control and Prevention) promotes evidence-based and practice-informed strategies to address nutrition and physical activity environments and behaviors. These public health strategies require translation into actionable approaches that can be implemented by state and local entities to address disparities. The Centers for Disease Control and Prevention used findings from an expert panel meeting to guide the development and dissemination of the Health Equity Resource Toolkit for State Practitioners Addressing Obesity Disparities (available at http://www.cdc.gov/obesity/health_equity/toolkit.html). The Toolkit helps public health practitioners take a systematic approach to program planning using a health equity lens. The Toolkit provides a six-step process for planning, implementing, and evaluating strategies to address obesity disparities. Each section contains (a) a basic description of the steps of the process and suggested evidence-informed actions to help address obesity disparities, (b) practical tools for carrying out activities to help reduce obesity disparities, and (c) a "real-world" case study of a successful state-level effort to address obesity with a focus on health equity that is particularly relevant to the content in that section. Hyperlinks to additional resources are included throughout.
Payne, Gayle Holmes; James, Stephen D.; Hawley, Lisa; Corrigan, Bethany; Kramer, Rachel E.; Overton, Samantha N.; Farris, Rosanne P.; Wasilewski, Yvonne
Obesity has been on the rise in the United States over the past three decades, and is high. In addition to population-wide trends, it is clear that obesity affects some groups more than others and can be associated with age, income, education, gender, race and ethnicity, and geographic region. To reverse the obesity epidemic, the Centers for Disease Control and Prevention) promotes evidence-based and practice-informed strategies to address nutrition and physical activity environments and behaviors. These public health strategies require translation into actionable approaches that can be implemented by state and local entities to address disparities. The Centers for Disease Control and Prevention used findings from an expert panel meeting to guide the development and dissemination of the Health Equity Resource Toolkit for State Practitioners Addressing Obesity Disparities (available at http://www.cdc.gov/obesity/health_equity/toolkit.html). The Toolkit helps public health practitioners take a systematic approach to program planning using a health equity lens. The Toolkit provides a six-step process for planning, implementing, and evaluating strategies to address obesity disparities. Each section contains (a) a basic description of the steps of the process and suggested evidence-informed actions to help address obesity disparities, (b) practical tools for carrying out activities to help reduce obesity disparities, and (c) a “real-world” case study of a successful state-level effort to address obesity with a focus on health equity that is particularly relevant to the content in that section. Hyperlinks to additional resources are included throughout. PMID:24962967
Full Text Available This work seeks to identify the impact of the participation of Private Equity funds and Venture Capital (PE/VC, the performance of companies that owned the contribution prior to the opening of capital (IPO. In a more objective the present study seeks to investigate whether companies that opened capital, financed by PE/VC, have performed better than the other formerly the Brazilian stock market debut. The sample of work consists of 116 companies that made the initial public offering (IPO in the São Paulo Stock Exchange (BOVESPA in the period January 2004 to December 2009. First identified that 41 enterprises debuted at BOVESPA being financed by PE/VC funds. Furthermore, the results indicate that the influence of PE/VC funds tend to improve some indices of profitability and market of companies after the IPO. In summary, the evidence found lead to the conclusion that the organizations of private equity and venture capital influence positively the performance of investee companies.
Full Text Available This study aims to evaluate the dialectical relationship between equity and efficiency of health resource allocation and health service utilization in China.We analyzed the inequity of health resource allocation and health service utilization based on concentration index (CI and Gini coefficient. Data envelopment analysis (DEA was used to evaluate the inefficiency of resource allocation and service utilization. Factor Analysis (FA was used to determine input/output indicators.The CI of Health Institutions, Beds in Health Institutions, Health Professionals and Outpatient Visits were -0.116, -0.012, 0.038, and 0.111, respectively. Gini coefficient for the 31 provinces varied between 0.05 and 0.43; out of these 23 (742% were observed to be technically efficient constituting the "best practice frontier". The other 8 (25.8% provinces were technically inefficient.Health professionals and outpatient services are focused on higher income levels, while the Health Institutions and Beds in Health Institutions were concentrated on lower income levels. In China, a few provinces attained a basic balance in both equity and efficiency in terms of current health resource and service utilization, thus serving as a reference standard for other provinces.
Marquez, Monica; Patel, Prachee; Raphael, Marisa; Morgenthau, Beth Maldin
Since 2001, the New York City Department of Health and Mental Hygiene (NYC DOHMH) has built a strong public health preparedness foundation, made possible in large part by funding from the Public Health Emergency Preparedness (PHEP) Cooperative Agreement provided by the Centers for Disease Control and Prevention. While this funding has allowed NYC DOHMH to make great progress in areas such as all-hazards planning, risk communication, disease surveillance, and lab capacity, the erosion of federal preparedness dollars for all-hazards preparedness has the potential to reverse these gains. Since the initiation of the PHEP grant in 2002, PHEP funding has steadily declined nationwide. Specifically, the total federal allocation has decreased approximately 20%, from $862,777,000 in 2005 to $688,914,546 in 2009. With city and state budgets at an all-time low, federal funding cuts will have a significant impact on public health preparedness programs nationwide. In this time of strict budgetary constraints, the nation would be better served by strategically awarding federal preparedness funds to areas at greatest risk. The absence of risk-based funding in determining PHEP grant awards leaves the nation's highest-risk areas, like New York City, with insufficient resources to prepare for and respond to public health emergencies. This article examines the progress New York City has made and what is at stake as federal funding continues to wane.
This paper analyzes the investment mode from dimensions of partnership type,corporate type,and contractual type. Firstly,the government should encourage private equity fund to invest PPP projects as a partner. Secondly,under the same tax burden,PE should invest as limited partnership. Thirdly,PE should combine equity investment with debt investment to overcome the shortcomings of pure equity investment of PPP project,which is more risky and has less profit.%从角色、组织形式、投资方式三个维度分析私募股权基金投资PPP项目的应用问题:1)政府应引导私募股权基金以社会投资人身份介入PPP项目,培育优质基础资产;2)在税负相当的情况下,应以有限合伙企业的形式投资PPP项目;3)应创新股债结合模式以克服PPP项目股权投资"风险大、利润薄"的缺陷.
U.S. Department of Health & Human Services — 1991-2014. Centers for Disease Control and Prevention (CDC). State Tobacco Activities Tracking and Evaluation (STATE) System. Funding Data, Appropriations...
U.S. Department of Health & Human Services — 1991-2014. Centers for Disease Control and Prevention (CDC). State Tobacco Activities Tracking and Evaluation (STATE) System. Funding Data, Appropriations...
Daar Abdallah S
Full Text Available Abstract Background While venture funding has been applied to biotechnology and health in high-income countries, it is still nascent in these fields in developing countries, and particularly in Africa. Yet the need for implementing innovative solutions to health challenges is greatest in Africa, with its enormous burden of communicable disease. Issues such as risk, investment opportunities, return on investment requirements, and quantifying health impact are critical in assessing venture capital’s potential for supporting health innovation. This paper uses lessons learned from five venture capital firms from Kenya, South Africa, China, India, and the US to suggest design principles for African health venture funds. Discussion The case study method was used to explore relevant funds, and lessons for the African context. The health venture funds in this study included publicly-owned organizations, corporations, social enterprises, and subsidiaries of foreign venture firms. The size and type of investments varied widely. The primary investor in four funds was the International Finance Corporation. Three of the funds aimed primarily for financial returns, one aimed primarily for social and health returns, and one had mixed aims. Lessons learned include the importance of measuring and supporting both social and financial returns; the need to engage both upstream capital such as government risk-funding and downstream capital from the private sector; and the existence of many challenges including difficulty of raising capital, low human resource capacity, regulatory barriers, and risky business environments. Based on these lessons, design principles for appropriate venture funding are suggested. Summary Based on the cases studied and relevant experiences elsewhere, there is a case for venture funding as one support mechanism for science-based African health innovation, with opportunities for risk-tolerant investors to make financial as well as social
Masum, Hassan; Chakma, Justin; Simiyu, Ken; Ronoh, Wesley; Daar, Abdallah S; Singer, Peter A
While venture funding has been applied to biotechnology and health in high-income countries, it is still nascent in these fields in developing countries, and particularly in Africa. Yet the need for implementing innovative solutions to health challenges is greatest in Africa, with its enormous burden of communicable disease. Issues such as risk, investment opportunities, return on investment requirements, and quantifying health impact are critical in assessing venture capital's potential for supporting health innovation. This paper uses lessons learned from five venture capital firms from Kenya, South Africa, China, India, and the US to suggest design principles for African health venture funds. The case study method was used to explore relevant funds, and lessons for the African context. The health venture funds in this study included publicly-owned organizations, corporations, social enterprises, and subsidiaries of foreign venture firms. The size and type of investments varied widely. The primary investor in four funds was the International Finance Corporation. Three of the funds aimed primarily for financial returns, one aimed primarily for social and health returns, and one had mixed aims. Lessons learned include the importance of measuring and supporting both social and financial returns; the need to engage both upstream capital such as government risk-funding and downstream capital from the private sector; and the existence of many challenges including difficulty of raising capital, low human resource capacity, regulatory barriers, and risky business environments. Based on these lessons, design principles for appropriate venture funding are suggested. Based on the cases studied and relevant experiences elsewhere, there is a case for venture funding as one support mechanism for science-based African health innovation, with opportunities for risk-tolerant investors to make financial as well as social returns. Such funds should be structured to overcome the
Ahmad Nizar Shihab
Full Text Available Indonesia is targeting to achieve Universal Health Coverage (UHC in 2019. Currently, the National Health Insurance program (JKN has been running since it was first started at January 1, 2014 and includes as many as 171 million participants from 254 million targeted population of Indonesia as efforts in achieving UHC. Objective: The aim of this study was to evaluate the effect of JKN against the equity in the utilization of inpatient care in thegovernment hospital (RS and private hospitals before the implementation of JKN in 2013 and one year after JKN implemented in 2015 into 4 main groups: health insurance, geographic (rural and urban, income per capita, and education groups. This study used mixed method data collection techniques by using quantitative data obtained from secondary data of the National Socioeconomic Survey (Susenas 2013 and 2015, and BPJS (Social Security Agency of Health 2014-2015. The qualitative data obtained from the study of literature (desk review. Data analysis was performed by considering the percentage, delta, ratio, and odds ratio of utilization of inpatient care in government and private hospitals. Based on the analysis of the fourgroups studied, showed that the JKN program improve equity and increase public access to the utilization of inpatient both at the Government and Private Hospital especially for the JKN participants, ruralpopulation, lowest income groups and less educated group. Health insurance membershipp group: more patients using health services use health insurance both in government and at private hospitals, but the number of JKN card owner is the highest in government hospital. Conversely, those with private insurance use more health services in private hospitals. Geographic groups (rural and urban: JKN increase greater equity for rural people than urban communities. The increase in the highest access especially in utilization of health services in private hospitals. The access for rural communities in
Omrani-Khoo, Habib; Lotfi, Farhad; Safari, Hossein; Zargar Balaye Jame, Sanaz; Moghri, Javad; Shafii, Milad
Equitable distribution of health system resources has been a serious challenge for long ago among the health policy makers. Conducted studies have mostly ever had emphasis on equality rather than equity. In this paper we have attempted to examine both equality and equity in resources distribution. This is an applied and descriptive study in which we plotted Lorenz and concentration curves to describe graphically the distribution of hemodialysis beds and nephrologists as two complementary resources in health care in relation to hemodialysis patients. To end this, inequality and inequity were measured by calculating Gini- coefficient, concentration and Robin Hood indices. We used STATA and EXCEL software to calculate indicators. The results showed that inequality was not seen in hemodialysis beds in population level. However, distribution of nephrologists without considering population needs was accompanied with some sort of inequality. Gini- coefficient for beds and nephrologists distribution in population level was respectively 0.02 and 0.38. Hence, calculation of concentration index for distribution of hemodialysis beds and nephrologists with regard to population needs indicated that unlike beds distribution, equity gap between nephrologists distribution against patients distribution among the provinces was considerably significant again. Our results imply that although hemodialysis beds in Iran have been distributed in connection with the population need, nephrologists' distribution is not the same as hemodialysis beds one and this imbalance in complementary resources, can affect both efficiency and equitable access to services for population.
Frenk, Julio; Chen, Lincoln
The 20th anniversary of the groundbreaking report of the Commission on Health Research for Development inspired a Symposium to assess progress made in strengthening essential national health research capacity in developing countries and in global research partnerships. Significant aspects of the health gains achieved in the 20th century can be attributed to the advancement and translation of knowledge, and knowledge continues to occupy center stage amidst growing complexity that characterizes the global health field. The way forward will entail a reinvigoration of research-generated knowledge as a crucial ingredient for global cooperation and global health advances. To do this we will need to overcome daunting gaps, including the divides between domestic and global health, among the disciplines of research (biomedical, clinical, epidemiological, health systems), between clinical and public health approaches, public and private investments, and between knowledge gained and action implemented. Overcoming systematically these obstacles can accelerate progress towards research for equity in health and development.
Full Text Available Abstract The 20th anniversary of the groundbreaking report of the Commission on Health Research for Development inspired a Symposium to assess progress made in strengthening essential national health research capacity in developing countries and in global research partnerships. Significant aspects of the health gains achieved in the 20th century can be attributed to the advancement and translation of knowledge, and knowledge continues to occupy center stage amidst growing complexity that characterizes the global health field. The way forward will entail a reinvigoration of research-generated knowledge as a crucial ingredient for global cooperation and global health advances. To do this we will need to overcome daunting gaps, including the divides between domestic and global health, among the disciplines of research (biomedical, clinical, epidemiological, health systems, between clinical and public health approaches, public and private investments, and between knowledge gained and action implemented. Overcoming systematically these obstacles can accelerate progress towards research for equity in health and development.
Welch, V; Petkovic, J; Pardo Pardo, J; Rader, T; Tugwell, P
Social media use has been increasing in public health and health promotion because it can remove geographic and physical access barriers. However, these interventions also have the potential to increase health inequities for people who do not have access to or do not use social media. In this paper, we aim to assess the effects of interactive social media interventions on health outcomes, behaviour change and health equity. We conducted a rapid response overview of systematic reviews. We used a sensitive search strategy to identify systematic reviews and included those that focussed on interventions allowing two-way interaction such as discussion forums, social networks (e.g. Facebook and Twitter), blogging, applications linked to online communities and media sharing. Eleven systematic reviews met our inclusion criteria. Most interventions addressed by the reviews included online discussion boards or similar strategies, either as stand-alone interventions or in combination with other interventions. Seven reviews reported mixed effects on health outcomes and healthy behaviours. We did not find disaggregated analyses across characteristics associated with disadvantage, such as lower socioeconomic status or age. However, some targeted studies reported that social media interventions were effective in specific populations in terms of age, socioeconomic status, ethnicities and place of residence. Four reviews reported qualitative benefits such as satisfaction, finding information and improved social support. Social media interventions were effective in certain populations at risk for disadvantage (youth, older adults, low socioeconomic status, rural), which indicates that these interventions may be effective for promoting health equity. However, confirmation of effectiveness would require further study. Several reviews raised the issue of acceptability of social media interventions. Only four studies reported on the level of intervention use and all of these reported
Arokiasamy, P; Pradhan, J
The concentration index is the most commonly used measure of socio-economic-related health inequality. However, a critical constraint has been that it is just a measure of inequality. Equity is an important goal of health policy but the average level of health also matters. In this paper, we explore evidence of both these crucial dimensions-equity (inequality) and efficiency (average health)-in child health indicators by adopting the recently developed measure of the extended concentration index on the National Family Health Survey (NFHS-3) data from India. An increasing degree of inequality aversion is used to measure health inequalities as well as achievement in the following child health indicators: under-2 child mortality, full immunization coverage, and prevalence of underweight, wasting and stunting among children. State-wise adjusted under-2 child mortality scores reveal an increasing trend with increasing values of inequality aversion, implying that under-2 child deaths have been significantly concentrated among the poor households. The level of adjusted under-2 child mortality scores increases significantly with the increasing value of aversion even in states advanced in the health transition, such as Kerala and Goa. The higher values of adjusted scores for lower values of aversion for child immunization coverage are evidence that richer households benefited most from the rise in full immunization coverage. However, the lack of radical changes in the adjusted scores for underweight among children with increasing degrees of aversion implies that household economic status was not the only determinant of poor nutritional status in India.
Wagstaff, A; van Doorslaer, E; van der Burg, H; Calonge, S; Christiansen, T; Citoni, G; Gerdtham, U G; Gerfin, M; Gross, L; Häkinnen, U; Johnson, P; John, J; Klavus, J; Lachaud, C; Lauritsen, J; Leu, R; Nolan, B; Perán, E; Pereira, J; Propper, C; Puffer, F; Rochaix, L; Rodríguez, M; Schellhorn, M; Winkelhake, O
This paper presents further international comparisons of progressivity of health care financing systems. The paper builds on the work of Wagstaff et al. [Wagstaff, A., van Doorslaer E., et al., 1992. Equity in the finance of health care: some international comparisons, Journal of Health Economics 11, pp. 361-387] but extends it in a number of directions: we modify the methodology used there and achieve a higher degree of cross-country comparability in variable definitions; we update and extend the cross-section of countries; and we present evidence on trends in financing mixes and progressivity.
Cavagnero, Eleonora; Bilger, Marcel
This article analyses the redistributive effect caused by health financing and the distribution of healthcare utilization in Argentina before and during the severe 2001/2002 economic crisis. Both dramatically changed during this period: the redistributive effect became much more positive and utilization shifted from pro-poor to pro-rich. This clearly demonstrates that when utilization is contingent on financing, changes can occur rapidly; and that an integrated approach is required when monitoring equity. From a policy perspective, the Argentine health system appears vulnerable to economic downturns mainly due to high reliance on out-of-pocket payments and the strong link between health insurance and employment.
Bernstein, Shai; Lerner, Josh; Sørensen, Morten
The growth of the private equity industry has spurred concerns about its impact on the economy. This analysis looks across nations and industries to assess the impact of private equity on industry performance. We find that industries where private equity funds invest grow more quickly in terms...
Kouyoumdjian, Fiona G; McIsaac, Kathryn E; Foran, Jessica E; Matheson, Flora I
Health research provides a means to define health status and to identify ways to improve health. Our objective was to define the proportion of grants and funding from the Government of Canada's health research investment agency, the Canadian Institutes of Health Research (CIHR), that was awarded for prison health research, and to describe the characteristics of funded grants. In this descriptive study, we defined prison health research as research on the health and health care of people in prisons and at the time of their release. We searched the CIHR Funding Decisions Database by subject and by investigator name for funded grants for prison health research in Canada in all competitions between 2010 and 2014. We calculated the proportion of grants and funding awarded for prison health research, and described the characteristics of funded grants. During the 5-year study period, 21 grants were awarded that included a focus on prison health research, for a total of $2 289 948. Six of these grants were operating grants and 6 supported graduate or fellowship training. In total, 0.13% of all grants and 0.05% of all funding was for prison health research. A relatively small proportion of CIHR grants and funding were awarded for prison health research between 2010 and 2014. If prison health is a priority for Canada, strategic initiatives that include funding opportunities could be developed to support prison health research in Canada.
Friedman, Eric A; Gostin, Lawrence O
The proposal for a global health treaty aimed at health equity, the Framework Convention on Global Health, raises the fundamental question of whether we can achieve true health equity, globally and domestically, and if not, how close we can come. Considerable knowledge currently exists about the measures required to, at the least, greatly improve health equity. Why, then, do immense inequities remain? Building on this basic question, we propose four areas that could help drive the health equity research and innovation agenda over the coming years.First, recognizing that local contexts will often affect the success of policies aimed at health equity, local research will be critical to adapt strategies to particular settings. This part of the research agenda would be well-served by directly engaging intended beneficiaries for their insights, including through participatory action research, where the research contributes to action towards greater health equity.Second, even with the need for more local knowledge, why is the copious knowledge on how to reduce inequities not more frequently acted upon? What are the best strategies to close policymakers' knowledge gaps and to generate the political will to apply existing knowledge about improving health equity, developing the policies and devoting the resources required? Linked to this is the need to continue to build our understanding of how to empower the activism that can reshape power dynamics.Today's unequal power dynamics contribute significantly to disparities in a third area of focus, the social determinants of health, which are the primary drivers of today's health inequities. Continuing to improve our understanding of the pathways through which they operate can help in developing strategies to change these determinants and disrupt harmful pathways.And fourth, we return to the motivating question of whether we can achieve health equity. For example, can all countries have universal health coverage that
Full Text Available Marcos Bosi Ferraz1,21Department of Medicine, Escola Paulista de Medicina, Federal University of São Paulo, São Paulo, Brazil; 2São Paulo Center for Health Economics (GRIDES, Escola Paulista de Medicina, Federal University of São Paulo, São Paulo, Brazil Abstract: Health care is a highly complex, dynamic, and creative sector of the economy. While health economics has to continue its efforts to improve its methods and tools to better inform decisions, the application needs to be aligned with the insights and models of other social sciences disciplines. Decisions may be guided by four concept models based on ethical and distributive justice: libertarian, communitarian, egalitarian, and utilitarian. The societal agreement on one model or a defined mix of models is critical to avoid inequity and unfair decisions in a public and/or private insurance-based health care system. The excess use of methods and tools without fully defining the basic goals and philosophical principles of the health care system and without evaluating the fitness of these measures to reaching these goals may not contribute to an efficient improvement of population health. Keywords: health care, health care system, population health
O'Neill, Marie S; Kinney, Patrick L; Cohen, Aaron J
The health burden of environmental exposures, including ambient air pollution and climate-change-related health impacts, is not equally distributed between or within regions and countries. These inequalities are currently receiving increased attention in environmental research as well as enhanced appreciation in environmental policy, where calls for environmental equity are more frequently heard. The World Health Organization (WHO) 2006 Global Update of the Air Quality Guidelines attempted to address the global-scale inequalities in exposures to air pollution and the burden of diseases due to air pollution. The guidelines stop short, however, of addressing explicitly the inequalities in exposure and adverse health effects within countries and urban areas due to differential distribution of sources of air pollution such as motor vehicles and local industry, and differences in susceptibility to the adverse health effects attributed to air pollution. These inequalities, may, however, be addressed in local air quality and land use management decisions. Locally, community-based participatory research can play an important role in documenting potential inequities and fostering corrective action. Research on environmental inequities will also benefit from current efforts to (1) better understand social determinants of health and (2) apply research evidence to reduce health disparities. Similarly, future research and policy action will benefit from stronger linkages between equity concerns related to health consequences of both air pollution exposure and climate change, since combustion products are important contributors to both of these environmental problems.
Pratt, Bridget; Loff, Bebe
Health research has been identified as a vehicle for advancing global justice in health. However, in bioethics, issues of global justice are mainly discussed within an ongoing debate on the conditions under which international clinical research is permissible. As a result, current ethical guidance predominantly links one type of international research (biomedical) to advancing one aspect of health equity (access to new treatments). International guidelines largely fail to connect international research to promoting broader aspects of health equity - namely, healthier social environments and stronger health systems. Bioethical frameworks such as the human development approach do consider how international clinical research is connected to the social determinants of health but, again, do so to address the question of when international clinical research is permissible. It is suggested that the narrow focus of this debate is shaped by high-income countries' economic strategies. The article further argues that the debate's focus obscures a stronger imperative to consider how other types of international research might advance justice in global health. Bioethics should consider the need for non-clinical health research and its contribution to advancing global justice.
@@ Article 1 In order to promote development of equity investment funds and encourage foreign investors to launch foreigninvested equity investment fund management enterprises in Beijing, this measure is promulgated according to the " Approval of the State Council on Supporting Zhongguancun Scientific Park Constructing State-class Independent Innovation Demonstration Zone"(State Council documents, No28,2009), the "Proposals of the CPC Beijing Municipal commission and the People's Government of Beijing on Promoting Finance Development" (Beijing documents, No.8,2008) , the " Proposals of the People's Government of Beijing on Finance Promoting Economic Development in Beijing"(Beijing Government documents, No.7,2009) , and the "Proposals on Promoting development of Equity Investment Fund Industry"(Beijing Finance Office,No.5,2009).
Full Text Available Abstract Background This methodological article is based on a health policy research project conducted in Burkina Faso (West Africa. Concept mapping (CM was used as a research method to understand the local views of equity among stakeholders, who were concerned by the health policy under consideration. While this technique has been used in North America and elsewhere, to our knowledge it has not yet been applied in Africa in any vernacular language. Its application raises many issues and certain methodological limitations. Our objective in this article is to present its use in this particular context, and to share a number of methodological observations on the subject. Methods Two CMs were done among two different groups of local stakeholders following four steps: generating ideas, structuring the ideas, computing maps using multidimensional scaling and cluster analysis methods, and interpreting maps. Fifteen nurses were invited to take part in the study, all of whom had undergone training on health policies. Of these, nine nurses (60% ultimately attended the two-day meeting, conducted in French. Of 45 members of village health committees who attended training on health policies, only eight were literate in the local language (Moore. Seven of these (88% came to the meeting. Results The local perception of equity seems close to the egalitarian model. The actors are not ready to compromise social stability and peace for the benefit of the worst-off. The discussion on the methodological limitations of CM raises the limitations of asking a single question in Moore and the challenge of translating a concept as complex as equity. While the translation of equity into Moore undoubtedly oriented the discussions toward social relations, we believe that, in the context of this study, the open-ended question concerning social justice has a threefold relevance. At the same time, those limitations were transformed into strengths. We understand that it was
Ferraz, Marcos Bosi
Health care is a highly complex, dynamic, and creative sector of the economy. While health economics has to continue its efforts to improve its methods and tools to better inform decisions, the application needs to be aligned with the insights and models of other social sciences disciplines. Decisions may be guided by four concept models based on ethical and distributive justice: libertarian, communitarian, egalitarian, and utilitarian. The societal agreement on one model or a defined mix of models is critical to avoid inequity and unfair decisions in a public and/or private insurance-based health care system. The excess use of methods and tools without fully defining the basic goals and philosophical principles of the health care system and without evaluating the fitness of these measures to reaching these goals may not contribute to an efficient improvement of population health. PMID:25709481
Shrime, Mark G.; Sekidde, Serufusa; Linden, Allison; Cohen, Jessica L.; Weinstein, Milton C.; Salomon, Joshua A.
Background The recently adopted Sustainable Development Goals call for the end of poverty and the equitable provision of healthcare. These goals are often at odds, however: health seeking can lead to catastrophic spending, an outcome for which cancer patients and the poor in resource-limited settings are at particularly high risk. How various health policies affect the additional aims of financial wellbeing and equity is poorly understood. This paper evaluates the health, financial, and equity impacts of governmental and charitable policies for surgical oncology in a resource-limited setting. Methods Three charitable platforms for surgical oncology delivery in Uganda were compared to six governmental policies aimed at improving healthcare access. An extended cost-effectiveness analysis using an agent-based simulation model examined the numbers of lives saved, catastrophic expenditure averted, impoverishment averted, costs, and the distribution of benefits across the wealth spectrum. Findings Of the nine policies and platforms evaluated, two were able to provide simultaneous health and financial benefits efficiently and equitably: mobile surgical units and governmental policies that simultaneously address surgical scaleup, the cost of surgery, and the cost of transportation. Policies that only remove user fees are dominated, as is the commonly employed short-term “surgical mission trip”. These results are robust to scenario and sensitivity analyses. Interpretation The most common platforms for increasing access to surgical care appear unable to provide health and financial risk protection equitably. On the other hand, mobile surgical units, to date an underutilized delivery platform, are able to deliver surgical oncology in a manner that meets sustainable development goals by improving health, financial solvency, and equity. These platforms compare favorably with policies that holistically address surgical delivery and should be considered as countries
Cristiani Vieira Machado
Full Text Available The article analyzes Federal funding of health policy in Brazil in the 2000s, focusing on the Ministry of Health’s budget implementation. Federal spending on health was less unstable between 2000 and 2002 and has expanded since 2006. However, it fluctuated as a share of both the Gross Domestic Product and Gross National Revenue. Federal intergovernmental transfers increased, exceeding 70% in 2007. Meanwhile, the proportion of Federal investments remained low, varying from 3.4% to 6.3%. The highest absolute amount of spending was on specialized outpatient and hospital care. The decade showed a proportionally greater increase in spending on pharmaceutical care. The growing allocation of Federal funds to States in the North and Northeast, especially for primary care and epidemiological surveillance, failed to offset the sharp regional inequalities in per capita Federal spending. The main characteristics of health funding limit Federal health policy governance and pose several challenges for the Brazilian Unified National Health System.
Benn, Christoph; Hyder, Adnan A
Inequities in health and health care are one of the greatest challenges facing the international community today. This problem raises serious questions for health care planners, politicians and ethicists alike. The major world religions can play an important role in this discussion. Therefore, interreligious dialogue on this topic between ethicists and health care professionals is of increasing relevance and urgency. This article gives an overview on the positions of Islam and Christianity on equity and the distribution of resources in health care. It has been written in close collaboration and constant dialogue between the two authors coming from the two religions. Although there is no specific concept for the modern term equity in either of the two religions, several areas of agreement have been identified: All human beings share the same values and status, which constitutes the basis for an equitable distribution of rights and benefits. Special provisions need to be made for the most needy and disadvantaged. The obligation to provide equitable health services extends beyond national and religious boundaries. Several areas require intensified research and further dialogue: the relationship between the individual and the community in terms of rights and responsibilities, how to operationalize the moral duty to decrease global inequalities in health, and the understanding and interpretation of human rights in regard to social services.
Baum, Fran; Newman, Lareen; Biedrzycki, Katherine; Patterson, Jan
Despite decades of concern about reducing health inequity, the Commission on the Social Determinants of Health (CSDH) painted a picture of persistent and, in some cases, increasing health inequity. It also made a call for increased evaluation of interventions that might reduce inequities. This paper describes such an intervention-the Social Inclusion Initiative (SII) of the South Australian Government-that was documented for the Social Exclusion Knowledge Network of the CSDH. This initiative is designed to increase social inclusion by addressing key determinants of health inequity-in the study period these were education, homelessness and drug use. Our paper examines evidence from a rapid appraisal to determine whether a social inclusion initiative is a useful aspect of government action to reduce health inequity. It describes achievements in each specific area and the ways they can be expected to affect health equity. Our study highlighted four factors central to the successes achieved by the SII. These were the independent authority and influence of the leadership of the SII, the whole of government approach supported by an overarching strategic plan which sets clear goals for government and the clear and unambiguous support from the highest level of government. We conclude that a social inclusion approach can be valuable in the quest to reduce inequities and that further research on innovative social policy approaches is required to examine their likely impact on health equity.
In many Latin American and Asian countries the ... ence of social health insurance, and some Asian countries .... rates increased with increasing income, especially for hos- pitals. .... tors have shown a growing interest in managed care, and.
Bradley, Beverly D; Jung, Tiffany; Tandon-Verma, Ananya; Khoury, Bassem; Chan, Timothy C Y; Cheng, Yu-Ling
Operations research (OR) is a discipline that uses advanced analytical methods (e.g. simulation, optimisation, decision analysis) to better understand complex systems and aid in decision-making. Herein, we present a scoping review of the use of OR to analyse issues in global health, with an emphasis on health equity and research impact. A systematic search of five databases was designed to identify relevant published literature. A global overview of 1099 studies highlights the geographic distribution of OR and common OR methods used. From this collection of literature, a narrative description of the use of OR across four main application areas of global health - health systems and operations, clinical medicine, public health and health innovation - is also presented. The theme of health equity is then explored in detail through a subset of 44 studies. Health equity is a critical element of global health that cuts across all four application areas, and is an issue particularly amenable to analysis through OR. Finally, we present seven select cases of OR analyses that have been implemented or have influenced decision-making in global health policy or practice. Based on these cases, we identify three key drivers for success in bridging the gap between OR and global health policy, namely international collaboration with stakeholders, use of contextually appropriate data, and varied communication outlets for research findings. Such cases, however, represent a very small proportion of the literature found. Poor availability of representative and quality data, and a lack of collaboration between those who develop OR models and stakeholders in the contexts where OR analyses are intended to serve, were found to be common challenges for effective OR modelling in global health.
Full Text Available Abstract The impact of increased national wealth, as measured by Gross Domestic Product (GDP, on public health is widely understood, however an equally important but less well-acclaimed relationship exists between improvements in health and the growth of an economy. Communicable diseases such as HIV, TB, Malaria and the Neglected Tropical Diseases (NTDs are impacting many of the world's poorest and most vulnerable populations, and depressing economic development. Sickness and disease has decreased the size and capabilities of the workforce through impeding access to education and suppressing foreign direct investment (FDI. There is clear evidence that by investing in health improvements a significant increase in GDP per capita can be attained in four ways: Firstly, healthier populations are more economically productive; secondly, proactive healthcare leads to decrease in many of the additive healthcare costs associated with lack of care (treating opportunistic infections in the case of HIV for example; thirdly, improved health represents a real economic and developmental outcome in-and-of itself and finally, healthcare spending capitalises on the Keynesian 'economic multiplier' effect. Continued under-investment in health and health systems represent an important threat to our future global prosperity. This editorial calls for a recognition of health as a major engine of economic growth and for commensurate investment in public health, particularly in poor countries.
R. Brugha; J. Kadzandira; J. Simbaya; P. Dicker; V. Mwapasa; A. Walsh
Background Shortages of health workers are obstacles to utilising global health initiative (GHI) funds effectively in Africa. This paper reports and analyses two countries' health workforce responses during a period of large increases in GHI funds. Methods Health facility record reviews were conduct
Wagstaff, A; van Doorslaer, E; Calonge, S; Christiansen, T; Gerfin, M; Gottschalk, P; Janssen, R; Lachaud, C; Leu, R E; Nolan, B
This paper presents the results of a ten-country comparative study of health care financing systems and their progressivity characteristics. It distinguishes between the tax-financed systems of Denmark, Portugal and the U.K., the social insurance systems of France, the Netherlands and Spain, and the predominantly private systems of Switzerland and the U.S. It concludes that tax-financed systems tend to be proportional or mildly progressive, that social insurance systems are regressive and that private systems are even more regressive. Out-of-pocket payments are in most countries an especially regressive means of raising health care revenues.
