Health Policy Objectives Research Articles

A Health Economics Inquiry into Regulatory Constraints on the European Tobacco Market.

Despite the implementation of significant measures by European countries in recent years, smoking rates in Europe remain persistently high. TheEuropean Commission is currently undertaking a comprehensive review of itstobacco regulations. This article aims to address critical inquiries that arise during the amendment of the regulatory framework. We evaluate the effectiveness of existing tobacco control methods and observe a diminishing impact on promoting smoking cessation. Additionally, we explore how individuals of varying genders respond to the regulatory environment. We propose a comprehensive and evidence-based framework for implementing a taxation system in response to the proliferation of emerging products, including e-cigarettes and heated tobacco. This system is designed to align effectively with health policy objectives, providing a strategic approach to curbing tobacco use and promoting public health.

Monitoring the level of health and inequality over time using the Population Health Performance Index

Abstract Background The Population Health Performance Index (PHPI) is a composite measure that combines average health outcomes and their distribution within a population, thereby allowing for a comprehensive assessment of population health and inequality. The aim of this study is to examine the extent to which the PHPI adds value to monitoring of health and inequality over time in comparison to absolute and relative inequality. Methods Data from the WHO Equity Monitor database on under-5 mortality disaggregated by wealth quintiles for Nepal, Ethiopia, Peru, Rwanda, and Zimbabwe were analysed using different years between 1994 and 2020. Descriptive comparative statistics were employed to assess trends in the PHPI and conventional pairwise measures of absolute and relative inequalities, with consideration of different weights for inequality aversion. Results PHPI trends correspond to the trend of absolute inequality in all five countries, although they exhibit less volatility over time. Relative inequality follows the trend of the PHPI in only two of the five countries (Ethiopia and Zimbabwe), reflecting the methodology utilised for the PHPI. PHPI scores vary based on different inequality aversion weights, highlighting the sensitivity of the index to methodological adjustments. Conclusions The PHPI demonstrates notable convergence of trends with conventional methods, thereby substantiating its utility as a comprehensive tool for the simultaneous measurement of health and inequality. As it is able to consider both absolute and relative inequality within its own calculations, the PHPI allows for independent analysis of its two key components. The PHPI facilitates a more nuanced understanding of population health and may be more easily understood by policymakers and other stakeholders. As it does not address the underlying causes of changes in health inequalities, further research is necessary to supplement monitoring activities. Key messages • PHPI is a valuable tool for health and inequality monitoring by integrating both average health and disparity in a single index, facilitating communication of trends over time. • The dual focus complements conventional methods with its multidimensionality and may enable stakeholders to assess health and inequalities in alignment with broader health policy objectives.

Pakistan’s path to universal health coverage: national and regional insights

BackgroundUniversal Health Coverage (UHC) is a common health policy objective outlined in the Sustainable Development Goals. With provincial governments taking the initiative, Pakistan has implemented and extended UHC program amid a complex public health landscape. In this context, we assess Pakistan’s progress toward achieving UHC at the national and subnational level.MethodsWe use data from the Demographic and Health Surveys and the Household Integrated Economic Survey to construct a UHC index at the national and subnational level for 2007, 2013, and 2018. Furthermore, we use Concentration Index (CI) and CI decomposition methodologies to assess the primary drivers of inequality in accessing medical services. Logistic regression and Sartori’s two-step model are applied to examine the key determinants of catastrophic health expenditure (CHE).ResultsOur analysis underscores Pakistan’s steady progress toward UHC, while revealing significant provincial disparities in UHC progress. Provinces with lower poverty rate achieve higher UHC index, which highlights the synergy of poverty alleviation and UHC expansion. Among the examined indicators, child immunization remains a key weakness that one third of the children are not fully vaccinated and one sixth of these not-fully-vaccinated children have never received any vaccination. Socioeconomic status emerges as a main contributor to disparities in accessing medical services, albeit with a declining trend over time. Household socioeconomic status is negatively correlated with CHE incidence, indicating that wealthier households are less susceptible to CHE. For individuals experiencing CHE, medicine expenditure takes the highest share of their health spending, registering a staggering 70% in 2018.ConclusionPakistan’s progress toward UHC aligns closely with its economic development trajectory and policy efforts in expanding UHC program. However, economic underdevelopment and provincial disparities persist as significant hurdles on Pakistan’s journey toward UHC. We suggest continued efforts in UHC program expansion with a focus on policy consistency and fiscal support, combined with targeted interventions to alleviate poverty in the underdeveloped provinces.

