Can healthy ageing moderate the effects of population ageing on economic growth and health spending trends in Mongolia? A modelling study.

BACKGROUND:  Population ageing will accelerate rapidly in Mongolia in the coming decades. We explore whether this is likely to have deleterious effects on economic growth and health spending trends and whether any adverse consequences might be moderated by ensuring better health among the older population. METHODS:  Fixed-effects models are used to estimate the relationship between the size of the older working-age population (55-69 years) and economic growth from 2020 to 2100 and to simulate how growth is modified by better health among the older working-age population, as measured by a 5% improvement in years lived with disability. We next use 2017 data on per capita health spending by age from the National Health Insurance Fund to project how population ageing will influence public health spending from 2020 to 2060 and how this relationship may change if the older population (≥ 60 years) ages in better or worse health than currently. RESULTS:  The projected increase in the share of the population aged 55-69 years is associated with a 4.1% slowdown in per-person gross domestic product (GDP) growth between 2020 and 2050 and a 5.2% slowdown from 2020 to 2100. However, a 5% reduction in disability rates among the older population offsets these effects and adds around 0.2% to annual per-person GDP growth in 2020, rising to nearly 0.4% per year by 2080. Baseline projections indicate that population ageing will increase public health spending as a share of GDP by 1.35 percentage points from 2020 to 2060; this will occur slowly, adding approximately 0.03 percentage points to the share of GDP annually. Poorer health among the older population (aged ≥ 60 years) would see population ageing add an additional 0.17 percentage points above baseline estimates, but healthy ageing would lower baseline projections by 0.18 percentage points, corresponding to potential savings of just over US$ 46 million per year by 2060. CONCLUSIONS:  Good health at older ages could moderate the potentially negative effects of population ageing on economic growth and health spending trends in Mongolia. Continued investment in the health of older people will improve quality of life, while also enhancing the sustainability of public budgets.

Population ageing and health financing: A method for forecasting two sides of the same coin.

There is a perception that population ageing will have deleterious effects on future health financing sustainability. We propose a new method-the Population Ageing financial Sustainability gap for Health systems (or alternatively, the PASH)-to explore how changes in the population age mix will affect health expenditures and revenues. Using a set of six anonymized country scenarios that are based on data from countries in Europe and the Western Pacific representing a diverse range of health financing systems, we forecast the size of the ageing-attributable gap between health revenues and expenditures from 2020 to 2100 under current health financing arrangements. In the country with the largest financing gap in 2100 (country S6) the majority (87.1%) is caused by growth in health expenditures. However in countries that are heavily reliant on labour-market related social contributions to finance health care, a sizeable share of the financing gap is due to reductions in health revenues. We argue that analyses giving equal attention to both health expenditures and revenues steers decision makers towards a more balanced set of policy options to address the challenges of population ageing, ranging from targeting expenditures and utilization of services to diversifying revenue.

VOCs and Odor Episodes near the German-Czech Border: Social Participation, Chemical Analyses and Health Risk Assessment.

People living on both sides of the German-Czech border are subject to episodes of odor air pollution. A joint German-Czech air sampling and risk assessment project was established to identify the substances responsible and their sources. Twenty-four volunteer study participants, 14 from the NW Czech Republic and 10 from Germany (Saxony) reported odors and collected canister samples during sampling periods in winter 2017 and 2018 and autumn 2018. Canister samples and passive samplers were analyzed for volatile organic compounds (VOCs) and passive samplers were analyzed for VOCs and carbonyls. OAVs (Odor Activity Values) and back trajectories were calculated with the aim of identifying the odor sources. Calculated OAVs were in excellent agreement with perceived smells close to an oil processing plant. Odorants identified in fifty canister samples during odor episodes and carbonyl measurements close to the edible oil processing plant were used for health evaluation. Odors reported by participants in Saxony frequently differed from those reported by participants in the Czech Republic. This suggests that certain sources of odor lying on either side of the border only affect that side and not the other with similar considerations regarding health effects. VOCs, including carbonyls, were also sampled at two relatively remote locations during winters of 2017 and 2018; two main sources of odorous compounds were identified at these sites. Analysis of samples taken at sampling sites shows that VOC air pollution and, to a lesser extent carbonyl pollution, originate from both industrial and local sources. Even though levels of sampled substances were not associated with acute effects at any site, long-term exposures to selected compounds could be cause for concern for carcinogenicity at some sites. Odors in Seiffen were associated with carcinogenic compounds in can samples. Although not necessarily representative of long-term exposures to the compounds studied, results such as these suggest that further study is needed to better quantify long-term exposure to potentially harmful compounds, and to either confirm or deny the existence of substantive health risk.

