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6.
8.
Health Aff (Millwood) ; 40(4): 664-671, 2021 04.
Artigo em Inglês | MEDLINE | ID: mdl-33764801

RESUMO

The COVID-19 pandemic has prompted concern about the integrity of the US public health infrastructure. Federal, state, and local governments spend $93 billion annually on public health in the US, but most of this spending is at the state level. Thus, shoring up gaps in public health preparedness and response requires an understanding of state spending. We present state spending trends in eight categories of public health activity from 2008 through 2018. We obtained data from the Census Bureau for all states except California and coded the data by public health category. Although overall national health expenditures grew by 4.3 percent in this period, state governmental public health spending saw no statistically significant growth between 2008 and 2018 except in injury prevention. Moreover, state spending levels on public health were not restored after cuts experienced during the Great Recession, leaving states ill equipped to respond to COVID-19 and other emerging health needs.


Assuntos
/epidemiologia , Gastos em Saúde , Saúde Pública/economia , /economia , Financiamento Governamental , Humanos , Pandemias , Estados Unidos/epidemiologia
10.
Rev Esp Salud Publica ; 952021 Mar 05.
Artigo em Espanhol | MEDLINE | ID: mdl-33664220

RESUMO

OBJECTIVE: The irruption of SARS-CoV-2 and its different incidence on the regional mortality rate could be revealing the effects of the change in the paradigm of health justice, initiated in Spain in 2010 and applied, more or less enthusiastically, by the different autonomous communities. The objective of this work was to look for if the socio-economic conditions and the policy of budgetary expenditure followed by the different Spanish autonomous communities have incidence, by themselves, on the mortality rate caused by the SARS-CoV-2. METHODS: Econometric research based on Multiple Linear Regression to determine the direct cause-effect relationship between the dependent variable, mortality associated with COVID-19, with explanatory variables of the health budget and socio-economic type. RESULTS: The number of deaths caused by COVID-19 has a positive relationship with the rate of GDP per capita and inversely with expenditure on hospital and specialized services, teaching and IRMs and with the resources allocated to health over the last nine years. A reduction in any of these health budget variables leads to an increase in mortality caused by COVID-19. CONCLUSIONS: The COVID-19 mortality rate has hit the wealthiest autonomous communities hardest but, above all, has hit those that, although richer, applied more restrictive budgetary measures in the period 2010-2018.


Assuntos
/mortalidade , Gastos em Saúde , /economia , Custos de Cuidados de Saúde , Humanos , Modelos Econométricos , Pandemias/economia , Saúde Pública/economia , Análise de Regressão , Espanha/epidemiologia
11.
Lancet Planet Health ; 5(2): e102-e107, 2021 02.
Artigo em Inglês | MEDLINE | ID: mdl-33581061

RESUMO

The scale of the COVID-19 pandemic is a consequence of international trade and globalisation, with the virus spreading along established trade and travel routes. However, the pandemic also affects international trade through reductions in both supply and demand. In this Viewpoint we describe the many implications for health and propose ways to mitigate them. Problems include reduced access to medical supplies (in particular, personal protective equipment and tests), budgetary shortfalls as a result of reduced tariffs and taxes, and a general decline in economic activity-leading, in many cases, to recessions, threats to social safety nets, and to increased precariousness of income, employment, and food security. However, in exceptional cases, the pandemic has also brought some transient benefits, including to the environment. Looking ahead, there will be great pressure to further liberalise rules on trade to encourage economic recovery, but it is essential that trade policy be informed by its many consequences for health to ensure that the benefits are maximised and threats are minimised through active identification and mitigation.


Assuntos
/epidemiologia , Comércio , Pandemias/economia , Saúde Pública , Comércio/economia , Comércio/tendências , Humanos , Internacionalidade , Saúde Pública/economia , Saúde Pública/tendências
12.
J Am Board Fam Med ; 34(Suppl): S203-S209, 2021 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-33622839

RESUMO

The Coronavirus disease 2019 (COVID-19) pandemic has laid bare the dis-integrated health care system in the United States. Decades of inattention and dwindling support for public health, coupled with declining access to primary care medical services have left many vulnerable communities without adequate COVID-19 response and recovery capacity. "Health is a Community Affair" is a 1966 effort to build and deploy local communities of solution that align public health, primary care, and community organizations to identify health care problem sheds, and activate local asset sheds. After decades of independent effort, the COVID-19 pandemic offers an opportunity to reunite and align the shared goals of public health and primary care. Imagine how different things might look if we had widely implemented the recommendations from the 1966 report? The ideas and concepts laid out in "Health is a Community Affair" still offer a COVID-19 response and recovery approach. By bringing public health and primary care together in community now, a future that includes a shared vision and combined effort may emerge.


