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Ileri SG, Sadana R, Balachandran A. How to finance national antimicrobial resistance action plans. Bull World Health Organ 2024; 102:370-372. [PMID: 38680462 PMCID: PMC11046159 DOI: 10.2471/blt.24.291638] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2024] [Revised: 03/08/2024] [Accepted: 03/08/2024] [Indexed: 05/01/2024] Open
Affiliation(s)
- Serife Genc Ileri
- Department of Economics, Faculty of Management, Istanbul Technical University, Macka Campus, 34367 Macka Istanbul, Türkiye
| | - Ritu Sadana
- Secretariat, WHO Council on the Economics of Health for All, World Health Organization, Geneva, Switzerland
| | - Anand Balachandran
- Surveillance, Prevention and Control Department, World Health Organization, Geneva, Switzerland
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2
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Sadana R, Illeri SG, Obrizan M, Huitron A, Dutt D, Duran-Fernandez R. Reframing the relationship between the economy and health. Bull World Health Organ 2024; 102:300-300A. [PMID: 38693942 PMCID: PMC11046145 DOI: 10.2471/blt.24.291710] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/03/2024] Open
Affiliation(s)
- Ritu Sadana
- Secretariat, WHO Council on the Economics of Health for All, World Health Organization, Avenue Appia 20, 1211Geneva 27, Switzerland
| | - Serife Genc Illeri
- Department of Economics, Istanbul Technical University, Istanbul, Türkiye
| | | | | | - Devika Dutt
- Department of International Development, Kings College London, London, England
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3
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Sadana R, Khosla R, Gisselquist R, Sen K. Continuing a scientific dialogue between sectors on health and economics. Bull World Health Organ 2024; 102:299-299A. [PMID: 38693944 PMCID: PMC11046151 DOI: 10.2471/blt.24.291722] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/03/2024] Open
Affiliation(s)
- Ritu Sadana
- Secretariat, WHO Council on the Economics of Health for All, World Health Organization, Avenue Appia 20, 1211 Geneva 27, Switzerland
| | - Rajat Khosla
- United Nations University International Institute for Global Health, Kuala Lumpur, Malaysia
| | - Rachel Gisselquist
- United Nations University World Institute for Development Economics Research, Helsinki, Finland
| | - Kunal Sen
- United Nations University World Institute for Development Economics Research, Helsinki, Finland
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Co M, Moreno-Agostino D, Wu YT, Couch E, Posarac A, Wi T, Sadana R, Carlisle S, Prina M. Non-pharmacological interventions for the prevention of sexually transmitted infections (STIs) in older adults: A systematic review. PLoS One 2023; 18:e0284324. [PMID: 37224103 PMCID: PMC10208510 DOI: 10.1371/journal.pone.0284324] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2021] [Accepted: 03/28/2023] [Indexed: 05/26/2023] Open
Abstract
BACKGROUND STIs in older adults (adults aged 50 years and older) are on the rise due to variable levels of sex literacy and misperceived susceptibility to infections, among other factors. We systematically reviewed evidence on the effect of non-pharmacological interventions for the primary prevention of sexually transmitted infections (STIs) and high-risk sexual behaviour in older adults. METHODS We searched EMBASE, MEDLINE, PSYCINFO, Global Health and the Cochrane Library from inception until March 9th, 2022. We included RCTs, cluster-randomised trials, quasi-RCTs, interrupted time series (ITS) and controlled and uncontrolled before-and-after studies of non-pharmacological primary prevention interventions (e.g. educational and behaviour change interventions) in older adults, reporting either qualitative or quantitative findings. At least two review authors independently assessed the eligibility of articles and extracted data on main characteristics, risk of bias and study findings. Narrative synthesis was performed. RESULTS Ten studies (two RCTs, seven quasi-experiment studies and one qualitative study) were found to be eligible for this review. These interventions were mainly information, education and communication activities (IECs) aimed at fostering participants' knowledge on STIs and safer sex, mostly focused on HIV. Most studies used self-reported outcomes measuring knowledge and behaviour change related to HIV, STIs and safer sex. Studies generally reported an increase in STI/HIV knowledge. However, risk of bias was high or critical across all studies. CONCLUSIONS Literature on non-pharmacological interventions for older adults is sparse, particularly outside the US and for STIs other than HIV. There is evidence that IECs may improve short-term knowledge about STIs however, it is not clear this translates into long-term improvement or behaviour change as all studies included in this review had follow-up times of 3 months or less. More robust and higher-quality studies are needed in order to confirm the effectiveness of non-pharmacological primary prevention interventions for reducing STIs in the older adult population.
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Affiliation(s)
- Melissa Co
- Health Service and Population Research Department, Institute of Psychiatry, Psychology and Neuroscience, King’s College London, London, United Kingdom
| | - Darío Moreno-Agostino
- Health Service and Population Research Department, Institute of Psychiatry, Psychology and Neuroscience, King’s College London, London, United Kingdom
- Centre for Longitudinal Studies, UCL Social Research Institute, University College London, London, United Kingdom
- ESRC Centre for Society and Mental Health, King’s College London, London, United Kingdom
| | - Yu-Tzu Wu
- Health Service and Population Research Department, Institute of Psychiatry, Psychology and Neuroscience, King’s College London, London, United Kingdom
- Population Health Sciences Institute, Faculty of Medical Sciences, Newcastle University, Newcastle upon Tyne, United Kingdom
| | - Elyse Couch
- Health Service and Population Research Department, Institute of Psychiatry, Psychology and Neuroscience, King’s College London, London, United Kingdom
- Center for Gerontology and Healthcare Research, Brown University, Providence, RI, United States of America
| | - Ana Posarac
- Ageing and Health Unit, Maternal, Newborn, Child and Adolescent Health and Ageing Department, World Health Organisation, Geneva, Switzerland
| | - Teodora Wi
- Department of Global HIV, Hepatitis and Sexually Transmitted Infections Programmes, World Health Organisation, Geneva, Switzerland
| | - Ritu Sadana
- Ageing and Health Unit, Maternal, Newborn, Child and Adolescent Health and Ageing Department, World Health Organisation, Geneva, Switzerland
- World Health Organization Secretariat, Council on the Economics of Health for All, Geneva, Switzerland
| | - Sophie Carlisle
- Health Service and Population Research Department, Institute of Psychiatry, Psychology and Neuroscience, King’s College London, London, United Kingdom
| | - Matthew Prina
- Health Service and Population Research Department, Institute of Psychiatry, Psychology and Neuroscience, King’s College London, London, United Kingdom
- Population Health Sciences Institute, Faculty of Medical Sciences, Newcastle University, Newcastle upon Tyne, United Kingdom
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Cesari M, Sumi Y, Han ZA, Perracini M, Jang H, Briggs A, Amuthavalli Thiyagarajan J, Sadana R, Banerjee A. Implementing care for healthy ageing. BMJ Glob Health 2022; 7:bmjgh-2021-007778. [PMID: 35185014 PMCID: PMC8860009 DOI: 10.1136/bmjgh-2021-007778] [Citation(s) in RCA: 17] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2021] [Accepted: 12/13/2021] [Indexed: 11/30/2022] Open
Abstract
The WHO concept of Healthy Ageing (ie, the process of developing and maintaining the functional ability that enables well-being in older age) has initiated a global discussion about the need for shifting paradigms to reorient health and social services towards person-centred and coordinated models of care. In particular, the integration of health and social care services is critical to provide the basis for comprehensive information sharing and service delivery to support the evolution of the older person over time. The capability to monitor and respond to an older person’s changing health and social care needs will enable prompt and personalised health and social care plans to be implemented. The implementation of an integrated care approach involves all the settings where persons age, but also requires a concerted action among micro (clinical), meso (service delivery) and macro (system) level. The community is of particular relevance given the primary objective of "ageing in place". However, from the perspective of the continuum of care and services acting synergistically, all health and social care settings (including long-term care facilities and hospitals) need to evolve and embrace an integrated way of operating to support functional ability in older people, while maximising resource and information sharing efficiencies. In this paper, we explain that government actions to promote well-being in older age should be built on a seamless continuum of care starting from the assessment of the older person’s intrinsic capacity and functional ability with the final aim of providing care aligned with the individual’s needs and priorities.
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Arias-Casais N, Amuthavalli Thiyagarajan J, Rodrigues Perracini M, Park E, Van den Block L, Sumi Y, Sadana R, Banerjee A, Han ZA. What long-term care interventions have been published between 2010 and 2020? Results of a WHO scoping review identifying long-term care interventions for older people around the world. BMJ Open 2022; 12:e054492. [PMID: 35105637 PMCID: PMC8808408 DOI: 10.1136/bmjopen-2021-054492] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/08/2021] [Accepted: 12/20/2021] [Indexed: 01/23/2023] Open
Abstract
OBJECTIVE The global population is rapidly ageing. To tackle the increasing prevalence of older adults' chronic conditions, loss of intrinsic capacity and functional ability, long-term care interventions are required. The study aim was to identify long-term care interventions reported in scientific literature from 2010 to 2020 and categorise them in relation to WHO's public health framework of healthy ageing. DESIGN Scoping review conducted on PubMed, CINHAL, Cochrane and Google Advanced targeting studies reporting on long-term care interventions for older and frail adults. An internal validated Excel matrix was used for charting.Setting nursing homes, assisted care homes, long-term care facilities, home, residential houses for the elderly and at the community. INCLUSION CRITERIA Studies published in peer-reviewed journals between 1 January 2010 to 1 February 2020 on implemented interventions with outcome measures provided in the settings mentioned above for subjects older than 60 years old in English, Spanish, German, Portuguese or French. RESULTS 305 studies were included. Fifty clustered interventions were identified and organised into four WHO Healthy Ageing domains and 20 subdomains. All interventions delved from high-income settings; no interventions from low-resource settings were identified. The most frequently reported interventions were multimodal exercise (n=68 reports, person-centred assessment and care plan development (n=22), case management for continuum care (n=16), multicomponent interventions (n=15), psychoeducational interventions for caregivers (n=13) and interventions mitigating cognitive decline (n=13). CONCLUSION The identified interventions are diverse overarching multiple settings and areas seeking to prevent, treat and improve loss of functional ability and intrinsic capacity. Interventions from low-resource settings were not identified.
