COVID-19 and the Cost of Vaccine Nationalism.

Experience shows that, in response to pandemics, national governments tend to follow their own interests instead of pursuing a more globally coordinated approach. This nationalistic behaviour could have negative consequences on how well the COVID-19 global pandemic is managed and contained. A situation in which countries push to get first access to a supply of vaccines, potentially hoarding key components for vaccine production, has been commonly referred to as "vaccine nationalism." This article examines how the management of the COVID-19 crisis may be affected by vaccine nationalism and what the associated economic cost would be of inequitable access to vaccines across countries.

Estimating the global economic benefits of physically active populations over 30 years (2020-2050).

OBJECTIVES: We assess the potential benefits of increased physical activity for the global economy for 23 countries and the rest of the world from 2020 to 2050. The main factors taken into account in the economic assessment are excess mortality and lower productivity. METHODS: This study links three methodologies. First, we estimate the association between physical inactivity and workplace productivity using multivariable regression models with proprietary data on 120 143 individuals in the UK and six Asian countries (Australia, Malaysia, Hong Kong, Thailand, Singapore and Sri Lanka). Second, we analyse the association between physical activity and mortality risk through a meta-regression analysis with data from 74 prior studies with global coverage. Finally, the estimated effects are combined in a computable general equilibrium macroeconomic model to project the economic benefits of physical activity over time. RESULTS: Doing at least 150 min of moderate-intensity physical activity per week, as per lower limit of the range recommended by the 2020 WHO guidelines, would lead to an increase in global gross domestic product (GDP) of 0.15%-0.24% per year by 2050, worth up to US$314-446 billion per year and US$6.0-8.6 trillion cumulatively over the 30-year projection horizon (in 2019 prices). The results vary by country due to differences in baseline levels of physical activity and GDP per capita. CONCLUSIONS: Increasing physical activity in the population would lead to reduction in working-age mortality and morbidity and an increase in productivity, particularly through lower presenteeism, leading to substantial economic gains for the global economy.

Employee Engagement in the NHS: A Secondary Data Analysis of the NHS Healthy Workforce and Britain's Healthiest Workplace Surveys.

Staff health and wellbeing is an important area for employers. Leading a healthy life, both physically and mentally, helps the individual health of employees, but also benefits employers through boosting productivity in the workplace. The Five Year Forward View strategy, published by NHS England in 2014, underscores the importance of staff health and wellbeing as a crucial factor in improving the performance of the NHS and chief executive Simon Stevens announced a number of new initiatives and policy developments aimed at improving health and wellbeing within the workforce in 2015. RAND Europe conducted an independent study to examine the factors associated with engagement among NHS employees as part of a project with the Health Foundation, a charity committed to bringing about better health and healthcare in the UK. RAND Europe analysed data from the NHS Healthy Workforce Survey, conducted in 2016 across 35 UK NHS organisations, as well as VitalityHealth's Britain's Healthiest Workplace (BHW) survey in 2016, which involved RAND Europe's analysis of the survey results. The views expressed in the study are the authors' own and do not necessarily represent the views of the Health Foundation.

Incentives and Physical Activity: An Assessment of the Association Between Vitality's Active Rewards with Apple Watch Benefit and Sustained Physical Activity Improvements.

The benefits of physical activity include a lowered risk of some major non-communicable diseases and improving wellbeing and mental health. However, roughly about one third of the global adult population is not meeting the minimum weekly level of physical activity recommended by the World Health Organisation. Discovery, a South African multi-national insurance group, offers two types of incentives to its members: Vitality Active Rewards and Vitality Active Rewards with Apple Watch. The Vitality Active Rewards scheme, a gain-framed incentive, rewards individuals for tracking and reaching different thresholds of physical activity, whereas the Vitality Active Rewards with Apple Watch benefit makes monthly repayments for an Apple Watch in amounts linked to different levels of physical activity thresholds that the individual reaches per month. Discovery commissioned RAND Europe to conduct an independent assessment on whether the Vitality Active Rewards with Apple Watch benefit is associated with increased physical activity levels for Vitality members that take up the benefit, compared to those individuals that only participate in the Vitality Active Rewards programme. The study also examined whether these associations persist over time. The findings of this study suggest that incentivising physical activity to tackle inactivity and a sedentary lifestyle can lead to better activity levels. When more unhealthy individuals take up an incentive of this kind, the results can lead on average to a more pronounced behaviour change than we see in already relatively more active and healthy individuals. This is important when designing health promotion programmes.

