Health care is central to sustainable development, but it is underfunded in many developing countries such as Nigeria. This study empirically examined gender variations and inequity in health care financing in Southeast Nigeria. To decompose the Gini coefficient and analyze inequity by gender and differences in health care financing among states in the region, Dagum's approach for decomposition of the Gini coefficient is used. Empirical results showed that gender inequity exists in health care financing in Southeast Nigeria. In addition, variations in health care financing inequity among states in the Southeast region were found. Based on the foregoing, the study recommends that when implementing health care financing reforms, different population groups be covered in order to achieve the broader equity and effectiveness goals. Furthermore, governments in various states should step up efforts to assist disadvantaged and oppressed communities, such as poor indigenous people, in terms of health care utilization, which could reduce the health care financing burden.
The National Health Service was established in the United Kingdom in 1948 as a universal, comprehensive service free at the point of delivery, which is publicly provided, funded, and accountable. Market incrementalism in England has eroded this system over three decades. The recently enacted Health and Care Act will erode it further. This article first explains briefly how legislation and policy initiatives in 1990, 2003, and 2012 furthered development of the market and private provision of health services, and then describes the main structural changes in the new Act and their implications. England is now moving decisively toward a marketized, two-tier, mixed-funding system with several similarities to the United States.
England's National Health Service (NHS) is in the process of major reform as old institutional structures based around an internal "market" are being replaced with integrated care systems. The changes represent a significant shift in ethos away from commercialisation to collaboration between health providers. But the way that these policies unfold will depend on the context within which they are implemented, and three decades of neoliberal reforms have left their mark on the structure of the health system. This paper shows how a powerful, politically-connected financialised private sector has evolved alongside a weakened public system, depleted further by the pandemic. While the share of overall public health spending reaching the private sector has not increased greatly over the past decade, private financial investors are strongly embedded in some segments of health delivery, particularly mental health services where shareholder returns are boosted by financial engineering. The boundaries between private and public are increasingly blurred with the NHS treating private patients and self-payment for health services is increasingly normalised. Rather than traditional privatisation, the health system is facing a more subtle and pernicious erosion of public services across different dimensions which seems likely to continue despite the new reforms.
The development of COVID-19 vaccines was a landmark in the current efforts to contain the global pandemic caused by the novel SARS-CoV-2. Consequently, vaccine rollout and inoculation campaigns continue to progress steadily across the globe. However, "skewed" rollout, or the inequitable or delayed access to the vaccines encountered particularly by low-income countries in Africa, remains a source of great concern. This may negatively affect the continent and could lead to increased transmission, travel restrictions, further economic disruptions, and increased morbidity and mortality. Ultimately, these negative consequences could directly or indirectly hamper global efforts to defeat the pandemic. Access to COVID-19 vaccines is a global priority and provides a source of hope to bring the pandemic under control. High-income nations, national governments, donor agencies, and other relevant stakeholders must support the World Health Organization's COVAX initiative to ensure fair, rapid and equitable distribution of the vaccines to countries, irrespective of income level. This effort will rapidly bring the pandemic under control and impact the recovery of the global economy. Low-income nations in Africa must significantly invest in research, health care, vaccines, and drug development and must remain proactive in preparing against future pandemics. This review examines the rollout of the COVID-19 vaccines with a focus on Africa.
The objective of this article is to assess the dominant global economic system and the resulting power relations from the perspective of the strategies used worldwide against the SARS-CoV-2 pandemic. The predominantly biomedical approach has not sufficiently taken into account the actual dimension of COVID-19 as a syndemic. While the much longer-term pandemic caused by the neoliberalism virus has not been systematically considered by public and global health scholars in the context of COVID-19, it exhibits essential characteristics of an infectious pathogen, and the symptoms can be described and detected according to biomedical criteria. Even more, the severity of leading symptoms of neoliberalism such as growing inequities calls for immunization campaigns and ultimately herd immunity from viral neoliberalism. However, achieving worldwide immunity would require an anti-neoliberal vaccine, which is extremely challenging to develop vis-à-vis the power relations in global health.
The factors impacting life expectancy (LE) are important to a country as LE reflects the essential quality of its population. Previous studies showed that other than economic factors, health status and resources (HSR) and sociodemographic (SD) also affect LE. This area has not been previously studied in Bahrain, especially in the past five decades. Hence, this study aims to develop an explanatory model for HSR, macroeconomic (ME), and SD factors on LE in Bahrain. The research was a retrospective, time-series design that collected the annual published data on SD, ME, HSR, and LE in Bahrain's population from 1971 to 2020. The data were analyzed using the partial least squares-structural equation modeling (PLS-SEM) method. The result shows that ME (0.463, P < .001) and HSR (0.595, P < .001) have significant direct effects on LE. ME has an indirect effect (0.488, P < .001) on LE via SD and HSR, and SD has an indirect effect (0.496, P < .001) on LE through HSR. During the socioeconomic downturn, the health resources provision should not be reduced as it directly affects LE. An integrated policy addressing socioeconomic and health-related factors could protect the future of Bahrain's population health outcomes.