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Affiliation(s)
- Natalia Arias-Casais
- ATLANTES Global Observatory for Palliative Care, University of Navarra, Pamplona, Spain
| | | | | | - Eunok Park
- College of Nursing, Jeju National University, Jeju, Republic of Korea
| | - Lieve Van den Block
- Department of Family Medicine and Chronic Care, Vrije Universiteit Brussel, Brussels, Belgium
- End-of-Life Care Research Group, Vrije Universiteit Brussel, Brussels, Belgium
| | - Yuka Sumi
- Maternal, Newborn, Child and Adolescent Health and Ageing, World Health Organization, Geneva, Switzerland
| | - Ritu Sadana
- Maternal, Newborn, Child and Adolescent Health and Ageing, World Health Organization, Geneva, Switzerland
| | - Anshu Banerjee
- Maternal, Newborn, Child and Adolescent Health and Ageing, World Health Organization, Geneva, Switzerland
| | - Zee-A Han
- Maternal, Newborn, Child and Adolescent Health and Ageing, World Health Organization, Geneva, Switzerland
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7
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Cesari M, Sadana R, Sumi Y, Amuthavalli Thiyagarajan J, Banerjee A. What Is Intrinsic Capacity and Why Should Nutrition Be Included in the Vitality Domain? J Gerontol A Biol Sci Med Sci 2022; 77:91-93. [PMID: 35015816 DOI: 10.1093/gerona/glab318] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- Matteo Cesari
- Ageing and Health Unit, Department of Maternal, Newborn, Child and Adolescent Health and Ageing, World Health Organization, Geneva, Switzerland.,IRCCS Istituti Clinici Scientifici Maugeri, University of Milan, Milan, Italy
| | - Ritu Sadana
- Ageing and Health Unit, Department of Maternal, Newborn, Child and Adolescent Health and Ageing, World Health Organization, Geneva, Switzerland
| | - Yuka Sumi
- Ageing and Health Unit, Department of Maternal, Newborn, Child and Adolescent Health and Ageing, World Health Organization, Geneva, Switzerland
| | | | - Anshu Banerjee
- Department of Maternal, Newborn, Child and Adolescent Health and Ageing, World Health Organization, Geneva, Switzerland
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Perracini MR, Arias-Casais N, Thiyagarajan JA, Rapson C, Isaac V, Ullah S, Hyobum J, Sadana R, Han ZA. A Recommended Package of Long-Term Care Services to Promote Healthy Ageing Based on a WHO Global Expert Consensus Study. J Am Med Dir Assoc 2021; 23:297-303.e14. [PMID: 34973958 DOI: 10.1016/j.jamda.2021.12.019] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2021] [Revised: 12/08/2021] [Accepted: 12/11/2021] [Indexed: 12/31/2022]
Abstract
OBJECTIVES To reach consensus on a minimum list of long-term care (LTC) interventions to be included in a service package delivered through universal health coverage (UHC). DESIGN A multistep expert consensus process. SETTING AND PARTICIPANTS Multinational and multidisciplinary experts in LTC and ageing. METHODS The consensus process was composed of 3 stages: (1) a preconsultation round that built on an initial list of LTC interventions generated by a previous scoping review; (2) 2-round surveys to reach consensus on important, acceptable, and feasible interventions for LTC; (3) a panel meeting to finalize the consensus. RESULTS The preconsultation round generated an initial list of 117 interventions. In round 1, 194 experts were contacted and 92 (47%) completed the survey. In round 2, the same experts contacted for round 1 were invited, and 115 (59%) completed the survey. Of the 115 respondents in round 2, 80 participated in round 1. Experts representing various disciplines (eg, geriatricians, family doctors, nurses, mental health, and rehabilitation professionals) participated in round 2, representing 42 countries. In round 1, 81 interventions achieved the predetermined threshold for importance, and in round 2, 41 interventions achieved the predetermined threshold for acceptability and feasibility. Nine conflicting interventions between rounds 1 and 2 were discussed in the panel meeting. The recommended list composed of 50 interventions were from 6 domains: unpaid and paid carers' support and training, person-centered assessment and care planning, prevention and management of intrinsic capacity decline, optimization of functional ability, interventions needing focused attention, and palliative care. CONCLUSIONS AND IMPLICATIONS An international discussion and consensus process generated a minimum list of LTC interventions to be included in a service package for UHC. This package will enable actions toward a more robust framework for integrated services for older people in need of LTC across the continuum of care.
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Affiliation(s)
- Monica R Perracini
- Ageing and Health Unit, Department of Maternal, Newborn, Child & Adolescent Health and Ageing, WHO, Geneva, Switzerland; Master's and Doctoral Programs in Physical Therapy, Universidade Cidade de São Paulo, São Paulo, Brazil
| | - Natalia Arias-Casais
- Ageing and Health Unit, Department of Maternal, Newborn, Child & Adolescent Health and Ageing, WHO, Geneva, Switzerland; Global Observatory for Palliative Care Institute for Culture and Society University of Navarra, Pamplona, Spain
| | - Jotheeswaran A Thiyagarajan
- Ageing and Health Unit, Department of Maternal, Newborn, Child & Adolescent Health and Ageing, WHO, Geneva, Switzerland
| | - Colin Rapson
- Ageing and Health Unit, Department of Maternal, Newborn, Child & Adolescent Health and Ageing, WHO, Geneva, Switzerland
| | - Vivian Isaac
- College of Medicine and Public Health, Flinders University, Adelaide, South Australia, Australia
| | - Shahid Ullah
- College of Medicine and Public Health, Flinders University, Adelaide, South Australia, Australia
| | - Jang Hyobum
- Ageing and Health Unit, Department of Maternal, Newborn, Child & Adolescent Health and Ageing, WHO, Geneva, Switzerland
| | - Ritu Sadana
- Ageing and Health Unit, Department of Maternal, Newborn, Child & Adolescent Health and Ageing, WHO, Geneva, Switzerland
| | - Zee A Han
- Ageing and Health Unit, Department of Maternal, Newborn, Child & Adolescent Health and Ageing, WHO, Geneva, Switzerland.
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Golino H, Moulder R, Shi D, Christensen AP, Garrido LE, Nieto MD, Nesselroade J, Sadana R, Thiyagarajan JA, Boker SM. Entropy Fit Indices: New Fit Measures for Assessing the Structure and Dimensionality of Multiple Latent Variables. Multivariate Behav Res 2021; 56:874-902. [PMID: 32634057 DOI: 10.1080/00273171.2020.1779642] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Abstract
The accurate identification of the content and number of latent factors underlying multivariate data is an important endeavor in many areas of Psychology and related fields. Recently, a new dimensionality assessment technique based on network psychometrics was proposed (Exploratory Graph Analysis, EGA), but a measure to check the fit of the dimensionality structure to the data estimated via EGA is still lacking. Although traditional factor-analytic fit measures are widespread, recent research has identified limitations for their effectiveness in categorical variables. Here, we propose three new fit measures (termed entropy fit indices) that combines information theory, quantum information theory and structural analysis: Entropy Fit Index (EFI), EFI with Von Neumman Entropy (EFI.vn) and Total EFI.vn (TEFI.vn). The first can be estimated in complete datasets using Shannon entropy, while EFI.vn and TEFI.vn can be estimated in correlation matrices using quantum information metrics. We show, through several simulations, that TEFI.vn, EFI.vn and EFI are as accurate or more accurate than traditional fit measures when identifying the number of simulated latent factors. However, in conditions where more factors are extracted than the number of factors simulated, only TEFI.vn presents a very high accuracy. In addition, we provide an applied example that demonstrates how the new fit measures can be used with a real-world dataset, using exploratory graph analysis.
