Content Type: Working Paper / Publication Year: within 25 Years / Topic: Health

1. Disease Mix and How Economic Freedom Matters for Health Outcomes

Author:: Vincent Geloso, Kelly Hyde, and Ilia Murtazashvili
Publication Date:: 03-2023
Content Type:: Working Paper
Institution:: The Cato Institute
Abstract:: We investigate the institutional foundations of public health. We argue that a key distinction in analysis of disease is between diseases of commerce (diseases associated with movement of people and with affluence) and diseases of poverty (primarily noncommunicable diseases that depend on wealth and income). We show that the mix of disease – the ratio of communicable diseases and those associated with longevity to diseases of poverty – increases in economically free countries. We argue that increasing burdens of diseases of commerce reflects the quality of institutions, as those diseases are better than living shorter, brutish lives where diseases of poverty claim many lives. This analysis also highlights an institutional trade‐off: economically free institutions reduce certain types of disease while contributing to others.
Topic:: Health, Infectious Diseases, Economy, Institutions, and Public Health
Political Geography:: Global Focus

2. FACTORING THE SMART POWER IN THE INDIA-EUROPEAN UNION ENGAGEMENTS: A SCOPING REVIEW

Author:: Nippun Gupta, Bawa Singh, Aslam Khan, and Jaspal Kaur
Publication Date:: 03-2023
Content Type:: Working Paper
Institution:: Institute for Research and European Studies (IRES)
Abstract:: Power is a critical factor in several types of diplomacy. India-EU relations are a classic case of how changing geopolitics prompted diplomatic acumen. This scoping review assesses the changing relations of both partners as a manifestation of Smart Power. The dynamic relations from normative-based to pragmatic and inclusive interests based are evaluated. Their value-based relations are put under international relations theories. Their changing factors of cooperation are used to justify their smart diplomacy, where contemporary relations are less likely to be affected by multilateral interests. To solidify claims of smart power in their relations, the recent TRIPS waiver schism illuminated health diplomacy between the two regions. This health diplomacy discourse promotes smart power diplomacy between India and the EU, where new avenues of cooperation emerge despite pandemic disagreements. The article explores how hybrid power is better than soft and hard power in silos by systematically searching and selecting the existing knowledge in the contemporary context.
Topic:: Diplomacy, Health, Bilateral Relations, European Union, Soft Power, Hard Power, and Smart Power
Political Geography:: Europe, South Asia, and India

3. The Labor Market Effects of Disability Benefit Loss

Author:: Anikó Bíró, Cecília Hornok, Judit Krekó, Dániel Prinz, and Ágota Scharle
Publication Date:: 09-2023
Content Type:: Working Paper
Institution:: Kiel Institute for the World Economy (IfW)
Abstract:: Disability benefits are costly and tend to reduce labor supply. While spending can be contained by careful targeting, correcting past flaws in eligibility rules or assessment procedures may entail welfare costs. We study a major reform in Hungary that reassessed the health and working capacity of a large share of beneficiaries. Leveraging age and health cutoffs in the reassessment, we estimate employment responses to loss or reduction of benefits. We find that among those who left disability insurance due to the reform 58% were employed in the primary labor market, 6% participated in public works and 36% were out of work without benefits in the post-reform period. The consequences of leaving disability insurance sharply differed by pre-reform employment status. 81% of beneficiaries who had some employment in the pre-reform year worked, while only 33% of those without pre-reform employment did. The gains of the reform in activating beneficiaries were small and strongly driven by pre-reform employment status. This points to the importance of combining financial incentives with broader labor market programs that increase employability.
Topic:: Health, Employment, Economy, Disability, Fiscal Policy, Insurance, Labor Market, and Welfare State
Political Geography:: Europe and Hungary

4. Planetary health: A holistic vision for people and the planet

Author:: Danielle Brady
Publication Date:: 09-2023
Content Type:: Working Paper
Institution:: European Policy Centre (EPC)
Abstract:: The nexus between health and the environment has been underscored by crises such as COVID-19 and the climate crisis. As awareness of policy interlinkages grows, so does the need for more coordinated EU and national policymaking. Calls for a more holistic approach have long been recognised, but the pandemic has further emphasised the importance of dismantling existing barriers in policymaking to improve the health status of people, animals, and the planet. This Discussion Paper, funded by Sitra, the Finnish Innovation Fund, advocates for implementing a planetary health approach across all levels of governance to encourage transdisciplinary action and puts forward ten recommendations: Pursue coordinated policymaking by breaking down silos. Appoint an Executive Vice President for the Well-being Economy. Plan and implement national roadmaps and establish common indicators. Create best practices platforms. Adopt planetary health for health systems. Promote education on planetary health. Adopt a European-wide communication campaign. Invest in research and innovation. Foster the integration of the European Health Data Space with future data spaces. Work with international partners to adopt a global planetary health approach. Planetary health offers many benefits for health and the environment. However, without concentrated efforts to move beyond the traditional siloed approach to policymaking, the benefits may never be realised.
Topic:: Climate Change, Health, European Union, and COVID-19
Political Geography:: Global Focus

5. Moving on Up: Multilevel Monitoring and Advocacy for Health Rights

Author:: Abrehet Gebremedhin
Publication Date:: 01-2023
Content Type:: Working Paper
Institution:: Accountability Research Center (ARC), American University
Abstract:: Multilevel approaches to monitoring and advocacy are often used by international development practitioners, particularly in civil society, in efforts to hold governments—from the national to the local—to account for policy implementation. However, such approaches are not yet well understood or identified by many scholars in the social accountability field. This evidence review addresses this gap through a cross-case comparison of multilevel approaches in ten health rights programs across Africa, Asia, and Latin America. It draws on published evaluations, working papers, and peer-reviewed journal articles, as well as insights shared by implementers and researchers. Cases were selected to illustrate health rights initiatives that included monitoring or advocacy activity at a minimum of two different levels: local health facility, district, regional, provincial or national. Four significant findings emerge from this review of evidence: Vertical integration is a relatively common feature of multilevel monitoring and advocacy in these ten cases and is most likely to take place at the lower ends of the health system. However, it is largely implicit, and often not articulated in project design or theories of change. Horizontal organizing—the coordination of civil society action across districts or geographies—is a less visible feature of multilevel approaches to health rights programming than vertical integration. Despite the multilevel nature of health monitoring and advocacy in these ten cases, less than half reported working at the regional or provincial level, indicating a ‘missing middle’ between local and national activity. Escalation—the process by which citizens’ unaddressed claims move upwards to those with greater decision- making powers—is an important mechanism for accountability and one way in which vertical integration can happen. However, escalation is not clearly articulated in much of the gray literature, and therefore merits further research. The findings from this evidence review have implications for strategy, including: the importance of explicitly identifying multilevel tactics for monitoring and advocacy; theorizing the process by which unaddressed claims can be addressed, particularly moving up beyond the local level; emphasizing the importance of the ‘middle’ and ensuring regional and provincial decision-making is leveraged; and looking to link vertical integration with opportunities for horizontal organizing.
Topic:: Civil Society, Health, Accountability, Advocacy, and Monitoring
Political Geography:: Africa, Asia, and Latin America

6. Does Project-Level Aid for Water and Sanitation Improve Child Health Outcomes? Evidence from Household Panel Data in Uganda

Author:: Lynda Pickbourn, Raymond Caraher, and Léonce Ndikumana
Publication Date:: 03-2023
Content Type:: Working Paper
Institution:: Political Economy Research Institute (PERI), University of Massachusetts Amherst
Abstract:: Empirical studies on the effectiveness of aid to the water, sanitation, and hygiene sector (WASH aid) have focused primarily on access to these services as the benchmark for evaluating the effectiveness of aid in this sector. Given the importance of WASH services for public health outcomes, the effectiveness of WASH aid should also be evaluated in terms of its impact on health outcomes. This is especially important in low- and middle-income countries where achieving sustained improvements in child health outcomes remains a challenge. This paper uses geocoded sub-national data on the location of WASH aid projects in Uganda in conjunction with six waves of nationally representative household-level panel survey data to examine the impact of aid-funded WASH projects on the probability of stunting among Ugandan children and infants. Analysing aid effectiveness at the sub-national level avoids the problems of cross-country heterogeneity in aid effectiveness that plagues other studies. Results of the difference-in-differences regression analysis suggest that proximity to an aid-funded WASH project reduces the probability of stunting by 14–21 per cent. The results suggest that scaling up aid to the WASH sector can help improve child health outcomes in the country.
Topic:: Health, Humanitarian Aid, Water, Sanitation, and Child Care
Political Geography:: Uganda and Africa

