Rural workers' health and productivity: an economic assessment of pesticide use in Minas Gerais, Brazil

This paper evaluates the economic impact of pesticide intoxication on the health of rural workers in the State of Minas Gerais, Brazil. To estimate the economic impact we considered the purchase cost of pesticides and the treatment costs of rural workers' affected by intoxication. These impacts were compared to the benefits of pesticide use, as estimated by the crop losses avoided through pesticide application. Data were obtained from the Fundacentro/Ministry of Work agency for the years 1991-2000, in nine municipalities of Minas Gerais, Brazil; and included epidemiological surveillance records and blood screening results. Rural workers' probabilities of intoxication were estimated as a function of their expositure characteristics by means of a logistic regression model. The changes in marginal probabilities associated with changes in expositure characteristics were also estimated. When health intoxication costs are included in the farmer's decision process, the financial benefit of pesticide use with certain crops is reduced. For zucchini, beans and corn, respectively, treatment costs represent about 42%, 25% and 25% of the pesticide use benefit. This study points to the need for an extensive investigation into the real benefits of pesticide use and its consequences for the environment and health in Brazil.     

Health departments' implementation of public health's core functions: an assessment of health impacts

OBJECTIVES: The purpose of this article was to investigate the relationship between state health agencies' adherence to the recommendations of the United State's Institute of Medicine's (IOM) report, "The Future of Public Health", and changes in their populations' health. STUDY DESIGN: Data were abstracted from agencies' plans, budgets, annual reports, etc. spanning a 5-year period. A comprehensive change in population health measure over the same period was drawn from the UnitedHealth Group's annual survey. METHODS: Configurations, based on public health core functions, were established using linear regression and qualitative comparative analysis. The dependent variable was a holistic measure of change in a state population's health status. RESULTS: State agencies that most completely adopted a public health model emphasizing assessment, assurance and policy development also experienced significant improvements in their population health measures. CONCLUSIONS: State agencies that more completely adopted the IOM's public health core functions had a concomitant improvement in their populations' health statuses. Further research to explore if there is a causal link between adoption of the core functions and positive health impacts is warranted.     

Catastrophic and poverty impacts of health payments: results from national household surveys in Thailand

OBJECTIVE: To estimate the incidence and describe the profile of catastrophic expenditures and impoverishment due to household out-of-pocket payments, comparing the periods before and after the introduction of universal health care coverage (UC). METHODS: Secondary data analyses of socioeconomic surveys on nationally representative households pre-UC in 2000 (n = 24,747) and post-UC in 2002 (n = 34,785) and 2004 (n = 34,843). FINDINGS: Households using inpatient care experienced catastrophic expenditures most often (31.0% in 2000, compared with 15.1% and 14.6% in 2002 and 2004, respectively). During the two post-UC periods, the incidence of catastrophic expenditures for inpatient services at private hospitals was 32.1% for 2002 and 27.8% for 2004. For those using inpatient care at district hospitals, the corresponding catastrophic expenditures figures were 6.5% and 7.3% in 2002 and 2004, respectively. The catastrophic expenditures incidence for outpatient services from private hospitals moved from 27.9% to 28.5% between 2002 and 2004. In 2000, before universal coverage was introduced, the percentages of Thai households who used private hospitals and faced catastrophic expenditures were 35.8% for inpatient care and 36.0% for outpatient care. Impoverishment increased for poor households because of payments for inpatient services by 84.0% in 2002, by 71.5% in 2004 and by 95.6% in 2000. The relative increase in out-of-pocket impoverishment was found in 98.8% to 100% of those who were poor following payments made to private hospitals, regardless of type of care. CONCLUSION: Households using inpatient services, especially at private hospitals, were more likely to face catastrophic expenditures and impoverishment from out-of-pocket payments. Use of services not covered by the UC benefit package and bypassing the designated providers (prohibited under the capitation contract model without proper referrals) are major causes of catastrophic expenditures and impoverishment.     

Evaluation of the public health impacts of traffic congestion: a health risk assessment

Background  

Traffic congestion is a significant issue in urban areas in the United States and around the world. Previous analyses have estimated the economic costs of congestion, related to fuel and time wasted, but few have quantified the public health impacts or determined how these impacts compare in magnitude to the economic costs. Moreover, the relative magnitudes of economic and public health impacts of congestion would be expected to vary significantly across urban areas, as a function of road infrastructure, population density, and atmospheric conditions influencing pollutant formation, but this variability has not been explored.     

