Policy Changes Research Articles

Market Factors, Not Quality, Influence Reimbursement for Pancreaticoduodenectomy in an Era of Price Transparency.

The Centers for Medicare and Medicaid Services (CMS) price transparency rule tries to facilitate cost-conscious decision-making. For surgical services, such as pancreaticoduodenectomy (PD), factors mediating transparency and real-world reimbursement are not well described. The Leapfrog Survey was used to identify United States hospitals performing PD. Financial and operational data were obtained from Turquoise Health and CMS Cost Reports. Chi-square tests and modified Poisson regression evaluated associations with reimbursement disclosure. Two-part logistic and gamma regression models estimated effects of hospital factors on commercial, Medicare, and self-pay reimbursements for PD. Of 452 Leapfrog hospitals, 295 (65%) disclosed PD hospital or procedure reimbursements. Disclosing hospitals were larger (beds >200: 81.0% vs. 71.3%, p = 0.04), reported higher net margins (0.7% vs. -2.1%, p = 0.04), more likely for-profit (26.1% vs. 6.4%, p < 0.001), and teaching-affiliated (82.0% vs. 65.6%, p < 0.001). Nonprofit status conferred hospitalization reimbursement increases of $8683-$12,329, while moderate market concentration predicted savings up to $5066. Teaching affiliation conferred reimbursement increases of $4589-$16,393 for hospitalizations and $644 for procedures. Top Leapfrog volume ratings predicted an increase of up to $7795 for only Medicare hospitalization reimbursement. Nondisclosure of hospital and procedural reimbursements for PD remains a major issue. Transparency was noted in hospitals with higher margins, size, and academic affiliation. Factors associated with higher reimbursement were non-profit status, academic affiliation, and more equitable market share. Reimbursement inconsistently tracked with PD quality or volume measures. Policy changes may be required to incentivize reimbursement disclosure and translate transparency into increased value for patients.

Delaying high school start times impacts depressed mood among students: evidence from a natural experiment.

Delaying high school start times prolongs weekday sleep. However, it is not clear if longer sleep reduces depression symptoms and if the impact of such policy change is the same across groups of adolescents. We examined how gains in weekday sleep impact depression symptoms in 2,134 high school students (mean age 15.16 ± 0.35 years) from the Minneapolis metropolitan area. Leveraging a natural experiment design, we used the policy change to delay school start times as an instrument to estimate the effect of a sustained gain in weekday sleep on repeatedly measured Kandel-Davies depression symptoms. We also evaluated whether allocating the policy change to subgroups with expected benefit could improve the impact of the policy. Over 2 years, a sustained half-hour gain in weekday sleep expected as a result of the policy change to delay start times decreased depression symptoms by 0.78 points, 95%CI (-1.32,-0.28), or 15.6% of a standard deviation. The benefit was driven by a decrease in fatigue and sleep-related symptoms. While symptoms of low mood, hopelessness, and worry were not affected by the policy on average, older students with greater daily screen use and higher BMI experienced greater improvements in mood symptoms than would be expected on average, signaling heterogeneity. Nevertheless, universal implementation outperformed prescriptive strategies. High school start time delays are likely to universally decrease fatigue and overall depression symptoms in adolescents. Students who benefit most with respect to mood are older, spend more time on screens and have higher BMI.

Protecting nutrition in a food crisis.

Food insecurity and malnutrition are rising worldwide due to disruptions in food systems related to interconnected health-, climate- and conflict-related crises. Although governments globally are committed to addressing nutritional challenges, policy responses have increasingly focused on food security and, particularly, on food affordability. However, these short-term measures often overlook the necessity of integrating nutritious foods into the food system to ensure improved long-term nutrition. By drawing on the United Nations Committee on World Food Security's Voluntary guidelines on food systems and nutrition, this article outlines opportunities for policy-makers to integrate nutrition into key elements of the crisis response. Key policy areas where nutrition could be further integrated include social protection, agricultural investment, trade policy and urban planning. Strengthening the focus of nutrition in these measures will be essential to establish long-term incentives that support food systems transformation for improved nutrition. Drawing on theories of the policy process, I propose that stronger governance and cross-sectoral dialogue will be critical to achieve sustained nutritional outcomes. Health policy-makers can play a leadership role in supporting cross-sectoral policy change by carefully framing the policy issues, advocating for institutional structures that promote collaboration across sectors to prioritize nutrition, and strengthening the management of conflicts of interest in food system policy-making.

