Tuesday, October 13, 2009

[EQ] Cities and public health crises

Cities and public health crises

Report of the international consultation

29-30 October 2008 - Lyon, France

Available online as PDF file at: http://www.who.int/ihr/lyon/FRWHO_HSE_IHR_LYON_2009.5.pdf

"…..The International Health Regulations require countries to strengthen their capacity for surveillance of and response to disease outbreaks and other public health emergencies both at national level and at state or city level too. That is why the World Health Organization (WHO), with the support of LyonbiopĂ´le, jointly organized an international technical consultation on "Cities and Public Health Crises" in Lyon, France, on 29-30 October 2008. Some 70 health specialists and others experienced in responding to disease outbreaks in cities took part.

 

In 1900, just 13% of the world's population lived in urban areas.
By 2008, half of the world's population was living in urban settings.
By 2025, 70% of the world's population will be urban.

Cities have a number of vulnerabilities such as unhealthy slums, crime and violence, and can even be targets for terrorist attacks. Further, since a city contains so many people, infectious diseases will be communicated faster and to more people there than in rural areas. Many cities have large international airports and sea-ports, making them prone to the import of diseases, while unsanitary areas within a city may be breeding grounds for epidemic-prone diseases such as cholera and other diarrhoeal diseases. People living on the street may become reservoirs of infections such as drug-resistant tuberculosis, while flocks of poultry and pigeons provide convenient hosts for emerging infections such as avian influenza viruses.

 

Coordinating the response

Crisis management in a city must be coordinated outside between the municipal and national or state authorities and inside between the services that provide health care and those that provide emergency response, as well as with public amenities such as transport services, airport and port authorities, tourism, industry, education, commerce, and the media.

 

A framework for collaboration between national and local authorities in times of crisis must be developed in advance to avoid confusion.

Maintaining water supply, sanitation and waste management is crucial to keep people in good health so if the usual services cannot be maintained alternatives must rapidly be provided. Many city-dwellers rely on public transport to get to work and buy food. Also, to avoid major financial losses, city authorities and company owners will need to keep businesses running during an emergency. Solutions must be found in advance to enable, for instance, employees to work from home.

Plans should also be ready to mobilize medical staff from other places to provide health care in designated facilities at a time of crisis. Last but not least, legal issues – such as quarantining infected persons or sharing a patient's data with outbreak investigators – are best resolved before a crisis occurs….."

 

Content:

Executive summary

1 - Introduction


2 - Background

The growth of cities

The vulnerability of cities

Slums

Crime and violence Natural disasters

Infectious diseases in cities

The speed of infection

Imported infections

Foodborne diseases

Infections that originate in the city

Nuclear and chemical accidents

The International Health Regulations

 

3 - Coordinating the response to public health crises in cities

Coordinating the stakeholders

Crisis management

Identifying stakeholders

Scenario modelling

Ensuring consistency

National and city responsibilities

Political interests

Business interests Informed decision-makers

Managing an evolving situation

Coordinating resources

Maintaining city services

Public amenities

Public services

Ensuring business continuity

Food supply

Small and medium enterprises

Public health in business continuity courses

Preparing for the worst

Existing systems for coordination

Legal issues

Emergency drills

Effectiveness of interventions

4 - Managing the response to public health crises in cities

Contact-tracing

Unknown contacts

Databases

Contacts with no address

Case management

Treating an unknown disease Diagnostic services

The surge of patients

Non-standard treatments

Isolation and quarantine

Limiting disease spread in hospitals

Temporary hospitals

Self-quarantine

Exodus

Stocks of medical equipment and supplies

Health workers

Shortage of health workers

Employment conditions

Accommodation for staff

Burial of the dead

Mapping the emergency

Travellers and non-residents

Locating and accommodating non-residents

Stranded passengers

Screening

The homeless

Human rights

Security for the public health team

The psychological state of survivors

5 - Communicating in a public health crisis

WHO's principles for outbreak communication

Avoiding mixed messages

Consistent messages

Crisis communication training

Regular news briefings

Setting an example

Communicating with subcultures

and immigrant groups

Convincing the educated

Communicating in an evolving situation

Changes in policy

Science-based information

Statistics

Respect for people's concerns

Media relations

6 - Conclusion

 


*      *     *

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]

"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] Measuring value for money in healthcare: concepts and tools

Measuring value for money in healthcare: concepts and tools

Peter C Smith

Centre for Health Economics

University of York - September 20, 2009

Available online at: http://www.health.org.uk/publications/research_reports/value_for_money.html

PDF: http://www.health.org.uk/document.rm?id=1381


“…..
The concept of value for money (VfM) has been central to health policy and the delivery of healthcare for some time. In its abstract form, the concept of VfM is straightforward: it represents the ratio of some measure of valued health system outputs to the associated expenditure, and few would argue that its pursuit is not a worthy goal.

 

The main reasons for an interest in VfM relate to accountability: to reassure payers, in particular taxpayers, that their money is being spent wisely, and to reassure patients that their claims on the health system are being treated fairly and consistently.

 

1.1 In practice, the measurement of VfM is challenging and gives rise to some important methodological questions. The main aim is to offer an understanding of how resources are successfully transformed into valued health system outputs. But there are several stages to that transformation, each of which can be measured with different degrees of accuracy and ease. The result has been a profusion of partial indicators of VfM, but a relative dearth of definitive measures that capture the whole transformation process in the form of a cost-effectiveness measure.

 

1.2 The two fundamental economic concepts underlying VfM are allocative efficiency and technical efficiency.

 

1.3 In undertaking any VfM analysis, it is essential first to decide on the nature of the entity under scrutiny. At one extreme this might be the whole health system. At the other extreme, it might be the treatment of an individual patient.

 

1.4 Another fundamental decision is whether to seek out a comprehensive measure of the costeffectiveness of the entire entity or to rely on partial indicators of some aspects of VfM.

 

In the latter case, incompleteness can take two forms: omission of some aspects of the transformation from resources to valued outcomes (for example, no health outcome data), or omission of some of some of the functions of the entity (for example, analysis of only the inpatient activities of a hospital).

 

1.5 There have been numerous efforts to implement VfM measurement schemes. These include whole-system productivity estimates, as attempted by the World Health Organization (WHO) in the World health report (WHR) 2000 and by the Office for National Statistics (ONS) in UK trends over time. These comprehensive, whole-system measures are experimental. More practical approaches have offered useful but incomplete indicators of VfM. All efforts have encountered severe methodological challenges and lack of data in key domains….”

Contents


Summary

1. Introduction

1.1. Why is VfM important?

1.2. What is value for money?

1.2.1. Allocative efficiency: guiding purchasing decisions

1.2.2. Technical efficiency: operational performance assessment

1.3. What is the unit of analysis?

1.4. Comprehensive or partial VfM measures?

1.5 Some examples of VfM performance measures

2. What are the components of VfM?

2.1. What is valued?

2.1.1. Health gain

2.1.2. The patient experience

2.1.3. Inequalities

2.1.4. Externalities and broader economic outcomes

2.1.5. Outputs: counting activity and processes

2.2. Valuing system outputs

2.3. What are the inputs?

2.4. Environmental constraints

2.5. Short run or long run?

3. Measuring VfM

3.1. Adjusting for environmental constraints

3.2. Analytic models of VfM

3.2.1. Statistical methods

3.2.2. Descriptive methods

4. Conclusions

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/ KMC 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

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