Устойчивое финансирование здравоохранения в условиях старения населения: Результаты применения различных механизмов увеличения доходов бюджета и вариантов политики

В предлагаемом кратком обзоре рассматриваются вопросы финансирования систем здравоохранения и долгосрочного ухода, а также освещаются вопросы потенциального влияния изменений в возрастной структуре населения на способность обеспечивать достаточные и стабильные бюджетные поступления из общих источников финансирования. Мы вводим новый методологический подход для моделирования воздействия старения населения на сбор доходов в бюджет от подоходного налога (включая налоги на прибыль и прирост капитала), налогов на товары и услуги, имущественных налогов и социальных отчислений. Далее рассматриваются варианты политики, направленные на устранение дефицита поступлений, который может возникнуть в результате старения населения. Подобные связанные с мерами политики выводы актуальны как для стран с большой долей стареющего населения, так и для стран, переживающих переходный период в возрастной структуре населения. Предлагаемый краткий обзор подготовлен совместно с Центром ВОЗ по развитию здравоохранения в г. Кобе, Япония.

Economic Contraction from COVID-19 in the Pacific: Implications for Health Financing.

Pacific Island countries (PIC) have emerged as among the most at-risk globally from the collateral economic damage resulting from the COVID-19 pandemic, despite being largely spared its direct health effects so far. Current projections indicate that all PIC will experience an economic contraction in 2020, ranging from -1.0% in Tuvalu to -21.7% in Fiji, worse than most countries globally on average. Given that more than 80% of financing for health in the Pacific comes from domestic and external public sources, the net impact of the economic contraction on resources for health will depend on whether overall public spending can offset the decline in economic activity and how health will be prioritized in government budgets relative to other sectors. Without active reprioritization, most countries could see a slowdown or even decline in per capita levels of public spending for health in the region, risking gains made in advancing universal health coverage in recent years. If health ministries do not act quickly and in consort with other ministries (particularly ministries of finance), including by taking active steps to improve the efficient use of existing resources and other measures to mitigate the economic effects of the crisis on resources for health, it is likely that current economic circumstances will result in unplanned changes. These changes may not deliver the health outcomes that the health ministries would select themselves and may result in a reversal of hard-fought health gains.

Sustainable health financing with an ageing population: implications of different revenue raising mechanisms and policy options

This is the second brief in the Economics of Healthy and Active Ageing series. While there have been many prior analyses of how population ageing affects health and long-term care expenditure trends, very little is known about how population ageing affects a country’s ability to generate revenues to pay for health. This brief looks at how health and long-term care systems are financed and reports on the potential effects of population ageing on countries’ ability to generate sufficient and stable revenues for health from common funding sources (i.e. income taxes, consumption taxes, property taxes and social contributions) in the future. The authors simulate the effects of population ageing on countries’ ability to generate revenues, a) for countries with younger populations undergoing rapid population ageing and b) for countries that already have large populations of older adults. The analyses find that for countries where the population is comprised of a large share of relatively younger people who are likely to be active in the labour market, population ageing can have a positive impact on revenue generation from all funding sources. This leads to the challenge in many country contexts of strengthening tax collection mechanisms to take advantage of this opportunity. However, in countries with a large (and growing) older population, relying in particular on social contributions generated from the labour market to raise revenues for health is expected to result in fewer revenues per person over the coming decades. The authors consider a number of policy options to address potential revenue shortcomings as a result of population ageing.

Sustainable health financing with an ageing population: will population ageing lead to uncontrolled health expenditure growth?

