Health Equity: 08/03/12

Friday, August 3, 2012

[EQ] Incentives, health promotion and equality

Incentives, health promotion and equality

Kristin Voigt

Department of Politics, Philosophy & Religion, Lancaster University, Lancaster, UK

Health Economics, Policy and Law (2012), Volume 7 - Issue 03 -Cambridge University Press

Website – PDF [27p.] at: http://bit.ly/Rptq3v

“……The use of incentives to encourage individuals to adopt ‘healthier’ behaviours is an increasingly popular instrument in health policy. Much of the literature has been critical of ‘negative’ incentives, often due to concerns about equality; ‘positive’ incentives, however, have largely been welcomed as an instrument for the improvement of population health and possibly the reduction of health inequalities. The aim of this paper is to provide a more systematic assessment of the use of incentives from the perspective of equality.

The paper begins with an overview of existing and proposed incentive schemes. I then suggest that the distinction between ‘positive’ and ‘negative’ incentives – or ‘carrots’ and ‘sticks’ – is of limited use in distinguishing those incentive schemes that raise concerns of equality from those that do not.

The paper assesses incentive schemes with respect to two important considerations of equality: equality of access and equality of outcomes. While our assessment of incentive schemes will, ultimately, depend on various empirical facts, the paper aims to advance the debate by identifying some of the empirical questions we need to ask. The paper concludes by considering a number of trade-offs and caveats relevant to the assessment of incentive schemes….” Abstract

“…………….The framework of incentive schemes is very broad and, as the survey of existing and proposed schemes in Section 2 showed, they can be designed in very different ways; our assessment of incentive schemes must be sufficiently sensitive to these differences. In this paper, I suggested that the distinction between ‘carrots’ and ‘sticks’, or ‘rewards’ and ‘penalties’, is of only limited benefit in assessing these schemes. I identified a number of criteria relevant from the perspective of equality.

These criteria could be helpful both in evaluating the ‘equality impact’ of incentive schemes and in designing schemes in a manner that is sensitive to considerations of equality. I also commented on how these considerations should feed into an overall evaluation of incentive schemes as a tool for improving population health.

At the same time, the paper raised a number of questions that can be answered only on the basis of empirical evidence; the paper identified some of the empirical questions we need to ask to determine whether incentive schemes are consistent with considerations of equality or even a policy tool for the reduction of social inequalities in health……” Author

KMC/2012/SDE
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[EQ] Better aid modalities: are we risking real results?

Better aid modalities: are we risking real results?

Bibliography and literature reviews, July 2012

Helen Tilley and Heidi Tavakoli
Overseas Development Institute – ODI

Available online PDF [39p.] at: http://bit.ly/OMZW2V

”….This literature review examines six research topics which explore ways to improve the effectiveness of aid modalities. Drawing on the discussions and comments at ODI's 2011 meeting series on the future of budget support, six topics for research to improve the range of policy options for delivering aid at the country level were identified:

- Building a new typology of existing (and emerging) aid instruments.

- Understanding recipient government perceptions of effective aid instruments.

- Embedding political economy insights in aid instrument design.

- Designing portfolios of complementary aid instruments

- Comparing the fiduciary risks of different aid instruments.

- Designing better frameworks for aid delivery options.

This literature review examines the relevant research that currently exists for each of these topics. It explores the key findings and main messages in the existing literature. In doing so it assesses whether the proposed research topic duplicates existing research or does in fact propose to explore a new set of issues. …”

“….The ultimate objective will be to provide evidence-based policy advice on options donors and recipient governments can pursue when designing and implementing aid instruments. Essentially, the framework will aim to lay out the range of aid features which should best address country specific risks, while delivering on results….”

Content

1 Introduction

2 Building a new typology of existing (and emerging) aid instruments

2.1 Key findings and main issues in the existing research

2.2 Summary: to what extent does the activity duplicate what has already been examined and usefully explore a new set of issues?

3 Understanding recipient government perceptions of effective aid instruments

3.1 Key findings and main issues in the existing research

3.2 Summary: to what extent does the activity duplicate what has already been examined and usefully explore a new set of issues?

4 Embedding political economy insights in aid instrument design

4.1 Key findings and main issues in the existing research

4.2 Summary: to what extent does the activity duplicate what has already been examined and usefully explore a new set of issues?

5 Designing portfolios of complementary aid instruments

5.1 Key findings and main issues in the existing research

5.2 Summary: to what extent does the activity duplicate what has already been examined and usefully explore a new set of issues?

6 Comparing the fiduciary risks of different aid instruments

7 Designing better frameworks for aid delivery options

7.1 Key findings and main issues in the existing research

7.2 Summary: to what extent does the activity duplicate what has already been examined and usefully explore a new set of issues?

8 Conclusion

References

KMC/2012/SDE
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[EQ] Is social capital good for health? A European perspective

Is social capital good for health? A European perspective

Lorenzo Rocco, University of Padua, Italy

Marc Suhrcke, University of East Anglia, United Kingdom

WHO Regional Office for Europe - Copenhagen, Denmark – 2012

Available online PDF [24p.] at: http://bit.ly/OMAeLM

“……The aim of the research reported here was to examine the causal impact of social capital on health in 14 European countries. Using data from the European Social Survey for 14 European countries, supplemented by regional-level data, the authors studied whether individual and/or community-level social capital positively affects health.

