Public Health Funding Research Articles

11.H. Round table: Making the case for public investment in health

Abstract Across the European Union (EU), public budgets are facing pressures and policy makers are becoming increasingly concerned about how to adequately and sustainably fund their health systems to keep up with need and demand. In recognition of this, in 2022 a Technical Support Instrument (TSI) project funded by the Directorate-General for Structural Reform Support (DG REFORM) was launched together with three European Union (EU) Member States with the goal of strengthening capacity to make the case for public investments in health. To support these efforts, the European Observatory on Health Systems and Policies (OBS) conducted an exercise to map relevant analytical approaches and tools for making the case for public investment in health. As a contribution to this workshop, OBS will present the key results from this exercise, including a framework that has been designed to support health policy makers, advisors and advocates by providing five key lines of argument and selected examples of tools, data, indicators and methods that can be used to successfully make the case for public funding for health. This will be complemented by two presentations on country experiences (in Austria and Malta) of navigating negotiations between health and finance and securing public funding for health. These will highlight both successes and challenges in practice. By looking at examples from MS on making the case for public investment in health, these presentations will frame the panel discussion that follows. The chairs will facilitate a discussion closely engaging the audience on how to build better narratives and exchanges which facilitate trust and alignment between health and finance stakeholders in the pursuit of strengthening the capacity to make the case for public investment in health. The workshop will highlight five lines of argument and practical examples of tools, data, indicators and methods that can be used to support the case for public investment in health. It will also focus on the important enablers (e.g. cooperation, communication, transparency, accountability, trust) for successful budget negotiations and discuss how these can be facilitated. Key messages • Budget cases for public funds for health tend to be most successful when they align well with the goals and objectives of finance stakeholders, and certain narratives and arrangements can foster this. • Data and evidence can help steer decision makers to make good choices (or at least avoid bad ones), but other factors serve as the fuel to push the budget case for health forward successfully. Speakers/Panelists Rebecca Forman European Observatory on Health Systems and Policies, London, UK Jonathan Cylus European Observatory on Health Systems and Policies, London, UK Stefan Eichwalder Ministry of Health, Vienna, Austria Neville Calleja Department of Health Information and Research, G’Mangia, Malta

The future of public health in Europe

Abstract EuroHealthNet - in collaboration with the Copenhagen Institute for Futures Studies - has conducted a Foresight study to collect insights and identify risks and opportunities. The study investigates the role of public health by 2035 in achieving health equity through health promotion and prevention, in the context of the digital and green transition. The multi-round study ran from June to November 2023. It consisted of a workshop, a kick-off meeting, two rounds of surveys using the Delphi method, and a final back-casting expert panel. The Foresight exercise involved 35 experts across Europe and covered six themes: public health policy and governance; public health financing and spending; sustainability and the green transition; health promotion and disease prevention; equity and society; digitalisation in public health. The presentation will highlight some of the outcomes, recommendations as well as experiences from this Foresight exercise and how it can be applied in practice.

An Innovative Public Health Solution with European Features for an American Problem

Abstract Problem The Eastern Shore of Maryland is a beautiful region that boasts a multicultural community of 455,000 year-round residents. Despite its rural location, the coastal lifestyle attracts retirees, making it the state’s oldest population. Unfortunately, the region also has the highest socioeconomic disparities in the state, which creates difficulties in accessing healthcare. This is a significant public health issue that results in costly barriers to preventive care and timely, accounting for $320 billion in unnecessary healthcare spending. Description of the problem Maryland’s healthcare funding formulas favor larger health systems in urban areas, leading to health inequities. To address this, we propose an innovative scenario analysis model partially based on European public health approaches. This model will adjust funding formulas based on each region’s specific needs and challenges, promoting fairness and equity in healthcare funding. Results Adopting this population health management approach would have built-in efficiencies: In the United States, healthcare spending tends to be higher among underserved populations due to delayed care, access challenges, missed diagnoses, and limited access to the latest scientific advances as well as proper preventive services. Lessons The proposed scenario-based public health funding approach targeting the needs of the underserved population on the Eastern Shore of Maryland could yield significant positive health outcomes and health savings generating a ripple effect across the state, and perhaps even the country. The lessons learned in how other countries handle public health funding could lead to global collaboration. Key messages • Our approach aims to provide a practical solution to unnecessary healthcare spending. • We must adapt to the changing tides to stay on course.