Lago, Fernando Pablo; Moscoso, Nebel Silvana; Elorza, María Eugenia; Ripari, Nadia Vanina
In this paper we analyze the degree of equity in access to the public health care system in the Province of Buenos Aires (Argentina). Through a quantitative retrospective study, we analyze the inequalities in the distribution of the total public health expenditure per capita. This variable is used as a proxy for the ability of the inhabitants of each jurisdiction to access health care services. The results indicate the existence of large disparities in the levels of expenditure devoted to the population without health coverage. Moreover, the existence of greater health care needs (estimated using infant mortality rates and percentage of homes with basic needs unmet) does not translate into higher levels of public expenditure. Finally, we detect a positive association between the relative wealth of municipalities (measured by the gross geographic product per capita) and the public health expenditure per capita.
to promote physical activity in school aged children . Walkability Checklist completed for five elementary schools in North Charleston (Burns...that JROTC includes nutrition education and physical activity (2) Prevalence of overweight /obesity tended to decrease rather than increase by grade...appropriate fitness sessions, and other related activities , Heart Health teaches children and families how to improve their nutrition, activity , and
Systemic Lupus Erythematosus in the southern North Charleston and Neck areas of Charleston County: Investigation of health disparities related to...their partners are more receptive to learning about healthy behaviors during pregnancy and thus the timing of this information has the potential for
This study provides evidence on the role of the public sector in the allocation of ambulatory specialty mental health services across income groups in the adult population. Results suggest that in the early to mid-1980s, the tax and transfer system effectively lowered the price of services to the poor and the rich, thus causing the highest use by persons at the extreme ends of the income distribution. High utilization at the low end of the income scale can be largely attributed to publicly provided insurance. A comparison of demand prior to the Medicaid cuts brought on by the Omnibus Budget and Reconciliation Act (OBRA) of 1981 with post-OBRA estimates reveals the extreme sensitivity of demand to changes in coverage. Among upper income groups the results imply that the implicit price of specialty mental health care falls as income rises. This finding is consistent with the hypothesis that the government's exclusion of health benefits and expenditures from taxation effectively lowers the price of medical services to individuals in high marginal income tax brackets. It also suggests that recent proposals to limit the tax exclusion of employer-paid premiums may lead to a more equitable distribution of resources in the specialty mental health sector.
research in the metabolic, molecular, and genetic pathogenesis of insulin resistance , Type 2 Diabetes, and obesity . His studies have involved the...VIEW achievement of its stated aims. 15. SUBJECT TERMS Health Disparities, Cancer, Obesity , Diabetes, Cardiovascular Community 16...American Physicians, the Endocrine Society, and the American Diabetes Association, and the North American Association for the Study of Obesity
A. Wagstaff (Adam); E.K.A. van Doorslaer (Eddy)
textabstractThis paper presents the results of a ten-country comparative study of health care financing systems and their progressivity characteristics. It distinguishes between the tax-financed systems of Denmark, Portugal and the U.K., the social insurance systems of France, the Netherlands and Sp
Lynch, Una; Lazenbatt, Anne; Freeman, Ruth; Lynch, Gerry; Neill, Eileen O
The aim of the study addresses the inequity in oral health status of long stay psychiatric patients, by promoting an inter-disciplinary team approach to oral health promotion. A cross sectional study using a modified version of the oral health assessment guide (OHAG) (Eilers et al 1988, Sjorgen & Nordstrom 2000) was used by a nurse who received training and calibration at the School of Dentistry, Queen's University, Belfast, to assess the oral health status of long stay psychiatric patients. The paper provides an overview of the literature relating to oral health within the context of holistic health. It highlights the non-random distribution of oral health problems amongst psychiatric patients and the potential contribution of health needs assessment to the realization of equity. The study focused on 65 long stay patients in a psychiatric hospital, mean length of time patients had been in the hospital was 25.6 years; nine patients had been living in the hospital between 40 and 65 years. The study achieved a response rate of 82% and identified that oral health of the psychiatric patients was generally very poor, compared to the general population. Only one patient did not have calculus, decayed or fractured teeth and 12 of the patients were endentate and there was a conspicuous absence of health promoting behaviours amongst the patient group. A case study is used to highlight the lived reality of the patients and the need for a holistic and an inter-disciplinary approach to oral health promotion, for patients residing in a psychiatric setting. This preliminary investigation highlights the benefits of systematic assessment of need: in this instance the use of the OHAG as a tool, for promoting equity based care by making visible the non random distribution of oral health problems amongst the patients.
Ferry Grace A
Full Text Available Abstract Objective To explore the equity of utilization of inpatient health care at rural Tanzanian health centers through the use of a short wealth questionnaire. Methods Patients admitted to four rural health centers in the Kigoma Region of Tanzania from May 2008 to May 2009 were surveyed about their illness, asset ownership and demographics. Principal component analysis was used to compare the wealth of the inpatients to the wealth of the region's general population, using data from a previous population-based survey. Results Among inpatients, 15.3% were characterized as the most poor, 19.6% were characterized as very poor, 16.5% were characterized as poor, 18.9% were characterized as less poor, and 29.7% were characterized as the least poor. The wealth distribution of all inpatients (p Conclusion The findings indicated that while current Tanzanian health financing policies may have improved access to health care for children under five, additional policies are needed to further close the equity gap, especially for obstetric inpatients.
Chinman, Matthew; Woodward, Eva N; Curran, Geoffrey M; Hausmann, Leslie R M
Health disparities are differences in health or health care between groups based on social, economic, and/or environmental disadvantage. Disparity research often follows 3 steps: detecting (phase 1), understanding (phase 2), and reducing (phase 3), disparities. Although disparities have narrowed over time, many remain. We argue that implementation science could enhance disparities research by broadening the scope of phase 2 studies and offering rigorous methods to test disparity-reducing implementation strategies in phase 3 studies. We briefly review the focus of phase 2 and phase 3 disparities research. We then provide a decision tree and case examples to illustrate how implementation science frameworks and research designs could further enhance disparity research. Most health disparities research emphasizes patient and provider factors as predominant mechanisms underlying disparities. Applying implementation science frameworks like the Consolidated Framework for Implementation Research could help disparities research widen its scope in phase 2 studies and, in turn, develop broader disparities-reducing implementation strategies in phase 3 studies. Many phase 3 studies of disparity-reducing implementation strategies are similar to case studies, whose designs are not able to fully test causality. Implementation science research designs offer rigorous methods that could accelerate the pace at which equity is achieved in real-world practice. Disparities can be considered a "special case" of implementation challenges-when evidence-based clinical interventions are delivered to, and received by, vulnerable populations at lower rates. Bringing together health disparities research and implementation science could advance equity more than either could achieve on their own.
This article discusses a community's solution to improving women's health in Guatemala. Indigenous women from the highland community of Cajola formed the Asociacion Pro-Bienestar de la Mujer Mam (APBMM). The APBMM identified a need for women health promoters and good, low-cost medicines. The Instituto de Educacion Integral para la Salud y el Desarrollo (IDEI) helped train 16 women as health communicators or promoters in 1996. The health communicators learned about setting up community medicine distribution. The mayor bypassed APBMM's efforts to set up medicine distribution and set up a community pharmacy himself. Someone else opened a private pharmacy. The 200-member group was frustrated and redirected their energies to making natural herbal medicines, such as eucalyptus rub. The group set up a community medicine chest in the IDEI medical clinic and sold modern medicine, homemade vapor rubs, and syrups. The group was joined by midwives and other volunteers and began educating mothers about treatment of diarrhea and respiratory diseases. The Drogueria Estatal, which distributes medicines nationally to nongovernmental groups, agreed to sell high quality, low cost medicine to the medicine chest, which was renamed Venta Social de Medicamentos (VSM). The health communicators are working on three potential income generation projects: VSM, the production and sale of traditional medicines and educational materials, and an experimental greenhouse to grow medicinal plants and research other crops that can be grown in the highlands.
随着金融市场的迅速崛起,各种投资基金应运而生,其中私募基金更是以其操作灵活、易于掉头等优势而深得普通投资者的青睐。同时,由于与之配套的法律制度不完善,内部管理机制不健全,市场恶性竞争等因素的影响使得投资者的资金安全性问题存在巨大隐患。资金是一个基金生存和发展的生命线,如何确保资金的安全性问题不仅关系到投资者的切身利益,而且事关基金的生存与发展。对整个金融市场结构的优化和市场经济的健康发展至关重要。%With the rapid rise of the financial markets,investment funds have emerged,including private equity funds is its flexible operation,easy-to-turn-around and other advantages and won the favor of ordinary investors.Ancillary legal system is imperfect,and the internal management mechanism is not perfect,vicious market competition and other factors make the investors' funds safety issues there is a huge hidden.The capital is the lifeline of the survival and development of a fund and how to ensure the security of funds is not only related to the vital interests of investors and fund related to survival and development.It's essential to optimize the entire structure of financial markets and the healthy development of the market economy.
from 15 churches throughout the Tri-County area. Participation in the Fourth Annual National Conference on Genetics/ Genomics on December 8, 2010...1 2 Glazed Carrots ½ cup 130 185 2 25 4 3 Green Beans ½ cup 25 485 1 5 0 3 Lettuce /Salsa/Sour Cream ⅓ cup 35 185 2 3 0 0 Lettuce /Tomato leaf/slice 15...confirmation/health assessment materials be sent/received; notifying re: transportation; assembling files; maintaining spreadsheet Jim Etheredge
Ugá, Maria Alicia Domínguez; Santos, Isabela Soares
Health care in Brazil is financed from many sources--taxes on income, real property, sales of goods and services, and financial transactions; private insurance purchased by households and firms; and out-of-pocket payments by households. Data on household budgets and tax revenues allow the burden of each source except firms' insurance purchases for their employees to be allocated across deciles of adjusted per capita household income, indicating the progressivity or regressivity of each kind of payment. Overall, financing is approximately neutral, with progressive public finance offsetting regressive payments. This last form of finance pushes some households into poverty.
Full Text Available Urban green spaces provide an array of benefits, or ecosystem services, that support our physical, psychological, and social health. In many cases, however, these benefits are not equitably distributed across diverse urban populations. In this paper, we explore relationships between cultural ecosystem services provided by urban green space and the social determinants of health outlined in the United States Healthy People 2020 initiative. Specifically, we: (1 explore connections between cultural ecosystem services and social determinants of health; (2 examine cultural ecosystem services as nature-based health amenities to promote social equity; and (3 recommend areas for future research examining links between urban green space and public health within the context of environmental justice.
Jennings, Viniece; Larson, Lincoln; Yun, Jessica
Urban green spaces provide an array of benefits, or ecosystem services, that support our physical, psychological, and social health. In many cases, however, these benefits are not equitably distributed across diverse urban populations. In this paper, we explore relationships between cultural ecosystem services provided by urban green space and the social determinants of health outlined in the United States Healthy People 2020 initiative. Specifically, we: (1) explore connections between cultural ecosystem services and social determinants of health; (2) examine cultural ecosystem services as nature-based health amenities to promote social equity; and (3) recommend areas for future research examining links between urban green space and public health within the context of environmental justice.
Brown, Helen J; McPherson, Gladys; Peterson, Ruby; Newman, Vera; Cranmer, Barbara
For contemporary Indigenous people, colonial relations (past and present) intersect with neoliberal policies and practices to create subtle forms of dispossession.These undermine the health of Indigenous peoples and create barriers restricting access to appropriate health services. Integrating insights from the critical geographer David Harvey, the authors demonstrate how the dispossession of land and language threaten health and well-being and worsen existing illness conditions. Drawing on the qualitative findings from a program of community-based research with the 'Namgis First Nation in the Canadian province of British Columbia, the authors argue for an account of how neoliberal mechanisms operate to further the "accumulation by dispossession" associated with historical and ongoing colonialism. Specifically, they show how neoliberal ideologies operate to sustain medical colonialism and health inequities for Indigenous peoples. The authors discuss the implications for nursing actions to achieve health equity in rural First Nations communities.
Barten, Françoise; Akerman, Marco; Becker, Daniel; Friel, Sharon; Hancock, Trevor; Mwatsama, Modi; Rice, Marilyn; Sheuya, Shaaban; Stern, Ruth
All three of the interacting aspects of daily urban life (physical environment, social conditions, and the added pressure of climate change) that affect health inequities are nested within the concept of urban governance, which has the task of understanding and managing the interactions among these different factors so that all three can be improved together and coherently. Governance is defined as: "the process of collective decision making and processes by which decisions are implemented or not implemented": it is concerned with the distribution, exercise, and consequences of power. Although there appears to be general agreement that the quality of governance is important for development, much less agreement appears to exist on what the concept really implies and how it should be used. Our review of the literature confirmed significant variation in meaning as well as in the practice of urban governance arrangements. The review found that the linkage between governance practices and health equity is under-researched and/or has been neglected. Reconnecting the fields of urban planning, social sciences, and public health are essential "not only for improving local governance, but also for understanding and addressing global political change" for enhanced urban health equity. Social mobilization, empowering governance, and improved knowledge for sustainable and equitable development in urban settings is urgently needed. A set of strategic research questions are suggested.
Sridharan, Sanjeev; Tannahill, Carol
This paper is an introduction to a special issue on "Re-thinking Evaluations of Health Equity Initiatives." The papers in this volume aim to build understanding of how evaluations can contribute to addressing inequities and how evaluation design can develop a better understanding and also better respond to: (i) policy maker and practitioner needs; (ii) the systemic and complex nature of the interventions necessary to impact inequities; (iii) an understanding of the processes that generate inequities. Copyright © 2012 Elsevier Ltd. All rights reserved.
Dixon, Jane; Omwega, Abiud M; Friel, Sharon; Burns, Cate; Donati, Kelly; Carlisle, Rachel
There is increasing recognition that the nutrition transition sweeping the world's cities is multifaceted. Urban food and nutrition systems are beginning to share similar features, including an increase in dietary diversity, a convergence toward "Western-style" diets rich in fat and refined carbohydrate and within-country bifurcation of food supplies and dietary conventions. Unequal access to the available dietary diversity, calories, and gastronomically satisfying eating experience leads to nutritional inequalities and diet-related health inequities in rich and poor cities alike. Understanding the determinants of inequalities in food security and nutritional quality is a precondition for developing preventive policy responses. Finding common solutions to under- and overnutrition is required, the first step of which is poverty eradication through creating livelihood strategies. In many cities, thousands of positions of paid employment could be created through the establishment of sustainable and self-sufficient local food systems, including urban agriculture and food processing initiatives, food distribution centers, healthy food market services, and urban planning that provides for multiple modes of transport to food outlets. Greater engagement with the food supply may dispel many of the food anxieties affluent consumers are experiencing.
Rosenberg, Sebastian P; Hickie, Ian B
The implementation of activity-based funding (ABF) in mental health from 1 July 2013 has significant risks and benefits. It is critical that the process of implementation is consistent with Australia's cherished goal of establishing a genuine and effective model of community-based mental health care. The infrastructure to support the application of ABF to mental health is currently weak and requires considerable development. States and territories are struggling to meet existing demand for largely hospital-based acute mental health care. There is a risk that valuable ABF-driven Commonwealth growth funds may be used to prop up these systems rather than drive the emergence of new models of community-based care. Some of these new models exist now and this article provides a short description. The aim is to help the Independent Hospital Pricing Authority better understand the landscape of mental health into which it now seeks to deploy ABF.
The pharmaceutical industry is essential to our national economy ,which plays an key role in improving people’s well-being, enhancing life quality and promoting the economic development and social progress. From the perspective of fund investment, the capital investment is always hunting for the pharmaceutical industry. This essay conducts comparative analysis on six equity funds in the pharmaceutical industry from the angle of performance and puts forward the long-term investment suggestions based on the sorting after the accumulated income of the fund and risk adjustment.%医药行业是我国国民经济的重要组成部分，它对于保护和增进人民健康、提高生活质量以及促进经济发展和社会进步均具有十分重要的作用。从基金投资看，医药行业一直是市场投资的热点。文章选取了6支医药行业的股票型基金，从绩效角度对其进行比较分析，主要通过基金累计收益和风险调整后收益对其进行排序，从而提出长期投资的建议。
Von Heimburg, Dina; Hakkebo, Berit
To identify key factors in implementing Health and Equity in All Policies (HEiAP) at the local level in two Norwegian municipalities in order to accelerate the progress of promoting health, well-being and equity in other local governments. This case study is presented as a narrative from policy-making processes in two Norwegian municipalities. The story is told from an insider perspective, with a focus on HEiAP policy makers in these two municipalities. The narrative identified key learning from implementing HEiAP at the local level, i.e. the importance of strengthening system and human capacities. System capacity is strengthened by governing HEiAP according to national legislation and a holistic governance system at the local level. Municipal plans are based on theory, evidence and local data. A 'main story' is developed to support the vision, defining joint societal goals and co-creation strategies. Policies are anchored by measuring and monitoring outcomes, sharing accountability and continuous dialogue to ensure political commitment. Human capacity is strengthened through participatory leadership, soft skills and health promotion competences across sectors. Health promotion competence at a strategic level in the organization, participation in professional networks, crowd sourcing toward common goals, and commitment through winning hearts and minds of politicians and other stakeholders are vital aspects. Our experience pinpoints the importance of strengthening system and human capacity in local governments. Further, we found it important to focus on the two strategic objectives in the European strategy 'Health 2020': (1) Improving health for all and reducing health inequalities; (2) improving leadership and participatory governance for health.
Mullin, Christopher M.; Brown, Kathleen Sullivan
The purpose of this study was to replicate both The Education Trust's "The Funding Gap" and D. Verstegen and L. Driscoll's "The Illinois Dilemma" studies published in 2008 utilizing the actual allocations to districts resulting from the fiscal policy mechanism (funding formula) in Illinois for the 2004-2005 school year to…
Canagarajah, Sudharshan; Ye, Xiao
This paper analyzes efficiency and equity issues in public expenditures on education and health in Ghana during the 1990s. Data were drawn from reports of the ministries of education and health and from household surveys conducted 1988-98. In the late 1990s, Ghana's public expenditures on education decreased. Basic education enrollment was…
Shannon, Geordan D; Im, Dana D; Katzelnick, Leah; Franco, Oscar H
Researchers evaluated the progress of Millennium Development Goal Three, which promotes gender equity and empowering women, by assessing the targets for education, employment, and government, and their relation to women's health in South Asia. Researchers obtained data from the United Nations, Inter-Parliamentary Union, International Labor Organization, World Bank, and World Health Organization. First, they performed a literature review including manuscripts that quantified a Millenium Development Goal Three outcome in South Asia and were published after 1991. They derived women's health outcomes from World Health Organization databases. Spearman's rank test was used to evaluate the relationship between change in gender parity and change in women's health outcomes. South Asia's average primary education Gender Parity Index (defined as the ratio of girls to boys enrolled in primary, secondary, and tertiary education and expressed as a value between 0 and 1.0) improved from 0.73 (SD 0.34) to 0.92 (SD 0.13) between 2000 and 2008. Secondary and tertiary education had a lower Gender Parity Index (average 2008 Gender Parity Index 0.87 (SD 0.21) and 0.59 (SD 0.23), respectively), but had also improved from 2000 (average Gender Parity Index = 0.77, SD 0.38) to 2008 (average Gender Parity Index = 0.52, SD 0.11). An average proportion of 22.1% (SD 12.58) of women participated in waged, non-agricultural employment and 16.6% (SD 10.3) in national parliaments. No clear association was found between change in gender equity and women's health in South Asia between 2000 and 2008. Some progress has been made toward gender equity in South Asia, although the results have been mixed and inequities persist, especially in employment and government. While gender equity does not appear to have been related to female health outcomes, both must be addressed simultaneously as priority development targets and remain prerequisites to achieving the overall Millennium Development Goals
许静; 吴妮娜; 金生国; 王芳; 王云霞; 刘利群; 卢祖洵
The objective of this study was to examine the inpatient bed(IB) allocation equity and utilization in Chinese city community health service centers(CHSCs).The data were derived from the Baseline Survey of National City Community Health Service System Building Project,which was conducted in 1917 CHSCs in 28 cities in 2007.The IB allocation was analyzed in terms of IB allocation quantity and distribution equity,and the IB utilization was analyzed by the IB utilization rate and average length of stay of the CH...
Objectives: to characterize the scientific contribution nursing has made regarding coverage, universal access and equity in health, and to understand this production in terms of subjects and objects of study. Material and methods: this was cross-sectional, documentary research; the units of analysis were 97 journals and 410 documents, retrieved from the Web of Science in the category, "nursing". Descriptors associated to coverage, access and equity in health, and the Mesh thesaurus, were applied. We used bibliometric laws and indicators, and analyzed the most important articles according to amount of citations and collaboration. Results: the document retrieval allowed for 25 years of observation of production, an institutional and an international collaboration of 31% and 7%, respectively. The mean number of coauthors per article was 3.5, with a transience rate of 93%. The visibility index was 67.7%, and 24.6% of production was concentrated in four core journals. A review from the nursing category with 286 citations, and a Brazilian author who was the most productive, are issues worth highlighting. Conclusions: the nursing collective should strengthen future research on the subject, defining lines and sub-lines of research, increasing internationalization and building it with the joint participation of the academy and nursing community. PMID:26959329
Langford, Rebecca; Panter-Brick, Catherine
Health interventions increasingly rely on formative qualitative research and social marketing techniques to effect behavioural change. Few studies, however, incorporate qualitative research into the process of program evaluation to understand both impact and reach: namely, to what extent behaviour change interventions work, for whom, in what contexts, and why. We reflect on the success of a community-based hygiene intervention conducted in the slums of Kathmandu, Nepal, evaluating both maternal behaviour and infant health. We recruited all available mother-infant pairs (n = 88), and allocated them to control and intervention groups. Formative qualitative research on hand-washing practices included structured observations of 75 mothers, 3 focus groups, and 26 in-depth interviews. Our intervention was led by Community Motivators, intensively promoting hand-washing-with-soap at key junctures of food and faeces contamination. The 6-month evaluation period included hand-washing and morbidity rates, participant observation, systematic records of fortnightly community meetings, and follow-up interviews with 12 mothers. While quantitative measures demonstrated improvement in hand-washing rates and a 40% reduction in child diarrhoea, the qualitative data highlighted important equity issues in reaching the ultra-poor. We argue that a social marketing approach is inherently limited: focussing on individual agency, rather than structural conditions constraining behaviour, can unwittingly exacerbate health inequity. This contributes to a prevention paradox whereby those with the greatest need of a health intervention are least likely to benefit, finding hand-washing in the slums to be irrelevant or futile. Thus social marketing is best deployed within a range of interventions that address the structural as well as the behavioural and cognitive drivers of behaviour change. We conclude that critiques of social marketing have not paid sufficient attention to issues of health
Ahmad Reza Hosseinpoor
Full Text Available Monitoring inequalities in health is fundamental to the equitable and progressive realization of universal health coverage (UHC. A successful approach to global inequality monitoring must be intuitive enough for widespread adoption, yet maintain technical credibility. This article discusses methodological considerations for equity-oriented monitoring of UHC, and proposes recommendations for monitoring and target setting. Inequality is multidimensional, such that the extent of inequality may vary considerably across different dimensions such as economic status, education, sex, and urban/rural residence. Hence, global monitoring should include complementary dimensions of inequality (such as economic status and urban/rural residence as well as sex. For a given dimension of inequality, subgroups for monitoring must be formulated taking into consideration applicability of the criteria across countries and subgroup heterogeneity. For economic-related inequality, we recommend forming subgroups as quintiles, and for urban/rural inequality we recommend a binary categorization. Inequality spans populations, thus appropriate approaches to monitoring should be based on comparisons between two subgroups (gap approach or across multiple subgroups (whole spectrum approach. When measuring inequality absolute and relative measures should be reported together, along with disaggregated data; inequality should be reported alongside the national average. We recommend targets based on proportional reductions in absolute inequality across populations. Building capacity for health inequality monitoring is timely, relevant, and important. The development of high-quality health information systems, including data collection, analysis, interpretation, and reporting practices that are linked to review and evaluation cycles across health systems, will enable effective global and national health inequality monitoring. These actions will support equity-oriented progressive
Petkovic, Jennifer; Barton, Jennifer L; Flurey, Caroline
and how to address equity issues within the core outcome sets of domains and instruments. METHODS: We surveyed current and previous OMERACT meeting attendees and members of the Campbell and Cochrane Equity Group regarding whether to address equity issues within the OMERACT Filter 2.0 Core Outcome Sets...
Kelly, J Daniel; Barrie, M Bailor; Ross, Rachel A; Temple, Brian A; Moses, Lina M; Bausch, Daniel G
Poor quality housing is an infringement on the rights of all humans to a standard of living adequate for health. Among the many vulnerabilities of those without adequate shelter is the risk of disease spread by rodents and other pests. One such disease is Lassa fever, an acute and sometimes severe viral hemorrhagic illness endemic in West Africa. Lassa virus is maintained in the rodent Mastomys natalensis, commonly known as the "multimammate rat," which frequently invades the domestic environment, putting humans at risk of Lassa fever. The highest reported incidence of Lassa fever in the world is consistently in the Kenema District of Sierra Leone, a region that was at the center of Sierra Leone's civil war in which tens of thousands of lives were lost and hundreds of thousands of dwellings destroyed. Despite the end of the war in 2002, most of Kenema's population still lives in inadequate housing that puts them at risk of rodent invasion and Lassa fever. Furthermore, despite years of health education and village hygiene campaigns, the incidence of Lassa fever in Kenema District appears to be increasing. We focus on Lassa fever as a matter of human rights, proposing a strategy to improve housing quality, and discuss how housing equity has the potential to improve health equity and ultimately economic productivity in Sierra Leone. The manuscript is designed to spur discussion and action towards provision of housing and prevention of disease in one of the world's most vulnerable populations.
Full Text Available Despite widespread gains toward the 5th Millennium Development Goal (MDG, pro-rich inequalities in reproductive health (RH and maternal health (MH are pervasive throughout the world. As countries enter the post-MDG era and strive toward UHC, it will be important to monitor the extent to which countries are achieving equity of RH and MH service coverage. This study explores how equity of service coverage differs across countries, and explores what policy factors are associated with a country's progress, or lack thereof, toward more equitable RH and MH service coverage.We used RH and MH service coverage data from Demographic and Health Surveys (DHS for 74 countries to examine trends in equity between countries and over time from 1990 to 2014. We examined trends in both relative and absolute equity, and measured relative equity using a concentration index of coverage data grouped by wealth quintile. Through multivariate analysis we examined the relative importance of policy factors, such as political commitment to health, governance, and the level of prepayment, in determining countries' progress toward greater equity in RH and MH service coverage.Relative equity for the coverage of RH and MH services has continually increased across all countries over the past quarter century; however, inequities in coverage persist, in some countries more than others. Multivariate analysis shows that higher education and greater political commitment (measured as the share of government spending allocated to health were significantly associated with higher equity of service coverage. Neither country income, i.e., GDP per capita, nor better governance were significantly associated with equity.Equity in RH and MH service coverage has improved but varies considerably across countries and over time. Even among the subset of countries that are close to achieving the MDGs, progress made on equity varies considerably across countries. Enduring disparities in access and
Quintal, Carlota; Lopes, José
Equity in health care financing is recognised as a main goal in health policy. It implies that payments should be linked to capacity to pay and that households should be protected against catastrophic health expenditure (CHE). The risk of CHE is inversely related to the share of out-of-pocket payments (OOP) in total health expenditure. In Portugal, OOP represented 26% of total health expenditure in 2010 [one of the highest among Organisation for Economic Co-operation and Development (OECD) countries]. This study aims to identify the proportion of households with CHE in Portugal and the household factors associated with this outcome. Additionally, progressivity indices are calculated for OOP and private health insurance. Data were taken from the Portuguese Household Budget Survey 2010/2011. The prevalence of CHE is 2.1%, which is high for a developed country with a universal National Health Service. The main factor associated with CHE is the presence of at least one elderly person in households (when the risk quadruples). Payments are particularly regressive for medicines. Regarding the results by regions, the Kakwani index for total OOP is larger (negative) for the Centre and lower, not significant, for the Azores. Payments for voluntary health insurance are progressive.
Michelle L Patterson PhD, RPsych
Full Text Available Underlying the daily lives of people with experiences of homelessness and mental illness is a complex interplay of individual and structural factors that perpetuate cycles of inequity. The introduction of novel methodological combinations within qualitative research has the potential to advance knowledge regarding the experience of health equity by such individuals and to clarify the relationship between these experiences and broader structural inequities. To explore the lived experience of inequity, we present a thematic analysis of narrative interviews in conjunction with timelines from 31 adults experiencing homelessness and mental illness. Use of these methods together enabled a novel and expanded appreciation for the varied ways in which differential access to the social determinants of health influences the trajectories and experiences of inequity for people who are homeless and mentally ill. The further utility of these methods for better understanding the experience of inequity is explored and implications for research, policy, and practice are discussed.
《私募股权众筹融资管理办法(试行)(征求意见稿)》虽对股权众筹的发展作出了积极回应,但作为现行法与社会实践妥协的产物,相关规定显示出适用性不足.对股权众筹予以再松绑不仅是理论上契合的需要,更是社会实践提出的迫切要求.除修改《证券法》相关条文外,尚需补充配套制度.创建融资限额豁免制度、放开股权众筹份额流转限制、建立股权众筹平台声誉机制、创新纠纷解决机制等,为股权众筹的有序、健康发展营造一个切实可行的制度环境.%Though positive feedback has been made on Administrative Measures in Private Equity Crowd Funding (Trial) (Exposure Draft) to the development of equity crowd funding, relevant provisions indicate a lack of applicability as a product of compromise between current laws and social practice. The deregulation on equity crowd funding is a need by theory, and furthermore an urgent requirement posed by social practice. In addition to the modification of the relevant provisions in Securities Act, it is necessary to complement the supporting system. Measures should be taken including creating a financing limit exemption system, easing the restriction on the share transferring of equity crowd funding, establishing a reputation mechanism of crowd funding platform, innovating the dispute settlement mechanism, so as to create a practical system environment to facilitate the orderly and healthy development of crowd funding.
Full Text Available El fin último de cualquier sistema de salud es contribuir a la mejora de la salud de la población y hacerlo de la manera más eficiente posible. Buscando mejorar las condiciones de eficiencia y equidad en que se prestan los servicios de salud, numerosos países en todo el mundo, incluyendo los latinoamericanos, han implementado reformas. A pesar de la aparente coincidencia en los objetivos de las reformas, la forma en que se implementan responden a conceptos y valores diferentes. En este artículo analizamos los valores, igualitarios y neoliberales, subyacentes en los distintos conceptos de equidad. A partir de ellos desarrollamos criterios que nos permitan interpretar algunas de las estrategias, financiamiento y prestación de los servicios de salud aplicados por las reformas de los sistemas de salud en Latinoamérica. Estos criterios son aplicados a las políticas de financiamiento y prestaciones de las reformas aplicadas en los sistemas de salud de Colombia y Costa Rica.The aim of any health care system is to help improve the people's health, and to do so as efficiently as possible. In order to improve the efficiency and equity of health services provision, many countries around the world have implemented reforms, including several Latin American nations. However similar the objectives may appear, the various ways societies implement such reforms reflect different values and concepts. This article analyzes the egalitarian and neoliberal values underlying different concepts of equity in health care. The authors develop criteria to interpret selected health services funding and provision strategies in Latin American health system reforms. These criteria are then applied to health care financing and delivery policies under the reforms currently being implemented in Colombia and Costa Rica.
Full Text Available This paper focuses on the returns of two segments of Private Equity (PE market in Europe and in the US; Venture Capital (VC and Buyout (BO. Contrary to the publicly traded stocks where information about the trade of securities is public, the measuring of the returns of these asset classes is not unambiguous. The returns of PE investments are considered as confidential information therefore we only have estimations about the real characteristics of the financial performance of the PE industry. Although it is impossible to observe the whole industry it is important to chart its performance because PE plays an essential role in the financing of firms, especially firms at special stages of their lives and the more information the investors and companies have, the more effective PE market can be therefore it can contribute to economic growth, employment, innovation etc. In the literature PE, VC and BO are not distinguished properly and they are often used as synonyms. Despite their similarities, there are significant differences in the features of these types of investments. In this paper the authors present the return characteristics of the PE industry of Europe and the US with regard to the stage-focus of PE funds. The key findings of this paper are that in average the returns of BO funds exceeded the returns of VC funds in the US as well as in Europe. Not just according to the absolute value of the returns, but also according to its risk-return tradeoff BO seems to be a preferable investment. The same statements can be made in case of the European market. The US returns are higher than European VC returns, because compared to the US VC industry the European is undeveloped. On the other hand the gap between the performances of BO funds is not as significant as the difference of VC funds. While in the 90’s US BO funds outperformed the European ones, after the millennia European BO returns were higher. The analysis of returns reveals the
Snow, Robert W; Okiro, Emelda A; Gething, Peter W; Atun, Rifat; Hay, Simon I
Financing for malaria control has increased as part of international commitments to achieve the Millennium Development Goals (MDGs). We aimed to identify the unmet financial needs that would be biologically and economically equitable and would increase the chances of reaching worldwide malaria-control ambitions. Populations at risk of stable Plasmodium falciparum or Plasmodium vivax transmission were calculated for 2007 and 2009 for 93 malaria-endemic countries to measure biological need. National per-person gross domestic product (GDP) was used to define economic need. An analysis of external donor assistance for malaria control was done for the period 2002-09 to compute overall and annualised per-person at-risk-funding commitments. Annualised malaria donor assistance was compared with independent predictions of funding needed to reach international targets of 80% coverage of best practices in case-management and effective disease prevention. Countries were ranked in relation to biological, economic, and unmet needs to examine equity and adequacy of support by 2010. International financing for malaria control has increased by 166% (from $0·73 billion to $1·94 billion) since 2007 and is broadly consistent with biological needs. African countries have become major recipients of external assistance; however, countries where P vivax continues to pose threats to control ambitions are not as well funded. 21 countries have reached adequate assistance to provide a comprehensive suite of interventions by 2009, including 12 countries in Africa. However, this assistance was inadequate for 50 countries representing 61% of the worldwide population at risk of malaria-including ten countries in Africa and five in Asia that coincidentally are some of the poorest countries. Approval of donor funding for malaria control does not correlate with GDP. Funding for malaria control worldwide is 60% lower than the US$4·9 billion needed for comprehensive control in 2010; this includes
Full Text Available Abstract Background The Commission on Health Research for Development concluded that "for the most vulnerable people, the benefits of research offer a potential for change that has gone largely untapped." This project was designed to assess low and middle income country capacity and commitment for equity-oriented research. Methods A multi-disciplinary team with coordinators from each of four regions (Asia, Latin America, Africa and Central and Eastern Europe developed a questionnaire through consensus meetings using a mini-Delphi technique. Indicators were selected based on their quality, validity, comprehensiveness, feasibility and relevance to equity. Indicators represented five categories that form the Health Research Profile (HRP: 1 Research priorities; 2 Resources (amount spent on research; 3 Production of knowledge (capacity; 4 Packaging of knowledge and 5 Evidence of research impact on policy and equity. We surveyed three countries from each region. Results Most countries reported explicit national health research priorities. Of these, half included specific research priorities to address inequities in health. Data on financing were lacking for most countries due to inadequate centralized collection of this information. The five main components of HRP showed a gradient where countries scoring lower on the Human Development Index (HDI had a lower capacity to conduct research to meet local health research needs. Packaging such as peer-reviewed journals and policy forums were reported by two thirds of the countries. Seven out of 12 countries demonstrated impact of health research on policies and reported engagement of stakeholders in this process. Conclusion Only one out of 12 countries indicated there was research on all fronts of the equity debate. Knowledge sharing and management is needed to strengthen within-country capacity for research and implementation to reduce inequities in health. We recommend that all countries (and external
Schlenker, Thomas; Huber, Carol A
In addition to the Affordable Care Act, states are more frequently turning to Medicaid waivers to achieve the "Triple Aim" goals of improving the experience of care, improving population health, and reducing per capita costs. These demonstration waivers provide opportunities to test innovative ways to finance and deliver care. Texas is currently implementing a waiver known as the Transformation and Quality Improvement Program. Its inclusion of public health agencies is a unique approach to a system typically limited to traditional providers. San Antonio Metropolitan Health District is one public health agency taking advantage of this new funding opportunity to implement 6 new or expanded programs targeting health issues of highest priority in this south Texas region. This article discusses the use of Medicaid waivers and the advantages and challenges of public health agency participation.
