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1. U.S. Health Care from a Global Perspective, 2022: Accelerating Spending, Worsening Outcomes

Author:
Munira Z. Gunja, Evan D. Gumas, and Reginald D. Williams II
Publication Date:
01-2023
Content Type:
Policy Brief
Institution:
Commonwealth Fund
Abstract:
In the previous edition of U.S. Health Care from a Global Perspective, we reported that people in the United States experience the worst health outcomes overall of any high-income nation.1 Americans are more likely to die younger, and from avoidable causes, than residents of peer countries. Between January 2020 and December 2021, life expectancy dropped in the U.S. and other countries.2 With the pandemic a continuing threat to global health and well-being, we have updated our 2019 cross-national comparison of health care systems to assess U.S. health spending, outcomes, status, and service use relative to Australia, Canada, France, Germany, Japan, the Netherlands, New Zealand, Norway, South Korea, Sweden, Switzerland, and the United Kingdom. We also compare U.S. health system performance to the OECD average for the 38 high-income countries for which data are available. The data for our analysis come from the Organisation for Economic Co-operation and Development (OECD) and other international sources (see “How We Conducted This Study” for details). For every metric we examine, we used the latest data available. This means that results for certain countries may reflect the height of the COVID-19 pandemic, when mental health conditions were surging, essential health services were disrupted, and patients may not have received the same level of care
Topic:
Health, Health Care Policy, Inequality, and Finance
Political Geography:
North America and United States of America

2. U.S. and Global Approaches to Financing Long-Term Care: Understanding the Patchwork

Author:
Celli Horstman, Evan D. Gumas, and Gretchen Jacobson
Publication Date:
02-2023
Content Type:
Policy Brief
Institution:
Commonwealth Fund
Abstract:
Most United States adults age 65 and older will need long-term care toward the end of their lives.1 Long-term care, provided in the home, community, or in institutional settings like a nursing home, includes medical care as well as personal, nonmedical care for people who are unable to perform activities of daily living, like cooking or bathing. Some services also may support social needs for those unable to perform what are known as instrumental activities of daily living, such as shopping or medication management. In 2018, more than 5 million people in the United States used home health care, including adult day care or home health agency services, and nearly 4 million people resided in nursing homes or residential care communities.2 Despite the widespread need for long-term care, the U.S. has no national program to cover the costs of long-term care. While certain states have implemented their own programs, the resulting patchwork of funding has left many Americans with no sustainable way to pay for the services they require. Other developed countries have comprehensive, national long-term care financing systems featuring broad eligibility and high levels of financial support. In this brief, we analyze data from multiple sources on long-term care costs in the U.S., as well as spending data from the Organisation for Economic Co-operation and Development (OECD), to better understand long-term care financing strategies in 12 high-income countries. In addition to these data, we synthesized initiatives to long-term care funding in these 12 countries. (For details, see “How We Conducted This Study.”) Since the U.S. does not have a national funding strategy, we also focused on individual state approaches. International and U.S. state approaches may provide insights to policymakers seeking to advance comprehensive long-term care funding.
Topic:
Health, Health Care Policy, Inequality, and Social Services
Political Geography:
Global Focus

3. A Future Projection of Post-Covid-19 in Japan: Universal Values and International Cooperation

Author:
Yukio Sakurai
Publication Date:
01-2023
Content Type:
Journal Article
Journal:
The Rest: Journal of Politics and Development
Institution:
Centre for Strategic Research and Analysis (CESRAN)
Abstract:
This essay aims to clarify the most popular impacts of the COVID-19 pandemic and examine a future projection of Post-COVID-19 in Japan. This is based on interdisciplinary studies, particularly the literature survey on global governance in English and Japanese. Japan has consistently lived after WWII under the principles of freedom, democracy, human rights, and the rule of law. Given the challenges caused by the pandemic, it is unpredictable how much conflict between multiple powers will hinder national security and economic globalization. The following five actions should be executed: Japan should participate in international research activities to envision a future society, Japan should adopt a unique future concept to address ageing populations and social security reform in their international cooperation, a review of neoliberalism, construction of a society that can respond to societal risks, and political leadership and freedom of speech to deal with serious social risks should be championed.
Topic:
Health, Governance, Pandemic, and COVID-19
Political Geography:
Japan and Asia

