The Economic Consequences Of Mortality Amenable To High-Quality Health Care In Low- And Middle-Income Countries

Neonatal encephalopathy in India: spatiotemporal variations in declining mortality

BACKGROUND

United Nations Sustainable Development Goals (SDGs) target reduction of global neonatal and infant mortality. We examined trends in both neonatal/overall infant mortality (NMR/IMR) and those related to neonatal encephalopathy (NE) for India.

METHODS

NE mortality data (1990-2019), stratified by age (0-6 days, 7-27 days) and location, were sourced from the Global Health Data Exchange. Birth cohort data were obtained from the UN Population Prospects. NE-NMR trends were analyzed using joinpoint regression to estimate annual percent change (APC) and average APC (AAPC). Pearson correlation assessed relationships between NE-NMR and sociodemographic index (SDI) or composite coverage index (CCI).

RESULTS

Of 811 million live births (1990-2019), 4.3 million deaths (uncertainty interval [UI]: 3.6-5.3 million) were NE-related. NE-NMR declined from 6.7 to 3.5 (47.5%, AAPC: -2.2%)], while all-cause NMR and IMR declined from 57.3 to 21.6 (62.6%; AAPC: -3.3%) and from 83.2 to 29.9 (64.1%, AAPC: -3.5%) per 1000 livebirths, respectively. NE-NMR correlated inversely with SDI (R² = 0.57, p < 0.01) but not with CCI (R² = 0.08, p = 0.13). Regional disparities persisted.

CONCLUSIONS

NE-related neonatal mortality declines, though significant, lags overall neonatal and infant mortality improvements. Sustained, focused and community-oriented efforts are critical to closing these disparities to meet India's SDG targets.

IMPACT

India has achieved significant reductions in neonatal encephalopathy (NE) and all-cause neonatal mortality over the past three decades. From 1990 to 2019, infant mortality rate (IMR) declined from 83 to 29 per 1000 livebirths though NE's share of IMR increased from 8% to 11.8%. Significant interstate variations in NE mortality persist, highlighting the need for targeted state-specific healthcare strategies. NE mortality strongly correlates with sociodemographic development, reflecting the critical role of broad social and economic progress. Strategic and sustained investments in healthcare systems are vital to closing data gaps, reducing disparities, and achieving single-digit neonatal mortality rates by 2030.

What is successful integration in primary health care: qualitative insights from the Chinese public

BACKGROUND

China is transforming its hospital-centric service delivery system into a people-centered integrated care model, with service delivery organized around the health needs and expectations of people.

OBJECTIVE

To guide reforms and align with public expectations, this study profiles successful integration in primary health care from the public perspective.

METHODS

Guided by the rainbow model of integrated care, semi-structured interviews were conducted in six provinces in China. A total of 58 interviewees completed the interviews. Tape-based analysis was used to produce narrative summaries. Researchers listened to the recordings and summarized by 30-s segments. Thematic analysis was performed on summaries to identify thematic families.

RESULTS

Five themes and 16 sub-themes were generated. Respondents' expectations were primarily on three themes: clinical integration (such as interaction between professional and client, continuity, and empowering and engaging individuals), functional integration (such as resources management, quality improvement, and reforming payment systems), and system integration (such as institutional distribution and supervision). Yet a few interviewees mentioned professional integration (multi-disciplinary collaboration) and organizational integration (inter-organizational strategy).

CONCLUSIONS

Qualitative data were used to reveal public perceptions of successful primary health care integration. Service processes, institutional distribution, regulation, resource management, and quality improvement are more visible to the public and will be priorities for future efforts. Whereas inter-organizational strategies and multi-disciplinary collaboration have been shown to facilitate service improvements. Future efforts could consider how policy efforts can be grounded in visible service delivery through management practices.

Female and male treatable mortality: socioeconomic and public finance related factors across European countries

Background

About 36.5% of premature deaths in European Union countries could have been avoided through prompt and effective medical treatment. This treatable mortality is even a priority established in Sustainable Development Goal (SDG) target 3.4. Given the gap in the literature about the socioeconomic drivers of this type of mortality, as well as the increasing importance of public financial management in defining priority policies, this study aims to analyze the socioeconomic and public finance drivers associated with treatable mortality for women and men across European countries.

Methods

Eurostat data is collected for 31 countries for the period 2011-2019 stratified by sex. Panel data quantile regression with fixed effects and conditional mean panel data model using feasible generalized least squares are estimated to explain treatable mortality in women and men.

Results

Key findings point to a positive association between the public finance indicator proxying health priority and the treatable mortality rate for both sexes; a difference between drivers of treatable mortality between men and women; and a different set of drivers across the different quantiles of treatable mortality.

Conclusion

Drivers of male and female treatable mortality may differ according to the country's level of mortality rate. Government health priority seems to account for previous treatable mortality rates as a reactive measure. Policymakers aiming to reduce treatable mortality are likely to use instruments such as health expenditure, improved employment, education levels, and perhaps proactive policy-setting priorities concerning health.

Performance evaluation of Mexico's health system at the national and subnational level, 1990-2019: an analysis of the Health Access and Quality Index

OBJECTIVES

This study aimed to comprehensively evaluate Mexico's health system performance from 1990 to 2019 utilising the Health Access and Quality Index (HAQI) as a primary indicator.

STUDY DESIGN

A retrospective ecological analysis was performed using data from the Global Burden of Diseases, Injuries and Risk Factors Study (GBD) study and the National Population Council (CONAPO).

METHODS

HAQI values for 1990, 2000, 2010, 2015, and 2019 were examined for each state in Mexico and three age groups (young, working, and post-working). Additionally, the marginalisation index was employed to assess inequalities in the HAQI distribution across states. The concentration index of the HAQI for each year was estimated, and the efficiency of states in producing the HAQI was evaluated using a data envelopment approach.

