Economic perspectives on public health

Promoting Health, Preventing Disease:The Economic Case

The rethoric behind disease prevention and Health promotion is well known. However, in practice, more needs to be done. A new book by WHO Euro reflects the economic case for such policies

Health promotion and disease prevention have a major role to play in Health policy worldwide, yet they are underused, partly because evidence to suport a strong case for action is difficult to gather. Aimed at a broad audience of policymakers, practitioners and academics, this book is designed to provide an economic perspective on the challenges to better health promotion and chronic disease prevention.

Four diferent considerations:

• The costs of inaction: What are the economic consequences of not taking action to promote and protect the health of the population?
• The costs of action: What would it cost to intervene by providing a promotion or preventive measure?
• The cost-effectiveness of action: What is the balance between what it costs to intervene and what would be achieved in terms of better outcomes – e.g. emotional well-being, physical health, improved quality of life, educational performance?
• The levers for change: What economic incentives can encourage more use of those interventions that are thought to be cost-effective and less use of those interventions which are not?

This book will be a key reference for public health policies, the background and state of the art, pros and cons of each policy, are clearly detailed. Highly recommended.

The quid pro quo at the heart of the international health regulations

Disease Diplomacy. International Norms and Global Health Security

The implementation of international health regulations has its pluses and minuses. Some countries show reluctance to accept a new landscape of global health security. All these issues are reflected in an interesting recent book.

We have seen dramatic changes in the past decade. The engagement of high-level political and security communities with an area that had previously been primarily treated as a technical concern has been a major cause of that change, but it has also meant that the new system is taking time to settle. Prior to 2005, the IHR had not been substantially revised since 1969.

International norms are by their very nature collective ideas, and they rely on that collectivity—the notion of states as forming a cohesive international society—in order to function effectively. When a number of states cannot meet the IHR core capacity requirements and cannot attract the help they need to do so, the entire ethos of the global health security regime is undermined. This, for us, is the challenge facing norm leaders: how to maintain the regime’s political purchase when the security discourse used to establish it is increasingly met with antipathy post-H1N1 and with a lack of financial support to institutionalize the necessary capacities in the domestic structures of the poorest states. Thus, one of the key lessons we draw from the norm-building process examined in this book is that recognizing appropriate behavioral standards and “wanting to do the right thing” are not the same as having the ability to conform to those standards.

A disease-producing organism

Disease Selection. The Way Disease Changed the World


Understanding human life is a great undertaking. After all these years the origins of our cells are not so clear. But let me quote a recent book and its suggested approach:

Evolutionary biologists have looked for some time for a suitable prokaryotic cell that when engulfed by another would form the nucleus of the nascent eukaryotic cell, but none has been identified that matches all the required criteria. However, Luis Villarreal, working with viruses, has come to the astounding conclusion that the primitive cell nucleus could have originated from a complex virus. The vaccinia virus, for example, seems to have all the same mechanisms that are required by a eukaryotic cell nucleus. The virus that formed the nucleus brought with it all the basic genes – thought to number about 324 – that are necessary to form the cell.
It requires a little time, and perhaps rereading of what has just been said, to realize that every cell in our bodies has a nucleus that was derived from a virus. We are the result of a very early disease process!

So not only is the nucleus of our cells derived from a virus but the mitochondria are from a parasitic bacterium. There can be no closer link between us and disease-producing organisms.

Technology, organization and the health system

The digital revolution: eight technologies that will change health and care

A short article by the King's Fund describes key technologies for the future. Really, the future is now:
1. The smartphone
2. At-home or portable diagnostics
3. Smart or implantable drug delivery mechanisms
4. Digital therapeutics
5. Genome sequencing
6. Machine learning
7. Blockchain
8. The connected community
As usual, we need to split technologies according to its value and social willingness to pay. Easier said than done. That's why I would suggest a close look at the report on Better value in NHS. Technology innovation without organizational change to take advantage of its value is extremely costly.
This is the agenda for NHS transformation:

Fragmented regulators in globalized markets

Food and Drug Regulation in an Era of Globalized Markets

The complexities of a globalized world have its impact on food and drug regulation. The options for a collaborative space between different agencies are huge, though the interest is low. Its an issue of power and fear, everybody knows that cooperating would be better, but a lack of commitment is the final result. This is not only an issue for health, of course, but I would like to highlight the fact that this should be the first issue of concern by health politicians worlwide. Meanwhile, you can read this book, though it is partial and limited but shows the current situation.

