Integrated Care Pathways for Bone Health: An Overview of Global Policies is a report by The Economist Intelligence Unit examining the global policy environment for bone health.
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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.
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.
Drug control policies in Eastern Europe and Central Asia: The economic, hea...
The former communist countries of Eastern Europe and Central Asia (EECA) are transition economies, attempting to manage rising healthcare costs whilst reforming their health systems. EECA is one of the few regions in the world where the incidence of Human Immunodeficiency Virus (HIV) is going up. Because of competing needs, public health interventions for HIV have been low on policymakers priority lists, with the allocation of domestic funds to scaling-up HIV prevention programmes falling short of demand.
Criminalisation of drug use and incarceration for drug-related offences are one of the main influences behind an increase in prison populations in EECA countries. Arresting and putting people who inject drugs (PWID) in prison is both expensive and associated with an increase in HIV infections. The funds allocated to incarcerating PWID massively outweigh those spent on prevention and treatment for this group. The stigma associated with drug use in EECA further hinders the expansion of HIV prevention programmes within mainstream public health.
In parts of Western Europe, evidenceinformed, properly scaled up, community-led harm reduction services exist, where criminal sanctions for individual use and possession of drugs are removed and human rights are respected. Such harm reduction approaches have helped decrease problems with drug use, reduce overcrowding in prisons and dramatically reduce the incidence of HIV in PWID. The case for addressing punitive criminalisation strategies and stigma associated with HIV in PWID in EECA is clear, yet progress towards decriminalisation remains slow.
This Economist Intelligence Unit (EIU) report aims to capture the attention of policy-makers in four study countries in the EECA region; Belarus, Kazakhstan, Kyrgyzstan and Russia to make the case for the cost effectiveness and health gains achieved when the criminalisation of drug use is reduced, harm reduction is scaled up and stigma and discrimination towards PWID and other vulnerable populations is reduced. To eliminate HIV in PWID this report arrives at the following four recommendations:
A shift in resource allocation. Investing the money saved from decriminalising drug use and possession for personal use (€38m-€773m over 20 years) into scaling up antiretroviral therapy (ART) and opioid agonist treatment (OAT) could effectively control the current HIV epidemics among PWID in the four study countries for no added cost. This both achieves the Joint United Nations Programme on HIV and AIDS (UNAIDS) coverage targets of ART in all settings, increases the coverage of OAT and reduces HIV incidence in PWID by 79.4-92.9% over 20 years. As OAT is not available in Russia, scaling up needle and syringe programmes (NSP) is an alternative solution which would be cheaper than scaling up OAT and ART. It would cost on average €46.5m per year to get 60% coverage of PWID and avert around 14,000 HIV infections per year. What is striking about these findings are the savings and HIV infections averted following such a simple shift in resources from criminalisation to harm reduction approaches, something governments cannot ignore.
Scaling up harm reduction in prison and continuity of care on release. Punishment should restrict freedom, not healthcare. Harm reduction needs to be scaled up not only in the community but also in prisons. The data explaining the risk of HIV transmission in prison is often blurred by underreporting and poor data collection. Special attention should be given to PWID when they leave prison, to ensure they continue to receive services, prevent overdose and further offending. Transitional care, which includes the provision of harm reduction interventions in prison and sustaining them post release is crucial to reducing HIV prevalence in the long term and should be made part of a national framework that straddles health and the criminal justice system.
Tackling stigma and discrimination. Stigma and discriminatory attitudes towards vulnerable populations need to be stopped. Stigmareducing workshops which educate the health and law enforcement sector on HIV prevention is a simple yet scarce solution in EECA. The importance of counselling, supporting positive mental health, addressing homelessness, preventing overdose and providing access to sexual and reproductive health services should be central to these educative workshops. Long term solutions require consistent and robust data collection on violence, discrimination and stigma, alongside actively using tools of influence such as shadow and alternative reporting to UN human rights treaty bodies.
Urgent law enforcement reform. To stop law enforcement officers from committing corrupt practices, there must be a reform of not only the police, but also a complete makeover of drug legislation and healthcare policies supporting drug users and people living with HIV. Punitive laws against key populations must be removed, and vulnerable populations such as sex workers, men who have sex with men, trans people, prisoners and PWID should be protected rather than antagonised by legal aid and law enforcement institutions.
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.
Two recent EC reports describe how the funding pledge of €1.4 billion from Horizon 2020, the EU’s Research and Innovation Programme (2014-2020), has been spent
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Health
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.
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.
The former communist countries of Eastern Europe and Central Asia (EECA) are transition economies, attempting to manage rising healthcare costs whilst reforming their health systems. EECA is one of the few regions in the world where the incidence of Human Immunodeficiency Virus (HIV) is going up. Because of competing needs, public health interventions for HIV have been low on policymakers priority lists, with the allocation of domestic funds to scaling-up HIV prevention programmes falling short of demand.
