Health Equity: February 2012

Wednesday, February 29, 2012

[EQ] Distributing Human Resources for Health: Ethics and Health Policy- Brocher Summer Academy - Switzerland, 18-22 June

Brocher Summer Academy in Global Population Health 2012

Geneva, Switzerland, 18th June – 22nd June

Distributing Human Resources for Health: Ethics and Health Policy

Applications are accepted until 15 March 2012

Of all the resources needed to conquer AIDS, TB, Malaria, and the other great threats to human health in the developing world, none is more essential than the people – doctors, nurses, scientists, and many others – who together constitute the workforce of health systems. Like money, drugs and other key resources, they are scarce. In other respects, however, they stand out among resources for health, for unlike pills and euros they have rights, and minds of their own, and they don’t necessarily go where health resource allocators want to send them.

The ethical issues that must be faced in responding to the critical shortage of trained health professionals in countries bearing the greatest burden of disease are likewise distinctive. Even the richest countries are short, and they are filling empty posts by offering jobs to well-trained health workers in the poorest countries. In the latter, lower incomes and difficult working conditions provide motivation to emigrate to where pay is higher, some research and career opportunities are more available, and living can be easier. This may enhance health workers’ job prospects and the quality of their lives, but the cumulative effect on the health of the populations they leave behind can be devastating. Medical brain drain flows virtually in one direction only; doctors, nurses, and scientists from wealthy countries do not clamour for appointments in the poor ones.

This ethical challenge will be addressed at the 2012 Summer Academy in the Ethics of Global Population Health, hosted by the Brocher Foundation on the shores of Lake Geneva. These biannual events introduce faculty and advanced graduate students to the fast-developing field of population-level bioethics, which addresses ethical questions, not in individual patient care, but in population- and global health.

The Summer Academy consists in five all-day sessions with lectures and discussions by internationally-renowned scholars in philosophy, the social and biomedical sciences, and global health practitioners. Apart from the faculty, participants are younger scholars and advanced graduate students, selected on the basis of their potential to become prominent contributors to the field. Early morning sessions address broad themes and methodological issues, and the rest of the day is dedicated to a specific set of dilemmas, this year, human resources for health.

ORGANISERS

Samia Hurst, University of Geneva

Nir Eyal, Harvard University

Dan Wikler, Harvard University

CONFIRMED SPEAKERS

Dan Brock, Harvard University

Simon Caney, University of Oxford

Michael Clemens, Center for Global Development
Mario Dal Poz, World Health Organization

Speranta Dumitru, Université Paris Descartes

Gilles Dussault, Instituto de Higiene et Medicina Tropical, Lisbon

Lisa Hirschhorn, Partners in Health

Fitzhugh Mullan, GW University (plenary)

Thomas Pogge, Yale University

John Roemer, Yale University

Peter Suter, Swiss Academies of Sciences

Jonathan Wolff, University College London

SCHEDULE - The 2012 Academy will be in session all day from Monday, 18th June, to Friday 22nd June.

TARGET AUDIENCE

Young scholars (post-doctoral fellows, junior faculty, and advanced graduate students) in philosophy, political science, economics and other social sciences, the biomedical sciences, and global health; and practitioners and professionals in health policy and global health

HOW TO APPLY

Attendance is limited to 40 participants. Participation is free, but a fee of CH 550, required of all those accepted for participation, covers course documentation, 5 nights of accommodation, 5 lunches and 4 dinners, and local transportation.

Your application form at http://bit.ly/zP8eDN should be accompanied by a short CV, one writing sample, and a one-paragraph description of your current research interests.

VENUE & CONTACT ADDRESS

Brocher Foundation - Summer Academy in Global Population Health

Rte d’Hermance, 471, CP 70

CH-1248 Hermance Switzerland

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Tuesday, February 28, 2012

[EQ] State of the Worlds Children 2012: Children in an Urban World - UNICEF

State of the World's Children 2012: Children in an Urban World

United Nations Children’s Fund (UNICEF) - February 2012

Full report available in PDF [156p.] at: http://uni.cf/zLwQa6

Website: http://uni.cf/zLR3hJ

Spanish: Estado Mundial de la Infancia 2012

Niñas y niños en un mundo urbano - http://uni.cf/AntFcJ

French: La Situation des enfants dans le monde 2012

Les enfants dans un monde urbain -: http://uni.cf/xG7Gks

“……..…..The experience of childhood is increasingly urban. Over half the world’s people – including more than a billion children – now live in cities and towns. Many children enjoy the advantages of urban life, including access to educational, medical and recreational facilities. Too many, however, are denied such essentials as electricity, clean water and health care – even though they may live close to these services. Too many are forced into dangerous and exploitative work instead of being able to attend school. And too many face a constant threat of eviction, even though they live under the most challenging conditions – in ramshackle dwellings and overcrowded settlements that are acutely vulnerable to disease and disaster.