Assessing the burden of nocturia in the workplace: the associations between nocturnal voiding, subjective well-being, work engagement and productivity.

Aims: Nocturia (getting up at night to urinate, where each urination being followed by sleep or intention to sleep) is a bothersome symptom with potentially negative consequences for individual health and daytime functioning. This study assessed the burden of nocturia in the workplace by investigating associations between nocturia and subjective well-being (SWB), work engagement and productivity.Methods: Using large-scale international workplace survey data, the associations between nocturia, SWB, work engagement (Utrecht Work Engagement Scale, UWES-9) and productivity (Work Productivity and Activity Impairment, WPAI) were assessed. Bivariate and multivariate regression analysis was used with adjustment for a large set of confounding factors, including sleep duration and sleep quality.Results: Across a study sample of 92,129 observations, aged 18-70, an average of 10% of the survey population reported ≥2 nocturnal voids (generally considered clinically significant nocturia), with prevalence of nocturia increasing with age. Individuals with nocturia reported a 35.7% (p < .001) higher relative sleep disturbance score and were 10.5 percentage points (pp) (p < .001) more likely to report short sleep. Adjusted for covariates, nocturia was associated with a 3.5% (p < .001) lower relative SWB score and a 2% (p < .001) lower relative UWES-9 work engagement score. Nocturia was associated with a 3.9 pp (p < .001) higher work impairment due to absenteeism and presenteeism (WPAI). Adjusting additionally for sleep disturbance and sleep duration reduced the magnitude of the estimated effects, suggesting a key role for poor sleep in explaining the relationship between nocturia and the outcomes (SWB, UWES-9, WPAI) assessed.Conclusions: A key contribution of this study is the assessment of the association between nocturia and a range of work performance outcomes in a sizeable study using validated instruments to measure work engagement and productivity. The study highlights the importance of taking sleep into account when assessing the relationship between nocturia and associated outcomes.

Why Sleep Matters-The Economic Costs of Insufficient Sleep: A Cross-Country Comparative Analysis.

The Centers for Disease Control and Prevention (CDC) in the United States has declared insufficient sleep a "public health problem." Indeed, according to a recent CDC study, more than a third of American adults are not getting enough sleep on a regular basis. However, insufficient sleep is not exclusively a US problem, and equally concerns other industrialised countries such as the United Kingdom, Japan, Germany, or Canada. According to some evidence, the proportion of people sleeping less than the recommended hours of sleep is rising and associated with lifestyle factors related to a modern 24/7 society, such as psychosocial stress, alcohol consumption, smoking, lack of physical activity and excessive electronic media use, among others. This is alarming as insufficient sleep has been found to be associated with a range of negative health and social outcomes, including success at school and in the labour market. Over the last few decades, for example, there has been growing evidence suggesting a strong association between short sleep duration and elevated mortality risks. Given the potential adverse effects of insufficient sleep on health, well-being and productivity, the consequences of sleep-deprivation have far-reaching economic consequences. Hence, in order to raise awareness of the scale of insufficient sleep as a public-health issue, comparative quantitative figures need to be provided for policy- and decision-makers, as well as recommendations and potential solutions that can help tackling the problem.

Review of Computerised Cognitive Behavioural Therapies: Products and Outcomes for People with Mental Health Needs.