4. Budget Brief: National Health Mission

Author:
Avani Kapur, Ritwik Shukla, and Sharad Pandey
Publication Date:
02-2023
Content Type:
Policy Brief
Institution:
Centre for Policy Research, India
Abstract:
National Health Mission (NHM) is Government of India’s (GoI’s) largest public health programme, which aims to achieve universal access to quality healthcare. It consists of two sub-missions: ■ National Rural Health Mission (NRHM); and ■ National Urban Health Mission (NUHM). This brief uses government data to analyse: ■ NHM finances, including proposed and approved budgets, releases, and expenditures; ■ Staff and bed availability; and ■ Outcomes.
Topic:
Health, Governance, Budget, and Public Spending
Political Geography:
South Asia and India

5. Budget Brief: Ayushman Bharat

Author:
Madhur Sharma, Rahul Das, and Avani Kapur
Publication Date:
02-2023
Content Type:
Policy Brief
Institution:
Centre for Policy Research, India
Abstract:
Ayushman Bharat, under the aegis of the Ministry of Health and Family Welfare (MoHFW), was launched by Government of India (GoI) on 23 September 2018. This brief uses government data to analyse the following components of the scheme: ■ Ayushman Bharat Pradhan Mantri Jan Arogya Yojana (AB-PMJAY); ■ Establishment of Health and Wellness Centres (HWCs); ■ Ayushman Bharat Digital Mission (ABDM); and ■ Pradhan Mantri Ayushman Bharat Health Infrastructure Mission (PM-ABHIM).
Topic:
Health, Governance, Budget, and Public Spending
Political Geography:
South Asia and India

6. Moving on Up: Multilevel Monitoring and Advocacy for Health Rights

Author:
Abrehet Gebremedhin
Publication Date:
01-2023
Content Type:
Working Paper
Institution:
Accountability Research Center (ARC), American University
Abstract:
Multilevel approaches to monitoring and advocacy are often used by international development practitioners, particularly in civil society, in efforts to hold governments—from the national to the local—to account for policy implementation. However, such approaches are not yet well understood or identified by many scholars in the social accountability field. This evidence review addresses this gap through a cross-case comparison of multilevel approaches in ten health rights programs across Africa, Asia, and Latin America. It draws on published evaluations, working papers, and peer-reviewed journal articles, as well as insights shared by implementers and researchers. Cases were selected to illustrate health rights initiatives that included monitoring or advocacy activity at a minimum of two different levels: local health facility, district, regional, provincial or national. Four significant findings emerge from this review of evidence: Vertical integration is a relatively common feature of multilevel monitoring and advocacy in these ten cases and is most likely to take place at the lower ends of the health system. However, it is largely implicit, and often not articulated in project design or theories of change. Horizontal organizing—the coordination of civil society action across districts or geographies—is a less visible feature of multilevel approaches to health rights programming than vertical integration. Despite the multilevel nature of health monitoring and advocacy in these ten cases, less than half reported working at the regional or provincial level, indicating a ‘missing middle’ between local and national activity. Escalation—the process by which citizens’ unaddressed claims move upwards to those with greater decision- making powers—is an important mechanism for accountability and one way in which vertical integration can happen. However, escalation is not clearly articulated in much of the gray literature, and therefore merits further research. The findings from this evidence review have implications for strategy, including: the importance of explicitly identifying multilevel tactics for monitoring and advocacy; theorizing the process by which unaddressed claims can be addressed, particularly moving up beyond the local level; emphasizing the importance of the ‘middle’ and ensuring regional and provincial decision-making is leveraged; and looking to link vertical integration with opportunities for horizontal organizing.
Topic:
Civil Society, Health, Accountability, Advocacy, and Monitoring
Political Geography:
Africa, Asia, and Latin America

7. Does Project-Level Aid for Water and Sanitation Improve Child Health Outcomes? Evidence from Household Panel Data in Uganda

Author:
Lynda Pickbourn, Raymond Caraher, and Léonce Ndikumana
Publication Date:
03-2023
Content Type:
Working Paper
Institution:
Political Economy Research Institute (PERI), University of Massachusetts Amherst
Abstract:
Empirical studies on the effectiveness of aid to the water, sanitation, and hygiene sector (WASH aid) have focused primarily on access to these services as the benchmark for evaluating the effectiveness of aid in this sector. Given the importance of WASH services for public health outcomes, the effectiveness of WASH aid should also be evaluated in terms of its impact on health outcomes. This is especially important in low- and middle-income countries where achieving sustained improvements in child health outcomes remains a challenge. This paper uses geocoded sub-national data on the location of WASH aid projects in Uganda in conjunction with six waves of nationally representative household-level panel survey data to examine the impact of aid-funded WASH projects on the probability of stunting among Ugandan children and infants. Analysing aid effectiveness at the sub-national level avoids the problems of cross-country heterogeneity in aid effectiveness that plagues other studies. Results of the difference-in-differences regression analysis suggest that proximity to an aid-funded WASH project reduces the probability of stunting by 14–21 per cent. The results suggest that scaling up aid to the WASH sector can help improve child health outcomes in the country.
Topic:
Health, Humanitarian Aid, Water, Sanitation, and Child Care
Political Geography:
Uganda and Africa

