Estimated impact of the 2020 economic downturn on under-5 mortality for 129 countries.

In low- and middle-income countries (LMICs), economic downturns can lead to increased child mortality by affecting dietary, environmental, and care-seeking factors. This study estimates the potential loss of life in children under five years old attributable to economic downturns in 2020. We used a multi-level, mixed effects model to estimate the relationship between gross domestic product (GDP) per capita and under-5 mortality rates (U5MRs) specific to each of 129 LMICs. Public data were retrieved from the World Bank World Development Indicators database and the United Nations World Populations Prospects estimates for the years 1990-2020. Country-specific regression coefficients on the relationship between child mortality and GDP were used to estimate the impact on U5MR of reductions in GDP per capita of 5%, 10%, and 15%. A 5% reduction in GDP per capita in 2020 was estimated to cause an additional 282,996 deaths in children under 5 in 2020. At 10% and 15%, recessions led to higher losses of under-5 lives, increasing to 585,802 and 911,026 additional deaths, respectively. Nearly half of all the potential under-5 lives lost in LMICs were estimated to occur in Sub-Saharan Africa. Because most of these deaths will likely be due to nutrition and environmental factors amenable to intervention, countries should ensure continued investments in food supplementation, growth monitoring, and comprehensive primary health care to mitigate potential burdens.

The relationship between night-time light and socioeconomic factors in China and India.

This paper re-examines the relationships between night-time light (NTL) and gross domestic product (GDP), population, road networks, and carbon emissions in China and India. Two treatments are carried out to those factors and NTL, which include simple summation in each administrative region (total data), and summation normalized by region area (density data). A series of univariate regression and multiple regression experiments are conducted in different countries and at different scales, in order to find the changes in the relationship between NTL and every parameter in different situations. Several statistical metrics, such as R2, Mean Relative Error (MRE), multiple regression weight coefficient, and Pearson's correlation coefficient are given special attention. We found that GDP, as a comprehensive indicator, is more representative of NTL when the administrative region is relatively comprehensive or highly developed. However, when these regions are unbalanced or undeveloped, the representation of GDP becomes weak and other factors can have a more important influence on the multiple regression. Differences in the relationship between NTL and GDP in China and India can also be reflected in some other factors. In many cases, regression after normalization with the administrative area has a higher R2 value than the total regression. But it is highly influenced by a few highly developed regions like Beijing in China or Chandigarh in India. After the scale of the administrative region becomes fragmented, it is necessary to adjust the model to make the regression more meaningful. The relationship between NTL and carbon emissions shows obvious difference between China and India, and among provinces and counties in China, which may be caused by the different electric power generation and transmission in China and India. From these results, we can know how the NTL is reflected by GDP and other factors in different situations, and then we can make some adjustments.

Assessment and influencing factors analysis of economic system vulnerability of the Belt and Road Initiative countries.

Economic vulnerability is an important indicator to measure regional coordination, health and stability. Despite the importance of vulnerabilities, this is the first study that presents 26 indicators selected from the dimensions of the domestic economic system, external economic system and financial system in the Belt and Road Initiative (BRI) countries. A quantitative analysis is conducted to analyze the characteristics of spatial heterogeneity of vulnerability of the economic subsystems and the comprehensive economic system of the BRI countries and the main influencing factors of the comprehensive economic system vulnerability (CESV) are identified based on obstacle degree model. The results show that the CESV of the East Asia, South Asia and ASEAN countries are lower than that of the Middle Eastern Europe, Central Asia and West Asia countries. The CESV of the BRI countries are generally in the middle level and the average vulnerability index of highly vulnerable countries is twice as much as that of lowly vulnerable countries. In addition, in terms of the vulnerability of the three subsystems, the spatial distribution of vulnerability of the domestic economic system (DESV) and financial system (FSV) is basically consistent with the spatial distribution pattern of CESV, both of which are low in East Asia and South Asia and high in West Asia and Central Asia. While, the vulnerability of external economic system (EESV) shows a different spatial pattern, with vulnerability of West Asia, Central Asia and ASEAN higher than that of East Asia and South Asia. The main obstacle factors influencing the CESV of BRI countries include GDP growth rate, saving ratio, ratio of bank capital to assets, service industry level, industrialization level and loan rate. Therefore, the key way to maintain the stability and mitigate the vulnerability of the economic system of BRI countries is to focus on the macroeconomic development and operation, stimulate the economy and market vitality, promote the development of industries, especially the service and secondary industries, and optimize the economic structure, banking system and financial system.