Public health for the world

Readings in Global Health Essential reviews from the New England Journal of Medicine

The book starts with this statement:

“Global Health” is a relatively recent construct, largely replacing and extending concepts embedded in prior terms such as “Tropical Medicine” and “International Health.” We have adopted a working definition of Global Health as “Public Health for the world”. In this view, everyone in the world is the relevant population, and Global Health seeks to prevent and treat the diseases that compromise good health anywhere in the world. A brief review of the origin and evolution of the concept of Global Health may cast light on some of the institutions and impulses still intrinsic to the study of Public Health for the world.

That's it. A selections of 18 articles from NEJM (plus intro and conclusions) is presented  in the book in order to understand the current change of paradigm:

1. Harvey V. Fineberg and David J. Hunter: A Global View of Health-An Unfolding Series
Part I: Global Disease Patterns and Predictions
2. Christopher J.L. Murray and Alan D. Lopez: Measuring the Global Burden of Disease
3. Anthony J. McMichael: Globalization, Climate Change, and Human Health
Part II: Infectious Diseases
4. Anthony S. Fauci and David M. Morens: The Perpetual Challenge of Infectious Diseases
5. Peter Piot and Thomas C. Quinn: Response to the AIDS Pandemic-A Global Health Model
6. Harvey V. Fineberg: Pandemic Preparedness and Response-Lessons from the H1N1 Influenza of 2009
7. Rupa Kanapathipillai, Armand G Sprecher, and Lindsey R Baden: Ebola Virus Disease: Past and Present
8. Gary J. Nabel: Designing Tomorrow's Vaccines
9. Donald R. Hopkins: Disease Eradication
Part III: Non-Communicable Diseases
10. Majid Ezzati and Elio Riboli: Behavioral and Dietary Risk Factors for Noncommunicable Diseases
11. Prabhat Jha and Richard Peto: Global Effects of Smoking, of Quitting, and of Taxing Tobacco
12. David J. Hunter and K. Srinath Reddy: Noncommunicable Diseases
13. Anne E. Becker and Arthur Kleinman: Mental Health and the Global Agenda
14. Robyn Norton and Olive Kobusingye: Injuries
Part IV: Health System Responses
15. Zulfiqar A. Bhutta and Robert E. Black: Global Maternal, Newborn, and Child Health-So Near and Yet So Far
16. Anne Mills: Health Care Systems in Low- and Middle-Income Countries
17. Jennifer Leaning and Debarati Guha-Sapir: Natural Disasters, Armed Conflict, and Public Health
Part V: Global Institutional Responses
18. Julio Frenk and Suerie Moon: Governance Challenges in Global Health
19. Lawrence O. Gostin and Devi Sridhar: Global Health Law
20. Nigel Crisp and Lincoln Chen: Global Supply of Health Professionals
21. David J. Hunter and Harvey V. Fineberg: Convergence to Common Purpose in Global Health

The book is specially appropriate for any health professional and politician. Clearly written and concrete messages, allows the reader to undestand that public health requires a deeper global coordination.

Health economics of genomics

Genomics and Society: Ethical, Legal, Cultural and Socioeconomic Implications

 Current advances in genomics require an update for health economists. A first reading that  I would recommend is the chapter by James Buchanan titled "Health economics perspectives of genomics" that has been published in a recent book. James is a health economist that works in Oxford University, and his blog is a must read on the topic.