Pandemic influenza control in Europe and the constraints resulting from incoherent public health laws.

Background With the emergence of influenza H1N1v the world is facing its first 21st century global pandemic. Severe Acute Respiratory Syndrome (SARS) and avian influenza H5N1 prompted development of pandemic preparedness plans. National systems of public health law are essential for public health stewardship and for the implementation of public health policy[1]. International coherence will contribute to effective regional and global responses. However little research has been undertaken on how law works as a tool for disease control in Europe. With co-funding from the European Union, we investigated the extent to which laws across Europe support or constrain pandemic preparedness planning, and whether national differences are likely to constrain control efforts. Methods We undertook a survey of national public health laws across 32 European states using a questionnaire designed around a disease scenario based on pandemic influenza. Questionnaire results were reviewed in workshops, analysing how differences between national laws might support or hinder regional responses to pandemic influenza. Respondents examined the impact of national laws on the movements of information, goods, services and people across borders in a time of pandemic, the capacity for surveillance, case detection, case management and community control, the deployment of strategies of prevention, containment, mitigation and recovery and the identification of commonalities and disconnects across states. Results Results of this study show differences across Europe in the extent to which national pandemic policy and pandemic plans have been integrated with public health laws. We found significant differences in legislation and in the legitimacy of strategic plans. States differ in the range and the nature of intervention measures authorized by law, the extent to which borders could be closed to movement of persons and goods during a pandemic, and access to healthcare of non-resident persons. Some states propose use of emergency powers that might potentially override human rights protections while other states propose to limit interventions to those authorized by public health laws. Conclusion These differences could create problems for European strategies if an evolving influenza pandemic results in more serious public health challenges or, indeed, if a novel disease other than influenza emerges with pandemic potential. There is insufficient understanding across Europe of the role and importance of law in pandemic planning. States need to build capacity in public health law to support disease prevention and control policies. Our research suggests that states would welcome further guidance from the EU on management of a pandemic, and guidance to assist in greater commonality of legal approaches across states.

Protocol for the modeling the epidemiologic transition study: a longitudinal observational study of energy balance and change in body weight, diabetes and cardiovascular disease risk.

ABSTRACT: BACKGROUND: The prevalence of obesity has increased in societies of all socio-cultural backgrounds. To date, guidelines set forward to prevent obesity have universally emphasized optimal levels of physical activity. However there are few empirical data to support the assertion that low levels of energy expenditure in activity is a causal factor in the current obesity epidemic are very limited. METHODS: The Modeling the Epidemiologic Transition Study (METS) is a cohort study designed to assess the association between physical activity levels and relative weight, weight gain and diabetes and cardiovascular disease risk in five population-based samples at different stages of economic development. Twenty-five hundred young adults, ages 25-45, were enrolled in the study; 500 from sites in Ghana, South Africa, Seychelles, Jamaica and the United States. At baseline, physical activity levels were assessed using accelerometry and a questionnaire in all participants and by doubly labeled water in a subsample of 75 per site. We assessed dietary intake using two separate 24-h recalls, body composition using bioelectrical impedance analysis, and health history, social and economic indicators by questionnaire. Blood pressure was measured and blood samples collected for measurement of lipids, glucose, insulin and adipokines. Full examination including physical activity using accelerometry, anthropometric data and fasting glucose will take place at 12 and 24 months. The distribution of the main variables and the associations between physical activity, independent of energy intake, glucose metabolism and anthropometric measures will be assessed using cross-section and longitudinal analysis within and between sites. DISCUSSION: METS will provide insight on the relative contribution of physical activity and diet to excess weight, age-related weight gain and incident glucose impairment in five populations' samples of young adults at different stages of economic development. These data should be useful for the development of empirically-based public health policy aimed at the prevention of obesity and associated chronic diseases.

The effects of poor financial information systems on the long term sustainability of local public services. Empirical evidence from the Catalan Municipalities

In this paper we describe the existence of financial illusion in public accountingand we comment on its effects for the future sustainability of local publicservices. We relate these features to the lack of incentives amongst publicmanagers for improving the financial reporting and thus management of publicassets. Financial illusion pays off for politicians and managers since it allowsfor larger public expenditure increases and managerial slack, these beingarguments in their utility functions. This preference is strengthen by the shorttime perspective of politically appointed public managers. Both factors runagainst public accountability. This hypothesis is tested for Spain by using anunique sample. We take data from around forty Catalan local authorities withpopulation above 20,000 for the financial years 1993-98. We build this databasis from the Catalan Auditing Office Reports in a way that it can be linkedto some other local social and economic variables in order to test ourassumptions. The results confirm that there is a statistical relationship between the financialillusion index (FI as constructed in the paper) and higher current expenditure.This reflects on important overruns and increases of the delay in payingsuppliers, as well as on a higher difficulties to face capital finance. Mechanismsfor FI creation have to do among other factors, with delays in paying suppliers(and thereafter higher future financial costs per unit of service), no adequateprovision for bad debts and lack of appropriate capital funding either forreposition or for new equipments. For this, it is crucial to monitor the way inwhich capital transfers are accounted in local public sheet balances. As a result,for most of the Municipalities we analyse, the funds for guaranteeing continuityand sustainability of public services provision are today at risk.Given managerial incentives at present in public institutions, we conclude thatpublic regulation recently enforced for assuring better information systems inlocal public management may not be enough to change the current state of affairs.

