Public Health Investment Research Articles

Simulating the Fiscal Impact of Anti-Obesity Medications as an Obesity Reduction Strategy.

While substantial public health investment in anti-smoking initiatives has had demonstrated benefits on health and fiscal outcomes, similar investment in reducing obesity has not been undertaken, despite the substantial burden obesity places on society. Anti-obesity medications (AOMs) are poorly prescribed despite evidence that weight loss is not sustained using other strategies alone.We used a simulation model to estimate the potential impact of 100% uptake of AOMs on Medicare and Medicaid spending, disability payments, and taxes collected relative to status quo with negligible AOM use. Relative to status quo, AOM use simulation would result in Medicare and Medicaid savings of $231.5 billion and $188.8 billion respectively over 75 years. Government tax revenues would increase by $452.8 billion. Overall, the net benefit would be $746.6 billion. Anti-smoking efforts have had substantial benefits for society. A similar investment in obesity reduction, including broad use of AOMs, should be considered.

Personalized Graduate Medical Education and the Global Surgeon: Training for Resource-Limited Settings.

The World Health Organization and the World Bank have identified improvement in access to surgical care as an urgent global health challenge and a cost-effective investment in public health. However, trainees in standard U.S. general surgery programs do not have adequate exposure to the procedures, technical skills, and foundational knowledge essential for providing surgical care in resource-limited settings. The Michael E. DeBakey Department of Surgery at Baylor College of Medicine (BCM) created a 7-year global surgery track within its general surgery residency in 2014. Individualized rotations equip residents with the necessary skills, knowledge, and experience to operate in regions with low surgeon density and develop sustainable surgical infrastructures. BCM provides a formal, integrated global surgery curriculum-including 2 years dedicated to global surgery-with surgical specialty rotations in domestic and international settings. Residents tailor their individual experience to the needs of their future clinical practice, region of interest, and surgical specialty. There have been 4 major outcomes of the BCM global surgery track: (1) increased exposure for trainees to a broad range of surgeries critical in resource-limited settings, (2) meaningful international partnerships, (3) contributions to global surgery scholarship, and (4) establishment of sustainable global surgery activities. To better facilitate access to safe, timely, and affordable surgical care worldwide, global surgeons should pursue expertise in topics not currently included in U.S. general surgical curricula, such as setting-specific technical skills, capacity building, and organizational collaboration. Future evaluations of the BCM global surgery track will assess the effect of individualized education on trainees' professional identities, clinical practices, academic pursuits, global surgery leadership preparedness, and comfort with technical skills not encompassed in general surgery programs. Increasing availability of quality global surgery training programs would provide a critical next step toward contributing to the delivery of safe surgical care worldwide.

Tobacco control in the context of the COVID-19 pandemic in Uganda: a policy implementation review.

BackgroundThe COVID-19 pandemic has caused more than 900,000 deaths globally. The risk of mortality is higher for people with pre-existing conditions such as cancers, respiratory and cardiovascular diseases and diabetes for which tobacco use is a known risk factor. We conducted a study to explore how efforts to address the COVID-19 pandemic in Uganda have been integrated with tobacco control policies to generate evidence to inform policy decisions about the public health response in general and tobacco control interventions in particular.MethodsWe conducted a desk based review of ‘grey’ literature data sources (i.e. data that were not included in peer reviewed journals) with information about tobacco and COVID-19 in Uganda. Data were also obtained from stakeholders involved tobacco control via an online survey and telephone interviews.FindingsA total of 136 data sources were identified, of which 107 were eligible for data extraction. The online stakeholder consultation involved invitations to 61 participants of whom 33 (54%) took part via the online survey while 5 (8.2%) opted for telephone interviews. In the context of the COVID-19 prevention interventions, social media can be a powerful platform for communicating anti-tobacco messages such as the vulnerability of tobacco users to COVID-19 and the exacerbated disease severity among COVID-19 patients with history of tobacco use. Two thirds (n=20, 65%) of survey respondents expected a tobacco tax increase to address health, economic and wider policy impacts of the COVID-19 crisis.ConclusionsAdvocacy should be conducted for taxation of tobacco products to reduce consumption and generate revenue to support public health investments. Public health institutions involved in the COVID-19 response should reject donations from the tobacco industry and its allies as is stipulated in the Framework Convention on Tobacco Control and the Uganda Tobacco Control Act 2015. The COVID-19 pandemic also offers an opportunity to promote tobacco cessation and strengthening tobacco control policy implementation by recognizing the role of tobacco use in exacerbating COVID-19 health outcomes.

