ORIGINAL_ARTICLE
Universal Pharmacare in Canada: A Prescription for Equity in Healthcare
Despite progressive universal drug coverage and pharmaceutical policies found in other countries, Canada remains the only developed nation with a publicly funded healthcare system that does not include universal coverage for prescription drugs. In the absence of a national pharmacare plan, a province may choose to cover a specific sub-population for certain drugs. Although different provinces have individually attempted to extend coverage to certain subpopulations within their jurisdictions, out-of-pocket expenses on drugs and pharmaceutical products (OPEDP) accounts for a large proportion of out-of-pocket health expenses (OPHE) that are catastrophic in nature. Pharmaceutical drug coverage is a major source of public scrutiny among politicians and policy-makers in Canada. In this editorial, we focus on social inequalities in the burden of OPEDP in Canada. Prescription drugs are inconsistently covered under patchworks of public insurance coverage, and this inconsistency represents a major source of inequity of healthcare financing. Residents of certain provinces, rural households and Canadians from poorer households are more likely to be affected by this inequity and suffer disproportionately higher proportions of catastrophic out-of-pocket expenses on drugs and pharmaceutical products (COPEDP). Universal pharmacare would reduce COPEDP and promote a more equitable healthcare system in Canada.
https://www.ijhpm.com/article_3680_02e541aef09dbfd33bb8f4dc8c515aac.pdf
2020-03-01
91
95
10.15171/ijhpm.2019.93
Universal Pharmacare
Health Policy
Equity
Canada
Mohammad
Hajizadeh
m.hajizadeh@dal.ca
1
School of Health Administration, Dalhousie University, Halifax, NS, Canada
LEAD_AUTHOR
Sterling
Edmonds
sterling.edmonds@dal.ca
2
Schulich School of Law, Dalhousie University, Halifax, NS, Canada
AUTHOR
Wirtz VJ, Hogerzeil HV, Gray AL, De Joncheere C, Ewen M. Essential medicines for universal health coverage. Lancet. 2017;389(10067):403-476. doi:10.1016/S0140-6736(16)31599-9
1
Morgan SG, Martin D, Gagnon M-A, Mintzes B, Daw JR, Lexchin J. Pharmacare 2020: The Future of Drug Coverage in Canada. Vancouver: Pharmaceutical Policy Research Collaboration, University of British Columbia; 2015.
2
World Health Organization. Health Systems Financing: The Path to Universal Coverage. Geneva, Switzerland: WHO; 2010.
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World Health Organization. Making fair choices on the path to universal health coverage. Bull World Health Organ 2014;92:389. doi:10.2471/blt.14.139139
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World Health Organization. Equitable access to essential medicines: a framework for collective action. Geneva, Switzerland: WHO; 2004.
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Wagstaff A, van Doorslaer E, Calonge S, et al. Equity in the finance of health care: some international comparisons. J Health Econ. 1992;11:361-387. doi:10.1016/0167-6296(92)90012-P
8
Martin D, Miller AP, Quesnel-Vallée A, Caron NR, Vissandjée B, Marchildon GP. Canada’s universal health-care system: achieving its potential. Lancet. 2018;391:1718-1735. doi:10.1016/S0140-6736(18)30181-8
9
Advisory Council on the implementation of National Pharmacare. A Prescription for Canada: Achieving Pharmacare for All - Final Report of the Advisory Council on the Implementation of National Pharmacare. Ottawa, Ontario; 2019.
10
Caldbick S, Wu X, Lynch T, Al-Khatib N, Andkhoie M, Farag M. The financial burden of out of pocket prescription drug expenses in Canada. Int J Heal Econ Manag. 2015;15(3):329-338. doi:10.1007/s10754-015-9171-3
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Marchildon GP, Jackson A. Charting the Path to National Pharmacare in Canada. Ottawa: Broadbent Institute; 2019.
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Hall EM. Royal Commission on Health Services. Ottawa: Queen's Printer; 1964.
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Romanow R. Building on Values: The Future of Health Care in Canada. Commission on the Future of Health Care in Canada; 2002.
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Government of Canada. Towards Implementation of National Pharmacare. Government of Canada; 2018.
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16
Edmonds S, Hajizadeh M. Assessing progressivity and catastrophic effect of out-of-pocket payments for healthcare in Canada: 2010–2015. Eur J Heal Econ. 2019;20(7):1001-1011. doi:10.1007/s10198-019-01074-x
17
Brandt J, Shearer B, Morgan SG. Prescription drug coverage in Canada: a review of the economic, policy and political considerations for universal pharmacare. J Pharm Policy Pract. 2018. doi:10.1186/s40545-018-0154-x
18
Morgan SG, Boothe K. Universal prescription drug coverage in Canada: Long-promised yet undelivered. Healthc Manag Forum. 2016;29(6):247-254. doi:10.1177/0840470416658907
19
Morgan SG, Law M, Daw JR, Abraham L, Martin D. Estimated cost of universal public coverage of prescription drugs in Canada. CMAJ. 2015;187(7):491-497. doi:10.1503/cmaj.141564
20
Morgan SG, Li W, Yau B, Persaud N. Estimated effects of adding universal public coverage of an essential medicines list to existing public drug plans in Canada. CMAJ. 2017;189(8): E295-E302. doi:10.1503/cmaj.161082
21
Wolfson MC, Morgan SG. How to pay for national pharmacare. CMAJ. 2018;190(47):E1384-E1388. doi:10.1503/cmaj.180897
22
Law MR, Cheng L, Dhalla IA, Heard D, Morgan SG. The effect of cost on adherence to prescription medications in Canada. CMAJ. 2012;184(3):297-302. doi:10.1503/cmaj.111270
23
Morgan SG, Lee A. Cost-related non-adherence to prescribed medicines among older adults: A cross-sectional analysis of a survey in 11 developed countries. BMJ Open. 2017;7:e014287. doi:10.1136/bmjopen-2016-014287
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Xu K, Evans DB, Kawabata K, Zeramdini R, Klavus J, Murray CJL. Household catastrophic health expenditure: A multicountry analysis. Lancet. 2003;362(9378):111-117. doi:10.1016/S0140-6736(03)13861-5
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26
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27
O’Donnell O, van Doorslaer E, Wagstaff A, Lindelow M. Analyzing Health Equity Using Household Survey Data - A Guide to Techniques and Their Implementation. Geneva: The World Bank; 2008.
