The 2023 report of the MJA-Lancet Countdown on health and climate change: sustainability needed in Australia's health care sector.

The MJA-Lancet Countdown on health and climate change in Australia was established in 2017 and produced its first national assessment in 2018 and annual updates in 2019, 2020, 2021 and 2022. It examines five broad domains: health hazards, exposures and impacts; adaptation, planning and resilience for health; mitigation actions and health co-benefits; economics and finance; and public and political engagement. In this, the sixth report of the MJA-Lancet Countdown, we track progress on an extensive suite of indicators across these five domains, accessing and presenting the latest data and further refining and developing our analyses. Our results highlight the health and economic costs of inaction on health and climate change. A series of major flood events across the four eastern states of Australia in 2022 was the main contributor to insured losses from climate-related catastrophes of $7.168 billion - the highest amount on record. The floods also directly caused 23 deaths and resulted in the displacement of tens of thousands of people. High red meat and processed meat consumption and insufficient consumption of fruit and vegetables accounted for about half of the 87 166 diet-related deaths in Australia in 2021. Correction of this imbalance would both save lives and reduce the heavy carbon footprint associated with meat production. We find signs of progress on health and climate change. Importantly, the Australian Government released Australia's first National Health and Climate Strategy, and the Government of Western Australia is preparing a Health Sector Adaptation Plan. We also find increasing action on, and engagement with, health and climate change at a community level, with the number of electric vehicle sales almost doubling in 2022 compared with 2021, and with a 65% increase in coverage of health and climate change in the media in 2022 compared with 2021. Overall, the urgency of substantial enhancements in Australia's mitigation and adaptation responses to the enormous health and climate change challenge cannot be overstated. Australia's energy system, and its health care sector, currently emit an unreasonable and unjust proportion of greenhouse gases into the atmosphere. As the Lancet Countdown enters its second and most critical phase in the leadup to 2030, the depth and breadth of our assessment of health and climate change will be augmented to increasingly examine Australia in its regional context, and to better measure and track key issues in Australia such as mental health and Aboriginal and Torres Strait Islander health and wellbeing.

Resilience: conceptualisations and challenges for effective heatwave public health planning.

OBJECTIVES: This article examines diverse perspectives on heatwave resilience in public health planning, interviewing stakeholders from various sectors. It identifies challenges, including operational, political, economic, and cultural aspects, hindering effective strategies. The study advocates for a holistic approach to heatwave resilience, emphasising interdisciplinary research and collaboration for targeted interventions. Enhancing resilience is crucial to mitigating adverse health impacts and safeguarding vulnerable populations during heatwaves. Conceptualisations of resilience related to heatwave public health planning and heatwave resilience vary significantly. There is a need to unveil the multifaceted nature of resilience in the context of heatwaves and identify key challenges that hinder effective public health planning efforts. STUDY DESIGN: Qualitative study to explore key stakeholders' conceptualisations of resilience and highlight challenges and opportunities needed for greater heatwave resilience and public health planning. METHODS: Interviews were conducted with a diverse group of key stakeholders involved in local, regional, and national heatwave planning, academics, civil sector and private sector representatives. RESULTS: The findings of this study highlight diverse conceptualisations of resilience. Conceptualisations of resilience mainly differ on the following: 'whom'; 'what'; 'how'; 'when'; and 'why'. This analysis shows that the concept of resilience is well understood but has different functions. The analysis of challenges revealed several key problems, such as operational and technical; political and governance; organisational and institutional; economic; linguistic; cultural, social, and behavioural; and communication, information, and awareness. These significantly hinder effective heatwave public health planning strategies. CONCLUSIONS: The study emphasises the need for a holistic and integrated approach to heatwave resilience. Addressing these challenges is crucial for enhancing heatwave public health planning. This study provides valuable insights into the complexities of heatwave resilience, offering guidance for different sectors of society to develop targeted interventions and strategies. The development of new resilience interdisciplinary and intersectoral research, practice, and governance will prove crucial to ongoing efforts to strengthen national heatwave resilience public health planning. By fostering resilience, societies can mitigate the adverse impacts of heatwaves and safeguard the health and well-being of vulnerable populations.

