At the Intersection of Health, Health Care and Policy Cite this article as: Alan R. Weil Our Health Is Global Health Health Affairs, 33, no.9 (2014):1502 doi: 10.1377/hlthaff.2014.0921
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Health Affairs is published monthly by Project HOPE at 7500 Old Georgetown Road, Suite 600, Bethesda, MD 20814-6133. Copyright © 2014 by Project HOPE - The People-to-People Health Foundation. As provided by United States copyright law (Title 17, U.S. Code), no part of Health Affairs may be reproduced, displayed, or transmitted in any form or by any means, electronic or mechanical, including photocopying or by information storage or retrieval systems, without prior written permission from the Publisher. All rights reserved.
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from the editor-in-chief
leagues analyze retail prices and conclude that although prices for malaria medicines decreased in six of seven pilots in Africa, wholesalers and retailers may be capturing subsidies designed to reduce those prices, leaving room for further price reductions.
DOI: 10.1377/hlthaff.2014.0921
Our Health Is Global Health by alan r. weil
I
t may take an Ebola outbreak for Americans to be reminded of the importance of global health, but opportunities abound for international learning for those who take the time to look. Last year Health Affairs reported that “The ‘Triple Aim’ Goes Global,” and in this issue we see how developing and industrialized countries around the world are confronting challenges and learning from each other on all three aims: cost, quality, and population health. Mark McClellan and colleagues launch the discussion by examining the global movement toward accountable care systems, which they define as systems “in which a group of providers are held jointly accountable for achieving a set of outcomes for a prospectively defined population over a period of time for an agreed cost.” Drawing from the experience of countries around the globe, they observe variability due to differing local circumstances but a consistent effort to iterate toward success by learning from experience. improving care Some of the greatest opportunities for global learning revolve around improving care. Health care and health financing systems vary, but the goals of patient engagement and whole-person care are shared around the world. Reinhard Busse and Juliane Stahl describe integrated care approaches in Germany, the Netherlands, and England. Kim Verhaegh and colleagues conducted a meta-analysis of transitional care initiatives designed to reduce hospital readmissions. Reviewing randomized control trials from North America, Europe, and Asia, they con-
1502
health affairs
clude that high-intensity, nurse-based interventions that include a home visit are effective in reducing readmissions within thirty days of discharge. Jeremy Laurance and colleagues show that “patient engagement is a global movement,” describing examples that employ widely varying approaches in the United Kingdom, the United Arab Emirates, India, and the United States. There is also a global need to improve end-of-life care. Mark Steedman and colleagues describe efforts to improve opioid availability in Nigeria, Uganda, India, Bangladesh, Myanmar, and Jordan. cost and access Lower prices improve affordability but reduce returns to the private sector, arguably impeding investments needed to produce adequate supply and innovation. Ernst Berndt and Iain Cockburn conclude that cost-saving measures in India have delayed drug availability, noting that optimal policy requires a joint examination of affordability and availability. Sarah Tougher and col-
september 2014
learn globally, act locally The desire to accelerate the spread of effective innovation is also global. Oliver Keown and colleagues draw lessons from eight countries in how innovation spreads. Going beyond the structural analysis that dominates most work on innovation, they focus on the “cultural dynamics that are required on the front lines of health care to support innovation and its diffusion.” We should not overstate similarities around the world. The World Health Organization reports that maternal mortality rates are 510 per 100,000 live births in sub-Saharan Africa, while they are only 16 per 100,000 in the most developed countries. And in 2012 malaria killed more than 600,000 people globally, but it poses no serious threat in much of the industrialized world. Yet overemphasis on differences creates barriers to international learning. The rising burden of noncommunicable diseases and the goal of reducing health disparities are global phenomena. And, as the emerging Ebola story reminds us, diseases themselves know no national boundaries. Let us not forget that the United States accounted for $2.6 trillion of the $6.5 trillion spent on health worldwide in 2010, according to the WHO. Whether we are examining simple dollars or opportunities for improving lives and care, our health is global health. acknowledgement Health Affairs appreciates major support for this issue provided by Qatar Foundation and its World Innovation Summit for Health (WISH), Hamad Medical Corporation, and Imperial College London, with additional support from the Commonwealth Fund. n
33:9
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8/20/14 2:36 PM
The online version of this article, along with updated information and services, is available at: http://content.healthaffairs.org/content/33/9/1502.full.html
For Reprints, Links & Permissions: http://healthaffairs.org/1340_reprints.php E-mail Alerts : http://content.healthaffairs.org/subscriptions/etoc.dtl To Subscribe: http://content.healthaffairs.org/subscriptions/online.shtml
Health Affairs is published monthly by Project HOPE at 7500 Old Georgetown Road, Suite 600, Bethesda, MD 20814-6133. Copyright © 2014 by Project HOPE - The People-to-People Health Foundation. As provided by United States copyright law (Title 17, U.S. Code), no part of Health Affairs may be reproduced, displayed, or transmitted in any form or by any means, electronic or mechanical, including photocopying or by information storage or retrieval systems, without prior written permission from the Publisher. All rights reserved.
