Human Development Index Category Research Articles

The Effectiveness of Climate Adaptation Finance and Readiness on Vulnerability in African Economies

Addressing climate vulnerability remains a priority for economies globally. This study used the panel-corrected standard error (PCSE) methodology to investigate the impact of adaptation financing on climate vulnerability. This analysis examined 52 African countries from 2012 to 2021 while considering their climate adaptation readiness. The impact was also assessed based on the Human Development Index (HDI) categories to reflect different levels of development. The findings showed that adaptation finance considerably influenced climate vulnerability reduction in Africa, particularly in nations with a moderate HDI. However, most countries still need higher levels of adaptation financing, resulting in a small impact on vulnerability reduction. Furthermore, the impact of readiness measures differed by HDI category. Economic and social climate readiness strongly impacted climate vulnerability in high-HDI nations, but governance preparedness was more critical in low-HDI countries. Based on the empirical facts, two policy proposals emerge. First, it is critical to reconsider the distribution of adaptation financing to reduce disparities and effectively alleviate climate vulnerability. Moreover, African economies should consider implementing innovative localized financing mechanisms to mobilize extra adaptation finance. Second, African governments should customize climate readiness interventions based on their HDI levels to improve the achievement of a positive impact on climate vulnerability.

National commitments to Aichi Targets and their implications for monitoring the Kunming-Montreal Global Biodiversity Framework

The Convention on Biological Biodiversity (CBD) exists as a major multilateral environmental agreement to safeguard biodiversity and “live in harmony with nature”. To deliver it, strategies and frameworks are set out in regular agreements that are then implemented at the national scale. However, we are not on track to achieve overall goals, and frameworks so far have not been successful. This could be due to unambitious targets, low follow-through on commitments, or desired outcomes for nature not being achieved when action is taken. Here, we focus on national planning and reporting documents from a set of 30% of Parties to the CBD. We found that nearly half of the commitments mentioned in national planning documents did not appear in the Sixth National Reports and that further losses emerged due to measures reported as incomplete or ineffective. There were differences between commitments to each of the Aichi Targets, with more losses in high-profile and “institutionally challenging” Targets. Commitments from Parties in different Human Development Index categories had different outcomes among Targets, and Parties self-identifying as “megadiverse countries” had overall higher rates of reported success. Our results are important for informing the monitoring of commitment implementation in the Kunming-Montreal “global biodiversity package”.

Global Prevalence of Anemia Among Women of Reproductive Age, 2000-2019

Introduction: A common disease with significant impacts on health and quality of life, anemia is particularly prevalent in women of reproductive age due to blood losses during menstruation and pregnancy. Data from the World Health Organization (WHO) was analyzed to compare trends in prevalence of anemia in women aged 15-49 among countries and over time with the goal of identifying regions both successful and in need of assistance in combatting anemia. Methods: Publicly available data was obtained from the WHO on the prevalence of anemia among women aged 15-49 from 194 countries from 2000-2019, data being reported as percentages. Anemia was defined as hemoglobin < 12 g/dL for non-pregnant women and < 11 g/dL for pregnant women, with severe anemia being defined as hemoglobin < 8 g/dL for non-pregnant women and < 7 g/dL for pregnant women. WHO data was from both individual-level and summary statistics sources and hemoglobin was adjusted for altitude. Human development index (HDI) data and categories (low, medium, high, and very high) were obtained from the United Nations. Data was analyzed based on year, country, geographic region, and HDI, with ANOVA and Tukey HSD tests being used to analyze the relationship between HDI and anemia. Results: Worldwide from 2000 to 2013 the prevalence of anemia decreased, and then increased from 2013 to 2019 though remained lower than at 2000 levels; severe anemia decreased throughout the world from 2000 to 2019. Throughout all years, African countries had the highest prevalence of anemia and severe anemia while American and European countries had the lowest (Figure 1). When analyzed by HDI category, there was a significant difference among HDI categories with both total and severe anemia ( P < 0.001 for both). With each decrease in HDI category (very high to high, etc.) there was a significant increase in prevalence of total anemia (Table 1, P < 0.001 for all). For severe anemia, there was a significant difference in prevalence of anemia between all HDI levels except very high and high ( P = 0.09). Discussion: This data suggests that although the prevalence of anemia among reproductive age women has decreased over time there is still much work remaining, particularly in low HDI countries, where the prevalence of anemia was over twice that of very high HDI countries in 2019, and the prevalence of severe anemia was over three times as high. More research is needed into the relationship of anemia and socioeconomic status as well as preventing, recognizing and treating anemia.

