Health Equity: September 2009

Wednesday, September 30, 2009

[EQ] A framework for analysing migrant health policies in Europe

A framework for analysing migrant health policies in Europe

Philipa Mladovsky, LSE Health, London School of Economics & Political Science, London, United Kingdom

Health policy (Amsterdam, Netherlands). 2009 Jul 6

Available online at: http://bit.ly/8zMlI

PMID: 19586680 - URL - http://www.ncbi.nlm.nih.gov/pubmed/19586680?dopt=Citation

“……Evidence suggests migrants experience inequalities in health and access to health care. However, to date there has been little analysis of the policies employed to address these inequalities.

This article develops a framework to compare migrant health policies, focusing on England, Italy, the Netherlands and Sweden.

The first issue addressed in the framework is data collection. All four countries collect migrant health data, but many methodological limitations remain.

The second issue is targeting of population groups. Countries typically focus either on first generation immigrants or on ethnic minorities, but not both, despite the often divergent needs of the two groups.

Another issue is whether specific diseases should take priority in migrant health policy. While communicable diseases, sexual and reproductive health and mental health have been targeted, there may be a lack of attention paid to lifestyle related risk factors and preventive care. Fourthly, decisions about the mix of demand and supply-side interventions need to be made and evaluated.

Finally, the challenge of implementation is discussed. Although migrant health policy has been elaborated in the four countries, implementation has not necessarily reflected this on the ground. These experiences signal important policy issues and options in the development of migrant health policies in Europe……..”

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[EQ] The Economic Burden of Health Inequalities in the United States

The Economic Burden of Health Inequalities in the United States

Thomas A. LaVeist – William C. & Nancy F. Richardson Professor in Health Policy, Department of Health Policy and Management, Johns Hopkins Bloomberg School of Public Health; Director, Hopkins Center for Health Disparities Solutions, Johns Hopkins Bloomberg School of Public Health.

Darrell J. Gaskin. – Associate Professor of Health Economics, Department of African American Studies, University of Maryland; Adjunct Associate Professor of Health Policy and Management, Department of Health Policy and Management, Johns Hopkins Bloomberg School of Public Health; Faculty Associate, Hopkins Center for Health Disparities Solutions, Johns Hopkins Bloomberg School of Public Health.

Patrick Richard – Assistant Research Professor of Health Economics, Department of Health Policy, The George Washington University School of Public Health and Health Services.

September 2009

Available online as PDF file [20p.] at:
http://www.jointcenter.org/index.php/content/download/2626/17002/file/Burden_Of_Health_FINAL_PREP.pdf

“…..This study, commissioned by the Joint Center for Political and Economic Studies and carried out by leading researchers from Johns Hopkins University and the University of Maryland, provides insight into how much of a financial burden racial disparities are putting on our health care system and society at large.

The researchers examined the direct costs associated with the provision of care to a sicker and more disadvantaged population, as well as the indirect costs of health inequities such as lost productivity, lost wages, absenteeism, family leave, and premature death….”

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[EQ] Public health approach - Tracking Diabetes

Tracking Diabetes: New York City’s A1C Registry

Shadi Chamany, Lynn D. Silver, Mary T. Bassett, Cynthia R. Driver, Diana K. Berger, Charlotte E. Neuhaus, Namrata Kumar, and Thomas R. Frieden
New York City Department of Health and Mental Hygiene; the Doris Duke Charitable Foundation; the New York City Health and Hospitals Corporation; the Centers for Disease Control and Prevention
The Milbank quarterly, Volume 87, Number 3, September 2009

Available online at: http://www.milbank.org/quarterly/8703feat.html

Context:
In December 2005, in characterizing diabetes as an epidemic, the New York City Board of Health mandated the laboratory reporting of hemoglobin A1C laboratory test results. This mandate established the United States’ first population-based registry to track the level of blood sugar control in people with diabetes. But mandatory A1C reporting has provoked debate regarding the role of public health agencies in the control of noncommunicable diseases and, more specifically, both privacy and the doctor-patient relationship.

Methods:
This article reviews the rationale for adopting the rule requiring the reporting of A1C test results, experience with its implementation, and criticisms raised in the context of the history of public health practice.

Findings:
For many decades, public health agencies have used identifiable information collected through mandatory laboratory reporting to monitor the population’s health and develop programs for the control of communicable and noncommunicable diseases. The registry program sends quarterly patient rosters stratified by A1C level to more than one thousand medical providers, and it also sends letters, on the provider’s letterhead whenever possible, to patients at risk of diabetes complications (A1C level >9 percent), advising medical follow-up. The activities of the registry program are similar to those of programs for other reportable conditions and constitute a joint effort between a governmental public health agency and medical providers to improve patients’ health outcomes….”