Raising the issue of quality in implementation science reporting in global health: Implications for health planning and practice.

Implementation outcomes, which focus on the barriers to, and facilitators and processes of healthcare delivery, are critical to translating research evidence to health planning and practice and to improving healthcare delivery. This article summarises key quality issues in reporting of implementation science outcomes within global health and describes the ways in which this presents a challenge for shifting health planning and practice across low-resource health systems. This article also suggests that the wider use of reporting guidelines for implementation outcomes could help address this issue.

Bolstering health systems to cope with the impacts of climate change events: A review of the evidence on workforce planning, upskilling, and capacity building.

BACKGROUND: As global CO2 emissions continue to rise and the 'era of global boiling' takes hold, the health workforce must cope with the challenge of providing care to increasing numbers of patients affected by climate change-related events (e.g., hurricanes, wildfires, floods). In this review, we describe the impacts of these events on the health workforce, and strategies responding to these challenges. METHODS: This rapid systematic review was guided by the Preferred Reporting Items for Systematic reviews and Meta-Analyses and a registered protocol (PROSPERO CRD42023433610). Eight databases were searched in May 2022 and again in June 2023. Empirical studies discussing climate change and workforce policy, planning, preparedness, and capacity were included. Inductive thematic analysis of extracted data was conducted. RESULTS: From the 60 included studies, two categories emerged: the impacts of climate events on the health workforce (n = 39), and workforce responses to and preparations for climate events (n = 58). Thirty-seven studies reported on both categories. Four impact themes were identified: absenteeism, psychological impacts, system breakdown, and unsafe working conditions; and six responses and preparations themes: training/skill development, workforce capacity planning, interdisciplinary collaboration, role flexibility, role incentivisation, and psychological support. CONCLUSION: This review provides an overview of some of the deleterious impacts of climate events on the health workforce, as well as potential strategies for the health workforce to prepare or respond to climate events. Future studies should assess the implementation and effectiveness of these strategies to ensure a continuously improving healthcare system, and a well-supported health workforce.

Targeted Therapy and Personalized Medicine.

Targeted therapy and personalized medicine are novel emerging disciplines of cancer research intended for treatment and prevention. One of the most significant advancements in modern oncology is the shift from an organ-centric strategy to a personalized strategy guided by deep molecular analysis. This shift in view, which focuses on the tumour's precise molecular changes, has paved the way for individualized treatment. Researchers and clinicians are using targeted therapies to select the best treatment available based on the molecular characterization of malignant cancer. In the treatment of a cancer, personalized medicine entails the use of genetic, immunological, and proteomic profiling to provide therapeutic alternatives as well as prognostic information about cancer. In this book, targeted therapies and personalized medicine have been covered for specific malignancies, including latest FDA-approved targeted therapies and it also sheds light on effective anti-cancer regimens and drug resistance. This will help to enhance our ability to conduct individualized health planning, make early diagnoses, and choose optimal medications for each cancer patient with predictable side effects and outcomes in a quickly evolving era. Various applications and tools' capacity have been improved for early diagnosis of cancer and the growing number of clinical trials that choose specific molecular targets reflects this predicament. Nevertheless, there are several limitations that must need to be addressed. Hence, in this chapter, we will discuss recent advancements, challenges, and opportunities in personalized medicine for various cancers, with a specific emphasis on target therapies in diagnostics and therapeutics.

Evaluating local primary health care actions to address health inequities: analysis of Australia's Primary Health Networks.

