Are we ready to build health systems that consider the climate?

At last, climate change does appear to have entered mainstream consciousness. In the scientific community, the climate change debate has shifted from focusing on establishing the truth of the claim that climate change is a reality to warming public opinion to the cause and acknowledging that climate change will have far-reaching effects on how we build, organize and manage climate-responsive social systems including health care systems. There is particular urgency to the debate for health services and systems in low income countries where some of the worst effects of climate change will be felt and where health systems are already over-stretched due to long-term lack of investment, a double burden of disease (preventive and non-communicable), a crisis in human resources and governance deficiencies. Despite the urgency, the health care systems development community appears insular in its interests and actions, and a clear leader that could coordinate the activities of different researchers, research bodies, policy makers and international organizations across relevant sectors including disaster management, climate and health care systems, has yet to emerge. This essay considers the political landscape, possible leaders and why it is necessary for health systems' professionals to move beyond the health sector in order to secure support for health and health care systems development in a post-Millennium Development Goals development framework that is defined by climate change

The development and psychometric properties of the Humanitarian Emergency Settings Perceived Needs (HESPER) Scale

Objectives. We developed the Humanitarian Emergency Settings Perceived Needs (HESPER) Scale, a valid and reliable scale to rapidly assess perceived needs of populations in humanitarian settings in low- and middle-income countries. Methods. We generated items through a literature review; reduced the number of items on the basis of a survey with humanitarian experts; pilot-tested the scale in Gaza, Jordan, Sudan, and the United Kingdom; and field-tested it in Haiti, Jordan, and Nepal. Results. During field-testing, intraclass correlation coefficients (absolute agreement) for the total number of unmet needs were 0.998 in Jordan, 0.986 in Haiti, and 0.995 in Nepal (interrater reliability), and 0.961 in Jordan and 0.773 in Nepal (test–retest reliability). Cohen’s κ for the 26 individual HESPER items ranged between 0.66 and 1.0 (interrater reliability) and between 0.07 and 1.0 (test–retest reliability) across sites. Most HESPER items correlated as predicted with related questions of the World Health Organization Quality of Life-100 (WHOQOL-100), and participants found items comprehensive and relevant, suggesting criterion (concurrent) validity and content validity. Conclusions. The HESPER Scale rapidly provides valid and reliable population-based data on perceived needs in humanitarian settings

The governance of the World Bank: Lessons from the corporate sector

World Bank, Governance, Representation, Accountability, Evaluation, F330, F530, G300,