Health Equity: September 2008

Tuesday, September 30, 2008

[EQ] Panel on Primary Health care: Addressing Health Determinants and Strenthening Health Systems

PANEL ON PRIMARY HEALTH CARE: ADDRESSING HEALTH DETERMINANTS AND STRENGTHENING HEALTH SYSTEMS

PAHO/WHO 48th DIRECTING COUNCIL/ 60th SESSION OF THE REGIONAL COMMITTEE ''

Wednesday October 1^st, 2008 from 8:30 am – 10:00 am Washington DC Time

To check local time in Washington DC against your time zone, see the World Clock at: http://www.timeanddate.com/worldclock/meeting.html )

ENGLISH - Webcast Directing Council

http://www.paho.org/english/DD/PIN/Webcast.htm

SPANISH - Webcast Consejo Directivo

http://www.paho.org/spanish/DD/PIN/Webcast.htm

PROVISIONAL AGENDA - Item 4.10 CD48/14, Rev. 1 (Eng.)

1. Opening: President of the Directing Council

2. Presenters:

A. Sir Michael Marmot: Chair, Commission on Social Determinants of Health: Recommendations of the Commission on Social Determinants of Health (CSDH), publicly constituted in March 2005 by the World Health Organization (WHO) through decisions of the 57th World Health Assembly, with the mission of collecting data and evidence on the social and environmental causes of health inequalities and on potential ways to correct them. More specifically, he will discuss three principles of action linked with:
(1) strategies for improving the living conditions, in which populations are born, grow, work, and age;
(2) the structural factors of unequal distribution of power, money, and resources; and

(3) raising public awareness about the social determinants of health and expansion of the knowledge base with training and measurement of the magnitude of health inequities. (10 minutes)

B. Dr. Wim Van Lerbeghe: Health Systems and Services Cluster, WHO

The main elements of WHO’s renewed vision in Primary Health Care (PHC), with special reference to the strengthening of PHC-based health systems and their contribution to the achievement of the Millennium Development Goals, the elimination of inequities in health care, and the guarantee of universal access to health services. (10 minutes)

C. Dr. Socorro Gross-Galiano: Assistant Director, PAHO

PAHO’s perspective for responding to the mandate to provide technical cooperation in order to strengthen PHC-based health systems. She will stress the creation of local service networks structured around PHC; the integration of health programs (by diseases or special groups) and the health services; efforts to extend social protection in health and universal coverage; human resources development; and intersectoral action to address health determinants and engage in health promotion by coordinating public policies to achieve the Millennium Development Goals. (10 minutes)

3. Commentators

• Dr. Hubert Alexander Minnis, Minister of Health, Bahamas (10 minutes)

• Dr. José Guillermo Maza, Minister of Health, El Salvador (10 minutes)

4. Plenary discussion (35 minutes)

Rapporteurs

• Dr. Hernán Montenegro, Regional Adviser on Health Systems and Services, PAHO/WHO

• Dr. Marilyn Rice, Regional Adviser on Sustainable Development and Environmental Health, PAHO/WHO

Information document: WHO Global and Regional Meetings and Initiatives in Support of the Renewal of Primary Health Care

http://www.paho.org/english/gov/cd/CD48-14a-e.pdf

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information Related to: Equity; Health inequality; Socioeconomic inequality in health; Socioeconomic
health differentials; Gender; Violence; Poverty; Health Economics; Health Legislation; Ethnicity; Ethics;
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and interpretations included in the Materials are those of the authors and not necessarily of The Pan American
Health Organization PAHO/WHO or its country members”.
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Monday, September 29, 2008

[EQ] Pharmaceutical Pricing Policies in a Global Market

Pharmaceutical Pricing Policies in a Global Market

OECD Health Policy Studies - Directorate for Employment, Labour and Social Affairs, Health Division
September 2008

Pharmaceutical pricing policies are designed with national objectives in mind, but are the transnational implications always taken into account?