Betancourt, Joseph R; Tan-McGrory, Aswita; Kenst, Karey S; Phan, Thuy Hoai; Lopez, Lenny
Leaders of health care organizations need to be prepared to improve quality and achieve equity in today's health care environment characterized by a focus on achieving value and addressing disparities in a diverse population. To help address this need, the Disparities Solutions Center at Massachusetts General Hospital launched the Disparities Leadership Program in 2007. The leadership program is an ongoing, year-long, executive education initiative that trains leaders from hospitals, health plans, and health centers to improve quality and eliminate racial and ethnic disparities in health care. Feedback from participating organizations demonstrates that health care leaders seem to possess knowledge about what disparities are and about what should be done to eliminate them. Data collection, performance measurement, and multifaceted interventions remain the tools of the trade. However, the barriers to success are lack of leadership buy-in, organizational prioritization, energy, and execution, which can be addressed through organizational change management strategies. Project HOPE—The People-to-People Health Foundation, Inc.
Moss, Nancy E
This paper explores the interrelationship of gender equity and socioeconomic inequality and how they affect women's health at the macro- (country) and micro- (household and individual) levels. An integrated framework draws theoretical perspectives from both approaches and from public health. Determinants of women's health in the geopolitical environment include country-specific history and geography, policies and services, legal rights, organizations and institutions, and structures that shape gender and economic inequality. Culture, norms and sanctions at the country and community level, and sociodemographic characteristics at the individual level, influence women's productive and reproductive roles in the household and workplace. Social capital, roles, psychosocial stresses and resources. health services, and behaviors mediate social, economic and cultural effects on health outcomes. Inequality between and within households contributes to the patterning of women's health. Within the framework, relationships may vary depending upon women's lifestage and cohort experience. Examples of other relevant theoretical frameworks are discussed. The conclusion suggests strategies to improve data, influence policy, and extend research to better understand the effect of gender and socioeconomic inequality on women's health.
...\\ See FAQs about Affordable Care Act Implementation (Part V) and Mental Health Parity Implementation... Parity and Addiction Equity Act of 2008. \\7\\ See FAQs about Affordable Care Act Implementation (Part V... Diagnostic and Statistical Manual of Mental Disorders (DSM), the most current version of the...
Aryeetey, G.C.N.O.; Jehu-Appiah, C.; Spaan, E.J.A.M.; Agyepong, I.; Baltussen, R.M.
Objectives To analyse the costs and evaluate the equity, efficiency and feasibility of four strategies to identify poor households for premium exemptions in Ghana's National Health Insurance Scheme (NHIS): means testing (MT), proxy means testing (PMT), participatory wealth ranking (PWR) and geograph
Hayman-White, Karla; Happell, Brenda
The impact of mental illness on disease and disability burden is receiving more recognition than has previously been the case. It is now commonly understood that approximately 20% of the Australian population will experience a mental illness at some stage during their lives. Unfortunately this recognition is not reflected in the funding of mental health services, or in strategies to identify and rectify shortfalls in the nursing workforce. This paper provides an exploration of two areas. Firstly an overview of the current funding devoted to mental health and secondly an examination of workforce data with a view to recognising likely future trends for psychiatric nursing. The data demonstrates the existence of a double dilemma, firstly that the need for psychiatric nurses is likely to increase, and secondly that the looming workforce crisis may be more severe than has been anticipated.
Full Text Available This article includes evidence on equity, governance and health financing outcomes of the Mexican health system. An evaluative research with a cross-sectional design was oriented towards the qualitative and quantitative analysis of financing, governance and equity indicators. Taking into account feasibility, as well as political and technical criteria, seven Mexican states were selected as study populations and an evaluative research was conducted during 2002-2010. The data collection techniques were based on in-depth interviews with key personnel (providers, users and community leaders, consensus technique and document analysis. The qualitative analysis was done with ATLAS TI and POLICY MAKER softwares. The Mexican health system reform has modified dependence at the central level; there is a new equity equation for resources allocation, community leaders and users of services reported the need to improve an effective accountability system at both municipal and state levels. Strategies for equity, governance and financing do not have adequate mechanisms to promote participation from all social actors. Improving this situation is a very important goal in the Mexican health democratization process, in the context of health care reform. Inequality on resources allocation in some regions and catastrophic expenditure for users is unequal in all states, producing more negative effects on states with high social marginalization. Special emphasis is placed on the analysis of the main strengths and weaknesses, as relevant evidences for other Latin American countries which are designing, implementing and evaluating reform strategies in order to achieve equity, good governance and a greater financial protection in health.
Vaughan, J P; Mogedal, S; Kruse, S; Lee, K; Walt, G; de Wilde, K
From 1948, when WHO was established, the Organisation has relied on the assessed contributions of its member states for its regular budget. However, since the early 1980s the WHO World Health Assembly has had a policy of zero real growth for the regular budget and has had to rely increasingly, therefore, on attracting additional voluntary contributions, called extrabudgetary funds (EBFs). Between 1984-85 and 1992-93 the real value of the EBFs apparently increased by more than 60% and in the 1990-91 biennium expenditure of extrabudgetary funds exceeded the regular budget for the first time. All WHO programmes, except the Assembly and the Executive Board, receive some EBFs. However, three cosponsored and six large regular programmes account for about 70% of these EBFs, mainly for vertically managed programmes in the areas of disease control, health promotion and human reproduction. Eighty percent of all EBFs received by WHO for assisted activities have been contributed by donor governments, with the top 10 countries (in Europe, North America and Japan) contributing about 90% of this total, whereas the UN funds and the World Bank have donated only about 6% of the total to date. By contrast, about 70% of the regular budget expenditure has been for organisational expenses and for the support of programmes in the area of health systems. Despite the fact that the more successful programmes are heavily reliant on EBFs, there are strong indications that donors, particularly donor governments, are reluctant to maintain the current level of funding without major reforms in the leadership and management of the Organisation. This has major implications for WHO's international role as the leading UN specialised agency for health.
Schlegelmilch, Jeff; Petkova, Elisaveta; Redlener, Irwin
Federal funding for health and medical preparedness in the USA has created an important foundation for preparing the health and medical systems to respond to a wide range of hazards. A declining trend in funding for these preparedness activities threatens to undo the progress that has been made over the last decade and reduce the state of readiness to respond to the health and medical impacts of disasters.
Glinos, Irene A
The WHO Global Code of Practice on the International Recruitment of Health Personnel is a landmark in the health workforce migration debate. Yet its principles apply only partly within the European Union (EU) where freedom of movement prevails. The purpose of this article is to explore whether free mobility of health professionals contributes to "equitably strengthen health systems" in the EU. The article proposes an analytical tool (matrix), which looks at the effects of health professional mobility in terms of efficiency and equity implications at three levels: for the EU, for destination countries and for source countries. The findings show that destinations as well as sources experience positive and negative effects, and that the effects of mobility are complex because they change, overlap and are hard to pin down. The analysis suggests that there is a risk that free health workforce mobility disproportionally benefits wealthier Member States at the expense of less advantaged EU Member States, and that mobility may feed disparities as flows redistribute resources from poorer to wealthier EU countries. The article argues that the principles put forward by the WHO Code appear to be as relevant within the EU as they are globally.
It is a great time for prevention. As the United States explores what health in our country should look like, it is an extraordinary time to highlight the role of prevention in improving health, saving lives, and saving money. The Affordable Care Act's investment in prevention has spurred innovation by communities and states to keep people healthy and safein the first place This includes growing awareness that community conditions are critical in determining health and that there is now a strong track record of prevention success. Community prevention strategies create lasting changes by addressing specific policies and practices in the environments and institutions that shape our lives and our health-from schools and workplaces to neighborhoods and government. Action at the community level also fosters health equity-the opportunity for every person to achieve optimal health regardless of identity, neighborhood, ability, or social status-and is often the impetus for national-level decisions that vitally shape the well-being of individuals and populations.
Howat, Peter; Stoneham, Melissa
Australia's population could reach 42 million by 2050. This rapid population growth, if unabated, will have significant social, public health and environmental implications. On the one hand, it is a major driver of climate change and environmental degradation; on the other it is likely to be a major contributor to growing social and health issues including a decline in quality of life for many residents. Disadvantaged and vulnerable groups will be most affected. The environmental, social and health-related issues include: pressure on the limited arable land in Australia; increased volumes of industrial and domestic waste; inadequate essential services; traffic congestion; lack of affordable housing; declining mental health; increased obesity problems; and inadequate aged care services. Many of these factors are related to the aggravation of climate change and health inequities. It is critical that the Australian Government develops a sustainable population plan with stabilisation of population growth as an option. The plan needs to ensure adequate hospitals and healthcare services, education facilities, road infrastructure, sustainable transport options, water quality and quantity, utilities and other amenities that are already severely overburdened in Australian cities. There is a need for a guarantee that affordable housing will be available and priority be given to training young people and Indigenous people for employment. This paper presents evidence to support the need for the stabilisation of population growth as one of the most significant measures to control climate change as well as to improve public health equity.
Full Text Available Abstract Background Deciding which health technologies to fund involves confronting some of the most difficult choices in medicine. As for other countries, the Israeli health system is faced each year with having to make these difficult decisions. The Public National Advisory Committee, known as ‘the Basket Committee’, selects new technologies for the basic list of health care that all Israelis are entitled to access, known as the ‘health basket’. We introduce a framework for health technology prioritization based explicitly on value for money that enables the main variables considered by decision-makers to be explicitly included. Although the framework’s exposition is in terms of the Basket Committee selecting new technologies for Israel’s health basket, we believe that the framework would also work well for other countries. Methods Our proposed prioritization framework involves comparing four main variables for each technology: 1. Incremental benefits, including ‘equity benefits’, to Israel’s population; 2. Incremental total cost to Israel’s health system; 3. Quality of evidence; and 4. Any additional ‘X-factors’ not elsewhere included, such as strategic or legal factors, etc. Applying methodology from multi-criteria decision analysis, the multiple dimensions comprising the first variable are aggregated via a points system. Results The four variables are combined for each technology and compared across the technologies in the ‘Value for Money (VfM Chart’. The VfM Chart can be used to identify technologies that are good value for money, and, given a budget constraint, to select technologies that should be funded. This is demonstrated using 18 illustrative technologies. Conclusions The VfM Chart is an intuitively appealing decision-support tool for helping decision-makers to focus on the inherent tradeoffs involved in health technology prioritization. Such deliberations can be performed in a systematic and transparent
Sadat, Somayeh; Carter, Michael W; Golden, Brian
Originally developed in the context of publicly traded for-profit companies, theory of constraints (TOC) improves system performance through leveraging the constraint(s). While the theory seems to be a natural fit for resource-constrained publicly funded health systems, there is a lack of literature addressing the modifications required to adopt TOC and define the goal and performance measures. This paper develops a system dynamics representation of the classical TOC's system-wide goal and performance measures for publicly traded for-profit companies, which forms the basis for developing a similar model for publicly funded health systems. The model is then expanded to include some of the factors that affect system performance, providing a framework to apply TOC's process of ongoing improvement in publicly funded health systems. Future research is required to more accurately define the factors affecting system performance and populate the model with evidence-based estimates for various parameters in order to use the model to guide TOC's process of ongoing improvement.
Dowling, Fiona, Ed.; Fitzgerald, Hayley, Ed.; Flintoff, Anne, Ed.
Issues of equity remain an essential theme throughout the study and practice of physical education (PE), youth sport and health. This important new book confronts and illuminates issues of equity and difference through the innovative use of narrative method, telling stories of difference that enable students, academics and professionals alike to…
Campbell-Lendrum, Diarmid; Corvalán, Carlos
Climate change is an emerging threat to global public health. It is also highly inequitable, as the greatest risks are to the poorest populations, who have contributed least to greenhouse gas (GHG) emissions. The rapid economic development and the concurrent urbanization of poorer countries mean that developing-country cities will be both vulnerable to health hazards from climate change and, simultaneously, an increasing contributor to the problem. We review the specific health vulnerabilities of urban populations in developing countries and highlight the range of large direct health effects of energy policies that are concentrated in urban areas. Common vulnerability factors include coastal location, exposure to the urban heat-island effect, high levels of outdoor and indoor air pollution, high population density, and poor sanitation. There are clear opportunities for simultaneously improving health and cutting GHG emissions most obviously through policies related to transport systems, urban planning, building regulations and household energy supply. These influence some of the largest current global health burdens, including approximately 800,000 annual deaths from ambient urban air pollution, 1.2 million from road-traffic accidents, 1.9 million from physical inactivity, and 1.5 million per year from indoor air pollution. GHG emissions and health protection in developing-country cities are likely to become increasingly prominent in policy development. There is a need for a more active input from the health sector to ensure that development and health policies contribute to a preventive approach to local and global environmental sustainability, urban population health, and health equity.
Abu-Zaineh, Mohammad; Mataria, Awad; Luchini, Stéphane; Moatti, Jean-Paul
This paper presents an application of the Urban and Lambert "upgraded-AJL Decomposition" approach that was designed to deal with the problem of close-income equals in equity analysis, and as applied to the area of health care finance. Contrary to most previous studies, vertical and horizontal inequities and the triple effects of inter-groups, intra-group and entire-group reranking of various financing schemes are estimated, with statistical significance calculated using the bootstrap method. Application is made on the three financing schemes present in the case of the Occupied Palestinian Territory. Results demonstrate the relative importance of the three forms of reranking in determining overall inequality. The paper offers policy recommendations to limit the existing inequalities in the system and to enhance the capacity of the governmental insurance scheme.
Ramon, Ismaila; Chattopadhyay, Sajal K; Barnett, W Steven; Hahn, Robert A
A recent Community Guide systematic review found that early childhood education (ECE) programs improve educational, social, and health-related outcomes and advance health equity because many are designed to increase enrollment for high-risk children. This follow-up economic review examines how the economic benefits of center-based ECE programs compare with their costs. Kay and Pennucci from the Washington State Institute for Public Policy, whose meta-analysis formed the basis of the Community Guide effectiveness review, conducted a benefit-cost analysis of ECE programs for low-income children in Washington State. We performed an electronic database search using both effectiveness and economic key words to identify additional cost-benefit studies published through May 2015. Kay and Pennucci also provided us with national-level benefit-cost estimates for state and district and federal Head Start programs. The median benefit-to-cost ratio from 11 estimates of earnings gains, the major benefit driver for 3 types of ECE programs (ie, state and district, federal Head Start, and model programs), was 3.39:1 (interquartile interval [IQI] = 2.48-4.39). The overall median benefit-to-cost ratio from 7 estimates of total benefits, based on all benefit components including earnings gains, was 4.19:1 (IQI = 2.62-8.60), indicating that for every dollar invested in the program, there was a return of $4.19 in total benefits. ECE programs promote both equity and economic efficiency. Evidence indicates there is positive social return on investment in ECE irrespective of the type of ECE program. The adoption of a societal perspective is crucial to understand all costs and benefits of ECE programs regardless of who pays for the costs or receives the benefits.
Numerous examples exist in population health of work that erroneously forces the causes of health to sum to 100%. This is surprising. Clear refutations of this error extend back 80 years. Because public health analysis, action, and allocation of resources are ill served by faulty methods, I consider why this error persists. I first review several high-profile examples, including Doll and Peto’s 1981 opus on the causes of cancer and its current interpretations; a 2015 high-publicity article in Science claiming that two thirds of cancer is attributable to chance; and the influential Web site “County Health Rankings & Roadmaps: Building a Culture of Health, County by County,” whose model sums causes of health to equal 100%: physical environment (10%), social and economic factors (40%), clinical care (20%), and health behaviors (30%). Critical analysis of these works and earlier historical debates reveals that underlying the error of forcing causes of health to sum to 100% is the still dominant but deeply flawed view that causation can be parsed as nature versus nurture. Better approaches exist for tallying risk and monitoring efforts to reach health equity. PMID:28272952
Clancy, Gerard P
Market- and legislation-driven health reforms are being implemented across the United States. Within this time of great change for health care delivery systems and medical schools lie opportunities to address the country's long-standing health inequities by using community needs assessments, health information technologies, and new models for care and payment. In this Commentary, the author, a university regional campus leader, shares several difficult personal experiences to demonstrate that health equity work undertaken by academic institutions also requires institutional leaders to pay attention to and gain an understanding of issues that go beyond public health data. The author reflects on lessons learned and offers recommendations that may help academic health center and university leaders be more effective as they take on the complex tasks involved in improving health inequities. These include reflection on personal strengths and deficiencies, engagement with the community, recognition of the historical roots of health disparities, and the development of trusting relationships between the institution and the community.
Kelly J Daniel
Full Text Available Abstract Poor quality housing is an infringement on the rights of all humans to a standard of living adequate for health. Among the many vulnerabilities of those without adequate shelter is the risk of disease spread by rodents and other pests. One such disease is Lassa fever, an acute and sometimes severe viral hemorrhagic illness endemic in West Africa. Lassa virus is maintained in the rodent Mastomys natalensis, commonly known as the “multimammate rat,” which frequently invades the domestic environment, putting humans at risk of Lassa fever. The highest reported incidence of Lassa fever in the world is consistently in the Kenema District of Sierra Leone, a region that was at the center of Sierra Leone’s civil war in which tens of thousands of lives were lost and hundreds of thousands of dwellings destroyed. Despite the end of the war in 2002, most of Kenema’s population still lives in inadequate housing that puts them at risk of rodent invasion and Lassa fever. Furthermore, despite years of health education and village hygiene campaigns, the incidence of Lassa fever in Kenema District appears to be increasing. We focus on Lassa fever as a matter of human rights, proposing a strategy to improve housing quality, and discuss how housing equity has the potential to improve health equity and ultimately economic productivity in Sierra Leone. The manuscript is designed to spur discussion and action towards provision of housing and prevention of disease in one of the world’s most vulnerable populations.
Scarborough, Jane; Eliott, Jaklin; Miller, Emma; Aylward, Paul
To suggest ways of increasing the cohesiveness of national primary healthcare strategies and hepatitis C strategies, with the aim of ensuring that all these strategies include ways to address barriers and facilitators to access to primary healthcare and equity for people with hepatitis C. A critical review was conducted of the first national Primary Healthcare System Strategy and Health Workforce Strategy with the concurrent Hepatitis C Strategy. Content relating to provision of healthcare in private general practice was examined, focussing on issues around access and equity. In all strategies, achieving access to care and equity was framed around providing sufficient medical practitioners for particular locations. Equity statements were present in all policies but only the Hepatitis C Strategy identified discrimination as a barrier to equity. Approaches detailed in the Primary Healthcare System Strategy and Health Workforce Strategy regarding current resource allocation, needs assessment and general practitioner incentives were limited to groups defined within these documents and may not identify or meet the needs of people with hepatitis C. Actions in the primary healthcare system and health workforce strategies should be extended to additional groups beyond those listed as priority groups within the strategies. Future hepatitis C strategies should outline appropriate, detailed needs assessment methodologies and specify how actions in the broad strategies can be applied to benefit the primary healthcare needs of people with hepatitis C.
Gotham, Dzintars; Meldrum, Jonathan; Nageshwaran, Vaitehi; Counts, Christopher; Kumari, Nina; Martin, Manuel; Beattie, Ben; Post, Nathan
Universities are significant contributors to research and technologies in health; however, the health needs of the world's poor are historically neglected in research. Medical discoveries are frequently licensed exclusively to one producer, allowing a monopoly and inequitable pricing. Similarly, research is often published in ways that make it inaccessible. Universities can adopt policies and practices to overcome neglect and ensure equitable access to research and its products. For 25 United Kingdom universities, data on health research funding were extracted from the top five United Kingdom funders' databases and coded as research on neglected diseases (NDs) and/or health in low- and lower-middle-income countries (hLLMIC). Data on intellectual property licensing policies and practices and open-access policies were obtained from publicly available sources and by direct contact with universities. Proportions of research articles published as open-access were extracted from PubMed and PubMed Central. Across United Kingdom universities, the median proportion of 2011-2014 health research funds attributable to ND research was 2.6% and for hLLMIC it was 1.7%. Overall, 79% of all ND funding and 74% of hLLMIC funding were granted to the top four institutions within each category. Seven institutions had policies to ensure that technologies developed from their research are affordable globally. Mostly, universities licensed their inventions to third parties in a way that confers monopoly rights. Fifteen institutions had an institutional open-access publishing policy; three had an institutional open-access publishing fund. The proportion of health-related articles with full-text versions freely available online ranged from 58% to 100% across universities (2012-2013); 23% of articles also had a creative commons CC-BY license. There is wide variation in the amount of global health research undertaken by United Kingdom universities, with a large proportion of total research
Hernández-Rincón, Erwin H; Pimentel-González, Juan P; Orozco-Beltrán, Domingo; Carratalá-Munuera, Concepción
The Pan American Health Organization (PAHO) and the Colombian Ministry of Health and Social Protection have determined a need for an approach to include Equity Focus (EF) and Social Determinants of Health (SDH) in health training programmes in Colombia. We studied the incorporation of EF and SDH in the curricula of several universities in Colombia to identify opportunities to strengthen their inclusion. Qualitative methodology was performed in two stages: (i) initial exploration (self-administered questionnaires and review of curricula) and (ii) validation of the information (semi-structured interviews). The inclusion of the EF and SDH in university curricula is regarded as an opportunity to address social problems. This approach addresses a broad cross-section of the curriculum, especially in the subjects of public health and Primary Health Care (PHC), where community outreach generates greater internalization by students. The dominance of the biomedical model of study plans and practice scenarios focusing on disease and little emphasis on community outreach are factors that limit the inclusion of the approach. The inclusion of EF and SDH in university curricula in Colombia has primarily focused on increasing the knowledge of various subjects oriented towards understanding the social dynamics or comprehensiveness of health and disease and, in some programmes, through practical courses in community health and PHC. Increased integration of EF and SDH in subjects or modules with clinical orientation is recommended. © The Author 2016. Published by Oxford University Press. All rights reserved. For permissions, please e-mail: firstname.lastname@example.org.
Guichard, Anne; Tardieu, Émilie; Dagenais, Christian; Nour, Kareen; Lafontaine, Ginette; Ridde, Valéry
The aim of this project was to identify and prioritize a set of conditions to be considered for incorporating a health equity tool into public health practice. Concept mapping and focus groups were implemented as complementary methods to investigate the conditions of use of a health equity tool by public health organizations in Quebec. Using a hybrid integrated research design is a richer way to address the complexity of questions emerging from intervention and planning settings. This approach provides a deeper, operational, and contextualized understanding of research results involving different professional and organizational cultures, and thereby supports the decision-making process. Concept mapping served to identify and prioritize in a limited timeframe the conditions to be considered for incorporation into a health equity tool into public health practices. Focus groups then provided a more refined understanding of the barriers, issues, and facilitating factors surrounding the tools adoption, helped distinguish among participants' perspectives based on functional roles and organizational contexts, and clarified some apparently contradictory results from the concept map. The combined use of these two techniques brought the strengths of each approach to bear, thereby overcoming some of the respective limitations of concept mapping and focus groups. This design is appropriate for investigating targets with multiple levels of complexity. Copyright © 2017 Elsevier Ltd. All rights reserved.
Embrett, Mark G; Randall, G E
Despite a dramatic growth in SDH/HE (social determinants of health/health equity) public policy research and demonstrated government interest in promoting equity in health policies, health inequities are actually growing among some populations and there is little evidence that "healthy public policies" are being adopted and implemented. Moreover, these issues are typically failing to even reach governments' policy agendas, which is a critical step towards serious debate and the identification of policy options. This systematic review pursues three main objectives. First, is to identify barriers to SDH/HE issues reaching the government policy agenda. Second, to evaluate the characteristics of peer-reviewed research articles that utilize common policy analysis theories. And third, to determine the extent to which the SDH/HE literature utilizes common policy analysis theories. Our systematic review, conducted in June 2012, identified 6200 SDH/HE related articles in the peer-reviewed literature; however, only seven articles explicitly used a commonly recognized policy analysis theory to inform their analysis. Our analysis revealed that the SDH/HE policy literature appears to be focused on advocacy rather than analysis and that the use of policy analysis theory is extremely limited. Our results also suggest that when such theories are incorporated into an analysis they are often not comprehensively employed. We propose explanations for this non-use and misuse of policy analysis theory, and conclude that researchers may have greater influence in helping to get SDH/HE issues onto government policy agendas if they gain a greater understanding of the policy process and the value of incorporating policy analysis theories into their research. Using a policy analysis lens to help identify why healthy public policies are typically not being adopted is an important step towards moving beyond advocacy to understanding and addressing some of the political barriers to reforms
Wittie, Michael; Ngo-Metzger, Quyen; Lebrun-Harris, Lydie; Shi, Leiyu; Nair, Suma
The Health Resources and Services Administration has supported the adoption of electronic health records (EHRs) by federally funded health centers for over a decade; however, little is known about health centers' current EHR adoption rates, progress toward Meaningful Use, and factors related to adoption. We analyzed cross-sectional data from all 1,128 health centers in 2011, which served over 20 million patients during that year. As of 2011, 80% of health centers reported using an EHR, and high proportions reported using many advanced EHR functionalities. There were no indications of disparities in EHR adoption by census region, urban/rural location, patient sociodemographic composition, physician staffing, or health center funding; however, there were small variations in adoption by total patient cost and percent of revenue from grants. Findings revealed no evidence of a digital divide among health centers, indicating that health centers are implementing EHRs, in keeping with their mission to reduce health disparities.
Wallerstein, Nina B; Yen, Irene H; Syme, S Leonard
The past quarter century has seen an explosion of concern about widening health inequities in the United States and worldwide. These inequities are central to the research mission in 2 arenas of public health: social epidemiology and community-engaged interventions. Yet only modest success has been achieved in eliminating health inequities. We advocate dialogue and reciprocal learning between researchers with these 2 perspectives to enhance emerging transdisciplinary language, support new approaches to identifying research questions, and apply integrated theories and methods. We recommend ways to promote transdisciplinary training, practice, and research through creative academic opportunities as well as new funding and structural mechanisms.
Charry, Ligia Constanza de; Carrasquilla, Gabriel; Roca, Sandra
Evaluating equity regarding early breast cancer detection by comparing real access to and opportunity for mammography screening according to women's social health insurance status. A retrospective follow-up study was conducted on women receiving breast cancer treatment in Bogotá, Cali, Medellin, Bucaramanga and Barranquilla between January 2005 and June 2006. A survey was carried out for collecting data about real access to and the opportunity of having mammography screening. OR and 95% confidence intervals were calculated (adjusted by multivariate logistical regression models) for establishing differences according to health insurance status. Possible interactions were investigated through verisimilarity log-like test. Women belonging to the contributory regime had a lower probability of real access to mammography screening for early detection of breast cancer than those affiliated to the subsidised regimen (OR=0,46; 0,26-0,72 95 %CI) and poor uninsured women (OR=0,36; 0,13-0,65 95 %CI). Educational level was also associated with real access to mammography, illiterate women having a lower probability of receiving mammography screening than literate women (OR=0,13; 0,02-0,30 95 %CI). Women having government-subsidised health insurance had a lower probability of accessing timely mammography screening (OR=0,10; 0,04-0,41 95 %CI). Mammography screening for the early detection of breast cancer is not equitable and such inequality particularly affects the most vulnerable women.
Boaz, R F
The debate over the future of the health care delivery system evolves around the policy issue of what constitutes a fair distribution of the medical services which are considered essential to prolonging life, curing disease, and relieving pain. A case can be made that a socially equitable distribution implies that consumption of medical services is independent of the consumer's income and payment for them unrelated to utilization. The present paper examines to what extent the provisions for financing a national health insurance system are likely to advance or hinder the fair distribution of health care services. Almost all bills specify a mix of direct (cost-shared) and indirect (prepaid) financing. When cost-sharing is based on the quantity of services or on the level of medical expenditure, it helps divert medical care and health insurance benefits to high-income persons at the expense of their low-or moderate-income counterparts. When indirect payments or premium levels are determined by insurance risks rather than by income, they may be too high for persons with moderate means, and are likely to exclude such persons from the national insurance program. When health insurance is tied to salaried employment, it discriminates against the unemployed and the self-employed. To rectify such inequities, some NHI proposals specify separate insurance plans for the disadvantaged. Such programs, which require income-testing to determine eligibility, are likely to be plagued by administrative complications currently engulfing other means-tested social welfare programs. The present paper makes some recommendations for the purpose of avoiding these difficulties and fostering equity in health care.
Caiaffa, W T; Friche, A A L; Dias, M A S; Meireles, A L; Ignacio, C F; Prasad, A; Kano, M
Detailed information on health linked to geographic, sociodemographic, and environmental data are required by city governments to monitor health and the determinants of health. These data are critical for guiding local interventions, resource allocation, and planning decisions, yet they are too often non-existent or scattered. This study aimed to develop a conceptual framework of Urban Health Observatories (UHOs) as an institutional mechanism which can help synthesize evidence and incorporate it into urban policy-making for health and health equity. A survey of a select group of existent UHOs was conducted using an instrument based on an a priori conceptual framework of key structural and functional characteristics of UHOs. A purposive sample of seven UHOs was surveyed, including four governmental, two non-governmental, and one university-based observatory, each from a different country. Descriptive and framework analysis methods were used to analyze the data and to refine the conceptual framework in light of the empirical data. The UHOs were often a product of unique historical circumstances. They were relatively autonomous and capable of developing their own locally sensitive agenda. They often had strong networks for accessing data and were able to synthesize them at the urban level as well as disaggregate them into smaller units. Some UHOs were identified as not only assessing but also responding to local needs. The findings from this study were integrated into a conceptual framework which illustrates how UHOs can play a vital role in monitoring trends in health determinants, outcomes, and equity; optimizing an intersectoral urban information system; incorporating research on health into urban policies and systems; and providing technical guidance on research and evidence-based policy making. In order to be most effective, UHOs should be an integral part of the urban governance system, where multiple sectors of government, the civil society, and businesses can
Prioritization of medical technologies requires a multi-dimensional view. Often, conflicting equity and efficiency criteria should be reconciled. The most dramatic manifestation of such conflict is in the prioritization of new medical technologies asking for public finance performed yearly by the Israeli Basket Committee. The aim of this paper is to compare the revealed preferences of the 2006/7 Basket Committee's members with the declared preferences of health policy-makers in Israel. We compared the ranking of a sample of 18 accepted and 16 rejected technologies evaluated by the 2006/7 Basket Committee with the ranking of these technologies as predicted based on the preferences of Israeli health policy-makers. These preferences were elicited by a recent Discrete Choice Experiment (DCE) which estimated the relative weights of four equity and three efficiency criteria. The candidate technologies were characterized by these seven criteria, and their ranking was determined. A third comparative ranking of these technologies was the efficiency ranking, which is based on international data on cost per QALY gained. The Committee's ranking of all technologies show no correspondence with the policy-makers' ranking. The correlation between the two is negative when only accepted technologies are ranked. The Committee's ranking is positively correlated with the efficiency ranking, while the health policy-makers' ranking is not. The Committee appeared to assign to efficiency considerations a higher weight than assigned by health policy-makers. The main explanation is that while policy-makers' ranking is based on stated preferences, that of the Committee reflects revealed preferences. Real life prioritization, made under a budget constraint, enhances the importance of efficiency considerations at the expense of equity ones. In order for Israeli health policy to be consistent and well coordinated across policy-makers, some discussions and exchanges are needed, to arrive at a
Putland, Christine; Baum, Fran; Ziersch, Anna; Arthurson, Kathy; Pomagalska, Dorota
Mounting evidence linking aspects of social capital to health and wellbeing outcomes, in particular to reducing health inequities, has led to intense interest in social capital theory within public health in recent decades. As a result, governments internationally are designing interventions to improve health and wellbeing by addressing levels of social capital in communities. The application of theory to practice is uneven, however, reflecting differing views on the pathways between social capital and health, and divergent theories about social capital itself. Unreliable implementation may restrict the potential to contribute to health equity by this means, yet to date there has been limited investigation of how the theory is interpreted at the level of policy and then translated into practice. The paper outlines a collaborative research project designed to address this knowledge deficit in order to inform more effective implementation. Undertaken in partnership with government departments, the study explored the application of social capital theory in programs designed to promote health and wellbeing in Adelaide, South Australia. It comprised three case studies of community-based practice, employing qualitative interviews and focus groups with community participants, practitioners, program managers and policy makers, to examine the ways in which the concept was interpreted and operationalized and identify the factors influencing success. These key lessons informed the development of practical resources comprising a guide for practitioners and briefing for policy makers. Overall the study showed that effective community projects can contribute to population health and wellbeing and reducing health inequities. Of specific relevance to this paper, however, is the finding that community projects rely for their effectiveness on a broader commitment expressed through policies and frameworks at the highest level of government decision making. In particular this
Full Text Available Se presenta una visión de largo plazo para la valoración de los avances en la equidad y en el derecho a la salud de la reforma del sistema de salud en Colombia. En medio de un sistema político restringido, los actores del campo de la salud en Colombia han construido opciones de tipo individualista que tienden a legalizar las desigualdades ligadas a la capacidad de pago de las personas. A pesar de los complejos mecanismos de regulación establecidos en el nuevo Sistema General de Seguridad Social en Salud, la tendencia apunta hacia una consolidación de las mismas desigualdades tradicionales y al distanciamiento de una garantía plena, equitativa y universal del derecho a la salud.The author develops a long-term perspective to assess advances in equity and the right to health in the Colombian health system reform. In a restricted political system, actors in the field of health in Colombia have chosen individualistic alternatives to legalize inequities in individual purchasing power for services. Despite the complex regulations established in the General System for Social Security in Health, there is a trend towards consolidating traditional inequities and to further restrict opportunities for achieving the right to health with full, equitable, universal guarantees.
With restricted public sector budgets, there is increasing pressure to obtain value for money in the allocation of health sector resources. Distortions and inefficiencies created by features of Australia's health funding arrangements prevent health resources moving from lower valued to higher valued activities. These distortions tend to restrict resources being allocated to disease prevention and health promotional approaches, favouring medical treatment. These propositions are illustrated, largely with reference to diabetes.
Full Text Available Abstract Background In response to limited resources, health care systems have adopted diverse cost-containment strategies and give priority to differing types of interventions. The perception of physicians, who witness the effects of these strategies, may provide useful insights regarding the impact of system-wide priority setting on access to care. Methods We conducted a cross-sectional survey to ascertain generalist physicians' perspectives on resources allocation and its consequences in Norway, Switzerland, Italy and the UK. Results Survey respondents (N = 656, response rate 43% ranged in age from 28–82, and averaged 25 years in practice. Most respondents (87.7% perceived some resources as scarce, with the most restrictive being: access to nursing home, mental health services, referral to a specialist, and rehabilitation for stroke. Respondents attributed adverse outcomes to scarcity, and some respondents had encountered severe adverse events such as death or permanent disability. Despite universal coverage, 45.6% of respondents reported instances of underinsurance. Most respondents (78.7% also reported some patient groups as more likely than others to be denied beneficial care on the basis of cost. Almost all respondents (97.3% found at least one cost-containment policy acceptable. The types of policies preferred suggest that respondents are willing to participate in cost-containment, and do not want to be guided by administrative rules (11.2% or restrictions on hospital beds (10.7%. Conclusion Physician reports can provide an indication of how organizational factors may affect availability and equity of health care services. Physicians are willing to participate in cost-containment decisions, rather than be guided by administrative rules. Tools should be developed to enable physicians, who are in a unique position to observe unequal access or discrimination in their health care environment, to address these issues in a more targeted way.