28
Amaya-Lara JL. Catastrophic expenditure due to out-of-pocket health payments and its determinants in Colombian households. Int J Equity Health. 2016;15(1):1-11. doi:10.1186/s12939-016-0472-z
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Mataria A, Raad F, Abu-Zaineh M, Donaldson C. Catastrophic Healthcare Payments and Impoverishment in the Occupied Palestinian Territory. Appl Health Econ Health Policy. 2010;8(6):393-405. doi:10.2165/11318200-000000000-00000
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Tomini SM, Packard TG, Tomini F. Catastrophic and impoverishing effects of out-of-pocket payments for health care in Albania: Evidence from Albania Living Standards Measurement Surveys 2002, 2005 and 2008. Health Policy Plan. 2013;28(4):419-428. doi:10.1093/heapol/czs073
31
Wagstaff A, Doorslaer E van. Catastrophe and impoverishment in paying for health care: with applications to Vietnam 1993-1998. Health Econ. 2003;12(11):921-933. doi:10.1002/hec.776
32
Hennessy D, Sanmartin C, Ronksley P, et al. Out-of-pocket spending on drugs and pharmaceutical products and costrelated prescription non-adherence among Canadians with chronic disease. Health Rep. 2016;27(6):3-8.
33
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34
ORIGINAL_ARTICLE
Long Waiting Times for Elective Hospital Care – Breaking the Vicious Circle by Abandoning Prioritisation
Background Policies assigning low-priority patients treatment delays for care, in order to make room for patients of higher priority arriving later, are common in secondary healthcare services today. Alternatively, each new patient could be granted the first available appointment. We aimed to investigate whether prioritisation can be part of the reason why waiting times for care are often long, and to describe how departments can improve their waiting situation by changing away from prioritisation. Methods We used patient flow data from 2015 at the Department of Otorhinolaryngology, Haukeland University Hospital, Norway. In Dynaplan Smia, Dynaplan AS, dynamic simulations were used to compare how waiting time, size and shape of the waiting list, and capacity utilisation developed with and without prioritisation. Simulations were started from the actual waiting list at the beginning of 2015, and from an empty waiting list (simulating a new department with no initial patient backlog). Results From an empty waiting list and with capacity equal to demand, waiting times were built 7 times longer when prioritising than when not. Prioritisation also led to poor resource utilisation and short-lived effects of extra capacity. Departments where prioritisation is causing long waits can improve their situation by temporarily bringing capacity above demand and introducing “first come, first served” instead of prioritisation. Conclusion A poor appointment allocation policy can build long waiting times, even when capacity is sufficient to meet demand. By bringing waiting times down and going away from prioritisation, the waiting list size and average waiting times at the studied department could be maintained almost 90% below the current level – without requiring permanent change in the capacity/demand ratio.
https://www.ijhpm.com/article_3682_db5fcd43e0c9b4c66615f604acca5cd8.pdf
2020-03-01
96
107
10.15171/ijhpm.2019.84
Appointment Allocation
Waiting Time
Waiting List Management
Prioritisation
Dynaplan Smia
Solbjørg Makalani Myrtveit
Sæther
makalani@myrtveit.com
1
Department of Health Promotion, Norwegian Institute of Public Health, Bergen, Norway
AUTHOR
Torhild
Heggestad
torhild.heggestad@helse-bergen.no
2
Department of Research and Development, Haukeland University Hospital, Bergen, Norway
AUTHOR
John-Helge
Heimdal
john-helge.heimdal@helse-bergen.no
3
Department of Clinical Medicine, University of Bergen, Bergen, Norway
AUTHOR
Magne
Myrtveit
magne@myrtveit.com
4
Dynaplan AS, Manger, Norway (https://www.dynaplan.com/en/)
LEAD_AUTHOR
Fuglset AS, Karstensen A, Håndlykken EK. Ventetider og pasientrettigheter 2015. Trondheim: Helsedirektoratet; 2016.
1
Karstensen A, Håndlykken EK. Ventetider og pasientrettigheter 2018. Trondheim: Helsedirektoratet; 2019.
2
Larsen BI. Ventelister, helsetap og sykehuskapasitet. Tidsskr Nor Laegeforen. 2001;121:2255.
3
Derrett S, Paul C, Morris JM. Waiting for elective surgery: effects on health-related quality of life. Int J Qual Health Care. 1999;11(1):47-57. doi:10.1093/intqhc/11.1.47
4
D'Souza DP, Martin DK, Purdy L, Bezjak A, Singer PA. Waiting lists for radiation therapy: a case study. BMC Health Serv Res. 2001;1:3.
5
Ostendorf M, Buskens E, van Stel H, et al. Waiting for total hip arthroplasty: avoidable loss in quality time and preventable deterioration. J Arthroplasty. 2004;19(3):302-309. doi:10.1016/j.arth.2003.09.015
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Sampalis J, Boukas S, Liberman M, Reid T, Dupuis G. Impact of waiting time on the quality of life of patients awaiting coronary artery bypass grafting. CMAJ. 2001;165(4):429-433.
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Koopmanschap MA, Brouwer WB, Hakkaart-van Roijen L, van Exel NJ. Influence of waiting time on cost-effectiveness. Soc Sci Med. 2005;60(11):2501-2504. doi:10.1016/j.socscimed.2004.11.022
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Joskow PL. The effects of competition and regulation on hospital bed supply and the reservation quality of the hospital. Bell J Econ. 1980;11(2):421-447. doi:10.2307/3003372
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Iversen T. A theory of hospital waiting lists. J Health Econ. 1993;12(1):55-71.
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Brustugun OT, Nome O, Bruland ØS, Ottestad L, Lilleby W. Brystkreftpasienters vurdering av ventetid før strålebehandling. Tidsskr Nor Laegeforen. 2003;123:1685-1686.
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Borowitz M, Moran V, Siciliani L. A review of waiting times policies in 13 OECD countries. OECD Health Policy Studies. 2013:49-68. doi:10.1787/9789264179080-6-en
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Piene H, Loeb M, Hem K. Sykehuskapasitet og ventetid for behandling-er det noen sammenheng? Tidsskr Nor Laegeforen. 2000;120:2988-2992.
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Bratlid D. Personellressurser og pasientbehandling ved et regionsykehus. Tidsskr Nor Laegeforen. 2000;120:3021-3026.
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Kreindler SA. Policy strategies to reduce waits for elective care: a synthesis of international evidence. Br Med Bull. 2010;95:7-32. doi:10.1093/bmb/ldq014
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Bratlid D. Ventelistesituasjonen ved et regionsykehus. Tidsskr Nor Laegeforen. 2003;123:3241-3244.
