Tuesday, January 24, 2012

[EQ] Divided We Stand: Why Inequality Keeps Rising

Divided We Stand: Why Inequality Keeps Rising

ISBN Number:9789264111639 - December 2011
Organisation for Economic Co-operation and Development (OECD)

Website: bit.ly/shh3fr

  In the three decades prior to the recent economic downturn, wage gaps widened and household income inequality increased in a large majority of OECD countries. This occurred even when countries were going through a period of sustained economic and employment growth. This report analyses the major underlying forces behind these developments:

- An Overview of Growing Income Inequalities in OECD Countries

- Special Focus: Inequality in Emerging Economies

- Part I. How Globalisation, Technological Change and Policies Affect Wage and Earnings Inequalities

- Part II. How Inequalities in Labour Earnings Lead to Inequalities in Household Disposable Income

- Part III. How the Roles of Tax and Transfer Systems Have Changed

 

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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;
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[EQ] How can the health equity impact of universal policies be evaluated?

How can the health equity impact of universal policies be evaluated?

Insights into approaches and next steps

Edited by:

Beth Milton, May Moonan, Margaret Whitehead, David Taylor-Robinson
WHO Collaborating Centre for Policy Research on Social Determinants of Health, University of Liverpool

WHO Regional Office for Europe - 2011

Available online PDF [67p.] at: http://bit.ly/slZJz1



 "………Taking population level action on the wider social determinants of health in efforts to reduce health inequities is an international public health imperative. However, an important barrier to action is the perceived lack of evidence about what works to reduce health inequities. This is particularly evident in relation to universal welfare policies, which can have profound effects on health inequities, both positive and negative in nature.

 

Because universal policies are usually applied to whole populations, and are often complex in nature with long causal chains, this precludes a true experimental design, and other approaches to evaluation are required. This report presents arguments and case studies from an expert group meeting convened to clarify the importance and challenges of evaluating universal policies, and to outline potential approaches to assessing the impact of universal policies on health inequities.


The report also identifies key research and policy questions that need evaluating as a matter of priority, and sets the agenda for partnership working to develop these methods further….."

Content:

 

Section 1: Introduction

1.1 Background

 

Section 2: Why is so important to evaluate universal policies" for their impact on health inequities?

2.1 Universal policies are potentially important determinants of health

2.3 The need for evidence to support efficient and effective use of scarce resources

2.4 Piecemeal learning at the local level

2.5 The current erosion of universal policies

2.6 Better evidence for policy--making


Section 3: What are the evaluation challenges and barriers in relation to such policies?

3.1 The issue of controls/comparison groups

3.2 Time--‐lags and long causal chains 􀍴 temporal issues for evaluators

3.3 Linking policy events to outcomes and indicators

3.4 Dealing with complexity

3.5 The 􀍞transferability􀍟 problem and the importance of context

3.6 The mismatch between research and policy time frames

3.7 The difficulty of engaging decision--‐makers from other sectors

3.8 The need to prioritize interventions for evaluation

3.9 The tension between 􀍞robust􀍟 and 􀍞􀅐ood enough􀍟 evidence


Section 4: Current promising approaches to evaluation and gaps/refinements needed

4.1 How might universal policies be evaluated?

Exploiting natural policy experiments

Retrospective analysis: the Inspector Morse/resilience approach

From randomization to case studies

Insights from Complexity Theory

Utilizing logic models and a systems approach

Cross--national comparative policy analyses

Assessing differential impacts

Using tracer groups or conditions

 

Section 5: Burning research questions and policies to evaluate as a matter of priority

5.1 What are the differential effects of national policies to deal with economic recession?

5.2 What are the effects of the 􀍞Choice􀍟 agenda on access to universal services?

5.3 What are the features of an equitable health care service?

5.4 What are the features of evaluations which have led to both reliable and misleading findings, and what are their effects on policy?

5.5 What are the essential elements of an evaluation methodology that capture the equity impact of a universal policy, including the historical context prior to policy implementation and the displacement effects of the implemented policy?

5.6 What lessons can we learn from collaborating with (for example) historians and archaeologists to systematically capture how the historical context of a 􀍞place􀍟 influences the impact (either positive or negative) of an implemented universal policy?

5.7 What lessons can we learn from economists in assessing the equity impact of a universal policy, factoring in the historical context of the 􀍞place􀍟?