Singapore's health-care system: key features, challenges, and shifts.

Since Singapore became an independent nation in 1965, the development of its health-care system has been underpinned by an emphasis on personal responsibility for health, and active government intervention to ensure access and affordability through targeted subsidies and to reduce unnecessary costs. Singapore is achieving good health outcomes, with a total health expenditure of 4·47% of gross domestic product in 2016. However, the health-care system is contending with increased stress, as reflected in so-called pain points that have led to public concern, including shortages in acute hospital beds and intermediate and long-term care (ILTC) services, and high out-of-pocket payments. The main drivers of these challenges are the rising prevalence of non-communicable diseases and rapid population ageing, limitations in the delivery and organisation of primary care and ILTC, and financial incentives that might inadvertently impede care integration. To address these challenges, Singapore's Ministry of Health implemented a comprehensive set of reforms in 2012 under its Healthcare 2020 Masterplan. These reforms substantially increased the capacity of public hospital beds and ILTC services in the community, expanded subsidies for primary care and long-term care, and introduced a series of financing health-care reforms to strengthen financial protection and coverage. However, it became clear that these measures alone would not address the underlying drivers of system stress in the long term. Instead, the system requires, and is making, much more fundamental changes to its approach. In 2016, the Ministry of Health encapsulated the required shifts in terms of the so-called Three Beyonds-namely, beyond health care to health, beyond hospital to community, and beyond quality to value.

Urban scaling, geography, centrality: Relation with local government structures.

We investigate socio-economic urban scaling behavior of municipalities in Denmark, the Netherlands, and in particular in Germany. Our interest is twofold. First we investigate whether, and to what extent, scaling occurs in various types of urban areas. The second important topic of research concerns the comparison of specific types of urban areas with regard to the values of the gross urban product. This is a new approach: two scaling systems are compared not only in terms of the scaling exponent, but also in terms of the differences in the gross urban product. We are specifically interested in the role of urban governance in terms of local urban government structures. Germany is our central case because it works as a natural experiment: a large number of urban areas is one-governance, but others are not. More specifically, we distinguish between cities of which the surrounding urban area belongs to the municipality of the city (kreisfreie cities), and those specific districts (Kreise) which are urban areas consisting of several municipalities. Our findings suggest that urban areas with one municipality perform better than urban areas with fragmented governance structures. We also investigate the relation between scaling of Kreise and simple measures of centrality, including the Zipf-distribution. A strong relation is found between the measured residuals of the scaling equations and the socio-economic position of cities assessed with a set of different socio-economic indicators. Given the debate on the effectiveness of municipal reform, our results may lead to challenging conclusions about the importance of one-municipality instead of multi-municipality governance in urban areas. These results are relevant for policy as they suggest that there is a benefit to unifying the governance structure of compact urban agglomerations.

How the banking system is creating a two-way inflation in an economy.

Here we argue that due to the difference between real GDP growth rate and nominal deposit rate, a demand pull inflation is induced into the economy. On the other hand, due to the difference between real GDP growth rate and nominal lending rate, a cost push inflation is created. We compare the performance of our model to the Fisherian one by using Toda and Yamamoto approach of testing Granger Causality in the context of non-stationary data. We then use ARDL Bounds Testing approach to cross-check the results obtained from T-Y approach.

Impact of land use land cover changes on ecosystem service value - A case study of Guangdong, Hong Kong, and Macao in South China.