Understanding equity of institutional delivery in public health centre by level of care in India: an assessment using benefit incidence analysis

BackgroundThe National Health Mission (NHM), the largest ever publicly funded health programme worldwide, used over half of the national health budget in India and primarily aimed to improve maternal and child health in the country. Though large scale public health investment has improved the health care utilization and health outcomes across states and socio-economic groups in India, little is known on the equity concern of NHM. In this context, this paper examines the utilization pattern and net benefit of public subsidy for institutional delivery by the level of care in India.MethodsData from the most recent round of the National Family Health Survey (NFHS 4), conducted during 2015–16, was used in the study. A total of 148,645 last birth delivered in a health centre during the 5 years preceding the survey were used for the analyses. Out-of-pocket (OOP) payment on delivery care was taken as the dependent variable and was analysed by primary care and secondary level of care. Benefits Incidence Analysis (BIA), descriptive statistics, concentration index (CI), and concentration curve (CC) were used to do the analysis.ResultsInstitutional delivery from the public health centres in India is pro-poor and has a strong economic gradient. However, about 28% mothers from richest wealth quintile did not pay for delivery in public health centres compared to 16% among the poorest wealth quintile. Benefit incidence analyses suggests a pro-poor distribution of institutional delivery both at primary and secondary level of care. In 2015–16, at the primary level, about 32.29% of subsidies were used by the poorest, 27.22% by poorer, 20.39% by middle, 13.36% by richer and 6.73% by the richest wealth quintile. The pattern at the secondary level was similar, though the magnitude was lower. The concentration index of institutional delivery in public health centres was − 0.161 [95% CI, − 0.158, − 0.165] compared to 0.296 [95% CI, 0.289, 0.303] from private health centres.ConclusionProvision and use of public subsidy for institutional delivery in public health centres is pro-poor in India. Improving the quality of service in primary health centres is recommended to increase utilisation and reduce OOP payment for health care in India.

An American Disgrace

An American Disgrace

How investment in public health has impacted the prevalence of tuberculosis in China: A study of provincial variations between 2005 and 2015.

How do public investments in public health actually impact health outcomes? This question has not been investigated enough, especially regarding infectious diseases. This study investigates the correlations between public health expenditure and the incidence of tuberculosis in China using a provincial panel dataset. The analysis focuses on the correlations between public health expenditure and tuberculosis incidence, using the fixed effects models and Two Stage Least Squares (2SLS) method. Overall, a 10% increase of public health expenditure per capita is associated with a 0.0019% decrease of tuberculosis incidence. A series of robustness tests show that the correlation between public health expenditure and TB incidence is valid. Future research should focus more on the performance of public health, particularly infectious diseases like tuberculosis, and provide references for health policymakers.

The ‘social worlds’ concept: a useful tool for public health-oriented studies of drinking cultures

Intervening in heavy drinking cultures within groups below the level of the population has been under-utilized as a means of reducing alcohol-associated harms. We argue that the concept of ‘social worlds’ is useful for the identification and investigation of heavy drinking cultures in collectivities at this level. The concept may also support investigations into other practices with health implications, such as other substance use or gambling. Social worlds are understood to be loosely bounded groups that change over time and any individual may be affiliated with many. Membership of a social world entails shared commitments, practices and norms generated and reiterated through interaction with other members, albeit not necessarily with all members participating together or at once. Social worlds of heavy alcohol consumption are also framed by the settings where people drink, products consumed and technologies used in doing so. As a tool to support public health efforts, we suggest that these social worlds should entail collective drinking, include sufficient members and involve a magnitude of harm to warrant public health investment and be accessible for research and intervention. Researchers can usefully consider how wider forces, including discourses about alcohol and the gendering of drinking practices, are enacted within particular social worlds. Although they may be explored through empirical research, social worlds of heavy drinking are analytic devices rather than perfect reflections of an objective reality. To see them as such allows us to define them strategically, looking for opportunities to modify cultures associated with harms.