Human Development Clustering in Indonesia: Using K-Means Method and Based on Human Development Index Categories

The quality of life for Indonesia's population can be measured from the human development index in each province. People who have a good quality of life indicate a prosperous life. The government has the responsibility to advance the welfare of the nation under the mandate of the constitution. The clustering of the human development index (HDI) in Indonesia is used to determine the distribution of quality of life or the distribution of social welfare. In this study, the K-Means method, which is a popular non-hierarchical clustering method, is used to classify human development in each province based on HDI indicators, namely Expected Years of Schooling, Mean Years of Schooling, Adjusted Per Capita Expenditure, and Life Expectancy at Birth. Provinces in Indonesia are clustered into 4 clusters. These results were also compared with the clustering based on HDI categories determined by Statistics Indonesia based on certain cut-off values. According to the HDI category, provinces in Indonesia fall into the medium, high, and very high categories. The results of the two groupings show that there is a trend toward appropriate characteristics for each group. Thus, K-Means can classify provinces in Indonesia according to the characteristics of the HDI indicators.

Distribution of nursing workforce in the world using Gini coefficient

IntroductionUnequal Access to human resources for health, reduces access to healthcare services, worsens the quality of services and reduces health outcomes. This study aims to investigate the distribution of the nursing workforce around the world.MethodsThis is a descriptive-analytical study, which was conducted in 2021. The number of nurses and world populations was gathered from World Health Organization (WHO) and The United Nations (UN) databases. The UN has divided world countries based on the Human Development Index (HDI) into four categories of very high, high, medium and low HDI. To investigate the distribution of the nurses around the world, we used the nurse population ratio (per 10,000 population), Gini coefficient, Lorenz curve and Pareto curve.FindingsOn average, there were 38.6 nurses for every 10,000 people in the world. Nations with the very high HDI, had the highest nurse/population ratio (95/10,000), while the low HDI nations had the lowest nurse/population ratio (7/10,000). Most nurses around the world were females (76.91%) who were in the age group of 35–44 (29.1%). The Gini coefficient of nations in the each four HDI categories varied from 0.217 to 0.283. The Gini coefficient of the nations between the four HDI categories was 0.467, and the Gini coefficient of the whole world was 0.667.ConclusionThere were inequalities between countries all over the world. Policymakers should focus on the equitable distribution of the nursing workforce across all local, national and regional levels.

Patterns of better breast cancer care in countries with higher human development index and healthcare expenditure: Insights from GLOBOCAN 2020.

The huge burden of breast cancer (BC) necessitates the profound and accurate knowledge of the most recent cancer epidemiology and quality of care provided. We aimed to evaluate BC epidemiology and quality of care and examine the effects of socioeconomic development and healthcare expenditure on disparities in BC care. The results from the GLOBOCAN 2020 study were utilized to extract data on female BC, including incidence and mortality numbers, crude rates, and age-standardized rates [age-standardized incidence rates (ASIRs) and age-standardized mortality rates (ASMRs)]. The mortality-to-incidence ratio (MIR) was calculated for different locations and socioeconomic stratifications to examine disparities in BC care, with higher values reflecting poor quality of care and vice versa. In both descriptive and analytic approaches, the human development index (HDI) and the proportion of current healthcare expenditure (CHE) to gross domestic product (CHE/GDP%) were used to evaluate the values of MIR. Globally, 2,261,419 (95% uncertainty interval (UI): 2,244,260-2,278,710) new cases of female BC were diagnosed in 2020, with a crude rate of 58.5/100,000 population, and caused 684,996 (675,493-694,633) deaths, with a crude rate of 17.7. The WHO region with the highest BC ASIR (69.7) was Europe, and the WHO region with the highest ASMR (19.1) was Africa. The very high HDI category had the highest BC ASIR (75.6), and low HDI areas had the highest ASMR (20.1). The overall calculated value of female BC MIR in 2020 was 0.30, with Africa having the highest value (0.48) and the low HDI category (0.53). A strong statistically significant inverse correlation was observed between the MIR and HDI values for countries/territories (Pearson's coefficient = -0.850, p-value < 0.001). A significant moderate inverse correlation was observed between the MIR and CHE/GDP values (Pearson's coefficient = -0.431, p-value < 0.001). This study highlighted that MIR of BC was higher in less developed areas and less wealthy countries. MIR as an indicator of the quality of care showed that locations with higher healthcare expenditure had better BC care. More focused interventions in developing regions and in those with limited resources are needed to alleviate the burden of BC and resolve disparities in BC care.