16
Murray M, Berwick DM. Advanced access: reducing waiting and delays in primary care. JAMA. 2003;289(8):1035-1040. doi:10.1001/jama.289.8.1035
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Kreindler SA. Watching your wait: evidence-informed strategies for reducing health care wait times. Qual Manag Health Care. 2008;17(2):128-135. doi:10.1097/01.QMH.0000316990.48673.9f
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Naiker U, FitzGerald G, Dulhunty JM, Rosemann M. Time to wait: a systematic review of strategies that affect out-patient waiting times. Aust Health Rev. 2018;42(3):286-293. doi:10.1071/ah16275
19
Valente R, Testi A, Tanfani E, et al. A model to prioritize access to elective surgery on the basis of clinical urgency and waiting time. BMC Health Serv Res. 2009;9:1. doi:10.1186/1472-6963-9-1
20
Abedini A, Ye H, Li W. Operating Room Planning under Surgery Type and Priority Constraints. Procedia Manuf. 2016;5:15-25. doi:10.1016/j.promfg.2016.08.005
21
Durán G, Rey PA, Wolff P. Solving the operating room scheduling problem with prioritized lists of patients. Ann Oper Res. 2017;258(2):395-414. doi:10.1007/s10479-016-2172-x
22
Comas M, Castells X, Hoffmeister L, et al. Discrete-event simulation applied to analysis of waiting lists. Evaluation of a prioritization system for cataract surgery. Value Health. 2008;11(7):1203-1213. doi:10.1111/j.1524-4733.2008.00322.x
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Bowers JA. Simulating waiting list management. Health Care Manag Sci. 2011;14(3):292-298. doi:10.1007/s10729-011-9171-x
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Abbasgholizadeh Rahimi S, Jamshidi A, Ruiz A, Ait-Kadi D. Multi-criteria Decision Making Approaches to Prioritize Surgical Patients. In: Matta A, Sahin E, Li J, Guinet A, Vandaele N, eds. Health Care Systems Engineering for Scientists and Practitioners. Cham: Springer; 2016:25-34.
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Abbasgholizadeh Rahimi S, Jamshidi A, Ruiz A, Ait-kadi D. A new dynamic integrated framework for surgical patients' prioritization considering risks and uncertainties. Decis Support Syst. 2016;88:112-120. doi:10.1016/j.dss.2016.06.003
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Norges Offentlige Utredninger (NOU). Prioritering på ny: gjennomgang av retningslinjer for prioriteringer innen norsk helsetjeneste. Priority setting revisited. Norwegian.) Oslo: Statens Forvaltningstjeneste; 1997:18.
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Norheim O, Allgott B, Aschim B, et al. Åpent og rettferdig–prioriteringer i helsetjenesten. Norges Offentlige Utredninger; 2014:12. The. 2013;2014.
29
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Helse- og omsorgsdepartementet. Høring - rapport om alternativer for regulering av pasientforløp og registrering av ventetid. Helse- og omsorgsdepartementet; 2018. https://www.regjeringen.no/no/dokumenter/horing---rapport-om-alternativer-for-regulering-av-pasientforlop-og-registrering-av-ventetid/id2606713/.
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34
Oudhoff JP, Timmermans DR, Rietberg M, Knol DL, van der Wal G. The acceptability of waiting times for elective general surgery and the appropriateness of prioritising patients. BMC Health Serv Res. 2007;7:32. doi:10.1186/1472-6963-7-32
35
MacCormick AD, Tan CP, Parry BR. Priority assessment of patients for elective general surgery: game on? ANZ J Surg. 2004;74(3):143-145.
36
Gangstøe JJ, Heggestad T, Norheim OF. Norwegian Priority Setting in Practice - an Analysis of Waiting Time Patterns Across Medical Disciplines. Int J Health Policy Manag. 2016;5(6):373-378. doi:10.15171/ijhpm.2016.23
37
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Bratlid D. Pasienttilgang og pasientbehandling ved et regionsykehus. Tidsskr Nor Laegeforen. 2002;122:386-391.
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Martin S, Smith PC. Rationing by waiting lists: an empirical investigation. J Public Econ. 1999;71(1):141-164. doi:10.1016/S0047-2727(98)00067-X
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Stavrunova O, Yerokhin O. An equilibrium model of waiting times for elective surgery in the NSW public hospitals. Econ Rec. 2011;87(278):384-398.
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43
Kreindler SA. Six ways not to improve patient flow: a qualitative study. BMJ Qual Saf. 2017;26(5):388-394. doi:10.1136/bmjqs-2016-005438
44
ORIGINAL_ARTICLE
HIV Modes of Transmission in Sudan in 2014
Background In Sudan, where studies on HIV dynamics are few, model projections provide an additional source of information for policy-makers to identify data collection priorities and develop prevention programs. In this study, we aimed to estimate the distribution of new HIV infections by mode of exposure and to identify populations who are disproportionately contributing to the total number of new infections in Sudan. Methods We applied the modes of transmission (MoT) mathematical model in Sudan to estimate the distribution of new HIV infections among the 15-49 age group for 2014, based on the main routes of exposure to HIV. Data for the MoT model were collected through a systematic review of peer-reviewed articles, grey literature, interviews with key participants and focus groups. We used the MoT uncertainty module to represent uncertainty in model projections and created one general model for the whole nation and 5 sub-models for each region (Northern, Central, Eastern, Kurdufan, and Khartoum regions). We also examined how different service coverages could change HIV incidence rates and distributions in Sudan. Results The model estimated that about 6000 new HIV infections occurred in Sudan in 2014 (95% CI: 4651-7432). Men who had sex with men (MSM) (30.52%), female sex workers (FSW) (16.37%), and FSW’s clients accounted (19.43%) for most of the new HIV cases. FSW accounted for the highest incidence rate in the Central, Kurdufan, and Khartoum regions; and FSW’s clients had the highest incidence rate in the Eastern and Northern regions. The annual incidence rate of HIV in the total adult population was estimated at 330 per 1 000 000 populations. The incidence rate was at its highest in the Eastern region (980 annual infections per 1 000 000 populations). Conclusion Although the national HIV incidence rate estimate was relatively low compared to that observed in some sub-Saharan African countries with generalized epidemics, a more severe epidemic existed within certain regions and key populations. HIV burden was mostly concentrated among MSM, FSW, and FSW’s clients both nationally and regionally. Thus, the authorities should pay more attention to key populations and Eastern and Northern regions when developing prevention programs. The findings of this study can improve HIV prevention programs in Sudan.
