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Edited by
Scott L. Greer, University of Michigan,Michelle Falkenbach, European Observatory on Health Systems and Policies,Josep Figueras, European Observatory on Health Systems and Policies,Matthias Wismar, European Observatory on Health Systems and Policies
Decent work and economic growth benefits greatly from a healthy population. In this vein, health policy itself can promote improved work and employment by making health sectors better employers. There are a range of opportunities to improving the quality of jobs and reducing inequalities, beginning with addressing particular management behaviors in particular units, to strong and well enforced antidiscrimination law, to paying a higher minimum wage. The political difficulty of making such adjustments, especially in the eyes of managers and policy makers, take the form of added costs to organizations and reduced pay differentials that benefit higher paid workers. The goal is thus to focus efforts on political actors such as unions and civil society that will support SDG8. A case study of Romania presents an overview of policy actions taken to address health workforce shortages, by tackling issues related to recruitment, retention and international mobility of health workers.
Edited by
Scott L. Greer, University of Michigan,Michelle Falkenbach, European Observatory on Health Systems and Policies,Josep Figueras, European Observatory on Health Systems and Policies,Matthias Wismar, European Observatory on Health Systems and Policies
Education has become the principal pathway to good health, financial security, stable employment, and social success. Due to the fact that education is strongly associated with life expectancy, morbidity and health behaviours it is widely recognized that health and education are mutually influential. While the focus has primarily been on the impact of education on health, advancing health and wellbeing remains a critical pathway to achieve education and life-long learning. As such, a re-orientation of systemic thinking and practice that builds on health and wellbeing as central elements of achieving quality education during the life course is key to achieving SDG 4 quality education.
Edited by
Scott L. Greer, University of Michigan,Michelle Falkenbach, European Observatory on Health Systems and Policies,Josep Figueras, European Observatory on Health Systems and Policies,Matthias Wismar, European Observatory on Health Systems and Policies
The goal of SDG 1 is to end poverty in all forms everywhere. Health systems are a significant determinant of the risk of impoverishment and financial hardship. We review methods for calculating catastrophic health spending and impoverishing spending, noting a distinction between those who are impoverished by out-of-pocket (OOP) health spending and those who are further impoverished by OOP health spending. Catastrophic health spending tends to be concentrated among poor households, but there is a high level of variability between countries. In particular, countries with higher public spending on health as a share of GDP have lower OOP spending, which in turn is associated with lower catastrophic health spending and impoverishment. Policymakers can also make progress on reducing the risk of impoverishment by making reforms to coverage policies. We conceptualise progress towards universal health coverage through an analysis of the coverage of people, services, and costs. Risk of financial hardship is minimised when the entire population is covered, the right services are covered to meet the population’s health needs, and costs are financed largely through pre-payment with risk pooling to avoid high user charges. The most successful systems use user charges sparingly, design user charges as fixed copayments rather than percentage-based coinsurance, and include income-based exemptions and OOP maximums.
Edited by
Scott L. Greer, University of Michigan,Michelle Falkenbach, European Observatory on Health Systems and Policies,Josep Figueras, European Observatory on Health Systems and Policies,Matthias Wismar, European Observatory on Health Systems and Policies
This introductory chapter makes the case for moving beyond the concept of Health in all Policies and towards a Health for all Policies approach. Health for All Policies is a framework emphasising co-benefits: the ways in which improved health or better health systems and policies can attain other goals. In terms of the SDGs, it captures the extent to which better health status, and use of health budgets, policies, and infrastructures, can contribute to all of the SDGs, whether fairly obvious ones (health enables education) to ones that require more thought (health care systems’ procurement and waste disposal systems affect life under the seas). The case for co-benefits is not just that it shows what health policy can do for other goals. It is not just that it shows what health policy should do for other goals such as sustainability or reducing gender and other inequalities. It also opens up new perspectives on coalitions, politics, and governance.