Global Burden, Risk Factors, and Trends of Non-Hodgkin Lymphoma in 2020 and Projections to 2040: A Population-Based Study

Background: Non-Hodgkin lymphoma (NHL) is one of the major health problems worldwide, but the global burden and trends of NHL have not been extensively assessed. We aimed to describe the disease burden, risk factors, trends in incidence and mortality of NHL globally. Methods: We collected up-to-date incidence and mortality data of NHL from the GLOBOCAN 2020, focusing on geographic disparities worldwide. The incidence trends of NHL in 42 countries over 15 years were examined, while mortality trends of 39 countries were calculated by data extracted from cancer registries. Prevalence data from the World Health Organization database was used to estimate the attributable risk factors in the development of NHL. Future burden estimates for incidence and mortality in 2040 were calculated by applying population projections in 2020. We reported incidence and mortality by sex and age alongside corresponding age-standardized rates and the average annual percentage change. Results: In 2020, there were an estimated 545,000 new cases and 260,000 deaths of NHL globally. The age-standardized incidence rates (ASIR) varied drastically across world areas, at least 10-fold in both sexes, with the highest rates observed in Australia and New Zealand. A great burden of NHL was recognized in high-income countries as the highest incidence rates were in Australia and New Zealand (ASIR, 12.5), Northern America (ASIR, 12.0), and Northern Europe (ASIR, 11.4) (Figure 1). Conversely, countries with a low human development index (HDI), such as those in North Africa, encountered a larger mortality burden in NHL than in highly-developed countries. In terms of different continents or regions, higher mortality rates were seen in Melanesia (ASR, 4.0), North Africa (ASR, 3.7), and Micronesia (ASR, 3.6). Considering the global trends of incidence, it was found that most developed countries had a trend of steady growth, while some low HDI countries have relatively large fluctuations in the incidence. In subgroups of different genders, close to 20 populations exhibited higher ASIRs for women than men. Observed trends also differed across age groups. The incidence of NHL increased in 34 populations (AAPCs, 4.9 to 0.1) among individuals aged 60 years or older. Taking into account differences in NHL burden across countries, we also reported estimated burden of NHL by HDI category. Considering all 185 countries, the ASIRs of NHL rose with HDI levels (= 0.41, P < 0.001), whereas the ASMRs of NHL were not associated with the levels of HDI (= 0, P = 0.754). HIV was generally believed to be a possible contributing factor to the development of some types of NHL, we presented the linear relation between the magnitude of the NHL incidence, HIV prevalence, and the level of HDI which seemly constricted to very high HDI countries. Regarding associated lifestyle risk factors, higher incidence of NHL was linked to a higher prevalence of obesity (β = 0.399, P < 0.001), a decreased prevalence of diabetes (β = -0.468, P <0.001) and hypertension (β = -0.386, P <0.001) based on the multivariate linear regression. As a result, countries with higher incidence were more likely to have a higher prevalence of obesity. In terms of demographic change, NHL incident cases are projected to rise to approximately 778,000 by 2040. Conclusions: In this pooled analysis, we provided evidence for the growing incidence trends in NHL, particularly among women and elderly populations. Despite the stable or downward mortality trends observed in most countries, the marked increase in the older population is still a public health issue that requires more attention. Future efforts should be directed to cultivating health awareness and formulating effective and locally tailored cancer prevention strategies, especially in most developing countries. Figure 1View largeDownload PPTFigure 1View largeDownload PPT Close modal