The rapid increase in anthropogenic activities, socioeconomic development, and land use land cover (LULC) changes since the opening of economic reforms (1978), have changed the ecosystem service value (ESV) in Guangdong, Hong Kong, and Macao (GKHM) region located in South China. This leads to the requirement of a significant tailored analysis of ecosystem services regarding incisive and relevant planning to ensure sustainability at regional level. This study focuses on the use of Landsat satellite imagery to quantify the precise impact of LULC changes on the ecosystem services in GHKM over the past three decades (1986-2017). The most renowned established unit value transfer method has been employed to calculate the ESV. The results show that the total ecosystem service value in GHKM has decreased from 680.23 billion CNY in 1986 to 668.45 billion CNY in 2017, mainly due to the decrease in farmland and fishponds. This overall decrease concealed the more dynamic and complex nature of the individual ESV. The most significant decrease took place in the values of water supply (-22.20 billion CNY, -14.72%), waste treatment (-20.77 billion CNY, -14.63%), and food production (-7.96 billion CNY, -33.18%). On the other hand, the value of fertile soil formation and retention (6.28 billion CNY, +7.26%) and recreation and culture (5.09 billion CNY, +12.91%) increased. Furthermore, total ESV and ESV per capita decreased significantly with the continuous increase in total gross domestic product (GDP) and GDP per capita. A substantial negative correlation exists between farmland ESV and GDP indicating human encroachment into a natural and semi natural ecosystems. The results suggest that in the rapidly urbanizing region, the protection of farmland and to control the intrusion of urban areas has marked an important societal demand and a challenge to the local government. This required a pressing need for smart LULC planning and to improve policies and regulation to guarantee ecosystem service sustainability for acceptable life quality in the study area and other fast expanding urban areas in China.

The role of personal factors in attitudes toward the adoption of new consumption behaviors in developing food systems.

Through dual-period surveys in urban China, administered in the years 1996 and 2013, this study investigates changes in the relationship among personal factors and the attitudes toward the adoption of new food consumption patterns as food systems develop. A structural equation model (SEM) is used to measure the association among three personal factors (traditionalism, do-it-yourself [DIY] propensity, and time scarcity) and attitudes toward three new food consumption behaviors (use of processed food, eating out, and convenience shopping). The results reveal complex relationships between personal factors and attitudes toward the adoption of new food shopping behaviors, indicating that supply-side models of retailing development are insufficient to adequately predict changes in food systems.

Associating the Change in New COVID-19 Cases to GDP per Capita in 38 European Countries in the First Wave of the Pandemic.

COVID-19 has affected all countries globally. We explore associations between the change in new COVID-19 registered cases per million population and various macroeconomic and well-being indicators in 38 European countries over a 2-month period (1st April-31st May 2020). A statistically significant (p = 0.002) negative association was estimated between the change in new COVID-19 cases and GDP per capita, after controlling for key health determinants including public expenditure on health, life expectancy, smoking tobacco and sanitation. The country with the highest GDP per capita in Europe (i.e., Luxemburg) was found to experience the lowest change in new COVID-19 cases within the time period whilst the opposite was found for countries with lower GDP per capita (i.e., Ukraine, Bulgaria, and Romania). The outcomes of this study indicate that, in the first wave of the pandemic in Europe, a country's GDP per capita might be associated with a lower rate of new COVID-19 cases. The study concludes by suggesting that in European regions a country's economic performance should be a critical health priority for policy makers.

Health care and the future of economic growth: exploring alternative perspectives.

The strong and positive relationship between gross domestic product (GDP) and health expenditure is one of the most extensively explored topics in health economics. Since the global financial crisis, a variety of theories attempting to explain the slow recovery of the global economy have predicted that future economic growth will be slower than in the past. Others have increasingly questioned whether GDP growth is desirable or sustainable in the long term as evidence grows of humanity's impact on the natural environment. This paper reviews recent data on trends in global GDP growth and health expenditure. It examines a range of theories and scenarios concerning future global GDP growth prospects. It then considers the potential implications for health care systems and health financing policy of these different scenarios. In all cases, a core question concerns whether growth in GDP and/or growth in health expenditure in fact increases human health and well-being. Health care systems in low growth or 'post-growth' futures will need to be much more tightly focused on reducing overtreatment and low value care, reducing environmental impact, and on improving technical and allocative efficiency. This will require much more concerted policy and regulatory action to reduce industry rent-seeking behaviours.