BACKGROUND: Meso-level, regional primary health care organisations such as Australia's Primary Health Networks (PHNs) are well placed to address health inequities through comprehensive primary health care approaches. This study aimed to examine the equity actions of PHNs and identify factors that hinder or enable the equity-orientation of PHNs' activities. METHODS: Analysis of all 31 PHNs' public planning documents. Case studies with a sample of five PHNs, drawing on 29 original interviews with key stakeholders, secondary analysis of 38 prior interviews, and analysis of 30 internal planning guidance documents. This study employed an existing framework to examine equity actions. RESULTS: PHNs displayed clear intentions and goals for health equity and collected considerable evidence of health inequities. However, their planned activities were largely restricted to individualistic clinical and behavioural approaches, with little to facilitate access to other health and social services, or act on the broader social determinants of health. PHNs' equity-oriented planning was enabled by organisational values for equity, evidence of local health inequities, and engagement with local stakeholders. Equity-oriented planning was hindered by federal government constraints and lack of equity-oriented prompts in the planning process. CONCLUSIONS: PHNs' equity actions were limited. To optimise regional planning for health equity, primary health care organisations need autonomy and scope to act on the 'upstream' factors that contribute to local health issues. They also need sufficient time and resources for robust, systematic planning processes that incorporate mechanisms such as procedure guides and tools/templates, to capitalise on their local evidence to address health inequities. Organisations should engage meaningfully with local communities and service providers, to ensure approaches are equity sensitive and appropriately targeted.

Patient-to-nurse ratios: Balancing quality, nurse turnover, and cost.

We consider the problem of setting appropriate patient-to-nurse ratios in a hospital, an issue that is both complex and widely debated. There has been only limited effort to take advantage of the extensive empirical results from the medical literature to help construct analytical decision models for developing upper limits on patient-to-nurse ratios that are more patient- and nurse-oriented. For example, empirical studies have shown that each additional patient assigned per nurse in a hospital is associated with increases in mortality rates, length-of-stay, and nurse burnout. Failure to consider these effects leads to disregarded potential cost savings resulting from providing higher quality of care and fewer nurse turnovers. Thus, we present a nurse staffing model that incorporates patient length-of-stay, nurse turnover, and costs related to patient-to-nurse ratios. We present results based on data collected from three participating hospitals, the American Hospital Association (AHA), and the California Office of Statewide Health Planning and Development (OSHPD). By incorporating patient and nurse outcomes, we show that lower patient-to-nurse ratios can potentially provide hospitals with financial benefits in addition to improving the quality of care. Furthermore, our results show that higher policy patient-to-nurse ratio upper limits may not be as harmful in smaller hospitals, but lower policy patient-to-nurse ratios may be necessary for larger hospitals. These results suggest that a "one ratio fits all" patient-to-nurse ratio is not optimal. A preferable policy would be to allow the ratio to be hospital-dependent.

Unit cost repositories for health program planning and evaluation: a report on research in practice with lessons learned.

BACKGROUND: Most low- and middle-income countries have limited access to cost data that meets the needs of health policy-makers and researchers in health intervention areas including HIV, tuberculosis, and immunization. Unit cost repositories (UCRs)-searchable databases that systematically codify evidence from costing studies-have been developed to reduce the effort required to access and use existing costing information. These repositories serve as public resources and standard references, which can improve the consistency and quality of resource needs projections used for strategic planning and resource mobilization. UCRs also enable analysis of cost determinants and more informed imputation of missing cost data. This report examines our experiences developing and using seven UCRs (two global, five country-level) for cost projection and research purposes. DISCUSSION: We identify advances, challenges, enablers, and lessons learned that might inform future work related to UCRs. Our lessons learned include: (1) UCRs do not replace the need for costing expertise; (2) tradeoffs are required between the degree of data complexity and the useability of the UCR; (3) streamlining data extraction makes populating the UCR with new data easier; (4) immediate reporting and planning needs often drive stakeholder interest in cost data; (5) developing and maintaining UCRs requires dedicated staff time; (6) matching decision-maker needs with appropriate cost data can be challenging; (7) UCRs must have data quality control systems; (8) data in UCRs can become obsolete; and (9) there is often a time lag between the identification of a cost and its inclusion in UCRs. CONCLUSIONS: UCRs have the potential to be a valuable public good if kept up-to-date with active quality control and adequate support available to end-users. Global UCR collaboration networks and greater control by local stakeholders over global UCRs may increase active, sustained use of global repositories and yield higher quality results for strategic planning and resource mobilization.

