世界経済・社会統計 = World development indicators

Chronic health conditions have been on the rise across the world. But few health care systems, have proved able to cope with managing this dramatic increase in chronic conditions. This report from the World Health Organization (WHO) provides a comprehensive framework for the prevention framework for the prevention and management of Chronic health conditions around the world. Chronic health conditions were defined in this report as “health problems that persist across time and require some degree of health care management”. This new report addresses how policy makers can take effective and innovative action to tackle these conditions. The report addresses the following issues: Exploring chronic conditions, including how and why they are increasing, what is their economic impact on patients, families, communities, and governments, and how to reduce their prevalence. The deficits in current systems of health to successfully manage chronic conditions because the acute care model dominates health care systems. The acute care model increased health care expenditures without improving populations health status. A new framework for health care systems to improve care for chronic conditions. This framework is comprised of fundamental components within the patient, health care organization and community, and policy levels. These components were described as “building blocks” that can be used to re-design a health care system to manage long-term health problems more effectively. The report describes eight essential elements for improving and creating innovations in the care of chronic conditions. These elements include: Supporting a shift in attitudes, so that decision­ makers, health workers and patients are aware that a shift in resources from the acute, episodic model of care is needed to meet the different of chronic conditions. Building political commitment to the process of preventing and managing chronic conditions. Avoiding fragmentation of services, to ensure that the care for chronic conditions is integrated. To align and analyze policies which affect chronic conditions, such as agricultural regulations, labor laws and health education. To use new, team care models and evidence-based skills for managing chronic conditions, worth more efficient use of health care personnel. To re-oriented Health care for chronic conditions around the patient and family. To support patients within their communities, because communities can fill a crucial gap in health services that are not provided by organized health care. To emphasize prevention, as many of the complications of chronic conditions can be prevented or reduced. This report provides a well-formulated framework for decision-makers and health service planners to implement strategies for comprehensively managing chronic conditions.

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Innovative care for chronic conditions: building blocks for action

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BACKGROUND 

Measurement of the global burden of disease with disability-adjusted life-years (DALYs) requires disability weights that quantify health losses for all non-fatal consequences of disease and injury. There has been extensive debate about a range of conceptual and methodological issues concerning the definition and measurement of these weights. Our primary objective was a comprehensive re-estimation of disability weights for the Global Burden of Disease Study 2010 through a large-scale empirical investigation in which judgments about health losses associated with many causes of disease and injury were elicited from the general public in diverse communities through a new, standardised approach.

METHODS 

We surveyed respondents in two ways: household surveys of adults aged 18 years or older (face-to-face interviews in Bangladesh, Indonesia, Peru, and Tanzania; telephone interviews in the USA) between Oct 28, 2009, and June 23, 2010; and an open-access web-based survey between July 26, 2010, and May 16, 2011. The surveys used paired comparison questions, in which respondents considered two hypothetical individuals with different, randomly selected health states and indicated which person they regarded as healthier. The web survey added questions about population health equivalence, which compared the overall health benefits of different life-saving or disease-prevention programmes. We analysed paired comparison responses with probit regression analysis on all 220 unique states in the study. We used results from the population health equivalence responses to anchor the results from the paired comparisons on the disability weight scale from 0 (implying no loss of health) to 1 (implying a health loss equivalent to death). Additionally, we compared new disability weights with those used in WHO's most recent update of the Global Burden of Disease Study for 2004.

FINDINGS

13,902 individuals participated in household surveys and 16,328 in the web survey. Analysis of paired comparison responses indicated a high degree of consistency across surveys: correlations between individual survey results and results from analysis of the pooled dataset were 0·9 or higher in all surveys except in Bangladesh (r=0·75). Most of the 220 disability weights were located on the mild end of the severity scale, with 58 (26%) having weights below 0·05. Five (11%) states had weights below 0·01, such as mild anaemia, mild hearing or vision loss, and secondary infertility. The health states with the highest disability weights were acute schizophrenia (0·76) and severe multiple sclerosis (0·71). We identified a broad pattern of agreement between the old and new weights (r=0·70), particularly in the moderate-to-severe range. However, in the mild range below 0·2, many states had significantly lower weights in our study than previously.

INTERPRETATION

This study represents the most extensive empirical effort as yet to measure disability weights. By contrast with the popular hypothesis that disability assessments vary widely across samples with different cultural environments, we have reported strong evidence of highly consistent results.