Executive summary: http://www.oecd.org/dataoecd/36/2/41303903.pdf

OECD website: http://www.oecd.org/document/36/0,3343,en_2649_33929_41000996_1_1_1_37407,00.html

“….This report assesses how pharmaceutical pricing and reimbursement policies have contributed to the achievement of certain health policy objectives. It examines the national and transnational effects of these policies, in particular, their implications for the availability of medicines in other countries, the prices of these medicines, and innovation in the pharmaceutical sector.

This publication presents an analysis of comparative price levels, making use of a unique dataset to construct the most comprehensive pan-OECD pharmaceutical price index to date. It also draws upon original case studies of pharmaceutical pricing and reimbursement policies in six OECD countries to provide specific examples of the impacts of policies on health system performance The latest comparable data and trends on different aspects of the performance of health systems in OECD countries….”

Table of Contents

Executive Summary
Introduction
Chapter 1. Key Characteristics of the Pharmaceutical Sector in OECD Economies

Chapter 2. The Pharmaceutical Industry and its Activities

Chapter 3. Pharmaceutical Pricing and Reimbursement and the Broader Pharmaceutical Policy

Chapter 4. The Impact of Pharmaceutical Pricing Policies on Performance in Meeting Health Policy Goals

Chapter 5. The Impact of National Pricing and Reimbursement Practices on Prices and Availability of Medicines in Other Countries

Chapter 6. The Impact of Pharmaceutical Pricing Policies on Pharmaceutical Innovation

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[EQ] Will It Work Here? A Decision maker's Guide to Adopting Innovations

Will It Work Here? A Decision maker’s Guide to Adopting Innovations

Agency for Healthcare Research and Quality -U.S. Department of Health and Human Services

RTI International for the Agency for Healthcare Research and Quality - AHRQ Publication No. 08-0051 September 2008

Available online at: http://www.innovations.ahrq.gov/resources/InnovationAdoptionGuide.pdf

“…The Guide helps users determine if an innovation would be a good fit—or an appropriate stretch—for their health care organization by asking a series of questions. It links users to actionable Web-based tools and presents case studies that illustrate how other organizations have addressed these questions. Users will be able to answer the four overarching questions the Guide poses:

- Does this innovation fit?

- Should we do it here?

- Can we do it here?

- How can we do it here?...”

Contents

Purpose

How to Use the Guide

Module I: Does the Innovation Fit?

What Is the Innovation?

Does It Further Our Goals?

Is It Compatible With Our Organization?

Module II: Should We Do It Here?

What Are the Potential Benefits?

What Are the Potential Costs ?

Can We Build a Business Case?

What Are the Risks ?

Module III: Can We Do It Here

Are We Ready for This Change ?

What Changes Will We Have to Make ?

Do We Have the Ingredients for Success ?

Module IV: How Will We Do It Here

How Will We Measure the Impact of the Innovation ?

Can We Try the Innovation First ?

How Will We Implement the Innovation ?

Index of Tools

References

Appendix: Case Study Report

Investigators

Cindy Brach, Nancy Lenfestey, Amy Roussel, Jacqueline Amoozegar, Asta Sorensen

Using Logic Models to Bring Together Planning, Evaluation, and Action

Logic Model Development Guide

W.K. Kellogg Foundation

PDF [72p.] at: http://www.wkkf.org/Pubs/Tools/Evaluation/Pub3669.pdf

The Informed Decisions Toolbox

http://toolbox.berkeley.edu/tools/

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[EQ] Introduction to Evidence-Informed Public Health and A Compendium of Critical Appraisal Tools for Public Health Practice

Introduction to Evidence-Informed Public Health and a Compendium of Critical Appraisal Tools for Public Health Practice

National Collaborating Centre for Methods and Tools (NCCMT)

McMaster University, Hamilton, Ontario - Public Health Agency of Canada - 2008

PDF file at: http://www.nccmt.ca/pubs/eiph_backgrounder.pdf

This background paper defines and summarizes the concept of Evidence-Informed Public Health.
The paper also includes a compendium of critical appraisal tools to help you incorporate the best research evidence into public health practice and policy development.

