Public Health Investment Research Articles

County-level factors associated with a mismatch between opioid overdose mortality and availability of opioid treatment facilities.

Opioid overdose deaths in the United States remain a major public health crisis. Little is known about counties with high rates of opioid overdose mortality but low availability of opioid use disorder (OUD) treatment facilities. We sought to identify characteristics of United States (US) counties with high rates of opioid overdose mortality and low rates of opioid treatment facilities. Rates of overdose mortality from 3,130 US counties were compared with availability of opioid treatment facilities that prescribed or allowed medications for OUD (MOUD), from 2018-2019. The outcome variable, "risk-availability mismatch" county, was a binary indicator of a high rate (above national average) of opioid overdose mortality with a low (below national average) rate of opioid treatment facilities. Covariates of interest included county-level sociodemographics and rates of insurance, unemployment, educational attainment, poverty, urbanicity, opioid prescribing, depression, heart disease, Gini index, and Theil index. Multilevel logistic regression, accounting for the clustering of counties within states, was used to determine associations with being a "risk-availability mismatch" county. Of 3,130 counties, 1,203 (38.4%) had high rates of opioid overdose mortality. A total of 1,098 counties (35.1%) lacked a publicly-available opioid treatment facility in 2019. In the adjusted model, counties with an additional 1% of: white residents (odds ratio, OR, 1.02; 95% CI, 1.01-1.03), unemployment (OR, 1.11; 95% CI, 1.05-1.19), and residents without insurance (OR, 1.04; 95% CI, 1.01-1.08) had increased odds of being a mismatch county. Counties that were metropolitan (versus non-metropolitan) had an increased odds of being a mismatch county (OR, 1.85; 95% CI, 1.45-2.38). Assessing mismatch between treatment availability and need provides useful information to characterize counties that require greater public health investment. Interventions to reduce overdose mortality are unlikely to be effective if they do not take into account diverse upstream factors, including sociodemographics, disease burden, and geographic context of communities.

Coverage, mapping and barriers to complete vaccination for age among children under 5 years in 2021: case of Adjara-Hounvè and Ahouicodji villages in southern Benin

Vaccination is a protective measure against infectious diseases and remains one of the best investments in public health. Some African countries are still struggling to reach the required child immunization coverage. Several factors are responsible for limiting immunization coverage. Most of the factors considered to limit immunization coverage are related to the health system. In addition, inaccessibility to care, especially during the critical period of the Covid-19 pandemic, greatly reduced vaccination coverage rates. In Benin, several vaccines are included in the Expanded Programme on Immunization or are administered as part of routine immunization. However, cases of non-compliance with the vaccine and persistent flaccid paralysis are still recorded in the commune of Ouidah in southern Benin. The aim of this study was to investigate the coverage and factors associated with full immunization for age in children aged 0-5 years. A cross-sectional survey was conducted from August to October 2021 in two villages (Adjara-Hounvè and Ahouicodji) in southern Benin. All the households were included. The survey regarded children under 5 for whom a vaccination record was presented. A couple child/mother was recruited after informed consent of the mother and her child. An univariate analysis followed by a multivariate analysis was performed by using a logistic regression model to identify the variables that influence vaccine completeness. Spatial description of vaccine completeness was performed using the kriging method using ArcGIS 10.8 mapping software. Results. Of the 414 mothers surveyed, 57.49% had an immunization card, from which information was collected. Of the 238 children recruited, 141 were in Adjara-Hounvè and 97 in Ahouicodji. Of the 238 children with an immunization card, 20.6% were fully immunized for their age. All children received Baccille Calmette Guérin vaccine at birth. Since poliomyelitis, pentavalent, pneumococcal conjugate, and rotavirus are three-dose vaccines, the percentage of children who received these vaccines decreased as the number of doses increased: 96.6%, 88.2%, 78.1% and 72.3% for the four doses of polio respectively. According to 53.4% of the respondents the reception at the vaccination site was poor, and according to 70.3% of them waiting time for vaccination sessions was long. Several reasons justified the absence of complete vaccination for the age of the children: vaccination site too far from the place of residence (59.54%), lack of financial means (29.78%) and the mother's ignorance (12.76%). Education level "primary" vs "none" (ORa = 3.32; CI95% 1.07-10.25), occupation "health staff" vs "housewife" (ORa = 21.18; CI95% 3.07-145.94), mothers' knowledge of Expanded Programme on Immunization diseases (ORa = 2, 20; CI95% 1.03-4.68) and children's age 0-2 months vs ≥ 16 months (ORa = 8.53; CI95% 2.52-28.85) and 9-15 months vs ≥ 16 months (ORa = 2.99; CI95% 1.24-7.23) increased complete immunization status for age. The homogeneity of behaviour related to age-complete immunization coverage in children under 5 years was evident at mapping. Age-complete immunization coverage in children under 5 years of age is very low, with a spatial homogeneity in community immunization uptake behaviour. Age-complete immunization coverage is an innovative indicator that can contribute to achieving age-specific immunization targets.