The authors controlled for other relevant factors that are also expected to affect health, and addressed – via an instrumental variable approach – the challenge of assessing causality in the relationship between social capital and health. The large variance of the error term due to measurement errors calls for strong instruments to obtain reliable estimates in a finite sample.

The dataset is rich enough in information to allow the finding of a seemingly strong causal relationship between social capital and individual health. Community social capital (defined at regional level) appears not to affect health once individual-level social capital is controlled for. Taken at face value, the findings suggest that policy interventions should be targeted at improving primarily individual social capital. In doing so they would achieve a double effect: on the one hand they would directly improve individual health; on the other they would contribute to community social capital, which reinforces the beneficial role of individual social capital….”

“….The novelty of this study in terms of policy implications is the discovery that interventions attempting to improve health by building social capital should be targeted at improving primarily individual social capital, because in so doing they would achieve a double effect: on the one hand, they would directly improve individual health; on the other, they would contribute to community social capital, which reinforces the beneficial role of individual social capital. Exploiting such reinforcing mechanism could improve the (cost–)effectiveness of policies: an intervention that succeeds in improving the social capital of a large number of individuals in one community would produce a larger health benefit than one that targets the same number of individuals located in a number of different communities….”

KMC/2012/SDE
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[EQ] Technologies for global health

Technologies for Global Health - The Imperial College London/ Lancet Commission

Website: http://bit.ly/Rhxk2L

August, 2012 – “………Collaboration between The Lancet and Imperial College London, UK, has resulted in a new Commission, which examines how medical technology should best be used to improve health in low- and middle-income countries. The report concludes that in many cases, medical technology—almost exclusively developed in rich countries—is simply inappropriate for use in poorer nations.

Executive summary

According to hospital inventories, an estimated 40% of healthcare equipment in developing countries is out of service, compared with less than 1% in high-income countries. The inappropriate deployment of medical technologies from wealthy countries plays a major part in this high failure rate.

Instead of relying on hand-me-down technologies from wealthier countries, which can be costly, inappropriate for local conditions, and even dangerous, the authors urge a renewed effort towards developing what they call "frugal technologies"—cost-effective technologies that are developed specifically to cope in local conditions.

Examples of frugal technologies which have been developed to meet local needs include: the Jaipur foot, a rubber prosthetic for people who have lost their leg and foot below the knee; PATH's Uniject injection system, which allows once-only use of needles for injectable contraceptives; and the eRanger, a durable rural ambulance, based around a motorbike and stretcher sidecar (which can be modified to carry one or two people).

The report also advocates a wider understanding of what we mean by medical technologies, pointing out that technological improvement to sanitation and road conditions could also have a far-reaching impact on public health in many low- and middle-income countries. Furthermore, the authors argue that advances in technology need to be accompanied by innovation to have a significant effect on health—this includes the development of effective delivery mechanisms and novel approaches to financing.

Editorial:

The Lancet, Volume 380, Issue 9840, 4 August 2012

Technologies for global health

Website: http://bit.ly/QKmY9C

“……As well as making existing technologies accessible, new technologies specifically designed for the poorer settings—frugal technologies—are important. The Jaipur foot, a rubber prosthetic for people who have a below-knee amputation, is an example of a frugal technology that has been successfully rolled out in 22 countries. But still desperately needed are vaccines that are heat stable, a heat-stable form of oxytocin, and a test for sickle-cell disease that can be used in resource-poor settings. New frugal technologies do not have to be sophisticated gadgets, but can be as simple as a checklist. A 29-item Safe Childbirth Checklist has been developed and successfully piloted in India, with a draft version available by the end of 2012.

Technologies do not have to be specifically designed for health purposes to have an effect. Information technology has a part to play in ensuring that health advice, or behavioural interventions, reach the greatest number of people, for example via mobile phones. And the wider technologies associated with improving road safety, sanitation, and food supplies are crucial to improve health for all.

Innovations in distribution, including working with the commercial sector, are also important to ensure that technologies reach those who need them, even in remote areas…..”

Technologies for global health

The Lancet, Volume 380, Issue 9840, 4 August 2012

Peter Howitt a , Prof Ara Darzi a, Prof Guang-Zhong Yang a, Hutan Ashrafian k, Prof Rifat Atun l n, Prof James Barlow n, Alex Blakemore i, Prof Anthony MJ Bull d, Josip Car m, Lesong Conteh a, Graham S Cooke f, Nathan Ford f, Simon AJ Gregson g, Karen Kerr a, Dominic King c, Myutan Kulendran c, Prof Robert A Malkin d, Prof Azeem Majeed j, Prof Stephen Matlin a, Robert Merrifield a, Hugh A Penfold o, Steven D Reid f, Prof Peter C SmithA c, Prof Molly M Stevens d h, Michael R Templeton e, Prof Charles Vincent k, Elizabeth Wilson b

The Lancet http://bit.ly/RopkZj

“….Availability of health technology is inversely related to health need. Although health-care systems in high-income countries make extensive use of technology, people in the world's poorest countries often lack the most fundamental drugs and devices. A concerted global effort to encourage the development and use of health technologies that can benefit the poorest people in the world is needed …..”

KMC/2012/KMC
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