The hardships endured by children in poor communities are often concealed – and thus perpetuated – by the statistical averages on which decisions about resource allocation are based. Because averages lump everyone together, the poverty of some is obscured by the wealth of others. One consequence of this is that children already deprived remain excluded from essential services.

Increasing numbers of children are growing up in urban areas. They must be afforded the amenities and opportunities they need to realize their rights and potential. Urgent action must be taken to:

• Better understand the scale and nature of poverty and exclusion affecting children in urban areas.

• Identify and remove the barriers to inclusion.

• Ensure that urban planning, infrastructure development, service delivery and broader efforts
to reduce poverty and inequality meet the particular needs and priorities of children.

• Promote partnership between all levels of government and the urban poor – especially children and young people.

• Pool the resources and energies of international, national, municipal and community actors in support of efforts to
ensure that marginalized and impoverished children enjoy their full rights.

These actions are not goals but means to an end: fairer, more nurturing cities and societies for all people –starting with children….”

Content:

Executive Summary [PDF]

Chapter 1 Children in an increasingly urban world

Chapter 2 Children's rights in urban settings

Chapter 3 Urban challenges

Chapter 4 Towards cities fit for children

Chapter 5 Uniting for children in an urban world

Statistical tables for 2011 Figures Photographs – Video

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Monday, February 27, 2012

[EQ] Paying for performance to improve the delivery of health interventions in low- and middle-income countries

Paying for performance to improve the delivery of health interventions
in low- and middle-income countries (Review)

Sophie Witter1, Atle Fretheim2,5, Flora L Kessy3, Anne Karin Lindahl4

1Immpact, University of Aberdeen, Aberdeen, UK. 2Global Health Unit, Norwegian Knowledge Centre for the Health Services, Oslo, Norway. 3Ifakara Health Institute (IHI), Dar es Salaam, Tanzania. 4Norwegian Knowledge Centre for the Health Services, Oslo, Norway. 5Institute of Health and Society, University of Oslo, Oslo, Norway

Cochrane Database of Systematic Reviews 2012, Issue 2. Art. No.: CD007899

Available online PDF [83p.] at: http://bit.ly/wAk4Gf

“…..There is a growing interest in paying for performance as a means to align the incentives of health workers and health providers with public health goals. However, there is currently a lack of rigorous evidence on the effectiveness of these strategies in improving health care and health, particularly in low- and middle-income countries. Moreover, paying for performance is a complex intervention with uncertain benefits and potential harms.
A review of evidence on effectiveness is therefore timely, especially as this is an area of growing interest for funders and governments.

Objectives

To assess the current evidence for the effects of paying for performance on the provision of health care and health outcomes in low and middle-income countries.

Search methods

We searched more than 15 databases in 2009, including the Cochrane Effective Practice and Organisation of Care Group Specialised Register (searched 3March 2009), CENTRAL (2009, Issue 1) (searched 3March 2009),MEDLINE, Ovid (1948 to present) (searched 24 June 2011), EMBASE, Ovid (1980 to 2009Week 09) (searched 2March 2009), EconLit, Ovid (1969 to February 2009) (searched 5 March 2009), as well as the Social Sciences Citation Index, ISI Web of Science (1975 to present) (searched 8 September 2010). We also searched the websites and online resources of numerous international agencies, organisations and universities to find relevant grey literature and contacted experts in the field. We carried out an updated search on the Results-Based Financing website in April 2011, and re-ran the MEDLINE search in June 2011.

Selection criteria

Pay for performance refers to the transfer of money or material goods conditional on taking a measurable action or achieving a predetermined performance target. To be included, a study had to report at least one of the following outcomes: changes in targeted measures of provider performance, such as the delivery or utilisation of healthcare services, or patient outcomes, unintended effects and/or changes in resource use. Studies also needed to use one of the following study designs: randomised trial, non-randomised trial ….”

