Monday, April 2, 2012

[EQ] Earth Institute: World Happiness Report

Earth Institute: World Happiness Report

Edited by John Helliwell, Richard Layard and Jeffrey Sachs
The Earth Institute, Columbia University – 2012

Available online PDF [158p.] at http://bit.ly/H7LRqG

 

“……it is not just wealth that makes people happy: Political freedom, strong social networks and an absence of corruption are together more important than income in explaining well-being differences between the top and bottom countries. At the individual level, good mental and physical health, someone to count on, job security and stable families are crucial.

 

These are among the findings of the first World Happiness Report, commissioned for the April 2nd United Nations Conference on Happiness (mandated by the UN General Assembly). The report, published by the Earth Institute and co-edited by the institute’s director, Jeffrey Sachs, reflects a new worldwide demand for more attention to happiness and absence of misery as criteria for government policy. It reviews the state of happiness in the world today and shows how the new science of happiness explains personal and national variations in happiness…..


“………..We live in an age of stark contradictions. The world enjoys technologies of unimaginable sophistication; yet has at least one billion people without enough to eat each day. The world economy is propelled to soaring new heights of productivity through ongoing technological and organizational advance; yet is relentlessly destroying the natural environment in the process. Countries achieve great progress in economic development as conventionally measured; yet along the way succumb to new crises of obesity, smoking, diabetes, depression, and other ills of modern life.

These contradictions would not come as a shock to the greatest sages of humanity, including Aristotle and the Buddha. The sages taught humanity, time and again, that material gain alone will not fulfill our deepest needs. Material life must be harnessed to meet these human needs, most importantly to promote the end of suffering, social justice, and the attainment of happiness. The challenge is real for all parts of the world.

As one key example, the world’s economic superpower, the United States, has achieved striking economic and technological progress over the past half century without gains in the self-reported happiness of the citizenry.

Instead, uncertainties and anxieties are high, social and economic inequalities have widened considerably, social trust is in decline, and confidence in government is at an all-time low. Perhaps for these reasons, life satisfaction has remained nearly constant during decades of rising Gross National Product (GNP) per capita.


The realities of poverty, anxiety, environmental degradation, and unhappiness in the midst of great plenty should not be regarded as mere curiosities. They require our urgent attention, and especially so at this juncture in human history. For we have entered a new phase of the world, termed the Anthropocene by the world’s Earth system scientists. The Anthropocene is a newly invented term that combines two Greek roots: “anthropo,” for human; and “cene,” for new, as in a new geological epoch.

The Anthropocene is the new epoch in which humanity, through its technological prowess and population of 7 billion, has become the major driver of changes of the Earth’s physical systems, including the climate, the carbon cycle, the water cycle, the nitrogen cycle, and biodiversity.

The Anthropocene will necessarily reshape our societies. If we continue mindlessly along the current economic trajectory, we risk undermining the Earth’s life support systems – food supplies, clean water, and stable climate – necessary for human health and even survival in some places. In years or decades, conditions of life may become dire in several fragile regions of the world. We are already experiencing that deterioration of life support systems in the drylands of the Horn of Africa and parts of Central Asia.

On the other hand, if we act wisely, we can protect the Earth while raising quality of life broadly around the world. We can do this by adopting lifestyles and technologies that improve happiness (or life satisfaction) while reducing human damage to the environment.