Si, Lei; Chen, Mingsheng; Palmer, Andrew J
Monitoring the equity of government healthcare subsidies (GHS) is critical for evaluating the performance of health policy decisions. China's low-income population encounters barriers in accessing benefits from GHS. This paper focuses on the distribution of China's healthcare subsidies among different socio-economic populations and the factors that affect their equitable distribution. It examines the characteristics of equitable access to benefits in a province of northeastern China, comparing the equity performance between urban and rural areas. Benefit incidence analysis was applied to GHS data from two rounds of China's National Health Services Survey (2003 and 2008, N = 27,239) in Heilongjiang province, reflecting the information in 2002 and 2007 respectively. Concentration index (CI) was used to evaluate the absolute equity of GHSs in outpatient and inpatient healthcare services. A negative CI indicates disproportionate concentration of GHSs among the poor, while a positive CI indicates the GHS is pro-rich, a CI of zero indicates perfect equity. In addition, Kakwani index (KI) was used to evaluate the progressivity of GHSs. A positive KI denotes the GHS is regressive, while a negative value denotes the GHS is progressive. CIs for inpatient care in urban and rural residents were 0.2036 and 0.4497 respectively in 2002, and those in 2007 were 0.4433 and 0.5375. Likewise, CIs for outpatient care are positive in both regions in 2002 and 2007, indicating that both inpatient and outpatient GHSs were pro-rich in both survey periods irrespective of region. In addition, KIs for inpatient services were -0.3769 (urban) and 0.0576 (rural) in 2002 and those in 2007 were 0.0280 and 0.1868. KIs for outpatient service were -0.4278 (urban) and -0.1257 (rural) in 2002, those in 2007 were -0.2572 and -0.1501, indicating that equity was improved in GHS in outpatient care in both regions but not in inpatient services. The benefit distribution of government healthcare subsidies
Sandman, David; Cozine, Maureen
With approximately 1.2 million New Yorkers poised to gain health insurance coverage as a result of federal health reform, demand for primary care services is likely to increase greatly. The Affordable Care Act includes $11 billion in funding to enhance primary care access at community health centers. Recognizing a need and an opportunity, in August 2010 the New York State Health Foundation made a grant of nearly $400,000 to the Community Health Care Association of New York State to work with twelve health centers to develop successful proposals for obtaining and using these federal funds. Ultimately, eleven of the twelve sites are expected to receive $25.6 million in federal grants over a five-year period-a sixty-four-fold return on the foundation's investment. This article describes the strategy for investing in community health centers; identifies key project activities, challenges, and lessons; and highlights its next steps for strengthening primary care.
Petersen, Poul Erik; Kwan, Stella
for health, healthy environments, healthy lifestyles, and the need for orientation of health services towards health promotion and disease prevention. This report advocates that oral health for all can be promoted effectively by applying this philosophy and some major public health actions are outlined....
Full Text Available Abstract Human resources for health are in crisis worldwide, especially in economically disadvantaged areas and areas with high rates of HIV/AIDS in both health workers and patients. International organizations such as the Global Health Workforce Alliance have been established to address this crisis. A technical working group within the Global Health Workforce Alliance developed recommendations for scaling up education and training of health workers. The paper will illustrate how decision-makers can use evidence and tools from an equity-oriented toolkit to scale up training and education of health workers, following five recommendations of the technical working group. The Equity-Oriented Toolkit, developed by the World Health Organization Collaborating Centre for Knowledge Translation and Health Technology Assessment in Health Equity, has four major steps: (1 burden of illness; (2 community effectiveness; (3 economic evaluation; and (4 knowledge translation/implementation. Relevant tools from each of these steps will be matched with the appropriate recommendation from the technical working group.
With this paper, five key domains of advocacy, clinical care and health promotion, education and health services delivery, workforce and professional development, and research are identified. All five require attention in order to reach the overarching goal of health equity for adolescents and young adults. SAHM believes that achieving health equity is related to its organizational mission and vision and is a key factor in driving excellence in adolescent health and medicine. SAHM will continue to expand its capacity, being introspective as an organization as well as make recommendations to others, in an effort to be collaborative and inclusive of professionals, programs, and systems that represent and serve the diverse populations for whom the Society advocates.
张昭; 马浩淼; 王文
The organization form of equity investment fund plays a key role in the performance of equity investment fund guided by the government. Under China's current legal and policy environment, government guidance equity investment fund mainly includes three kinds of organization forms---trust, corporation and limited partnership. The limited partnership PE is supposed to be the best organiza-tion form when equity investment fund is established, because of its reasonable configuration of powers and responsibilities, professional and efficient operation and management, relatively low operation cost and other advantages. However, limited partnership PE itself has certain underlying weak points, like information asymmetry and internal governance alienation, needing to introduce denial of legal per-son's personality , reconstruction of internal governance of funds, improvement of fund decision-making and income distribution mecha-nism to improve the system, so that it can display its superiority.%股权投资基金的组织形式是影响政府引导性股权投资基金运作绩效的核心问题。在我国当前的法律和政策环境下，政府引导性股权投资基金主要包括信托制、公司制和有限合伙制三种组织形式，其中有限合伙型PE以其权责配置科学合理、运营管理专业高效、运作成本相对较低等独特优势，理应成为设立股权投资基金的首选组织形式。但是有限合伙型PE本身也存在信息不够对称和内部治理异化等潜在缺陷，需要通过引入法人人格否认、重构基金内部治理、改进基金决策和收入分配机制等进行制度补阙和机制改良，使其发挥好应有的制度优势。
Full Text Available Abstract Background Shortages of health workers are obstacles to utilising global health initiative (GHI funds effectively in Africa. This paper reports and analyses two countries' health workforce responses during a period of large increases in GHI funds. Methods Health facility record reviews were conducted in 52 facilities in Malawi and 39 facilities in Zambia in 2006/07 and 2008; quarterly totals from the last quarter of 2005 to the first quarter of 2008 inclusive in Malawi; and annual totals for 2004 to 2007 inclusive in Zambia. Topic-guided interviews were conducted with facility and district managers in both countries, and with health workers in Malawi. Results Facility data confirm significant scale-up in HIV/AIDS service delivery in both countries. In Malawi, this was supported by a large increase in lower trained cadres and only a modest increase in clinical staff numbers. Routine outpatient workload fell in urban facilities, in rural health centres and in facilities not providing antiretroviral treatment (ART, while it increased at district hospitals and in facilities providing ART. In Zambia, total staff and clinical staff numbers stagnated between 2004 and 2007. In rural areas, outpatient workload, which was higher than at urban facilities, increased further. Key informants described the effects of increased workloads in both countries and attributed staff migration from public health facilities to non-government facilities in Zambia to PEPFAR. Conclusions Malawi, which received large levels of GHI funding from only the Global Fund, managed to increase facility staff across all levels of the health system: urban, district and rural health facilities, supported by task-shifting to lower trained staff. The more complex GHI arena in Zambia, where both Global Fund and PEPFAR provided large levels of support, may have undermined a coordinated national workforce response to addressing health worker shortages, leading to a less effective
Sheppard, Maria K
Despite the unproven effectiveness of many practices that are under the umbrella term 'complementary alternative medicine' (CAM), there is provision of CAM within the English National Health Service (NHS). Moreover, although the National Institute for Health and Care Excellence was established to promote scientifically validated medicine in the NHS, the paradox of publicly funded, non-evidence based CAM can be explained as linked with government policy of patient choice and specifically patient treatment choice. Patient choice is useful in the political and policy discourse as it is open to different interpretations and can be justified by policy-makers who rely on the traditional NHS values of equity and universality. Treatment choice finds expression in the policy of personalised healthcare linked with patient responsibilisation which finds resonance in the emphasis CAM places on self-care and self-management. More importantly, however, policy-makers also use patient choice and treatment choice as a policy initiative with the objective of encouraging destabilisation of the entrenched healthcare institutions and practices considered resistant to change. This political strategy of system reform has the unintended, paradoxical consequence of allowing for the emergence of non-evidence based, publicly funded CAM in the NHS. The political and policy discourse of patient choice thus trumps evidence based medicine, with patients that demand access to CAM becoming the unwitting beneficiaries.
Smit, Warren; Hancock, Trevor; Kumaresen, Jacob; Santos-Burgoa, Carlos; Sánchez-Kobashi Meneses, Raúl; Friel, Sharon
The importance of reestablishing the link between urban planning and public health has been recognized in recent decades; this paper focuses on the relationship between urban planning/design and health equity, especially in cities in low and middle-income countries (LMICs). The physical urban environment can be shaped through various planning and design processes including urban planning, urban design, landscape architecture, infrastructure design, architecture, and transport planning. The resultant urban environment has important impacts on the health of the people who live and work there. Urban planning and design processes can also affect health equity through shaping the extent to which the physical urban environments of different parts of cities facilitate the availability of adequate housing and basic infrastructure, equitable access to the other benefits of urban life, a safe living environment, a healthy natural environment, food security and healthy nutrition, and an urban environment conducive to outdoor physical activity. A new research and action agenda for the urban environment and health equity in LMICs should consist of four main components. We need to better understand intra-urban health inequities in LMICs; we need to better understand how changes in the built environment in LMICs affect health equity; we need to explore ways of successfully planning, designing, and implementing improved health/health equity; and we need to develop evidence-based recommendations for healthy urban planning/design in LMICs.
Berry, Nicole S; Murphy, Jill; Coser, Larissa
Over the last 25 years, the language of empowerment has been woven into the guiding missions and descriptions of institutions, funding and projects globally. Although theoretical understandings of empowerment within the domain of health promotion remain contentious, we have little idea of how a shift toward an empowerment agenda has affected the daily work of those in the field of health promotion. A systematic examination of the implementation of the empowerment agenda is important as it can help us understand how redistributive agendas are received within the multiple institutional contexts in which health promotion work is carried out. The goal of this study, therefore, was to try to understand the empowerment agenda within the context of everyday health promotion. We conducted semi-structured interviews with health promoters from a variety of geographical regions, institutional backgrounds, and job capacities. Essentially we found that empowerment remains conceptually dear to health promoters' understanding of their work, yet at the same time, mainstreaming empowerment is at odds with central trends and initiatives that govern this work. We argue that many of the stumbling blocks that have hindered this specific agenda are actually central stumbling blocks for the wider field of health promotion. We examine some of the barriers to implementing transformational change. Overcoming the primary limitations uncovered in this exploration of empowerment is actually crucial to progressive work in health promotion in general, particularly work that would seek to lessen inequities.
Prasad, Amit; Kano, Megumi; Dagg, Kendra Ann-Masako; Mori, Hanako; Senkoro, Hawa Hamisi; Ardakani, Mohammad Assai; Elfeky, Samar; Good, Suvajee; Engelhardt, Katrin; Ross, Alex; Armada, Francisco
Following the recommendations of the Commission on Social Determinants of Health (2008), the World Health Organization (WHO) developed the Urban Health Equity Assessment and Response Tool (HEART) to support local stakeholders in identifying and planning action on health inequities. The objective of this report is to analyze the experiences of cities in implementing Urban HEART in order to inform how the future development of the tool could support local stakeholders better in addressing health inequities. The study method is documentary analysis from independent evaluations and city implementation reports submitted to WHO. Independent evaluations were conducted in 2011-12 on Urban HEART piloting in 15 cities from seven countries in Asia and Africa: Indonesia, Iran, Kenya, Mongolia, Philippines, Sri Lanka, and Vietnam. Local or national health departments led Urban HEART piloting in 12 of the 15 cities. Other stakeholders commonly engaged included the city council, budget and planning departments, education sector, urban planning department, and the Mayor's office. Ten of the 12 core indicators recommended in Urban HEART were collected by at least 10 of the 15 cities. Improving access to safe water and sanitation was a priority equity-oriented intervention in 12 of the 15 cities, while unemployment was addressed in seven cities. Cities who piloted Urban HEART displayed confidence in its potential by sustaining or scaling up its use within their countries. Engagement of a wider group of stakeholders was more likely to lead to actions for improving health equity. Indicators that were collected were more likely to be acted upon. Quality of data for neighbourhoods within cities was one of the major issues. As local governments and stakeholders around the world gain greater control of decisions regarding their health, Urban HEART could prove to be a valuable tool in helping them pursue the goal of health equity.
Buyx, A M
It is well-documented that the socio-economic status has an important influence on health. In all developed countries, health is closely correlated with income, education, and type of employment, as well as with several other social determinants. While data on this socio-economic health gradient have been available for decades, the moral questions surrounding social health inequalities have only recently been addressed within the field of public health ethics. The present article offers a brief overview of relevant data on social health inequalities and on some explanatory models from epidemiology, social medicine and related disciplines. The main part explores three influential normative accounts addressing the issue of health inequalities. Finally, an agenda for future work in the field of public health ethics and health inequalities is sketched, with particular attention to the German context.
Eleanor E. MacPherson
Full Text Available Background: Gender inequalities are important social determinants of health. We set out to critically review the literature relating to gender equity and sexual and reproductive health (SRH in Eastern and Southern Africa with the aim of identifying priorities for action. Design: During November 2011, we identified studies relating to SRH and gender equity through a comprehensive literature search. Results: We found gender inequalities to be common across a range of health issues relating to SRH with women being particularly disadvantaged. Social and biological determinants combined to increase women's vulnerability to maternal mortality, HIV, and gender-based violence. Health systems significantly disadvantaged women in terms of access to care. Men fared worse in relation to HIV testing and care with social norms leading to men presenting later for treatment. Conclusions: Gender inequity in SRH requires multiple complementary approaches to address the structural drivers of unequal health outcomes. These could include interventions that alter the structural environment in which ill-health is created. Interventions are required both within and beyond the health system.
Hahn, Robert A; Knopf, John A; Wilson, Sandra Jo; Truman, Benedict I; Milstein, Bobby; Johnson, Robert L; Fielding, Jonathan E; Muntaner, Carles J M; Jones, Camara Phyllis; Fullilove, Mindy T; Moss, Regina Davis; Ueffing, Erin; Hunt, Pete C
communities, they are likely to advance health equity. Published by Elsevier Inc.
Rannan-Eliya, Ravindra P; Anuranga, Chamara; Manual, Adilius; Sararaks, Sondi; Jailani, Anis S; Hamid, Abdul J; Razif, Izzanie M; Tan, Ee H; Darzi, Ara
Malaysia has made substantial progress in providing access to health care for its citizens and has been more successful than many other countries that are better known as models of universal health coverage. Malaysia's health care coverage and outcomes are now approaching levels achieved by member nations of the Organization for Economic Cooperation and Development. Malaysia's results are achieved through a mix of public services (funded by general revenues) and parallel private services (predominantly financed by out-of-pocket spending). We examined the distributional aspects of health financing and delivery and assessed financial protection in Malaysia's hybrid system. We found that this system has been effective for many decades in equalizing health care use and providing protection from financial risk, despite modest government spending. Our results also indicate that a high out-of-pocket share of total financing is not a consistent proxy for financial protection; greater attention is needed to the absolute level of out-of-pocket spending. Malaysia's hybrid health system presents continuing unresolved policy challenges, but the country's experience nonetheless provides lessons for other emerging economies that want to expand access to health care despite limited fiscal resources.
... DISABILITY FUND UNDER THE FOREIGN SERVICE RETIREMENT AND DISABILITY SYSTEM (FSRDS) AND THE FOREIGN SERVICE PENSION SYSTEM (FSPS) § 17.4 Equity and good conscience. (a) Defined. Recovery is against equity and...
Kalanda, Boniface; Makwiza, Ireen; Kemp, Julia
Universal provision of antiretroviral therapy (ART), while feasible, is expensive. In light of this limitation, the World Health Organisation (WHO) has launched the 3 × 5 initiative, to provide ART to 3 million people by the end of the year 2005. In Southern Africa, large-scale provision of ART will likely be achieved through fragile public health systems. ART programmes should therefore be developed and expanded in ways that will not aggravate inequities or result in the inappropriate withdrawal of resources from other health interventions or from other parts of the health system. This paper, proposes a framework for monitoring equity in access and health systems issues in ART programmes in Southern Africa. It proposes that an equity monitoring system should comprise seven thematic areas. These thematic areas encompass a national monitoring system which extends beyond one agency or single data collection method. Together with monitoring of targets in terms of numbers treated, there should also be monitoring of health systems impacts and issues in ART expansion, with reporting both nationally and to a regional body.
This article proposes the establishment of a prize fund to incentivise public health research within the BRICS association, which comprises the five major emerging world economies: Brazil, Russia, India, China and South Africa. This would stimulate cooperative healthcare research within the group and, on the proviso that the benefits of the research are made freely available within the association, would be rewarding for researchers. The results of the research stimulated by the prize would provide beneficial new healthcare technologies, targeting the most vulnerable and needy groups. The proposed fund is consistent with current international patent law and would not only avoid some of the problems associated with the "Health Impact Fund", but also create a new model for healthcare research.
Kelman Chris W
Full Text Available Abstract Background In Australia there is a socioeconomic gradient in morbidity and mortality favouring socioeconomically advantaged people, much of which is accounted for by ischaemic heart disease. This study examines if Australia's universal health care system, with its mixed public/private funding and delivery model, may actually perpetuate this inequity. We do this by quantifying and comparing socioeconomic inequalities in the receipt of coronary procedures in patients with acute myocardial infarction (AMI and patients with angina. Methods Using linked hospital and mortality data, we followed patients admitted to Western Australian hospitals with a first admission for AMI (n = 5539 or angina (n = 7401 in 2001-2003. An outcome event was the receipt, within a year, of a coronary procedure—angiography, angioplasty and/or coronary artery bypass surgery (CABG. Socioeconomic status was assigned to each individual using an area-based measure, the SEIFA Index of Disadvantage. Multivariable proportional hazards regression was used to model the association between socioeconomic status and procedure rates, allowing for censoring and adjustment of multiple covariates. Mediating models examined the effect of private health insurance. Results In the AMI patient cohort, socioeconomic gradients were not evident except that disadvantaged women were more likely than advantaged women to undergo CABG. In contrast, in the angina patient group there were clear socioeconomic gradients for all procedures, favouring more advantaged patients. Compared with patients in the most disadvantaged quintile of socioeconomic status, patients in the least disadvantaged quintile were 11% (1-21% more likely to receive angiography, 52% (29-80% more likely to undergo angioplasty and 30% (3-55% more likely to undergo CABG. Private health insurance explained some of the socioeconomic variation in rates. Conclusions Australia's universal health care system does not guarantee
Campbell, James; Buchan, James; Cometto, Giorgio; David, Benedict; Dussault, Gilles; Fogstad, Helga; Fronteira, Inês; Lozano, Rafael; Nyonator, Frank; Pablos-Méndez, Ariel; Quain, Estelle E; Starrs, Ann; Tangcharoensathien, Viroj
Achieving universal health coverage (UHC) involves distributing resources, especially human resources for health (HRH), to match population needs. This paper explores the policy lessons on HRH from four countries that have achieved sustained improvements in UHC: Brazil, Ghana, Mexico and Thailand. Its purpose is to inform global policy and financial commitments on HRH in support of UHC. The paper reports on country experiences using an analytical framework that examines effective coverage in relation to the availability, accessibility, acceptability and quality (AAAQ) of HRH. The AAAQ dimensions make it possible to perform tracing analysis on HRH policy actions since 1990 in the four countries of interest in relation to national trends in workforce numbers and population mortality rates. The findings inform key principles for evidence-based decision-making on HRH in support of UHC. First, HRH are critical to the expansion of health service coverage and the package of benefits; second, HRH strategies in each of the AAAQ dimensions collectively support achievements in effective coverage; and third, success is achieved through partnerships involving health and non-health actors. Facing the unprecedented health and development challenges that affect all countries and transforming HRH evidence into policy and practice must be at the heart of UHC and the post-2015 development agenda. It is a political imperative requiring national commitment and leadership to maximize the impact of available financial and human resources, and improve healthy life expectancy, with the recognition that improvements in health care are enabled by a health workforce that is fit for purpose.
Tangcharoensathien, Viroj; Mills, Anne; Palu, Toomas
The Sustainable Development Goals (SDGs), to be committed to by Heads of State at the upcoming 2015 United Nations General Assembly, have set much higher and more ambitious health-related goals and targets than did the Millennium Development Goals (MDGs). The main challenge among MDG off-track countries is the failure to provide and sustain financial access to quality services by communities, especially the poor. Universal health coverage (UHC), one of the SDG health targets indispensable to achieving an improved level and distribution of health, requires a significant increase in government investment in strengthening primary healthcare - the close-to-client service which can result in equitable access. Given the trend of increased fiscal capacity in most developing countries, aiming at long-term progress toward UHC is feasible, if there is political commitment and if focused, effective policies are in place. Trends in high income countries, including an aging population which increases demand for health workers, continue to trigger international migration of health personnel from low and middle income countries. The inspirational SDGs must be matched with redoubled government efforts to strengthen health delivery systems, produce and retain more and relevant health workers, and progressively realize UHC.
Achieving universal health coverage (UHC) involves distributing resources, especially human resources for health (HRH), to match population needs. This paper explores the policy lessons on HRH from four countries that have achieved sustained improvements in UHC: Brazil, Ghana, Mexico and Thailand. Its purpose is to inform global policy and financial commitments on HRH in support of UHC.
对于传统的金融投资而言,风险投资是一种观念和方法的革新,传统金融投资着眼点是未来的现金流量,而风险投资更为关注被投资企业管理者的能力、技术以及企业的发展前景等,因此受金融市场的总体趋势、政府政策导向、科技发展水平等宏观环境影响较大.正确把握好宏观环境发展趋势,对于私募股权投资公司战略分析和战略选择尤为重要.本文采取了PEST、波特五力模型、SWOT矩阵等多种方法,在详细讨论宏观环境、公司竞争环境、公司现状的基础上,总结了H私募股权投资基金公司的优势与不足,得到了公司战略目标、战略规划以及5大战略重点.本文的研究意义在于为H私募股权投资基金公司制定战略地图以及基于平衡积分卡的绩效管理体系奠定基础.%Compared with the traditional financial investment method, venture capital is a revolution of concept and method, which focus on the ability of entrepreneur, the technology and the development potential rather than the future cash flow. So it is majorly effectedby the macro environment financial market situation, government policy focusing and the technology development. This paper uses PEST, Porter five forces model and SWOT matrix to detailed discuss the macro environment, company competition environment and company current situation, then concludes the propositions and contraditions of H private equity investment fund company, to summarize the strategic target, strategic plan and the five strategic point of the company. This paper is mainly written for the company^ strategic map making and the performance evaluation system building.
Thomas, Deborah; Sarangi, Biraj Laxmi; Garg, Anu; Ahuja, Arti; Meherda, Pramod; Karthikeyan, Sujata R; Joddar, Pinaki; Kar, Rajendra; Pattnaik, Jeetendra; Druvasula, Ramesh; Dembo Rath, Alison
Health equity is high on the international agenda. This study provides evidence of how health systems can be strengthened to improve health equity in a low-income state. The paper presents a case study of how the Government of Odisha in eastern India is transforming the health system for more equitable health and nutrition outcomes. Odisha has a population of over 42 million, high levels of poverty, and poor maternal and child health concentrated in its Southern districts and among Scheduled Tribe and Scheduled Caste communities. Conducted between 2008 and 2012 with the Departments of Health and Family Welfare, and Women and Child Development, the study reviewed a wide range of literature including policy and programme documents, evaluations and studies, published and grey material, and undertook secondary analysis of state level household surveys. It identifies innovative and expanded provision of health services, reforms to the management and development of human resources for health, and the introduction of a number of cash transfer and entitlement schemes as contributing to closing the gap between maternal and child health and nutrition outcomes of Scheduled Tribes, and the Southern districts, compared to the state average. The institutional delivery rate for Scheduled Tribes has risen from 11.7% in 2005-06 to 67.3% in 2011, and from 35.6% to 79.8% for all women. The social gradient has also closed for antenatal and postnatal care and immunisation. Nutrition indicators though improving are proving slower to budge. The paper identifies how political will, committed policy makers and fiscal space energised the health system to promote equity. Sustained political commitment will be required to continue to address the more challenging human resource, health financing and gender issues.
Full Text Available This study contributes to the literature about the effects of space and place on health by introducing a socio-territorial approach to urban health disparities in West Africa. It explores how urban spaces, specifically neighbourhoods, are shaped by social and economic relations and strategies of territorial control. We examine the potential influence of socio-territorial processes on vulnerability to disease, access to medical care, healthscapes, and illness experiences. Our research was conducted in Senegal and relied on a mixed methods design. We identified four neighbourhoods that represent the socio-spatial heterogeneity of the city of Saint-Louis and utilized the following methods: geographic and anthropological field research, household surveys, health knowledge and behaviour surveys, clinical exams, and illness interviews. Our results highlight the socio-territorial processes at work in each neighbourhood, clinical findings on three health measures (overweight, high blood pressure, and hyperglycaemia and health experiences of individuals with hypertension or type II diabetes. We found significant differences in the prevalence of the three health measures in the study sites, while experiences managing hypertension and diabetes were similar. We conclude that a socio-territorial approach offers insight into the complex constellation of forces that produce health disparities in urban settings.
Vialard, Lucie; Squiban, Clara; Fournet, Florence; Salem, Gérard; Foley, Ellen E.
This study contributes to the literature about the effects of space and place on health by introducing a socio-territorial approach to urban health disparities in West Africa. It explores how urban spaces, specifically neighbourhoods, are shaped by social and economic relations and strategies of territorial control. We examine the potential influence of socio-territorial processes on vulnerability to disease, access to medical care, healthscapes, and illness experiences. Our research was conducted in Senegal and relied on a mixed methods design. We identified four neighbourhoods that represent the socio-spatial heterogeneity of the city of Saint-Louis and utilized the following methods: geographic and anthropological field research, household surveys, health knowledge and behaviour surveys, clinical exams, and illness interviews. Our results highlight the socio-territorial processes at work in each neighbourhood, clinical findings on three health measures (overweight, high blood pressure, and hyperglycaemia) and health experiences of individuals with hypertension or type II diabetes. We found significant differences in the prevalence of the three health measures in the study sites, while experiences managing hypertension and diabetes were similar. We conclude that a socio-territorial approach offers insight into the complex constellation of forces that produce health disparities in urban settings. PMID:28117751
Pennington, Andy; Dreaves, Hilary; Scott-Samuel, Alex; Haigh, Fiona; Harrison, Annie; Verma, Arpana; Pope, Daniel
An overarching recommendation of the global Commission on Social Determinants of Health was to measure and understand health inequalities and assess the impact of action. In a rapidly urbanising world, now is the time for Urban HIA. This article describes the development of robust and easy-to-use HIA tools to identify and address health inequalities from new urban policies. Rapid reviews and consultation with experts identified existing HIA screening tools and methodologies which were then analyzed against predefined selection criteria. A draft Urban HIA Screening Tool (UrHIST) and Urban HIA methodology (UrHIA) were synthesised. The draft tools were tested and refined using a modified Delphi approach that included input from urban and public health experts, practitioners and policy makers. The outputs were two easy-to-use stand-alone urban HIA tools. The reviews and consultations identified an underpinning conceptual framework. The screening tool is used to determine whether a full HIA is required, or for a brief assessment. Urban health indicators are a readily available and efficient means of identifying variations in the health of populations potentially affected by policies. Indicators are, however, currently underutilised in HIA practice. This may limit the identification of health inequalities by HIA and production of recommendations. The new tools utilise health indicator data more fully. UrHIA also incorporates a hierarchy of evidence for use during impact analysis. The new urban HIA tools have the potential to enhance the rigour of HIAs and improve the identification and amelioration of health inequalities generated by urban policies.
Cacari-Stone, Lisa; Wallerstein, Nina; Garcia, Analilia P; Minkler, Meredith
Insufficient attention has been paid to how research can be leveraged to promote health policy or how locality-based research strategies, in particular community-based participatory research (CBPR), influences health policy to eliminate racial and ethnic health inequities. To address this gap, we highlighted the efforts of 2 CBPR partnerships in California to explore how these initiatives made substantial contributions to policymaking for health equity. We presented a new conceptual model and 2 case studies to illustrate the connections among CBPR contexts and processes, policymaking processes and strategies, and outcomes. We extended the critical role of civic engagement by those communities that were most burdened by health inequities by focusing on their political participation as research brokers in bridging evidence and policymaking.
Hoffmann, Falk; Koller, Daniela
Objectives: Analyses of health insurance claims data are getting more important in public health and health services research. Since there are several different health insurance funds in Germany, the specific characteristics of regional and socio-demographic population covered by a single fund has to be considered. The aim of this study is to evaluate the differences in socio-demographic and health-related variables between health insurance funds. Methods: This study is based on the GEDA-Study 2009 and 2010, 2 representative cross-sectional telephone surveys (n=42 534). We included socio-economic factors as well as information on area of residence and health-related variables to health status, health behavior and cardiovascular diseases. Results: There are fewer privately insured persons in the eastern regions of Germany. Insurants of the public health insurances have a lower socio-economic status and many have a migration background. Similar results can be found for smoking, obesity and cardiovascular factors. These differences between funds were found in many regional analyses. Conclusions: Especially differences in socio-economic factors are constant between insurance funds and regions. Therefore, the results show that analyses of one single health insurance fund cannot be generalized to the whole population. To ensure precise estimates on health services, morbidity or quality monitoring, we need data sets that integrate more funds. © Georg Thieme Verlag KG Stuttgart · New York.
Full Text Available Abstract This article is the third in a three-part review of research on globalization and the social determinants of health (SDH. In the first article of the series, we identified and defended an economically oriented definition of globalization and addressed a number of important conceptual and metholodogical issues. In the second article, we identified and described seven key clusters of pathways relevant to globalization's influence on SDH. This discussion provided the basis for the premise from which we begin this article: interventions to reduce health inequities by way of SDH are inextricably linked with social protection, economic management and development strategy. Reflecting this insight, and against the background of the Millennium Development Goals (MDGs, we focus on the asymmetrical distribution of gains, losses and power that is characteristic of globalization in its current form and identify a number of areas for innovation on the part of the international community: making more resources available for health systems, as part of the more general task of expanding and improving development assistance; expanding debt relief and taking poverty reduction more seriously; reforming the international trade regime; considering the implications of health as a human right; and protecting the policy space available to national governments to address social determinants of health, notably with respect to the hypermobility of financial capital. We conclude by suggesting that responses to globalization's effects on social determinants of health can be classified with reference to two contrasting visions of the future, reflecting quite distinct values.
Labonté, Ronald; Schrecker, Ted
This article is the third in a three-part review of research on globalization and the social determinants of health (SDH). In the first article of the series, we identified and defended an economically oriented definition of globalization and addressed a number of important conceptual and metholodogical issues. In the second article, we identified and described seven key clusters of pathways relevant to globalization's influence on SDH. This discussion provided the basis for the premise from which we begin this article: interventions to reduce health inequities by way of SDH are inextricably linked with social protection, economic management and development strategy. Reflecting this insight, and against the background of the Millennium Development Goals (MDGs), we focus on the asymmetrical distribution of gains, losses and power that is characteristic of globalization in its current form and identify a number of areas for innovation on the part of the international community: making more resources available for health systems, as part of the more general task of expanding and improving development assistance; expanding debt relief and taking poverty reduction more seriously; reforming the international trade regime; considering the implications of health as a human right; and protecting the policy space available to national governments to address social determinants of health, notably with respect to the hypermobility of financial capital. We conclude by suggesting that responses to globalization's effects on social determinants of health can be classified with reference to two contrasting visions of the future, reflecting quite distinct values.
Kuwawenaruwa, August; Borghi, Josephine; Remme, Michelle; Mtei, Gemini
There is limited evidence on how health care inputs are distributed from the sub-national level down to health facilities and their potential influence on promoting health equity. To address this gap, this paper assesses equity in the distribution of health care inputs across public primary health facilities at the district level in Tanzania. This is a quantitative assessment of equity in the distribution of health care inputs (staff, drugs, medical supplies and equipment) from district to facility level. The study was carried out in three districts (Kinondoni, Singida Rural and Manyoni district) in Tanzania. These districts were selected because they were implementing primary care reforms. We administered 729 exit surveys with patients seeking out-patient care; and health facility surveys at 69 facilities in early 2014. A total of seventeen indices of input availability were constructed with the collected data. The distribution of inputs was considered in relation to (i) the wealth of patients accessing the facilities, which was taken as a proxy for the wealth of the population in the catchment area; and (ii) facility distance from the district headquarters. We assessed equity in the distribution of inputs through the use of equity ratios, concentration indices and curves. We found a significant pro-rich distribution of clinical staff and nurses per 1000 population. Facilities with the poorest patients (most remote facilities) have fewer staff per 1000 population than those with the least poor patients (least remote facilities): 0.6 staff per 1000 among the poorest, compared to 0.9 among the least poor; 0.7 staff per 1000 among the most remote facilities compared to 0.9 among the least remote. The negative concentration index for support staff suggests a pro-poor distribution of this cadre but the 45 degree dominated the concentration curve. The distribution of vaccines, antibiotics, anti-diarrhoeal, anti-malarials and medical supplies was approximately
Full Text Available BACKGROUND: The legal framework and funding mechanisms of the national health research system were recently reformed in Mexico. A study of the resource allocation for health research is still missing. We identified the health research areas funded by the National Council on Science and Technology (CONACYT and examined whether research funding has been aligned to national health problems. METHODS AND FINDINGS: We collected the information to create a database of research grant projects supported through the three main Sectoral Funds managed by CONACYT between 2003 and 2010. The health-related projects were identified and classified according to their methodological approach and research objective. A correlation analysis was carried out to evaluate the association between disease-specific funding and two indicators of disease burden. From 2003 to 2010, research grant funding increased by 32% at a compound annual growth rate of 3.5%. By research objective, the budget fluctuated annually resulting in modest increments or even decrements during the period under analysis. The basic science category received the largest share of funding (29% while the less funded category was violence and accidents (1.4%. The number of deaths (ρ = 0.51; P<0.001 and disability-adjusted life years (DALYs; ρ = 0.33; P = 0.004 were weakly correlated with the funding for health research. Considering the two indicators, poisonings and infectious and parasitic diseases were among the most overfunded conditions. In contrast, congenital anomalies, road traffic accidents, cerebrovascular disease, and chronic obstructive pulmonary disease were the most underfunded conditions. CONCLUSIONS: Although the health research funding has grown since the creation of CONACYT sectoral funds, the financial effort is still low in comparison to other Latin American countries with similar development. Furthermore, the great diversity of the funded topics compromises the efficacy of the
Full Text Available Abstract Introduction A recent health reform was implemented in Chile (the AUGE reform with the objective of reducing the socioeconomic gaps to access healthcare. This reform did not seek to eliminate the private insurance system, which coexists with the public one, but to ensure minimum conditions of access to the entire population, at a reasonable cost and with a quality guarantee, to cover an important group of health conditions. This paper’s main objective is to enquire what has happened with the use of several healthcare services after the reform was fully implemented. Methods Concentration and Horizontal Inequity indices were estimated for the use of general practitioners, specialists, emergency room visits, laboratory and x-ray exams and hospitalization days. The change in such indices (pre and post-reform was decomposed, following Zhong (2010. A “mean effect” (how these indices would change if the differential use in healthcare services were evenly distributed and a “distribution effect” (how these indices would change with no change in average use were obtained. Results Changes in concentration indices were mainly due to mean effects for all cases, except for specialists (where “distribution effect” prevailed and hospitalization days (where none of these effects prevailed over others. This implies that by providing more services across socioeconomic groups, less inequality in the use of services was achieved. On the other hand, changes in horizontal inequity indices were due to distribution effects in the case of GP, ER visits and hospitalization days; and due to mean effect in the case of x-rays. In the first three cases indices reduced their pro-poorness implying that after the reform relatively higher socioeconomic groups used these services more (in relation to their needs. In the case of x-rays, increased use was responsible for improving its horizontal inequity index. Conclusions The increase in the average use of
Full Text Available Abstract Background A growing body of literature has demonstrated that higher social capital is associated with improved health conditions. However, some research indicated that the association between social capital and health was substantially attenuated after adjustment for material deprivation. Studies exploring the association between poverty, social capital and health still have some serious limitations. In China, health equity studies focusing on urban poor are scarce. The purpose of this study is therefore to examine how poverty and individual-level social capital in urban China are associated with health equity. Methods Our study is based on a household study sample consisting of 1605 participants in two Chinese cities. For all participants, data on personal characteristics, health status, health care utilisation and social capital were collected. Factor analysis was performed to extract social capital factors. Dichotomised social capital factors were used for logistic regression models. A synergy index (if it is above 1, we can know the existence of the co-operative effect was computed to examine the interaction effect between lack of social capital and poverty. Results Results indicated the poor had an obviously higher probability of belonging to the low individual-level social capital group in all the five dimensions, with the adjusted odds ratios ranging from 1.42 to 2.12. When the other variables were controlled for in the total sample, neighbourhood cohesion (NC, and reciprocity and social support (RSS were statistically associated with poor self-rated health (NC: OR = 1.40; RSS: OR = 1.34. However, for the non-poor sub-sample, no social capital variable was a statistically significant predictor. The synergy index between low individual-level NC and poverty, and between low individual-level RSS and poverty were 1.22 and 1.28, respectively, indicating an aggravating effect between them. Conclusion In this study, we have shown that
... loans. (c) Failure to comply with the requirements of this section will subject a school to the... with Federal capital contributions. Any fund established by a school with Federal capital contributions... school must at all times maintain all monies relating to the fund in one or more...
