Future and potential spending on health 2015-40: Development assistance for health, and government, prepaid private, and out-of-pocket health spending in 184 countries

Background: The amount of resources, particularly prepaid resources, available for health can affect access to health care and health outcomes. Although health spending tends to increase with economic development, tremendous variation exists among health financing systems. Estimates of future spending can be beneficial for policy makers and planners, and can identify financing gaps. In this study, we estimate future gross domestic product (GDP), all-sector government spending, and health spending disaggregated by source, and we compare expected future spending to potential future spending. Methods: We extracted GDP, government spending in 184 countries from 1980-2015, and health spend data from 1995-2014. We used a series of ensemble models to estimate future GDP, all-sector government spending, development assistance for health, and government, out-of-pocket, and prepaid private health spending through 2040. We used frontier analyses to identify patterns exhibited by the countries that dedicate the most funding to health, and used these frontiers to estimate potential health spending for each low-income or middle-income country. All estimates are inflation and purchasing power adjusted. Findings: We estimated that global spending on health will increase from US$9.21 trillion in 2014 to$24.24 trillion (uncertainty interval [UI] 20.47-29.72) in 2040. We expect per capita health spending to increase fastest in upper-middle-income countries, at 5.3% (UI 4.1-6.8) per year. This growth is driven by continued growth in GDP, government spending, and government health spending. Lower-middle income countries are expected to grow at 4.2% (3.8-4.9). High-income countries are expected to grow at 2.1% (UI 1.8-2.4) and low-income countries are expected to grow at 1.8% (1.0-2.8). Despite this growth, health spending per capita in low-income countries is expected to remain low, at $154 (UI 133-181) per capita in 2030 and$195 (157-258) per capita in 2040. Increases in national health spending to reach the level of the countries who spend the most on health, relative to their level of economic development, would mean $321 (157-258) per capita was available for health in 2040 in low-income countries. Interpretation: Health spending is associated with economic development but past trends and relationships suggest that spending will remain variable, and low in some low-resource settings. Policy change could lead to increased health spending, although for the poorest countries external support might remain essential

Global burden and strength of evidence for 88 risk factors in 204 countries and 811 subnational locations, 1990–2021: a systematic analysis for the Global Burden of Disease Study 2021

Background: Understanding the health consequences associated with exposure to risk factors is necessary to inform public health policy and practice. To systematically quantify the contributions of risk factor exposures to specific health outcomes, the Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) 2021 aims to provide comprehensive estimates of exposure levels, relative health risks, and attributable burden of disease for 88 risk factors in 204 countries and territories and 811 subnational locations, from 1990 to 2021. Methods: The GBD 2021 risk factor analysis used data from 54 561 total distinct sources to produce epidemiological estimates for 88 risk factors and their associated health outcomes for a total of 631 risk–outcome pairs. Pairs were included on the basis of data-driven determination of a risk–outcome association. Age-sex-location-year-specific estimates were generated at global, regional, and national levels. Our approach followed the comparative risk assessment framework predicated on a causal web of hierarchically organised, potentially combinative, modifiable risks. Relative risks (RRs) of a given outcome occurring as a function of risk factor exposure were estimated separately for each risk–outcome pair, and summary exposure values (SEVs), representing risk-weighted exposure prevalence, and theoretical minimum risk exposure levels (TMRELs) were estimated for each risk factor. These estimates were used to calculate the population attributable fraction (PAF; ie, the proportional change in health risk that would occur if exposure to a risk factor were reduced to the TMREL). The product of PAFs and disease burden associated with a given outcome, measured in disability-adjusted life-years (DALYs), yielded measures of attributable burden (ie, the proportion of total disease burden attributable to a particular risk factor or combination of risk factors). Adjustments for mediation were applied to account for relationships involving risk factors that act indirectly on outcomes via intermediate risks. Attributable burden estimates were stratified by Socio-demographic Index (SDI) quintile and presented as counts, age-standardised rates, and rankings. To complement estimates of RR and attributable burden, newly developed burden of proof risk function (BPRF) methods were applied to yield supplementary, conservative interpretations of risk–outcome associations based on the consistency of underlying evidence, accounting for unexplained heterogeneity between input data from different studies. Estimates reported represent the mean value across 500 draws from the estimate's distribution, with 95% uncertainty intervals (UIs) calculated as the 2·5th and 97·5th percentile values across the draws. Findings: Among the specific risk factors analysed for this study, particulate matter air pollution was the leading contributor to the global disease burden in 2021, contributing 8·0% (95% UI 6·7–9·4) of total DALYs, followed by high systolic blood pressure (SBP; 7·8% [6·4–9·2]), smoking (5·7% [4·7–6·8]), low birthweight and short gestation (5·6% [4·8–6·3]), and high fasting plasma glucose (FPG; 5·4% [4·8–6·0]). For younger demographics (ie, those aged 0–4 years and 5–14 years), risks such as low birthweight and short gestation and unsafe water, sanitation, and handwashing (WaSH) were among the leading risk factors, while for older age groups, metabolic risks such as high SBP, high body-mass index (BMI), high FPG, and high LDL cholesterol had a greater impact. From 2000 to 2021, there was an observable shift in global health challenges, marked by a decline in the number of all-age DALYs broadly attributable to behavioural risks (decrease of 20·7% [13·9–27·7]) and environmental and occupational risks (decrease of 22·0% [15·5–28·8]), coupled with a 49·4% (42·3–56·9) increase in DALYs attributable to metabolic risks, all reflecting ageing populations and changing lifestyles on a global scale. Age-standardised global DALY rates attributable to high BMI and high FPG rose considerably (15·7% [9·9–21·7] for high BMI and 7·9% [3·3–12·9] for high FPG) over this period, with exposure to these risks increasing annually at rates of 1·8% (1·6–1·9) for high BMI and 1·3% (1·1–1·5) for high FPG. By contrast, the global risk-attributable burden and exposure to many other risk factors declined, notably for risks such as child growth failure and unsafe water source, with age-standardised attributable DALYs decreasing by 71·5% (64·4–78·8) for child growth failure and 66·3% (60·2–72·0) for unsafe water source. We separated risk factors into three groups according to trajectory over time: those with a decreasing attributable burden, due largely to declining risk exposure (eg, diet high in trans-fat and household air pollution) but also to proportionally smaller child and youth populations (eg, child and maternal malnutrition); those for which the burden increased moderately in spite of declining risk exposure, due largely to population ageing (eg, smoking); and those for which the burden increased considerably due to both increasing risk exposure and population ageing (eg, ambient particulate matter air pollution, high BMI, high FPG, and high SBP). Interpretation: Substantial progress has been made in reducing the global disease burden attributable to a range of risk factors, particularly those related to maternal and child health, WaSH, and household air pollution. Maintaining efforts to minimise the impact of these risk factors, especially in low SDI locations, is necessary to sustain progress. Successes in moderating the smoking-related burden by reducing risk exposure highlight the need to advance policies that reduce exposure to other leading risk factors such as ambient particulate matter air pollution and high SBP. Troubling increases in high FPG, high BMI, and other risk factors related to obesity and metabolic syndrome indicate an urgent need to identify and implement interventions. Funding: Bill & Melinda Gates Foundation