Large scale system transformation: Ukraine

Abstract In the context of the EU-Ukraine Accession agreement, Ukraine started large scale public health systems reform back in 2015. The COVID-19 pandemic tested the response capacity of the national public health system and led to some improvement during the pandemic such as on laboratory capacity. It also generated lessons for strengthening national and subnational health emergency preparedness and response. Multiple interventions, including a Joint External Evaluation led to the adoption of the Public Health System Law in 2022, laying the foundation to bolster health promotion, disease prevention, and health protection. The Ukrainian Public Health Centre was substantially strengthened, partly oriented on models in other European countries. Corresponding centers for diseases control and prevention at the oblast level were reformed and a subnational network of these centers was created. While the war has a significant impact on the public health system, infrastructure, people and more, decision makers and professionals keep working on sustaining and moving forward the achievements on public health reforms, for example with the adoption of the National Health Strategy 2030 and the adoption of the National Health Security Plan. Further legal and strategic preparations are afoot to strengthen public health services governance capacity, financing, institutional innovation and development, and public health workforce development.

Modelling the potential impact of a tax on fruit juice in South Africa: implications for the primary prevention of type 2 diabetes and health financing

BackgroundSouth Africa is experiencing a persistent growth in non-communicable diseases. Diabetes is among the top ten causes of mortality, especially among women, which is partly driven by high levels of added sugar consumption and obesity. To reduce obesity rates and the incidence of diabetes, South Africa introduced a tax on sugar sweetened beverages (also known as the Health Promotion Levy (HPL)) in 2018. The tax is applicable to sugar-sweetened beverages but excludes 100% fruit juice. The government is currently considering extending the tax to include fruit juices. This study models the potential health and economic impact of taxing fruit juices at 20% of the retail price of one liter.MethodsTo analyze the distributional impact of the tax, this study uses extended cost-effectiveness analysis methodology. Data on price elasticities, healthcare cost, income, fruit juice consumption were sourced from the literature and representative national surveys. The potential impact of the tax on diabetes incidence, prevalence, mortality, and financial benefits were estimated for each income group (lowest, quintile 1 to highest, quintile 5).FindingsWe estimate that a 20% tax on fruit juice would avert 156,640 incident cases of type 2 diabetes mellitus over 20 years, with most disease averted occurring among the first- and fifth-income groups. Averted deaths from diabetes would average 2,000 deaths per quintile (for quintiles 1 to 4) and about 2,800 in quintile 5. The improved health resulting from averted incidence and deaths will reduce overall healthcare expenditure by R7.5 billion over 20 years, of which R2.3 billion will occur in the fifth quintile. The South African government will also save about R300 million in subsidizing diabetes-related healthcare cost as a result of prevention; and would raise R8.6 billion in tax revenues per annum. Out-of-pocket expenditure savings will be R303 million and a financial risk protection (money-metric value of insurance) of R4.6 billion over the 20-year period.ConclusionWe conclude that an HPL that significantly raises the retail price of fruit juices would reduce consumption and diabetes-related morbidity and mortality. The tax will also provide significant financial benefits in the form of reduced healthcare costs for both government and households as well as providing financial risk protection to individuals. Health taxes are win-win policies that improve population health and generate revenue for governments to fund public health services delivery and thus improve overall health financing activities of the government. Therefore, population level disease prevention measures such as health taxes are important for achieving universal health coverage.

Health outcome convergence and the roles of public health financing and governance in Africa.