7. Inequality in Chile: Perceptions and Patterns

Author:: Ignacia Lecaros, Daniela Paz Cruzat, Ricardo Pommer Muñoz, Pablo Tillan, and Michael Walton
Publication Date:: 09-2023
Content Type:: Working Paper
Institution:: The John F. Kennedy School of Government at Harvard University
Abstract:: Chile has pioneered many things: a market-oriented, “neoliberal” approach to development; an impressive transition from authoritarianism to democracy; innovations in social policy; and an extraordinary series of street protests between 2006 and 2019. While often lauded as a model of economic and social development, the protests reflect acute concerns over perceived failures in the Chilean political, economic and cultural system, concerns that were profoundly inflected with issues of inequality and lack of fairness. To inform this contrast, this paper undertakes a systematic assessment of the perceptions and perspectives of Chilean citizens, both in the context of the protests and in their broader expressed views in surveys. The core theme is that “the street was right”, in the specific sense that the protests reflected much wider sentiments across social classes over perceived inequities in economic advancement, social provisioning, and the undignified “treatment” by state actors and elites. The paper then compares these perceptions with some of the “objective” measures of inequality. While alternative measures indicate modest declines in some measures of inequality, Chile remains a very high inequality society, in relation to income, wealth, and education. These perceptions and patterns are central to Chile’s current development challenges, in ways that resonate with the position of many countries in today’s polarized environment. This is the first of two papers, with the sequel exploring the underlying drivers of inequality and implications for policy direction.
Topic:: Education, Health, Inequality, Protests, State, Perception, and Fairness
Political Geography:: South America and Chile

8. Activating Spaces, Scaling Up Voices: Community-based Monitoring and Planning of Health Services in Maharashtra, India

Author:: Abhay Shukla, Shweta Marathe, Deepali Yakkundi, Trupti Malti, and Jonathan Fox
Publication Date:: 06-2023
Content Type:: Working Paper
Institution:: Accountability Research Center (ARC), American University
Abstract:: From 2007, the Indian government’s National Health Mission (NHM) supported civil society networks to carry out large-scale participatory monitoring to improve health service access and quality under the Community-based Monitoring and Planning (CBMP) program. In the state of Maharashtra, this social accountability initiative endured more than a decade and a half, despite constraints and unpredictable government funding. The CBMP program in Maharashtra supported state-wide civil society networks to enable active citizen participation in health oversight committees. It was rooted in a broad network of diverse community-based organizations and civil society organizations that work with socially excluded communities, led by Support for Advocacy and Training to Health Initiatives (SATHI). The CBMP network combined many social accountability tools into a multilevel strategy, using community assessments of health services and local meetings with clinic staff to inform problem-solving efforts at local, district, and state levels of the health system. This government-funded civil society initiative worked with local officials to convene public dialogues and to activate previously dormant official oversight bodies, animated by a parallel network of autonomous monitoring committees. This Working Paper presents SATHI’s analysis of the CBMP program’s strategy and institutional dynamics, and documents its lasting effects on two participatory oversight institutions: Village Health, Sanitation, and Nutrition Committees (VHSNCs)—part of local government, and Rogi Kalyan Samitis (Patient Welfare Committees)—part of the health system. Field research, carried out shortly before the pandemic, compared the activation of these hybrid oversight bodies in areas with and without a legacy of intensive CBMP action. Key findings include: Official participatory spaces for citizen engagement with the health system were much more active in districts where CBMP networks had intensively promoted grassroots capacity for voice. Frontline health system responsiveness to issues that could be addressed locally—identified as ‘CBMP-sensitive’—was very high. But the health system’s degree of responsiveness to problem-solving efforts decreased at higher levels. The period of intensive CBMP effort to build grassroots awareness and capacity was limited to six years. Nevertheless, that effort had lasting effects on the levels of activity of local hybrid health oversight bodies. The pandemic revealed additional evidence of the medium-term survival and institutional impact of CBMP-enabled social networks.
Topic:: Civil Society, Health, Governance, Accountability, Community, Monitoring, Planning, Monitoring, and and Evaluation (PME)
Political Geography:: South Asia and India

9. A lockdown a day keeps the doctor away: The effectiveness of non-pharmaceutical interventions during the Covid-19 pandemic

Author:: Anthonin Levelu and Alexander Sandkamp
Publication Date:: 05-2022
Content Type:: Working Paper
Institution:: Kiel Institute for the World Economy (IfW)
Abstract:: Countries have employed a variety of non-pharmaceutical interventions (NPIs) in order to curtail the COVID-19 pandemic. However, the success of individual measures in reducing the number of infections remains controversial. This paper exploits a panel data set of 107 countries to estimate the effects of 14 NPIs on the spread of the disease. While almost all measures had a dampening effect on the reproduction rate of the virus, public information campaigns and school closings were most effective, followed by testing policies, contact tracing and international travel restrictions. Public event cancellation and school closings were less effective during the second wave of the pandemic, while public information campaigns and the obligation to wear masks worked better. Several NPIs had a stronger impact on infections in autocratic countries, while others were less effective.
Topic:: Health, Economy, Public Policy, Public Health, and COVID-19
Political Geography:: Global Focus

10. Planetary Health: Reflections from Asia

Author:: Margareth Sembiring
Publication Date:: 06-2022
Content Type:: Working Paper
Institution:: Centre for Non-Traditional Security Studies, S. Rajaratnam School of International Studies
Abstract:: Planetary Health is a concept that advocates the care of the planet for human own survivability. It underscores the health implications of environmental degradation brought about by human activities and development progress, and calls for a systemic approach that considers and addresses socio-environmental trade-offs of certain policy and/or economic objectives. In view of multiple crises that have been happening in recent years – from the COVID-19 pandemic to the war in Ukraine – which have further negatively affected the environment, understanding how Planetary Health can be applied to address continuing environmental decline is critical. Planetary Health is a relatively new term in Asia. Drawing from the discussions in the 6th NTS-Asia Consortium Annual Conference in April 2022, this NTS Insight maps the different ways Indonesia, India, Bangladesh, Japan, and China engage Planetary Health in their specific contexts. The interpretations of the concept are likely to influence the trajectory of its implementation.
Topic:: Health, International Cooperation, Recovery, Pandemic, and COVID-19
Political Geography:: Asia

11. Is Doughnut Economics a Means Towards Achieving Planetary Health?

Author:: Jonathan Ramakrishna
Publication Date:: 11-2022
Content Type:: Working Paper
Institution:: Centre for Non-Traditional Security Studies, S. Rajaratnam School of International Studies
Abstract:: With the advent of climate change, the global focus is no longer lingering alone on climate change mitigation and has shifted towards climate adaptation as well. The 2015 Paris Agreement’s target of restricting the average temperature rise in the 21st century to well below two degrees Celsius compared to pre-industrial levels is increasing unlikely, given the inaction of states and the global lack of progress in meeting Paris Agreement goals. As nations scramble to meet Nationally Determined Contributions (NDCs) and effectively design climate policies, the global crisis has given rise to a new domain, Planetary Health. Planetary Health, an interdisciplinary field, is described as a solutions-focused discipline which aims to analyse, mitigate, and resolve human disruption to Earth’s natural systems in the new Anthropocene epoch. The Anthropocene epoch, on the other hand, is established as a geological climate where human activity is drastically altering earth’s systems to an extent that will be reflected in fossil records. Planetary Health inextricably links human health to the health of the planet and illustrates the interdependency of the two, and this relationship has been substantiated by findings which concur that countries with higher ecological threats concurrently experience greater social vulnerability. When climate-induced disasters occur due to human action, there are subsequent consequences on food, water, energy, and human security. The consequences are disproportionately felt by vulnerable communities in states that lack resources and capabilities to address the consequent impacts on human security, and climate instability is a driving force behind political instability. Thus, there is cause for concern not only for the planet’s health but also for human health as the environment’s health continues to dwindle in the Anthropocene Epoch. As such, the concept of Planetary Health is a response to threatened climate security and human security.
Topic:: Economics, Health, International Cooperation, and Strategic Stability
Political Geography:: Global Focus