Common mental health problems, such as depression, anxiety, and other disorders, affect many people and incur increasing costs to individuals, employers, and government. Several challenges have been identified in the provision of public services for people with common mental health problems. A previous study by RAND Europe suggested that providing access to online mental health assessment and support and building on computerised cognitive behavioural therapy (cCBT) interventions could help reach out to the general population and, in particular, those less likely to seek help elsewhere. This study explores online platforms and mobile applications that offer cognitive behavioural therapy (CBT) for people with mental health needs. Overall, this review shows that a variety of cCBT products exist which differ both in terms of the conditions products aim to address and the ways in which platforms are designed. The tools offer support through a varying number of modules (or lessons) clustered around specific issues that need to be addressed. The number of modules offered by the tools differs slightly by condition: platforms for anxiety disorders and insomnia are on average lengthier, with a median number of modules of 9 and 8 respectively, compared to those for depression in which the median is 6.5. The majority of tools use a linear structure and offer at least some additional guidance, although the intensity of this extra support is typically low.

Is More Always Better in Designing Workplace Wellness Programs?: A Comparison of Wellness Program Components Versus Outcomes.

OBJECTIVE: Assess whether adding more components to a workplace wellness program is associated with better outcomes by measuring the relationship of program components to one another and to employee participation and perceptions of program effectiveness. METHODS: Data came from a 2014 survey of 24,393 employees of 81 employers about services offered, leadership, incentives, and promotion. Logistic regressions were used to model the relationship between program characteristics and outcomes. RESULTS: Components individually are related to better outcomes, but this relationship is weaker in the presence of other components and non-significant for incentives. Within components, a moderate level of services and work time participation opportunities are associated with higher participation and effectiveness. CONCLUSIONS: The "more of everything" approach does not appear to be advisable for all programs. Programs should focus on providing ample opportunities for employees to participate and initiatives like results-based incentives.

Psychological Wellbeing and Work: Improving Service Provision and Outcomes.

This study explores proposals to improve employment and health outcomes for people with common mental health problems and makes a number of recommendations. These include: using evidence-based models to provide services that combine employment and mental health support; increasing integration between existing treatment and employment services to improve outcomes in both areas; applying evidence-based models in new ways or a using combination of approaches; and providing timely access to coordinated treatment and employment support for a greater number of people with common mental health problems.

Comparing the costs of alternative models of end-of-life care.

OBJECTIVES: This study explores the financial consequences of decreased acute care utilization and expanded community-based care for patients at the end of life in England. METHOD: A Markov model based on cost and utilization data was used to estimate the costs of care for cancer and organ failure in the last year of life and to simulate reduced acute care utilization. RESULTS: We estimated at pounds 1.8 billion the cost to the taxpayer of care for the 127,000 patients dying from cancer in 2006. The equivalent cost for the 30,000 people dying from organ failure was pounds 553 million. Resources of pounds 16 to pounds 171 million could be released for cancer. CONCLUSION: People generally prefer to die outside hospital. Our results suggest that reducing reliance on acute care could release resources and better meet peoples' preferences. Better data on the cost-effectiveness of interventions are required. Similar models would be useful to decision-makers evaluating changes in service provision.

Evaluation of DG SANCO Data Management Practices.

The European Commission Health and Consumer Protection Directorate-General (DG SANCO) commissioned RAND Europe to provide support in developing a comprehensive data strategy for DG SANCO that meets the needs of increasingly evidence-based policymaking in the future. This work builds on previous work by RAND Europe conducted for DG SANCO, mapping out international good practice of data management. The work described in this study had two aims: to assess the current data management practices within DG SANCO that relate to the four specific issues identified by DG SANCO: data needs, DG SANCO data sources, key partnerships on data, and data quality; and to develop, on the basis of this review, recommendations for improving DG SANCO's current data management and the definition of DG SANCO's Good Practice Model for Data Strategy. This article presents the findings of RAND Europe's analysis.