Enhancing Cancer Economic Data Resources: The Interagency Consortium to Promote Health Economics Research on Cancer (HEROiC).

BACKGROUND: Cancer diagnosis and treatment can substantially affect health and financial outcomes for patients and families. Research in health care delivery across the cancer control continuum includes diverse activities led by multiple government and private sector organizations. Assessing the economic drivers and influencing factors associated with costs across this continuum is challenging as organizations leading research efforts often do not have forums to share data, develop linkages, and explore collaborative opportunities. OBJECTIVE: To describe the objectives, activities, and goals of the Interagency Consortium to Promote Health Economics Research on Cancer (HEROiC) to strengthen data resources and capacity for collaborative patient-focused cancer health economics research. MAIN ARGUMENT: HEROiC's goals include assessing the economic burden of cancer; examining the effects of policies, health care setting/system factors, and health service delivery approaches across the cancer control continuum; and enhancing collaborations among researchers and organizations. CONCLUSIONS: Data resources to study economic outcomes associated with cancer control are highly fragmented; HEROIC provides a forum to collaboratively develop, enhance, and utilize data resources and infrastructure for patient-centered cancer health economics research. This includes sharing data resources, developing linkages, identifying new data collection venues, and creating and supporting the dissemination of evidence-based information to diverse stakeholders. These efforts provide critical information to address the economic burden of cancer. RELEVANCE TO THE SPECIAL ISSUE: Cancer diagnosis and treatment affect patient health and financial outcomes. This commentary describes how HEROiC will enhance research data infrastructure and collaborations to support patient-centered research with the goal of reducing the economic burden of cancer.

Mapping 2 Decades of Research in Health Services Research, Health Policy, and Health Economics Journals.

OBJECTIVE: To identify major research topics and exhibit trends in these topics in 15 health services research, health policy, and health economics journals over 2 decades. DATA SOURCES: The study sample of 35,159 abstracts (1999-2020) were collected from PubMed for 15 journals. STUDY DESIGN: The study used a 3-phase approach for text analyses: (1) developing the corpus of 40,618 references from PubMed (excluding 5459 of those without abstract or author information); (2) preprocessing and generating the term list using natural language processing to eliminate irrelevant textual data and identify important terms and phrases; (3) analyzing the preprocessed text data using latent semantic analysis, topic analyses, and multiple correspondence analysis. PRINCIPAL FINDINGS: Application of analyses generated 16 major research topics: (1) implementation/intervention science; (2) HIV and women's health; (3) outcomes research and quality; (4) veterans/military studies; (5) provider/primary-care interventions; (6) geriatrics and formal/informal care; (7) policies and health outcomes; (8) medication treatment/therapy; (9) patient interventions; (10) health insurance legislation and policies; (11) public health policies; (12) literature reviews; (13) cost-effectiveness and economic evaluation; (14) cancer care; (15) workforce issues; and (16) socioeconomic status and disparities. The 2-dimensional map revealed that some journals have stronger associations with specific topics. Findings were not consistent with previous studies based on user perceptions. CONCLUSION: Findings of this study can be used by the stakeholders of health services research, policy, and economics to develop future research agendas, target journal submissions, and generate interdisciplinary solutions by examining overlapping journals for particular topics.

How Can Anesthesiologists Influence Policymaking? Reflections from a Year at the Council of Economic Advisers.

From September 2019 to August 2020, the author served as a senior economist on the Council of Economic Advisers, a government agency charged with providing economic analysis and advice to the President of the United States and senior government officials. Working with the Council yielded many useful lessons on how anesthesiologists can influence healthcare policy. First, because the President has wide latitude over many areas of health policy that directly impact patient care and anesthesiologists' working environment, anesthesiologists should focus their efforts on influencing policymakers within the executive branch of government in addition to influencing lawmakers. Second, policymakers are busy and typically do not have a technical background, so anesthesiologists must learn how to communicate with them succinctly and at an appropriate level. Finally, because policymakers often need analysis quickly, anesthesiologists must meet these needs even if the underlying analysis is rougher and less precise that what would normally be needed for peer review.