https://www.ijhpm.com/article_3688_26d017a2b02361253acf611ac346d5be.pdf
2020-03-01
108
115
10.15171/ijhpm.2019.91
Sudan
Modes of Transmission (MoT)
HIV
Maryam
Nasirian
maryamnasirian@who-hivhub.org
1
Epidemiology and Biostatistics Department, Health School, Isfahan University of Medical Sciences, Isfahan, Iran
AUTHOR
Sina
Kianersi
sinakianersi@gmail.com
2
Department of Epidemiology and Biostatistics, Indiana University School of Public Health-Bloomington, Bloomington, IN, USA
AUTHOR
Mohammad
Karamouzian
karamouzian.m@gmail.com
3
School of Population and Public Health, Faculty of Medicine, University of British Columbia, Vancouver, BC, Canada
AUTHOR
Mohammed
Sidahmed
abdelrahimm@sud.emro.who.int
4
World Health Organization, Sudan Office, Khartoum, Sudan
AUTHOR
Mohammad Reza
Baneshi
rbaneshi2@gmail.com
5
Modeling in Health Research Center, Institute for Futures Studies in Health, Kerman University of Medical Sciences, Kerman, Iran
AUTHOR
Ali Akbar
Haghdoost
ahaghdoost@gmail.com
6
HIV/STI Surveillance Research Center, and WHO Collaborating Center for HIV Surveillance, Institute for Futures Studies in Health, Kerman University of Medical Sciences, Kerman, Iran
AUTHOR
Hamid
Sharifi
sharifihami@gmail.com
7
HIV/STI Surveillance Research Center, and WHO Collaborating Center for HIV Surveillance, Institute for Futures Studies in Health, Kerman University of Medical Sciences, Kerman, Iran
LEAD_AUTHOR
Karamouzian M, Madani N, Doroudi F, Haghdoost AA. Improving the quality and quantity of HIV data in the Middle East and North Africa: key challenges and ways forward. Int J Health Policy Manag. 2017;6(2):65-69. doi:10.15171/ijhpm.2016.112
1
Gökengin D, Doroudi F, Tohme J, Collins B, Madani N. HIV/AIDS: trends in the Middle East and North Africa region. Int J Infect Dis. 2016;44:66-73. doi:10.1016/j.ijid.2015.11.008
2
UNAIDS. Global AIDS Update. Geneva: UNAIDS; 2016. https://www.unaids.org/sites/default/files/media_asset/global-AIDS-update-2016_en.pdf. Published 2016.
3
WHO, UAIDS, UNICEF. Global report: UNAIDS report on the global AIDS epidemic. Geneva: UNAIDS; 2013.
4
UNAIDS. UNAIDS AIDSinfo, Indicators. http://aidsinfo.unaids.org/. Published 2018.
5
Khamis AH. HIV and AIDS related knowledge, beliefs and attitudes among rural communities hard to reach in Sudan. Health. 2013;5(9):1494-1501. doi:10.4236/health.2013.59203
6
Ismail SM, Kari F, Kamarulzaman A. The Socioeconomic Implications among People Living with HIV/AIDS in Sudan: Challenges and Coping Strategies. J Int Assoc Provid AIDS Care. 2017;16(5):446-454. doi:10.1177/2325957415622449
7
UNAIDS. HIV and AIDS estimates. http://www.unaids.org/en/regionscountries/countries/sudan. Published 2016.
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Elhadi M, Elbadawi A, Abdelrahman S, et al. Integrated bio-behavioural HIV surveillance surveys among female sex workers in Sudan, 2011-2012. Sex Transm Infect. 2013;89 Suppl 3:iii17-22. doi:10.1136/sextrans-2013-051097
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Elrashied S. HIV sero-prevalence and related risky sexual behaviours among insertive men having sex with men (IMSM) in Khartoum state, Sudan. AIDS 2008-XVII International AIDS Conference; Mexico city, Mexico; 2008.
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El-Sony AI, Khamis AH, Enarson DA, Baraka O, Mustafa SA, Bjune G. Treatment results of DOTS in 1797 Sudanese tuberculosis patients with or without HIV co-infection. Int J Tuberc Lung Dis. 2002;6(12):1058-1066.
11
Federal Ministry of Health, Sudan National AIDS and STI Control Program. Global AIDS Response Progress Reporting 2012 – 2013. https://www.unaids.org/sites/default/files/country/documents/SDN_narrative_report_2014.pdf. Published 2014.
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Federal Ministry of Health of Sudan. Country progress report. http://files.unaids.org/en/dataanalysis/knowyourresponse/countryprogressreports/2014countries/SDN_narrative_report_2014.pdf. Accessed April, 2017. Published 2012.
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Government of South Sudan. Sudan Household Health Survey 2nd Round 2010 Summary Report. https://reliefweb.int/report/sudan/sudan-household-and-health-survey-second-round-2010-summary-report. Published 2010.
14
Wabwire-Mangen F, Odiit M, Kirungi W, Kisitu DK, Wanyama JO. HIV Prevention Response and Modes of Transmission Analysis. Uganda, Kampala, Uganda National AIDS Commission. http://www.numat.jsi.com/Resources/Docs/UnaidsUgandaCountryReport_09.pdf. Published 2009.
15
Case KK, Ghys PD, Gouws E, et al. Understanding the modes of transmission model of new HIV infection and its use in prevention planning. Bull World Health Organ. 2012;90(11):831-838A. doi:10.2471/blt.12.102574
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UNAIDS. Modeling the expected short-term distribution of new HIV infections by modes of transmission. Geneva: UNAIDS; 2012.
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The National Bureau of Statistics. Fifth Sudan Population and Housing Census-2008. 2010.
18
Abu-Raddad L, Akala FA, Semini I, Riedner G, Wilson D, Tawil O. Characterizing the HIV/AIDS epidemic in the Middle East and North Africa: time for strategic action. World Bank; 2010. https://openknowledge.worldbank.org/handle/10986/2457. Published 2010.
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Abdelrahim MS. HIV prevalence and risk behaviors of female sex workers in Khartoum, north Sudan. Aids. 2010;24 Suppl 2:S55-60. doi:10.1097/01.aids.0000386734.79553.9a
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Nasir EF, Astrøm AN, David J, Ali RW. HIV and AIDS related knowledge, sources of information, and reported need for further education among dental students in Sudan--a cross sectional study. BMC Public Health. 2008;8:286. doi:10.1186/1471-2458-8-286
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Stover J, Johnson P, Zaba B, Zwahlen M, Dabis F, Ekpini RE. The Spectrum projection package: improvements in estimating mortality, ART needs, PMTCT impact and uncertainty bounds. Sex Transm Infect. 2008;84 Suppl 1:i24-i30. doi:10.1136/sti.2008.029868
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Sudan HIV Epidemiology Analysis Group. Epidemiology of HIV in Sudan Staging and Analysis Sudan. http://www.aidsinfoonline.org/kpatlas/document/SDN/SDN_2013_PSE_FSW_MSM.pdf. Published 2013.
24
Estimates of global, regional, and national incidence, prevalence, and mortality of HIV, 1980-2015: the Global Burden of Disease Study 2015. Lancet HIV. 2016;3(8):e361-e387. doi:10.1016/s2352-3018(16)30087-x
25
Mumtaz G, Hilmi N, McFarland W, et al. Are HIV epidemics among men who have sex with men emerging in the Middle East and North Africa?: a systematic review and data synthesis. PLoS Med. 2010;8(8):e1000444. doi:10.1371/journal.pmed.1000444
26
Mumtaz GR, Riedner G, Abu-Raddad LJ. The emerging face of the HIV epidemic in the Middle East and North Africa. Curr Opin HIV AIDS. 2014;9(2):183-191. doi:10.1097/coh.0000000000000038
27
Federal Ministry of Health. UNGASS Report 2008–2009, North Sudan. UNAIDS, Sudan National AIDS Control Programme. https://www.unaids.org/sites/default/files/country/documents/SDN_narrative_report_2014.pdf. 2010.
