世界経済・社会統計 = World development indicators

计量经济分析 = Econometric analysis

WRITING GROUP MEMBERS Emelia J. Benjamin, MD, SCM, FAHA Michael J. Blaha, MD, MPH Stephanie E. Chiuve, ScD Mary Cushman, MD, MSc, FAHA Sandeep R. Das, MD, MPH, FAHA Rajat Deo, MD, MTR Sarah D. de Ferranti, MD, MPH James Floyd, MD, MS Myriam Fornage, PhD, FAHA Cathleen Gillespie, MS Carmen R. Isasi, MD, PhD, FAHA Monik C. Jiménez, ScD, SM Lori Chaffin Jordan, MD, PhD Suzanne E. Judd, PhD Daniel Lackland, DrPH, FAHA Judith H. Lichtman, PhD, MPH, FAHA Lynda Lisabeth, PhD, MPH, FAHA Simin Liu, MD, ScD, FAHA Chris T. Longenecker, MD Rachel H. Mackey, PhD, MPH, FAHA Kunihiro Matsushita, MD, PhD, FAHA Dariush Mozaffarian, MD, DrPH, FAHA Michael E. Mussolino, PhD, FAHA Khurram Nasir, MD, MPH, FAHA Robert W. Neumar, MD, PhD, FAHA Latha Palaniappan, MD, MS, FAHA Dilip K. Pandey, MBBS, MS, PhD, FAHA Ravi R. Thiagarajan, MD, MPH Mathew J. Reeves, PhD Matthew Ritchey, PT, DPT, OCS, MPH Carlos J. Rodriguez, MD, MPH, FAHA Gregory A. Roth, MD, MPH Wayne D. Rosamond, PhD, FAHA Comilla Sasson, MD, PhD, FAHA Amytis Towfighi, MD Connie W. Tsao, MD, MPH Melanie B. Turner, MPH Salim S. Virani, MD, PhD, FAHA Jenifer H. Voeks, PhD Joshua Z. Willey, MD, MS John T. Wilkins, MD Jason HY. Wu, MSc, PhD, FAHA Heather M. Alger, PhD Sally S. Wong, PhD, RD, CDN, FAHA Paul Muntner, PhD, MHSc On behalf of the American Heart Association Statistics Committee and Stroke Statistics Subcommittee Heart Disease and Stroke Statistics—2017 Update

Heart Disease and Stroke Statistics—2017 Update: A Report From the American Heart Association

http://diposit.ub.edu/dspace/bitstream/2445/122776/1/gbd2016riskfactorscollaborators2017_3028.pdf

Global, regional, and national comparative risk assessment of 79 behavioural, environmental and occupational, and metabolic risks or clusters of risks in 188 countries, 1990-2013: A systematic analysis for the Global Burden of Disease Study 2013

In 1974 an article appeared in Science magazine with the dry-sounding title “Judgment Under Uncertainty: Heuristics and Biases” by a pair of psychologists who were not well known outside their discipline of decision theory. In it Amos Tversky and Daniel Kahneman introduced the world to Prospect Theory, which mapped out how humans actually behave when faced with decisions about gains and losses, in contrast to how economists assumed that people behave. Prospect Theory turned Economics on its head by demonstrating through a series of ingenious experiments that people are much more concerned with losses than they are with gains, and that framing a choice from one perspective or the other will result in decisions that are exactly the opposite of each other, even if the outcomes are monetarily the same. Prospect Theory led cognitive psychology in a new direction that began to uncover other human biases in thinking that are probably not learned but are part of our brain’s wiring.

Thinking fast and slow.