Progress in health outcomes across Africa has been uneven, marked by significant disparities among countries, which not only challenges the global health security but impede progress towards achieving the United Nations' Sustainable Development Goals 3 and 10 (SDG 3 and SDG 10) and Universal Health Coverage (UHC). This paper examines the progress of African countries in reducing intra-country health outcome disparities between 2000 and 2019. In other words, the paper investigates the convergence hypothesis in health outcome using a panel data from 40 African countries. Data were sourced from the World Development Indicators, the World Governance Indicators, and the World Health Organization database. Employing a non-linear dynamic factor model, the study focused on three health outcomes: infant mortality rate, under-5 mortality rate, and life expectancy at birth. The findings indicate that while the hypothesis of convergence is not supported for the selected countries, evidence of convergence clubs is observed for the three health outcome variables. The paper further examine the factors contributing to club formation by using the marginal effects of the ordered logit regression model. The findings indicate that the overall impact of the control variables aligns with existing research. Moreover, governance quality and domestic government health expenditure emerge as significant determinants influencing the probability of membership in specific clubs for the child mortality rate models. In the life expectancy model, governance quality significantly drives club formation. The results suggest that there is a need for common health policies for the different convergence clubs, while country-specific policies should be implemented for the divergent countries. For instance, policies and strategies promoting health prioritization in national budget allocation and reallocation should be encouraged within each final club. Efforts to promote good governance policies by emphasizing anti-corruption measures and government effectiveness should also be encouraged. Moreover, there is a need to implement regional monitoring mechanisms to ensure progress in meeting health commitments, while prioritizing urbanization plans in countries with poorer health outcomes to enhance sanitation access.

Organization and financing of the health care system in Kazakhstan

Despite the challenges posed by the consequences of the global pandemic, achieving the country's national development goals remains a strategic direction of public health policy. The article aims to study the dynamics of healthcare financing in Kazakhstan, provide forecasts of upcoming development, and compare it with healthcare systems of developed countries. Based on the analysis of the current state and potential problems, recommendations were developed to improve the healthcare financing system in Kazakhstan. This article also analyzes the main parameters of health financing in the Republic of Kazakhstan for the period 2012–2022 and, in comparison with developed countries, provides the main reasons for maintaining low parameters of public health financing, which becomes a real obstacle to the implementation of measures aimed at achieving universal health coverage. During the research, a wide range of methodological approaches was applied, including system analysis (the study of an object as an integral system, interrelated elements), comparative analysis (comparison of the studied object with others in a number of characteristics), functional analysis (identification of the functions of the elements of the object and their interrelations), economic and statistical analysis and synthesis (collection, processing, interpretation of economic and statistical data), mathematical methods (modeling of studied processes and phenomena using mathematical models), dialectical methods (the study of an object in its development, change and contradictions), analysis of the burden of the disease (assessment of the economic and social consequences of the disease).

COVID-19 in Perspective: A Witness Seminar1.

In June 2023, we brought together leaders who responded to the emergency phase COVID-19 pandemic in Ontario as part of a "Witness Seminar." This approach to studying history was developed by the Institute of Contemporary British History. It has been extensively used in the history of science and medicine by the Wellcome Trust History of Twentieth Century Medicine. A witness seminar provides a collective oral history, in which participants can express diverse perspectives, build on each other's thoughts, and create a documentary record for policy makers and future historians. The published transcript provides an intimate look at how the pandemic played out in the eyes of some of key responders and raises many questions about the history of public health funding and administration in the province of Ontario, the failures in long-term care, and the need to improve pandemic communication. This article documents the success of the pandemic response.

The Power of Cultural Validation: A Global Strategy for Combating Infectious Diseases

Cultural Validation is a technique that works to increase access and break down barriers for what many policymakers and public health officials identify as “hard to reach populations.” During the COVID-19 Pandemic, policymakers and public health officials often cited “vaccine hesitancy” as a key challenge to reaching vulnerable populations, including immigrants, Spanish-speaking communities, and others who have been marginalized. Yet, community-based programs utilizing “Cultural Validation” techniques demonstrated that barriers to access – not hesitancy – were the true culprits. In fact, public health partnerships, laws, policies and funding that support the full integration of Cultural Validation techniques can ensure vaccine equity across the board. Cultural Validation can be applied to any community, and its success is made possible by four 4 key factors: • Researching and getting to know people in the community through genuine and authentic relationship-building prior to engagements. • Developing culturally relevant materials and marketing strategies. • Hosting events at places that are familiar to the community. • Providing genuine, authentic care in service delivery

How do we fund Public Health in Australia? How should we?