The origination and development of the public health concept as an investee: Theoretical forerunners

Subject. We determine the substance of public health as a target of management in terms of investment. Objectives. We analyze theoretical forerunners of the origination and the development of the public health concept in terms of its economic substance as a resource and investee. Methods. We sort out literary data and carry out the logic, focused and content analysis of the text. Results. The article analyzed approaches to understanding the substance and evolution of health and public health as concepts. We believe that it is necessary to specify the definition of public health in terms of its economic substance as a resource. We correspondingly analyzed the related concept, such as health capital, human capital. We suggest interpreting the public health as a medical, social and economic resource, whose quality and value are gauged with a set of demographic, medical and statistical metrics. Their level depends on the living conditions of people who are virtually investees. Conclusions and Relevance. The theoretical study and suggested definition contribute to the development of the public health theory in terms of its economic substance and dependence on the socio-economic situation in the country or the region, and the volume and method of investing in the living conditions of people. The findings can be used for further research into the nexus of the mix and volume of investment in public health and its level in the region.

Regarding Investment in a Healthier Future: Impact of the 2012 Institute of Medicine Finance Report.

Governments at all levels work to ensure a healthy public, yet financing, organization, and delivery of public health services differ across the United States. A 2012 Institute of Medicine Finance report provided a series of recommendations to ensure a high-performing and adequately funded public health infrastructure. This review examines the influence of the Finance report's 10 recommendations on public health policy and practice. This review utilized peer-reviewed and gray literature published since 2012. Documents that address at least one of the Finance report's 10 recommendations and contain information on either official actions taken in response to the Finance report or evidence of the report's influence on the practice community. Of 2394 unique documents found, a total of 56 documents met the eligibility criteria. Review of these 56 documents indicated that the most substantial activity related to the recommendations was focused on the "minimum package of public health services" concept and establishment of a uniform chart of accounts. Progress has been mixed on the Finance report recommendations. Improved tracking and auditing of public health activity appears to be advancing, yet financial benchmarks remain unmet. Challenges remain in determining actual investment in public health and equitable resource allocation approaches. State and local health department use of cost estimation methodology and a uniform chart of accounts tool has contributed to an increase in understanding and improvement in public health spending. The Finance report has served as a strong impetus for advocating for an increased investment in governmental public health. Efforts are bolstered by informed public health practitioners and stakeholders but often stymied by policy makers who must balance complex competing issues and priorities. Although many successes have occurred, further work is needed toward improving investment in the nation's public health.

The Cost of Providing the Foundational Public Health Services in Ohio.

To examine levels of expenditure and needed investment in public health at the local level in the state of Ohio pre-COVID-19. Using detailed financial reporting from fiscal year (FY) 2018 from Ohio's local health departments (LHDs), we characterize spending by Foundational Public Health Services (FPHS). We also constructed estimates of the gap in public health spending in the state using self-reported gaps in service provision and a microsimulation approach. Data were collected between January and June 2019 and analyzed between June and September 2019. Eighty-four of the 113 LHDs in the state of Ohio covering a population of almost 9 million Ohioans. In FY2018, Ohio LHDs spent an average of $37 per capita on protecting and promoting the public's health. Approximately one-third of this investment supported the Foundational Areas (communicable disease control; chronic disease and injury prevention; environmental public health; maternal, child, and family health; and access to and linkages with health care). Another third supported the Foundational Capabilities, that is, the crosscutting skills and capacities needed to support all LHD activities. The remaining third supported programs and activities that are responsive to local needs and vary from community to community. To fully meet identified LHD needs in the state pre-COVID-19, Ohio would require an additional annual investment of $20 per capita on top of the current $37 spent per capita, or approximately $240 million for the state. A better understanding of the cost and value of public health services can educate policy makers so that they can make informed trade-offs when balancing health care, public health, and social services investments. The current environment of COVID-19 may dramatically increase need, making understanding and growing public health investment critical.

Tracking Environmental and Health Disparities to Strengthen Resilience Before the Next Crisis.