Global renewable energy transition in fossil fuel dependent regions

The worldwide shift towards renewable energy, as defined by the United Nations' Sustainable Development Goals (SDGs) in 2015, is a crucial milestone in achieving a sustainable future. The core focus of SDG 7 is to advance the accessibility, dependability, and environmentally-friendly nature of energy, aiming to substantially enhance the proportion of renewable energy sources and enhance energy efficiency. Although there have been significant developments in renewable energy, notably in solar and wind technologies, the rate of transition is still inadequate to achieve climate objectives. This study examines the imperative of implementing policy changes and integrated strategies to align global and local goals, while tackling the issues of resource allocation and the pressing need to transition away from fossil fuels in order to mitigate global temperature increase. Case studies showcase effective national endeavors, such as Brazil's Proalcool, Germany's Energiewende, and India's ambitious renewable energy objectives, illustrating diverse strategies for bolstering renewable energy capability. The report also analyzes the economic consequences for emerging nations that heavily rely on fossil fuels and the expected effects of reduced fossil fuel consumption. This article offers a detailed analysis of the current advancements, difficulties, and variations across different regions in the field of renewable energy. It gives valuable information on the future of global renewable energy plans, highlighting the importance of unified worldwide endeavors to attain a sustainable energy future.

A theoretical approach to user education in public licensing: Defending against copyright trolling

This paper develops a theoretical model to prevent copyright trolling through user education and policy advocacy, particularly in the context of Creative Commons (CC) and public licensing. Copyright trolling, which exploits users’ lack of legal literacy and understanding of licensing terms, poses significant challenges to the free and open sharing of knowledge. The paper explores the relationship between legal literacy, public knowledge, and digital education, proposing that targeted educational interventions can empower users to avoid exploitation. It also advocates for the implementation of structured, government-backed, and institutional programs to promote licensing literacy. Policy-driven educational frameworks, integrated into broader digital literacy initiatives, are essential for reducing the risks posed by copyright trolling. The paper concludes with recommendations for future educational programs and policy changes to mitigate copyright trolling and foster a more informed and resilient digital ecosystem.

Evaluating the effectiveness of climate change policies and initiatives in the United States: A comprehensive review

Climate change presents profound challenges, demanding effective policies to mitigate its impacts. This paper reviews the effectiveness of climate policies in the United States, analyzing scholarly articles, government reports, and relevant literature. The review covers diverse policies such as greenhouse gas regulations, renewable energy initiatives, energy efficiency programs, and adaptation measures. It assesses their success in reducing carbon emissions, advancing a low-carbon economy, and enhancing resilience to climate impacts. Key findings highlight significant successes, such as the rise in renewable energy due to renewable portfolio standards and reduced emissions from vehicle fuel efficiency standards. State-level initiatives, like carbon pricing and renewable energy targets, also show promising outcomes. However, the review identifies substantial challenges, including political and economic obstacles, inconsistent policies across states, and the need for better federal-state-local collaboration. Additionally, disparities in policy benefits, with marginalized communities facing greater burdens and limited access to renewable resources, are significant concerns. To enhance the effectiveness of climate policies, the study recommends fostering coherent policies across all government levels, promoting equitable and inclusive climate solutions, raising public awareness, and supporting innovation in clean technologies. This comprehensive review provides valuable insights for policymakers and stakeholders to develop strategies that effectively address climate change, promote sustainability, and ensure a fair transition to a low-carbon future.