12. Consumption of New and Emerging Tobacco and Nicotine Products in Zambia: Implications for Policy

Author:: Shimukunki Manchishi, Edna Kabala, and Mulenga Chonzi Mulenga
Publication Date:: 04-2022
Content Type:: Working Paper
Institution:: Zambia Institute for Policy Analysis and Research (ZIPAR)
Abstract:: The global economy has in recent years observed a rapid increase in the consumption of New and Emerging Tobacco and Nicotine Products (NETNPs). Consumers of the NETNPs in Zambia and elsewhere justify consumption of these products on grounds that they are less harmful and expose them to fewer health risks compared to traditional tobacco smoke. However, studies have shown that these NETNPs do not entirely filter out harmful chemicals from tobacco as presumed by many people, and in some cases may even expose smokers to more smoke over longer periods of time as is the case of water pipe (shisha). This study investigated the consumption and taxation of NETNPs in Zambia to generate knowledge and come up with evidence-based policy recommendations aimed at informing appropriate stakeholders on the consumption and taxation of NETNPs. The study employed a mixed methodology encompassing a desk review, a survey of 400 respondents and key informant interviews. In terms of the consumption of NETNPs, the study revealed that a majority of those surveyed consume water pipe, which ranked highest among the NETNPs consumed in Zambia. Other NETNPs commonly consumed include bidis, e-cigarettes and dry snuff (nsunko). The consumption of these products varied according to the economic status of the consumers, with products such as snus and e-cigarettes being much more preferred and consumed by those in employment because they can afford more costly products. Meanwhile, products such as water pipe and bidis were the products of choice among those not employed and this could also be attributed to the relatively lower cost of the products. Regarding the socio-demographic characteristics of the surveyed sample, the study established that most of the consumers of NETNPs were young, unmarried males. A notable finding in the study was that those who had attained tertiary level of education were the biggest consumers of NETNPs. With regards to taxation of NETNPs, the study has found that there is potential to increase taxes substantially based on consumers’ willingness to pay which would require very high tax levels to deter consumption. This would require the government to considerably increase excise taxes on these products which would ultimately increase their price and hence curtail their consumption. The study has established that the taxation of all tobacco products in Zambia is the sole responsibility of the ZRA which draws its mandate from various provisions of the Zambian law. Broadly there are eight categories used to classify tobacco and nicotine products based on the HS codes. This broad classification forms the basis for taxation of tobacco and nicotine products in Zambia. The study has established that there are four main taxes applied on tobacco products in Zambia, these include: a 25% customs duty levied on the value of the product imported; a VAT of 16% on the value of the product; a 5% surtax; and excise duty of 145% of the value for duty purposes (VDP) or K355 per kg for all tobacco products.
Topic:: Health, Digital Economy, Business, Tax Systems, Public Policy, Tobacco, Public Health, and Gender
Political Geography:: Africa and Zambia

13. An Ambitious USG Advanced Commitment for Subscription-Based Purchasing of Novel Antimicrobials and Its Expected Return on Investment

Author:: Rachel Silverman and Adrian Towse
Publication Date:: 11-2022
Content Type:: Working Paper
Institution:: Center for Global Development
Abstract:: Antimicrobial drugs form the backbone of modern medicine. Yet their lifespan is naturally limited; over time, use of these drugs selects for mutations that survive exposure to those same drugs, driving “antimicrobial resistance,” or AMR. Already, drug-resistant infections kill an estimated 35,000 Americans and 1.27 million global citizens every year. In the absence of sufficient research and development (R&D) investment for new antimicrobials, deaths from drug-resistant infections could increase dramatically in the coming decade. However, the R&D pipeline for new antimicrobials remains sparse, constrained by an array of market failures that prevent private companies from capturing a sufficient private return on investment (ROI) despite the very high social value of new antimicrobials. Widespread recognition of these market failures among experts and policymakers has driven a search for creative solutions, and generated enthusiasm for the use of pull mechanisms which could help incentivize antibiotic development. One particularly promising pull approach—so-called “subscription models”—would offer guaranteed annual payments to successful antibiotic developers delinked from sales volumes. A subscription approach is included in the pending PASTEUR Act, which is legislation introduced by lawmakers in the US House of Representatives and Senate and endorsed in President Biden’s 2023 budget request. In this paper, we consider the expected return on investment for such a program—that is, an ambitious new program to incentivize antibiotic development via a US government subscription-based pull mechanism (though not necessarily the PASTEUR Act, per se). We construct an illustrative subscription program from first principles, with parameters drawn (where possible) from the literature and some simplifying and deliberately conservative assumptions about program design and remuneration. We model the 10- and 30-year costs and benefits of such an initiative, both from the US domestic perspective and from a global welfare perspective. We find that the program is likely to generate a very high social ROI in both the short and long-term. From the US domestic perspective—considering both the value of averted death/disease and associated hospital costs—ROI is calculated at 6:1 over a 10-year time horizon and 28:1 over a 30-year time horizon. From the global perspective—exclusively considering the health value of DALYs (Disability Adjusted Life Years) averted—ROI grows to 27:1 over a 10-year time horizon and 125:1 over the full 30-year program duration. Sensitivity analysis suggests that the overall high returns are robust under a wide variety of alternative assumptions and scenarios. Based on these high social returns, we encourage the US Congress to urgently finance and authorize a subscription program for new antimicrobials, with particularly consideration for the PASTEUR Act.
Topic:: Health, Science and Technology, Innovation, and Medicine
Political Geography:: North America and United States of America

14. The Next Game Changers: A Priority Innovation Agenda for Global Health

Author:: Cordelia Kenney and Rachel Silverman
Publication Date:: 10-2022
Content Type:: Working Paper
Institution:: Center for Global Development
Abstract:: Over the last century, scientific and technological innovation has led to unprecedented improvements in health outcomes—yet research and development (R&D) investments and progress to address health threats has been uneven. Commercial R&D has focused where investors can expect substantial financial returns: rich countries, the diseases that affect them, and high-tech solutions designed for the richest and most sophisticated systems. Despite supplemental funding from philanthropic and government grants, R&D to address many leading causes of death and disability—especially those that primarily affect low- and middle-income countries (LMICs) or insure against future risk—has been consistently underfunded relative to potential health gain. This implies that many untapped opportunities remain to dramatically improve global health and welfare via biomedical innovation. In this paper, we report the results of a horizon-scanning exercise to source opportunities for global health R&D investment—that is, high-value potential biomedical innovations which are currently underfunded but which could be transformative for health, quality of life, and health security in LMICs and around the world. Drawing from a literature review and expert interviews with researchers, economists, funders, advocates, and implementers, we lay out an expansive and high-promise (though non-comprehensive) biomedical innovation agenda for global health spanning the unfinished MDG agenda; non-communicable diseases; and global health security. We conclude with a discussion of implications for research, funding, and practice.
Topic:: Development, Health, Science and Technology, Innovation, and Emerging Technology
Political Geography:: Global Focus

15. Prioritizing Public Spending on Health in Lower-Income Countries: The Role of the Global Financing Facility for Women, Children and Adolescents

Author:: Janeen Madan Keller, Rachel Silverman, Julia Kaufman, and Amanda Glassman
Publication Date:: 12-2022
Content Type:: Working Paper
Institution:: Center for Global Development
Abstract:: The Global Financing Facility (GFF), launched in 2015, is a partnership backed by a multi-donor World Bank trust fund that aims to “prioritize and scale-up evidence-driven investments to improve reproductive, maternal, newborn, child, and adolescent health and nutrition (RMNCAH-N) interventions” in low- and lower middle-income countries. A major component of the GFF’s operational model is centered around the investment case, described by the GFF as “a description of the changes that a country wants to see with regard to reproductive, maternal, newborn, child, and adolescent health (RMNCAH) and a prioritized set of investments required to achieve these results.” Looking retrospectively at investment cases and associated ongoing World Bank operations, this paper aims to shed light on specific aspects of the GFF’s operating model, approach, theory of change, and results to date related to the “development of a costed and prioritized investment case,” and whether the investment case helps to prioritize public spending on health in the real world. The portfolio-wide findings suggest that the GFF delivers a clear value-add within the global health architecture by directing more funding to flow directly through governments via increased World Bank lending for RMNCAH-N (especially in the context of COVID-19-related service disruptions and fiscal contractions). The role of the investment case in aligning and prioritizing resources behind a consensus set of highest-value RMNCAH-N interventions within a specific funding envelope is less well documented in the public domain; GFF efforts to directly influence government RMNCAH-N spending decisions and their efficiency seem to occur primarily through follow-on resource mapping and expenditure tracking. The paper concludes with three recommendations for the GFF and its donors: (1) pursue a deliberate strategy for prioritization of RMNCAH-N services and products within the realistic budget constraint to advance evidence-based decisions on certain trade-offs; (2) increase transparency and public visibility into GFF-supported activities and funding, especially related to RMNCAH-N product procurement and overall resource tracking; and (3) explore incentives for increased donor co-financing within the framework of World Bank projects as a strategy to pool and channel more resources through government coffers.
Topic:: Health, Children, Women, Public Spending, and Gender
Political Geography:: Global Focus

