Tuesday, June 9, 2009

[EQ] Remembering Peter Townsend: April 6, 1928 - June 7, 2009

From: Nancy Krieger
Sent: Tuesday, June 09, 2009

Obituary
Peter Townsend, Social policy professor at the LSE and joint founder of the Child Poverty Action Group

“…..A note to honor the passing of a key scholar and activist who throughout his life linked issues of social justice, public health, and well-being: Peter Townsend (1928-2009), co-author of the internationally renowned 1980 Black Report on health inequalities in the UK, creator of the Townsend index of deprivation (an area-based measure of economic deprivation used widely in health research in the UK and adapted for use elsewhere), and a critical analyst of and advocate against poverty and its harmful effects on health and well-being….”

Centre for the Study of Human Rights - London School of Economics and Political Science
http://www.lse.ac.uk/collections/humanRights/peterTownsend.htm

See below the obituary just published in The Guardian, available at:
http://www.guardian.co.uk/society/2009/jun/09/obituary-peter-townsend


Nancy Krieger, PhD
Professor, Department of Society, Human Development, and Health
Harvard School of Public Health
677 Huntington Avenue, Kresge 717 Boston, MA 02115 (USA)

 

 

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[EQ] Measuring Disparities in Health Status and in Access and Use of Health Care

MEASURING DISPARITIES IN HEALTH STATUS AND IN ACCESS AND USE OF HEALTH CARE

IN OECD COUNTRIES

 

Michael de Looper and Gaetan Lafortune

OECD HEALTH WORKING PAPERS NO. 43

Organisation for Economic Co-operation and Development, 2009

 

Available online as PDF file [55p.] at: http://www.olis.oecd.org/olis/2009doc.nsf/LinkTo/NT00000DE2/$FILE/JT03260782.PDF

 

“………Most OECD countries have endorsed as major policy objectives the reduction of inequalities in health status and the principle of adequate or equal access to health care based on need. These policy objectives require an evidence-based approach to measure progress. This paper assesses the availability and comparability of selected indicators of inequality in health status and in health care access and use across OECD countries, focussing on disparities among socioeconomic groups.

 

These indicators are illustrated using national or cross-national data sources to stratify populations by income, education or occupation level. In each case, people in lower socioeconomic groups tend to have a higher rate of disease, disability and death, use less preventive and specialist health services than expected on the basis of their need, and for certain goods and services may be required to pay a proportionately higher share of their income to do so.

 

Options for future OECD work in measuring health inequalities are provided through suggesting a small set of indicators for development and inclusion in the OECD Health Data database. Some indicators appear to be more advanced for international data collection, since comparable data are already being collected in a routine fashion in most OECD countries. These include the indicators of inequalities in self-rated health, self-rated disability, the extent of public health care coverage and private health insurance coverage, and self-reported unmet medical and dental care needs.

 

Increased availability and comparability of data will improve the validity of cross-national comparisons of socioeconomic inequalities in health status and health care access and use. Harmonisation of definitions and collection instruments, and the greater use of data linkages in order to allow disaggregation by socioeconomic status, will determine whether health inequalities can be routinely monitored across OECD countries…..”

 

 

TABLE OF CONTENTS

INTRODUCTION

A FOCUS ON SOCIOECONOMIC INEQUALITIES IN HEALTH

Selection of leading indicators of health inequalities

Classifying social groups

Measures of socioeconomic inequalities in health

Data sources and challenges to improve comparability

1. INDICATORS OF INEQUALITIES IN HEALTH STATUS

1.1 Mortality-based indicators

1.2 Morbidity-based indicators

1.3 Summary measures of population health

 

