The burden of disease around the world

Global Burden of Disease (GBD) 2019

The Lancet latest issue: 

The potential to improve health by risk reduction is well reported in GBD 2019. All risks quantified in GBD collectively account for 48% of global DALYs. Exposure to many risks highly correlated with SDI has been steadily decreasing as global SDI has increased, including household air pollution; child growth failure; and unsafe water, sanitation, and handwashing. Additionally, there have been notable decreases in exposure to smoking. Figure 4 shows the annualised rate of change in exposure from 2010 to 2019 for select risk factors ordered by global attributable DALYs. Among the 15 leading causes of attributable DALYs shown, high systolic blood pressure, high fasting plasma glucose, high body-mass index (BMI), ambient particulate matter pollution, alcohol use, and drug use stand out because rates of exposure are increasing by more than 0·5% per year.

 Success in reducing the disease burden from causes of communicable, maternal, neonatal, and nutritional  CMNN diseases by global collective action to fund key programmes should be celebrated. Catch-up social and economic development is fuelling more rapid health progress in the lower socio-demographic index (SDI) quintiles. But there is reason to believe that, although the past 70 years have largely been a story of sustained improvements in health, rising exposure to crucial risks, such as high BMI, high fasting plasma glucose, and ambient particulate matter pollution, as well as stagnant exposure to many other behavioural risks, including diet quality and physical activity, might attenuate progress. Most alarmingly, the mortality decreases in cardiovascular diseases of the past half a century have slowed substantially, or even reversed, in some nations with high SDI. 

Good news!

 

Check the resource center.

The Bio Revolution has alredy started

The world is at a “special moment” as revolutionary advances in biology converge with progress in computing automation and Artificial Intelligence (Matthias Evers, Senior Partner at McKinsey & Company)

The Bio Revolution / Reshaping the EU’s industrial strategy, from competition to trade policy

Dying from COVID

 Magnitude, demographics and dynamics of the effect of the first wave of the COVID-19 pandemic on all-cause mortality in 21 industrialized countries

The total mortality effect of the COVID-19 pandemic is the difference between the observed number of deaths from all causes and the number of deaths had the pandemic not occurred, which is not directly measurable. The most common approach to calculating the number of deaths had the pandemic not occurred has been to use the average number of deaths over previous years—for example, the most recent 5 years—for the corresponding week or month when the comparison is made. This approach, however, does not take into account changes in population size and age structure, nor long- and short-term trends in mortality, which are particularly pronounced for some age groups52,53. Nor does this approach account for time-varying factors, such as temperature, that are largely external to the pandemic but also affect death rates.

We developed an ensemble of 16 Bayesian mortality projection models that each make an estimate of weekly death rates that would have been expected if the COVID-19 pandemic had not occurred. We used multiple models because there is inherent uncertainty in the choice of model that best predicts death rates in the absence of pandemic. 

I suggest you to find where is Spain... 

Comparison of percent increase in deaths from any cause as a result of the COVID-19 pandemic between men and women, for all ages and by age group.

 

Markets in Healthcare, some weaknesses and what to do about them

 The Role of Market Forces in U.S. Health Care

No market functions perfectly, however, and health care markets are more imperfect than most.

The article explains weaknesses of the market and some potential fine tunning to avoid them. And says: 

Many of the “single-payer” health care systems around the world have some market components, and many are actually expanding the role of markets. The more important question is how government and markets can complement one another. Essentially, we do not need to abandon markets — we can make them better. Specifically, relatively incremental actions, such as continued support for ACA  marketplaces, continued efforts to increase the effectiveness of transparency initiatives, procompetitive reforms to reduce the deleterious consequences of provider consolidation,5 and regulations to prevent the most severe market failures, such as limits on surprise billing or more aggressive caps on excessive prices in the commercial market, seem like first-order ways to improve market functioning with a relatively light touch.  If we fail to improve market functioning, stronger government involvement will most likely be needed.

My impression is that unless there is stronger government involvement there will no be equity of access, specially after covid pandemic.