Conclusions:
Mandatory reporting has proven successful in helping combat other major epidemics. New York City’s A1C Registry activities combine both traditional and novel public health approaches to reduce the burden of an epidemic chronic disease, diabetes. Despite criticism that mandatory reporting compromises individuals’ right to privacy without clear benefit, the early feedback has been positive and suggests that the benefits will outweigh the potential harms. Further evaluation will provide additional information that other local health jurisdictions may use in designing their strategies to address chronic disease…..”

Commentary:
Beyond Historical Precedent
Amy L. Fairchild, Center for the History and Ethics of Public Health, Department of Sociomedical Sciences, Mailman School of Public Health, Columbia University

Commentary:
A Legal Perspective on Diabetes Surveillance—Privacy and the Police Power
Michelle M. Mello and Lawrence O. Gostin
Harvard University; Georgetown University

“……….The New York City A1C Registry (NYCAR) program is an unusual and groundbreaking extension of the reach of public health law. It marks the first time that the government has mandated name-based reporting of a chronic, noninfectious disease not caused by an environmental toxin and where the data are given to patients and physicians. Although the program has generated deep social controversy, remarkably it has not been challenged in court.

Nonetheless, the law offers a useful lens through which to consider the program’s justification and legitimacy. In this commentary to the article in this issue by Chamany and colleagues (2009), we examine the state’s powers and responsibilities; patients’ rights to privacy and security of personal data; and physicians’ “privacy” rights…..”

Commentary:
Public Health and Health Care Quality Assurance—Strange Bedfellows?
Jonathan E. Fielding, Los Angeles County Department of Public Health

“….What is the role of governmental public health in ensuring the quality of medical care? With some notable exceptions, state and local public health departments have taken a passive role in medical care system quality assurance. Yet medical care can contribute much to improving the health of populations and at least some to reducing health disparities.

The article in this issue of The Milbank Quarterly by Chamany and colleagues describes one public health agency’s novel approach to the clinical management of adult diabetics: working with health care providers…………”

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Tuesday, September 29, 2009

[EQ] Analysis of policy development in European countries for tackling non communicable diseases NCD

Gaining Health

Analysis of policy development in European countries for tackling non communicable diseases

By Anna Ritsatakis and Péter Makara

Editors: Jill L. Farrington, Robert Geneau and Bosse Pettersson

Regional Office for Europe of the World Health Organization 2009

Available online as PDF file [274p.] at: http://www.euro.who.int/Document/E92828.pdf

The structure of the book is as follows.

Chapter 1. Introduction - This chapter gives the rationale for the study and an overview of the book.

Chapter 2. History and context of policies to tackle NCD non communicable diseases

This chapter describes the key features of NCD non communicable diseases policy development in the last two decades, the broader context and related policy initiatives.

Chapter 3. Methodology, underlying concepts and values

This chapter sets out why and how the original study was carried out, with an explanation of underlying concepts and values.

Chapter 4. Country case studies

The case studies describe NCD non communicable diseases policy development in Albania, Finland, France, Greece, Hungary, Ireland, Kyrgyzstan and Lithuania. These eight countries were selected to provide reasonable geographical coverage and to include countries at different levels of economic development and with a range of political, administrative and health care systems and length of NCD policy experience.

Chapter 5. Reflections on experiences

Drawing on cross-analysis of the case studies and other sources, this chapter reflects on country experience throughout the policy cycle, presents the lessons learnt, and illustrates how different stakeholders and NCD issues influence the development of policies.

Chapter 6. Pointers for the future

Leading on from the conclusions of the analysis, this chapter offers countries valuable pointers on moving forward within the framework of the European NCD Strategy and also alerts them to emerging challenges and opportunities for NCD policy development in the future.

Contents

Chapter 1 Introduction 1

Chapter 2 History and context of policies to tackle NCD

Chapter 3 Methodology, underlying concepts and values

Chapter 4 Case studies: policy development in countries for tackling noncommunicable diseases

Albania – Finland – France – Greece Hungary –Ireland – Kyrgyzstan – Lithuania

Chapter 5 Reflections on experiences

Chapter 6 Pointers to the future

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[EQ] How can gender equity be addressed through health systems?

How can gender equity be addressed through health systems?