The third policy brief in the Economics of Healthy and Active Ageing series looks at the long-term implications of population ageing for health spending growth. With the number and share of older people in the population increasing in nearly every country, there is much concern that this will translate into significantly higher growth in health spending in the future given that older people, on average, have higher health care costs than younger counterparts. Yet, a closer look at the evidence suggests this is unlikely to transpire, irrespective of the current and future age structure of a country. In this brief, the authors use historical data on per person health spending by age group to develop a set of projections on health care spending growth through 2060 due to population ageing for a) countries that already have a large share of the population at older ages and b) countries with relatively younger populations that are undergoing rapid population ageing. Hypothetical scenarios are also explored in recognition that health spending by age patterns might vary in the future. These scenarios are intended to approximate 1) an increase in demand and a concomitant increase in the volume of health services provided to older people; 2) an increase in the intensity of services for older people; 3) the introduction of a new high- cost medicine aimed primarily at older people; and 4) a structural change in which spending on long-term care (including health and social care) is covered by public health budgets. These analyses find that population ageing is not, and will not become, a major driver of growth in health expenditures. Moreover, they suggest that in countries where age demographics are changing but the size of the older population is not yet large, the costs of improving coverage and access to services for older people are likely to be manageable and now is a good time to begin investing in the health system while the population is relatively young. However, while population ageing will not become a main driver of health expenditure growth, policy choices related to how health services are delivered, the prices paid (or negotiated) for services, medicines and technologies, and volumes of care will ultimately determine health spending by age trends. The authors conclude by considering policy options that can be implemented to target these factors, helping to limit future growth in health expenditures within a context of population ageing.

Occurrence of ochratoxin A in Astragalus propinquus root and its transfer to decoction.

The aim of this study was to conduct a survey assessing (a) the ochratoxin A (OTA) content in different samples of Astragalus propinquus root (AR), one of the fundamental herbs in traditional Chinese medicine, and (b) the rate of OTA transfer to AR decoctions that are traditionally used to reduce general weakness and increase overall vitality. A validated method of high-performance liquid chromatography with fluorescence detection (HPLC-FLD) was used to determine OTA concentrations in AR samples and AR decoctions. The limit of quantification was 0.35 ng/g; the recovery of the HPLC method for AR samples was 82%; and the relative standard deviation (SD) of repeatability was 2.6%. All 40 tested AR samples were positive, with a mean value of 451.0 ng/g (range, 28.8-1700.0 ng/g). The transfer rate of OTA to decoctions, from a naturally contaminated and homogenized AR sample (internal reference material) with a concentration of OTA of 288.9 ng/g ± 12.3 (SD), was 83.4% ± 8.5 (SD). We believe it is necessary to continue OTA monitoring in AR and other herbal products, estimate the actual human usual intake, and perform health risk assessment.

Harnessing the private health sector by using prices as a policy instrument: Lessons learned from South Africa.

Governments frequently draw upon the private health care sector to promote sustainability, optimal use of resources, and increased choice. In doing so, policy-makers face the challenge of harnessing resources while grappling with the market failures and equity concerns associated with private financing of health care. The growth of the private health sector in South Africa has fundamentally changed the structure of health care delivery. A mutually reinforcing ecosystem of private health insurers, private hospitals and specialists has grown to account for almost half of the country's spending on health care, despite only serving 16% of the population with the capacity to pay. Following years of consolidation among private hospital groups and insurance schemes, and after successive failures at establishing credible price benchmarks, South Africa's private hospitals charge prices comparable with countries that are considerably richer. This compromises the affordability of a broad-based expansion in health care for the population. The South African example demonstrates that prices can be part of a structure that perpetuates inequalities in access to health care resources. The lesson for other countries is the importance of norms and institutions that uphold price schedules in high-income countries. Efforts to compromise or liberalize price setting should be undertaken with a healthy degree of caution.

Transfer of ochratoxin A from raw black tea to tea infusions prepared according to the Turkish tradition.

BACKGROUND: Ochratoxin A (OTA) is a natural contaminant of food including tea with multiple toxic effects, which poses a threat to human health. In terms of lifestyle, the Turkish population is a frequent visitor of tearooms, and the traditional Turkish tea preparation is one of the most popular ways of preparing tea infusion. RESULTS: The aim of this study was to investigate OTA transfer from raw black tea to the tea infusion prepared according to the Turkish tradition. A high-performance liquid chromatography method with a limit of quantification of 0.35 ng g-1 was used for OTA determination. The OTA amount in raw black teas from Turkey ranged from ≤0.35 ng g-1 up to 56.7 ng g-1 . An homogenised sample of black tea naturally contaminated with 55.0 ng g-1 was used to prepare infusions. The OTA transfer from the black tea to the infusion was found to be 41.5% ± 7%. CONCLUSION: These data are important for the realisation of a 'Total Diet study' (TDS). The TDS can be a complementary tool to estimate the population dietary exposure to OTA across the entire diet by analysing main foods prepared 'as consumed' (tea infusions) and not 'as purchased' (raw tea). © 2017 Society of Chemical Industry.

