Blog Home

Archive for the 'Global Health' Category




Health Affairs Web First: Assessing Health And Health Care Perceptions In sub-Saharan Africa


February 27th, 2015

A large share of Western aid to developing countries goes to sub-Saharan Africa, a region where spending on health care is around $100 per person in 2005 price-adjusted terms. This region, which experienced large gains in life expectancy in the years following World War II, suffered health-related setbacks in the closing years of the twentieth century as a result of the HIV/AIDS epidemic.

The authors of a February 25 Health Affairs Web First study used data from the Gallup Organization’s 2012 World Poll to investigate health and health care perceptions in sub-Saharan Africa compared to other regions of the world. The poll found that sub-Saharan Africans’ overall evaluation of their well-being was lower than that of any other population in the world. Additionally, only 42.4 percent of residents in that region were satisfied with the availability of high-quality health care in their community, also the lowest level in the world. Even so, when sub-Saharan Africans were asked to name the issues that should be the highest priorities for their government, health care was not seen as the most pressing issue.

Read the rest of this entry »

Vaccinating Against Iron-Deficiency Anemia: A New Technology For Maternal And Child Health


February 19th, 2015

When we think of killer diseases of global health importance, iron-deficiency anemia (IDA) is not something that immediately comes to mind. Yet the December 2014 publication of leading causes of death by the Global Burden of Disease Study 2013 reveals that IDA kills an estimated 183,400 people annually. To put this number in perspective, in the year 2013, IDA killed more people worldwide than ovarian cancer. In terms of years of life lost, IDA ranked higher than cervical cancer.

The fact that we compared IDA to two other well-known threats to the health of women is no accident. Because women of child-bearing age have low underlying iron reserves, they are at great risk of becoming deficient in iron and progressing to IDA. Pregnant women are especially vulnerable to IDA because of the high iron demands of the growing fetus. Growing children represent another important group who develop IDA.

Read the rest of this entry »

What Ebola Teaches Us About Public Health In America


February 9th, 2015

Editor’s note: This post is part of a series stemming from the Third Annual Health Law Year in P/Review event held at Harvard Law School on Friday, January 30, 2015. The conference brought together leading experts to review major developments in health law over the previous year, and preview what is to come. A full agenda and links to video recordings of the panels are here.

2014 saw an epidemic of Ebola in Sierra Leone, Guinea, and Liberia, and an epidemic of fear in the US. Neither epidemic covered public health in glory. For Science, Ebola was the “breakdown of the year;” the Association of Schools and Programs of Public Health called it “the most important public health story” of the year; Politfact labeled it the political “lie of the year,” and Time magazine named “the Ebola fighters” its “Person of the Year.” All of these characterizations contain some truth.

Response to the epidemic in Africa relied heavily on volunteer organizations, especially Christian charity groups like Samaritan’s Purse and SIM (Serving In Mission), and medical NGOs, most notably Doctors Without Borders (MSF). It was MSF that called out the World Health Organization (WHO) for its failure to recognize the epidemic, and then its inability to respond to it. Their International Health Regulations, it turned out, were much more like guidelines than any form of law, and the WHO had no capacity to effectively respond to a new epidemic.

Read the rest of this entry »

After The Worst In Liberia And Sierra Leone


February 9th, 2015

From January 19-27, we traveled to Liberia and Sierra Leone to engage with national leaders, health workers, citizens, non-governmental organization (NGO) implementers, international organizations, and United States, United Kingdom (UK), and other officials, including the African Union (AU), Chinese, and Cuban medical delegations. It was a moment of hope and nervous adjustment, as Ebola cases dropped suddenly and unexpectedly in Liberia, followed by reductions in Sierra Leone and Guinea.

We listened to the reflections of those who lived through and led the mobilization to roll back the unprecedented Ebola emergency, as it raged in the second half of 2014. We sought to understand the latest phase, as complicated efforts have begun to move beyond an emergency response and seek to achieve “zero” Ebola infections in 2015 — while safeguarding against new outbreaks. We discussed briefly early plans for long-term recovery. Across these different phases and concerns, we had a special interest in examining the US contribution.

The visit generated countless conversations with diverse experts who were remarkably gracious, insightful, and candid in their remarks. In this post we share select major impressions we carried home. These opinions are, of course, ours, and ours alone.

Read the rest of this entry »

How The Ebola Crisis Could Help Save 75,000 Patients


February 4th, 2015

It has taken an epidemic in West Africa to expose a troubling issue for U.S. hospitals and health policy: the short shrift given infection prevention.

