Health at the centre of all policies

 The Lancet Planetary Health

The public health implications of the Paris Agreement: a modelling study

Great article, a must read

Compared with the current pathways scenario, the sustainable pathways scenario resulted in an annual reduction of 1·18 million air pollution-related deaths, 5·86 million diet-related deaths, and 1·15 million deaths due to physical inactivity, across the nine countries, by 2040. Adopting the more ambitious health in all climate policies scenario would result in a further reduction of 462 000 annual deaths attributable to air pollution, 572 000 annual deaths attributable to diet, and 943 000 annual deaths attributable to physical inactivity. These benefits were attributable to the mitigation of direct greenhouse gas emissions and the commensurate actions that reduce exposure to harmful pollutants, as well as improved diets and safe physical activity.

Though I'm not a fan of such predictions, these are some figures related to 9 countries only to take into account. More interesting articles released in the same issue.

Just take these ones, for instance, on diet:

Number of deaths avoided attributable to dietary risks in the year 2040, relative to CPS per 100 000 population, by scenario and country

The health impacts associated with the combination of all risks is smaller than the sum of individual risks because the former controls for co-exposure (ie, each death is attributed to only one risk factor). CPS=current pathways scenario. HPS=health in all climate policies. SPS=sustainable pathways scenario.

PS.Un año de pandemia y seguimos elucubrando respuestas

The response to public health crisis

  Pandemics, Publics, and Politics: Staging Responses to Public Health Crises

The inescapable architecture of everyday life

 Choice Architecture. A New Approach to Behavior, Design, and Wellness

The contents of the book:

1  The Inescapable Architecture of Everyday Life

2  A Framework for Architectural Interpretation

2.1 Rational Persons

2.2 Architects and Designers

2.3 Looking a Little More Closely at What Happens Inside Phil

2.6 The Architectural Problem

2.7 Phil Can Sometimes be Inconsistently Rational

2.8 How Tom’s Irrationality can Sometimes Help Him

2.9 The Architectural Problem Revisited

3  Rational and Irrational Behavior

3.1 Back to Consistent Rationality

3.2 Anchoring

3.3 Availability

3.4 The Cost of Zero Cost

3.5 Nonlinearity

3.6 Representativeness

3.7 Framing

3.8 Reference Point Shifts

3.9 An Overview of the Architectural Problem

4. Reflecting on choice architecture

4.1 Choice architecture is not a tree

4.2 The Structure of Architectural Experience

4.3 A Few Cautionary Remarks

4.4 Uncertainty

Behavior design

 Reset: An Introduction to Behavior Centered Design

A hot topic :

There are over 100 change theories in health psychology alone, and the field of behavioral economics has over 100 “nudges” for inspiring behavior change as well (just to mention the two most prominent fields dealing with this topic). This book is about a new, generic way of approaching behavior change called Behavior Centered Design (BCD).

The obesity industry

 The Hungry Gene. The Inside Story of the Obesity Industry

Latin America Health Reform

 Banking on health: the world bank and health sector reform in Latin America

PPP in health

 Public-Private Partnerships in Health. Improving Infrastructure and Technology

Gardasil case study

 Politics, Propaganda, and Public Health: A Case Study in Health Communication and Public

Clinical philosophy

 Clinical Reasoning:Knowledge, Uncertainty,and Values in Health Care

Values and health

 VALUES, ETHICS AND HEALTH CARE

Peter Duncan dixit:

We develop health care, and fund health care systems, broadly so that we can improve health. This very wide conception of the ends of health care leads us back to the kinds of things that Edwards mentions. From these, we can perhaps suggest that the values central to health care include things like autonomy (associated with further values such as free will, respect and consent), caring (also involving compassion and responsibility) and equality (which might also include values of justice and fairness).

 

Measuring trends towards universal health care

 A comprehensive assessment of universal health coverage in 111 countries: a retrospective observational study

A low incidence of catastrophic expenses sometimes reflects low service coverage (often in low-income countries) but sometimes occurs despite high service coverage (often in high-income countries). At a given level of service coverage, financial protection also varies. UHC index scores are generally higher in higher-income countries, but there are variations within income groups. Adjusting the UHC index for inequality in service coverage makes little difference in some countries, but reduces it by more than 10% in others. Seven of the 12 countries for which we were able to produce trend data have increased their UHC index over time (with the greatest average yearly increases seen in Ghana [1·43%], Indonesia [1·85%], and Vietnam [2·26%]), mostly by improving both financial protection and service coverage. Some increased their UHC index, despite reductions in financial protection, by substantially increasing their service coverage. The UHC index decreased in five of 12 countries with trend data, mostly because financial protection worsened with stagnant or declining service coverage. Our UHC indicators (except inpatient admissions) are significantly and positively associated with GDP per capita, and most are correlated with the share of health spending channelled through social health insurance and government schemes. However, associations of our UHC indicators with the share of GDP spent on health and the shares of health spending channelled through non-profit and private insurance are ambiguous.

