How to secure the future funding and sustainability of UK care homes
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Value-based healthcare in Sweden: Reaching the next level
The need to get better value from healthcare investment has never been more important as ageing populations and increasing numbers of people with multiple chronic conditions force governments to make limited financial resources go further.
These pressures, along with a greater focus on patient-centred care, have raised the profile of VBHC, especially in European healthcare systems. Sweden, with its highly comprehensive and egalitarian healthcare system, has been a leader in implementing VBHC from the beginning, a fact that was underscored in a 2016 global assessment of VBHC published by The Economist Intelligence Unit.
This paper looks at the ways in which Sweden has implemented VBHC, the areas in which it has faced obstacles and the lessons that it can teach other countries and health systems looking to improve the value of their own healthcare investments.
Breast cancer patients and survivors in the Asia-Pacific workforce
With more older women also working, how will the rising trend of breast cancer survivorship manifest in workplace policies, practices and culture? What challenges do breast cancer survivors face when trying to reintegrate into the workforce, or to continue working during treatment? How can governments, companies and society at large play a constructive role?
This series of reports looks at the situation for breast cancer survivors in Australia, New Zealand and South Korea. It finds that while progress has been made, more needs to be done, particularly in South Korea, where public stigma around cancer remains high.The Cost of Silence
Cardiovascular diseases levy a substantial financial toll on individuals, their households and the public finances. These include the costs of hospital treatment, long-term disease management and recurring incidence of heart attacks and stroke. They also include the costs of functional impairment and knock-on costs as families may lose breadwinners or have to withdraw other family members from the workforce to care for a CVD patient. Governments also lose tax revenue due to early retirement and mortality, and can be forced to reallocate public finances from other budgets to maintain an accessible healthcare system in the face of rising costs.
As such, there is a need for more awareness of the ways in which people should actively work to reduce their CVD risk. There is also a need for more primary and secondary preventative support from health agencies, policymakers and nongovernmental groups.
To inform the decisions and strategies of these stakeholders, The Economist Intelligence Unit and EIU Healthcare, its healthcare subsidiary, have conducted a study of the prevalence and costs of the top four modifiable risk factors that contribute to CVDs across the Asian markets of China, Australia, Hong Kong, Japan, Singapore, South Korea, Taiwan and Thailand.
Download the report to learn more.
Projet global de financement pour l’élimination du cancer du col de l’utérus : Financer la prévention secondaire dans les contextes de faible revenu
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Medidas globales de financiación para eliminar el cáncer de cuello uterino:...
El cáncer de cuello uterino es el cuarto cáncer que se detecta con mayor frecuencia en mujeres en todo el mundo, aunque es uno de los tipos de cáncer que mejor se pueden tratar y más se pueden prevenir si se detectan a tiempo. La morbilidad y la mortalidad del cáncer de cuello uterino afectan de forma dispar a las mujeres de países con unos ingresos bajos o entre bajos y medios, y aquellas de los países más pobres. En 2020, la Organización Mundial de la Salud (OMS) introdujo una iniciativa global para erradicar el cáncer de cuello uterino como problema de salud pública, y estableció objetivos intermedios para 2030.
Aunque existen dificultades en países con bajos recursos en torno a la viabilidad a largo plazo y la sostenibilidad económica de las iniciativas para abordar esta prioridad urgente de salud, la idea de conseguir una erradicación representa una nueva oportunidad de adoptar un enfoque de continuidad, en el que se toma como base la cobertura sanitaria universal y se exploran enfoques innovadores en cuanto a la financiación y la prestación a medida que los países amplían sus servicios de erradicación.
En este informe de The Economist Intelligence Unit se exploran algunos de desafíos de alto nivel asociados a la financiación de la erradicación del cáncer de cuello uterino en países con recursos limitados. Se aprovechar el conjunto de prioridades que se presenta a continuación para involucrar a los responsables de la toma de decisiones de financiación y políticas:
Generar información local para la toma de decisiones y el planteamiento de una financiación sanitaria. Se requiere un análisis en profundidad de la epidemiología, así como de los obstáculos para la detección del cáncer de cuello uterino y, cuando sea necesario, de los servicios de tratamiento de seguimiento en el ámbito del país, así como fundamentar la priorización de las soluciones más sostenibles y con el mayor impacto. Asimismo, dichos análisis deben identificar y abordar las deficiencias en materia de financiación y asignación de recursos dentro de los sistemas sanitarios.
Evaluar la financiación nacional y el alcance de los servicios de gran calidad mediante el uso de las herramientas disponibles de cálculo de costes y elaboración de modelos de la OMS para elaborar planes de ampliación graduales y viables. Las soluciones diseñadas para ajustarse a las limitaciones de asequibilidad y capacidad de cada país resultarán más sostenibles a largo plazo. Se debe dar prioridad al uso de las herramientas existentes de cálculo de costes y elaboración de modelos para identificar carencias y oportunidades para pasar gradualmente a programas de ámbito nacional. El éxito de los programas de erradicación depende de un enfoque sistemático y organizado, que se implementa a través del marco de una cobertura sanitaria universal bien planificada con presupuestos y planes de servicios sanitarios integrados.
Abogar por la integración en el ámbito de las políticas, la financiación, los programas y los servicios para alcanzar el éxito y la sostenibilidad. A la hora de abordar la sanidad pública, los enfoques independientes introducen deficiencias desde el punto de vista financiero que se deben evitar. Se debería obtener partido del solapamiento entre el cáncer de cuello uterino y otras prioridades de la sanidad pública —como el VIH y los servicios sanitarios de reproducción—, y aprovechar el marco de la estrategia de erradicación a nivel mundial de la OMS para generar una integración financiera. Se requiere un sólido liderazgo en el ámbitos nacional y de prestación de servicios para garantizar la integración y que se materialicen los beneficios asociados.
Utilizar soluciones financieras innovadoras y mixtas para complementar la financiación nacional. La financiación nacional de los servicios oncológicos —incluidos los del cáncer de cuello uterino— en países con bajos recursos es posible que no sea suficiente para ampliar los programas nacionales. Las consecuencias económicas globales de la pandemia de la COVID-19 afectarán aún más a los presupuestos sanitarios. Los países deben ampliar sus inversiones nacionales y hacer un mejor uso de los impuestos y los programas de seguros sociales, al tiempo que se aprovechan los sistemas de financiación suplementaria alternativos donde proceda. Debería plantearse un enfoque colaborativo por el que se aprovechen los bancos de desarrollo, la financiación mixta, el capital, la experiencia y la celeridad del sector privado.
Value-based healthcare in Sweden: Reaching the next level
The need to get better value from healthcare investment has never been more important as ageing populations and increasing numbers of people with multiple chronic conditions force governments to make limited financial resources go further.
These pressures, along with a greater focus on patient-centred care, have raised the profile of VBHC, especially in European healthcare systems. Sweden, with its highly comprehensive and egalitarian healthcare system, has been a leader in implementing VBHC from the beginning, a fact that was underscored in a 2016 global assessment of VBHC published by The Economist Intelligence Unit.
This paper looks at the ways in which Sweden has implemented VBHC, the areas in which it has faced obstacles and the lessons that it can teach other countries and health systems looking to improve the value of their own healthcare investments.
Breast cancer patients and survivors in the Asia-Pacific workforce
With more older women also working, how will the rising trend of breast cancer survivorship manifest in workplace policies, practices and culture? What challenges do breast cancer survivors face when trying to reintegrate into the workforce, or to continue working during treatment? How can governments, companies and society at large play a constructive role?
This series of reports looks at the situation for breast cancer survivors in Australia, New Zealand and South Korea. It finds that while progress has been made, more needs to be done, particularly in South Korea, where public stigma around cancer remains high.Medidas globales de financiación para eliminar el cáncer de cuello uterino: financiación de servicios de prevención secundaria en países con bajos recursos
El cáncer de cuello uterino es el cuarto cáncer que se detecta con mayor frecuencia en mujeres en todo el mundo, aunque es uno de los tipos de cáncer que mejor se pueden tratar y más se pueden prevenir si se detectan a tiempo. La morbilidad y la mortalidad del cáncer de cuello uterino afectan de forma dispar a las mujeres de países con unos ingresos bajos o entre bajos y medios, y aquellas de los países más pobres. En 2020, la Organización Mundial de la Salud
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Projet global de financement pour l’élimination du cancer du col de l’utéru...
