Rethink cities to promote an active lifestyle and tackle climate change: best practices from the OECD

Background

City design can have major health and environmental implications. The overall layout of cities influences air quality, as urban sprawl can encourage the use of motorised vehicles and decrease active travelling. Furthermore, lack of trees has a negative impact on particulate matter levels and contributes to the urban heat island effect. There is a growing interest for creating an urban environment conducive of healthier lifestyles.

Methods

The analysis uses the five OECD criteria to assess best practices in public health - Effectiveness, Efficiency, Equity, Evidence-base, and Extent of coverage - to carry out a systematic assessment of selected candidate best practices to improve the public health potential of cities. The impact of scaling up these interventions within and across countries is evaluated by using the OECD SPHeP-NCD microsimulation model.

Results

Interventions such as Superblocks in Barcelona, which reshapes the city layout to make them more people centric and less vehicles reliant, or Cycle Superhighways from Denmark, which develops cycling networks, have a the potential to avoid a significant number of chronic diseases by promoting an active lifestyle and decreasing transport-related pollution. Such interventions can also decrease healthcare expenditure and, if well designed, health disparities.

Discussion

While many urban design interventions are a good investment for countries and, in general, there is good support, a number of implementation hurdles exist. First, extent of coverage is still relatively limited across European countries. Second, changes take time to be implemented and some of the health impact materializes in the longer-term. Third, the implementation of such interventions is generally competence of other authorities, other than the health authorities. Building strong multi-stakeholder approaches and making a strong case for such investments can promote change.

Financial Risk Protection and Unmet Healthcare Need in Russia

BACKGROUND

Achieving universal health coverage (UHC) includes financial risk protection. To date, catastrophic healthcare expenditure (CHE), the impoverishing effect of out-of-pocket (OOP) healthcare payments, and unmet healthcare need are the most widely used indicators for assessing the financial risk protection of a healthcare system. This study aimed to estimate the Russian healthcare system's financial risk protection by focusing on CHE, OOP and unmet healthcare need.

METHODS

The study used eight waves of the Russia Longitudinal Monitoring Survey (RLMS) (2010-2017) to analyze the financial risk protection of the Russian healthcare system. Commonly used indicators - CHE, both incidence and intensity, the impoverishing effect of CHE and unmet need -were used.

RESULTS

We found low incidence and intensity of CHE in the Russian Federation. Our results are robust to various definitions of CHE (eg, as a share of total household expenditure or total household income). Furthermore, the impoverishing effect of OOP healthcare payments remains limited, despite the most recent economic slowdown (2014- 2016). This could be explained by a noticeable reduction in CHE during the crisis years, as postponing healthcare was adopted as a coping mechanism, particularly among households heavily affected by the crisis.

CONCLUSION

As stressed by the UHC framework, our findings suggest that CHE only partly captures inefficiencies and inequities in coverage, because one tenth of households forwent medical care for medicines and certain services. As spending on medicines and dental care are the main drivers of CHE, policy interventions should focus on extending coverage for pharmaceutical and dental care and target financial barriers to seeking care, particularly for the poor and vulnerable.

Tackling the cancer burden: the economic impact of primary prevention policies

Cancer is a noncommunicable disease (NCD) with increasing incidence and therefore constitutes a major public health issue. To reduce the health and economic burden of cancer, policy‐makers across the world have implemented a range of preventative interventions targeting risk factors with a known link to the disease. In this article, we examine the impact of six primary prevention interventions – related to physical inactivity, unhealthy diet or harmful alcohol use – on cancer‐related health outcomes and healthcare expenditure. Here, we used the OECD Strategic Public Health Planning for NCDs (SPHeP‐NCDs) model to quantify outcomes and costs for each intervention for years 2020–2050 across 37 countries. Results from the model indicate that all interventions could lead to a reduction in the number of new cancer cases, in particular those targeting harmful alcohol consumption. Introducing an alcohol tax, for instance, is estimated to reduce related cancer cases by 5619 a year or 174 193 by 2050. A breakdown of results by type of cancer revealed interventions had the largest impact on colorectal cancer with, on average, 41 140 cases avoided per intervention by 2050. In proportional terms, interventions had the greatest impact on new oesophageal and liver cancers. Findings from this article are designed to assist decision‐makers efficiently allocate limited resources to meet public health objectives.