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17644
Health
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.
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.
For most of 2020 the covid-19 pandemic has shone a stark spotlight on many health system vulnerabilities globally, and particularly in Latin America. These vulnerabilities, punctuated by huge national death tolls, have catalysed change to some extent by placing pressure on political leaders who have otherwise been slow to invest effectively in the health sector.
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17643
Health
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.
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.
A life-course approach to hygiene: understanding burden and behavioural cha...
Hygiene refers to the practices that help to maintain health and prevent the spread of diseases. While good hygiene is primarily about behaviours, the ability to practise them well is supported by having the appropriate infrastructure in place, such as access to clean water and soap.
Poor water, sanitation and hygiene (WASH) increases death rates and ill health, creates greater demand for healthcare interventions, widens social inequalities, and has repercussions for quality of life and the wider economy.
There are two main transmission routes for infection—the faecal-oral and respiratory pathways—and hygiene measures work by disrupting them.
Attaining good hygiene is complex, and it is becoming increasingly clear that a more holistic approach is needed that engages and empowers local populations, and is locally sensitive and sustainable.
The life-course approach, which has its origins in preventing or reducing the impact of non-communicable diseases through encouraging good behaviours while recognising the contribution of other factors, including environmental ones, could provide a useful framework for communicable disease and hygiene. Looking at hygiene through a life-course lens could form part of a smarter approach that embeds good hygiene behaviour from childhood (to gain the most cumulative benefit), and then reinforces it throughout a person’s lifetime to boost good hygiene practices if these start to wane.
This report looks at the burden, challenges and opportunities of a life-course approach at four key life stages by focusing on specific infectious diseases or challenges at those time points.
Childhood and hygiene: a focus on diarrhoea
Every year diarrhoeal diseases kill around 0.5m children under five, with the majority of deaths in South Asia and sub-Saharan Africa. The majority of diarrhoeal deaths in low- and middle-income countries (LMICs) across all age groups can be attributed to WASH. Handwashing with soap can reduce transmission of diarrhoeal diseases and, to a lesser extent, respiratory infections. It is estimated that handwashing with soap after faecal contact only occurs in about 26% of events globally,, and the frequency of handwashing was lowest in regions with poor access to handwashing facilities. In 2017 the UN estimated that 3bn people lacked basic handwashing facilities at home. Furthermore almost half (47%) of schools worldwide lack handwashing facilities with available soap and water, and one in four health care facilities lack basic water services.
Experience from implementing hygiene interventions in schools and health centres suggests that interventions to improve hygiene in LMICs need to be two pronged, encouraging handwashing behaviour while also improving infrastructure to enable it.
Adolescence and hygiene: a focus on menstrual hygiene
Around 1.9bn women—about 26% of the world’s population—are of menstruating age, spending around 65 days per annum managing menstrual blood flow. As defined by the WHO/UNICEF Joint Monitoring Programme for Water Supply Sanitation and Hygiene (JMP), adequate menstrual hygiene requires women and adolescent girls to be able to access clean menstrual management material to absorb or collect menstrual blood, change their sanitary protection in privacy, have access to soap and water to clean themselves and wash reusable pads, and have an understanding of the basic facts linked to the menstrual cycle and how to manage it with dignity and without discomfort or fear.
Although menstrual hygiene issues impact girls and women across the globe, they have the biggest impact in LMICs where cultural, social and religious beliefs can further disadvantage menstruating girls and women.,, Menstruation affects the education of girls, including their attendance, engagement with lessons and potentially their life chances, and research is needed to measure the impact. In the workplace, menstruation affects women’s productivity and absenteeism.
Improving menstrual hygiene management is complex but must begin primarily with education in schools. Currently many girls in LMICs are unprepared for their first period; they often rely on information from their mothers, which tends to be framed in the context of protection from pregnancy rather than the needs and preferences of their daughters.
Adults and hygiene: a focus on slums
The world is becoming increasingly urbanised owing to adults being drawn from rural areas to towns and cities. Over 90% of this urban growth is occurring in LMICs, where the number of urban residents is growing by an estimated 70m each year, and many will end up in urban slums. The number of urban slum dwellers stands at over 880m and is growing. High-density living conditions, poor housing, low incomes, lack of convenient access to affordable clean water and soap, and lack of effective solutions for sanitation and solid waste management mean that the people in these communities are particularly vulnerable to infectious diseases. Currently, opportunities for interventions to reinforce the importance of hygiene behaviour during adulthood are limited, especially in informal settlements. Innovative slum improvement initiatives are required, with the full participation of slum residents.
Older people and hygiene: a focus on respiratory hygiene
Deaths from lower respiratory tract infections are highest in the under 5 and over 70 age groups, and most of this burden occurs in countries with low socio-demographic development.