28
Mohamed BA. Correlates of condom use among males in North Sudan. Sex Health. 2014;11(1):31-36. doi:10.1071/sh13090
29
Mumtaz GR, Weiss HA, Thomas SL, et al. HIV among people who inject drugs in the Middle East and North Africa: systematic review and data synthesis. PLoS Med. 2014;11(6):e1001663. doi:10.1371/journal.pmed.1001663
30
Mishra S, Pickles M, Blanchard JF, Moses S, Shubber Z, Boily MC. Validation of the modes of transmission model as a tool to prioritize HIV prevention targets: a comparative modelling analysis. PLoS One. 2014;9(7):e101690. doi:10.1371/journal.pone.0101690
31
Wilson D, Halperin DT. "Know your epidemic, know your response": a useful approach, if we get it right. Lancet. 2008;372(9637):423-426. doi:10.1016/s0140-6736(08)60883-1
32
ORIGINAL_ARTICLE
Neo-Liberalism, Policy Incoherence and Discourse Coalitions Influencing Non-Communicable Disease Strategy; Comment on “How Neoliberalism Is Shaping the Supply of Unhealthy Commodities and What This Means for NCD Prevention”
Lencucha and Thow have highlighted the way in which neo-liberalism is enshrined within institutional mechanisms and conditions the policy environment to shape public policy on non-communicable diseases (NCDs). They critique the strong (but important) focus of public health policy research on corporate interests and influence over NCD policy, and point toward neo-liberal policy paradigms shaping the relationship between the state, market and society as an area for critique and further exploration. They also importantly underline the way in which the neo-liberal policy paradigm shapes the supply of unhealthy goods and argue that health advocates have not engaged enough with supply side issues in critiques of policy debates on NCDs. This is an important consideration especially in the Asia-Pacific where trade and agricultural policies have markedly shaped production and what is being produced within countries. In this commentary, I reflect upon how neoliberalism shapes intersectoral action across trade, development and health within and across institutions. I also consider scope for international civil society to engage in advocacy on NCDs, especially where elusive ‘discourse coalitions’ influenced by neoliberalism may exist, rather than coordinated ‘advocacy coalitions.’
https://www.ijhpm.com/article_3681_c2bdc7bb5b938f6ec3db79a9b047c2d6.pdf
2020-03-01
116
118
10.15171/ijhpm.2019.95
Neoliberalism
Non-communicable Disease
Policy
Discourse
Samantha
Battams
sam.battams@flinders.edu.au
1
Southgate Institute for Health, Society and Equity, Flinders University, SA, Australia
LEAD_AUTHOR
Lencucha R, Thow AM. How Neoliberalism Is Shaping the Supply of Unhealthy Commodities and What This Means for NCD Prevention. Int J Health Policy Manag. 2019;8(9):514-520. doi:10.15171/ijhpm.2019.56
1
Battams S. Australia’s role in health governance and diplomacy in the Asia-Pacific region: Focus on NCDs. 3rd Population Health Congress (PHAA, AEA, AHPA, AFPHM); Hobart, Australia; September 2015.
2
Battams S. The impact of neoliberalism on Australia’s rollout of global non-communicable disease strategy nationally and health diplomacy role for the Asia-Pacific region. The Australian Sociological Association conference – Neoliberalism and Contemporary Challenges for the Asia-Pacific; Cairns; November 2015.
3
Battams S. Coordinated action across trade and health policy sectors to progress Non-Communicable Disease (NCD) strategy. PHAA 44th Annual Conference & 20th Chronic Diseases Network Conference; Alice Springs, NT; September 2016.
4
Battams S. Challenges for Australia’s role in effectively implementing global non-communicable disease (NCD) strategy. Adelaide, SA: Southgate Institute for Health, Society and Equity, Flinders University; 2017.
5
Battams S, Townsend B. Power asymmetries, policy incoherence and noncommunicable disease control - a qualitative study of policy actor views. Crit Public Health. 2019;29(5):596-609. doi:10.1080/09581596.2018.1492093
6
Rosser A. Neo-liberalism and the politics of Australian aid policy-making. Aust J Int Aff. 2008;62(3):372-385. doi:10.1080/10357710802286825
7
van Hulst M, Yanow D. From policy “frames” to “framing” theorizing a more dynamic, political approach. Am Rev Public Adm. 2016;46(1):92-112. doi:10.1177/0275074014533142
8
Sabatier P, Jenkins-Smith H. The advocacy coalition framework. In: Sabatier P, ed. Theories of the Policy Process. Colorado, USA: Westview Press; 1999:117-166.
9
Schrecker T. Globalization, austerity and health equity politics: taming the inequality machine, and why it matters. Criti Public Health. 2016;26(1):4-13. doi:10.1080/09581596.2014.973019
10
Bacchi C. Analysing Policy: What's the problem represented to be? Frenchs Forest, NSW: Pearson Education; 2009.
11
Fischer F. Reframing Public Policy: Discursive Politics and Deliberative Practices. Oxford: Oxford University Press; 2003.
12
ORIGINAL_ARTICLE
Calls for Stricter Legislation and Fear in the European Immigrant Community: Reflections of the Public Charge Debate Ongoing in the United States; Comment on “A Crisis of Humanitarianism: Refugees at the Gates of Europe”
In the editorial, “A Crisis of Humanitarianism: Refugees at the Gates of Europe,” Marianna Fotaki elegantly highlights the changing dynamics of governmental policy toward refugees, forced migrants into Europe and the move away from the principles of humanitarianism.1 The perceived threats to economy, security, and concerns of globalization and multiculturalism often are manifested as a “cry of wolf ” about alleged health risks. This in effect has raised concerns of inadmissibility on health-related grounds and calls for stricter legislation for determining who is eligible for legal permanent residence, precipitated in part by the “public charge” debate occurring in the United States.2 As Marianna notes “anti-migration rhetoric is now a permanent fixture of European politics.”
https://www.ijhpm.com/article_3683_318f27bdf43ecb9932e9e7dfc75f35ba.pdf
2020-03-01
119
120
10.15171/ijhpm.2019.97
Refugees
Immigrants
Public Charge
Jimmy
Efird
jimmy.efird@stanfordalumni.org
1
Cooperative Studies Program Epidemiology Center, Health Services Research and Development, DVAHCS (Duke Affiliate), Durham, NC, USA
LEAD_AUTHOR
Fotaki M. A crisis of humanitarianism: Refugees at the gates of Europe. Int J Health Policy Manag. 2019;8(6):321-324. doi:10.15171/IJHPM.2019.22
1
Hong M, Varghese R, Jindal C, Efird J. Refugee policy implications of U.S. immigration medical screenings: a new era of inadmissibility on health-related grounds. Int J Environ Res Public Health. 2017;14(10):E1107. doi:10.3390/ijerph14101107
2
U.S. Citizen and Immigration Services. Public Charge. https://www.uscis.gov/greencard/public-charge. Accessed July 28, 2019.
