Health Equity: 06/04/12

Monday, June 4, 2012

[EQ] The cost of Inaction on the Social Determinants of Health

The cost of Inaction on the Social Determinants of Health

The National Centre for Social and Economic Modelling (NATSEM)
University of Canberra, Australia

Report no. 2/2012, June 4, 2012 CHA-NATSEM Second Report on Health Inequalities

Laurie Brown, Professor and Research Director (Health), Linc Thurecht, Senior Research Fellow and Binod Nepal, Senior Research Fellow

Available online as PDF file [54p.] at: http://bit.ly/M5704c

“……..The aim of this research is to provide an indication of the extent of the cost of Government inaction in developing policies and implementing strategies that would reduce socio-economic differences within the Australian population of working age (25-64 years) that give rise to health inequities.

The cost of inaction is measured in terms of the loss of potential social and economic outcomes that might otherwise have accrued to socio-economically disadvantaged individuals if they had had the same health profile of more socio-economically advantaged Australians.

For the purposes of this report, the contrast is made between those who are most socio-economically disadvantaged and those who are least disadvantaged defined in terms of household income, level of education, housing tenure and degree of social connectedness.

Four types of key outcomes are considered:
- the number of disadvantaged Australians of working age experiencing health inequity,
- satisfaction with life,
- economic outcomes (including employment, income from paid work,
- savings to Government expenditure on social security payments and transfers) and savings to the health system.

The Report aims to address five key questions:

• If the most socio-economically disadvantaged Australians of working age had the same self-reported health status profile of the least disadvantaged groups,
how many more individuals would be in good health rather than poor health?

• If the most socio-economically disadvantaged Australians of working age had the same prevalence of long-term health conditions as the least disadvantaged groups, how many more individuals would be free from chronic long-term illness?

• If individuals in the most socio-economically disadvantaged groups had the same health profile – in terms of self-assessed health status and long-term health conditions – of the least disadvantaged groups, how many more individuals would be satisfied with their life?

• If individuals in the most socio-economically disadvantaged groups had the same health profile of the least disadvantaged groups, what improvements in employment status, income from paid work and reductions in government pensions, allowances and other public transfers are likely to be gained?

• If individuals in the most socio-economically disadvantaged groups had the same health profile of the least disadvantaged groups, what savings might occur to the health system in terms of reduced number of hospital separations, number of doctor- and medical-related services and prescribed medicines and associated costs to Government? ….”

CONTENTS

Executive Summary

1 Introduction

2 Measuring Health and Socio-Economic Disadvantage

2.1 Key Health and Socio-Economic Indicators

2.2 Measuring Lost Benefits – the Costs of Inaction

2.3 Missing Data

2.4 Profile of the Study Population

3 How Many Disadvantaged Australians of Working Age Are Experiencing Health Inequity?

4 Costs To Well-Being - Potential Gains in Satisfaction With Life

5 Lost Economic Benefits – Potential Economic Gains From Closing Health Gaps

5.1 Potential Gains in Employment

5.2 Income and Gains in Annual Earnings

5.3 Government Pensions and Allowances and Savings in Government Expenditure

6 Savings To The Health System From Closing Health Gaps

6.1 Reduced Use of Australian Hospitals

6.2 Reduced Use of Doctor and Medical Related Services

6.3 Reduced Use of Prescribed Medicines

7 Summary and Conclusions

References Appendix 1 - Technical Notes

KMC/2012/SDE
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”.
------------------------------------------------------------------------------------
PAHO/WHO Website
Equity List - Archives - Join/remove: http://listserv.paho.org/Archives/equidad.html
Twitter http://twitter.com/eqpaho

IMPORTANT: This transmission is for use by the intended
recipient and it may contain privileged, proprietary or
confidential information. If you are not the intended
recipient or a person responsible for delivering this
transmission to the intended recipient, you may not
disclose, copy or distribute this transmission or take
any action in reliance on it. If you received this transmission
in error, please dispose of and delete this transmission.

Thank you.

[EQ] Well-being evidence for policy: A review

Well-being evidence for policy: A review

nef (the new economics foundation) UK - 2012

Available online PDF [88p.] at http://bit.ly/HupZaE

“…..Over the last 30 years, there has been a considerable growth in academic research on the causes of well-being.
In general, this literature gives a fairly consistent picture of which factors have associations with subjective well-being.
However, it is only in the last few years that there has been the corresponding level of interest from policymakers at national level….”

“……This review consists of the following sections:

The Glossary explains key surveys used, measures used, and some of the common abbreviations that appear in this review.

The Introduction reviews some of the key sources of well-being data, the types of measures used and outlines the key methodological issues with this evidence.

Part 1 presents a summary of the current literature on well-being and its determinants and has been structured by policy areas. Policies made in each of these areas will have the potential to explicitly affect well-being. This report aims to provide an overview of current findings but it is not a fully comprehensive review – for this, readers should turn to individual study findings and literature associated with specific areas of research.