Identifying Significant Factors Affecting the Human Development Index in East Java Using Ordinal Logistic Regression Model

The achievement of human development can be reviewed from the Human Development Index (HDI), which is sourced from indicators of health, education, and state income. East Java Province is the second-most populous province in Indonesia which has a high work intensity in economic aspects and abundant natural and human resources. However, judging from the level of the human development index, East Java Province occupies the lowest position compared to other provinces on the island of Java. This study aims to identify significant factors affecting East Java's HDI using ordinal logistic regression. The data from Indonesia Statistics (Indonesian: Badan Pusat Statistik, BPS) of East Java province in 2020 includes seven variables, namely Gross Regional Domestic Product (GRDP), high school participation rate, infant mortality rate, health facilities, population density, labor force participation rate, and open unemployment rate. This study produced two ordinal logistic regression models in medium category HDI and high category HDI with a classification accuracy value of 97.37%. From this model obtained, a significant factor affecting the HDI of East Java is the participation rate of high school and health facilities.

Ovarian cancer today and tomorrow: A global assessment by world region and Human Development Index using GLOBOCAN 2020.

Ovarian cancer remains to have relatively poor prognosis particularly in low-resourced settings. It is therefore important to continually examine the burden of ovarian cancer to identify areas of disparities. Our study aims to provide an overview of the global burden of ovarian cancer using the GLOBOCAN 2020 estimates by country, world region, and Human Development Index (HDI) levels, as well as the predicted future burden by the year 2040 by HDI. Age-standardized incidence and mortality rates for ovarian cancer in 185 countries were calculated by country, world region, and for the four-tier HDI. The number of new cases and deaths were projected for the year 2040 based on demographic projections by HDI category. Approximately 314 000 new ovarian cancer cases and 207 000 deaths occurred in 2020. There were marked geographic variations in incidence rates, with the highest rates observed in European countries with very high HDI and low rates were found in African countries within the lowest HDI group. Comparable mortality rates were observed across the four-tier HDI. Relative to 2020 estimates, our projection for 2040 indicates approximately 96% and 100% increase in new ovarian cancer cases and deaths, respectively, among low HDI countries compared to 19% and 28% in very high HDI countries. Our study highlights the disproportionate current and future burden of ovarian cancer in countries with lower HDI levels, calling for global action to reduce the burden and inequality of ovarian cancer in access to quality cancer care and treatment.

Global burden of periodontal disease and its relation with socioeconomic development during 1990-2019.

To analyze the global burden of periodontal disease and its relation with socioeconomic development. Data of global disability-adjusted life year (DALY) due to periodontal disease and human development index (HDI) from 1990 to 2019 were obtained from Global Health Data Exchange (GHDx) and human development reports. The trend of the global burden of periodontal disease from 1990 to 2019 was described. The correlation between age-standardized DALY rates and HDI were examined in 2019, and between-country periodontal disease burden inequality from 1990 to 2019 was measured using health-related Gini coefficients and concentration indexes. From 1990 to 2019, the global DALY rate due to periodontal disease increased from 78.63 to 85.48, and the epidemiological burden did not increase significantly. Statistical differences were found across different HDI categories for age-standardized DALY rates of periodontal disease ( 44.315, <0.01) in 2019. Linear regression analysis also revealed a negative correlation between age-standardized DALY rate of periodontal disease and HDI ( = -0.417, <0.01) . Gini coefficients decreased from 0.361 to 0.281 and concentration indexes fell from 0.0339 to -0.0538 between 1990 and 2019. The global burden of periodontal disease did not increase between 1990 and 2019, though the socioeconomic-associated inequality still existed. The burden of periodontal disease was more concentrated in less developed countries, and the socioeconomic-associated inequality has increased since 2000.