Workshop: Capacity building for national public health advocacy: case studies from national associations

The first statement of the EUPHA on the Future of Public Health in Europe refers to the need for going 'to policymakers, politicians and practitioners in all sectors of society and advise them on how to promote public health throughout society'. WHO-EURO Director General Marc Danzon, quoted in the second EUPHA statement on the responsibility of policy makers indicates that 'learning is not systematically applied in health policy development in our continent'. Statement 3 calls for the integration of public health into the political agenda in all sectors. The first EUPHA president, Louise Gunning-Schepers, quoted in Statement 10 called on EUPHA to become 'a powerful advocate of the public health community'. In addition to the above, the EU is now actively seeking ways to build capacity to implement its health strategy. Learning and building the capacity to achieve our aims The aims and objectives to promote the public's health as reflected in EUPHA's 10 statements are also mirrored in the national public health associations. However, many of EUPHA's national associations have little or limited experience in promoting public health policy at the national level. To assist in the learning of advocacy for public health policies, case studies presenting experiences of national public health organizations in lobbying for national public health policy will be presented and discussed. In addition to sharing experiences, the presentations will identify successful approaches to public health advocacy as well as lessons learned from unsuccessful attempts.

Incidencia territorial de la política universitaria

La tendencia descentralizadora impulsada por la política universitaria española ha tenido, sin lugar a dudas, un impacto importante sobre la economía de las regiones en las que se ha asentado una Universidad de nueva creación. Los estudios del impacto económico de la Universidad sobre el área geográfica en la que se desenvuelve, son un importante instrumento para justificar e incentivar la descentralización geográfica de la educación superior, especialmente en tiempos en los que las rigideces presupuestarias exigen racionalizar al máximo los niveles de gasto público. Una de las técnicas habitualmente utilizadas para evaluar los efectos de la Universidad sobre la economía regional, es la basada en el análisis input-output. Dicho análisis estima el impacto total del gasto, incluyendo los efectos directos, los efectos indirectos y los efectos inducidos del consumo. La metodología input-output es precisamente, la que se aplica en este trabajo para poder cuantificar el impacto que las actividades de la Universidad de Lleida han tenido sobre la economía territorial.

Diferentes padrões de políticas salariais nos estados brasileiros: uma análise a partir do diferencial de salários público-privado

Public servant wages represent a significant part of Brazilian state governments' current expenses. Based on the literature, this paper has tried to identify which states practice efficient, compensatory or appropriation wage politics through the estimation of public-private wage differentials. The differential of salaries was calculated between 1995 and 2004 following the Oaxaca's technique. The results show that the wage policy of an important number of states has had efficiency and a numerous part of the North and the Northeast states have developed compensatory politics. The Federal District and Roraima practiced a wage policy characterized by explicit appropriation.

Política fiscal anticíclica, crise financeira internacional e crescimento econômico no Brasil

This study analyzes the long run equilibrium relationship and causality between economic growth and public expenditure in Brazil covering the period 1980-2008. The empirical results of the Granger causality test in a multivariate framework have shown up the importance of public investments not only to face the adverse effects of the international financial crisis, but also in stimulating the economic growth. Also, the results indicate the need of controlling the growing path of other current expenditure, social security and public debt.

Social control of public expenditures in a multilevel principal-agent approach

ABSTRACTThis study enhances the principal-agent model by incorporating a multilevel perspective and differences among agency situations. A theoretical discussion is developed using a proposed intersection of methodological focuses and a descriptive-exemplificative hypothetical analysis. The analysis is applied to public expenditure social control in representative democracies, and as a result, a principal-agent model unfolds that incorporates a decision-making perspective and focuses on formulation, negotiation, articulation, and implementation competencies. Thus, it is possible to incorporate elements into the principal-agent model to make it more permeable to individual, group, and societal idiosyncrasies with respect to public expenditure social control.