3
National Immigration Law Center. Public Charge (revised October 2013). https://www.nilc.org/issues/economic-support/pubcharge/. Accessed July 28, 2019.
4
Geddes A. The history of smallpox. Clin Dermatol 2006;24(3):152-157. doi:10.1016/j.clindermatol.2005.11.009
5
ORIGINAL_ARTICLE
Towards Critical Analysis of the Political Determinants of Health; Comment on “How Neoliberalism Is Shaping the Supply of Unhealthy Commodities and What This Means for NCD Prevention”
The recent perspective article “How Neoliberalism Is Shaping the Supply of Unhealthy Commodities and What This Means for NCD Prevention,” by Lencucha and Throw, interrogates how the dominant neoliberal paradigm restricts meaningful policy action to prevent non-communicable diseases (NCDs). It contributes an NCD perspective to the existing literature on neoliberalism and health, which to date has been dominated by a focus on HIV, gender and trade agreements. It further advances the emerging commercial determinants of health (CDoH) scholarship by calling for more nuanced analysis of how the governance of both health and the economy facilitates corporate influence in policy-making. In political science terms, Lencucha and Throw are calling for greater structural analysis. However, their focus on the pragmatic, as opposed to political, aspects of neoliberalism reflects a hesitancy within health scholarship to engage in political analysis. This depoliticization of health serves neoliberal interests by delegitimizing critical questions about who sustains and benefits from current institutional norms. Lencucha and Throw’s call for greater interrogation of the structures of neoliberalism forms a basis from which to advance analysis of the political determinants of health.
https://www.ijhpm.com/article_3684_f3088d66f2b038a6c70459e0fdb5fd59.pdf
2020-03-01
121
123
10.15171/ijhpm.2019.102
Neoliberalism
Governance
Politics
Global Health
Critical
Julia
Smith
jhs6@sfu.ca
1
Simon Fraser University, Burnaby, BC, Canada
LEAD_AUTHOR
Mackenbach JP. Political determinants of health. Eur J Public Health. 2014;24(1):2. doi:10.1093/eurpub/ckt183
1
Lencucha R, Thow AM. How neoliberalism is shaping the supply of unhealthy commodities and what this means for NCD prevention. Int J Health Policy Manag. 2019;8(9):514-520. doi:10.15171/ijhpm.2019.56
2
Gill S, Benatar S. Global Health Governance and Global Power: A Critical Commentary on the Lancet-University of Oslo Commission Report. Int J Health Serv. 2016;46(2):346-365. doi:10.1177/0020731416631734
3
Msimang S. HIV/AIDS, globalisation and the international women's movement. Gend Dev. 2003;11(1):109-113.
4
O’Manique C. Global Neoliberalism and Aids Policy: International responses to sub-Saharan Africa’s pandemic. Stud Polit Econ. 2004;73(1):47-68. doi:10.1080/19187033.2004.11675151
5
Love R. Corporate wealth or public health? WTO/TRIPS flexibilities and access to HIV/AIDS antiretroviral drugs by developing countries. Dev Pract. 2007;17(2):208-219. doi:10.1080/09614520701195915
6
Friel S, Gleeson D, Thow AM, et al. A new generation of trade policy: potential risks to diet-related health from the trans pacific partnership agreement. Global Health. 2013;9:46. doi:10.1186/1744-8603-9-46
7
McKee M, Stuckler D. Revisiting the corporate and commercial determinants of health. Am J Public Health. 2018;108(9):1167-1170. doi:10.2105/ajph.2018.304510
8
Kickbusch I, Allen L, Franz C. The commercial determinants of health. Lancet Glob Health. 2016;4(12):e895-e896. doi:10.1016/s2214-109x(16)30217-0
9
Sibeon R. Agency, structure, and social chance as cross-disciplinary concepts. Politics. 1999;19(3):139-144. doi:10.1111/1467-9256.00097
10
Giddens A. Agency, Structure. In: Central Problems in Social Theory. London: Macmillan Education UK; 1979.
11
Cerny PG. Embedding Neoliberalism: The Evolution of a Hegemonic Paradigm. The Journal of International Trade and Diplomacy. 2008;2(1):1-46.
12
Harvey D. Neoliberalism Is a Political Project. Jacobin. July 23, 2016. https://www.jacobinmag.com/2016/07/david-harvey-neoliberalism-capitalism-labor-crisis-resistance/. Accessed 20 September 2019.
13
Gill S, Benatar SR. History, structure and agency in global health governance: Comment on "Global health governance challenges 2016 - are we ready?" Int J Health Policy Manag. 2017;6(4):237-241. doi:10.15171/ijhpm.2016.119
14
Kay A, Williams O. Introduction: The International Political Economy of Global Health Governance. In: Kay A, Williams O, eds. Global Health Governance. London: Palgrave Macmillan UK; 2009:1-23.
15
Reich MR. Political economy analysis for health. Bull World Health Organ. 2019;97(8):514. doi:10.2471/blt.19.238311
16
Gill S, Benatar S. Global Health Governance and Global Power: A Critical Commentary on the Lancet-University of Oslo Commission Report. Int J Health Serv. 2016;46(2):346-365. doi:10.1177/0020731416631734
17
Yamin AE, Boulanger VM. Embedding sexual and reproductive health and rights in a transformational development framework: lessons learned from the MDG targets and indicators. Reprod Health Matters. 2013;21(42):74-85. doi:10.1016/s0968-8080(13)42727-1
18
Bambra C, Fox D, Scott-Samuel A. Towards a politics of health. Health Promot Int. 2005;20(2):187-193. doi:10.1093/heapro/dah608
19
Williams SJ. Beyond Meaning, Discourse and the Empirical World: Critical Realist Reflections on Health. Soc Theory Health. 2003;1(1):42-71. doi:10.1057/palgrave.sth.8700004
20
Smith J. Civil Society Organizations and the Global Response to HIV/AIDS. London: Routledge; 2017.