Use of routine health information systems data in developing and monitoring district and facility health plans: a scoping review.

BACKGROUND: Routine Health Information Systems data should be used in a systematic and institutionalised manner to support the making of plans, the monitoring of plans and in supportive supervision. To explore to what extent there is discussion about the linkage between planning, monitoring and supervision of sub-national programs using routine data we conducted a scoping review. The review question was: How are routine health information systems used in developing and monitoring health plans at district and facility level? METHODS: From a search of Ovid Medline (all), EMBASE and Web of Science along with a review of grey literature and involving a number of key stakeholders in identifying any missing resources a total of over 2200 documents were reviewed and data from 13 documents were extracted. RESULTS: Overall, there are many descriptions of how to implement and strengthen systems, ways to assess and improve data availability and quality, tools to improve the data use context, training in data use and mechanisms to involve stakeholders and strengthen infrastructure. However, there are gaps in examples of routine health data being used in the development, monitoring and supervision of plans at district and facility level. CONCLUSIONS: There appears to be no institutionalised obligation of planners to monitor plans, very little guidance on how to practically monitor programs and minimal discussion about how to use the routinely available data to supportively supervise the implementation of the plans. To overcome these shortcomings, we recommend that practical procedures to ensure linkage of existing district plans to regular monitoring of priority programs are institutionalised, that mechanisms for making managers institutionally accountable for monitoring and supervising these plans are put in place, and that practical guidelines for linking plans with routine health information system data and regular monitoring and supportive supervision are developed.

Healthcare services gap analysis: a supply capture and demand forecast modelling, Dubai 2018-2030.

BACKGROUND: Health systems aim to provide a range of services to meet the growing demand of Dubai's heathcare system aims to provide a range of services to meet the growing demand of its population health needs and to ensure that standards of easy access, quality, equity and responsiveness are maintained. Dubai Health Authority (DHA) uses health services planning tools to assess the health needs of its population and sets priorities and effective regulatory strategies to achieve equilibrium of supply and demand of healthcare services and ensure adequate healthcare services are available, in terms of both quality and quantity. This study aims to measure the gap between demand and supply in health care services in Dubai at the baseline and to forecast the gap size and type (according to medical specialty, key medical planning units and geographical area) till 2030. The specific consequential aim includes identification of appropriate strategic directions for regulation, licensing, policies, insurance. METHODOLOGY: The supply of healthcare services, professionals and medical equipment is captured through a census of all healthcare facilities licensed for practice in the Emirate of Dubai. The demand is estimated using a need based approach, where demand for episodes of medical care are estimated by age and gender and aligned to the internationally defined diagnosis related groups (IR-DGRs). The estimated episodes are then forecasted into the future, until 2030, using three scenarios of population growth (high, medium and low) for the emirate of Dubai. The captured supply and forecasted demand has been categorized into eight key health-planning units (KPUs) to allow for understanding of the population healthcare service needs by main service categories. Using a software for health services planning, a gap analysis between supply and demand is conducted till year 2030. RESULTS: The results revealed a current and expected undersupply and oversupply for some healthcare services by medical specialty and geographical area of the Emirate. By 2030, the largest gaps exists in acute beds, which would require 1,590 additional beds, for acute-same day beds, an additional 1575 beds, for outpatient consultation rooms, an additional 2,160 consultation rooms, for emergency department, an additional 107 emergency bays, and for long-term care and rehabilitation beds, an additional 675 beds. The top specialty needs for these categories include cardiology, orthopedics, rheumatology, psychiatry, pediatric medicine & surgery, gastroenterology, hematology & oncology, renal medicine, primary care, respiratory medicine, endocrinology, rehabilitation and long-term care. CONCLUSIONS: There is an existing and growing requirement to support the healthcare services capacity needs for the top service lines and geographical areas with the largest gaps. Future licensing is required to ensure that new facilities are geographically distributed in a balanced way, and requests for licensing that create or augment oversupply should be avoided.