Le cancer du col de l’utérus est le quatrième cancer le plus courant chez les femmes à travers le monde. Pourtant, il s’agit de l’un des cancers les plus faciles à prévenir et à traiter en cas de détection précoce. Les femmes vivant dans les pays à revenu faible ou intermédiaire et les femmes les plus défavorisées au sein de tous les pays ont beaucoup plus de probabilités de développer un cancer du col de l’utérus et d’en mourir. En 2020, l’Organisation Mondiale de la Santé (OMS) a lancé une initiative mondiale visant à éliminer le cancer du col de l’utérus en tant que problème de santé publique, avec des objectifs intermédiaires à atteindre d’ici 2030.
Alors qu’il existe des défis dans les contextes de faible revenu au regard de la viabilité et la pérennité des financements des efforts liés à cette priorité de santé publique, l’ambition d’élimination représente une nouvelle opportunité d’adopter une approche globale. Il s’agira dès lors de s’appuyer sur la couverture de santé universelle et d’envisager des modes de financement et d’interventions innovants pour développer progressivement les services d’élimination de la maladie dans chaque pays.
Ce rapport de The Economist Intelligence Unit aborde les principaux défis liés au financement pour l’élimination du cancer du col de l’utérus dans des contextes de faible revenu. Les priorités listées ci-dessous peuvent servir à interpeller les dirigeants politiques ou les organismes de financement :
Recueillir des données locales pour mieux documenter la conception et les prises de décisions concernant les mécanismes de financement en santé. Dans chaque pays, il est indispensable de disposer d’une connaissance approfondie de l’épidémiologie et des freins qui pourraient s’opposer au déploiement du dépistage du cancer du col de l’utérus et, si nécessaire, à l’accès aux traitements, afin de donner la priorité aux solutions les plus efficaces et les plus durables. Ces analyses doivent aussi permettre d’identifier et de résoudre les problèmes de financement et de distribution des ressources au sein des systèmes de santé.
Déterminer les capacités de financement au niveau national dans chaque pays et la disponibilité de services de qualité à l’aide d’outils existants d’évaluation et de projection des coûts pour concevoir des programmes d’élimination adaptés et réalistes. À ce titre, des solutions adaptées aux possibilités et aux ressources de chaque pays seront plus pérennes. Les outils actuels d’évaluation et de projection des coûts doivent être utilisés en priorité pour identifier les opportunités et les insuffisances afin de pouvoir étendre progressivement les programmes d’élimination au niveau national. Leur bon fonctionnement repose sur une approche systématique et organisée, qui sera plus facile à déployer dans le cadre d’une couverture sanitaire universelle efficace, intégrant la budgétisation et la planification des services de santé.
Favoriser l’intégration de cet objectif aux enjeux politiques, au financement, à un programme et aux services de santé pour une efficacité durable. Les approches cloisonnées de la santé publique créent des inefficacités pouvant être minimisées ou complètement évitées. Les synergies avec d’autres priorités de santé publique, comme le VIH ou la planification familiale, doivent être recherchées. Le cadre de la stratégie mondiale de l’OMS pour l’élimination doit être utilisé pour promouvoir l’intégration financière. Un engagement fort des preneurs de décision aux niveaux mondial, national, programmatique et des services doit être encouragé pour s’assurer que l’intégration soit optimale et que tous les bénéfices en soient tirés.
Privilégier des solutions innovantes optimisant différentes sources de financement pour compléter le financement national.Dans des contextes de faible revenu, le financement national dédié aux services de lutte contre le cancer, dont le cancer du col de l’utérus, n’est pas suffisant pour développer des programmes à l’échelle nationale. Les conséquences financières mondiales de la pandémie de Covid-19 impacteront à long terme le financement de la santé. Les pays concernés doivent accroître leurs dépenses nationales de santé et améliorer leur utilisation des impôts et des systèmes d’assurance maladie, tout en favorisant l’utilisation d’autres systèmes de financement alternatifs lorsqu’ils sont disponibles. Des approches en consortium permettant de mobiliser des fonds auprès de banques de développement en combinant financement public et privé tout en favorisant l’expertise et la rapidité doit être envisagé.
Value-based healthcare in Sweden: Reaching the next level
The need to get better value from healthcare investment has never been more important as ageing populations and increasing numbers of people with multiple chronic conditions force governments to make limited financial resources go further.
These pressures, along with a greater focus on patient-centred care, have raised the profile of VBHC, especially in European healthcare systems. Sweden, with its highly comprehensive and egalitarian healthcare system, has been a leader in implementing VBHC from the beginning, a fact that was underscored in a 2016 global assessment of VBHC published by The Economist Intelligence Unit.
This paper looks at the ways in which Sweden has implemented VBHC, the areas in which it has faced obstacles and the lessons that it can teach other countries and health systems looking to improve the value of their own healthcare investments.
Breast cancer patients and survivors in the Asia-Pacific workforce
With more older women also working, how will the rising trend of breast cancer survivorship manifest in workplace policies, practices and culture? What challenges do breast cancer survivors face when trying to reintegrate into the workforce, or to continue working during treatment? How can governments, companies and society at large play a constructive role?
This series of reports looks at the situation for breast cancer survivors in Australia, New Zealand and South Korea. It finds that while progress has been made, more needs to be done, particularly in South Korea, where public stigma around cancer remains high.The impact of covid-19 on non-communicable diseases in Asia
The covid-19 pandemic, which assumed global proportions in the first half of 2020, has drastically impacted how healthcare systems operate. While much attention has necessarily focussed on the medical response to the pandemic, the broader impact on other aspects of health services such as the provision of care for non-communicable diseases (NCDs), like cancer, heart disease, diabetes, is more difficult to quantify. One NCD which has had a particularly low public profile during this period is osteoporosis.
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Osteoporosis: A challenge obscured, not eliminated
Covid-19 has rightly seized the attention of health system officials. Nevertheless, the disease has done nothing to change the underlying consideration which led the WHO – and, just as recently, also the Asia-Pacific Economic Cooperation (APEC) and the G201 – to raise the policy profile of healthy ageing’s importance to economic growth and human well-being. More and more of us are living longer and longer. This is good news, but also presents challenges. One too often overlooked will be the need to address a rapid increase in the proportion of people susceptible to osteoporosis and its attendant, often devastating, bone fractures.
Ageing populations: Asia-Pacific in the lead
This demographic shift is most visible in Asia, with its unprecedentedly rapid population ageing. In the first half of the 21st century, the proportion of people aged 60 or more in many leading Asia-Pacific countries, and in the region as a whole, will roughly triple – in some cases quadruple. The partial exceptions, such as Japan and Australia, are countries where population ageing began earlier (Figure 1).
Such percentage figures in part reflect the region’s very low, by historic standards, birth rates. Also at play, though, is increasing longevity. Currently, of the jurisdictions covered by UN Population Division data, four of the five with the highest life expectancy are in Asia – Hong Kong, Japan, Macao, and Singapore – while Australia and South Korea also make the top 11. Newborns in all these places can expect to live 84 or 85 years.2
This growing longevity, along with limited but still positive population growth in much of Asia, is driving a rapid increase in the absolute numbers of older individuals across the region. In most major countries, the number of people aged 60 and above will, during the Decade of Healthy Ageing alone, rise by between roughly a third and a half. After that 10-year span, 250 million more over 60s will live in Asia-Pacific than when the decade started – 41% growth (Table 1).
Rapidly expanding osteoporosis risk
This rising longevity represents a societal and medical triumph. It also, though, brings substantial healthcare challenges. Age correlates with any number of noncommunicable disease (NCDs) such as diabetes, cancer, and cardiovascular diseases. These already represent a formidable burden on health systems and a challenge to governments seeking to provide sustainable health services. Nevertheless, their human and economic cost can be greatly reduced by primary and secondary prevention, early diagnosis, and effective treatment. Delivering these interventions for NCDs as a whole, though, remains very much a “work in progress” for most health systems. “We’re right at the point of inflection,” says Paul Mitchell, communications director and executive board member of the Fragility Fracture Network. “We’re entering a new demographic era. If we don’t radically change the way that we respond to the longevity miracle by putting into place systems that optimise recovery, prevent events and enable older people to lead independent lives as long as possible, then the human and economic costs will be dire.”