8. Non-economic loss and damage: closing the knowledge gap

Author:
International Centre for Climate Change and Development (ICCCAD)
Publication Date:
01-2023
Content Type:
Policy Brief
Institution:
International Centre for Climate Change and Development (ICCCAD)
Abstract:
Climate-related loss and damage is escalating, with many countries experiencing new forms of climate impact, of increasing intensity. The focus until now has been on calculating the economic repercussions of climate risk. Its wider impacts and resulting hidden costs of climate change — such as loss of cultural heritage — are less understood and harder to quantify. This knowledge gap on non-economic loss and damage, which is largely due to limited coordination around research and sparse evidence originating from the global South, urgently needs addressing. This briefing proposes a comprehensive approach for building the evidence base on non-economic loss and damage, particularly the creation of a Loss and Damage Research Observatory. This online platform will lay the foundations for a collaborative South–South–North community of practitioners, ultimately leading to informed policy on this critical area of climate action.
Topic:
Climate Change, Health, Displacement, Conservation, Indigenous, Resilience, and Biodiversity
Political Geography:
Global Focus

9. The UN’s Response to the COVID-19 Infodemic

Author:
Gabriel Delsol and Albert Trithart
Publication Date:
05-2023
Content Type:
Policy Brief
Institution:
International Peace Institute
Abstract:
The COVID-19 pandemic has been accompanied by a related “infodemic.” This infodemic emerged as widespread demand for information about the public health emergency was met with large volumes of false and misleading information. Many of the national and international institutions leading the response to the COVID-19 pandemic, including the UN, quickly recognized that they also needed to respond to the infodemic. This led to a quick, broad-based response by a broad array of UN agencies and partners. To date, however, there has been no systematic mapping or assessment of the range of initiatives across the UN system. To begin filling that gap, this paper provides an overview of the UN system’s response to the COVID-19 infodemic across four areas: monitoring harmful information related to COVID-19; dispelling false information and providing authoritative information; building information resilience; and setting the agenda. It then assesses some of the successes and challenges of the response across four areas: external partnerships, including with governments, civil society, academia, and social media companies; coordination within the UN system; financial, human, and technological capacity; and impact assessment. The report concludes that the UN’s infodemic response finds itself at a pivotal point: Due to donor fatigue around COVID-19, funding for the infodemic response is falling even while the need for a robust infrastructure to address infodemics and other information disorders may be increasing. UN entities working to address the infodemic and other information disorders should therefore consider the following: Engaging in a consultative process to develop a shared understanding of the infodemic by defining its specific harms in relation to each of their mandates; Sustaining and building capacity to counter infodemics and other information disorders, both in communications departments and in other sections working on infodemic management; Adopting a more standardized, system-wide approach to the use of new technologies and engagement with technology platforms; and Continuing to strengthen long-term information resilience by building the capacity of governments to manage infodemics and supporting strong, independent media.
Topic:
Health, Science and Technology, United Nations, and COVID-19
Political Geography:
Global Focus

10. Disease Mix and How Economic Freedom Matters for Health Outcomes

Author:
Vincent Geloso, Kelly Hyde, and Ilia Murtazashvili
Publication Date:
03-2023
Content Type:
Working Paper
Institution:
The Cato Institute
Abstract:
We investigate the institutional foundations of public health. We argue that a key distinction in analysis of disease is between diseases of commerce (diseases associated with movement of people and with affluence) and diseases of poverty (primarily noncommunicable diseases that depend on wealth and income). We show that the mix of disease – the ratio of communicable diseases and those associated with longevity to diseases of poverty – increases in economically free countries. We argue that increasing burdens of diseases of commerce reflects the quality of institutions, as those diseases are better than living shorter, brutish lives where diseases of poverty claim many lives. This analysis also highlights an institutional trade‐​off: economically free institutions reduce certain types of disease while contributing to others.
Topic:
Health, Infectious Diseases, Economy, Institutions, and Public Health
Political Geography:
Global Focus