When the "Scytale" of Alcohol Runs in a Family and Alcohol Use Becomes a Transgenerational Issue: Case Report of a Father and Son Attending the Same Therapeutic Program.

Children whose parents are diagnosed with alcohol use problems are exposed to genetic and environmental risk factors and face a greater risk of developing mental health and behavioral problems and a higher risk of alcohol use. In this study, we present the case of a father and his son, both diagnosed with alcohol use disorder, who both attended, 12 years apart, the Inpatient Alcohol Treatment Program of the Alcohol Treatment Unit, in the Psychiatric Hospital of Attica, in Athens. The Alcohol Treatment Unit offers two inpatient treatment programs that have been operating since 1996 and are based on the principles of the Therapeutic Community. It was the first time that both a father and son coming from the same family attended one of these programs. The aim of this study is to extract useful information regarding the dynamics of a family in which alcohol dependence is transferred from generation to generation. Therapists try to decode this transference and interpret attitudes and behaviors under these circumstances.

Planning universal accessibility to public health care in sub-Saharan Africa.

Achieving universal health care coverage-a key target of the United Nations Sustainable Development Goal number 3-requires accessibility to health care services for all. Currently, in sub-Saharan Africa, at least one-sixth of the population lives more than 2 h away from a public hospital, and one in eight people is no less than 1 h away from the nearest health center. We combine high-resolution data on the location of different typologies of public health care facilities [J. Maina et al., Sci. Data 6, 134 (2019)] with population distribution maps and terrain-specific accessibility algorithms to develop a multiobjective geographic information system framework for assessing the optimal allocation of new health care facilities and assessing hospitals expansion requirements. The proposed methodology ensures universal accessibility to public health care services within prespecified travel times while guaranteeing sufficient available hospital beds. Our analysis suggests that to meet commonly accepted universal health care accessibility targets, sub-Saharan African countries will need to build ∼6,200 new facilities by 2030. We also estimate that about 2.5 million new hospital beds need to be allocated between new facilities and ∼1,100 existing structures that require expansion or densification. Optimized location, type, and capacity of each facility can be explored in an interactive dashboard. Our methodology and the results of our analysis can inform local policy makers in their assessment and prioritization of health care infrastructure. This is particularly relevant to tackle health care accessibility inequality, which is not only prominent within and between countries of sub-Saharan Africa but also, relative to the level of service provided by health care facilities.

Factors that influence evidence-informed meso-level regional primary health care planning: a qualitative examination and conceptual framework.

BACKGROUND: Evidence-informed primary health care (PHC) planning in decentralised, meso-level regional organisations has received little research attention. In this paper we examine the factors that influence planning within this environment, and present a conceptual framework. METHODS: We employed mixed methods: case studies of five Australian Primary Health Networks (PHNs), involving 29 primary interviews and secondary analysis of 38 prior interviews; and analysis of planning documents from all 31 PHNs. The analysis was informed by a WHO framework of evidence-informed policy-making, and institutional theory. RESULTS: Influential actors included federal and state/territory governments, Local Health Networks, Aboriginal Community Controlled Health Organisations, local councils, public hospitals, community health services, and providers of allied health, mental health and aged care services. The federal government was most influential, constraining PHNs' planning scope, time and funding. Other external factors included: the health service landscape; local socio-demographic and geographic characteristics; (neoliberal) ideology; interests and politics; national policy settings and reforms; and system reorganisation. Internal factors included: organisational structure; culture, values and ideology; various capacity factors; planning processes; transition history; and experience. The additional regional layer of context adds to the complexity of planning. CONCLUSIONS: Like national health policy-making, meso-level PHC planning occurs in a complex environment, but with additional regional factors and influences. We have developed a conceptual framework of the meso-level PHC planning environment, which can be employed by similar regional organisations to elucidate influential factors, and develop strategies and tools to promote transparent, evidence-informed PHC planning for better health outcomes.