“Sustainable Development” is the term given to the combination of human well-being, social inclusion, and environmental sustainability. We can say that the quest for happiness is intimately linked to the quest for sustainable development.....”
Jeffrey Sachs - Director, The Earth Institute, Columbia University

Content:


1. Introduction


PART I

2. The State of World Happiness

3. The Causes of Happiness and Misery

4. Some Policy Implications

References to Chapters 1-4


PART II

5. Case Study: Bhutan

6. Case Study: ONS

7. Case Study: OECD

KMC/2012/SDE
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[EQ] Country-Level Decision Making for Control of Chronic Diseases

Country-Level Decision Making for Control of Chronic Diseases


Workshop Summary

Alexandra Beatty, Rapporteur
Board on Global Health; Institute of Medicine – IOM 2012

Available online at: http://bit.ly/H8QUFs
           

“……..There is growing recognition that chronic diseases represent a major health threat in low- and middle-income countries, accompanied by significant economic consequences. Yet most governments, global health institutions, and development agencies have largely overlooked chronic diseases when investing in health in developing countries (IOM, 2010). These countries have limited resources and many competing demands, from basic development priorities to a range of important health needs.

However, despite these challenges, a recent Institute of Medicine report, Promoting Cardiovascular Health in the Developing World (2010), concluded that not only is it possible to reduce the burden of cardiovascular and related chronic diseases in developing countries but such a reduction will be critical to achieving global health and development goals. To reduce the burden of chronic diseases in these countries, the report concluded that it will be necessary to:

• Improve local data and mechanisms for monitoring and evaluation;

• Build knowledge of effective, affordable, and feasible interventions and programs as well as how to implement these
  interventions and programs in the settings where they are needed;
• Align the effort with local characteristics and needs, such as disease burden, priorities, capacity, and resources;

• Recognize the realities of resource constraints and competing priorities that require difficult choices;

• Set clear, measurable goals;

• Build successful collaborations within and beyond the health sector;

• Integrate efforts across chronic diseases with common risk factors; and

• Integrate efforts with existing health and development priorities.

The workshop included two main groups of presentations. In the first, representatives from six economically, demographically, and geographically diverse countries described their experiences, progress, and lessons learned in planning and implementing chronic disease control efforts at the country level, including the availability and gaps in useful, country-level data.

The second consisted of examples of tools, models, and methods to inform possible components of a toolkit that could support countries in their decision making related to chronic diseases. The full workshop agenda can be found in Appendix A.

The final chapter draws together themes from the presentations and discussions throughout the workshop, focusing on the considerations that could be most useful in the development and implementation of a toolkit to support country-level planning for control of chronic diseases…..”

 

 

KMC/2012/HSD
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[EQ] Private versus public strategies for health service provision for improving health outcomes in resource-limited settings

Private versus public strategies for health service provision for
improving health outcomes in resource-limited settings

Dominic Montagu, Andrew Anglemyer, Mudita Tiwari, Katie Drasser, George W. Rutherford, Tara Horvath, Gail E. Kennedy
Lisa Bero, Nirali Shah, Heather Kinlaw

Global Health Sciences, University of California, San Francisco, CA - July 2011

Available online at: http://bit.ly/s5PnT0

“……….Private healthcare providers deliver a significant proportion of healthcare services in low- and middle-income countries (LMIC). Poorer patients get sick and go without care more frequently, and spend more of their incomes on private healthcare than the wealthy.

Based on evidence from demographic health surveys (DHS), private healthcare providers deliver a significant proportion of healthcare services in low- and middle  income countries (LMIC). Some of the reasons for seeking care from private providers cited by patients include better and more flexible access to providers, shorter waiting times, greater sensitivity to patient needs, and greater confidentiality. In many cases, governments fail to create systems to remove or penalize publicly funded staff who offer low-quality services to patients. As a result, patients seeking quality care may turn to private care.


For the purpose of this review, we have used the definitions of ‘private’ providers given within the surveyed literature so long as it approximates the more formal definitions. In contrast to services offered by government employees, private healthcare services involve a spectrum of providers and institutions, including nonprofit or religious institutions. Private-sector services vary by country and range from sophisticated tertiary care facilities comparable to the highest of international standards, to individual doctors and nurses practicing out of one-room clinics and unqualified providers offering services that are neither regulated nor monitored.