Part 2 compares some of the relative effects of the different factors to give an idea of how they compare in terms of their influence on well-being. This provides useful information for policymakers who have (often limited) funds and are under pressure to direct these towards the policies with maximum benefits for subjective well-being.

The Appendix includes most of the fuller data tables that were used as sources for Part 2 to compare the effect sizes of different independent variables within well-being equations. They are intended to give readers more information, and the largest three coefficients are highlighted within each table.

References: Given its emphasis on evidence from the literature, in this review we use the traditional academic referencing style, giving (author and date) at the appropriate point of the text. The full list of references is given at the end of the document….”

Contents

Well-being evidence for policy: A review

Academic context

Policy context

Surveys

Measures

Statistical terms

Part 1: A summary of the existing evidence

1.1 The economy

Income

Income inequality

Benefits and welfare payments

Unemployment

Unemployment rate

Inflation

Type of work

Quality of work

Hours worked

Debt

Commuting

1.2 Social relationships and community

Social activity

Volunteering

Membership of organisations

Membership of religious organisations

Trust

Governance

Marriage and personal relationships

Family relationships

Having children

1.3 Health

Physical health

Psychological health
Physical activity

Other health behaviour

Sleep

1.4 Education and care

Education

Informal care

1.5 The local environment

Physical environment

Urban spaces and their design

Housing

Urbanisation

Pollution

Crime

Transport

Traffic

Climate

1.6 Personal characteristics

Age

Gender

Ethnicity

Genetics

Personality

Materialist values

Part Two: The relative impacts of different factors on well-being

Overview of findings

UK data

European data

US data

Making trade-offs: a case study of unemployment and inflation

Appendix: Comparing effect sizes

United Kingdom

European

United States

References

Thank you.

[EQ] The Economic Impact of Improvements in Primary Healthcare Performance

The Economic Impact of Improvements in Primary Healthcare Performance PHC

Simone Dahrouge, Rose Anne Devlin, Bill Hogg, Grant Russell, Doug Coyle, Dean Fergusson
Canadian Health Services Research Foundation – CHSRF – 2012

Available online PDF [89p.] at: http://bit.ly/KJVjE6

This report presents the results of four different approaches to evaluate the economic impact of enhancements to PHC:

1. A synthesis of the literature on the macro- and micro-economic effects of good health, with specific relevance to PHC performance.

2. A systematic review of the economic impact of incorporating a pharmacist into a Primary Healthcare Performance PHC practice.

3. A simulation exercise that evaluates the economic impact of improvements to influenza immunization rates for older adults
brought about by provider reminder systems in PHC.

4. A literature review of reductions in burden of illness associated with four specific enhancements to chronic disease management in
PHC that produce health benefits. These include PHC improvements that result in improved blood pressure control,
enhanced diabetes management, increased uptake of cancer screening and improved continuity of care….”

“….Three of the four approaches used in the report suggest that improvements to the performance of PHC in Canada would yield economic benefits.
Better health outcomes have a positive impact on employment, productivity and economic growth.
Simulation results indicate that increasing the influenza vaccination rate of the elderly population results in cost savings.
Improved health outcomes for chronic disease management were linked to cost savings through reductions in hospitalizations, professional visits, emergency room visits and increased productivity; and higher continuity of care was associated with lower resource utilization and reduced healthcare costs.

Despite literature that shows a positive health benefit of pharmacist integration in PHC, studies of the economic impact are inconclusive…..”

Content:

The gaps in Canada’s PHC performance level

Technical quality of care (Figure 1)

Accessibility (Figure 2)

Quality improvement initiatives (Figure 3)

Practice organization (Figure 4)

Interventions to improve quality in primary healthcare

Quality improvement initiatives

Information technology

Human resources

Economic impact of improvements in PHC

The link between PHC services and economics: A review of the literature

The link between PHC and health (Arrow 1)

Macroeconomic factors and health (Arrow 2)

Microeconomic factors and health (Arrow 3)

Conclusions

The economic impact of adding a pharmacist in a PHC practice:

A systematic review

A simulation of the impact of improvements in influenza vaccination rates

Model based simulator

Scenarios – Data – Results - Sensitivity analysis

Conclusions

Economic impact of improvements in selected indicators

Introduction

Hypertension

Diabetes

Cancer

Continuity

Recommendations and expert commentaries

Findings

National coordination body

Investments in primary healthcare

Investing in high quality PHC research/evaluation

Limitations

Conclusions

APPENDICES

Appendix: A: Result-based logic model for PHC

Appendix: B: OECD framework

Appendix: C: Synthesis of review literature – study protocol

Appendix: D: Description of studies included in the section on interventions to improve PHC performance

Appendix: E: Systematic review – study protocol

Appendix: F: Quality assessment checklist and quality assessment results

Appendix: G: Flow diagram summarizing the flow of information through the different phases of the systematic review

Appendix: H: Included studies

Appendix: I: Elderly population projections from 2010 to 2036

Appendix: J: Population vaccination rates for elderly population in 2007

Appendix: K: Simulation results by province
Appendix: L: References

KMC/2012/HSS
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

Thank you.