2. INDICATORS OF INEQUALITIES IN HEALTH CARE ACCESS AND USE

2.1 Health insurance coverage

2.2 Out-of-pocket expenditure

2.3 Health care utilisation

2.4 Unmet care needs

CONCLUSION

GLOSSARY OF TERMS

ANNEX 1: A SUMMARY OF THE “EFFECTIVE COVERAGE” MEASURE

ANNEX 2: QUESTIONS ON SELF-RATED HEALTH AND DISABILITY AND HEALTH CARE ACCESS IN CROSS-NATIONAL SURVEYS

BIBLIOGRAPHY

 

 

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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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[EQ] The Obesity Epidemic: Analysys of Past and Projected Future Trends

THE OBESITY EPIDEMIC: ANALYSIS OF PAST AND PROJECTED FUTURE TRENDS IN

SELECTED OECD COUNTRIES

 

Franco Sassi, Marion Devaux, Michele Cecchini and Elena Rusticelli

OECD HEALTH WORKING PAPERS NO. 45
Organisation for Economic Co-operation and Development, 2009

 

 

Available online as PDF  file [81p.]  at :

http://www.olis.oecd.org/olis/2009doc.nsf/LinkTo/NT00000EFE/$FILE/JT03261624.PDF

 

 

“……….This paper provides an overview of past and projected future trends in adult overweight and obesity in OECD countries. Using individual-level data from repeated cross-sectional national surveys, some of the main determinants and pathways underlying the current obesity epidemic are explored, and possible policy levers for tackling the negative health effect of these trends are identified.

 

First, projected future trends show a tendency towards a progressive stabilisation or slight shrinkage of pre-obesity rates, with a projected continued increase in obesity rates. Second, results suggest that diverging forces are at play, which have been pushing overweight and obesity rates into opposite directions. On one hand, the powerful influences of obesogenic environments (aspects of physical, social and economic environments that favour obesity) have been consolidating over the course of the past 20-30 years.

 

On the other hand, the long term influences of changing education and socio-economic conditions have made successive generations increasingly aware of the health risks associated with lifestyle choices, and sometimes more able to handle environmental pressures.

 

Third, the distribution of overweight and obesity in OECD countries consistently shows pronounced disparities by education and socio-economic condition in women (with more educated and higher socio-economic status women displaying substantially lower rates), while mixed patterns are observed in men.

 

Fourth, the findings highlight the spread of overweight and obesity within households, suggesting that health-related behaviours, particularly those concerning diet and physical activity, are likely to play a larger role than genetic factors in determining the convergence of BMI levels within households…..”

 

TABLE OF CONTENTS

 


SECTION I

1.1. International trends in obesity, diet, physical activity, and their determinants

1.2 Aims of the study


SECTION II

Data and methods

2.1. Data sources

2.2. Analytical models

 

 

SECTION III

Results

3.1. Descriptive statistics
3.2. Age, period and cohort effects

3.3. Disparities in overweight and obesity across socio-economic groups

3.4. Future projections of overweight and obesity rates

3.5. Multilevel models

 

 

SECTION IV DISCUSSION OF FINDINGS AND CONCLUSIONS

4.1. The driving forces behind the epidemic: individual attitudes and environmental influences.

4.2. Unequal lifestyles, unequal health: disparities in obesity across social groups

4.3. The spread of obesity within families and social networks.

 

 

ANNEXES

ANNEX 1 – DETAILS OF HEALTH SURVEY DATA AND SAMPLE CHARACTERISTICS

ANNEX 2 – VARIABLES EXTRACTED FROM HEALTH SURVEY DATASETS

ANNEX 3 – DETAILS OF STATISTICAL MODELS USED IN THE ANALYSIS

ANNEX 4 –INEQUALITIES IN OBESITY AND OVERWEIGHT BY LEVEL OF EDUCATION

ANNEX 5 – INEQUALITIES IN OBESITY AND OVERWEIGHT BY SOCIO-ECONOMIC CONDITION

ANNEX 6 – ESTIMATES AND STANDARD ERRORS FROM SINGLE-LEVEL AND MULTILEVEL LOGISTIC MODELS

REFERENCES

 

 

 

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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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[EQ] Financial incentives for return of service in underserved areas