Great article by Wagstaff and Neelsen.

Hospital market concentration and dominance

 Overcoming the Market Dominance of Hospitals

The facts:

Consolidation has been a predominant business strategy for hospitals and physicians in the United States for decades. Hospitals consolidate to gain market share and use resulting leverage to charge higher prices to private payers or employers large enough to self-insure. One major reason this may occur with relatively little resistance is the nature of health care markets. Numerous plans compete to offer health insurance to employers, and employers that self-insure must select from among these plans or third-party administrators (TPAs).

To attract employers, payers and TPAs strive to offer large networks of clinicians and health care centers to minimize care disruptions for employees. But when most physicians in a region are employed by a large hospital network, private payers and employers often have limited options other than to contract with that network, forcing them to tolerate 6% to 10% increases in prices each year.7 Adding to their leverage, these large networks often offer differentiated services like organ transplants or advanced specialty therapies that make them a “must-have” in private-payer or employer networks. Thus, the financial incentive for hospitals to merge or acquire physicians to gain must-have status is high.

Hospital consolidation is also supported by the nature of antitrust regulations, which are limited by how markets are defined. Since the 1990s, academics and regulators have defined local markets in health care using tertiary hospital catchment areas or hospital referral regions (HRRs). HRRs were constructed based on referral patterns of cardiovascular and neurosurgery hospitalizations from 1992-1993 Medicare data for research purposes.8 Yet these outdated HRRs meant for research are frequently used in antitrust enforcement today, despite the hospital mergers that have occurred since their development. In 2018, a review of community hospitals reported that 3491 of 5198 hospitals (67%) belonged to a multihospital health system, compared with just 2524 of 4956 (51%) in 1998.

Take-away message:

 COVID-19 has the potential to exacerbate the nation’s history of hospital consolidation. Stronger incentives to counteract consolidation could protect patients against potential adverse effects of anticompetitive hospital networks. Policy makers and regulators should consider legislation that defines and regulates market-dominant hospitals MDHs, while promoting asset redistribution via market-dominant hospitals redistribution fund  MRF, as a potential safeguard to the adverse consequences of the consolidation trend

 Eivissa

Platforms, a business model (3)

 HBR's 10 Must Reads on Platforms and Ecosystems

Previous posts on platforms.

Mazzucato on platforms

This collection of articles includes "Pipelines, Platforms, and the New Rules of Strategy," by Marshall W. Van Alstyne, Geoffrey G. Parker, and Sangeet Paul Choudary; "Strategies for Two-Sided Markets," Thomas R. Eisenmann, Geoffrey Parker, and Marshall W. Van Alstyne; "Finding the Platform in Your Product," by Andrei Hagiu and Elizabeth Altman; "What's Your Google Strategy?," by Andrei Hagiu and David B. Yoffie; "In the Ecosystem Economy, What's Your Strategy? ," by Michael G. Jacobides; "Right Tech, Wrong Time," by Ron Adner and Rahul Kapoor; "Managing Our Hub Economy," by Marco Iansiti and Karim R. Lakhani; "Why Some Platforms Thrive and Others Don't," by Feng Zhu and Marco Iansiti; "Spontaneous Deregulation," by Benjamin Edelman and Damien Geradin; "Alibaba and the Future of Business," by Ming Zeng; and "Fixing Discrimination in Online Marketplaces," by Ray Fisman and Michael Luca.

Beyond CRISPR-Cas9

 Expanding the possibilities of CRISPR genome editing with Cas14 and CasΦ

SpCas9 comes from a bacterium called Streptococcus pyogenes (hence “Sp”). S. pyogenes is a human pathogen. There is some evidence that using SpCas9 for genome editing in humans may lead to dangerous immune reactions (Ferdosi et al 2019) although other reports have questioned the importance of this finding.

In addition SpCas9 is quite large. It is 1368 amino acids (aa) long and can be difficult to fit into standard delivery vehicles (learn about CRISPR delivery here). Thus it can be hard to get SpCas9 into target cells and tissues.

Finally, SpCas9 requires the presence of a specific DNA sequence known as a “PAM” to target an adjacent sequence for genome editing. SpCas9’s PAM is 5’-NGG-3’. The need for this sequence restricts the number of sites SpCas9 can edit. This limits SpCas9’s usefulness.