Epidemiology and social justice in light of social determinants of health research
social determinants of health
public health ethics
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The present article identifies how social determinants of health raise two categories of philosophical problems that also fall within the smaller domain of ethics; one set pertains to the philosophy of epidemiology, and the second set pertains to the philosophy of health and social justice. After reviewing these two categories of ethical concerns, the limited conclusion made is that identifying and responding to social determinants of health requires inter-disciplinary reasoning across epidemiology and philosophy. For the reasoning used in epidemiology to be sound, for its scope and (moral) purpose as a science to be clarified as well as for social justice theory to be relevant and coherent, epidemiology and philosophy need to forge a meaningful exchange of ideas that happens in both directions.
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Good Practices in Health Financing : Lessons from Reforms in Low and Middle-Income CountriesWaters, Hugh R.; Schieber, George J.; Gottret, Pablo (Washington, DC : World Bank, 2012-05-25)This volume focuses on nine countries that have completed, or are well along in the process of carrying out, major health financing reforms. These countries have significantly expanded their people's health care coverage or maintained such coverage after prolonged political or economic shocks. In doing so, this report seeks to expand the evidence base on good performance in health financing reforms in low- and middle-income countries. The countries chosen for the study were Chile, Colombia, Costa Rica, Estonia, the Kyrgyz Republic, Sri Lanka, Thailand, Tunisia, and Vietnam. With health at the center of global development policy on humanitarian as well as economic and health security grounds, the international community and developing countries are closely focused on scaling up health systems to meet the Millennium Development Goals (MDGs), improving financial protection, and ensuring long-term financing to sustain these gains. With the scaling up of aid, both donors and countries have come to realize that money alone cannot buy health gains or prevent impoverishment due to catastrophic medical bills. This realization has sent policy makers looking for reliable evidence about what works and what does not, but they have found little to guide their search.
Who pays? Out-of-Pocket Health Spending and Equity Implications in the Middle East and North AfricaElgazzar, Heba; Arfa, Chokri; Salti, Nisreen; Majbouri, Mehdi; Salehi-Isfahani, Djavad; Raad, Firas; Chaaban, Jad; Fesharaki, Sanaz; Mataria, Awad (World Bank, Washington, DC, 2013-05-29)Ensuring affordable, effective health care and financial protection against the adverse effects of household out-of-pocket (OOP) health expenditures represents an important policy objective in most countries, yet relatively little evidence exists regarding patterns and implications of household health expenditures in the Middle East and North Africa (MENA) region. This paper examines the scope of out-of-pocket expenditures and their implications on living standards and policy reforms in six MENA countries including Yemen, the West Bank and Gaza, Egypt, Iran, Tunisia, and Lebanon. Results show that OOP payments represent a relatively high share of total national health care financing at 49 percent on average in the MENA region as of 2006. Households pay an average of 6 percent of their total household expenditure on health. Most of this OOP is spent on medications, doctor visits and diagnostic services. Lower-income and rural households generally face greater financial risk; yet this is reversed where private health services are utilized and paid for more frequently by higher-income groups. 7 to 13 percent of households face particularly high OOP payments, or catastrophic expenditures equal to at least 10 percent of household spending. Poverty rates tend to increase by up to 20 percent after health care spending is accounted for. Results are discussed in light of ongoing policy efforts to strengthen social protection for health care.
Turkey on the Way of Universal Health Coverage through the Health Transformation Program (2003-13)Aran, Meltem; Rokx, Claudia; Bump, Jesse; Celik, Yusuf; Sparkes, Susan; Tatar, Mehtap (World Bank Group, Washington, DC, 2014-12-31)Beginning in 2003, Turkey initiated a
series of reforms under the Health Transformation Program
(HTP) that over the past decade have led to the achievement
of universal health coverage (UHC). The progress of Turkey s
health system has few if any parallels in scope and
speed. Before the reforms, Turkey s aggregate health
indicators lagged behind those of OECD member states and
other middle-income countries. The health financing system
was fragmented, with four separate insurance schemes and a
Green Card program for the poor, each with distinct
benefits packages and access rules. Both the Ministry of
Labor and Social Security and Ministry of Health (MoH) were
providers and financiers of the health system, and four
different ministries were directly involved in public health
care delivery. Turkey s reform efforts have impacted
virtually all aspects of the country s health system and
have resulted in the rapid expansion of the proportion of
the population covered and of the services to which they are
entitled. At the same time, financial protection has
improved. For example, (i) insurance coverage increased from
64 to 98 percent between 2002 and 2012; (ii) the share of
pregnant women having four antenatal care visits increased
from 54 to 82 percent between 2003 and 2010; and (iii)
citizen satisfaction with health services increased from
39.5 to 75.9 percent between 2003 and 2011. Despite dramatic
improvements there is still space for Turkey to continue to
improve its citizens health outcomes, and challenges lie
ahead for improving services beyond primary care. The main
criticism to reform has so far come from health sector
workers; the future sustainability of reform will rely not
only on continued fiscal support to the health sector but
also the maintenence of service provider satisfaction.