World Health Organisation Archives - InnoHEALTH magazine

Health and Wellness Coach Platform for Industrial Workers

InnoHEALTH Magazine — Fri, 31 May 2019 10:59:45 +0000

Inappropriate diet, relationship problems, stress and lack of physical activity lead to chronic diseases and other health issues, such as obesity, diabetes, heart conditions, depression, and even some types of cancer. An unhealthy lifestyle and its consequences have a direct impact on acompany’s productivity and on the life of the employees and their families. keeping this in mind, the SESI Innovation Center for Health Technologies, Brazil, has created a health platform aiming to bring health and wellbeing for the industry workers.

According to a recent study published in the scientific journal Lancet shows that about 9.15% of the world population was considered obese in 2016, which implies around more than 700 million people on the planet. The World Health Organization (WHO) declared that obesity is one of the biggest public health problems in the world. According to a projection by the same study, for 2025 about 32% of the world adult population will be considered overweight and more than 10% obese.

According to the WHO, chronic diseases are one of the leading causes of death in the world, whereas more than 40% of these deaths (16 million) were premature and could have been avoided by simple interventions.

Besides that, chronic diseases account for 65% of all health expenditures in the world. In Brazil, it is estimated that chronic and noncommunicable diseases will cause a total loss of 8.7% in GDP by 2030, which is equivalent to approximately US $ 184 billion. According to the WHO, chronic diseases are one of the leading causes of death in the world, whereas more than 40% of these deaths (16 million) were premature and could have been avoided by simple interventions. By reducing the risk factors for chronic diseases, the number of premature deaths could be reduced by half. For this reason, it is crucial to stimulate behavioral changes related to health habits.

About the author

Fernanda Vargas Amaral is a Ph.D. in Sports Medicine and works at SESI Innovation Center for Health Technologies, in Brazil.

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Non-Pharmacological Management of COPD

InnoHEALTH Magazine — Wed, 17 Apr 2019 08:46:29 +0000

Chronic Obstructive Pulmonary disease (COPD) is a chronic inflammatory condition of the lungs causing obstructed airflow from the lungs (previously known as Chronic Bronchitis and Emphysema). Most common symptoms are chronic cough, sputum production, and breathing difficulty. Risk factors for COPD are smoking, indoor air pollution (biomass fuel used for cooking and heating), outdoor air pollution and occupational dust and chemicals (vapors, irritants, and fumes).

COPD is the fifth leading cause of death as per World Health Organisation 2002 report and likely to be the third leading cause by 2030. It is not only deaths, but the financial burden on individuals and the countries is huge. Regular follow-up with the doctor and taking medication regularly is one part.

Non-pharmacological interventions (Pulmonary rehabilitation) which are useful in the management are:

Smoking cessation- most important, it helps in a further decline of lung function and symptom improvement

Diet- those with high BMI (body mass index) increased work of breathing – should lose weight. Those with low BMI-with reduced muscle mass will have a weakness: nutritional supplementation advised

Exercise- increasing muscle strength, breathing techniques – such as Pranayama are proven to be helpful

Occupational safety- strategies aimed at reducing the burden of inhaled particles and gases

Vaccination- flu vaccination and pneumococcal vaccines help in reducing exacerbation of COPD

About Aware Gleneagles Global Hospitals

Our 300 bedded L. B. Nagar Hospital consists of seven-operation theatres with advanced quaternary care facility with state-of-the-art infrastructure certified by NABH, NABL & HALAL. The hospital caters to several key specialties including oncology, neurosurgery, and liver diseases besides various ailments. It brings advanced technologies that drive new and more effective treatments. Aware Gleneagles Global Hospitals cater to several overseas patients suffering from various disorders such as liver ailments, kidney failures, breast cancer, leukemia, neurological disorders amongst others. We have an international reputation as a center of excellence for advanced clinical care.

Aware Gleneagles Global Hospitals is part of Parkway Pantai, a fully owned subsidiary of IHH Healthcare. In India, we operate as a chain of multi-super specialty hospitals offering tertiary and quaternary healthcare services with over 2,000 beds and state-of-the-art, world-class hospitals in Bangalore, Chennai, Hyderabad, and Mumbai.

We aim to strengthen and expand our leading market position as a destination for multi-organ transplant for patients from India, Africa, the Middle East, and South East Asia. We are committed to further our aspiration of making quality healthcare more accessible to all. Website: www.gleneaglesglobalhospitals.com

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Global nutrition needs swift efforts

InnoHEALTH Magazine — Mon, 30 Apr 2018 11:05:15 +0000

Global nutrition crisis threatens human development, demands ‘critical step change’ in response – Report

Women’s health in India has emerged as a major nutritional challenge with the country wrestling largest number of anemic women in the world and the other having to tackle diseases related with obesity –that is on the rise, warns the latest Global Nutrition Report, 2017. It says there is malnutrition among adults globally.A total of 614 million women aged between 15–49 years were affected by anemia. India had the largest number of women impacted, followed by China, Pakistan, Nigeria and Indonesia.In India and Pakistan, more than half of all women of reproductive age have anemia.