Role of the health literacy assessment in healthcare: Content validation of "Health Literacy Behaviour" nursing outcome.

To validate the content of the "Health Literacy Behaviour" nursing outcome (NO). A content validation study was conducted during 2022. Each indicator was included in the NO, and its response levels were operationally defined. The initial version of each indicator and its response levels were refined and validated through the Delphi method. A panel of health literacy (HL) and nursing taxonomies experts evaluated the content through two content validity indicators. The content validity of the NO and each index was determined by calculating the content validity index (CVI). A qualitative analysis of the recommendations provided by the experts was carried out to improve the understanding of the indicators and their levels. A total of 108 experts participated in this study. Mostly females with more than 10 years of professional experience. The results demonstrated a high CVI of the indicators and the NO "Health Literacy Behaviour." All indicators achieved excellent (CVI≥0.80) relevance and clarity. The CVI universal average method (CVI-p) of the NO achieved an excellent result of 0.90. The indicators included in the NO "Health Literacy Behaviour" have content validity. These findings provide evidence-based indicators to measure the patient's actions to obtain, process, and understand information about health and disease, interact with the health system, and make informed health decisions. The validation of this NO would identify populations with low HL, allowing the health of this community to be promoted. Health literacy should be a priority objective of health management and policies.

The politics and governance of drug production in public-private partnerships: Brazil’s response to hepatitis C

ABSTRACT The local manufacture of advanced pharmaceutical products has been a long-standing objective of health and industry policy in many developing countries, including in Latin America. This strategy has been applied to fight epidemics such as HIV/AIDS, malaria, and the COVID-19 pandemic. However, we still know little about the politics and governance that enable such arrangements, especially when there is no consent from the originator company. This study focuses on the case of Brazil, a country that is well-known for its health-industry policy, which includes the local production of direct-acting antivirals (DAAs), a new treatment for hepatitis C. We seek to explain the factors that have contributed to Brazil’s successful production of generic versions of DAAs, and, later, to the decision by the Ministry of Health (MoH) to procure drugs from multinational pharmaceutical companies rather than from local laboratories. A lack of support for domestic production by important stakeholders, the patent holder’s attempt to block domestic production and the MoH’s adoption of more modern treatment guidelines under a different procurement logic all created an unfavourable environment for local production and procurement of DAAs. Our study draws implications for middle-income countries that wish to produce drugs domestically without voluntary license agreements.

Prevalence and Risk Factors for Congenital Malformations in Morocco

Background: Congenital malformations are among the most pressing health concerns globally. In Morocco, minimizing the morbidity and mortality associated with congenital malformations is a key health policy objective. In the Marrakech-Safi region, the prevalence and etiology of congenital malformations remain unclear. Objectives: This study seeks to ascertain the prevalence of clinically evident congenital malformations and identify the factors contributing to their incidence in the Marrakech-Safi region. Methods: A retrospective study was conducted in the maternity ward of the Mohamed VI University Hospital Center in Marrakech in 2022. An obstetric chart was utilized to gather sociodemographic, obstetrical, maternal, and neonatal data from the target population, including risk factors. The data were analyzed using SPSS 21 software. Results: Out of 17 250 files reviewed, 159 births with malformations were identified, resulting in a prevalence of 0.92% of births. Newborns with multiple malformations constituted 22.64% of all cases, with a prevalence of 2.08/1000 births. Neural tube defects were the most common, with a prevalence of 3.65/1000 births, followed by musculoskeletal defects and digestive tract defects. Chromosomal malformations, specifically trisomy 21, were the fifth most common, with a prevalence of 1.4/1000 births. Facial and urogenital malformations were the least frequent in this study. The occurrence of congenital malformations in this region is influenced by various risk factors, including maternal age, male sex, parity, medical history, and newborn weight at birth. Conclusions: In the Marrakech-Safi region, congenital malformations are influenced by a wide range of risk factors. Identifying these factors is crucial for healthcare providers to enhance surveillance among at-risk populations and develop effective preventive, diagnostic, and therapeutic strategies.