In a thoughtful December Health Affairs Blog post, Dr. Leonard Mermel, an epidemiologist and infection control specialist, noted that over a three-month period his hospital’s work on Ebola preparedness “significantly strained our ability to manage other infection control challenges.”

That is a red flag for health care policymakers. As hospitals focus on Ebola preparations, we can’t lose sight of the fact that more than 700,000 Americans contract health care associated infections (HAIs) each year. About 75,000 people die from HAIs, such as Clostridium difficile (C. diff), Methicillin-resistant Staphylococcus aureus (MRSA) and vancomycin-resistant enterococcus (VRE).

This is more than 10 times the number of patients who have died from Ebola across the globe.

Read the rest of this entry »

Request For Abstracts: Health Affairs Food And Health Theme Issue


February 4th, 2015

Health Affairs is planning a theme issue on food and health in November 2015. The issue will present work that explores the relationship between the food we consume and our wellbeing on the individual, societal, and global levels. Articles will address causes and consequences of dietary excess and insufficiency, analyze policies and programs aimed at influencing these, and explore the roles of public policy, industry, and stakeholder groups in the context of dietary behavior.

We invite all interested authors to submit abstracts for consideration for this issue.

The issue will consider the implications of global food production and distribution for the health of consumers and food workers, environmental quality, and food prices, among other things. It will also examine actions taken from the community level upward to address increasingly universal concerns about food-related illness. Several papers will provide broad overviews of key issues, but we are particularly interested in empirical analyses of specific policies, programs, and practices aimed at influencing dietary behavior and clarifying our thinking about food’s role in health.

Read the rest of this entry »

The Puzzle Of Antibiotic Innovation


February 3rd, 2015

Editor’s note: This post is part of a series stemming from the Third Annual Health Law Year in P/Review event held at Harvard Law School on Friday, January 30, 2015. The conference brought together leading experts to review major developments in health law over the previous year, and preview what is to come. A full agenda and links to video recordings of the panels are here.

Dame Sally Davies, the Chief Medical Officer of England, warns that we are approaching an antibiotic apocalypse. A former chief economist at Goldman Sachs estimates that unless dramatic action is taken now, antimicrobial resistance could kill 50 million people a year and cause $100 trillion in cumulative economic damages.

In the US, dire warnings have issued from the Centers for Disease Control and Prevention (CDC), the President’s Council of Advisors on Science and Technology, and the President himself through an Executive Order on Combating Antibiotic-Resistant Bacteria in September 2014 (summary here). The President’s new budget asks for $1.2 billion to be spent on antibiotic resistance.

But last week, the science press breathlessly celebrated the discovery of a new antibiotic, teixobactin, cultured from soil samples collected in a grassy field in Maine (the study was published in Nature). Crisis over?

Read the rest of this entry »

A (Global) Cornucopia Of Clues To Optimize Medication Use


January 6th, 2015

The most common patient care intervention, issuing a prescription, is fraught with continuing challenges for patients, their caregivers, and practitioners. Patients rely on medications across a continuum of care, with expectations for self-management; some experience unintended problems along the way. For older patients, such problems often result in emergency hospitalizations, many of which could be prevented.

Historically, integration to support safe and appropriate medicine use across the U.S. health care ecosystem has been sporadic, including within our siloed Medicare Part D benefit. Other countries, however, are well on their way to better integration.

In the following blog post, we share examples from the United Kingdom and Australia. Fortunately, U.S. practitioners who recognize optimizing medication use as an essential element of population health can look to several recent federal opportunities to support their efforts.

Read the rest of this entry »

Request For Abstracts: Health Affairs Non-Communicable Disease Theme Issue


December 19th, 2014

Health Affairs is planning a theme issue on non-communicable diseases (NCDs) in September 2015. The issue will present work that describes the burden of NCDs, approaches to prevention and treatment of NCDs, and analysis of policies and initiatives aimed at prevention and treatment. The issue will have a global perspective.

We invite interested authors to submit abstracts for consideration for this issue.

We are using a broad definition of NCDs to include cancer, cardiovascular disease, respiratory illness, diabetes, mental illness, and the like. The issue will not focus on injuries, per se, but will address disability as an element of the disease burden of NCDs.

