Health Equity: 08/16/12

Thursday, August 16, 2012

[EQ] Why We Need Urban Health Equity Indicators: Integrating Science, Policy, and Community

Why We Need Urban Health Equity Indicators:
Integrating Science, Policy, and Community

"….discuss the need for urban health equity indicators, which can capture the social determinants of health, track policy decisions, and promote greater urban health equity…."

Jason Corburn1*, Alison K. Cohen2

1 University of California Berkeley, Department of City and Regional Planning & School of Public Health, Berkeley, California, United States of America, 2 University of California Berkeley, School of Public Health, Division of Epidemiology, Berkeley, California, United States of America

PLoS Med 9(8): e1001285. doi:10.1371/journal.pmed.1001285 – August 14, 2012

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

"…..Measuring the forces that contribute to urban health is one challenge for promoting more healthy and equitable cities. Burden of disease estimates have tended to focus on the whole world or specific geographic regions [4],[5]. These data can mask intra-city differences and global data may not be relevant to inform national or municipal policy making.

Public health has developed metrics for single pathogenic exposures or risk factors, but these measures often ignore both community assets that promote health equity and the cumulative impacts on health from exposure to multiple urban environmental, economic, and social stressors [6],[7]. Recognizing these population health challenges, the United Nations (UN) Commission on Social Determinants of Health (2008) called for "health equity to become a marker of good government performance" and for the UN to "adopt health equity as a core global development goal and use a social determinants of health indicators framework to monitor progress"

More recently, the 2011 World Social Determinants of Health Conference and the Pan-American Health Organization's Urban Health Strategy called for the development of new urban health equity indicators that track the drivers of health inequities across place and time, particularly within a city neighborhood.

In this paper, we briefly outline an approach for promoting greater urban health equity through the drafting and monitoring of indicators. We draw examples from the cities of Richmond, California, and Nairobi, Kenya. More specifically, we argue that participatory indicator processes hold the potential to shape new healthy and equitable urban governance by:

- integrating science with democratic decision making;

- tracking policy decisions that shape the distribution of health outcomes; and

- including protocols for ongoing monitoring and adjusting of measures over time….."

Summary points:

As the urban population of the planet increases and puts new stressors on infrastructure and institutions and
exacerbates economic and social inequalities, public health and other disciplines must find new ways to address urban health equity.

Urban indicator processes focused on health equity can promote new modes of healthy urban governance, where the
formal functions of government combine with science and social movements to define a healthy community and direct policy action.

An inter-related set of urban health equity indicators that capture the social determinants of health, including community assets,
and track policy decisions, can help inform efforts to promote greater urban health equity.

Adaptive management, a strategy used globally by scientists, policy makers, and civil society groups to manage
complex ecological resources, is a potential model for developing and implementing urban health equity indicators.

Urban health equity indicators are lacking and needed within cities of both the global north and south,
but universal sets of indicators may be less useful than context-specific measures accountable to local needs…..

KMC/2012/SDE
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[EQ] Health policy responses to the financial crisis in Europe

Health policy responses to the financial crisis in Europe

Philipa Mladovsky, Divya Srivastava, Jonathan Cylus, Marina Karanikolos, Tamás Evetovits, Sarah Thomson, Martin McKee

World Health Organization, on behalf of the European Observatory on Health Systems and Policies 2012

Available online PDF file [132p.] at: http://bit.ly/OjPpqD

Key messages

· Economic shocks present policy-makers with three main challenges:

o Health systems require predictable sources of revenue. Sudden interruptions to public revenue streams can make it difficult to maintain necessary levels of health care.

o Cuts to public spending on health made in response to an economic shock typically come at a time when health systems may require more, not fewer, resources – for example, to address the adverse health effects of unemployment.

o Arbitrary cuts to essential services may further destabilize the health system if they erode financial protection, equitable access to care and the quality of care provided, increasing costs in the longer term. In addition to introducing new inefficiencies, cuts across the board are unlikely to address existing inefficiencies, potentially exacerbating the fiscal constraint.

· The response to the crisis across the European Region varied across health systems. Some countries introduced no new policies, while others introduced many. Some health systems were better prepared than others due to fiscal measures they had taken before the crisis, such as accumulating financial reserves. There were many instances in which policies planned before 2008 were implemented with greater intensity or speed as they became more urgent or politically feasible in face of the crisis. There were also cases where planned reforms were slowed down or abandoned in response to the crisis.

