Friday, July 9, 2010

[EQ] Redressing the Unconscionable Health Gap: A Global Plan for Justice

Redressing the Unconscionable Health Gap: A Global Plan for Justice


Lawrence O. Gostin
O’Neill Institute for National and Global Health Law, Georgetown University Law Center
The Harvard Law & Policy Review, Volume 4, Number 2, 2010, pp. 271-294


Available online at: http://bit.ly/cmUy7o

Or at: http://papers.ssrn.com/sol3/papers.cfm?abstract_id=1635895

 


“……….The world’s distribution of the “good” of human health remains fundamentally unfair, causing enormous physical and mental suffering by those who experience the compounding disadvantages of poverty and ill health. If the health gap is unfair and unacceptable, then how can the international community be galvanized to make a genuine difference? In this article, I propose an international call to action through the adoption of a Global Plan for Justice (GPJ)—a voluntary compact among states and their partners in business, philanthropy, and civil society to redress health inequalities. The GPJ would be a form of “soft” norm setting, rather than a legally binding treaty, achieved with the passage of a World Health Assembly resolution.
 
Under the GPJ, states would devote resources to a Global Health Fund based on their ability to pay—for example, 0.25% of Gross National Income (GNI) per annum—in addition to maintaining current development assistance devoted to programs and activities of their choice. Global Health Fund resources would be allocated based on the health needs of developing countries measured by poverty, morbidity, and premature mortality.
 
The core missions of the Global Plan for Justice would be to (1) ensure the fair allocation of essential vaccines and medicines, with particular attention to low- and middle-income countries in a public health emergency; (2) meet basic survival needs, creating the conditions in which people can be healthy; and (3) help countries that will suffer most to adapt to the health impacts of climate change.
 
For an explanation of how the Global Plan for Justice fits into other innovative Global Health Governance strategies, see http://www.acslaw.org/node/16479 (explaining the progression from a Joint Learning Initiative for National and Global Responsibilities for Health, to a Global Plan for Justice, through to a Framework Convention on Global Health). See also, Lawrence O. Gostin, Meeting Basic Survival Needs of the World’s Least Healthy People: Toward a Framework Convention on Global Health, 96 Georgetown Law Journal, Vol. 96, 2008, pp. 331-392 (2008), http://ssrn.com/abstract=1014082...... From Lawrence Gostin

 

 


The Unconscionable Health Gap: A Global Plan for Justice


Lawrence O. Gostin
O’Neill Institute for National and Global Health Law, Georgetown University Law Center
The Lancet, Volume 375, Number 9725, May 1, 2010, pp. 1504-05


Available online at: http://www.thelancet.com/journals/lancet/article/PIIS0140-6736(10)60065-7/fulltext


“…………….
International norms recognize the special value of health. The WHO Constitution states that “the enjoyment of the highest attainable standard of health” is a fundamental human right. The right to health, moreover, is a treaty obligation with clear obligations.
 
Despite robust international norms, unconscionable health disparities exist between the world’s rich and poor, causing enormous suffering. The WHO urges “closing the health gap in a generation” through action on the social determinants of health.  
As the Marmot Commission observed: “the social conditions in which people are born, live, and work are the single most important determinant of good or ill health.”
 
If the health gap is unfair and unacceptable, then how can the international community be galvanized to make a genuine difference? This commentary proposes an international call to action through a Global Plan for Justice—a voluntary compact among states and their partners….”
 
For a fuller examination of the Global Plan for Justice (GPJ), see Lawrence O. Gostin, Redressing the Unconscionable Health Gap: A Global Plan for Justice, 4 Harv. L. & Pol’y Rev. 271 (2010), available at http://hlpronline.com/2010/06/gostin_justice/  . For an explanation of how the GPJ fits into other innovative Global Health Governance strategies, see
http://www.law.georgetown.edu/oneillinstitute/documents/2010-07_Global_Plan_for_Justice.pdf  
(explaining the progression from a Joint Learning Initiative for National and Global Responsibilities for Health, to a Global Plan for Justice, through to a Framework Convention on Global Health). See also, Lawrence O. Gostin, Meeting Basic Survival Needs of the World’s Least Healthy People: Toward a Framework Convention on Global Health, 96 Geo. L.J. 331 (2008), http://ssrn.com/abstract=1014082, http://scholarship.law.georgetown.edu/ois_papers/1/
 

 

 

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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
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[EQ] Caring for people with chronic conditions - A health system perspective

Caring for people with chronic conditions

A health system perspective

Edited by Ellen Nolte and Martin McKee - Open University Press
World Health Organization on behalf of the European Observatory on Health Systems and Policies.

 

Available online PDF [290p.] at: http://bit.ly/bfLNa7

“………Marked success in reducing deaths from acute illnesses in the past half century has resulted in a new emphasis on chronic diseases. As premature death from acute illness is reduced, the prevalence of conditions that accumulate over time rises, particularly in a world in which greater exposure to unnatural environments increases long term vulnerability to ill health.

 

Chronic illness, whether resulting from infections (increasingly viral or fungal), external injuries, developmental abnormalities, autoimmune defects, genetic susceptibilities, or cellular degeneration, are a product of multiple influences on health. No longer is there a culpable ‘agent’ of disease causation, and ‘disease’ itself is no longer a straightforward concept.