It is a global issue that many women in high-income countries also suffer from; prevalence rates may be as high as 18% in countries such as France and Switzerland. Obesity (body mass index (BMI) ≥30) is most common among North American men (33%) and women (34%), and lowest among Asian and African men (6%) and Asian women (9%).

Also Read:
Difference Between Pranayama and Breathing
Yoga Mojo Going Viral – Meditation in India

Overweight and obesity are increasing in almost every country and are a real concern for many low and middle income countries, not just high-income ones.The problem affects more women than men in all the world’s regions, reflecting a wider global gender disparity.

Hypertension is most common (28%) among African women and European men, and lowest (11%) among North American women. A quarter of Asian and Latin American men suffered from raised blood pressure in 2015. While more women worldwide are affected by obesity, the case for diabetes and hypertension is mixed. There is more diabetes among men than women in Asia, Europe, Northern America and Oceania, and more hypertension among men than women in all regions except Africa.

The world now faces a serious nutrition- related challenge, whether stemming from under nutrition or obesity, states Global Nutrition Report 2017.

The report found the vast majority (88%) of countries studied face a serious burden of two or three of these forms of malnutrition. It highlights the damaging impact this burden is having on broader global development efforts.

“The world can’t afford not to act on nutrition or we risk putting the brakes on human development as a whole,” said Corinna Hawkes, Co-Chair of the Global Nutrition Report’s Independent Expert Group and Director of the Centre for Food Policy at City, University London. “We will not achieve any of the Global Goals for Sustainable Development (SDGs) by the 2030 deadline unless there is a critical step change in our response to malnutrition in all its forms. Equally, we need action throughout the goals to tackle the many causes of malnutrition.”

The Report calls for nutrition to be placed at the heart of efforts to end poverty, fight disease, raise educational standards and tackle climate change.

“We know that a well-nourished child is one-third more likely to escape poverty,” said Jessica Fanzo, Bloomberg Distinguished Professor of Global Food and Agriculture Policy Ethics at Johns Hopkins University and Global Nutrition Report CoChair.

At least 41 million children under five are overweight, with the problem affecting high and lower income countries alike
At least 10 million children in Africa are now classified as overweight
One-third of North American men (33%) and women (34%) are obese
155 million under-fives are stunted; Africa is the only region where absolute numbers are rising, due to population growth
52 million children worldwide are defined as wasted, meaning they do not weigh enough for their height

In all 140 countries studied, the report found ‘significant burdens’ of three important forms of malnutrition used as an indicator of broader trends:
1) childhood stunting-children too short for their age due to lack of nutrients, suffering irreversible damage to brain capacity,
2) anemia in women of reproductive age-a serious condition that can have long term health impacts for mother and child, and
3) overweight adult women-a rising concern as women are disproportionately affected by the global obesity epidemic.

“They will learn better in school, be healthier and grow into productive contributors to their economies. Good nutrition provides the brainpower, the ‘grey matter infrastructure’ to build the economies of the future.”

Rates of undernutrition in children are decreasing, the report said, with recent gains in some countries. But global progress is not fast enough to meet internationally agreed nutrition goals, including the Sustainable Development Goals (SDG) target 2.2 to end all forms of malnutrition by 2030.

EmornUdomkesmalee, Co-Chair of the Global Nutrition Report’s Independent Expert Group and Senior Advisor, Institute of Nutrition, Mahidol University, Thailand, said, “It’s not just about more money – although that is important – it’s also about breaking down silos and addressing malnutrition in a more joined-up way alongside all the other drivers of development. There’s a powerful multiplier effect here that we have to harness.”

The report found that overweight and obesity are on the rise in almost every country.With 2 billion of the world’s 7 billion people are now overweight or obese and a less than 1 per cent chance of meeting the global target of halting the rise in obesity and diabetes by 2025.

Rising rates of anemiaamong women of reproductive age are also cited as a concern with almost one in three women affected worldwide and no country on track to meet global targets. “Historically, maternal anemia and child undernutrition have been separate problems to obesity and noncommunicable diseases,” said MsFanzo. “The reality is they are intimately connected and driven by inequalities everywhere in the world. That’s why governments and their partners need to tackle them holistically, not as distinct problems.” Donor funding for nutrition rose by just two per cent in 2015, to US$867 million, representing a slight fall in the overall percentage of global aid. The report says funding needs to be ‘turbo charged’ and calls for a tripling of global investments in nutrition, to $70bn for over next 10 years to tackle childhood stunting, wasting and anemia and to increase breastfeeding rates. Crucially, donors are only spending 0.01 per cent of official development assistance on diet related Non-Communicable Diseases, a ‘disturbingly low’ level.