The European Union, economies and public health: not one without the other.

OBJECTIVES: In this article, we aim to discuss the historical and current challenges facing public health in the European Union (EU) and present opportunities for the EU and Member States to maintain national public health ownership, supported by more substantial EU-level approaches building on existing legislation and practice. STUDY DESIGN: This is a descriptive study design. METHODS: A narrative review of the literature was performed and described. RESULTS: Historically, the EU has played only a small role in Member States' public health systems and delivery. The EU's policies primarily affect trade and overall economic decisions pertaining to Member States, with limited emphasis on the complex but essential interplay between economies and public health. In recent years, the public health challenges facing the EU, such as climate change, antimicrobial resistance, migrant health and now COVID-19, have become increasingly apparent. CONCLUSIONS: To establish a healthier EU, the development of a European Health Union and the Health in All Policies approach of the EU and the World Health Organization must explicitly manifest itself in policies and actions.

The Effect of EU Integration on Health Care in Central and Eastern Europe.

The effect of EU policy and its legal framework on health care in CEE member states has been complex. In relation to health care access and financial sustainability, it has been detrimental in certain parts of CEE. This has primarily been the result of economic/fiscal governance instruments of the EU and free-movement rules facilitating outflows of health care professionals. Although there has been a general improvement in access to health care since accession to the EU, the instruments the EU has used to handle the economic crisis have somewhat offset this improvement. Additionally, outflow of health care professionals has resulted in retention strategies such as salary increases and investments in medical infrastructure in some CEE member states, increasing the standard of health care. Still, differences between East and West in terms of important health indicators continue to exist, and EU instruments aimed at compensating this generally lack power to provide meaningful solutions. It seems more solidarity between member states is the only way to increase legitimacy of the European integration in CEE member states and thus prevent them from feeling as outsiders within the EU. Without such a development, CEE countries will continue to lag behind other parts of the Union.

Meeting the challenges posed by per diem in development projects in southern countries: a scoping review.

PURPOSE: This study presents the results of a review whose goal is to generate knowledge on the possible levers of action concerning per diem practices in southern countries in order to propose reforms to the existing schemes. METHODOLOGY: A synthesis of available knowledge was performed using scoping review methodology: a literature search was conducted using several databases (Medline, Cinahl, Embase, PubMed, Google Scholar, ProQuest) and grey literature. A total of 26 documents were included in the review. Furthermore, interviews were conducted with the authors of the selected articles to determine whether the proposed recommendations had been implemented and to identify any outcomes. RESULTS: For the most part, the results of this review are recommendations supporting per diem reform. In terms of strategy, the recommendations call for a redefinition of per diems by limiting their appeal. Issued recommendations include reducing daily allowance rates, paying per diem only in exchange for actual work, increasing control mechanisms or harmonizing rates across organizations. In terms of operations, the recommendations call for the implementation of concrete actions to reduce instances of abuse, including not paying advances or introducing reasonable flat-rate per diem. That said, the authors contacted stated that few per diem reforms had been implemented as a result of the issued recommendations. CONCLUSION: The results of the study clearly identify possible levers of action. Such levers could make up the groundwork for further reflection on context and country-specific reforms that are carried out using a dynamic, participatory and consensual approach.

Spatiotemporal Trends of Malaria in Relation to Economic Development and Cross-Border Movement along the China-Myanmar Border in Yunnan Province.