Osteoporosis provides one of the clearest examples of a challenge which health systems already need to address and which will become only more pressing with as Asia-Pacific’s population of older citizens burgeons. Some time around the age of 25 to 30, the typical person begins to experience a loss in bone mineral density (BMD). This continues to some extent throughout one’s life and accelerates in women during the years of menopause. Although some decline in BMD is natural, it can go too far. Put simply, osteoporosis is the term for when this process reduces BMD to a dangerously low level.
The link between ageing and osteoporosis prevalence is both clear and dramatic. South Korean national survey figures show that 15% of women in that country have the condition while in their 50s, but this proportion rises steadily over time so that 86% of those in their 80s. The equivalent figures for men, 4% and 27%, are less dramatic but still indicate a widespread health issue.3 Although comparable prevalence data from other countries are limited, South Korea’s figures are consistent with those found elsewhere. A study of a rural population in Henan, China, also saw a steady increase in the number affected from age 50 onward and had similar results to the Korean one for people in their 70s (female prevalence was 37% in both; male was 20% in Henan and 15% in Korea).4 An urban Indian study, meanwhile, found that, among its subjects average, BMD started below that of the Korean average for people in their 40s and then declined even more rapidly over time.5
From Osteoporosis to the Toll of Fragility Fracture
Osteoporosis does not diminish quality of life: many who have it fail even to notice. The clinical problem is the greatly heightened risk off fragility fractures – the term for breaks caused by events or injuries which would not under normal circumstances be expected to cause a fracture. These typically occur at the wrist, spine, and hip. All can be serious and represent health system challenges. For example, although many fragility fractures of the spine may initially be small, treatment of serious ones cost the South Korean National Health Insurance Service US$282m in 2016 – an increase of 46% from just four years earlier.6
That said, fragility fractures of the hip are generally the most serious ones and associated with the greatest healthcare burden. A study covering nine major Asian jurisdictions, which collectively have 70% of the continent’s population – China, Hong Kong, India, Japan, South Korea, Malaysia, Singapore, Taiwan, and Thailand – estimated that in 2018 these places 1.12m hip fractures.7
The resultant human and economic costs implications are likely stark. One-year mortality after a hip fracture in Asia – in both middle and high-income states – range between around 10% and around 25%, reaching 30% in India. This is consistent with outcomes in much of the rest of the world.8 Meanwhile those who do survive continue to face significant challenges. An extensive research review found that typically only around half regain their previous physical capacity.9 The economic cost is also substantial. The nine-nation study cited above calculated that the aggregate direct treatment costs in those countries reached US$9.5 bn in 2018.10
This same research provides worrying projections for the future: if nothing is done, demographic change alone will mean that by 2050 the nine countries it covers will see 2.56m hip fractures which health systems will need to spend US$15bn to treat, not accounting for any inflation.11
Finally, not all hip-fracture patients receive the necessary surgery due to the lack of access to affordable services in resource-limited or rural settings. Even where appropriate treatment is accessible and government-funded, costs for rehabilitation and prevention of second fractures are a burden. In Taiwan, for example, lower socio-economic status was related to an increased risk of death in the one year following a hip fracture.12
Now That We Have Your Attention…
Demographics are not destiny. Asia does not need to face what Dr Irewin Tabu, – a leading orthopaedist in the Philippines – calls the “tsunami of fragility fractures” that would go with rising osteoporosis prevalence. Potential interventions exist to prevent osteoporosis and its results: in individuals both young and old, appropriate lifestyle choices – including eating healthy foods, engaging in weight-bearing exercise, and not smoking – can help maintain BMD, thereby reducing the chances of developing osteoporosis; various medications can increase BMD, thereby decreasing the chance of fracture when osteoporosis is diagnosed; effective rehabilitation and secondary prevention after fractures can reduce the likelihood for further breakages (which are often worse than the initial ones).
With so many people affected by osteoporosis, any universal or universalising health system will need to take it seriously. In order to help stakeholders understand the scope of the challenge and possible options available to address it, the Economist Intelligence Unit, sponsored by Amgen, has published two important studies: Demystifying ageing: Lifting the burden of fragility fractures and osteoporosis in Asia-Pacific (2017)13 and Ageing with strength: Addressing fragility fractures in Asia-Pacific (2019).14 We are now building on this with the current article as well as a series of newsletters in the coming months to look at several of the most prominent issues in the area of osteoporosis and fragility fracture care. Future topics will include: the impact of Covid-19 on osteoporosis diagnosis, monitoring, and treatment; the state of care the Philippines and Thailand, two important Asian emerging economies; and innovations in policy advocacy and stakeholder cooperation to address this complex challenge. Please keep an eye out for these publications.
1. Asia-Pacific Economic Cooperation, https://www.apec.org/Groups/SOM-Steering-Committee-on-Economic-and-Techn... ; G20, https://g20-meeting2019.mhlw.go.jp/health/img/G20Okayama_HM_EN.pdf 2. United Nations, Department of Economic and Social Affairs, Population Division, World Population Prospects 2019, 2019, online database, https://population.un.org/wpp/ 3. Jongseok Lee et al., “Age-Related Changes in the Prevalence of Osteoporosis according to Gender and Skeletal Site: The Korea National Health and Nutrition Examination Survey 2008-2010,” Endocrinology and Metabolism, 2013, https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3811701/ 4. Dou Qiao et al., “Gender-specific prevalence and influencing factors of osteopenia and osteoporosis in Chinese rural population: the Henan Rural Cohort Study,” BMJ Open, 2020, https://bmjopen.bmj.com/content/bmjopen/10/1/e028593.full.pdf 5. A Ramalingaiah et al., “Burden of Osteoporosis in the Urban Indian Population,” EC Orthopaedics 2017, https://www.ecronicon.com/ecor/pdf/ECOR-07-00196.pdf 6. Sung Hoon Choi et al., “Incidence and Management Trends of Osteoporotic Vertebral Compression Fractures in South Korea: A Nationwide Population-Based Study,” Asian Spine Journal, 2020, https://www.asianspinejournal.org/journal/view.php?number=1122 7. CL Cheung et al., “An updated hip fracture projection in Asia: The Asian Federation of Osteoporosis Societies study”, Osteoporosis Sarcopenia, Vol. 4, No. 1, 2018, 2018, https://www.ncbi.nlm.nih.gov/pubmed/30775536 8. Colum Downey et al., “Changing trends in the mortality rate at 1-year post hip fracture – a systematic review,” World Journal of Orthopedics¸ 2019, https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6428998/. NB: The Japanese figure of 2.4% in this article should be discounted. Examination of the source shows that this was the outcome of the intervention arm of a small trial and not representative of normal care (TomohiroYoshizawa et al., “Rehabilitation in a convalescent rehabilitation ward following an acute ward improves functional recovery and mortality for hip fracture patients: a sequence in a single hospital,” Journal of Physical Therapy Science, 2017, https://www.jstage.jst.go.jp/article/jpts/29/6/29_jpts-2017-131/_pdf/-ch... 9. Suzanne Dyer, “A critical review of the long-term disability outcomes following hip fracture,” BMC Geriatrics, 2016, https://bmcgeriatr.biomedcentral.com/articles/10.1186/s12877-016-0332-0 10. CL Cheung et al., “An updated hip fracture projection in Asia: The Asian Federation of Osteoporosis Societies study”, Osteoporosis Sarcopenia, Vol. 4, No. 1, 2018, 2018, https://www.ncbi.nlm.nih.gov/pubmed/30775536 11. Ibid. 12. Hsu I-Lin, et al. “Socioeconomic Inequality in One-Year Mortality of Elderly People with Hip Fracture in Taiwan”, International Journal of Environmental Research and Public Health, 2018, https://www.mdpi.com/1660-4601/15/2/352 13. https://eiuperspectives.economist.com/healthcare/demystifying-ageing-lif... 14. https://eiuperspectives.economist.com/healthcare/ageing-strength-address...Demystifying ageing: Lifting the burden of fragility fractures and osteopor...
Fragility fractures are already a significant public health challenge across Asia-Pacific. Their lasting impact on societies and economies is well-documented, leading to loss of mobility, independence and, in some instances, death for their elderly sufferers. In many traditional Asia-Pacific societies, where older people often serve as caregivers for younger generations, fractures can devastate entire families and communities. From a broader perspective, the cost of treating hip fractures to Asia-Pacific societies equates to 19% of GDP per capita, underscoring the enormity of the problem.