RESULTS

Through the analysis of national and subnational data, results indicated an overall improvement in healthcare access and quality during the study period. Although differences in the HAQI value related to state marginalisation decreased from 1990 to 2015, by 2019, the inequality had returned to a level comparable to 2000. Efficiency in producing health (HAQI values) exhibited substantial heterogeneity and fluctuations in the ranking order over time. States such as Nuevo León consistently performed well, while others, such as Guerrero, Chihuahua, Mexico City, and Puebla, consistently underperformed.

CONCLUSIONS

The findings from this study emphasise the necessity for nuanced strategies to address healthcare disparities and enhance the overall system performance. The study provides valuable insights for ongoing discussions about the future of Mexico's healthcare system, aiming to inform evidence-based policy decisions and improve the nationwide delivery of healthcare services.

The economic value of reducing avoidable mortality

Living longer and healthier boosts individual and family welfare. As part of the World Bank's Healthy Longevity Initiative, we quantified the economic value of achieving the highest possible life span. We estimated the economic value of reducing avoidable mortality, defined as the difference between observed (or projected) mortality and lowest achieved (or projected) mortality, by world regions, sex, and age, between 2000 and 2021, with projection to 2050. In 2019, 69% of mortality, or 40 million deaths, was avoidable. The economic value of avoidable mortality globally was 23% of annual income, meaning that, globally, populations would be willing to give up about one-fifth of their current income in exchange for a year living at the lowest achieved mortality rate. This value ranges from 19% in China to 34% in sub-Saharan Africa. Under the rapid-progress scenario, in which countries experience fast but plausible mortality reductions from 2019 to 2050, we would expect globally the gap between projected and frontier life expectancy to be halved by 2050, and the economic value after achieving this scenario is equivalent to 14% of annual income. Our work provides supportive evidence on the high economic value placed on improving health.

Public health events and economic growth in a neoclassical framework

Public health events (PHEs) have emerged as significant threats to human life, health, and economic growth. PHEs, such as COVID-19, have prompted a reevaluation for enhanced regular prevention and control (RPC). In this study, we focus on the core concept of prevention and control intensity (PCI), and establish a neoclassical economic growth model from the long-term and macro perspective to balance life protection and economic growth. The model construct the mechanism of PCI on economic growth through population dynamics and capital accumulation under the backdrop of RPC for PHEs. We find the conditions for PCI when the economy achieves steady state, and provides an algorithm establishing the optimal strategy that maximises per capita disposable income based on the optimal PCI and consumption. Simulation result quantifies an inverted U-shaped relationship between PCI and capital per capita, output per capita and consumption per capita in the steady state. The model suggests that, given the PHEs of inducing potential unemployment shock, it is worthwhile to combine the implementation of moderate PCI with coordinated policies of income distribution.

Interpreting results, impacts and implications from WHO FCTC tobacco control investment cases in 21 low-income and middle-income countries

BACKGROUND

Tobacco control investment cases analyse the health and socioeconomic costs of tobacco use and the benefits that can be achieved from implementing measures outlined in the WHO Framework Convention on Tobacco Control (WHO FCTC). They are intended to provide policy-makers and other stakeholders with country-level evidence that is relevant, useful and responsive to national priorities and policy context.

METHODS

This paper synthesises findings from investment cases conducted in Armenia, Cabo Verde, Cambodia, Chad, Colombia, Costa Rica, El Salvador, Eswatini, Georgia, Ghana, Jordan, Laos, Madagascar, Myanmar, Nepal, Samoa, Sierra Leone, Sri Lanka, Suriname, Tunisia and Zambia. We examine annual socioeconomic costs associated with tobacco use, focusing on smoking-related healthcare expenditures, the value of lives lost due to tobacco-related mortality and workplace productivity losses due to smoking. We explore potential benefits associated with WHO FCTC tobacco demand-reduction measures.

RESULTS

Tobacco use results in average annual socioeconomic losses of US$95 million, US$610 million and US$1.6 billion among the low-income (n=3), lower-middle-income (n=12) and upper-middle-income countries (n=6) included in this analysis, respectively. These losses are equal to 1.1%, 1.8% and 2.9% of average annual national gross domestic product, respectively. Implementation and enforcement of WHO FCTC tobacco demand-reduction measures would lead to reduced tobacco use, fewer tobacco-related deaths and reduced socioeconomic losses.

CONCLUSIONS

WHO FCTC tobacco control measures would provide a positive return on investment in every country analysed.

Global supply chains amplify economic costs of future extreme heat risk

Evidence shows a continuing increase in the frequency and severity of global heatwaves1,2, raising concerns about the future impacts of climate change and the associated socioeconomic costs3,4. Here we develop a disaster footprint analytical framework by integrating climate, epidemiological and hybrid input-output and computable general equilibrium global trade models to estimate the midcentury socioeconomic impacts of heat stress. We consider health costs related to heat exposure, the value of heat-induced labour productivity loss and indirect losses due to economic disruptions cascading through supply chains. Here we show that the global annual incremental gross domestic product loss increases exponentially from 0.03 ± 0.01 (SSP 245)-0.05 ± 0.03 (SSP 585) percentage points during 2030-2040 to 0.05 ± 0.01-0.15 ± 0.04 percentage points during 2050-2060. By 2060, the expected global economic losses reach a total of 0.6-4.6% with losses attributed to health loss (37-45%), labour productivity loss (18-37%) and indirect loss (12-43%) under different shared socioeconomic pathways. Small- and medium-sized developing countries suffer disproportionately from higher health loss in South-Central Africa (2.1 to 4.0 times above global average) and labour productivity loss in West Africa and Southeast Asia (2.0-3.3 times above global average). The supply-chain disruption effects are much more widespread with strong hit to those manufacturing-heavy countries such as China and the USA, leading to soaring economic losses of 2.7 ± 0.7% and 1.8 ± 0.5%, respectively.