The covid-19 pandemic of 2020 has highlighted the particular risks posed to older people by respiratory disease. For example, until December 23rd 2020, 92% of covid-19 deaths in the US had occurred among those aged 55 or older, and only 0.2% in the under-25s. As countries have grappled to contain the pandemic, it has also become clear that there needs to be greater consideration of and emphasis on hygiene standards for preventing respiratory diseases. Hygiene interventions generally put particular importance on behaviours that reduce diarrhoeal diseases, particularly washing hands after using the toilet and before eating, rather than regular cleaning and disinfection of frequent touch points, cough etiquette and washing hands when entering or leaving a different environment.
Our understanding of the basic science of respiratory pathogen transmission pathways and how to interrupt them also needs to be improved. More attention to hygiene during pandemics and epidemics has been shown to have benefits for reducing the incidence of other infectious diseases. For example, from March to September 2020 there were 7,029 influenza notifications in Australia, compared with an annual average of 149,832 over the same period in the previous five years.
A life-course approach to hygiene: understanding burden and behavioural changes is a report produced by The Economist Intelligence Unit and sponsored by the Reckitt Global Hygiene Institute. This research covers the factors that need to be considered to establish good hygiene practices and behaviour, with a particular focus on four areas: diarrhoea, slums, menstrual hygiene and respiratory hygiene. Extensive evidence was gathered from the literature and 11 expert interviews were conducted to help inform our research and this report. Our thanks are due to the following for their time and insights (listed alphabetically):
Kelly Alexander, senior learning and influencing advisor, Water+, CARE, Atlanta, Georgia, US
Jason Corburn, professor at the School of Public Health and Department of City and Regional Planning, and director of the Institute of Urban and Regional Development, University of California, Berkeley, US
David Duncan, chief of WASH, UNICEF, Laos
Samayita Ghosh, senior research associate at the Centre for Environmental Health, Public Health Foundation of India, India
Julie Hennegan, research fellow, Maternal, Child and Adolescent Health Programme, Burnet Institute, Melbourne, Australia; adjunct research associate, Johns Hopkins Bloomberg School of Public Health, US
Karin Leder, professor of clinical epidemiology and head of the Infectious Diseases Epidemiology Unit at the School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia
Stephen Luby, professor of medicine (Infectious Diseases & Geographic Medicine) and director of research at the Center for Innovation in Global Health, Stanford University, California, US
David Nabarro, co-director of the Imperial College Institute of Global Health Innovation, London, UK; special envoy to the World Health Organisation (WHO) director-general on COVID-19; and strategic director of 4SD (Skills, Systems and Synergies for Sustainable Development)
Poornima Prabhakaran, additional professor, head (environmental health) and deputy director, Centre for Environmental Health, Public Health Foundation of India, India
Ian Ross, economist and PhD student (health economics), London School of Hygiene and Tropical Medicine, UK
Joy Ruwodo, director, public affairs for the Ending Neglected Diseases (END) Fund Africa Region
Hygiene refers to the practices that help to maintain health and prevent the spread of diseases. While good hygiene is primarily about behaviours, the ability to practise them well is supported by having the appropriate infrastructure in place, such as access to clean water and soap.
Poor water, sanitation and hygiene (WASH) increases death rates and ill health, creates greater demand for healthcare interventions, widens social inequalities, and has repercussions for quality of life and the wider economy.
There are two main transmission routes for infection—the faecal-oral and respiratory pathways—and hygiene measures work by disrupting them.
Attaining good hygiene is complex, and it is becoming increasingly clear that a more holistic approach is needed that engages and empowers local populations, and is locally sensitive and sustainable.
The life-course approach, which has its origins in preventing or reducing the impact of non-communicable diseases through encouraging good behaviours while recognising the contribution of other factors, including environmental ones, could provide a useful framework for communicable disease and hygiene. Looking at hygiene through a life-course lens could form part of a smarter approach that embeds good hygiene behaviour from childhood (to gain the most cumulative benefit), and then reinforces it throughout a person’s lifetime to boost good hygiene practices if these start to wane.
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.
Non-alcoholic fatty liver disease (NAFLD) is a little-known condition, yet a quarter of the global adult population is estimated to have it. The majority of people living with the disease exhibit no symptoms, consequently the condition often goes undiagnosed until more advanced stages, leading to worse long-term outcomes for patients and a greater burden on health systems. General awareness of the condition amongst the public and non-liver specialist healthcare providers is also low.
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17637
Health
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.
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.
G7 leaders announce additional funding commitments of over US$6 billion for COVAX, the vaccines pillar of the Access to COVID-19 Tools (ACT) Accelerator
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Health
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.
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.
The path to malaria elimination in sub-Saharan Africa is an Economist Intelligence Unit report, sponsored by Abbott. The report looks at the strategies countries in sub-Saharan Africa are using to combat the disease and the challenges that countries are facing on the path to malaria elimination.
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17626
Health
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.
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.
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.
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.asia
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.
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