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21. What’s next for healthcare in Poland: diagnosis and prognosis

Author:
Alicja Domagała, Christoph Sowada, Krzysztof Kuszewski, Marzena Tambor, and Stanisława Golinowska
Publication Date:
12-2018
Content Type:
Special Report
Institution:
Center for Social and Economic Research - CASE
Abstract:
The health protection system is the object of constant pressures and difficulties in mitigating them, and even more so eliminating or at least reducing them. Changes are undertaken under the influence of a one-sided political assessment, the interests of various groups of participants or the protests of successive groups of medical staff. There is no professional and fully documented diagnosis of the system, made by independent experts, which could serve as the basis for a comprehensive health protection reform plan, rather than individual, incidental changes that disrupt the system’s already very fragile balance. A well thought-out reform, properly distributed over time, so that at no point does it cause negative health effects. A reform agreed among stake-holders and adopted with understanding of the need for changes, so that it is supported by society. A reform for which there will be funds, institutions and engaged professionals – leaders in health protection. A reform that won’t be criticized or changed when the government changes. Such a reform is waiting to be presented and debated. We begin this process by pointing out and presenting the system’s main problems. At the top of the list of issues that must be taken up urgently we place the problem of insufficient resources, but associated with other activities that are essential to achieve higher effectiveness in accomplishing health goals. There is no single miraculous way of balancing and fixing the functioning of the health protection system. This requires both greater financing, qualitatively and quantitatively appropriate staffing, and good institutions. Financial resources are a necessary condition but not a sufficient one – if there is no staff or appropriate institutions, and these are shaped over years. In this publication we present four subjects, corresponding to that list of the main issues that must be addressed urgently. We begin with the problem of good governance, meaning achieving a decisive improvement in institutional solutions in health protection. Next we take up the problem of the need for growth in financial outlays, with judicious public and individual responsibility. We strongly accent the need for development in Poland of medical and support staff, presenting the problems of neglect and the deep shortage of professionals, which is currently paralyzing the health service. The final text, though no less important in the group of priority problems in health protection, concerns public health and demands that it be properly valued by treating care for the health of the population as an investment in human capital with a measurable and significant rate of return.
Topic:
Demographics, Health, Labor Issues, Governance, Health Care Policy, Social Policy, and Public Policy
Political Geography:
Europe and Poland

22. ACKNOWLEDGING THE FLEXIBILITIES OF THE TRIPS AGREEMENT: ENSURING THE RIGHT TO ACCESS TO MEDICINES OR A STRATEGY OF PASSIVE REVOLUTION?

Author:
Sevgi BALKAN-ŞAHİN
Publication Date:
10-2018
Content Type:
Journal Article
Journal:
Alternative Politics
Institution:
Department of International Relations, Abant Izzet Baysal University, Turkey
Abstract:
The Doha Ministerial Declaration on the Trade-Related Aspects of Intellectual Property Rights (TRIPS) Agreement and Public Health adopted in November 2001 clarified the right to use the TRIPS flexibilities to promote public health. Examining the hegemonic struggle of opposing social forces from a neo-Gramscian perspective, the paper attributes this outcome to the strategy of trasformismo used by market-oriented social forces to legitimize the policies of the World Trade Organization (WTO) and prevent resistance against the market-driven TRIPS Agreement. It argues that although non-governmental organizations (NGOs) such as Medecins Sans Frontieres, Third World Network, and Oxfam worked as a counter-hegemonic force to ensure the access of least developed countries to generic versions of patented drugs, flexibilities confirmed by the Doha Declaration can be seen more as a strategy of trasformismo to absorb counter-hegemonic ideas than the counter-hegemonic groups’ successful incorporation of the right to ensure public health into the TRIPS Agreement.
Topic:
Health, World Trade Organization, Hegemony, Health Care Policy, NGOs, and Public Health
Political Geography:
United States, Europe, Asia, and North America