Sarah Payne, School for Policy Studies, University of Bristol, United Kingdom
Joint Policy Brief #12, 2009
World Health Organization, on behalf of the European Observatory on Health Systems and Policies

Available online as PDF file [45p.] at: http://www.euro.who.int/document/E92846.pdf

Key messages (English, French, German and Russian): http://www.euro.who.int/HEN/policybriefs/20090924_1

“………Gender differences in health and in how well health systems and health care services meet the needs of women and men are well known: in Europe, there are variations in terms of life expectancy, the risk of mortality and morbidity, health behaviours and in the use of health care services. There is also increasing research evidence demonstrating the importance of a number of different social determinants of health, and these interact with gender inequalities in ways that can magnify the impact on health.

Additionally, there has also been an increasing recognition that health policy may exacerbate gender inequalities when it fails to address the needs of either men or women, and that health systems must address gender equity. This forms part of good stewardship, as well as meeting the needs of the populations served. Gender equity objectives have also been identified in position statements from WHO, the United Nations and the European Union (EU).

For the purposes of this policy brief, the ‘policy problem’ is the way in which health systems might address gender equity in order to reduce the health gap between men and women and to improve efficiency.

This document identifies some of the main approaches used to address gender equity in health systems, elaborating on three examples in order to suggest how these methods might be developed in the context of health policies across Europe…..”

Contents

Key messages

Executive summary

Policy brief

The policy issue: gender equity in health systems and health care services

Approaches for gender equity

Policy approaches: three examples

Facilitating implementation

Summary

References

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[EQ] Growing Pains in Latin America: An Economic Growth Framework as Applied to Brazil, Costa Rica, Colombia, Mexico, and Peru

Growing Pains in Latin America:
An Economic Growth Framework as Applied to:
Brazil, Costa Rica, Colombia, Mexico, and Peru

Liliana Rojas-Suarez, Senior fellow at the Center for Global Development, is an expert on financial services and the development impact of global financial flows.
Center for Global Development - September 2009

Available online at: http://www.cgdev.org/content/publications/detail/1422848/

Website: http://www.cgdev.org/content/publications/detail/1422848/

“…….Before the global economic crisis began in 2008, all countries in Latin America, long known as the world’s most economically and financially volatile region, had experienced five consecutive years of economic growth, a feat that had not been achieved since the 1970s. Yet despite this growth, Latin America’s incomeper-capita gap relative to high-income countries and other emerging-market economies widened, and poverty remained stubbornly high. Latin America, in short, suffered from growing pains even when things were going reasonably well.

What policies could help Latin America avoid these pains and achieve accelerated, sustained growth that reduces poverty and inequality? To find out, CGD senior fellow Liliana Rojas-Suarez convened a task force to identify the foundations of growth in the region.1 Prominent experts in Latin America were then invited to apply this framework to five very different countries by assessing past reform efforts and offering practical suggestions for the future. The task-force framework and the subsequent case studies form the book Growing Pains in Latin America: An Economic Growth Framework as Applied to Brazil, Colombia, Costa Rica, Mexico and Peru.

An Economic Growth Framework for Latin American

The framework identifies the key foundations for growth in Latin America and provides a mechanism for designing reforms that strengthen these foundations while taking into account the region’s unique characteristics and obstacles to market-based reforms and sustainable growth.

The unique features of Latin America

While Latin America shares many features with the rest of the developing world, and countries within Latin America differ significantly among themselves, three features characterize most countries in the region: Latin America is the most financially open, the most democratic, and the most socially unequal of the world’s developing regions……….”

The Book:

Growing Pains in Latin America lays out and applies a region-specific framework for delivering sustainable economic growth.

A task force of experts led by CGD senior fellow Liliana Rojas-Suarez and MIT professor Simon Johnson describes the framework, its (simple) principles, and its flexibility and ability to adapt. Other experts then apply the framework to Brazil, Colombia, Costa Rica, Mexico, and Peru, providing specific policy recommendations while taking into account the unique conditions of each country.

In an introductory essay, Rojas-Suarez explains and contextualizes the need for a new approach to growth in Latin America. Comprehensive yet flexible, the recommendations in Growing Pains can be applied to all of Latin America and will be valuable to anyone concerned with growth, prosperity, and equality in the region.

· Front Matter

· Chapter 1. Introduction

· Chapter 2. Helping Reforms Deliver Growth in Latin America: A Framework for Analysis

· Chapter 3. Pro- and Anti-Market Reforms in Democratic Brazil

· Chapter 4. Colombia’s Efforts at Achieving Inclusive and Sustainable Growth

· Chapter 5. Political and Institutional Obstacles to Reform in Costa Rica

· Chapter 6. How Can Reforms Help Deliver Growth in Mexico?

· Chapter 7. Helping Reforms Deliver Inclusive Growth in Peru

· Contributors

· Index

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