A global trend of caffeine consumption over time and related-environmental impacts.

Caffeine is one of the most consumed substances, and it has been largely detected in aquatic ecosystems. We investigated the trends in caffeine consumption over three decades and its relationships with gross domestic product (GDP) and human development index (HDI) to understand global patterns and to identify potential hotspots of contamination. The total caffeine consumption is increasing mainly due to population growth. Moreover, caffeine consumption per capita is also increasing in some countries, such as Brazil, Italy, and Ethiopia. A high positive correlation between caffeine consumption per capita with HDI and GDP was found for coffee-importing countries in Europe, while a high negative correlation was found for coffee-exporting countries in Africa. The literature review showed that the highest caffeine concentrations coincide with countries that present an increasing caffeine consumption per capita. Also, approximately 35% of the caffeine concentrations reported in the literature were above the predicted no-effect concentration in the environment and, again, overlaps with countries with increasing per capita consumption. Despite the high degradation rate, caffeine consumption tends to increase in a near future, which may also increase the overall amount of caffeine that comes into the environment, possibly exceeding the thresholds of several species described as tolerant to the current environmental concentrations. Therefore, it is essential to prevent caffeine from reaching aquatic ecosystems, implementing sewage treatment systems, and improving their efficiency.

Associations between national financial trends and facial plastic surgery procedural volume.

OBJECTIVE(S): To characterize procedural trends in facial plastic and reconstructive surgery procedures in relation to the United States economy. METHODS: Retrospective cohort study examining annual procedure rates were determined from the American Society of Plastic Surgeons (ASPS) National Clearinghouse of Plastic Surgery Procedural Statistics from January 1 2007 to December 30, 2017. Procedures were compared to economic activity of the United States as measured by gross domestic product (GDP) were compared using Kolmogorov-Smirnov goodness of fit testing and piecewise multivariate regression modeling. RESULTS: Annual trends in procedural rates showed an overall decrease in the rates of rhinoplasty (284,960 to 218,924), blepharoplasty (240,660 to 209,571), and otoplasty (28,571 to 23,433) from 2007 to 2017. Total cosmetic surgery remained fairly stable, while minimally invasive cosmetic surgery increased in frequency over the study period. On piecewise regression analysis, rhinoplasty (P = .02), rhytidectomy (P = .007), invasive cosmetic surgery (P < .001) were significantly associated with GDP, whereas otoplasty (P = .98) and reconstructive surgery (P = .11) were not associated with GDP. CONCLUSION: Cosmetic plastic surgery procedures show a greater correlation to GDP than reconstructive procedures. Trends in plastic surgery cases over the last decade show a decreasing number of rhinoplasty, otoplasty, and blepharoplasty, with stabilization in the last few years. An increasing number of reconstructive cases are found. LEVEL OF EVIDENCE: 4 Laryngoscope, 130:632-636, 2020.

Guide posts for investment in primary health care and projected resource needs in 67 low-income and middle-income countries: a modelling study.

