From the Editor-In-Chief Health AffairsVol. 36, No. 11: Global Health Policy Global Health PolicyAlan R. WeilPUBLISHED:November 2017Free Accesshttps://doi.org/10.1377/hlthaff.2017.1347AboutSectionsView PDFPermissions ShareShare onFacebookTwitterLinked InRedditEmail ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsDownload Exhibits TOPICSDiseasesSystems of careDiabetesGlobal healthPrimary careChildren's healthCost reductionNo matter what may divide countries, when it comes to health we have much in common. The burden of disease is shifting, efficiency and quality improvement are shared goals, and workforce challenges abound. This month’s Health Affairs covers a broad range of global health policy topics. As health systems make progress tackling communicable diseases and life expectancy has increased, countries face a rising burden of noncommunicable diseases such as diabetes, cancer, and cardiovascular disease. Thomas Bollyky and colleagues map the growth of these diseases against each country’s health system functioning. They conclude that “countries that are projected to have the greatest increase in their noncommunicable disease burden as a share of health burden are also ranked lowest (least prepared) in our health system capacity index for noncommunicable diseases,” with African nations particularly at risk. As development assistance has increased dramatically over the past two decades, the risk that those funds will be poorly aligned with recipient countries’ goals has also increased. Melisa Martinez-Alvarez and colleagues examine trends in two dimensions of aid effectiveness—alignment with local strategies and harmonization across donor efforts—for reproductive, maternal, newborn, and child health funding. The authors found little improvement between 2008 and 2013, and some worsening in the area of alignment. One factor in the lack of progress was the donor organizations’ perceived need for control and accountability. Improving health requires knowing which illnesses cause people to die. India, like most low- and middle-income countries, had good information on cause of death for only the small minority of people who die in the hospital. Mireille Gomes and colleagues report findings from India’s Million Death Study, which relied upon verbal autopsies to gather information regarding the likely cause of death for people who died at home. Among the many interesting findings are that deaths related to smoking and malaria have been significantly underreported, estimates of HIV-related deaths have been far too high, and there has been a substantial incidence of sex-selection abortions. Poorly managed diabetes can lead to inpatient hospital stays—which could have been avoided with receipt of appropriate primary care. Jianchao Quan and colleagues analyze avoidable admissions from diabetes complications in Japan, Singapore, Hong Kong, and communities outside Beijing. Overall spending and preventable admission rates increased during 2008–13, but significant improvement was observed in Japan and Beijing. The authors’ results “provide empirical evidence to support the hypothesis that a higher number of…outpatient visits in a given year is correlated with a lower likelihood of a diabetes-related avoidable hospital admission in the following year.” Innovation This issue includes papers on the effects of a broad array of innovations. Adriane Wynn and colleagues show the value of community health workers in South Africa. Duncan Maru and colleagues document how a public-private partnership improved maternal, newborn, and child health services in rural Nepal. Aaron Baum and colleagues explain how microfinance institutions can be a mechanism for delivering care in rural Haiti. And Jessica Cohen and colleagues report the results of a randomized controlled trial that nudged pregnant women in Nairobi, Kenya, to deliver in higher-quality facilities. Sharing Lessons Mark McClellan and colleagues apply a framework for accountable care reform to case studies of accountable care models from around the globe. They note the “development of organizational competencies to implement the innovations, alongside payment and other policy reforms that enable the innovations to succeed and be sustained.” Achieving the promise of universal health coverage requires having the workforce to meet the health needs of the population. Arthika Sripathy and colleagues point out that “a system that focuses solely on producing greater numbers of trained health care workers is not enough.” Based upon case studies from Thailand, Brazil, and India, they explain that addressing workforce shortages depends upon providing appropriate incentives through the entire professional education pipeline. In the search for ways to save money, high-income countries have become more interested in innovations developed in resource-constrained settings, sometimes called frugal innovation. Yasser Bhatti and colleagues create case studies of innovations and analyze them for the lessons they yield. Common features of frugal innovations are use of lower-cost settings and providers, improved communication with patients, and the use of simple processes and organizational structures. Acknowledgment Health Affairs thanks the Qatar Foundation and its World Innovation Summit for Health, Imperial College London, Sidra Medical and Research Center, and Hamad Medical Corporation for their support of this issue. Loading Comments... Please enable JavaScript to view the comments powered by Disqus. DetailsExhibitsReferencesRelated Article Metrics History Published online 6 November 2017 Information© 2017 Project HOPE—The People-to-People Health Foundation, Inc.PDF download