Focus: Health Equity: Financial Protection Indexes and the Iranian Health Transformation Plan: A Systematic Review

Background: On May 5, 2014, the Iranian Ministry of Health and Medical Education launched the Health Transformation Plan (HTP) as a major healthcare reform to curb out-of-pocket (OOP) expenses and protect people from catastrophic health expenditures (CHEs). Therefore, in this study, we conducted a comprehensive literature search with the aim of systematically investigating the impacts of HTP on OOP and CHE after the implementation of the plan. Method: Web of Science, PubMed, Scopus, Embase, and Iranian bibliographic thesauri and repositories such as MagIran, Elmnet, and Scientific Information Database were searched. Studies published between May 2014 and December 2020 that reported the impact of HTP on the financial indicators under investigation in this study (OOP and CHEs) that were conducted in Iran. Estimated pooled change both for OOP and CHEs was calculated as effect size utilizing meta-analytical techniques. Also, heterogeneity among studies was assessed with the I² statistics. Results: Seventeen studies were included, nine of which evaluated the OOP index, six studies assessed the CHEs index, and two studies examined both the OOP and CHEs indexes. The OOP was found to decrease after the implementation of the HTP (with an estimated decrease of 13.02% (95% CI: 9.09-16.94). Also, CHEs experienced a decrease of 5.80% (95% CI: 3.85-7.74). Conclusion: The findings show that the implementation of HTP has reduced health costs. In this regard and in order to keep reducing the costs that many people are unable to pay, the government and other organizations involved in the health system should provide sustainable financial resources in order to continue running HTP. However, there remain gaps and weaknesses that can be solved through discussion with all the actors involved.     

同一个世界 同一个健康

随着工业化和城镇化水平的持续提高,人类的生活方式发生了翻天覆地的变化,在传统因素依然制约人类健康的同时,食源性疾病与营养结构不合理、畜禽养殖方式转变与宠物快速发展带来人与动物关系深刻变化、生态环境与居住环境变化等非传统因素,对人类健康的制约凸显。面对这些人类健康的新挑战,我们必须因应时代变化,在大力发展医疗卫生事业的同时,树立营养健康、动物健康、环境健康三位一体的现代健康新理念。努力提高营养健康水平,以宠物健康为新的关注点高度重视动物健康,以人居、社区环境为重点营造健康生态环境,建立起现代健康新模式。     

The Health of Ecology and the Ecology of Health

The health of ecology refers to ecosystem health—an extension of the concept of health to the ecosystem level. Health is reflected in the absence of distress syndrome, and by productivity, organization and resilience that characterize sustainability in the Earth's ecosystems. Transformation of ecosystems under stress from healthy to pathological conditions is often irreversible, even when the initial stress factors are removed. The ecology of health refers to the fact that human health is influenced by ecological conditions. The breakdown of ecosystems under stress are often conducive to an increase in human pathogens, recycling toxic substances, reduced yields and compromised food supplies, scarcity of potable water, and air pollution, all of which increases human health vulnerability. Addressing human health issues from an ecological perspective takes account of the social, ecological, and biophysical determinants. This opens the door to potential interventions “upstream”, in order to prevent illness, in addition to treating the disease once the malady has occurred.     

Health Development Meets the End of State Socialism: Visions of Democratization, Women's Health, and Social Well-Being for Contemporary Russia

As development organizations undertake thetask of improving the public health in formersocialist states, their interventions are shaped by aparticular cultural logic and predetermined frame ofpossible action. In the context of local encounters,however, they often confront competing interpretationsof a society's prevailing needs. How they managesuch differences may not only explain the outcomes ofa given project, but may also reveal the capacitiesand limitations of development agencies to engineerpost-socialist change. This article examines a recentWHO project in St. Petersburg, Russia, which definedwomen's ``social well-being' as a local health concern.While the project employed a discourse of ``democracy'to promote women's empowerment in the clinic, itsparameters of intervention neither incorporated localknowledge nor addressed the structural relationsunderlying clinic-level conflicts. Two kinds ofresults ensued: the ideology of democracy wasrejected, while WHO's recommendations were partiallyappropriated as profit-making strategies.     

卫生信息化背景下电子健康档案建设的法律思考

在卫生信息化日快速发展的背景下, 电子健康档案日益被重视并开始逐步推广,但是其中存在的法律问题也同时显现。在分析我国电子健康档案信息安全的基础上,对电子健康档案的法律地位、患者的隐私权、医师注意义务以及政府的公共行政权利等方面进行了探讨。     

Quantifying Health Across Populations

In this article, I argue that as a theoretical matter, a population's health‐level is best quantified via averagism. Averagism asserts that the health of a population is the average of members’ health‐levels. This model is better because it does not fall prey to a number of objections, including the repugnant conclusion, and because it is not arbitrary. I also argue that as a practical matter, population health‐levels are best quantified via totalism. Totalism asserts that the health of a population is the sum of members’ health‐levels. Totalism is better here because it fits better with cost‐benefit analysis and such an analysis is the best practical way to value healthcare outcomes. The two results are compatible because the theoretical and practical need not always align, whether in general or in the context of population health.     

