The ambition of universal health coverage entails estimation of the number, type and distribution of health workers required to meet the population need for health services. The demography of the population, including anticipated or estimated changes, is a factor in determining the ‘universal’ needs for health and well-being. Demography is concerned with the size, breakdown, age and gender structure and dynamics of a population. The same science, and its robust methodologies, is equally applicable to the demography of the health workforce itself. For example, a large percentage of the workforce close to retirement will impact availability, a geographically mobile workforce has implications for health coverage, and gender distribution in occupations may have implications for workforce acceptability and equity of opportunity. In a world with an overall shortage of health workers, and the expectation of increasing need as a result of both population growth in the global south and population ageing in the global north, studying and understanding demographic characteristics of the workforce can help with future planning. This paper discusses the dimensions of health worker demography and considers how demographic tools and techniques can be applied to the analysis of the health labour market. A conceptual framework is introduced as a step towards the application of demographic principles and techniques to health workforce analysis and planning exercises as countries work towards universal health coverage, the reduction of inequities and national development targets. Some illustrative data from Nepal and Finland are shown to illustrate the potential of this framework as a simple and effective contribution to health workforce planning.

Universal health coverage implies that people obtain the health services they need without experiencing financial hardship. While the factors contributing to catastrophic health expenditure (CHE) among households are well understood, few studies have examined this relationship in the context of environmentally vulnerable regions, such as tropical deltas. This study aims to examine the disparities in the prevalence of CHE and impoverishment due to out-of-pocket (OOP) healthcare payments in the Mekong Delta in comparison with rest of Vietnam. It also intends to investigate the associations between economic and environmental shocks, CHE and the impoverishment from healthcare payments. Using data from the Vietnam Household Living Standards Survey 2012, the prevalence of CHE was estimated from the fraction of healthcare costs in relation to household consumption expenditure. The poverty headcount was estimated using the total household consumption expenditure considering both with and without OOP expenditure for healthcare in comparison with the national poverty-line. Simple and multiple logistic regression models were used to examine the associations between geography, health systems, environmental and demographic variables and OOP healthcare expenditure related CHE, and impoverishment respectively. Both the level of OOP household healthcare expenditure and the proportion of households suffering from impoverishment as the result of such payments were higher in the Mekong Delta region compared to rest of Vietnam. Although the results from the multiple regression analysis showed that households in the Mekong Delta region were significantly less likely to suffer from CHE, they were significantly more likely to be impoverished due to OOP healthcare expenditure. While health insurance membership did not have a significant effect on either outcomes, households that faced an economic or an environmental shock in past 5 years were considerably more likely to suffer from CHE and impoverishment from OOP healthcare payments. The findings suggest that the financial protection capacity of health insurance schemes in Vietnam should be improved and expanded to reduce impoverishment as the result of OOP healthcare payments, particularly in the Mekong Delta region. Additional investments in disaster preparedness strategies can further help to reduce the financial burden of households in this environmentally vulnerable region.

The local population of Sundarbans, an environmentally vulnerable delta region in south-eastern India, is currently affected by combined negative impacts of cyclone Amphan and the COVID-19 pandemic. The lockdown measures have created an additional burden on the health care system, while flooding during Amphan increased the risk of spreading water-borne diseases. In this viewpoint, we provide a conceptual model of the complex interlinkages among the combined multi-hazard effects, human health and water availability, with possible mitigation measures. We then discuss the specific pathways through which these immediate and long-term impacts occur and highlight the risk of together slowing progress on SDG3 and SDG6 in the Sundarbans. Finally, we call for coordinated assessment, support and appropriate intervention measures to secure clean water availability and minimize the health impacts of the recent multiple disasters in this tropical delta region.

Rural communities in Thailand have long managed and used forest resources for their livelihoods. Using survey data collected from 400 households across two villages in northeastern Thailand, this study identifies the factors influencing household members’ participation in local community forest management (CFM) programs. Results of the logit regression models revealed that occupation, the number of years of residence in the community, household income and expense, the receipt of CFM information and training, CFM knowledge, decision process in CFM program, and the perceived social and institutional benefits of CFM positively influenced participation in the CF programs. Furthermore, self-efficiency was found to negatively influence participation. Overall, the findings indicate that local people who are less confidence or do not view participation goals as important but when they have been trained, have knowledge about the value of community forest. They are more likely to participate in CFM programs. These results improve our understanding of household participation in community forest management and highlight the need for context-specific approaches to community engagement in forest management programs for optimal policy solutions.

The dominant movement of people in the mega-deltas of Asia is from agriculture-dominated rural areas to urban settlements, driven by growing opportunities, but resulting in new human development challenges. In this context, the present study aims to investigate whether remittance income leads to enhanced multiple dimensions of well-being in sending areas in deltas, by focusing on two delta regions with significant out-migration rates, Bangladeshi Ganges Brahmaputra and the Vietnamese Mekong deltas. The paper develops a conceptual framework that draws on existing migration theories and the aspirations and capabilities theories. Data from large scale sample household surveys (2010 Bangladesh Household Income and Expenditure Survey and 2012 Vietnam Living Standards Survey) are analysed through multilevel regression modelling to examine well-being outcomes in sending areas and links to remittance income. The results show that the temporal extent of internal and international migration is positively associated with remittances in both delta regions. The results also suggest that in both delta regions remittances have a significant positive effect on household well-being in the source rural areas, including overall income, investments in health, food security and access to sanitation. The study concludes that landscapes of urban and rural deltas are increasingly economically integrated which suggests greater resilience even for environmentally-at-risk tropical deltas.