Bauer, Greta R
Intersectionality theory, developed to address the non-additivity of effects of sex/gender and race/ethnicity but extendable to other domains, allows for the potential to study health and disease at different intersections of identity, social position, processes of oppression or privilege, and policies or institutional practices. Intersectionality has the potential to enrich population health research through improved validity and greater attention to both heterogeneity of effects and causal processes producing health inequalities. Moreover, intersectional population health research may serve to both test and generate new theories. Nevertheless, its implementation within health research to date has been primarily through qualitative research. In this paper, challenges to incorporation of intersectionality into population health research are identified or expanded upon. These include: 1) confusion of quantitative terms used metaphorically in theoretical work with similar-sounding statistical methods; 2) the question of whether all intersectional positions are of equal value, or even of sufficient value for study; 3) distinguishing between intersecting identities, social positions, processes, and policies or other structural factors; 4) reflecting embodiment in how processes of oppression and privilege are measured and analysed; 5) understanding and utilizing appropriate scale for interactions in regression models; 6) structuring interaction or risk modification to best convey effects, and; 7) avoiding assumptions of equidistance or single level in the design of analyses. Addressing these challenges throughout the processes of conceptualizing and planning research and in conducting analyses has the potential to improve researchers' ability to more specifically document inequalities at varying intersectional positions, and to study the potential individual- and group-level causes that may drive these observed inequalities. A greater and more thoughtful incorporation
Wallerstein, Nina; Duran, Bonnie
Community-based participatory research (CBPR) has emerged in the last decades as a transformative research paradigm that bridges the gap between science and practice through community engagement and social action to increase health equity. CBPR expands the potential for the translational sciences to develop, implement, and disseminate effective interventions across diverse communities through strategies to redress power imbalances; facilitate mutual benefit among community and academic partners; and promote reciprocal knowledge translation, incorporating community theories into the research. We identify the barriers and challenges within the intervention and implementation sciences, discuss how CBPR can address these challenges, provide an illustrative research example, and discuss next steps to advance the translational science of CBPR.
Mburu, F M
The main development problems in the Third World are known to be gross socioeconomic inequality, widespread poor health status accompanied by high fertility and infant mortality rates, low life expectancy, mass illiteracy and mass poverty. In most of these countries governments invest a great deal of scarce resources toward the consequences of poverty rather than it causes. The paucity of resources for such social services is exacerbated by continuously increasing demands and needs which have to be satisfied. Unmet needs tend to cause apathy in the population. For purposes of controlling poverty and its consequences, these must be clearly formulated and relevant policies, a commitment to implement such policies, adequate administrative capacity and reasonably adequate resources. In the case of the health services system, the same requirements apply. Above all, the health system has to be directed toward the greatest needs of the population. This must involve policy makers, implementors and the consumer community. This paper argues that health systems cannot be an effective weapon against the consequences of poverty unless the above kinds of policy exist and are implemented.
Adem Kılıçman; Jaisree Sivalingam
We focus on the equity mutual funds offered by three Malaysian banks, namely Public Bank Berhad, CIMB, and Malayan Banking Berhad. The equity mutual funds or equity trust is grouped into four clusters based on their characteristics and categorized as inferior, stable, good performing, and aggressive funds based on their return rates, variance and treynor index. Based on the cluster analysis, the return rates and variance of clusters are represented as triangular fuzzy numbers in order to refl...
Wilson, Annabelle M; Kelly, Janet; Magarey, Anthea; Jones, Michelle; Mackean, Tamara
Aboriginal and Torres Strait Islander people experience inequity in health outcomes in Australia. Health care interactions are an important starting place to seek to address this inequity. The majority of health professionals in Australia do not identify as Aboriginal and/or Torres Strait Islander people and the health care interaction therefore becomes an example of working in an intercultural space (or interface). It is therefore critical to consider how health professionals may maximise the positive impact within the health care interaction by skilfully working at the interface. Thirty-five health professionals working in South Australia were interviewed about their experiences working with Aboriginal people. Recruitment was through purposive sampling. The research was guided by the National Health and Medical Research Council Values and Ethics for undertaking research with Aboriginal communities. Critical social research was used to analyse data. Interviews revealed two main types of factors influencing the experience of non-Aboriginal health professionals working with Aboriginal people at the interface: the organisation and the individual. Within these two factors, a number of sub-factors were found to be important including organisational culture, organisational support, accessibility of health services and responding to expectations of the wider health system (organisation) and personal ideology and awareness of colonisation (individual). A health professional's practice at the interface cannot be considered in isolation from individual and organisational contexts. It is critical to consider how the organisational and individual factors identified in this research will be addressed in health professional training and practice, in order to maximise the ability of health professionals to work with Aboriginal and Torres Strait Islander people and therefore contribute to addressing health equity.
Schang, Laura K; Czabanowska, Katarzyna M; Lin, Vivian
Worldwide, countries face the challenge of securing funds for health promotion. To address this issue, some governments have established health promotion foundations, which are statutory bodies with long-term and recurrent public resources. This article draws on experiences from Austria, Australia, Germany, Hungary and Switzerland to illustrate four lessons learned from the foundation model to secure funding for health promotion. These lessons are concerned with: (i) the broad spectrum of potential revenue sources for health promotion foundations within national contexts; (ii) legislative anchoring of foundation revenues as a base for financial sustainability; (iii) co-financing as a means to increase funds and shared commitment for health promotion; (iv) complementarity of foundations to existing funding. Synthesizing the lessons, we discuss health promotion foundations in relation to wider concerns for investment in health based on the values of sustainability, solidarity and stewardship. We recommend policy-makers and researchers take notice of health promotion foundations as an alternative model for securing funds for health promotion, and appreciate their potential for integrating inter-sectoral revenue collection and inter-sectoral funding strategies. However, health promotion foundations are not a magic bullet. They also pose challenges to coordination and public sector stewardship. Therefore, health promotion foundations will need to act in concert with other governance instruments as part of a wider societal agenda for investment in health.
Chomi, Eunice; Mujinja, Phares; Hansen, Kristian Schultz
Background The Tanzanian health insurance system comprises multiple health insurance funds targeting different population groups but which operate in parallel, with no mechanisms for redistribution across the funds. Establishing such redistributive mechanisms requires public support, which...... data collected from a survey of 695 households relating to perceptions of household heads towards cross-subsidisation of the poor to enable them to access health services. Kruskal-Wallis test is used to compare perceptions by membership status. Generalized ordinal logistic regression models are used...
Pega, Frank; Valentine, Nicole B; Matheson, Don; Rasanathan, Kumanan
The important role that monitoring plays in advancing global health is well established. However, the role of social monitoring as a tool for addressing social determinants of health (SDH) and health equity-focused policies remains under-researched. This paper assesses the extent and ways in which New Zealand's (NZ) Social Reports (SRs) supported a SDH- and health equity-oriented policy programme nationally over the 2000-2008 period by documenting the SRs' history and assessing its impact on policies across sectors in government and civil society. We conducted key-informant interviews with five senior policy-makers and an e-mail survey with 24 government and civil society representatives on SRs' history and policy impact. We identified common themes across these data and classified them accordingly to assess the intensity of the reports' use and their impact on SDH- and health equity-focused policies. Bibliometric analyses of government publications and media items were undertaken to empirically assess SRs' impact on government and civil society. SRs in NZ arose out of the role played by government as the "benevolent social welfare planner" and an understanding of the necessity of economic and social security for "progress". The SRs were linked to establishing a government-wide programme aimed at reducing inequalities. They have been used moderately to highly in central and local government and in civil society, both within and outside the health sector, but have neither entered public treasury and economic development departments nor the commercial sector. The SRs have not reached the more universal status of economic indicators. However, they have had some success at raising awareness of, and have stimulated isolated action on, SDH. The NZ case suggests that national-level social monitoring provides a valuable tool for raising awareness of SDH across government and civil society. A number of strategies could improve social reports' effectiveness in stimulating
Gómez Eduardo J
Full Text Available Abstract Objectives The impact of donors, such as national government (bi-lateral, private sector, and individual financial (philanthropic contributions, on domestic health policies of developing nations has been the subject of scholarly discourse. Little is known, however, about the impact of global financial initiatives, such as the Global Fund to Fight AIDS, Tuberculosis, and Malaria, on policies and health governance of countries receiving funding from such initiatives. Methods This study employs a qualitative methodological design based on a single case study: Brazil. Analysis at national, inter-governmental and community levels is based on in-depth interviews with the Global Fund and the Brazilian Ministry of Health and civil societal activists. Primary research is complemented with information from printed media, reports, journal articles, and books, which were used to deepen our analysis while providing supporting evidence. Results Our analysis suggests that in Brazil, Global Fund financing has helped to positively transform health governance at three tiers of analysis: the national-level, inter-governmental-level, and community-level. At the national-level, Global Fund financing has helped to increased political attention and commitment to relatively neglected diseases, such as tuberculosis, while harmonizing intra-bureaucratic relationships; at the inter-governmental-level, Global Fund financing has motivated the National Tuberculosis Programme to strengthen its ties with state and municipal health departments, and non-governmental organisations (NGOs; while at the community-level, the Global Fund’s financing of civil societal institutions has encouraged the emergence of new civic movements, participation, and the creation of new municipal participatory institutions designed to monitor the disbursement of funds for Global Fund grants. Conclusions Global Fund financing can help deepen health governance at multiple levels. Future work
Full Text Available We examined patterns of Canadian Institute for Health Research (CIHR funding on autism spectrum disorder (ASD research. From 1999 to 2013, CIHR funded 190 ASD grants worth $48 million. Biomedical research received 43% of grants (46% of dollars, clinical research 27% (41%, health services 10% (7%, and population health research 8% (3%. The greatest number of grants was given in 2009, but 2003 saw the greatest amount. Funding is clustered in a handful of provinces and institutions, favouring biomedical research and disfavouring behavioural interventions, adaptation, and institutional response. Preference for biomedical research may be due to the detriment of clinical research.
Rao, Mala; Singh, Prabal Vikram; Katyal, Anuradha; Samarth, Amit; Bergkvist, Sofi; Renton, Adrian; Netuveli, Gopalakrishnan
.... We aimed to assess whether the innovative state-funded Rajiv Aarogyasri Community Health Insurance Scheme of Andhra Pradesh state launched in 2007, has achieved equity of access to hospital inpatient...
Ward, Kim; Sanders, David; Leng, Henry; Pollock, Allyson M
To investigate equity in the geographical distribution of community pharmacies in South Africa and assess whether regulatory reforms have furthered such equity. Data on community pharmacies from the national department of health and the South African pharmacy council were used to analyse the change in community pharmacy ownership and density (number per 10,000 residents) between 1994 and 2012 in all nine provinces and 15 selected districts. In addition, the density of public clinics, alone and with community pharmacies, was calculated and compared with a national benchmark of one clinic per 10,000 residents. Interviews were conducted with nine national experts from the pharmacy sector. Community pharmacies increased in number by 13% between 1994 and 2012--less than the 25% population growth. In 2012, community pharmacy density was higher in urban provinces and was eight times higher in the least deprived districts than in the most deprived ones. Maldistribution persisted despite the growth of corporate community pharmacies. In 2012, only two provinces met the 1 per 10,000 benchmark, although all provinces achieved it when community pharmacies and clinics were combined. Experts expressed concerns that a lack of rural incentives, inappropriate licensing criteria and a shortage of pharmacy workers could undermine access to pharmaceutical services, especially in rural areas. To reduce inequity in the distribution of pharmaceutical services, new policies and legislation are needed to increase the staffing and presence of pharmacies.
Full Text Available This research paper examines performance of top twelve Indian mutual funds by Asset Under Management (AUM. We use seven portfolio performance measurement parameters like Alpha, Beta, Standard Deviation, R Squared, Sharpe Ratio, Treynor Ratio and Jensen’s Alpha. The study reveals which amongst these mutual fund is the best performer based on all these parameters and the benchmark taken for this is NIFTY Index. The mutual funds selected are HDFC Top 200 Fund, Franklin India Bluechip Fund, ICICI Prudential Focused Bluechip Equity Fund, DSPBR Top 100 Equity Fund, Birla Sun Life Equity Fund, DSPBR Top 100 Equity Fund, UTI Mastershare Fund, Reliance Equity Opportunity Fund, SBI Magnum Equity, Reliance Top 200 Fund, SBI Bluechip Fund, ICICI Prudential Top 200 Fund, Principal Large Cap Fund. This study is primarily done to evaluate performance of the select mutual funds over a period of five years.
Dec 10, 2015 ... (NHI) White Paper (version 40) providing the background and justification of the country's moves to join ... The International. Monetary Fund (IMF) has cut its forecast for economic growth in South Africa for a second time in ...
Ashok Kumar Bhardwaj
Full Text Available Research is a cornerstone for knowledge generation, which in turns requires capacity building for its tools and techniques. Despite having a vast infrastructure in India the research in medical science has been carried out in limited and focused institutions. In order to build the capacity in carrying out research activities a five-day planning workshop was conducted at state run medical college. Total 22 medical faculty members participated in the workshop with average public health experience of 12 years (range: 5–25 years. The knowledge was assessed objectively by multiple-choice questionnaire. The mean score increased from 6.7 to 7.9 from pre- to posttest. About seventy-percent participants showed improvement, whereas 21.0% showed deterioration in the knowledge and the rest showed the same score. Apart from knowledge skills also showed improvement as total 12 research projects were generated and eight were approved for funding by the Indian Council of Medical Research (ICMR, New Delhi. It can be concluded that a supportive environment for research can be built with the technical assistance.
Rader, Tamara; Ueffing, Erin; Garcia-Elorrio, Ezequiel; Idzerda, Leanne; Ciapponi, Agustin; Irazola, Vilma; Welch, Vivian; Lyddiatt, Anne; Shea, Beverley; Newman, Stanton; Osborne, Richard; Tugwell, Peter S
The 2008 World Health Report emphasizes the need for patient-centered primary care service delivery models in which patients are equal partners in the planning and management of their health. It is argued that this involvement will lead to improved management of disease, improved health outcomes and patient satisfaction, better informed decision-making, increased compliance with healthcare decisions, and better resource utilization. This article investigates the domains captured by the Effective Consumer Scale (EC-17) in relation to vulnerable population groups that experience health inequity. Particular focus is paid to the domain of health literacy as an area fundamental to patients' involvement in managing their condition and negotiating the healthcare system. In examining the possible influence of Outcome Measures in Rheumatology Clinical Trials (OMERACT) on health equity, we used the recent translation and validation of the EC-17 scale into Spanish and tested Argentina as an example. Future plans to use the EC-17 with vulnerable groups include formal collaboration and needs assessment with the community to tailor an intervention to meet its needs in a culturally relevant manner. Some systematic reviews have questioned whether interventions to improve effective consumer skills are appropriate in vulnerable populations. We propose that these populations may have the most to gain from such interventions since they might be expected to have relatively lower skills and health literacy than other groups.
Jehu-Appiah, C.; Aryeetey, G.C.N.O.; Spaan, E.J.A.M.; Agyepong, I.; Baltussen, R.M.P.M.
OBJECTIVES: This paper outlines the potential strategies to identify the poor, and assesses their feasibility, efficiency and equity. Analyses are illustrated for the case of premium exemptions under National Health Insurance (NHI) in Ghana. METHODS: A literature search in Medline search was perform
Shapiro, Ester R
This article applies transdisciplinary approaches to critical health education for gender equity by analyzing textual and political strategies translating/culturally adapting the U.S. feminist health text, Our Bodies Ourselves (OBOS), for Latin American/Caribbean and U.S. Latina women. The resulting text, Nuestros Cuerpos, Nuestras Vidas (NCNV), was revised at multiple levels to reflect different cultural\\sociopolitical assumptions connecting individual knowledge, community-based and transnational activist organizations, and strategic social change. Translation/cultural adaptation decisions were designed to ensure that gender-equitable health promotion education crossed cultural borders, conveying personal knowledge and motivating individual actions while also inspiring participation in partnerships for change. Transdisciplinary approaches integrating critical ecosystemic frameworks and participatory methods can help design health promotion education mobilizing engaged, gender-equitable health citizenship supporting both personal and societal change.
Blieden, N; Flinders, S; Hawkins, K; Reid, M; Alphs, L D; Arfken, C L
The study examined the effect of clozapine treatment on the health care costs and health status of people with schizophrenia who are supported by public funds. Thirty-three patients with schizophrenia hospitalized in a state facility were interviewed within one week of starting clozapine and six months later. Health status was assessed with four clinical rating scales measuring severity of psychopathology, negative symptoms, depression, and quality of life. Cost and health care utilization data were collected for the six months before and after initiation of clozapine. Only 52 percent of the subjects stayed on clozapine for six months. Subjects who continued on clozapine were more likely to be discharged within six months than those who did not continue. Six months after clozapine was started, health care costs showed a sayings of $11,464 per person, even after adjustment for pretreatment costs, and health status was improved. For subjects who continued on clozapine for six months, clozapine treatment was associated with reduced days of psychiatric hospital care, reduced overall costs despite increased outpatient treatment and residential costs, and improved health status.
Dal Poz Mario R
Full Text Available Abstract Recent studies have shown evidence of a direct and positive causal link between the number of health workers and health outcomes. Several studies have identified an adequate health workforce as one of the key ingredients to achieving improved health outcomes. Global health initiatives are faced with human resources issues as a major, system-wide constraint. This article explores how the Global Fund addresses the challenges of a health workforce bottleneck to the successful implementation of priority disease programmes. Possibilities for investment in human resources in the Global Fund's policy documents and guidelines are reviewed. This is followed by an in-depth study of 35 Global Fund proposals from five African countries: Ethiopia, Ghana, Kenya, Malawi and Tanzania. The discussion presents specific human resources interventions that can be found in proposals. Finally, the comments on human resources interventions in the Global Fund's Technical Review Panel and the budget allocation for human resources for health were examined. Policy documents and guidelines of the Global Fund foster taking account of human resources constraints in recipient countries and interventions to address them. However, the review of actual proposals clearly shows that countries do not often take advantage of their opportunities and focus mainly on short-term, in-service training in their human resources components. The comments of the Technical Review Panel on proposed health system-strengthening interventions reveal a struggle between the Global Fund's goal to fight the three targeted diseases, on the one hand, and the need to strengthen health systems as a prerequisite for success, on the other. In realizing the opportunities the Global Fund provides for human resources interventions, countries should go beyond short-term objectives and link their activities to a long-term development of their human resources for health.
Welch, Vivian A; Akl, Elie A; Pottie, Kevin
OBJECTIVE: The aim of this paper is to describe a conceptual framework for how to consider health equity in the GRADE (Grading Recommendations Assessment and Development Evidence) guideline development process. STUDY DESIGN AND SETTING: Consensus-based guidance developed by the GRADE working grou...
Tetroe, J.M.; Graham, I.D.; Foy, R.; Robinson, N.; Eccles, M.P.; Wensing, M.J.P.; Durieux, P.; Legare, F.; Nielson, C.P.; Adily, A.; Ward, J.E.; Porter, C.; Shea, B.; Grimshaw, J.M.
CONTEXT: The process of knowledge translation (KT) in health research depends on the activities of a wide range of actors, including health professionals, researchers, the public, policymakers, and research funders. Little is known, however, about health research funding agencies' support and promot
Tetroe, J.M.; Graham, I.D.; Foy, R.; Robinson, N.; Eccles, M.P.; Wensing, M.J.P.; Durieux, P.; Legare, F.; Nielson, C.P.; Adily, A.; Ward, J.E.; Porter, C.; Shea, B.; Grimshaw, J.M.
CONTEXT: The process of knowledge translation (KT) in health research depends on the activities of a wide range of actors, including health professionals, researchers, the public, policymakers, and research funders. Little is known, however, about health research funding agencies' support and promot
Bernet, Patrick M
Public health services are delivered through a variety of organizations. Traditional accounting of public health expenditures typically captures only spending by government agencies. New Hampshire collected information from public health partners, such as community centers that host smoking cessation classes or health education done by Girls, Inc. This study compares the new data to spending by government agencies, focusing on breakdowns by fund source and service categories. Expanded funds secured by these partners account for a 42% of all local public health spending, and they spent 4 times more than government agencies on promoting healthy behavior. The funding formula analysis tool revealed that these partners spent in ways that would be politically difficult to achieve. In an era of declining budgets, an understanding of public health's partners is increasingly vital.
Silvestre, Jason; Ahn, Jaimo; Levin, L Scott
The National Institutes of Health (NIH) is the largest supporter of biomedical research in the U.S., yet its contribution to orthopaedic research is poorly understood. In this study, we analyzed the portfolio of NIH funding to departments of orthopaedic surgery at U.S. medical schools. The NIH RePORT (Research Portfolio Online Reporting Tools) database was queried for NIH grants awarded to departments of orthopaedic surgery in 2014. Funding totals were determined for award mechanisms and NIH institutes. Trends in NIH funding were determined for 2005 to 2014 and compared with total NIH extramural research funding. Funding awarded to orthopaedic surgery departments was compared with that awarded to departments of other surgical specialties in 2014. Characteristics of NIH-funded principal investigators were obtained from department web sites. In 2014, 183 grants were awarded to 132 investigators at 44 departments of orthopaedic surgery. From 2005 to 2014, NIH funding increased 24.3%, to $54,608,264 (p = 0.030), but the rates of increase seen did not differ significantly from those of NIH extramural research funding as a whole (p = 0.141). Most (72.6%) of the NIH funding was awarded through the R01 mechanism, with a median annual award of $343,980 (interquartile range [IQR], $38,372). The majority (51.1%) of the total funds supported basic science research, followed by translational (33.0%), clinical (10.0%), and educational (5.9%) research. NIH-funded orthopaedic principal investigators were predominately scientists whose degree was a PhD (71.1%) and who were male (79.5%). Eleven NIH institutes were represented, with the National Institute of Arthritis and Musculoskeletal and Skin Diseases (NIAMS) providing the preponderance (74.2%) of the funding. In 2014, orthopaedic surgery ranked below the surgical departments of general surgery, ophthalmology, obstetrics and gynecology, otolaryngology, and urology in terms of NIH funding received. The percentage increase of NIH
Midwives are working in federally funded health centers in increasing numbers. Health centers provide primary and preventive health care to almost 20 million people and are located in every US state and territory. While health centers serve the entire community, they also serve as a safety net for low-income and uninsured individuals. In 2010, 93% of health center patients had incomes below 200% of the Federal Poverty Guidelines, and 38% were uninsured. Health centers, including community health centers, migrant health centers, health care for the homeless programs, and public housing primary care programs, receive grant funding and enjoy other benefits due to status as federal grantees and designation as federally qualified health centers. Clinicians working in health centers are also eligible for financial and professional benefits because of their willingness to serve vulnerable populations and work in underserved areas. Midwives, midwifery students, and faculty working in, or interacting with, health centers need to be aware of the regulations that health centers must comply with in order to qualify for and maintain federal funding. This article provides an overview of health center regulations and policies affecting midwives, including health center program requirements, scope of project policy, provider credentialing and privileging, Federal Tort Claims Act malpractice coverage, the 340B Drug Pricing Program, and National Health Service Corps scholarship and loan repayment programs.
Understanding the performance and impact of public knowledge translation funding interventions: Protocol for an evaluation of Canadian Institutes of Health Research knowledge translation funding programs
McLean Robert K D
Full Text Available Abstract Background The Canadian Institutes of Health Research (CIHR has defined knowledge translation (KT as a dynamic and iterative process that includes the synthesis, dissemination, exchange, and ethically-sound application of knowledge to improve the health of Canadians, provide more effective health services and products, and strengthen the healthcare system. CIHR, the national health research funding agency in Canada, has undertaken to advance this concept through direct research funding opportunities in KT. Because CIHR is recognized within Canada and internationally for leading and funding the advancement of KT science and practice, it is essential and timely to evaluate this intervention, and specifically, these funding opportunities. Design The study will employ a novel method of participatory, utilization-focused evaluation inspired by the principles of integrated KT. It will use a mixed methods approach, drawing on both quantitative and qualitative data, and will elicit participation from CIHR funded researchers, knowledge users, KT experts, as well as other health research funding agencies. Lines of inquiry will include an international environmental scan, document/data reviews, in-depth interviews, targeted surveys, case studies, and an expert review panel. The study will investigate how efficiently and effectively the CIHR model of KT funding programs operates, what immediate outcomes these funding mechanisms have produced, and what impact these programs have had on the broader state of health research, health research uptake, and health improvement. Discussion The protocol and results of this evaluation will be of interest to those engaged in the theory, practice, and evaluation of KT. The dissemination of the study protocol and results to both practitioners and theorists will help to fill a gap in knowledge in three areas: the role of a public research funding agency in facilitating KT, the outcomes and impacts KT funding
Full Text Available Las evidencias aportadas por los estudios sobre los determinantes sociales de la salud modifican la relación entre la ética y la medicina, entre lo normativo y lo descriptivo en el estudio de la salud pública. También modifican la concepción tradicional de la equidad, las políticas sanitarias necesarias y el futuro de la bioética. Más concretamente: 1 la frontera entre la medicina y la ética se vuelve mucho más difusa, sobre todo en el campo de la epidemiología, cuyos objetivos son ahora inseparables de consideraciones éticas; 2 la concepción de la equidad en salud definida tradicionalmente a partir del acceso al sistema sanitario debe corregirse o ampliarse para incorporar las desigualdades injustas de salud que se producen antes de que los enfermos lleguen al sistema sanitario; y 3 el tradicional sesgo autonomista de la bioética debe sustituirse por una preocupación prioritaria por la justicia social y su relación con la salud.The evidence shown by studies on the social determinants of health has changed the relationship between ethics and medicine. The evidence shown by studies on the social determinants of health has changed the relationship between ethics and medicine, and between a normative and a descriptive approach. Studies on the social determinants of health have also modified the traditional concept of equity, necessary health policies and the future of bioethics. More specifically: 1 the boundary between medicine and ethics has become much fuzzier, especially in the field of epidemiology, whose objectives are now inseparable from ethical considerations; 2 the concept of health equity traditionally defined as access to healthcare should be corrected or expanded to incorporate unfair health inequalities that occur before patients reach the healthcare system; and 3 the traditional autonomy bias of bioethics should be replaced by a primary concern for social justice and its relationship with health.
health maintenance organisation (HMO), the other providing a ... medical schemes to have greater control over where and how health ... Medicine claims processing organisation .... simple feedback along these lines is relatively ineffective in.
D. Cumming; G. Fleming; A. Schwienbacher
We introduce the concept of style drift to private equity investment. We present theory and evidence pertaining to style drifts in terms of a fund manager's stated focus on particular stages of entrepreneurial development. We develop a model that derives conditions under which style drifts are less
Mala Rao; Prabal Vikram Singh; Anuradha Katyal; Amit Samarth; Sofi Bergkvist; Adrian Renton; Gopalakrishnan Netuveli
.... We aimed to assess whether the innovative state-funded Rajiv Aarogyasri Community Health Insurance Scheme of Andhra Pradesh state launched in 2007, has achieved equity of access to hospital inpatient...
Baker Brook K
Full Text Available Abstract Background The potentially destructive polarisation between 'vertical' financing (aiming for disease-specific results and 'horizontal' financing (aiming for improved health systems of health services in developing countries has found its way to the pages of Foreign Affairs and the Financial Times. The opportunity offered by 'diagonal' financing (aiming for disease-specific results through improved health systems seems to be obscured in this polarisation. In April 2007, the board of the Global Fund to fight AIDS, Tuberculosis and Malaria agreed to consider comprehensive country health programmes for financing. The new International Health Partnership Plus, launched in September 2007, will help low-income countries to develop such programmes. The combination could lead the Global Fund to fight AIDS, Tuberculosis and Malaria to a much broader financing scope. Discussion This evolution might be critical for the future of AIDS treatment in low-income countries, yet it is proposed at a time when the Global Fund to fight AIDS, Tuberculosis and Malaria is starved for resources. It might be unable to meet the needs of much broader and more expensive proposals. Furthermore, it might lose some of its exceptional features in the process: its aim for international sustainability, rather than in-country sustainability, and its capacity to circumvent spending restrictions imposed by the International Monetary Fund. Summary The authors believe that a transformation of the Global Fund to fight AIDS, Tuberculosis and Malaria into a Global Health Fund is feasible, but only if accompanied by a substantial increase of donor commitments to the Global Fund. The transformation of the Global Fund into a 'diagonal' and ultimately perhaps 'horizontal' financing approach should happen gradually and carefully, and be accompanied by measures to safeguard its exceptional features.
Health insurance funds need the results of health services research more than ever due to the socio-legal and socio-economic conditions currently prevailing. This should be possible by taking transparency and data protection into consideration, by cooperating with outside researchers while ensuring flexible use of routine data and if necessary gathering additional data, and by establishing links to epidemiological and registry data. It should become normative to clear the way for health insurance funds to regularly include this type of research in budget planning and to this end provide access to a suitable source of funds. In conclusion, it can simply be stated that it no longer suffices to effectively make a new clinically tested procedure, product, and service available because health insurance funds and their partners must know more precisely what this all accomplishes in practice.
Shmueli, Amir; Engelcin-Nissan, Esti
Four health funds operate nationally in Israel, but their local market shares vary dramatically across localities. To identify the main localities' characteristics which affect the size of the market shares of the various health funds. A total of 60 Localities with more than 20,000 inhabitants were chosen. The following Localities' characteristics were retrieved for the year 2004: the market shares of the four health funds, average income, standardized mortality ratio (SMR), periphery index, the age structure, the distance from the nearest general hospital, the share of Arab population, and size. Four market share equations were estimated using SURE (seemingly unrelated regressions estimation), allowing for inter-equation correlations. The results show that the market shares of the different health funds are affected by different factors. Clalit Health Services' (CHS) share increases with the distance from Tel Aviv and SMR, and decreases with the level of mean income and the distance from the nearest CHS hospital. Leumit's market share increases only with the distance from a CHS's hospital. The market share of Maccabi Healthcare Services is higher in central localities, Jewish localities, small cities and further away from a non-CHS hospital. Meuhedet's market share is higher in big cities, rich and healthy localities, and in Localities which are further away from CHS's hospitals. These findings indicate that the presence of the health funds in different Localities varies according to the Localities' characteristics. There appears to be a market segmentation and "specialization" of certain health funds in specific populations, and of the other health funds in the rest of the population.
Hyde, Justeen; Kim, Basil; Martinez, Linda Sprague; Clark, Mary; Hacker, Karen
Local public health authorities (LPHAs) are recognized as playing critical roles in response to biological, chemical, and other health emergencies. An influx of emergency preparedness funding has created new and expanding responsibilities for LPHAs. Concern that funding for emergency response is diverting attention and resources away from other core public health responsibilities is increasing. In order to determine the impact of emergency preparedness funding on public health infrastructure, qualitative interviews with 27 LPHAs in the metro-Boston area were conducted as part of an on-going evaluation of preparedness planning in Massachusetts. Feedback on the benefits and challenges of recent emergency preparedness planning mandates was obtained. Benefits include opportunities to develop relationships within and across public health departments and increases in communication between local and state authorities. Challenges include budget constraints, staffing shortages, and competing public responsibilities. Policy recommendations for improving planning for emergency response at the local level are provided.
J.H. Block (Jörn); L. Hornuf (Lars); A. Moritz (Alexandra)
textabstractStart-ups often post updates during equity crowdfunding campaigns. Yet, little is known about the effects of such updates on funding success. We investigate this question using hand-collected data from 71 funding campaigns on two German equity crowdfunding portals. Using a combination of
Kirst, Maritt; Shankardass, Ketan; Bomze, Sivan; Lofters, Aisha; Quiñonez, Carlos
Monitoring inequalities in healthcare is increasingly being recognized as a key first step in providing equitable access to quality care. However, the detailed sociodemographic data that are necessary for monitoring are currently not routinely collected from patients in many jurisdictions. We undertook a mixed methods study to generate a more in-depth understanding of public opinion on the collection of patient sociodemographic information in healthcare settings for equity monitoring purposes in Ontario, Canada. The study included a provincial survey of 1,306 Ontarians, and in-depth interviews with a sample of 34 individuals. Forty percent of survey participants disagreed that it was important for information to be collected in healthcare settings for equity monitoring. While there was a high level of support for the collection of language, a relatively large proportion of survey participants felt uncomfortable disclosing household income (67%), sexual orientation (40%) and educational background (38%). Variation in perceived importance and comfort with the collection of various types of information was observed among different survey participant subgroups. Many in-depth interview participants were also unsure of the importance of the collection of sociodemographic information in healthcare settings and expressed concerns related to potential discrimination and misuse of this information. Study findings highlight that there is considerable concern regarding disclosure of such information in healthcare settings among Ontarians and a lack of awareness of its purpose that may impede future collection of such information. These issues point to the need for increased education for the public on the purpose of sociodemographic data collection as a strategy to address this problem, and the use of data collection strategies that reduce discomfort with disclosure in healthcare settings.
I show herein how to develop fundable proposals to support your research. Although the proposal strategy I discuss is commonly used in successful proposals, most junior faculty (and many senior scholars) in political science and other social sciences seem to be unaware of it. I dispel myths about funding, and discuss how to find funders and target…
Full Text Available Dissemination and implementation (D&I research is a growing area of science focused on overcoming the science-practice gap by targeting the distribution of information and adoption of interventions to public health and clinical practice settings. This study examined D&I research projects funded under specific program announcements by the US National Institutes of Health (NIH from 2005 to 2012. The authors described the projects’ D&I strategies, funding by NIH Institute, focus, characteristics of the principal investigators (PIs and their organizations, and other aspects of study design and setting. Results showed 46 R01s, 6 R03s, and 24 R21s funded totaling $79.2 million. The top funders were the National Cancer Institute and the National Institute of Mental Health, together providing 61% of funding. The majority of PIs were affiliated with Schools of Medicine or large, nonprofit research organizations and think tanks. Only 4% of projects were to PIs with appointments at Schools of Nursing, with 7% of the funding. The most commonly funded projects across all of the studies focused on cancer control and screening, substance abuse prevention and treatment, and mental health services. Typically implemented in community and organizational settings, D&I research provides an excellent opportunity for team science, including nurse scientists and interdisciplinary collaborators.