A Computational Approach to Economic Inequality, Happiness and Human Development

In this paper, we study the connections of categorical levels of Human Development Index (HDI), GDP per capita, World Happiness Index, the Gini indexes of Income and Wealth inequalities together with poverty rate for 98 world countries. By clustering analysis, we identify four groups of countries with similar features. K-means clustering algorithm is applied to obtain four clusters of sizes 21-26 countries by explaining 68.3% of the total variation in data. The analysis reveals significant differences between the clusters, while also factors with largest differences within the clusters. Secondly, multinomial logistic regression (MLR) is applied in predicting the HDI categories of the full sample of 98 world countries for year 2018. The MLR model can capture also nonlinear relationship. The logistic regression model achieved 91.8% overall accuracy. The results of our research together from earlier literature is followed by suggestions for the future research.

Neurodevelopmental Trajectories of Preterm Infants of Italian Native-Born and Migrant Mothers and Role of Neonatal Feeding.

There is evidence that preterm infants of migrant mothers are at a higher risk of adverse perinatal outcomes than those of native-born mothers, and that human milk feeding is beneficial to infants’ neurodevelopment. Using the United Nations Human Development Index (HDI) to classify mother’s country of origin, we investigated whether type of neonatal feeding (human milk vs. mixed milk vs. exclusive formula milk) affected preterm newborn neurodevelopment varying across different HDI categories (Italian native-born vs. high HDI migrant vs. low HDI migrant) up to 2 years of age. Neurodevelopment of 530 infants born in Italy at ≤32 weeks of gestational age and/or weighing <1500 g was measured at 3-, 6-, 9-, 12-, 18-, and 24-months corrected age (CA) using the revised Griffiths Mental Development Scale 0–2 years. The trajectories of the general developmental quotient and its five subscales were estimated using mixed models. At 24-months CA only preterm infants of low HDI migrant mothers and fed exclusive formula milk showed moderate neurodevelopment impairment, with lower developmental trajectories of eye-hand coordination, performance, and personal-social abilities. Migrant mothers from low HDI countries and their preterm infants should be targeted by specific programs supporting maternal environment, infant development, and human or mixed milk neonatal feeding. Future research should focus on a deeper understanding of the mechanisms through which type of feeding and mother migrant conditions interact in influencing preterm infants’ neurodevelopment.

Impact of scaled up human papillomavirus vaccination and cervical screening and the potential for global elimination of cervical cancer in 181 countries, 2020-99: a modelling study.

Impact of scaled up human papillomavirus vaccination and cervical screening and the potential for global elimination of cervical cancer in 181 countries, 2020-99: a modelling study.

Globally temporal transitions of blood lead levels of preschool children across countries of different categories of Human Development Index

In the past decades, efforts to eliminate lead from gasoline, paint and drinking water around the world have substantially reduced human blood lead levels. This study was therefore aimed at examining the global temporal trends in the blood lead levels of preschool children by the category of UN Human Development Index (HDI). In total, 103 blood lead records were retrieved from 51 articles searched from PubMed and Google Scholar, with study subjects aged up to 8years old. Collected preschool children blood lead levels were plotted chronologically by HDI category and their reciprocals were used in regression analysis against calendar year to establish their temporal transition trends in the past decades. Results show that the modes of blood lead level of the preschool children were reduced from 4–6μg/dL to 0.8–1.5μg/dL, from 6–15μg/dL to 3–6μg/dL and from 12–16 to 5–6μg/dL for the very high HDI countries, the high HDI countries and the medium/low HDI countries, respectively. The highest correlation coefficient, 0.849, between the reciprocal of blood lead level and the calendar year was found for the very high HDI countries. Based on the regression lines, the predicted preschool children mean blood lead levels in the year of 2030 are 0.74μg/dL, 2.21μg/dL and 2.86μg/dL, respectively, for the very high HDI countries, the high HDI countries and the medium/low HDI countries. Persistent differences in blood lead level prevailed among countries of different HDI category, suggesting the effects of disparities and inequalities, at the state level, on preschool children blood lead levels. Further action is warranted to reduce the already low environmental lead exposure to eliminate the developmental burden of lead on children through (1) identification of individual local factors for lead exposure and (2) averting health disparity and inequalities at the state level.

Laryngeal cancer: Global socioeconomic trends in disease burden and smoking habits.