21
Benatar S, Upshur R, Gill S. Understanding the relationship between ethics, neoliberalism and power as a step towards improving the health of people and our planet. The Anthropocene Review. 2018;5(2):155-176. doi:10.1177/2053019618760934
22
ORIGINAL_ARTICLE
Paradigm Shift: New Ideas for a Structural Approach to NCD Prevention; Comment on “How Neoliberalism Is Shaping the Supply of Unhealthy Commodities and What This Means for NCD Prevention”
It is a well-documented fact that transnational corporations engaged in the production and distribution of health-harmful commodities have been able to steer policy approaches to address the associated burden of non-communicable diseases (NCDs). While the political influence that corporations wield stems in part from significant financial resources, it has also been enabled and magnified by what has been referred to as global health’s neoliberal deep core, which has subjected health policy to the individualisation of risk and responsibility and the privileging of market-based policy responses. The accompanying perspective article from Lencucha and Thow draws attention to neoliberalism in the NCD space and the way it has historically structured patterns of thinking and doing that foreground economic interests over health considerations. In this commentary, we explore how shifting from a focus on material power to discursive power creates space to see the NCD agenda as a battle of economic ideas as well as dollars, and consequently the importance of public health engagement in the next vision for the economy.
https://www.ijhpm.com/article_3691_a441d183fdd9824a0115688e467bcfc9.pdf
2020-03-01
124
127
10.15171/ijhpm.2019.105
Non-Communicable Diseases
Neoliberalism
Health Policy
Ashley
Schram
ashley.schram@anu.edu.au
1
School of Regulation and Global Governance, Australian National University, Canberra, ACT, Australia
LEAD_AUTHOR
Sharni
Goldman
sharni.goldman@anu.edu.au
2
School of Regulation and Global Governance, Australian National University, Canberra, ACT, Australia
AUTHOR
United Nations General Assembly. Progress on the Prevention and Control of Non-Communicable Diseases. https://ncdalliance.org/sites/default/files/resource_files/UNSG%20Report%20on%20NCDs%20December%202017%20A.72.662%20SG%20report.pdf. Published 2017.
1
Yang JS, Mamudu HM, John R. Incorporating a structural approach to reducing the burden of non-communicable diseases. Global Health. 2018;14(1):66. doi:10.1186/s12992-018-0380-7
2
Glasgow S, Schrecker T. The double burden of neoliberalism? Noncommunicable disease policies and the global political economy of risk. Health Place. 2015;34:279-286. doi:10.1016/j.healthplace.2015.06.005
3
Freudenberg N. The manufacture of lifestyle: the role of corporations in unhealthy living. J Public Health Policy. 2012;33(2):244-256. doi:10.1057/jphp.2011.60
4
Stuckler D, McKee M, Ebrahim S, Basu S. Manufacturing epidemics: the role of global producers in increased consumption of unhealthy commodities including processed foods, alcohol, and tobacco. PLoS Med. 2012;9(6):e1001235. doi:10.1371/journal.pmed.1001235
5
Gilmore AB, Savell E, Collin J. Public health, corporations and the new responsibility deal: promoting partnerships with vectors of disease? J Public Health (Oxf). 2011;33(1):2-4. doi:10.1093/pubmed/fdr008
6
Lencucha R, Thow AM. How neoliberalism is shaping the supply of unhealthy commodities and what this means for NCD prevention. Int J Health Policy Manag. 2019;8(9):514-520. doi:10.15171/ijhpm.2019.56
7
Rushton S, Williams OD. Frames, paradigms and power: global health policy-making under neoliberalism. Glob Soc. 2012;26(2):147-167. doi:10.1080/13600826.2012.656266
8
Peretti J. Fat profits: how the food industry cashed in on obesity. The Guardian. August 7, 2013. https://www.theguardian.com/lifeandstyle/2013/aug/07/fat-profits-food-industry-obesity.
9
Glasgow SM. The Politics of Non-Communicable Disease Policy. Farnham: Ashgate; 2012.
10
Quinn D. Beyond Civilization: Humanity's Next Great Adventure. Broadway Books; 2000.
11
Denniss R. Curing Affluenza: How to Buy Less Stuff and Save the World. Black Inc; 2017.
12
Lelieveld J, Klingmuller K, Pozzer A, et al. Cardiovascular disease burden from ambient air pollution in Europe reassessed using novel hazard ratio functions. Eur Heart J. 2019;40(20):1590-1596. doi:10.1093/eurheartj/ehz135
13
Friel S, Bowen K, Campbell-Lendrum D, Frumkin H, McMichael AJ, Rasanathan K. Climate change, noncommunicable diseases, and development: the relationships and common policy opportunities. Annu Rev Public Health. 2011;32:133-147. doi:10.1146/annurev-publhealth-071910-140612
14
Kubiszewski I. Beyond GDP: are there better ways to measure well-being? The Conversation. 2014. http://theconversation.com/beyond-gdp-are-there-better-ways-to-measure-well-being-33414. Accessed September 23, 2019.
15
Roy E. New Zealand 'wellbeing' budget promises billions to care for most vulnerable. The Guardian. May 30, 2019. https://www.theguardian.com/world/2019/may/30/new-zealand-wellbeing-budget-jacinda-ardern-unveils-billions-to-care-for-most-vulnerable. Accessed September 23, 2019.
16
St Martin K, Roelvink G, Gibson K, Graham J. Introduction: an economic politics for our times. In: St Martin K, Roelvink G, Gibson K, Graham J, eds. Making Other Worlds Possible: Performing Diverse Economies. University of Minnesota Press; 2015:1-25.
17
Cameron J. Enterprise innovation and economic diversity in community-supported agriculture: sustaining the agricultural commons. In: St Martin K, Roelvink G, Gibson K, Graham J, eds. Making Other Worlds Possible: Performing Diverse Economies. University of Minnesota Press; 2015:1-25.
18
De Schutter O. The political economy of food systems reform. Eur Rev Agric Econ. 2017;44(4):705-731. doi:10.1093/erae/jbx009
19
Vivero Pol JL, Ruivenkamp G, Hilton A. Transition towards a food commons regime: re-commoning food to crowd-feed the world. In: Ruivenkamp G, Hilton A, eds. Perspectives on Commoning: Autonomist Principles and Practices. London, UK: Zed Books; 2017.
20
Tirado-von der Pahlen C. Climate change, the food commons and human health. In: Vivero Pol JL, Ferrando T, De Schutter O, Mattei U, eds. Routledge Handbook of Food as a Commons. Routledge; 2018.
21
Raworth K. Doughnut Economics: Seven Ways to Think like a 21st-Century Economist. Chelsea Green Publishing; 2017.
22
Hartwich OM. Neoliberalism: The Genesis of a Political Swearword. St Leonards, Australia: The Centre for Independent Studies; 2009. https://www.cis.org.au/app/uploads/2015/07/op114.pdf. Accessed September 23, 2019.
23
Monbiot G. Neoliberalism – the ideology at the root of all our problems. The Guardian; 2016. https://www.theguardian.com/books/2016/apr/15/neoliberalism-ideology-problem-george-monbiot. Published April 15, 2016. Accessed September 9, 2017.
