Global atlas on cardiovascular disease prevention and control.

https://globalhealth.duke.edu/sites/default/files/event-attachments/2.18_meara.pdf

Global Surgery 2030: evidence and solutions for achieving health, welfare, and economic development

Let's read! We will often find out this sentence everywhere. When still being a kid, mom used to order us to always read, so did the teacher. Some books are fully read in a week and we need the obligation to support reading. What about now? Do you still love reading? Is reading only for you who have obligation? Absolutely not! We here offer you a new book enPDFd preventing chronic diseases a vital investment to read.

Preventing Chronic Diseases: A Vital Investment

People in poor countries tend to have less access to health services than those in better-off countries, and within countries, the poor have less access to health services. This article documents disparities in access to health services in low- and middle-income countries (LMICs), using a framework incorporating quality, geographic accessibility, availability, financial accessibility, and acceptability of services. Whereas the poor in LMICs are consistently at a disadvantage in each of the dimensions of access and their determinants, this need not be the case. Many different approaches are shown to improve access to the poor, using targeted or universal approaches, engaging government, nongovernmental, or commercial organizations, and pursuing a wide variety of strategies to finance and organize services. Key ingredients of success include concerted efforts to reach the poor, engaging communities and disadvantaged people, encouraging local adaptation, and careful monitoring of effects on the poor. Yet governments in LMICs rarely focus on the poor in their policies or the implementation or monitoring of health service strategies. There are also new innovations in financing, delivery, and regulation of health services that hold promise for improving access to the poor, such as the use of health equity funds, conditional cash transfers, and coproduction and regulation of health services. The challenge remains to find ways to ensure that vulnerable populations have a say in how strategies are developed, implemented, and accounted for in ways that demonstrate improvements in access by the poor.

https://nyaspubs.onlinelibrary.wiley.com/doi/pdf/10.1196/annals.1425.011

Poverty and access to health care in developing countries.

https://www.who.int/medicines/news/MedPrices_Word2.pdf

Medicine prices, availability, and affordability in 36 developing and middle-income countries: a secondary analysis.

Objective To assess the availability and affordability of medicines used to treat cardiovascular disease, diabetes, chronic respiratory disease and glaucoma and to provide palliative cancer care in six low- and middle-income countries. Methods A survey of the availability and price of 32 medicines was conducted in a representative sample of public and private medicine outlets in four geographically defined areas in Bangladesh, Brazil, Malawi, Nepal, Pakistan and Sri Lanka. We analysed the percentage of these medicines available, the median price versus the international reference price (expressed as the median price ratio) and affordability in terms of the number of days’ wages it would cost the lowest-paid government worker to purchase one month of treatment. Findings In all countries < 7.5% of these 32 medicines were available in the public sector, except in Brazil, where 30% were available, and Sri Lanka, where 28% were available. Median price ratios varied substantially, from 0.09 for losartan in Sri Lanka to 30.44 for aspirin in Brazil. In the private sector in Malawi and Sri Lanka, the cost of innovator products (the pharmaceutical product first given marketing authorization) was three times more than generic medicines. One month of combination treatment for coronary heart disease cost 18.4 days’ wages in Malawi, 6.1 days’ wages in Nepal, 5.4 in Pakistan and 5.1 in Brazil; in Bangladesh the cost was 1.6 days’ wages and in Sri Lanka it was 1.5. The cost of one month of combination treatment for asthma ranged from 1.3 days’ wages in Bangladesh to 9.2 days’ wages in Malawi. The cost of a one-month course of intermediate-acting insulin ranged from 2.8 days’ wages in Brazil to 19.6 in Malawi. Conclusion Context-specific policies are required to improve access to essential medicines. Generic products should be promoted by educating professionals and consumers, by implementing appropriate policies and incentives, and by introducing market competition and/or price regulation. Improving governance and management efficiency, and assessing local supply options, may improve availability. Prices could be reduced by improving purchasing efficiency, eliminating taxes and regulating mark-ups.

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The availability and affordability of selected essential medicines for chronic diseases in six low- and middle-income countries