Treatable mortality and health care related factors across European countries

Introduction

Despite the improvements in European health systems, a large number of premature deaths are attributable to treatable mortality. Men make up the majority of these deaths, with a significant gap existing between women and men's treatable mortality rate in the EU.

Aim

This study aims to identify the healthcare-related factors, including health expenditures, human and physical resources, and hospital services use associated with treatable mortality in women and men across European countries during the period 2011-2019.

Methods

We use Eurostat data for 28 EU countries in the period 2011-2019. We estimate a panel data linear regression with country fixed effects and quantile linear regression for men and women.

Results

The results found (i) differences in drivers for male and female treatable mortality, but common drivers hold the same direction for both sexes; (ii) favorable drivers are GDP per capita, health expenditures, number of physicians per capita, and (only for men) the average length of a hospital stay, (iii) unfavorable drivers are nurses and beds per capita, although nurses are not significant for explaining female mortality.

Conclusion

Policy recommendations may arise that involve an improvement in hospital bed management and the design of more specific policies aimed at healthcare professionals.

Measurement of the burdens of neonatal disorders in 204 countries, 1990-2019: a global burden of disease-based study

BACKGROUND

Neonatal disorders are facing serious public health challenges. Previous studies were based on limited data sources and had a narrow geographical scope. We aim to understand the trends of alteration in the burden of neonatal disorders from 1990 to 2019 in 204 countries and territories.

METHODS

Data were investigated from the Global Burden of Disease Study 2019. First, we visualized the burden of neonatal disorders using the number of cases and the age-standardized incidence rate (ASIR), death rate (ASDR), and disability-adjusted life years (ASR-DALYs) from 1990 to 2019. Second, estimated annual percentage changes (EAPCs) were used to evaluate the temporal trends of disease burden during different periods. Finally, the sociodemographic index (SDI) and human development index (HDI) were used to determine whether there exists a correlation between socioeconomic development level, human development level, and potential burden consequences.

RESULTS

Overall, in the past 30 years, the ASIR trends have remained relatively steady, whereas the ASDR and ASR-DALYs have declined. However, the burden of neonatal disorders varied greatly in various regions and countries. Among 21 regions, the ASIR trend had the largest increase in Central Latin America (EAPC = 0.42, 95%CI = 0.33-0.50). Conversely, the ASDR and ASR-DALYs experienced the largest decrease in Central Europe (EAPC = -5.10, 95%CI = -5.28 to 4.93) and East Asia (EAPC = -4.07, 95%CI = -4.41 to 3.73), respectively. Among 204 countries, the ASIR (EAPC = 3.35, 95%CI = 3.13-3.56) trend in Greece displayed the most significant increase, while the ASDR (EAPC = 1.26, 95%CI = 1.01-1.50) and ASR-DALYs (EAPC = 1.26, 95%CI = 1.03-1.49) trends in Dominica experienced the most substantial increase. Furthermore, there was a strong correlation between the EAPCs in ASIR, ASDR, ASR-DALYs, and SDI or HDI in 2019, with some exceptions. In addition, countries with elevated levels of HDI experienced a faster increase in ASDR and ASR-DALYs for neonatal disorders.

CONCLUSION

Although the burden of neonatal disorders shows a downward trend from 1990 to 2019, it is still not optimistic. It is necessary to implement a multi-pronged approach to reduce the increasing burden of neonatal disorders.

Does the market reward quality? Evidence from India

There are two salient facts about health care in low and middle-income countries; (1) the private sector plays an important role and (2) the care provided is often of poor quality. Despite these facts we know little about what drives quality of care in the private sector and why patients seek care from poor quality providers. We use two field studies in India that provide insight into this issue. First, we use a discrete choice experiment to show that patients strongly value technical quality. Second, we use standardized patients to show that better quality providers are not able to charge higher prices. Instead providers are able to charge higher prices for elements of quality that the patient can observe, which are less important for health outcomes. Future research should explore whether accessible information on technical quality of local providers can shift demand to higher quality providers and improve health outcomes.

The Budget Impact Analysis of Adopting Direct Oral Anticoagulants for Stroke Prevention in Nonvalvular Atrial Fibrillation Patients in Malawi

OBJECTIVES

This study aimed to estimate the budget impact of adopting direct oral anticoagulants (DOACs) for stroke prevention in patients with nonvalvular atrial fibrillation in Malawi after the inclusion of DOACs in the World Health Organization's essential medicine list.

METHODS

A model was developed in Microsoft Excel. An eligible population of 201 491 was adjusted with 0.05 % incidence rate and mortality rates yearly according to the treatments. The model estimated the implication of supplementing rivaroxaban or apixaban to the standard treatment mix (also the comparator), thus warfarin and aspirin. The current market share of 43% aspirin and 57% warfarin was adjusted proportionally with 10% DOAC uptake in the first year and 5% annually over the subsequent 4 years. Clinical events of stroke and major bleeding from the ROCKET-AF and ARISTOTLE trials were used because health outcome indicators affect resource utilization. The analysis was conducted solely from the Malawi Ministry of Health perspective and it considered direct costs over 5 years. The sensitivity analysis involved varying drug costs, population, and care costs from both public and private sectors.

RESULTS

The research suggests that despite potential savings of $6 644 141 to $6 930 812 in stroke care because of fewer stroke events, the total Ministry of Health healthcare budget (approximately $260 400 000) may increase by between $42 488 342 to $101 633 644 in 5 years because drug acquisition costs are greater than savings.

CONCLUSIONS

With a fixed budget and current DOACs prices, Malawi can consider using DOACs in patients at the highest risk while waiting for cheaper generic versions.