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Affiliation(s)
| | | | - Dingjing Shi
- Department of Psychology, University of Virginia
| | | | | | | | | | - Ritu Sadana
- Ageing and Health Unit, Department of Maternal, Newborn, Child, Adolescent Health and Ageing, World Health Organization
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Moreno-Agostino D, Prina M, Chua KC, Jotheeswaran AT, Sadana R, Officer A, Kamenov K, Cieza A. Measuring functional ability in healthy ageing: a nationwide cross-sectional survey in the Philippine older population. BMJ Open 2021; 11:e050827. [PMID: 34635522 PMCID: PMC8506858 DOI: 10.1136/bmjopen-2021-050827] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
OBJECTIVES To analyse the empirical support of the functional ability concept in the healthy ageing framework developed by the WHO in a sample of the Philippine older population. According to this framework, environmental factors may enhance or hinder functional ability, which is the person's ability to do what they value, broadly represented by subjective well-being. Moreover, this network of relationships may be moderated by personal characteristics such as gender. DESIGN Cross-sectional observational study. SETTING Philippines, general population. PARTICIPANTS Respondents of the 2016 National Disability Prevalence Survey/Model Functioning Survey aged 50+ (N=2825). PRIMARY AND SECONDARY OUTCOME MEASURES Latent (unobserved) measures of functional ability, environmental factors (physical environmental factors and social network and support) and subjective well-being (positive affect, negative affect and evaluative well-being) were obtained from different items from the survey questionnaire using a SEM framework. RESULTS We found that the relationship between environmental factors and the three components of subjective well-being considered in this study was partially explained by differences in functional ability. The portion of those effects accounted for by functional ability was comparatively larger for the physical than for the social environmental factors. We found no evidences of gender differences in this network of relationships. CONCLUSIONS These findings suggest the relevance of functional ability at explaining the relationship between environmental factors and subjective well-being in older adults. Future studies may replicate these findings longitudinally and including other relevant measures as the person's objective level of intrinsic capacity.
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Affiliation(s)
- Dario Moreno-Agostino
- Health Service and Population Research, King's College London, London, UK
- Centre for Longitudinal Studies, UCL Social Research Institute, University College London, London, UK
- ESRC Centre for Society and Mental Health, King's College London, London, UK
| | - Matthew Prina
- Health Service and Population Research, King's College London, London, UK
| | - Kia-Chong Chua
- Health Service and Population Research, King's College London, London, UK
| | | | - Ritu Sadana
- Ageing and Health Unit, Maternal, Newborn, Child & Adolescent Health & Ageing Department, World Health Organization, Geneva, Switzerland
| | - Alana Officer
- Demographic Change and Healthy Ageing Unit, Social Determinants of Health Department, World Health Organization, Geneve, Switzerland
| | - Kaloyan Kamenov
- Sensory Functions, Disability and Rehabilitation Unit, Department of Noncommunicable Diseases, World Health Organization, Geneve, Switzerland
| | - Alarcos Cieza
- Sensory Functions, Disability and Rehabilitation Unit, Department of Noncommunicable Diseases, World Health Organization, Geneve, Switzerland
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Zeki Al Hazzouri A, Elbejjani M, Chahine MA, Sadana R, Sibai AM. Late-life learning and health: challenges, opportunities, and future directions. Lancet Healthy Longev 2021; 2:e613-e614. [PMID: 34632440 PMCID: PMC8483348 DOI: 10.1016/s2666-7568(21)00207-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Affiliation(s)
- Adina Zeki Al Hazzouri
- Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, NY, USA
| | - Martine Elbejjani
- Department of Internal Medicine, Clinical Research Institute, American University of Beirut, Beirut 1107 2020, Lebanon
| | - Maya Abi Chahine
- University for Seniors Program, American University of Beirut, Beirut 1107 2020, Lebanon
| | - Ritu Sadana
- Ageing and Health, World Health Organization, Geneva, Switzerland
| | - Abla M Sibai
- Department of Epidemiology, American University of Beirut, Beirut 1107 2020, Lebanon
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Arokiasamy P, Selvamani Y, Jotheeswaran AT, Sadana R. Socioeconomic differences in handgrip strength and its association with measures of intrinsic capacity among older adults in six middle-income countries. Sci Rep 2021; 11:19494. [PMID: 34593926 PMCID: PMC8484588 DOI: 10.1038/s41598-021-99047-9] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2021] [Accepted: 09/20/2021] [Indexed: 12/18/2022] Open
Abstract
Handgrip strength, a measure of muscular strength is a powerful predictor of declines in intrinsic capacity, functional abilities, the onset of morbidity and mortality among older adults. This study documents socioeconomic (SES) differences in handgrip strength among older adults aged 50 years and over in six middle-income countries and investigates the association of handgrip strength with measures of intrinsic capacity-a composite of all the physical and mental capacities of an individual. Secondary data analysis of cross-sectional population-based data from six countries from the WHO's Study on global AGEing and adult health (SAGE) Wave 1 were conducted. Three-level linear hierarchical models examine the association of demographic, socioeconomic status and multimorbidity variables with handgrip strength. Regression-based Relative Index of Inequality (RII) examines socioeconomic inequalities in handgrip strength; and multilevel linear and logistic hierarchical regression models document the association between handgrip strength and five domains of intrinsic capacity: locomotion, psychological, cognitive capacity, vitality and sensory. Wealth quintiles are positively associated with handgrip strength among men across all countries except South Africa while the differences by education were notable for China and India. Work and nutritional status are positively associated with handgrip strength. Our findings provide new evidence of robust association between handgrip strength and other measures of intrinsic capacity and confirms that handgrip strength is a single most important measure of capacity among older persons.
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Affiliation(s)
- P Arokiasamy
- International Institute for Population Sciences (IIPS), Govandi Station Road, Mumbai, 400088, India
| | - Y Selvamani
- International Institute for Population Sciences (IIPS), Govandi Station Road, Mumbai, 400088, India.
| | - A T Jotheeswaran
- Department of Maternal, Newborn, Child, Adolescent Health and Ageing, World Health Organization, 20 Avenue Appia, 1211, Geneva, Switzerland
| | - Ritu Sadana
- Head, Ageing and Health, Department of Maternal, Newborn, Child, Adolescent Health and Ageing, World Health Organization, 20 Avenue Appia, 1211, Geneva, Switzerland
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Welch V, Mathew CM, Babelmorad P, Li Y, Ghogomu ET, Borg J, Conde M, Kristjansson E, Lyddiatt A, Marcus S, Nickerson JW, Pottie K, Rogers M, Sadana R, Saran A, Shea B, Sheehy L, Sveistrup H, Tanuseputro P, Thompson‐Coon J, Walker P, Zhang W, Howe TE. Health, social care and technological interventions to improve functional ability of older adults living at home: An evidence and gap map. Campbell Syst Rev 2021; 17:e1175. [PMID: 37051456 PMCID: PMC8988637 DOI: 10.1002/cl2.1175] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/13/2023]
Abstract
Background By 2030, the global population of people older than 60 years is expected to be higher than the number of children under 10 years, resulting in major health and social care system implications worldwide. Without a supportive environment, whether social or built, diminished functional ability may arise in older people. Functional ability comprises an individual's intrinsic capacity and people's interaction with their environment enabling them to be and do what they value. Objectives This evidence and gap map aims to identify primary studies and systematic reviews of health and social support services as well as assistive devices designed to support functional ability among older adults living at home or in other places of residence. Search Methods We systematically searched from inception to August 2018 in: MEDLINE, EMBASE, Cochrane Database of Systematic Reviews, CENTRAL, CINAHL, PsycINFO, AgeLine, Campbell Library, ASSIA, Social Science Citation Index and Social Policy & Practice. We conducted a focused search for grey literature and protocols of studies (e.g., ProQuest Theses and Dissertation Global, conference abstract databases, Help Age, PROSPERO, Cochrane and Campbell libraries and ClinicalTrials.gov). Selection Criteria Screening and data extraction were performed independently in duplicate according to our intervention and outcome framework. We included completed and on-going systematic reviews and randomized controlled trials of effectiveness on health and social support services provided at home, assistive products and technology for personal indoor and outdoor mobility and transportation as well as design, construction and building products and technology of buildings for private use such as wheelchairs, and ramps. Data Collection and Analysis We coded interventions and outcomes, and the number of studies that assessed health inequities across equity factors. We mapped outcomes based on the International Classification of Function, Disability and Health (ICF) adapted categories: intrinsic capacities (body function and structures) and functional abilities (activities). We assessed methodological quality of systematic reviews using the AMSTAR II checklist. Main Results After de-duplication, 10,783 records were screened. The map includes 548 studies (120 systematic reviews and 428 randomized controlled trials). Interventions and outcomes were classified using domains from the International Classification of Function, Disability and Health (ICF) framework. Most systematic reviews (n = 71, 59%) were rated low or critically low for methodological quality.The most common interventions were home-based rehabilitation for older adults (n = 276) and home-based health services for disease prevention (n = 233), mostly delivered by visiting healthcare professionals (n = 474). There was a relative paucity of studies on personal mobility, building adaptations, family support, personal support and befriending or friendly visits. The most measured intrinsic capacity domains were mental function (n = 269) and neuromusculoskeletal function (n = 164). The most measured outcomes for functional ability were basic needs (n = 277) and mobility (n = 160). There were few studies which evaluated outcome domains of social participation, financial security, ability to maintain relationships and communication.There was a lack of studies in low- and middle-income countries (LMICs) and a gap in the assessment of health equity issues. Authors' Conclusions There is substantial evidence for interventions to promote functional ability in older adults at home including mostly home-based rehabilitation for older adults and home-based health services for disease prevention. Remotely delivered home-based services are of greater importance to policy-makers and practitioners in the context of the COVID-19 pandemic. This map of studies published prior to the pandemic provides an initial resource to identify relevant home-based services which may be of interest for policy-makers and practitioners, such as home-based rehabilitation and social support, although these interventions would likely require further adaptation for online delivery during the COVID-19 pandemic. There is a need to strengthen assessment of social support and mobility interventions and outcomes related to making decisions, building relationships, financial security, and communication in future studies. More studies are needed to assess LMIC contexts and health equity issues.