Private providers – institutions or individuals – are distinguished in economic terms from the public sector by their ownership characteristic. As such, a private provider’s profits or losses accrue to the owner, rather than to the government or society. In practice, ‘private’ providers are often described as health practitioners who are not directly controlled by government authorities and regulations.

The private sector is particularly important for the poor. Poorer patients get sick and go without care more frequently, and spend proportionately more of their incomes on private healthcare than the wealthy. What this means for public health, and for the health of the poor in particular, depends upon the quality of care and the affordability of care provided – two topics which have been the subject of many studies, often with conflicting results.

This review will be of value to stakeholders both inside and outside the research community, helping public health practitioners, policy makers, donor agencies and global health institutions in making evidence-based decisions on healthcare and healthcare policy. Should private-sector doctors, clinics or hospitals provide better care than their government counterparts, then the focus of quality assurance must initially be within government and private providers could be considered for hire or contracting as a means of expanding government-funded care. If private providers have worse outcomes than government alternatives, then training, regulation or suppression of private practice should be considered.

Objective

We have focused in this review upon comparable health outcomes. The objective of this study is to determine the health outcomes from services delivered to the poor by private for-profit, private non-profit and public-sector providers, and the trade-offs between private for-profit, private non-profit and public-sector sources of care for low and middle-income countries (LMIC). The review asks what is known regarding the relative morbidity or mortality….”

Content:

Executive summary

1 Background

2. Methods used in the review

2.1 User involvement

2.2 Identifying and describing studies

2.3 Quality assurance

2.4 Data extraction

2.5 Quality assessment

2.6 Methods for synthesis

2.7 Deriving conclusions and implications

3. Search results

4. Synthesis results

4.1 Further details of studies included in the synthesis

4.2 Synthesis of evidence

4.3 Synthesis: quality assurance results

4.4 Summary of the results of the synthesis

6. Conclusions and recommendations

7. References

Appendices

Appendix 1.1: Authorship of this report

Appendix 2.1: Search strategy

Appendix 3.1: Study details

Appendix 4.1: Forest Plots

Appendix 4.2: GRADE summary of evidence

Appendix 4.3: GRADE evidence profiles

 

“……This is a systematic review and meta-analysis using both Cochrane Collaboration and GRADE methods. The Cochrane Collaboration is an international network of healthcare professionals, researchers and consumers committed to developing and maintaining comprehensive, regularly updated systematic reviews of healthcare interventions. The GRADE approach is a systematic method of assessing the quality of studies included in a systematic review and developing recommendations or guidelines based upon the evidence. It has been adopted by the British Medical Journal (BMJ), the Infectious Diseases Society of America (IDSA), the World Health Organization (WHO), and numerous other agencies and organizations for use in assessing evidence quality and developing guidelines.


We included randomized controlled trials (RCTs), other types of controlled intervention studies, and observational studies that explored the impact of public and private healthcare provision in LMIC for this analysis. We limited the analysis to studies which reported on direct measures of improved health/health status/survival such as mortality or morbidity, lifestyle factors where evidence indicates an effect on the above, and/or adverse health effects of use of public or private healthcare.

Risk of bias in the included observational studies was assessed using the Newcastle- Ottawa Quality Assessment Scale (NOQAS). An overall assessment of the quality of evidence (high, moderate or low) was assigned to each main outcome in all included studies using the GRADE approach.

 

A meta-analysis for some outcomes was carried out, because we identified a sufficient number of studies to provide an acceptable body of evidence to examine the intervention. We assessed the extent of heterogeneity in results across comparable studies using forest plots, the I2 statistic and the Chi2 test.

Where there was evidence of heterogeneity, a random-effects model was applied. Data synthesis was performed using RevMan 5. We provided a summary estimate and 95% confidence interval and generated a forest plot for each meta-analysis. We performed subgroup analyses by stratifying studies by factors that might be a source of bias or potentially added substantially to heterogeneity between studies for any outcome for which we found multiple comparable studies…..”

 

 

KMC/2012/HSS
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