Reflections on the development of health economics in low- and middle-income countries

Health economics is a relatively new discipline, though its antecedents can be traced back to William Petty FRS (1623–1687). In high-income countries, the academic discipline and scientific literature have grown rapidly since the 1960s. In low- and middle-income countries, the growth of health economics has been strongly influenced by trends in health policy, especially among the international and bilateral agencies involved in supporting health sector development. Valuable and influential research has been done in areas such as cost–benefit and cost-effectiveness analysis, financing of healthcare, healthcare provision, and health systems analysis, but there has been insufficient questioning of the relevance of theories and policy recommendations in the rich world literature to the circumstances of poorer countries. Characteristics such as a country''s economic structure, strength of political and social institutions, management capacity, and dependence on external agencies, mean that theories and models cannot necessarily be transferred between settings. Recent innovations in the health economics literature on low- and middle-income countries indicate how health economics can be shaped to provide more relevant advice for policy. For this to be taken further, it is critical that such countries develop stronger capacity for health economics within their universities and research institutes, with greater local commitment of funding.     

21世纪初农业生态系统健康研究方向

农业生态系统健康是指农业生态系统免受发生“失调综合症”,处理胁迫的状态和满足持续生产农产品的能力,目前,农业生态系统健康研究范围主要涉及农业生态系统健康评价方法,土壤质量和水质与农业生态系统健康的联系,农业生态系统健康与人类健康的关系,害虫生态管理对农业生态系统健康的贡献,杂草综合管理在农业生态系统健康中的作用,从生态病理学到农业生态系统健康,线虫群落作为农业生态系统健康指示生物的研究,转基因作物对农业生态系统健康的生态影响评价,农业投入政策对农业生态系统健康的影响,景观生态学在农业生态系统健康评价中的应用,农业生态系统健康与绿色食品开发等,首先论述了农业生态系统健康研究的现状,介绍了农业生态系统健康研究实例-土壤健康的生物指标,最后提出了今后农业生态系统健康的研究方向,为保障农产品安全和增进人类健康提供依据。     

On the measurement of health and its effect on the measurement of health inequality

We examine the extent to which self-reported health measures suffer from income-related reporting heterogeneity and then characterize how this reporting heterogeneity affects the estimation of income-related health inequality. We run a comprehensive set of tests of reporting heterogeneity using several self-reported health measures and several clinical measures of health from the National Health and Nutritional Examination Surveys. We propose the use of a multidimensional measure using clinical indicators of health in the context of measuring income-related health inequality, and we examine the extent of income-related health inequality, as measured by the concentration index, using both self-reported measures of health and the multidimensional clinical measure. Our results confirm the existence of significant, positive, income-related reporting heterogeneity and also suggest that higher income individuals react more strongly to a change in clinical health measures. Using self-assessed health suggests that income-related health inequality is about three times larger than when using more objective, self-reported health measures and ten times larger than when using the multidimensional clinical measure of health.     

Community engagement in global health research that advances health equity

Community engagement is gaining prominence in global health research. So far, a philosophical rationale for why researchers should perform community engagement during such research has not been provided by ethics scholars. Its absence means that conducting community engagement is still often viewed as no more than a ‘good idea’ or ‘good practice’ rather than ethically required. In this article, we argue that shared health governance can establish grounds for requiring the engagement of low‐ and middle‐income country (LMIC) community members in global health research, where such research aims to help reduce health disparities. This philosophical basis has important implications for the ethical goals ascribed to engagement and the approach adopted to undertake it. We suggest the ethical goals of engagement in equity‐oriented global health research should include: (a) generating research topics and questions that reflect the key problems disadvantaged groups face in accessing healthcare, services and broader social determinants of health and (b) promoting the translation of research findings into policy and practice in ways that benefit the health of disadvantaged groups. We propose engagement practice should have the following features: deliberation with LMIC community members to make a range of project decisions, beginning with setting research topics and questions; inclusion of members of disadvantaged groups and those with the power to change policy and practice to benefit them; and purposeful structuring of deliberations to minimize the impact of power disparities between LMIC community members. Finally, we reflect on how these features differ from those typical of much current community engagement practice in LMICs.     

