[EQ] Asymmetries of Poverty: Why Global Burden of Disease Valuations Underestimate the Burden of Neglected Tropical Diseases

Asymmetries of Poverty:
Why Global Burden of Disease Valuations Underestimate the Burden of Neglected Tropical Diseases

 

Charles H. King, Anne-Marie Bertino

Center for Global Health and Diseases, Case Western Reserve University School of Medicine, Cleveland, Ohio, USA

PLoS Negl Trop Dis 2(3): e209. doi:10.1371/journal.pntd.0000209

 

Available online at: http://www.plosntds.org/article/info%3Adoi%2F10.1371%2Fjournal.pntd.0000209

 

“……The disability-adjusted life year (DALY) initially appeared attractive as a health metric in the Global Burden of Disease (GBD) program, as it purports to be a comprehensive health assessment that encompassed premature mortality, morbidity, impairment, and disability. It was originally thought that the DALY would be useful in policy settings, reflecting normative valuations as a standardized unit of ill health. However, the design of the DALY and its use in policy estimates contain inherent flaws that result in systematic undervaluation of the importance of chronic diseases, such as many of the neglected tropical diseases (NTDs), in world health……”

Measuring the Burden of Neglected Tropical Diseases: The Global Burden of Disease Framework

 

Colin D. Mathers, Information, Evidence and Research Cluster, World Health Organization, Geneva, Switzerland

Majid Ezzati, Harvard School of Public Health and Harvard University Initiative for Global Health, Cambridge, Massachusetts, United States of America

Alan D. Lopez, School of Population Health, University of Queensland, Brisbane, Queensland, Australia

PLoS Negl Trop Dis 1(2): e114. doi:10.1371/journal.pntd.0000114

 

“……Reliable, comparable information about the main causes of disease and injury in populations, and how these are changing, is a critical input for debates about priorities in the health sector. Traditional sources of information about the descriptive epidemiology of diseases, injuries, and risk factors are generally incomplete, fragmented, and of uncertain reliability and comparability. The Global Burden of Disease (GBD) study has provided a conceptual and methodological framework to quantify and compare the health of populations using a summary measure of both mortality and disability, the disability-adjusted life year (DALY).

 

This paper describes key features of the Global Burden of Disease analytic approach, which provides a standardized measurement framework to permit comparisons across diseases and injuries, as well as risk factors, and a systematic approach to the evaluation of data. ……”

 

Published: November 7, 2007

 

The Global Burden of Disease Assessments—WHO Is Responsible?
Stein C, Kuchenmüller T, Hendrickx S, Prüss-Űstün A, Wolfson L, et al. (2007)
PLoS Negl Trop Dis 1(3): e161. doi:10.1371/journal.pntd.0000161
http://www.plosntds.org/article/info%3Adoi%2F10.1371%2Fjournal.pntd.0000161

 

 

Open-access articles distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction
in any medium, provided the original author and source are credited.

 

 

 

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[EQ] An Overview of Methods for Monitoring Social Disparities in Cancer

An Overview of Methods for Monitoring Social Disparities in Cancer with an Example Using Trends in Lung Cancer Incidence by Area-Socioeconomic Position and Race-Ethnicity, 1992–2004

Sam Harper¹, John Lynch¹, Stephen C. Meersman², Nancy Breen², William W. Davis² and Marsha E. Reichman²

¹ Department of Epidemiology, Biostatistics, and Occupational Health, McGill University, Montreal, Quebec, Canada
² Division of Cancer Control and Population Sciences, National Cancer Institute, National Institutes of Health, Bethesda

Website: http://aje.oxfordjournals.org/cgi/content/abstract/167/8/889

“……The authors provide an overview of methods for summarizing social disparities in health using the example of lung cancer. They apply four measures of relative disparity and three measures of absolute disparity to trends in US lung cancer incidence by area-socioeconomic position and race-ethnicity from 1992 to 2004.

Among females, measures of absolute and relative disparity suggested that area-socioeconomic and race-ethnic disparities increased over these 12 years but differed widely with respect to the magnitude of the change. Among males, the authors found substantial disagreement among summary measures of relative disparity with respect to the magnitude and the direction of change in disparities.

Among area-socioeconomic groups, the index of disparity increased by 47% and the relative concentration index decreased by 116%, while for race-ethnicity the index of disparity increased by 36% and the Theil index increased by 13%.