Financing surgical, obstetric, anaesthesia, and trauma care in the Asia-Pacific region: proceedings

Surgical, obstetric, and anaesthesia care saves lives, prevents disability, promotes economic prosperity, and is a fundamental human right. Session two of the three-part virtual meeting series on Strategic Planning to Improve Surgical, Obstetric, Anaesthesia, and Trauma Care in the Asia-Pacific Region discussed financing strategies for surgical care. During this session, participants made a robust case for investing in surgical care given its cost-effectiveness, macroeconomic benefits, and contribution to health security and pandemic preparedness. Funding for surgical system strengthening could arise from both domestic and international sources. Numerous strategies are available for mobilising funding for surgical care, including conducive macroeconomic growth, reprioritisation of health within government budgets, sector-specific domestic revenue, international financing, improving the effectiveness and efficiency of health budgets, and innovative financing. A wide range of funders recognised the importance of investing in surgical care and shared their currently funded projects in surgical, obstetric, anaesthesia, and trauma care as well as their funding priorities. Advocacy efforts to mobilise funding for surgical care to align with the existing funder priorities, such as primary health care, maternal and child health, health security, and the COVID-19 pandemic. Although the COVID-19 pandemic has constricted the fiscal space for surgical care, it has also brought unprecedented attention to health. Short-term investment in critical care, medical oxygen, and infection prevention and control as a part of the COVID-19 response must be leveraged to generate sustained strengthening of surgical systems beyond the pandemic.

The potential impact of novel tuberculosis vaccine introduction on economic growth in low- and middle-income countries: A modeling study

BACKGROUND

Most individuals developing tuberculosis (TB) are working age adults living in low- and middle-income countries (LMICs). The resulting disability and death impact economic productivity and burden health systems. New TB vaccine products may reduce this burden. In this study, we estimated the impact of introducing novel TB vaccines on gross domestic product (GDP) growth in 105 LMICs.

METHODS AND FINDINGS

We adapted an existing macroeconomic model to simulate country-level GDP trends between 2020 and 2080, comparing scenarios for introduction of hypothetical infant and adolescent/adult vaccines to a no-new-vaccine counterfactual. We parameterized each scenario using estimates of TB-related mortality, morbidity, and healthcare spending from linked epidemiological and costing models. We assumed vaccines would be introduced between 2028 and 2047 and estimated incremental changes in GDP within each country from introduction to 2080, in 2020 US dollars. We tested the robustness of results to alternative analytic specifications. Both vaccine scenarios produced greater cumulative GDP in the modeled countries over the study period, equivalent to $1.6 (95% uncertainty interval: $0.8, 3.0) trillion for the adolescent/adult vaccine and $0.2 ($0.1, 0.4) trillion for the infant vaccine. These GDP gains were substantially lagged relative to the time of vaccine introduction, particularly for the infant vaccine. GDP gains resulting from vaccine introduction were concentrated in countries with higher current TB incidence and earlier vaccine introduction. Results were sensitive to secular trends in GDP growth but relatively robust to other analytic assumptions. Uncertain projections of GDP could alter these projections and affect the conclusions drawn by this analysis.

CONCLUSIONS

Under a range of assumptions, introducing novel TB vaccines would increase economic growth in LMICs.

Global, regional, and national incidence and mortality of neonatal sepsis and other neonatal infections, 1990–2019

Background

Neonatal infections, especially neonatal sepsis, are one of the major causes of incidence and mortality in pediatrics. However, the global burden of neonatal sepsis and other neonatal infections (NSNIs) remains unclear.

Methods

From the 2019 global disease burden study, we collected annual incident cases, deaths, age-standardized incidence rates (ASIRs), and age-standardized deaths rates (ASDRs) of NSNIs in the past 30 years. Analysis indicators included the percentage of relative changes in incident cases and deaths, and the estimated annual percentage changes (EAPCs) of ASIRs and ASDRs. Correlations were assessed between the EAPCs of ASIRs and ASDRs and social evaluation indicators, including sociodemographic index (SDI) and universal health coverage index (UHCI).

Results

Globally, the number of incident cases of NSNIs grew by 12.79% per year, and the number of deaths dropped by 12.93% per year. During this period, global ASIR of NSNIs increased by 46% annually on average, while ASDR decreased by 53% annually on average. The ASIR and ASDR of female NSNIs were consistently lower than that of male NSNIs. The EAPC of female ASIR was 0.61, nearly twice that of male ASIR, and female ASIR was growing rapidly. The same declining trends of ASDR were noted in males and females. The ASIR of NSNIs in high-SDI regions grew by an average of 14% annually from 1990 to 2019. Except for high-SDI regions, the ASIRs of other 4 SDI regions maintained a rising trend at a high level, and were improved in the past 10 years. The ASDRs of all 5 SDI regions generally showed a downward trend. The region with the highest ASIR of NSNIs was Andean Latin America, and Western Sub-Saharan Africa had the highest mortality. We found a negative correlation between EAPCs of ASDRs and UHCI in 2019.

Conclusion

The global health situation was still not optimal. The incidence of NSNIs remained high, and continues to rise. The mortality of NSNIs has decreased, especially in the countries/territories with high UHCI. Therefore, it is crucial to improve the overall awareness and management of NSNIs, and take interventions for NSNIs worldwide.

Understanding the relationships between health spending, treatable mortality and economic productivity in OECD countries

Introduction

Population health is one of the highest priorities for countries, which can translate into increased economic prosperity. This encourages research on health in an economic context.

Methods

The objective was to assess the relationships between health spending, treatable respiratory mortality, and gross domestic product (GDP) in countries of the Organization for Economic Co-operation and Development (OECD). The research was conducted with respect to health systems (tax-based, insurance-based) and gender differentiation of the productive population (aged 25-64 years). Descriptive analysis, regression analysis, and cluster analysis were used to achieve the main objective. The data covered the period from 1994 to 2016.