Resilient social workers’ perspective on their professional work during the COVID-19 pandemic. An interpretative phenomenological analysis

ABSTRACT This study aimed to an in-depth understanding and meaning making of the resilience processes of resilient social workers providing services during the COVID-19 pandemic, over a period of two years from the outbreak. A sample of 23 resilient social workers covering a range of different social services organisations in Romania participated in three focus groups. The method of interpretative phenomenological analysis has led to a matrix of four themes: resilience process, resilience factors, the meaning of the pandemic, the focus group experience. Findings showed that resilience processes evolved over three phases interpreted through the lenses of Bridges transitions model: firstly (March 2020–May 2020) ‘shock and chaos', secondly (June 2020–February 2021) ‘identifying order in chaos'; thirdly, (March 2021–March 2022) ‘integration and growth’. Findings indicate that individual resilience factors and team factors prevailed over organisational factors, even though supportive leadership and organisational support acted as resilience enhancers. Within a socio-ecological approach, a focus on individual resilience factors and relationships must not distract from the contribution that structural and social policy changes may have on resilience processes. Lessons learned - can contribute to the development of a resilience-informed approach to social work education and practice at both national and European level.

Demographic ageing: an opportunity to rethink economy, society and regions

Abstract Ageing is often depicted negatively, but we challenge passive views, suggesting that an “active ageing” agenda requires rethinking economy, urban form and societal responses. We present demographic trends in ageing, migration and urbanization across global regions. Building from psychological theories of ageing regarding disengagement and continuity, we argue for an adjustment response at the societal level to address needed structural changes in economy, social policy and regional planning. These adjustments should prioritize well-being and purpose over economic growth; social policy that links household, informal and formal care and new approaches to urban and regional planning that remake cities for all ages. Ageing requires new paradigms. These societal adjustments will permit new approaches that could build a more inclusive world.

A Systematic Literature Review on the Role of Human Ecology Higher Education Institutions in Policy Development for Food and Nutrition Security in the Philippines

The issue of Food and Nutrition Security (FNS) in the Philippines has been exacerbated by the COVID-19 pandemic and persistent social, environmental and agricultural problems. To address this concern, the involvement of Higher Education Institutions (HEIs) is explored by reviewing the local policies in the Philippines. Applications and recommendations on how human ecology can address the complex problem of FNS were then noted. This systematic literature review used a framework synthesis approach wherein the Australian National University (ANU) Transdisciplinary Framework was used to check if the stated policies, applications, and recommendations were aligned with the framework components, which are interactive, integrative, change-oriented, systemic, context-based, and pluralistic. This transdisciplinary framework is expected to promote policy change and development related to FNS. After that, 38 articles were included in the review. Upon the review, no local policies fit all of the ANU Transdisciplinary Framework’s components. Nonetheless, these policies mostly separately address food security and nutrition security. However, there are still no established responses to the concern of FNS as an integrated concept of food security and nutrition security. HEIs contribute to developing FNS-related policies by intensifying advocacy for integrating food and nutrition security and improving FNS-related research and programs.

Effects of legal age change on adolescents’ perception of access to alcohol in Portugal

Abstract Background Adolescents and young adults are a group particularly vulnerable to the effects of alcohol consumption. In Portugal, legislative changes in 2013 and 2015 prohibited the sale of alcoholic beverages to under-18s. This study aimed, first, to evaluate the impact of these policy shifts on the perceived access to alcohol among Portuguese adolescents, and second, to assess the different impacts across gender and socioeconomic strata. Methods Data from the ESPAD survey, spanning 1995-2019, was used. A quasi-experimental difference-in-differences study design was employed, using Finland, Norway, and Sweden as controls. The perceived access to beer, wine, and spirits among 16-year-old adolescents was used as outcomes, adjusted for gender and parental education. Results were also stratified by gender and by parental education status. Results After the increase in the minimum age for alcohol sales, there was a higher perceived easiness of access to beer (coef=0.018, p = 0.001) and a decline in spirits (coef=-0.088, p = 0.022), with no changes in wine. Male adolescents exhibited a decrease in the perception of access to spirits (coef=-0.100, p = 0.007) and wine (coef=-0.049, p = 0.049), while changes in the perception of access to beer were non-significant. Similar patterns were observed in female adolescents, yet non-significant for wine or spirits. These positive impacts on beer and negative impacts on spirits were observed in the different socioeconomic groups; wine was the exception, with only the highest-education group showing a decrease in the perception of access (coef=-0.056, p = 0.011). Conclusions In this study, the effect of raising the minimum age for alcohol sales in Portugal varied according to the alcoholic beverage, gender, and, for wine, according to the socioeconomic group. These findings suggest limitations in the policy’s effectiveness and equity. Future research should delve into the underlying causes to optimize health-promoting policies. Key messages • Portugal’s alcohol policy changes led to differential impacts on the perception of access to alcohol, with an impact in higher alcohol content beverages. • The impact of alcohol policy changes also differed across gender and socioeconomic status, with a stronger effect on male adolescents and higher socioeconomic strata.