The heterogeneity and complexity of malaria involves political and natural environments, socioeconomic development, cross-border movement, and vector biology; factors that cannot be changed in a short time. This study aimed to assess the impact of economic growth and cross-border movement, toward elimination of malaria in Yunnan Province during its pre-elimination phase. Malaria data during 2011-2016 were extracted from 18 counties of Yunnan and from 7 villages, 11 displaced person camps of the Kachin Special Region II of Myanmar. Data of per-capita gross domestic product (GDP) were obtained from Yunnan Bureau of Statistics. Data were analyzed and mapped to determine spatiotemporal heterogeneity at county and village levels. There were a total 2,117 malaria cases with 85.2% imported cases; most imported cases came from Myanmar (78.5%). Along the demarcation line, malaria incidence rates in villages/camps in Myanmar were significantly higher than those of the neighboring villages in China. The spatial and temporal trends suggested that increasing per-capita GDP may have an indirect effect on the reduction of malaria cases when observed at macro level; however, malaria persists owing to complex, multi-faceted factors including poverty at individual level and cross-border movement of the workforce. In moving toward malaria elimination, despite economic growth, cooperative efforts with neighboring countries are critical to interrupt local transmission and prevent reintroduction of malaria via imported cases. Cross-border workers should be educated in preventive measures through effective behavior change communication, and investment is needed in active surveillance systems and novel diagnostic and treatment services during the elimination phase.

Building Community Well-being by Leveraging the Economic Impact of Health Systems.

Local communities face systematically deepening disparities in economic, health, and well-being outcomes. Nurses are increasingly leading initiatives to positively impact the social determinants of health in local communities. This article describes how to use the enormous economic impact of hospitals and health systems as anchor institutions embedded in local communities. By leveraging the everyday business practices of hospitals and health systems, such as hiring, purchasing, and investing, nurses can help to transform the economic and consequent health well-being of socioeconomically disadvantaged individuals and neighborhoods. Hiring, purchasing, and investing in nearby neighborhoods build community wealth through both gainful employment and subsequent recirculation of money locally. Improving the economic viability of the local community positively impacts concomitant social determinants of health. Nurses, with their experience and expertise in collaboration and communication with diverse stakeholder and with their high ranking as the most trusted profession, are natural leaders to build community networks and partnerships that promote community transformation for well-being.

Impact of Political Economy on Population Health: A Systematic Review of Reviews.

Background. Although there is a large literature examining the relationship between a wide range of political economy exposures and health outcomes, the extent to which the different aspects of political economy influence health, and through which mechanisms and in what contexts, is only partially understood. The areas in which there are few high-quality studies are also unclear. Objectives. To systematically review the literature describing the impact of political economy on population health. Search Methods. We undertook a systematic review of reviews, searching MEDLINE, Embase, International Bibliography of the Social Sciences, ProQuest Public Health, Sociological Abstracts, Applied Social Sciences Index and Abstracts, EconLit, SocINDEX, Web of Science, and the gray literature via Google Scholar. Selection Criteria. We included studies that were a review of the literature. Relevant exposures were differences or changes in policy, law, or rules; economic conditions; institutions or social structures; or politics, power, or conflict. Relevant outcomes were any overall measure of population health such as self-assessed health, mortality, life expectancy, survival, morbidity, well-being, illness, ill health, and life span. Two authors independently reviewed all citations for relevance. Data Collection and Analysis. We undertook critical appraisal of all included reviews by using modified Assessing the Methodological Quality of Systematic Reviews (AMSTAR) criteria and then synthesized narratively giving greater weight to the higher-quality reviews. Main Results. From 4912 citations, we included 58 reviews. Both the quality of the reviews and the underlying studies within the reviews were variable. Social democratic welfare states, higher public spending, fair trade policies, extensions to compulsory education provision, microfinance initiatives in low-income countries, health and safety policy, improved access to health care, and high-quality affordable housing have positive impacts on population health. Neoliberal restructuring seems to be associated with increased health inequalities and higher income inequality with lower self-rated health and higher mortality. Authors' Conclusions. Politics, economics, and public policy are important determinants of population health. Countries with social democratic regimes, higher public spending, and lower income inequalities have populations with better health. There are substantial gaps in the synthesized evidence on the relationship between political economy and health, and there is a need for higher-quality reviews and empirical studies in this area. However, there is sufficient evidence in this review, if applied through policy and practice, to have marked beneficial health impacts. Public Health Implications. Policymakers should be aware that social democratic welfare state types, countries that spend more on public services, and countries with lower income inequalities have better self-rated health and lower mortality. Research funders and researchers should be aware that there remain substantial gaps in the available evidence base. One such area concerns the interrelationship between governance, polities, power, macroeconomic policy, public policy, and population health, including how these aspects of political economy generate social class processes and forms of discrimination that have a differential impact across social groups. This includes the influence of patterns of ownership (of land and capital) and tax policies. For some areas, there are many lower-quality reviews, which leave uncertainties in the relationship between political economy and population health, and a high-quality review is needed. There are also areas in which the available reviews have identified primary research gaps such as the impact of changes to housing policy, availability, and tenure.