As populations age, many believe fragility fractures will become more widespread, yet this is not necessarily the case. Osteoporosis, a condition that makes bones more likely to break and a leading cause of fractures, was within living memory thought to be a natural part of ageing. This myth is gradually being dispelled. The condition is preventable and treatable—a fact which receives too little attention across the region. This study looks at the challenge fragility fractures and osteoporosis pose and how health systems are responding in eight Asia-Pacific economies: Australia, Hong Kong, Japan, New Zealand, Singapore, South Korea, Taiwan and Thailand (called collectively in the text the “scorecard economies”).
Download the report in English | 한국어 | 繁體中文 View the infographic in English | 한국어 | 繁體中文 Fight the Fracture, a public education campaign, aims to empower patients who have suffered a fragility fracture and their caregivers to proactively seek medical professional help in secondary care prevention ‒ the prevention of a subsequent fracture ‒ by providing them with educational information, tools and resources. Find out more about Fight the Fracture at: www.fightthefracture.asiaValue-based healthcare in Sweden: Reaching the next level
The need to get better value from healthcare investment has never been more important as ageing populations and increasing numbers of people with multiple chronic conditions force governments to make limited financial resources go further.
These pressures, along with a greater focus on patient-centred care, have raised the profile of VBHC, especially in European healthcare systems. Sweden, with its highly comprehensive and egalitarian healthcare system, has been a leader in implementing VBHC from the beginning, a fact that was underscored in a 2016 global assessment of VBHC published by The Economist Intelligence Unit.
This paper looks at the ways in which Sweden has implemented VBHC, the areas in which it has faced obstacles and the lessons that it can teach other countries and health systems looking to improve the value of their own healthcare investments.
Osteoporosis: A challenge obscured, not eliminated
Covid-19 has rightly seized the attention of health system officials. Nevertheless, the disease has done nothing to change the underlying consideration which led the WHO – and, just as recently, also the Asia-Pacific Economic Cooperation (APEC) and the G201 – to raise the policy profile of healthy ageing’s importance to economic growth and human well-being. More and more of us are living longer and longer. This is good news, but also presents challenges.
17543
Related content
Demystifying ageing: Lifting the burden of fragility fractures and osteopor...
Fragility fractures are already a significant public health challenge across Asia-Pacific. Their lasting impact on societies and economies is well-documented, leading to loss of mobility, independence and, in some instances, death for their elderly sufferers. In many traditional Asia-Pacific societies, where older people often serve as caregivers for younger generations, fractures can devastate entire families and communities. From a broader perspective, the cost of treating hip fractures to Asia-Pacific societies equates to 19% of GDP per capita, underscoring the enormity of the problem.
As populations age, many believe fragility fractures will become more widespread, yet this is not necessarily the case. Osteoporosis, a condition that makes bones more likely to break and a leading cause of fractures, was within living memory thought to be a natural part of ageing. This myth is gradually being dispelled. The condition is preventable and treatable—a fact which receives too little attention across the region. This study looks at the challenge fragility fractures and osteoporosis pose and how health systems are responding in eight Asia-Pacific economies: Australia, Hong Kong, Japan, New Zealand, Singapore, South Korea, Taiwan and Thailand (called collectively in the text the “scorecard economies”).
Download the report in English | 한국어 | 繁體中文 View the infographic in English | 한국어 | 繁體中文 Fight the Fracture, a public education campaign, aims to empower patients who have suffered a fragility fracture and their caregivers to proactively seek medical professional help in secondary care prevention ‒ the prevention of a subsequent fracture ‒ by providing them with educational information, tools and resources. Find out more about Fight the Fracture at: www.fightthefracture.asiaAgeing with strength: Addressing fragility fractures in Asia-Pacific
By 2050 Asia-Pacific will be home to 1.3bn people older than 60. This growth will happen at a time when lifespans are also becoming longer. As a result, the region is expected to see an increase in diseases associated with age. Among them is osteoporosis, a condition that makes bones less dense and more fragile and can cause fragility, or low-impact, fractures—those that occur (often to the hip, spine or wrist) when someone falls from a standing height or lower.
Osteoporosis is defined as having a bone mass density (BMD) 2.5 standard deviations below the average value of a young healthy woman. It is a disease that affects far more women than men, but the latter still account for about a fifth to a quarter of hip fragility fractures worldwide.
What are the key challenges for osteoporosis patients in the APAC region and how are these affecting their daily lives? Download our report for more insights.
NO TIME FOR SILENCE: Exploring policy approaches to investment in stroke prevention in Europe
No time for silence: exploring policy approaches to investment in stroke prevention in France, Germany, Italy, Spain and the UK is an independent report written by The Economist Intelligence Unit, sponsored by The Bristol Myers Squibb–Pfizer Alliance. The report considers policy and investment efforts around best practices for preventing stroke including resources for education, awareness and detection. To better understand variations in European policy, the research has been conducted across five major countries: France, Germany, Italy, Spain and the UK.
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Value-based healthcare in Sweden: Reaching the next level
The need to get better value from healthcare investment has never been more important as ageing populations and increasing numbers of people with multiple chronic conditions force governments to make limited financial resources go further.
These pressures, along with a greater focus on patient-centred care, have raised the profile of VBHC, especially in European healthcare systems. Sweden, with its highly comprehensive and egalitarian healthcare system, has been a leader in implementing VBHC from the beginning, a fact that was underscored in a 2016 global assessment of VBHC published by The Economist Intelligence Unit.
This paper looks at the ways in which Sweden has implemented VBHC, the areas in which it has faced obstacles and the lessons that it can teach other countries and health systems looking to improve the value of their own healthcare investments.
Breast cancer patients and survivors in the Asia-Pacific workforce
With more older women also working, how will the rising trend of breast cancer survivorship manifest in workplace policies, practices and culture? What challenges do breast cancer survivors face when trying to reintegrate into the workforce, or to continue working during treatment? How can governments, companies and society at large play a constructive role?
This series of reports looks at the situation for breast cancer survivors in Australia, New Zealand and South Korea. It finds that while progress has been made, more needs to be done, particularly in South Korea, where public stigma around cancer remains high.The Cost of Silence
Cardiovascular diseases levy a substantial financial toll on individuals, their households and the public finances. These include the costs of hospital treatment, long-term disease management and recurring incidence of heart attacks and stroke. They also include the costs of functional impairment and knock-on costs as families may lose breadwinners or have to withdraw other family members from the workforce to care for a CVD patient. Governments also lose tax revenue due to early retirement and mortality, and can be forced to reallocate public finances from other budgets to maintain an accessible healthcare system in the face of rising costs.
As such, there is a need for more awareness of the ways in which people should actively work to reduce their CVD risk. There is also a need for more primary and secondary preventative support from health agencies, policymakers and nongovernmental groups.
To inform the decisions and strategies of these stakeholders, The Economist Intelligence Unit and EIU Healthcare, its healthcare subsidiary, have conducted a study of the prevalence and costs of the top four modifiable risk factors that contribute to CVDs across the Asian markets of China, Australia, Hong Kong, Japan, Singapore, South Korea, Taiwan and Thailand.
Download the report to learn more.
Designing a vaccine against covid-19: Cautious optimism and lessons from HIV
More from this series
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Covid-19 population tracker: deaths from covid-19 and the ones we must not...
There has been a morbid fascination with the number of deaths associated with covid-19 and the extent to which countries are mishandling the crisis. But we are also facing a data crisis which distorts proper analysis of either.
Scientists are tinkering with models on the expected number of deaths based on incomplete data as not all countries apply the same covid-19 testing rules and not all deaths are accurately recorded. At the same time countries are still deliberating about who they should test, be it asymptomatic cases, only those with symptoms, those presenting to healthcare systems or healthcare workers.
Officials in the US have cast doubt on the numbers being reported by China, and not all countries have the resources to follow the WHO’s “test, test, test” advice. This is particularly true for economies with under-developed healthcare systems such as India, Africa and Latin America.
So with that cautionary note, we have tried to work with the data at hand—incomplete as it is—to map the number of confirmed cases of covid-19 against deaths per 100,000 population over time. While the absolute numbers of deaths are important to note because each loss of life is painful to loved ones, we should also look at death rates across populations to better understand the virus and to keep abreast of potentially effective containment measures. In developing countries cause of death information is often hard to obtain, mostly because systems for recording these details are inadequate or non-existent.