From Pandemic to Heatwave: Digital Strategies for Health Resilience

Abstract Heatwaves threaten public health in the EU, as evidenced by the high heat-related mortality in the summer of 2022. Despite their frequency, European heat-health action plans (HHAPs) largely exclude digital solutions. The COVID-19 pandemic shifted perceptions and use of digital health tools, demonstrating their effectiveness in responding to health crises and providing insights for heatwave management. This work explores the potential of further including digital health interventions into European HHAPs. The objective is to identify adaptable digital strategies to mitigate heatwave health impacts. We started by analyzing WHO’s guidance on the creation of HHAPs, as well as the European Observatory on Health Systems and Policies’ assessment of the four main areas supported by digital health tools during the pandemic. Later, we proposed four main areas where digital health solutions could be efficiently integrated. Each area underwent a rapid literature review to identify digital solutions used during COVID-19, followed by a critical analysis for applicability in heat-health action planning. We identified four areas where the implementation of digital tools should be explored: Communication and Information Dissemination (focusing on raising awareness among vulnerable groups, caregivers, and organizations); Modeling and Forecasting (developing precise forecasts for proactive planning); Health services coordination (among services delivering immediate care during heatwaves); Monitoring and Population Surveillance (implementing strategies to identify and mitigate heat-related risks e.g. among vulnerable populations). Results indicate that digital health solutions from COVID-19 can enhance national HHAPs. Tools for pandemic prevention and response are applicable to extreme weather events. The pandemic’s increased digital usage resulted from policy changes and infrastructure investment - leveraging these advancements could prepare Europe for extreme heat threats. Key messages • Results indicate that digital health solutions from COVID-19 can enhance national HHAPs. Tools for pandemic prevention and response are applicable to extreme weather events. • The pandemic’s increased digital usage resulted from policy changes and infrastructure investment - leveraging these advancements could prepare Europe for extreme heat threats.

The Longlasting Program Keluarga Harapan as Conditional Cash Transfer in Indonesia: The Existing Problems and the Policy Recommendations

Program Keluarga Harapan (PKH) is a conditional cash transfer program in Indonesia that requires beneficiaries to meet certain requirements such as school attendance and health checks. Adopted from similar models in Latin America, PKH aims to reduce short-term poverty and invest in the health and education of future generations. Since its launch in 2007, PKH has operated in various regions with different poverty and infrastructure issues. PKH faces several challenges, including mistargeting of beneficiaries and burdensome bureaucracy for the poor. To address this, improvements to the targeting system and simplification of document procedures are recommended. The program has also contributed to reducing stunting through improved nutrition and health education, although health facilities need to be improved. In the education sector, PKH has succeeded in increasing school enrollment and attendance, but has not significantly reduced child labor. In terms of livelihoods, PKH encourages beneficiaries to shift to non-agricultural jobs, although often only casual labor. This study uses descriptive and explanatory designs to describe and explain the evolution of the PKH policy from 2007. Descriptive design is used to describe policy changes that occurred during the period, while explanatory design is used to explain the factors that influence policy changes and their impact on program effectiveness. The results found that there were problems with PKH facilitators including insufficient numbers, high workloads, and low salaries, which affected their effectiveness. To improve the performance of facilitators, new recruitment, regular training, and increased salaries and working conditions are recommended.