Evolution of health sector strategic planning in Tanzania: What have we learnt and how can we improve?

Progressive realization of Universal Health Coverage is inevitable given resource constraints. The incremental approach must be reflected in health sector strategic plans which serve as roadmaps. Using a matrix based on the health systems building blocks to extract data, we reviewed three successive sector strategies to assess priority issues addressed. We undertook a thematic synthesis to draw lessons and conclusion reported in this paper. Our review shows good practice as well as areas desiring attention if health sector strategic plans are to serve the intended purpose. Although all strategies were aligned to global and national development aspirations, were developed in a participatory manner they did not reflect the required incremental approach. The challenges to be addressed and the priorities remained largely the same over a 15-year period. The strategies and key results areas to be implemented in the different strategies were numerous with funding gaps. Improving the utility of strategic plans requires improving both the process and content. Implied in this approach is the need for prioritised and affordable strategic plans that reflect incremental efforts to attaining long term targets coupled with strong trend analysis and monitoring. Additionally, we advocate for strategic plan with a longer timeframe perhaps 10 years with adjustments at regular intervals.

'Scorched Earth: The portrait of health in Brazil after the Bolsonaro's administration and the first 100 days of the Lula Government in health'.

This article is a rejoinder to the rebuttal letter authored by Jair Bolsonaro's former Minister of Health and Secretary of Primary Care to our initial article, 'From Bolsonaro to Lula: The opportunity to rebuild universal healthcare in Brazil during the government transition,' published in the International Journal of Health Planning and Management. We aim to refute the claims that we consider unsubstantiated and disconnected from reality, while reiterating the risks posed by authoritarian and antidemocratic far-right governments, such as Bolsonarism in Brazil, to the sustainability and resilience of universal health systems. This political threat is gaining momentum across several countries worldwide, thereby endangering the Democratic Rule of Law, institutions, and social policies. Furthermore, we emphasise the significant actions implemented during the first 100 days of President Lula's government, which align with the priorities established during the governmental transition process and strengthen the prospects of reconstructing and fortifying the Brazilian universal health system.

Planning and financing of RMNCH+A under National Health Mission: A case study of the Gurugram District of Haryana State.

BACKGROUND: The Health Planning Process under National Health Mission (NHM) is participatory in nature and the State Programme Implementation Plan (PIP) is an aggregation of District PIPs which is examined and approved by the National Programme Coordination Committee (NPCC), Ministry of Health and Family Welfare, Government of India. Many times there are delays in releasing of Record of Proceedings (ROPs)/approvals. This affects utilisation of NHM funds at district level and below and desired outcomes are not achieved. The present study aims to analyse the process of fund flow, disbursement and utilisation of funds on various components under Reproductive Maternal New born Child and Adolescent Health (RMNCH+A) in the district Gurugram. METHODOLOGY: The study was conducted in the District Gurugram of Haryana State, India. One Community Health Centres (CHCs), two Primary Health Centres (PHCs) and four Sub Health Centres were randomly selected. Primary and secondary data were collected in the study. Medical Officer (I/C), Accounts Staff and Health Workers were interviewed using separate schedules regarding process of disbursement, delays in release and utilisation of funds. Separate checklists were prepared to collect data on availability and utilisation of funds at District, CHC and PHC levels under different components of programme. FINDINGS: Study found that PIP is prepared with inputs from Block level but community participation at (PHC) and below was not present. There was a delay in reaching funds to district due to delayed release of ROPs. Almost 30%-40% of the budget could not be utilised due to delay in receiving of budget. Utilisation of funds was less in some programme activities due to vacant positions project staff. Only 38% and 31% of the funds were utilised under the child health and family planning budget head for the district of Gurugram in the year 2016-17. Accounts staffs were overburdened which affected monitoring of funds utilisation. Budget release from State to District and below was through e-Banking. Auxiliary Nurse Midwives (ANMs) at Sub centre used to get Untied Funds at the end of third quarter. The Government introduced new 18 broad budget heads in NHM Budget for improving utilisation of budget. CONCLUSION: Delayed release of ROPs and erroneous estimation of budget under the programme, very rigid and large number of budget heads poses challenges of understanding and analysing expenditure and affects utilisation of funds under the NHM. Moreover, vacant positions in the programme, unrealistic planning, weak community participation in planning of expenditure and unexplained budget cut in ROPs were main challenges faced by the District.

