sick planet, sick people

"No amount of medical technology will enable us to have healthy humans on a sick planet." Thomas Berry

We have come to recognize that the health of humanity depends on ensuring the health and resilience of our planet — from our climate, to our forests, to the air we breathe and the water we drink,”

A proper understanding of the health impacts of environmental exposures depends on many scientists from different disciplines working closely together.

The Planetary Health Alliance is a growing consortium of over 300 universities, non-governmental organizations, research institutes, and government entities from around the world committed to understanding and addressing global environmental change and its health impacts.

If you have 10m watch this video

Photo: Author: Homentatge a Toni Catany Jordi Soldevila

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The addiction to technology adoption in health

A major driver of cost growth in health care is the rapid increase in the utilisation of existing technology and not simply the adoption of new technology.

Health economists and health technology assessment analysts have become obsessed by technology adoption questions and have largely ignored ‘technology management’ questions.

Technology management would include the life-cycle assessment of technologies in use, to assess their real-world performance; and monitoring of technology indication creep. A rebalancing of focus might serve to encourage a more self-critical and learning culture amongst those involved in technology evaluation analysis.

Further, health economists and health technology assessment analysts could make a more significant contribution to system efficiency through rebalancing their efforts away from technology adoption questions towards technology management issues.

Article (pdf) 
Url: Health Economics:  

Authors: Cam Donaldson , Stirling Bryan , Craig Mitton

photo: Rose generated by Artificial Intelligence Sant Jordi 2022 (UPC)

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War is hell: Mental health consequences of war #stopthewar

War has a catastrophic effect on the health and well being of nations. Studies have shown that conflict situations cause more mortality and disability than any major disease. War destroys communities and families and disrupts the social and economic development of nations.

The effects of war include long-term physical and psychological harm to children and adults, as well as reduction in material and human capital. Among the consequences of war, the impact on the mental health of the civilian population is one of the most significant. Other consequences, besides deaths include endemic poverty, malnutrition, disability, economic/social decline and psychosocial illness, to mention only a few.

Women are more affected than men. Other vulnerable groups are children, the elderly and the disabled.

This paper briefly reviews the evidence from published literature about the impact of war on the mental health of the general population, the refugees, the soldiers and specific vulnerable groups. The review presents data concerning some major wars/conflicts and then briefly outlines the risk factors emerging from the literature.

Prevalence rates are associated with the degree of trauma, and the availability of physical and emotional support. The use of cultural and religious coping strategies is frequent in developing countries.

Mental health and war: brief review (article pdf) (2006)

photo: Emilio Morenatti

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Trust in public institutions and the Code of Ethics of the public service in Catalonia

The United Nations Department of Economic and Social Affairs provides thought leadership through its UN DESA Policy Briefs series, presenting timely and relevant analysis and policy guidance on global economic and social issues. Here we present the policy brief #108

Trust in public institutions: Trends and implications for economic security
The legitimacy of public institutions is crucial for building peaceful and inclusive societies.

While levels of trust in institutions vary significantly across countries, opinion surveys suggest that there has been a decline in trust in public institutions in recent decades.

Economic insecurity—which the COVID-19 crisis threatens to exacerbate—and perceptions of poor or corrupt government performance undermine the social contract and are closely linked to declines in institutional trust. Rebuilding public trust in the light of the current crisis demands services that work for everyone and jobs that provide income security, as well as more inclusive institutions.

Policy brief #108

The Code of Ethics of the Public Service of Catalonia

This code, was approved in october 2021 and constitutes a common ethical framework for all the people who work in the respective administrations and public sectors (politicians, civil servants, managers, advisers,...) as well as those who work in private organizations and entities that carry out effective public services on behalf of the administrations.

The main objective of the Code is to guide the actions of public servants from the key of values, thus strengthening the integrity of their actions and thus helping to promote the improvement of public service, the improvement of democratic quality, and the recovery of the confidence of the citizenship in its institutions.

Catalan government web: Ethics code

photo: Una habitación donde siempre llueve (Barcelona) Juan Muñoz

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Recessions and health

Recessions are complex events that affect personal health and behavior via various potentially opposing mechanisms. While recessions are known to have negative effects on mental health and lead to an increase in suicides, it has been proven that they reduce mortality rates.

A general health policy agenda in relation to recessions remains ambiguous due to the lack of consistency between different individual- and country-level approaches. However, aggregate regional patterns provide valuable information, and local social planners could use them to design region-specific policy responses to mitigate the negative health effects caused by recessions.

Pros

1. Substantial country-level research shows that mortality declines (i.e. people live longer) during recessions.
2. Recessions can make more time available for individuals to lead a healthy lifestyle.
3. Motor vehicle deaths have been shown to decrease during recessions.
4. Some studies suggest that during recessions the stigma of being unemployed decreases.

Cons

1. A plethora of individual-level studies show that recessions lead to adverse mental health, especially for working-age and low-income people.
2. The number of suicides appears to increase during periods of recession.
3. Income loss due to recessions decreases investments in health-enhancing goods and services.
4. Austerity measures that may be common during recessions, such as budget cuts to social welfare, mainly affect vulnerable population groups and the long-term unemployed.