The bubbles represent absolute deaths in an individual country. You can eliminate regions from the timeline to see, for example, how Europe is faring against North America, or zoom in on the trajectory for an individual country. As of April 20th, death rates appear to be highest in Europe with Belgium reaching around 50 deaths per 100,000 population.
While people are still focused on covid-19 deaths, be prepared for a new type of death associated with covid-19 over time. These are deaths and morbidity that will arise as healthcare systems direct more and more resources to covid-19 and less and less to common diseases such as stroke and cancer. For developing countries, the common diseases affected will be tuberculosis, malaria and AIDS.
These “excess” deaths may also arise as people become more fearful of overloading healthcare systems or worried about catching the virus if they attend healthcare facilities including hospitals. There are also the deaths of older people living in residential care facilities or dying at home that are not being properly accounted for. If you have cancer and your treatment is delayed, that is a life and death situation for your overall prognosis. The same applies if treatment is delayed following the first signs of stroke. Patients living with chronic health conditions will see a significant change in the level of service and care received during this crisis, and the damage caused may take years to repair.
So while scientists study the data around covid-19, expect new data to emerge on how other diseases have been affected by this pandemic.
David Miliband: International political response to covid-19 scores “D-minu...
David Miliband is taking refuge in North-west Connecticut during the covid-19 lockdown, but his thoughts are very much global, and inevitably political.
The former UK foreign secretary heads up the International Rescue Committee (IRC), a humanitarian non-governmental organisation (NGO) that works in war-ravaged countries and helps resettle refugees. Refugees, who make up nearly 30% of the world’s 71m “forcibly” displaced people, are especially vulnerable to disease: they have limited access to healthcare, live in poor sanitary conditions and often suffer from pre-existing illnesses. So what needs to be done?
“It's very, very basic,” Mr Miliband says. Are they counted? Are they covered when it comes to testing or healthcare access? Are they assisted by income support schemes or other mechanisms? Do they have rights?
“If the answer to those questions is ‘No’, we know that the consequence is not just a lot of poverty and security violence,” he explains. It also elicits a survivalist response born of desperation. “[People] go underground and they try to make ends meet in any way that they can. And that obviously carries its own dangers, especially in the context of a public health pandemic.”
IRC is working at Cox’s Bazar in Bangladesh. Host to over 1m displaced Rohingya Muslims from neighbouring Myanmar, it is one of the world’s largest and most crowded refugee camps. Social distancing to contain the spread of covid-19 in such camps is, of course, hard.
“I think it would be beyond unfortunate if this [pandemic] was used to further buttress the trend that we've seen in the past 15 years which is what people call democratic recession. And that is the retreat of countries from democratic models.”
“It's easier for the rich than the poor,” Mr Miliband says. “[But] we shouldn't somehow take refuge in the idea that social distancing can't be done so we just shrug our shoulders.”
Where social distancing is more difficult, Mr Miliband explains, hygiene, effective isolation measures and testing become more important: fever testing, at a minimum, and eventually covid-19 testing.
“I also think some social distancing is achieved through masks,” he explains. “It's important that we don't say that because masks are not the whole answer, that they're not any part of the answer. So, in other words, social distancing is more difficult but not impossible.”
In many of the countries where IRC operates, however, Mr Miliband reports a “shocking” lack of covid-19 testing ability. He cites a recent video chat with the IRC team in Somalia who reported that “there have been 700 tests and 436 cases, so a very low number of tests but a very high hit rate”.
Other resources, such as ventilators and intensive care beds, are also scarce. In South Sudan there are only four ventilators for its 11.7m population while Burkina Faso has only 11 for its 19.1m citizens. But the answer is not “trying to send 10,000 ventilators to South Sudan,” Mr Miliband explains.
“Not least because it'll be too late by the time they get there, but because it's a very skilled job to run a ventilator; it takes a whole set of health infrastructure to monitor and implement. So the truth is the prospects for someone who needs a ventilator in South Sudan are utterly grim.”
Political response
Although he works for an international NGO, Mr Miliband remains a political animal. A request to grade the international political response to covid-19 hits a nerve.
“If you are asking me to grade different actions, I have to be grading inactions.The G7 [group of the world's seven largest economies] couldn't agree on a statement because of a ridiculous argument about insistence on calling it a ‘Wuhan virus’. The G20 [which links governments and central banks from 19 countries and the EU] has had one virtual meeting [as of May 1st]. The UN Security Council has not yet been able to agree the resolution to back up the secretary-general’s call in respect of ceasefires. So, it's D-minus territory for the international political response.”
Mr Miliband, whose ministerial tenure included the 2008 financial crisis, is slightly more positive about the economic response to covid-19. He believes there has been “some lesson-learning, but there obviously hasn't been something formally co-ordinated”. Regarding the scientific community, he comments that “there's been a lot of transparency from the scientists, including Chinese scientists, about presenting their data”.
The World Health Organisation (WHO) has faced criticism for its handling of the crisis, but Mr Miliband is forgiving. “Every big organisation [...] will make mistakes, but the real lesson about the WHO is that it's got too little power and too little funding and too little independence—it needs to be able to rectify all three,” he says.
“The lesson is that we need a stronger, better funded, more independent WHO that can speak truth to power.” He considers its year-by-year dependence on donor funding problematic, commenting that endowment with longer-term funding would allow for greater independence.
Geopolitical rivals
The way in which countries have responded to covid-19 will be fuel for global rivalries, Mr Miliband predicts. “I think there’s undoubtedly going to be very significant geopolitical competition in trying to exploit and benefit from comparison coming out of this crisis.”
China’s reputation could come under particular scrutiny, especially given the harsh criticism its handling of the outbreak has received from the US. “I think different parts of the world will trust [China] differently. And of course one question is, ‘How will the world trust China in absolute terms?’, and the second question is, ‘How will you trust China relative to other countries?’”
Mr Miliband believes there was denialism in China at the outbreak of covid-19 and partly attributes this to its one party system. But there is continued denialism in the US, he adds. “Sadly, both democratic and autocratic countries have suffered from denialism.”
The US has reported a striking 79,000-plus deaths from covid-19 (as of May 11th), the highest death toll worldwide. Mr Miliband fears the “continued chaos and [certain] aspects of the American response are going to be used by autocrats around the world to say the democratic systems can't work and can't cope”.
By contrast, South Korea has reported only 256 covid-19 deaths out of a population of 51.3m. Germany, with its 83.7m population, has suffered 7,569 deaths (as of May 11th). Mr Miliband accredits this success to “the power of open societies” to build social trust and organise an effective national response.
“I think it would be beyond unfortunate if this [pandemic] was used to further buttress the trend that we've seen in the past 15 years which is what people call democratic recession. And that is the retreat of countries from democratic models.”
The UK response
So what about the covid-19 response in the UK, Mr Miliband’s home country and political proving ground? The country has the highest number of deaths in Europe at nearly 32,000 (as of May 11th).
“It's really grieving to see the death toll in the UK,” he says. “I think I'm right in saying that around one-eighth of the global death toll is British, even though [less than 1%] of the global population is British. That’s a shocking mismatch.”
There are very serious questions to be answered, he says, about when the lockdown happened, how testing was organised, what happened with contact tracing and the alarm bell that should have been sounded regarding care homes. “Those are all questions which are going to need a very searching set of enquiries.”
Is he confident that Keir Starmer, the new leader of the UK’s Labour party, will hold the government to account? “I think he'll be very good at that. He is a very accomplished lawyer. Britain has a proper opposition for the first time in five years.”
Does he miss politics? Yes, he says, with no hesitation. “In politics and government, you have more power than if you're an NGO—but you also have more obstacles.”
Solidarity in a crisis
Circling back to refugees, does he think attitudes towards them have improved or worsened over time?
“I think it is very mixed,” he says. “Two-thirds of the American public didn't want Jews to be allowed in from Europe in the late 1930s. So that's more or less some of the proportions on the before. But [...] crises [can] bring social solidarity”.
While there are many stark obstacles ahead, Mr Miliband welcomes the fact that some countries are recognising how critical immigrants are to their healthcare systems and broader social structures.
“I think human nature is both fearful and intrigued by people who are different. And you've got to hope that those of us who think life is more interesting because we're not the same don't lose heart.
