September 14, 2019

On sugar and taxes

Should We Tax Sugar-Sweetened Beverages? An Overview of Theory and Evidence

The real question is how to tax the addiction industry. Sugar is only one case. Right now, these are the guiding principles (for sugar):
1. Focus on Counteracting Externalities and Internalities, Not on Minimizing
Sugary Drink Consumption
2. Target Policies to Reduce Consumption among People Generating the Largest
Externalities and Internalities
3. Tax Grams of Sugar, Not Ounces of Liquid
4. Tax Diet Drinks and Fruit Juice If and Only If They Also Cause Uninternalized
Health Harms
5. When Judging Regressivity, Consider Internality Benefits, Not Just Who Pays the
6. If Possible, Implement Taxes Statewide
7. The Benefits of Sugar-Sweetened Beverage Taxes Probably Exceed Their Costs
Furthermore, sugar-sweetened beverage taxes are not a panacea—they will not, by themselves, solve the obesity epidemic in America or elsewhere. But sin taxes have proven to be a feasible and effective policy instrument in other domains, and the evidence suggests that the benefits of sugar-sweetened beverage taxes likely exceed the costs

September 12, 2019


Artificial intelligence in society

We do need a deep understanding of what artificial intelligence may represent for our future. It's not strictly a technical issue, it will affect many aspects of our lives. In the OECD report there is a good explanation of its potential impact. In p. 61 you'll find a brief description of health applications.
This report is released after the agreement on OECD AI principles last June.

Michael Jang

September 6, 2019

The excessive migration of health professionals

Recent Trends in International Migration of Doctors, Nurses and Medical Students

Among the 18 OECD countries for which data are available from 2010/11 to 2015/16, the number on foreign-born doctors rose by over 20%, a much higher growth rate than the overall increase of 10%. As a result, the proportion of foreign-born doctors across these OECD countries rose by 3 percentage points to 27% in 2016. The trend for nurses is similar, with the number of foreign-born nurses increasing by 20% while the overall increase was about 10%, so their share increased by 1.5 percentage points to 16%.
Of all doctors working in 26 OECD countries in 2016, 16% (about 483 000) obtained at least their first medical degree in another country, up from 14.5% (about 424 000) in 2011. The share and number of foreign-trained nurses have also risen to 7% (about 546 000) of all nurses working in 25 OECD countries in 2016, up from 6.6% (about 461 000) in 2011.
There is something wrong. A deficit of 20% of physicians supply that has to be solved by foreign professionals means that nobody is planning future demand. This is a big mistake, a result of political inaction.

September 5, 2019

Statistical significance once again

What Statistics Can and Can’t Tell Us About Ourselves

Great article from Hannah Fry in The New Yorker.

In the era of Big Data, we’ve come to believe that, with enough information, human behavior is predictable. But number crunching can lead us perilously wrong.

September 4, 2019

How technology may reduce the compensation of health professionals


Six years ago I said that the argument of continous growth of health care expenditures due to techonology and ageing was flawed. Bob Evans explained long time ago that politicians sya that costs are inevitable to avoid responsibilities.
I demonstrated that it was possible to constrain health expenditures having both effects: technology innovation and ageing. Right now, it seems that OECD has not seen these patterns and publishes a review and says that according to:
Historical growth rates across OECD countries (1995-2015), we can estimate a historical contribution of around 1% yearly health care expenditure growth. Looking at projections in the next decades, health expenditure is projected to grow at a slightly lower pace compared to the previous period, with 2.7% estimated yearly growth . On average, this would mean a contribution of 0.9% per year to total health expenditure coming from technological change.
And...what happens if there is no growth in per capita health expenditures as has happened in our country in the last decade? which is the contribution of technology?. The answer is easy. If technology has been applied in fact, there has been a reduction in the cost of other inputs (!!!). And I can guess that there is only one factor that explains the growth in technology costs, the reduction in human resources costs. Salaries have decreased in real terms and there is no prospect for recover. I think that this result is the worst of any potential scenario. Physicians and professionals have to be compensated according to effort, responsibility and performance. Reducing its relative compensation is not an option. If you want innovation you have to pay for it.

 Guido Guidi. In Sardegna: 1974, 2011, an exhibition at the MAN museum (Museo d’Arte Provincia di Nuoro)

September 1, 2019

Precision Public Health

Optimizing Precision Medicine for Public Health

Precision public health (PPH) is an emerging topic of public health that complements the development of precision medicine and utilizes advances in new technologies and knowledge unlocked through big data to better target public health efforts within populations

In publically funded healthcare systems two broad priorities for decision-makers are “to do the most, for the most” (47), and to “reduce health inequity” across the population
The solution in reconciling the n of 1 with the n of many approach for precision medicine and public health respectively lies within using precision medicine  technologies to more accurately identify and define population cohorts, through increased understanding of the underlying causes and biological pathways of disease and health. That is, improved molecular understanding of disease and the underlying  biological pathways create new knowledge that unlocks opportunities for discovery and re-aggregation of patient cohorts.
This article provides some hints about the impact of precision medicine in public health. However, you'll not find the details on how to apply it in practice. We are just in the begining of this approach.