The choice of a summary measure of disparity may affect the interpretation of changes in health disparities. Important issues to consider are the reference point from which differences are measured, whether to measure disparity on the absolute or relative scale, and whether to weight disparity measures by population size. A suite of indicators is needed to provide a clear picture of health disparity change….”.

 

 

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[EQ] Out-of-pocket health expenditure in a population covered by the Family Health Program in Brazil

Out-of-pocket health expenditure in a population covered by the Family Health Program in Brazil

Aluísio JD Barros^1,* and Andréa D Bertoldi^1,2

¹Centro de Pesquisas Epidemiológicas, Universidade Federal de Pelotas. Pelotas, RS, Brasil.
²Programa de Pós-graduação em Saúde Coletiva, Universidade do Vale do Rio dos Sinos, São Leopoldo, RS, Brasil.

International Journal of Epidemiology, doi:10.1093/ije/dyn063 – March 2008

Abstract:
http://ije.oxfordjournals.org/cgi/content/abstract/dyn063v1?maxtoshow=&HITS=10&hits=10&RESULTFORMAT=1&author1=Andrea+D+Bertoldi&andorexacttitle=and&andorexacttitleabs=and&andorexactfulltext=and&searchid=1&FIRSTINDEX=0&sortspec=relevance&fdate=//&resourcetype=HWCIT

Background The Brazilian public health system, free and universal, should limit out-of-pocket health expenses. However, Brazil was reported as one of the countries with the highest proportion of families experiencing catastrophic expenditure. This study was designed to assess occurrence of high health spending in a low-income population, as well as the pattern of out-of-pocket health payments.

Methods A cross-sectional study was done in Porto Alegre, Brazil, in 2003, with a sample representative of families covered by the Family Health Program. Health expenses were recorded with reference to 30 days prior to the interview and income data were collected with reference to the previous calendar month. Health expenditure was explored in terms of total household health expenditure >5, 10 and 20% of household income and >40% households capacity to pay.

Results The final study sample included 869 households. Medicines were responsible for 47% of household expenditure with health; second came private health plans which accounted for 22%. The richest spent, on average, 70 times more them the poorest with health plans, 26 times more with dental treatment and six times more with medicines. About 16% households committed 20% or more of their income with health, independent of economic position. Similarly, 12% of the households had health expenditure in excess of 40% of their capacity to pay.

Conclusion The proportion of income spent on health was similar across economic groups, but this ‘equality’ is achieved at an unacceptably high level. Specific strategies to reduce such vulnerability are needed.

Can mothers rely on the Brazilian health system for their deliveries?
An assessment of use of the public system and out-of-pocket expenditure in the 2004 Pelotas Birth Cohort Study, Brazil

Aluísio JD Barros, Iná S Santos and Andréa D Bertoldi
BMC Health Services Research 2008, 8:57 doi:10.1186/1472-6963-8-57

            Available online at: http://www.biomedcentral.com/1472-6963/8/57
           

Background: In a country where comprehensive free health care is provided via a public health system (SUS), an unexpected high frequency of catastrophic out-of-pocket expenditure has been described. We studied how deliveries were financed among mothers of a birth cohort and whether they were an important source of household out-of-pocket expenditure.

Methods: All deliveries occurring in the city of Pelotas, Brazil, during 2004, were recruited for a birth cohort study. All mothers were interviewed just after birth and three months later. Comprehensive data on the pregnancy, delivery, birth conditions and newborn health were collected, along with detailed information on expenses related to the delivery.

Results: The majority of the deliveries (81%) were financed by the public health system, a proportion that increased to more than 95% among the 40% poorest mothers. Less than 1% of these mothers reported some out-of-pocket expenditure. Even among those mothers covered by a private health plan, nearly 50% of births were financed by the SUS. Among the 20% richest, a third of the deliveries were paid by the SUS, 50% by private health plans and 17% by direct payment.

Conclusion: The public health system offered services in quantity and quality enough to attract even beneficiaries of private health plans and spared mothers from the poorest strata of the population of practically any expense.

 

 

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This message from the Pan American Health Organization, PAHO/WHO, is part of an effort to disseminate
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Information Technology - Virtual libraries; Research & Science issues.  [DD/ KMS Area]

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and interpretations included in the Materials are those of the authors and not necessarily of The Pan American
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