Monday, April 7, 2008

[EQ] Analyzing Health Equity Using Household Survey Data Analyzing: A Guide to Techniques and Their Implementation

Analyzing Health Equity Using Household Survey Data Analyzing: A Guide to

Techniques and Their Implementation

Owen O'Donnell, Eddy van Doorslaer, Adam Wagstaff, and Magnus Lindelow

WBI Learning Resources Series - Published by the World Bank – 2007
Updated April, 2008 with downloadable Powerpoint presentations (with notes) for self-teaching, along with customizeable Stata "do" files

The book is downloadable for free from www.worldbank.org/analyzinghealthequity

“……Health equity has become an increasingly popular research topic during the course of the past 25 years. Many factors explain this trend, including a growing demand from policymakers, better and more plentiful household data, and increased computer power. But progress in quantifying and understanding health equities would not have been possible without appropriate analytic techniques. These techniques are the subject of this book.

The book includes chapters dealing with data issues and the measurement of the key variables in health equity analysis

Part I - Quantitative techniques for interpreting and presenting health equity data
Part II - Application of these techniques in the analysis of equity in health care utilization and health care spending
Part III - The aim of the book is to provide researchers and analysts with a step-by-step practical guide to the measurement of a variety of aspects of health equity, with worked examples and computer code, mostly for the computer program Stata. It is hoped that these step-by-step guides, and the easy-to-implement computer routines contained in them, will help stimulate yet more research in the field, especially policy-oriented health equity research that enables researchers to help policymakers develop and evaluate programs to reduce health inequities.

The book can be ordered online, and electronic versions of the chapters can be downloaded using the links below. Also available are Powerpoint lectures of chapters, customizable "do" files for use in Stata, a Stata "do" file for dominance checking, and an Excel file for computing standard errors of the concentration index with grouped data…”

Electronic versions of the book and individual chapters, Powerpoint lectures, Stata and Excel files

Electronic versions of the book and individual chapters:

Download: Complete Book (PDF 6.42MB)

Table of Contents (PDF 58kb)

Ch. 1: Introduction (PDF 119kb)

Ch. 2: Data for Health Equity Analysis: Requirements, Sources and Sample Designs (PDF 159kb)

Ch. 3: Health Outcome #1: Child Survival (PDF 107kb)

Ch. 4: Health Outcome #2: Anthropometrics (PDF 1.05MB)

Ch. 5: Health Outcome #3: Adult Health (PDF 156kb)

Ch. 6: Measurement of Living Standards (PDF 188kb)

Ch. 7: Concentration Curves (PDF 134kb)

Ch. 8: The Concentration Index (PDF 176kb)

Ch. 9: Extensions to the Concentration Index: Inequality Aversion and the Health Achievement Index (PDF 132kb)

Ch. 10: Multivariate Analysis of Health Survey Data (PDF 188kb)

Ch. 11: Nonlinear Models for Health and Medical Expenditure Data (PDF 194kb)

Ch. 12: Explaining Differences Between Groups: Oaxaca Decomposition (PDF 166kb)

Ch. 13: Explaining Socioeconomic-Related Health Inequality: Decomposition of the Concentration Index (PDF 95.5kb)

Ch. 14: Who Benefits from Health Sector Subsidies? Benefit Incidence Analysis (PDF 177kb)

Ch. 15: Measuring and Explaining Inequity in Health Service Delivery (PDF 123kb)

Ch. 16: Who Pays for Health Care? Progressivity of Health Finance (PDF 154kb)

Ch. 17: Redistributive Effect of Health Finance (PDF 78.9kb)

Ch. 18: Catastrophic Payments for Health Care (PDF 134kb)

Ch. 19: Health Care Payments and Poverty (PDF 107kb)

Powerpoint lectures
(NB slides have notes beneath them, so you may want to right-click and save the PPT file so you can print it out with the notes showing):

Ch. 1: Introduction (PPT 556kb)

Ch. 2: Data for Health Equity Analysis: Requirements, Sources and Sample Designs (PPT 219kb)

Ch. 3: Health Outcome #1: Child Survival (PPT 166kb)

Ch. 4: Health Outcome #2: Anthropometrics (PPT 392kb)

Ch. 5: Health Outcome #3: Adult Health (PPT 426kb)

Ch. 6: Measurement of Living Standards (PPT 238kb)

Ch. 7: Concentration Curves (PPT 141kb)

Ch. 8: The Concentration Index (PPT 254kb)