Not for commercial use or unauthorized distribution Downloaded from content.healthaffairs.org by Health Affairs on September 9, 2014 at University of Wisconsin-Madison
from the editor-in-chief
leagues analyze retail prices and conclude that although prices for malaria medicines decreased in six of seven pilots in Africa, wholesalers and retailers may be capturing subsidies designed to reduce those prices, leaving room for further price reductions.
DOI: 10.1377/hlthaff.2014.0921
Our Health Is Global Health by alan r. weil
I
t may take an Ebola outbreak for Americans to be reminded of the importance of global health, but opportunities abound for international learning for those who take the time to look. Last year Health Affairs reported that “The ‘Triple Aim’ Goes Global,” and in this issue we see how developing and industrialized countries around the world are confronting challenges and learning from each other on all three aims: cost, quality, and population health. Mark McClellan and colleagues launch the discussion by examining the global movement toward accountable care systems, which they define as systems “in which a group of providers are held jointly accountable for achieving a set of outcomes for a prospectively defined population over a period of time for an agreed cost.” Drawing from the experience of countries around the globe, they observe variability due to differing local circumstances but a consistent effort to iterate toward success by learning from experience. improving care Some of the greatest opportunities for global learning revolve around improving care. Health care and health financing systems vary, but the goals of patient engagement and whole-person care are shared around the world. Reinhard Busse and Juliane Stahl describe integrated care approaches in Germany, the Netherlands, and England. Kim Verhaegh and colleagues conducted a meta-analysis of transitional care initiatives designed to reduce hospital readmissions. Reviewing randomized control trials from North America, Europe, and Asia, they con-
1502
health affairs
clude that high-intensity, nurse-based interventions that include a home visit are effective in reducing readmissions within thirty days of discharge. Jeremy Laurance and colleagues show that “patient engagement is a global movement,” describing examples that employ widely varying approaches in the United Kingdom, the United Arab Emirates, India, and the United States. There is also a global need to improve end-of-life care. Mark Steedman and colleagues describe efforts to improve opioid availability in Nigeria, Uganda, India, Bangladesh, Myanmar, and Jordan. cost and access Lower prices improve affordability but reduce returns to the private sector, arguably impeding investments needed to produce adequate supply and innovation. Ernst Berndt and Iain Cockburn conclude that cost-saving measures in India have delayed drug availability, noting that optimal policy requires a joint examination of affordability and availability. Sarah Tougher and col-
september 2014
learn globally, act locally The desire to accelerate the spread of effective innovation is also global. Oliver Keown and colleagues draw lessons from eight countries in how innovation spreads. Going beyond the structural analysis that dominates most work on innovation, they focus on the “cultural dynamics that are required on the front lines of health care to support innovation and its diffusion.” We should not overstate similarities around the world. The World Health Organization reports that maternal mortality rates are 510 per 100,000 live births in sub-Saharan Africa, while they are only 16 per 100,000 in the most developed countries. And in 2012 malaria killed more than 600,000 people globally, but it poses no serious threat in much of the industrialized world. Yet overemphasis on differences creates barriers to international learning. The rising burden of noncommunicable diseases and the goal of reducing health disparities are global phenomena. And, as the emerging Ebola story reminds us, diseases themselves know no national boundaries. Let us not forget that the United States accounted for $2.6 trillion of the $6.5 trillion spent on health worldwide in 2010, according to the WHO. Whether we are examining simple dollars or opportunities for improving lives and care, our health is global health. acknowledgement Health Affairs appreciates major support for this issue provided by Qatar Foundation and its World Innovation Summit for Health (WISH), Hamad Medical Corporation, and Imperial College London, with additional support from the Commonwealth Fund. n
33:9
Downloaded from content.healthaffairs.org by Health Affairs on September 9, 2014 at University of Wisconsin-Madison Sept_2014_eic.indd 1110
8/20/14 2:36 PM
