Putting health in all policies: The National Institute for Welfare Enhancement

Welfare is a rather vague term whose meaning depends on ideology, values and judgments. Material resources are just means to enhance people’s well-being, but growth of the Gross Domestic Production is still the standard measure of the success of a society. Fortunately, recent advances in measuring social performance include health, education and other social outcomes. Because “what we measure affects what we do” it is hoped that social policies will change. The movement Health in all policies and its associated Health Impact Assessment methodology will contribute to it. The task consists of designing transversal policies that consider health and other welfare goals, the short term and long-term implications and intergenerational redistributions of resources. As long as marginal productivity on health outside the healthcare system is higher than inside it, efficiency needs cross-sectoral policies. And fairness needs them even more, because in order to reduce social inequalities in health, a wide social and political response is needed. Unless we reduce the well-documented inefficiencies in our current health care systems the welfare states will fail to consolidate and the overall economic wellbeing could be in serious trouble. In this article we sketched some policy solutions such as pricing according to net benefits of innovation and public encouragement of radical innovation besides the small type incremental and market-led innovation. We proposed an independent agency, the National Institute for Welfare Enhancement to guarantee long term fair and efficient social policies in which health plays a central role.Public health policies; Health Impact Assessment; Welfare; Health in All Policies.

Sustainable urban liveability : a practical proposal based on a composite indicator

This article presents a proposal for a composite index to assess the degree of sustainable urban liveability. It makes two key contributions to this field of study. The first is a proposal for the concept of sustainable urban liveability that includes the need to meet a minimum number of environmental conditions in terms of resource consumption and the deterioration of the environment. The second contribution is the use of a non-compensatory aggregation technique in order to construct the composite index. This kind of aggregation technique does not allow trade-offs between partial indicators. In the particular context of sustainable urban liveability, it prevents poor performance by the natural environment indicators from being compensated by positive results in the remaining indicators. The proposed composite index for sustainable urban liveability is applied to the case of 58 Spanish cities. The results reveal significant differences in the degree of sustainable urban liveability for this group of cities, but more importantly, they highlight the potential of this proposal for urban managementS

Danger: local corruption is contagious!

Corruption is a major problem, and not only in developing countries. It impedes economic growth, weakens the rule of law and undermines the legitimacy of institutions. Although it has been studied at national level from different perspectives, there is a recent growing body of research on local corruption. As far as we know, these latter studies focused on corruption and its effects on votes. However, a further question arises as to whether there is a mimetic effect on neighbouring municipalities? We employ data from Spain, and the boom in local corruption in the 2000s, to respond to this question. Specifically we have constructed a panel database (2001-2010) on local characteristics, economic factors and corruption at local level in order to achieve this. Our spatial econometrics methodology supports the hypothesis that corruption is not local-specific, and leads to two opposing outcomes: on the one hand, local corruption is contagious and the probability of being ‘infected’ increases by 3.1 per cent for each corrupt neighbouring municipality; on the other hand the likelihood of a municipality being taken to court increases by 6.7 per cent for each neighbouring municipality accused. Although the former is alarming, the latter provides hope in the fight against local corruption

The effect of a change in co-payment on prescription drug demand in a National Health System: The case of 15 drug families by price elasticity of demand.

OBJECTIVES: To test the heterogeneity of the effect of a change in pharmaceutical cost-sharing by therapeutic groups in a Spanish region. METHODS: Data: random sample (provided by the Canary Islands Health Service) of 40,471 people covered by the Spanish National Health System (SNHS) in the Canary Islands. The database includes individualised monthly-dispensed medications (prescribed by the SNHS) from one year before (August 2011) to one year after (June 2013) the Royal Decree Law 16/2012 (RDL 16/2012). Sample: two intervention groups (low-income pensioners and middle-income working population) and one control group (low-income working population). Empirical model: quasi-experimental difference-in-differences design to study the change in consumption (measured in number of monthly Defined Daily Dose (DDDs) per individual) among 13 therapeutic groups. The policy break indicator (three-level categorical variable) tested the existence of stockpiling between the reform's announcement and its implementation. We ran 16 linear regression models (general, by therapeutic groups and by comorbidities) that considered whether the exclusion of some drugs from public provision impacted on consumption more than the co-payment increase. RESULTS: General: Reduction (-13.04) in consumption after the reform's implementation, which was fully compensated by a previous increase (16.60 i.e., stockpiling) among low-income pensioners. The middle-income working population maintained its trend of increasing consumption. Therapeutic groups: Reductions in consumption after the reform's implementation among low-income pensioners in 7 of the 13 groups, which were fully compensated for by a previous increase (i.e., stockpiling) in 4 groups and partially compensated for in the remaining 3. The analysis without the excluded medicines provided fewer negative coefficients. Comorbidities: Reduction in consumption that was only slightly compensated for by a previous increase (i.e., stockpiling). CONCLUSIONS: The negative impact of cost-sharing produced, among low-income pensioners, a risk of loss of adherence to treatments, which could deteriorate the health status of individuals, especially among pensioners within the most inelastic therapeutic groups (associated with chronic diseases) and patients with comorbidities (also, associated with chronic diseases). Notwithstanding the above, this risk was more related to the exclusion of some drugs from provision than to the cost-sharing increase

Drug utilization studies and data registries in primary care

This article reviews the methodology of the studies on drug utilization with particular emphasis on primary care. Population based studies of drug inappropriateness can be done with microdata from Health Electronic Records and e-prescriptions. Multilevel models estimate the influence of factors affecting the appropriateness of drug prescription at different hierarchical levels: patient, doctor, health care organization and regulatory environment. Work by the GIUMAP suggest that patient characteristics are the most important factor in the appropriateness of prescriptions with significant effects at the general practicioner level.Drug Utilization Studies, Multilevel Models, Primary Care, Health Information Systems, Health Economics.

Obesity and Cardiometabolic Risk Factors : from Childhood to Adulthood

Obesity has become a major epidemic in the 21st century. It increases the risk of dyslipidemia, hypertension, and type 2 diabetes, which are known cardiometabolic risk factors and components of the metabolic syndrome. Although overt cardiovascular (CV) diseases such as stroke or myocardial infarction are the domain of adulthood, it is evident that the CV continuum begins very early in life. Recognition of risk factors and early stages of CV damage, at a time when these processes are still reversible, and the development of prevention strategies are major pillars in reducing CV morbidity and mortality in the general population. In this review, we will discuss the role of well-known but also novel risk factors linking obesity and increased CV risk from prenatal age to adulthood, including the role of perinatal factors, diet, nutrigenomics, and nutri-epigenetics, hyperuricemia, dyslipidemia, hypertension, and cardiorespiratory fitness. The importance of 'tracking' of these risk factors on adult CV health is highlighted and the economic impact of childhood obesity as well as preventive strategies are discussed