Common values in assessing health outcomes from disease and injury: Disability weights measurement study for the Global Burden of Disease Study 2010

https://www.thelancet.com/pdfs/journals/landia/PIIS2213-8587(15)00521-5.pdf

Constraints and challenges in access to insulin: a global perspective

Background: The double burden of tuberculosis (TB) and diabetes mellitus (DM) is hitting certain Asian countries harder than other areas. In a global estimate, 15% of all TB cases could be attribut...

https://tandfonline.com/doi/pdf/10.1080/16549716.2016.1264702

Diabetes and pulmonary tuberculosis: a global overview with special focus on the situation in Asian countries with high TB-DM burden

Health system reform in Kyrgyzstan is seen as a relative success story in central Asia. Initially, most attention focused on structural changes, and it is only since 2006 that the delivery of care and the experience of health service users have risen on the agenda. One exception from the earlier period was a rapid appraisal of the management of diabetes, undertaken in 2002. Using that study as a baseline, we describe the findings of a new evaluation of diabetes management, undertaken in 2009, using the Rapid Assessment Protocol for Insulin Access, now implemented in seven countries. Access to care has improved through the creation of the Family Medical Centres and the deployment of endocrinologists to them. Another improvement is the access to insulin and related medicines, although assessment of the procurement system reveals that the government is getting very poor value for money. Looking ahead, there are grounds for optimism that the passage of the law on diabetes may progressively have a greater impact. Although the law is not yet fully implemented, it has enabled the diabetes associations to defend the rights of their members. This increased capacity is credited with some improvements in diabetes care.

Diabetes in Kyrgyzstan: changes between 2002 and 2009

The increasing number of patients co-affected with Diabetes and TB may place individuals with low socio-economic status at particular risk of persistent poverty. Kyrgyz health sector reforms aim at reducing this burden, with the provision of essential health services free at the point of use through a State-Guaranteed Benefit Package (SGBP). However, despite a declining trend in out-of-pocket expenditure, there is still a considerable funding gap in the SGBP. Using data from Bishkek, Kyrgyzstan, this study aims to explore how households cope with the economic burden of Diabetes, TB and co-prevalence.

/pdf/coping-with-the-economic-burden-of-diabetes-tb-and-co-uuh4nfi7cf.pdf

Coping with the economic burden of Diabetes, TB and co-prevalence: evidence from Bishkek, Kyrgyzstan.

The incidence of diabetes and tuberculosis co-morbidity is rising, yet little work has been done to understand potential implications for health systems, healthcare providers and individuals. Kyrgyzstan is a priority country for tuberculosis control and has a 5% prevalence of diabetes in adults, with many health system challenges for both conditions. Patient exit interviews collected data on demographic and socio-economic characteristics, health spending and care seeking for people with diabetes, tuberculosis and both diabetes and tuberculosis. Qualitative data were collected through semi-structured interviews with healthcare workers involved in diabetes and tuberculosis care, to understand delivery of care and how providers view effectiveness of care. The experience of co-affected individuals within the health system is different than those just with tuberculosis or diabetes. Co-affected patients do not receive more care and also have different care for their tuberculosis than people with only tuberculosis. Very high levels of catastrophic spending are found among all groups despite these two conditions being included in the Kyrgyz state benefit package especially for medicines. This study highlights that different patterns of service provision by disease group are found. Although Kyrgyzstan has often been cited as an example in terms of health reforms and developing Primary Health Care, this study highlights the challenge of managing conditions that are viewed as “too complicated” for non-specialists and the impact this has on costs and management of individuals.

/pdf/addressing-the-double-burden-of-diabetes-and-tuberculosis-51cgjbjpo8.pdf

Addressing the double-burden of diabetes and tuberculosis: lessons from Kyrgyzstan

https://www.thelancet.com/article/S2214109X16301395/pdf

Aida Abdraimova

Papers

Diabetes in Kyrgyzstan: changes between 2002 and 2009

Coping with the economic burden of Diabetes, TB and co-prevalence: evidence from Bishkek, Kyrgyzstan.

Addressing the double-burden of diabetes and tuberculosis: lessons from Kyrgyzstan

Professional medical associations in low-income and middle-income countries.