Edited by
Scott L. Greer, University of Michigan,Michelle Falkenbach, European Observatory on Health Systems and Policies,Josep Figueras, European Observatory on Health Systems and Policies,Matthias Wismar, European Observatory on Health Systems and Policies
This chapter examines the wide-ranging and often poorly defined SDG 17 (means of implementation) in the context of health policy and governance. It fundamentally asks: How can health policies and systems contribute to achieving goals from SDG 17? The author argues that there are significant synergies between health policy and SDG 17 as many of the factors that potentially make ‘sustainable development’ possible require healthy populations and functional health systems. When health and sustainable growth goals align, good population health, resting on environmentally sustainable food chains, adequate support for public health systems, good access to healthcare, and good enough governance for health, can provide benefits to the global economy and help to move towards a model of sustainable development.
Edited by
Scott L. Greer, University of Michigan,Michelle Falkenbach, European Observatory on Health Systems and Policies,Josep Figueras, European Observatory on Health Systems and Policies,Matthias Wismar, European Observatory on Health Systems and Policies
Inequalities, specifically in Post-Apartheid South Africa, have been extensively analyzed, yet little attention has been paid to the effect of health policy on inequalities. The chapters goal is to demonstrate how SDG 3 (Health for All) can work with SDG10 (Reduce Inequalities) to fight longstanding societal inequalities. One of the first steps is the creation of the National Health Insurance (NHI), whose goal is to cover the entire population with adequate health care at an affordable price. Health and health outcomes are, however, not only affected by provision or access to healthcare and health services. They result from multidimensional and complex factors linked to the social determinants of health. So while the NHI may reduce inequality and inequity in health care, further attention will need to be placed on socio-economic inequality given the social and economic disparities among the population groups in the country.
Edited by
Scott L. Greer, University of Michigan,Michelle Falkenbach, European Observatory on Health Systems and Policies,Josep Figueras, European Observatory on Health Systems and Policies,Matthias Wismar, European Observatory on Health Systems and Policies
Achieving co-benefits places the focus on politics and governance. This chapter presents two basic frameworks for identifying opportunities to make successful policy for co-benefits. One is for addressing the problem of change within government, in the framework commonly used by advocates of intersectoral policy. We adopt a framework that can clearly identify key dynamics and opportunities for the construction of cross-cutting policies, as well as the areas in which, under current circumstances, progress is likely to be limited and advocates might find themselves frustrated or defending their achievements against attack. The second approach to analyzing politics and the possibility of action is grounded in the analysis of agenda-setting, which has been profitably applied to the area of intersectoral policy for health. In both cases, these are basic analytic frameworks for understanding which action is likely to be effective, in order to improve the likelihood that proposals for achieving co-benefits do achieve their potential benefits.
Edited by
Scott L. Greer, University of Michigan,Michelle Falkenbach, European Observatory on Health Systems and Policies,Josep Figueras, European Observatory on Health Systems and Policies,Matthias Wismar, European Observatory on Health Systems and Policies
The logic of co-benefits produces many theoretically interesting ideas, but to become convincing, it must be paired with competent policy analysis and evaluation. This chapter focuses on the many examples of co-benefits in practice and research literature in order to demonstrate that many policies have effects, intended or unintended, beyond their main targets.
Edited by
Scott L. Greer, University of Michigan,Michelle Falkenbach, European Observatory on Health Systems and Policies,Josep Figueras, European Observatory on Health Systems and Policies,Matthias Wismar, European Observatory on Health Systems and Policies
This chapter explores the linkages between Sustainable Development Goal (SDG) 3 ‘Health’ and SDG 5 ‘Achieve gender equality and empower all women and girls’. We argue that health equity and gender equality are ‘twin forces’ that are historically connected and cannot be separated, creating either strong co-benefits or a ‘double jeopardy’ scenario for health and gender equality. Developments at the cross-roads of SDG 3 and SDG 5 are never ‘gender neutral’ and need attention for two reasons: to strengthen the health policy co-benefits and to prevent and mitigate adverse effects if gender equality is ignored. We introduce a conceptual model of researching co-benefits that expands the focus on macro-level co-benefits towards more complex governance processes and outcomes, including gender mainstreaming approaches. Selected empirical case studies consider major targets of SDG 5 and related SDG 3 sub-goals, illustrating different scenarios of implementation of health and gender co-benefits in a range of policy and governance contexts. The empirical cases illustrate that governance actions and intersectoral structures/institutional pathways shape the ‘windows of opportunity’ for co-benefits, yet co-benefits remain contested and must be re-assured, a lesson most recently learned from the COVID−19 pandemic.
