Health care facility in Surabaya city, East Java, Indonesia. © spotters/Shutterstock

Anyone looking for proof of the valuable role social protection plays in our economies should look no further than Indonesia. After all, here’s a country of over 260 million people living on more than 6,000 islands where administrative and logistical challenges are simply routine. Even Indonesia’s presidential election, held on 17 April, was hailed as an achievement in itself.

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The opioid crisis continues to devastate families and communities, especially in North America, but also increasingly in Sweden, Norway, Ireland, and England and Wales. This is in part due to doctors’ over-prescription: in the United States, for example, 240 million opioid prescriptions were dispensed in 2015, nearly one for every adult in the general population. Illegal opioids are also increasingly available.

On 17 May, health ministers from the G7 countries met in Paris and reinforced their commitment to strengthen primary health care systems. They launched the G7 Primary Health Care Universal Knowledge Initiative (see the G7 declaration). It is a welcome step.

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At some point in just about everyone’s life, we are affected by poor mental health.­ In the EU an estimated 1 in every 6 people experience a mental health problem. In Finland, which has the highest estimated incidence of mental disorders in the EU, close to 1 in 5 are affected. Mental illness has a high economic cost–the cost of treatment, social security programmes, lower employment and lost productivity add up to a total average of 4% of GDP in EU countries. In Finland it is higher still: an estimated 5.3% of GDP in 2016.

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Mental health problems affect about 84 million people in the EU, according to the latest estimates from the Institute for Health Metrics and Evaluation. That’s more than one in six people facing problems that range from anxiety to depression to drug and alcohol addiction, as well as severe mental illnesses like bipolar or schizophrenic disorders.

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In her Oscar-winning performance as the main character of the 2014 film Still Alice, actress Julianne Moore played a linguistics professor diagnosed with early-onset familial Alzheimer's disease, a rare form of dementia. It was a reminder of the struggle that is affecting the everyday life of a growing number of people worldwide.

Looking back at what we have achieved over the past few decades in the health sector, in many ways the future is looking quite bright. People are living longer, healthier lives. Health data continues to grow exponentially. New health technologies, such as fitness trackers, wearables and remote monitoring systems, are breaking down the information walls of hospitals and clinics, empowering people to assess and monitor better their own health in real time. And new drug treatments tailored to the genetic profile of each individual–precision medicine–have the potential to revolutionise healthcare. 

Exposure to a chemical can lead to adverse effects on the health of people and wildlife. 

Toyin Ajayi, Chief Medical Officer, Commonwealth Care Alliance (CCA) ©Marco Illuminati/OECD

People-centred healthcare was the focus of the Policy Forum and Ministerial Meeting on the Future of Health, 16-17 January 2017, at which ministers, professionals and experts from over 40 countries shared ideas and practices on issues such as access, technology, metrics and costs.

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Who would have thought that the Ice Bucket Challenge would be credited for bankrolling healthcare breakthroughs? The online campaign, which encouraged participants to be filmed while pouring a bucket of ice water on their heads and then inviting friends to do the same, was started in 2014 by ordinary people as a fun way to raise money for a relative with motor neuron disease, a normally fatal neurodegenerative condition that is also known as Lou Gehrig’s Disease, or Amyotrophic Lateral Sclerosis (ALS). The idea went viral, with millions of people, as well as famous presidents and rock stars, joining in. The challenge became the fifth most popular Google search in 2014 and raised more than US$220 million worldwide. Little wonder the ALS Association credits its recent discovery of a new gene, giving hope for ”real, meaningful therapies” for ALS, to the Ice Bucket Challenge. 

At a time when universal health coverage struggles under the onslaught of rising costs and budgetary strains around the world, the OECD Ministerial Statement: The Next Generation of Health Reforms of 17 January 2017 offers much needed support to the ideal of equitable access to people-centred healthcare.

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For everyone working in the healthcare sector, 2017 arrives with much to celebrate and a great deal to ponder. On the one hand, we can look back on decades of sustained progress, with universal coverage of healthcare rising and people enjoying generally healthier and longer lives than ever before. Funding is increasing and the OECD’s figures on the state of play show the number of doctors and nurses has grown significantly across most OECD countries since 2000.

Is there such a thing as a right amount of health spending? In an ideal world, this would likely mean spending that achieves effective healthcare services, with good outcomes for patients, the right number of professionals with the right skills, and delivers good value for tax payers with little, if any, wastage. Finding that balance is a difficult challenge. 