Clinical characteristic, common sites, and geographical distribution of pediatric tuberculosis patients in Southwest China.

The data report of a large sample, dynamic epidemiology, and characteristic analysis of pediatric tuberculosis (TB) in Southwest China is not clear. Herein, we conducted descriptive dynamic epidemiology, characteristic analysis and geographical distribution study of pediatric TB inpatients in Southwest China for more than 20 years. Patients with pediatric TB were recruited from October 2002 to September 2022 in Southwest of China based on etiology or clinical confirmation. Extract hospitalization medical record information for each patient. The geographical distribution chart of cases is used to display the trend of case flow segmented every 5 years. Among 3,024 pediatric TB patients with an average age of 9.11 ± 4.39, 17.49% (529) had pulmonary tuberculosis (PTB), 9.06% (274) had extrapulmonary tuberculosis (EPTB), and 73.45% (2,221) had combined TB. The most common form of EPTB is disseminated TB (28.98%), followed by TB lymphadenitis (20.56%), pleural TB (19.72%), and TB meningitis (19.68%). Children aged 0-4 years had a high risk of TB meningitis and a severe symptoms, while children in the elderly age group had a high risk of pleural TB. In the past 20 years, hospitalized TB pediatric cases mainly came from Sichuan, Tibet, Qinghai, Yunnan and other places. The number of patients from ethnic minorities, especially Tibetans, showed an upward trend on a yearly basis (χ2 = 401.43, P < 0.001). Public health investment and effective management in pediatric TB should be further strengthened.

Estimating the economic burden of stroke in China: a cost-of-illness study

ObjectivesStroke imposes a heavy economic burden and loss of productivity on individuals and society. This study assessed a range of crucial factors, including direct costs and indirect costs, to gauge...

Determinants of private-sector antibiotic consumption in India: findings from a quasi-experimental fixed-effects regression analysis using cross-sectional time-series data, 2011–2019

The consumption of antibiotics varies between and within countries. However, our understanding of the key drivers of antibiotic consumption is largely limited to observational studies. Using Indian data that showed substantial differences between states and changes over years, we conducted a quasi-experimental fixed-effects regression study to examine the determinants of private-sector antibiotic consumption. Antibiotic consumption decreased by 10.2 antibiotic doses per 1000 persons per year for every ₹1000 (US$12.9) increase in per-capita gross domestic product. Antibiotic consumption decreased by 46.4 doses per 1000 population per year for every 1% increase in girls’ enrollment rate in tertiary education. The biggest determinant of private sector antibiotic use was government spending on health—antibiotic use decreased by 461.4 doses per 1000 population per year for every US$12.9 increase in per-capita government health spending. Economic progress, social progress, and increased public investment in health can reduce private-sector antibiotic use.