Rapid health technology assessment to inform policy: a case study with respiratory syncytial virus

Abstract Background Respiratory syncytial virus (RSV) can cause severe acute respiratory tract infection in infants and older adults. However, until recently, no immunisation interventions were available to reduce the burden of RSV disease in the general population. New health technologies have now been authorised in Europe for infants (a long-acting monoclonal antibody (nirsevimab) and a maternal vaccine (RSVpreF)), and two vaccines for adults aged ≥60 years (RSVPreF3 and RSVpreF). A rapid health technology assessment (HTA) was requested by the Irish Department of Health to support an interim decision on RSV immunisation. Methods The rapid HTA commenced in January 2024, and comprised description of technology, a summary of international practice, national and international epidemiology and burden of disease, and a costing analysis. The summary of international practice (including underpinning evidence) was undertaken rather than a systematic review of effectiveness and safety due to the rapidly changing evidence base and short timeline within which information was required. Results While new recommendations regarding immunisation against RSV are emerging internationally in response to recently authorised technologies, implementation and funding strategies are not currently widespread. Compared with a full HTA, a rapid HTA enabled an efficient and flexible approach to producing a high quality evidence synthesis to inform a temporary policy decision, taking approximately 6 months to complete rather than 12 months or longer. A full HTA is planned to inform long-term decision-making on this topic, but would not have been feasible to inform an interim decision. Conclusions This rapid HTA will inform a temporary decision on immunisation policy for a single RSV season in Ireland. Conducting a rapid HTA prior to a full HTA has enabled timely decision-making, with implications for Ireland’s national healthcare system and people at risk of severe RSV-related disease. Key messages • Innovations in immunisation against RSV are leading to changes in policy across Europe. • Rapid HTA can support timely, evidence-based public health decision-making in a fast-evolving field.

The importance of healthcare monitoring systems

Abstract Issue Healthcare evaluation is an important tool of governance in the health sector that reinforces its key components: evidence-based care, effectiveness, programme standards, performance monitoring, quality improvement, risk and incident management and patient-centered care. One of the evaluation systems used by the Veneto Region (north italian region of about 4.8 million inhabitants) consists of the National Outcomes Programme (PNE) developed by the Italian National Agency for Regional Healthcare Services (AGENAS) on behalf of the Health Ministry. Description The PNE is an instrument used to measure, analyze, evaluate and monitor clinical and welfare assistance performances of Italian healthcare facilities. The Veneto Region, in particular, utilizes a regional epidemiologic service to periodically monitor 21 performance indicators based on “treemap” methodology. These indicators are used to assess processes, outcomes and volumes. The data used to monitor these practices derive from the hospital discharge documentation (SDO) and tax registry information system. The aim of this monitoring system is to track any critical situation that is not in alignment with national guidelines and to improve the efficacy, efficiency, appropriateness and safety within the healthcare system. Results In the Veneto region, over the course of nearly 10 years, this method of management has led to the development of various training courses that guide clinicians to correctly document and code different diagnosis and treatments. The treemap process of analysis has also made possible various clinical audits that have provided significant policy changes regarding risk and overall health management. Lessons Having a constant view of healthcare performance has proven to be helpful not only to identify some common gaps in care given from different facilities on a national level, but also guides different regions to develop specific strategies that lead to quality improvement. Key messages • Data on healthcare quality can be used as comparative information and for quality improvement. • Continuous monitoring of specific performance indicators can help identify difficulties in healthcare facilities and create strategies for long term solutions.

Alcohol policy and alcohol-attributed disease burden in Finland and the Baltic countries 1995-2019

Abstract Introduction Alcohol remains a significant contributor to mortality and morbidity in Finland and the Baltic countries, particularly among men. This study aimed to assess alcohol policy restrictiveness in this region from 1995 to 2019 using a modified version of the Bridging the Gap (BtG-M) policy scale and examine its association with alcohol-related disease burden. Methods The study utilised national statutory laws to score policy restrictiveness (higher BtG-M scores mean stricter policies) and age-standardised rates of disability-adjusted life years (DALYs), years of life lost (YLLs), years lived with disability (YLDs) and deaths per 100,000 from the 2019 Global Burden of Disease Study (GBD). Spearman correlation tests and panel data regression models were applied to assess the association between policy scores and burden of disease. Results Finland maintained a high BtG-M score, while the Baltic countries experienced recent increases from initially lower scores. Alcohol-related disease burden showed an inverse association with policy changes in these countries. Strongest association was seen between the BtG-M score and DALY rates attributed to injuries. Premature mortality among men constituted the largest proportion of disease burden. Discussion and Conclusions Despite challenges in accessing and comparing policy data over time, we showed a strong association between alcohol policy and alcohol-related harm in Finland and the Baltic countries. This study is one of the first to use the BtG-M scale to monitor changes in alcohol policies over time and their relationship to alcohol-related harm using GBD methodology. The study highlights the effects of national alcohol policies on levels of alcohol-related harm. Key messages • This study stands out due to its longitudinal study design, which quantitatively compares the level of alcohol policy restrictiveness in Finland and the Baltic countries from 1995 to 2019. • Our study suggests that shifts towards more restrictive alcohol policies are linked to reduction in alcohol-related harm in Finland and the Baltic countries.