Pledges to invest in nutrition must be ‘concrete’ and ‘acted upon’, not ‘empty rhetoric’, the report said. Of the 203 commitments made at the Nutrition for Growth Summit in 2013 those most likely to be classified as ‘on course’ are the UN agencies’ at 86 per cent, followed by ‘other organisations’ at 75 per cent and NGO policy commitments at 73 per cent.

The report found there is a critical need for better data on nutrition – many countries don’t have enough data to track the nutrition targets they signed up to and to identify who is being left behind.

Report says the world consumes too much salt. Intake varies by region, but no region had intakes within the WHO-recommended limits of 2 g/day of sodium. Asia has the highest intake (4.3 g/day of sodium), followed by Europe (4.0 g/day of sodium). At national level, only seven countries (Burundi, Comoros, Gabon, Jamaica, Kenya, Malawi and Rwanda) have sodium intakes within desirable limit).

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InnoHEALTH Volume 1 Issue 1 (July to September 2016) – https://goo.gl/iWAwN2
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Exercise in big parks can reduce depression

InnoHEALTH Magazine — Wed, 11 Apr 2018 08:51:44 +0000

Those who exercise in large parks in cities are less prone to depression

Availability of large neighbourhood parks encourages people to increase their physical activity, and those suffering from chronic conditions who regularly exercise in these parks are less prone to major depression, a new study has found. Besides increasing physical activity, regular exposure to outdoor green spaces improves cognitive functioning and lowers mortality risks. This is significant for those with chronic conditions like arthritis, diabetes, asthma and heart diseases as they are the most vulnerable to depression.

The study was done in Delhi, which has several public parks in residential areas. “Large parks in Delhi have diverse landscapes and are more likely to receive regular and frequent visitors, providing an opportunity for regular socialization,” say researchers.

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People who used large-sized neighbourhood parks walked for more than 150 minutes per week, the study found. For overall health, fitness and cognitive maintenance, the World Health Organization recommends adults to engage in 150 minutes of physical activity per week.

Dr. Debarati Mukherjee, lead author of the study says,” High levels of exercise encourage birth of new neurons which aid memory functions and learning.”

Researchers measured the association between park availability and major depression in 1208 adult park-users in Delhi. Major depression was measured using a structured clinical interview. Compared to residents exposed to large parks, major depression was 3.1 times higher among those exposed to small parks. They also showed that large-sized parks reduced stress and increased satisfaction with the immediate living environment.

“There are several mechanisms by which mental health is enhanced by physical activity. This is largely by increasing levels of endorphins in the brain” said Dr Dorairaj Prabhakaran of Public Health Foundation of India and one of the researchers. Endorphins are a group of chemicals that are natural mood elevators.

Dr. Mukherjee says that high levels of exercise encourage birth of new neurons which aid memory functions and learning. Physical activity is also thought to reverse cell and tissue damage as seen in Parkinson’s and Alzheimer’s.

Researchers point out that negative impact of shrinking green spaces due to rapid socio-economic development in metropolitan cities has not been studied, stressing the need for more studies on the matter. In addition to health benefits, urban green spaces reduce air and noise pollution. They also function as an important habitat islands for urban wildlife.

Certain neighborhoods may enable behaviours that promote mental health, while other residents may find it more restrictive to follow a healthy and happy lifestyle.

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Dr. Mukherjee says, “Our study provides the first empirical evidence of the benefits of availability of parks in the Indian context. It highlights the importance of having large parks near people’s living quarters”. The study could be a model for similar studies in other cities across the country.

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The scientists also recommend inclusion of urban green spaces in city planning to increase overall health of people. Their findings come at an important time whena largescale development in major cities is being undertaken in the country. “This is an opportune moment given that development of sustainable cities is ongoing in 109 cities selected in the SMART Cities Mission. Allocating municipal land for large urban parks should have a high priority,” adds Dr. Prabhakaran.

Altogether, 11 scientists from India, America and United Kingdom contributed to this study. Participating institutions include Centre for Control of Chronic Conditions, Public Health Foundation of India, All India Institute of Medical Sciences, National Institute of Mental Health and Neurosciences, Rollins School of Public Health USA, London School of Hygiene and Tropical Medicine UK. The findings were recently published in journal Health and Place.

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Philips lighting research on eyesight

InnoHEALTH Magazine — Mon, 09 Apr 2018 07:06:58 +0000

Philips Lighting (Euronext Amsterdam ticker: LIGHT), the world leader lighting, has released findings that reveal that almost two third of Indians agree that poor light quality is detrimental to eyesight but just one fifth (21%) will actually take corrective measures such as buying light bulbs that are comfortable for their eyes. The survey also highlighted that for most Indians, eyecare is not treated at par with skincare and other health issues such as managing one’s weight and fitness levels.