The COVID-19 pandemic has underscored how underlying disparities in environmental and health conditions exacerbate vulnerability during public health emergencies in low-income and communities of color. Neglected epidemics-high rates of pollution, chronic disease, and racial and socioeconomic health disparities-have continued amid persistent systemic racism and declining investment in public health. Recognized too late due to shortcomings in public health data tracking, COVID-19 has surged through vulnerable communities. Improved public health tracking is critical for informing the country's recovery from COVID-19, and it can be leveraged to measure and reduce health disparities and strengthen community resilience to respond more effectively to the next public health crisis. We emphasize how public health tracking agencies can engage communities in data collection and reporting; we also discuss the complementary role that communities can take to mobilize data to change policies and institutions, strengthening resilience through increased information and capacity driven by community priorities. Success requires the continuous collection of timely data at a community scale, and public health agencies partnering with communities to use the information in decision making and evaluation to ensure progress over time. We highlight community-engaged data collection and reporting-community air monitoring in Imperial County, CA-as an example of working with communities to improve public health data collection and reporting, increase community dialogue and engagement in governmental decision making, and inform public health tracking to reduce health disparities and strengthen community resilience.

Estimating the Fiscal Consequences of National Immunization Programs Using a "Government Perspective" Public Economic Framework.

Infectious diseases can impose considerable mortality and morbidity for children and adult populations resulting in both short- and long-term fiscal costs for government. Traditionally, healthcare costs are the dominant consideration in economic evaluations of vaccines, which likely ignores many costs that fall on governments in relation to vaccine-preventable conditions. In recent years, fiscal health modeling has been proposed as a complementary approach to cost-effectiveness analysis for considering the broader consequences for governments attributed to vaccines. Fiscal modeling evaluates public health investments attributed to treatments or preventive interventions in the case of vaccination, and how these investments influence government public accounts. This involves translating morbidity and mortality outcomes that can lead to disability, associated costs, early retirement due to poor health, and death, which can result in lost tax revenue for government attributed to reduced lifetime productivity. To assess fiscal consequences of public health programs, discounted cash flow analysis can be used to translate how changes in morbidity and mortality influence transfer payments and changes in lifetime taxes paid based on initial health program investments. The aim of this review is to describe the fiscal health modeling framework in the context of vaccines and demonstrate key features of this approach and the role that public economic assessment of vaccines can make in understanding the broader economic consequences of investing in vaccination programs. In this review, we describe the theoretical foundations for fiscal modeling, the aims of fiscal model, the analytical outputs, and discuss the relevance of this framework for evaluating the economics of vaccines.

Enhancing partnerships and collaboration in times of change

Abstract Issue In 2019, the government of the Canadian province of Ontario announced major changes to the structure, governance and funding of public health services. Throughout these changes, publicly funded local and regional public health organizations are still expected to provide effective, evidence-informed programming to their communities. The National Collaborating Centre for Methods and Tools (NCCMT) has facilitated collaborations to support Ontario public health through this transition. Description of the problem In order to support evidence-informed public health in Ontario during this transition, the NCCMT reached out to current and potential partners, within and beyond the public health sector for a multidisciplinary approach. We conducted a needs assessment for an evidence review repository, which would allow public health practitioners to share and build upon each other's work. Finally, demonstrating the value of public health to policymakers can be inherently challenging as the return on investment in public health is often very long term. We partnered with health units in varying capacities to find and synthesize evidence to advocate for continued investment in public health. Results This initiative has provided important lessons in developing and maintaining strong partnerships. Looking beyond the public health sector can establish mutually beneficial partners and allies in other disciplines. A key finding was the need to establish infrastructure to support collaboration and resource sharing. Finally, we learned that big picture questions like demonstrating the value of public health require many different perspectives, inputs and areas of expertise. Lessons Through this initiative, we have developed a multidisciplinary, collaborative approach to supporting evidence-informed public health through times of major restructuring. This approach can be applied to future changes to public health on smaller or larger scales, or within other geographic regions. Key messages Multidisciplinary approaches can support collaboration, unity and advocacy in times of change. Establishing infrastructure to support collaboration and sharing of resources is valuable.

Leaders' Future Orientation and Public Health Investment Intention: A Moderated Mediation Model of Self-Efficacy and Perceived Social Support.