Beyond the Hazard: The Role of Beliefs in Health Risk Perception

This article addresses how beliefs about health risks cluster and how these relate to perceptions of risk among Canadians. A principal components analysis conducted on items reflecting various beliefs from the Canadian National Health Risk Perception Survey extracted four underlying dimensions: Cancer Dread, Trust in Regulators, Environmental Concern, and Personal Agency. Factor scores were then used to investigate relationships between belief factors and the perceived health risk of various hazards with gender, education, income, and province of residence as covariates. Environmental and Therapeutic health risk perceptions were significantly higher in respondents with high Cancer Dread and high Environmental Concern, but lower in respondents with high Trust in Regulators. Environmental health risk perceptions were lower in respondents with high Personal Agency, whereas Social health risk perceptions were higher in respondents with high Cancer Dread and Personal Agency. Results suggest that information about health risk–related beliefs can be useful in improving our understanding of the public's perceived risk of health hazards.     

美国区域卫生信息化及有效使用电子健康档案的启示

通过介绍美国区域卫生信息化发展、有效使用EHR计划、区域卫生信息化组织等，探讨推进区域卫生信息化和电子健康档案应用过程中的问题和挑战，包括公共医学术语和技术标准、电子健康档案及区域卫生信息化潜在经济效益、电子健康档案应用保障机制、区域卫生信息化水平评价及区域卫生信息化组织可持续运营等，以提供借鉴。     

基层医疗卫生服务体系建设现状分析

梳理及归纳了我国在转变基层医疗卫生机构运行机制和服务模式,改善社区卫生、农村卫生的结构与功能,完善投入机制,加强基层卫生人才队伍建设,努力构建城乡一体化的基层医疗卫生服务体系等方面的探讨与实践,为建立健全基层医疗卫生服务体系,使城乡居民享受到安全、有效、方便、价廉的基本医疗服务提供参考。     

Including Ethnic Minorities in Mental Health Intervention Research: A Practical Approach to a Long-Standing Problem

This paper examines a controversy that arose while developing a supplement to Mental Health: A Report of the Surgeon General that was focused on ethnic minority mental health. The controversy involved whether and how to make recommendations about ethnic minorities seeking mental health care. We found that few studies provided information on outcomes of mental health care for ethnic minorities. In this paper, we discuss outcomes of mental health care for ethnic minorities and how to proceed in developing an evidence base for understanding mental health care and minorities. We conclude that entering representative (based on population) numbers of ethnic minorities in efficacy trials is unlikely to produce useful information on outcomes of care because the numbers will be too small to produce reliable findings. We also conclude that while conducting randomized efficacy trials for all mental health interventions for each ethnic group would be impractical, innovative and theoretically informed studies that focus on specific cultural groups are needed to advance the knowledge base. We call for theory-driven research focused on mental health disparities that has the potential for understanding disparities and improving outcomes for ethnic minority populations.     

Health Security and Risk Aversion

Health security has become a popular way of justifying efforts to control catastrophic threats to public health. Unfortunately, there has been little analysis of the concept of health security, nor the relationship between health security and other potential aims of public health policy. In this paper I develop an account of health security as an aversion to risky policy options. I explore three reasons for thinking risk avoidance is a distinctly worthwhile aim of public health policy: (i) that security is intrinsically valuable, (ii) that it is necessary for social planning and (iii) that it is an appropriate response to decision‐making in contexts of very limited information. Striking the right balance between securing and maximizing population health thus requires a substantive, and hitherto unrecognized, value judgment. Finally, I critically evaluate the current health security agenda in light of this new account of the concept and its relationship to the other aims of public health policy.     

Trichloroethylene in the Environment: Public Health Concerns

The Agency for Toxic Substances and Disease Registry (ATSDR) prepares toxi-cological profiles for hazardous substances found at waste sites and elsewhere in the environment. In 1997 the agency updated its toxicological profile for trichloroethylene and included new and expanded information on the health effects associated with exposures to trichloroethylene. Several endpoints of concern are described in the profile. However, in this paper only results from studies reporting developmental and carcinogenic effects from trichloroethylene exposures in human and experimental animal studies are summarized and evaluated. Based on its assessment of the available studies and limitations in the reported findings, ATSDR has determined there is limited but suggestive evidence that developmental effects may be a concern for some persons exposed to TCE in drinking water. Moreover, developmental effects may be the most sensitive of all non-cancer health effects associated with trichloroethylene exposures. Significant questions remain about the likely mode(s) of action for TCE-induced carcinogenesis in humans and the basis for differences in pharmacokinetics handling of TCE across animal strains and sex. However, on the basis of animal data and the suggestive, yet inconclusive, human data available, ATSDR has determined that cancer should be an effect of concern for people exposed to TCE in the environment. ATSDR agrees that the available literature supports the premise that TCE is “reasonably anticipated to be a human carcinogen” as defined by the U.S. National Toxicology Program.     