16. Social Policy Expansion and Retrenchment After Latin America’s Commodity Boom

Author:: Sara Niedzwiecki and Jennifer Pribble
Publication Date:: 05-2022
Content Type:: Working Paper
Institution:: Kellogg Institute for International Studies
Abstract:: The literature on social policy expansion and retrenchment in Latin America is vast, but scholars differ in how they explain the outcomes, arriving at different conclusions about the role of democracy, left parties, favorable economic conditions, and social movements in shaping reform. What can welfare state developments since the end of the commodity boom teach us about the theoretical power of these arguments? This paper engages this question, seeking to explain recent incidents of social policy reform in 10 presidential administrations in Argentina, Brazil, Chile, and Uruguay. Using a combination of crisp-set qualitative comparative analysis (csQCA) and case studies, we identify multiple paths toward social policy expansion and retrenchment that involve the absence and presence of electoral competition, economic resources, party ideology and linkage mechanism, social movement pressure, international pressure, and legacies. The results show that while both parties of the left and right expanded social programs, only the right engaged in retrenchment, yet partisanship alone is insufficient for explaining reform outcomes, as the variable must appear in combination with other factors depending on the party’s linkage mechanism. The results provide new insight into the politics of social policy reform in Latin America, showing the relevance of complex forms of causality.
Topic:: Health, Poverty, Social Movement, Democracy, Inequality, Public Policy, and Political Parties
Political Geography:: Brazil, Argentina, South America, Uruguay, Latin America, and Chile

17. Does an effective government lower COVID19’s health impact? Evidence from Viet Nam

Author:: Duc Anh Dang and Ngoc Anh Tran
Publication Date:: 06-2022
Content Type:: Working Paper
Institution:: United Nations University
Abstract:: Government effectiveness has played an important role in tackling the crisis caused by the coronavirus (COVID-19) pandemic. This paper discusses the different aspects of government effectiveness in explaining the variation in the COVID-19 confirmed cases and death levels in Viet Nam. We use the Provincial Governance and Public Administration Performance Index in 2019 to measure the quality of government effectiveness at the local level. The findings show the importance of health system capacity in the battle against COVID-19. We find that increased government transparency is significantly associated with lower confirmed rates. For the impact of the level of participation, we find that provinces that have higher quality of village head elections or where people have more opportunities to participate tend to have lower infected cases, especially where people participate in the formal and informal association and have voted in the National Assembly election.
Topic:: Government, Health, Pandemic, and COVID-19
Political Geography:: Vietnam and Southeast Asia

18. Health and ethnic inequalities in Mozambique with special reference to leprosy

Author:: Isabel Maria Casimiro and Júlio Machele
Publication Date:: 05-2022
Content Type:: Working Paper
Institution:: United Nations University
Abstract:: The subject of this paper is health and ethnic inequalities in Mozambique, with special reference to leprosy. It is argued that the health policies and strategies adopted in the colonial and post-colonial periods led to an unequal distribution not only of certain diseases but also of health infrastructures. The colonial regime, by neglecting and creating ineffective leprosaria in central and northern Mozambique, ‘ethnicized’ Lazarus disease, a fact corroborated by its current unequal distribution. In turn, post-colonial health policies and health coverage failed to take this inequality into account. The current National Leprosy Control Program aims to end leprosy and thus eliminate its identification with the ethnolinguistic groups in northern and central Mozambique. This qualitative study, which draws on reports from the Ministry of Health and NGOs, statistics, and observations, falls within the scope of the social sciences, with an emphasis on the comparative historical-sociological method.
Topic:: Health, Inequality, Ethnicity, and Leprosy
Political Geography:: Africa and Mozambique

19. ‘Peace through Health’ in the Israeli-Palestinian conflict: Ground for dialogue or guise for continued occupation?

Author:: Yotam Rosner
Publication Date:: 05-2022
Content Type:: Working Paper
Institution:: Mitvim: The Israeli Institute for Regional Foreign Policies
Abstract:: “Peace through Health” is a theoretical and applied approach that sees humanitarian health initiatives as a primary basis for dialogue and cooperation between adversaries. This approach posits that health initiatives can spawn increased discourse and dialogue between parties to a conflict, build trust and promote cooperation on various issues, eventually facilitating the transition from conflict to peace. Based on interviews with representatives of an Israeli human rights organization that provides health services in the Occupied Territories, this article examines the implementation of the “peace through health” approach in the Israeli-Palestinian conflict. Under the Oslo Accords, Israel handed responsibility for the health of the Palestinian population to the Palestinian Authority (PA).However, continued Israeli control and absence of full Palestinian sovereignty have resulted in a weakened and poor Palestinian health system. The severe shortage of health resources has created growing Palestinian dependence on local and international humanitarian health organizations, including health professionals from the Israeli side. An analysis of the interviews conducted for this article indicates that the humanitarian assistance by Israeli health professionals provides an opportunity to develop dialogue, achieve logistical cooperation, and establish trust between the peoples.At the same time, the article discusses the possible disadvantages of this approach in the Israeli-Palestinian test case as an example of humanitarian work that fosters normalization and preserves the status quo of occupation.
Topic:: Health, Occupation, Conflict, Peace, and Dialogue
Political Geography:: Middle East, Israel, and Palestine

20. COVID-19 in the European Union: health impacts and effects on economic activity

Author:: Leonardo Cadamuro, Scott Marcus, and Francesco Papadia
Publication Date:: 07-2022
Content Type:: Working Paper
Institution:: Bruegel
Abstract:: This paper quantitatively describes different aspects of the COVID-19 pandemics: new cases, hospitalisations, intensive-care admissions and deaths, while illustrating their changing relationships over time. It then assesses how the different variables have affected relevant sectoral and macroeconomic indicators. Finally, it concludes that, from an economic perspective, what matters when it comes to managing the pandemic is to prevent intensive-care admissions and deaths arising from COVID-19. The success of vaccination should be measured in terms of its ability to prevent the most serious consequences, rather than its ability to prevent infections and hospitalisations.
Topic:: Health, European Union, Economy, Macroeconomics, and COVID-19
Political Geography:: Global Focus

21. Radioactive Consequences of a War in Ukraine

Author:: Rico Chandra
Publication Date:: 02-2022
Content Type:: Working Paper
Institution:: Council on International Policy (CIP)
Abstract:: A war in Ukraine could lead to thousands of radioactive sources getting lost, or worse, getting stolen and repurposed for political destabilization. So what is a radioactive “source”? It is a material that is specifically manufactured for the purpose of emitting radiation. For example, some forms of cancer are treated using radiotherapy whereby intense gamma radiation, emitted from a pencil-sized lump of radioactive metal, is directed at the tumor. This lump of highly radioactive metal is a radioactive “source”.
Topic:: Health, Military Strategy, Radiological Weapons, and Russia-Ukraine War
Political Geography:: Russia, Europe, and Ukraine

22. Heroes on Strike: Trends in Global Health Worker Protests During COVID-19

Author:: Sorcha A. Brophy, Veena Sriram, Haotian Zong, Chloei Andres, Maria Paz Mawyin, and Narayanan GL
Publication Date:: 04-2022
Content Type:: Working Paper
Institution:: Accountability Research Center (ARC), American University
Abstract:: This Accountability Note describes global trends in health worker protests between March 11, 2020 and March 10, 2021. We argue that the frequent characterization of health workers as heroes of the pandemic obscures the fact that health workers themselves describe the challenges they face during this time as violations of their rights as workers, highlighting the obligations of their employers to provide working conditions and remuneration that justify the risk they assume. Using data from the Armed Conflict Location & Event Data (ACLED) Project, we first provide a global overview of the growth in health worker protest activity in the March 2020–2021 period as compared to the March 2019–2020 period. Health workers engaged in protest activity with greater frequency during the first year of the pandemic than during the prior year. The eighty-five countries included in the ACLED data set in both the March 2019–2020 period and the March 2020–2021 period experienced a sixty-two percent increase in health worker protest activity (from 2416 protests to 3913 protests). We then provide an overview of the content of the 6589 health worker protests in the ACLED dataset between March 2020 and March 2021, describing protests in 149 countries in terms of five categories: working conditions and remuneration, resources, health system delivery issues, public policy, and other. By far, the largest category of protests during this period are those related to working conditions and remuneration. Approximately sixty-six percent (N=4358) of global protests in the 2020–2021 period expressed health worker dissatisfaction about issues such as: occupational hazards, unpaid wages, risk allowances and job security. Surprisingly, personal protective equipment (PPE) concerns—an issue covered frequently in the media—motivated a relatively low percentage of the protests (less than nine percent). We note this not to downplay the gravity of global PPE shortages, but to situate PPE shortages as one among many health worker concerns during the pandemic. Protests initiated by health workers about health system delivery issues provide an important reminder that even in the middle of a pandemic, not everything was about COVID-19. Sixty-two percent of the health system-related protests during the 2020–2021 period were about issues that were not coded as directly related to the COVID-19 pandemic. Similarly, the vast majority of health workers’ protests around public policy were not about pandemic-related government policy, but about social issues like climate change, immigration, police brutality, and elections. The aim of this analysis is to understand what health workers advocated for during a time of immense pressure, and to identify some broad areas of concern for health sector accountability. Through this analysis, we prepare the groundwork for future research and action, and share preliminary guidance regarding how health sector stakeholders—including government, health worker associations, unions, and civil society—might develop improved systems of accountability.
Topic:: Health, Protests, Crisis Management, and COVID-19
Political Geography:: Global Focus