ObjectiveTo map how public health is funded in Australia. To assess whether changes to funding methods might improve system performance. MethodsReview of publicly accessible documents and discussions with public health key informants. ResultsAustralia spent $140 per person on public health in 2019-20, (1.8% of total health spending). But there is considerable state and territory variation. This money flows through multiple channels and payment mechanisms. Responsibility for what is funded is largely delegated to authorities close to the problems. This makes it easier to choose the best mechanism for funding an activity. Much information is hidden from view, however. This makes it impossible to assess whether the potential for population benefit is fully realised. ConclusionsAustralia avoids some of the difficulties experienced elsewhere because funding is largely devolved to states in block grants; they shape their own investments. The US, by contrast, prefers categorical funds for specific purposes. Three suggestions for making the funding system here more visible, useful and accountable are canvassed, including ‘satellite accounts’. Implications for Public HealthFunding needs to be more transparent before it is possible to assess whether public health system performance could be improved through changes to the way public health is funded.

Public Health Financing and Population Health: What Role Do Institutions Play?

ABSTRACTThis study investigates the multifaceted interactions among public health financing, institutions, and population health. It also sought to determine whether the efficacy of government health interventions to reduce child mortality and improve life expectancy in Africa's most populous country had been hampered by its institutional framework. The research analyzed the links among institutional, socioeconomic, and health variables using the autoregressive distributed lag estimator across a 37‐year period (1984–2020). The findings show that short‐term public health spending in Nigeria has a significant negative effect on health outcomes, whereas long‐term spending has a significant positive effect. Although public health financing significantly impacted long‐run life expectancy, its short‐run impact is statistically insignificant. Moreover, public health financing is positively linked with lower infant mortality in the long run but directly associated with higher rates in the short run. It further discovered that weak institutional framework is responsible for low life expectancy and high infant mortality. Institutions exert an unconditional significant negative impact on short‐ and long‐term health outcomes. Findings also show that both the short‐ and long‐term net effects of government health financing and institutions on the health outcomes are negative and statistically significant. So, institutions and public health financing are substitutes, with institutions unable to adequately improve their role in the public finance–health outcomes relations. Furthermore, the thresholds at which short‐ and long‐term institutional settings will modulate direct links between public finance and health outcomes are 5.01 and 2.62, respectively. Hence, the empirical findings validate the defective nature of the Nigerian institutional settings. Policy prescriptions for improving health outcomes are recommended based on the findings.

City-Level Sugar-Sweetened Beverage Taxes and Youth Body Mass Index Percentile

Levying excise taxes on sugar-sweetened beverage (SSB) distributors, which are subsequently passed on to consumers, is a policy implemented to reduce the high prevalence of cardiometabolic disease and generate public health funding. Taxes are associated with lower SSB purchases and consumption, but it is unknown whether they are associated with weight-related outcomes in youth. To determine the association of SSB excise taxes with youth body mass index (BMI) trajectories. This cohort study was conducted from 2009 to 2020, including 6 years before tax implementation and 4 to 6 years after tax implementation. The California cities of Albany, Berkeley, Oakland, and San Francisco, which implemented SSB excise taxes, were compared against 40 demographically matched control cities in California. Participants included Kaiser Permanente members aged 2 to 19 years at cohort entry (baseline) with continuous residence in selected cities with at least 1 pretax and 1 posttax BMI recorded in their electronic health record. Data analysis was performed from January 2021 to May 2023. Implementation of SSB excise taxes. Centers for Disease Control and Prevention age-specific and sex-specific BMI percentiles and percentage of youth with overweight or obesity before tax implementation through 4 to 6 years after implementation were compared with control cities. Statistical analysis was conducted using the difference-in-differences (DID) method. A sensitivity analysis used the synthetic control method. A total of 44 771 youth (mean [SD] age at baseline, 6.4 [4.2] years; 22 337 female [49.9%]) resided in the cities with SSB taxes; 345 428 youth (mean [SD] age, 6.9 [4.2] years; 171 0168 female [49.5%]) resided in control cities. There was a -1.64-percentage point (95% CI, -3.10 to -0.17 percentage points) overall difference in the mean change of BMI percentile between exposure and control cities after SSB tax implementation. There was no significant overall difference in the percentage of youth with overweight or obesity or youth with obesity compared with control cities. All DID estimates were significant for youth residing in exposure cities in terms of BMI percentile (age 2-5 years in 2017, -2.06 percentage points [95% CI, -4.04 to -0.09 percentage points]; age 6-11 years in 2017, -2.79 percentage points [95% CI, -4.29 to -1.30 percentage points]), percentages of youth with overweight or obesity (age 2-5 years, -5.46 percentage points [95% CI, -8.47 to -2.44 percentage points]; age 6-11 years, -4.23 percentage points [95% CI, -6.90 to -1.57 percentage points]), and percentages of youth with obesity (age 2-5 years; -1.87 percentage points [95% CI, -3.36 to -0.38 percentage points]; age 6-11 years, -1.85 percentage points [95% CI, -3.46 to -0.24 percentage points]). Compared with control cities, changes in mean BMI percentiles were significant for male (-1.98 percentage points; 95% CI, -3.48 to -0.48 percentage points), Asian (-1.63 percentage points; 95% CI, -3.10 to -0.16 percentage points), and White (-2.58 percentage points; 95% CI, -4.11 to -1.10 percentage points) youth. Compared with control cities, White youth in exposure cities had improvements in the percentage with overweight or obesity (-3.73 percentage points; 95% CI, -6.11 to -1.35 percentage points) and the percentage with obesity (-2.78 percentage points; 95% CI, -4.18 to -1.37 percentage points). In this cohort study, SSB excise taxes were associated with lower BMI percentile among youth. Policymakers should consider implementing SSB excise taxes to prevent or reduce youth overweight and obesity and, ultimately, chronic disease, particularly among children younger than 12 years.