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Affiliation(s)
- Vivian Welch
- Methods CentreBruyère Research InstituteOttawaCanada
| | | | | | - Yanfei Li
- Evidence‐Based Social Science Research Center, School of Public HealthLanzhou UniversityLanzhouChina
| | | | | | - Monserrat Conde
- Cochrane Campbell Global Ageing Partnership FieldFaroPortugal
| | | | | | - Sue Marcus
- Radcliffe Department of MedicineUniversity of OxfordOxfordUK
| | | | | | - Morwenna Rogers
- NIHR ARC, South West Peninsula (PenARC)University of Exeter Medical SchoolExeterUK
| | | | | | - Beverly Shea
- Bruyère Research InstituteUniversity of OttawaOttawaCanada
| | - Lisa Sheehy
- Bruyère Research InstituteUniversity of OttawaOttawaCanada
| | - Heidi Sveistrup
- Bruyère Research InstituteUniversity of OttawaOttawaCanada
- Faculty of Health SciencesUniversity of OttawaOttawaCanada
| | | | - Joanna Thompson‐Coon
- NIHR ARC South West Peninsula (PenARC)University of Exeter Medical SchoolExeterUK
| | - Peter Walker
- Faculty of MedicineUniversity of OttawaOttawaCanada
| | - Wei Zhang
- Access to Medicines, Vaccines and Health ProductsWorld Health OrganizationGenevaSwitzerland
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Diaz T, Strong KL, Cao B, Guthold R, Moran AC, Moller AB, Requejo J, Sadana R, Thiyagarajan JA, Adebayo E, Akwara E, Amouzou A, Aponte Varon JJ, Azzopardi PS, Boschi-Pinto C, Carvajal L, Chandra-Mouli V, Crofts S, Dastgiri S, Dery JS, Elnakib S, Fagan L, Jane Ferguson B, Fitzner J, Friedman HS, Hagell A, Jongstra E, Kann L, Chatterji S, English M, Glaziou P, Hanson C, Hosseinpoor AR, Marsh A, Morgan AP, Munos MK, Noor A, Pavlin BI, Pereira R, Porth TA, Schellenberg J, Siddique R, You D, Vaz LME, Banerjee A. A call for standardised age-disaggregated health data. Lancet Healthy Longev 2021; 2:e436-e443. [PMID: 34240065 PMCID: PMC8245325 DOI: 10.1016/s2666-7568(21)00115-x] [Citation(s) in RCA: 25] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Abstract
The 2030 Sustainable Development Goals agenda calls for health data to be disaggregated by age. However, age groupings used to record and report health data vary greatly, hindering the harmonisation, comparability, and usefulness of these data, within and across countries. This variability has become especially evident during the COVID-19 pandemic, when there was an urgent need for rapid cross-country analyses of epidemiological patterns by age to direct public health action, but such analyses were limited by the lack of standard age categories. In this Personal View, we propose a recommended set of age groupings to address this issue. These groupings are informed by age-specific patterns of morbidity, mortality, and health risks, and by opportunities for prevention and disease intervention. We recommend age groupings of 5 years for all health data, except for those younger than 5 years, during which time there are rapid biological and physiological changes that justify a finer disaggregation. Although the focus of this Personal View is on the standardisation of the analysis and display of age groups, we also outline the challenges faced in collecting data on exact age, especially for health facilities and surveillance data. The proposed age disaggregation should facilitate targeted, age-specific policies and actions for health care and disease management.
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Affiliation(s)
- Theresa Diaz
- Maternal, Newborn, Child and Adolescent Health, and Ageing Department, WHO, Geneva, Switzerland
| | - Kathleen L Strong
- Maternal, Newborn, Child and Adolescent Health, and Ageing Department, WHO, Geneva, Switzerland
| | - Bochen Cao
- Data and Analytics Department, WHO, Geneva, Switzerland
| | - Regina Guthold
- Maternal, Newborn, Child and Adolescent Health, and Ageing Department, WHO, Geneva, Switzerland
| | - Allisyn C Moran
- Maternal, Newborn, Child and Adolescent Health, and Ageing Department, WHO, Geneva, Switzerland
| | - Ann-Beth Moller
- UNDP/UNFPA/UNICEF/WHO/World Bank Special Programme of Research, Development and Research Training in Human Reproduction, Department of Sexual and Reproductive Health and Research, WHO, Geneva, Switzerland
| | - Jennifer Requejo
- Division of Data, Analysis, Planning and Monitoring, UNICEF, New York, NY, USA
| | - Ritu Sadana
- Maternal, Newborn, Child and Adolescent Health, and Ageing Department, WHO, Geneva, Switzerland
| | | | - Emmanuel Adebayo
- Adolescent Health Unit, Institute of Child Health, College of Medicine, University of Ibadan, Ibadan, Nigeria
| | - Elsie Akwara
- UNDP/UNFPA/UNICEF/WHO/World Bank Special Programme of Research, Development and Research Training in Human Reproduction, Department of Sexual and Reproductive Health and Research, WHO, Geneva, Switzerland
| | - Agbessi Amouzou
- Johns Hopkins Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD, USA
| | | | - Peter S Azzopardi
- Global Adolescent Health Group, Maternal Child and Adolescent Health Program, Burnet Institute, Melbourne, VIC, Australia
- Adolescent Health and Wellbeing Program, Wardliparingga Aboriginal Health Equity Theme, South Australian Health and Medical Research Institute, Adelaide, SA, Australia
- Department of Pediatrics, VIC, Australia
- University of Melbourne, VIC, Australia
| | - Cynthia Boschi-Pinto
- Department of Epidemiology and Biostatistics, Fluminense Federal University, Rio de Janeiro, Brazil
| | - Liliana Carvajal
- Division of Data, Analysis, Planning and Monitoring, UNICEF, New York, NY, USA
| | - Venkatraman Chandra-Mouli
- UNDP/UNFPA/UNICEF/WHO/World Bank Special Programme of Research, Development and Research Training in Human Reproduction, Department of Sexual and Reproductive Health and Research, WHO, Geneva, Switzerland
| | | | - Saeed Dastgiri
- Tabriz Health Services Management Research Center, Tabriz University of Medical Sciences, Tabriz, Iran
| | | | - Shatha Elnakib
- UNDP/UNFPA/UNICEF/WHO/World Bank Special Programme of Research, Development and Research Training in Human Reproduction, Department of Sexual and Reproductive Health and Research, WHO, Geneva, Switzerland
| | - Laura Fagan
- UN Major Group for Children and Youth, New York, NY, USA
| | | | - Julia Fitzner
- Global Infectious Hazard Preparedness Department, WHO, Geneva, Switzerland
| | | | - Ann Hagell
- Association for Young People's Health, London, UK
| | | | | | | | | | | | - Claudia Hanson
- Department of Global Public Health, Karolinska Institute, Stockholm, Sweden
| | | | - Andrew Marsh
- Maternal, Newborn, Child and Adolescent Health, and Ageing Department, WHO, Geneva, Switzerland
| | - Alison P Morgan
- Nossal Institute for Global Health, Melbourne School of Population and Global Health, VIC, Australia
- Global Financing Facility, World Bank, Washington, DC, USA
| | - Melinda K Munos
- Johns Hopkins Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD, USA
| | | | - Boris I Pavlin
- Health Emergency Information and Risk Assessment Department, WHO, Geneva, Switzerland
| | | | - Tyler A Porth
- Division of Data, Analysis, Planning and Monitoring, UNICEF, New York, NY, USA
| | | | | | - Danzhen You
- Division of Data, Analysis, Planning and Monitoring, UNICEF, New York, NY, USA
| | - Lara M E Vaz
- Population Reference Bureau, Washington, DC, USA
| | - Anshu Banerjee
- Maternal, Newborn, Child and Adolescent Health, and Ageing Department, WHO, Geneva, Switzerland
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15
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Golino H, Shi D, Christensen AP, Garrido LE, Nieto MD, Sadana R, Thiyagarajan JA, Martinez-Molina A. Investigating the performance of exploratory graph analysis and traditional techniques to identify the number of latent factors: A simulation and tutorial. Psychol Methods 2020; 25:292-320. [PMID: 32191105 PMCID: PMC7244378 DOI: 10.1037/met0000255] [Citation(s) in RCA: 131] [Impact Index Per Article: 32.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
Exploratory graph analysis (EGA) is a new technique that was recently proposed within the framework of network psychometrics to estimate the number of factors underlying multivariate data. Unlike other methods, EGA produces a visual guide-network plot-that not only indicates the number of dimensions to retain, but also which items cluster together and their level of association. Although previous studies have found EGA to be superior to traditional methods, they are limited in the conditions considered. These issues are addressed through an extensive simulation study that incorporates a wide range of plausible structures that may be found in practice, including continuous and dichotomous data, and unidimensional and multidimensional structures. Additionally, two new EGA techniques are presented: one that extends EGA to also deal with unidimensional structures, and the other based on the triangulated maximally filtered graph approach (EGAtmfg). Both EGA techniques are compared with 5 widely used factor analytic techniques. Overall, EGA and EGAtmfg are found to perform as well as the most accurate traditional method, parallel analysis, and to produce the best large-sample properties of all the methods evaluated. To facilitate the use and application of EGA, we present a straightforward R tutorial on how to apply and interpret EGA, using scores from a well-known psychological instrument: the Marlowe-Crowne Social Desirability Scale. (PsycInfo Database Record (c) 2020 APA, all rights reserved).
