Public Health Investment Research Articles

2022 Inflation Reduction Act: Climate Investments Are Public Health Investments.

2022 Inflation Reduction Act: Climate Investments Are Public Health Investments.

Reflections on the post-Covid city

Abstract What will COVID-19 and the shift to remote work do to the cities of the world? The temporary disruptions have been enormous and remain enormous as of the late summer of 2022. Offices remain vacant in many large cities. Within the US, the pandemic sped up the longer-term movement of people and firms to the sunbelt. Looking forward, there seem to be two possible scenarios, depending on the pandemic events of the future. If COVID-19 is only the first of a wave of deadly global disease events, then the urban renaissance that began thirty years ago could end. If COVID-19 is a one-off pandemic, then the impact of disease and telecommuting on urban life will be more limited. The enduring demand of people to enjoy urban amenities, and the value of learning face-to-face should enable cities to survive this shock. The stark gap between these two scenarios highlights the importance of global investments in public health that can reduce the risk of future pandemics.

The role of exercise in the treatment of depression: biological underpinnings and clinical outcomes.

Globally, depression is a leading cause of disability and has remained so for decades. Antidepressant medications have suboptimal outcomes and are too frequently associated with side effects, highlighting the need for alternative treatment options. Although primarily known for its robust physical health benefits, exercise is increasingly recognized for its mental health and antidepressant benefits. Empirical evidence indicates that exercise is effective in treating individuals with depression; however, the mechanisms by which exercise exerts anti-depressant effects are not fully understood. Acute bouts of exercise have been shown to transiently modulate circulating levels of serotonin and norepinephrine, brain-derived neurotrophic factor, and a variety of immuno-inflammatory mechanisms in clinical cohorts with depression. However, exercise training has not been demonstrated to consistently modulate such mechanisms, and evidence linking these putative mechanisms and reductions in depression is lacking. The complexity of the biological underpinnings of depression coupled with the intricate molecular cascade induced by exercise are significant obstacles in the attempt to disentangle exercise's effects on depression. Notwithstanding our limited understanding of these effects, clinical evidence uniformly argues for the use of exercise to treat depression. Regrettably, exercise remains underutilized despite being an accessible, low-cost alternative/adjunctive intervention that can simultaneously reduce depression and improve overall health. To address the gaps in our understanding of the clinical and molecular effects of exercise on depression, we propose a model that leverages systems biology and multidisciplinary team science with a large-scale public health investment. Until the science matches the scale of complexity and burden posed by depression, our ability to advance knowledge and treatment will continue to be plagued by fragmented, irreproducible mechanistic findings and no guidelines for standards of care.

Recasting solidarity during the COVID-19 pandemic: a case study

ABSTRACT The practices of social movements during the pandemic show how severe limitations on political and social organization have been turned into opportunities by increasing the focus on social justice and care-based initiatives, building trust and solidarity. This case study explores how the urban militants of the anti-military occupation movement A Foras (Out) maintained visibility during the pandemic. Besides calling attention to the unethical growth of military spending concurrent with the lack of investment in public health during the COVID-19 crisis, the movement engaged in mutualistic action against pandemic-related issues, such as isolation, and social exclusion. We examine ethnographically this hybridized mobilization, which is grounded on the significance of solidarity, community, and the nature of public life. By making social inequality, exclusion and isolation more visible, mutualistic practices act in the social justice arena as a ‘purposive orientation’. This case study offers an example of a grassroots social movement renewing its space of knowledge production by widening its agency and reconfiguring care as an action for political change, adding to the notion of caring democracy by giving rise to a mutualist initiative based on horizontality and potential reciprocity. The article provides an up-to-date understanding of how imaginaries and care practices activated around solidarity, security, and safety are recasting society in southern Europe in the wake of COVID-19. It contributes to the debate around caring democracy in social movements studies by rethinking the significance of caring infrastructures and, ultimately, the meaning of solidarity and trust.

Comparison of Public Health Investments of Various Countries Amid a Need for Greater Transparency: A Narrative Review.

A robust health system demands investments in public health and healthcare as they aid in closing the health protection gap. They are primarily responsible for longer life expectancies, disease prevention, and protection. Loopholes in the public health system were formed due to a lack of transparency and have only worsened throughout COVID-19. Spending more on public health is associated with fewer deaths, fewer food-borne illnesses, better sanitation, food safety, clean air and water, increased immunizations to stave against infectious diseases, and a decline in low birth weight. A comprehensive literature and data search was conducted using web-based search engines like PubMed, National Center for Biotechnology Information (NCBI), Google Scholar, Science Direct, and the New England Journal of Medicine. The review study standpoints healthcare spending, out-of-pocket expenditures, and other monetary use in various low-to-high-income countries, and the results are graphically represented. Countries with a strong public health system provide all the necessary aid to protect their citizens. They have cost-effective, readily available resources with fewer out-of-pocket expenditures (OOPs), government schemes, and health insurance to help their people. During our research, it was found how little the Indian government spends on healthcare as a percentage of gross domestic product (GDP) as compared to 'thought-to-be' poor countries like Bhutan.

