Background: International policy towards access to essential medicines in Africa has focused until recently on international procurement of large volumes of medicines, mainly from Indian manufacturers, and their import and distribution.
Author Archives: GlobalizationAndHealth
Background: The UK government committed to undertaking impact assessments of its policies on the health of populations in low and middle-income countries in its cross-government strategy "Health is Global".
Background: Diabetes has become an increasingly prevalent and severe public health issue in Algeria. This article investigates the prevalence, the cost and the management of this disease. Its first objective is to better understand the burden (both from an epidemiological and economic perspective) and management of diabetes. The second objective is to understand the health policy strategy adopted by Algeria in order to respond to the disease. Methods: We conducted a literature review of prevalence, costs, management and outcomes of diabetes and its complications.
Background: Socioeconomic status is a recognised determinant of health status, and the association may be mediated by unhealthy behaviours and psychosocial adversities, which, in developed countries, both aggregate in low socioeconomic sectors of the population. We explored the hypothesis that unhealthy behavioural choices and psychological distress do not both aggregate in low socioeconomic status groups in developing countries. Methods: Our study is based on a cross-sectional comparison between national population samples of adults in England and Thailand. Psychological distress was assessed using the General Health Questionnaire (GHQ-12) or three anxiety-oriented items from the Kessler scale (K6).
Background: The burden of chronic kidney disease (CKD) will rise in parallel with the growing prevalence of type two diabetes mellitus in South Asia but is understudied. Using a cross-sectional survey of adults living in a middle-income neighborhood of Dhaka, Bangladesh, we tested the hypothesis that the prevalence of CKD in this group would approach that of the U.S. and would be strongly associated with insulin resistance. Methods: We enrolled 402 eligible adults (>30 years old) after performing a multi-stage random selection procedure. We administered a questionnaire, and collected fasting serum samples and urine samples
Background: The Global Burden of Disease (GBD) 2010 Study has published disability-adjusted life year (DALY) data at both regional and country levels from 1990 to 2010. Concurrently, the Institute for Health Metrics and Evaluation (IHME) has published estimates of development assistance for health (DAH) at the country-disease level for this same period of time.FindingsWe use disease burden data from the GBD 2010 study and financing data from IHME to calculate ratios of DAH to DALYs across regions and diseases. We examine the magnitude of these ratios and how they have varied over time. We hypothesize that the variation in this ratio across regions would be relatively small. However, from 2006 to 2010, we find there was considerable variation in the levels of DAH per DALY across regions
Background: Serving on volunteer groups undertaking medical mission trips is a common activity for health care professionals and students. Although volunteers hope such work will assist underserved populations, medical mission groups have been criticized for not providing sustainable health services that focus on underlying health problems. As members of a volunteer medical mission group, we performed a bed net indicator study in rural Mali. We undertook this project to demonstrate that volunteers are capable of undertaking small-scale research, the results of which offer locally relevant results useful for disease prevention programs. The results of such projects are potentially sustainable beyond the duration of a mission trip
Background: The objective of this review was to describe and situate the burden and treatment of diabetes within the broader context of the French health care system. Methods: Literature review on the burden, treatment and outcomes of diabetes in France, complemented by personal communication with with diabetes experts in the Paris public hospital system. Results: Prevalence of diabetes in the French population is estimated at 6%. Diabetes has the highest prevalence among all chronic conditions covered 100% by France’s statutory health insurance (SHI), and the number of covered patients has doubled in the past 10 years. In 2010, the SHI cost for pharmacologically-treated diabetes patients amounted to €17.7 billion, including an estimated €2.5 billion directly related to diabetes treatment and prevention and €4.2 billion for treatment of diabetes-related complications
Background: The study aimed at developing a set of attributes for a ‘good’ health system performance assessment (HSPA) framework from literature and experiences in different contexts and using the attributes for a structured approach to lesson learning for low-income countries (LICs). Methods: Literature review to identify relevant attributes for a HSPA framework; attribute validation for LICs in general, and for Uganda in particular, via a high-level Ugandan expert group; and, finally, review of a selection of existing HSPA frameworks using these attributes. Results: Literature review yielded six key attributes for a HSPA framework: an inclusive development process; its embedding in the health system’s conceptual model; its relation to the prevailing policy and organizational set-up and societal context; the presence of a concrete purpose, constitutive dimensions and indicators; an adequate institutional set-up; and, its capacity to provide mechanisms for eliciting change in the health system. The expert group contextualized these attributes and added one on the adaptability of the framework.Lessons learnt from the review of a selection of HSPA frameworks using the attributes include: it is possible and beneficial to involve a range of stakeholders during the process of development of a framework; it is important to make HSPA frameworks explicit; policy context can be effectively reflected in the framework; there are marked differences between the structure and content of frameworks in high-income countries, and low- and middle-income countries; champions can contribute to put HSPA high on the agenda; and mechanisms for eliciting change in the health system should be developed alongside the framework. Conclusion: It is possible for LICs to learn from literature and the experience of HSPA in other contexts, including HICs
Background: Newly established high-technology areas such as eHealth require regulations regarding the interoperability of health information infrastructures and data protection. It is argued that government capacities as well as the extent to which public and private organizations participate in policy-making determine the level of eHealth legislation. Both explanatory factors are influenced by international organizations that provide knowledge transfer and encourage private actor participation. Methods: Data analysis is based on the Global Observatory for eHealth – ATLAS eHealth country profiles which summarizes eHealth policies in 114 countries.