Impact of Health Investment on Economic Development in Nigeria

This study examined the impact of health investment on economic development in Nigeria. Using secondary data sourced from Central Bank of Nigeria Statistical Bulletins and World Bank development indicators, World Bank Database for the period of 1981- 2020. It applied Augmented Dickey Fuller (ADF) and Philips-Perron (PP) tests for unit root which indicated that all the variables were stationary at first difference except gross fixed capital formation at level. The mixed order of the unit root tests necessitated the adoption of Autoregressive Distributed Lag (ARDL) bounds Cointegration technique. The study submitted that a strong evidence of cointegration among the variables exist. It prove that health investment variables (recurrent and capital health investment, public education expenditure, gross fixed capital formation and labour participation rate) have positive impacts on economic development in Nigeria except foreign exchange rate which reveals negative impact. The result of Pairwise Granger causality test indicated that there were uni-directional and bidirectional causality among health investment variables and economic development in Nigeria. Therefore, it concluded that health investment variables have positive and significant impacts on economic development in Nigeria except exchange rate. Moreover, this study recommended that health policy should be made by government to increase the budgetary allocation to health sector particularly on recurrent and capital public health investment, improve quality of education through statutory allocation to education sector, provide exchange rate policy that will encourage investment in human capital by individuals and private sector. Finally, the government should expand institutional capacity to produce qualified manpower, improve personnel salaries, wages and working conditions in health and education sectors

Cost-effectiveness of Improved WIC Food Package for Preventing Childhood Obesity.

The Special Supplemental Nutrition Program for Women, Infants, and Children (WIC) prevents food insecurity and supports nutrition for more than 3 million low-income young children. Our objectives were to determine the cost-effectiveness of changes to WIC's nutrition standards in 2009 for preventing obesity and to estimate impacts on socioeconomic and racial/ethnic inequities. We conducted a cost-effectiveness analysis to estimate impacts from 2010 through 2019 of the 2009 WIC food package change on obesity risk for children aged 2 to 4 years participating in WIC. Microsimulation models estimated the cases of obesity prevented in 2019 and costs per quality-adjusted-life year gained. An estimated 14.0 million 2- to 4-year old US children (95% uncertainty interval (UI), 13.7-14.2 million) were reached by the updated WIC nutrition standards from 2010 through 2019. In 2019, an estimated 62 700 (95% UI, 53 900-71 100) cases of childhood obesity were prevented, entirely among children from households with low incomes, leading to improved health equity. The update was estimated to cost $10 600 per quality-adjusted-life year gained (95% UI, $9760-$11 700). If WIC had reached all eligible children, more than twice as many cases of childhood obesity would have been prevented. Updates to WIC's nutrition standards for young children in 2009 were estimated to be highly cost-effective for preventing childhood obesity and contributed to reducing socioeconomic and racial/ethnic inequities in obesity prevalence. Improving nutrition policies for young children can be a sound public health investment; future research should explore how to improve access to them.

Determining the Effect of Voluntary Participation in Communicating with PLHIV in Siaya County, Kenya