Pandemic preparedness with 20/20 vision: Applying an intersectional equity lens to health workforce planning.

Human resource for health (HRH) is considered critical for achieving Universal Health Coverage, and the crisis surrounding HRH is now established as a global emergency. Their vital role has been central in the pandemic response. Yet, the discussions and deliberations on the recent pandemic treaty circumscribe HRH discussions to their capacities and protection, and address discrimination mainly in relation to gender. While this paper endorses the case for prioritisation of HRH in global pandemic preparedness planning, it re-frames the HRH crisis in relation to the institutional and structural factors driving HRH shortage, maldistribution and skills-needs misalignment. We critique the supply-and-demand framing of HRH crisis as one that obliviates the systematic inequalities within health systems that underpin health workforce motivations, distribution, satisfaction and performance. We propose an intersectional equity lens to redefine the HRH challenges, understand their underlying drivers and accordingly integrate in the global pandemic preparedness plans.

For UW Health, Health Plan Ownership Provides Financial Stability.

For health systems seeking a path forward and upward in a value-based environment, ownership of a health plan can yield many positives, including a chance to drive value-based care, financial margin improvement, and opportunities for rewarding partnerships. However, being both a payer and a provider-a "payvider"-can make extraordinary demands on both the health system and health plan. Developing this hybrid business has been a learning experience for UW Health, an academic medical center that, like others in academic healthcare, was built on a fee-for-service model. Today, UW Health is a majority owner of what has become the state's largest provider-owned health plan. As illustrated here, health plan ownership is not for every system. The burdens are heavy. But for UW Health, it is an important component of both mission and margin.

[The evaluation of opinions of residents of the Northern Caucasus Okrug about healthy municipal planning issues].

The article presents the results of examination of opinions of residents of the North Caucasus Federal District concerning healthy urban planning issues. The most residents of large cities are satisfied with infrastructure of their city, while residents of small towns are less satisfied with it. The prioritization of importance of solving various problems of urban life, opinions of residents are not solidary and differ depending on age and place of residence of respondents. For example, construction of playgrounds is a priority for residents of reproductive age from small towns. Only one out of ten of respondents would like to participate in strategy of development of their cities of residence.

[The comparative analysis of opinions of residents of the northern Caucasus Okrug and persons making decisions concerning issues of healthy municipal planning in its municipalities].

The article presents comparative results of studying opinion of citizens and officials making decisions on modernization of urban environment, about cities conditions. It is established that valuations of citizens and decision makers about urban infrastructure, its quantity and quality, process of cooperation in this area as well as consideration of interests in healthy urban planning differ significantly. The majority of surveyed decision-makers are more satisfied with conditions of their city infrastructure than citizens. The same trend persists in assessing quantity and quality of sport and physical education institutions. On the contrary, environmental situation in municipalities is more likely to suit citizens as compared to decision makers. The decision-makers are more optimistic about intersectorial cooperation in issues of healthy urban planning. The respondents note that issues and interests of health are not sufficiently considered in development and adoption of urban planning decisions in their municipalities. To correct the situation, it is necessary to implement appropriate strategies of healthy urban planning, to determine organizational mechanisms for their implementation in national conditions and to confirm their effectiveness in organizational experiment.