23. IMPOTENT WARRIORS Perspectives on Gulf War Syndrome, Vulnerability and Masculinity

Author:
Susie Kilshaw
Publication Date:
01-2018
Content Type:
Book
Institution:
Berghahn Books
Abstract:
Gulf began to surface. This mysterious illness was given the name “Gulf War Syndrome” (GWS). This book is an investigation into this recently emergent illness, particularly relevant given ongoing UK deployments to Iraq, describing how the illness became a potent symbol for a plethora of issues, anxieties, and concerns. At present, the debate about GWS is polarized along two lines: there are those who think it is a unique, organic condition caused by Gulf War toxins and those who argue that it is probably a psychological condition that can be seen as part of a larger group of illnesses. Using the methods and perspective of anthropology, with its focus on nuances and subtleties, the author provides a new approach to understanding GWS, one that makes sense of the cultural circumstances, specific and general, which gave rise to the illness.
Topic:
Health, Gulf War, Masculinity, and PTSD
Political Geography:
United States, Iraq, United Kingdom, Europe, and Middle East

24. A New Strategy for European Health Policy

Author:
Anna-Lena Kirch and Daniel Braun
Publication Date:
09-2018
Content Type:
Commentary and Analysis
Institution:
German Council on Foreign Relations (DGAP)
Abstract:
Germany considers itself a leading European power that utilizes its influence to promote EU cohesion in the face of Brexit and numerous other crises. However, a different picture emerges in European health policy, an area that is not only being discussed as an essential part of the EU’s social dimension but also in the context of its security and development positioning: Far from shaping the discussion, Germany is at times even perceived as the brakeman to an effective European health policy.
Topic:
Health and International Affairs
Political Geography:
Europe

25. Quality and cost-effectiveness in long-term care and dependency prevention: the Polish policy landscape

Author:
Stanisława Golinowska and Agnieszka Sowa-Kofta
Publication Date:
07-2017
Content Type:
Special Report
Institution:
Center for Social and Economic Research - CASE
Abstract:
With the population ageing the development of sustainable long-term care institutions is of great importance in many European countries. In Poland, currently dominant, traditional and family based care will become insufficient with increasing cohorts of older people. Presented paper discusses recent developments in long-term care policy in the country. Long-term care institutions are separated in the two sectors, with little field for cooperation and coordination of activities. Over the past years policy addressing ageing related problems was developed, focusing on the active ageing instruments. Dependency prevention and active ageing are among goals of national policies formulated separately in the health and social sector. Information policy and monitoring long-term care services’ provision remains insufficient. Coordination of activities mainly takes place at the local level. Local governments and non-governmental organizations, often cooperating with representatives of older people, are active in providing services to older people in community and often incorporating innovative solutions in care.
Topic:
Demographics, Health, Social Policy, Labor Policies, Public Policy, and Aging
Political Geography:
Europe, Poland, and European Union

26. Paying for Prescription Drugs Around the World: Why Is the U.S. an Outlier?

Author:
Shawn Bishop, David Squires, and Dana O. Sarnak
Publication Date:
10-2017
Content Type:
Special Report
Institution:
The Commonwealth Fund
Abstract:
arious factors contribute to high per capita drug spending in the U.S. While drug utilization appears to be similar in the U.S. and the nine other countries considered, the prices at which drugs are sold in the U.S. are substantially higher. These price differences appear to at least partly explain current and historical disparities in spending on pharmaceutical drugs. U.S. consumers face particularly high out-of-pocket costs, both because the U.S. has a large uninsured population and because cost-sharing requirements for those with coverage are more burdensome than in other countries. Most Americans support reducing pharmaceutical costs. International experience demonstrates that policies like universal health coverage, insurance benefit design that restricts out-of-pocket spending, and certain price control strategies, like centralized price negotiations, can be effective.
Topic:
Health, Health Care Policy, and Drugs
Political Geography:
United States, Europe, and Global Focus