To characterize health burden and determine the associated level of equality of laryngeal carcinoma (LC) burden at a global level. One hundred eighty-four countries were organized by socioeconomic status using Human Development Index (HDI) categorizations provided by the United Nations Development Program. Disability-adjusted life years (DALYs), obtained from The Global Health Data Exchange, were calculated and compared between each HDI category for the period from 1990 to 2015. Equality of LC burden was then evaluated with concentration indices. Global LC burden, as measured by age-standardized DALYs, has improved significantly over the 25-year period studied. This burden has declined for very high, high, and medium HDI countries, whereas it has remained unchanged for low HDI countries. The majority of LC global burden was found in high socioeconomic countries before 2010 and has shifted toward low socioeconomic countries, as indicated by concentration indices. Over the last 25 years, Central and Eastern Europe continue to have the largest disease burden in the world. This is the first analysis that we are aware of investigating health disparities of LC at a global level. The global burden of the disease has declined, which is a trend corresponding with significantly reduced smoking behaviors in developed countries. Although the global inequality gap decreased between 2010 and 2015, there remain reasons for concern. Smoking continues to trend upward in low socioeconomic countries, which could increase LC burden in low socioeconomic countries in the near future. A new global initiative directed toward low socioeconomic countries may yield dividends in preventing subsequent disparities in the LC burden. 4. Laryngoscope, 128:2039-2053, 2018.

Oropharyngeal cancer mortality according to the human development index in the Metropolitan Region of Chile, 2002-2014.

To determine mortality rates for oropharyngeal cancer according to the Human Development Index (HDI) per district in the Metropolitan Region (RM), Santiago, Chile, between 2002 and 2014. Materials and Methods: An ecological study was carried out. The sample corresponded to individuals over 45 years, from the Metropolitan Region, with oropharyngeal cancer as cause of death, as registered in the Chilean National Institute of Statistics (INE). The HDI was classified into three categories: “medium” (8 districts), “high” (18 districts) and “very high” (25 districts). The crude and adjusted mortality rates were calculated for each year and period. Results: The oropharyngeal cancer adjusted mortality rate for the chosen period was 3.98 deaths per 100,000 inhabitants. The specific mortality rate from oropharyngeal cancer in the “medium” HDI category was 4.01; in the “high” DHI category, 4.42; and in the “very high” HDI category, 3.79. Conclusion: Mortality from oropharyngeal cancer was higher in the “medium” HDI category between 2002 and 2014.

What do we know about the needs and challenges of health systems? A scoping review of the international literature

BackgroundWhile there is an extensive literature on Health System (HS) strengthening and on the performance of specific HSs, there are few exhaustive syntheses of the challenges HSs are facing worldwide. This paper reports the findings of a scoping review aiming to classify the challenges of HSs investigated in the scientific literature. Specifically, it determines the kind of research conducted on HS challenges, where it was performed, in which health sectors and on which populations. It also identifies the types of challenge described the most and how they varied across countries.MethodsWe searched 8 databases to identify scientific papers published in English, French and Italian between January 2000 and April 2016 that addressed HS needs and challenges. The challenges reported in the articles were classified using van Olmen et al.’s dynamic HS framework. Countries were classified using the Human Development Index (HDI). Our analyses relied on descriptive statistics and qualitative content analysis.Results292 articles were included in our scoping review. 33.6% of these articles were empirical studies and 60.1% were specific to countries falling within the very high HDI category, in particular the United States. The most frequently researched sectors were mental health (41%), infectious diseases (12%) and primary care (11%). The most frequently studied target populations included elderly people (23%), people living in remote or poor areas (21%), visible or ethnic minorities (15%), and children and adolescents (15%). The most frequently reported challenges related to human resources (22%), leadership and governance (21%) and health service delivery (24%). While health service delivery challenges were more often examined in countries within the very high HDI category, human resources challenges attracted more attention within the low HDI category.ConclusionsThis scoping review provides a quantitative description of the available evidence on HS challenges and a qualitative exploration of the dynamic relationships that HS components entertain. While health services research is increasingly concerned about the way HSs can adopt innovations, little is known about the system-level challenges that innovations should address in the first place. Within this perspective, four key lessons are drawn as well as three knowledge gaps.