Background paper: English Version [PDF, 398Kb] Version française [PDF, 417Kb]
Compendium: English Version [PDF, 301Kb] Version française [PDF, 306Kb]

Can I use this evidence in my program decision? Assessing Applicability and Transferability of Evidence

This paper summarizes the current literature and provides a process for evaluating the feasibility and generalizability of evidence to public health practice. A tool was then developed to help public health managers and planners in making decisions about program priorities in their communities

English Version [PDF, 100Kb] Version française [PDF, 100Kb]

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Friday, September 26, 2008

[EQ] EVIPNet Americas: informing policies with evidence

EVIPNet Americas: informing policies with evidence

The Lancet, Volume 372, Number 9644, 27 September 2008

Website: http://www.thelancet.com/journals/lancet/article/PIIS0140673608614592/fulltext

[Free Subscription required]

“….Public-health and health-system policies based on sound scientific evidence and best practices can improve health and equity, and the use of research results is essential for health and development.1–5 Yet accessing and incorporating research evidence to inform decision making does not occur systematically, but is especially critical in low-income and middle-income countries that face tremendous health challenges with insufficient resources…”

Evidence portal available at:

Spanish: http://evidences.bvsalud.org/php/index.php?lang=es

English: http://evidences.bvsalud.org/php/index.php?lang=en

Portuguese: http://evidences.bvsalud.org/php/index.php?lang=pt

...¨The Evidence Portal of the Virtual Health Library (VHL) is a Portal that unites, organizes, and offers integrated access to health information sources of better level of evidence in agreement with the Evidence-based Medicine (EBM) methodology, and access to information sources about the EBM methodology itself.

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[EQ] Report In Portuguese: As causas sociais das in iquidades em sa=?iso-8859-1?Q?=FAde?= no Brasil

AS CAUSAS SOCIAIS DAS INIQÜIDADES EM SAÚDE NO BRASIL

Relatório Final da Comissão Nacional sobre Determinantes Sociais da Saúde

(CNDSS) Abril 2008

PDF file [216p.] http://www.cndss.fiocruz.br/pdf/home/relatorio.pdf

O relatório da Comissão Nacional sobre Determinantes Sociais da Saúde (CNDSS) possui três objetivos:

· traçar um panorama geral da situação de saúde do país, com ênfase em dados, informações e conhecimentos
sobre as iniqüidades em saúde geradas pelos determinantes sociais;

· propor políticas, programas e intervenções relacionadas aos DSS a partir da avaliação das políticas e intervenções
atualmente em curso e das experiências registradas na literatura nacional e internacional;

· descrever as atividades desenvolvidas pela Comissão para cumprir com seus objetivos

“.....se incluem dois tipos de recomendações. Um primeiro deriva da análise de políticas e programas existentes na esfera federal e que incidem sobre os DSS. Apresenta-se uma análise de conjunto dessas políticas e programas, buscando identificar superposições, paralelismos ou contradições, com as correspondentes recomendações para superação dos problemas encontrados, visando uma ação intersetorial mais integrada.

Um segundo grupo de recomendações se refere à institucionalização de determinados processos que são fundamentais para a atuação sustentável sobre os DSS e cujo desenvolvimento deve gerar políticas e programas específicos. Incluem-se recomendações para a institucionalização da ação intersetorial visando a melhoria da qualidade de vida e saúde, da participação social e empoderamento de grupos populacionais mais vulneráveis e da produção sistemática de informações e conhecimentos sobre as relações entre Determinantes Sociais da Saúde DSS e a saúde e sobre avaliação de intervenções....”