The International Journal of Health Services was established more than half a century ago to provide a forum for the analysis of those services that have as an explicit function the prevention of disease and promotion of health, understanding health (as the World Health Organization’s Constitution does) “as a state of complete physical, mental, and social well-being and not merely the absence of disease or infirmity.” This understanding of health includes quality of life and the biological, psychological, and social well-being of the individual and of the population: health is both an individual and a collective phenomenon. Several people who were instrumental in the development of that WHO definition of health, such as Karl Evang (co-founder of the WHO and previously Director of the Norwegian Directorate for Health) and John Brotherston (who had been Professor of Public Health and Social Medicine in Edinburgh and, later, Chief Medical Officer of Scotland), encouraged the establishment of this journal. I had been a student of Brotherston in the early 1960 s at the Usher Institute in Edinburgh and had the pleasure to know Evang when he visited what was then called the John Hopkins School of Hygiene and Public Health. I consulted with them, and they were both very supportive of the Journal’s creation. The key person in the establishment of the Journal, however, was Professor Kerr L. White, a Canadian who had played an important role in the founding of the National Health Program in Canada. Hopkins invited him to establish the Department of Medical Care and Hospitals, and Kerr invited me to join the department when I finished my studies in Scotland. One of his first requests of me when I joined the faculty was to start the Journal, a proposal I had made previously. Many others added their voices to support the need for the Journal. From the beginning, the Journal had the vocation of learning about reality in order to change it—that is, to improve it. The period in which the journal was founded, the early 1970 s, was a moment of great creativity and inquiry in academic institutions in many parts of the world. It had followed the 1960 s, known for their questioning of the excessive conservative values and policies carried out in the 1950 s. It was in this context that scholars from many parts of the world agreed on establishing the Journal with the title International Journal of Health Services. The word “International” signaled the desire to have a broad plurality of positions between, among, and within countries, providing a forum for debate on the major issues of the moment. An Editorial Board with approximately 30 well-known and highly respected scholars from many countries, assisted by an equally international body of Editorial Consultants who constituted the axis of an extensive network of reviewers, guaranteed—and continues to guarantee—the excellence and scientific rigor of the articles and contributions to the Journal. Their function was to assist the Editor-in-Chief and Associate Editors in the Journal’s leadership. During this half a century, the Editorial Board and Editorial Consultants have changed, but a special note of thanks is owed to a minority who have volunteered to serve throughout the whole period. Among them was Giovanni Berlinguer from Italy, who died a few years ago. We miss him and are grateful for his endurance, generosity, and commitment to the Journal. The International Journal of Health Services has always been independent and not tied to any association or institute. A note of appreciation, however, needs to be made to the International Association of Health Policy, the largest international association among professionals and scholars working on health policy, also established in that period, who saw a great need for the Journal and helped in its promotion, particularly in Latin America. The Journal was owned initially by Baywood Publishers, which was later acquired by Sage, the largest academic publisher in the United States. The sponsor has always been the School of Public Health of the Johns Hopkins University. As a member of its faculty, I was the journal’s Founding Editor and have been its Editor in Chief from the beginning. The leadership of the Journal has included an excellent group of Associate Editors (recently, David Himmelstein of the City University of New York and Harvard University in the United States, Carles Muntaner of the University of Toronto in Canada, and Stephanie Woolhandler of the City University of New York and Harvard University in the I. Letter from the Editor
What can national governments do to improve their capacity for well-being? While increasing public medical care expenditures can facilitate increased well-being in developing nations, cross-national research often finds that public medical care expenditures have no effect on indicators of well-being, such as child mortality. This ineffective public spending could be due to a lack of governance; however, this relationship is understudied in the cross-national literature. Using 2-way fixed and generalized least squares random effects models for a sample of 74 low- and middle-income nations from 1996 to 2012, I examine how the interaction among 5 measures of national governance and public medical care expenditures impact child mortality. The findings reveal the importance of governance in determining the effectiveness of public medical care expenditures. Both public medical care expenditures and governance improvements are essential to reduce child mortality.
