29 d’octubre 2019

The impact of an ageing population

Sustainable health financing with an ageing population: implications of different revenue raising mechanisms and policy options

Sustainable health financing with an ageing population: Will population ageing lead to uncontrolled health expenditure growth?

Three documents from WHO Europe are available regarding financing health for an ageing population. You can skip the third, it is about predictions for 2060. This is useless as I've said many times.
However, I agree with this comment:
These analyses find that population ageing is not, and will not become, a major driver of growth in health expenditures. Moreover, they suggest that in countries where age demographics are changing but the size of the older population is not yet large, the costs of improving coverage and access to services for older people is likely to be manageable and now is a good time to begin investing in the health system while the population is relatively young.
However, while population ageing will not become a main driver of health expenditure growth, policy choices related to how health services are delivered, the prices paid (or negotiated) for services, medicines and technologies, and volumes of care will ultimately determine health spending by age trends.

25 d’octubre 2019

The end of social health insurance

Social Health Insurance in Europe: Basic Concepts and New Principles

During the first decade of this century, health reforms have advocated for universal health coverage in those countries with social health insurance based on contributions. This is a strong trend that needs to be evaluated. A recent article describes in detail these changes and says:
Contrary to some expectations, SHI in Europe has further expanded toward universal coverage, with access to health care considered a right based on either direct or indirect financial contributions. Indeed, Germany is now the only example in Europe where groups of the population can opt out from the main insurance system. And, since 2009, the overall population is required to be covered by either social or private insurance. 

24 d’octubre 2019

The world is fat

 The Heavy Burden of Obesity – The Economics of Prevention

Almost a decade after the publication of the first OECD report on obesity, a new one has been released. This are the facts:
More than half the population is now overweight in 34 out of 36 OECD countries and almost one in four people is obese. Average rates of adult obesity in OECD countries have increased from 21% in 2010 to 24% in 2016, so an additional 50 million people are now obese. Despite a drive in the last decade to deal with increased obesity, more needs to be done amid sedentary lifestyles and an almost 20% increase in calorie supply – i.e. calories available for consumption – in the OECD over the past 50 years.
So what?
The OECD identifies four categories of policies to tackle the problem and gauges the effect of three promising “policy packages” to help countries achieve greater impact and coherence in tackling the obesity epidemic. Food and menu labelling, regulation of advertising of unhealthy foods to children and the promotion of exercise, including by doctors and schools, are among the measures analysed.
Most of the strategies requires a confrontation with the food industry, and governments usually try to avoid it. We'll see what happens.

Heavy burden of obesity - facts and figures

16 d’octubre 2019

Gen-ethics (2)

Special Issue: The Ethics Of Human Genome Editing

The CRISPR journal has released a special issue on ethics. You'll find an article with the title "Heritable Genome Editing and the Downsides of a Global Moratorium". This is exactly the opposite argument that Françoise Baylis provides in her book. I think that it is unacceptable a recommendation that nations should "regulate HGE for safety and efficacy only and without distinguishing between therapeutic and enhancing modifications". We can't leave such decisions to scientists and practitioners. I'm really concerned about it.

10 d’octubre 2019


Altered Inheritance
CRISPR and the Ethics of Human Genome Editing

Our future belongs to all of us. Or maybe not? Maybe somebody could decide for us without noticing it?. The "decisions about the use of genetic technologies in humans are too important to be left to scientists", society has to achieve a broad consensus. Françoise Baylis in her new book sheds light on this issue. She explained his position in an article last spring and now she has published a remarkable book on ethics and genome editing. Her calls for an open and comprehensive international process to reach political, scientific, and social/ethical consensus on regulation of human genome editing have been  unattended up to now. Her ultimate goal:
I want to live in a world that promotes equity and justice and celebrates difference, a world where everyone matters. I want to live in a world where we embrace neighborliness, reciprocity, social solidarity, and community in pursuit of human flourishing and the common good. I want to live in a world where we value collegial as opposed to competitive relations. I don’t want to live in a world where a select, privileged few are able to inscribe their privilege in their DNA and thereby exacerbate unfair class divisions and other social injustices. For these reasons, I want for all of us to reflect on whether heritable human genome editing is a boon or a threat.
I agree. An essential reading highly recommended.

