Health Equity: 08/19/10

Thursday, August 19, 2010

[EQ] Health Financing in Brazil, Russia and India: What Role Does the International Community Play?

Health Financing in Brazil, Russia and India:
What Role Does the International Community Play?

Devi Sridhar^1,* and Eduardo J. Gómez²
¹All Souls College, Oxford, UK and ²Rutgers University, New Jersey, USA

Oxford University Press in association with The London School of Hygiene and Tropical Medicine
Health Policy and Planning, doi:10.1093/heapol/czq016 - 2010;1–13

Website: http://bit.ly/abmBl1

“….In this paper we examine whether Brazil, Russia and India havesimilar financing patterns to those observed globally. We assesshow national health allocations compare with epidemiologicalestimates for burden of disease. We identify the major causesof burden of disease in each country, as well as the contributionHIV/AIDS, tuberculosis and malaria make to the total burdenof disease estimates.

We then use budgetary allocation informationto assess the alignment of funding with burden of disease data.We focus on central government allocations through the Ministryof Health or its equivalent. We found that of the three casesexamined, Brazil and India showed the most bias when it cameto financing HIV/AIDS over other diseases. And this occurreddespite evidence indicating that HIV/AIDS (among all three countries)was not the highest burden of disease when measured in termsof age-standardized DALY rates.

We put forth several factorsbuilding on Reich’s (2002) framework on ‘reshapingthe state from above, from within and from below’ to helpexplain this bias in favour of HIV/AIDS in Brazil and India,but not in Russia: ‘above’ influences include theavailability of external funding, the impact of the media coupledwith recognition and attention from philanthropic institutions,the government’s close relationship with UNAIDS (UN JointProgramme on HIV/AIDS), WHO (World Health Organization) andother UN bodies; ‘within’ influences include politicaland bureaucratic incentives to devote resources to certain issuesand relationships between ministries; and ‘below’influences include civil society activism and relationshipswith government.

Two additional factors explaining our findingscross-cutting all three levels are the strength of the privatesector in health, specifically the pharmaceutical industry,and the influence of transnational advocacy movements emanatingfrom the USA and Western Europe for particular diseases.^…”

KEY MESSAGES

- Analysing budgetary allocations in health is the first step towards understanding the power relations among various stakeholders at global, national and local levels, as well as the relative influence of power, ideas, institutions and culture in promoting investment and policy in certain health areas and not others.

- Resource allocation for public health in Brazil and India converge with global priorities while Russia’s financing pattern diverges.

- The combination of pressure from donors through financing of particular diseases, from the pharmaceutical industry, and from transnational advocacy movements at the global, national and local level seems to be key to understanding convergence in Brazil and India and divergence in Russia….”

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[EQ] Mobilizing Action Toward Community Health (MATCH)

Mobilizing Action Toward Community Health (MATCH)

CDC: Preventing Chronic Disease September 2010 - Prev Chronic Dis 2010;7(5).

Website: http://www.cdc.gov/pcd/issues/2010/sep/toc.htm

Observations on Incentives to Improve Population Health

J. Michael McGinnis, MD, MPP, Institute of Medicine

Initial Reflections

“……The pace of progress in population health can be influenced by the incentives in play and the metrics that trigger them. The MATCH (Mobilizing Action Toward Community Health) articles in this issue of Preventing Chronic Disease explore the use of incentives to improve population health and hold implications for the development and application of the measures to which they are linked. Metrics in population health can serve to draw and focus attention, encourage action, and direct rewards and penalties. When those rewards and penalties take on an economic dimension, the results can be powerful.

This potential application of population health measures is especially important if the aim is to transform the allocation of social energy and resources, as it clearly must be. Currently, our national health investment profile is deeply flawed — more than 95% of every health dollar goes to treatment rather than prevention. In a system in which all our salient incentives are structured to reward volume over value, we miss virtually no opportunity to treat disease, often unsuccessfully or erroneously.

On the other hand, each day we miss countless opportunities to prevent disease and promote health. If we seek to reform health care payment systems to yield better health returns, investment in prevention has to move to the highest — not lowest — priority. If our aim is to fashion the health equivalent of indicators that shape our economic policies, the most rational social investment strategy would center around prevention and our health care payment system would follow suit.

A reformed health care payment system can advance health as the fundamental priority in 3 ways. First, every American should receive coverage for the clinical preventive services that are appropriate to him or her without copayment. Second, grant support should be set aside for community-based initiatives that are necessary to improve the health and health care of the community’s residents. Finally, resources to address the overall health care needs of a population should be shaped by a blend of the community’s health needs and efforts, as reflected by metrics that indicate trends for determinants of the population’s health status…..”

The Articles

The articles in this issue present a number of perspectives relevant to considering how incentives might work for population health improvement.
Described below are common elements and how we might think about using incentives….”