The impact of public health measures on the coronavirus-2019 pandemic was analyzed by comparing mandatory versus voluntary nonpharmaceutical interventions between 2 comparable European countries and among 3 U.S. states. Using an ecological retrospective cohort study design, we examine differences in mortality, economic impact, and equity. Compared to voluntary policies, mandatory shelter-in-place policies were associated with a 3- to 5-fold lower population-adjusted mortality in the U.S. model and between 11- to 12-fold lower in the European one. Voluntary shelter-in-place measures were associated with overall increased mortality cost, as measured by value of a statistical life; somewhat greater decreases in gross domestic product; and substantial negative impacts on minority communities, who experienced markedly increased mortality rates (the percentage of minority deaths was 2.3 and 4 times greater in the U.S. model and 14.5 times higher in the European one) and mortality cost (2.7- and 4.5-fold higher in the U.S. model and 11.1-fold higher in the European one). We conclude that voluntary policies are less effective than mandatory ones, based on historical precedent and the current analysis. Negative effects on health equity mirrored the increased mortality outcomes of voluntary policies, and there was no apparent economic benefit associated with voluntary measures.
Precarious employment as a determinant of health remains on the rise in Europe, in contrast to the European Pillar of Social Rights. Research in epidemiology, public health, and occupational health research has debated the health impacts of precarious employment. A number of studies have concluded that precarious employment contributes to poor health. More recent research has focused on the contextual influences of the association between precarious employment and health. Accordingly, we argue that the welfare state and the specific institutional arrangements on the national level determine and mediate the extent of the association between precarious employment and health. This research synthesis: (a) debates explanations for the rise of precarious employment in Europe, (b) illustrates how precarious employment has risen in Europe since the 1980s, (c) indicates empirical findings of the association between precarious employment and health in Europe, (d) discusses how research explains between-country differences of the association between precarious employment and health, and (e) presents empirical findings on the contextual determinants of the association between precarious employment and health in Europe.
In March 2022, the New Democratic Party (NDP), Canada's social democratic party, and the centrist Liberal government signed a supply and confidence agreement. In return for the NDP agreeing to vote with the government on all crucial issues until June 2025, the Liberals pledged to bring in both pharmacare and dental care programs. Pharmacare, universal public insurance coverage for prescription drugs, had been promised for more than 50 years but never implemented, while public dental care was an almost completely neglected issue. This article explains the long genesis of pharmacare, the need for public dental care, and the political circumstances that led to the agreement. However, at this point, details about both plans are largely absent. As a result, how well those plans will serve the needs of Canadians is yet to be determined.
Economic recession has dire consequences on overall health. None have explored the impact of economic crisis (EC) on infective endocarditis (IE) mortality. We conducted a retrospective, nationwide, temporal trend study analyzing mortality trends by age, sex, and adverse outcomes in patients diagnosed with IE in Spain from 1997 to 2014. Data were divided into two subperiods: pre-EC (January 1997-August 2008) and post-EC (September 2008-December 2014). A total of 25 952 patients presented with IE. The incidence increased from 301.4 to 365.1 per 10 000 000 habitants, and the mortality rate rose from 24.3% to 28.4%. Those aged >75 years experienced more adverse outcomes. Complications due to sepsis, shock, acute kidney injury requiring dialysis, and heart failure increased after the EC onset, and expenditures soared to €16 216. Expenditure per community was related to mortality (P < .001). The EC resulted as an independent predictor for mortality (hazard ratio 1.06; 95% confidence interval 1.01-1.11). Incidence and mortality rate in patients with IE after the onset of the EC have increased as a result of rising adverse outcomes despite an overall increased investment.
The commercial determinants of health (CDoH) describe the adverse health effects associated with for-profit actors and their actions. Despite efforts to advance the definition, conceptualization, and empirical analyses of CDoH, the term's practical application to mitigate these effects requires the capacity to measure the influences of specific components of CDoH and the cumulative impacts of CDoH on the health and well-being of specific populations. Building on the Global Burden of Disease Study, we begin by conceptualizing CDoH as risk factor exposures that span agency and structural influences. We identify 6 components of these influences and propose an initial set of indicators and datasets to rank exposures as high, medium, or low. These are combined into a commercial determinants of health index (CDoHi) and illustrated by 3 countries. Although now a proof of concept, comparative analysis of CDoH exposures by population, over time and space, and their associated health outcomes will become possible with further development of indicators and datasets. Expansion of the CDoHi and application to varied populations groups will enable finer targeting of interventions to reduce health harms. The measurement of improvements to health and wellness from such interventions will, in turn, inform overall efforts to address the CDoH.
Existing frameworks seek to elucidate the social, political, and commercial determinants of health in order to inform practice, policy, and research that can improve health and reduce health inequities. Each approach has widened the scope of public health practice and research and identified new partners and targets for intervention. But as the public health crises of the past decade have shown, these frameworks have not yet yielded insights that have enabled the public health profession and movement to prevent or overcome dominant threats to global health and health equity. This report explores the value of an integrated framework that combines insights from previous scholarship and practice using the social, political, and commercial determinants of health. It proposes the questions such an integration would need to answer and suggests processes and tasks that could lead to the creation of a blended framework.
