Committed to health for all? How the G7/G8 rate

Role of household waste, governance quality, and greener energy for public health: Evidence from developed economies

In the current times, the global economies and international organizations declared that pollution is one of the prominent causes of declined human health. Still, most literature is biased toward economic sustainability and ignores such vital issues. The current study tends to identify the factors affecting public health in the Group of Seven economies except for Italy (G6). Specifically, this study aims to investigate the influence of household waste (HHW), bureaucratic quality (BQ), democratic accountability (DA), urbanization growth (URP), GDP per capita, and renewable energy use (EPR) on public health, throughout 1996-2020. This study uses advanced panel data approaches and finds the heterogeneity of slope coefficients, the dependence of cross-sections, and the persistence of cointegration between the variables. The asymmetric distribution of data leads to employing the novel method of moment quantile regression. The estimated results reveal that URP, GDPPC, and EPR significantly increase domestic general government health expenditures, improving public health. However, HHW and BQ adversely affect public health by reducing health expenditures. The robustness of the results is tested via utilizing the panel quantile regression. Based on the empirical findings, this study suggests policies regarding the improvement in public health expenditure, R&D investment, spending in renewable energy sector, and strengthening of the institutional quality.

Comparison of historical medical spending patterns among the BRICS and G7

OBJECTIVE

The past few decades have been marked by a bold increase in national health spending across the globe. Rather successful health reforms in leading emerging markets such as BRICS reveal a reshaping of their medical care-related expenditures. There is a scarcity of evidence explaining differences in long-term medical spending patterns between top ranked G7 traditional welfare economies and the BRICS nations.

METHODS

A retrospective observational study was conducted on a longitudinal WHO Global Health Expenditure data-set based on the National Health Accounts (NHA) system. Data were presented in a simple descriptive manner, pointing out health expenditure dynamics and differences between the two country groups (BRICS and G7) and individual nations in a 1995-2013 time horizon.

RESULTS

Average total per capita health spending still remains substantially higher among G7 (4747 Purchase Power Parity (PPP) $PPP in 2013) compared to the BRICS (1004 $PPP in 2013) nations. The percentage point share of G7 in global health expenditure (million current PPP international $US) has been falling constantly since 1995 (from 65% in 1995 to 53.2% in 2013), while in BRICS nations it grew (from 10.7% in 1995 to 20.2% in 2013). Chinese national level medical spending exceeded significantly that of all G7 members except the US in terms of current $PPP in 2013.

CONCLUSIONS

Within a limited time horizon of only 19 years it appears that the share of global medical spending by the leading emerging markets has been growing steadily. Simultaneously, the world's richest countries' global share has been falling constantly, although it continues to dominate the landscape. If the contemporary global economic mainstream continues, the BRICS per capita will most likely reach or exceed the OECD average in future decades. Rising out-of-pocket expenses threatening affordability of medical care to poor citizens among the BRICS nations and a too low percentage of GDP in India remain the most notable setbacks of these developments.

The multiple meanings of global health governance: a call for conceptual clarity

BACKGROUND

The term global health governance (GHG) is now widely used, with over one thousand works published in the scholarly literature, almost all since 2002. Amid this rapid growth there is considerable variation in how the term is defined and applied, generating confusion as to the boundaries of the subject, the perceived problems in practice, and the goals to be achieved through institutional reform.

METHODOLOGY

This paper is based on the results of a separate scoping study of peer reviewed GHG research from 1990 onwards which undertook keyword searches of public health and social science databases. Additional works, notably books, book chapters and scholarly articles, not currently indexed, were identified through Web of Science citation searches. After removing duplicates, book reviews, commentaries and editorials, we reviewed the remaining 250 scholarly works in terms of how the concept of GHG is applied. More specifically, we identify what is claimed as constituting GHG, how it is problematised, the institutional features of GHG, and what forms and functions are deemed ideal.