Purpose: This research aimed to determine 1the effect 1of voluntary participation 1in communicating with PLHIV 1in 1Siaya, 1Kenya.&#x0D; Methodology: This study utilized a 1descriptive research approach and 1inferential 1design through a 1field survey, employing two distinct 1sets of questionnaires. One was administered 1to the key informant and the other to Persons Living with HIV (PLHIV).1Spearman’s 1rho 1correlations 1and simple linear1regression1models were also applied to assess the association between voluntary engagement as 1the independent variable and communication as the 1dependent 1variable. ANOVA 1test 1was also performed 1to test the hypothesis 1and results were 1presented 1in 1tables.&#x0D; Findings: The study comprised a sample size of 376 individuals, constituting 96.18% of willing respondents who agreed to participate in 1interviews. Seventeen unresponsive records were excluded from the analysis. A Normality 1Test was conducted to assess whether the study sample was drawn from a population with a normal distribution. Under the 1null 1hypothesis, no significant difference was found between the sample and the population it represented. Consequently, there was substantial evidence to reject the 1null 1hypothesis and accept the 1alternative 1hypothesis (p-value=0.000 CI=95%). Moreover, the findings revealed that 82.30% voluntarily enrolled in the 1Text 1for 1Adherence (T4A) 1mobile 1app, 70.71% signed the consent form, and 6.07% indicated that 1consent was implied.&#x0D; Unique Contribution to Theory, Practice and Policy: This study extends 1Technology readiness theory studies to mhealth field where it is beginning to gain traction. It also indicates the significance of individuals willingly participating in mHealth interventions upon enrollment. Voluntary participation is an imperative condition of any research undertaking. This study's results additionally confirmed that mHealth interventions enhance the well-being of individuals managing chronic illnesses. This study is likely to inform policy changes and or amendments in the mhealth space in many jurisdictions. An 1intervention 1such 1as 1Text for1Adherence (1T4A) may encourage 1the 1government 1to support system developers. It can also take over the project as a public health investment instead of leaving it to private sector or non-governmental organizations. Study further extends the body of knowledge in use of mhealth interventions.

Pedagogical and Education-Related Measures suggested by the Algerian and British governments for the higher education sector during the COVID-19 pandemic – a comparative study

The COVID-19 pandemic has had far-reaching effects, not only on public health but also on the global economy, social interactions, and daily life. It has highlighted the importance of global cooperation and the need for more investment in public health and emergency preparedness. The pandemic also exposed weaknesses in many countries’ educational management systems; it has forced many higher education institutions to adopt new teaching and learning methods to minimize the risk of transmission. This resulted in the need for comparative studies to evaluate the effectiveness of different pedagogical responses and to find common ground on the most effective practices and responses that would help higher education institutions better prepare for similar challenges in the future. The present study provides a comparative study and outcomes through a record of the pedagogical responses by higher education authorities in two completely different contexts (Algeria and the UK). The authors of the paper adopted a desktop analysis approach through valid and first-hand reliable sources like government and university official releases. This research methodology would involve a systematic and rigorous approach to data collection and analysis to ensure the reliability and validity of the research findings. Through coding and thematic analysis of the collected data, the researchers concluded that the efficiency of the responses and decisions adopted by higher education institutions varied depending on a range of factors such as the institution’s resources, infrastructure, and student population. However, the pandemic highlighted the need for agile and serious responses to ensure the safety and well-being of students and the campus community.

"Post-Protean" Public Health and the Geroscience Hypothesis.

Despite unprecedented investments in public health and biomedical research, improvements in life expectancy and healthy life expectancy have stagnated in the United States. Part of the reason for this development can be traced back to the influence of "Protean" over "Post-Protean" public health, the names that can be given to two contrasting visions of public health advanced in the early twentieth century. Protean public health prescribes "waging a war" against disease and was successful in reducing the early-life mortality risks from infectious disease. But Protean public health has proven less effective in improving the quality of life of older persons. Post-Protean public health prioritizes the experimental method and research into the indirect methods of improving health. It articulated a vision of public heath that was given a more concrete specification by Alex Comfort in what is now referred to as the Geroscience Hypothesis. To improve the health prospects of aging populations the dominance of Protean public health must be relaxed, to enable the benefits of Post-Protean public health to be realized. Doing so means shifting public health's aspirations towards increasing the healthspan vs "saving lives" by extending the duration of time older persons can survive by managing the multi-morbidities of late life.