A valuation study to identify the determinants of the demand for time spent outdoors among users of hospital facilities, their willingness-to-pay for green infrastructure improvements, and the implications for planning

ABSTRACT Green infrastructure has been promoted as an urban planning tool for the achievement of health and environmental policy objectives. The capacity of economic valuation methods to estimate monetary benefit values for intangible goods, such as mental health and wellbeing, renders them useful in justifying green infrastructure interventions and guiding their implementation. In this case study we used stated preference methods to elicit cross-sectional data on the preferences of staff (n=118), visitors (n=88), and inpatients (n=35) of Musgrave Park Hospital in Northern Ireland, for improvements in the hospital’s outdoor grounds. To our knowledge, this is the first paper to use the contingent behavior method to examine the demand for time spent on the improved outdoor grounds of a hospital and the first to use the contingent valuation method to obtain the respective willingness-to-pay values. The results show that the three hospital user groups differed in their preferred types of green infrastructure and their motivations for using the outdoor grounds, an important input for planning the transformation of the outdoors. Other findings suggest that to maximize health and well-being benefits, complementary measures to address the issues of sedentary lifestyles and inadequate use of the outdoors as a stress-coping mechanism are needed.

Access to Innovative Medicines: Regulation Change and Factors Associated with Drug Approval Lag in Malaysia.

Drug approval lag is the time difference for new medicine to obtain marketing authorization approval in the study country compared to the first global approval. Drug approval lag delays the availability of innovative medicine to patients. This may lead to delay in treatment and severe public health implications. The study aimed to determine drug approval lag in Malaysia, the factors associated with drug approval lag (drug characteristics, regulatory factors and applicant type) and the association of the submission lag and review time with the regulation change. All new pharmaceutical products approved between January 2015 and March 2021 were examined (n = 136) using publicly available information. Factors associated with drug approval lag were determined using multiple linear regression. The median drug approval lag was 855days. Drug approval lag was associated with drug characteristics and regulatory factors. Median submission lag and median review time for products which fulfilled the requirement for the new regulations (Conditional Registration/ Facilitated Registration Pathway) were shorter compared to products which did not fulfil the requirement. Drug approval lag may delay the access of innovative medicine to patients, and this may lead to an increase in morbidity, mortality and healthcare costs. Good Regulatory Practices ensure efficient and transparent regulatory system which support the public health policy objectives in the most efficient way. The new regulations in Malaysia reduced the median submission lag and review time. The findings may be useful for regulators to consider for future policy development for medication access.

A Critical Review of the Sustainability of South Africa's Health System, User’s Satisfaction and Key Performance Scores

The South African Government has made accessibility and equity the primary focus of its health policy objectives since 1994. However, the extent to which these policies achieve their aims of lessening inequality is not synthetically documented. This study critically reviews and synthesises the literature on the nature of the South African health system, user’s satisfaction and key performance scores. The study conducted a content analysis of several research papers and policy papers in the South African health sector. The review showed that the current health system is dualistic, indicating that the public health system is not living up to the National Core Scores and that this has impacted negatively on the level of satisfaction of households. The evidence demonstrated ongoing discrepancies in access to and use of health services, notwithstanding legislative initiatives. Moreover, the review showed that user’s perceptions of the quality of public healthcare services are deteriorating in South Africa. There is evidence of treatment delays, long waiting times, acute shortages of doctors, specialists and nurses, a lack of appropriate medication and poor health services delivery. The evidence provided about the South African health system can contribute to global policy discussions about health equity on the use of health services by households from different socioeconomic backgrounds and how policies can increase access to quality health care for low-income households.
 