The 2019 report of the MJA-Lancet Countdown on health and climate change: a turbulent year with mixed progress.

The MJA-Lancet Countdown on health and climate change was established in 2017 and produced its first Australian national assessment in 2018. It examined 41 indicators across five broad domains: climate change impacts, exposures and vulnerability; adaptation, planning and resilience for health; mitigation actions and health co-benefits; economics and finance; and public and political engagement. It found that, overall, Australia is vulnerable to the impacts of climate change on health, and that policy inaction in this regard threatens Australian lives. In this report we present the 2019 update. We track progress on health and climate change in Australia across the same five broad domains and many of the same indicators as in 2018. A number of new indicators are introduced this year, including one focused on wildfire exposure, and another on engagement in health and climate change in the corporate sector. Several of the previously reported indicators are not included this year, either due to their discontinuation by the parent project, the Lancet Countdown, or because insufficient new data were available for us to meaningfully provide an update to the indicator. In a year marked by an Australian federal election in which climate change featured prominently, we find mixed progress on health and climate change in this country. There has been progress in renewable energy generation, including substantial employment increases in this sector. There has also been some progress at state and local government level. However, there continues to be no engagement on health and climate change in the Australian federal Parliament, and Australia performs poorly across many of the indicators in comparison to other developed countries; for example, it is one of the world's largest net exporters of coal and its electricity generation from low carbon sources is low. We also find significantly increasing exposure of Australians to heatwaves and, in most states and territories, continuing elevated suicide rates at higher temperatures. We conclude that Australia remains at significant risk of declines in health due to climate change, and that substantial and sustained national action is urgently required in order to prevent this.

Cognitive biases in public health and how economics and sociology can help overcome them.

OBJECTIVES: The objective of this study was to identify important gaps in the public health evidence base and consider the implications of these for public health and public health economics. STUDY DESIGN: This was a review and critique of public health policy in the UK. METHODS: Using two key psychological concepts relating to cognitive biases, viz. cognitive dissonance and heuristics, the shortcomings in public health approaches to confronting the prevalence of non-communicable diseases are described. The implications are drawn out. RESULTS: Two cognitive biases in public health thinking are identified. (i) A dissonance between what is known and what is done, resulting in the repetition of solutions that have previously been shown to have had little or no effect. (ii) The habitual use of set of heuristics which mean that simple solutions to complex problems are preferred to undertaking the detailed assessment of how to bring about change. These biases mean that the evidence about the dynamics of populations and the ways that the mechanisms of prevention actually operate seldom feature in the way interventions, policy and practice are undertaken. The evidence base is consequently highly skewed. CONCLUSIONS: Health economics combined with sociological reasoning has potentially an important role to play in developing the ideas that will overcome the problems attaching to the cognitive biases.

What is health economics?