Results

The results of the regression analysis revealed negative relationships between health spending and treatable respiratory mortality in countries with a tax-based health system for male and female working-age populations, as well as in countries with an insurance-based health system for male population. This means that higher health spending was associated with lower treatable respiratory mortality. Also, lower treatable mortality was associated with higher GDP, especially in the male productive population from countries with an insurance-based health system. In this study, countries with a tax-based health system were characterized by higher health spending, lower rates of treatable mortality from respiratory system diseases, and higher GDP compared to countries with an insurance-based health system. Males reported a higher mortality rate than females. Among the countries with a tax-based health system, the United Kingdom and Latvia showed less positive outcomes, while Italy and Iceland were the countries with the most positive outcomes. Among the countries with an insurance-based health system, Hungary and Slovakia reported poor outcomes, while France, Switzerland and Luxembourg were characterized by very positive outcomes. The United States showed a high mortality rate despite its high economic outcomes, i.e., health spending and GDP.

Discussion

Health care financing in particular is one of the instruments of health policy. It seems that the leaders of countries should ensure a sufficient level of health financing, as higher health spending can contribute to lower mortality rates in a country. This may translate into higher productivity. Especially countries with underfunded health systems should increase their health spending.

Global trends in incidence and death of neonatal disorders and its specific causes in 204 countries/territories during 1990–2019

Background

Neonatal disorders (ND) are a significant global health issue. This article aimed to track the global trends of neonatal disorders in 204 countries/territories from 1990 to 2019.

Methods

Data was explored from the Global Burden of Disease study 2019. Estimated annual percentage change (EAPC) and age-standardized rate (ASR) were calculated to quantify the trends of neonatal disorders and their specific causes, mainly included neonatal preterm birth (NPB), neonatal encephalopathy due to birth asphyxia and trauma (NE), neonatal sepsis and other neonatal infections (NS), and hemolytic disease and other neonatal jaundice (HD).

Results

In 2019, there were 23,532.23 × 10³ incident cases of ND, and caused 1882.44 × 10³ death worldwide. During 1990–2019, trends in the overall age-standardized incidence rate (ASIR) of ND was relatively stable, but that of age-standardized death rate (ASDR) declined (EAPC = -1.51, 95% confidence interval [CI]: -1.66 to -1.36). Meanwhile, decreasing trends of ASDR were observed in most regions and countries, particularly Cook Islands and Estonia, in which the respective EAPCs were -9.04 (95%CI: -9.69 to -8.38) and -8.12 (95%CI: -8.46 to -7.77). Among the specific four causes, only the NPB showed decreasing trends in the ASIR globally (EAPC = -0.19, 95%CI: -0.26 to -0.11). Decreasing trends of ASDR caused by ND underlying specific causes were observed in most regions, particularly the HD in Armenia, with the EAPC was -13.08 (95%CI: -14.04 to -12.11).

Conclusions

Decreasing trends of death caused by neonatal disorders were observed worldwide from 1990 to 2019. However, the burden of neonatal disorders is still a considerable challenge, especially in low-resource settings, which need more effective health strategies.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12889-022-12765-1.

The role of registered charities in the delivery of global surgery in low- and middle-income countries - a personal experience

The world's resources are unequally divided. Investment in healthcare in Low- and Middle-Income Countries (LMICs) has traditionally involved vertical public health strategies with little emphasis on the delivery of safe and effective surgery and anesthesia. The past 20 years has witnessed greater awareness of the numbers of people who have no access to surgery, the morbidity and mortality of such limited access, and the cost to the individual and society if a solution is not found. Global surgery has become a hot topic and The Millennium Development Goals (MDG) and the Sustainable Development Goals (SDG) have underlined the importance of surgery in national health care plans. The harsh metrics reported by the Lancet Commission has framed the problem in more concrete terms and as of today, over 5 billion people lack access to safe surgery, over 143 million extra surgeries are needed annually to affect the imbalance and more than 15,000 children die each day in Sub Saharan Africa and Southeast Asia from preventable disease, including the lack of access to safe surgery. Horizontal integrated healthcare that includes surgical provision is the new norm, but its introduction is expensive and will need time. The ambition of universal healthcare access for all people (SDG) with a corresponding reduction in child and maternal mortality will be difficult for most governments. Altruistic, Non-Governmental Organizations (NGOs) are ideally placed to assist this goal but must introduce changes in practice to include onsite and off-site training, broad partnerships with other NGOs and academic bodies and greater advocacy with governments to ensure sustainability. NGOs should work in concert with local agencies, hospitals and governments to meet local needs.

Examining the Economic Perspective of Treatable Mortality: The Role of Health Care Financing and the Importance for Economic Prosperity

Health is an essential element of economic life and is therefore considered a source of comparative economic development of countries. The aim of the study was to examine the associations between health care financing, specific treatable mortality of males and females of working age, and economic prosperity, taking into account to the classification of health systems applied in the countries of the Organization for Economic Co-operation and Development (OECD). An insurance-based health system and a tax-based health system were identified in these countries, and data were collected for the period 1994-2016. Descriptive analysis, panel regression analysis and cluster analysis were used to achieve the aim. The analytical process included economic indicators [health expenditure, gross domestic product (GDP)] and health indicators (treatable mortality from circulatory system diseases and endocrine, nutritional and metabolic diseases). The results revealed significant negative associations of health care financing with treatable mortality from circulatory system diseases and endocrine, nutritional, and metabolic diseases in both health systems and both gender categories. There were also negative associations between treatable mortality in both diagnosis groups and economic prosperity. These results have shown that health care financing is linked to economic prosperity also through health variability in the working age population. In terms of assessing economic and health outcomes, less positive and more positive countries were identified using cluster analysis. Countries such as Latvia with a tax-based health system and Hungary, Lithuania, Estonia with an insurance-based health system were characterized by great potential for improvements. Although reducing treatable mortality is a great motivation for public health leaders to increase health care financing, the importance for economic prosperity may be a more compelling argument. Effective interventions should be considered in the light of their regional, social and economic contexts.