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[EQ] Social Inequalities in Health in Montreal

Social Inequalities in Health in Montréal

2011 Report of the Director of Public Health

Direction de santé publique - Agence de la santé et des services sociaux de Montréal -Canada

Available online at: http://bit.ly/wjwf4K

“……Social inequalities in health in Montréal, like elsewhere, are due in large part to income gaps among individuals. The increase in income inequality between wealthy and less wealthy people in Canada has come to the attention of the Organisation for Economic Co-operation and Development (OECD); it has noted that over the past few years, Canadian rates of poverty and inequality have risen more than the average for member countries. In particular, since the end of the 1990s, mechanisms for income redistribution no longer suffice to correct the increase in income inequalities among Canadian households. All age groups are not equally affected since the low-income rate for seniors is about 6% while that for children hovers around 15%.

Policies and incentives to work implemented in Québec in the past few years have focused on improving families’ living conditions. Compared with other provinces,

Québec has been more successful in reducing social inequalities, as can be seen in after-tax income….”

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[EQ] Social determinants of health: the environmental dimension

Social determinants of health: the environmental dimension

The Lancet, Volume 379, Issue 9817, Page 686, 25 February 2012

Website: http://bit.ly/xfxoNk

“……The concept of environmental health might typically conjure up images of people living in smog-filled cities, or by contaminated rivers or overflowing landfill sites. However, it also concerns the spaces in which people most frequently inhabit: their homes and workplaces.

Furthermore, the conditions in which people live and work can vary according to factors such as income, occupation, education, and ethnicity, and lead to inequalities in exposure to environmental risks and related diseases…..”

Environmental health inequalities in Europe
Assessment report

WHO European Centre for Environment and Health, Bonn Office
WHO Regional Office for Europe, 2012

Available online PDF [212p.] at: http://bit.ly/xA9tmV

“…..Recent debate on the social determinants of health has indicated that the unequal distribution of health and well-being in national populations is a major challenge for public health governance. This is equally true for environmental health conditions and for exposure to environmental risk, which varies strongly by a range of sociodemographic determinants and thus causes inequalities in exposure to – and potentially in disease resulting from – environmental conditions.

Interventions tackling such environmental health inequalities need to be based on an assessment of their magnitude and on the identification of population groups that are most exposed or most vulnerable to environmental risks. However, data to quantify the environmental health inequality situation are not abundant, making comprehensive assessments difficult at both national and international levels.

WHO Regional Office for Europe has carried out a baseline assessment of the magnitude of environmental health inequality in the European Region based on a core set of 14 inequality indicators. The main findings of the assessment report indicate that socioeconomic and demographic inequalities in risk exposure are present in all countries and need to be tackled throughout the Region. However, the report also demonstrates that each country has a specific portfolio of inequalities, documenting the need for country-specific inequality assessments and tailored interventions on the national priorities….”

CONTENT

Executive summary

Introduction

Chapter 1. The concept of environmental health inequalities

A historic perspective

Inequality and inequity

Identification and assessment of inequalities and inequities

Environmental health inequality: hazard and risk

Sociodemographic factors, exposure and vulnerability

The psychosocial dimension in environmental health inequality

Framing the problem

Chapter 2. Housing-related inequalities

Data and methods

Inequalities in inadequate water supply

Inequalities in lack of a flush toilet in the dwelling

Inequalities in lack of a bath or shower in the dwelling

Inequalities in overcrowding

Inequalities in dampness in the home

Inequalities in keeping the home adequately warm

Inequalities in keeping the home adequately cool

Chapter 3. Injury-related inequalities

Inequalities in work-related injuries

Inequalities in fatal road traffic injuries (RTIs)

Inequalities in fatal poisoning

Inequalities in fatal falls

Chapter 4. Environment-related inequalities

Inequalities in noise exposure at home

Inequalities in lack of access to recreational or green areas

Inequalities in second-hand smoke exposure at home

Inequalities in second-hand smoke exposure at work

Chapter 5. Gaps in evidence and restrictions on assessing environmental health inequalities

Missing data

Limited stratification by sociodemographic determinants

Data quality

Consistency and comparability

Access to data

Cumulative and multiple exposures

Country priorities

Data gaps and relevance for public health

Chapter 6. Priorities for action on environmental health inequalities

Suggested subregional priorities for action

Suggested priorities for national action

Conclusion

Annex 1. National environmental health inequality fact sheets

Annex 2. Examples of national practices in analysis and presentation of environmental health inequalities

Annex 3. Assessment of priority areas for national action

Thank you.