BACKGROUND: Primary health care (PHC) is a driving force for advancing towards universal health coverage (UHC). PHC-oriented health systems bring enormous benefits but require substantial financial investments. Here, we aim to present measures for PHC investments and project the associated resource needs. METHODS: This modelling study analysed data from 67 low-income and middle-income countries (LMICs). Recognising the variation in PHC services among countries, we propose three measures for PHC, with different scope for included interventions and system strengthening. Measure 1 is centred on public health interventions and outpatient care; measure 2 adds general inpatient care; and measure 3 further adds cross-sectoral activities. Cost components included in each measure were based on the Declaration of Astana, informed by work delineating PHC within health accounts, and finalised through an expert and country validation meeting. We extracted the subset of PHC costs for each measure from WHO's Sustainable Development Goal (SDG) price tag for the 67 LMICs, and projected the associated health impact. Estimates of financial resource need, health workforce, and outpatient visits are presented as PHC investment guide posts for LMICs. FINDINGS: An estimated additional US$200-328 billion per year is required for the various measures of PHC from 2020 to 2030. For measure 1, an additional $32 is needed per capita across the countries. Needs are greatest in low-income countries where PHC spending per capita needs to increase from $25 to $65. Overall health workforces would need to increase from 5·6 workers per 1000 population to 6·7 per 1000 population, delivering an average of 5·9 outpatient visits per capita per year. Increasing coverage of PHC interventions would avert an estimated 60·1 million deaths and increase average life expectancy by 3·7 years. By 2030, these incremental PHC costs would be about 3·3% of projected gross domestic product (GDP; median 1·7%, range 0·1-20·2). In a business-as-usual financing scenario, 25 of 67 countries will have funding gaps in 2030. If funding for PHC was increased by 1-2% of GDP across all countries, as few as 16 countries would see a funding gap by 2030. INTERPRETATION: The resources required to strengthen PHC vary across countries, depending on demographic trends, disease burden, and health system capacity. The proposed PHC investment guide posts advance discussions around the budgetary implications of strengthening PHC, including relevant system investment needs and achievable health outcomes. Preliminary findings suggest that low-income and lower-middle-income countries would need to at least double current spending on PHC to strengthen their systems and universally provide essential PHC services. Investing in PHC will bring substantial health benefits and build human capital. At country level, PHC interventions need to be explicitly identified, and plans should be made for how to most appropriately reorient the health system towards PHC as a key lever towards achieving UHC and the health-related SDGs. FUNDING: The Bill & Melinda Gates Foundation.

Trade openness and the obesity epidemic: a cross-national study of 175 countries during 1975-2016.

PURPOSE: This study assessed the longitudinal relationship between trade openness and obesity rate across 175 countries during 1975-2016. METHODS: Two-way (country and year) fixed-effects regressions were performed to examine the openness index (i.e., sum of export and import over gross domestic product) in relation to country obesity rate, using data from World Health Organization and World Bank. RESULTS: The openness index was found to be positively associated with country obesity prevalence-a 10% increase in the openness index was associated with an increase in obesity rate by 0.80% (95% confidence interval, 0.67%-0.94%). Across continents, the positive relationship between the openness index and obesity prevalence was strongest among Asian countries, followed by countries in North America and Africa. Across income levels, the positive relationship between the openness index and obesity prevalence was strongest among lower middle-income countries, followed by upper middle-income countries and low-income countries. In contrast, no relationship between the two was identified among high-income countries. CONCLUSIONS: Trade openness was positively associated with country obesity prevalence, and its influence concentrated among developing nations. Policy makers should closely monitor the evolution in obesity rate during trade liberalization and nutrition transition to minimize its negative impact on weight-related population health.

Environmental Kuznets Curve and Trade Openness in Turkey: Bootstrap ARDL Approach with a Structural Break.

In this study, the validity of the environmental Kuznets curve (EKC) hypothesis is examined with the newly developed bootstrap autoregressive distributed lag (ARDL) approach by incorporating the effects of trade openness for Turkey from 1969 to 2017. The bootstrap ARDL approach results show that there is a long-run relationship between per capita carbon dioxide (CO2) emissions, per capita real income, and trade openness in the presence of one structural break. The results of the long-run estimators indicate that the inverted U-shaped EKC hypothesis is valid, and trade openness has an increasing impact on CO2 emissions. However, Turkey has not yet reached the level of income necessary to reduce pollution. The results of the Fourier Toda-Yamamoto Granger causality test also show that unidirectional causality runs through per capita real income and trade openness to per capita CO2 emissions. In addition to these findings, it has been determined that the decrease in growth rate and production experienced during the 2001 financial crisis in Turkey reduced environmental pollution in both the short and long runs. Consequently, these results show that the scale and composition effects outweigh for economic growth and trade openness in Turkey.