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Abstract
The World Health Organization (WHO) Global strategy and action plan on ageing and health (1) provides a policy framework to align health systems to the diverse needs of older populations. It promotes person-centred care that strengthen older peoples’ intrinsic capacity (physical and mental capacity) and ability to function where they live, a shift away from specialized medical treatment for each disease or condition. With its endorsement in 2016, WHO Member States recognized a pressing need to develop integrated, community-based approaches to prevent declines in intrinsic capacity. To operationalize ‘intrinsic capacity (IC)’, domains closely associated with care dependency were proposed: mobility, cognition, psychological capacity (depressive symptoms), vitality (malnutrition), and sensory capacity (hearing and vision) (2).
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17
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Affiliation(s)
- Ritu Sadana
- Department of Maternal, Newborn, Child and Adolescent Health, and Aging, World Health Organization, avenue Appia 20, 1211 Geneva 27, Switzerland
| | - Anshu Banerjee
- Department of Maternal, Newborn, Child and Adolescent Health, and Aging, World Health Organization, avenue Appia 20, 1211 Geneva 27, Switzerland
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18
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Welch V, Howe TE, Marcus S, Mathew CM, Sadana R, Rogers M, Sheehy L, Borg J, Pottie K, Thompson‐Coon J, Lyddiatt A, Kristjansson E, Nickerson JW, Walker P, Tanuseputro P, Shea B, Sveistrup H, Babelmorad P, Zhang W. PROTOCOL: Health, social care and technological interventions to improve functional ability of older adults: Evidence and gap map. Campbell Syst Rev 2019; 15:e1054. [PMID: 37131851 PMCID: PMC8356486 DOI: 10.1002/cl2.1054] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Indexed: 05/04/2023]
Abstract
This is a protocol for a Campbell Evidence and Gap Map. The objectives are to identify and assess the available evidence on health, social care and technological interventions to improve functional ability among older adults.
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Affiliation(s)
- Vivian Welch
- Methods CentreBruyère Research InstituteOttawaCanada
| | - Tracey E. Howe
- School of Health & Life SciencesGlasgow Caledonian UniversityGlasgowUK
| | - Sue Marcus
- Radcliffe Department of MedicineUniversity of OxfordOxfordUK
| | | | - Ritu Sadana
- Ageing and Life‐courseWorld Health OrganizationGenevaSwitzerland
| | - Morwenna Rogers
- NIHR PenCLAHRC, Institute of Health ResearchUniversity of Exeter Medical SchoolExeterUK
| | | | - Johan Borg
- Division of Social Medicine and Global HealthLund UniversityMalmoSweden
| | - Kevin Pottie
- Bruyère Research InstituteOttawaONCanada
- Department of Family MedicineUniversity of OttawaOttawaONCanada
| | - Joanna Thompson‐Coon
- NIHR CLAHRC South West Peninsula (PenCLAHRC)University of Exeter Medical SchoolExeterUK
| | | | | | | | - Peter Walker
- Department of MedicineThe Ottawa HospitalOttawaONCanada
| | - Peter Tanuseputro
- Bruyère Research InstituteOttawaONCanada
- Ottawa Hospital Research InstituteOttawaONCanada
| | | | - Heidi Sveistrup
- Bruyère Research InstituteOttawaONCanada
- School of Rehabilitation Sciences, Faculty of Health SciencesUniversity of OttawaOttawaONCanada
| | | | - Wei Zhang
- Vaccines and Health ProductsWorld Health OrganizationGenevaSwitzerland
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19
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Gebremariam KM, Sadana R. On the ethics of healthy ageing: setting impermissible trade-offs relating to the health and well-being of older adults on the path to universal health coverage. Int J Equity Health 2019; 18:140. [PMID: 31488220 PMCID: PMC6727389 DOI: 10.1186/s12939-019-0997-z] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2019] [Accepted: 06/05/2019] [Indexed: 11/30/2022] Open
Abstract
This article aims to clarify the moral underpinning of the policy framework of Healthy Ageing. It is a policy adopted by the World Health Organization designed to operate in alignment with the United Nations (UN) framework of the Sustainable Development Goals (SDGs) and the urgency given for the achievement of Universal Health Coverage (UHC). It particularly reflects on what, if anything, justifies protecting the most basic rights to health and well-being of older adults from possible policy trade-offs on the path to UHC.It argues that the dignity of older adults-under which are nested more specific ideas of self-respect, respect for autonomy, as well as the ethical priority for living well-underpins a categorical moral injunction against imposing the familiar utilitarian calculus as the default criterion for policy trade-offs across age groups. Respect for the dignity of older persons marks the moral threshold that every society ought to uphold even under conditions of relative resource scarcity.The moral constraint on permissible policy trade-offs relating to the health of older adults must reflect an understanding of older persons as active agents in the social structure of (their) well-being, not merely as passive vessels through which a good healthy life may or may not occur. We argue that there are three main domains where trade-offs are unacceptable from the moral point of view: it is impermissible (1) to prioritise key service(s) across different (vulnerable) age groups on the basis of actual or future contribution to society, (2) to prioritise across different age groups when co-prioritisation is warranted by the ethical theory, and (3), to always prioritise (by default) services that improve well-being over those that foster respect for dignity and autonomy.
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Affiliation(s)
| | - Ritu Sadana
- Ageing and Life Course, World Health Organization, 20 Avenue Appia, 1211 Geneva 27, Switzerland
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20
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Affiliation(s)
- Ritu Sadana
- Department of Ageing and Life Course, World Health Organization, avenue Appia 20, 1211 Geneva 27, Switzerland
| | - Agnes Soucat
- Health Systems Governance and Financing, World Health Organization, Geneva, Switzerland
| | - John Beard
- Department of Ageing and Life Course, World Health Organization, avenue Appia 20, 1211 Geneva 27, Switzerland
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21
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Marsman D, Belsky DW, Gregori D, Johnson MA, Low Dog T, Meydani S, Pigat S, Sadana R, Shao A, Griffiths JC. Healthy ageing: the natural consequences of good nutrition-a conference report. Eur J Nutr 2018; 57:15-34. [PMID: 29799073 PMCID: PMC5984649 DOI: 10.1007/s00394-018-1723-0] [Citation(s) in RCA: 36] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
Many countries are witnessing a marked increase in longevity and with this increased lifespan and the desire for healthy ageing, many, however, suffer from the opposite including mental and physical deterioration, lost productivity and quality of life, and increased medical costs. While adequate nutrition is fundamental for good health, it remains unclear what impact various dietary interventions may have on prolonging good quality of life. Studies which span age, geography and income all suggest that access to quality foods, host immunity and response to inflammation/infections, impaired senses (i.e., sight, taste, smell) or mobility are all factors which can limit intake or increase the body's need for specific micronutrients. New clinical studies of healthy ageing are needed and quantitative biomarkers are an essential component, particularly tools which can measure improvements in physiological integrity throughout life, thought to be a primary contributor to a long and productive life (a healthy "lifespan"). A framework for progress has recently been proposed in a WHO report which takes a broad, person-centered focus on healthy ageing, emphasizing the need to better understand an individual's intrinsic capacity, their functional abilities at various life stages, and the impact by mental, and physical health, and the environments they inhabit.
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Affiliation(s)
- D Marsman
- Procter & Gamble, Cincinnati, OH, USA
| | - D W Belsky
- Duke University, Raleigh-Durham, NC, USA
| | | | | | - T Low Dog
- Integrative Medicine Concepts, Tucson, AZ, USA
| | | | - S Pigat
- Creme Global, Dublin, Ireland
| | - R Sadana
- World Health Organization, Geneva, Switzerland
| | - A Shao
- Amway/Nutrilite, Buena Park, CA, USA
| | - J C Griffiths
- Council for Responsible Nutrition-International, Washington, DC, USA.
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22
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Kuruvilla S, Sadana R, Montesinos EV, Beard J, Vasdeki JF, Araujo de Carvalho I, Thomas RB, Drisse MNB, Daelmans B, Goodman T, Koller T, Officer A, Vogel J, Valentine N, Wootton E, Banerjee A, Magar V, Neira M, Bele JMO, Worning AM, Bustreo F. A life-course approach to health: synergy with sustainable development goals. Bull World Health Organ 2017; 96:42-50. [PMID: 29403099 PMCID: PMC5791871 DOI: 10.2471/blt.17.198358] [Citation(s) in RCA: 43] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2017] [Revised: 10/24/2017] [Accepted: 10/24/2017] [Indexed: 12/03/2022] Open
Abstract
A life-course approach to health encompasses strategies across individuals’ lives that optimize their functional ability (taking into account the interdependence of individual, social, environmental, temporal and intergenerational factors), thereby enabling well-being and the realization of rights. The approach is a perfect fit with efforts to achieve universal health coverage and meet the sustainable development goals (SDGs). Properly applied, a life-course approach can increase the effectiveness of the former and help realize the vision of the latter, especially in ensuring health and well-being for all at all ages. Its implementation requires a shared understanding by individuals and societies of how health is shaped by multiple factors throughout life and across generations. Most studies have focused on noncommunicable disease and ageing populations in high-income countries and on epidemiological, theoretical and clinical issues. The aim of this article is to show how the life-course approach to health can be extended to all age groups, health topics and countries by building on a synthesis of existing scientific evidence, experience in different countries and advances in health strategies and programmes. A conceptual framework for the approach is presented along with implications for implementation in the areas of: (i) policy and investment; (ii) health services and systems; (iii) local, multisectoral and multistakeholder action; and (iv) measurement, monitoring and research. The SDGs provide a unique context for applying a holistic, multisectoral approach to achieving transformative outcomes for people, prosperity and the environment. A life-course approach can reinforce these efforts, particularly given its emphasis on rights and equity.