Barriers to Voluntary Medical Male Circumcision Uptake to Prevent HIV Transmission: A Qualitative Study among Married Men

Background: Voluntary medical male circumcision (VMMC) is a relatively new intervention that has been found to reduce sexual transmission of HIV among heterosexual partners by 60% when properly practiced. However, the poor acceptance of VMMC makes it difficult to accomplish the objectives of health policy to boost uptake. The purpose of this study was to explore the barriers to VMMC Uptake among married men in Kitgum municipality. Methods: The qualitative descriptive design was employed in this study. The purposive sampling method was used to recruit 30 married men who lived within any of the three divisions of the municipality and had been married for at least one year. Data collection was done using an in-depth interview method. Inductive content analysis was used to generate the themes and categories. Results: The study findings revealed that fear, financial uncertainty, involvement of female health workers, cultural beliefs, religious belief, sexual dissatisfaction and advanced age were barriers to voluntary medical male circumcision uptake among the married men in Kitgum municipality. Conclusion: In Kitgum municipality, VMMC Uptake is still low, but the majority of the males had sufficient knowledge about it. We found the low uptake was primarily attributed to anxiety, involvement of female health workers, financial instability, sexual unhappiness, and advanced age. There is a need for proper re-packaging of the health education messages during mobilisations to address the anticipated side effects and to clearly state the reasons for the VMMC program. There is a need for proper re-packaging of the health education messages during mobilisations to address the communication gaps and to clearly state the reasons for VMMC program. Adequate psychological preparation of the men to expect any sex of staffs working in these clinics.

#DiabetesOnAPlate: the everyday deployment and contestation of diabetes stigma in an online setting

ABSTRACT People living with Type 1 and Type 2 diabetes (T1DM &T2DM) report that media – including journalism, health promotion, and popular culture – are a primary source of stigmatic representations of diabetes, and that this compromises their physical and mental health. This view of diabetes as stigmatised is not shared by many health professionals and nor the wider public. We used an existing representation of diabetes on Instagram, #DiabetesOnAPlate, to examine how stigmatic representations of diabetes are (re)produced, discussed, and contested. Our analysis found that, consistent with the notion of diabetes as stigmatised, use of the hashtag #DiabetesOnAPlate on Instagram is associated with public health discourses of indulgent eating and with posts that signal recognition of this as a moral transgression. A subsequent on-line survey found that participants who did not have diabetes did not recognise a prototypical #DiabetesOnAPlate post as stigmatic. Whilst some with T1DM and T2DM did perceive and contest the stigma, T1DM participants did so for their group (but not for T2DM); and there was evidence that some T2DM participants internalised the stigma. These findings support concerns about the everyday, divisive nature of stigmatic representations of diabetes on social network sites, which on the one hand reflect public health discourse and on the other may compromise health policy objectives and exacerbate health inequalities.

Productivity analysis of regional-level hospital care in the Czech republic and Slovak Republic