A country-level comparison of access to quality surgical and non-surgical healthcare from 1990-2016

BACKGROUND

The Healthcare Access and Quality (HAQ) index, developed by the Institute for Health Metrics and Evaluation, uses estimates of amenable mortality to quantify health system performance over time. While much is known about general health system performance globally, few studies have portrayed the performance of surgical systems. In order to quantify access to quality surgical care, evaluate changes over time, and link these changes to health care investments, surgical and non-surgical Health Access and Quality sub-indices were developed.

DESIGN

We categorized 32 amenable mortality causes as either surgical or non-surgical conditions. Using principal components analysis and scaled amenable mortality rates, we constructed a surgical and non-surgical Health Access and Quality sub-index. Using these sub-indices, relative improvement over time was compared. An expenditure model with country fixed effects was built to explore drivers of differences in relative improvement of sub-indices.

RESULTS

Compared to low-income countries, high-income countries have been 2.77 times more effective at improving surgical care (p < .05). Government expenditure on healthcare has a larger effect on improving surgical Health Access and Quality (p < 0.05) while development assistance for health has a larger effect on improving non-surgical Health Access and Quality (p < 0.05).

CONCLUSIONS AND RELEVANCE

Global health investment must prioritize strengthening health systems as opposed to the historically favored vertical programming. In order to achieve health equity in low-income countries, more focus should be placed on domestic financing of surgical systems. Health Access and Quality sub-indices can be used by countries to identify targets, monitor progress, and evaluate interventions aimed at improving access to quality surgical healthcare.

The Macroeconomic Consequences Of Firearm-Related Fatalities In OECD Countries, 2018-30: A Value-Of-Lost-Output Analysis

We modeled gross domestic product (GDP) losses attributable to firearm-related fatalities in each of thirty-six Organization for Economic Cooperation and Development (OECD) countries using the value-of-lost-output approach from 2018 to 2030. There are three categories of firearm-related fatalities: physical violence, self-harm, and unintentional injury. We project that the thirty-six OECD countries will lose $239.0 billion in cumulative GDP from 2018 to 2030 from firearm-related fatalities. Most of these losses ($152.5 billion) will occur as a result of fatalities in the US. In 2030 alone, the OECD countries will collectively lose $30.4 billion (0.04 percent) of their estimated annual GDP from firearm-related fatalities. The highest relative losses will occur in Mexico and the US; the lowest will occur in Japan. Firearm-related fatalities are expected to disproportionately affect the US and Mexican economies. Across the OECD, 48.5 percent of economic losses will be attributable to physical violence, 47.0 percent to self-harm, and 4.6 percent to unintentional injury. These findings provide a more complete picture of the toll of firearm-related fatalities, a global public health crisis that, without intervention, will continue to impose significant economic losses across OECD countries.

Premature mortality in the US: A convergence study

Premature mortality is an important public health indicator with ramifications to social and economic outcomes. The purpose of this study is to examine whether premature mortality, measured by the years of potential life lost (YPLL), converges among the U.S. states and which mortality components lead to divergence. To this end, we calculate the YPLL and apply the Phillips and Sul (2007, 2009) convergence test methodology. We find that for males and blacks all U.S. states converge to a steady-state while for females, whites and total population, the states form convergence clubs. These clubs differ mainly due to variances in infant, cardiovascular and unintentional injury mortalities with the ones with the lesser YPLL located mainly on the west and east coast.

Contribution of amenable mortality to life expectancy differences between the Dutch Caribbean islands of Aruba and Curaçao and the Netherlands

Objective.

To identify specific health care areas whose optimization could improve population health in the Dutch Caribbean islands of Aruba and Curaçao.

Methods.

Comparative observational study using mortality and population data of the Dutch Caribbean islands and the Netherlands. Mortality trends were calculated, then analyzed with Joinpoint software, for the period 1988–2014. Life expectancies were computed using abridged life tables for the most recent available data of all territories (2005–2007). Life expectancy differences between the Dutch Caribbean and the Netherlands were decomposed into cause-specific contributions using Arriaga’s method.

Results.

During the period 1988–2014, levels of amenable mortality have been consistently higher in Aruba and Curaçao than in the Netherlands. For Aruba, the gap in amenable mortality with the Netherlands did not significantly change during the study period, while it widened for Curaçao. If mortality from amenable causes were reduced to similar levels as in the Netherlands, men and women in Aruba would have added, respectively, 1.19 years and 0.72 years to their life expectancies during the period 2005–2007. In Curaçao, this would be 2.06 years and 2.33 years. The largest cause-specific contributions were found for circulatory diseases, breast cancer, perinatal causes, and nephritis/nephrosis (these last two causes solely in Curaçao).

Conclusions.

Improvements in health care services related to circulatory diseases, breast cancer, perinatal deaths, and nephritis/nephrosis in the Dutch Caribbean could substantially contribute to reducing the gap in life expectancy with the Netherlands. Based on our study, we recommend more in-depth studies to identify the specific interventions and resources needed to optimize the underlying health care areas.

Gender Inequalities in Health and Their Effect on the Economic Prosperity Represented by the GDP of Selected Developed Countries-Empirical Study

The objective is to evaluate the relations between gender health inequalities and economic prosperity in the Organisation for Economic Co-operation and Development (OECD) countries. The groups included health indicators in the specification of men, women and gender inequalities: life expectancy, causes of mortality and avoidable mortality. The variable determining the economic prosperity was represented by the Gross Domestic Product (GDP). The analytical processing included descriptive analysis, analysis of differences and analysis of relationships. The regression analysis was presented as the main output of the research. Most of the significant gender differences in health showed a more positive outcome for women. It is possible to identify a certain relation between gender health inequalities and economic prosperity. If there is some reduction in gender inequalities in health, the economic prosperity will increase. The reduction seems to be more effective on the part of men than women. The output of the cluster analysis showed the relations of indicators evaluating the inequalities and the prosperity. The countries such as Luxembourg, Norway or Switzerland showed very positive outputs, on the other hand, the countries with a potential for the improvement are Lithuania, Latvia or Estonia. Overall, the policies should focus on reducing the inequalities in avoidable mortality as well as reducing the frequent diseases in younger people.