RESULTS

After examining the broader notion of global governance and increasingly ubiquitous term "global health", the paper identifies three ontological variations in GHG scholarship - the scope of institutional arrangements, strengths and weaknesses of existing institutions, and the ideal form and function of GHG. This has produced three common, yet distinct, meanings of GHG that have emerged - globalisation and health governance, global governance and health, and governance for global health.

CONCLUSIONS

There is a need to clarify ontological and definitional distinctions in GHG scholarship and practice, and be critically reflexive of their normative underpinnings. This will enable greater precision in describing existing institutional arrangements, as well as serve as a prerequisite for a fuller debate about the desired nature of GHG.

Global Health Governance at a Crossroads

This review takes stock of the global health governance (GHG) literature. We address the transition from international health governance (IHG) to global health governance, identify major actors, and explain some challenges and successes in GHG. We analyze the framing of health as national security, human security, human rights, and global public good, and the implications of these various frames. We also establish and examine from the literature GHG's major themes and issues, which include: 1) persistent GHG problems; 2) different approaches to tackling health challenges (vertical, horizontal, and diagonal); 3) health's multisectoral connections; 4) neoliberalism and the global economy; 5) the framing of health (e.g. as a security issue, as a foreign policy issue, as a human rights issue, and as a global public good); 6) global health inequalities; 7) local and country ownership and capacity; 8) international law in GHG; and 9) research gaps in GHG. We find that decades-old challenges in GHG persist and GHG needs a new way forward. A framework called shared health governance offers promise.

The evolution, etiology and eventualities of the global health security regime

BACKGROUND

Attention to global health security governance is more important now than ever before. Scientists predict that a possible influenza pandemic could affect 1.5 billion people, cause up to 150 million deaths and leave US$3 trillion in economic damages. A public health emergency in one country is now only hours away from affecting many others.

METHODS

Using regime analysis from political science, the principles, norms, rules and decision-making procedures by which states govern health security are examined in the historical context of their punctuated evolution. This methodology illuminates the catalytic agents of change, distributional consequences and possible future orders that can help to better inform progress in this area.

FINDINGS

Four periods of global health security governance are identified. The first is characterized by unilateral quarantine regulations (1377-1851), the second by multiple sanitary conferences (1851-92), the third by several international sanitary conventions and international health organizations (1892-1946) and the fourth by the hegemonic leadership of the World Health Organization (1946-????). This final regime, like others before it, is challenged by globalization (e.g. limitations of the new International Health Regulations), changing diplomacy (e.g. proliferation of global health security organizations), new tools (e.g. global health law, human rights and health diplomacy) and shock-activated vulnerabilities (e.g. bioterrorism and avian/swine influenza). This understanding, in turn, allows us to appreciate the impact of this evolving regime on class, race and gender, as well as to consider four possible future configurations of power, including greater authority for the World Health Organization, a concert of powers, developing countries and civil society organizations.

CONCLUSIONS

This regime analysis allows us to understand the evolution, etiology and eventualities of the global health security regime, which is essential for national and international health policymakers, practitioners and academics to know where and how to act effectively in preparation for tomorrow's challenges.

State downsizing as a determinant of infant mortality and achievement of Millennium Development Goal 4

The aim of this study was to evaluate the worldwide effect of state downsizing policies on achievement of U.N. Millennium Development Goal 4 (MDG4) on infant mortality rates. In an ecological retrospective cohort study of 161 countries, from 1978 to 2002, the authors analyzed changes in government consumption (GC) as determining exposure to achievement of MDG4. Descriptive methods and a multiple logistic regression were applied to adjust for changes in gross domestic product, level of democracy, and income inequality. Excess infant mortality in the exposed countries, attributable to reductions in GC, was estimated. Fifty countries were found to have reduced GC, and 111 had increased GC. The gap in infant mortality rate between these groups of countries doubled in the study period. Non-achievement of MDG4 was associated with reductions in GC and increases in income inequality. The excess infant mortality attributable to GC reductions in the exposed countries from 1990 to 2002 was 4,473,348 deaths. The probability of achieving MDG4 seems to be seriously compromised for many countries because of reduced public sector expenditure during the last 25 years of the 20th century, in response to World Bank/International Monetary Fund Washington Consensus policies. This seeming contradiction between the goals of different U.N. branches may be undermining achievement of MDG4 and should be taken into account when developing future global governance policy.