An opportunistic tracer group for evaluation 􀍴 children in low--income households

5.8 Researching knowledge exchange issues


Section 6: Establishing a longer term partnership

Section 7: Conclusion

Section 8: References and bibliography

 

 

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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]
Washington DC USA

"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
Health Organization PAHO/WHO or its country members".
------------------------------------------------------------------------------------
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[EQ] User fee removal in the health sector in low-income countries: lessons from recent national initiatives

User fee removal in the health sector in low-income countries:
lessons from recent national initiatives

Edited by Bruno Meessen, Lucy Gilson and Abdelmajid Tibouti

Health Policy and Planning - Volume 26, Supplement 2 - November 2011

Available free online at: http://bit.ly/zTUg1n

This supplement, sponsored by Unicef, focuses on the challenges related to the design and implementation of user fee removal policies in low-income countries.

"User fees have triggered impassioned discussions in international health over the last two decades. Promoted by a number of international organizations since the late 1980s as a strategy to finance struggling public health facilities in many low-income countries, recent years have seen growing criticism of the impact of fees on access to health services, particularly for the poorest groups.....

In mid-2008, UNICEF approached a group of researchers with the request to document recent experience with user fee removal. While aid actors in the North were still arguing fiercely about the pros and cons of user fees, a growing number of countries had already decided to remove user fees, at least for some priority services.... A consensus was easily reached between UNICEF and the research team led by the Institute of Tropical Medicine, Antwerp: the multi-country review would not (again) focus on evidence against or in favour of user fees, but would instead try to document how countries formulated and implemented user fee removal.

This focus was seen as valuable because it could generate practical lessons for other countries interested in such a step....  the research team judged that the main question of the multi-country review—the challenges related to design and implementation of user fee removal policies—deserved more visibility than just another report....

Our objectives for this supplement were multiple. From the start we decided we would welcome contributions from different regions and fields of expertise, as the supplement had to be useful for researchers, but also for programme officers and policy makers directly involved in health care financing policies in low-income countries. We acknowledged that contributors would adopt different types of methodological approaches to address different questions. We were also keen to get contributions from the different ‘corners’ of the user fee debate. Experts familiar with the controversy can see for themselves that this objective has been achieved; a glance at the list of contributors to this supplement suffices...."

The full supplement is available free online:
Volume 26 suppl 2 November 2011

User fee removal in low-income countries:
sharing knowledge to support managed implementation
[Editorial].

Bruno Meessen 1,*, Lucy Gilson 2,3 and Abdelmajid Tibouti 4

1Department of Public Health, Institute of Tropical Medicine, Antwerp, Belgium, 2School of Public Health and Family Medicine, University of Cape Town, South Africa, 3Department of Global Health & Development, London School of Hygiene and Tropical Medicine, London, UK and 4UNICEF, New York, USA

http://bit.ly/ytNMUA

“………..As international organizations, development partners have also a major responsibility in terms of knowledge management. It is our firm belief that real efforts must be made at regional level to bring together relevant knowledge—not just formal evidence—to support fee removal and improvements in financial access. A top priority should be to remove the walls between the different ‘niches’ of knowledge: policy makers, scientists, operational actors and aid agencies must learn to develop knowledge together (Meessen et al. 2011). Countries should also better share lessons of experience and good practices. There is, therefore, a need for much better collective learning……….”

Removing user fees for health services in low-income countries: a multi-country review framework for assessing the process of policy change

http://bit.ly/xV1J1H

Removing user fees in the health sector: a review of policy processes in six sub-Saharan African countries

http://bit.ly/wsVwkl

The national subsidy for deliveries and emergency obstetric care in Burkina Faso

http://bit.ly/zZTP8w

Abolition of user fees: the Uganda paradox

http://bit.ly/xKDwF3

Can innovative health financing policies increase access to MDG-related services? Evidence from Rwanda

http://bit.ly/zvlY74

The sudden removal of user fees: the perspective of a frontline manager in Burundi

http://bit.ly/yY6Y50

Abolishing user fees for children and pregnant women trebled uptake of malaria-related interventions in Kangaba, Mali

http://bit.ly/wgAYgw

The national free delivery policy in Nepal: early evidence of its effects on health facilities

http://bit.ly/AfxyHx

Removing user fees for basic health services: a pilot study and national roll-out in Afghanistan

http://bit.ly/xzW0Ye

Removing user fees: learning from international experience to support the process

http://bit.ly/xhTE2W



Twitter http://twitter.com/eqpaho


 *      *     *
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]
Washington DC USA

“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
Health Organization PAHO/WHO or its country members”.
------------------------------------------------------------------------------------
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Equity List - Archives - Join/remove: http://listserv.paho.org/Archives/equidad.html
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IMPORTANT: This transmission is for use by the intended
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confidential information. If you are not the intended
recipient or a person responsible for delivering this
transmission to the intended recipient, you may not
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any action in reliance on it. If you received this transmission
in error, please dispose of and delete this transmission.

Thank you.