We plan to publish 15-20 peer-reviewed articles including research, analyses, and commentaries from leading researchers and scholars, analysts, industry experts, and health and health care stakeholders. Some papers will provide an overview of an issue relevant to NCDs, but we are particularly interested in empirical analyses of specific policies, care models, and other approaches to addressing NCDs. All papers must focus on issues of interest to public policy makers and private leaders in health care and related sectors.

Read the rest of this entry »

Should Doctors Deny Ebola Patients CPR?


December 11th, 2014

The first time I did CPR, coagulated blood spurted onto my new white coat from a wound in the patient’s chest. Another time a patient’s urine soaked through the knees of my pants as I knelt at his side.

Even in the best of conditions, cardiopulmonary resuscitation (CPR) is a spit-smeared, bloody business that can expose health care workers to all kinds of body fluids. Like all health care workers, I put on gloves and a game face and accept such things as part of patient care.

The 2014 Ebola outbreak changes all that. Hospitals all around the world are now training staff in personal protective equipment (PPE) use and convening rapid response teams. A key part of this process involves grappling with how dangerous it will be to perform CPR on patients with Ebola.

Fully 70 percent of those stricken with Ebola in 2014 have died. That means in countries like the United States where we attempt CPR routinely to save dying patients, health care workers will be called to resuscitate Ebola patients.

From placement of an artificial airway to the administration of chest compressions and beyond, each step in CPR can expose health care workers to body fluids containing as many as a million viral particles in each drop and well-proven to transmit Ebola. In contradistinction to the bowling alley and subway exposures that have drawn so much media attention, health care workers performing CPR on Ebola patients will truly be in the direct line of viral fire.

Read the rest of this entry »

New On GrantWatch Blog


November 21st, 2014

Health Affairs GrantWatch Blog brings you news and views of what foundations are funding in health policy and health care.

Here are the most recent posts:

Read the rest of this entry »

Health Affairs Web First: In 11-Country Survey Of Older Adults, Americans Are Sickest But Have Quickest Access To Specialists


November 20th, 2014

A new survey of the health and care experiences of older adults in eleven different countries, released recently as a Web First by Health Affairs, found that Americans were sicker than their counterparts abroad, with 68 percent of respondents living with two or more chronic conditions and 53 percent taking four or more medications. Also, Americans were most likely to report cost-related expenses for care (19 percent of respondents) than residents in any of the other countries surveyed.

On the other hand, the United States compared favorably in some aspects: For example, 83 percent of US respondents had a treatment plan they could carry out in their daily life, one of the highest rates across the surveyed countries.

A few other key findings:

Read the rest of this entry »

Analysis Of Medicare Spending Slowdown Leads Health Affairs Blog October Most-Read List


November 17th, 2014

Loren Adler and Adam Rosenberg’s examination of the causes of slower Medicare spending growth was the most-read Health Affairs Blog post in October. Their post was followed by Jeff Goldsmith’s interview with former Kaiser Permanente CEO George Halvorson.

Next on the top-ten list was J. Stephen Morrison’s look at the US response to Ebola and the role of Centers for Disease Control and Prevention Director Tom Frieden, followed by Tim Jost’s post on reference pricing and network adequacy.

The full list is below:

Read the rest of this entry »

Using Mobile Technology To Overcome Jurisdictional Challenges To A Coordinated Immunization Policy


November 14th, 2014

On March 20, 2014, the Government of Canada and the federal Minister of Health announced the release of ImmunizeCanada (ImmunizeCA), a smart phone application (app) designed to both provide accurate information on immunization for Canadians and allow them to track their and their family members’ immunizations. Based on a prototype developed for parents in Ontario and in partnership with the Canadian Public Health Association, our development team received funding from the Public Health Agency of Canada to build a national immunization app. Our task was to build an Apple- and Android-compatible app, containing all 13 provincial/territorial schedules and vaccine information from each jurisdiction in both Canadian official languages (French and English).

The application uses demographic information entered by the user and the most recent recommended provincial vaccination schedule to create a custom profile for multiple family members. It allows parents to track and carry their children’s immunizations records on their mobile device. The application also permits the creation of adult-specific schedules and includes information on travel vaccines. It is also possible to sync the app with your smartphone calendar, generate appointment reminders, print or share an immunization record by email, and access answers to common questions.

Read the rest of this entry »

The Latest Health Wonk Review


November 14th, 2014

A belated hat tip to Wing of Zock, where Jennifer Salopek produced a great Health Wonk Review last week. In her “election week edition,” Jennifer gives an overview of many insightful posts, including a Health Affairs Blog post by Lawrence Gostin on the United States’ misguided self-interest on ebola.