“....As causas sociais das iniquidades em saúde no Brasil" foi oficialmente entregue ao Sr. Presidente da República no dia 1o. de Agosto de 2008..”

ÍNDICE

PREFÁCIO

APRESENTAÇÃO

I – INTRODUÇÃO

II - ANÁLISE DA SITUAÇÃO DE SAÚDE

1. Situação e tendências da evolução demográfica, social e econômica

2. A estratificação socioeconômica e a saúde

3. Condições de vida, ambiente e trabalho

4. Redes sociais, comunitárias e saúde

5. Comportamentos, estilos de vida e saúde

6. Saúde materno-infantil

7. Saúde indígena

III – RECOMENDAÇÕES

IV –BIBLIOGRAFIA

V – ANEXOS

SUMÁRIO EXECUTIVO

EXECUTIVE SUMMARY

A redação do Relatório esteve a cargo de Alberto Pellegrini Filho, da Secretaria Técnica da CNDSS (ST/CNDSS). Alice Branco, também da ST/CNDSS, foi responsável pela busca e seleção de dados, informações e indicadores sobre a situação de saúde e seus determinantes, através de consultas a diversos sistemas de informação de abrangência nacional.

A Comissão Nacional sobre Determinantes Sociais da Saúde, responsável por este relatório, esteve integrada pelos seguintes membros:

Adib Jatene

Aloísio Teixeira

Cesar Victora

Dalmo Dallari

Elza Berquó

Eduardo Eugênio Gouvêa Vieira

Jaguar, jornal carioca O Dia.

Jairnilson Paim

Lucélia Santos

Moacyr Scliar

Paulo Buss

Roberto Smeraldi

Rubem César Fernandes

Sandra de Sá

Sônia Fleury

Zilda Arns

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Thursday, September 25, 2008

[EQ] Overview of Evidence Relating to Shifting the Balance of Care

Overview of Evidence Relating to Shifting the Balance of Care:

A Contribution to the Knowledge Base

Lucy Johnston, Clare Lardner and Ruth Jepson

Scottish Government Social Research, 2008

Available online PDF [81p.] at: http://www.scotland.gov.uk/Resource/Doc/237140/0065049.pdf

“….This report presents the findings of a short review of evidence. The aim was to provide an overview of evidence to contribute to the debate on, and inform the development of, the policy on shifting the balance of care a key theme within health and community care policy which is intended to bring about improvements in service delivery and health outcomes.

Shifting the balance of care is a term used to describe change at a number of levels, for example, shifting the location of care towards more community-based facilities, shifting the focus of care towards long term conditions and changing the roles and responsibilities of patients and professionals.

The search for evidence identified 4,900 items. These were screened for relevance and quality and 601 items remained. Of these, 205 were high level evidence (e.g. systematic reviews) and are briefly summarised here. The remaining 396 primary research studies are mapped to indicate coverage of relevant topics and gaps in the evidence. All 601 studies included in the review can be found on the Shifting the Balance of Care website:

www.shiftingthebalance.scot.nhs.uk.

The high level evidence suggests that the following interventions could contribute to shifting the balance of care:

Shifting the focus of care via:

- Assessment of older people (especially as a prelude to case management)

- Multi- disciplinary working (less conclusive in relation to palliative care)

- Integrated care for older people, people with LTC, Alzheimer’s and people with HIV/AIDS

- Disease management (especially in relation to long term conditions)

- Early supported discharge with community-based rehabilitation for stroke and other patients

- Rehabilitation in the community for a range of conditions

Shifting the location of care via:

- Housing adaptations and equipment

- Supported discharge for older people and for people after a stroke

- Early supported discharge for older people and people after a stroke

- Care at home and hospital at home interventions

- Community hospitals

- Day hospitals

Changing roles via:

- Substitution of roles

- Respite and day care services to support unpaid carers

Shifting responsibilities via:

- Telephone support services

- Telephone consultation

- Self care support

- Self monitoring of long term conditions

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