Globalization and social determinants of health: Introduction and methodological background (part 1 of 3)

Globalization is a key context for the study of social determinants of health (SDH). Broadly stated, SDH are the conditions in which people live and work, and that affect their opportunities to lead healthy lives.In this first article of a three-part series, we describe the origins of the series in work conducted for the Globalization Knowledge Network of the World Health Organization's Commission on Social Determinants of Health and in the Commission's specific concern with health equity. We explain our rationale for defining globalization with reference to the emergence of a global marketplace, and the economic and political choices that have facilitated that emergence. We identify a number of conceptual milestones in studying the relation between globalization and SDH over the period 1987-2005, and then show that because globalization comprises multiple, interacting policy dynamics, reliance on evidence from multiple disciplines (transdisciplinarity) and research methodologies is required. So, too, is explicit recognition of the uncertainties associated with linking globalization - the quintessential "upstream" variable - with changes in SDH and in health outcomes.

Globalization and social determinants of health: Promoting health equity in global governance (part 3 of 3)

This article is the third in a three-part review of research on globalization and the social determinants of health (SDH). In the first article of the series, we identified and defended an economically oriented definition of globalization and addressed a number of important conceptual and metholodogical issues. In the second article, we identified and described seven key clusters of pathways relevant to globalization's influence on SDH. This discussion provided the basis for the premise from which we begin this article: interventions to reduce health inequities by way of SDH are inextricably linked with social protection, economic management and development strategy.

Reflecting this insight, and against the background of the Millennium Development Goals (MDGs), we focus on the asymmetrical distribution of gains, losses and power that is characteristic of globalization in its current form and identify a number of areas for innovation on the part of the international community: making more resources available for health systems, as part of the more general task of expanding and improving development assistance; expanding debt relief and taking poverty reduction more seriously; reforming the international trade regime; considering the implications of health as a human right; and protecting the policy space available to national governments to address social determinants of health, notably with respect to the hypermobility of financial capital. We conclude by suggesting that responses to globalization's effects on social determinants of health can be classified with reference to two contrasting visions of the future, reflecting quite distinct values.

Foreign policy matters: a normative view of the G8 and population health

The Group of Eight (G8) countries occupy a dominant position in the international economic and political order. Given what is known about influences on the social determinants of health in an interconnected world, the G8 are a logical starting point for any enquiry into the relations between foreign policy and health. We first make five arguments for adopting an explicitly normative, equity-oriented perspective on the performance of G8 policy in areas related to population health. We then examine G8 performance with respect to the crucial policy triad of development assistance, debt relief and trade, finding that neither rhetoric nor promising institutional innovation has been matched by resources commensurate with demonstrated levels of need. We conclude that it is necessary to pursue advocacy efforts based on the normative perspective we have put forward and that doing so effectively requires further investigation of why some policies are more receptive than others to policies of redistribution both within and outside their borders.

Making G8 leaders deliver: an analysis of compliance and health commitments, 1996-2006

International health policy-makers now have a variety of institutional instruments with which to pursue their global and national health goals. These instruments range from the established formal multilateral organizations of the United Nations to the newer restricted-membership institutions of the Group of Eight (G8). To decide where best to deploy scarce resources, we must systematically examine the G8's contributions to global health governance. This assessment explores the contributions made by multilateral institutions such as the World Health Organization, and whether Member States comply with their commitments. We assessed whether G8 health governance assists its member governments in managing domestic politics and policy, in defining dominant normative directions, in developing and complying with collective commitments and in developing new G8-centred institutions. We found that the G8's performance improved substantially during the past decade. The G8 Member States function equally well, and each is able to combat diseases. Compliance varied among G8 Member States with respect to their health commitments, and there is scope for improvement. G8 leaders should better define their health commitments and set a one-year deadline for their delivery. In addition, Member States must seek WHO's support and set up an institution for G8 health ministers.