New perspectives on the contribution of sanitary investments to mortality decline in English cities, 1845-1909.

Health improved in English cities in the last third of the nineteenth century, in tandem with substantial increases in public spending on water supplies and sanitation. However, previous efforts to measure the contribution of public expenditures to mortality improvements have been hampered by difficulties in quantifying public health investments and the lack of mortality data for specifically urban populations. We improve upon the existing evidence base by (1) creating measures of the stock of urban district sanitary capital, by type, on the basis of capital expenditure flows, rather than loan stocks; (2) using mortality and capital stock data that relate to the same administrative units (urban districts), and (3) studying the period 1880-1909 as well as the earlier period from 1845. The stock of sewerage capital was robustly related to improvements in all-cause mortality after 1880. The size of this effect varied with the extent of public investment in water supplies, suggesting complementarity between the two assets. For the period 1845-84, investments in water were associated with declines in infant and child mortality but the effect was much smaller and less precisely estimated in later decades. Our results suggest that improvements in water and sewerage targeted different transmission pathways for faecal-oral diseases.

Vaccines Are Profoundly Effective, and We Can't Stop There.

In 1999, the Centers for Disease Control and Prevention (CDC) hailed vaccines as one of the ten great public health achievements of the 20th century. Over the last few decades, scientific advances have resulted in the availability of vaccines for once-fatal illnesses, and public health investments in vaccine provision have resulted in high coverage for most routine childhood vaccines.1.

The Correlates of Government Expenditure on Mental Health Services: An Analysis of Data From 78 Countries and Regions.

BackgroundGovernmental investment in mental health is of vital importance for the implementation and maintenance of educational, preventive, and therapeutic services related to mental illness, particularly in low- and middle-income countries (LMICs). However, mental health expenditures represent only a small portion of total health spending in many countries. Little is known about the economic, social, or health-related factors that may influence variations in governmental spending in this sector.MethodsData on government expenditure on mental health as a percentage of total healthcare expenditure, collected by the WHO from 78 countries and regions in the period 2013-2014, was available for study. These data were analyzed in relation to key economic, social, and health-related indicators. The selection of these indicators was based on prior national and regional research and expert opinion as reported in the existing literature.ResultsGovernment spending on mental health was below 1% of health expenditure in 24.4% of the countries studied. A number of economic, social, and health-related indicators were significantly associated with variations in spending on mental health. Based on the partial correlation, sub-group, and multivariate linear regression analyses, the variables most significantly associated with low government spending on mental health were the burden of communicable diseases (β = −.47, p = .001) and cultural collectivism (β = −.37, p = .008).ConclusionsThese results suggest that low government investment in mental health may be associated not only with economic or political factors but also with variations in disease burden and in cultural attitudes across countries. Though no direct assumption regarding causation can be made, such findings may be of value when advocating for greater public investment in mental health, particularly in non-Western cultures with a high competing burden of infectious diseases.

Colonial Origins of Comparative Development in Ghana

A striking feature of Ghana’s development landscape is the stark development disparity between a relatively developed South and a trailing North. Explanations for the disparity have often been hinged on differences in geography and past colonial experience. In this study, I provide an empirical justification for the historical hypothesis that the dynamics of colonial rule contributed significantly to the development divergence between the North and the South. I exploit the asymmetric regional distribution of past colonial public investments in education, health and infrastructure to show that the dynamics of colonial rule explain a significant portion of the development disparity between the two regions. I also survey compelling historical anecdotes to show that prior to the colonial project the North was a relatively prosperous region.

The politics of public health investments

Public health investments help to prevent mortality and reduce health care costs. Yet very few studies have examined the determinants of preventive care investments across countries and over time. We develop a theory of health spending priorities contrasting preventive and curative care. Preventive care is particularly unlikely to be prioritized by governments since it is a public good that requires the allocation of scarce resources in the present to generate diffuse benefits that unfold only in the long-term. As such, public health is a “quiet” policy that is not supported by interest groups or public opinion. These characteristics have two implications: like other long-term investments, public health programs are particularly vulnerable to fiscal austerity, and prevention expenditures are not influenced by government partisanship since parties cannot attract votes with such low visibility, long term investments. We use a dataset covering 25 OECD countries from 1970 to 2018 to demonstrate that fiscal consolidations are negatively associated with the absolute level of preventive care and with its proportion relative to curative care. We also confirm that left-wing governments are not more likely to invest in public health than right-wing governments. Finally, contributing to the literature on comparative health care systems, we show that National Health Services systems maintain higher preventive care investments than Social Health Insurance systems.

