Publications (14)462.38 Total impact
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Article: Prevention and management of chronic disease: a litmus test for health-systems strengthening in low-income and middle-income countries.
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ABSTRACT: National health systems need strengthening if they are to meet the growing challenge of chronic diseases in low-income and middle-income countries. By application of an accepted health-systems framework to the evidence, we report that the factors that limit countries' capacity to implement proven strategies for chronic diseases relate to the way in which health systems are designed and function. Substantial constraints are apparent across each of the six key health-systems components of health financing, governance, health workforce, health information, medical products and technologies, and health-service delivery. These constraints have become more evident as development partners have accelerated efforts to respond to HIV, tuberculosis, malaria, and vaccine-preventable diseases. A new global agenda for health-systems strengthening is arising from the urgent need to scale up and sustain these priority interventions. Most chronic diseases are neglected in this dialogue about health systems, despite the fact that non-communicable diseases (most of which are chronic) will account for 69% of all global deaths by 2030 with 80% of these deaths in low-income and middle-income countries. At the same time, advocates for action against chronic diseases are not paying enough attention to health systems as part of an effective response. Efforts to scale up interventions for management of common chronic diseases in these countries tend to focus on one disease and its causes, and are often fragmented and vertical. Evidence is emerging that chronic disease interventions could contribute to strengthening the capacity of health systems to deliver a comprehensive range of services-provided that such investments are planned to include these broad objectives. Because effective chronic disease programmes are highly dependent on well-functioning national health systems, chronic diseases should be a litmus test for health-systems strengthening.The Lancet 11/2010; 376(9754):1785-97. · 38.28 Impact Factor -
Article: Education of health professionals for the 21st century: a global independent Commission.
The Lancet 04/2010; 375(9721):1137-8. · 38.28 Impact Factor -
Article: Primary health care and the social determinants of health: essential and complementary approaches for reducing inequities in health.
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ABSTRACT: Increasing focus on health inequities has brought renewed attention to two related policy discourses - primary health care and the social determinants of health. Both prioritise health equity and also promote a broad view of health, multisectoral action and the participation of empowered communities. Differences arise in the lens each applies to the health sector, with resultant tensions around their mutual ability to reform health systems and address the social determinants. However, pitting them against each is unproductive. Health services that do not consciously address social determinants exacerbate health inequities. If a revitalised primary health care is to be the key approach to organise society to minimise health inequities, action on social determinants has to be a major constituent strategy. Success in reducing health inequities will require ensuring that the broad focus of primary health care and the social determinants is kept foremost in policy - instead of the common historical experience of efforts being limited to a part of the health sector.Journal of epidemiology and community health 11/2009; 65(8):656-60. · 3.04 Impact Factor -
Article: Venice Statement on global health initiatives and health systems.
The Lancet 10/2009; 374(9692):783-4. · 38.28 Impact Factor -
Article: An assessment of interactions between global health initiatives and country health systems.
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ABSTRACT: Since 2000, the emergence of several large disease-specific global health initiatives (GHIs) has changed the way in which international donors provide assistance for public health. Some critics have claimed that these initiatives burden health systems that are already fragile in countries with few resources, whereas others have asserted that weak health systems prevent progress in meeting disease-specific targets. So far, most of the evidence for this debate has been provided by speculation and anecdotes. We use a review and analysis of existing data, and 15 new studies that were submitted to WHO for the purpose of writing this Report to describe the complex nature of the interplay between country health systems and GHIs. We suggest that this Report provides the most detailed compilation of published and emerging evidence so far, and provides a basis for identification of the ways in which GHIs and health systems can interact to mutually reinforce their effects. On the basis of the findings, we make some general recommendations and identify a series of action points for international partners, governments, and other stakeholders that will help ensure that investments in GHIs and country health systems can fulfil their potential to produce comprehensive and lasting results in disease-specific work, and advance the general public health agenda. The target date for achievement of the health-related Millennium Development Goals is drawing close, and the economic downturn threatens to undermine the improvements in health outcomes that have been achieved in the past few years. If adjustments to the interactions between GHIs and country health systems will improve efficiency, equity, value for money, and outcomes in global public health, then these opportunities should not be missed.The Lancet 07/2009; 373(9681):2137-69. · 38.28 Impact Factor -
Article: Signposts to research for health.
The Lancet 12/2008; 372(9649):1521-2. · 38.28 Impact Factor -
Article: From Mexico to Mali: progress in health policy and systems research.
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ABSTRACT: In 2004, the ministerial summit in Mexico drew attention to the historic neglect of health policy and systems research (HPSR) and called for increased funding, investment in national institutional capacity for HPSR, and resources for selected priority research topics. On the basis of meeting discussions, published reports, and available data from research funders and organisations in low-income and middle-income countries, we discuss how HPSR has evolved since the summit in Mexico. Funding for HPSR, particularly in low-income countries, is mainly supported by international and bilateral organisations. Increased interest in health systems has translated into increased support for HPSR. However, small grants and lack of coordination between funders inhibit capacity development, and substantial gaps remain between institutional capacities of high-income and low-income countries. Lack of national capacity is judged to be the key constraint to the development of HPSR. Recommendations from the summit in Mexico remain pertinent, and momentum towards their achievement must be accelerated through the ministerial forum in Mali and beyond.The Lancet 12/2008; 372(9649):1571-8. · 38.28 Impact Factor -
Article: China and global health.
The Lancet 11/2008; 372(9648):1439-41. · 38.28 Impact Factor -
Article: Tackling the challenges to health equity in China.
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ABSTRACT: In terms of economic development, China is widely acclaimed as a miracle economy. Over a period of rapid economic growth, however, China's reputation for health has been slipping. In the 1970s China was a shining example of health development, but no longer. Government and public concerns about health equity have grown. China's health-equity challenges are truly daunting because of a vicious cycle of three synergistic factors: the social determinants of health have become more inequitable; imbalances in the roles of the market and government have developed; and concerns among the public have grown about fairness in health. With economic boom and growing government revenues, China is unlike other countries challenged by health inequities and can afford the necessary reforms so that economic development goes hand-in-hand with improved health equity. Reforms to improve health equity will receive immense popular support, governmental commitment, and interest from the public-health community worldwide.The Lancet 11/2008; 372(9648):1493-501. · 38.28 Impact Factor -
Article: From Mexico to Mali: a new course for global health.
The Lancet 02/2008; 371(9607):91-3. · 38.28 Impact Factor -
Article: Clinical trial registration: transparency is the watchword.
The Lancet 06/2006; 367(9523):1631-3. · 38.28 Impact Factor -
Article: A 15th grand challenge for global public health.
The Lancet 02/2006; 367(9507):284-6. · 38.28 Impact Factor -
Article: An open letter to the Executive Board of WHO.
The Lancet 01/2003; 360(9348):1797. · 38.28 Impact Factor -
Article: Market Failures and Orphan Diseases
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ABSTRACT: Ariel Pablos-Mendez, Sunil Chacko and Timothy Evans discuss the growing problem of market failures in the development of essential vaccines and drugs for orphan diseases, as well as the public–private mechanisms available to bring the opportunity of new science and technology to bear on diseases of the poor. Development (1999) 42, 79–83. doi:10.1057/palgrave.development.1110090Development. 01/1999; 42(4):79-83.