Prior studies have investigated the issue of public health and health policy from economic, environmental, and healthcare perspectives. Research on public health from leaders’ perspective may also help to advance our knowledge about leaders’ perceptions, attitudes, and behavioral intentions toward public health management. Therefore, this study is based on social ideal theory, social cognitive theory, and social trust theory to investigate the influence of leaders’ future orientation on public health investment intention with the mediating role of leaders’ self-efficacy and the moderating role of perceived social support. Using a structural equation modeling with a sample data of 381 leaders of government agencies in Vietnam, empirical results indicate that leaders’ future orientation has a positive influence on public health investment intention. Furthermore, self-efficacy is found to have a positive mediating effect in the relationship between leaders’ future orientation and public health investment intention. In addition, perceived social support positively moderates the link between leaders’ future orientation and self-efficacy. Perceived social support also moderates the indirect effect of leaders’ future orientation on public health investment intention through self-efficacy. On one hand, this study contributes to theoretical research by clarifying the effects of leaders’ perceptions, and cognitive and behavioral intentions toward public health investment. Findings of this study may have implications for researchers who may have interest in studying the issue of public health management from leaders’ viewpoints. On the other hand, this study contributes to practitioners since understanding how leaders’ characteristics affect public health investment will enhance the quality of policy makers’ decision-making in improving public health for citizens and society.

Health as an asset: Enhancing personal, social and economic life

Abstract Background Health policy in the UK increasingly advocates health as an asset (Baker, 2014; NHS England, 2019) focussing on the holistic capacity of health to support the wider flourishing of individuals (Hanlon et al., 2011). This research illuminates the cross-cutting impacts of public health investment for the personal social and economic life of individuals. Methods An observational longitudinal study based on data from the British Household Panel and Understanding Society Surveys covering 25 years from 1991 is undertaken. Satisfaction with partners, subjective financial situation and levels of structural social capital are regressed on measures of general subjective health and the GHQ12 score of mental health and confounders. A fixed effects instrumental variable panel data estimation identifies causal effects. Results With a significance level of at least p < 0.05, mental illness reduces satisfaction with personal relationships for males (n = 115,273). For males and females, both greater general subjective health and mental health improve feelings of coping financially (n = 329,282) and social capital (n = 150,298). Conclusions Changes in sets of health conditions, acting through general and mental health, produce cross-cutting impacts on personal, social and economic outcomes. These findings support the proposition that health is an asset and that both further analysis and prioritisation of greater coordinated deployment of health care assets in communities is needed. References Baker, D. (2014). Developing and implementing a robust asset-based approach to public health. Perspectives in Public Health, 134(3), 129-130. Hanlon, P., Carlisle, S., Hannah, M., Reilly, D., & Lyon, A. (2011). Making the case for a “fifth wave” in public Health. Public Health, 125(1), 30-36. NHS England. (2019). The NHS Long Term Plan - a summary, 2. Key messages Health can be viewed as an asset comprising of a range of conditions that can have causal impacts on the personal, social and economic lives of individuals and their wider flourishing. Harnessing health as an asset requires the development of greater integrated health care, social and individual support to capitalise on the cross-cutting impacts of health.

Programa de ensino pelo trabalho: levantamento de demandas acerca da atuação de agentes comunitário de saúde em uma unidade de saúde na Cidade de Belém, Brasil

Os Agentes Comunitários de Saúde (ACS), são profissionais que integram a equipe de saúde do Programa Estratégia Saúde da Família (ESF). A atuação do ACS acontece nas comunidades em contato com a população, em seus núcleos familiares. Contudo, o objetivo deste estudo é relatar a experiência de discentes participantes do Programa de Ensino pelo Trabalho, a partir de uma atividade realizada com ACS e descrever acerca das principais dificuldades na sua atuação nas microáreas de uma ESF da cidade de Belém. Para melhor sistematização, o levantamento de demandas acerca da atuação dos ACS foi dividida em 5 etapas: na primeira etapa foi apresentado os espaços e os serviços oferecidos da unidade pela enfermeira responsável aos universitários. Na segunda etapa, houve a apresentação das ACS da equipe e a organização da atividade para o levantamento de demandas da unidade. Na terceira e quarta etapa, realizou-se a atividade sistematizada pelos alunos. A quinta etapa, contou com a organização de estratégias a serem inseridas na unidade para o aprimoramento do serviço. A partir da realização da atividade, verificou-se que as principais dificuldades identificadas pelos ACS deste território eram: ausência de materiais de proteção, ausência de acolhimento e desinteresse da população, problemas pessoais, sobrecarga de trabalho, ausência de infraestrutura e capacitação. O objetivo deste estudo foi alcançado. Entretanto, nota-se a fragilidade nos investimentos do poder público na saúde. Todavia, é importante haver constante capacitação a estes profissionais, visando a melhoria do atendimento à população.