Assuntos
/terapia , Prestação Integrada de Cuidados de Saúde/organização & administração , Atenção Primária à Saúde/normas , Saúde Pública/normas , /epidemiologia , Comportamento Cooperativo , Prestação Integrada de Cuidados de Saúde/tendências , Humanos , Pandemias , Atenção Primária à Saúde/economia , Atenção Primária à Saúde/tendências , Saúde Pública/economia , Saúde Pública/tendências , Estados Unidos/epidemiologia
13.
Can J Public Health ; 112(2): 186-190, 2021 04.
Artigo em Inglês | MEDLINE | ID: mdl-33625685

RESUMO

Inspired by Fiset-Laniel et al.'s (2020) article entitled "Public health investments: neglect or wilful omission? Historical trends in Quebec and implications for Canada", we assessed public health investments since the establishment of the Nova Scotia provincial health authority in 2015. We analyzed Nova Scotia Department of Health and Wellness budgets from 2015-2016 to 2019-2020 and observed that less than 1% of funding was budgeted for public health annually, an amount well below the recommendation that 5-6% of healthcare funding be spent on public health. Healthcare spending has increased annually since 2015-2016, but proportions of funding to different programs and services have remained static. Specifically, we did not observe a change in investment in public health over time, suggesting that while the government does not necessarily spend too much or too little on healthcare, it spends far too little on public health. This chronic under-funding is problematic given the high rates of non-communicable diseases in Nova Scotia and health inequities experienced within the population. The 2020 COVID-19 pandemic has highlighted the importance of public health work, and the need for a pandemic recovery plan that prioritizes investment in all areas of public health in Nova Scotia.


Assuntos
Orçamentos/tendências , Financiamento Governamental/economia , Saúde Pública/economia , Disparidades nos Níveis de Saúde , Humanos , Doenças não Transmissíveis/epidemiologia , Nova Escócia/epidemiologia
14.
Artigo em Inglês | MEDLINE | ID: mdl-33525330

RESUMO

The COVID-19 pandemic stressed the importance of understanding the sources of vulnerabilities that can lead to a financial crisis and highlighted the predominant impact on health systems. Firstly, the paper aims to conduct a retrospective analysis of the Romanian health care system, over the period of time 1985-2019, based on our own computed sustainability index for public health. Secondly, using the Gregory-Hansen cointegration method, we provide new evidence on the causal relationship between health expenditure and GDP for Romania over the period of time 1985-2017. Based on the retrospective analysis of the long-run co-movement between health spending and GDP, the study allows one to prospectively examine not only the effects of the COVID-19 pandemic on health care spending, but also to reveal the government's fiscal position and vulnerabilities. Our results highlight the intergenerational costs related to the policy incoherence roadmap and regulatory fragmentation, stressing the importance of economic system resilience through fiscal diligence and the consolidation of the institutional context.


Assuntos
/economia , Gastos em Saúde , Pandemias/economia , Saúde Pública/economia , Humanos , Estudos Retrospectivos , Romênia/epidemiologia
17.
J Med Internet Res ; 23(1): e21382, 2021 01 22.
Artigo em Inglês | MEDLINE | ID: mdl-33480859