Financial incentives for return of service in underserved areas:
a systematic review

 

BMC Health Services Research 2009, 9:86 doi:10.1186/1472-6963-9-86

Till Barnighausen1, David E Bloom 2

1.       Africa centre for health and Population Studies, University of KwaZulu-Natal,  Mtubatuba, South Africa

2.       Department of Global Health and Population, Harvard School of Public Health Boston USA

 

Available online as PDF file [52p.] at; http://www.biomedcentral.com/content/pdf/1472-6963-9-86.pdf

 

Background

In many geographic regions, both in developing and in developed countries, the number of health workers is insufficient to achieve population health goals. Financial incentives for return of service are intended to alleviate health worker shortages: A (future) health worker enters into a contract to work for a number of years in an underserved area in exchange for a financial pay-off.

Methods

We carried out systematic literature searches of PubMed, the Excerpta Medica database, the Cumulative Index to Nursing and Allied Health Literature, and the National Health Services Economic Evaluation Database for studies evaluating outcomes of financial-incentive programs published up to February 2009. To identify articles for review, we combined three search themes (health workers or students, underserved areas, and financial incentives). In the initial search, we identified 10,495 unique articles, 10,302 of which were excluded based on their titles or abstracts. We conducted full-text reviews of the remaining 193 articles and of 26 additional articles identified in reference lists or by colleagues.

Forty-three articles were included in the final review. We extracted from these articles information on the financial-incentive programs (name, location, period of operation, objectives, target groups, definition of underserved area, financial incentives and obligation) and information on the individual studies (authors, publication dates, types of study outcomes, study design, sample criteria and sample size, data sources, outcome measures and study findings, conclusions, and methodological limitations). We reviewed program results (descriptions of recruitment, retention, and participant satisfaction), program effects (effectiveness in influencing health workers to provide care, to remain, and to be satisfied with work and personal life in underserved areas), and program impacts (effectiveness in influencing health systems and health outcomes).

Results

Of the 43 reviewed studies 34 investigated financial-incentive programs in the US. The remaining studies evaluated programs in Japan (five studies), Canada (two), New Zealand (one) and South Africa (one). The programs started between 1930 and 1998. We identified five different types of programs (service-requiring scholarships, educational loans with service requirements, service-option educational loans, loan repayment programs, and direct financial incentives). Financial incentives to serve for one year in an underserved area ranged from year-2000 United States dollars 1,358 to 28,470. All reviewed studies were observational.

The random-effects estimate of the pooled proportion of all eligible program participants who had either fulfilled their obligation or were fulfilling it at the time of the study was 71% (95% confidence interval 60-80%). Seven studies compared retention in the same (underserved) area between program participants and non-participants. Six studies found that participants were less likely than non-participants to remain in the same area (five studies reported the difference to be statistically significant, while one study did not report a significance level); one study did not find a significant difference in retention in the same area. Thirteen studies compared provision of care or retention in any underserved area between participants and non-participants.

Eleven studies found that participants were more likely to (continue to) practice in any underserved area (nine studies reported the difference to be statistically significant, while two studies did not provide the results of a significance test); two studies found that program participants were significantly less likely than non-participants to remain in any underserved area. Seven studies investigated the satisfaction of participants with their work and personal lives in underserved areas.

Conclusions

Financial-incentive programs for return of service are one of the few health policy interventions intended to improve the distribution of human resources for health on which substantial evidence exists. However, the majority of studies are from the US, and only one study reports findings from a developing country, limiting generalizability. The existing studies show that financial-incentive programs have placed substantial numbers of health workers in underserved areas and that program participants are more likely than non-participants to work in underserved areas in the long run, even though they are less likely to remain at the site of original placement. As none of the existing studies can fully rule out that the observed differences between participants and non-participants are due to selection effects, the evidence to date does not allow the inference that the programs have caused increases in the supply of health workers to underserved areas.

 

 

 

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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
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