Correlation of the Na

Geopolymer was used for the soil stabilization of Kedah’s soil at different ratios of solid to liquid and Na2SiO3 to NaOH in order to achieve the desired compressive strength. The geopolymerization process which produces an aluminosilicate gel was occurred due to the mixing of Kedah’s soil and fly ash with Na2SiO3 and NaOH. Soil stabilization by geopolymer was synthesized by the activation of fly ash and Kedah’s soil with Na2SiO3 and NaOH at different ratios of solid to liquid (1.5, 2.0, 2.5 and 3.0) and Na2SiO3 to NaOH (0.5, 1.0, 1.5, 2.0, 2.5 and 3.0) at a specific constant concentration of NaOH solution of 6M. The compressive strength up to 5.12 MPa was obtained at 3.0 of solid to liquid ratio and 2.5 of Na2SiO3 to NaOH ratio in 7 days curing at room temperature

Correlation of the Na2SiO3 to NaOH Ratios and Solid to Liquid Ratios to the Kedah’s Soil Strength

Geopolymer was used for the soil stabilization of Kedah’s soil at different ratios of solid to liquid and Na2SiO3 to NaOH in order to achieve the desired compressive strength. The geopolymerization process which produces an aluminosilicate gel was occurred due to the mixing of Kedah’s soil and fly ash with Na2SiO3 and NaOH. Soil stabilization by geopolymer was synthesized by the activation of fly ash and Kedah’s soil with Na2SiO3 and NaOH at different ratios of solid to liquid (1.5, 2.0, 2.5 and 3.0) and Na2SiO3 to NaOH (0.5, 1.0, 1.5, 2.0, 2.5 and 3.0) at a specific constant concentration of NaOH solution of 6M. The compressive strength up to 5.12 MPa was obtained at 3.0 of solid to liquid ratio and 2.5 of Na2SiO3 to NaOH ratio in 7 days curing at room temperature

Review on Potential of Geopolymer for Concrete Repair and Rehabilitation

Cracking, spalling, surface deterioration, seepage and other concrete damage of the existing infrastructure have raised concern among residents, local authorities and developers. Dealing with concrete infrastructure rehabilitation is an important issue due to most of infrastructures today are concrete based. To simply patch up the spalling concrete as temporary solution and sooner or later, the cracks will return to haunt. This paper reviewed the current research and studies on concrete repair materials, highlighting the properties of geopolymer. It covers geopolymer repair materials which addressed in the field of concrete infrastructure rehabilitation. Geopolymer had good repair characteristics and displays the potential as an excellent repair material

Review on Potential of Geopolymer for Concrete Repair and Rehabilitation

Cracking, spalling, surface deterioration, seepage and other concrete damage of the existing infrastructure have raised concern among residents, local authorities and developers. Dealing with concrete infrastructure rehabilitation is an important issue due to most of infrastructures today are concrete based. To simply patch up the spalling concrete as temporary solution and sooner or later, the cracks will return to haunt. This paper reviewed the current research and studies on concrete repair materials, highlighting the properties of geopolymer. It covers geopolymer repair materials which addressed in the field of concrete infrastructure rehabilitation. Geopolymer had good repair characteristics and displays the potential as an excellent repair material