24
Friel S. A Time for Hope? Pursuing a Vision of a Fair, Sustainable and Healthy World. Glob Policy. 2018;9(2):276-282. doi:10.1111/1758-5899.12557
25
ORIGINAL_ARTICLE
Corruption in Health Systems: The Conversation Has Started, Now Time to Continue it; Comment on “We Need to Talk About Corruption in Health Systems”
Holistic and multi-disciplinary responses should be prioritized given the depth and breadth through which corruption in the healthcare sector can cover. Here, taking the Peruvian context as an example, we will reflect on the issue of corruption in health systems, including corruption with roots within and outside the health sector, and ongoing efforts to combat it. Our reflection of why corruption in health systems in settings with individual and systemic corruption should be an issue that is taken more seriously in Peru and beyond aligns with broader global health goals of improving health worldwide. Addressing corruption also serves as a pragmatic approach to health system strengthening and weakens a barrier to achieving universal health coverage and Sustainable Development Goals related to health and justice. Moreover, we will argue that by pushing towards a practice of normalizing the conversation about corruption in health has additional benefits, including expanding the problematization to a wider audience and therefore engaging with communities. For young researchers and global health professionals with interests in improving health systems in the early career stages, corruption in health systems is an issue that could move to the forefront of the list of global health challenges. This is a challenge that is uniquely multi-disciplinary, spanning the health, economy, and legal sectors, with wider societal implications.
https://www.ijhpm.com/article_3692_f84715a5299f529bbdcc0fbe28efc5b8.pdf
2020-03-01
128
132
10.15171/ijhpm.2019.104
Corruption
Health Systems
Global Health
Peru
Hongsheng S.
Lu
baobei08@gmail.com
1
Global Health Research Center, Duke Kunshan University, Kunshan, Jiangsu, China
AUTHOR
Bing X.
Ho
bh121098@gmail.com
2
Trinity College for Arts & Sciences, Duke University, Durham, NC, USA
AUTHOR
J. Jaime
Miranda
jaime.miranda@upch.pe
3
CRONICAS Center of Excellence in Chronic Diseases, Universidad Peruana Cayetano Heredia, Lima, Peru
LEAD_AUTHOR
Kaplan J. Translating Research for Better Policy: Advice from Dr. Patricia García, Former Minister of Health of Peru. Medium. September 20, 2018. https://medium.com/@VoicesHSPH/translating-research-for-better-policy-advice-from-dr-cf53df09f82b. Accessed August 10, 2019.
1
Jumpa M, Jan S, Mills A. The role of regulation in influencing income-generating activities among public sector doctors in Peru. Hum Resour Health. 2007;5:5. doi:10.1186/1478-4491-5-5
2
Onwujekwe O, Agwu P, Orjiakor C, et al. Corruption in Anglophone West Africa health systems: a systematic review of its different variants and the factors that sustain them. Health Policy Plan. 2019;34(7):529-543. doi:10.1093/heapol/czz070
3
McPake B, Russo G, Hipgrave D, Hort K, Campbell J. Implications of dual practice for universal health coverage. Bull World Health Organ. 2016;94(2):142-146. doi:10.2471/blt.14.151894
4
Plan Nacional de Lucha contra la Corrupción. Un compromiso de todos. Presidencia del Consejo de Ministros; 2008. http://www.pcm.gob.pe/InformacionGral/plan_anticorrupcion/plan_anticorrupcion.pdf. Accessed August 20, 2019.
5
Lucha frontal contra la corrupción: Una política diferente para un país distinto. Presidencia del Consejo de Ministros. http://www.pcm.gob.pe/lucha-frontal-contra-la-corrupcion-una-politica-diferente-para-un-pais-distinto/. Accessed August 20, 2019.
6
Dirección General de la Defensoría de la Salud, Ministerio de Salud. Plan de Lucha Contra la Corrupción en el Ministerio de Salud 2015-2016. Lima: Ministerio de Salud; 2015. http://bvs.minsa.gob.pe/local/MINSA/3253.pdf.
7
Decreto Legislativo N° 1327. Decreto Legislativo que establece medidas de protección para el denunciante de actos de corrupción y sanciona las denuncias realizadas de mala fe. El Peruano; 2019. http://busquedas.elperuano.pe/normaslegales/decreto-legislativo-que-establece-medidas-de-proteccion-para-decreto-legislativo-n-1327-1471010-6/. Accessed August 20, 2019.
8
OTRANS: Oficina de Transparencia y Anticorrupción. Ministerio de Salud; 2019. https://www.minsa.gob.pe/otrans/?op=81&tall=7. Accessed August 20, 2019.
9
Denuncias Anticorrupción. Ministerio de Salud; 2019. https://www.minsa.gob.pe/otrans/denuncias/. Accessed August 20, 2019.
10
Ministerio de Salud lanza campaña para combatir actos de corrupción. RPP; 2016. https://rpp.pe/lima/actualidad/ministerio-de-salud-lanza-campana-para-combatir-actos-de-corrupcion-noticia-1001588. Accessed August 20, 2019.
11
Gaitonde R, Oxman AD, Okebukola PO, Rada G. Interventions to reduce corruption in the health sector. Cochrane Database Syst Rev. 2016(8):Cd008856. doi:10.1002/14651858.CD008856.pub2
12
Hospital Loayza: médicos atienden en clínicas privadas en sus horas pagadas por Minsa. América Noticias; 2019. https://www.americatv.com.pe/noticias/actualidad/doctores-hospital-loayza-pacientes-medicos-n352219. Accessed August 20, 2019.
13
Médicos del Loayza atienden en clínicas privadas en horas de trabajo para el Estado. Diario Correo; 2018. https://diariocorreo.pe/edicion/lima/medicos-del-loayza-atienden-en-clinicas-privadas-en-horas-de-trabajo-para-el-estado-video-860808/. Accessed August 20, 2019.
14
Hussmann K. Addressing corruption in the health sector: securing equitable access to health care for everyone. U4 Issue. 2011:1. https://www.cmi.no/publications/file/3934-addressing-corruption-in-the-health-sector.pdf. Accessed August 20, 2019.
15
Watts J. Operation Car Wash: The biggest corruption scandal ever? The Guardian; 2017. http://www.theguardian.com/world/2017/jun/01/brazil-operation-car-wash-is-this-the-biggest-corruption-scandal-in-history. Accessed August 20, 2019.
16
Ugalde A, Homedes N. [The impact of researchers loyal to Big Pharma on the ethics and quality of clinical trials in Latin America]. Salud Colect. 2015;11(1):67-86. doi:10.1590/s1851-82652015000100006
17
Sample I. Big pharma mobilising patients in battle over drugs trials data. The Guardian. July 21, 2013. http://www.theguardian.com/business/2013/jul/21/big-pharma-secret-drugs-trials. Accessed August 20, 2019.
18
The rationale for fighting corruption. CleanGovBiz Initiative, OCED; 2014. https://www.oecd.org/cleangovbiz/49693613.pdf. Accessed August 20, 2019.
19
Kenny C. Construction, corruption, and developing countries. Policy, Research working paper No. WPS 4271. Washington, DC: World Bank; 2007.
20
Puertas que giran sin parar. Salud con lupa. https://saludconlupa.com/reportajes/la-salud-en-la-mesa-del-poder/puertas-que-giran-sin-parar/. Accessed August 20, 2019.
21
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