In “How Cities Can Save China” Henry Paulson, former US Treasury Secretary and current head of the Paulson Institute, argues in this week’s New York Times that better city planning will allow China’s investments to be more balanced, debt levels to be lowered, pollution to be eased, and a consumption windfall to be realized.
Malaria, a life threatening mosquito-borne infectious disease, poses a risk to approximately 3.3 billion people, approximately half of the world’s population. Most malaria cases occur in Sub-Saharan Africa, but they also occur in Asia, Latin America, and to a lesser extent the Middle East and parts of Europe. In 2010, malaria was found in 106 countries and territories, with an estimated 216 million cases and nearly 0.7 million deaths – mostly among children living in Africa. In addition to its health toll, malaria places a heavy economic burden on many countries with high disease rates, with estimates of as much as a 1.3 percent reduction in GDP in those countries.
In my post “Should you trust a medical journal?” I think I might have been a bit unfair. Not on The Lancet, which I have since discovered, via comments on David Roodman’s blog, has something of a track record of publishing sensational but not exactly evidence-based social science articles, but rather on Ernst Spaan et al. for challenging the systematicness of their systematic review of health insurance impacts in developing countries. It’s not that I now think Spaan et al. did a wonderful job. It’s just that I think they probably shouldn’t have been singled out in the way they were.
While we non-physicians may feel a bit peeved when we hear “Trust me, I’m a doctor”, our medical friends do seem to have evidence on their side. GfK, apparently one of the world’s leading market research companies, have developed a GfK Trust Index, and yes they found that doctors are one of the most trusted professions, behind postal workers, teachers and the fire service. World Bank managers might like to know that bankers and (top) managers come close to the bottom, just above advertising professionals and politicians.
Given the trust doctors enjoy, the recent brouhaha over allegations of low quality among some of the social science articles published in medical journals must be a trifle embarrassing to the profession. Here’s the tale so far, plus a cautionary note about a recent ‘systematic review’.
In case you hadn’t noticed, there’s a growing clamor for a global commitment to universal health coverage (UHC). You might have seen the recent special issue of the Lancet on “the struggle for UHC”. Inevitably, accompanying this clamor, there’s been a lot of wracking of brains on how to measure progress toward UHC. With the excitement of a new political agenda, there’s understandably a desire to carve out a new measurement agenda too. While not wanting dampen people’s enthusiasm for the UHC cause, I would like us to reflect whether on the measurement agenda we’re building enough on what’s been done before.
This week four new policy research working papers were published covering performance of skilled migrants in US, induced participatory projects, Vietnam’s hospital autonomization policy, and worldwide indicators on localization and decentralization.
In 1960, I wouldn’t have been writing this blog post. For a start I was just a baby at the time. Second, we were several decades away from 1994 when Justin Hall – then a student at Swarthmore – would sit down and tap out the world’s first blog. Most importantly of all, though, according to Google’s ngram viewer, people didn’t write about health systems much in 1960 (see chart). Usage of the term in books took off only in the mid 1960s, waned in the 1980s, and then started rising again in the 1990s. This doesn’t look like a statistical artifact. Usage of the term “Nobel prize” has stayed relatively constant over the period, and while the term “health economics” has also trended upwards, the growth has been much slower. So “health systems” is a fairly new term – and it’s on the rise.
Not everyone thinks that’s a good thing.
Quantity inequalities may be dwarfed by quality inequalities
In my last post on UC I argued that UC is best thought of as a means to achieving lower inequalities and improved financial protection in the health sector, but that in practice UC is unlikely to be sufficient – and may not even be necessary – for us to achieve these goals.
In this post, I argue that our focus on narrowing inequalities in the quantity of care is leading us to ignore another and potentially more important type of inequality in the health sector: inequality in the quality of care.
With just four years to the target date of 2015, progress on the health-related Millennium Development Goals (MDGs) has been slow. Measuring progress has been hampered by the lack of quality and timely data; this is especially true when measuring progress toward goals that rely on civil registration for their information, such as Goal 4 on reducing child mortality. Available data in the new edition of World Development Indicators show that of the 144 countries for which data are available, more than 100 countries remain off-track to reach the MDG 4 by 2015.
Major funders of public health research – the World Bank included – have today issued a joint statement to champion the wider sharing of data to achieve better public health worldwide.
|Mother and boy being attended to by Health Education nurse. Sri Lanka. Photo © Dominic Sansoni / World Bank|
This is a great step forward: advances in public health throughout the decades, perhaps like no other discipline, have been underpinned by careful research based on data. An early and celebrated example is the epidemiologist John Snow’s study of the relationship between the water supply and cholera outbreaks in central London in 1854, which used public data to establish the link between contaminated water and the disease. More recently, the mapping of the human genome was completed by a global collaborative effort based on the sharing of effort and data.
In many fields and in many countries, sharing of data is fast becoming normal practice (www.data.gov). An environment where data are open, freely available and easily accessible to all can provide tremendous benefits for development. At the World Bank we opened our databases last April. And there are great examples of agencies starting to routinely provide access to their datasets, which were previously closely guarded, such as data collected through household surveys.