白洋淀生态系统健康评价

涵盖热力学指标的指标体系可全面表征湖泊生态系统在受扰条件下的健康状态。本文在实地监测的基础上,应用浮游植物生物量(BA)、浮游动物生物量/浮游植物生物量(BZ/BA)浮游植物群落初级生产量(P)、能质(Ex)、结构能质(Exst)和浮游植物对TP的缓冲能力(βp)表征白洋淀的健康状态,并通过集成健康综合指数,确定了白洋淀14个水域的健康等级。结果表明,白洋淀大部分水域健康受损较为严重。枣林庄和采蒲台水域处于亚健康状态,烧车淀、光淀张庄和东田庄水域处于不健康状态,其余9个水域均处于病态。结合各水域人类干扰活动的分布可知,白洋淀健康退化的程度与人类干扰强度密切相关。府河和淀内居民生活及水产养殖污水排放是造成白洋淀健康受损的主要原因。该结果可为白洋淀生态系统的管理和修复提供一定的科学依据。     

The intersection of social determinants of health,the microbiome,and health outcomes in immigrants: A scoping review

In the present scoping review, we explore whether existing evidence supports the premise that social determinants of health (SDoH) affect immigrant health outcomes through their effects on the microbiome. We adapt the National Institute on Minority Health and Health Disparities' research framework to propose a conceptual model that considers the intersection of SDoH, the microbiome, and health outcomes in immigrants. We use this conceptual model as a lens through which to explore recent research about SDoH, biological factors associated with changes to immigrants' microbiomes, and long-term health outcomes. In the 17 articles reviewed, dietary acculturation, physical activity, ethnicity, birthplace, age at migration and length of time in the host country, socioeconomic status, and social/linguistic acculturation were important determinants of postmigration microbiome-related transformations. These factors are associated with progressive shifts in microbiome profile with time in host country, increasing the risks for cardiometabolic, mental, immune, and inflammatory disorders and antibiotic resistance. The evidence thus supports the premise that SDoH influence immigrants' health postmigration, at least in part, through their effects on the microbiome. Omission of important postmigration social-ecological variables (e.g., stress, racism, social/family relationships, and environment), limited research among minoritized subgroups of immigrants, complexity and inter- and intra-individual differences in the microbiome, and limited interdisciplinary and biosocial collaboration restrict our understanding of this area of study. To identify potential microbiome-based interventions and promote immigrants' well-being, more research is necessary to understand the intersections of immigrant health with factors from the biological, behavioral/psychosocial, physical/built environment, and sociocultural environment domains at all social-ecological levels.     

Self-efficacy and the promotion of health for depressed single mothers

Single mothers are a vulnerable population at risk for poor mental and physical health. This paper discusses the mental and physical health of single mothers, as well as the psychosocial and socio-economic risk factors placing single mothers at risk for poor health outcomes. Some of these include, gender, income level, educational status, social support, stress and certain personality characteristics. Theoretical models with the potential to explore ways to promote health in depressed single mothers will also be presented. The paper concludes with the application of these models to primary prevention and the promotion of health for single mothers along with recommendations for future research.     

Integrating mental health into primary health care in Iraq

The Ministry of Health in Iraq is undertaking a systematic programme to integrate mental health into primary care in order to increase population access to mental health care. This paper reports the evaluation of the delivery of a ten day interactive training programme to 20% of primary care centres across Iraq. The multistage evaluation included a pre- and post-test questionnaire to assess knowledge, attitudes and practice in health workers drawn from 143 health centres, a course evaluation questionnaire and, in a random sample of 41 clinics, direct observation of health workers skills and exit interviews of patients, comparing health workers who had received the training programme with those from the same clinics who had not received the training. Three hundred andseventeen health workersparticipated in the training, which achieved an improvement in test scores from 42.3% to 59%. Trained health workers were observed by research psychiatrists to have a higher level of excellent skills than the untrained health workers, and patient exit interviews also reported better skills in the trained rather than untrained health workers. The two week course has thus been able to achieve significant change, not only in knowledge, but also in subsequent demonstration of trained practitioners practical skills in the workplace. Furthermore, it has been possible to implement the course and the evaluation despite a complex conflict situation.     

African desert dust in the Caribbean atmosphere: Microbiology and public health

Air samples collected on St. John in the U.S.Virgin Islands were screened for the presenceof viable bacteria and fungi to determine ifthe number of cultivatable microbes in theatmosphere differed between ``clear atmosphericconditions' and ``African dust-events.' Resultsindicate that during ``African dust-events,' thenumbers of cultivatable airborne microorganismscan be 2 to 3 times that found during ``clearatmospheric conditions.' Direct microbialcounts of air samples using an epifluorescentmicroscopy assay demonstrated that during an``African dust-event,' bacteria-like andvirus-like particle counts were approximatelyone log greater than during ``clear atmosphericconditions.' Bacteria-like particles exhibitingautofluoresence, a trait of phototrophs, wereonly detected during an ``African dust-event.'     