RESUMO

BACKGROUND: A population-level survey (PLS) is an essential and standard method used in public health research that supports the quantification of sociodemographic events, public health policy development, and intervention designs. Data collection mechanisms in PLS seem to be a significant determinant in avoiding mistakes. Using electronic devices such as smartphones and tablet computers improves the quality and cost-effectiveness of public health surveys. However, there is a lack of systematic evidence to show the potential impact of electronic data collection tools on data quality and cost reduction in interviewer-administered surveys compared with the standard paper-based data collection system. OBJECTIVE: This systematic review aims to evaluate the impact of the interviewer-administered electronic data collection methods on data quality and cost reduction in PLS compared with traditional methods. METHODS: We conducted a systematic search of MEDLINE, CINAHL, PsycINFO, the Web of Science, EconLit, Cochrane CENTRAL, and CDSR to identify relevant studies from 2008 to 2018. We included randomized and nonrandomized studies that examined data quality and cost reduction outcomes, as well as usability, user experience, and usage parameters. In total, 2 independent authors screened the title and abstract, and extracted data from selected papers. A third author mediated any disagreements. The review authors used EndNote for deduplication and Rayyan for screening. RESULTS: Our search produced 3817 papers. After deduplication, we screened 2533 papers, and 14 fulfilled the inclusion criteria. None of the studies were randomized controlled trials; most had a quasi-experimental design, for example, comparative experimental evaluation studies nested on other ongoing cross-sectional surveys. A total of 4 comparative evaluations, 2 pre-post intervention comparative evaluations, 2 retrospective comparative evaluations, and 4 one-arm noncomparative studies were included. Meta-analysis was not possible because of the heterogeneity in study designs, types, study settings, and level of outcome measurements. Individual paper synthesis showed that electronic data collection systems provided good quality data and delivered faster compared with paper-based data collection systems. Only 2 studies linked cost and data quality outcomes to describe the cost-effectiveness of electronic data collection systems. Field data collectors reported that an electronic data collection system was a feasible, acceptable, and preferable tool for their work. Onsite data error prevention, fast data submission, and easy-to-handle devices were the comparative advantages offered by electronic data collection systems. Challenges during implementation included technical difficulties, accidental data loss, device theft, security concerns, power surges, and internet connection problems. CONCLUSIONS: Although evidence exists of the comparative advantages of electronic data collection compared with paper-based methods, the included studies were not methodologically rigorous enough to combine. More rigorous studies are needed to compare paper and electronic data collection systems in public health surveys considering data quality, work efficiency, and cost reduction. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID): RR2-10.2196/10678.


Assuntos
Análise Custo-Benefício/normas , Confiabilidade dos Dados , Inquéritos Epidemiológicos/economia , Saúde Pública/economia , Saúde Pública/métodos , Estudos Transversais , Humanos , Estudos Retrospectivos
18.
Prev Med ; 145: 106441, 2021 04.
Artigo em Inglês | MEDLINE | ID: mdl-33515588

RESUMO

The COVID-19 pandemic will have long-term consequences due to social and economic disruption. This study aimed to understand the contextual, media, and economic factors associated with anticipated mental health consequences from the COVID-19 pandemic among Americans. A nationally representative survey of 1001 respondents was conducted in April 2020. Chi-square tests and logistic regressions examined anticipated emotional or psychological effects on respondents or members of their households should social distancing measures continue. Specific analyses focused on: 1) COVID-19 experience - knowing someone or being infected; living in a state with a high death rate; or state social distancing policies; 2) media exposure - source of coronavirus information and time spent on coronavirus news; and 3) economics - current economic effects; and anticipated long-term financial effects. 41% of respondents anticipated mental health consequences. Living in a state with a greater COVID-19 death rate (OR 1.73; 95% CI 1.10, 2.72) and anticipating long-term financial difficulties (OR 2.98; 95% CI 1.93, 4.60) were both associated with greater likelihood of anticipated mental health consequences. Those whose primary news source was television, as opposed to print or online, were almost 50% less likely to anticipate mental health challenges (OR 0.52 CI 0.33, 0.81), while those who reported spending two or more hours daily on COVID-19 news were 90% more likely (OR 1.90; 95% CI 1.27, 2.85). Aspects of community health, media consumption, and economic impacts influence anticipated poor mental health from the COVID-19 pandemic, suggesting each domain is relevant to interventions to address the consequences.


Assuntos
/economia , Transtornos Mentais/economia , Transtornos Mentais/epidemiologia , Transtornos Mentais/psicologia , Saúde Pública/economia , Saúde Pública/estatística & dados numéricos , Feminino , Humanos , Masculino , Pandemias/economia , Pandemias/estatística & dados numéricos , Inquéritos e Questionários , Estados Unidos
20.
Am J Public Health ; 111(2): 293-300, 2021 02.
Artigo em Inglês | MEDLINE | ID: mdl-33351658

RESUMO

The "political economy of health" is concerned with how political and economic domains interact and shape individual and population health outcomes. However, the term is variously defined in the public health, medical, and social science literatures.This could result in confusion about the term and its associated tradition, thereby constituting a barrier to its application in public health research and practice.To address these issues, I survey the political economy of health tradition, clarify its specifically Marxian theoretical legacy, and discuss its relevance to understanding and addressing public health issues. I conclude by discussing the benefits of employing critical theories of race and racism with Marxian political economy to better understand the roles of class exploitation and racial oppression in epidemiological patterning.


Assuntos
Disparidades em Assistência à Saúde/economia , Saúde Pública/economia , Disparidades nos Níveis de Saúde , Humanos , Racismo , Determinantes Sociais da Saúde , Estados Unidos
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