The world must devise a globally fair covid-19 vaccine allocation system
Vaccination is our best hope for stopping the coronavirus pandemic in its tracks. But producing safe, effective and globally accessible vaccines within the next 12 to 18 months is not only a scientific challenge: new levels of collaboration and investment across industry and government will be essential.
This pandemic is the biggest public health threat that humankind has faced in a century. It is wreaking havoc on societies and economies and it is an acid test for public-private partnerships. We need to move fast to unleash the funding required to develop vaccines.
Delivering covid-19 vaccines for the world—at record speed—will take a collective effort. We must combine the resources and expertise of academia and the private sector with the ability only governments have to mobilise the political will and amass the large sums of money that will be required.
No therapies to prevent or treat covid-19 are available, but research is advancing at a breakneck pace. The private and public sectors must now collaborate to ensure the best and fairest use of new products—wherever they come from—when they arrive.
In the case of vaccines, this means pursuing multiple approaches across both established and new technologies rather than trying to pick one or two “winners” prematurely since many candidate vaccines will inevitably fall by the wayside.
Given the threat posed by covid-19 we must regard vaccines as a global good: a shared resource that is deployed for the good of all irrespective of a country’s ability to pay. Given the global threat posed by covid-19 and the universal, simultaneous need for a vaccine, the world must devise a globally fair allocation system to ensure that healthcare workers and the most vulnerable segments of the world’s population get priority access.
Today, exceptional science is being done around the world. Researchers have been working around the clock to produce vaccine candidates ever since the genome of the new virus was sequenced in January 2020. The good news is this has yielded a flood of more than 90 promising candidates. Now this effort must be buttressed by large-scale public-sector assistance to optimise clinical trial procedures and scale-up manufacturing capacity—something that involves risky upfront investments before any product is approved.
The Oslo-based Coalition for Epidemic Preparedness Innovations (CEPI) provides a platform to deliver just this kind of private-public co-operation. The coalition was initially set up in 2017 after West Africa’s deadly Ebola epidemic to accelerate work on vaccines against emerging infectious diseases.
CEPI—a partnership of governments, industry and philanthropies—has a clear roadmap to accelerate covid-19 vaccine development at an estimated cost of US$2bn over the next 12-18 months. Financial support from the UK, Germany, Norway, Denmark and Finland has brought in around US$660m. Closing the remaining financing gap is imperative if we are to stay on track.
Vaccine development is complex and expensive. Rates of attrition are high. We need multiple candidates to ensure that we can produce safe and effective vaccines. My organisation estimates that a large part of the US$2bn will be needed by the middle of this year to develop eight vaccine candidates through initial phase 1 testing, prepare for phase 2/3 trials and to invest in manufacturing processes for up to six candidates.
Assuming one or more of these candidates succeeds, there will then be a huge global demand requiring unparalleled efforts to harness manufacturing capacity and distribution networks.
Last month, G20 leaders pledged to support the global effort against covid-19, including contributing to this vital vaccine work. The message could not be clearer: now is the time for governments and industry to join forces to fight back against this deadly disease.
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The Cost of Silence: Cardiovascular disease in Asia
The Cost of Silence: Cardiovascular disease in Asia is a report by The Economist Intelligence Unit and EIU Healthcare. It provides a study of the economic impact of CVD risk factors on the following Asian markets: China, Australia, Hong Kong, Japan, Singapore, South Korea, Taiwan and Thailand.
Specifically, the study captures the cost of ischaemic heart disease (IHD) and stroke. IHD, also called coronary heart disease (CHD) or coronary artery disease, is the term given to heart problems caused by narrowed heart (coronary) arteries that supply blood to the heart muscle, which can lead to stable angina, unstable angina, myocardial infarctions or heart attacks, and sudden cardiac death. Stroke is characterised by the sudden loss of blood circulation to an area of the brain due to blockage of brain vessels, or a haemorrhage or blood clot.
This study further combines an evidence review of existing research on CVDs and primary research in the form of expert interviews.
Key findings of the report are as follow:
The rising incidence of CVD poses a substantial challenge to Asia-Pacific markets The four main modifiable cardiovascular risk factors pose a communications challenge for governments and health agencies. Hypertension is the risk factor that contributes the highest cost. The costs of CVDs are not fixed. Greater awareness and policymaker attention can substantially reduce CVD costs as many obstacles and corresponding solutions have been identified as effective. Policy options for primary prevention include choice “nudges”. Effective secondary prevention can also significantly affect costs and outcomes.Demystifying ageing: Lifting the burden of fragility fractures and osteopor...
Fragility fractures are already a significant public health challenge across Asia-Pacific. Their lasting impact on societies and economies is well-documented, leading to loss of mobility, independence and, in some instances, death for their elderly sufferers. In many traditional Asia-Pacific societies, where older people often serve as caregivers for younger generations, fractures can devastate entire families and communities. From a broader perspective, the cost of treating hip fractures to Asia-Pacific societies equates to 19% of GDP per capita, underscoring the enormity of the problem.
As populations age, many believe fragility fractures will become more widespread, yet this is not necessarily the case. Osteoporosis, a condition that makes bones more likely to break and a leading cause of fractures, was within living memory thought to be a natural part of ageing. This myth is gradually being dispelled. The condition is preventable and treatable—a fact which receives too little attention across the region. This study looks at the challenge fragility fractures and osteoporosis pose and how health systems are responding in eight Asia-Pacific economies: Australia, Hong Kong, Japan, New Zealand, Singapore, South Korea, Taiwan and Thailand (called collectively in the text the “scorecard economies”).
Download the report in English | 한국어 | 繁體中文 View the infographic in English | 한국어 | 繁體中文 Fight the Fracture, a public education campaign, aims to empower patients who have suffered a fragility fracture and their caregivers to proactively seek medical professional help in secondary care prevention ‒ the prevention of a subsequent fracture ‒ by providing them with educational information, tools and resources. Find out more about Fight the Fracture at: www.fightthefracture.asia亚太地区心血管疾病二级预防报告
亚太地区心血管疾病的负担因国家/地区而异,但无论任何国家/地区都负担沉重。总体来说,心血管疾病在该地区是造成死亡的首要或次要原因,其患病率也在不断增长。除此以外,该地区人口结构的变化——患心血管疾病的年轻人增加,同时患有多种合并症的老龄人口也呈增长趋势——令医疗系统越来越不堪重负。
应对心血管疾病相关问题的进展主要集中于一级预防领域,同时心血管疾病年龄标准化患病率也正在降低。然而心脏病和卒中复发的几率长期居高不下,令人难以接受,而与之相关的经济和人力成本亦威胁着已经取得的进步。由于越来越多的患者能在心脏病或卒中首次发病时幸存,复发事件所带来的负担很可能会更加沉重。这一状况需要紧急的关注,但同时也带来了一个非常有可能实现的机遇——改善该患者群体所接受的医疗护理及其效果。
本次由经济学人智库(The Economist Intelligence Unit/The EIU)所做的分析探究了亚太地区在管理心血管疾病复发事件上的政策响应措施,研究主要聚焦于以下八个经济体:澳大利亚、中国大陆、中国香港、中国台湾、日本、新加坡、韩国以及泰国。
本研究主要发现包括:
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高まる二次予防の重要性: アジアにおける心疾患医療の現状・課題
国によって状況は異なるものの、心血管疾患(CVD)がもたらす負担が非常に大きいことは間違いない。CVD は全てのアジア諸国で二大死因となっており、患者数も増加の一途を辿っている。またアジアでは、若年層のCVD 患者・高齢者層の合併症患者が並行して増えており、医療体制にさらなる負担をもたらしている。
近年、CVD に関連する問題への対策は、一次予防の分野で進化を遂げつつあり、年齢調整罹患率にも減少の兆しが見られる。しかし急性心筋梗塞・脳卒中の再発率は依然として高く、その経済的・人的コストも大きいのが実状である。また一度目の発症での生存率が向上している今、再発によって生じる負担はさらに増す可能性が高い。ただし、対応が急務となっているこうした現状に取り組むことが現実的であることを鑑みると、当該患者グループのケア体制・アウトカムを向上させる重要な機会だと捉えることができる。
ザ・エコノミスト・インテリジェンス・ユニット(EIU)の本報告書は、アジア太平洋地域8 カ国(オーストラリア・中国・香港・日本・シンガポール・韓国・台湾・タイ)を対象として、CVD の再発予防に向けた政策的取り組みを検証する。
主要な論点は以下の通り:
多くの国はCVD 政策を掲げているが、包括性の面で大きな差がある。 改善可能なリスク因子への取り組みは、具体的な法案・行動計画、および成果評価に必ずしも結びついていない。 政府による成果評価の仕組みは発展途上である。 包括医療に不可欠なプライマリケアは近年進化を遂げつつある。 多くの国はリハビリサービスを実施しているが、提供能力は限られており、利用者も伸び悩んでいる。 連携を通じた患者中心の包括医療の必要性 取り組みの成功の鍵を握るのは患者エンパワーメント データ活用の加速と成果評価の仕組みも重要な鍵となる조치 부재의 비용: 아시아 태평양 지역 내 심혈관 질환의 2차 예방
아시아 태평양 지역의 심혈관 질환(CVD)부담은 국가별로 상이하나 모두 상당하다.CVD는 지역 전반에서 사망 원인 1위 또는2위를 차지하고 있으며, 유병률도 계속높아지고 있다. 또한 CVD를 경험하는 젊은환자와 여러 동반 이환을 가진 고령화 인구두 집단 모두의 증가라는 지역 내 인구통계적변화로 인해 각국의 보건의료체계에 부하가걸리고 있다.