23. The Environmental Impact of Syria’s Conflict: A Preliminary Survey of Issues

Author:: Roba Gaafar
Publication Date:: 04-2021
Content Type:: Working Paper
Institution:: Arab Reform Initiative (ARI)
Abstract:: The Syrian conflict has had devastating human and economic consequences, but it also greatly damaged the environment in the country. This paper provides a preliminary survey of a set of environmental challenges that impose significant health, social and economic costs, including air pollution, deforestation, soil and vegetation degradation, and water depletion, and suggests green solutions for post-conflict relief and reconstruction.
Topic:: Climate Change, Environment, Health, Conflict, Green Technology, and Pollution
Political Geography:: Middle East and Syria

24. Mental Health Reforms in Lebanon During the Multifaceted Crisis

Author:: Sara Catherine Mourani and Marie-Christine Ghreichi
Publication Date:: 09-2021
Content Type:: Working Paper
Institution:: Arab Reform Initiative (ARI)
Abstract:: Multiple disasters over the past two years have greatly harmed the mental health of the Lebanese population. Despite a long history with political turmoil, discussing mental health in Lebanon remains culturally taboo. Responses to mental health remain under-supported and challenges surrounding this sector will be critical in Lebanon’s transition out of the crisis. This paper seeks to investigate the current state of the mental health system in Lebanon and provides policy recommendations to improve its adaptability in responding to the multifaceted crisis the country is currently experiencing.
Topic:: Health, Reform, Mental Health, and Health Crisis
Political Geography:: Middle East and Lebanon

25. Did Alcohol Policy Really Cause the Postsocialist Mortality Crisis? Revisiting the Rebound and Affordability Hypotheses

Author:: Aytalina Azarova, Gabor Scheiring, Michael Ash, and Lawrence King
Publication Date:: 04-2021
Content Type:: Working Paper
Institution:: Political Economy Research Institute (PERI), University of Massachusetts Amherst
Abstract:: This paper reexamines the argument that alcohol policies were the major factor behind the mortality crisis in postsocialist Russia. We show that the correlation between the Gorbachev anti-alcohol campaign (rebound hypothesis), alcohol prices in the 1990s (affordability hypothesis), and mortality reported in previous analyses is not robust to splitting oblasts into Far- East and the rest of Russia. Our analysis conducted on a sample of 534 towns in the European part of Russia also finds no robust evidence supporting the two hypotheses. In contrast, findings linking privatization to mortality are robust to controlling for the anti-alcohol campaign and the affordability of alcohol.
Topic:: Health, Political Economy, Mortality, Alcohol, and Affordability
Political Geography:: Russia and Soviet Union

26. China’s Improvised Mask Diplomacy in Chile

Author:: Urdinez. Francisco
Publication Date:: 04-2021
Content Type:: Working Paper
Institution:: Carnegie Endowment for International Peace
Abstract:: During the pandemic, Chinese medical and equipment supplies to Chile have come mostly from a diverse cast of Chinese players with local experience in Chile. They adapted to Chile’s unique system of emergency and disaster management. China has become a global power, but there is too little debate about how this has happened and what it means. Many argue that China exports its developmental model and imposes it on other countries. But Chinese players also extend their influence by working through local actors and institutions while adapting and assimilating local and traditional forms, norms, and practices. With a generous multiyear grant from the Ford Foundation, Carnegie has launched an innovative body of research on Chinese engagement strategies in seven regions of the world—Africa, Central Asia, Latin America, the Middle East and North Africa, the Pacific, South Asia, and Southeast Asia. Through a mix of research and strategic convening, this project explores these complex dynamics, including the ways Chinese firms are adapting to local labor laws in Latin America, Chinese banks and funds are exploring traditional Islamic financial and credit products in Southeast Asia and the Middle East, and Chinese actors are helping local workers upgrade their skills in Central Asia. These adaptive Chinese strategies that accommodate and work within local realities are mostly ignored by Western policymakers in particular. Ultimately, the project aims to significantly broaden understanding and debate about China’s role in the world and to generate innovative policy ideas. These could enable local players to better channel Chinese energies to support their societies and economies; provide lessons for Western engagement around the world, especially in developing countries; help China’s own policy community learn from the diversity of Chinese experience; and potentially reduce frictions.
Topic:: Diplomacy, Disaster Relief, Health, Pandemic, and COVID-19
Political Geography:: China, Asia, South America, and Chile

27. Reducing mobility of SARS-CoV-2 variants to safeguard containment

Author:: Martin Hellwig, Viola Priesemann, and Guntram Wolff
Publication Date:: 05-2021
Content Type:: Working Paper
Institution:: Bruegel
Abstract:: Escape variants can cause new waves of COVID-19 and put vaccination strategies at risk. To prevent or delay the global spread of these waves, virus mobility needs to be minimised through screening and testing strategies, which should also cover vaccinated people. The costs of these strategies are minimal compared to the costs to health, society and economy from another wave.
Topic:: Health, Governance, Global Political Economy, Vaccine, and COVID-19
Political Geography:: Global Focus

28. COVID-19 in Africa: The implications for macroeconomic and socioeconomic dimensions

Author:: Mma Amara Ekeruchera
Publication Date:: 04-2021
Content Type:: Working Paper
Institution:: Centre for the Study of the Economies of Africa (CSEA)
Abstract:: The COVID-19 outbreak began in December 2019 in the Wuhan city of China and has continued to spread globally. As of this writing, 28.2 million cases have been recorded globally with 910,000 deaths. Aside the health impact, the pandemic has led to an unprecedented disruption in economic activities, initiating a sudden demand, supply, and financial shock. The mitigation strategies put in place by governments across the world to curb the virus as well as the uncertainty associated with the pandemic has led to a reduction in the consumption of non-essential commodities. Meanwhile, disruptions to global supply chains in a closely connected world as well as the reduced demand have necessitated a slowdown in production. Furthermore, investors have become more risk averse with the prices of risk assets falling to levels experienced in the 2007-20008 global financial crisis. To counteract the fall in private sector demand, stabilize the financial system, and ensure economic recovery, governments and central banks across the world have deployed a range of policies and programmes. Central banks are cutting policy rates and providing direct liquidity to the financial system. Federal and sub-national governments are providing tax relief, cash transfers, and employee retention schemes to alleviate the burden on affected individuals and businesses. Africa is not left behind as governments have increased spending plans (about 1.9% of their GDP) and central banks are adopting more accommodating monetary policies.
Topic:: Economics, Health, Monetary Policy, Central Bank, Macroeconomics, Pandemic, COVID-19, Socioeconomics, and Supply Chains
Political Geography:: Africa

29. ASEAN Matters for America/America Matters for ASEAN

Author:: East-West Center
Publication Date:: 12-2021
Content Type:: Working Paper
Institution:: East-West Center
Abstract:: This project maps the trade, investment, employment, business, diplomacy, security, education, tourism, and people-to-people connections between the United States and the 10 member states of the Association of Southeast Asian Nations (ASEAN) at the national, state, and local levels. Part of the Asia Matters for America initiative, this publication, the one-page connections summaries for states, and the AsiaMattersforAmerica.org website are resources for understanding the robust and dynamic US-ASEAN relationship.
Topic:: Defense Policy, Agriculture, Diplomacy, Health, and Infrastructure
Political Geography:: Asia, North America, Southeast Asia, and United States of America

30. Meeting the Global Health Challenge to Reduce Death and Disability from Alcohol, Tobacco, and Sugar-Sweetened Beverage Consumption with Corrective Taxes

Author:: Chris Lane and Vinayak Bhardwaj
Publication Date:: 11-2021
Content Type:: Working Paper
Institution:: Center for Global Development
Abstract:: Behind the daily trauma of COVID-19 lies a larger and longer-lasting global health challenge resulting from the consumption of tobacco, alcohol, and sugar-sweetened beverages. Using a sample of 25 large advanced and emerging market economies accounting for three-quarters of global GDP, we show that about 60 million productive life years were lost every year in 2000, 2010, and 2019 from death and disability attributable to alcohol, tobacco, and diets high in sugar-sweetened beverages. Using the cost-of-illness framework, the economic value of these lost productive years in 2019 is approximately $2.1 trillion in our country sample (in 2017 purchasing power parity dollars [PPP$]). We show that over a 20-year period, a higher tax effort is associated with larger reductions in economic costs. We also show that total corrective taxes for all the products under investigation fall far short of the indirect costs of consumption in all countries. We conclude that all advanced economies and emerging markets could reap substantial macroeconomic benefits from better health by raising corrective taxes on alcohol and tobacco and by introducing corrective taxes on sugar-sweetened beverages.
Topic:: Health, Disability, Tax Systems, Health Crisis, and Addiction
Political Geography:: Global Focus

31. Exploring How the US International Development Finance Corporation Can Support Health Sector Investments: Is the Glass Half Full or Half Empty?