景观健康概念、特征及其评价

景观健康是近年来出现景观生态学与新兴的生态系统健康学领域的一个新的生态学概念,旨在探讨人类强烈活动干扰下遭受严重污染与退化,甚至会逐渐消失的景观生态系统的健康问题。本文针对目前所存在的有关景观健康的基本概念,景观健康的特征与标准进行了详细介绍,并就景观健康评价指标的确立,评价时空尺度与等级以及评价方法分别进行了探讨。最后,还强调了在进行景观健康评价时应运用比较的,综合的以及发展的观点开展研究。     

Monitoring the health of selected eastern arc forests in Tanzania

The eastern arc mountains (EAMs) are a chain of isolated mountains (534,000 ha) in Kenya and Tanzania surrounded by arid woodlands and influenced by the Indian Ocean. In 1900 there was three times the amount of forest cover there is today. Much of the original forests have been converted into agricultural crops. These mountains are recognized as a globally important ‘hot spot’ by World Wide Fund for Nature (WWF) and World Conservation of Union (IUCN) for forest biodiversity and are major national, regional and local sources of hydropower, water and wide array of forest‐based benefits and agricultural production. In February 2000 we began a 3‐year evaluation of forest health, land‐use change and information sharing in the EAMs. Permanent sample plots were used to evaluate forest health. This paper summarizes the baseline data from eighteen permanent sample plots in the east Usambara's and nine in Ulugurus. The eastern arc web site ( http://www.easternarc.org ) was established, continues to expand and contains some detailed information on the project. Information gathered will assist land managers, planners, policy makers, interested communities (villages) and individuals in decision‐making. These data can also provide an early warning system of stresses on forest catchments.     

Effects of parental public health insurance eligibility on parent and child health outcomes

Many states expanded their Medicaid programs to low-income adults under the Affordable Care Act (ACA). These expansions increased Medicaid coverage among low-income parents and their children. Whether these improvements in coverage and healthcare use lead to better health outcomes for parents and their children remains unanswered. We used longitudinal data on a large, nationally representative cohort of elementary-aged children from low-income households from 2010 to 2016. Using a difference-in-differences approach in state Medicaid policy decisions, we estimated the effect of the ACA Medicaid expansions on parent and child health. We found that parents’ self-reported health status improved significantly post-expansion in states that expanded Medicaid through the ACA by 4 percentage points (p < 0.05), a 4.7% improvement. We found no significant changes in children’s use of routine doctor visits or parents’ assessment of their children’s health status. We observed modest decreases in children’s body mass index (BMI) of about 2% (p < 0.05), especially for girls.     

Lessons learned in developing community mental health care in Africa

This paper summarizes the findings for the African Region of the WPA Task Force on Steps, Obstacles and Mistakes to Avoid in the Implementation of Community Mental Health Care. We present an overview of mental health policies, plans and programmes in the African region; a summary of relevant research and studies; a critical appraisal of community mental health service components; a discussion of the key challenges, obstacles and lessons learned, and some recommendations for the development of community mental health services in the African region.     

Designing research funding schemes to promote global health equity: An exploration of current practice in health systems research

International research is an essential means of reducing health disparities between and within countries and should do so as a matter of global justice. Research funders from high‐income countries have an obligation of justice to support health research in low and middle‐income countries (LMICs) that furthers such objectives. This paper investigates how their current funding schemes are designed to incentivise health systems research in LMICs that promotes health equity. Semi‐structured in‐depth interviews were performed with 16 grants officers working for 11 funders and organisations that support health systems research: the Alliance for Health Policy and Systems Research, Comic Relief, Doris Duke Foundation, European Commission, International Development Research Centre, Norwegian Agency for Development Cooperation, Research Council of Norway, Rockefeller Foundation, UK Department of International Development, UK Medical Research Council, and Wellcome Trust. Thematic analysis of the data demonstrates their funding schemes promote health systems research with (up to) five key features that advance health equity: being conducted with worst‐off populations, focusing on research topics that advance equitable health systems, having LMIC ownership of the research agenda, strengthening LMIC research capacity, and having an impact on health disparities. The different types of incentives that encouraged proposed projects to have these features are identified and classified by their strength (strong, moderate, weak). It is suggested that research funders ought to create and maintain funding schemes with strong incentives for the features identified above in order to more effectively help reduce global health disparities.