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SUCCESSES AND FAILURES OF HEALTH

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SUCCESSES AND FAILURES OF HEALTH Powered By Docstoc
					Johan Mackenbach
   Europe is an underutilized ‘natural laboratory’
    for policy evaluation

   Over the past 40 years, there were enormous
    variations in population health trends

   While health care and social policies have
    often been studied, health policy has not
   Successes and failures of health policy in
    Europe: performance indicators

   The Netherlands: strengths and weaknesses
    of health policy

   Determinants of health policy performance:
    economic, social, political
 Tobacco control            Infectious disease
 Alcohol control            Hypertension
 Food and nutrition         Cancer screening
 Fertility, pregnancy,      Mental health
  childbirth                 Road traffic injury
 Child health               Air pollution



                                 Mackenbach & McKee 2013
 Tobacco control            Infectious disease
 Alcohol control            Hypertension
 Food and nutrition         Cancer screening
 Fertility, pregnancy,      Mental health
  childbirth                 Road traffic injury
 Child health               Air pollution



                                 Mackenbach & McKee 2013
 Tobacco control            Infectious disease
 Alcohol control            Hypertension
 Food and nutrition         Cancer screening
 Fertility, pregnancy,      Mental health
  childbirth                 Road traffic injury
 Child health               Air pollution



                                 Mackenbach & McKee 2013
 Literature reviews to identify effective
  interventions
 Relate implementation to intermediate and
  final health outcomes
 Select performance indicators and create
  summary score
 Rank countries, identify determinants of
  health policy performance

                            Mackenbach & McKee 2013
Mackenbach & McKee 2013
Mackenbach & McKee 2013
Mackenbach & McKee 2013
Mackenbach & McKee 2013
Mackenbach & McKee 2013
Policy area   Indicator                   Netherlands                  Europe

Tobacco       Tobacco Control Scale                               46               46
              Daily smokers                                       32               32
              Lung cancer mortality                               68               62
Alcohol       Alcohol Control index                               16               14
              Alcohol consumption                                 10               12
              Liver cirrhosis mortality                            6                26
Nutrition     Iodine deficiency                                   31                35
              Fat consumption                                     37                33
              Fruit and vegetables                               239              217
Pregnancy     Teenage pregnancy                                  1.4               5.4
              Neonatal mortality                                 2.9               3.9
              Maternal mortality                                 4.7              11.0
Child         Measles immunization                                97               95
              Child Safety Score                                  46               36
              Postneonatal mortality                             1.0               2.1
                                                        Mackenbach & McKee 2013
Policy area        Indicator                 Netherlands                   Europe

Infections         AIDS incidence                                    1.5              1.5
                   MRSA infections                                   2.6              4.4
                   Influenza vaccination                              61               53
Hypertension       Blood pressure                                   131               133
                   Cerebrovascular mort.                              34               77

Cancer screening   Breast cancer screening                             2              n.a.
                   Cervical ca. mortality                            2.4              5.8
Road safety        Safety belt use                                    94               81
                   Car occupant mortality                            0.5              2.8
                   Pedestrian mortality                              0.1              1.5
Air pollution      SO2 emissions                                    2.3               13.4
                   Urban ozone                                     1360              3584

Summary score      % high minus % low                                 56                5
                                                           Mackenbach & McKee 2013
Mackenbach & McKee 2013
   Enormous gaps in implementation of effective
    health policies in Europe, particularly in Central and
    Eastern Europe

   Substantial part of gap in life expectancy with
    Western Europe is due to higher mortality from
    causes of death amenable to health policy