BackgroundProviding hospital care is an essential objective of national health policies. The countries that share common history, when they emerged from the same health system and similar conditions in the early 1990s, after the division of Czechoslovakia, became the objects of evaluation of the development of technical efficiency of hospital care. The subsequent development of their health care system also was very similar, but no longer entirely identical. The article aims to identify the trends and disparities in the productivity of the capacities of hospital care on the regional level (NUTS III.) in the Czech Republic and the Slovak Republic in 2009–2018 before the COVID-19 pandemic using the multi-criteria decision methods.MethodsThe window analysis as a dynamic DEA method based on moving averages and also the Malmquist Index, that allows the evaluation of changes in relative efficiency and of changes in the production possibilities frontier have become the key methods for evaluating the over time efficiency evolution. To model technical efficiency, an output-oriented method assuming constant returns to scale was chosen. Aggregated input and output parameters for each region were the object of study.ResultsThe results showed that differences in the efficiency trends in terms of the examined parameters among the individual regions are slightly greater in the Czech Republic than in the Slovak Republic. The least efficient regions are those where capital cities are located. Furthermore, the analysis showed that in 2018 all of the Slovak Republic regions improved its productivity compared to 2009 and that technological conditions had a significant impact on this improvement. The results of the Czech Republic regions show productivity improvement in 57% of the regions that, on the contrary, was due to changes in technical efficiency.ConclusionsIt should be recommended to the state- and regional-level governments to refrain from unilaterally preferring the orientation of public policies on the efficiency of the provision of hospital care, and rather focus on increasing the quality and availability of hospital care, especially in smaller, rural, and border regions, in the interest of population safety during pandemics and other emergencies.

Why do women attend antenatal care but give birth at home? a qualitative study in a rural Ghanaian District.

The Sustainable Development Goal Three has prioritised reducing maternal, under-5 and neonatal mortalities as core global health policy objectives. The place, where expectant mothers choose to deliver their babies has a direct effect on maternal health outcomes. In sub-Saharan Africa, existing literature has shown that some women attend antenatal care during pregnancy but choose to deliver their babies at home. Using the Andersen and Newman Behavioural Model, this study explored the institutional and socio-cultural factors motivating women to deliver at home after attending antenatal care. A qualitative, exploratory, cross-sectional design was deployed. Data were collected from a purposive sample of 23 women, who attended antenatal care during pregnancy but delivered their babies at home, 10 health workers and 17 other community-level stakeholders. The data were collected through semi-structured interviews, which were audio-recorded, transcribed and thematically analysed. In line with the Andersen and Newman Model, the study discovered that traditional and religious belief systems about marital fidelity and the role of the gods in childbirth, myths about consequences of facility-based delivery, illiteracy, and weak women's autonomy in healthcare decision-making, predisposed women to home delivery. Home delivery was also enabled by inadequate midwives at health facilities, the unfriendly attitude of health workers, hidden charges for facility-based delivery, and long distances to healthcare facilities. The fear of caesarean section, also created the need for women who attended antenatal care to deliver at home. The study has established that socio-cultural and institutional level factors influenced women's decisions to deliver at home. We recommend a general improvement in the service delivery capacity of health facilities, and the implementation of collaborative educational and women empowerment programmes by stakeholders, to strengthen women's autonomy and reshape existing traditional and religious beliefs facilitating home delivery.

Availability of Key Essential Medicines in Public Health Facilities of South Indian Union Territory: One of the Crucial Components of Universal Health Coverage.

IntroductionThe supply of essential medicines is one of the vital components of primary health care. One of the important objectives of Indian health policy is to provide all the essential medicines at an affordable cost for the public. The performance of healthcare facilities is directly affected by the supply of essential medicines. This study was conducted to check the availability of key essential medicines in selected public healthcare facilities of the South Indian Union Territory.MethodsA snapshot survey was conducted between March 2019 and February 2020 in 10 selected public health facilities to assess the availability of 50 key essential medicines. Percentage availability for all surveyed medicines for the individual facility as well as percentage availability of individual medicines in all surveyed health facilities was calculated.ResultsPercentage availability of 50 key essential medicines in 10 surveyed public health facilities was found in a range of 66 to 80%. Out of 50 medicines, 26 (52%) medicines were available in more than 80% of health facilities while six (12%) medicines were available in less than 30% of surveyed facilities.ConclusionThis study reported the high availability of essential medicines in public health facilities as compared to similar studies done in other parts of India but the availability of some essential medicines was found sub-optimal and needs to be improved.