A93: Creating Incentives to Improve Population Health Steven Lewis

PEER REVIEWED

A94: Principles to Guide the Development of Population Health Incentives Robert H. Haveman

A95: Understanding the Production of Population Health and the Role of Paying for Population Health John Mullahy

A96: Using Social Marketing to Manage Population Health Performance Michael L. Rothschild

A97: Making Better Use of the Policies and Funding We Already Have Raymond J. Baxter

A98: Paying for Performance in Population Health: Lessons From Health Care Settings David A. Asch, Rachel M. Werner

A99: Realizing and Allocating Savings From Improving Health Care Quality and Efficiency Daniel M. Fox

A100: Accountability Metrics and Paying for Performance in Education and Health Care John F. Witte

A101: Population Health Rankings as Policy Indicators and Performance Measures Thomas R. Oliver

A102: Learning From the European Experience of Using Targets to Improve Population Health Peter C. Smith, Reinhard Busse

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[EQ] Forgotten Families: Globalization and the Health of Canadians

Forgotten Families: Globalization and the Health of Canadians

Ronald Labonté,Canada Research Chair, Globalization and Health Equity, Institute of Population Health, Professor, Department of Epidemiology and Community Medicine, Faculty of Medicine, University of Ottawa

Vol. 2(2) 2010 Transdisciplinary Studies in Population Health Series

Available online as PDF [209p.] at: http://bit.ly/cIRZvL

“……..Key GHC Research Questions:

· What are the major causal pathways by which globalization affects or is likely to affect health, health disparities and the determinants of health in Canada, with special reference to families with children in low-income households in metropolitan areas?

· How does globalization affect the international context in which Canada must address health equity and determinants of health?

· How effectively has Canadian public policy responded to the challenges for health outcomes and determinants of health presented by globalization?

· What demonstrably effective best practices to avoid or mitigate the potentially negative health effects of globalization can be identified from the experience of other countries?

· What are the key policy entry points for addressing the impact of globalization on health disparities in the future?

Researchers involved in this multi-year project (2006-2011) come from varied backgrounds, including geography, political science, psychology, biostatistics, sociology, economics, anthropology, women’s studies, education and medicine. This pluralism is reflected in the content and methods used by the different contributors to this volume; and in the range of inferences and conclusions they independently reach that bear on the GHC research network’s basic questions. We cannot claim that each contribution represents a transdisciplinary effort, in the sense of creating a novel understanding of the phenomena under investigation. Rather, the Conference and the revised contributions gathered in this monograph are the beginning of a transdisciplinary approach: a multidisciplinary conversation around a shared concern (globalization and health equity) and how better to understand it.

Overview of the Monograph

The contributions to this monograph break into two parts. Part 1 provides a comparative perspective, drawing in experiences of health and welfare policy reforms from other parts of the world; while Part 2 begins to drill down into the Canadian experiences …”

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[EQ] Trade, Growth and Population Health: An Introductory Review

Trade, Growth and Population Health: An Introductory Review

Caroline Andrew. Louise Bouchard, Ronald Labonté, Vivien Runnels (Editors)

Chantal Blouin, Associate Director, Centre for Trade Policy and Law, Carleton University, Ottawa

Lisa Forman, Assistant Professor, Dalla Lana School of Public Health, Director, Comparative Program on Health and Society, Munk Centre for International Studies, University of Toronto

Vol. 2(1) 2010 Transdisciplinary Studies in Population Health Series

Available online as PDF [94p.] at: http://bit.ly/bXbnYl

“……..Human societies have long histories of trade with each other. One might describe barter and exchange as inherently human social qualities. When such barter extends beyond the village marketplace, however, issues of power and elite interests inevitably surface. Trade between societies has been marked by conflict as much as by equanimity: witness the forced opening of the closed economies of China by the British in the 19th century, Japan by the USA in the early 20th century, and the allegations of more contemporary coercion exercised by powerful countries over weaker ones in today’s free trade negotiations, a point addressed later in this paper.

This paper focuses on one central question: What are the actual or potential implications of today’s global trade regime on health?

We do not address this question through detailed examination of the multiplicity and complexity of trade rules, the proper treatment of which would be book length. Rather, we approach the question indirectly through an examination of a broad range of health-trade relationships. This reflects the paper’s intent, which is to familiarize researchers and students across a range of disciplines engaged in population health with some of the key health issues and controversies associated with contemporary trade.

We begin by examining how trade liberalization is thought to improve social welfare, generally, and health, specifically. This includes an assessment of trade liberalization as part of the larger neoliberal economic orthodoxy that has dominated international policy-making for the past three decades. This deconstruction of the dominant historical and current arguments supporting liberalized trade is important since its basic premise – increasing economic growth, development and ‘trickle-down’ poverty reduction – has failed to live up to its theoretical promise and is flawed by its absence of any reference to ecological scale.

The paper then turns to the actual and potential constraints trade treaties impose on the policy space and capacity of governments to regulate for health goals. This assessment is followed by more detailed accounts of trade agreements that directly affect health through liberalization of trade in health and other health-determining services, and through the global expansion of intellectual property rights. Most population health discussions of trade begin and end with these two issues. But, as this paper next argues, treaties and ongoing negotiations related to tariffs reduction, agriculture, investment, government procurement and standards-setting are likely to have more long-term, if indirect, health impacts.

One of the acknowledged innovations of today’s global trading system is its formalization of dispute settlements when one country perceives another as breaking agreed upon trade rules. Because dispute settlements can penalize countries that break the rules economically, trade treaties are amongst the ‘harder’ of international laws governing inter-state relations.

This raises questions about how well trade law accommodates public and global health equity concerns. Although this theme runs throughout the entire paper, we conclude with a discussion of trade and global governance issues, and offer a brief account of reforms to the global trading system that have been mooted by a number of researchers and development economists to ‘put trade in its place:’ that is, to ensure that trade liberalization retains its place as a means to other development goals (including health) and not as an end in itself to which other goals should be subordinated……………..”

Table of Contents

Introduction

Shrinking policy space meets diminishing policy capacity to create greater economic insecurity

From the general to specific: trade treaties’ direct effects on policy space and capacity on health

Agreements with direct health effects

Agreements with indirect health effects

Health in dispute

Reforming global economic governance: redistribution, regulation and rights

References

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