CVD 관련 문제 해결에 관한 진척은 1차예방 분야에 초점이 맞춰져 이루어져왔으며, CVD의 연령표준화 발생률은감소하기 시작했다. 그러나 여전히 허용할수 없는 높은 수준의 심장마비 및 뇌졸중재발률과 그에 따른 경제적 및 인적 비용이존재해 이러한 진척을 저해하고 있다. 첫심장마비 또는 뇌졸중 생존자가 더많아짐에 따라 2차 사건 관련 부담이증가할 가능성이 높다. 이는 긴급한 주의를요구하는 상황인 동시에, 해당 환자 집단의관리와 결과를 개선할 수 있는 탁월하고현실적인 기회이기도 하다.
본 이코노미스트 인텔리전스 유닛분석에서는 아시아 태평양 지역8개국(호주, 중국, 홍콩, 일본, 싱가포르,한국, 대만, 태국)의 2차 심혈관 사건관리에 대한 정책적 대응을 살펴본다. 본 연구의 주요 결과는 다음을 포함한다. 관련 정책은 확실히 존재하나, 정책이상당히 포괄적인 국가도 있고 그렇지 않은국가도 있다. 조절 가능한 위험인자에 대한 정책을 법률과실천에 성공적으로 반영했는지 여부와 그로인한 영향은 아직 확인되지 않았다. 정부 감사가 결여되어 있다. 통합 관리의 핵심 요소인 1차 의료 체계가발전하고 있다. 재활 서비스가 존재하나 보장 범위가제한적이며, 업체들은 환자 유치와 유지에어려움을 겪고 있다. 필요한 목표는 환자 중심의 통합적이고조정된 관리 환자 권한부여는 성공의 핵심 데이터 극대화 및 진척도 측정Data and digital technologies to improve clinical outcomes for high-risk ca...
Cardiovascular diseases (CVD) account for around one quarter of deaths in Australia.1 The Economist Intelligence Unit estimates that the annual direct and indirect costs of CVD in Australia totals US$12.3bn.2 There are numerous modifiable risk factors for CVD, but the most important include hypertension (high blood pressure), high cholesterol, tobacco use, diabetes and obesity.3 While much of the recent focus has been on primary prevention through lifestyle modification, those highrisk patients with existing CVD—such as peripheral artery disease or a previous heart attack or stroke—require particular attention to avoid further morbidity and mortality.
The improved use of data and digital health tools has the potential to enable more coordinated and patient-centred models of care. The Digital Health CRC takes this further in saying “research and innovation in digital health offers Australia significant economic and business development opportunities, as well as great promise for the better health of our community”.4
On 27 May 2020, The Economist Intelligence Unit—supported by the Australian Cardiovascular Alliance (ACvA) and Digital Health CRC and with sponsorship from Amgen—convened a virtual roundtable discussion with 25 representatives from across the Australian cardiovascular healthcare landscape.
Co-hosted by the Economist Intelligence Unit with Dr Gemma Figtree, president of ACvA and professor in medicine at University of Sydney & Royal North Shore Hospital, and Dr Tim Shaw, director of research and workforce capacity at Digital Health CRC, the roundtable aimed to identify barriers, challenges and opportunities to improve outcomes for highrisk CVD patients by improving the use of data and digital technologies.
1 Australian Institute of Health and Welfare. Cardiovascular disease. In: Welfare AIoHa, editor. Canberra 2019. 2 Economist Intelligence Unit. “The cost of silence: Cardiovascular disease in Asia”, 2019 3 Centers for Disease Control and Prevention. “Know your risk for heart diseases”. Available from: https://www.cdc.gov/heartdisease/risk_factors.htm (Accessed Jun 2020). 4 Digital Health CRC. “About us”. Available from: https://www.digitalhealthcrc.com/about-us/ (Accesed Jun 2020).
Covid-19: tracking the pandemic
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Covid-19: the greatest burden will fall on older people in low- and middle-...
We are living in unprecedented times. The covid-19 pandemic is escalating rapidly with more than 173, 300 confirmed cases and over 7,000 deaths in 152 countries and regions (see Figure 1). The majority of cases and deaths are among people aged 60 years and older living in low- and middle-income countries (LMICs) where healthcare resources to treat people and control the epidemic are limited.
Guidance largely ignores this issue in both high income countries (HICs) and LMICS, the latter of which contain 69% of the global population aged 60 years and over. Their health systems are also weaker, leaving them vulnerable to the worst impacts of covid-19. Limited guidance which is more relevant to HICs has been produced for older people but not for health and social care workers, care homes or day centres. No detailed age-specific data on global cases and mortality has been produced by the World Health Organisation (WHO) even though mortality rates jump sharply in older people, rising from 8% in those aged 70 to 79 years to 15% in those aged 80 and over (see Figure 2 which shows the effect of age on risk of dying from covid-19 from the Chinese outbreak).
In the absence of clear comprehensive guidelines for prevention and control of covid-19 among older people, ad hoc policies are emerging. In Italy scarce hospital and intensive care services are being prioritised for younger, otherwise healthy patients over older patients, according to reports. In the UK, people aged 70 and over will be expected to self-isolate themselves for up to four months in the coming weeks.
In LMICs, older people provide an integral economic and social resource to societies, including bringing up grandchildren to support the labour mobility of their adult children and relatives. Beyond grief and bereavement the implications of covid-19 deaths among the older population will be profound, especially when family members working abroad are unable to return home at short notice.
Increasing numbers of very old people are now being cared for in nursing homes in LMICs. These homes are often unregulated, provide care of very poor quality and may even act as incubators of infection (as do cruise ships, prisons, mines and HIC nursing homes). Outbreaks in LMIC institutions would have serious implications, further underpinning the need for international guidance similar to that issued recently by the International Federation of the Red Cross and Red Crescent Societies, UNICEF and the WHO regarding children and schools.
The ability of health systems to cope with a surge in demand is extremely limited, especially for patients needing intensive care. Health systems in LMICs face severe constraints on capacity at normal times and are unlikely to be able to keep up, especially if the precarious staffing levels—already depleted by migration, low salaries and poor working conditions—and limited gerontological expertise are reduced further by illness. The needs of older people are not being adequately addressed in developing covid-19 policy and practice. Current social distancing policies ignore the precarious existence of many older people and fail to account for the realities faced by those living alone and individuals who are dependent on others. The high levels of illiteracy in LMICs also present a challenge which has yet to be considered in any meaningful way.
An age perspective needs to be explicitly included in the development of national and global planning for covid-19, and it is increasingly clear that a global expert group should be formed to provide support and guidance for older people, home carers, residential facilities and overburdened hospitals in LMICs.
Shah Ebrahim is an honorary professor of public health at the London School of Hygeine & Tropical Medicine. He would like to thank Peter Lloyd- Sherlock, professor of social policy and international development, University of East Anglia; Leon Geffen, Samson Institute for Ageing Research, Cape Town, South Africa; and Martin McKee, professor of European public health, London School of Hygiene & Tropical Medicine, for contributing to this article. The views and opinions expressed in this article are those of the author(s) and do not necessarily reflect the views of The Economist Group or any of its affiliates. The Economist Group cannot accept any responsibility or liability for reliance by any person on this article or any of the information, opinions or conclusions set out in the article.