27. Antimicrobial Resistance as an Emerging Threat to National Security

Author:
Maxine Builder
Publication Date:
01-2015
Content Type:
Working Paper
Institution:
Atlantic Council
Abstract:
Growing rates of antimicrobial resistance (AMR) pose a threat to public health that could undo many of the medical advances made over the last seventy years, eroding the global medical safety net and posing a significant threat to national security. Diseases once eliminated by a single course of antibiotics show drug resistance, often to several different classes of drugs. Some of the implications of increasing rates of AMR are intuitive, such as longer duration of illness, extended hospital stays, and higher rates of mortality. But other effects of a postantibiotics world are less obvious, such as the inability to perform life-saving operations or the ability for a simple scratch on the arm to kill. Humanity could soon find itself living in a reality in which communicable diseases such as tuberculosis, cholera, pneumonia, and other common infections cannot be controlled. This potentially catastrophic problem still can be abated, and the global health community, including the World Health Organization (WHO), has highlighted AMR as a priority in global health. But all sectors of the international community, not simply those in public health, need to take immediate steps to reverse the current trends and eliminate the systematic misuse of antimicrobial drugs, especially in livestock, and restore the pipeline of new antimicrobial drugs. The significant health and economic costs of AMR are difficult to quantify due to incomplete data that often underreports the extent of the problem, since there are no standard metrics or consensus on methodology to measure rates of AMR. But even the piecemeal statistics that exist paint a bleak picture. In a 2013 report, the US Centers for Disease Control and Prevention (CDC) reports at least two million Americans acquire serious infections to one or more strains of AMR bacteria annually, and at least 23,000 people die of these infections.1 A 2008 study estimated the excess direct costs to the US medical system attributable to AMR infections at $20 billion, with additional estimated productivity losses to be as high as $35 billion.2 With the increase in resistant infections and continuing rise in medical costs, the cost to the American medical system no doubt also has increased. This trend is not a uniquely American problem; it is truly global in scope. The European Union (EU) reports about 25,000 deaths annually due to drug-resistant bacteria, at an overall, combined cost of $2 billion in healthcare costs and productivity losses.3 There were over 14.7 million incidents of moderate-to-severe adverse reactions to antibiotics each year between 2001 and 2005 in China. Of these, 150,000 patients died annually.4 The most recent available data on China estimates that treatment of AMR infections during that same time period cost at least $477 million, with productivity losses of more than $55 million each year.5 A 2005 study of the United Kingdom (UK) found that the real annual gross domestic losses due to AMR were between 0.4 and 1.6 percent.6 Although slightly outdated, this estimate may be a useful guide in assessing the global impact of AMR, and given the trend of increasing resistance, it is likely that the impact will also increase accordingly. That said, it is prudent to repeat that the disparities in the quality of data reporting standards across China, the United States, the United Kingdom, and the European Union make it difficult to directly compare the severity of the impacts AMR has on each entity. The primary cause of AMR globally is antibiotic overuse and misuse, be it from doctors inappropriately prescribing antibiotics to treat viral infections or individuals seeking over-the-counter antibiotics for self-treatment. But another driver, less obvious than overuse in humans, is the use of antimicrobials in livestock, and the ratio of use in animals as compared to humans is astounding. In the United States, about 80 percent of all antibiotics are consumed in either agriculture or aquaculture. Generally, these drugs are administered to livestock as growth promoters and are medically unnecessary. Resistance in livestock quickly spreads to humans, and many community-acquired infections are the result of a contaminated food supply. Although most infections are acquired in the community, most deaths attributed to resistant infections occur in healthcare settings, and healthcare-acquired (or nosocomial) infections are another driver of AMR. At this point, AMR does not pose an immediate and direct threat to national security. Rather, this is a creeping global security crisis. If current trends continue, these drugs upon which the world relies will lose effectiveness. The gains made in fighting infectious diseases will be reversed, and a wide range of routine surgeries and easily treatable infections will become much more dangerous and deadly. This will cause the health of the world's working population to deteriorate, and the economic productivity and social cohesion of the globe to decline. At any time, a “black swan” event—triggered by an outbreak of drug-resistant tuberculosis, cholera, or pneumonia, for example—could prove catastrophic, endangering the fabric of societies and our globalized economy, forcing a stop to international trade and travel to prevent further spread. The issue of AMR is a tragedy of the commons in which individual incentives lead to the overuse and eventual destruction of a shared resource. International cooperation is required to walk back from this ledge and avoid a postantibiotics world, even though it is impossible to completely reverse the damage already done.
Topic:
Health, National Security, Infectious Diseases, and Health Care Policy
Political Geography:
United States, China, United Kingdom, America, and Europe