A multicriteria vulnerability index for equitable resource allocation in public health funding.

This paper describes an action research project with the Centre universitaire intégré de santé et de services sociaux - Capitale Nationale (CIUSSS-CN) who identified a need to assess vulnerability in their territories in order toensure equitable distribution of the Integrated Perinatal and Early Childhood Services (SIPPE) program funds. The objective was to design and validate a multicriteria model to provide a more accurate portrait of vulnerability based on recent social realities. Our multidisciplinary research team of 7 members included experts in analytics, decision aiding, and community and public health. In collaboration with 6 CIUSSS-CN professionals, we co-constructed, during 9 workshops, a multicriteria model to aggregate the multiple dimensions of vulnerability. We used a value-focused thinking approach and applied the method MACBETH assisted by a geographic information system. Criteria, scales, and weights were validated and led to a vulnerability score for each CIUSSS-CN territory. This score provides a more accurate portrait of territorial disparities based on data and the participants' experience. The model was implemented in a dynamic user-friendly tool and serves to support decision-makers in the resource allocation process. Knowledge transfer was conducted during and after the process. This multidisciplinary research has served to anchor public health funding in local realities, with an emphasis on equity and stakeholder engagement. Our mixed-method approach integrating qualitative and quantitative data is adaptable to other contexts. Our results can enhance intervention effectiveness and allow for a better response to the needs of the population targeted by the SIPPE program.

Northern Nevada Public Health: Utilizing the Public Health Workforce Calculator and Workforce Capacity Self-assessment Tools to Develop a Framework for Workforce Investment.

Health departments nationally are critically understaffed and lack infrastructure support. By examining current staffing and allocations through a Foundational Public Health Services (FPHS) lens at the Northern Nevada Public Health (NNPH), there is an opportunity to make a strong case for greater investment if current dedicated full-time equivalents are inadequate and to guide which investments in public health workforce are prioritized. To assess the use of the Public Health Workforce Calculator (calculator) and other tools to identify and prioritize FPHS workforce needs in a field application. Field application of the calculator in conjunction with the use of FPHS workforce capacity self-assessment tools. NNPH. NNPH and Public Health Foundation (PHF). From June 2022 through April 2023, PHF collaborated with NNPH, serving Washoe County, to provide expertise and assistance as NNPH undertook an assessment of its workforce needs based upon the FPHS model. Comparison of the calculator output with FPHS workforce capacity self-assessment tools. The calculator and the FPHS capacity self-assessment process yielded complementary FPHS workforce capacity gap data. The use of a structured and transparent process, coupled with additional tools that included prioritizing needs, provided a viable and sustainable process for public health workforce investment planning. NNPH successfully utilized the results to bolster a supplemental funding request and a state public health appropriation. The use of the calculator and an FPHS workforce capacity self-assessment in a facilitated and structured process such as that used by NNPH to identify staffing priorities may hold promise as an approach that could be used to support decision-making and justification for infrastructure resources when funding for public health increases in the future.