Edited by
Scott L. Greer, University of Michigan,Michelle Falkenbach, European Observatory on Health Systems and Policies,Josep Figueras, European Observatory on Health Systems and Policies,Matthias Wismar, European Observatory on Health Systems and Policies
This finally introductory chapter emphasises the goal of the book: Rather than reinvent the idea of HiAP, we propose that it simply needs to be expanded. Instead of just offering the one-directional relationship that HiAP proposes (other sectors è health), an expansion of thought is required to make this offer two-dimensional. Health for all policies posits that other sectors help the health sector, and that the health sector helps other sectors. This new relationship highlights what health can do for other sectors while simultaneously attaining co-benefits for its own sector.
An environmental strategy is an integrated set of choices about how a company should interact with the environment and its environmental stakeholders. A first step is identifying how a company impacts the environment and the stakeholder demand for improving those impacts. Stakeholders demand depends on the co-benefits they receive from environmental improvements and the resources they are able to deploy in pursuit of those improvements. A second step is identifying the market and nonmarket channels through which stakeholders can transfer value to the company in return for producing an environmental improvement. A third step is ensuring credibility – how can its stakeholders ensure that the environmental improvements are genuine and that each side will follow through on its promises in the exchange? A final step is to identify how the environmental strategy fits with the company’s competitive strategy. An environmental strategy can enhance a company’s market and nonmarket strategies in ways that are difficult for competitors to mimic, thus creating new sources of sustainable competitive advantage.
A green product is differentiated from similar products through an augmented sustainability feature, such as being produced with less environmental harm of having a smaller environmental impact upon disposal. The case of Stonyfield organic yogurt and the company’s founders, Samuel Kaymen and Gary Hirshberg, illustrate the challenges of selling green products. Green products need to offer co-benefits to garner consumer demands. A co-benefit is a functional, emotional, or social value that a recipient receives along with the product’s environmental benefits. Stonyfield’s organic yogurt offered consumers health and warm-glow emotional co-benefits stemming from the lower pesticides used in its production. Certifications and brands can play important roles in assuring customers that a green product’s promised benefits are genuine. Stonyfield used organic certification and its own quirky brand to solve these credibility challenges.
Chapter 5 introduces the major causes of skepticism, including misinformation and worldviews and values, and offers some possible strategies for countering these influences.
The top priority in addressing climate change is to reduce net emissions of greenhouse gases to zero as swiftly as possible. Among the policy instruments for achieving this goal: carbon markets and carbon taxes; subsidies and incentives for energy conservation and for developing renewable energy technologies; building a new network of advanced nuclear reactors to provide carbon-free energy; imposing restraints on deforestation and planting large numbers of new trees; developing powerful new technologies for removing carbon dioxide from the atmosphere; incentivizing private citizens to reduce the carbon footprint of their lifestyles; and introducing new governmental policies for decarbonizing national economies. By combining all these strategies, humankind could realistically reach net zero emissions by the middle years of this century. From that point forward, it can start actively removing existing accumulations of carbon dioxide, eventually bringing global warming to a halt and reversing some of the damage that’s already been done.
President Reagan’s 1981 executive order exalted the use of formal cost–benefit analysis in determining whether to promulgate regulations (to the extent environmental laws permit those considerations). Regulations to curb pollution from oil and gas operations and the combustion of oil and gas, as documented in various studies, yield larger benefits than costs. To tilt cost–benefit analysis to disfavor these regulations, the administration adopted methods that systematically understated the economic benefits from regulations. It ignored public health and environmental benefits from reducing emissions, despite documentation by scientific studies, and ignored benefits that are difficult to capture in monetary terms. It also adopted assumptions that gave only limited consideration to the well-being of future generations and of non-Americans, both controversial ethical choices. The administration, forced by existing court decisions to take into account climate impacts, chose an extremely paltry sum of $1 per ton of carbon dioxide (down from $51, as calculated by the Interagency Working Group during the Obama administration). Armed with skewed economic analysis, the administration weakened numerous regulations governing the operations of the oil and gas sector, including curbing emissions of methane, a potent greenhouse gas.
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