Rosenbaum, Paul; Shortt, S E D; Walker, D M C
In 1994 the School of Medicine of Queen's University in Kingston, Ontario, its clinical teachers, and the three principal teaching hospitals initiated a new approach to funding, the Alternative Funding Plan, a pragmatic response to the inability of fee-for-service billing by clinical faculty to subsidize the academic mission of the health sciences center. The center was funded to provide a package of service and academic deliverables (outputs), rather than on the basis of payment for physician clinical activity (inputs). The new plan required a new governance structure representing stakeholders and raised a number of important issues: how to reconcile the preservation of physician professional autonomy with corporate responsibilities; how to gather requisite information so as to equitably allocate resources; and how to report to the Ontario Ministry of Health and Long-term Care in order to demonstrate accountability. In subsequent iterations of the agreement it was necessary to address issues of flexibility resulting from locked-in funding levels and to devise meaningful performance measures for departments and the center as a whole. The authors conclude that the Alternative Funding Plan represents a successful innovation in funding for an academic health sciences center in that it has created financial stability, as well as modest positive effects for education and research. The Ontario government hopes to replicate the model at the province's other four health sciences centers, and it may have applicability in any jurisdiction in which the costs of medical education outstrip the capacity of faculty clinical earnings.
Connor, Margaret; Nelson, Katherine; Maisey, Jane
Health Reporoa Inc. offers a first contact rural nursing service to the village of Reporoa and surrounding districts. From 2003 to 2006 it became a project site through selection for the Ministry of Health (MoH) primary health care nursing innovation funding. Health Reporoa Inc. successfully achieved its project goals and gained an ongoing contract from Lakes District Health Board to consolidate and further expand its services at the close of the funding period. This paper examines the impact of the innovation funding during the project period and in the two years that followed. The major impact came through an expansion of the accessible free health service to the local population; advancing nursing practice; increased connection to the nursing profession and wider health community, and enhanced affirmation of the nursing contribution. The rural nursing service model developed at Health Reporoa, through the benefit of innovation funding, can now act as a blueprint for other rural health services, particularly those in high deprivation areas.
Ridde, Valéry; Turcotte-Tremblay, Anne-Marie; Souares, Aurélia; Lohmann, Julia; Zombré, David; Koulidiati, Jean Louis; Yaogo, Maurice; Hien, Hervé; Hunt, Matthew; Zongo, Sylvie; De Allegri, Manuela
The low quality of healthcare and the presence of user fees in Burkina Faso contribute to low utilization of healthcare and elevated levels of mortality. To improve access to high-quality healthcare and equity, national authorities are testing different intervention arms that combine performance-based financing with community-based health insurance and pro-poor targeting. There is a need to evaluate the implementation of these unique approaches. We developed a research protocol to analyze the conditions that led to the emergence of these intervention arms, the fidelity between the activities initially planned and those conducted, the implementation and adaptation processes, the sustainability of the interventions, the possibilities for scaling them up, and their ethical implications. The study adopts a longitudinal multiple case study design with several embedded levels of analyses. To represent the diversity of contexts where the intervention arms are carried out, we will select three districts. Within districts, we will select both primary healthcare centers (n =18) representing different intervention arms and the district or regional hospital (n =3). We will select contrasted cases in relation to their initial performance (good, fair, poor). Over a period of 18 months, we will use quantitative and qualitative data collection and analytical tools to study these cases including in-depth interviews, participatory observation, research diaries, and questionnaires. We will give more weight to qualitative methods compared to quantitative methods. Performance-based financing is expanding rapidly across low- and middle-income countries. The results of this study will enable researchers and decision makers to gain a better understanding of the factors that can influence the implementation and the sustainability of complex interventions aiming to increase healthcare quality as well as equity.
In the background of worldwide financial crisis in 2007, the private equity （PE） funds in China began to transfer their investment hotspot to traditional industry in the need of avoiding risk, and the investment of PE funds for catering enterprises was emerging quickly in the capital market. By analyzing the features of PE funds and the catering industry, this article demonstrates the necessities for the catering enterprises to accept investments from the capital market, and elaborates the mode and key points in connecting the catering enterprises with PE funds, in the hope of offering references for the catering industry to utilize the capital market effectively.%在2007年全球金融危机背景下，我国的私募股权（PE）基金因其避险需求，开始将投资热点转向传统产业^，资本市场也随之开始出现了一波私募股权基金对餐饮企业的投资热潮。本文通过对餐饮业与私募股权基金的特点分析，论证了餐饮企业为做大做强而接收资本市场投资的必要性，并给出餐饮企业与私募股权基金的对接模式与控制要点，希望为餐饮业有效利用资产市场起到借鉴作用。
Association du personnel
In ECHO no. 41 on 5 November “Health insurance: what is the current situation?” we explained to you the situation of our Health Insurance Scheme and the ideas currently being discussed to ensure its future balance. If you missed this episode, you should catch up on it now so that you understand what follows.
Health inequities are determined by multiple factors within the health sector and beyond. While gaps in social health protection coverage and effective access to health care are among the most prominent causes of health inequities, social and economic inequalities existing beyond the health sector contribute greatly to barriers to access affordable and acceptable health care. © The Author 2014. Published by Oxford University Press. All rights reserved. For Permissions, please email: email@example.com.
de Cruppé, Werner; Blumenstock, Gunnar; Fischer, Imma; Selbmann, Hans-Konrad; Geraedts, Max
Nine out of ten demonstration projects on clinical benchmarking funded by the German Ministry of Health were evaluated. Project reports and interviews were uniformly analysed using a list of criteria and a scheme to categorize the realized benchmarking approach. At the end of the funding period four benchmarking networks had implemented all benchmarking steps, and six were continued after funding had expired. The improvement of outcome quality cannot yet be assessed. Factors promoting the introduction of benchmarking networks with regard to organisational and process aspects of benchmarking implementation were derived.
Full Text Available Background: Global health is shifting gradually from a limited focus on individual communicable disease goals to the formulation of broader sustainable health development goals. A major impediment to this shift is that most low- and middle-income countries (LMICs have not established adequate sustainable funding for health promotion and health infrastructure. Objective: In this article, we analyze how Thailand, a middle-income country, created a mechanism for sustainable funding for health. Design: We analyzed the progression of tobacco control and health promotion policies over the past three decades within the wider political-economic and sociocultural context. We constructed a parallel longitudinal analysis of statistical data on one emerging priority – road accidents – to determine whether policy shifts resulted in reduced injuries, hospitalizations and deaths. Results: In Thailand, the convergence of priorities among national interest groups for sustainable health development created an opportunity to use domestic tax policy and to create a semi-autonomous foundation (ThaiHealth to address a range of pressing health priorities, including programs that substantially reduced road accidents. Conclusions: Thailand's strategic process to develop a domestic mechanism for sustainable funding for health may provide LMICs with a roadmap to address emerging health priorities, especially those caused by modernization and globalization.
Charoenca, Naowarut; Kungskulniti, Nipapun; Mock, Jeremiah; Hamann, Stephen; Vathesatogkit, Prakit
Global health is shifting gradually from a limited focus on individual communicable disease goals to the formulation of broader sustainable health development goals. A major impediment to this shift is that most low- and middle-income countries (LMICs) have not established adequate sustainable funding for health promotion and health infrastructure. In this article, we analyze how Thailand, a middle-income country, created a mechanism for sustainable funding for health. We analyzed the progression of tobacco control and health promotion policies over the past three decades within the wider political-economic and sociocultural context. We constructed a parallel longitudinal analysis of statistical data on one emerging priority - road accidents - to determine whether policy shifts resulted in reduced injuries, hospitalizations and deaths. In Thailand, the convergence of priorities among national interest groups for sustainable health development created an opportunity to use domestic tax policy and to create a semi-autonomous foundation (ThaiHealth) to address a range of pressing health priorities, including programs that substantially reduced road accidents. Thailand's strategic process to develop a domestic mechanism for sustainable funding for health may provide LMICs with a roadmap to address emerging health priorities, especially those caused by modernization and globalization.
Full Text Available Abstract Background In Norway, admission teams at Community Mental Health Centres (CMHCs assess referrals from General Practitioners (GPs, and classify the referrals into priority groups according to treatment needs, as defined in the Act of Patient Rights. In this study, we analyzed classification of similar referrals to determine the reliability of classification into priority groups (i.e., horizontal equity. Methods Twenty anonymous case vignettes based on representative referrals were classified by 42 admission team members at 16 CMHCs in the South-East Health Region of Norway. All clinicians were experienced, and were responsible for priority setting at their centres. The classifications were first performed independently by the 42 clinicians (i.e., individual rating, and then evaluated utilizing team consensus within each CMHC (i.e., team rating. Interrater reliability was estimated using intraclass correlation coefficients (ICCs while the reliability of rating across raters and units (generalizability were estimated using generalizability analysis. Results The ICCs (2.1 single measure, absolute agreement varied between 0.40 and 0.51 using individual ratings and between 0.39 and 0.58 using team ratings. Our findings suggest a fair (low degree of interrater reliability, and no improvement of team ratings was observed when compared to individual ratings. The generalizability analysis, for one rater within each unit, yields a generalizability coefficient of 0.50 and a dependability coefficient of 0.53 (D study. These findings confirm that the reliability of ratings across raters and across units is low. Finally, the degree of inconsistency, for an average measurement, appears to be higher within units than between units (G study. Conclusion The low interrater reliability and generalizability found in our study suggests that horizontal equity to mental health services is not ensured with respect to priority. Priority -setting in teams provides
Friedman, Sarah A; Thalmayer, Amber G; Azocar, Francisca; Xu, Haiyong; Harwood, Jessica M; Ong, Michael K; Johnson, Laura Lambert; Ettner, Susan L
Did mental health cost-sharing decrease following implementation of the Mental Health Parity and Addiction Equity Act (MHPAEA)? Specialty mental health copayments, coinsurance, and deductibles, 2008-2013, were obtained from benefits databases for "carve-in" plans from a national commercial managed behavioral health organization. Bivariate and regression-adjusted analyses compare the probability of use and (conditional) level of cost-sharing pre- and postparity. An interaction term is added to compare differential levels of pre- and postparity cost-sharing changes for plans that were and were not already at parity pre-MHPAEA. Controlling for employer/plan characteristics, MHPAEA is associated with higher intermediate care copayments ($15.9) but lower outpatient ($2.6) copayments among in-network-only plans. Among plans with in- and out-of-network benefits, MHPAEA is associated with lower inpatient ($23.2) and outpatient ($2.5) copayments, but increases in inpatient and intermediate in-network and out-of-network coinsurance (about 1 percentage point). Among the few plans not at parity pre-MHPAEA, changes in use and level of cost-sharing associated with MHPAEA were more dramatic. Mixed evidence that MHPAEA led to more generous mental health benefits may stem from the finding that many plans were already at parity pre-MHPAEA. Future policy focus in mental health may shift to slowing growth in cost-sharing for all health services. © Health Research and Educational Trust.
Marks, Beth A; Heller, Tamar
Health is influenced by political, economic, social, cultural, environmental, behavioral and biological conditions--either positively or negatively. Health promotion aims to make these factors more favorable through health advocacy. Advocating for physical, mental, and social health requires that individuals with I/DD have opportunities to identify and realize their aspirations, develop the capacity to satisfy their needs, and possess the ability to adapt and/or cope with the environment. Because health is both an individual and a social responsibility, effective health promotion strategies must incorporate linkages between health and development, particularly for vulnerable and disadvantaged groups where deprivation in health and economic resources exist simultaneously and reinforce each other . Incorporating health and development at the core of health promotion activities addresses issues of poverty, poor health, and unemployment, while accounting for social, cultural and economic differences. Health promotion enables people with I/DD to achieve their health goals by ensuring equal opportunities and resources. This includes having supportive environments, access to information, and life skills and opportunities to make healthy choices. People cannot achieve their health goals unless they can control health determinants. Health promotion efforts require coordinated action from all interested groups (e.g., government entities, health and other social and economic sectors, nongovernmental and voluntary organizations, local authorities, industry and media), including individuals, families and communities. Community-based health promotion emphasizes community participation, along with empowerment of community members to address inequities and increase control over their health . Individual satisfaction and participation are critical components in community coalitions that are providing health promotion programs. Moreover, community leadership, shared decision
Full Text Available Substantiating the concept of equity is an issue of interest to specialists in accounting, taxation and finance. The purpose of this article is to present three of the sensitive issues generated by the concept of equity. One aspect considered is the demarcation of financial liabilities from the equity instruments. The distinction between equity and debt instruments is necessary because it has consequences on financial reporting. A second part of the study focuses on the fiscal side, trying to find the answer to the question: Are there deferred taxes recognized in equity? Deferred tax liabilities will be presented at the end of the year in equity and not debt, because they are related to gains recorded directly in equity. The third part of the article discusses the financial importance of equity, focusing on subscription and attribution rights as financial instruments used when raising capital. By creating subscription rights it is desired to obtain immediate funds needed to finance the entity.
Full Text Available Substantiating the concept of equity is an issue of interest to specialists in accounting, taxation and finance. The purpose of this article is to present three of the sensitive issues generated by the concept of equity. One aspect considered is the demarcation of financial liabilities from the equity instruments. The distinction between equity and debt instruments is necessary because it has consequences on financial reporting. A second part of the study focuses on the fiscal side, trying to find the answer to the question: Are there deferred taxes recognized in equity? Deferred tax liabilities will be presented at the end of the year in equity and not debt, because they are related to gains recorded directly in equity. The third part of the article discusses the financial importance of equity, focusing on subscription and attribution rights as financial instruments used when raising capital. By creating subscription rights it is desired to obtain immediate funds needed to finance the entity.
Examines school-funding equity litigation concerning rural schools, effects of political power on rural funding, rural and urban competition for funding, unique funding problems of rural schools, the growing threat to equity posed by sales-tax funding schemes, and future funding-litigation strategies for rural schools. Tables list relevant federal…
Italian Global Health Watch
Full Text Available “Global Funds are like stars in the sky, you can see them, admire them, appreciate their abundance… but fail to touch them.” - Ministry of Health Official, Malawi Abstract The paper traces the evolution of international health policies and international health institutions, starting from the birth of the World Health Organization, the setting up of the Health for All target at the Alma Ata conference in 1978 and the rise of neo-liberal policies promoted by international financial institutions from 1980 to the present. The paper looks at different issues surrounding public-private partnerships and the setting up of the Global Fund to fight AIDS, Tuberculosis and Malaria and the influence of these institutions on the health systems in poor countries.
Rump, Alexis; Schöffski, Oliver
Objective The modern Japanese health care system was established during the Meiji period (1868-1912) using the example of Germany. In this paper, the funding and remuneration of health services and products in Japan are described. The focus lies on the mechanisms used to implement health policy goals and to control costs. Method Selective literature search. Results All permanent residents in Japan are enrolled in one of more than 3,000 compulsory health funds. Employees and public servants are covered through company or government-related health insurance schemes. Independent workers, the unemployed and the pensioners are usually assigned to health insurance plans managed by local city governments. The elderly over 75 years are insured through special health funds managed at the prefectural level. To correct the fiscal disparities among the health insurance programs, a risk adjustment is realized by compensatory financial transfers between the funds and substantial subsidies from the central and local governments. The statutory benefits package that is identical for all insurance plans is regulated in a single comprehensive schedule. All the covered health services and products are listed with the fees and compensations, and the conditions for the service providers to be remunerated are also stated. This fee and compensation schedule is regularly revised every 2 years under the leadership of the Ministry of Health, Labor and Welfare. The revisions are intended to contain health expenditures and to set incentives for the achievement of health policy goals. Conclusion The funding of the Japanese health care system and the risk adjustment mechanisms among health funds are well established and show a rather static character. The short- and mid-term development of the system is mainly controlled on the side of the expenditures through the unique and comprehensive fee and compensation schedule. The regular revisions of this schedule permit to react at relatively short
Rosenstreich, Gabi; Comfort, Jude; Martin, Paul
The current period of health reform in Australia offers an opportunity for positive actions to be taken to address the significant challenges that lesbian, gay, bisexual, trans, intersex and other sexuality, sex and gender diverse (LGBTI) people face in the health system. This paper provides analysis of why this group should be considered a priority health group using a social determinants of health framework, which has, to date, largely been ignored within primary health care policy reform in Australia. Several key areas of the primary health care reform package are considered in relation to LGBTI health and well-being. Practical suggestions are provided as to how the primary health care sector could contribute to reducing the health inequities affecting LGBTI people. It is argued that care needs to be taken to ensure the reform process does not further marginalise this group.
Full Text Available Abstract Background In the United States, a dedicated property tax describes the legal authority given to a local jurisdiction to levy and collect a tax for a specific purpose. We investigated for an association of locally dedicated property taxes to fund local public health agencies and improved health status in the eight states designated as the Mississippi Delta Region. Methods We analyzed the difference in health outcomes of counties with and without a dedicated public health tax after adjusting for a set of control variables using regression models for county level data from 720 counties of the Mississippi Delta Region. Results Levying a dedicated public health tax for counties with per capita income above $28,000 is associated with improved health outcomes of those counties when compared to counties without a dedicated property tax for public health. Alternatively, levying a dedicated property tax in counties with lower per capita income is associated with poor health outcomes. Conclusions There are both positive and negative consequences of using dedicated property taxes to fund public health. Policymakers should carefully examine both the positive association of improved health outcomes and negative impact of taxation on poor populations before authorizing the use of dedicated local property tax levies to fund public health agencies.
Bikker, Jacob A.; Spierdijk, Laura; van der Sluis, Pieter Jelle
This article analyzes market impact costs of equity trading by one of the world's largest pension funds. We find that, on average, these costs are small in terms of market disruption, but substantial in terms of costs for the pension fund. Average market impact costs equal 20 basis points for buys a
Gerhardus, Ansgar; Becher, Heiko; Groenewegen, Peter; Mansmann, Ulrich; Meyer, Thorsten; Pfaff, Holger; Puhan, Milo; Razum, Oliver; Rehfuess, Eva; Sauerborn, Rainer; Strech, Daniel; Wissing, Frank; Zeeb, Hajo; Hummers-Pradier, Eva
Public health research is complex, involves various disciplines, epistemological perspectives and methods, and is rarely conducted in a controlled setting. Often, the added value of a research project lies in its inter- or trans-disciplinary interaction, reflecting the complexity of the research questions at hand. This creates specific challenges when writing and reviewing public health research grant applications. Therefore, the German Research Foundation (DFG), the largest independent research funding organization in Germany, organized a round table to discuss the process of writing, reviewing and funding public health research. The aim was to analyse the challenges of writing, reviewing and granting scientific public health projects and to improve the situation by offering guidance to applicants, reviewers and funding organizations. The DFG round table discussion brought together national and international public health researchers and representatives of funding organizations. Based on their presentations and discussions, a core group of the participants (the authors) wrote a first draft on the challenges of writing and reviewing public health research proposals and on possible solutions. Comments were discussed in the group of authors until consensus was reached. Public health research demands an epistemological openness and the integration of a broad range of specific skills and expertise. Applicants need to explicitly refer to theories as well as to methodological and ethical standards and elaborate on why certain combinations of theories and methods are required. Simultaneously, they must acknowledge and meet the practical and ethical challenges of conducting research in complex real life settings. Reviewers need to make the rationale for their judgments transparent, refer to the corresponding standards and be explicit about any limitations in their expertise towards the review boards. Grant review boards, funding organizations and research ethics committees
Graham, Garth N; Ostrowski, MaryLynn; Sabina, Alyse B
Health care disparities and high chronic disease rates burden many communities and disproportionally impact racial/ethnic populations in the United States. These disparities vary geographically, increase health care expenses, and result in shortened lifespans. Digital technologies may be one tool for addressing health disparities and improving population health by increasing individuals' access to health information-especially as most low-income U.S. residents gain access to smartphones. The Aetna Foundation partners with organizations to use digital technologies, including mobile applications, data collection, and related platforms, for learning and sharing. Projects range from the broad-childhood education, lifestyle modification, health IT training, and nutrition education, to the specific-local healthy foods, stroke rehabilitation, and collection of city-level data. We describe our approaches to grantmaking and discuss lessons learned and their implications. When combined with sound policy strategies, emerging, scalable, digital technologies will likely become powerful allies for improving health and reducing health disparities.
Gómez-García, Teresa; Moreno-Casbas, Teresa; González-María, Esther; Fuentelsaz-Gallego, Carmen
To analyze the relationship between burden of disease during 2007-2009 and public funding of research in health in Spain during 2008-2010. Descriptive cross-sectional study of burden of disease and funding allocated for research in diseases in the Spanish National Health System. A review was made of a total of 6,573 project titles funded for the years 2008, 2009 and 2010. During this period, a total of 472.7 million Euros were assigned as grants for research projects. Malignant tumors and neuropsychiatric diseases were the illnesses with greatest funding support. During the study period, it was estimated that there was a total of 15,253,331.3 disability-adjusted life years (DALYs) in Spain, with neuropsychiatric diseases being the category representing most DALYs with 4,396,900 (28.8%). The relationship between funding and DALYs was obtained with a Pearson r equal to 0.759 (p<0.001). The study of congenital diseases had higher funding per DALY than any other disease with an investment of 290.4€/DALY. Among these, the study of cleft palate and esophageal atresia, with ratios of 3,432.7€/DALY and 3,387.6€/DALY respectively, obtained the greatest funding. The study shows that the relative distribution of economic resources in the study period is consistent with the burden suffered by the Spanish population. This relationship is altered by the funding of the study of congenital anomalies, because of the low number of projects in this area. Copyright © 2013 Elsevier España, S.L. All rights reserved.
simply has no obligation to address social or health inequalities because any measure to ... health care judge actions (allocating resources) to be right or wrong based on ... utilitarian theories of health care justice do not consider individual inequities as ... 12), where no one knows his/her place in society, rational and self-.
杨学来; 徐凌忠; 张毓辉
目的：测量和分析某省卫生筹资系统公平性。方法：根据卫生筹资公平系统框架，利用某省第四次家庭卫生服务调查数据从卫生资金筹集公平、资金分配公平和筹资风险保护3个维度简要分析该省卫生筹资公平性状况。结果：某省综合卫生筹资Kakwani指数为0.0345，卫生资金筹集具有累进性，但存在公共筹资比重不高、不同人群医疗保障水平存在差异的问题；政府补助分布向富裕人群倾斜，低收入人群受益较少；与筹资和受益公平状况相对应，该省18.32%的家庭发生灾难性卫生支出，3.67%的人因为就医花费陷入贫困。结论：某省在筹资风险保护方面需要进一步改善。%Objective:To measure and analyze the equity of health financing system in a province. Methods:Analyzing the status of health financing equity in a province under the systematic framework of health financing equity. Equity in health financing, allocation equity and financial risk protection were analyzed using related quantitative methods based on the 4th Household Health Survey data. Results: The Kakwani Index for overall health financing is 0.034 5 indicating a progressive financing, but there are differences in the level of health security among different population groups at different economic levels as well as relative low share of public finance;more government subsidy was allocated to richer people and the low-income people benefit lower; the catastrophic payment headcount was 18.32% and 3.67% the patients were pushed into poverty due to out-of-pocket payment. Conclusion: Financial risk protection should be further improved in a province.
Browne, Annette J; Varcoe, Colleen; Ford-Gilboe, Marilyn; Wathen, C Nadine
The primary health care (PHC) sector is increasingly relevant as a site for population health interventions, particularly in relation to marginalized groups, where the greatest gains in health status can be achieved. The purpose of this paper is to provide an overview of an innovative multi-component, organizational-level intervention designed to enhance the capacity of PHC clinics to provide equity-oriented care, particularly for marginalized populations. The intervention, known as EQUIP, is being implemented in Canada in four diverse PHC clinics serving populations who are impacted by structural inequities. These PHC clinics serve as case studies for the implementation and evaluation of the EQUIP intervention. We discuss the evidence and theory that provide the basis for the intervention, describe the intervention components, and discuss the methods used to evaluate the implementation and impact of the intervention in diverse contexts. Research and theory related to equity-oriented care, and complexity theory, are central to the design of the EQUIP intervention. The intervention aims to enhance capacity for equity-oriented care at the staff level, and at the organizational level (i.e., policy and operations) and is novel in its dual focus on: (a) Staff education: using standardized educational models and integration strategies to enhance staff knowledge, attitudes and practices related to equity-oriented care in general, and cultural safety, and trauma- and violence-informed care in particular, and; (b) Organizational integration and tailoring: using a participatory approach, practice facilitation, and catalyst grants to foster shifts in organizational structures, practices and policies to enhance the capacity to deliver equity-oriented care, improve processes of care, and shift key client outcomes. Using a mixed methods, multiple case-study design, we are examining the impact of the intervention in enhancing staff knowledge, attitudes and practices; improving
Thorson, A; Johansson, E
Earlier studies from Vietnam have highlighted the importance of studying gender aspects of health-seeking and diagnosis of potential tuberculosis patients. A longer doctor's delay to diagnosis among female TB patients has been shown. The objective of the present study was to explore doctors' views about and explanations for the longer doctor's delay. Five focus group discussions and three in-depth interviews were performed in a rural province in Vietnam. Thematic content analysis was used to interpret the data. The doctors suggest that women are lost or delayed within the health care-seeking chain, mainly because of barriers associated with the female gender. These barriers are identified, but yet the patient-doctor encounter seems to be steered by an equality principle. This results in gender blindness since equal treatment is suggested despite needs being different. We argue that gender equity should be the guiding principle for the tuberculosis patient-doctor encounter. An equity principle emphasises that needs vary with factors like gender or context. We suggest more research into the health care-seeking chain in order to identify the specific steps where TB diagnosis of men and women may be delayed. Interventions are needed in order to reduce delay to TB diagnosis especially for women and the current TB control strategy, (DOTS), needs to be examined from an equity perspective.
Vitor Laerte Pinto Junior
Full Text Available Health surveillance (HS is one of the key components of the Brazilian Unified Health System (SUS. This article describes recent changes in health surveillance funding models and the role these changes have had in the reorganization and decentralization of health actions. Federal law no. 8.080 of 1990 defined health surveillance as a fundamental pillar of the SUS, and an exclusive fund with equitable distribution criteria was created in the Basic Operational Norm of 1996 to pay for health surveillance actions. This step facilitated the decentralization of health care at the municipal level, giving local authorities autonomy to plan and provide services. The Health Pact of 2006 and its regulation under federal decree No. 3252 in 2009 bolstered the processes of decentralization, regionalization and integration of health care. Further changes in the basic concepts of health surveillance around the world and in the funding policies negotiated by different spheres of government in Brazil have been catalysts for the process of HS institutionalization in recent years.
Hobdell, Martin; Sinkford, Jeanne; Alexander, Charles
situation raises certain ethical issues with regard to professional responsibilities. It also raises some important questions for dental education. This Section has chosen to focus its efforts on examining two issues: * What can be done within dental schools? * What can be done external to dental schools...... identified is the realization by students, and faculty/teaching staff of the quest of life-long learning against a background of the social and ethical responsibilities of health professionals. The conclusion of the group is that biology is not the sole determinant of health. Understanding the role of social......The charge of this Section is ethics and global responsibilities in oral health and disease. Oral health is determined by the same factors as those for general health. To a limited extent, the level of oral health care and dental education. The philosophy and organization of the health care system...
Ashwell, Margaret; Stone, Elaine; Mathers, John; Barnes, Stephen; Compston, Juliet; Francis, Roger M; Key, Tim; Cashman, Kevin D.; Cooper, Cyrus; Khaw, Kay Tee; Lanham-New, Susan; Macdonald, Helen; Prentice, Ann; Shearer, Martin; Stephen, Alison
The UK Food Standards Agency convened an international group of expert scientists to review the Agency-funded projects on diet and bone health in the context of developments in the field as a whole. The potential benefits of fruit and vegetables, vitamin K, early-life nutrition and vitamin D on bone health were presented and reviewed. The workshop reached two conclusions which have public health implications. First, that promoting a diet rich in fruit and vegetable intakes might be beneficial...
Full Text Available This paper aims at presenting the determinants of private equity investments in Romania over the period 2000 - 2013. Additionally, this paper presents the main highlights in terms of evolution, source of funding and activities in which the private equity funds invested during the crisis. Starting from the existing literature, this paper extends the analysis of private equity drivers to Romanian market by including variables such as: economic growth, market capitalization, interest rate, unemployment rate and public R&D expenditure which were already tested in previous papers. In addition, this paper introduces new variables such us productivity and corruption index which we consider important factors in explaining the evolution of private equity investments in Romania.
Full Text Available Abstract Background In March 2009, the Task Force for Innovative International Financing for Health Systems recommended "a health systems funding platform for the Global Fund, GAVI Alliance, the World Bank and others to coordinate, mobilize, streamline and channel the flow of existing and new international resources to support national health strategies." Momentum to establish the Health Systems Funding Platform was swift, with the World Bank convening a Technical Workshop on Health Systems Strengthening (HSS, and serial meetings organized to progress the agenda. Despite its potential significance, there has been little comment in peer-reviewed literature, though some disquiet in the international development community around the scope of the Platform and the capacity of the partners, which appears disproportionate to the available information. Methods This case study uses documentary analysis, participant observation and 24 in-depth interviews to examine the processes of development and key issues raised by the Platform. Results The findings show a fluid and volatile process, with debate over whether ongoing engagement in HSS by Global Fund and GAVI represents a dilution of organizational focus, risking ongoing support, or a paradigm shift that facilitates the achievement of targeted objectives, builds systems capacity, and will attract additional resources. Uncertainty in the development of the Platform reflects the flexibility of the recently formed global health initiatives, and the instability of donor commitments, particularly in the current financial climate. But implicit in the conflict is tension between key global stakeholders over defining and ownership of the health systems agenda. Conclusions The tensions appear to have been resolved through a focus on national planning, applying International Health Partnership principles, though the global financial crisis and key personnel changes may yet alter outcomes. Despite its dynamic
Campbell-Lendrum,Diarmid; Corvalán, Carlos
Climate change is an emerging threat to global public health. It is also highly inequitable, as the greatest risks are to the poorest populations, who have contributed least to greenhouse gas (GHG) emissions. The rapid economic development and the concurrent urbanization of poorer countries mean that developing-country cities will be both vulnerable to health hazards from climate change and, simultaneously, an increasing contributor to the problem. We review the specific health vulnerabilitie...
The Lancet-University of Oslo Commission on Global Governance for health correctly concluded that: 'with globalization, health inequity increasingly results from transnational activities that involve actors with different interests and degrees of power'. At the same time, taking up that Commission's focus on political determinants of health and 'power asymmetries' requires recognizing the interplay of globalization with domestic politics, and the limits of global influences as explanations for policies that affect health inequalities. I make this case using three examples - trade policy, climate change policy, and the domestic politics of poverty reduction and social policy - and a concluding observation about the 2015 UK election.
Full Text Available Background: Social health is important to be assessed as a dimension of health. In this study we tried to determine areas and sub-areas of children social health indicators. Methods: In a structured way, we reviewed the main social health databases and documents since 1995, both Iranian and international were reviewed to develop conceptual framework and to extract indicators. Results: According to reviewed documents, indicators of social health were categorized into four groups. In first category indicators are related to system capacities such as facilities and institutions, financial, and human resources. Social system functions are classified as group two. The main subcategories of social health functions are policy development and enforcement, social marketing, community organizing, coalition building and collaboration, education, case management, screening, surveillance, and investigation. In group three, named as social factors, the main determined areas are life skills, early child development, family functioning, and social networks. Indicators related to social outcomes are categorized as group four. The main related positive social outcomes are social wellbeing and happiness and the main negative outcomes are physical health outcome (injuries, infectious diseases, etc., mental health outcomes, development and learning outcomes, risky behaviors, academic outcomes, and legal outcomes. Conclusion: Our recommended model develops a conceptual framework for child social health indicators. This framework and extracted indicators can be used to compare different populations to assess inequity for evidence based policy making and to implement proper interventions.
Contreras, Javier; Raventós, Henriette; Rodríguez, Gloriana; Leandro, Mauricio
The World Health Organization (WHO) Mental Health Action Plan 2013-2020 urges its Member States to strengthen leadership in mental health, ensure mental and social health interventions in community-based settings, promote mental health and strengthen information systems, and increase evidence and research for mental health. Although Costa Rica has strongly invested in public health and successfully reduced the burden of nutritional and infectious diseases, its transitional epidemiological pattern, population growth, and immigration from unstable neighboring countries has shifted the burden to chronic disorders. Although policies for chronic disorders have been in place for several decades, mental disorders have not been included. Recently, as the Ministry of Health of Costa Rica developed a Mental Health Policy for 2013-2020, it became evident that the country needs epidemiological data to prioritize evidence-based intervention areas. This article stresses the importance of conducting local epidemiological studies on mental health, and calls for changes in research funding priorities by public and private national and international funding agencies in order to follow the WHO Mental Health Action Plan.
Brown, Scott S; Sen, Kasturi; Decoster, Kristof
Global health partnerships created to encourage funding efficiencies need to be approached with some caution, with claims for innovation and responsiveness to development needs based on untested assumptions around the potential of some partners to adapt their application, funding and evaluation procedures within these new structures. We examine this in the case of the Health Systems Funding Platform, which despite being set up some three years earlier, has stalled at the point of implementation of its key elements of collaboration. While much of the attention has been centred on the suspension of the Global Fund's Round 11, and what this might mean for health systems strengthening and the Platform more broadly, we argue that inadequate scrutiny has been made of the World Bank's contribution to this partnership, which might have been reasonably anticipated based on an historical analysis of development perspectives. Given the tensions being created by the apparent vulnerability of the health systems strengthening agenda, and the increasing rhetoric around the need for greater harmonization in development assistance, an examination of the positioning of the World Bank in this context is vital.
Verhave, J.C.; Troyanov, S.; Mongeau, F.; Fradette, L.; Bouchard, J.; Awadalla, P.; Madore, F.
BACKGROUND AND OBJECTIVES: It is uncertain how many patients with CKD and cardiovascular risk factors in publicly funded universal health care systems are aware of their disease and how to achieve their treatment targets. DESIGN, SETTING, PARTICIPANTS, & MEASUREMENTS: The CARTaGENE study evaluated B
Day, Michael; Boseley, Sarah
The World Health Organization faces allegations that it attempted to secure a $10,000 donation from a pharmaceutical company by asking a patients' group to act as a covert channel for the funds, an arrangement that would break the WHO's own rules on accepting money from the pharmaceutical industry. The WHO denies attempts to bend its donation rules.