Introduction Globally, approximately 35 million deaths (60% of all deaths) are attributable to chronic diseases each year, with more than 30 million deaths (52% of all deaths) due to cardiovascular disease (accounting for 30% of all deaths), cancer (13% of all deaths), chronic respiratory disease (7% of all deaths) and diabetes (2% of all deaths). (1) The global burden of disease resulting from all non-communicable conditions, (1) which includes premature death and disability, is 49%; 80% of these deaths occur in low- and middle-income countries. (1,2) Medicines represent a substantial proportion of the economic costs of treating chronic diseases in these countries. For example, in Latin America and the Caribbean it is estimated that medicine costs account for 44% of the direct medical costs of diabetes. (3) Further, in low- and middle-income countries 50-90% of the population have to pay for medicines themselves, (4) rendering treatment unaffordable for many. A significant proportion of chronic disease morbidity and mortality can be prevented if medications are made accessible and affordable. In patients with a high risk of cardiovascular disease, aspirin, beta-blockers, angiotensin-converting enzyme (ACE) inhibitors and lipid-lowering medicines reduce the risk of future vascular events by about a quarter each. When used together, these medicines have the potential to reduce the relative risk by 75% and substantially reduce the recurrence of cardiovascular events. (5) Similarly, making cost-effective treatments available to patients with asthma and diabetes may lead to substantial reductions in morbidity and mortality. (6-9) Several studies have examined the availability, price and affordability of essential medicines, however none have focused specifically on medicines used to treat chronic diseases. (10-13) Little data exist on whether patients have access to affordable medicines for chronic diseases in low- and middle-income countries. A health-care facility-based study of practice patterns used for the secondary prevention of cardiovascular disease in 10 low- and middle-income countries looked at the proportion of patients with coronary heart disease and patients with cerebrovascular disease receiving medicine. (14) The proportion of coronary heart disease patients receiving aspirin was 81.2%; for beta-blockers it was 48.1%; for ACE inhibitors it was 39.8%; and for statins it was 29.8%. The proportions for patients with cerebrovascular disease were: 70.6% for aspirin; 22.8% for beta-blockers; 37.8% for ACE inhibitors; and 14.1% for statins. There are many reasons why medicines are not used more often. These include poor availability, a lack of affordability, poor prescribing practices and a lack of patient adherence. (14) Thus, despite the availability of cost-effective interventions, gaps in the treatment of chronic diseases persist. WHO is therefore initiating a global initiative to improve the care of chronic diseases in low- and middle-income countries. (15) As part of the initiative's preliminary activities, a survey of selected medicines used to treat chronic diseases was undertaken in selected countries to determine: * whether medicines were available, affordable and how much they cost; * whether there were variations in availability, price or affordability between the public and private sectors and between innovator brands (that is, the product that receives marketing authorization first, which is usually the patented version of the medicine) and generic equivalents; and * the contribution that mark-ups, taxes and other costs add to the final price of medicine. Our general hypothesis was that the essential medicines used to treat chronic diseases in low- and middle-income countries have limited availability and may not be affordable. Methods The survey was conducted in three low-middle income countries (Brazil, only in Rio Grande do Sul state; Pakistan and Sri Lanka) and three low-income countries (Bangladesh, Malawi and Nepal). …

Disponibilidad y asequibilidad de algunos medicamentos esenciales para las enfermedades crónicas en seis países de ingresos bajos y medios

Introduction Globally, approximately 35 million deaths (60% of all deaths) are attributable to chronic diseases each year, with more than 30 million deaths (52% of all deaths) due to cardiovascular disease (accounting for 30% of all deaths), cancer (13% of all deaths), chronic respiratory disease (7% of all deaths) and diabetes (2% of all deaths) (1) The global burden of disease resulting from all non-communicable conditions, (1) which includes premature death and disability, is 49%; 80% of these deaths occur in low- and middle-income countries (1,2) Medicines represent a substantial proportion of the economic costs of treating chronic diseases in these countries For example, in Latin America and the Caribbean it is estimated that medicine costs account for 44% of the direct medical costs of diabetes (3) Further, in low- and middle-income countries 50-90% of the population have to pay for medicines themselves, (4) rendering treatment unaffordable for many A significant proportion of chronic disease morbidity and mortality can be prevented if medications are made accessible and affordable In patients with a high risk of cardiovascular disease, aspirin, beta-blockers, angiotensin-converting enzyme (ACE) inhibitors and lipid-lowering medicines reduce the risk of future vascular events by about a quarter each When used together, these medicines have the potential to reduce the relative risk by 75% and substantially reduce the recurrence of cardiovascular events (5) Similarly, making cost-effective treatments available to patients with asthma and diabetes may lead to substantial reductions in morbidity and mortality (6-9) Several studies have examined the availability, price and affordability of essential medicines, however none have focused specifically on medicines used to treat chronic diseases (10-13) Little data exist on whether patients have access to affordable medicines for chronic diseases in low- and middle-income countries A health-care facility-based study of practice patterns used for the secondary prevention of cardiovascular disease in 10 low- and middle-income countries looked at the proportion of patients with coronary heart disease and patients with cerebrovascular disease receiving medicine (14) The proportion of coronary heart disease patients receiving aspirin was 812%; for beta-blockers it was 481%; for ACE inhibitors it was 398%; and for statins it was 298% The proportions for patients with cerebrovascular disease were: 706% for aspirin; 228% for beta-blockers; 378% for ACE inhibitors; and 141% for statins There are many reasons why medicines are not used more often These include poor availability, a lack of affordability, poor prescribing practices and a lack of patient adherence (14) Thus, despite the availability of cost-effective interventions, gaps in the treatment of chronic diseases persist WHO is therefore initiating a global initiative to improve the care of chronic diseases in low- and middle-income countries (15) As part of the initiative's preliminary activities, a survey of selected medicines used to treat chronic diseases was undertaken in selected countries to determine: * whether medicines were available, affordable and how much they cost; * whether there were variations in availability, price or affordability between the public and private sectors and between innovator brands (that is, the product that receives marketing authorization first, which is usually the patented version of the medicine) and generic equivalents; and * the contribution that mark-ups, taxes and other costs add to the final price of medicine Our general hypothesis was that the essential medicines used to treat chronic diseases in low- and middle-income countries have limited availability and may not be affordable Methods The survey was conducted in three low-middle income countries (Brazil, only in Rio Grande do Sul state; Pakistan and Sri Lanka) and three low-income countries (Bangladesh, Malawi and Nepal) …

The Availability and Affordability of Selected Essential Medicines for Chronic Diseases in Six Low- and Middle-Income countries/Disponibilite et Accessibilite Economique Dans Six Pays a Revenu Faible Ou Moyen D'une Serie De Medicaments Essentiels, Destines a Traiter Des Maladies chroniques/Disponibilidad Y Asequibilidad De Algunos Medicamentos Esenciales Para Las Enfermedades Cronicas En Seis Paises De Ingresos Bajos Y Medios

Keiko Fukino

Papers

The availability and affordability of selected essential medicines for chronic diseases in six low- and middle-income countries

Disponibilidad y asequibilidad de algunos medicamentos esenciales para las enfermedades crónicas en seis países de ingresos bajos y medios