First 3-D Printed Human Corneas

In Mumbai, durability of the bulb emerged as the highest priority while making purchase decision for light bulbs, with almost 47% of adults choosing it over other factors like price and eye comfort. While 49% of adults in the city agree that light quality affects eyesight, only 21% will opt for lighting that is comfortable for their eyes. The study conducted amongst 9,000 adults across twelve countries including India, also revealed uncomfortably entrenched mindsets with about half of the Indian population compromising on their eyesight by prioritising price (50%) and durability (48%) of bulbs over eye comfort, while making purchase decisions for light bulbs.

The situation is quite alarming considering the invasion of digital technology in our lives translating into longer screen exposure times, with almost 70% of Indians surveyed spending more than 6 hours a day in front of a screen and a similar number complaining of eyestrain! This also comes at a time as myopia hits record levels globally, with the World Health Organization predicting that one in two people will be short sighted by 2050, a vision emergency of sorts, in the not too distant future!

Ophthalmologists understand the gravity of the situation and are pulling out all stops to sensitise the general population to step up on their eye care quotient. They highlight a continued need to educate the public about eye care. In response to this situation the All India Ophthalmological Society has developed a number of proactive community oriented programs, guidelines and resources to enhance ophthalmic education amongst the public. The study of over 9,000 adults across twelve countries – India, China, USA, Czech Republic, France, Germany, Indonesia, Poland, Spain, Sweden, Thailand and Turkey – becomes even more relevant given the dire situation. It was commissioned to explore how quality LED lighting can help ameliorate the eye comfort problem amongst consumers. As per the findings of the study, 44% of Indians don’t visit an eye specialist on a regular basis while about three fourths on an average use weight (73%) and fitness (60%) as overall indicators of health. Clearly, eye care does not rank at par with other perceived health metrics. Quality lighting is not only related to longevity, but is also incredibly important when it comes to ensuring our eyes aren’t strained and feel comfortable. people should choose high quality lamps that are comfortable for their eyes.

PHILIPS LIGHTING RESEARCH

• While 49% adults in Mumbai agree that light quality affects their eye sight, only one in five (21%) will opt for lighting that is comfortable for their eyes

• Almost half of adults in Mumbai consider durability (47%) and price (45%) of bulbs over comfort for their eyes, while making purchase decisions

• More than half (53%) of adults in the city don’t regularly get their eyes checked; eye care does not rank at par with other perceived health metrics such as managing weight, fitness levels and skin care

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Keeping hospitals in the best of health

InnoHEALTH Magazine — Wed, 21 Feb 2018 06:08:23 +0000

Hospitals will remain at the core of healthcare and with good quality medical facilities limited to corporate hospitals or a few of the government run large hospitals, altering the health map of the country has to start from the hospital premises.

Keynote Address: Dr. S. Venkataramanaiah
Moderator: Dr. Sandeep Bhalla
Panelists
• Dr. Santana Biswas
• Dr. Tarun Marole
• Dr. Mukesh Taneja
• M V Amaresh Kumar

Hospitals in India play a vital role in healthcare with most of the high-end medical facilities available only at the hospitals. But these large institutes are very far away from the masses as more than 70 percent of the Indian population lives in rural areas. That leads to a reality that medical facilities must go beyond hospitals, with an innovative approach, to serve the masses and make India a healthy place.

Addressing the issue as keynote speaker, Professor Krishnan from IIM, shed light on the management aspect of innovations and spelled out the needs of the industry for the sake of ensuring that all innovations become a reality and benefit the masses.

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In his words, he said, “Innovations in healthcare must consider three aspects: Begin with identifying core functionalities of equipment without having to sacrifice on the safety aspect. Secondly, start from scratch. Build upwards and incorporate all the technical features that you feel are essential to the product; downscaling features will not necessarily downscale your cost; lastly, collaborate and team up with others who will complement your product, effort and intentions. There’s no one entity that has all the knowledge and resources to develop any product in its entirety. So build up on sound partnerships using complementary technology and process.”

In support of the view, Dr. S. Venkataramanaiah highlighted data usage as one of the most effective tools to implement an innovative approach for spreading good health. He said, “Data clearly indicates that there’s a huge demand for private players in the health sector. Everyone is and needs to be medically insured and ensured of good health by private or a government body. On the other hand, healthcare has some major deficiencies like availability of medical help at anytime and anywhere. Like you have roadside assistance available all over the country, such a facility for health and medical urgencies is still not available.

“So innovative approach in production, processing, delivering service or business management is the answer to finding solutions to new challenges faced in the health sector,” he said

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In a more myopic approach to the topic of distance solutions Dr. Mukesh Taneja shared some startling data from the WHO.

“According to World Health Organization’s 2010 data 285 million people are visually impaired; 90 percent of these are in the developing world; and 80 percent of these are preventable,” he said.