IntroductionLimited resources in low- and middle-income countries (LMICs) drive tremendous innovation in medicine, as well as in other fields. It is not often recognized that several important surgical tools and methods, widely used in high-income countries, have their origins in LMICs. Surgical care around the world stands much to gain from these innovations. In this paper, we provide a short review of some of these succesful innovations and their origins that have had an important impact in healthcare delivery worldwide.Review: Examples of LMIC innovations that have been adapted in high-income countries include the Bogota bag for temporary abdominal wound closure, the orthopaedic external fixator for complex fractures, a hydrocephalus fluid valve for normal pressure hydrocephalus, and intra-ocular lens and manual small incision cataract surgery.
Background: It is widely acknowledged that austerity measures in the wake of the global financial crisis are starting to undermine population health results. Yet, few research studies have focused on the ways in which the financial crisis and the ensuing ‘Great Recession’ have affected health equity, especially through their impact on social determinants of health; neither has much attention been given to the health consequences of the fiscal austerity regime that quickly followed a brief period of counter-cyclical government spending for bank bailouts and economic stimulus. Canada has not remained insulated from these developments, despite its relative success in maneuvering the global financial crisis. Methods: The study draws on three sources of evidence: A series of semi-structured interviews in Ottawa and Toronto, with key informants selected on the basis of their expertise (n = 12); an analysis of recent (2012) Canadian and Ontario budgetary impacts on social determinants of health; and documentation of trend data on key social health determinants pre- and post the financial crisis. Results: The findings suggest that health equity is primarily impacted through two main pathways related to the global financial crisis: austerity budgets and associated program cutbacks in areas crucial to addressing the inequitable distribution of social determinants of health, including social assistance, housing, and education; and the qualitative transformation of labor markets, with precarious forms of employment expanding rapidly in the aftermath of the global financial crisis.
Background: Glivec (imatinib mesylate), produced by the pharmaceutical company Novartis, is prescribed in case of Chronic Myeloid Leukemia, one of the most common blood cancers in eastern countries. After more than a decade of legal battles surrounding its patentability, the Supreme Court of India gave its final decision on April 1st of 2013, rejecting the appeal of the Swiss giant drug manufacturer. In 2006, the Indian Patent Office first refused Glivec’s patent under Section 3(d) of the Indian Patent Act arguing that it was only a modified version of an existing drug, Imatinib, and therefore that the drug was not innovative. Novartis replied filing legal challenges against the Indian government but the final verdict in April of 2013 ends the battle. Indeed, the Supreme Court stated that even if the bioavailability of the drug was improved, it did not demonstrate enhanced efficacy and that Glivec was not patentable.
Background: With an estimated 74% of all deaths attributable to non-communicable diseases (NCDs) in 2010, NCDs have become a major health priority in Brazil. The objective of the study was to conduct a comprehensive literature review on diabetes in Brazil; specifically: the epidemiology of type 2 diabetes, the availability of national and regional sources of data (particularly in terms of direct and indirect costs) and health policies for the management of diabetes and its complications. Methods: A literature search was conducted using PubMed to identify articles containing information on diabetes in Brazil. Official documents from the Brazilian government and the World Health Organization, as well as other grey literature and official government websites were also reviewed. Results: From 2006 to 2010, an approximate 20% increase in the prevalence of self-reported diabetes was observed