Ch. 9: Extensions to the Concentration Index: Inequality Aversion and the Health Achievement Index (PPT 123kb)

Ch. 10: Multivariate Analysis of Health Survey Data (PPT 205kb)

Ch. 11: Nonlinear Models for Health and Medical Expenditure Data (PPT 320kb)

Ch. 12: Explaining Differences Between Groups: Oaxaca Decomposition (PPT 231kb)

Ch. 13: Explaining Socioeconomic-Related Health Inequality: Decomposition of the Concentration Index (PPT 274kb)

Ch. 14: Who Benefits from Health Sector Subsidies? Benefit Incidence Analysis (PPT 359kb)

Ch. 15: Measuring and Explaining Inequity in Health Service Delivery (PPT 213kb)

Ch. 16: Who Pays for Health Care? Progressivity of Health Finance (PPT 416kb)

Ch. 17: Redistributive Effect of Health Finance (PPT 268kb)

Ch. 18: Catastrophic Payments for Health Care (PPT 287kb)

Ch. 19: Health Care Payments and Poverty (PPT 465kb)

Stata programs and Excel files:
To accompany Analyzing Health Equity Using Household Survey Data:

· Spreadsheet for computing concentration index and stand error of CI with grouped data

· Stata ado file to check concentration curve dominance (right-click to save file)

Stata do files for individual chapters (right-click to save file)

Ch. 5: Health Outcome #3: Adult Health (DO 12.4kb)

Ch. 7: Concentration Curves (DO 12.9kb)

Ch. 8: The Concentration Index (DO 6.12kb)

Ch. 9: Extensions to the Concentration Index: Inequality Aversion and the Health Achievement Index (DO 3.06kb)

Ch. 10: Multivariate Analysis of Health Survey Data (DO 5.83kb)

Ch. 11: Nonlinear Models for Health and Medical Expenditure Data (DO 7.15kb)

Ch. 12: Explaining Differences Between Groups: Oaxaca Decomposition (DO 3.78kb)

Ch. 13: Explaining Socioeconomic-Related Health Inequality: Decomposition of the Concentration Index (DO 4.11kb)

Ch. 14: Who Benefits from Health Sector Subsidies? Benefit Incidence Analysis (DO 4.41kb)

Ch. 15: Measuring and Explaining Inequity in Health Service Delivery (DO 14.3kb)

Ch. 16: Who Pays for Health Care? Progressivity of Health Finance (DO 7.92kb)

Ch. 17: Redistributive Effect of Health Finance (DO 4.78kb)

Ch. 18: Catastrophic Payments for Health Care (DO 6.67kb)

Ch. 19: Health Care Payments and Poverty (DO 6.12kb)

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This message from the Pan American Health Organization, PAHO/WHO, is part of an effort to disseminate
information Related to: Equity; Health inequality; Socioeconomic inequality in health; Socioeconomic
health differentials; Gender; Violence; Poverty; Health Economics; Health Legislation; Ethnicity; Ethics;
Information Technology - Virtual libraries; Research & Science issues. [DD/ KMS Area]

“Materials provided in this electronic list are provided "as is". Unless expressly stated otherwise, the findings
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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[EQ] The harvest plot: A method for synthesising evidence about the differential effects of interventions

The harvest plot: A method for synthesising evidence about the differential effects of interventions

David Ogilvie, Debra Fayter, Mark Petticrew, Amanda Sowden, Sian Thomas, Margaret Whitehead, and Gill Worthy

¹Medical Research Council Social and Public Health Sciences Unit, Glasgow, UK

²Centre for Reviews and Dissemination, University of York, York, UK

³Department of Public Health, University of Liverpool, Liverpool, UK

⁴Medical Research Council Epidemiology Unit, Cambridge, UK

⁵London School of Hygiene and Tropical Medicine, London, UK

BMC Medical Research Methodology 2008, 8:8doi:10.1186/1471-2288-8-8

The electronic version of this article is the complete one and can be found online at: http://www.biomedcentral.com/1471-2288/8/8

Background

One attraction of meta-analysis is the forest plot, a compact overview of the essential data included in a systematic review and the overall 'result'.
However, meta-analysis is not always suitable for synthesising evidence about the effects of interventions which may influence the wider determinants of health. As part of a systematic review of the effects of population-level tobacco control interventions on social inequalities in smoking, we designed a novel approach to synthesis intended to bring aspects of the graphical directness of a forest plot to bear on the problem of synthesising evidence from a complex and diverse group of studies.