A Comprehensive Analysis and Comparison of the U.S.’ and China’s Healthcare System

In an era of rapid globalization, understanding healthcare financing systems across diverse nations can offer crucial insights. This research project delves into the inner workings of the United States Medicaid and Medicare program and China's state-sponsored healthcare insurance schemes. Each represents a unique model of public health investment, shaped by distinct political philosophies and social contracts. The analysis reveals that the U.S. Medicaid program, despite its broad reach and comprehensive services, grapples with issues of equitable access and sustainable financing. In contrast, China's multi-tiered system offers a more standardized, although less comprehensive, form of coverage and faces challenges related to service quality and rural-urban disparities. Both nations, however, are in the continuous process of adapting their healthcare models to meet changing demographic and economic needs. By critically examining these two healthcare funding mechanisms, this study contributes to the ongoing dialogue on public health financing, offering recommendations for future policy interventions and reforms in both countries and potentially others.

Public health expenditure, government effectiveness and labour productivity in West Africa

Purpose: This study aimed at empirically exploring how the expenditure of public health and the effectiveness of government impacted the productivity of labour in West Africa.&#x0D; Design/Methodology/Approach: This study used data from 1980 to 2022 generated by the World Bank and adopted multiple regression, mediation and correlation analysis. Additionally, the co-integration test of Johansen and the residual-based test using the Engel-Granger approach were used. &#x0D; Findings: Expenditures on the health of the public and the effectiveness of government indicated some positive but insignificant impacts on labour productivity in the short run. At the same time, the expenditure on public health indicated a long-term, significant and adverse impact on labour productivity in Nigeria, Togo, Guinea, Senegal and Mali.&#x0D; Conclusion: The present study explored how expenditure on public health and the effectiveness of the government impacted the productivity of labour in West Africa. Apparently, the level of public health expenditure and government effectiveness are yet to positively impact the productivity of labour.&#x0D; Practical Implications: These results presented the critical role of public health expenditure and government effectiveness in enhancing the productivity of labour. Therefore, the study suggests that the government invest significantly in healthcare services in order to promote and safeguard the health of the people.&#x0D; Contribution to the Literature: This study offers an innovative perspective on labour productivity by highlighting the crucial roles played by governments in public health investment for productivity.

Contemporary Public Health Finance: Varied Definitions, Patterns, and Implications.

The financing of public health systems and services relies on a complex and fragmented web of partners and funding priorities. Both underfunding and "dys-funding" contribute to preventable mortality, increases in disease frequency and severity, and hindered social and economic growth. These issues were both illuminated and magnified by the COVID-19 pandemic and associated responses. Further complicating issues is the difficulty in constructing adequate estimates of current public health resources and necessary resources. Each of these challenges inhibits the delivery of necessary services, leads to inequitable access and resourcing, contributes to resource volatility, and presents other deleterious outcomes. However, actions may be taken to defragment complex funding paradigms toward more flexible spending, to modernize and standardize data systems, and to assure equitable and sustainable public health investments.

National Health Mission and the Status of Public Healthcare in Indian States

This contribution makes the 18th part of the social change indicators series, a collation of available data on developmental issues. This note looks at the status of public healthcare through six select public healthcare infrastructure and workforce indicators in the post-NHM periods in the states of India. Abandoning the primary health care approach—where the state plays the primary role of planner and provider—perpetuated the inadequate public expenditure on health in India. The National Health Mission (NHM)—the largest health programme in India that was launched in 2005 to achieve universal access to equitable, affordable, and quality healthcare services—suffered through this. Public healthcare in India was in poor shape when the NHM was launched. Several key indicators have further deteriorated since then. A few indicators registered modest improvement during the first 10 years of the NHM, but even that has plateaued in the more recent period of 2014–2021. These sobering findings call for a renewed thrust on public investment in health for robust primary health care.

Efficiency trends of essential public health services and possible influencing factors since the new round health reform in China: a case study from Hainan Province.