Alonso, Nivaldo; Massenburg, Benjamin B; Galli, Rafael; Sobrado, Lucas; Birolini, Dario
to analyze demographic Brazilian medical data from the national public healthcare system (SUS), which provides free universal health coverage for the entire population, and discuss the problems revealed, with particular focus on surgical care. data was obtained from public healthcare databases including the Medical Demography, the Brazilian Federal Council of Medicine, the Brazilian Institute of Geography and Statistics, and the National Database of Healthcare Establishments. Density and distribution of the medical workforce and healthcare facilities were calculated, and the geographic regions were analyzed using the public private inequality index. Brazil has an average of two physicians for every 1,000 inhabitants, who are unequally distributed throughout the country. There are 22,276 board certified general surgeons in Brazil (11.49 for every 100,000 people). The country currently has 257 medical schools, with 25,159 vacancies for medical students each year, with only around 13,500 vacancies for residency. The public private inequality index is 3.90 for the country, and ranges from 1.63 in the Rio de Janeiro up to 12.06 in Bahia. A significant part of the local population still faces many difficulties in accessing surgical care, particularly in the north and northeast of the country, where there are fewer hospitals and surgeons. Physicians and surgeons are particularly scarce in the public health system nationwide, and better incentives are needed to ensure an equal public and private workforce. analisar dados demográficos do Sistema Único de Saúde (SUS) brasileiro, que promove cobertura de saúde universal a toda população, e discutir os problemas revelados, com particular ênfase nos cuidados cirúrgicos. os dados foram obtidos a partir dos bancos de dados de saúde pública da Demografia Médica, do Conselho Federal de Medicina, do Instituto Brasileiro de Geografia e Estatística e do Cadastro Nacional dos Estabelecimentos de Saúde. A densidade e a
Atun, Rifat; Pothapregada, Sai Kumar; Kwansah, Janet
The support of global health initiatives in recipient countries has been vigorously debated. Critics are concerned that disease-specific programs may be creating vertical and parallel service delivery structures that to some extent undermine health systems. This case study of Ghana aimed to explore...... care delivery. Ghana has benefited from US $175 million of approved Global Fund support to address the HIV epidemic, accounting for almost 85% of the National AIDS Control Program budget. Investments in infrastructure, human resources, and commodities have enabled HIV interventions to increase...... of the strengths and weaknesses of the relationship between Global Fund-supported activities and the health system and to identify positive synergies and unintended consequences of integration. Ghana has a well-functioning sector-wide approach to financing its health system, with a strong emphasis on integrated...
Westring, Alyssa; McDonald, Jennifer M; Carr, Phyllis; Grisso, Jeane Ann
In 2008, the National Institutes of Health funded 14 R01 grants to study causal factors that promote and support women's biomedical careers. The Research Partnership on Women in Biomedical Careers, a multi-institutional collaboration of the investigators, is one product of this initiative.A comprehensive framework is needed to address change at many levels-department, institution, academic community, and beyond-and enable gender equity in the development of successful biomedical careers. The authors suggest four distinct but interrelated aspects of culture conducive to gender equity: equal access to resources and opportunities, minimizing unconscious gender bias, enhancing work-life balance, and leadership engagement. They review the collection of eight articles in this issue, which each address one or more of the four dimensions of culture. The articles suggest that improving mentor-mentee fit, coaching grant reviewers on unconscious bias, and providing equal compensation and adequate resources for career development will contribute positively to gender equity in academic medicine.Academic medicine must adopt an integrated perspective on culture for women and acknowledge the multiple facets essential to gender equity. To effect change, culture must be addressed both within and beyond academic health centers (AHCs). Leaders within AHCs must examine their institutions' processes, resources, and assessment for fairness and transparency; mobilize personnel and financial resources to implement evidence-based initiatives; and assign accountability for providing transparent progress assessments. Beyond AHCs, organizations must examine their operations and implement change to ensure parity of funding, research, and leadership opportunities as well as transparency of assessment and accreditation.
15. SUBJECT TERMS Health Disparities, Cancer, Obesity, Diabetes , Cardiovascular Community 16. SECURITY CLASSIFICATION OF: 17. LIMITATION OF ABSTRACT...burden of chronic diseases, including diabetes , hypertension, cancers, metabolic syndrome and periodontal disease. The rural nature of the region...appropriate multi-level interventions to improve oral health literacy and oral care self-management practices. Notably, the program incorporated advanced CAD
This article focuses on the health of women and girls, and the role of addressing gender inequalities experienced by women and girls. The health of both males and females is influenced by sex, or biological factors, and gender, or socially constructed influences, including gender differences in the distribution and impact of social determinants of health, access to health promoting resources, health behaviors and gender discourse, and the ways in which health systems are organized and financed, and how they deliver care. Various strategies to address the health of women and girls have been developed at intergovernmental, regional, and national level, and by international nongovernmental organizations. These include vertical programs which aim to target specific health risks and deliver services to meet women and girl's needs, and more cross-cutting approaches which aim at "gender" policy making. Much of this work has developed following the adoption of gender mainstreaming principles across different policy arenas and scales of policy making, and this article reviews some of these strategies and the evidence for their success, before concluding with a consideration of future directions in global policy. Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.
众筹，是项目发起人在互联网平台发布创业项目信息，吸引公众为该项目筹集资金的融资方式。众筹的出现带来了金融理念的重大转变，有望成为解决中小微企业和创业项目融资的重要途径。但是，股权众筹模式在中国均面临法律与政策风险，生存空间几乎没有，急需监管机构出台相关法律和政策进行松绑。金融业监管机构应及时调整对待民间融资的固有思维模式，出台便利中小微企业融资和投资者利益保护的规则，完善监管机制。这是中国在金融领域赶上欧美等发达国家的大好机会。%Crowd-funding is a way of financing by the project sponsor who releases the project information via the internet to attract the public to raise funds for the project.The emergence of the crowd-funding brings about a significant shift in financial concepts.It is expected to become an important way to solve the small and micro enterprises’financing predicaments.However,equity-based crowd-funding is facing risks in terms of policies and laws in China.There is hardly policy and legal environment for its existence.It is urgent for regulatory bodies to make relevant laws and policies.The Chinese financial regulatory authority should change their old habitual way of thinking about the non-governmental financing,make regulations favorable to the protection of medium small and micro-sized enterprises’financing and investors’interests and perfect the supervision mechanism.This is an important opportunity for China to catch up with Europe and other developed countries in the financial field.
Besides the increasing costs of health technologies and the epidemic and demographic transactions, the causes of the current inadequacy of resources in the health field are also to be ascribed to people changed expectations toward nursing and medicine. Such aspects have put in a critical position the working of the health services, which are incapable of facing the escalating and relentless health expenses. The evidence-based approach to the clinical practice and the following output of guidelines as a solution to the rationing of health services, may, in someone opinion, make headway towards the control of expenditure because it allows a synergy between optimal and basic principles. The reasoned use of the resources does not only presuppose that nurses can decide, as far as the patient is concerned, what is strictly necessary and at the same time most effective to the fulfillment of the nursing needs which have been pinpointed; nurses should also commit themselves to organise for the best, according to their level of responsibility, the scenario where clinic decisions are taken and to affect the guidance processes of the strategic choices of the institution they are part of. Nurses, as other professional do, have to honour also a commission which implies, on different levels, to take on an executive function, a teamwork function, an active and responsible cooperation in the working of health service. A superficial and cursory use of the guidelines as an allocation of resources might, on the other hand, raise objections in the name of ethics: health cannot be treated as a commodity, nor can health be subjected to market laws of supply and demand. The degree of legitimation of a health policy must therefore derive from the degree of harmonization and coherence between an evidence element and a social and cultural context where both have to be put a test.
Duncan O S Gillespie
Full Text Available Public health action to reduce dietary salt intake has driven substantial reductions in coronary heart disease (CHD over the past decade, but avoidable socio-economic differentials remain. We therefore forecast how further intervention to reduce dietary salt intake might affect the overall level and inequality of CHD mortality.We considered English adults, with socio-economic circumstances (SEC stratified by quintiles of the Index of Multiple Deprivation. We used IMPACTSEC, a validated CHD policy model, to link policy implementation to salt intake, systolic blood pressure and CHD mortality. We forecast the effects of mandatory and voluntary product reformulation, nutrition labelling and social marketing (e.g., health promotion, education. To inform our forecasts, we elicited experts' predictions on further policy implementation up to 2020. We then modelled the effects on CHD mortality up to 2025 and simultaneously assessed the socio-economic differentials of effect.Mandatory reformulation might prevent or postpone 4,500 (2,900-6,100 CHD deaths in total, with the effect greater by 500 (300-700 deaths or 85% in the most deprived than in the most affluent. Further voluntary reformulation was predicted to be less effective and inequality-reducing, preventing or postponing 1,500 (200-5,000 CHD deaths in total, with the effect greater by 100 (-100-600 deaths or 49% in the most deprived than in the most affluent. Further social marketing and improvements to labelling might each prevent or postpone 400-500 CHD deaths, but minimally affect inequality.Mandatory engagement with industry to limit salt in processed-foods appears a promising and inequality-reducing option. For other policy options, our expert-driven forecast warns that future policy implementation might reach more deprived individuals less well, limiting inequality reduction. We therefore encourage planners to prioritise equity.
Introduction Exposure to environmental hazards and beneficial factors varies with income and other socioeconomic and demographic factors. The resulting environmental inequalities have direct and indirect impacts on health and wellbeing. Many environmental inequalities relate to n...
Introduction Exposure to environmental hazards and beneficial factors varies with income and other socioeconomic and demographic factors. The resulting environmental inequalities have direct and indirect impacts on health and wellbeing. Many environmental inequalities relate to n...
Fredriksen-Goldsen, Karen I.; Espinoza, Robert
The marriage equality movement and the Affordable Care Act have enormous potential to reduce health disparities in LGBT elders, but more data and additional policy changes are sorely needed. PMID:25960600
Kidd, Sean A; McKenzie, Kwame J
In this commentary the authors highlight the difficulties developed countries have had in generating effective means of addressing inequities in mental health. Limitations in research, policy, and service responses are discussed and the social entrepreneurship framework is suggested as a means of better understanding how mental health disparities might be addressed. The example of the Canadian Centre for Victims of Torture is provided to illustrate the points made.
Jacobson, Michael F
Those who provide information about scientific issues and science policy normally present themselves as being objective and "scientific." This article describes a range of health charities, professional associations, nonprofit advocacy organizations, and industry-created organizations that receive significant funding from industry. In some cases, industry appears either to influence an organization's positions or to limit an organization's freedom to speak out on matters of interest to the funders. Nonprofit organizations need to consider the potential influence on their independence if they accept funding from interested companies and trade associations.
Rubin, Jessica B; Paltiel, A David; Saltzman, W Mark
With the founding of the National Institute of Biomedical Imaging and Bioengineering (NIBIB) in 1999, the National Institutes of Health (NIH) made explicit its dedication to expanding research in biomedical engineering. Ten years later, we sought to examine how closely federal funding for biomedical engineering aligns with U.S. health priorities. Using a publicly accessible database of research projects funded by the NIH in 2008, we identified 641 grants focused on biomedical engineering, 48% of which targeted specific diseases. Overall, we found that these disease-specific NIH-funded biomedical engineering research projects align with national health priorities, as quantified by three commonly utilized measures of disease burden: cause of death, disability-adjusted survival losses, and expenditures. However, we also found some illnesses (e.g., cancer and heart disease) for which the number of research projects funded deviated from our expectations, given their disease burden. Our findings suggest several possibilities for future studies that would serve to further inform the allocation of limited research dollars within the field of biomedical engineering.
Stuckler, David; Basu, Sanjay
In April 2009, the G20 countries committed US $750 billion to the International Monetary Fund (IMF), which has assumed a central role in global economic management. The IMF provides loans to financially ailing countries, but with strict conditions, typically involving a mix of privatization, liberalization, and fiscal austerity programs. These loan conditions have been extremely controversial. In principle, they are designed to help countries balance their books. In practice, they often translate into reductions in social spending, including spending on public health and health care delivery. As more countries are being exposed to IMF policies, there is a need to establish what we know and do not know about the IMF's effects on global health. This article introduces a series in which contributors review the evidence on the relationship between the IMF and public health and discuss potential ways to improve the Fund's effects on health. While more evidence is needed for some regions, there is sufficient evidence to indicate that IMF programs have been significantly associated with weakened health care systems, reduced effectiveness of health-focused development aid, and impeded efforts to control tobacco, infectious diseases, and child and maternal mortality. Reforms are urgently needed to prevent the current wave of IMF programs from further undermining public health in financially ailing countries and limiting progress toward the health Millennium Development Goals.
Williams, David R; Duncan, W Jack; Ginter, Peter M; Shewchuk, Richard M
Agency theory remains the dominant means of examining governance issues and ownership characteristics related to large organizations. Research in these areas within large organizations has increased our understanding, yet little is known about the influence that these mechanisms and characteristics have had on IPO firm performance. This study tests an agency perspective that venture capital involvement, governance and equity characteristics affect health care and biotechnology IPO firm performance. Our results indicate that there is no correlation between these factors and health care and biotechnology IPO wealth creation. For these entrepreneurs, our findings suggest a contingent approach for the use of these mechanisms.
Full Text Available Background: Addressing inequitable coverage of maternal and child health care services among different socioeconomic strata of population and across states is an important part of India's contemporary health program. This has wide implications for the achievement of the Millennium Development Goal targets. Objective: This paper assesses the inequity in coverage of maternal, newborn, and child health (MNCH care services across household wealth quintiles in India and its states. Design: Utilizing the District Level Household and Facility Survey conducted during 2007–08, this paper has constructed a Composite Coverage Index (CCI in MNCH care. Results: The mean overall coverage of 45% was estimated at the national level, ranging from 31% for the poorest to 60% for the wealthiest quintile. Moreover, a massive state-wise difference across wealth quintiles was observed in the mean overall CCI. Almost half of the Indian states and union territories recorded a =50% coverage in MNCH care services, which demands special attention. Conclusion: India needs focused efforts to address the inequity in coverage of health care services by recognising or defining underserved people and pursuing well-planned time-oriented health programs committed to ameliorate the present state of MNCH care.
Christensen, Peter Ove; Feltham, Gerald A.
-coupon interest rates. We show that standard estimates of the cost of capital, based on historical stock returns, are likely to be a significantly biased measure of the firm’s cost of capital, but also that the bias is almost impossible to quantify empirically. The new approach recognizes that, in practice......We review and critically examine the standard approach to equity valuation using a constant risk-adjusted cost of capital, and we develop a new valuation approach discounting risk-adjusted fundamentals, such as expected free cash flows and residual operating income, using nominal zero...
Games for Health Journal Editor Bill Ferguson recently discussed The Robert Wood Johnson Foundation's important role in funding health game research with Paul Tarini, Senior Program Officer for the Foundation's Pioneer Portfolio.
... 2. ``Liquidity Fund'' Definition 3. ``Private Equity Fund'' Definition 4. Large Private Fund Adviser... Liquidity Fund Advisers D. Burden Estimates for Large Private Equity Advisers E. Burden Estimates for... Fund (``IMF'') and Bank for International Settlements (``BIS'') emphasize the importance of...
Nelson, Stephen C; Prasad, Shailendra; Hackman, Heather W
Race is an independent factor in health disparity. We developed a training module to address race, racism, and health care. A group of 19 physicians participated in our training module. Anonymous survey results before and after the training were compared using a two-sample t-test. The awareness of racism and its impact on care increased in all participants. White participants showed a decrease in self-efficacy in caring for patients of color when compared to white patients. This training was successful in deconstructing white providers' previously held beliefs about race and racism.
Gould, Solange M.
Climate change is a significant public health danger, with a disproportionate impact on low-income and communities of color that threatens to increase health inequities. Many important social determinants of health are at stake in California climate change policy-making and planning, and the distribution of these will further impact health inequities. Not only are these communities the most vulnerable to future health impacts due to the cumulative impacts of unequal environmental exposures a...
Abu-Zaineh, Mohammad; Mataria, Awad; Luchini, Stéphane; Moatti, Jean-Paul
This paper analyzes the redistributive effect and progressivity associated with the current health care financing schemes in the Occupied Palestinian Territory, using data from the first Palestinian Household Health Expenditure Survey conducted in 2004. The paper goes beyond the commonly used "aggregate summary index approach" to apply a more detailed "disaggregate approach". Such an approach is borrowed from the general economic literature on taxation, and examines redistributive and vertical effects over specific parts of the income distribution, using the dominance criterion. In addition, the paper employs a bootstrap method to test for the statistical significance of the inequality measures. While both the aggregate and disaggregate approaches confirm the pro-rich and regressive character of out-of-pocket payments, the aggregate approach does not ascertain the potential progressive feature of any of the available insurance schemes. The disaggregate approach, however, significantly reveals a progressive aspect, for over half of the population, of the government health insurance scheme, and demonstrates that the regressivity of the out-of-pocket payments is most pronounced among the worst-off classes of the population. Recommendations are advanced to improve the performance of the government insurance schemes to enhance its capacity in limiting inequalities in health care financing in the Occupied Palestinian Territory.
Barten, F.J.M.H.; Akerman, M.; Becker, D.; Friel, S.; Hancock, T.; Mwatsama, M.; Rice, M.; Sheuya, S.; Stern, R.
All three of the interacting aspects of daily urban life (physical environment, social conditions, and the added pressure of climate change) that affect health inequities are nested within the concept of urban governance, which has the task of understanding and managing the interactions among these
Viniece Jennings; Lincoln Larson; Jessica Yun
Urban green spaces provide an array of benefits, or ecosystem services, that support ourÂ physical, psychological, and social health. In many cases, however, these benefits are not equitablyÂ distributed across diverse urban populations. In this paper, we explore relationships betweenÂ cultural ecosystem services provided by urban green space and the social determinants...
Full Text Available Health financing reforms in low- and middle- income countries (LMICs over the past decades have focused on achieving equity in financing of health care delivery through universal health coverage. Benefit and financing incidence analyses are two analytical methods for comprehensively evaluating how well health systems perform on these objectives. This systematic review assesses progress towards equity in health care financing in LMICs through the use of BIA and FIA.Key electronic databases including Medline, Embase, Scopus, Global Health, CinAHL, EconLit and Business Source Premier were searched. We also searched the grey literature, specifically websites of leading organizations supporting health care in LMICs. Only studies using benefit incidence analysis (BIA and/or financing incidence analysis (FIA as explicit methodology were included. A total of 512 records were obtained from the various sources. The full texts of 87 references were assessed against the selection criteria and 24 were judged appropriate for inclusion. Twelve of the 24 studies originated from sub-Saharan Africa, nine from the Asia-Pacific region, two from Latin America and one from the Middle East. The evidence points to a pro-rich distribution of total health care benefits and progressive financing in both sub-Saharan Africa and Asia-Pacific. In the majority of cases, the distribution of benefits at the primary health care level favoured the poor while hospital level services benefit the better-off. A few Asian countries, namely Thailand, Malaysia and Sri Lanka, maintained a pro-poor distribution of health care benefits and progressive financing.Studies evaluated in this systematic review indicate that health care financing in LMICs benefits the rich more than the poor but the burden of financing also falls more on the rich. There is some evidence that primary health care is pro-poor suggesting a greater investment in such services and removal of barriers to care can enhance
@@ Introduction The National Institutes of Health (NIH), a part of the U.S.Department of Health and Human Services, is the nation's medical research agency-making important discoveries that improve health and save lives.Thanks in large part to NIH-funded medical research, Americans today are living longer and healthier.Life expectancy in the United States has jumped from 47 years in 1900 to 78 years as reported in 2009, and disability in people over age 65 has dropped dramatically in the past 3 decades.In recent years, nationwide rates of new diagnoses and deaths from all cancers combined have fallen significantly.
Research, Screening, Service, Training, Web and Internet , Wellness Council Target Population Communities, I-95 Corridor, Coastal Carolina, Groups...Marijuana – 215 copies Drug Facts: Marijuana – 204 copies Drug Facts: Alcohol – 192 copies La Ciencia De La Adiccion – 33 copies La bebida y su...What media channels, such as TV, radio, newspapers, or the internet , have been most helpful to you as sources of health information? How important
Stores, Healthcare System, Hospitals Materials (Training Tools, Evaluation), MUSC, Health Clubs, PTO, Restaurants , Schools, SEVIEW Consultants...you be able to give me a list of dates and times when it would be more convenient for us to talk? Interviewer writes down a list of more convenient ...at this time? YES Or NO If YES, continue If NO, then ask them if there is another time or date that would be more convenient for you to
HIV/AIDS prevalence in Uganda is beginning to show an upward trend despite increased inflow of funds to fight HIV/AIDS in Uganda. To monitor health sector financing from an HIV/AIDS perspective so as to produce recommendations for effective health service delivery mechanisms in Uganda We reviewed the literature and conducted key interviews with service users, policy makers and HIV/AIDS program managers at national and local government levels. Thematic and content analysis guided the presentation of results. While efforts have been put in place to meet its national minimum health care package, much of the support in HIV/AIDS is from donors and NGOs. There is still no clear harmonisation of funding mechanisms and big short fall in health sector budgeting especially at local government level. At this rate Uganda may not achieve its targets HIV/AIDS funding in Uganda is largely dependant on donors. There is need for increased and sustained financing from the government if the impact of HIVAIDS is to be reduced.
de Lima, Luciana Dias
In the Brazilian society's context of meager financial resources for health care, associated with structural features of fiscal federalism and with the current model of funding transfers for the Unified Health System's (SUS), important inequities directly impact political negotiations and the deployment of federal financing alternatives which are not directly linked to the supply and production of health care activities and services by states and municipalities. We observed that health policies, since the second half of the nineties, have developed their own mechanisms that, in the above mentioned context, tend to accommodate different interests and federative conflicts generated by structural factors and by institutional rules. However, the absence of an integrated planning program between the criteria to establish resource redistribution for financing the Unified Health System and the Brazilian Federation's fiscal sharing system, end up reinforcing certain asymmetric patterns and generating new imbalances, making the compensation of inequities difficult in public health spending at the sub-national domain.
Full Text Available It is not clear whether between-country health inequity in Sub-Saharan Africa has been reduced over time due to economic development and increased foreign investments. We used the World Health Organization’s data about 46 nations in Sub-Saharan Africa to test if under-5 mortality rate (U5MR and life expectancy (LE converged or diverged from 1990 to 2011. We explored whether the standard deviation of selected health indicators decreased over time (i.e., sigma convergence, and whether the less developed countries moved toward the average level in the group (i.e., beta convergence. The variation of U5MR between countries became smaller from 1990 to 2001. Yet this sigma convergence trend did not continue after 2002. Life expectancy in Africa from 1990–2011 demonstrated a consistent convergence trend, even after controlling for initial differences of country-level factors. The lack of consistent convergence in U5MR partially resulted from the fact that countries with higher U5MR in 1990 eventually performed better than those countries with lower U5MRs in 1990, constituting a reversal in between-country health inequity. Thus, international aid agencies might consider to reassess the funding priority about which countries to invest in, especially in the field of early childhood health.
Ergo, Alex; Ritter, Julie; Gwatkin, Davidson R; Binkin, Nancy
Equitable access to programs and health services is essential to achieving national and international health goals, but it is rarely assessed because of perceived measurement challenges. One of these challenges concerns the complexities of collecting the data needed to construct asset or wealth indices, which can involve asking as many as 40 survey questions, many with multiple responses. To determine whether the number of variables and questions could be reduced to a level low enough for more routine inclusion in evaluations and research without compromising programmatic conclusions, we used data from a program evaluation in Honduras that compared a pro-poor intervention with government clinic performance as well as data from a results-based financing project in Senegal. In both, the full Demographic and Health Survey (DHS) asset questionnaires had been used as part of the evaluations. Using the full DHS results as the "gold standard," we examined the effect of retaining successively smaller numbers of variables on the classification of the program clients in wealth quintiles. Principal components analysis was used to identify those variables in each country that demonstrated minimal absolute factor loading values for 8 different thresholds, ranging from 0.05 to 0.70. Cohen's kappa statistic was used to assess correlation. We found that the 111 asset variables and 41 questions in the Honduras DHS could be reduced to 9 variables, captured by only 8 survey questions (kappa statistic, 0.634), without substantially altering the wealth quintile distributions for either the pro-poor program or the government clinics or changing the resulting policy conclusions. In Senegal, the 103 asset variables and 36 questions could be reduced to 32 variables and 20 questions (kappa statistic, 0.882) while maintaining a consistent mix of users in each of the 2 lowest quintiles. Less than 60% of the asset variables in the 2 countries' full DHS asset indices overlapped, and in none of
The world was different when the Ottawa Charter for Health Promotion was released 30 years ago. Concerns over the environment and what we now call the ‘social determinants of health’ were prominent in 1986. But the acceleration of ecological crises and economic inequalities since then, in a more complex and multi-polar world, pose dramatically new challenges for those committed to the original vision of the Charter. Can the 2015 Sustainable Development Goals (SDGs), agreed to by all the world’s governments, offer a new advocacy and programmatic platform for a renewal of health promotion’s founding ethos? Critiqued from both the right and the left for, respectively, their aspirational idealism and lack of political analysis, the SDGs are an imperfect but still compelling normative statement of how much of the world thinks the world should look like. Many of the goals and targets provide signals for what we need to achieve, even if there remains a critical lacuna in articulating how this is to be done. The fundamental flaw in the SDGs is the implicit assumption that the same economic system, and its still-present neoliberal governing rules, that have created or accelerated our present era of rampaging inequality and environmental peril can somehow be harnessed to engineer the reverse. This flaw is not irrevocable, however, if health promoters – practitioners, researchers, advocates – focus their efforts on a few key SDGs that, with some additional critique, form a basic blueprint for a system of national and global regulation of capitalism (or even its transformation) that is desperately needed for social and ecological survival into the 22nd century. Whether or not these efforts succeed is a future unknown; but that the efforts are made is a present urgency. PMID:28005546
Neglected Infectious Diseases (NID) affect more than one billion people worldwide, and are associated with poverty, geographic isolation of populations, social stigma, lack of precise data on estimates on both the global and local burden of disease (underreporting of the diseases), inadequate financial and political resources to effective control measures, lack of lobbying on behalf of the most vulnerable population, as well as scarce drug and diagnostic methods development. In this article we describe the relationship between NID, poverty and inequality, we propose a new concept of disease in the tropics, expanding the list of diseases that share characteristics with NID in the Peruvian context, discuss the limited availability of drugs and diagnostic tests to properly deal with these diseases, as well as highlight the contributions by the Peruvian National Institute of Health, and as final thoughts, we state that the solution for the prevention and control of NID must include an integrated approach, including the social determinants of health in the context of the fight against poverty and inequality.
Bayer, Ronald; Sampat, Bhaven N
We discuss the public and private sponsoring of university research and the issues it raises in a context of diminished federal funding. We consider research funding at schools of public health and why these schools have historically had weaker links to industry than have other academic units. We argue that the possibility of enhanced links with industry at schools of public health may raise specific concerns beyond those facing universities generally. Six issues should be considered before entering into these relationships: (1) the effects on research orientation, (2) unacceptability of some funders, (3) potential threats to objectivity and academic freedom, (4) effects on academic standards, (5) the effects on dissemination of knowledge, and (6) reputational risks.
Ho Maria T
Full Text Available Abstract Background District health systems in Africa depend largely on public funding. In many countries, not only are these funds insufficient, but they are also released in an untimely fashion, thereby creating serious cash flow problems for district health managers. This paper examines how the untimely release of public sector health funds in Ghana affects district health activities and the way district managers cope with the situation. Methods A qualitative approach using semi-structured interviews was adopted. Two regions (Northern and Ashanti covering the northern and southern sectors of Ghana were strategically selected. Sixteen managers (eight directors of health services and eight district health accountants were interviewed between 2003/2004. Data generated were analysed for themes and patterns. Results The results showed that untimely release of funds disrupts the implementation of health activities and demoralises district health staff. However, based on their prior knowledge of when funds are likely to be released, district health managers adopt a range of informal mechanisms to cope with the situation. These include obtaining supplies on credit, borrowing cash internally, pre-purchasing materials, and conserving part of the fourth quarter donor-pooled funds for the first quarter of the next year. While these informal mechanisms have kept the district health system in Ghana running in the face of persistent delays in funding, some of them are open to abuse and could be a potential source of corruption in the health system. Conclusion Official recognition of some of these informal managerial strategies will contribute to eliminating potential risks of corruption in the Ghanaian health system and also serve as an acknowledgement of the efforts being made by local managers to keep the district health system functioning in the face of budgetary constraints and funding delays. It may boost the confidence of the managers and even enhance
Dunn, James R; van der Meulen, Emily; O'Campo, Patricia; Muntaner, Carles
The emergent realist perspective on evaluation is instructive in the quest to use theory-informed evaluations to reduce health inequities. This perspective suggests that in addition to knowing whether a program works, it is imperative to know 'what works for whom in what circumstances and in what respects, and how?' (Pawson & Tilley, 1997). This addresses the important issue of heterogeneity of effect, in other words, that programs have different effects for different people, potentially even exacerbating inequities and worsening the situation of marginalized groups. But in addition, the realist perspective implies that a program may not only have a greater or lesser effect, but even for the same effect, it may work by way of a different mechanism, about which we must theorize, for different groups. For this reason, theory, and theory-based evaluations are critical to health equity. We present here three examples of evaluations with a focus on program theories and their links to inequalities. All three examples illustrate the importance of theory-based evaluations in reducing health inequities. We offer these examples from a wide variety of settings to illustrate that the problem of which we write is not an exception to usual practice. The 'Housing First' model of supportive housing for people with severe mental illness is based on a theory of the role of housing in living with mental illness that has a number of elements that directly contradict the theory underlying the dominant model. Multisectoral action theories form the basis for the second example on Venezuela's revolutionary national Barrio Adentro health improvement program. Finally, decriminalization of prostitution and related health and safety policies in New Zealand illustrate how evaluations can play an important role in both refining the theory and contributing to improved policy interventions to address inequalities. The theoretically driven and transformative nature of these interventions create
Heggeness, Misty L; Evans, Lisa; Pohlhaus, Jennifer Reineke; Mills, Sherry L
To measure diversity within the National Institutes of Health (NIH)-funded workforce. The authors use a relevant labor market perspective to more directly understand what the NIH can influence in terms of enhancing diversity through NIH policies. Using the relevant labor market (defined as persons with advanced degrees working as biomedical scientists in the United States) as the conceptual framework, and informed by accepted economic principles, the authors used the American Community Survey and NIH administrative data to calculate representation ratios of the NIH-funded biomedical workforce from 2008 to 2012 by race, ethnicity, sex, and citizenship status, and compared this against the pool of characteristic individuals in the potential labor market. In general, the U.S. population during this time period was an inaccurate comparison group for measuring diversity of the NIH-funded scientific workforce. Measuring accurately, we found the representation of women and traditionally underrepresented groups in NIH-supported postdoc fellowships and traineeships and mentored career development programs was greater than their representation in the relevant labor market. The same analysis found these demographic groups are less represented in the NIH-funded independent investigator pool. Although these findings provided a picture of the current NIH-funded workforce and a foundation for understanding the federal role in developing, maintaining, and renewing diverse scientific human resources, further study is needed to identify whether junior- and early-stage investigators who are part of more diverse cohorts will naturally transition into independent NIH-funded investigators, or whether they will leave the workforce before achieving independent researcher status.
Kuwawenaruwa, August; Mtei, Gemini; Baraka, Jitihada; Tani, Kassimu
Inequity in access and use of child and maternal health services is impeding progress towards reduction of maternal mortality in low-income countries. To address low usage of maternal and newborn health care services as well as financial protection of families, some countries have adopted demand-side financing. In 2010, Tanzania introduced free health insurance cards to pregnant women and their families to influence access, use, and provision of health services. However, little is known about whether the use of the maternal and child health cards improved equity in access and use of maternal and child health care services. A mixed methods approach was used in Rungwe district where maternal and child health insurance cards had been implemented. To assess equity, three categories of beneficiaries' education levels were used and were compared to that of women of reproductive age in the region from previous surveys. To explore factors influencing women's decisions on delivery site and use of the maternal and child health insurance card and attitudes towards the birth experience itself, a qualitative assessment was conducted at representative facilities at the district, ward, facility, and community level. A total of 31 in-depth interviews were conducted on women who delivered during the previous year and other key informants. Women with low educational attainment were under-represented amongst those who reported having received the maternal and child health insurance card and used it for facility delivery. Qualitative findings revealed that problems during the current pregnancy served as both a motivator and a barrier for choosing a facility-based delivery. Decision about delivery site was also influenced by having experienced or witnessed problems during previous birth delivery and by other individual, financial, and health system factors, including fines levied on women who delivered at home. To improve equity in access to facility-based delivery care using
Li, Suxiao; de Haan, Jakob; Scholtens, Bert; Yang, Haizhen
We investigate whether international fund flows are pro-or counter-cyclical by employing a concordance index. International fund flows are investments in bond and equity markets by institutional investors, such as mutual funds, exchange traded funds, closed-end funds and hedge funds. We find that fu
Gandré, Coralie; Prigent, Amélie; Kemel, Marie-Louise; Leboyer, Marion; Chevreul, Karine
Since 2007, actions have been undertaken in France to foster mental health research. Our objective was to assess their utility by estimating the evolution of public and non-profit funding for mental health research between 2007 and 2011, both in terms of total funding and the share of health research budgets. Public and non-profit funding was considered. Core funding from public research institutions was determined through a top-down approach by multiplying their total budget by the ratio of the number of psychiatry-related publications to the total number of publications focusing on health issues. A bottom-up method was used to estimate the amount of project-based grants and funding by non-profit organizations, which were directly contacted to obtain this information. Public and non-profit funding for mental health research increased by a factor of 3.4 between 2007 and 2011 reaching €84.8 million, while the share of health research funding allocated to mental health research nearly doubled from 2.2% to 4.1%. Public sources were the main contributors representing 94% of the total funding. Our results have important implications for policy makers, as they suggest that actions specifically aimed at prioritizing mental health research are effective in increasing research funding. There is therefore an urgent need to further undertake such actions as funding in France remains particularly low compared to the United Kingdom and the United States, despite the fact that the epidemiological and economic burden represented by mental disorders is expected to grow rapidly in the coming years.
In the United States, the overall teen birth rate has been decreasing. In 1991, the teen birth rate was 61.8 births for every 1,000 teen females, but in 2014, the same overall rate decreased to 24.2 births for every 1,000 teen females. Unfortunately, this decrease has not reflected equally across all the races/ethnic groups. In 2014, the teen birth rate for Hispanics was 38 births per 1,000 teen females. The NASN is aware about the disparities on teen birth among racial/ethnical groups and has released a specific statement about the role of school nurses on the improvement of pregnancy outcomes. This article explains the cultural, linguistic, and educational barriers faced by Hispanic teens with limited English proficiency when preventing pregnancy and describes the development and implementation of a sexual and reproductive health education curriculum. The implications for school nurses will be discussed.
founders of the Asian American Health Coalition. Dr. Torres and the CRMH Hispanic Community Relations Coordinator – Ms. Anedny Delgado -Laubscher...tratamiento y los efectos secundarios del tratamiento. Estos incluyen problemas para controlar la orina, problemas con los intestinos , y problemas sexuales...problemas para controlar la orina, problemas con los intestinos , y problemas sexuales 22 Final Report Page 306 ¿Qué pasa si no me hago las pruebas
Pearson, Cythina R; Duran, Bonnie; Oetzel, John; Margarati, Maya; Villegas, Malia; Lucero, Julie; Wallerstein, Nina
Although there is strong scientific, policy, and community support for community-engaged research (CEnR)-including community-based participatory research (CBPR)-the science of CEnR is still developing. To describe structural differences in federally funded CEnR projects by type of research (i.e., descriptive, intervention, or dissemination/policy change) and race/ethnicity of the population served. We identified 333 federally funded projects in 2009 that potentially involved CEnR, 294 principal investigators/project directors (PI/PD) were eligible to participate in a key informant (KI) survey from late 2011 to early 2012 that asked about partnership structure (68% response rate). The National Institute on Minority Health & Health Disparities (19.1%), National Cancer Institute (NCI; 13.3%), and the Centers for Disease Control and Prevention (CDC; 12.6%) funded the most CEnR projects. Most were intervention projects (66.0%). Projects serving American Indian or Alaskan Native (AIAN) populations (compared with other community of color or multiple-race/unspecified) were likely to be descriptive projects (p<.01), receive less funding (p<.05), and have higher rates of written partnership agreements (p<.05), research integrity training (p<.05), approval of publications (p<.01), and data ownership (p<.01). AIAN-serving projects also reported similar rates of research productivity and greater levels of resource sharing compared with those serving multiple-race/unspecified groups. There is clear variability in the structure of CEnR projects with future research needed to determine the impact of this variability on partnering processes and outcomes. In addition, projects in AIAN communities receive lower levels of funding yet still have comparable research productivity to those projects in other racial/ethnic communities.