Private health care market shaping and changes in inequities in childhood diarrhoea treatment coverage: evidence from the analysis of baseline and endline surveys of an ORS and zinc scale-up program in Nigeria

BackgroundNearly 90,000 under-five children die from diarrhoea annually in Nigeria. Over 90% of the deaths can be prevented with oral rehydration salt (ORS) and zinc treatment but coverage nationally was less than 34% for ORS and 3% for zinc with wide inequities. A program was implemented in eight states to address critical barriers to the optimal functioning of the health care market to deliver these treatments. In this study, we examine changes in the inequities of coverage of ORS and zinc over the intervention period.MethodsBaseline and endline household surveys were used to measure ORS and zinc coverage and household assets. Principal component analysis was used to construct wealth quintiles. We used multi-level logistic regression models to estimate predictive coverage of ORS and zinc by wealth and urbanicity at each survey period. Simple measures of disparity and concentration indices and curves were used to evaluate changes in ORS and zinc coverage inequities.ResultsAt baseline, 28% (95% CI: 22–35%) of children with diarrhoea from the poorest wealth quintile received ORS compared to 50% (95% CI: 52–58%) from the richest. This inequality reduced at endline as ORS coverage increased by 21%-points (P < 0.001) for the poorest and 17%-points (P < 0.001) for the richest. Zinc coverage increased significantly for both quintiles at endline from an equally low baseline coverage level. Consistent with the findings of the pairwise comparison of the poorest and the richest, the summary measure of disparity across all wealth quintiles showed a narrowing of inequities from baseline to endline. Concentration curves shifted towards equality for both treatments, concentration indices declined from 0.1012 to 0.0480 for ORS and from 0.2640 to 0.0567 for zinc. Disparities in ORS and zinc coverage between rural and urban at both time points was insignificant except that the use of zinc in the rural at endline was significantly higher at 38% (95%CI: 35–41%) compared to 29% (95%CI, 25–33%) in the urban.ConclusionThe results show a pro-rural improvement in coverage and a reduction in coverage inequities across wealth quintiles from baseline to endline. This gives an indication that initiatives focused on shaping healthcare market systems may be effective in reducing health coverage gaps without detracting from equity as a health policy objective.

The inverse care law re-examined: a global perspective

An inverse care law persists in almost all low-income and middle-income countries, whereby socially disadvantaged people receive less, and lower-quality, health care despite having greater need. By contrast, a disproportionate care law persists in high-income countries, whereby socially disadvantaged people receive more health care, but of worse quality and insufficient quantity to meet their additional needs. Both laws are caused not only by financial barriers and fragmented health insurance systems but also by social inequalities in care seeking and co-investment as well as the costs and benefits of health care. Investing in more integrated universal health coverage and stronger primary care, delivered in proportion to need, can improve population health and reduce health inequality. However, trade-offs sometimes exist between health policy objectives. Health-care technologies, policies, and resourcing should be subjected to distributional analysis of their equity impacts, to ensure the objective of reducing health inequalities is kept in sight.

The challenges of breast cancer care in Mexico during health-care reforms and COVID-19.

The challenges of breast cancer care in Mexico during health-care reforms and COVID-19.

Prioritization of interventions in pursuit of maternal health policy objectives to mitigate stillbirth risks. An exploratory qualitative study at subnational level in Uganda