· European Region countries employed a mix of policy tools in response to the financial crisis. Some of the policy responses were positive, suggesting that some countries have used the crisis to increase efficiency. The breadth and scope of statutory coverage was largely unaffected and in some cases benefits were expanded for low-income groups. However, some countries reduced the depth of coverage by increasing user charges for essential services, which is a cause for concern. Little was done to increase efficiency through policies to improve public health.

· Policies to secure financial sustainability in the face of the financial crisis, and to improve the health sector’s fiscal preparedness for financial crises, should be consistent with the fundamental goals of the health system.

· To risk over-simplifying, policy tools likely to promote health system goals include: risk pooling; strategic purchasing; health technology assessment; controlled investment; public health measures; price reductions for pharmaceuticals combined with rational prescribing and dispensing; shifting from inpatient to day-case or ambulatory care; integration and coordination of primary care and secondary care, and of health and social care; reducing administrative costs while maintaining capacity to manage the health system; fiscal policies to expand the public revenue base; and counter-cyclical measures, including subsidies, to protect access and financial protection, especially among poorer people and regular users of health care.

· Policy tools that risk undermining health system goals include: reducing the scope of essential services covered; reducing population coverage; increases in waiting times for essential services; user charges for essential services; and attrition of health workers caused by reductions in salaries.

· Where the short-term situation compels governments to cut public spending on health, the policy emphasis should be on cutting wisely to minimize adverse effects on health system performance, enhancing value and facilitating efficiency-enhancing reforms in the longer run.

KMC/2012/HSS
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[EQ] The quest for universal health coverage: achieving social protection for all in Mexico

The quest for universal health coverage:
achieving social protection for all in Mexico

….Mexico achieves universal health coverage in less than a decade….

Felicia Marie Knaul, Eduardo González-Pier , Octavio Gómez-Dantés, David García-Junco, Héctor Arreola-Ornelas b, Mariana Barraza-Lloréns, Rosa Sandoval, Francisco Caballero, Mauricio Hernández-Avila, Mercedes Juan, David Kershenobich, Gustavo Nigenda, Enrique Ruelas, Jaime Sepúlveda, Roberto Tapia, Guillermo Soberón, Salomón Chertorivski , Julio Frenk

The Lancet, Early Online Publication, 16 August 2012doi:10.1016/S0140-6736(12)61068-X

Full text PDF [22p.] at: http://bit.ly/NHqb9H

The Lancet: http://bit.ly/Q3cAFX

“……Mexico is reaching universal health coverage in 2012. A national health insurance programme called Seguro Popular, introduced in 2003, is providing access to a package of comprehensive health services with financial protection for more than 50 million Mexicans previously excluded from insurance. Universal coverage in Mexico is synonymous with social protection of health.

This report analyses the road to universal coverage along three dimensions of protection: against health risks, for patients through quality assurance of health care, and against the financial consequences of disease and injury. We present a conceptual discussion of the transition from labour-based social security to social protection of health, which implies access to effective health care as a universal right based on citizenship, the ethical basis of the Mexican reform. We discuss the conditions that prompted the reform, as well as its design and inception, and we describe the 9-year, evidence-driven implementation process, including updates and improvements to the original programme.

The core of the report concentrates on the effects and impacts of the reform, based on analysis of all published and publically available scientific literature and new data. Evidence indicates that Seguro Popular is improving access to health services and reducing the prevalence of catastrophic and impoverishing health expenditures, especially for the poor. Recent studies also show improvement in effective coverage.

This research then addresses persistent challenges, including the need to translate financial resources into more effective, equitable and responsive health services. A next generation of reforms will be required and these include systemic measures to complete the reorganisation of the health system by functions. The paper concludes with a discussion of the implications of the Mexican quest to achieve universal health coverage and its relevance for other low-income and middle-income countries

In a Lancet Editorial accompanying the paper, Mexico’s health reforms are described as a “remarkable feat”, with the journal pointing out that “crucially, Mexico has demonstrated how Universal health Coverage UHC, as well as being ethically the right thing to do, is the smart thing to do. Health reform, done properly, boosts economic development.” Online/Health Policy http://dx.doi.org/10.1016/S0140-6736(12)61068-X

The Lancet’s 2006 Series on Health system reform in Mexico, http://www.thelancet.com/series/health-system-reform-in-mexico
Podcast interview with Felicia Knaul and Julio Frenk
http://download.thelancet.com/flatcontentassets/audio/lancet/2012/16august.mp3

KMC/2012/HSS
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Thank you.