And speaking of India, 70 percent of the population lives in rural areas, however 90 percent of the medical facilities are located in urban areas. So, there’s a huge gap between the care providers and the population who they should be reaching. And we believe that telemedicine – a very innovative approach — is the answer to bridge this gap. Eye problems can more effectively be pictured and online imaging of affected eye can easily be examined and diagnosed by a distant located ophthalmologist.
“We, at LV Prasad Eye Institute, extensively use this telemedicine platform and are reaching out to the rural population with the help of health workers and specially trained technicians who operate our remotely located Vision Centers.”

The next panelist, Dr. Santanu Biswas, from the UAE shared his international perspective and said, “If you are to work on remote distance technology, you cannot work in isolation. You choose partners in technology, data procurement and delivery system. This means your dependence on your partners is even more critical as you depend on their credibility, technical compatibility and similar intentions. This is the reason that even though we have been talking about digital health and e-health; but other than the fact that it’s been a buzzword for the last 15 years, it has not become a well-charted module. We are still talking about the concept and exploring innovations that will truly support the telemedicine or e-health platform. This is because we are trying to marry and merge a conventional health system with an imposed telemedicine process.”

Concluding his views on the subject he summed it up saying, “I think we need to rediscover a totally new innovative approach to telemedicine, which will use innovative technology, innovative approach and an all-new processing and delivery system. And this will evolve, as this is the future.”

Dr. Tarun Ramole, speaking in the role of an investor and entrepreneur spoke candidly about the business aspect of telemedicine. In his opinion, Telemedicine, as a business is a very lucrative platform. The gap between the resources and the users remains very high and in a country like India is not going to be easy to fill that.

“Telemedicine will be a very reliable option to bridge the gap and that makes it a very viable business option. But, like most businesses, telemedicine also has challenges that are very unique. Starting with, most start-ups end up replicating what is already there in the market “with improvisations”. What we need is new solutions and not improved solutions. You must think innovatively to innovate things,” he concluded his opinion with a very upfront approach on the subject.

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“We need to understand mechanism of disease. Innovations are needed in the management of acute illness. You also need data to apply biotechnology at its best and develop guidelines. Especially for contagious diseases, we need to keep track of various demographic realities on ground through good quality data that should be available to medical experts, without any corruption in the data. What is required is a simple device available at the location and operational without the need of any complex operations.”

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Technology is available in your pocket for your good heal. Starting with your smart phone, by which you can count the steps you take and the calories that you burn in a day, innovation hence has already become part of our life and we our using technology of today with very innovative approach and amazing outcomes.

“Even the shortage of doctors or specialists is taken care of by telemedicine or long distance consultation, he said”

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Cost is the most important element to determine easy diagnostics and cheap diagnostics. With that intent, we started our lab for local operations in Varanasi. With the advancement of biotechnology and implementation of biotechnology, we have developed some very affordable tools and devices to test and analyse clinical tests. Initially it was done locally in Varanasi with support from Banaras Hindu University, but our results also received encouraging support from doctors and specialists at All India Institute of Medical Medical Sciences in Delhi.”

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INDIA'S NUTRITION ATLAS GOES LIVE

InnoHEALTH Magazine — Mon, 22 Jan 2018 05:23:24 +0000

The Hyderabad-based National Institute of Nutrition (NIN) has developed the country’s first Nutrition Atlas to provide all the relevant data and information about nutrition.

The Nutrition Atlas provides information and data on nutritional status of population groups at national and state levels, along with an overview of nutrition-related deficiencies, disorders and prevalence levels in various parts of the country along-with information on nutrients, nutrient rich foods, nutritional deficiency disorders and a host of other topics.

The portal also includes information on nutrition rich foods and nutri-guide for various nutrients, minerals, essential amino-acids, fatty acids, dietary fibers and proteins, along with their biochemical cutoffs, recommended dietary allowances, signs and symptoms and dietary sources.

The Atlas is interactive and displays information in the form a user may select and has been developed through a long drawn, cohesive and technical exercise by a multidisciplinary team in the bioinformatics division of NIN. It makes use of publicly available data sources like reports of National Nutrition Monitoring Bureau, National Family Health Survey, World Health Organisation and other public databases. The Dashboard acts like an information management tool, helping the user track data on under nutrition, over nutrition, overweight, obesity and communicable and noncommunicable diseases. It can also provide different time trends on each of these parameters. The development conducted the research under ICMR.

ARTICLE SHARED FROM ‘INDIA SCIENCE WIRE’

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HEALTH PROMOTION WITHIN WHO FAMILY CITIES IN THE BALTIC SEA REGION

InnoHEALTH Magazine — Thu, 11 May 2017 09:32:04 +0000

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Health Promotion within WHO Healthy Cities in the Baltic Sea Region

Johanna Reiman is M.Sc. (Agriculture), M.Sc. (Economics), and has 28 years working experience in health and wellbeing. She has organized tons of international conferences and seminars, promoted multi-stakeholder programmes and projects and promoted ideas to innovations.