Artificial intelligence and the future of global health

Concurrent advances in information technology infrastructure and mobile computing power in many low and middle-income countries (LMICs) have raised hopes that artificial intelligence (AI) might help to address challenges unique to the field of global health and accelerate achievement of the health-related sustainable development goals. A series of fundamental questions have been raised about AI-driven health interventions, and whether the tools, methods, and protections traditionally used to make ethical and evidence-based decisions about new technologies can be applied to AI. Deployment of AI has already begun for a broad range of health issues common to LMICs, with interventions focused primarily on communicable diseases, including tuberculosis and malaria. Types of AI vary, but most use some form of machine learning or signal processing. Several types of machine learning methods are frequently used together, as is machine learning with other approaches, most often signal processing. AI-driven health interventions fit into four categories relevant to global health researchers: (1) diagnosis, (2) patient morbidity or mortality risk assessment, (3) disease outbreak prediction and surveillance, and (4) health policy and planning. However, much of the AI-driven intervention research in global health does not describe ethical, regulatory, or practical considerations required for widespread use or deployment at scale. Despite the field remaining nascent, AI-driven health interventions could lead to improved health outcomes in LMICs. Although some challenges of developing and deploying these interventions might not be unique to these settings, the global health community will need to work quickly to establish guidelines for development, testing, and use, and develop a user-driven research agenda to facilitate equitable and ethical use.

Unnatural death in India

Rising adult mortality is an essential feature of the mortality transition. Vulnerability to disease and infection decreases with age, and adult mortality is more likely to be from unnatural causes such as suicide, homicide and road traffic accidents. This study aimed to assess the patterns of unnatural deaths in India as a whole and for various population subgroups. Data were obtained from the fourth wave of the National Family Health Survey (NFHS-4) conducted in 2015-16 in 29 states and 7 union territories of India. The survey collected information on deaths in households occurring in the 3 years before the survey. Rate of unnatural mortality and years of life lost were calculated separately for males and females as well as for urban and rural populations. Unnatural mortality in India was found to make up 10.3% of total deaths, and was greater among the population aged 10 to 45 years. The unnatural mortality rate in India was 0.67 per 1000 population: 0.84 per 1000 among the male population and 0.49 per 1000 among the female population. A strict positive association was found between the unnatural mortality rate and a state's development level. In addition, a substantial loss of person-years of life due to unnatural mortality was observed. The results serve as a reminder of the need to adopt measures to reduce this avoidable loss of life in India. Prevention strategies should be targeted at the most vulnerable populations to limit young-age fatality, with its resulting loss of productive years of life.

Bariatric Surgery Offer in Brazil: a Macroeconomic Analysis of the Health system's Inequalities

BACKGROUND

Brazil currently holds the second place in the worldwide ranking of the largest number of bariatric surgical procedures performed. The offer of bariatric surgery in the public health system is not sufficient for its demand; it remains to be determined whether the recent economic downturn affected this offer.

OBJECTIVE

To analyze the proportion of bariatric surgeries performed by the public system in Brazil and assess the influence of macroeconomic variables over time.

METHODS

This is a nationwide analysis which correlated the estimated number of bariatric surgeries in Brazil in both public and private health-providing systems from 2003 through 2017 with the main macroeconomic variables of Brazil during the evaluated period (gross domestic product [GDP], inflation rate, and unemployment rate), and both overall and public healthcare expenditures.

RESULTS

The proportion of surgeries performed in the public system varied from 7.1% in 2014 to 10.4% in 2004. There was a significant positive correlation between the public proportion of surgeries with the unemployment rate (R = 0.55666; P = 0.03868). There were significant negative correlations between the proportion of public surgeries with the public health expenditure per capita (R = - 0.88811; P = 0.00011) and with the public percentage of healthcare expenditure per capita (R = - 0.67133; P = 0.01683).

CONCLUSION

There were direct correlations between the number of public bariatric procedures and the unemployment rate, as well as with the public healthcare expenditure per capita. Despite the increase in the number of public procedures, its proportion reveals an insufficiency of the current offer of bariatric surgery provided by the public system.

Towards high-quality peri-operative care: a global perspective

Article 25 of the United Nations' Universal Declaration of Human Rights enshrines the right to health and well-being for every individual. However, universal access to high-quality healthcare remains the purview of a handful of wealthy nations. This is no more apparent than in peri-operative care, where an estimated five billion individuals lack access to safe, affordable and timely surgical care. Delivery of surgery and anaesthesia in low-resource environments presents unique challenges that, when unaddressed, result in limited access to low-quality care. Current peri-operative research and clinical guidance often fail to acknowledge these system-level deficits and therefore have limited applicability in low-resource settings. In this manuscript, the authors priority-set the need for equitable access to high-quality peri-operative care and analyse the system-level contributors to excess peri-operative mortality rates, a key marker of quality of care. To provide examples of how research and investment may close the equity gap, a modified Delphi method was adopted to curate and appraise interventions which may, with subsequent research and evaluation, begin to address the barriers to high-quality peri-operative care in low- and middle-income countries.

Global Burden of Head and Neck Cancer: Economic Consequences, Health, and the Role of Surgery

OBJECTIVE

We aimed to describe the mortality burden and macroeconomic effects of head and neck cancer as well as delineate the role of surgical workforce in improving head and neck cancer outcomes.

STUDY DESIGN

Statistical and economic analysis.

SETTING

Research group.