A Scoping Review of Health Equity Interventions in Governmental Public Health.

Despite major efforts in research, practice, and policy, racial and ethnic disparities in health and health care persist in the United States. Interventions in collaboration with governmental public health may provide ways to address these persistent racial and ethnic health and health care disparities and improve health outcomes. To conduct a comprehensive review of health equity interventions performed in collaboration with public health agencies. This scoping review includes intervention studies from Ovid MEDLINE, PsycINFO, and Academic Search Premier, published between 2017 and 2023. The search strategy used terminology focused on 4 concepts: race/ethnicity, equity, health departments, and epidemiologic studies. The following inclusion criteria were determined a priori: (1) intervention tailored to reduce racial/ethnic health disparities, (2) public health department involvement, (3) health outcome measures, (4) use of epidemiologic study methods, (5) written in English, (6) implemented in the United States, (7) original data (not a commentary), and (8) published between January 2017 and January 2023. This review focused primarily on 4 dimensions of racial health equity interventions including intervention components, intervention settings, intervention delivery agents, and intervention outcomes. This review indicated that health equity interventions involving public health agencies focused on the following categories: (1) access to care, (2) health behavior, (3) infectious disease testing, (4) preventing transmission, and (5) cancer screening. Critical strategies included in interventions for reaching racial/ethnic minoritized people included using community settings, mobile clinics, social media/social networks, phone-based interventions, community-based workers, health education, active public health department involvement, and structural/policy change. This scoping review aims to provide an evidence map to inform public health agencies, researchers, and funding agencies on gaps in knowledge and priority areas for future research and to identify existing health equity interventions that could be considered for implementation by public health leaders.

A calculation of capitation-based payment standardto chronic disease cases in primary care settings

BackgroundOutpatient medical care payment play a pivotal role in the reform of medical insurance payment methods. With ongoing reforms in China, a variety of payment strategies, including capitation and the ambulatory patient groups (APG) point method, are being progressively implemented. ObjectiveThis study aims to identify appropriate capitation calculation methods for chronic diseases in Beijing and to provide recommendations for implementing capitation payments reforms in the city. MethodsWe focused on four prevalent chronic diseases—hypertension, diabetes, coronary heart disease, and stroke—and analyzed basic medical data and public health funding in Beijing's districts C and H as case studies. This research was aimed at developing a capitation calculation method tailored to these locales, determining payment standards for major chronic diseases in primary care clinics, and thus supporting the advancement of capitation reform for outpatient chronic diseases. ResultsUsing medical insurance data and public health funding data from 2017 to 2019, a top-down allocation was employed to determine the capitation payment standards in district H: 4,693.11 Yuan for hypertension, 6,597.70 Yuan for diabetes, 5,644.46 Yuan for coronary heart disease, and 6,437.78 Yuan for stroke. A bottom-up costing approach was used in district C, resulting in payment standards of 4,884.18 Yuan for hypertension, 5,960.63 Yuan for diabetes, 3,733.93 Yuan for coronary heart disease, and 3,886.66 Yuan for stroke. ConclusionThe outpatient costs associated with different chronic disease populations vary considerably. In view of maintaining equity in medical insurance and the fairness of capitation fees, it is imperative to apply risk adjustments to the benchmark capitation fee. Personalized services should be tailored to the diverse types and severities of chronic diseases. It is also crucial to provide customized basic medical and public health services to various chronic disease patients as part of the capitation payment reform for outpatient services. Additionally, enhancing the capabilities of community health services in managing chronic diseases, improving contracting percentages, and establishing effective incentive and evaluation mechanisms for general practitioners are essential for equitable distribution of surplus from capitation payments.

Examining the Problems and Solutions to Facilitate the Payment and Receipt of Health Taxes.