 

Milgrom and Wilson on auctions and Nobel Prize

The Prize in Economic Sciences 2020

The quest for perfect auction

Additional readings

When basic and applied sciences meet together:

Milgrom and Wilson’s ground-breaking initial work should be regarded as basic research. They wanted to use and develop game theory to analyse how diferent actors behave strategically when they each have access to diferent information. Auctions – with their clear rules that govern this strategic behaviour – comprised a natural arena for their research. However, auctions have gained in practical signifcance and, since the mid-1990s, they have been increasingly used in the distribution of complex public assets, such as frequency bands, electricity and natural resources. Fundamental insights from auction theory provided the foundation for constructing new auction formats that overcame these new challenges. 

The new auction formats are a beautiful example of how basic research can subsequently generate inventions that beneft society. The unusual feature of this example is that the same people developed the theory and the practical applications. The Laureates’ ground-breaking research about auctions has thus been of great beneft, for buyers, sellers and society as a whole.

Long time ago, I studied my PhD with Milgrom-Roberts book on organizational economics, later I published an article on auctions for primary care in Hacienda Publica, using Milgrom ideas. It is a well deserved Prize, I know what it really means.

 

The future of work (2)

 A World Without Work. Technology, Automation and How We Should Respond

The struggle for subsistence was the challenge that preoccupied most of mankind. Our generation has been fortunate to wake up in a world where people need not be condemned to that fate, where there is in principle enough economic prosperity for us all to keep ourselves and our families alive. The looming problems—of inequality, power, and meaning—are just the consequences of this unprecedented
prosperity. They are the price we pay for the material abundance that some of us (though as yet not all of us) have been fortunate to enjoy. And in my view, it is a price worth  paying. 
In the twenty-first century, we will have to build a new age of security, one that no longer relies on paid work for its foundations. And we have to begin this task today. Although we cannot know exactly how long it will take to arrive at a world with less work for human beings to do, there are clear signs that we are on our way there. The problems of inequality, power, and meaning are not lurking in the distance, hidden out of sight in the remote future. They have already begun to unfold, to trouble and test our inherited institutions and traditional ways of life. It is up to us now to respond.

 

The future of work

 Work in the Age of Data

The exponential increase in data processing, transmission, and storage capacity brought about by the digital revolution, and the concomitant reduction in costs per unit, marks the start of a new era: the “Age of Data.” We are in the midst of a period of rapid transformation, in the economy, society, and our way of life. And these changes are having particularly far-reaching effects on the world of work.

Nineteen leading experts from all over the world outline the major, radical reforms needed to address  the challenges of the Age of Data and to harness technology as a powerful force for drastically improving  working conditions and living standards at a global scale.

 

CRISPR Nobel prize

 Genetic scissors: a tool for rewriting the code of life

GREAT NEWS! 

The Royal Swedish Academy of Sciences has decided to award the Nobel Prize in Chemistry 2020 to

Emmanuelle Charpentier, Max Planck Unit for the Science of Pathogens, Berlin, Germany

Jennifer A. Doudna, University of California, Berkeley, USA

“for the development of a method for genome editing”

Popular information: Genetic scissors: a tool for rewriting the code of life (pdf)

Scientific Background: A tool for genome editing (pdf)

Unfortunately, the Royal Swedish Academy of Sciences has shown its ignorance about the real discovery of CRISPR. It happened in the '90s in Salines de Santa Pola by Dr. Martinez Mojica.

Health as a priority

Prioritizing health: A prescription for prosperity

Mckinsey Global Institute has released a relevant report:

In Prioritizing health: A prescription for prosperity, we measure the potential to reduce the burden of disease globally through the application of proven interventions across the human lifespan over two decades. By intervention, we mean actions aimed at improving the health of an individual. These range from public sanitation programs to surgical procedures and adherence to medication and encompass interventions recommended by leading institutions like the World Health Organization or national medical associations. We also examine the potential to reduce the disease burden from innovations over the same period.