Dryland Salinity and Ecosystem Distress Syndrome: Human Health Implications

Clearing of native vegetation for agriculture has left 1.047 million hectares of southwest Western Australia affected by dryland salinity, and this area may expand up to a further 1.7–3.4 million hectares if trends continue. Ecosystems in saline-affected regions display many of the classic characteristics of Ecosystem Distress Syndrome, one outcome of which has not yet been investigated in relation to dryland salinity: adverse human health implications. This article seeks to review existing information and identify potential adverse human health effects. Three key potential impacts on human health resulting from dryland salinity are identified: wind-borne dust and respiratory health; altered ecology of the mosquito-borne disease Ross River virus; and mental health consequences of salinity-induced environmental degradation. Given the predicted increase in extent and severity of dryland salinity over coming decades, adverse outcomes of salinity are likely to be further exacerbated, including those related to human health. There is a clear need to investigate the issues discussed in this review and also to identify other potential adverse health effects of dryland salinity. Investigations must be multidisciplinary to sufficiently examine the broad scope of these issues. The relationship between human health and salinity may also be relevant beyond Australia in other countries where secondary soil salinization is occurring.     

Fair Resource Allocation to Health Research: Priority Topics for Bioethics Scholarship

This article draws attention to the limited amount of scholarship on what constitutes fairness and equity in resource allocation to health research by individual funders. It identifies three key decisions of ethical significance about resource allocation that research funders make regularly and calls for prioritizing scholarship on those topics – namely, how health resources should be fairly apportioned amongst public health and health care delivery versus health research, how health research resources should be fairly allocated between health problems experienced domestically versus other health problems typically experienced by disadvantaged populations outside the funder's country, and how domestic and non‐domestic health research funding should be further apportioned to different areas, e.g. types of research and recipients. These three topics should be priorities for bioethics research because their outcomes have a substantial bearing on the achievement of health justice. The proposed agenda aims to move discussion on the ethics of health research funding beyond its current focus on the mismatch between worldwide basic and clinical research investment and the global burden of disease. Individual funders’ decision‐making on whether and to what extent to allocate resources to non‐domestic health research, health systems research, research on the social determinants of health, capacity development, and recipients in certain countries should also be the focus of ethical scrutiny.     

An Integrated Framework for Risk Management and Population Health

The traditional medical model of health and health policy development has focused on individuals and the role of medical care in preventing and treating disease and injury. Recent attention to health inequities and social determinants of health has raised the profile of population heath and evidence-based strategies for improving the health of whole populations. At the same time, risk science has emerged as an important new discipline for the assessment and management of risks to health. This article reviews historical developments in the fields of risk management and population health and proposes a joint population health risk management framework that integrates the key elements of both fields. Applying this integrated approach to managing population health risks will facilitate the development of evidence-based health policy. It will encourage a more systematic and comprehensive evaluation of population health issues and promote the use of a broader suite of interventions to reduce health risks and enhance population health status.     

Wuhan, China and Pittsburgh, USA: Urban Environmental Health Past, Present, and Future

This article briefly reviews environmental history in the “Sister Cities” of Wuhan, China and Pittsburgh, USA. Specifically, it analyzes key changes in air, water, land, and sustainability in each of the two cities in terms of both “driving forces” and of the actions of key stakeholders (policymakers, educators, industry/business, nongovernmental organizations [NGOs], and the public). It concludes by discussing prospects for synergies between the two cities in continuing to improve environmental health, and the implications of these ideas for other cities in both the “developing” and the “developed” world.     

Transforming Global Health with Mobile Technologies and Social Enterprises: Global Health and Innovation Conference

More than 2,000 people convened for the ninth annual Global Health and Innovation Conference at Yale University on April 21-22, 2012. Participants discussed the latest innovations, ideas in development, lessons learned, opportunities and challenges in global health activities. Several themes emerged, including the important role of frontline workers, strengthening health systems, leveraging social media, and sustainable and impact-driven philanthropy. Overall, the major outcome of the conference was the increased awareness of the potential of mobile technologies and social enterprises in transforming global health. Experts warned that donations and technological advances alone will not transform global health unless there are strong functioning health infrastructures and improved workforce. It was noted that there is a critical need for an integrated systems approach to global health problems and a need for scaling up promising pilot projects. Lack of funding, accountability, and sustainability were identified as major challenges in global health.