Reproductive Tourism in Argentina: Clinic Accreditation and its Implications for Consumers, Health Professionals and Policy Makers

A subcategory of medical tourism, reproductive tourism has been the subject of much public and policy debate in recent years. Specific concerns include: the exploitation of individuals and communities, access to needed health care services, fair allocation of limited resources, and the quality and safety of services provided by private clinics. To date, the focus of attention has been on the thriving medical and reproductive tourism sectors in Asia and Eastern Europe; there has been much less consideration given to more recent ‘players’ in Latin America, notably fertility clinics in Chile, Brazil, Mexico and Argentina. In this paper, we examine the context-specific ethical and policy implications of private Argentinean fertility clinics that market reproductive services via the internet. Whether or not one agrees that reproductive services should be made available as consumer goods, the fact is that they are provided as such by private clinics around the world. We argue that basic national regulatory mechanisms are required in countries such as Argentina that are marketing fertility services to local and international publics. Specifically, regular oversight of all fertility clinics is essential to ensure that consumer information is accurate and that marketed services are safe and effective. It is in the best interests of consumers, health professionals and policy makers that the reproductive tourism industry adopts safe and responsible medical practices.

Ethics in Health Policy for Allergy : A Practical Approach for Decision-Makers

Comme à l’approche d’un tsunami, l’incidence grandissante des allergies affecte maintenant plus de 30% de la population des pays développés. Étant la cause de nombreuses morbidités et un risque significatif de mortalité, les allergies nécessitent des dépenses exorbitantes au système de santé et constituent une des plus importantes sources d’invalidité. Cette thèse a pour but de contribuer à faciliter la prise de décision éclairée dans le développement de politiques en santé en lien avec cette maladie immunitaire chronique en utilisant des principes d’éthique comme outils pour guider le développement de politiques en santé. Le premier chapitre démontre le présent déficit d’analyses des enjeux éthiques en allergologie et démontre de quelle façon les réflexions en éthique peuvent guider le développement de politiques et l’élaboration de stratégies appliquées aux allergies. Les chapitres qui suivront présentent des applications spécifiques des principes d’éthiques ciblant des contextes précis comme des méthodes qui fournissent des outils de réflexion et des cadres théoriques qui peuvent être appliqués par les décideurs pour guider des interventions en santé concernant les allergies et les conditions de co-morbidité reliées. Le second chapitre présente un cadre théorique pour l’évaluation et la priorisation d’interventions en santé publique par la diminution des allergènes présents dans l’environnement basées sur des théories de justice sociale. Les critères entourant les politiques d’évaluation se concentrent sur les enjeux éthiques référant aux populations vulnérables, sur une distribution plus égale des bénéfices pour la santé, et sur le devoir d’éviter la stigmatisation. Le troisième chapitre offre aux administrateurs et au personnel infirmier du réseau scolaire un cadre décisionnel pour guider le développement de politiques efficaces et éthiquement justifiables concernant les allergies alimentaires pour les écoles. Dans ce contexte, les principes de base d’éthique en santé publique et en bioéthique - par exemple, l’empowerment des populations vulnérables dans la prise en charge de leur santé et la protection de la confidentialité du dossier médical - servent d’outils pour évaluer les politiques. Le dernier chapitre emploie les principes de base de recherche en éthique comme méthode pour développer un argumentaire en faveur de la réforme des réglementations entourant la production de médicaments immunothérapeutiques. La nécessité éthique d’éviter les risques de méfait à l’endroit du sujet humain dans la recherche permettra de servir de guide pour structurer de futures politiques en santé publique en égard à la production d’immunothérapeutiques à l’échelle mondiale.

Targeted Public Distribution System in Food Grains:Extent of Utlization by the Tribal Population in Kerala