Read the rest of this entry »

Health Affairs Web First: For Global Health Programs Aiding Developing Countries, Analyzing A New Funding Model


November 13th, 2014

Development assistance for health in low-and-middle-income countries nearly tripled from 2001 to 2010, with much of that growth directed toward the response to HIV. Donor agencies struggle to determine how much assistance a country should receive. A new study, recently released as a Health Affairs Web First, presents three allocation methodologies to align funding with priorities.

The study authors Victoria Fan, Amanda Glassman, and Rachel Silverman then select a model—one with enough flexibility to solve mismatches between disease burdens and allocations—to evaluate the progress that could be made by one organization—the Global Fund to Fight AIDS, Tuberculosis, and Malaria—in fighting HIV. The authors found that under the new funding model, substantial shifts in the Global Fund’s portfolio are likely to result from concentrating resources in countries with more HIV cases and lower per capita income.

Read the rest of this entry »

The United States’ Misguided Self-Interest On Ebola


October 31st, 2014

The Ebola epidemic in West Africa is spiraling out of control. The international community allowed a manageable outbreak to mushroom into a health and humanitarian crisis. The World Health Organization (WHO) has been enfeebled and largely sidelined. Belatedly, the United States sent military troops into Liberia and spearheaded a United Nations Security Council resolution. Yet since isolated Ebola cases have appeared on our shores, the US has begun to look inward, at risk of falling into a trap that I will call “misguided self-interest.”

While the West African epidemic rages, the US delayed significant action until long after the unprecedented nature of the Ebola epidemic became clear, and even now the response is incommensurate with the massive need. Now we are transferring our gaze from the real crisis and headed on an insular journey.

I grant the premise that a country’s first responsibility is to protect its inhabitants. But calls for a travel ban from the region and newly announced state quarantine policies that would ensnare travelers from affected countries appear selfish. To put it in perspective, the US has experienced only a few domestically diagnosed cases, with an exceedingly low risk of an outbreak.

Read the rest of this entry »

Health Affairs Web First: Vietnam’s Health Care System, Explained By Its Minister Of Health


October 30th, 2014

In August, Vietnam’s Minister of Health, Nguyen Thi Kim Tien, was interviewed for Health Affairs by Tsung-Mei Cheng, recently released as a Health Affairs Web First.

Among the topics discussed was an overview of the unique characteristics of Vietnam’s health system; its strengths and weaknesses; health financing reform aimed at reaching the goal of universal health coverage; the prevention and control of infectious diseases; and how Vietnam has performed in achieving the Millennium Development Goals.

Cheng is a health policy research analyst at the Woodrow Wilson School of Public and International Affairs, Princeton University, in New Jersey. Health Affairs has previously published Cheng’s interviews with other world health ministers, including Thomas Zeltner of Switzerland (2010) and Chen Zhu of China (2012).

Read the rest of this entry »

Ebola And EHRs: An Unfortunate And Critical Reminder


October 28th, 2014

The Dallas hospital communication lapse that led to the discharge of a Liberian man with Ebola symptoms is an example of the failure of American health care system to effectively share health information, even within single institutions. It is not possible to know whether a faster response would have saved Thomas Eric Duncan’s life or reduced risk to the community and health workers.

What is clear is that rapid sharing of information is one of the elements critical to halting the spread of Ebola. Had all members of the initial care team known of the patient’s recent arrival from an Ebola-stricken country and acted appropriately to quarantine Mr. Duncan, this would have limited the chance of exposing the public and enabled faster preventive protocols for treating personnel.

Read the rest of this entry »

Lessons from Ebola: The Infectious Disease Era, And The Need To Prepare, Will Never Be Over


October 28th, 2014

With the wall-to-wall news coverage of Ebola recently, it’s hard for many to distinguish fact from fiction and to really understand the risk the disease poses and how prepared we are to fight it.

Fighting infectious diseases requires constant vigilance. Along with Ebola, health officials around the globe are closely watching other emerging threats: MERS-CoV, pandemic flu strains, Marburg, Chikungunya and Enterovirus D68. The best defense to all of these threats is a good offense — detecting, treating and containing as quickly and effectively as possible.

And yet, we have consistently degraded our ability to respond to these new, emerging and re-emerging threats by underfunding and undercutting existing capabilities and expecting the country to ramp up overnight when new threats emerge.

Read the rest of this entry »

Click here to email us a new post.