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There are challenges in taking health as a core of the planning process in the cities. Lack of clear responsibilities in part of the municipalities, weak leadership for health, and missing procedures are only a few examples. This results in insufficient budget allocations. Economic challenges continuously overweigh health in decision–making, even if choosing correct actions could bring considerable savings. It is essential that the municipality or region knows the health situation in the respected area and has the resources and skills to analyse impacts of major policies from the health perspective. Political will and legal backing are also important in bringing cross- sectoral health promotion into practice.

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Health promotion work needs innovations on the local level. Healthy Cities is a programme which encourages cities and municipalities for cross-sectoral work. Health and wellbeing should be put high on the agenda of the cities. Structures are needed to ensure the sustainability of the work. This means that all city functions must take health promotion into account. Education, transport, urban planning, culture and youth services should take residents’ health to their plans. It is advisable to build a cross-sectoral health and wellbeing board which follows the plans and activities. Healthy Cities is about involving all sectors.

Healthy Cities work in phases and the themes vary. Phase VI (2014-2018) themes are linked to European Health 2020 strategy. Thus, the topics are 1) improving health for all and reducing health inequities; and 2) improving leadership and participatory governance for health.

All in all, the health promotion work is connected to urban health. Urbanization is a trend all over the world. People move to cities as there are most of the jobs. Cities also have a wide variety of culture and possibilities for various types of housing. City life may – despite its benefits – bring aspects which are harmful to life. Loneliness, sedative lifestyle, pollution and lack of social belonging are serious problems which affect people’s lives. Cities should find innovative solutions to the challenges their people face over the life course.

European Health Challenges

Europe is facing big changes which affect the health of the population. Societies are ageing rapidly. Unemployment is a problem of young people and affects also persons in middle age and older. Migration changes the services needed. Urbanization means that planning becomes more challenging for cities. Ensuring the wellbeing of the population requires an open mind and readiness for cooperation. Municipalities have to start to combat the challenged together with companies and non-governmental organisations. World Health Organization is willing to help cities plan their work for the health of the residents. In Healthy Cities programme open local innovations are shared among the network members.

Western lifestyle is a threat to the society. The health data show that non-communicable diseases (NCDs) cause the biggest disease burden in all European countries. Illnesses such as diabetes, cancer, and cardiovascular diseases account for an ever larger share of fatal illnesses. This challenge is being faced by other parts of the world also.

In the Baltic Sea Region countries, non-communicable diseases cause about 80 % of deaths. These diseases are preventable and can be avoided by the modification of unhealthy lifestyles, e.g. healthy habits. Diets containing more vegetables, adequate physical activity and the avoidance of smoking should all be adopted. The national governments recognize this necessity in their health programmes and strategies. How they are implemented depends on the capacity of the municipalities, their politicians, public health administrators and methods of working. Healthy Cities programme states that unifying the efforts of different sectors and making health promotion not only effective otherwise but also cost-effective.

WHO Healthy Cities– How Did It Start?

For decades, United Nations organisations have traditionally worked with ministries and nations. Healthy Cities began as a World Health Organization project in 1987. It has over the years become a movement with very committed cities. The network has an annual business and technical conference and also runs several sub-networks. The WHO Healthy Cities programme has promoted cross-sectoral well-being effort as well as comprehensive and systematic policies and planning for health. The Healthy Cities movement is present in more than 30 European countries and over 1400 cities and regions.

Baltic Region Healthy Cities Association has served as a World Health Organization Collaboration Centre for Healthy Cities and Urban Health in the Baltic Region since 2002. The Association assists cities in implementing Healthy Cities’ goals and to build capacity for health and well-being. Furthermore, the Association is involved in health promotion projects, many of which concentrate on promoting cross-sectoral planning for health. The members of Baltic Region Healthy Cities Association include the City of Turku, University of Turku, Åbo Akademi University and the Social Insurance Institute of Finland. Baltic Region Healthy Cities Association – based in Turku, Finland – aims at increasing the awareness of local governments in adopting health as a central part of the decision-making process in municipalities.

Health inequities mean that differences in societies grow. In Europe, many people are doing well and live healthy and long lives. However, there are people whose health conditions are bad and they may be outside the society with no education. Despite several years of efforts to combat the inequities, the divide is only growing.

Coordinated Action Is Needed

Social and welfare costs remain to account for a very large share of both national and local budgets in all countries surrounding the Baltic Sea. Promotion of health and well-being requires coordinated action from all sectors of the society at national, regional and local level. It has been confirmed that investment in health promotion is cost-effective and that the best results are obtained if all sectors work together, taking into account the effects of policies on well-being. This means that, for example, education, economic and cultural sectors can strongly promote health. Also, traffic and environmental departments should enhance human well-being.