BackgroundGlobal calls for renewed efforts to address stillbirth burden highlighted areas for policy and implementation resulting in national level translations. Information regarding adapted strategies to effect policy objectives into service delivery by frontline health workers remains scanty especially at subnational level. The study explored strategies prioritized to mitigate stillbirth risk in the context of operationalizing recommendations from the global campaigns at a subnational level in Uganda.MethodsA cross-sectional qualitative exploratory study was conducted among a purposively selected sample of sixteen key informants involved in delivery of maternal and child health services in Mukono district. Analysis followed thematic content analysis deductively focusing on those policy priorities highlighted in the global stillbirth campaigns and reflected at the national level in the different guidelines. Results.Interventions to address stillbirth followed prioritization of service delivery aspects to respond to identified gaps. Efforts to increase uptake of family planning services for example included offering it at all entry points into care with counseling forming part of the package following stillbirth. Referrals were streamlined by focusing on addressing delays from the referring entity while antenatal care attendance was boosted through provision of incentives to encourage mothers to comply. Other prioritized aspects included perinatal death audits and improvements in data systems while differentiated care focused on aligning resources to support high risk mothers. This was in part influenced by the limited resources and skills which made health workers to adapt routine to fit implementation context.ConclusionsThe resource availability determined aspects of policy to prioritize while responding to stillbirth risk at subnational level by frontline health workers. Their understanding of risk, feasibility of implementation and the desire for optimal health systems performance worked to define the nature of services delivered calling for purposeful consideration of resource availability and implementation context while prioritizing stillbirth reduction at subnational level.

The cactus cladode (Opuntia ficus indica) modulates uricemia, improves endothelial dysfunction and corrects oxidative damage in rats fed a cafeteria diet

PurposeThe effects of Opuntia ficus indica (OFI) cladodes on uricemia level, endothelial dysfunction and oxidative damage were studied in young rats fed a cafeteria diet (CD).Design/methodology/approachA total of 16 young male Wistar rats (weighing 110 ± 20 g and four weeks old) were divided into two homogenous groups. The first group received a CD containing 50% of hyperlipidic diet and 50% of junk food mix (processed mix: hyper-fat, hyper-salted and sweetened) (CD group), and the second group (CD + OFI nopalitos) received the same diet supplemented with 50 g of fresh OFI nopalitos (young cladodes) for 30 days.FindingsOFI nopalitos regulate the hyperuricemia, improve the endothelial dysfunction by raising the bioavailability of nitric oxide(NO) and reduce prooxidant markers by reducing lipid peroxidation and protein oxidation (p &lt; 0.05) and boosting antioxidant capacity and enhancing the antioxidant enzymes activities (p &lt; 0.05) in blood and aorta tissues of rats early fed with a high-fat diet /junk food.Social implicationsBy-products of OFI have specific functional properties that may be beneficial in metabolic disorders and offer a better alternative with an economic and sustainable development perspective.Originality/valueBy-products of OFI highlight potential functional properties mainly based on its potent antioxidant capacity. By-products of OFI can be used as a promising nutraceutical resource to prevent various metabolic disorders in relation with cardiovascular diseases or hyperuricemia in subjects consuming junk food and or living in the Western society to reach the objectives of health policy and maintain a sustainable health system development.

Fostering long-term care planning in practice: extending objectives and advancing stochastic treatment within location-allocation modelling

Many countries are currently concerned with the planning of networks of Long-Term Care (LTC), which requires considering a multiplicity of policy objectives and anticipating the impact of key uncertainties. Nevertheless, location-allocation literature has not been modelling key health policy objectives, and the use of stochastic planning models entails low practical usability due to prohibitive computational times. This study tackles these issues by proposing an approach that supports the reorganization of LTC networks (in terms of services location, capacity planning and patients allocation) while exploring different health policy objectives and considering uncertainty within a reasonable computational time, leading to the development of a stochastic multi-objective mathematical programming model – the LTCNetPlanner. The LTCNetPlanner builds upon health economics and policy concepts to model the maximization of health and wellbeing together with cost- and equity-related objectives within location-allocation literature. Concerning uncertainty, a scenario-based stochastic approach is developed and alternative scenario reduction methods enabling a faster model resolution are explored within the LTCNetPlanner. Specifically, it is proposed a novel Morphol-KMG method able to reduce the number of scenarios while accounting for experts’ knowledge. A case study in the Great Lisbon region is explored, showing the usefulness of the proposed scenario reduction method to reduce computational times, and how planning decisions change when health and wellbeing benefits are considered.