The present study seeks to evaluate the change in mental health inequalities in the department of Meta after the signing of Colombia’s Peace Agreement in 2016 with the FARC guerrilla group. Using a validated survey instrument composed of 20 questions (‘SRQ-20’), we measure changes in mental health inequalities from 2014, before the signing of the agreement, to 2018, after the signing. We then decompose the changes in inequalities to establish which socioeconomic factors explain differences in mental health inequalities over time. Our study uses information from the Conflicto, Salud y Paz (CONPAS) survey conducted in the department of Meta, Colombia, in 1309 households in 2018, with retrospective information for 2014. To measure inequalities, we calculate the concentration indices for both years. Through the Oaxaca change decomposition method, we disaggregate changes in mental health inequalities into its underlying factors. This method allows us to explain the relationship between changes in mental health inequalities and changes in inequalities in several sociodemographic factors. It also identifies the extent to which these factors help explain the changes in mental health inequalities. Mental health inequalities in Meta were reduced almost by half from 2014 to 2018. In 2018, the population at the lower and middle socioeconomic levels had fewer chances of experiencing mental health disorders in comparison to 2014. The reduction in mental health differences is mostly attributed to reductions in the influence of certain sociodemographic variables, such as residence in rural zones and conflict-affected territories, working in the informal sector, or experiencing internal displacement. However, even though mental health inequalities have diminished, overall mental health outcomes have worsened in these years. The reduction in the contribution of conflict-related variables for explaining mental health inequalities could mean that the negative consequences of conflict on mental health have started to diminish in the short run after the peace agreement. Nevertheless, conflict and the presence of other socioeconomic inequalities still contribute to persistent adverse mental health outcomes in the overall population. Thus, public policy should be oriented towards improving mental health care services in these territories, given the post-accord context.

/pdf/a-light-of-hope-inequalities-in-mental-health-before-and-3dmpcjg5sc.pdf

A light of hope? Inequalities in mental health before and after the peace agreement in Colombia: a decomposition analysis

Assessing the potential or actual impact on health and health inequalities of policies aiming to improve Early Child Development (ECD) in England. (Background Report to Marmot Review)

We examine the influence of harmful alcohol use on mental health using a flexible two-step instrumental variables approach and household survey data from nine countries of the former Soviet Union. Using alcohol advertisements to instrument for alcohol, we show that problem drinking has a large detrimental effect on psychological distress, with problem drinkers exhibiting a 42% increase in the number of mental health problems reported and a 15% higher chance of reporting very poor mental health. Ignoring endogeneity leads to an underestimation of the damaging effect of excessive drinking. Findings suggest that more effective alcohol polices and treatment services in the former Soviet Union may have added benefits in terms of reducing poor mental health. Copyright © 2015 John Wiley & Sons, Ltd.

/pdf/psychological-distress-and-problem-drinking-1lcmy74n28.pdf

Psychological Distress and Problem Drinking

Poor mental health is among the growing number of noncommunicable diseases in low- and middle-income countries. Despite poor mental health accounting for an already considerable and growing burden of disease in many low- and middle-income countries, policy action to confront the challenge has been limited, at both international and national levels. Recently, several low- and middle-income countries have embarked on the journey toward universal health coverage by expanding their public health insurance provision, with the ultimate objective of improving population health, in addition to other health system objectives. Mental health interventions typically may not have been specifically covered in the publicly funded benefit package, and this raises the question of whether, and if so, by how much, the expansion of public health insurance may have directly or indirectly contributed to improved mental health. We assessed the impact of Ghana’s implementation of national health insurance on psychological distress. Our study used the first wave of the 2009–2010 Ghana Social Economic Panel survey, including 10,007 respondents. We employed instrumental variable and propensity score matching methods to estimate the causal impact of health insurance on psychological distress, measured by the Kessler Psychological Distress Scale (K10). Higher K10 values indicate greater psychological distress. The median K10 score in Ghana was 16 (P < 0.001), with a minimum of 10 (P < 0.001) and a maximum of 45 (P < 0.001). The results from the instrumental variable estimations, without matching, indicated that the K10 score for the insured was 11.8% lower (P < 0.001) than that of the uninsured. After running the instrumental variable regression on the matched sample, the K10 score for the insured was 10.6% (P < 0.001) lower than that of the uninsured. Similarly, the estimates based on propensity score matching indicated that the insured had a lower K10 score (− 0.023; P < 0.05). Furthermore, the beneficial impact of health insurance on psychological distress is larger for wealthier than poorer insurance members and varies across regions in Ghana. The findings were robust to the various estimation methods. This study suggests that having health insurance is associated with reduced psychological distress and hence improved mental health, even though mental illness treatment or prevention were at best only partially covered by the National Health Insurance Scheme in Ghana.