Every year, 8 million small arms and 15 billion rounds of ammunition are manufactured in the world. Every day, 700 people worldwide (more than 2.5 million in a decade) die from firearms such as pistols, shotguns, assault rifles, or machine guns. Between 1968 and 2011, there were 1.4 million gun-related deaths in the United States (including suicides, homicides, and accidents) compared with 1.2 million North American deaths in all wars. This article looks at the historic and cultural context that has generated and shaped the U.S.'s "gun culture" and prevailing mentality regarding the right to bear arms, critiquing the vision that such a pro-arms mentality is an intrinsic and unchangeable element of U.S. culture. It exposes the neoliberal roots of the current U.S. gun violence epidemic, asking the question of "why?" in order to move toward an alternative conventional wisdom and overcome this urgent public health crisis in the U.S. and elsewhere.
Korean cosmetics sales workers in department stores face harmful working environments, including limited restroom access, working long hours in a standing position, and customer violence. This study investigated health disparities between cosmetics saleswomen and the general population of working women in South Korea. We assessed the prevalence of health indicators, including physician-diagnosed disease, using a cross-sectional survey of 860 Korean cosmetics saleswomen in September 2018. Health indicators of cosmetics saleswomen were compared to those of general working women from the nationally representative datasets (e.g., National Health Insurance Service-National Sample Cohort). We estimated age-standardized prevalence ratios (SPRs) for health outcomes, including physical, mental, and health-related behavioral conditions. Cosmetics saleswomen were more likely to be diagnosed or treated for physical and mental conditions (e.g., cystitis SPR: 4.03, 95% confidence interval [CI]: 3.48-4.65; plantar fasciitis SPR: 23.48, 95% CI: 18.12-29.93; varicose vein SPR: 38.41, 95% CI: 32.18-45.49; and depression SPR: 11.18, 95% CI: 8.53-14.40) compared to general working women. Prevalence of smoking and hazardous alcohol consumption was also higher among cosmetics saleswomen than those of general women workers. Given our findings, further research is needed to identify work-related risk factors that could deteriorate cosmetic sales workers' health in South Korea.
Health care is central to sustainable development, but it is underfunded in many developing countries such as Nigeria. This study empirically examined gender variations and inequity in health care financing in Southeast Nigeria. To decompose the Gini coefficient and analyze inequity by gender and differences in health care financing among states in the region, Dagum's approach for decomposition of the Gini coefficient is used. Empirical results showed that gender inequity exists in health care financing in Southeast Nigeria. In addition, variations in health care financing inequity among states in the Southeast region were found. Based on the foregoing, the study recommends that when implementing health care financing reforms, different population groups be covered in order to achieve the broader equity and effectiveness goals. Furthermore, governments in various states should step up efforts to assist disadvantaged and oppressed communities, such as poor indigenous people, in terms of health care utilization, which could reduce the health care financing burden.
In this paper, we study the incidence of COVID-19 and the associated fatality with altitude using high frequency, district level data from India. To understand the implications of the nationwide lockdown after the outbreak, we use data for about four months- two from the lockdown period starting from March 25 till May 31, 2020 and about two months after unlocking was initiated (June 1-July 26, 2020). The multivariate regression result indicates slower growth in average rate of infection during the lockdown period in hilly regions, the gains of which attenuated after the unlocking was initiated. Despite these early gains, the rate of fatalities is significantly higher during the lockdown period in comparison to the plains. The findings remain robust to multiple alternative specifications and methods including one that accounts for confounding possibilities via unobservable and provides consistent estimates of bias adjusted treatment effects. The evidence supports the need for provisioning of public health services and infrastructure upgradation, especially maintenance of adequate stock of life support devices, in high altitude regions. It also underscores the necessity for strengthening and revising the existing Hill Areas Development Programme and integrating important aspects of public health as part of this policy.
This article analyzes the relationship between various forms of intimate partner violence (IPV) and unmet need for family planning (FP) in South Asia. The data were obtained from the latest wave of the Demographic and Health Survey in Afghanistan, India, Maldives, Nepal, and Pakistan. Binary logistic regression analyses show mixed results, with a significant association between at least one type of IPV and unmet need for FP in all countries under study, except Maldives. There were also contrasting findings on the IPV–unmet need nexus, with a positive sign in some but negative sign in others. Women who experienced physical violence were associated with a higher odds of having an unmet need in Pakistan, but the opposite was true in Afghanistan and Nepal. The odds of having an unmet need were higher among Indian women who experienced IPV (sexual and emotional). In Afghanistan, women who experienced IPV (physical and emotional) have lower odds of having an unmet need. However, the interaction analysis of IPV (physical and sexual) and partners’ controlling behavior showed a positive association with unmet need. Policymakers need to develop policies and strategies to prevent IPV and reduce unmet need for FP, in line with the Sustainable Development Goals.