OBJECTIVES: This paper describes the principles of economics and their application to the promotion, protection and restoration of oral health in populations and the planning, management and delivery of oral health care. After illustrating the economic determinants of oral health, the demand for oral health care is discussed with particular reference to asymmetric information between patient and provider. The reasons for the market failure in (oral) health care and their implications for efficiency and equity are explained. We go on to describe how economic evaluation contributes to policies aimed at maximising oral health gains where resources are constrained. The behavioural aspects of patients´ demand for and dental professionals´ provision of oral health services are discussed. Finally, we outline methods for planning the dental workforce in ways that reflect system goals.

Road traffic safety: An analysis of the cross-effects of economic, road and population factors.

PURPOSE: Through the study of economic, traffic and population data related to road traffic accidents from 2004 to 2016, this paper analyzed the impact of various factors on road traffic casualties in China, and provided theoretical basis and suggestions for the road traffic safety management in China. METHODS: Based on three aspects (economy, road, population) with five factors (gross domestic product (GDP), traffic investment, new vehicle ownership, new road mileage and newly increased population), this paper collected the relevant data of road traffic accidents in 31 provinces and cities in China, from 2004 to 2016. A panel model was established to carry out empirical analysis. RESULTS: All factors have a significant impact on the number of road traffic accident casualties. When other factors remain unchanged, the number of road traffic casualties decreased by an average of 0.19 for every 100 million CNY increased in GDP. For every 100 million CNY increased in traffic investment, the number of road traffic casualties is reduced by an average of 13.93, indicating that economic development can improve road traffic safety to a certain extent. On the contrary, the growth in road mileage, new motor vehicles and population has increased the number of road traffic casualties. For every 10, 000 km of new road mileage, the number of traffic accident casualties has increased by 284.04. For every 10,000 newborns, the number of road traffic casualties increased by 7.33; as the number of new motor vehicles increases by 10,000, the number of road traffic casualties increased by an average of 21.77. CONCLUSION: The increase of GDP and traffic investment can significantly reduce the number of road traffic casualties in China, which shows that economic development is essential to improve road traffic safety. The numbers of new road mileage, newly increased population and the new motor vehicles are positively correlated with the number of traffic accident casualties in traffic accidents, which reflects the existing problems in road design, distribution of road resources, and traffic management in China. Therefore, it is necessary to improve the economic and road related aspects to improve road traffic safety.

Analysis on the accident casualties influenced by several economic factors based on the traffic-related data in China from 2004 to 2016.

PURPOSE: By studying the economic data related to road traffic accidents in recent 10 years, this paper explores the impact of various economic factors on the number of casualties in traffic accidents in China, and puts forward related prevention and management measures. METHODS: Based on five economic factors including the number of new health institutions, health investment, transportation investment and disposable income per capita, this paper collects the data of traffic accidents in 31 provinces and municipalities of China from 2004 to 2016 and estimates the parameters using fixed effect model. RESULTS: The number of health institutions, health investment, transportation investment and disposable income per capita are negatively correlated with the number of traffic accident casualties; the number of new health institutions is positively correlated with the number of traffic accident casualties; health investment and transportation investment have a great impact on the number of road traffic accident casualties. CONCLUSION: Economic development has a positive impact on improving traffic conditions, but the increase in the number of new health institutions does not reduce the number of casualties in accidents. The irrational layout of health institutions and imperfect road traffic management mechanism should be taken into account.

Trade challenges at the World Trade Organization to national noncommunicable disease prevention policies: A thematic document analysis of trade and health policy space.

