Summary: A search (precision value 94%, recall value 93%) of the ISI Web of Science database (1992–2001) revealed that mental health publications accounted for 3–4% of the health literature. A 10/90 divide in internationally accessible mental health literature was evident and remained undiminished through 10 years as low- and middle-income countries (n= 152) contributed only 6%, high-income countries (n=54) 94%, and 14 leading high-income countries (with more than 1% contribution for majority of years under consideration) contributed 90% of internationally accessible mental health research. Steps should be taken to improve the research infrastructure and capacity to conduct and disseminate mental health research in general, and on a priority basis in low- and middle-income countries.
Social and scientific discourses on healthy ageing and on health equity are increasingly available, yet from a global perspective limited conceptual and analytical work connecting both has been published. This review was done to inform the WHO World Report on Ageing and Health and to inform and encourage further work addressing both healthy aging and equity. We conducted an extensive literature review on the overlap between both topics, privileging publications from 2005 onward, from low-, middle-, and high-income countries. We also reviewed evidence generated around the WHO Commission on Social Determinants of Health, applicable to ageing and health across the life course. Based on data from 194 countries, we highlight differences in older adults’ health and consider three issues: First, multilevel factors that contribute to differences in healthy ageing, across contexts; second, policies or potential entry points for action that could serve to reduce unfair differences (health inequities); and third, new research areas to address the cause of persistent inequities and gaps in evidence on what can be done to increase healthy ageing and health equity. Each of these areas warrant in depth analysis and synthesis, whereas this article presents an overview for further consideration and action.
Two commonly used metrics for assessing progress toward universal health coverage involve assessing citizens’ rights to health care and counting the number of people who are in a financial protection scheme that safeguards them from high health care payments. On these metrics most countries in Latin America have already “reached” universal health coverage. Neither metric indicates, however, whether a country has achieved universal health coverage in the now commonly accepted sense of the term: that everyone—irrespective of their ability to pay—gets the health services they need without suffering undue financial hardship. We operationalized a framework proposed by the World Bank and the World Health Organization to monitor progress under this definition and then constructed an overall index of universal health coverage achievement. We applied the approach using data from 112 household surveys from 1990 to 2013 for all twenty Latin American countries. No country has achieved a perfect universal health cover...
OBJECTIVE: To measure and explain income-related inequalities in health and health care utilization in the period 2000 - 2009 in Chile, while assessing variations within the country and determinants of inequalities. METHODS: Data from the National Socioeconomic Characterization Survey for 2000, 2003, and 2009 were used to measure inequality in health and health care utilization. Income-related inequality in health care utilization was assessed with standardized concentration indices for the probability and total number of visits to specialized care, generalized care, emergency care, dental care, mental health care, and hospital care. Self-assessed health status and physical limitations were used as proxies for health care need. Standardization was performed with demographic and need variables. The decomposition method was applied to estimate the contribution of each factor used to calculate the concentration index, including ethnicity, employment status, health insurance, and region of residence. RESULTS: In Chile, people in lower-income quintiles report worse health status and more physical limitations than people in higher quintiles. In terms of health service utilization, pro-rich inequities were found for specialized and dental visits with a slight pro-rich utilization for general practitioners and all physician visits. All pro-rich inequities have decreased over time. Emergency room visits and hospitalizations are concentrated among lower-income quintiles and have increased over time. Higher education and private health insurance contribute to a pro-rich inequity in dentist, general practitioner, specialized, and all physician visits. Income contributes to a pro-rich inequity in specialized and dentist visits, whereas urban residence and economic activity contribute to a pro-poor inequity in emergency room visits. CONCLUSIONS: The pattern of health care utilization in Chile is consistent with policies implemented in the country and in the intended direction. The significant income inequality in the use of specialized and dental services, which favor the rich, deserves policy makers' attention and further investigation related to the quality of these services.
Aim: To measure the impact of taxes and prices on alcohol use with particular attention to the different context of rising alcohol consumption in low‐ and middle‐income countries.Methods: Systematic review: we searched MEDLINE, Embase, EconLit and LILACS, grey literature, hand‐searched five specialty journals and examined references of relevant studies. We considered all reviews that included studies that quantitatively examined the relationship between alcohol prices or taxes and alcohol use. At least two reviewers independently screened the articles and extracted the characteristics, methods and main results and assessed the quality of each included study. We identified 30 reviews.Results: There was overwhelming evidence that higher alcohol prices and taxes were associated with lower total alcohol consumption and that price responsiveness varied by beverage type. Total own‐price elasticities of alcohol demand were consistently negative and substantial enough to be policy meaningful; total own‐price elasticities for beer, wine and spirits were found to be approximately −0.3, −0.6 and −0.65. Reviews generally concluded that higher taxes and prices were associated with lower heavy episodic drinking and heavy drinking, although the magnitude of these associations was generally unclear. Reviews provided no evidence that alcohol price responsiveness differed by socioeconomic status, mixed and contradictory evidence with respect to age and sex and limited evidence that price responsiveness in low‐ and middle‐income countries was approximately the same as in high‐income countries.Conclusions: Taxes are effective in reducing alcohol use. Moreover, increasing the price of alcohol by increasing taxes can also be expected to increase tax revenue, because the demand for alcohol is most certainly inelastic.