Baltic Region Healthy Cities Association has accomplished numerous local health promotion projects. Recent themes in the projects include promoting volunteering of elderly people and thus making them participate in the society and find meaningful daily activities (www.letusbeactive.eu). Promoting children’s healthy habits is a theme of a project where the other partners are University of Turku, University of Tallinn Rakvere College and City of Jurmala in Latvia. One theme where the Association has been active is health literacy. It has been found that many Europeans lack understanding of health information. Health and welfare experts should pay special attention to understandable health information and ensure that guidance given is understood.

The World Health Organization definition of health says that “Health is a state of complete physical, mental and social well-being and not merely the absence of disease or infirmity.” The challenge remains around the Baltic Sea and the rest of Europe to ensure health for all.

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The post HEALTH PROMOTION WITHIN WHO FAMILY CITIES IN THE BALTIC SEA REGION appeared first on InnoHEALTH magazine.

Healthcare Reform is Trickier Than You Think

InnoHEALTH Magazine — Wed, 29 Mar 2017 06:50:30 +0000

Healthcare is a troubled industry. There is no known health service system that would work to the satisfaction of all major stakeholders, patients, providers, and payers. No matter the amounts spent, nothing is ever enough.

The resource problem looks different in the rich and in the developing world. In affluent countries demand is relentlessly driven by new technologies and cures, ageing populations, life-style –related problems and the medicalization of trivial ailments. Islands of undercare dot a sea of overcare. In the developing world the situation is the reverse.

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All responsible governments have noticed that the situation is unsustainable. In Finland gross health service expenses have doubled since the year 2000 outpacing economic growth by several percentage points. Health and welfare has become the cuckold that kicks other public tasks, such as infrastructure, education and defense out of the nest.

The obvious counter-measure is to increase productivity. According to a recent study by Aalto University, there is ample room for that. If all districts in the country, after adjusting for local variations in population and morbidity, would perform at the level of the national average, one billion euro could be saved out of a total expenditure of eighteen billion. If all would perform at the level of the best, no innovations required, the savings could be three billions.

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Such regional variation is puzzling in a health system that is to ninety percent tax financed and centrally regulated. Neither the government, nor the professions have been able to implement standardized best practices. There is a strong case for Lean healthcare.

Raw improvement of everything, however, may be a dull weapon. There are several interesting patterns that are not visible to the naked eye. A data –driven helicopter perspective is needed. There are areas where improvement would be especially welcome, and not only in the shape of smooth processes but better structures and allocations.

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Curiously, there can be simultaneous overspending and undercare. A common observation is that healthcare expenditure follows the Pareto distribution or the 20/80 rule: one fifth of the population spends four fifths of the resources. In a recent study, The Nordic Healthcare Group (NHG), a consultancy, studied the health expenses in a medium-sized city. The distribution was sharper than the traditional Pareto. Ten percent consumed seventy percent. There was a hard core of high spenders, a few hundred individuals that consumed more than half of the total municipal health and welfare budget. They could be divided into three categories: expensive somatic cases such as premature and massive trauma; elderly multi-morbidity patients in around-the-clock care; and the sad combination of substance abuse and mental disorder. With the possible exception of the first group, these people did not get value for the money. Their quality of life was overall bad.

This happens in a welfare society that has for decades mobilized the full force of the state and committed massive resources to universal access and equality of care. Still there some people are simultaneously overserved and undercared.

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Growth has been fastest in the extremes of the care spectrum. The most technically advanced specialist care spends like there were no tomorrow. The low end of home and community care is not that expensive per unit, but the number of cases increases dramatically. In Finland between the years 2000 and 2014 expenditure for specialist care doubled, long-term care for the elderly and handicapped grew 160%, while primary care have had to do with a paltry 60% increase. The trouble is in the middle.

Since WHO’s Alma Ata declaration in 1978 every policymaker has paid lip service to the strengthening of primary care. Therapies should be administered at the lowest sufficient level to save the specialized resources to those that truly need them. It is better to treat diseases early than to allow time to turn them into complications. Despite the best of intentions, quite the opposite is happening. A relatively weakened primary care feeds growing numbers of increasingly sick people to hospitals.

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It is common knowledge that free markets do not work in healthcare. The relative weights of primary and secondary care, however are powerfully market driven. Consider two hypothetical doctors. A is an accomplished neurosurgeon, who successfully saves lives by removing brain tumors. B is a general practitioner, whose working day is an endless stream of small infections, minor trauma, and unspecified pain. As a patient, taxpayer, or regulator, how much would you be willing to pay for a day’s work to A and to B?

The answer is obvious. Medical students, investors and decision makers have long since decided to follow the money. In the Nordic countries center-left governments have traditionally been suspicious, if not openly hostile to markets in healthcare. Still, and despite all the Alma Ata –rhetoric, they have been incapable of stemming this particular market mechanism.

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This points to a broader problem. It appears that even in publicly financed and administered systems, public sector provision is not under public sector control. The government did not call for rampant cost-inflation. No politician has demanded queues and increasing socio-economic health inequality. Still it happens.