Anaphylaxis in Brazil between 2011 and 2019.

BackgroundThere is a lack of population‐based studies of anaphylaxis from low‐ and middle‐income countries. This hampers public health planning and investments and may influence availability of adrenaline auto‐injectors.ObjectiveWe conducted the first national population‐based study of anaphylaxis hospitalization in Brazil.MethodsDescriptive study using routinely reported data to the Brazilian Hospital Information System for the years 2011–2019. Information available is coded based on the International Classification of Diseases (ICD)‐10 and covers main cause of hospitalization (primary cause) and any conditions contributing to it (secondary cause).ResultsOver 9 years, we identified 5716 admissions due to anaphylaxis for all causes. The average hospitalization rate related to anaphylaxis was 0.71/100,000 population per year, with a 2.4% (95% CI 1.9%, 2.9%) increase per annum over the study period. Admissions were more frequent among females (52.8%), except for cases due to insect sting. Most admissions occurred in adulthood, from 30 to 59 years (36.3%) but 13.8% in preschool children (0–4 years). There were more young children admitted for food‐related anaphylaxis, and more adults admitted for drug/iatrogenic‐related anaphylaxis. There were 334 cases (5.8% of admissions) of fatal anaphylaxis over the study period, with increased case fatality rate over time.Conclusions and Clinical RelevanceThis is the first study of anaphylaxis hospital admissions using nation‐wide data from a low‐ or middle‐income country. Hospital admissions and fatalities from anaphylaxis in Brazil appear to be increasing.

Public Health and Payers—Bridging the Gap to Boost Public Health Investment

Public Health and Payers—Bridging the Gap to Boost Public Health Investment

Health Economics Research in Cancer Screening: Research Opportunities, Challenges, and Future Directions.

Cancer screening has long been considered a worthy public health investment. Health economics offers the theoretical foundation and research methodology to understand the demand- and supply-side factors associated with screening and evaluate screening-related policies and interventions. This article provides an overview of health economic theories and methods related to cancer screening and discusses opportunities for future research. We review 2 academic disciplines most relevant to health economics research in cancer screening: applied microeconomics and decision science. We consider 3 emerging topics: cancer screening policies in national as well as local contexts, "choosing wisely" screening practices, and targeted screening efforts for vulnerable subpopulations. We also discuss the strengths and weaknesses of available data sources and opportunities for methodological research and training. Recommendations to strengthen research infrastructure include developing novel data linkage strategies, increasing access to electronic health records, establishing curriculum and training programs, promoting multidisciplinary collaborations, and enhancing research funding opportunities.

Can Public Health Investment and Oversight save Digital Mental Health?

Can Public Health Investment and Oversight save Digital Mental Health?

Tailoring immunisation programmes in a time of SARS-CoV-2: What can be learnt by comparing the findings of childhood and COVID-19 vaccine evaluation studies in an underserved population?

ObjectivesA WHO Tailoring Immunization Programmes (TIP) evaluation was conducted in 2014-16 to investigate suboptimal childhood vaccination coverage in the north London Orthodox Jewish community. In 2021-22 a qualitative evaluation of the COVID-19 vaccine programme (CVP) was conducted in the same setting. This paper examines whether the issues identified by the TIP affected the CVP and what differences emerged between these two vaccine programme evaluations. Study designQualitative study. MethodsThe CVP evaluation involved conducting 28 semi-structured interviews with public health professionals, Orthodox Jewish welfare and religious representatives, and household members in February-May 2021. The key considerations arising from the thematic analysis of this data was then compared systematically with the overarching findings from the TIP study. ResultsThe issues identified in the TIP study diverged and converged with results from the CVP evaluation: i) participants did not express concerns of unmet CVP information needs; ii) the social value of COVID-19 vaccines was influenced by international travel requirements; iii) in contrast to commissioning constraints noted to have limited flexible delivery of childhood immunisations in the TIP evaluation, the CVP was characterised by a flexible commissioning and delivery model. This model was facilitated by significant government investment as part of the COVID-19 pandemic response. ConclusionsThe comparative analysis indicates that flexible vaccine commissioning and fit for purpose public health investment can influence how documented knowledge is translated into action. Implications are raised for how routine vaccination services are equipped to serve the needs of minority populations with historically suboptimal coverage levels.