AUTHOR’S MAIN MESSAGE

Evaluations of the health-related impacts of economic recessions have shown inconsistent results. However, if recessions cause a greater deterioration in individuals’ mental health and a larger number of suicides, then governments should be motivated to work even harder to recover the world’s economies after downturns occur. 

Governments should acknowledge that the potential impact of recessions on people’s health depends on the extent to which people are protected from vulnerability. Welfare policies, such as labor market programs, debt relief programs, and access to health and mental health services, should thus play a significant role as a mediator in the relationship between recessions and health.

Nick Drydakis Professor in Economics and Director of the Centre for Pluralist Economics, Anglia Ruskin University, UK 

Article

photo: Joan Miró Couple d'amoureux aux jeux de fleurs d'amandier

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The benefits of Women's Health research

Women's health has suffered from insufficient research addressing women. The research community has not widely embraced the value of this research, and the impact of limited knowledge about women's health relative to men's is far-reaching. Without information on the potential return on investment for women's health research, research funders, policymakers, and business leaders lack a basis for altering research investments to improve knowledge of women's health.

As part of an initiative of the Women's Health Access Matters (WHAM) nonprofit foundation, RAND Corporation researchers examined the impact of increasing funding for women's health research, with a focus on the following three disease areas: brain health, immune and autoimmune disease, and cardiovascular disease. Using microsimulation analyses, the research team studied the societal cost impact of increasing research funding in three diseases that present a large disease burden for women: Alzheimer's disease and Alzheimer's disease–related dementias (AD/ADRD), coronary artery disease (CAD), and rheumatoid arthritis (RA).

Key Findings

• Investing in women's health research yields benefits beyond investing in general research
• The return on investment is higher for most scenarios in which research funding impact is assumed to be higher for women than men. Assuming an equal impact of research on women and men generally results in lower returns.
• Research investment yields benefits for all people, but the specific emphasis on women’s health can result in downstream socioeconomic benefits that improve on general research.
• Large societal gains may be possible by increasing investment in women's health research
• Savings include increased life years, reduced years with disease, fewer years of functional dependence, and reductions in disruptions to work productivity.

Recommendations

• Increase research funding directed at women's health. The potential gains from women-focused research are substantial, given the limitations in knowledge about disease development and impacts for women relative to men.
• Pursue research on the biology of disease in women, including early identification, and identify barriers to diagnosis in women.
• Expand research agendas to address the complicated relationships between disease and work productivity in women. Impacts include lost productivity for those with the disease and for informal caregivers, the majority of whom are women.
• Raise awareness of the potential value of investment in women's health research. The ways in which women's health research is disadvantaged relative to general research are multifaceted, with major implications for disease burdens.

Article (pdf) 

Authors: Baird, Matthew D., Melanie A. Zaber, Annie Chen, Andrew W. Dick, Chloe E. Bird, Molly Waymouth, Grace Gahlon, Denise D. Quigley, Hamad Al-Ibrahim, and Lori Frank, Research Funding for Women's Health: Modeling Societal Impact. Santa Monica, CA: RAND Corporation, 2021. https://www.rand.org/pubs/research_reports/RRA708-4.html.

photo: Lluïsa Vidal

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Integrated Care (IC) and utilization: some evidence

Is integration of primary, secondary and social care better for patients and is it cost effective? Andrew Street, Professor of Health Economics, discusses a recent paper he published with co-authors Anne Mason and Panagiotis Kasteridis, which evaluated the cost-effectiveness of integrated care (IC) programmes in South Somerset for people with long-term conditions.

Objectives: As part of the Vanguard programme, two integrated care models were introduced in South Somerset for people with complex care needs: the Complex Care Team and Enhanced Primary Care. The authors assessed their impact on a range of utilization measures and mortality. 

• Complex Care Team (CCT), provides senior medical input, care coordination, and a personalized care plan to support self-care.
• Staffed by GPs with expertise in chronic care management, complex care nurses and other keyworkers, the CCTs aim to prevent avoidable hospitalizations or, for those in hospital, to support appropriate inpatient care.

Methods: They used monthly individual-level linked primary and secondary care data from April 2014 to March 2018 to assess outcomes before and after the introduction of the care models. The analysis sample included 564 Complex Care Team and 841 Enhanced Primary Care cases that met specific criteria. 

They employed propensity score methods to identify out-of-area control patients and difference-in-differences analysis to isolate the care models’ impact. 

Results: They found no evidence of significantly reduced utilization in any of the Complex Care Team or Enhanced Primary Care cohorts. The death rate was significantly lower only for those in the first Enhanced Primary Care cohort. 

Conclusions: The integrated care models did not significantly reduce utilization nor consistently reduce mortality. Future research should test longer-term outcomes associated with the new models of care and quantify their contribution in the context of broader initiatives.

Watch Andrew Street explaining the article (5m) 

Article (pdf) Evaluating integrated care for people with complex needs (2021)

Photo Richard Long 2012 A circle in Antartica

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