SUBJECTS AND METHODS

We conducted a statistical analysis on data from the World Development Indicators and the 2016 Global Burden of Disease study to describe the relationship between surgical workforce and global head and neck cancer mortality-to-incidence ratios. A value of lost output model was used to project the global macroeconomic effects of head and neck cancer.

RESULTS

Significant differences in mortality-to-incidence ratios existed between Global Burden of Disease study superregions. An increase of surgical, anesthetic, and obstetric provider density by 10% significantly correlated with a reduction of 0.76% in mortality-to-incidence ratio (P < .0001; adjusted R² = 0.84). There will be a projected global cumulative loss of $535 billion US dollars (USD) in economic output due to head and neck cancer between 2018 and 2030. Southeast Asia, East Asia, and Oceania will suffer the greatest gross domestic product (GDP) losses at $180 billion USD, and South Asia will lose $133 billion USD.

CONCLUSION

The mortality burden of head and neck cancer is increasing and disproportionately affects those in low- and middle-income countries and regions with limited surgical workforces. This imbalance results in large and growing economic losses in countries that already face significant resource constraints. Urgent investment in the surgical workforce is necessary to ensure access to timely surgical services and reverse these negative trends.

Implementation of an international standardized set of outcome indicators in pregnancy and childbirth in Kenya: Utilizing mobile technology to collect patient-reported outcomes

Background

Limited data exist on health outcomes during pregnancy and childbirth in low- and middle-income countries. This is a pilot of an innovative data collection tool using mobile technology to collect patient-reported outcome measures (PROMs) selected from the International Consortium of Health Outcomes Measurement (ICHOM) Pregnancy and Childbirth Standard Set in Nairobi, Kenya.

Methods

Pregnant women in the third trimester were recruited at three primary care facilities in Nairobi and followed prospectively throughout delivery and until six weeks postpartum. PROMs were collected via mobile surveys at three antenatal and two postnatal time points. Outcomes included incontinence, dyspareunia, mental health, breastfeeding and satisfaction with care. Hospitals reported morbidity and mortality. Descriptive statistics on maternal and child outcomes, survey completion and follow-up rates were calculated.

Results

In six months, 204 women were recruited: 50% of women returned for a second ante-natal care visit, 50% delivered at referral hospitals and 51% completed the postnatal visit. The completion rates for the five PROM surveys were highest at the first antenatal care visit (92%) and lowest in the postnatal care visit (38%). Data on depression, dyspareunia, fecal and urinary incontinence were successfully collected during the antenatal and postnatal period. At six weeks postpartum, 86% of women breastfeed exclusively. Most women that completed the survey were very satisfied with antenatal care (66%), delivery care (51%), and post-natal care (60%).

Conclusion

We have demonstrated that it is feasible to use mobile technology to follow women throughout pregnancy, track their attendance to pre-natal and post-natal care visits and obtain data on PROM. This study demonstrates the potential of mobile technology to collect PROM in a low-resource setting. The data provide insight into the quality of maternal care services provided and will be used to identify and address gaps in access and provision of high quality care to pregnant women.

Global surgery and the sustainable development goals

Background

The field of global surgery has gained significant recent momentum, catalysed by the 2015 publication of the Lancet Commission on Global Surgery, Disease Control Priorities 3 and World Health Assembly resolution 68.15. These reports characterized the global burden of disease amenable to surgical care, called for global investment in surgical systems, and recognized surgery and anaesthesia as essential components of universal health coverage.

Methods

A strategy proposed to strengthen surgical care is the development of national surgical, obstetric and anaesthesia plans (NSOAPs). This review examined how NSOAPs could contribute to the achievement of sustainable development goals (SDGs) 1, 3, 5, 8, 9, 10, 16 and 17 by 2030, focusing on their potential impact on the healthcare systems in Ethiopia, Tanzania and Zambia.

Results

Due to the cross-cutting nature of surgery, obstetrics and anaesthesia, investing in these services will escalate progress to achieve gender equality, economic growth and infrastructure development. Universal health coverage will not be achieved without addressing the financial ramifications to the poor of seeking and receiving surgical care. NSOAPs provide a strategic framework and a data collection platform for evidence-based policy-making, accountability and implementation guidance.

Conclusion

The development and implementation of data-driven NSOAPs should be recognized as a powerful road map to accelerate achievement of the SDGs by 2030.

Mortality due to low-quality health systems in the universal health coverage era: a systematic analysis of amenable deaths in 137 countries

BACKGROUND

Universal health coverage has been proposed as a strategy to improve health in low-income and middle-income countries (LMICs). However, this is contingent on the provision of good-quality health care. We estimate the excess mortality for conditions targeted in the Sustainable Development Goals (SDG) that are amenable to health care and the portion of this excess mortality due to poor-quality care in 137 LMICs, in which excess mortality refers to deaths that could have been averted in settings with strong health systems.

METHODS

Using data from the 2016 Global Burden of Disease study, we calculated mortality amenable to personal health care for 61 SDG conditions by comparing case fatality between each LMIC with corresponding numbers from 23 high-income reference countries with strong health systems. We used data on health-care utilisation from population surveys to separately estimate the portion of amenable mortality attributable to non-utilisation of health care versus that attributable to receipt of poor-quality care.

FINDINGS

15·6 million excess deaths from 61 conditions occurred in LMICs in 2016. After excluding deaths that could be prevented through public health measures, 8·6 million excess deaths were amenable to health care of which 5·0 million were estimated to be due to receipt of poor-quality care and 3·6 million were due to non-utilisation of health care. Poor quality of health care was a major driver of excess mortality across conditions, from cardiovascular disease and injuries to neonatal and communicable disorders.

INTERPRETATION

Universal health coverage for SDG conditions could avert 8·6 million deaths per year but only if expansion of service coverage is accompanied by investments into high-quality health systems.

FUNDING

Bill & Melinda Gates Foundation.