Health Equity: 08/17/12

Friday, August 17, 2012

[EQ] Interrogating scarcity: how to think about 'resource-scarce settings'

Interrogating scarcity: how to think about ‘resource-scarce settings’

Ted Schrecker, Bruyère Research Institute, Ottawa, Canada

Health Policy Planning (2012); August 16, 2012

Available online at: http://bit.ly/N6EEYU

“…..The idea of resource scarcity permeates health ethics and health policy analysis in various contexts. However, health ethics inquiry seldom asks—as it should—why some settings are ‘resource-scarce’ and others not. In this article I describe interrogating scarcity as a strategy for inquiry into questions of resource allocation within a single political jurisdiction and, in particular, as an approach to the issue of global health justice in an interconnected world.

I demonstrate its relevance to the situation of low- and middle-income countries (LMICs) with brief descriptions of four elements of contemporary globalization: trade agreements; the worldwide financial marketplace and capital flight; structural adjustment; imperial geopolitics and foreign policy. This demonstration involves not only health care, but also social determinants of health.

Finally, I argue that interrogating scarcity provides the basis for a new, critical approach to health policy at the interface of ethics and the social sciences, with specific reference to market fundamentalism as the value system underlying contemporary globalization…..” [author]

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

“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] Test, Learn, Adapt: Developing Public Policy with Randomised Controlled Trials

Test, Learn, Adapt: Developing Public Policy with Randomised Controlled Trials

Laura Haynes, Visiting Researcher at King’s College London

Owain Service, Deputy Director of the Behavioural Insights Team
Ben Goldacre, Research Fellow at London School of Hygiene and Tropical Medicine

Professor David Torgerson, Director of the York Trials Unit

Published by UK Cabinet Office Behavioural Insights Team – June 2012

Available online at: http://bit.ly/NGBz3Q

“……Randomised controlled trials (RCTs) are the best way of determining whether a policy is working. They are now used extensively in international development, medicine, and business to identify which policy, drug or sales method is most effective. They are also at the heart of the Behavioural Insights Team’s methodology.

However, RCTs are not routinely used to test the effectiveness of public policy interventions in the UK. We think that they should be.

What makes RCTs different from other types of evaluation is the introduction of a randomly assigned control group, which enables you to compare the effectiveness of a new intervention against what would have happened if you had changed nothing.

The introduction of a control group eliminates a whole host of biases that normally complicate the evaluation process – for example, if you introduce a new “back to work” scheme, how will you know whether those receiving the extra support might not have found a job anyway?....”

Content

Executive Summary

Introduction

Part 1 -What is an RCT and why are they important?

What is a randomised controlled trial?

The case for RCTs - debunking some myths

1.We don’t necessarily know‘what works’

2. RCTs don’t have to cost a lot of money

3. There are ethical advantages to using RCTs

4. RCTs do not have to be complicated or difficult to run

PART II - Conducting an RCT: 9 key steps

Test

Step1: Identify two or more policy interventions to compare

Step 2:Define the outcome that the policy is intended to influence

Step 3:Decide on the randomisation unit

Step 4:Determine how many units are required for robust results

Step 5: Assign each unit to one of the policy interventions using a robustly random method

Step 6: Introduce the policy interventions to the assigned groups

Learn

Step 7: Measure the results and determine the impact of the policy interventions

Adapt

Step 8: Adapt your policy intervention to reflect your findings

Step 9: Return to step 1

KMC/2012/SDE
Twitter http://twitter.com/eqpaho

Thank you.

[EQ] International shortfall inequality in life expectancy in women and in men, 1950-2010

International shortfall inequality in life expectancy in women and in men, 1950–2010

Ahmad Reza Hosseinpoor ^a, Sam Harper ^b, Jennifer H Lee ^c, John Lynch ^d, Colin Mathers ^a & Carla Abou-Zahr ^e

a. Department of Health Statistics and Information Systems, World Health Organization, avenue Appia 20, 1211 Geneva 27, Switzerland.
b. Department of Epidemiology, Biostatistics & Occupational Health, McGill University, Montreal, Canada.
c. Department of Ethics, Equity, Trade and Human Rights, World Health Organization, Geneva, Switzerland.
d. School of Population Health and Clinical Practice, University of Adelaide, Adelaide, Australia.
e. Consultant, Health Statistics and Information, Geneva, Switzerland.
Bulletin of the World Health Organization - Volume 90, Number 8, August 2012

Available online at: http://bit.ly/Sxo8DE

“………Life expectancy at birth has long been recognized as a summary measure of mortality that allows inequality levels and trends to be compared within and across societies.1 The second half of the 20th century saw large and sustained increases in life expectancy at birth throughout the world; between 1950–1955 and 2005–2010, global average life expectancy at birth rose from 48 to 70 years in women and from 45 to 65 years in men.2

However, global averages mask considerable variation across countries.1 International inequalities in life expectancy fell sharply between 1950 and 1990 primarily because of rapid decreases in mortality in developing countries.3,4 These improvements were associated with increased access to safe water and sanitation, childhood immunization and improved public health infrastructure, as well as improved child and maternal nutrition and declining fertility.3

Life expectancy trends closely mirror reductions in mortality among male and female children less than 5 years of age, which is hardly surprising given that life expectancy estimates are strongly influenced by under-five mortality.5 On the other hand, the last decade of the 20th century was a period of stagnation, and inequalities in overall life expectancy increased largely because of the decline in life expectancy in sub-Saharan Africa caused by the epidemic of human immunodeficiency virus (HIV) infection and acquired immunodeficiency syndrome (AIDS).6,7 Consequently, this region is key to understanding between-country health inequality in the late 20th century.

Research on international inequalities in life expectancy has traditionally focused on overall mortality,3,6,8 but there are well known gender differences in mortality trends across countries,9–11 and within-country inequalities in life expectancy also vary by gender.12–14 This suggests that the pattern of international inequality in life expectancy could differ by gender, but no known studies have compared international trends in inequalities in life expectancy separately for women and men. We used a “shortfall” measure of inequality, a method that should be distinguished from measures of total inequality8,15 and akin to the notion of “shortfall” inequality discussed by Sen and others.16–19

The shortfall method compares life expectancy in a given country with some maximum or selected norm to identify inequality. For example, in the assessment of gender inequality in life expectancy, shortfalls in longevity for males and females have been compared with their respective biological maxima.20 This differs from traditional measures of inequality that use the population average rate as the reference value.

The aims of this study are to assess international shortfall inequalities in life expectancy among women and men and to quantify how much specific geographic regions and country income groups contribute to them…..”

KMC/2012/HSD
Twitter http://twitter.com/eqpaho

Thank you.