The impact of Ghana’s national health insurance on psychological distress

In nearly every region, suboptimal diet is the leading risk factor for poor health; hunger and malnutrition result in substantial burdens and contribute to the incidence and prevalence of noncommunicable diseases (NCDs) (Forouzanfar and others 2015; Lim and others 2012). Improving individual and population dietary habits needs to become a health system and public health priority (IFPRI 2015). In recent years, interventions have been evaluated to improve dietary habits, including individual-level interventions in the health system (for example, nutrition counseling); population-level interventions; and novel, technology-based interventions (for example, Internet- and mobile-based programs). A detailed discussion of these interventions is beyond the scope of this chapter. Here, we focus on dietary priorities and policies for global NCDs, including key dietary targets, current distributions of consumption, and ensuing health burdens. We summarize the evidence for effective population-level interventions to improve diet quality, and we discuss data gaps and needs for assessing cost-effectiveness.The global effects of hunger and nutrient deficiencies have been recognized for more than a century, but the emergence of poor diet as a major cause of NCDs has been documented only in recent decades (Forouzanfar and others 2015; Lim and others 2012). Optimal responses to this global challenge have been slowed by several factors, including the relatively recent attention given to the science of diet and NCDs; a historical focus on isolated nutrients rather than foods and diet patterns; and an emphasis on diet-induced obesity (WHO 2012). These factors have led to the neglect of the far larger burdens of NCDs owing to nonobesity-related pathways. Modern nutritional science, originating in the early 20th century, focused on nutrient deficiency diseases, such scurvy, pellagra, and rickets. The initial recognition in the late twentieth century of the additional major effect of diet on NCDs led to nutrient deficiency paradigms being extended to the study of chronic diseases (Mozaffarian and Ludwig 2010). Nutrient deficiency diseases, however, are explicitly caused and can be prevented or treated by single nutrients. In contrast, NCDs arise from complex perturbations of food intakes and overall dietary patterns, including insufficiencies of specific healthful foods and excesses of unhealthful foods (Afshin and others 2014; Chen and others 2013; de Munter and others 2007; Imamura and others 2015; Kaluza, Wolk, and Larsson 2012; Micha, Wallace, and Mozaffarian 2010; Mozaffarian and Rimm 2006; Mozaffarian and others 2006).The global obesity epidemic has appropriately focused attention on diet. However, adiposity is only one pathway of effect of diet on NCDs. Diet quality has an enormous effect on NCDs, in particular, cardiovascular diseases, independent of body weight or obesity. Although undernutrition is an appropriate term for caloric and nutrient deficiency, overnutrition is an incorrect corollary for NCDs and even obesity. The term fails to capture the complexity of poor food habits that cause NCDs: (1) inadequate ingestion of healthful foods; and (2) ingestion of foods created by suboptimal processing (for example, those rich in refined grains, starches, and sugars), foods prepared by modern methods (for example, high temperature commercial cooking), and foods containing additives such as trans fats and sodium. Accordingly, the appropriate term for the global epidemic of diet-induced NCDs is not overnutrition, but malnutrition: poor dietary quality or composition.

Marc Suhrcke

Papers

A light of hope? Inequalities in mental health before and after the peace agreement in Colombia: a decomposition analysis

Assessing the potential or actual impact on health and health inequalities of policies aiming to improve Early Child Development (ECD) in England. (Background Report to Marmot Review)

Psychological Distress and Problem Drinking

The impact of Ghana’s national health insurance on psychological distress

Effectiveness of Dietary Policies to Reduce Noncommunicable Diseases