Health assessment and economic assessment in health: introduction to the debate on the points of intersection

The study aims to infer the existence of a continuum between Health Assessment and Economic Assessment in Health, by highlighting points of intersection of these forms of appraisal. To achieve this, a review of the theoretical foundations, methods and approaches of both forms of assessment was conducted. It was based on the theoretical model of health evaluation as reported by Hartz et al and economic assessment in health approaches reported by Brouwer et al. It was seen that there is a continuum between the theoretical model of evaluative research and the extrawelfarist approach for economic assessment in health, and between the normative theoretical model for health assessment and the welfarist approaches for economic assessment in health. However, in practice the assessment is still conducted using the normative theoretical model and with a welfarist approach.     

The iterative use of economic evaluation as part of the process of health technology assessment

The economic evaluation of health care technologies has a key role within the new National Health Service health technology assessment process. There has, however, been little discussion of the best way of combining economic and clinical research. Economic evaluation should be iterative, generating progressively firmer estimates of cost-effectiveness and helping to maximise the efficiency of health care R&D. Here, four stages of economic analysis are suggested, starting with stage I when the basic clinical science is complete, and finishing with stage IV analysis to generalise the results of earlier studies to routine clinical practice.     

Needs assessment: developing an economic approach

Health authorities and health boards in the UK are required under the provisions of the NHS Act, 1990, to assess the needs of their resident populations for health care and, through contracting, to act as purchasers of services informed by those needs. This paper presents an economic approach to informing the purchaser on priority setting for contracting. For illustrative purposes, the technique is applied to services for elderly people with dementia. The paper demonstrates that an economic approach to needs assessment is both desirable and practicable.     

Expected epidemiological impacts of introducing an HIV vaccine in Thailand: a model-based analysis

Background

The RV144 trial conducted in Thailand was the first to demonstrate modest protective efficacy of an HIV vaccine. Its estimated initial efficacy was ∼74%, but this waned considerably over time.

Methods

We developed a mathematical model to reflect historical and current HIV trends across different at-risk populations in Thailand. The model was used to estimate the expected number of infections that would be averted if a vaccine with outcome characteristics similar to the RV144 vaccine was implemented in Thailand at varying levels of coverage.

Results

In the absence of a vaccine, we projected roughly 65,000 new HIV infections among adults during the period between 2011 and 2021. Due to the waning efficacy of the vaccine, vaccination campaigns were found to have modest long-term public health benefit unless re-vaccination occurred. We forecast that an RV144-like vaccine with coverage of 30% of the population would lead to a 3% reduction in HIV incidence during the next 10 years. In comparison, 30% coverage of annual or biennial re-vaccination with the vaccine was found to result in 23% and 14% reductions in incidence, respectively. Coverage of 60% without re-vaccination resulted in a 7% reduction. Epidemiological outcomes were found to depend primarily on three factors: vaccination coverage, vaccine efficacy, and the duration of protection the vaccine provided.

Discussion

Due to the short duration of protection the vaccine provides without re-vaccination, our model predicts modest benefit from a vaccination campaign with an RV144-like HIV vaccine in Thailand. Annual or biannual re-vaccination is predicted to greatly increase the long-term public health benefits of a vaccination campaign. The feasibility of vaccine implementation, as well as its economic viability, remains to be determined.     

Increasing excise taxes on cigarettes in California: a dynamic simulation of health and economic impacts

BACKGROUND: California raised cigarette excise taxes in 1999, and may generate additional health and economic benefits by raising them further. METHODS: A dynamic computer simulation model follows births, deaths, migration, aging, and changes in smoking status for the entire population of California over 75 years to estimate the cumulative health and economic outcomes of these changes under several excise tax rate conditions (up to 100% price increase). RESULTS: A 20% tax-induced cigarette price increase would reduce smoking prevalence from 17% to 11.6% with large gains in cumulative life years (14 million) and QALY's (16 million) over 75 years. Total spending on cigarettes by consumers would increase by 270 million dollars in that span (all going to tax revenue), and those who reduce the number of years spent as a smoker would spend 12.5 billion dollars less on cigarettes. Total smoking-related medical costs would drop by 188 billion dollars. These benefits increase greatly with larger tax increases, with which tax revenues continue to rise even as smoking prevalence falls. CONCLUSIONS: Even considering benefits from the 1999 increase, California has not yet maximized the potential of excise taxes to lessen the negative impacts of smoking. Additional tax increases would provide added health benefits and revenue to the state.     