BACKGROUND: It has long been contested that trade rules and agreements are used to dispute regulations aimed at preventing noncommunicable diseases (NCDs). Yet most analyses of trade rules and agreements focus on trade disputes, potentially overlooking how a challenge to a regulation's consistency with trade rules may lead to 'policy or regulatory chill' effects whereby countries delay, alter, or repeal regulations in order to avoid the costs of a dispute. Systematic empirical analysis of this pathway to impact was previously prevented by a dearth of systematically coded data. METHODS AND FINDINGS: Here, we analyse a newly created dataset of trade challenges about food, beverage, and tobacco regulations among 122 World Trade Organization (WTO) members from January 1, 1995 to December 31, 2016. We thematically describe the scope and frequency of trade challenges, analyse economic asymmetries between countries raising and defending them, and summarise 4 cases of their possible influence. Between 1995 and 2016, 93 food, beverage, and tobacco regulations were challenged at the WTO. 'Unnecessary' trade costs were the focus of 16.4% of the challenges. Only one (1.1%) challenge remained unresolved and escalated to a trade dispute. Thirty-nine (41.9%) challenges focussed on labelling regulations, and 18 (19.4%) focussed on quality standards and restrictions on certain products like processed meats and cigarette flavourings. High-income countries raised 77.4% (n = 72) of all challenges raised against low- and lower-middle-income countries. We further identified 4 cases in Indonesia, Chile, Colombia, and Saudi Arabia in which challenges were associated with changes to food and beverage regulations. Data limitations precluded a comprehensive evaluation of policy impact and challenge validity. CONCLUSIONS: Policy makers appear to face significant pressure to design food, beverage, and tobacco regulations that other countries will deem consistent with trade rules. Trade-related influence on public health policy is likely to be understated by analyses limited to formal trade disputes.

From health for all to universal health coverage: Alma Ata is still relevant.

With increasing adoption of universal health coverage (UHC), the health for all agenda is resurgent around the world. However, after a promising start the first time in 1978, the health for all agenda fizzled over the next decade. This commentary discusses the origin of the health for all agenda in the 1970s and the influence of global politico-economic forces in shaping that agenda, its demise and the resurgence in the form of UHC in the twenty-first century. We discuss UHC's focus on finances and the increasing role of market economy in health care, and the opportunities and risks UHC poses. We conclude by saying that UHC's greater focus on finances is prudent, but in order to achieve its promise, UHC needs to regulate the market based provision of healthcare, and incorporate more of the people and community centered ethos of its earlier iteration from 40 years ago.

Psychologically Informed Implementations of Sugary-Drink Portion Limits.

In 2012, the New York City Board of Health prohibited restaurants from selling sugary drinks in containers that would hold more than 16 oz. Although a state court ruled that the Board of Health did not have the authority to implement such a policy, it remains a legally viable option for governments and a voluntary option for restaurants. However, there is very limited empirical data on how such a policy might affect the purchasing and consumption of sugary drinks. We report four well-powered, incentive-compatible experiments in which we evaluated two possible ways that restaurants might comply with such a policy: bundling (i.e., dividing the contents of oversized cups into two regulation-size cups) and providing free refills (i.e., offering a regulation-size cup with unlimited refills). Bundling caused people to buy less soda. Free refills increased consumption, especially when a waiter served the refills. This perverse effect was reduced in self-service contexts that required walking just a few steps to get a refill.

Local-Community Interests and South Carolinian Newspapers' Coverage of Smoke-Free Policies.

In this quantitative content analysis, we assess how smoke-free policies are presented in South Carolinian newspapers. In particular, this study examines the extent to which newspapers' coverage of smoke free-policies has represented the interests of their local communities. We compare newspapers in the communities whose economy relies heavily on the tourism and hospitality industry (The Post & Courier in Charleston and The Sun News in Myrtle Beach) and newspapers elsewhere (The State in Columbia and The Greenville News in Greenville), and see whether there are meaningful differences between the newspapers in the way they portray smoke-free policies, particularly in terms of their selective uses of news sources and key arguments. Our findings indicate that South Carolinian newspapers portrayed smoke-free policies largely as a political issue. Many political reasons to either support or oppose the policies were found in almost two out of three articles. We also found that The Post & Courier and The Sun News were more likely than The State and The Greenville News to make arguments against smoke-free policies, and this was particularly so when they were talking about economic impacts of the policies. Public health and media advocacy implications are discussed in detail.