Author:: Julia Kaufman, Janeen Madan Keller, and Rachel Silverman
Publication Date:: 07-2021
Content Type:: Working Paper
Institution:: Center for Global Development
Abstract:: Health sector investments present an opportunity for the US International Development Finance Corporation (DFC), under the Biden-Harris administration, to demonstrate meaningful global leadership and refocus on its development mandate, driving broader health benefits and contributing to global economic recovery. DFC’s early days have been defined by a mixed record, notably in the health sector. Still, in the context of the pandemic’s health and economic impacts, the agency is well positioned to help strengthen pandemic preparedness and expand equitable access to health products and innovation in low- and middle-income countries. Through investments to build private sector manufacturing and delivery capacity, DFC can help stem and reverse these losses and insure against future health crises. This policy paper explores how DFC can strategically invest in health while balancing sometimes competing policy imperatives related to health equity, commercial viability, and foreign policy interests. We first provide an overview of the development finance landscape in the health sector and select DFC health-focused investments to date. We then suggest three high-impact engagement opportunities in the health sector for DFC to consider, including building regional manufacturing hubs for health supplies; providing R&D incentives for biotechnology; and supporting robust supply chains for health-adjacent services and delivery models. Lastly, we outline key principles to guide future DFC health sector investments, such as compatibility with long-term universal health coverage goals, a learning agenda for development effectiveness, and health-specific considerations for additionality and co-financing.
Topic:: Development, Health, Finance, and Investment
Political Geography:: North America and United States of America

32. Therapeutic Communities in Brazil

Author:: Mauricio Fiore and Taniele Rui
Publication Date:: 06-2021
Content Type:: Working Paper
Institution:: Social Science Research Council
Abstract:: Spread across Brazil and attaining an unparalleled political force, therapeutic communities are as inescapable in the debate on drug policy as they are complex to define. Although they are not a Brazilian creation, they have been operating in that country for decades, and their dissemination intensified in the 1990s. In 2011, they were officially incorporated into Brazil's Psychosocial Care Network (Rede de Atenção Psicossocial, or RAPS). Since then, therapeutic communities have been at the center of public debates about their regulation; about how they should—or even if they should—be a part of the healthcare system; about the level of supervision to which they should be submitted; about their sources of funding, particularly whether or not they should have access to public funding; and, most importantly, about the quality of the services they offer and the many reports of rights violation that have been made public. However, a well-informed public debate can only flourish if the available information is based on sound evidence. The SSRC’s Drugs, Security and Democracy Program is concerned with the policy relevance of the research projects it supports, and the debate around therapeutic communities in Brazil points to a clear need for impartial research that addresses different cross-cutting aspects of this topic in its various dimensions: legal, regulatory, health, and observance of human rights, among others. It is in this context that we publish this working paper series on therapeutic communities in Brazil. The eight articles that compose this series offer a multidisciplinary view of the topic, expanding and deepening the existing literature and offering powerful contributions to a substantive analysis of therapeutic communities as instruments of public policy. Although they can be read separately, it is as a whole that the strength of the eight articles that make up this series becomes more evident. Even though they offer different perspectives, they are complementary works in—and already essential for—delineating and understanding the phenomenon of therapeutic communities in Brazil.
Topic:: Health, Health Care Policy, Domestic Policy, and Community
Political Geography:: Brazil and South America

33. A “Hidden Front” in the Battle Against COVID-19: How Behavioral Data is Helping Contain the Pandemic and Improve Policy

Author:: Paul von Chamier and Neil Martin
Publication Date:: 11-2021
Content Type:: Working Paper
Institution:: Center on International Cooperation
Abstract:: COVID-19 has provided a sharp reminder of the key role citizens’ perceptions and attitudes play in shaping the outcomes of public policy. This experience is changing the way governments use data to combat the pandemic and set priorities for the recovery.
Topic:: Health, Recovery, Data, and COVID-19
Political Geography:: Global Focus

34. Building back better after the COVID-19 pandemic

Author:: Miguel Jaramillo and Bruno Escobar
Publication Date:: 11-2021
Content Type:: Working Paper
Institution:: Group for the Analysis of Development (GRADE)
Abstract:: In this policy-oriented paper, we provide a pre- and post-pandemic socioeconomic analysis of Peru, along with a financially sustainable five-year Building Back Better recovery plan, which emphasizes the urgency of addressing some of the country’s structural weaknesses. We underscore the importance of public investment for this effort, but widen the focus to include current public expenditure, in order to take steps towards building a more universal social protection system. We show that this also contributes to reducing the gender imbalances in the labor market that the pandemic exposed and exacerbated. We provide a financial programming exercise that demonstrates that the plan is financially responsible under a reasonable fiscal rule. Four core ideas stand out from our analysis. Firstly, while public investment can be key to reigniting economic growth, it does not go very far in tackling structural weaknesses. Secondly, public spending in health can actually achieve this from two fronts: by beginning to build a universal access social protection system and by addressing gender imbalances in the labor market. Thirdly, focusing public discussion on social protection enables a broader approach to policy reform by including formal employment and productivity enhancing reforms, which are essential for the sustainability of a broad social protection system. Finally, we also show that the sector mix in public investment has an impact on employment results, both in terms of the volume of jobs generated and their gender composition.
Topic:: Health, Inequality, COVID-19, Socioeconomics, Public Spending, and Gender
Political Geography:: South America and Peru

35. Building Resilient Health Systems: Experimental Evidence from Sierra Leone and the 2014 Ebola Outbreak

Author:: Bilal Siddiqi, Maarten Voors, Johannes Haushofer, Oeindrila Dube, and Darin Christensen
Publication Date:: 03-2020
Content Type:: Working Paper
Institution:: Empirical Studies of Conflict Project (ESOC)
Abstract:: Developing countries are characterized by high rates of mortality and morbidity. A potential contributing factor is the low utilization of health systems, stemming from the low perceived quality of care delivered by health personnel. This factor may be especially critical during crises, when individuals choose whether to cooperate with response efforts and frontline health personnel. We experimentally examine efforts aimed at improving health worker performance in the context of the 2014–15 West African Ebola crisis. Roughly two years before the outbreak in Sierra Leone, we randomly assigned two accountability interventions to government-run health clinics — one focused on community monitoring and the other gave status awards to clinic staff. We find that over the medium run, prior to the Ebola crisis, both interventions led to improvements in utilization of clinics and patient satisfaction with the health system. In addition, child health outcomes improved substantially in the catchment areas of community monitoring clinics. During the crisis, the interventions also led to higher reported Ebola cases, as well as lower mortality from Ebola—particularly in areas with community monitoring clinics. We explore three potential mechanisms: the interventions (1) increased the likelihood that patients reported Ebola symptoms and sought care; (2) unintentionally increased Ebola incidence; or (3) improved surveillance efforts. We find evidence consistent with the first: by building trust and confidence in health workers, and improving the perceived quality of care provided by clinics prior to the outbreak, the interventions encouraged patients to report and receive treatment. Our results suggest that accountability interventions not only have the power to improve health systems during normal times, but can additionally make health systems resilient to crises that may emerge over the longer run.
Topic:: Health, Infectious Diseases, Health Care Policy, Mortality, Public Health, and Pandemic
Political Geography:: West Africa and Sierra Leone

36. Productivity and Adaptability: Why COVID-19 Has Not Overrun American Hospitals

Author:: Hanns Kuttner
Publication Date:: 11-2020
Content Type:: Working Paper
Institution:: Hudson Institute
Abstract:: Early in the COVID-19 epidemic, many gloomy images emerged of what might be ahead. In one, hospitals would be overrun by more COVID-19 patients than they could treat. Models developed at the Institute for Health Metrics and Evaluation (IHME) provided numbers that supported the image. For the most part, overrun hospitals did not happen. Things turned out better because America’s hospitals did better than the IHME model thought they could. Hospital productivity has proved to be greater than anticipated in the IHME model. Productivity determines how many patients hospitals can serve. Productivity reflects how many beds a hospital has and how many days each patient stays in a bed. The most common pattern in hospitals, patients who are discharged alive and do not require time in an intensive care unit (ICU), provide an example. Length of stay for that group has been a third shorter than assumed in the IHME model. The data required to tell the adaptability story in detail is not yet available. Only a qualitative assessment is possible at this point. Hospitals adapted in ways not anticipated in the IHME model. For example, they delayed elective surgical procedures, freeing up beds. The story will become more detailed as data about hospital admissions and the clinical course of COVID-19 patients becomes available.
Topic:: Health, Science and Technology, Health Care Policy, COVID-19, and Pharmaceuticals
Political Geography:: North America and United States of America