The Norwegian political scientist Stein Ringen has eloquently described this phenomenon in his book A Nation of Devils. Politicians may think they are in charge. As a matter of fact they don’t do things, they just issue statements, make decisions and allocate money. Before anything real happens on the ground, the issue has to travel through a lengthy chain of civil servants and administrators, who have every opportunity to turn gold into lead.

It is well known that a core issue in health policy is the information asymmetry between patients and doctors. A similar, perhaps even more devastating asymmetry is between politicians and professionals. For this reason planned economies have never worked as planned.

If markets don’t work and command-and-control is hopeless, something else needs to be done. The answer is to be sought from the design of quasi-markets. While greed is and has always been pervasive, nothing controls the greed of a seller as efficiently as the greed of a buyer.

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The current center-right Finnish Government has realized the problem and initiated a sweeping reform. While the initiative sill has to run the gauntlet of entrenched interest groups and parliamentary opposition the basic principles are clear.

For a nation to contain health expenditures at a sustainable level without endangering public health, some or all of the following mechanisms must be put at work:

– Care should be initiated at the right time; not too early, not too late.

– Care should be administered at the lowest sufficient level; primary and secondary care must take joint responsibility of care pathways.

– The care of very expensive multi-morbidity cases must be integrated to include somatic, psychiatric and social care.

– The overall productivity and quality of care processes and administration must be improved following the principles of Lean healthcare.

– Care should, when possible, be evidence –based not to do useless interventions.

– Increasing health literacy and the awareness of life-style related diseases should reduce demand.

The core issue is how to design a system that can put to work all or some of these mechanisms. There are no simple solutions. Policy makers have two levers at their disposal, information and money.

The information should be about value. As Michael Porter and other proponents of the Value –based Healthcare movement have suggested, value is the relation between health outcomes and the money spent, measured at the patient level over a full cycle of care. To develop accurate and comparable measures of health outcomes is a formidable task that is currently undertaken by several research and development initiatives around the world.

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If such information were available, policy makers could design health finance systems that could align the interests of patients, payers and providers.

In Finland some of the central policy proposals are, first, a single-payer system. The state collects all money and distributes them to regional authorities.

Second, all caregivers should be organized as limited liability companies with standardized accounting and reporting. While most of the money will still flow from the taxpayers, every caregiver would get its income following the same rules and be subject to the same outcome measures. The current public providers who would loose their privileges and be forced to compete, obviously, will furiously resist.

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Third, to allow patient choice and strengthen primary care, a finance system based on capitation is proposed. Each citizen should register with a health- and welfare center, which would then receive a fixed annual per capita remuneration from the government.

The amount of the capitation money, and the corresponding variety of services that it should cover, are hotly debated. At the low end, the amount could be calculated based on the average annual spend of the healthy adult population, which currently is in the range of 250 €. At the high end it could include just everything and be about 3 500 €, which is the total per capita expenditure. In the latter case the primary care centers would get full control of all financial flows. On the behalf of patients they would purchase clinical interventions from specialist hospitals as needed, essentially taking the role of an insurer. There would be several problems with such drastic measures, so there will probably be a compromise allowing some part of the specialist care to be financed on a fee-for-service –basis by the regions.

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While capitation –based finance provides strong incentives to primary care; there are some known pitfalls. Since the income comes by registered citizen and the costs come from the resources needed to provide service, there is a temptation to engage in skimming, i.e. lure healthy individuals to register while denying service from those with pre-existing conditions. This can be tackled by legislation that prohibits denying anybody from registering as well as kicking anybody off the list. There would still be the risk of undercare and cost-shifting, i.e. costly patients are referred to specialist care, and to be paid directly by the government.

The design of a quasi-market with regulated competition and patient choice requires accurate and publicly available information on value: the relation between outcomes and euros spent at each care organization. Therefore the key task for researchers and policy makers is to develop and experiment with information systems that could do this.

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For health policy makers in India and other rapidly developing countries this may sound like a rich-man’s problem. Indeed it is. The message, however, should be that money will not solve a nations health problems. The pit has no bottom. Health systems emerge slowly and are difficult to change. Latecomers can always have the privilege to learn from other’s mistakes and make a mighty leap to the front.

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About the author

Paul Lillrank has been Professor of Quality and Service Management at Aalto University since 1994. He has served as the Head of the Department of Industrial Engineering and Management and been Academic Dean of the school’s MBA program. He received a Ph.D. in Social and Political Sciences at Helsinki University in 1988 after spending six years as a post-graduate student in Japan where he researched quality management in Japanese industry. He is a pioneer in introducing industrial management methods to the study of healthcare service production. He has been visiting professor at the University of Tokyo, and teaches regularly at the Indian Institute of Technology, Kharagpur.

The post Healthcare Reform is Trickier Than You Think appeared first on InnoHEALTH magazine.