Associations between national viral hepatitis policies/programmes and country-level socioeconomic factors: a sub-analysis of data from the 2013 WHO viral hepatitis policy report

BackgroundAs more countries worldwide develop national viral hepatitis strategies, it is important to ask whether context-specific factors affect their decision-making. This study aimed to determine whether country-level socioeconomic factors are associated with viral hepatitis programmes and policy responses across WHO Member States (MS).MethodsWHO MS focal points completed a questionnaire on national viral hepatitis policies. This secondary analysis of data reported in the 2013 Global Policy Report on the Prevention and Control of Viral Hepatitis in WHO Member States used logistic regression to examine associations between four survey questions and four socioeconomic factors: country income level, Human Development Index (HDI), health expenditure and physician density.ResultsThis analysis included 119 MS. MS were more likely to have routine viral hepatitis surveillance and to have a national strategy and/or policy/guidelines for preventing infection in healthcare settings if they were in the higher binary categories for income level, HDI, health expenditure and physician density. In multivariable analyses, the only significant finding was a positive association between having routine surveillance and being in the higher binary HDI category (adjusted odds ratio 26; 95% confidence interval 2.0–340).ConclusionCountries with differing socioeconomic status indicators did not appear to differ greatly regarding the existence of key national policies and programmes. A more nuanced understanding of the multifaceted interactions of socioeconomic factors, health policy, service delivery and health outcomes is needed to support country-level efforts to eliminate viral hepatitis.

Shifting the Physical Inactivity Curve Worldwide by Closing the Gender Gap.

The aims of this study were to (i) examine gender differences in physical inactivity in countries with different levels of Human Development Index (HDI); and (ii) assess whether small changes in the prevalence of inactivity in women could achieve the World Health Organization's (WHO) global inactivity target. Data on inactivity were extracted for 142 countries for the year 2010 from the WHO Data Repository. Data for HDI were obtained for the year 2010 from the United Nations Development Program. Absolute and relative gender differences were calculated for countries according to four HDI categories. The potential effects of increasing women's activity levels on achievement of the WHO physical inactivity target were computed. Overall inactivity prevalence was higher in women (27%) than in men (20%). Women were more inactive than men in all except eight countries. Absolute gender differences [median 7.5% (range -10.1 to 33.2)] did not vary by HDI category, but there was a small negative correlation between relative gender difference in inactivity and HDI (rho -0.19; p=0.02), which was mostly influenced by three outlier countries with low HDI. A decrease in inactivity levels of 4.8% points among women across the world would achieve the WHO target of reducing global levels of inactivity by 10%. Gender differences in the prevalence of physical inactivity were highly variable, both within and across categories of HDI. Interventions which result in small changes in inactivity prevalence in women would achieve the 2025 WHO global target for inactivity, without any change to the prevalence in men.

The weight of inequalities: Duration of residence and offspring's birthweight among migrant mothers in Sweden

In this study we assessed the effect duration of residence on the association between maternal origin and birthweight in Sweden. Considering sibling information, we also investigated how far the presence or lack of such an effect could be biased by the use of cross-sectional data, since there may be a selection among those mothers who decide to have a child soon after moving to the country (e.g. those with a more stable family situation). Using the Swedish Medical Birth Register for the period 1992-2012, we performed linear and multinomial regressions, multilevel linear regressions, and random effect meta-analysis. Offspring of foreign-born mothers were lighter on average (−120 g [-143,-60]) and had a higher risk of having low birthweight (RRR:1.70 [1.61,1.80]) compared to those with Swedish-born mothers. The variation of birthweight by duration of residence was small (less than 50 g) compared to the gradient found between countries grouped according to the human development index (HDI), where the difference between countries with low and very high HDI was of 105 g. Moreover, no clear pattern toward a convergence with the Swedish population was observed after nine years in the country, which was confirmed when we compared the between- and within-mother analyses by HDI categories. Overall, our results support the thesis that contextual early life conditions have an impact on adult health (reproductive health in this case) with consequences in the next generation that cannot be buffered by the situation experienced in the host country.