03 d’octubre 2019

Social differences in health and health systems

Health for Everyone?
Social Inequalities in Health and Health Systems

I still don't know why do we talk about inequalities, I've always thought that we should care about differences. The word inequality drives your mind towards equality, and we all know that this will not happen. Therefore, there are differences that are unfair and avoidable, and these are the ones we have to be concerned.
And when we talk bout social determinants, maybe we should focus on commercial determinants and it would help. Why commercial? Because these factors are more actionable compared to others.
You will not find all these reflections in the new report by OECD. Anywasy it is worth reading to confirm it, though the perspective is the standard one (Marmot) and not new.
What you really have to read is the notice at the begining of each chapter that says:
Note by Turkey:
The information in this document with reference to “Cyprus” relates to the southern part of the Island. There is no single authority representing both Turkish and Greek Cypriot people on the Island. Turkey recognises the Turkish Republic of Northern Cyprus (TRNC). Until a lasting and equitable solution is found within the context of the United
Nations, Turkey shall preserve its position concerning the “Cyprus issue”.
Note by all the European Union Member States of the OECD and the European Union:
The Republic of Cyprus is recognised by all members of the United Nations with the exception of Turkey. The information in this document relates to the area under the effective control of the Government of the Republic of Cyprus.
Shame on Turkey. This notice is an example of the decision that needs to take the OECD urgently: to exclude Turkey from his organization. It is really unacceptable what Turkey has done and it is doing in Cyprus. Europe and OECD are avoiding the conflict saying "The information in this document relates to the area under the effective control of the Government of the Republic of Cyprus". The conflict should be solved as soon as possible with the withdrawal of Turkey from Cyprus. That's all.

PS. What I said in the blog on Cyprus 8 years ago:

PS. Carta de lluny. Tot d'una passejant pel carrer Ledra vaig topar amb una frontera. Em trobava a una capital europea, dividida, envaïda. L'illa de Xipre va quedar escapçada el 1974. Aquella invasió va provocar 200.000 desplaçats que van perdre-ho tot fins el dia d'avui. El genocidi cultural i el saqueig posterior encara dura. He tingut ocasió de visitar dues exposicions que mostren l'espoli que s'està produint a la regió de Morphou (pot visitar-se al Banc de Xipre) i el rescat d'algun botí d'antiquari de l'any passat a Alemanya (Makarios Foundation). Vaig quedar tocat en veure-ho. Tresors artístics destruits per tal que la cultura d'altres desaparegui definitivament. Molt fort.
La situació política és delicada després de l'explosió de l'arsenal de Limassol a mitjans de juliol. Vam assistir a concerts on l'electricitat la subministràven amb generadors, i a Limassol moltes  botigues no tenien llum. Tenen una bombolla urbanística com una catedral i està a punt d'esclatar.
L'escapada cap al Nord va tenir tres destins: Salamina, Famagusta i Kyrenia. Arribar a Salamina suposava fer un visat i assegurança del cotxe però el difícil era arribar-hi perquè no hi havia cap cartell. Salamina és un complex interessant però descuidat i menystingut. Famagusta té una mescla que em va sobtar visualment, catedrals gòtiques escapçades amb minarets. Havia de ser extraordinària però s'han encarregat deliberadament de destruir-la, s'observa clarament quan passeges. Kyrenia va ser un descans, lloc acollidor. Al port amb una calor sofocant vam passar una bona estona. Vam oblidar per pocs moments el país envaït on ens trobàvem.
Crec que els governs que faciliten, impulsen o s'inhibeixen davant del genocidi cultural haurien de ser exclosos del circuit, pena d'infàmia, cosa que per ara no fa ningú.
Hem tingut ocasió de visitar Pafos, els Troodos i les esglésies patrimoni de la humanitat, Kourion, i molts altres llocs. El menjar i en especial la qualitat del peix és envejable. Un bon record i una experiència més per a compartir.