Health and health system effects on poverty: A narrative review of global evidence

Uncovering the carbon cost: Environmental impact of free flap reconstruction procedures in the UK

INTRODUCTION

Free flap reconstruction procedures are renowned for their duration and the requirement for many staff and large quantities of equipment. This single-centre cross-sectional study aimed to quantify the total emissions related to two such procedures carried out at a district general hospital.

METHODS

One deep inferior epigastric perforator (DIEP) free flap procedure and one anterolateral thigh (ALT) free flap procedure, both carried out in February 2024, were analysed. Data related to staff transport, anaesthetic duration, mass of disposable equipment, quantity of reusable surgical equipment and consumption of electricity and heating for the relevant theatre areas were collected. Emissions were calculated using UK government conversion factors and classified by scope and contributory element as per the Greenhouse Gas Protocol.

RESULTS

Total emissions were estimated at 385.5 kgCO2eq for the DIEP and 369.6 kgCO2eq for the ALT. Scope 1 emissions related to heating, atmospheric release of general anaesthetic and incineration of waste accounted for 33.7% of DIEP emissions and 35.6% of ALT emissions. Scope 2 emissions related to the use of grid electricity accounted for 44.8% of DIEP emissions and 46.7% of ALT emissions. Scope 3 emissions related to staff transport, cleaning of reusable equipment and the supply chain for disposable equipment accounted for 21.5% of DIEP emissions and 17.7% of ALT emissions.

CONCLUSION

Significant reductions in emissions may be achievable without significant infrastructural changes through initiatives to reduce staff transport by single-occupancy car, improving the energy efficiency of the theatre areas and reducing the use of single-use surgical equipment.

Perceptions of health and healthcare needs in low-resource settings: qualitative insights from Bengaluru's urban slum and rural areas

Background

Despite the multitude of healthcare services available in India, health inequalities persist. People in low-resource settings are both disadvantaged and have the greatest need for healthcare. To address these disparities and achieve universal health coverage, healthcare services need to be tailored to the specific needs of this population.

Objective

This study aimed to understand health and healthcare perceptions of people in slums and villages in and around Bengaluru, a city in the southern part of India. It was conducted in partnership with Bangalore Baptist Hospital, a charity hospital dedicated to supporting underserved populations in this region.

Methods

The study employed qualitative methods. Twenty-eight open-ended interviews and eight focus groups were conducted with residents of selected slums and villages in and around Bengaluru. The interviews were transcribed verbatim, translated to English and analyzed applying thematic analysis.

Results and conclusion

The study finds that participants defined health as the absence of illness, the ability to work, and the result of a good lifestyle. With regards to healthcare expectations, the analysis shows the themes of the "good doctor," recovering quickly, cost affordability, cleanliness, and emergency services and diagnostic facilities. In addition, stigma related to healthcare, was identified, especially among residents of villages. Participants highlight the importance of good relationships with healthcare providers and accessible healthcare facilities to improve healthcare uptake in Bengaluru's slums and rural areas. This study also shows that achieving universal health coverage requires addressing not only direct costs but also other associated expenses like travel and lost wages, considering healthcare costs as a comprehensive expense tied to patients' living conditions. These results contribute to the growing body of literature on health and healthcare perceptions in low-resource settings, offering insights that may inform future research and context-specific strategies for improving healthcare access and delivery.

Pathways for India to Reduce Ambient Air Pollution Health Burden and Achieve the Sustainable Development Goal (SDG-3.4)

Sustainable Development Goal 3.4 (SDG-3.4) aims to reduce non-communicable disease (NCD) mortality by one-third by 2030, compared to 2015 levels. First, we examined whether the National Clean Air Program (NCAP) is sufficient to allow India to achieve this target. Subsequently, we integrated GAINS-simulated sector-specific PM2.5 concentrations across three pathways─business-as-usual (BAU), advanced control technology (ACT), and sustainable development scenario (SDS)─with the Global Burden of Disease framework to assess potential health benefits for 2030 at a subnational scale and evaluate the feasibility of accomplishing SDG-3.4. In 2015, ambient PM2.5 attributable premature deaths were 0.72 million (95& UIs: 0.53-0.89), and an aggregated 0.12 million (0.08-0.16) deaths could be prevented if the NCAP target is met by 2026. However, states could reduce 3.6-10.8% of targeted NCD mortality by 2030 with a lagged 40% reduction in PM2.5 levels relative to the baseline. PM2.5-attributable deaths would change to 0.79 million (0.57-1.1), 0.76 million (0.6-1.1), and 0.63 million (0.48-0.81) in 2030 under the BAU, ACT, and SDS pathways, respectively. Implementing stringent emission controls through policy and technological interventions, primarily focusing on household and energy sectors, would reduce NCD mortality by 5-13% across subregions. Simultaneously controlling other risk factors would accelerate India's journey toward achieving SDG-3.4.

Pediatrics leading the way: co-enrollment as the next step in health-related social needs screening and referral

PURPOSE OF REVIEW

To contextualize how pediatrics led the field in developing and implementing tools to screen for social determinants of health in clinical care as well as in creating innovative interventions to mitigate them, and to summarize where the evidence points as the next frontier.

RECENT FINDINGS

The evidence showed that health-related social needs (HRSN), like food insecurity, energy insecurity, and housing instability, continue to drive poor health outcomes across the lifespan; patients and healthcare providers are open to discussing HRSN in clinical settings, though some providers feel ill-equipped to do so; to mitigate HRSN, healthcare plays a unique role in ensuring patients' HRSN are understood, referring to effective resources through building strong, lasting relationships with community partners, embedding services in the healthcare setting across all departments, and empowering patient families to participate in programs and services; and administrative burden hinders families from getting all the benefits to which they are entitled, which streamlined co-enrollment processes can address.

SUMMARY

Pediatric providers can add a unique and credible voice to seeking changes to the safety-net, including co-enrollment, that could reduce administrative burden, address patients' HRSN, and improve health starting in the prenatal period through later adulthood.

The impact of health on labour market outcomes: A rapid systematic review

The relationship between an individual's health and their labour market outcomes has long been a subject of health economics research. This review aims to provide an up-to-date, global review of the substantive findings in the existing literature. We pay particular attention to causal effects, acknowledging the methodological complexities that have long challenged the research and emphasizing the importance of overcoming them to present robust, policy-relevant evidence. The recent literature shows a notable advancement in addressing these methodological issues compared to previous work. The evidence reviewed suggests that individuals with better health overwhelmingly exhibit higher earnings and often enhanced labour supply. These findings extend beyond geographical boundaries, as evidence from diverse regions underscores the global significance of this association. The review covers evidence from a wide range of health indicators and conditions - including e.g. self-reported health, chronic diseases, disability, nutritional health, infections, mental health, addictions and others. Within and across the different health domains, the health-related factors exert varying degrees of influence on labour market outcomes, highlighting the multifaceted nature of the health-labour relationship and its potentially profound implications for individuals, communities, and economies.