Friday, December 7, 2007

[EQ] The burden and costs of chronic diseases in low-income and middle-income countries

The Lancet Series, Chronic Diseases

 

The burden and costs of chronic diseases in low-income and middle-income countries


Dele O Abegunde, Department of Chronic Diseases and Health Promotion, WHO
Colin D Mathers, Department of Measurement and Health Information Systems, WHO
Taghreed Adam, Monica Ortegon, Department of Health Systems Financing, WHO

Kathleen Strong, Department of Chronic Diseases and Health Promotion, World Health Organization, Geneva, Switzerland

The Lancet,  Volume 370, Number 9603, 8 December 2007

 

Available online at: http://www.thelancet.com/journals/lancet/article/PIIS0140673607616961/fulltext

[Free subscription required]

 

“…..This paper estimates the disease burden and loss of economic output associated with chronic diseases—mainly cardiovascular diseases, cancer, chronic respiratory diseases, and diabetes—in 23 selected countries which account for around 80% of the total burden of chronic disease mortality in developing countries.

 

 In these 23 selected low-income and middle-income countries, chronic diseases were responsible for 50% of the total disease burden in 2005. For 15 of the selected countries where death registration data are available, the estimated age-standardised death rates for chronic diseases in 2005 were 54% higher for men and 86% higher for women than those for men and women in high-income countries.

 

If nothing is done to reduce the risk of chronic diseases, an estimated US$84 billion of economic production will be lost from heart disease, stroke, and diabetes alone in these 23 countries between 2006 and 2015. Achievement of a global goal for chronic disease prevention and control—an additional 2% yearly reduction in chronic disease death rates over the next 10 years—would avert 24 million deaths in these countries, and would save an estimated $8 billion, which is almost 10% of the projected loss in national income over the next 10 years…..”

 

Scaling up interventions for chronic disease prevention: the evidence

 

Thomas A Gaziano,  Harvard Medical School, Boston, MA, USA
Gauden Galea , WHO, Geneva, Switzerland
K Srinath Reddy,  Public Health Foundation of India, New Delhi, India
The Lancet,  Volume 370, Number 9603, 8 December 2007

 

Available online at: http://www.thelancet.com/journals/lancet/article/PIIS0140673607616973/fulltext

[Free subscription required]

 

“…….Interventions to prevent morbidity and mortality from chronic diseases need to be cost effective and financially feasible in countries of low or middle income before recommendations for their scale-up can be made. We review the cost-effectiveness estimates on policy interventions (both population-based and personal) that are likely to lead to substantial reductions in chronic diseases—in particular, cardiovascular disease, diabetes, cancer, and chronic respiratory disease. We reviewed data from regions of low, middle, and high income, where available, as well as the evidence for making policy interventions where available effectiveness or cost-effectiveness data are lacking.

 

The results confirm that the cost-effectiveness evidence for tobacco control measures, salt reduction, and the use of multidrug regimens for patients with high-risk cardiovascular disease strongly supports the feasibility of the scale-up of these interventions. Further assessment to determine the best national policies to achieve reductions in consumption of saturated and trans fat—chemically hydrogenated plant oils—could eventually lead to substantial reductions in cardiovascular disease.

 

Finally, we review evidence for policy implementation in areas of strong causality or highly probable benefit—eg, changes in personal interventions for diabetes reduction, restructuring of health systems, and wider policy decisions…..”

 

 

 

*      *      *     * 

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/ IKM Area] 

“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”.

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[EQ] Patients' charters and health responsibilities

Patients’ charters and health responsibilities

 

Harald Schmidt, assistant director, Nuffield Council on Bioethics, London UK
BMJ 2007;335(7631):1187 - 8 December, 2007 - doi:10.1136/bmj.39387.393160.AD

 

 

“…We all have responsibility for our health, the health of others, and to the organisations that provide health care. But, as Harald Schmidt describes, specifying and formalising these duties can create ethical problems …”

 

Avaolable online at: http://www.bmj.com/cgi/content/full/335/7631/1187

 

“….The British Medical Association BMA recently called for a charter setting out the responsibilities patients have within the National Health Service and what patients can expect from the NHS.1 The proposal raises questions about the scope, specificity, and status of such a charter. Should it be legally binding or simply set out aspirations? How many and what kind of responsibilities should be included? I examine how initiatives in Scotland, Germany, and the United States have dealt with these questions and look at the ethical tensions raised. …”

 