37. Combating China’s COVID-19 Propaganda Offensive to Undermine the United States on the Global Stage

Author:: John Lee
Publication Date:: 03-2020
Content Type:: Working Paper
Institution:: Hudson Institute
Abstract:: Throughout the United States, it is becoming increasingly clear that the Chinese Communist Party (CCP) is exploiting COVID-19 in an effort to reshape the global order and enhance China’s international leadership at the expense of the US. A range of prominent commentators further assert that the Trump administration bears much of the blame for this turn of events. This argument tends to rest on twin assumptions:1 China is winning the battle of narratives when it comes to comparative national competence and its decisiveness in responding to its COVID-19 outbreak. The Trump administration is damaging America’s standing by getting off to a bad start in its response to the pandemic, exposing the underlying weaknesses of American institutions and preparedness for such a crisis. These arguments correctly acknowledge that the global pandemic is occurring within a context of US-China strategic, political, and economic competition and/or rivalry. This is the point of warnings to the administration that there is more at stake than containing and managing the virus, even if that is the immediate priority.
Topic:: International Relations, Foreign Policy, Economics, Health, National Security, and COVID-19
Political Geography:: China and East Asia

38. The Effects of Financial Inclusion on Development Outcomes: New Insights from ASEAN and East Asian Countries

Author:: Rajabrata Banerjee, Ronald Donato, and Admasu Afsaw Maruta
Publication Date:: 09-2020
Content Type:: Working Paper
Institution:: Economic Research Institute for ASEAN and East Asia (ERIA)
Abstract:: This study empirically examines the effects of financial inclusion on economic development, – economic growth, education, health, and income inequality – in 20 Asian countries in the period 2004-2015. The financial inclusion index at an aggregate level is constructed using a hybrid methodology (reported in the previous paper) and we empirically examine its relationship with particular development outcomes. We then disaggregate the index into the three dimensions of financial inclusions – access, usage, and quality – and further into the top two indicators from each dimension based on principal component analysis scores (reported in the previous paper), to examine whether specific dimensions or indicators are more strongly associated with particular development outcomes than with others. Our results show that aggregate financial inclusion has a strong positive effect on all development outcomes and this effect improves for countries with lower political risk. At the dimension level, while usage is the only dimension impacting on economic growth, and access is the only dimension impacting on health outcomes, both usage and access influence education and income inequality. Moreover, the top ranked indicators in each dimension exert a far greater positive influence on development outcomes than the second highest ranked indicators. Our findings show that adopting a single blanket policy may not be appropriate to realise the full potential of financial inclusion in a less developed country. Policy prescriptions should therefore target specific dimension and indicators of financial inclusion to maximise the positive effect on development outcomes.
Topic:: Development, Health, Finance, and Fiscal Policy
Political Geography:: Asia

39. Health Technology Assessment for the US Healthcare System

Author:: Aspen Institute and USC Schaeffer Center For Health Policy & Economics
Publication Date:: 03-2020
Content Type:: Working Paper
Institution:: Aspen Institute
Abstract:: The USC Schaeffer Center for Health Policy & Economics and the Aspen Institute’s Health, Medicine & Society Program have together established an advisory panel to consider how the U.S. can better link the price of health technologies to the benefits they provide to patients while ensuring a sustainable healthcare ecosystem that supports innovation.
Topic:: Health, Science and Technology, Health Care Policy, and Emerging Technology
Political Geography:: North America and United States of America

40. Addressing Antimicrobial Resistance

Author:: Aspen Health Strategy Group
Publication Date:: 04-2020
Content Type:: Working Paper
Institution:: Aspen Institute
Abstract:: In June 2019, the Aspen Health Strategy Group met for three days to explore the topic of antimicrobial resistance. We are pleased to present the final report from our work, based upon the group’s rich discussion. In the tradition of the thought-provoking conversations and dialogue on how to address critical societal issues — the hallmark of the Aspen Institute — the report includes five big ideas to address antimicrobial resistance.
Topic:: Health, Public Health, Resistance, and Medicine
Political Geography:: Global Focus

41. Intended and Unintended Consequences of a New Limit on Working Hours in South Korea: Implications for Precarious Employment

Author:: Sungchul Park and Hansoo Ko
Publication Date:: 06-2020
Content Type:: Working Paper
Institution:: Walter H. Shorenstein Asia-Pacific Research Center
Abstract:: Effective as of July 1, 2018, South Korea set a new cap on employees’ weekly working hours, decreasing the maximum number from 68 to 52. In this study, we comprehensively analyze the effectiveness of the law’s implementation by observing changes in work time, health status, health care utilization, health behavior, monthly expenses, and satisfaction between pre- and post-implementation periods (2014–2017 vs. 2019). We find evidence of both intended and unintended consequences—and, in this last category, some are beneficial and some not. As intended, employees eligible for the 52-hour work week saw their average working hours decrease, while their monthly spending on leisure increased substantially. A beneficial unintended consequence was that work time also decreased in firms with less than 300 employees that had not yet implemented the 52-hour work schedule (they have done so since, in January 2020). Among adverse unintended consequences, the most notable were heterogeneous effects across employment types (full-time vs. precarious employment) and, in particular, negative impacts on precarious employees (that is, those facing relatively high levels of job insecurity). Despite almost no change in their work time, precarious employees saw substantial increases in outpatient visits and monthly expenses for health care, indicating suggestive evidence of adverse health consequences. Another adverse unintended consequence was that overall job satisfaction decreased among several groups of employees. This may reflect a heavy workload among employees still expected to work overtime, especially experienced employees or those working in large firms. While employment rates increased after the new schedule’s implementation, the majority were in precarious jobs. This has negative implications because of the adverse health impacts of being in precarious employment; also, the workload of experienced employees in this field might have intensified amid all the new hiring. Our findings suggest key policy recommendations for how to leverage the benefits of the 52-hour cap on weekly working hours while addressing its negative unintended consequences.
Topic:: Health, Labor Issues, Employment, and Labor Policies
Political Geography:: Asia and South Korea

42. Solutions for the “Vanishing Drug” Conundrum in Lebanon: A Change in the Subsidy System Coupled with a Digital Prescribing Platform

Author:: Nadim El Jamal, Ulfat Usta, Mona Nasrallah, Elie Al-Chaer, Ghassan Hamadeh, and Hussain Isma'eel
Publication Date:: 11-2020
Content Type:: Working Paper
Institution:: Arab Reform Initiative (ARI)
Abstract:: The shortage of foreign currency caused by the multiple crises in Lebanon threatens the availability of pharmaceutical products, with patients experiencing shortages of many drugs despite an importation subsidy system for pharmaceuticals financed by the Central Bank’s foreign reserves. This paper describes Lebanon’s pharmaceutical supply chain and the Central Bank’s subsidy system and proposes recommendations to ensure the continuous availability of medication on pharmacy shelves.
Topic:: Health, Drugs, Medicine, and Pharmaceuticals
Political Geography:: Middle East and Lebanon

43. The safest time to fly: Pandemic response in the era of Fox News

Author:: Maxim Ananyev, Michael Poyker, and Yuan Tian
Publication Date:: 03-2020
Content Type:: Working Paper
Institution:: Nottingham Interdisciplinary Centre for Economic and Political Research (NICEP)
Abstract:: We document a causal effect of conservative Fox News Channel in the United States on physical distancing during COVID-19 pandemic. We measure county-level mobility covering all U.S. states and District of Columbia produced by GPS pings to 15-17 million smartphones and zip-code-level mobility using Facebook location data. Then, using the historical position of Fox News Channel in the cable lineup as the source of exogenous variation, we show that increased exposure to Fox News led to a smaller reduction in distance traveled and smaller increase in the probability to stay home after the national emergency declaration in the United States. Our results show that slanted media can have a harmful effect on containment efforts during a pandemic by affecting people’s behaviour.
Topic:: Health, Media, Journalism, Public Health, Data, and COVID-19
Political Geography:: United States