In India, Food Security meant supply of food grains and the medium was Public Distribution System. Public Distribution System (PDS) is a rationing mechanism that entitles households to specified quantities of selected commodities at subsidized prices. The Objectives of PDS are maintaining Price Stability, rationing during times of scarcity, welfare of the poor, and keeping a check on private trade. Kerala has registered remarkable improvement in poverty reduction in general over the years among all social sections, including scheduled caste and scheduled tribe population. As part of the structural adjustment intended to reduce public expenditure, PDS has been modified as Revamped PDS (RPDS) during 1992 and later on as Targeted PDS (TPDS) in 1997, intended to target households on the basis of income criterion, classifying people as Below Poverty Line (BPL) and Above Poverty Line (APL). TPDS provides 25Kg. of food gra.ins through the Fair Price Shops per month @ Rs.3/- per Kg. of rice/ wheat to the BPL category and @Rs.8.90 and Rs.6.7O for rice and wheat respectively to the APL category of people. Since TPDS is intended to target the poor people, the subsidy spent by the government for the scheme should be beneficial to the poor people and naturally they should utilize the benefits by purchasing the food grains allotted under the scheme. Several studies have shown that there is underutilization of the allotments under TPDS. Therefore, the extent of utilization of TPDS in food grains, how and why remains as a major hurdle, in improving the structure and system of PDS. Livelihood of the tribal population being under threat due to increasing degradation of the resources, the targeting system ought to be effective among the tribal population. Therefore, performance of the TPDS in food grains, in terms of the utilization by the tribal population in Kerala, impact thereof and the factors, if any, affecting proper utilization were considered as the research problem in this study. The study concentrated on the pattern of consumption of food grains by the tribal people, whether their hunger needs are met by distribution of food grains through the TPDS, extent to which TPDS in food grains reduce their share of expenditure on food in the total household expenditure, and the factors affecting the utilization of the TPDS in food grains by the tribal population. Going through the literature, it has been noted that only few studies concentrated on the utilization of TPDS in food grains among the tribal population in Kerala.The Research Design used in this study is descriptive in nature, but exploratory in some aspects. Idukki, Palakkad and Wayanad have more than 60% of the population of the tribals in the state. Within the three districts mentioned above, 14 villages with scheduled tribe concentration were selected for the study. 95 tribal colonies were selected from among the various tribal settlements. Collection of primary data was made from 1231 households with in the above tribal colonies. Analysis of data on the socio-economic factors of the tribal people, pattern of food consumption, extent of reduction in the share of expenditure on food among the household expenditure of the tribal people and the impact of TPDS on the tribal families etc. and testing of hypotheses to find out the relation/association of each of the six variables, using the data on BPL and APL categories of households separately have resulted in findings such as six percent of the tribal families do not have Ration Cards, average per capita consumption of food grains by the tribal people utilizing TPDS meets 62% of their minimum requirement, whereas the per capita consumption of food grains by the tribal people is higher than the national average per capita consumption, 63% deficiency in food grains may be felt by tribal people in general, if TPDS is withdrawn, and the deficit for BPL tribal people may be 82%, TPDS facilitates a reduction of 9.71% in the food expenditure among the total household expenditure of the tribal people in general, share of food to non-food among BPL category of tribals is 55:45 and 40:60 among the APL, Variables, viz. household income, number of members in the family and distance of FPS from tribal settlements etc. have influence on the quantity of rice being purchased by the tribal people from the Fair Price Shops, and there is influence of household income and distance of FPS from tribal settlements on the quantity of rice being purchased by the tribal people from the open market. Rationing with differential pricing on phased allotments, rectification of errors in targeting, anomalies in norms and procedures for classifying tribal people as BPL/APL, exclusive Income Generation for tribal population, paddy cultivation in the landholdings possessed by the tribal people, special drive for allotment of Ration Cards to the tribal people, especially those belonging to the BPL category, Mobile Fair Price Shops in tribal settlements, ensure quality of the food grains distributed through the TPDS, distribution of wheat flour in packed condition instead of wheat through the Fair Price Shops are recommended to address the shortcomings and weaknesses of the TPDS vis-avis the tribal population in Kerala.

La Universidad Nacional de Colombia: Entre el interés privado y el bien público en el transcurso de las dos últimas décadas.

El propósito de esta monografía es analizar la incidencia que ha tenido el modelo de autofinanciación incentivado por el Estado colombiano en el carácter público de la Universidad Nacional de Colombia en los últimos veinte años, a partir de la teoría de los bienes club. Se plantea desde el análisis teórico y factico una revisión a la normatividad de la Educación Superior en Colombia para explicar la forma en que el aumento desequilibrado de los recursos propios frente a los aportes de la nación en el presupuesto de la Universidad Nacional de Colombia, sumado a algunas problemáticas en los gastos de funcionamiento, ha perpetuado los niveles de exclusión en el acceso al bien, restringiendo de esta forma el carácter público del servicio que ha prestado esta institución en las últimas dos décadas.

Natural resource windfalls and efficiency of local government expenditures: evidence from Peru

We study the role of natural resource windfalls in explaining the efficiency of public expenditures. Using a rich dataset of expenditures and public good provision for 1,836 municipalities in Peru for period 2001-2010, we estimate a non-monotonic relationship between the efficiency of public good provision and the level of natural resource transfers. Local governments that were extremely favored by the boom of mineral prices were more efficient in using fiscal windfalls whereas those benefited with modest transfers were more inefficient. These results can be explained by the increase in political competition associated with the boom. However, the fact that increases in efficiency were related to reductions in public good provision casts doubts about the beneficial effects of political competition in promoting efficiency.

Natural resources, redistribution and Human capital formation

How do resource booms affect human capital accumulation? We exploit time and spatial variation generated by the commodity boom across local governments in Peru to measure the effect of natural resources on human capital formation. We explore the effect of both mining production and tax revenues on test scores, finding a substantial and statistically significant effect for the latter. Transfers to local governments from mining tax revenues are linked to an increase in math test scores of around 0.23 standard deviations. We find that the hiring of permanent teachers as well as the increases in parental employment and improvements in health outcomes of adults and children are plausible mechanisms for such large effect on learning. These findings suggest that redistributive policies could facilitate the accumulation of human capital in resource abundant developing countries as a way to avoid the natural resources curse.