 

Diseases, after all, are professionally defined entities without clear biological representations. They can be and are artificially created to suit special interests, and the sum of deaths due to specific diseases in the world exceeds the actual number of deaths. As the case-fatality rate of specific disease decreases, multimorbidity is the result; diseases now rarely exist in isolation in individuals.

 

Moreover, diseases are but one manifestation of illness; impaired comfort from symptoms, impaired activity from anatomical and physiological derangements, and impaired cognitive and emotional function from biological and psychosocial dysfuntions are legitimate concerns for individuals, subpopulations, and populations……”

 

Content

 

Introduction  - Ellen Nolte and Martin McKee

The burden of chronic disease in Europe  - Joceline Pomerleau, C├ęcile Knai and Ellen Nolte

Economic aspects of chronic disease and chronic disease management  -Marc Suhrcke, Daragh K. Fahey and Martin McKee

Integration and chronic care: a review  - Ellen Nolte and Martin McKee

Preventing chronic disease: everybody’s business - Thomas E. Novotny

Supporting self-management - Mieke Rijken, Martyn Jones, Monique Heijmans and Anna Dixon

The human resource challenge in chronic care - Carl-Ardy Dubois, Debbie Singh and Izzat Jiwani

Decision support - Nicholas Glasgow, Isabelle Durand-Zaleski, ElisabethChan and Dhigna Rubiano

Paying for chronic disease care - Reinhard Busse and Nicholas Mays

Making it happen - Ellen Nolte and Martin McKee

 

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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/ KMC Area]

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http://www.euro.who.int/__data/assets/pdf_file/0006/96468/E91878.pdf





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[EQ] Increasing access to health workers in remote and rural areas through improved retention- Global Policy Recommendations

Increasing access to health workers in remote and rural areas through improved retention
Global Policy Recommendations

World Health Organization -  July 2010 ISBN: 9789241564014

Available online PDF [79p.] at: http://bit.ly/bw3qy9

Globally, approximately one half of the population lives in rural areas, but less than 38% of the nurses and less than 25% of the physicians work there. While getting and keeping health workers in rural and remote areas is a challenge for all countries, the situation is worse in the 57 countries that have an absolute shortage of health workers.

After a year-long consultative effort, this document proposes sixteen evidence-based recommendations on how to improve the recruitment and retention of health workers in underserved areas. It also offers a guide for policy makers to choose the most appropriate interventions, and to implement, monitor and evaluate their impact over time.

Annexes

:: Annex 1 – Grade evidence profiles [pdf 151kb]
:: Annex 2 – Descriptive evidence profiles [pdf 220kb]

 

Tables of contents

 

Preface

Contributors and acknowledgments

Executive Summary

1. Introduction

1.1 Rationale 7

1.2 Objective 8

1.3 Target audience 8

1.4 Scope 9

1.4.1 Types of health workers targeted 9

1.4.2 Geographical areas covered 9

1.4.3 Categories of interventions covered 10

1.5 Process for formulating the global recommendations 10

1.6 Dissemination process 11

1.7 Methodology 11

1.8 Structure of the report 11

2. Principles to guide the formulation of national policies to improve retention of health workers in remote and rural areas

2.1 Focus on health equity 13

2.2 Ensure rural retention policies are part of the national health plan 13

2.3 Understand the health workforce 14

2.4 Understand the wider context 14

2.5 Strengthen human resource management systems 15

2.6 Engage with all relevant stakeholders from the beginning of the process 16

2.7 Get into the habit of evaluation and learning 16

3. Evidence-based recommendations to improve attraction, recruitment and retention of health workers in remote and rural areas

3.1 Education 18

3.1.1 Get the “right” students 18

3.1.2 Train students closer to rural communities 19

3.1.3 Bring students to rural communities 21

3.1.4 Match curricula with rural health needs 21

3.1.5 Facilitate professional development 22

3.2 Regulatory interventions 23

3.2.1 Create the conditions for rural health workers to do more 23

3.2.2 Train more health workers faster to meet rural health needs 24

2 3.2.3 Make the most of compulsory service 25

3.2.4 Tie education subsidies to mandatory placements 26

3.3 Financial incentives 27

3.3.1 Make it worthwhile to move to a remote or rural area 28

3.4 Personal and professional support 29

3.4.1 Pay attention to living conditions 30

3.4.2 Ensure the workplace is up to an acceptable standard 31

3.4.3 Foster interaction between urban and rural health workers 31

3.4.4 Design career ladders for rural health workers 32

3.4.5 Facilitate knowledge exchange 33

3.4.6 Raise the profile of rural health workers 34

4. Measuring results: how to select, implement and evaluate rural retention policies

4.1 Relevance: which interventions best respond to national priorities and the expectations of health workers and rural communities? 36

4.2 Acceptability: which interventions are politically acceptable and have the most stakeholder support? 36

4.3 Affordability: which interventions are affordable? 38

4.4 Effectiveness: have complementarities and potential unintended consequences between various interventions been considered? 38

4.5 Impact: what indicators will be used to measure impact over time? 39

5. Research gaps and research agenda

5.1 Research gaps 42

5.1.1 Study all types of health workers 42

5.1.2 More research in low-income countries 42

5.1.3 More well-designed evaluations 42

5.1.4 Quality of the evidence – not only “what works”, but also “why” and “how” 42

5.2 Research agenda 43

6. Deciding on the strength of the recommendations 44

Methodology

List of participants

References
               

 

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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/ KMC 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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