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Countries around the world are struggling with rising healthcare bills. Every introduction of pricey new biologics, surgical procedures, and exotic “precision” treatments causes ever-increasing fiscal stress, leading to deficit spending, cutbacks in other government services, and insurance costs shouldered by firms and employees alike. Yet, freezing budgetary allocations is clearly not an option, as citizens in our ageing societies are likely to demand more and better access to new health innovations, and essential healthcare services. What can be done?

Nowhere in the world do women have as many opportunities as men, whether those opportunities are economic, social or political. If we’re going to make our commitments under the Sustainable Development Goals (SDGs) count, we have to start here.

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Every year 1.25 million people are killed and as many as 50 million seriously injured in road crashes worldwide. This epidemic of road injury causes huge economic losses and places severe burdens on public health systems. Fortunately, this predictable and preventable global health emergency has now been given the international recognition it deserves. Road safety is included in the United Nations Sustainable Development Goal for Health, with a target to halve road deaths and injuries by 2020. This provides the strongest possible mandate for urgent action against a scourge that has become the number one killer of young people in all regions of the world. 

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Telehealth is not a substitute for seeing real doctors, but can play a valuable role in patient-centred healthcare and in closing the rural-urban divide as well. But it will require investment and determined policies. 

OECD Observer: On the OECD healthcare conference website you paraphrase Donald Berwick: “We are all guests in our patients’ lives”.* What exactly do you mean by this eloquent phrase? 

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The number of doctors and nurses has reached an all-time high in the OECD area. Some 3.6 million doctors and 10.8 million nurses were working in OECD countries in 2013, up from 2.9 and 8.3 respectively in 2000. Jobs in the health and social sector now account for more than 10% of total employment in many OECD countries.

"Even marginal shifts in public policy or human resource design can have a very positive impact on an employee’s current state and healthy retirement prospects."

Dementia is an umbrella term coined to embrace all the chronic brain disorders that progressively lead to brain damage and the deterioration of memory, functional capacity and social relations. Alzheimer’s disease, which is fatal, is the most common form of dementia, representing about 60-80% of cases, according to a 2009 study carried out by the non-governmental organisation Alzheimer Europe.

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People in the OECD area are living longer and healthier lives. Improved lifestyles are one reason, as are better medical treatments. But could the number of doctors also be a contributing factor?

Dementia is a devastating condition for which there is no cure available. Care is costly, financially and emotionally. The cost for health systems is likely to rise in ageing societies. The condition damages the brain, and leads to a decline in a person’s functional and cognitive capabilities.

Countries are not doing as well as they could in the battle against cancer, according to Cancer Care: Assuring Quality to Improve Survival. Cancer remains one of the leading health care challenges in all OECD countries, where more than 5 million new cases are diagnosed every year. 

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Vaccines are one of the most cost-effective means of preventing illness and death, particularly in children. Yet, more than 22 million babies born worldwide each year–four times the number of births in Europe–go unvaccinated, leaving them at risk of contracting, and potentially dying from, vaccine-preventable diseases like measles. 

Until now considered a model in terms of reducing poverty and inequality, Brazil has recently faced the wrath of hundreds of thousands of protesters from across all sections of society, riling up against inflation, while calling for better access to health care, education and other public services.OECD analyst Horacio Levy explains.

You've probably heard that old adage, where someone asks someone else if they “ate lead paint chips” as a child, after they did something stupid or silly. The effects of lead poisoning, however, are not silly. Many academics believe lead poisoning in children correlated to spikes in crime more than any other single factor. Granted, it takes more than a noticeable pattern to establish causality, the meta-analysis of other factors all seem to point in the direction of lead.

Patients in most OECD countries face long hospital waiting times, whether for primary care, out-patient specialist care or even emergency care. Tax payers rightly expect better service, and hospital waiting times are understandably a contentious political issue.

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A recent OECD Recommendation on the Governance of Clinical Trials issued in December 2012 could improve the outlook for fighting deadly diseases around the world. Here is how.

Economic data

GDP growth: +0.5% Q2 2019 year-on-year
Consumer price inflation: 1.9% August 2019 annual
Trade: +0.4% exp, -1.2% imp, Q1 2019
Unemployment: 5.1% August 2019
Last update: 9 September 2019

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