28. The Conflict over Aviation Emissions: A Case of Retreating EU Leadership?

Author:
Antto Vihma and Harro van Asselt
Publication Date:
02-2014
Content Type:
Policy Brief
Institution:
Finnish Institute of International Affairs
Abstract:
Notwithstanding the incremental steps taken in October 2013, meaningful action on regulating international aviation emissions through the International Civil Aviation Organisation (ICAO) remains a distant prospect. The European Union (EU) must decide on its aviation Directive without the guarantee of a global market-based mechanism being agreed in 2016. The strong and uncompromising positions of countries opposed to the inclusion of foreign airlines in the EU's emissions trading system (ETS) are more related to a realist game of politics rather than to the design details of the policy instrument. The political and legal arguments against the European Commission's proposal to amend the EU ETS vis à vis aviation emissions are unconvincing. Europe should also insist on its own sovereign rights-such as the right to regulate international aviation in its own airspace-and consider ways of manifesting more assertiveness in the future in order not to create a precedent with the retreat in the Aviation Directive case. Otherwise, the EU ma y become vulnerable to pressure in other areas of regulation with extraterritorial implications, and the EU's credibility when faced with strong and coordinated external influences might be undermined.
Topic:
Climate Change, Health, Treaties and Agreements, and Infrastructure
Political Geography:
Europe

29. Trading Away Access to Medicines - Revisited: How the European trade agenda continues to undermine access to medicines

Author:
Sophie Bloemen, Tessel Mellema, and Leïla Bodeux
Publication Date:
09-2014
Content Type:
Policy Brief
Institution:
Oxfam Publishing
Abstract:
The failure of the current pharmaceutical research and development (R) system is revealed by the World Health Organization (WHO) alert about the lack of effective medicines to address antimicrobial resistance, and the absence of a treatment for the deadly Ebola virus that is ravaging communities in West Africa at the time of writing.
Topic:
Health, International Trade and Finance, and Health Care Policy
Political Geography:
Europe

30. Extending Working Life in Finland

Author:
Anna-Elisabeth Thum and Marten von Werder
Publication Date:
11-2013
Content Type:
Working Paper
Institution:
Centre for European Policy Studies
Abstract:
This report reviews national and private initiatives to allow the elderly to continue their participation in the Finnish labour market and provides an analysis of the labour market and living conditions of seniors. We are interested in how those over 50 can be engaged in various forms of employment and lifelong learning. We find strong evidence that Finland generally provides good institutional conditions for active ageing. The quick and early ageing process was tackled by the fundamental pension reform that already prolonged retirement substantially and will probably facilitate later retirement as the attitudes concerning retirement change. On the other hand, Finland still seems to lack behind the other Nordic welfare states, has considerable problems in providing the same health conditions to low educated people in physically demanding occupations and could - with respect to family pension in particular - invest further effort in reforming the pension system. While many of the reforms Finland has conducted seem to be favourable and transferable to other European countries that still face the steepest phases of ageing in their societies, a reluctance towards changing attitudes that we observe in Finland, shows that organizing active ageing is a long-term project.
Topic:
Demographics, Economics, Health, and Labor Issues
Political Geography:
Europe and Finland