DAAs for chronic hepatitis C: good public health investment in Vietnam

DAAs for chronic hepatitis C: good public health investment in Vietnam

Cost-Utility Analysis of Direct-Acting Antivirals for Treatment of Chronic Hepatitis C Genotype 1 and 6 in Vietnam.

ObjectiveVery few cost-utility analyses have either evaluated direct-acting antivirals (DAAs) on hepatitis C virus (HCV) genotype 6 patients or undertaken societal perspective. Recently, DAAs have been introduced into the Vietnamese health insurance drug list for chronic hepatitis C (CHC) treatment without empirical cost-effectiveness evidence. This study was conducted to generate these data on DAAs among CHC patients with genotypes 1 and 6 in Vietnam.MethodsA hybrid decision-tree and Markov model was employed to compare costs and quality-adjusted life-years (QALYs) of available DAAs, including (1) sofosbuvir/ledipasvir, (2) sofosbuvir/velpatasvir, and (3) sofosbuvir plus daclatasvir, with pegylated-interferon plus ribavirin (PR). Primary data collection was conducted in Vietnam to identify costs and utility values. Incremental cost-effectiveness ratios were estimated from societal and payer perspectives. Uncertainty and scenario analyses and value of information analyses were performed.ResultsAll DAAs were cost-saving as compared with PR in CHC patients with genotypes 1 and 6 in Vietnam, and sofosbuvir/velpatasvir was the most cost-saving regimen, from both societal and payer perspectives. From the societal perspective, DAAs were associated with the increment of quality-adjusted life-years by 1.33 to 1.35 and decrement of costs by $6519 to $7246. Uncertainty and scenario analyses confirmed the robustness of base-case results, whereas the value of information analyses suggested the need for further research on relative treatment efficacies among DAA regimens.ConclusionsAllocating resources for DAA treatment for HCV genotype 1 and 6 is surely a rewarding public health investment in Vietnam. It is recommended that the government rapidly scale up treatment and enable financial accessibility for HCV patients.

Public health investments and mortality risk in Brazilian peritoneal dialysis patients.

BackgroundEnd-stage kidney disease (ESKD) treatment is very costly and accounts for a significant percentage of public healthcare expenditures. Beyond direct costs, dialysis patients use other healthcare levels, but the impact of public investment on each of these levels is unclear. This study aimed to investigate the association between direct financing at different healthcare levels and overall mortality in peritoneal dialysis (PD) patients.MethodsWe included all adult incident PD patients from a Brazilian prospective, nationwide PD cohort. Overall mortality was the primary outcome of interest. We used a three-level multilevel survival analysis to investigate whether mortality was associated with the investments destined to different levels of healthcare complexity: (i) primary, (ii) medium and high and (iii) professional healthcare training and community awareness.ResultsWe evaluated 5707 incident PD patients from 78 Brazilian cities, which were divided into four quartiles for each healthcare level (Groups I–IV). After taking the highest quartile (Group IV) as a reference, investment in the primary health level was not associated with patient survival. Otherwise, medium and high complexity levels were associated with higher mortality risk. Also, investment in healthcare manager training and community awareness had an impact on patient survival.ConclusionsInvestments in different levels of the healthcare system have distinct impacts on PD patient survival. Investment in healthcare manager training and community awareness seems to be a promising strategy on which to focus, given the relatively low cost and positive impact on outcome.

Viewpoint - Handwashing and COVID-19: Simple, right there…?

COVID-19 is a disease with no proven pharmaceutical intervention and no proven vaccine. In such circumstances, prevention is all we have. The role of handwashing in the prevention of communicable diseases has been known for over a century, yet it remains severely neglected as a public health investment, to be periodically re-discovered during pandemic-scale infections. Over 26% of the global population has no access to a handwashing station in the home; for many low-income countries this proportion rises to over 50%. In other instances, the water is unaffordable or the supply has been shut off on account of unpaid bills. But when there is no water in the home or yard, or no mechanism for delivering enough water, good hand-washing is extremely difficult. Well before COVID-19, global cost-benefit analyses of water and sanitation investments, with benefits measured in time-savings as well as health, showed significant net benefits in all sub-regions of the developing world. This Viewpoint paper argues that, in the current crisis and its aftermath, it is imperative for governments and donors to prioritize and generously fund affordable, reliable, and accessible water services in underserved regions of the world. More than ever before, this is a foundational investment for health, dignity and development.