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Affiliation(s)
- Shyama Kuruvilla
- Office of the Assistant Director-General, Family, Women's and Children's Health, World Health Organization, avenue Appia 20, 1211 Geneva 27, Switzerland
| | - Ritu Sadana
- Department of Ageing and Life Course, World Health Organization, Geneva, Switzerland
| | - Eugenio Villar Montesinos
- Department of Public Health, Environmental and Social Determinants of Health, World Health Organization, Geneva, Switzerland
| | - John Beard
- Department of Ageing and Life Course, World Health Organization, Geneva, Switzerland
| | - Jennifer Franz Vasdeki
- Office of the Assistant Director-General, Family, Women's and Children's Health, World Health Organization, avenue Appia 20, 1211 Geneva 27, Switzerland
| | | | - Rebekah Bosco Thomas
- Department of Gender, Equity and Human Rights, World Health Organization, Geneva, Switzerland
| | - Marie-Noel Brunne Drisse
- Department of Public Health, Environmental and Social Determinants of Health, World Health Organization, Geneva, Switzerland
| | - Bernadette Daelmans
- Department of Maternal, Newborn, Child and Adolescent Health, World Health Organization, Geneva, Switzerland
| | - Tracey Goodman
- Department of Immunization, Vaccines and Biologicals, World Health Organization, Geneva, Switzerland
| | - Theadora Koller
- Department of Gender, Equity and Human Rights, World Health Organization, Geneva, Switzerland
| | - Alana Officer
- Department of Ageing and Life Course, World Health Organization, Geneva, Switzerland
| | - Joanna Vogel
- Department of Maternal, Newborn, Child and Adolescent Health, World Health Organization, Geneva, Switzerland
| | - Nicole Valentine
- Department of Public Health, Environmental and Social Determinants of Health, World Health Organization, Geneva, Switzerland
| | - Emily Wootton
- Department of Immunization, Vaccines and Biologicals, World Health Organization, Geneva, Switzerland
| | - Anshu Banerjee
- Office of the Assistant Director-General, Family, Women's and Children's Health, World Health Organization, avenue Appia 20, 1211 Geneva 27, Switzerland
| | - Veronica Magar
- Department of Gender, Equity and Human Rights, World Health Organization, Geneva, Switzerland
| | - Maria Neira
- Department of Public Health, Environmental and Social Determinants of Health, World Health Organization, Geneva, Switzerland
| | - Jean Marie Okwo Bele
- Department of Immunization, Vaccines and Biologicals, World Health Organization, Geneva, Switzerland
| | - Anne Marie Worning
- Office of the Director-General, World Health Organization, Geneva, Switzerland
| | - Flavia Bustreo
- Office of the Assistant Director-General, Family, Women's and Children's Health, World Health Organization, avenue Appia 20, 1211 Geneva 27, Switzerland
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23
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Affiliation(s)
| | - Ritu Sadana
- Aging and Life Course, World Health Organization, Geneva, Switzerland
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24
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Sadana R, Blas E, Budhwani S, Koller T, Paraje G. Healthy Ageing: Raising Awareness of Inequalities, Determinants, and What Could Be Done to Improve Health Equity. Gerontologist 2017; 56 Suppl 2:S178-93. [PMID: 26994259 DOI: 10.1093/geront/gnw034] [Citation(s) in RCA: 79] [Impact Index Per Article: 11.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
PURPOSE OF THE STUDY Social and scientific discourses on healthy ageing and on health equity are increasingly available, yet from a global perspective limited conceptual and analytical work connecting both has been published. This review was done to inform the WHO World Report on Ageing and Health and to inform and encourage further work addressing both healthy aging and equity. DESIGN AND METHODS We conducted an extensive literature review on the overlap between both topics, privileging publications from 2005 onward, from low-, middle-, and high-income countries. We also reviewed evidence generated around the WHO Commission on Social Determinants of Health, applicable to ageing and health across the life course. RESULTS Based on data from 194 countries, we highlight differences in older adults' health and consider three issues: First, multilevel factors that contribute to differences in healthy ageing, across contexts; second, policies or potential entry points for action that could serve to reduce unfair differences (health inequities); and third, new research areas to address the cause of persistent inequities and gaps in evidence on what can be done to increase healthy ageing and health equity. IMPLICATIONS Each of these areas warrant in depth analysis and synthesis, whereas this article presents an overview for further consideration and action.
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Affiliation(s)
- Ritu Sadana
- Department of Ageing and Life Course, World Health Organization, Geneva, Switzerland.
| | - Erik Blas
- International Public Health and Development, Copenhagen, Denmark
| | - Suman Budhwani
- Institute of Health Policy, Management and Evaluation, University of Toronto, Ontario, Canada
| | - Theadora Koller
- Gender, Equity and Human Rights Team, World Health Organization, Geneva, Switzerland
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Beard JR, Officer A, de Carvalho IA, Sadana R, Pot AM, Michel JP, Lloyd-Sherlock P, Epping-Jordan JE, Peeters GMEEG, Mahanani WR, Thiyagarajan JA, Chatterji S. The World report on ageing and health: a policy framework for healthy ageing. Lancet 2016; 387:2145-2154. [PMID: 26520231 PMCID: PMC4848186 DOI: 10.1016/s0140-6736(15)00516-4] [Citation(s) in RCA: 1203] [Impact Index Per Article: 150.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
Although populations around the world are rapidly ageing, evidence that increasing longevity is being accompanied by an extended period of good health is scarce. A coherent and focused public health response that spans multiple sectors and stakeholders is urgently needed. To guide this global response, WHO has released the first World report on ageing and health, reviewing current knowledge and gaps and providing a public health framework for action. The report is built around a redefinition of healthy ageing that centres on the notion of functional ability: the combination of the intrinsic capacity of the individual, relevant environmental characteristics, and the interactions between the individual and these characteristics. This Health Policy highlights key findings and recommendations from the report.
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Affiliation(s)
- John R Beard
- Ageing and Life Course, World Health Organization, Geneva, Switzerland.
| | - Alana Officer
- Ageing and Life Course, World Health Organization, Geneva, Switzerland
| | | | - Ritu Sadana
- Ageing and Life Course, World Health Organization, Geneva, Switzerland
| | - Anne Margriet Pot
- Ageing and Life Course, World Health Organization, Geneva, Switzerland
| | | | | | | | | | - Wahyu Retno Mahanani
- Health statistics and information systems, World Health Organization, Geneva, Switzerland
| | | | - Somnath Chatterji
- Health statistics and information systems, World Health Organization, Geneva, Switzerland
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Affiliation(s)
- Ritu Sadana
- World Health Organization, Geneva, Switzerland
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Östlin P, Schrecker T, Sadana R, Bonnefoy J, Gilson L, Hertzman C, Kelly MP, Kjellstrom T, Labonté R, Lundberg O, Muntaner C, Popay J, Sen G, Vaghri Z. Priorities for research on equity and health: towards an equity-focused health research agenda. PLoS Med 2011; 8:e1001115. [PMID: 22069378 PMCID: PMC3206017 DOI: 10.1371/journal.pmed.1001115] [Citation(s) in RCA: 71] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
Abstract
Piroska Östlin and colleagues argue that a paradigm shift is needed to keep the focus on health equity within the social determinants of health research agenda.
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Affiliation(s)
- Piroska Östlin
- World Health Organization Regional Office for Europe, Copenhagen, Denmark.