Health reform, a lost chance (once again)

30 MESURES PER ENFORTIR EL SISTEMA DE SALUT

In the midst of covid crisis, our government created a Comitè d’Experts per a la Transformació del Sistema Públic de Salut. It gave them 2 months to solve such a complex issue, and this is the result. The message is clear, the implementation fuzzy. My impression is that if the Parliament asked for a reform and we delivered a report 6 years ago and nothing happened, now that the government is leaving it is not the best moment to think about it. Nevertheless, health reform, public and private, is as relevant as it was 6 years ago, but unfortunately nobody is taking charge.

PS. Someday I'll explain what really happened, the enablers and the blockers, and why all this has still impact in the current situation.

Integrated care as organizational innovation

Innovative Integrated Health And Social Care Programs In Eleven High-Income Countries 

High-income countries face the challenge of providing effective and efficient care to the relatively small proportion of their populations with high health and social care needs. Recent reports suggest that integrated health and social care programs target specific high-needs population segments, coordinate health and social care services to meet their clients’ needs, and engage clients and their caregivers. We identified thirty health and social care programs in eleven high-income countries that delivered care in new ways. We used a structured survey to characterize the strategies and activities used by these programs to identify and recruit clients, coordinate care, and engage clients and caregivers. We found that there were some common features in the implementation of these innovations across the eleven countries and some variation related to local context or the clients served by these programs.

Needs segmentation, Patient coordination and Engagement are the crucial topics. More details inside the article.

 

Specialty pharmaceuticals regulation

SPENDING REVIEW FASE II. ESTUDIO GASTO HOSPITALARIO EN EL SISTEMA NACIONAL DE SALUD 

Airef has release a report on specialty pharmaceuticals in the National health service. This is a crucial issue to understand health expenditure, and the report helps a lot.

The ppt, here.

Private health insurance landscape

 Private health insurance: history, politics and performance

This is  a collection of comparative case studies analysing the history, politics and performance of private health insurance globally and its implications for universal health coverage. An essential reading.

And these are the contents:

1 Why private health insurance?

2 Private finance publicly subsidized: the case of Australian health insurance

3 Private health insurance in Brazil, Egypt and India

4 Private health insurance in Canada

5 Regulating private health insurance: France’s attempt at getting it all

6 Statutory and private health insurance in Germany and Chile: two stories of coexistence and conflict

7 Uncovering the complex role of private health insurance in Ireland

8 Integrating public and private insurance in the Israeli health system: an attempt to reconcile conflicting values

9 Private health insurance in Japan, Republic of Korea and Taiwan, China

10 The role of private health insurance in financing health care in Kenya

11 Private health insurance in the Netherlands

12 The challenges of pursuing private health insurance in low- and middle-income countries: lessons from South Africa

13 Undermining risk pooling by individualizing benefits: the use of medical savings accounts in South Africa

14 Consumer-driven health insurance in Switzerland, where politics is governed by federalism and direct democracy

15 Regression to the increasingly mean? Private health insurance in the United States of America

16 Health savings accounts in the United States of America

Patients are not consumers

 Patient-Centered Care, Yes; Patients As Consumers, No

There are numerous calls for building health care delivery systems that are more patient centered. The focus on patient-centered care has increasingly begun to rely upon, and even merge with, the concept of patients as consumers. Early references to patients as consumers were made by patient advocates who were attempting to challenge professional and corporate dominance in health care. Today, “consumer-driven” health care has become associated with neoliberal efforts to emphasize market factors in health reform and deemphasize government regulation and financing. In our view, a narrow focus on consumerism is conceptually confused and potentially harmful. The consumer metaphor wrongly assumes that health care is a market in the usual understanding of that term, that the high cost of US health care is a function of excessive consumer demand, and that price transparency and competition can deliver on the promise of reducing costs or ensuring quality. Furthermore, a consumer metaphor places disproportionate burdens on patients to reduce health care costs, and it could erode professional obligations to provide appropriate and effective care.

So, all said.