Health as an economic engine: evidence for the importance of health in economic development

Most discussions on the relationships between health and economic conditions have focused on the impact of differences in personal finances or national economic conditions on health. Recently, however, the role of health as an 'economic engine' has been promoted. This paradigm proposes that better health leads to economic development. Evidence from historical, national, and transnational studies have shown that improved health increases economic growth through impacts on micro- and macro-economic factors. In this review, we will summarize the evidence supporting these concepts as a basis for discussing their implications for underdeveloped regions within the United States.     

Raising taxes to reduce smoking prevalence in the US: a simulation of the anticipated health and economic impacts

OBJECTIVE: To estimate health and economic outcomes of raising the excise taxes on cigarettes. METHODS: We use a dynamic computer simulation model to estimate health and economic impacts of raising taxes on cigarettes (up to 100% price increase) for the entire population of the USA over 20 years. We also perform sensitivity analysis on price elasticity. RESULTS: A 40% tax-induced cigarette price increase would reduce smoking prevalence from 21% in 2004 to 15.2% in 2025 with large gains in cumulative life years (7 million) and quality adjusted life years (13 million) over 20 years. Total tax revenue will increase by $365 billion in that span, and total smoking-related medical costs would drop by $317 billion, resulting in total savings of $682 billion. These benefits increase greatly with larger tax increases, and tax revenues continue to rise even as smoking prevalence falls. CONCLUSIONS: Increasing taxes on cigarettes is a unique policy intervention that reduces smoking prevalence, generates additional tax revenue, and results in significant savings in medical care costs.     

Social determinants of health: an economic perspective

The World Health Organization has recently received the findings of its Commission on the Social Determinants of Health. The Commission's report offers a remarkable summary of the evidence, and makes a passionate case for government action to address the social determinants of health, especially as they relate to health inequity. This paper summarizes the ways in which economic analysis could strengthen policy under three headings: examining the causal impact of the determinants of health and of associated policies; prioritising actions; and determining the role of government in influencing behaviour. Copyright © 2009 John Wiley & Sons, Ltd.     

Arsenic in tube well water in Bangladesh: health and economic impacts and implications for arsenic mitigation

A national drinking water quality survey conducted in 2009 furnished data that were used to make an updated estimate of chronic arsenic exposure in Bangladesh. About 20 million and 45 million people were found to be exposed to concentrations above the national standard of 50 µg/L and the World Health Organization’s guideline value of 10 µg/L, respectively. From the updated exposure data and all-cause mortality hazard ratios based on local epidemiological studies, it was estimated that arsenic exposures to concentrations > 50 µg/L and 10–50 µg/L account for an annual 24 000 and perhaps as many as 19 000 adult deaths in the country, respectively. Exposure varies widely in the 64 districts; among adults, arsenic-related deaths account for 0–15% of all deaths. An arsenic-related mortality rate of 1 in every 16 adult deaths could represent an economic burden of 13 billion United States dollars (US$) in lost productivity alone over the next 20 years. Arsenic mitigation should follow a two-tiered approach: (i) prioritizing provision of safe water to an estimated 5 million people exposed to > 200 µg/L arsenic, and (ii) building local arsenic testing capacity. The effectiveness of such an approach was demonstrated during the United Nations Children’s Fund 2006–2011 country programme, which provided safe water to arsenic-contaminated areas at a cost of US$ 11 per capita. National scale-up of such an approach would cost a few hundred million US dollars but would improve the health and productivity of the population, especially in future generations.     

The health care sector as economic driver: an economic analysis of the health care market in the city of Berlin

Taking the German capital Berlin as an example, the role of the health care sector in terms of employment, revenues and growth is empirically assessed. The article is based on the authors study Gesundheitsmarkt Berlin—Perspektiven für Wachstum und Beschäftigung (Henke et al. 2002) (The Berlin Health Care Market—Growth and Employment Prospects). For this purpose, the authors collected data for the years 1998, 1999 and 2000 on turnovers and employment in the various sectors of the local health care market. Results indicate that 177,781 persons, or almost one out of eight persons, are employed in health-related areas in Berlin, which is more than in the German average. The gross value added of Berlins health care market has been estimated at €6.8 billion, corresponding to 10% of the gross value added of Berlins overall economy in 1999. Health expenditures are estimated at 11.9%, which is higher than the German average at 10.8%. Taking these figures as a basis, suggestions to strengthen and further develop this potential are derived. This article demonstrates that health care can be an important economic factor in the regional context and thus should not only be regarded as a cost factor but should be developed.