Methods

We coded the included studies (n = 85) on two methodological dimensions (suitability of study design and quality of execution) and extracted data on effects stratified by up to six different dimensions of inequality (income, occupation, education, gender, race or ethnicity, and age), distinguishing between 'hard' (behavioural) and 'intermediate' (process or attitudinal) outcomes. Adopting a hypothesis-testing approach, we then assessed which of three competing hypotheses (positive social gradient, negative social gradient, or no gradient) was best supported by each study for each dimension of inequality.

Results

We plotted the results on a matrix ('harvest plot') for each category of intervention, weighting studies by the methodological criteria and distributing them between the competing hypotheses. These matrices formed part of the analytical process and helped to encapsulate the output, for example by drawing attention to the finding that increasing the price of tobacco products may be more effective in discouraging smoking among people with lower incomes and in lower occupational groups.

Conclusion

The harvest plot is a novel and useful method for synthesising evidence about the differential effects of population-level interventions.

It contributes to the challenge of making best use of all available evidence by incorporating all relevant data. The visual display assists both the process of synthesis and the assimilation of the findings. The method is suitable for adaptation to a variety of questions in evidence synthesis and may be particularly useful for systematic reviews addressing the broader type of research question which may be most relevant to policymakers.

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[EQ] Protecting health from climate change - World Health Day 2008

Protecting health from climate change - World Health Day 2008

World Health Organization – April 2008

Available online as PDF file [34p.] at: http://www.who.int/world-health-day/toolkit/report_web.pdf

“………..There is now widespread agreement that the earth is warming, due to emissions of greenhouse gases caused by human activity. It is also clear that current trends in energy use development and population growth will lead to continuing – and more severe – climate change.

The changing climate will inevitably affect the basic requirements for maintaining health: clean air and water, sufficient food and adequate shelter. Each year, about 800 000 people die from causes attributable to urban air pollution, 1.8 million from diarrhoea largely resulting from lack of access to clean water supply and sanitation, and from poor hygiene, 3.5 million from malnutrition and approximately 60 000 in natural disasters.

A warmer and more variable climate threatens to lead to higher levels of some air pollutants, increase transmission of diseases through unclean water and through contaminated food, to compromise agricultural production in some of the least developed countries, and to increase the hazards of extreme weather.

Climate change also brings new challenges to the control of infectious diseases. Many of the major killers are highly climate sensitive as regards temperature and rainfall, including cholera and the diarrhoeal diseases, as well as diseases including malaria, dengue and other infections carried by vectors. In sum, climate change threatens to slow, halt or reverse the progress that the global public health community is now making against many of these diseases.

In the long run, however, the greatest health impacts may not be from acute shocks such as natural disasters or epidemics, but from the gradual build-up of pressure on the natural, economic and social systems that sustain health, and which are already under stress in much of the developing world. These gradual stresses include reductions and seasonal changes in the availability of fresh water, regional drops in food production, and rising sea levels. Each of these changes has the potential to force population displacement and increase the risks of civil conflict.

All populations are vulnerable – but some are more vulnerable than others

All populations will be affected by a changing climate, but the initial health risks vary greatly, depending on where and how people live. People living in small island developing states and other coastal regions, megacities, and mountainous and polar regions are all particularly vulnerable in different ways.

Health effects are expected to be more severe for elderly people and people with infirmities or pre-existing medical conditions. The groups who are likely to bear most of the resulting disease burden are children and the poor, especially women. The major diseases that are most sensitive to climate change – diarrhoea, vector-borne diseases like malaria, and infections associated with undernutrition – are most serious in children living in poverty……… ‘

Content:

Statement by the Director-General of the World Health Organization

Summary

WHAT ARE THE RISKS?

1. Climate change: past and future

2. Climate and it’s impact on the fundamentals of health

3. “Natural” disasters: the growing influence of climate change on heatwaves, floods, droughts and storms

4. Changing patterns of infection

5. Long-term stresses: water shortages, malnutrition, displacement and conflict

WHO IS AT RISK?

6. Vulnerable regions: exposed

7. Children: life-long exposure to health risks from climate change

8. The most vulnerable: they support the greatest health burdens

9. All of us: our shared health security

WHAT NEEDS TO BE DONE?

10. Putting health at the heart of the climate change agenda

11. Strengthening public health systems

References

Website: http://www.who.int/world-health-day/en/index.html

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