Transfer of ochratoxin A into tea and coffee beverages.

Ochratoxin A (OTA) is nephrotoxic, hepatotoxic, immunotoxic, neurotoxic, reprotoxic, teratogenic, and carcinogenic (group 2B), being characterized by species and sex differences in sensitivity. Despite the fact that OTA is in some aspects a controversial topic, OTA is the most powerful renal carcinogen. The aim of this study was to make a small survey concerning OTA content in black tea, fruit tea, and ground roasted coffee, and to assess OTA transfer into beverages. OTA content was measured using a validated and accredited HPLC-FLD method with a limit of quantification (LOQ) of 0.35 ng/g. The OTA amount ranged from LOQ up to 250 ng/g in black tea and up to 104 ng/g in fruit tea. Black tea and fruit tea, naturally contaminated, were used to prepare tea infusions. The transfer from black tea to the infusion was 34.8% ± 1.3% and from fruit tea 4.1% ± 0.2%. Ground roasted coffee naturally contaminated at 0.92 ng/g was used to prepare seven kinds of coffee beverages. Depending on the type of process used, OTA transfer into coffee ranged from 22.3% to 66.1%. OTA intakes from fruit and black tea or coffee represent a non-negligible human source.

Ochratoxin A levels in blood serum of Czech women in the first trimester of pregnancy and its correspondence with dietary intake of the mycotoxin contaminant.

The mycotoxin ochratoxin A (OTA) can elicit a wide range of toxic properties including embryotoxicity and teratogenicity. OTA crosses the placenta at early gestation rather than in late gestation, maternal OTA exposure may represent a risk for the developing fetus. The study focuses on the assessment of OTA intake of pregnant women (aged 19-40 years) in the first trimester of pregnancy by means OTA levels in 100 blood serum samples by high-performance liquid chromotography with fluorescence detection (HPLC-FD) method and comparison with dietary OTA exposure in pregnant women. Of all, 96% tested serum samples were positive with values ranging from 0.1 to 0.35 µg/l with a mean value of 0.15 µg/l.

A comparison of ELISA and HPLC methods for determination of ochratoxin A in human blood serum in the Czech Republic.

Ochratoxin A (OTA) is one of the most naturally occurring fungal toxins in food. It has been detected in high concentrations in serum samples of nephropathic patients and can be applied as one of the markers of potential risk of this disease. Also, OTA can cause adverse effects on human health such as genotoxicity and is anticipated to be a potential human carcinogen. In this study, enzyme-linked immunosorbent assay (ELISA) and high performance liquid chromatography (HPLC) were applied in analysis of 115 blood serum samples of women in the child rearing age from the Czech Republic and both methods were compared. The OTA was presented in a broad range of concentrations from 0.037 to 1.130 µg/L. The outcome of ELISA and HPLC measurements were well correlated (r=0.907). However, it was observed that ELISA tend to result in underestimating the OTA level at the low serum concentrations. Both methods had the same limits of quantification of 0.050 µg/L under standard operation conditions. When OTA concentration in a sample was too low, the sample was redissolved in only 300 µL of methanol and the detection limit for HPLC was lowered to 0.030 µg OTA/L.

Ochratoxin A exposure biomarkers in the Czech Republic and comparison with foreign countries.

Among ochratoxins, ochratoxin A (OTA) occupies a dominant place and represents significant risk for human and animal health which also implies economic losses around the world. OTA is nephrotoxic, hepatotoxic, teratogenic and immunotoxic mycotoxin. OTA exposure may lead to formation of DNA adducts resulting to genotoxicity and carcinogenicity (human carcinogen of 2B group). Now it seems that OTA could be "a complete carcinogen" which obliges to monitor its presence in biological materials, especially using the suitable biomarkers. In this article, OTA findings in urine, blood, serum, plasma and human kidneys (target dose) in the Czech Republic and comparison with foreign countries are presented.