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Sadana R, Harper S. Data systems linking social determinants of health with health outcomes: advancing public goods to support research and evidence-based policy and programs. Public Health Rep 2011; 126 Suppl 3:6-13. [PMID: 21836730 PMCID: PMC3150122 DOI: 10.1177/00333549111260s302] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Affiliation(s)
- Ritu Sadana
- Ritu Sadana is a Coordinator at the World Health Organization (WHO) in Geneva, Switzerland, and in 2009 helped set up the WHO Scientific Research Group on Equity Analysis and Research. Sam Harper is an Assistant Professor at McGill University in the Department of Epidemiology, Biostatistics and Occupational Health in Montreal, QC, Canada. Dr. Harper is supported by a Chercheur-boursier from the Fonds de la Recherche en Sante du Québec
| | - Sam Harper
- Ritu Sadana is a Coordinator at the World Health Organization (WHO) in Geneva, Switzerland, and in 2009 helped set up the WHO Scientific Research Group on Equity Analysis and Research. Sam Harper is an Assistant Professor at McGill University in the Department of Epidemiology, Biostatistics and Occupational Health in Montreal, QC, Canada. Dr. Harper is supported by a Chercheur-boursier from the Fonds de la Recherche en Sante du Québec
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Lavis JN, Guindon GE, Cameron D, Boupha B, Dejman M, Osei EJA, Sadana R. Bridging the gaps between research, policy and practice in low- and middle-income countries: a survey of researchers. CMAJ 2010; 182:E350-61. [PMID: 20439449 DOI: 10.1503/cmaj.081164] [Citation(s) in RCA: 67] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022] Open
Abstract
BACKGROUND Many international statements have urged researchers, policy-makers and health care providers to collaborate in efforts to bridge the gaps between research, policy and practice in low- and middle-income countries. We surveyed researchers in 10 countries about their involvement in such efforts. METHODS We surveyed 308 researchers who conducted research on one of four clinical areas relevant to the Millennium Development Goals (prevention of malaria, care of women seeking contraception, care of children with diarrhea and care of patients with tuberculosis) in each of 10 low- and middle-income countries (China, Ghana, India, Iran, Kazakhstan, Laos, Mexico, Pakistan, Senegal and Tanzania). We focused on their engagement in three promising bridging activities and examined system-level, organizational and individual correlates of these activities. RESULTS Less than half of the researchers surveyed reported that they engaged in one or more of the three promising bridging activities: 27% provided systematic reviews of the research literature to their target audiences, 40% provided access to a searchable database of research products on their topic, and 43% established or maintained long-term partnerships related to their topic with representatives of the target audience. Three factors emerged as statistically significant predictors of respondents' engagement in these activities: the existence of structures and processes to link researchers and their target audiences predicted both the provision of access to a database (odds ratio [OR] 2.62, 95% CI 1.30-5.27) and the establishment or maintenance of partnerships (OR 2.65, 95% CI 1.25-5.64); stability in their contacts predicted the provision of systematic reviews (OR 2.88, 95% CI 1.35-6.13); and having managers and public (government) policy-makers among their target audiences predicted the provision of both systematic reviews (OR 4.57, 95% CI 1.78-11.72) and access to a database (OR 2.55, 95% CI 1.20-5.43). INTERPRETATION Our findings suggest potential areas for improvement in light of the bridging strategies targeted at health care providers that have been found to be effective in some contexts and the factors that appear to increase the prospects for using research in policy-making.
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Affiliation(s)
- John N Lavis
- McMaster Health Forum, McMaster University, Hamilton, Ont.
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Abstract
Using more than 3.5 million bibliographic references in Thomson ISI Web of Science (health-related articles, notes, and reviews) and a broad definition of health (covering related social, medical, environmental, and physical sciences) research production, collaboration patterns and “visibility” of that production for largest producers in the Western Pacific Region of the World Health Organization are estimated for the 1992-2001 period. Two findings are of particular interest in relation to the production of relevant knowledge on health topics and equity in the access to this knowledge. The first is that intraregional collaboration is low and that large regional producers of research (ie, Japan, Australia, China, etc) collaborate more with high-income countries from other regions than among themselves within the region, or with smaller regional research producers. The second one is that “visibility” of health research in the region is relatively low, even for high-income countries. High “visibility” research is mostly done with the involvement, through collaboration, of extra-region high-income countries. Collaboration between low-income or middle-income countries is mostly in low “visibility” research.
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Affiliation(s)
- Guillermo Paraje
- School of Management, Universidad Adolfo Ibáñez, Santiago
de Chile, Chile,
| | - Ritu Sadana
- Information, Evidence and Research Cluster, World Health
Organization, Geneva, Switzerland
| | - Reijo Salmela
- Western Pacific Regional Office, World Health Organization,
Manila, The Philippines
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Blas E, Gilson L, Kelly MP, Labonté R, Lapitan J, Muntaner C, Ostlin P, Popay J, Sadana R, Sen G, Schrecker T, Vaghri Z. Addressing social determinants of health inequities: what can the state and civil society do? Lancet 2008; 372:1684-9. [PMID: 18994667 DOI: 10.1016/s0140-6736(08)61693-1] [Citation(s) in RCA: 99] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
In this Health Policy article, we selected and reviewed evidence synthesised by nine knowledge networks established by WHO to support the Commission on the Social Determinants of Health. We have indicated the part that national governments and civil society can play in reducing health inequity. Government action can take three forms: (1) as provider or guarantor of human rights and essential services; (2) as facilitator of policy frameworks that provide the basis for equitable health improvement; and (3) as gatherer and monitor of data about their populations in ways that generate health information about mortality and morbidity and data about health equity. We use examples from the knowledge networks to illustrate some of the options governments have in fulfilling this role. Civil society takes many forms: here, we have used examples of community groups and social movements. Governments and civil society can have important positive roles in addressing health inequity if political will exists.
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Affiliation(s)
- Erik Blas
- World Health Organization, Geneva, Switzerland
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Affiliation(s)
- Ritu Sadana
- Ethics, Equity, Trade and Human Rights, World Health Organization, 20 avenue Appia, 1211 Geneva 27, Switzerland
| | - Alena Petrakova
- Human Resources for Health, World Health Organization, Geneva, Switzerland
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Petrakova A, Sadana R. Problems and progress in public health education. Bull World Health Organ 2007; 85:963-5; discussion 966-70. [PMID: 18278257 PMCID: PMC2636301 DOI: 10.2471/blt.07.046110] [Citation(s) in RCA: 28] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2007] [Revised: 10/08/2007] [Accepted: 10/11/2007] [Indexed: 11/27/2022] Open
Abstract
Further development of public health education is critical to improve population health globally. A debate on the relevance and direction of some 400 schools of public health and many other related institutions around the world is therefore timely. Some argue that most public health schools set up in low-income countries blindly follow their counterparts in high-income countries, reproducing classroom-based teaching, churning out epidemiologists with limited understanding of how to work within a health system to address local needs or how to align multiple partners towards population and equity health objectives. Others argue that schools in high-income countries focus on the science, whereas those in low-income countries plagued with resource constraints focus exclusively on the art. This round table discussion asks deans and directors of schools of public health from around the world to identify innovations in public health training, research and practice that will render schools relevant to health and development challenges.
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Affiliation(s)
- Alena Petrakova
- Human Resources for Health, World Health Organization, Geneva, Switzerland.
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Affiliation(s)
- Ritu Sadana
- Equity Analysis and Evidence Unit, WHO, 20 avenue Appia, 1211 Geneva 27, Switzerland
| | - A Mushtaque
- Equity Analysis and Evidence Unit, WHO, 20 avenue Appia, 1211 Geneva 27, Switzerland
| | - R Chowdhury
- BRAC James P. Grant School of Public Health, Dhaka, Bangladesh, and Columbia University Mailman School of Public Health, New York, NY, USA
| | - Alena Petrakova
- Knowledge Communities and Strategy Unit, WHO, Geneva, Switzerland
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Abstract
A search (precision value 94%, recall value 93%) of the ISI Web of Science database (1992-2001) revealed that mental health publications accounted for 3-4% of the health literature. A 10/90 divide in internationally accessible mental health literature was evident and remained undiminished through 10 years as low- and middle-income countries (n=152) contributed only 6%, high-income countries (n=54) 94%, and 14 leading high-income countries (with more than 1% contribution for majority of years under consideration) contributed 90% of internationally accessible mental health research. Steps should be taken to improve the research infrastructure and capacity to conduct and disseminate mental health research in general, and on a priority basis in low- and middle-income countries.
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Affiliation(s)
- Shekhar Saxena
- Department of Mental Health and Substance Abuse, World Health Organization, CH-1211 Geneva, Switzerland.
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D'Souza C, Sadana R. Why do case studies on national health research systems matter?: identifying common challenges in low- and middle-income countries. Soc Sci Med 2005; 62:2072-8. [PMID: 16165261 DOI: 10.1016/j.socscimed.2005.08.022] [Citation(s) in RCA: 31] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2005] [Indexed: 11/15/2022]
Abstract
Since health research has become increasingly acknowledged as an important tool for development, many approaches have been undertaken to understand national health research from a systems perspective. This paper reviews 28 case studies that describe or analyse health research systems in 26 low- and middle-income countries. These case studies were sponsored either by the Council on Health Research for Development or the South-East Asia Regional Office of the World Health Organization. In reviewing these case studies, we identify several common challenges facing national health research systems. These challenges include the lack of coordination in research activities; the inadequate participation of stakeholders in research, policy and implementation processes; the lack of demand for research and the low accessibility of research findings. These obstacles are compounded by some fundamental systems constraints, such as the lack of financial resources, human capacities, infrastructure and data. By identifying from these case studies the common challenges of health research systems as well as approaches to overcome these, this paper highlights the potential for case studies to inform policies and strategies for strengthening health research systems, and presents recommendations for future case studies to increase this potential.
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Sadana R, Pang T. Current approaches to national health research systems analysis: a brief overview of the WHO health research system analysis initiative. Ciênc saúde coletiva 2004. [DOI: 10.1590/s1413-81232004000200012] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
This article introduces the WHO health research system analysis (HRSA) initiative as an input to the World Health Report 2004 on health research, "Knowledge for Better Health". Section 2 presents the HRSA conceptual framework for operational description and analysis of national health research from a system rather than sector perspective. Section 3 summarizes research projects addressing contemporary cross-national issues, aiming to: provide answers to key questions, further explore contested areas within systems, and improve decision-making on research investment options. Section 4 summarizes the comprehensive country studies on research systems. Section 5 outlines a pilot study on methods for 18 comprehensive country studies, including Brazil, Chile, and Costa Rica. Section 6 concludes that the pilot study and eventual main phase to describe and analyze national health research systems will demonstrate WHO's commitment to strengthening capacity in partnership with countries.