Analysis Of The Impact Of Tax Reform On Income Tax (PPH) 21 Revenue In Indonesia

This research aims to analyze the impact of tax reform on Income Tax (PPH) 21 revenues in Indonesia. Tax reform was carried out by the government to increase efficiency and fairness in the tax system. The main focus of this research is identifying tax policy changes that have been implemented and analyzing how these changes affect PPH Article 21 revenue. This research uses a qualitative approach with descriptive methods, while the type of research uses literature study research to analyze tax policy, as well as the impact of tax reform on revenue. PPH Article 21. It is hoped that the results of this research will provide a better understanding of the effectiveness of tax reform in increasing income tax revenues from high-income employees.

Mindful Transportation: A Conceptual Framework for Enhancing Accessibility for People with Disabilities in Malaysia

This conceptual paper explores the integration of mindfulness principles into the development of transportation services for people with disabilities (PWDs) in Malaysia. Transportation plays a critical role in promoting inclusivity and enhancing the quality of life for PWDs, yet accessibility remains a significant challenge due to infrastructural barriers, lack of awareness, and limited empathy from service providers. Drawing on the concepts of mindfulness, which are rooted in awareness, empathy, and responsiveness, this paper proposes a framework that emphasizes inclusivity, respect, and collaboration among key stakeholders. The proposed framework emphasizes the need for a holistic approach that incorporates physical accessibility, staff training, and policy reforms. Inclusivity involves modifying infrastructure to meet universal design standards, while empathy requires transport providers to understand the unique challenges faced by PWDs and offer compassionate, tailored services. Responsiveness, a key element of mindfulness, calls for flexible and adaptive transport services that cater to the real-time needs of PWDs, ensuring that they can access public transportation with ease and dignity. By applying this mindful approach, the transportation system can become more accommodating and respectful toward PWDs, thereby reducing social exclusion and improving their mobility. This paper contributes to the growing body of literature on disability inclusion and provides actionable strategies for policymakers, transport providers, and disability organizations to work together in creating a more accessible public transportation system. Future research should investigate the practical application of this framework and its potential to drive policy changes that benefit PWDs across Malaysia.

Personalised care for hyperlipidaemia by tailoring shared decision-making toward patient priorities &amp; needs: results from a patient-led study

Abstract Background The European cardiovascular disease community is actively promoting a shift towards delivering more personalized cardiovascular care. This shift requires a reassessment of current clinical approaches, including approaches to shared decision-making. To be effective, shared decision-making should be grounded in factors impacting treatment adherence and oriented toward patient-relevant outcomes. (1)(2) Purpose To learn from people with hyperlipidemia about their experiences, priorities and needs inside and outside the health system, including pathways and barriers to diagnosis, treatment and adherence. These insights can guide healthcare providers (HCPs) in delivering personalised, patient-centred care. Methods A global Steering Committee of patient advocates, cardiology researchers and HCPs guided study design and interpretation. Forty-six individuals with confirmed high cholesterol (51% female) in Brazil, Australia and the US participated in 60-minute interviews. Half of participants were required to have a prior hospitalization for an ASCVD event. Transcripts were analyzed using a team-based approach. Results Participants are described in Picture 1. Across countries, participants described how HCPs can work with patients to personalize care through realistic, individualized care plans. First, HCPs can make patients more comfortable by using plain language (e.g., heart problems not cardiovascular events) and clearly explain the life-threatening dangers of unmanaged LDL-C, a prerequisite for patients to take high cholesterol management seriously. Once the risks are clear, HCPs and patients can co-develop care plans based on attainable, measurable goals. Topics that should be discussed include individual circumstances that may impact care plan adherence, such as competing priorities (e.g., work travel or family obligations), support system, and finances. Other topics include the range of treatments and lifestyle changes, including how these work in tandem. When discussing treatment options, HCPs can address treatment attributes desirable to patients, including convenience, treatment benefits, safety profiles and costs. Convenience attributes reflect participant desires for therapies that come in a form they are comfortable administering (e.g., tablet, injection) combined with a desire to minimize administration frequency. Meaningful treatment benefits include improving laboratory values, avoiding heart-related events and living longer to spend more time with family. Conclusions: This study identified topics patients would like their HCP to include in shared decision-making. It can inform HCP efforts to deliver personalised cardiovascular care. Structural barriers to effective shared decision-making exist in many health systems, including the time HCPs have allotted to appointments, administrative burden and access. Patient advocacy organisations and HCP organisations can partner to drive policy changes to overcome these barriers.Study ParticipantsIllustrative Quotes