The secret life of coronavirus: Why we need such drastic social distancing...
Left unchecked, the novel coronavirus (covid-19) will continue to sweep the globe. The horror stories from emergency departments and initial estimates of fatality rates starkly portend large numbers of people dying from both the virus and insufficient healthcare capacity. However, there is disagreement about what it will take to halt this progression and how far our preventative measures should go.
Our analysis in early February of 458 confirmed covid-19 cases across 93 Chinese cities was one of the clear early warnings that without interventions the average time between successive cases in a transmission chain is less than a week (around four days). Moreover, people can spread covid-19 before they even know they are sick, and there are individuals known as “super-spreaders” who infect an unusually large number of others.
These data help us understand why covid-19 is measurably more difficult to contain than a similar virus, SARS (severe acute respiratory syndrome). It comes down to a race between humans and the virus—how rapidly we can track down an infected person’s contacts versus how quickly the viral infection can incubate and spread.
While covid-19 moves quickly and sometimes silently, SARS is slow and visible. The serial interval of each demonstrates why covid-19 is the more insidious threat: if person A infects person B, the serial interval is the time between person A developing symptoms and person B developing symptoms. SARS has a serial interval of around eight days—twice as long as covid-19—and no pre-symptomatic transmission.
Imagine that a patient is diagnosed with SARS two days after first feeling sick. Public health authorities would have time on their side, perhaps a full six days to track down and isolate anyone who had contact with the patient over the prior two days. With covid-19, by the time of diagnosis a patient may have already been contagious for several days. During this period they may have infected many others who are also now spreading the virus—possibly without displaying any symptoms.
This is why covid-19 requires more drastic measures than SARS. It can spread quickly and silently, and we cannot possibly identify every infectious individual in an emerging outbreak, particularly with limited laboratory-testing capacity.
Super-spreading events compound the challenge. Among the 458 Chinese cases, five people infected over five others, with the biggest super-spreader infecting at least 16 people. Network theory—the mathematics that underlies the computer models that predict how the disease will spread— tells us that even a few people capable of infecting large numbers of others can dramatically amplify transmission and undermine interventions.
The recent threats of SARS, swine flu, Ebola, and Zika have brought fame to an epidemiological statistic known as R0. It stands for the basic reproduction number and is intended to be an indicator of the contagiousness of infectious agents (it is pronounced R-naught). In short it tells us how many people each new case will infect during the early days of a pandemic on average. An outbreak is expected to continue if R0 has a value >1 and to end if R0 is <1.
A lot of attention has been paid to recent estimates suggesting that covid-19 has a lower R0 than SARS, roughly two versus three. Clearly, then, R0 is not the whole story. It indicates whether one case will turn into two or three or four, but not how quickly or how silently that will come to pass.
The level of intervention required to curb an outbreak very much depends on all three factors: its R0 value, speed, and visibility in the community. We should not be fooled by the relatively modest R0 of covid-19 as its speed and stealth make it all the more difficult to contain. Even if each case infects only two others, the number of infections can skyrocket undetected in the absence of early and extensive control measures that limit person-to-person contact.
Our study highlights the elusiveness of covid-19. Keeping people apart is the only guaranteed way to block infections given the immense challenge of identifying contagious and soon-to-be contagious cases. Whether the policy goal is to stop transmission, protect those at high risk, or "flatten the curve" to ensure that fewer people are sick at any one time, extreme social distancing strategies of the type we have been seeing are strongly recommended.
Professor Lauren Ancel Meyers is the Cooley Centennial Professor of biology and statistics at the University of Texas at Austin, where she develops powerful mathematical methods for forecasting the spread of diseases and designing effective disease control strategies. The views and opinions expressed in this article are those of the author(s) and do not necessarily reflect the views of The Economist Group or any of its affiliates. The Economist Group cannot accept any responsibility or liability for reliance by any person on this article or any of the information, opinions or conclusions set out in the article.
Covid-19 pandemic accelerates the rise of digital payments
China, South Korea and the US Federal Reserve have started quarantining or disinfecting banknotes. It is well-known that currency in circulation can serve as a vehicle for transmitting pathogens, though the potency of pathogens transmitted via cash remains unclear. The human influenza virus, for example, can remain alive and infectious for more than two weeks on banknotes. Although it’s not known whether the exchange of currency infected with influenza can dramatically increase its spread, responses from the US, Korean and Chinese governments raise concerns.
It’s possible that these governments are simply taking extreme precautionary measures. It’s also possible that physical currency can indeed be a significant transmission medium for highly infectious diseases such as covid-19. A local branch of the People's Bank of China in Guangzhou has even opted to destroy banknotes that have been in circulation in high-risk settings such as hospitals or wet-markets.
These measures reflect earlier governmental responses to infectious disease. A late 1940s report on Egypt’s cholera epidemic highlighted the viability of cholera pathogens on banknotes. Throughout history people have responded to sickness in a similar way by washing or fumigating banknotes, yet we still have limited understanding of how physical currencies might transmit new pathogens.
There’s no doubt that covid-19 will accelerate the pre-existing trend towards digital payments in Asia, and China in particular. In late October 2019, Chinese President Xi Jinping endorsed blockchain—a digital ledger technology on which digital currencies can be transacted—as “an important breakthrough for independent innovation of core technologies”. He added that the People’s Bank of China intended to replace cash with a government-issued digital currency. The Chinese government actively promotes its internet banking infrastructure, whereas Western nations rarely use a top-down approach to governance.
In China, where digital payments are already prevalent, covid-19 could be a significant driver for the total elimination of cash. In 2018, nearly 73% of Chinese internet users made online payments (up from 18% in 2008). According to a recent survey by Deutsche Bank, this increase is partly driven by young people who are typically more open to adopting new technologies. China and Southeast Asian countries have much larger young populations than Europe and the US.
Western countries have tended to move at a slower pace towards digital payments than, for example, China. Part of the reason for this lies, according to Deutsche Bank, in different payment cultures of countries. A third of the people in OECD countries consider cash to be their favourite payment method, and more than half believe cash will always be around. Citizens in many European countries (notably Germany) and those in the US have a marked preference for cash.
Source: Deutsche Bank, The Future of Payments.
But even in Western countries that share similar payment cultures we can observe variation in digital preparedness. In terms of homegrown fintech champions that could benefit most from a digital payments transition, Europe’s are much smaller in size than large US counterparts such as Apple Pay, Google Pay, and PayPal—to name a few. Beyond that, many of Europe’s leading digital payment service companies are controlled or backed by US and Chinese companies (eg Swedish financial technology company IZettle was recently acquired by PayPal and Germany’s mobile N26 bank is backed by China’s Tencent).
Nonetheless, European countries are determined to be at the forefront of digital currencies. Central banks such as the Bank of England, the European Central Bank, the Swiss National Bank and the Swedish Riksbank have started to assess the feasibility of digital central bank currencies. These would perform all the functions of banknotes and coins and could then be used by households and businesses to make both payments and savings. The transition will not be easy. Digital central bank currencies require infrastructure that can record in-person and online transactions, which means that governments will need private sector co-operation.
Under “normal” conditions it would take a long time to change culturally ingrained habits and institutional legacies related to long and well-established payments systems. Jodie Kelley—CEO of the US Electronic Transactions Association—said in a recent interview that “people default to what’s familiar, unless there’s something to jolt you out of it”. She continued that “contactless payments have come up as a new option for consumers who are much more conscious of what they touch”.
The covid-19 pandemic could move the world more rapidly towards digital payments. In France, the Louvre museum in Paris recently banned cash due to covid-19 fears. The museum did this even though its policy clashes with the Bank of France's requirement that all businesses accept cash.
It is too early to conclude what the changes might look like in each cultural, demographic, and institutional context, but we can be sure that covid-19 is already reinforcing existing trends towards increased digitisation of payments.
Dr Marion Laboure and Sachin Silva are the co-authors of this blog. Marion Laboure is a macro strategist at Deutsche Bank and Sachin Silva is a doctoral candidate and fellow at Harvard University specialising in global health and economics.
The views and opinions expressed in this article are those of the author(s) and do not necessarily reflect the views of The Economist Group or any of its affiliates. The Economist Group cannot accept any responsibility or liability for reliance by any person on this article or any of the information, opinions or conclusions set out in the article.