What’s Politics Got to Do with It? Health, the G8, and the Global Economy

This chapter examines the pledges made by developed countries, particularly the rich club of G8 nations, to make globalization work better for the world's poor. It shows that contrary to the ringing rhetoric, they find that levels of foreign aid remain pitifully inadequate.

The G8 and global health: What now? What next?

The policies of the G8 countries (the G7 industrialized countries plus Russia) matter for population health and the determinants of health worldwide. In the years before the 2005 Summit, relevant G7 commitments were more often broken than kept, representing an inadequate response to the scale of health crises in countries outside the industrialized world. The commitments made in 2005 by some G7 countries to increase development assistance to the longstanding target of 0.7% of Gross National Income, and by the G7 as a whole to additional debt cancellation for some developing countries, were welcome and overdue. However, Canada and the United States did not state timetables for reaching the development assistance target, and new conditionalities attached to debt relief may undermine the benefits for population health. Lack of adequate funding for the Global Fund to Fight AIDS, Tuberculosis and Malaria, even after the September 2005 replenishment meeting, is unconscionable; yet even if those funds were provided, additional resources for developing country health systems would be needed. Similarly, widespread agreement on the need for improving market access for developing country exports was not met with any concrete policy response to the "asymmetrical" nature of recent trade liberalization; neither was the need to control the deadly trade in small arms. To respond adequately to global health needs, the G8 will need to adopt an agenda that more fundamentally alters the distribution of economic and political power, within and among nations.

The G8 and global health: What now? What next?

The policies of the G8 countries (the G7 industrialized countries plus Russia) matter for population health and the determinants of health worldwide. In the years before the 2005 Summit, relevant G7 commitments were more often broken than kept, representing an inadequate response to the scale of health crises in countries outside the industrialized world. The commitments made in 2005 by some G7 countries to increase development assistance to the longstanding target of 0.7% of Gross National Income, and by the G7 as a whole to additional debt cancellation for some developing countries, were welcome and overdue. However, Canada and the United States did not state timetables for reaching the development assistance target, and new conditionalities attached to debt relief may undermine the benefits for population health. Lack of adequate funding for the Global Fund to Fight AIDS, Tuberculosis and Malaria, even after the September 2005 replenishment meeting, is unconscionable; yet even if those funds were provided, additional resources for developing country health systems would be needed. Similarly, widespread agreement on the need for improving market access for developing country exports was not met with any concrete policy response to the "asymmetrical" nature of recent trade liberalization; neither was the need to control the deadly trade in small arms. To respond adequately to global health needs, the G8 will need to adopt an agenda that more fundamentally alters the distribution of economic and political power, within and among nations.

Wealth and health: the need for more strategic public health research

This article argues that public health researchers have often ignored the analysis of wealth in the quest to understand the social determinants of health. Wealth concentration and the inequities in wealth between and within countries are increasing. Despite this scare accurate data are available to assist the analysis of the health impact of this trend. Improved data collection on wealth distribution should be encouraged. Epidemiologists and political economy of health researchers should pay more attention to understanding the dynamics of wealth and its consequences for population health. Policy research to underpin policies designed to reduce inequities in wealth distribution should be intensified.

Health as a complete state: the added value in work performance and healthcare costs

OBJECTIVE

Health is widely believed to be more than the absence of illness, yet no previous research has documented whether organizations would benefit if occupational health moved beyond an "absence of illness" model.

METHODS

Cross-sectional data from the Midlife Development in the United States (MIDUS) study were used to compare productivity outcomes and health care use among individuals in (1) complete ill health, (2) incomplete health, and (3) complete health.

RESULTS

Across the outcomes, individuals characterized as being completely healthy reported the greatest productivity and the lowest health care use. By contrast individuals in incomplete health had intermediate levels on outcomes and individuals in complete ill-health had the poorest outcomes.

CONCLUSION

There is additional benefit of moving occupational health priorities from health as the absence of illness to health as more than the absence of illness.