   Even in Western Europe, countries could typically
    reduce years of life lost by 30-50% by adopting
    policies in countries with best practices
Mackenbach & McKee 2013
                                 Mannen
                                                     Oversterfte
                                 Overledenen         t.o.v. Zweden         Oversterfte t.o.v.
                                 (abs.)              (abs.)                Zweden (%)
Longkanker                                 6709                 3709                      55
Levercirrose                                   557                    0                    0
Ischemische hartziekte                     6004                       0                    0
Zuigelingensterfte                             378                   123                  33
Maternale sterfte                          n.v.t.               n.v.t.                 n.v.t.
Externe oorzaken (1-19)                         23                    0                    0
Infectieziekten                                408                   20                    5
Cerebrovasculaire aandoeningen             3462                       0                    0
Baarmoederhalskanker                       n.v.t.               n.v.t.                 n.v.t.
Borstkanker                                n.v.t.               n.v.t.                 n.v.t.
Verkeersongevallen                             508               125                      25

                                          Mackenbach & McKee, submitted for
                                          publication
                                 Vrouwen
                                                     Oversterfte
                                 Overledenen         t.o.v. Zweden        Oversterfte t.o.v.
                                 (abs.)              (abs.)               Zweden (%)
Longkanker                                   3714                    0                    0
Levercirrose                                   314                   0                    0
Isch. hartziekte                             4378                    0                    0
Zuigelingensterfte                             317               102                     32
Maternale sterfte                                4                   0                    0
Externe oorzaken (1-19)                         12                    1                  12
Infectieziekten                                266                   0                    0
Cerebrovasculaire aandoeningen               5377                    0                    0
Baarmoederhalskanker                           205                   0                    0
Borstkanker                                  3213                948                     30
Verkeersongevallen                             202                   63                  31

                                           Mackenbach & McKee, submitted for
                                           publication
                               Background:
                            Economic conditions
                             Political conditions
                              Social conditions




           Will:                                               Means:
  Political commitment                              Knowledge and information
    Business support                                Institutional arrangements
Professional engagement                                    Organizational
   Population support                                       effectiveness
                                                       Financial resources



                                   Delivery:
                            Initiation or redesign
                            Population coverage
                           Programmatic design
                          Monitoring and evaluation
                                                          Mackenbach & McKee 2013
Mackenbach & McKee 2013
                 Nether
                 -lands




Mackenbach & McKee 2013
Traditional values
emphasize:
•God is very important
•Obedience and religious
faith more important than
independence
•Abortion never justified
•Strong sense of national
pride
•Respect for authority

Survival values
emphasize:
•Economic & physical
security more important
than self-expression and
quality of life
•Would not sign a petition
•Have to be careful about
trusting people
                                  GDP   Values   Democracy Govt. eff.

Tobacco control score                   ++

Alcohol policy score                                             ++

Neonatal mortality                               +++

Child safety score                                               ++

Influenza vaccination             +++

Cervical cancer mortality         ---

Seat belt wearing                                                ++

SO2 emissions                                                    ---
Summary score                           +++
 +: p<.05 ++: p<.01 +++: p<.001
                                                       Mackenbach & McKee 2013
Achtergrondvariabele             Jaar             Nederland        Europa

Bruto Nationaal Product                   2000          31927               18227

Zelfexpressie waarden                   2000/06          1.94                0.11

Democratie                                2000                10             7.73

Effectiviteit van bestuur                 2002           2.09                0.79

Linkse partijen in de regering     1990-2009            31.86               37.66

Etnische versplintering                   2001           0.11                0.29



                                                         Mackenbach & McKee 2013
   Political science literature: social-democratic
    government reduces income inequality

   No association between social-democratic
    government 1990-2008 and health policy

   Weak association between social-democratic
    government 1960-2008 and health policy

                                Mackenbach & McKee, submitted for publication
Univariate beta=1.671 (n.s.), multivariate beta = -0.103 (n.s.)

             Mackenbach & McKee, submitted for publication
Univariate beta=1.381 (p=0.04), multivariate beta = 0.812 (n.s.)

             Mackenbach & McKee, submitted for publication
Mackenbach & McKee, submitted for publication
   Over the past decades, there have been large
    differences between European countries in the
    implementation of effective health policies

   Seen from a European perspective, the Netherlands is
    part of a “sub-top”, with excellent performance in some
    areas and modest performance in some others

   Tobacco control and alcohol control are among the
    areas in which the Netherlands can do better – but this
    will require more political will
THANK
 YOU!

				
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