Disability-adjusted life years 19 former socialist economies in the European region, 1990-2019

Abstract Background Within the Western Balkan Strategic Partnership Project (Work Package 4: Use of Population Health Metrics for Enhanced Surveillance), we conducted a study to describe health progress in 19 former socialist economies (FSEs) in Europe from 1990 to 2019. Our metric of choice was age and sex-standardized rates per 100,000 population of total disability-adjusted life years (ASR-DALY). Methods We applied joinpoint regression with extracted ASR-DALY data from the Institute for Health Metrics and Evaluation result tool. The annual per cent change (APC) and average annual per cent change (AAPC) from 1990 to 2019 were analyzed in 19 former socialist economies (FSEs) in Europe, including Albania, Belarus, Bosnia and Herzegovina (BH), Bulgaria, Croatia, Czechia, Estonia, Latvia, Lithuania, Montenegro, North Macedonia, Poland, Moldova, Romania, Russia, Serbia, Slovakia, Slovenia, and Ukraine. Results The ASR-DALY decreased in Estonia (APC1994-1997= -5.2%, p = 0.034; APC2013-2019= -0.7%, p = 0.07), Latvia (APC1994-1997= -6.3%, p = 0.03; APC1997-2007= -1%, p = 0.001; APC2007-2011= -3.9%, p = 0.01), BH (APC1995-1998= -13.3%, p = 0.041; APC1998-2019= -0.5%, p = 0.004), Bulgaria (APC1997-2000= -2.5%, p = 0.022), Lithuania (APC2007-2010= -4.9%, p = 0.018), North Macedonia (APC2007-2011= -1.9%, p = 0.023, APC2011-2019= -0.5%, p = 0.005), Czechia (APC2014-2019= -0.6%, p = 0.014), Moldavia (APC1998-2007= -0.6%, p = 0.06), and Ukraine (APC1995-2008= -0.5%, p = 0.035). Slovenia performed the best amongst the FSEs (ASR-DALY2019: 16677.51 for women, 21985.95 for men and 19134.73 for both sexes), Ukraine the worst (ASR-DALY2019: 26154.88 for women, 47983.60 for men and 35852.17 for both sexes). Conclusions Except for Ukraine, all FSEs in the European region achieved health improvement. The most common was a three-year decline in ASR-DALY. Health policy changes, investments in health care, and harmonization with EU regulations were among the factors contributing to improved population health in the FSEs. Key messages • Bosnia and Herzegovina is the only FSE in Europe with a continuous 24-year decline in total ASR-DALY. • Reducing total ASR-DALY significantly in a three-year time frame is possible.

Made in South Asia: Centering Labor in Textile and Garment Manufacturing Work, 1970s to 2020s

Abstract Labor in the textile and garment industry is at the heart of a series of recent books on South Asia. Together these books document the different scales at which textile and garment work has been structured and restructured over the last century, and its implications for workers, their health as well as collective solidarity. Across the countries of Bangladesh, India, Nepal, and Sri Lanka, the industry developed and declined in vastly different temporalities and rhythms. Yet, as these works reveal, workers have often been confronted with similar challenges brought on by the boom-and-bust cycles of industrial development. In each case, textile and garment workers have been forced to navigate transitions to premature deindustrialization, closure, or national/transnational industrial policy changes. The books center workers and their long “post”-industrial or industrial “afterlives,” as they cope with the dramatic changes in the global manufacturing of textile and garment.