“…….With rising healthcare costs, higher burdens of chronic diseases, and increasing evidence about the contribution of genetic and behavioural factors to disease, the issue of personal responsibility for health is here to stay. Moreover, the health responsibility debate is not only for the future. There have been concerns about the decision of some primary care trusts to require, for example, patients to lose weight or stop smoking before routine surgery.21 A clear policy is needed that engages in detail with the highly complex issues raised by health responsibilities. A health responsibility charter within an NHS constitution would be a unique opportunity to clarify  which types of responsibilities are compatible with the ethos of the NHS, and which ones are not……”

 

A rational way forward for the NHS in England
A discussion paper outlining an alternative approach to health reform

British Medical Association, BMA , London, May 2007

Available online as PDF file [82p.] at: http://www.bma.org.uk/ap.nsf/AttachmentsByTitle/PDFrationalwayforward/$FILE/rationalwayforward.pdf?OpenElement&Highlight=2,rational,way,forward,for,NHS,England .

 

Content:

Introduction

Overview and recommendations

A. Where and why is the current reform programme going wrong?

B. Outlining our alternative approach to health service reform

Appendix 1: Recommendations

Appendix 2: The core values of the NHS

Appendix 3: The aims of health and healthcare

Appendix 4: Debates that are central to the formation of coherent and effective reform: issues arising from the evidence

Appendix 5: A new framework for clinical management

Appendix 6: A critique of markets in healthcare

A glossary of terms

References

 

 

 

*      *      *     * 

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/ IKM Area] 

“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”.

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PAHO/WHO Website: http://www.paho.org/

EQUITY List - Archives - Join/remove: http://listserv.paho.org/Archives/equidad.html

 

 

 

    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 notify us immediately by email to infosec@paho.org, and please dispose of and delete this transmission. Thank you.  

[EQ] Nuffield Trust report - Health Policy Futures

 

ENGAGING WITH CARE

A VISION FOR THE HEALTH AND CARE WORKFORCE OF ENGLAND

 

Sandra Dawson, Zoƫ Slote Morris, Will Erickson, Graham Lister, Beth Altringer, Pam Garside, Marian Craig
The Nuffield Trust, UK 2007

 

Available online as PDF file [90p] at: http://www.nuffieldtrust.org.uk/ecomm/files/Engaging_with_Care.pdf

 

Summary PDF [6p.] at: http://www.nuffieldtrust.org.uk/uploadedFiles/EWC-Summary.pdf

 

“……Health and care needs in England will change dramatically over the next 15 years, but the people we recruit and train and the facilities we build now will still be part of the landscape in 15 years’ time. The decisions we take now will affect health and care in 2022. While it is impossible to forecast with precision, we can imagine possible futures and plan policy directions accordingly.

 

Several factors point toward a looming crisis in the provision of care, including:

• an ageing population

• increasing chronic disease

• greater expectations for health and wellbeing

• increasing demand for care

• greater strains on public finance

• an anticipated shortfall in informal carers

• a possible decline in community support and ‘volunteerism’

• conflicting views and increasing anxiety about emphasising self-care

• problems of recruitment and motivation of formal employed carers.

This Nuffield Trust report, part of the Health Policy Futures series, explores the development of three possible scenarios of the English health and care system in 2022. Each scenario is associated with a different type of engagement with health and care and is shaped by different sets of policies.

The engaged consumer in a health system shaped by transactions between paid and unpaid participants.

The engaged worker in a health system shaped by leading engagement with those who provide care, including informal and self-carers, as well as paid employees.

The engaged citizen in a health system which minimises the causes of illness and maximises wellbeing through fully engaging citizens and their communities.

 

The scenarios are not mutually exclusive. The main issue is not which of these scenarios is most desirable, but how to achieve an appropriate balance between diverse imperatives. The authors report that several common assumptions emerged:

• change in the health and care system must continue, but at a pace that allows workforces to be engaged

• To be effective, system change must be accompanied by cultural change, so the engagement of workforces in the design and
   implementation of reform is essential

• policy must be refocused on the improvement of health and wellbeing

• special measures will be needed to address disadvantage and social isolation

• the dominant model of health and care should be recognised as long-term care

• leadership will be required at every level in the system and in the community.


The authors highlight conclusions for action for policymakers, health and care leaders, educators, workers and members of the public.

Four key messages are highlighted:

• individuals, families and communities – particularly those who are disadvantaged – need to feel empowered and supported
   to take control of their health, wellbeing and care

• political central control must be disengaged from local solutions and local governance

• system change must be supported by changes in education and training

• a basic insurance package for the 21st century must be defined….”

 

 

*      *      *     * 

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/ IKM Area] 

“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: http://www.paho.org/

EQUITY List - Archives - Join/remove: http://listserv.paho.org/Archives/equidad.html

 

 

    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 notify us immediately by email to infosec@paho.org, and please dispose of and delete this transmission. Thank you.