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Abstract
South Asian countries face similar health problems and would benefit from collaboration in health research
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Affiliation(s)
- Ritu Sadana
- Health Research Systems Analysis Initiative, Research Policy and Cooperation Department, Evidence and Information for Policy Cluster, World Health Organization, CH-1211 Geneva 27, Switzerland.
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Mathers CD, Murray CJ, Salomon JA, Sadana R, Tandon A, Lopez AD, Ustün B, Chatterji S. Healthy life expectancy: comparison of OECD countries in 2001. Aust N Z J Public Health 2004; 27:5-11. [PMID: 14705260 DOI: 10.1111/j.1467-842x.2003.tb00372.x] [Citation(s) in RCA: 32] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
Abstract
OBJECTIVES To compare average levels of population health for Australia and other OECD countries in 2001. METHODS Healthy life expectancies (HALE) for OECD countries for 2001 are based on analysis of mortality data for OECD countries, country-specific estimates of health state prevalences for 135 causes from the Global Burden of Disease 2000 study, and an analysis of 34 health surveys in 28 OECD countries, using novel methods to improve the comparability of self-report data. RESULTS HALE at birth ranges from a low of 59.8 years for Turkey to a high of 73.6 years in Japan in 2001. Australia ranks fourth among OECD countries at 71.6 years with a 95% uncertainty interval of 70.9 to 72.8 years, ahead of New Zealand in 13th place at 70.3 years. The equivalent 'lost' healthy years at birth range from around 10 years in OECD countries with lowest life expectancies to around eight years in those with high life expectancies at birth. There is a statistically significant association between higher levels of health expenditure and higher healthy life expectancy across OECD countries, although causal inferences require more sophisticated analyses of the health system and non-health system determinants of levels of health. CONCLUSIONS The new methods used in the WHO Multi-Country Household Survey Study have increased the comparability of self-report data across OECD countries, a major step forward in the use of self-reported data on health. Building on this experience, WHO is developing improved health status measurement techniques for a World Health Survey to be carried out in 2002/03.
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Affiliation(s)
- Colin D Mathers
- Global Program on Evidence for Health Policy, World Health Organization, 20 Avenue Appia, 1211 Geneva 27, Switzerland.
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Abstract
This paper focuses on patterns of healthy life expectancy for older women around the globe in the year 2000, and on the determinants of differences in disease and injury for older ages. Our study uses data from the World Health Organization for women and men in 191 countries. These data include a summary measure of population health, healthy life expectancy (HALE), which measures the number of years of life expected to be lived in good health, and a complementary measure of the loss of health (disability-adjusted life years or DALYs) due to a comprehensive set of disease and injury causes. We examine two topics in detail: (1) cross-national patterns of female-male differences in healthy life expectancy at age 60; and (2) identification of the major injury and disability causes of disability in women at older ages. Globally, the male-female gap is lower for HALE than for total life expectancy. The sex gap is highest for Russia (10.0 years) and lowest in North Africa and the Middle East, where males and females have similar levels of healthy life expectancy, and in some cases, females have lower levels of healthy life expectancy. We discuss the implications of the findings for international health policy.
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Affiliation(s)
- Colin D Mathers
- Global Programme on Evidence for Health Policy, World Health Organization, Geneva, Switzerland.
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Sadana R, Pang T. Health research systems: a framework for the future. Bull World Health Organ 2003; 81:159. [PMID: 12764510 PMCID: PMC2572413] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/02/2023] Open
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Pang T, Sadana R, Hanney S, Bhutta ZA, Hyder AA, Simon J. Knowledge for better health: a conceptual framework and foundation for health research systems. Bull World Health Organ 2003; 81:815-20. [PMID: 14758408 PMCID: PMC2572351] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/28/2023] Open
Abstract
Health research generates knowledge that can be utilized to improve health system performance and, ultimately, health and health equity. We propose a conceptual framework for health research systems (HRSs) that defines their boundaries, components, goals, and functions. The framework adopts a systems perspective towards HRSs and serves as a foundation for constructing a practical approach to describe and analyse HRSs. The analysis of HRSs should, in turn, provide a better understanding of how research contributes to gains in health and health equity. In this framework, the intrinsic goals of the HRS are the advancement of scientific knowledge and the utilization of knowledge to improve health and health equity. Its four principal functions are stewardship, financing, creating and sustaining resources, and producing and using research. The framework, as it is applied in consultation with countries, will provide countries and donor agencies with relevant inputs to policies and strategies for strengthening HRSs and using knowledge for better health.
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Affiliation(s)
- Tikki Pang
- Research Policy & Cooperation, World Health Organization, Geneva, Switzerland.
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Sadana R. Definition and measurement of reproductive health. Bull World Health Organ 2002; 80:407-9. [PMID: 12077618 PMCID: PMC2567784] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/25/2023] Open
Abstract
An internationally agreed conceptual definition of reproductive health is applied to the development and testing of practical indicators for use in the community. Basic criteria are proposed for an interview-based tool to measure reproductive health -- as opposed to morbidity or mortality -- adapting methods from the health status measurement field. Proposed domains and indicators linked to the definition of reproductive health adopted at the International Conference on Population and Development (ICPD) should be comparable across and within diverse populations. Two sets of domains that describe reproductive health are recommended for further development and testing, seven domains that focus directly on health and six others that assess related areas of well-being.
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Affiliation(s)
- Ritu Sadana
- Evidence and Information for Policy, World Health Organization, Geneva, Switzerland.
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Abstract
We describe here the methods used to produce the first estimates of healthy life expectancy (DALE) for 191 countries in 1999. These were based on estimates of the incidence, prevalence, and disability distributions for 109 disease and injury causes by age group, sex, and region of the world, and an analysis of 60 representative health surveys across the world. We used Sullivan's method to compute healthy life expectancy for men and women in each WHO member country. Japan had the highest average healthy life expectancy of 74.5 years at birth in 1999. The bottom ten countries are all in sub-Saharan Africa, where the HIV-AIDS epidemic is most prevalent, resulting in DALE at birth of less than 35 years. Years of healthy life lost due to disability represent 18% of total life expectancy in the bottom countries, and decreases to around 8% in the countries with the highest healthy life expectancies. Globally, the male-female gap is lower for DALE than for total life expectancy. Healthy life expectancy increases across countries at a faster rate than total life expectancy, suggesting that reductions in mortality are accompanied by reductions in disability. Although women live longer, they spend a greater amount of time with disability. As average levels of health expenditure per capita increase, healthy life expectancy increases at a greater rate than total life expectancy.
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Affiliation(s)
- C D Mathers
- Global Programme on Evidence for Health Policy, World Health Organization, Geneva, 1211 27, Geneva, Switzerland.
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Sadana R. Measuring reproductive health: review of community-based approaches to assessing morbidity. Bull World Health Organ 2000; 78:640-54. [PMID: 10859858 PMCID: PMC2560761] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/16/2023] Open
Abstract
This article begins by reviewing selected past approaches to estimating the prevalence of a range of morbidities through the use of household or community-based interview surveys in developed and developing countries. Subsequently, it reviews epidemiological studies that have used a range of methods to estimate the prevalence of reproductive morbidities. A detailed review of recent community or hospital based health interview validation studies that compare self-reported, clinical and laboratory measures is presented. Studies from Bangladesh, Bolivia, China, Egypt, India, Indonesia, Nigeria, Philippines and Turkey provide empirical evidence that self-reported morbidity and observed morbidity measure different phenomena and therefore different aspects of reproductive health and illness. Rather than estimating the prevalence of morbidity, interview-based surveys may provide useful information about the disability or burden associated with reproductive health and illness.
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Affiliation(s)
- R Sadana
- Global Programme on Evidence for Health Policy, World Health Organization, Geneva, Switzerland.
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Abstract
This community-based study presents the results of 17 focus-group discussions primarily among poor married women of reproductive age in urban and rural Cambodia regarding their experiences with modern contraceptive methods and their preferences for different technical attributes, including effectiveness, mode of administration, secrecy and rapid return of fertility. Key findings indicate that women who use modern contraceptive technologies desire highly effective methods of birth control. Cambodian women are primarily interested in longer-acting methods, view weight gain positively and are less concerned about a rapid return to fertility upon discontinuation of a method or secrecy from their partners. Women report a high level of side-effects as well as a high level of individual variation between side-effects and each modern contraceptive method used. Women with more knowledge and experience of modern contraceptive technologies alter their preference for highly effective methods based on a method's perceived suitability. Specifically, women may switch from a modern method associated with negative side-effects to a lesser effective traditional method, either to take a break from unwanted side-effects or discontinue modern methods altogether, if another suitable method is unavailable. These and other findings point to the need for greater development and choice of contraceptive methods with different technical attributes; improved information that clearly and simply describes how each method works within a women's body and its expected side-effects; improved access to reproductive health services; and improved assessment of women's underlying burden of reproductive illness not directly associated with modern contraceptives.
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Affiliation(s)
- R Sadana
- Department of Population and International Health, Harvard School of Public Health, Boston, MA 02115, USA.
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