Health Equity: 01/08/10

Friday, January 8, 2010

[EQ] Global health Risks - Mortality and burden of disease attributable to selected major risks

Global health Risks

Mortality and burden of disease attributable to selected major risks

World Health Organization – December 2009

Available online PDF [70p.] at: http://www.who.int/healthinfo/global_burden_disease/GlobalHealthRisks_report_full.pdf

“…………The leading global risks for mortality in the world are high blood pressure (responsible for 13% of deaths globally), tobacco use (9%), high blood glucose (6%), physical inactivity (6%), and overweight and obesity (5%). These risks are responsible for raising the risk of chronic diseases such as heart disease, diabetes and cancers. They affect countries across all income groups: high, middle and low.

The leading global risks for burden of disease as measured in disability-adjusted life years (DALYs) are underweight (6% of global DALYs) and unsafe sex (5%), followed by alcohol use (5%) and unsafe water, sanitation and hygiene (4%). Three of these risks particularly affect populations in low-income countries, especially in the regions of South-East Asia and sub-Saharan Africa. The fourth risk – alcohol use – shows a unique geographic and sex pattern, with its burden highest for men in Africa, in middle-income countries in the Americas and in some high-income countries.

This report uses a comprehensive framework for studying health risks developed for The world health report 2002, which presented estimates for the year 2000. The report provides an update for the year 2004 for 24 global risk factors. It uses updated information from WHO programmes and scientific studies for both exposure data and the causal associations of risk exposure to disease and injury outcomes. The burden of disease attributable to risk factors is measured in terms of lost years of healthy life using the metric of the disability-adjusted life year. The DALY combines years of life lost due to premature death with years of healthy life lost due to illness and disability.

Although there are many possible definitions of “health risk”, it is defined in this report as “a factor that raises the probability of adverse health outcomes”. The number of such factors is countless and the report does not attempt to be comprehensive. For example, some important risks associated with exposure to infectious disease agents or with antimicrobial resistance are not included. The report focuses on selected risk factors which have global spread, for which data are available to estimate population exposures or distributions, and for which the means to reduce them are known.

Five leading risk factors identified in this report (childhood underweight, unsafe sex, alcohol use, unsafe water and sanitation, and high blood pressure) are responsible for one quarter of all deaths in the world, and one fifth of all DALYs. Reducing exposure to these risk factors would increase global life expectancy by nearly 5 years.

Eight risk factors (alcohol use, tobacco use, high blood pressure, high body mass index, high cholesterol, high blood glucose, low fruit and vegetable intake, and physical inactivity) account for 61% of cardiovascular deaths. Combined, these same risk factors account for over three quarters of ischaemic heart disease: the leading cause of death worldwide. Although these major risk factors are usually associated with high-income countries, over 84% of the total global burden of disease they cause occurs in low- and middle-income countries. Reducing exposure to these eight risk factors would increase global life expectancy by almost 5 years………….”

1 Introduction

1.1 Purpose of this report

1.2 Understanding the nature of health risks

1.3 The risk transition

1.4 Measuring impact of risk

1.5 Risk factors in the update for 2004

1.6 Regional estimates for 2004

2 Results

2.1 Global patterns of health risk

2.2 Childhood and maternal undernutrition

2.3 Other diet-related risk factors and physical inactivity

2.4 Sexual and reproductive health

2.5 Addictive substances

2.6 Environmental risks

2.7 Occupational and other risks

3 Joint effects of risk factors

3.1 Joint contribution of risk factors to specific diseases

3.2 Potential health gains from reducing multiple risk factors

3.3 Conclusions

Annex A: Data and methods

References

* * *
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[EQ] Addressing financial sustainability in health systems

Addressing financial sustainability in health systems

Sarah Thomson, Research Fellow, European Observatory on Health Systems and Policies, and LSE Health, London

Tom Foubister, Research Officer, LSE Health, London

Josep Figueras, Director, European Observatory on Health Systems and Policies, Brussels

Joseph Kutzin, Regional Adviser, Health Systems Financing, and Head of the WHO Office, Barcelona

Govin Permanand, Programme Manager/Technical Officer, Health Evidence Network, WHO Regional Office for Europe, Copenhagen

Lucie Bryndová, Adviser to the Minister of Health, Cabinet of the Minister, Prague

World Health Organization 2009 on behalf of the European Observatory on Health Systems and Policies 2009

Available online PDF [49p.] at: http://www.euro.who.int/Document/E93058.pdf

“………The question as to whether health systems will be financially sustainable in the future is frequently raised in health policy debate. The problem is often phrased in terms of the ability of governments and others adequately to finance health care in the face of growing cost pressures, with population ageing, new technologies and consumer expectations around health care coverage and quality being the three most commonly cited challenges.

Although the notion of ‘financial sustainability’ appears to be central to health policy debate, it does not form part of most health system objectives, including those of the World Health Organization’s health system performance framework (1). Moreover, there is little clarity or consensus about the term's meaning, beyond it having something to do with ‘ability to pay’ or ‘affordability’. Nevertheless, the underlying ‘sustainability’ issue – balancing rising cost pressures against limited resources – is a concern across countries, all the more so in the context of the current financial crisis. Inevitably, this means addressing trade-offs, both within the health sector itself and more broadly between the health sector and the rest of the economy.

This policy summary aims to shed light on the notion of financial sustainability and to examine its policy relevance in practical terms. Without a better understanding of what is meant by financial sustainability and, importantly, without explicitly linking the issue to questions such as willingness to pay for health care, the value of the benefits gained from health spending and how to improve the performance of the health system, policy responses to sustainability concerns may be misdirected and yield unintended consequences.

This policy summary shows the limitations of adopting financial sustainability as a ‘policy goal’, arguing instead that it should be understood as a 'policy constraint', and translating this notion into three key policy-relevant questions……….”

Contents

Preface

1 Introduction

2 Understanding the challenge of financial sustainability in health

3 How much should we spend on health care?

4 What level of health care coverage should we provide?

5 How can we enhance value in the health system?

6 Conclusion

References

    IMPORTANT: This transmission is for use by the intended recipient and it may contain privileged, proprietary or confidential information. If you are not the intended recipient or a person responsible for delivering this transmission to the intended recipient, you may not disclose, copy or distribute this transmission or take any action in reliance on it. If you received this transmission in error, please notify us immediately by email to infosec@paho.org, and please dispose of and delete this transmission. Thank you.