Out- Of- Pocket health expenditure and household consumption patterns in Benin: Is there a crowding out effect?

Health shocks are common and have serious consequences for households in developing countries where health insurance is lacking. In this study, we examine whether out-of-pocket health expenditures crowd out household consumption of non-healthcare necessities, such as education items in Benin using a sample of 14,952 households from the global vulnerability and food security analysis survey. We estimated a system of conditional Engel curves with three stage least squared (3SLS) and seemingly unrelated regression (SURE) for seven categories of goods using the Quadratic Almost Ideal Demand System (QUAIDS) in the form of budget shares corresponding to proportions of total non-health expenditure. Findings show that out of pocket health expenditure leads households to spend more on health care that in fine crowd out expenditure in other necessity goods such as education item. These findings highlight the need for social protection programs to mitigate the impact of health shocks on vulnerable households in Benin.

Post-COVID-19 WHO Reform: Ethical Considerations

This study argues against the expansive approach to the WHO reform, according to which to be a better global health leader, WHO should do more, be given more power and financial resources, have more operational capacities, and have more teeth by introducing more coercive monitoring and compliance mechanisms to its IHR. The expansive approach is a political problem, whose root cause lies in ethics: WHO's political overambition is grounded on WHO's lack of conceptual clarity on what good leadership means and what health (as a human right) means. This study presents this ethical analysis by putting forth an alternative: the humble approach to the WHO reform. It argues that to be a better leader, WHO should do much less and have a much narrower mandate. More specifically, WHO should focus exclusively on coordination efforts, by ensuring truthful, evidence-based, consistent, and timely shared communications regarding PHEIC among WHO member-states and other global health stakeholders, if the organization desires to be a real global health leader whose authority the international community respects and whose guidance people trust.

Obesity, equity and choice

Obesity is often considered a public health crisis in rich countries that might be alleviated by preventive regulations such as a sugar tax or limiting the density of fast food outlets. This paper evaluates these regulations from the point of view of equity. Obesity is in many countries correlated with socioeconomic status and some believe that preventive regulations would reduce inequity. The puzzle is this: how could policies that reduce the options of the badly off be more equitable? Suppose we distinguish: (1) the badly off have poor options from (2) the badly off are poor at choosing between their options (ie, have a choosing problem). If obesity is due to a poverty of options, it would be perverse to reduce them further. Some people in public health say that preventive regulations do not reduce options but, I shall argue, they are largely wrong. So the equity case for regulations depends on the worst off having a choosing problem. It also depends on their having a choosing problem that makes their choices against their interests. Perhaps they do. I ask, briefly, what the evidence has to say about whether the badly off choose against their interests. The evidence is thin but implies that introducing preventive regulations for the sake of equity would be at least premature.

Public health nurse educators' conceptualisation of public health as a strategy to reduce health inequalities: a qualitative study

BACKGROUND

Nurses have long been identified as key contributors to strategies to reduce health inequalities. However, health inequalities are increasing in the UK despite policy measures put in place to reduce them. This raises questions about: convergence between policy makers' and nurses' understanding of how inequalities in health are created and sustained and educational preparation for the role as contributors in reducing health inequalities.

AIM

The aim of this qualitative research project is to determine public health nurse educators' understanding of public health as a strategy to reduce health inequalities.

METHOD

26 semi-structured interviews were conducted with higher education institution-based public health nurse educators.

FINDINGS

Public health nurse educators described health inequalities as the foundation on which a public health framework should be built. Two distinct views emerged of how health inequalities should be tackled: some proposed a population approach focusing on upstream preventive strategies, whilst others proposed behavioural approaches focusing on empowering vulnerable individuals to improve their own health.

CONCLUSION

Despite upstream interventions to reduce inequalities in health being proved to have more leverage than individual behavioural interventions in tackling the fundamental causes of health inequalities, some nurses have a better understanding of individual interventions than take population approaches.

Can community-based peer support promote health literacy and reduce inequalities? A realist review

Background

Community-based peer support (CBPS) has been proposed as a potentially promising approach to improve health literacy (HL) and reduce health inequalities. Peer support, however, is described as a public health intervention in search of a theory, and as yet there are no systematic reviews exploring why or how peer support works to improve HL.

Objective

To undertake a participatory realist synthesis to develop a better understanding of the potential for CBPS to promote better HL and reduce health inequalities.

Data sources

Qualitative evidence syntheses, conceptual reviews and primary studies evaluating peer-support programmes; related studies that informed theoretical or contextual elements of the studies of interest were included. We conducted searches covering 1975 to October 2011 across Scopus, Global Health (including MEDLINE), ProQuest Dissertations & Theses database (PQDT) [including the Education Resources Information Center (ERIC) and Social Work Abstracts], The King’s Fund Database and Web of Knowledge, and the Institute of Development Studies supplementary strategies were used for the identification of grey literature. We developed a new approach to searching called ‘cluster searching’, which uses a variety of search techniques to identify papers or other research outputs that relate to a single study.

Study eligibility criteria

Studies written in English describing CBPS research/evaluation, and related papers describing theory, were included.

Study appraisal and synthesis methods

Studies were selected on the basis of relevance in the first instance. We first analysed within-programme articulation of theory and appraised for coherence. Cross-programme analysis was used to configure relationships among context, mechanisms and outcomes. Patterns were then identified and compared with theories relevant to HL and health inequalities to produce a middle-range theory.

Results

The synthesis indicated that organisations, researchers and health professionals that adopt an authoritarian design for peer-support programmes risk limiting the ability of peer supporters (PSs) to exercise autonomy and use their experiential knowledge to deliver culturally tailored support. Conversely, when organisations take a negotiated approach to codesigning programmes, PSs are enabled to establish meaningful relationships with people in socially vulnerable groups. CBPS is facilitated when organisations prioritise the importance of assessing community needs; investigate root causes of poor health and well-being; allow adequate time for development of relationships and connections; value experiential cultural knowledge; and share power and control during all stages of design and implementation. The theory now needs to be empirically tested via further primary research.

Limitations

Analysis and synthesis were challenged by a lack of explicit links between peer support for marginalised groups and health inequalities; explicitly stated programme theory; inconsistent reporting of context and mechanism; poor reporting of intermediate process outcomes; and the use of theories aimed at individual-level behaviour change for community-based interventions.

Conclusions

Peer-support programmes have the potential to improve HL and reduce health inequalities but potential is dependent upon the surrounding equity context. More explicit empirical research is needed, which establishes clearer links between peer-supported HL and health inequalities.

Study registration

This study is registered as PROSPERO CRD42012002297.

Funding

The National Institute for Health Research Public Health Research programme.