This article aimed to evaluate the efficiency trends and influencing factors of essential public health services in Hainan Province after the healthcare reform launched in 2009 in China. The efficiency of essential public health services (EPHS) at primary health institutions was assessed using data envelopment analysis (DEA), and the efficiency change was analyzed by employing the Malmquist productivity index (MPI). We used Tobit regression to identify the influence of environmental factors on the efficiency of public health services. The bootstrap method was adopted to reduce the impact of random errors on the result. The bootstrapping bias-corrected efficiency revealed that the average values of technical efficiency, pure technical efficiency, and scale efficiency were 0.7582, 0.8439, and 0.8997, respectively, which meant that the EPHS in Hainan Province were not at the most effective state. The average bias-corrected MPI was 1.0407 between 2010 and 2011 and 1.7404 between 2011 and 2012. MPIs were less than 1.0000 during other periods investigated, ranging from 0.8948 to 0.9714, indicating that the efficiency of EPHS has been decreasing since 2013. The Tobit regression showed that the regression coefficients of per capita GDP, population density, the proportion of older people aged over 65, and the proportion of ethnic minority population were 0.0286, -0.0003, -0.0316, and - 0.0041 respectively, which were statistically significant (p < 0.05). There was a short-term improvement in the efficiency of EPHS in Hainan after the launch of the new round of health reform. However, this trend has not been sustained after 2013. In particular, equalized financial investment in essential public health could not fulfill the needs of poor counties. This has resulted in the inability to improve scale efficiency in some counties, which in turn has affected the improvement of overall EPHS efficiency. Therefore, to promote EPHS efficiency sustainably, it is suggested that under this model of provincial control of counties, the equity of resource allocation should be effectively improved while further advancing the technology of service delivery.

Integration of Social Return on Investment with Health Impact Assessment and evaluation frameworks

Abstract Background To enable sustainable investment in public health to aid recovery from the COVID-19 pandemic and other global adversities, it is necessary to incorporate social, economic and environmental outcomes and value measurement into decision-making processes. Holistic frameworks, such as Social Return on Investment (SROI), look to capture this through understanding stakeholder impact and committing to valuing and monetizing their perceived outcomes. However, opportunities for conducting standalone SROI analyses may be limited due to resources. A solution is to undertake an SROI analysis alongside other analytical frameworks, impact assessments or evaluation methods. Methods In 2023, two innovative case studies in Wales, United Kingdom, integrated SROI into evaluations and assessments. The first is in conjunction with a Health Impact Assessment (HIA) on a sexual health self-testing service in a prison setting, while the second is in combination with an evaluation of a breastfeeding and infant nutrition programme. Results SROI offers a broad framework through which to integrate a holistic health economics lens to different types of evaluation and impact assessment. Traditional evaluations and HIA share common elements with SROI, for example developing a theory of change in evaluations and the screening and scoping stages of a HIA. Learning reflections for future integration were identified, for example ensuring quality assessment approaches align and ensuring design is scoped to enable effective integration from study outset. Conclusions SROI is the predominant tool used to assess the wider value of policies or programmes by identifying and evaluating holistic outcomes which have traditionally been difficult to measure. However, opportunities for standalone SROI studies may be limited for several reasons. As demonstrated, integrating SROI into different methods and approaches offers the opportunity to expand thinking on understanding value in a resource efficient way. Key messages • Social Return on Investment (SROI) can be effectively integrated into different evaluation approaches and Health Impact Assessment. • Integration of approaches has been shown to be resource efficient and beneficial to better understanding value and impact on health and well-being.

Exploring the Challenges in Delivering Sexual and Reproductive Healthcare in Iran