In addition to creating significant health gains, taxation can be used to increase public health funding. However, achieving the goals of health-related taxes faces many barriers and problems. We aimed to examine the barriers and solutions to facilitate the payment and receipt of health taxes. The present descriptive and analytical study was conducted in 2021-2022. The first part of the research was the questionnaire's design and validation, and the second part was using the designed questionnaire to collect and analyze data. The validity of the questionnaire was measured using the content validity, and the reliability of the questionnaire was measured using Cronbach's alpha. Then, the questionnaires were distributed in person at the workplace of 430 professors, managers, and experts in economics and health, and the collected data were reviewed and analyzed. Barriers and problems related to structure and infrastructure, evasion, avoidance, and tax exemption, and coordination and cooperation are the most important problems related to health taxes. Moreover, evasion, avoidance and tax exemption, cultural and social issues, and coordination and cooperation are the most important solutions to overcome the problems of health taxes. To dispel the barriers and facilitate the payment and receipt of health-related taxes and achieve the goals of the health sectors, it is very important to deal with tax evasion, build a culture, and close cooperation with related organizations.

Indiana's Public Health Investment Holds Insights For Other States.

Indiana has a business-friendly environment, but historical underinvestment in public health has yielded poor health outcomes. In 2023, when trust in governmental public health was strained nationwide, Indiana increased public health spending by 1,500percent. In this article, we explain how Indiana achieved this unprecedented legislative victory for public health, describing the context, approach, and lessons learned. Specifically, an Indiana University report linking economic vitality and overall health sparked the creation of a governor's commission charged with exploring ways to address Indiana's shortcomings. Working with the Indiana Department of Health, the commission developed multisectoral coalitions and business and government partnerships, and it maintained consistent and coordinated communication with policy makers. Lessons learned included the value of uncoupling public health from partisan narratives, appointing diverse commission membership with strategically selected cochairs, involving local leaders, and ensuring local decision-making control. We believe that Indiana's approach holds insights for other states interested in strengthening public health funding in the current era.

How group structure impacts the numbers at risk for coronary artery disease: polygenic risk scores and nongenetic risk factors in the UK Biobank cohort.

The UK Biobank (UKB) is a large cohort study that recruited over 500,000 British participants aged 40-69 in 2006-2010 at 22 assessment centers from across the United Kingdom. Self-reported health outcomes and hospital admission data are 2 types of records that include participants' disease status. Coronary artery disease (CAD) is the most common cause of death in the UKB cohort. After distinguishing between prevalence and incidence CAD events for all UKB participants, we identified geographical variations in age-standardized rates of CAD between assessment centers. Significant distributional differences were found between the pooled cohort equation scores of UKB participants from England and Scotland using the Mann-Whitney test. Polygenic risk scores of UKB participants from England and Scotland and from different assessment centers differed significantly using permutation tests. Our aim was to discriminate between assessment centers with different disease rates by collecting data on disease-related risk factors. However, relying solely on individual-level predictions and averaging them to obtain group-level predictions proved ineffective, particularly due to the presence of correlated covariates resulting from participation bias. By using the Mundlak model, which estimates a random effects regression by including the group means of the independent variables in the model, we effectively addressed these issues. In addition, we designed a simulation experiment to demonstrate the functionality of the Mundlak model. Our findings have applications in public health funding and strategy, as our approach can be used to predict case rates in the future, as both population structure and lifestyle changes are uncertain.

Daily Case Trends of COVID-19

The COVID-19 pandemic has caused immense and immeasurable disruption to billions of lives worldwide, and the strain on healthcare workers and facilities will undoubtedly be seen for years to come. Many factors impact the incidence and prevalence of COVID-19 in states, such as policies and legislation, funding, partisanship of the statehouse, vaccination rates, and rurality. The purpose of this paper is to analyze the differences in the daily positive cases between Indiana and Washington State and examine the respective ways each state tried to mitigate the morbidity and mortality of the virus. Indiana and Washington State were chosen as the states have similar populations in different geographical locations in the country and varying responses to the pandemic. Data was obtained from the respective state health departments over a period of two and a half years from March 2020 to December 2022. Independent t-tests were used for the analysis of the data between Indiana and Washington. Overall, Indiana had a higher daily positive case rate when compared to Washington. Indiana had a lower vaccination rate and had more hospitalizations and deaths compared to Washington and the US population as a whole. The difference in the findings of each state could be attributed to the partisanship of the state and the ways in which partisanship influences the enacting of legislation and policies intended to mitigate disease, as well as public health funding allocated by the state.