44. Deindustrialization and Deaths of Despair: Mapping the Impact of Industrial Decline on Ill Health

Author:: Gabor Scheiring, David Stuckler, and Lawrence King
Publication Date:: 11-2020
Content Type:: Working Paper
Institution:: Political Economy Research Institute (PERI), University of Massachusetts Amherst
Abstract:: A growing literature on deaths of despair has argued that workers’ declining life expectancy in deindustrialized rustbelt areas in the U.S. and the associated deepening of health inequalities signal the profound existential crisis of contemporary capitalism. Competing explanations downplay the negative consequences of “creative destruction” and focus instead on unhealthy lifestyles. This article contributes to this debate by presenting the first empirical analysis of the role of deindustrialization in the deaths of despair epidemic that hit Eastern Europe in the 1990s. Drawing on the thematic analysis of 82 semi-structured interviews in four deindustrialized towns in Hungary, the article constructs a general sociological framework for analyzing deaths of despair applicable to other rustbelt areas. Deindustrialization engenders individual and social processes that affect health by increasing stress and eroding coping resources. By conceptualizing deindustrialization as a fundamental cause of ill health, sociology has great potential to contribute to understanding the root causes of deaths of despair.
Topic:: Health, Political Economy, Capitalism, Mortality, Industry, and Deindustrialization
Political Geography:: Europe and Hungary

45. The Coronavirus in Syria

Author:: Ido Yahel
Publication Date:: 08-2020
Content Type:: Working Paper
Institution:: Moshe Dayan Center for Middle Eastern and African Studies
Abstract:: In the latest edition of Tel Aviv Notes, Ido Yahel examines the emergence of the coronavirus in Syria and its implications for the war-torn country and the region.
Topic:: Health, Syrian War, Coronavirus, and COVID-19
Political Geography:: Middle East and Syria

46. Fight the COVID-19 Pandemic and Improve Global Health Governance

Author:: Lin Ren, Aizong Xiong, Guoding Wu, Chen Shen, Xu Tian, and Bo Peng
Publication Date:: 07-2020
Content Type:: Working Paper
Abstract:: The fast spreading of the COVID-19 across the globe points to the urgency of strengthening global health governance. As the core global health governance institution, the WHO has taken a series of actions after the eruption of the epidemic and played an important role in providing guidance and coordinating global forces to combat the epidemic. The epidemic, however, has also exposed some defects of the global health governance mechanism, especially the WHO, and posed challenge to it. The international community needs to strengthen its support for the WHO to improve its role in the global health governance.
Topic:: Health, Governance, and COVID-19
Political Geography:: China, Asia, and Global Focus

47. Optimal Contracting with Altruistic Agents: A Structural Model of Medicare Payments for Dialysis Drugs

Author:: Martin Gaynor, Nirav Mehta, and Seth Richards-Shubik
Publication Date:: 05-2020
Content Type:: Working Paper
Institution:: Centre for Human Capital and Productivity (CHCP), Western University
Abstract:: We study physician agency and optimal payment policy in the context of an expensive medication used in dialysis care. Using Medicare claims data we estimate a structural model of treatment decisions, in which physicians differ in their altruism and marginal costs, and this heterogeneity is unobservable to the government. In a novel application of nonlinear pricing methods, we theoretically characterize the optimal unrestricted contract in this screening environment with multidimensional heterogeneity. We combine these results with the estimated model to construct the optimal contract and simulate counterfactual outcomes. The optimal contract is a flexible fee-for-service contract, which pays for reported treatments but uses variable marginal payments instead of constant reimbursement rates, resulting in substantial health improvements and reductions in costs. Our structural approach also yields important qualitative findings, such as rejecting the optimality of any linear contract, and may be employed more broadly to analyze a variety of applications.
Topic:: Economics, Government, Health, Health Care Policy, Human Capital, Productivity, and Medicare
Political Geography:: United States

48. Is the Coronavirus Catalyzing New Civic Collaborations for Open Government?

Author:: Abigail Bellows and Nada Zohdy
Publication Date:: 11-2020
Content Type:: Working Paper
Institution:: Carnegie Endowment for International Peace
Abstract:: The pandemic is spurring elite and grassroots civic actors to cooperate more, but the gulf between them remains wide. Civic actors must seize the opportunity for reform on open government issues. From Africa to Latin America to Europe, the coronavirus pandemic has generated a surge in public demand for government transparency and accountability. To seize this window for reform, elite and grassroots civic actors concerned with open governance must overcome the cleavage that has long existed between them. Thus far, the pandemic has catalyzed some new civic collaborations, but not at the scale or depth needed to seize that window. In general, civil society groups report feeling more isolated during the pandemic. In some places, the urgency of tackling open government issues during the pandemic has helped overcome that isolation by deepening partnerships among existing networks. But in other places, those partnerships have yet to take shape, and new alliances are less likely to form without the benefit of face-to-face interactions. Even the partnerships that have crystallized or deepened do not appear to be changing the fundamental roles of elite and grassroots civic actors. It is possible that this shift may happen over time. Or it may be that the pandemic alone is not enough to dislodge structural barriers to deeper cooperation. The pandemic has dramatically changed the operations of elite and grassroots actors alike. The impact of those changes on collaboration between the two depends on preexisting levels of technological capacity. In places with limited connectivity, the pandemic has exacerbated the digital divide, adversely affecting grassroots actors. Meanwhile, in places with good connectivity, technology is enabling broader (though shallower) participation, laying the groundwork for more elite-grassroots collaboration. Although many civil society groups are struggling financially during the pandemic, those effects are mitigated to some degree by continuing donor interest in the open government sector. This is encouraging, as coalition building requires dedicated, flexible resources. Finally, it is a more dangerous time to be working on open government issues in general, and grassroots actors bear disproportionate risks in doing so. This underscores the need for more vertical alliances to mitigate civic space threats.
Topic:: Civil Society, Government, Health, Pandemic, and COVID-19
Political Geography:: Global Focus

49. Biological Risks in India: Perspectives and Analysis

Author:: Shruti Sharma
Publication Date:: 12-2020
Content Type:: Working Paper
Institution:: Carnegie Endowment for International Peace
Abstract:: India faces a host of biological risk factors. Drawing lessons from the coronavirus pandemic and prior biological disasters, India’s government should pursue new safety protocols and develop new institutions to manage future biological risk. Infectious diseases such as COVID-19, the disease caused by the novel coronavirus; severe acute respiratory syndrome (SARS); Middle East respiratory syndrome (MERS); and the diseases caused by the Ebola, Nipah, and Zika viruses have exposed countries’ susceptibility to naturally occurring biological threats. Even though scientists from multiple countries concluded that the virus responsible for the coronavirus pandemic shifted naturally from an animal source to a human host,1 the international community should not ignore the possibility of pathogens escaping accidentally from research labs and threats of deliberate manipulation to create more dangerous bioweapons. India is especially vulnerable to such infections because of its geographical position, large population, low healthcare spending, minimal expenditure on research that benefits public health, weak coordination between central and state health authorities, limited involvement of private actors, poor awareness of biosecurity, and the rickety state of public health infrastructure. Most recently, COVID-19 has revealed the deep fault lines in India’s public health infrastructure, including a shortage of healthcare workers, lack of trained epidemiologists, scarcity of medical equipment, poor access to healthcare facilities in rural areas, and inefficient disease reporting and surveillance in most states. The pandemic should therefore be a wake-up call for India to assess gaps in its public health infrastructure and divert its resources toward the healthcare sector to prepare itself for both natural and man-made biological emergencies. Like any country, India faces three major biological threats: naturally occurring infections in humans or animals, or agricultural infestations; infections arising from accidental release of pathogens into the environment; and possible outbreaks caused by deliberate weaponization of dangerous pathogens that affect humans, animals, or crops. These threats—either alone or together—will force India to strengthen its capacity to detect and respond to them.
Topic:: Health, Biology, and Non-Traditional Threats
Political Geography:: South Asia and India

50. Pay for Performance for Prenatal Care and Newborn Health: Evidence from a Developing Country

Author:: Maria Laura Alzúa and Noemi Katzkowicz
Publication Date:: 12-2020
Content Type:: Working Paper
Institution:: Center for Distributive, Labor and Social Studies (CEDLAS)
Abstract:: Empirical literature analyzing the effect of pay-for-performance programs (P4P) for healthcare providers on maternal care and newborn health outcomes is scarce. In 2008, Uruguay’s Ministry of Public Health implemented a P4P called Metas Asistenciales (Healthcare Goals), a country-wide program that grants healthcare providers an economic incentive for complying with certain maternal and newborn healthcare goals. Health organizations use these funds to provide maternal and child health services. Using administrative records and a difference-in-difference methodology, we evaluate the effect of the Metas Asistenciales program on maternal and newborn health outcomes. We find that in the institutions affected by the program, 10 percentage points more women received an adequate number of prenatal checkups and pregnancy detection in the first trimester improved by 5 percentage points. We also found better results among newborns for indicators related to birth weight, premature births, and stillbirths. In sum, the program had a positive, significant impact on the rate of pregnant women’s utilization of health services and on newborn health outcomes. This study thus provides evidence supporting the idea that economic incentives are a promising tool for incentivizing healthcare providers to achieve better health services in developing countries.
Topic:: Health, Health Care Policy, Children, and Birthing
Political Geography:: South America and Uruguay

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COLUMBIA UNIVERSITY PRESS