Abstract Background Sexual and reproductive healthcare (SRH) is key to achieving sustainable development goal (SDG) 5 but remains a challenge for women in Iran. In 2012 the government discontinued funding for the Family Planning Programme which provided free contraception and recently mass civil unrest has swept country wide. Healthcare workers (HCWs) are legally inhibited with the care they can provide, with the population resorting to unsafe practices. This study aims to explore the challenges in accessing SRH services, provide insight into the barriers HCWs face, and guide policy recommendations to improve the delivery of SRH. Methods A mixed methods approach was conducted for this study: a scoping review was performed using Arksey and O'Malley's framework, and qualitative semi-structured interviews were conducted in English and Farsi remotely with HCWs who have practised in Iran in the last 10 years. An inductive and deductive approach was used to guide thematic analysis. Results 37 studies exploring barriers of accessing SRH in Iran were identified. Six qualitative semi-structured interviews were conducted. Main emerging themes included 1) Lack of education in SRH leading to knowledge gaps, 2) “Fear and shame” culture created by sociocultural taboos, resulting in unsafe abortions, 3) Gender inequality with increasing violence during civil unrest and 4) Inadequate investment in public health, with financial burden on patients. Discussion The basic SRH needs of women in Iran are not being met with a concerning regression in women's rights over the last decade. Socio-political factors underpin a lack of education, inadequate public health and gender inequality. Policy recommendations include ratification of women's rights to health protected by legislation, commitment to investment into preventative services for SRH and formal education. Empowerment of women and commitment to building a strong public health system will greatly facilitate the attainment of SDG 5. Key messages • SRH barriers are inadequate legalisation, poor education and lack of universal health coverage. This results in harmful practices, like unsafe abortions, and over-reliance on costly private health. • To sustainably fulfil the SRH needs there must be a realisation of women's rights, restoration of state-funded reproductive health programmes and implementation of formal SRH education.

5.O. Workshop: Best Practices against child obesity

Abstract European countries in the field of health promotion and prevention of non-communicable diseases, indicating best practices and specific risk factors from research results on child obesity that have already developed from previous research actions. The overall goal of the JA is to implement two best practices Grunau Moves established in Germany and Smart Family established in Finland in different MS. The implementation process will include the knowledge transfer between best practice owners (Smart Family and Grunau Moves) and partner organisations from the Member States through the implementation of actions, the cooperation and exchange of knowledge between member states, the organisation of meetings, and related technical support. Also important part of the project is to produce policy developments to foster public health investments at community level in each country member on Health Promotion, Disease Prevention and Management of Non-Communicable Diseases. Scope of the project will be to promote to participating member states healthy lifestyles in families with children to prevent childhood obesity, to increase physical activity and healthy diet in children,families and communities with a focus on social norms, recognition and self-esteem in deprived districts in member states. Also, to study the different prerequisites for member states to implement either Grunau Moves or Smart Family. Finally, to prepare the sustainability of these best practices and transfer to other member states based on the acquired knowledge and experience. The expected results focus on the identification of concrete challenges in the prevention of non-communicable diseases and policy solutions in the form of best practices and innovative solutions for collective action between the Member States and the Commission, to tackle the main public health challenges Key messages • To strengthen a cooperative approach in tackling childhood obesity. • To improve the planning and development of the policies to tackle childhood obesity.

Beyond Education Dollars: Does Social Safety Net Spending Affect High School Graduation Rates?

PurposeTo examine the relationship between social safety net (SSN) spending and high school graduation rates for all students, as well as students belonging to minoritized groups. Also, to determine whether public SSN investments and PK-12 education are independent. MethodsUsing Common Core Data and the State-by-State Spending on Kids data, we estimated the effects of per-child SSN spending on graduation rates over time (2010–2016) using two-way fixed effects. ResultsSSN spending positively impacts high school graduation rates, with slightly larger magnitudes for students belonging to minoritized groups. The effects of public investments in SSN health, and PK-12 education on high school graduation rates are independent. DiscussionOur results indicate that the positive effects of SSN spending on high school graduation rates are independent of any impacts associated with education spending, suggesting that these two types of public investments affect high school graduation through different pathways.

Small numbers, big impact: making a utilitarian case for the contribution of inclusion health to population health in England

Inclusion health groups make up a small proportion of the general population, so despite the extreme social exclusion and poor health outcomes that these groups experience, they are often overlooked...