Nghiem, Nhung; Cleghorn, Christine L; Leung, William; Nair, Nisha; Deen, Frederieke S van der; Blakely, Tony; Wilson, Nick
Mass media campaigns and quitlines are both important distinct components of tobacco control programmes around the world. But when used as an integrated package, the effectiveness and cost-effectiveness are not well described. We therefore aimed to estimate the health gain, health equity impacts and cost-utility of the package of a national quitline service and its promotion in the mass media. We adapted an established Markov and multistate life-table macro-simulation model. The population was all New Zealand adults in 2011. Effect sizes and intervention costs were based on past New Zealand quitline data. Health system costs were from a national data set linking individual health events to costs. The 1-year operation of the existing intervention package of mass media promotion and quitline service was found to be net cost saving to the health sector for all age groups, sexes and ethnic groups (saving $NZ84 million; 95%uncertainty interval 60-115 million in the base-case model). It also produced greater per capita health gains for Māori (indigenous) than non-Māori (2.2 vs 0.73 quality-adjusted life-years (QALYs) per 1000 population, respectively). The net cost saving of the intervention was maintained in all sensitivity and scenario analyses for example at a discount rate of 6% and when the intervention effect size was quartered (given the possibility of residual confounding in our estimates of smoking cessation). Running the intervention for 20 years would generate an estimated 54 000 QALYs and $NZ1.10 billion (US$0.74 billion) in cost savings. The package of a quitline service and its promotion in the mass media appears to be an effective means to generate health gain, address health inequalities and save health system costs. Nevertheless, the role of this intervention needs to be compared with other tobacco control and health sector interventions, some of which may be even more cost saving. © Article author(s) (or their employer(s) unless otherwise
Stuckler, David; Basu, Sanjay; Gilmore, Anna; Batniji, Rajaie; Ooms, Gorik; Marphatia, Akanksha A; Hammonds, Rachel; McKee, Martin
The International Monetary Fund's recent claims concerning its impact on public health are evaluated against available data. First, the IMF claims that health spending either does not change or increases with IMF-supported programs, but there is substantial evidence to the contrary. Second, the IMF claims to have relaxed strict spending requirements in response to the 2008-9 financial crisis, but there is no evidence supporting this claim, and some limited evidence from the Center for Economic Policy Research contradicting it. Third, the IMF states that wage ceilings on public health are no longer part of its explicit conditionalities to poor countries, as governments can choose how to achieve public spending targets; but in practice, ministers are left with few viable alternatives than to reduce health budgets to achieve specific IMF-mandated targets, so the result effectively preserves former policy. Fourth, the IMF's claim that it has increased aid to poor countries also seems to be contradicted by its policies of diverting aid to reserves, as well as evidence that a very small fraction of the Fund's new lending in response to the financial crisis has reached poor countries. Finally, the IMF's claim that it follows public health standards in tobacco control contrasts with its existing policies, which fail to follow the guidelines recommended by the World Bank and World Health Organization. The authors recommend that the IMF (1) become more transparent in its policies, practices, and data to allow improved independent evaluations of its impact on public health (including Health Impact Assessment) and (2) review considerable public health evidence indicating a negative association between its current policies and public health outcomes.
Crane, Barbara B; Dusenberry, Jennifer
Since 2001, the US government has used its power as a leading donor to family planning programmes to pursue policies in conflict with global agreements on reproductive rights. Prominent among these policies is the Mexico City Policy (or Global Gag Rule), which restricts non-governmental organisations (NGOs) in developing countries that receive USAID family planning funding from engaging in most abortion-related activities, even with their own funds. This paper reviews the history and political origins of the Gag Rule under several Republican party presidents. The Gag Rule has not achieved an overall reduction in abortions; rather, where it has disrupted family planning services, the policy is more likely to have increased the number of abortions. This paper concludes that the Gag Rule is a radical intrusion on the rights and autonomy of recipients of US funding. Regardless of whether or not it is rescinded in the future, the underlying issues in the politics of US reproductive health assistance are likely to persist. NGOs that wish to free themselves from the constraints it imposes must find the means to end their dependence on USAID funding, including turning to other donors. NGOs should also take the lead in opposing policies such as the Gag Rule that violate global agreements.
Levit, Katharine R; Kassed, Cheryl A; Coffey, Rosanna M; Mark, Tami L; Stranges, Elizabeth M; Buck, Jeffrey A; Vandivort-Warren, Rita
Spending on mental health (MH) and substance abuse (SA) treatment is expected to double between 2003 and 2014, to $239 billion, and is anticipated to continue falling as a share of all health spending. By 2014, our projections of SA spending show increasing responsibility for state and local governments (45 percent); deteriorating shares financed by private insurance (7 percent); and 42 percent of SA spending going to specialty SA centers. For MH, Medicaid is forecasted to fund an increasingly larger share of treatment costs (27 percent), and prescription medications are expected to capture 30 percent of MH spending by 2014.
... From the Federal Register Online via the Government Publishing Office DEPARTMENT OF HEALTH AND HUMAN SERVICES Indian Health Service Office of Urban Indian Health Programs Funding Opportunity: Title V HIV/AIDS Program AGENCY: Indian Health Service, HHS. ] ACTION: Notice: correction. SUMMARY: The...
Full Text Available Background: Many governments and health care providers worldwide are enthusiastic to develop medical tourism as a service export. Despite the popularity of this policy uptake, there is relatively little known about the specific local factors prospectively motivating and informing development of this sector. Objective: To identify common social, economic, and health system factors shaping the development of medical tourism in three Central American and Caribbean countries and their health equity implications. Design: In-depth, semi-structured interviews were conducted in Mexico, Guatemala, and Barbados with 150 health system stakeholders. Participants were recruited from private and public sectors working in various fields: trade and economic development, health services delivery, training and administration, and civil society. Transcribed interviews were coded using qualitative data management software, and thematic analysis was used to identify cross-cutting issues regarding the drivers and inhibitors of medical tourism development. Results: Four common drivers of medical tourism development were identified: 1 unused capacity in existing private hospitals, 2 international portability of health insurance, vis-a-vis international hospital accreditation, 3 internationally trained physicians as both marketable assets and industry entrepreneurs, and 4 promotion of medical tourism by public export development corporations. Three common inhibitors for the development of the sector were also identified: 1 the high expense of market entry, 2 poor sector-wide planning, and 3 structural socio-economic issues such as insecurity or relatively high business costs and financial risks. Conclusion: There are shared factors shaping the development of medical tourism in Central America and the Caribbean that help explain why it is being pursued by many hospitals and governments in the region. Development of the sector is primarily being driven by public
Johnston, Rory; Crooks, Valorie A.; Cerón, Alejandro; Labonté, Ronald; Snyder, Jeremy; Núñez, Emanuel O.; Flores, Walter G.
Background Many governments and health care providers worldwide are enthusiastic to develop medical tourism as a service export. Despite the popularity of this policy uptake, there is relatively little known about the specific local factors prospectively motivating and informing development of this sector. Objective To identify common social, economic, and health system factors shaping the development of medical tourism in three Central American and Caribbean countries and their health equity implications. Design In-depth, semi-structured interviews were conducted in Mexico, Guatemala, and Barbados with 150 health system stakeholders. Participants were recruited from private and public sectors working in various fields: trade and economic development, health services delivery, training and administration, and civil society. Transcribed interviews were coded using qualitative data management software, and thematic analysis was used to identify cross-cutting issues regarding the drivers and inhibitors of medical tourism development. Results Four common drivers of medical tourism development were identified: 1) unused capacity in existing private hospitals, 2) international portability of health insurance, vis-a-vis international hospital accreditation, 3) internationally trained physicians as both marketable assets and industry entrepreneurs, and 4) promotion of medical tourism by public export development corporations. Three common inhibitors for the development of the sector were also identified: 1) the high expense of market entry, 2) poor sector-wide planning, and 3) structural socio-economic issues such as insecurity or relatively high business costs and financial risks. Conclusion There are shared factors shaping the development of medical tourism in Central America and the Caribbean that help explain why it is being pursued by many hospitals and governments in the region. Development of the sector is primarily being driven by public investment promotion
Johnston, Rory; Crooks, Valorie A; Cerón, Alejandro; Labonté, Ronald; Snyder, Jeremy; Núñez, Emanuel O; Flores, Walter G
Many governments and health care providers worldwide are enthusiastic to develop medical tourism as a service export. Despite the popularity of this policy uptake, there is relatively little known about the specific local factors prospectively motivating and informing development of this sector. To identify common social, economic, and health system factors shaping the development of medical tourism in three Central American and Caribbean countries and their health equity implications. In-depth, semi-structured interviews were conducted in Mexico, Guatemala, and Barbados with 150 health system stakeholders. Participants were recruited from private and public sectors working in various fields: trade and economic development, health services delivery, training and administration, and civil society. Transcribed interviews were coded using qualitative data management software, and thematic analysis was used to identify cross-cutting issues regarding the drivers and inhibitors of medical tourism development. Four common drivers of medical tourism development were identified: 1) unused capacity in existing private hospitals, 2) international portability of health insurance, vis-a-vis international hospital accreditation, 3) internationally trained physicians as both marketable assets and industry entrepreneurs, and 4) promotion of medical tourism by public export development corporations. Three common inhibitors for the development of the sector were also identified: 1) the high expense of market entry, 2) poor sector-wide planning, and 3) structural socio-economic issues such as insecurity or relatively high business costs and financial risks. There are shared factors shaping the development of medical tourism in Central America and the Caribbean that help explain why it is being pursued by many hospitals and governments in the region. Development of the sector is primarily being driven by public investment promotion agencies and the private health sector seeking
Bozorgmehr, Kayvan; Schneider, Christine; Joos, Stefanie
Research on inequities in access to health care among asylum-seekers has focused on disparities between asylum-seekers and resident populations, but little attention has been paid to potential inequities in access to care within the group of asylum-seekers. We aimed to analyse the principles of horizontal equity (i.e., equal access for equal need irrespective of socioeconomic status, SES) and vertical equity (higher allocation of resources to those with higher need) among asylum-seekers in Germany. We performed a secondary exploratory analysis on cross-sectional data obtained from a population-based questionnaire survey among all asylum-seekers (aged 18 or above) registered in three administrative districts in Germany during the three-month study period (N = 1017). Data were collected on health care access (health care utilisation of four types of services and unmet medical need), health care need (approximated by sex, age and self-rated health status), and SES (highest educational attainment and subjective social status, SSS). We calculated odds ratios and 95% confidence intervals (CI) in multiple logistic regression models to analyse associations between SES indicators and access to health care under control of need. We contacted 60.4% (614) of the total asylum-seekers population, of which 25.4% (N = 156) participated in the study. Educational attainment showed no significant effect on health care access in crude models, but was positively associated with utilisation of psychotherapists and hospital admissions in adjusted models. Higher SSS was positively associated with health care utilisation of all types of services. The odds of hospitals admissions for asylum-seekers in the medium and highest SSS category were 3.18 times [1.06, 9.59] and 1.6 times [0.49, 5.23] the odds of those in the lowest SSS category. After controlling for need variables none of the SES indicators were significantly associated with measures of access to care, but a positive
Katikireddi, S Vittal; Valles, Sean A
The categorization of variables can stigmatize populations, which is ethically problematic and threatens the central purpose of public health: to improve population health and reduce health inequities. How social variables (e.g., behavioral risks for HIV) are categorized can reinforce stigma and cause unintended harms to the populations practitioners and researchers strive to serve. Although debates about the validity or ethical consequences of epidemiological variables are familiar for specific variables (e.g., ethnicity), these issues apply more widely. We argue that these tensions and debates regarding epidemiological variables should be analyzed simultaneously as ethical and epistemic challenges. We describe a framework derived from the philosophy of science that may be usefully applied to public health, and we illustrate its application.
Paulo Antônio de Carvalho Fortes
Full Text Available OBJETIVO: Conhecer a atribuição de significado dada por bioeticistas brasileiros quanto à equidade no sistema de saúde. MÉTODOS: Pesquisa qualitativa, exploratória. Entre julho de 2007 e julho de 2008, foram entrevistados 20 bioeticistas, dirigentes e ex-dirigentes da Sociedade Brasileira de Bioética e de suas regionais (2005-2008. O tratamento dos dados foi realizado por análise de discurso. RESULTADOS: Os discursos levaram ao estabelecimento das seguintes ideias centrais: tratar desigualmente os desiguais conforme suas necessidades; equidade e desigualdades compensadas; equidade e maximização dos benefícios; equidade e mérito social; equidade e direitos. CONCLUSÃO: Os resultados da pesquisa evidenciam a existência entre os bioeticistas pesquisados de uma diversidade de interpretações sobre equidade no sistema de saúde, reforçando a noção de que é difícil, no mundo contemporâneo, decidir sobre o que seria um sistema justo e equânime.OBJECTIVE: To understand the meaning assigned to ethical thought that should guide Brazilian bioethicists regarding the equity of a Health System. METHODS: Between July 2007 and July 2008, 20 bioethicists, directors and former directors of the 'Sociedade Brasileira de Bioética' (Bioethics Brazilian Society and their regional administrations were interviewed. RESULTS: Discourse analysis led to definition of these main points: To treat the unequals unequally according to their needs; Compensate equity and inequalities; Distributive justice and maximization of benefits; Justice and social merit and Justice and rights. CONCLUSION: Research results disclose a pluralism of values that jeopardizes determination of moral equity in the health system., Exhausting dialogues among all interested parties are necessary to reach a possible consensus.
... HIV/AIDS Program Announcement Type: New Limited Competition. Funding Announcement Number: HHS-2012-IHS... competitive grant applications for the Office of Urban Indian Health Programs Title V HIV/AIDS program. This... competition: The Minority AIDS Initiative funding that the grants are awarded from was awarded to the...
Harwood, Jessica M; Azocar, Francisca; Thalmayer, Amber; Xu, Haiyong; Ong, Michael K; Tseng, Chi-Hong; Wells, Kenneth B; Friedman, Sarah; Ettner, Susan L
The federal Mental Health Parity and Addiction Equity Act (MHPAEA) sought to eliminate historical disparities between insurance coverage for behavioral health (BH) treatment and coverage for medical treatment. Our objective was to evaluate MHPAEA's impact on BH expenditures and utilization among "carve-in" enrollees. We received specialty BH insurance claims and eligibility data from Optum, sampling 5,987,776 adults enrolled in self-insured plans from large employers. An interrupted time series study design with segmented regression analysis estimated monthly time trends of per-member spending and use before (2008-2009), during (2010), and after (2011-2013) MHPAEA compliance (N=179,506,951 member-month observations). Outcomes included: total, plan, patient out-of-pocket spending; outpatient utilization (assessment/diagnostic evaluation visits, medication management, individual and family psychotherapy); intermediate care utilization (structured outpatient, day treatment, residential); and inpatient utilization. MHPAEA was associated with increases in monthly per-member total spending, plan spending, assessment/diagnostic evaluation visits [respective immediate increases of: $1.05 (P=0.02); $0.88 (P=0.04); 0.00045 visits (P=0.00)], and individual psychotherapy visits [immediate increase of 0.00578 visits (P=0.00) and additional increases of 0.00017 visits/mo (P=0.03)]. MHPAEA was associated with modest increases in total and plan spending and outpatient utilization; for example, in July 2012 predicted per-enrollee plan spending was $4.92 without MHPAEA and $6.14 with MHPAEA. Efforts should focus on understanding how other barriers to BH care unaddressed by MHPAEA may affect access/utilization. Future research should evaluate effects produced by the Affordable Care Act's inclusion of BH care as an essential health benefit and expansion of MHPAEA protections to the individual and small group markets.
Townend, David; Duguet, Anne-Marie
All academics, perhaps with the exception of those who are hermits with independent private means, are concerned with questions of networking and research funding. The nature of academic life is to search out new ideas and revisit old ones, and to discuss these ideas with others. This requires networks of colleagues and funding to provide the basic resources of time and literature. This may be at the local level, but increasingly the expectation is that these activities should become more and more elaborate; our networks are now international, and our time and resources cost ever increasing amounts which, for many if not most academics, must be found outside the general budget of the home University. Our success as academics is measured, in increasing part, on our ability to show our networking and external funding credentials. There is a more resounding reason to pursue both networking and externally funded research: through such projects the experience of each individual can be increased such that the result is far greater than one could achieve alone. Networking and external funding are not ends in themselves, but they can and should be a great enhancement to academic life and contribution. None of this is news or a novel claim; it is simply today's environment. This paper considers some opportunities for how networking and externally funded research might help the EAHL to realise its aims in developing the discipline of health law. We, as authors, do not claim any special expertise in the area, and readers are quite justified in thinking "who are they to talk to us about what we clearly know much more about?" However, we were asked to start a discussion at the inaugural conference of the Association, and the thoughts that we present now were designed to do that. It is a discussion which will form one of the early activities of the Association. Here the paper is divided first issues concerning networking, and second those concerning research funding from sources
Brown, M; McCool, B P
Because of limited cash, sponsors of some community and religious hospitals have sought to sell or lease their institutions to a not-for-profit (NFP) system or to a for-profit system. A number of national alliances address the capital formation problem of NFP institutions. Until now they have been almost exclusively concerned with acquiring less costly debt. Without new equity capital, market influence is difficult to obtain. Even well-managed voluntary systems face a serious threat from well-capitalized investor-owned systems. Increased competition among hospitals and physicians will force future advantages to those who have capital. It will also restrict funding of certain programs and services by voluntary enterprises. In anticipation of this, various forms of partnerships have developed with investor-owned systems. To regain the initiative as the premier sponsors of health care, religious and other voluntary systems must go beyond merely competing in their markets to acquiring weaker institutions. They also must revitalize private giving and excel in efficiency to offset threats from ambulatory, day-care operations and from high-technology hospitals. Structural changes in the industry can be predicted, including the following: The trend toward integration for production, financing, and marketing will continue. Public market equity capital will be increasingly used to finance medical practice. Hospitals that sell their equity values will establish service foundations. National alliances will continue, but strictly local systems will maintain operation. Investor-owned systems will move increasingly into high-technology tertiary care.
Full Text Available This study analyzes the results of a cross-sectional survey which set out to determine the costs to patients of searching for and receiving health care in public and private institutions. The information analyzed was obtained from the study population of the Mexican National Health Survey. The dependent variable was the out-of-pocket users' costs and the independent variables were the insurance conditions, type of institution and income. The empirical findings suggest that there is a need for a more detailed analysis of user costs in middle income countries in general, where the health system is based on social security, public assistance and private institutions. This study shows that the out of pocket costs faced by users are inequitable and fall disproportionately upon socially and economically marginalized populations.
Curtis, Elana; Wikaire, Erena; Jiang, Yannan; McMillan, Louise; Loto, Rob; Airini; Reid, Papaarangi
Achieving health equity for indigenous and ethnic minority populations requires the development of an ethnically diverse health workforce. This study explores a tertiary admission programme targeting Māori and Pacific applicants to nursing, pharmacy and health sciences (a precursor to medicine) at the University of Auckland (UoA), Aotearoa New Zealand (NZ). Application of cognitive and non-cognitive selection tools, including a Multiple Mini Interview (MMI), are examined. Indigenous Kaupapa Māori methodology guided analysis of the Māori and Pacific Admission Scheme (MAPAS) for the years 2008-2012. Multiple logistic regression models were used to identify the predicted effect of admission variables on the final MAPAS recommendation of best starting point for success in health professional study i.e. 'CertHSc' (Certificate in Health Sciences, bridging/foundation), 'Bachelor' (degree-level) or 'Not FMHS' (Faculty of Medical and Health Sciences). Regression analyses controlled for interview year, gender and ancestry. Of the 918 MAPAS interviewees: 35% (319) were Māori, 58% (530) Pacific, 7% (68) Māori/Pacific; 71% (653) school leavers; 72% (662) females. The average rank score was 167/320, 40-80 credits below guaranteed FMHS degree offers. Just under half of all interviewees were recommended 'CertHSc' 47% (428), 13% (117) 'Bachelor' and 38% (332) 'Not FMHS' as the best starting point. Strong associations were identified between Bachelor recommendation and exposure to Any 2 Sciences (OR:7.897, CI:3.855-16.175; p MAPAS mathematics test (OR:1.043, CI:1.028-1.059; p MAPAS admissions process may provide an exemplar for other tertiary institutions looking to widen participation via equity-targeted admission processes.
Virginia La Rosa-Salas
Full Text Available Es ampliamente conocido que un gran segmento de la población disfruta de un mayor status de salud y de una mayor calidad de cuidados para su salud que otros. Para resolver este problema, priorizar es inevitable, sin embargo el problema surge al pensar en la manera de llevar a cabo estas prioridades. Lo más racional sería buscar la equidad entre toda la población, la manera en que toda la gente reciba el mismo cuidado para la misma necesidad. Equidad en el cuidado de la salud es un imperativo ético no sólo por el valor intrínseco que tiene el poseer una buena salud, sino que sin una buena salud las personas serían incapaces de disfrutar de otros benefi cios que la vida les puede proporcionar. Este artículo también explica cómo la efi ciencia en el cuidado para la salud también es importante, pero al mismo tiempo, cualquier innovación y racionalización llevada a cabo para la provisión del sistema de salud debería estar basadaen la dignidad humana, haciendo a la persona prevalecer sobre criterios económicos. Por lo tanto, este artículo está basado en derechos humanos fundamentales. El principal objetivo es asegurar que aquellos que tienen deberes públicos implementen los derechos esenciales de la persona humana. Desde este punto de vista, equidad sugiere igualdad: igualdad en acceso a los servicios y tratamiento, e igualdad en la calidad del cuidado proveído. En conclusión, este artículo intenta poner juntos la dignidad humana y la efi ciencia en el contexto de equidad reconciliándolos en un terreno común.
de Carvalho Leite Jose C
Full Text Available Abstract Background Needs-based resource allocation is fundamental to equitable care provision, which can meet the often-complex, fluctuating needs of people with Chronic Fatigue Syndrome/Myalgic Encephalomyelitis (CFS/ME. This has posed challenges both for those providing and those seeking support providers, in building shared understanding of the condition and of actions to address it. This qualitative study reports on needs for equity in health and social care expressed by adults living with CFS/ME. Methods The participants were 35 adults with CFS/ME in England, purposively selected to provide variation in clinical presentations, social backgrounds and illness experiences. Accounts of experienced needs and needs-related encounters with health and social services were obtained through a focus group (n = 6 and semi-structured interviews (n = 35. These were transcribed and needs related topics identified through data-led thematic analysis. Findings Participants emphasised needs for personalised, timely and sustained support to alleviate CFS/ME impacts and regain life control, in three thematic areas: (1 Illness symptoms, functional limitations and illness management; (2 practical support and social care; (3 financial support. Access of people with CFS/ME to support from health and social services was seen to be constrained by barriers stemming from social, cultural, organisational and professional norms and practices, further heightened for disadvantaged groups including some ethnic minorities. These reduced opportunities for their illness to be explained or associated functional limitations and social disadvantages to be addressed through social support. Participants sought more understanding of bio-psycho-social aspects of CFS/ME, of felt needs of people with CFS/ME and of human rights and disability rights, for providing person-centred, equitable care. Conclusions Changes in attitudes of health practitioners, policy makers and general public
Rudge, James W; Phuanakoonon, Suparat; Nema, K Henry; Mounier-Jack, Sandra; Coker, Richard
In Papua New Guinea, investment by the Global Fund to Fight AIDS, Tuberculosis and Malaria (the Global Fund) has played an important role in scaling up the response to HIV and tuberculosis (TB). As part of a series of case studies on how Global Fund-supported programmes interact with national health systems, we assessed the nature and extent of integration of the Global Fund portfolios within the national HIV and TB programmes, the integration of the HIV and TB programmes within the general health system, and system-wide effects of Global Fund support in Papua New Guinea. The study relied on a literature review and 30 interviews with key stakeholders using the Systemic Rapid Assessment Toolkit and thematic analysis. Global Fund-supported activities were found to be largely integrated, or at least coordinated, with the national HIV and TB programmes. However, this has reinforced the vertical nature of these programmes with respect to the general health system, with parallel systems established to meet the demands of programme scale-up and the performance-based nature of Global Fund investment in the weak health system context of Papua New Guinea. The more parallel functions include monitoring and evaluation, and procurement and supply chain systems, while human resources and infrastructure for service delivery are increasingly integrated at more local levels. Positive synergies of Global Fund support include engagement of civil-society partners, and a reliable supply of high-quality drugs which may have increased patient confidence in the health system. However, the severely limited and overburdened pool of human resources has been skewed towards the three diseases, both at management and service delivery levels. There is also concern surrounding the sustainability of the disease programmes, given their dependence on donors. Increasing Global Fund attention towards health system strengthening was viewed positively, but should acknowledge that system changes are slow
Radford, Andrea; Pink, George; Ricketts, Thomas
To make informed management decisions, healthcare executives must have timely and useful information about the performance of their organizations. A review of the methods used by the Health Resources and Services Administration's Bureau of Primary Health Care to evaluate the performance of community health centers (CHCs) revealed a lack of such information. This information gap motivated the development of a comparative performance scorecard for the federally funded CHCs in North Carolina. The scorecard includes 19 indicators in four performance dimensions (access to care, financial performance, human resources, and utilization and productivity). A survey of participating CHC executive directors showed that the comparative performance scorecard is a useful tool for managing and evaluating the performance of CHCs.
Littlefield, Lyn; Giese, Jill
The Australian Government's Better Access to Mental Health Care initiative introduced mental health reforms that included the availability of Medicare-funded psychology services. The mental health initiative has resulted in a huge uptake of these services, demonstrating the strong community demand for psychological treatment. The initiative has…
Lievrouw, Leah A.; Farb, Sharon E.
Reviews a selection of recent studies from various disciplines on information and social equity and on the digital divide in order to outline a basic conceptual framework for considering information equity. Highlights include equity versus equality; vertical and horizontal perspectives; social capital and public goods; and intellectual property.…
The Governing Board of the Pension Fund held its one-hundred-and-twenty-second meeting on 3 February 2004. Opening the meeting, the Chairman, J. Bezemer, welcomed W. Zapf's alternate T. Lagrange, A. Naudi's alternate P. Geeraert, and M. Goossens' alternate M. Vitasse, who were attending the Governing Board for the first time. The Governing Board heard a report from its Chairman on the meeting of the CERN Council on 19 December 2003, at which, under Pension Fund matters, the Council had approved a pensions adjustment of 0.7%. The Governing Board then heard a report on the main elements of the Investment Committee's meeting on 3 December 2003. During a presentation, Expert Timing System (Madrid) and the Compagnie de Trésorerie Benjamin de Rothschild (Geneva) had proposed a bond portfolio investment following the same quantitative investment principles as the equities portfolio they already managed for the Fund. After some deliberation, the Investment Committee had decided, on that basis, to award t...
Full Text Available The Global Health 2035 report notes that the "grand convergence"--closure of the infectious, maternal, and child mortality gap between rich and poor countries--is dependent on research and development (R&D of new drugs, vaccines, diagnostics, and other health tools. However, this convergence (and the R&D underpinning it will first require an even more fundamental convergence of the different worlds of public health and innovation, where a largely historical gap between global health experts and innovation experts is hindering achievement of the grand convergence in health.
Hernandez-Villafuerte, Karla; Sussex, Jon; Robin, Enora; Guthrie, Sue; Wooding, Steve
Publicly funded biomedical and health research is expected to achieve the best return possible for taxpayers and for society generally. It is therefore important to know whether such research is more productive if concentrated into a small number of 'research groups' or dispersed across many. We undertook a systematic rapid evidence assessment focused on the research question: do economies of scale and scope exist in biomedical and health research? In other words, is that research more productive per unit of cost if more of it, or a wider variety of it, is done in one location? We reviewed English language literature without date restriction to the end of 2014. To help us to classify and understand that literature, we first undertook a review of econometric literature discussing models for analysing economies of scale and/or scope in research generally (not limited to biomedical and health research). We found a large and disparate literature. We reviewed 60 empirical studies of (dis-)economies of scale and/or scope in biomedical and health research, or in categories of research including or overlapping with biomedical and health research. This literature is varied in methods and findings. At the level of universities or research institutes, studies more often point to positive economies of scale than to diseconomies of scale or constant returns to scale in biomedical and health research. However, all three findings exist in the literature, along with inverse U-shaped relationships. At the level of individual research units, laboratories or projects, the numbers of studies are smaller and evidence is mixed. Concerning economies of scope, the literature more often suggests positive economies of scope than diseconomies, but the picture is again mixed. The effect of varying the scope of activities by a research group was less often reported than the effect of scale and the results were more mixed. The absence of predominant findings for or against the existence of
Background: The expansion of trust law to the German statutory health insurance (SHI) and the declining numbers of sickness funds suggest a strong concentration process in the German SHI market. The paper examines the level and development of market concentration since the introduction of the free choice of sickness funds in 1996. Data: The study is based on a dataset containing information on membership, contribution rate, openness, area of activity and legal successor for all sickness funds in the period from 1996 to 2013. Methods: Market concentration is measured by the concentration rate (cumulative market share of the largest market participants) and the Herfindahl-Hirschman index (HHI). In addition, the change in the HHI is also disaggregated into 3 factors: opening, switching and fusion of sickness funds. Results: Concentration rate and HHI decreased significantly between 1996 and 2008 due to opening of former closed sickness funds and a switching behaviour from large to small funds. The SHI Competition Enhancement Act of 2007 led to a turnaround. The reform permitted cross-type mergers and introduced a completely new system of budget allocation with the central health fund. The latter put an end to the growing membership of small funds due to adverse selection processes. As a result, market concentration in the German SHI rises. Although recent mega-mergers were uncritical for nationwide competition, the study already indicates the risk of market dominance on the regional level.
Oxman, Andrew D; Lavis, John N; Lewin, Simon; Fretheim, Atle
This article is part of a series written for people responsible for making decisions about health policies and programmes and for those who support these decision makers. In this article we address considerations of equity. Inequities can be defined as "differences in health which are not only unnecessary and avoidable but, in addition, are considered unfair and unjust". These have been well documented in relation to social and economic factors. Policies or programmes that are effective can improve the overall health of a population. However, the impact of such policies and programmes on inequities may vary: they may have no impact on inequities, they may reduce inequities, or they may exacerbate them, regardless of their overall effects on population health. We suggest four questions that can be considered when using research evidence to inform considerations of the potential impact a policy or programme option is likely to have on disadvantaged groups, and on equity in a specific setting. These are: 1. Which groups or settings are likely to be disadvantaged in relation to the option being considered? 2. Are there plausible reasons for anticipating differences in the relative effectiveness of the option for disadvantaged groups or settings? 3. Are there likely to be different baseline conditions across groups or settings such that that the absolute effectiveness of the option would be different, and the problem more or less important, for disadvantaged groups or settings? 4. Are there important considerations that should be made when implementing the option in order to ensure that inequities are reduced, if possible, and that they are not increased?
Guerrero, Erick G; Harris, Lesley; Padwa, Howard; Vega, William A; Palinkas, Lawrence
Little is known about how the Affordable Care Act (ACA) will be implemented in publicly funded addiction health services (AHS) organizations. Guided by a conceptual model of implementation of new practices in health care systems, this study relied on qualitative data collected in 2013 from 30 AHS clinical supervisors in Los Angeles County, California. Interviews were transcribed, coded, and analyzed using a constructivist grounded theory approach with ATLAS.ti software. Supervisors expected several potential effects of ACA implementation, including increased use of AHS services, shifts in the duration and intensity of AHS services, and workforce professionalization. However, supervisors were not prepared for actions to align their programs' strategic change plans with policy expectations. Findings point to the need for health care policy interventions to help treatment providers effectively respond to ACA principles of improving standards of care and reducing disparities.
Los fondos de inversión son cada vez más importantes para la economía de los países desarrollados, debido a una creciente implantación de estos instrumentos de inversión en las finanzas personales. La necesidad de analizar el grado de veracidad de la información suministrada por los gestores a los partícipes de los fondos de inversión, ha motivado una muy reciente línea de investigación en la literatura financiera que ha permitido identificar un comportamiento atípico en la gestión de dichos ...
Ashwell, Margaret; Stone, Elaine; Mathers, John; Barnes, Stephen; Compston, Juliet; Francis, Roger M; Key, Tim; Cashman, Kevin D; Cooper, Cyrus; Khaw, Kay Tee; Lanham-New, Susan; Macdonald, Helen; Prentice, Ann; Shearer, Martin; Stephen, Alison
The UK Food Standards Agency convened an international group of expert scientists to review the Agency-funded projects on diet and bone health in the context of developments in the field as a whole. The potential benefits of fruit and vegetables, vitamin K, early-life nutrition and vitamin D on bone health were presented and reviewed. The workshop reached two conclusions which have public health implications. First, that promoting a diet rich in fruit and vegetable intakes might be beneficial to bone health and would be very unlikely to produce adverse consequences on bone health. The mechanism(s) for any effect of fruit and vegetables remains unknown, but the results from these projects did not support the postulated acid-base balance hypothesis. Secondly, increased dietary consumption of vitamin K may contribute to bone health, possibly through its ability to increase the gamma-carboxylation status of bone proteins such as osteocalcin. A supplementation trial comparing vitamin K supplementation with Ca and vitamin D showed an additional effect of vitamin K against baseline levels of bone mineral density, but the benefit was only seen at one bone site. The major research gap identified was the need to investigate vitamin D status to define deficiency, insufficiency and depletion across age and ethnic groups in relation to bone health.
Sobelson, Robyn K; Young, Andrea C
The Centers for Public Health Preparedness (CPHP) program was a five-year cooperative agreement funded by the Centers for Disease Control and Prevention (CDC). The program was initiated in 2004 to strengthen terrorism and emergency preparedness by linking academic expertise to state and local health agency needs. The purposes of the evaluation study were to identify the results achieved by the Centers and inform program planning for future programs. The evaluation was summative and retrospective in its design and focused on the aggregate outcomes of the CPHP program. The evaluation results indicated progress was achieved on program goals related to development of new training products, training members of the public health workforce, and expansion of partnerships between accredited schools of public health and state and local public health departments. Evaluation results, as well as methodological insights gleaned during the planning and conduct of the CPHP evaluation, were used to inform the design of the next iteration of the CPHP Program, the Preparedness and Emergency Response Learning Centers (PERLC).