The association between educational attainment and longevity using individual-level data from the 1940 census

We combine individual data from the 1940 full-count census with death records and other information available on the Family Tree at familysearch.org to create the largest individual dataset to date (17 million) to study the association between years of schooling and age at death. Conditional on surviving to age 35, one additional year of education is associated with roughly 0.4 more years of life for both men and women for cohorts born 1906-1915 and smaller for earlier cohorts. Focusing on the 1906-1915 cohort we find that this association is identical when we use sibling or twin fixed effects. This association varies substantially by place of birth. For men, the association is stronger in places with greater incomes, higher quality of school, and larger investments in public health. Women also exhibit great heterogeneity in the association, but our measures of the childhood environment do not explain it.

Public Health Response to Multistate Salmonella Typhimurium Outbreak Associated with Prepackaged Chicken Salad, United States, 2018.

Quantifying the effect of public health actions on population health is essential when justifying sustained public health investment. Using modeling, we conservatively estimated that rapid response to a multistate foodborne outbreak of Salmonella Typhimurium in the United States in 2018 potentially averted 94 reported cases and $633,181 in medical costs and productivity losses.

Economic Growth Effect of Public Health Investment and Its Impact on Living Environment.

Based on the concern of Chinese residents for health and the improvement of related service demand, this paper studies the economic growth effect of public health investment and its impact on living environment by analyzing the determination coefficient estimated by Spearman and nonlinear curve. The results show that the impact of increasing government financial public health investment on regional economic growth rate is not only related to regional economic aggregate and development level, but also related to regional education level and regional publicity level in logical analysis. The improvement of residents' living environment brought by public infrastructure investment can effectively stimulate residents' concept of health consumption and then make the economy of nonpublic health undertakings achieve a higher growth rate. The economic growth rate brought by nonpublic health undertakings is also an important component of the local economic growth rate. It can be seen that strengthening the infrastructure construction of urban living environment can not only improve the overall living environment quality of the city, but also promote the development of the city and the development speed of the city.

Public health and social measures to mitigate the health and economic impact of the COVID-19 pandemic in Turkey, Egypt, Ukraine, Kazakhstan, and Poland during 2020–2021: situational analysis

BackgroundThe COVID-19 pandemic had a colossal impact on human society globally. There were similarities and differences in the public health and social measures taken by countries, and comparative analysis facilitates cross-country learning of contextual practices and sharing lessons to mitigate the COVID-19 pandemic impact. Our aim is to conduct a situational analysis of the public health and social measures to mitigate the health and economic impact of the COVID-19 pandemic in Turkey, Egypt, Ukraine, Kazakhstan, and Poland during 2020–2021.MethodsWe conducted a situational analysis of the COVID-19 pandemic response in Turkey, Egypt, Ukraine, Kazakhstan, and Poland from the perspectives of the health system and health finance, national coordination, surveillance, testing capacity, health infrastructure, healthcare workforce, medical supply, physical distancing and non-pharmaceutical interventions, health communication, impact on non-COVID-19 health services, impact on the economy, education, gender and civil liberties, and COVID-19 vaccination.ResultsSince the onset of the COVID-19 pandemic, Turkey, Egypt, Ukraine, Kazakhstan, and Poland have expanded COVID-19 testing and treatment capacity over time. However, they faced a shortage of healthcare workforce and medical supplies. They took population-based quarantine measures rather than individual-based isolation measures, which significantly burdened their economies and disrupted education. The unemployment rate increased, and economic growth stagnated. Economic stimulus policy was accompanied by high inflation. Despite the effort to sustain essential health services, healthcare access declined. Schools were closed for 5–11 months. Gender inequality was aggravated in Turkey and Ukraine, and an issue was raised for balancing public health measures and civil liberties in Egypt and Poland. Digital technologies played an important role in maintaining routine healthcare, education, and public health communication.ConclusionsThe COVID-19 pandemic has exposed weaknesses in healthcare systems in the emerging economies of Turkey, Egypt, Ukraine, Kazakhstan, and Poland, and highlighted the intricate link between health and economy. Individual-level testing, isolation, and contact tracing are effective public health interventions in mitigating the health and economic impact of the COVID-19 pandemic in comparison to population-level measures of lockdowns. Smart investments in public health, including digital health and linking health security with sustainable development, are key for economic gain, social stability, and more equitable and sustainable development.

Transforming or tinkering: the world remains unprepared for the next pandemic threat

Transforming or tinkering: the world remains unprepared for the next pandemic threat