Public health challenges最新文献

{"title":"Oral Health in Tanzania: Unmasking Its Neglected Dimension.","authors":"Majani Edward, Daniel Agyapong, Innocent Kitandu Paul, Ibrahim Idris, Gbassara Koulagna Boris, Nathan Ezie Kengo, Emelia Azeyele Kpiebaya, Shuaibu Saidu Musa, Don Eliseo Lucero-Prisno","doi":"10.1002/puh2.70000","DOIUrl":"10.1002/puh2.70000","url":null,"abstract":"<p><p>The World Health Organization's definition of oral health underscores its holistic nature encompassing physiological, psychosocial, and functional dimensions. The current estimates of oral diseases in Tanzania and around the world underscore the urgency of intervention, particularly in light of rising sugar consumption trends. The unique challenges facing Tanzania, including inadequate knowledge, limited infrastructure, and disparities in oral healthcare access, are analyzed within the broader context of sub-Saharan Africa's health priorities. This article addresses the multifaceted challenges of oral health neglect in Tanzania, emphasizing the imperative need for a comprehensive and integrated approach. The discussion offers a detailed exploration of determinants contributing to oral health neglect, spanning socioeconomic, behavioral, and commercial factors, with a focus on their implications for Tanzanian communities. Recommendations are presented as a strategic roadmap, encompassing public health education, integrated healthcare services, government intervention, educational programs, community engagement, financial accessibility, and research initiatives. By synthesizing these recommendations into a cohesive framework, a proactive and collaborative approach to mitigate the consequences of oral health neglect in Tanzania, emphasizing the need for transformative policies and cultural sensitivity, is therefore envisioned.</p>","PeriodicalId":74613,"journal":{"name":"Public health challenges","volume":"3 3","pages":"e70000"},"PeriodicalIF":0.0,"publicationDate":"2024-09-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12039738/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144268086","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Systems Thinking, Causal Loop Diagram, and Systems Dynamic in Public Health Challenges: Navigating Long COVID Syndrome and Sense of Smell in LGBTQIA+ Communities.","authors":"Behnaz Akbari, Jessica M Wang, Namdar Baghaei-Yazdi, Hooshang Lahooti, Janet Hope Sherman","doi":"10.1002/puh2.70004","DOIUrl":"10.1002/puh2.70004","url":null,"abstract":"<p><strong>Background: </strong>The coronavirus pandemic has profoundly affected global health, economic stability, and environmental sustainability. Despite these challenges, significant gaps in data remain, particularly in effectively assessing and engaging diverse communities such as color, LGBTQIA+ individuals, and low-income groups. This shortage of comprehensive research limits our capacity to undertake sensitive studies, specifically in dealing with the complexities of long COVID, which some individuals continue to suffer from after their initial recovery.</p><p><strong>Objective: </strong>This review delves into the ongoing repercussions of long-term COVID-19, a postinfectious syndrome marked by neurological symptoms such as cognitive deficits and sensory impairments, which may last well beyond the acute phase of the illness. These symptoms frequently overlap with mental health issues (e.g., anxiety and depression), which can aggravate the socioeconomic challenges faced by vulnerable populations, especially within the LGBTQA+ communities.</p><p><strong>Methods: </strong>To tackle these complex interactions, we have introduced a novel public health framework: model-based systems thinking (MBST), which incorporates System Dynamics and causal loop diagrams (CLD).</p><p><strong>Results and discussion: </strong>The articles were selected on the basis of their discussion of COVID-19-associated anosmia, exploration of olfactory dysfunction alongside neurocognitive disorders, and the challenges experienced in LGBQA+ communities. This approach offers a robust framework for dissecting the intricate ties between socioeconomic factors, health outcomes, and the extended recovery trajectories associated with long-term COVID-19, with a particular focus on olfactory dysfunction. We also explore strategies to make our models more accessible to healthcare providers and the LGBTQA+ communities, encouraging its broader adoption.</p><p><strong>Conclusion: </strong>Long COVID's impact on public health and marginalized communities highlights the urgent need for adopting systems thinking models. Additionally, this article calls for a concerted effort from all experts to foster multidisciplinary, team-based research and implement effective support measures for COVID-19 survivors across all communities, mainly focusing on the scientific, social, and behavioral challenges LGBTQIA+ and low-income individuals face.</p>","PeriodicalId":74613,"journal":{"name":"Public health challenges","volume":"3 3","pages":"e70004"},"PeriodicalIF":0.0,"publicationDate":"2024-09-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12039704/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144268087","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Factors Associated With Satisfaction With Diabetes Care Among Patients Attending Public Diabetic Clinics in Dar es Salaam, Tanzania: A Cross-Sectional Study.","authors":"Emmanuel Z Chona, Lusajo F Kayange, Masunga K Iseselo","doi":"10.1002/puh2.70002","DOIUrl":"10.1002/puh2.70002","url":null,"abstract":"<p><strong>Background: </strong>Diabetes is a major public health problem worldwide, currently affecting more than 537 million people. The disease is associated with high morbidity and mortality rates. Modern diabetes care has evolved toward more patient-centered approaches, emphasizing individualized treatment plans and targets. This study sought to assess the level of satisfaction with diabetes care and related factors among patients attending public diabetes clinics in Dar es Salaam, Tanzania.</p><p><strong>Methods: </strong>This descriptive cross-sectional study used a simple random sampling method to recruit 423 diabetic patients from May to October 2023. Data collection was conducted using a structured questionnaire administered by an interviewer. The collected data were coded and analyzed using Statistical Package for the Social Sciences (SPSS) version 25.</p><p><strong>Results: </strong>The mean (±SD) age of participants was 58.7 (±11.68) years. About half (51.1%) of participants reported being satisfied with the diabetes care provided, 26.2% were very satisfied, and 22.7% were dissatisfied. Participants who usually spend 1-3 h pursuing services at the facilities had 0.40 less odds of being dissatisfied with diabetes care offered at the clinics compared to those who spend more than 3 h on each attendance (adjusted odds ratio [adjusted OR] 0.40, 95% confidence interval [CI] 0.21-0.76, <i>p</i> = 0.005). For each one-unit increase in the communication subscale score, the likelihood of satisfaction (as opposed to being very satisfied) increased (adjusted OR 1.23, 95% CI 1.09-1.38, <i>p</i> = 0.001). Each one-unit increase in the accessibility subscale score increased the probability of satisfaction (adjusted OR 1.12, 95% CI 1.02-1.24, <i>p</i> = 0.023) and decreased the probability of dissatisfaction (adjusted OR 0.85, 95% CI 0.76-0.95, <i>p</i> = 0.004).</p><p><strong>Conclusion: </strong>These findings highlight the importance of effective communication and accessibility in improving patient satisfaction with diabetes care in public clinics. Health facilities and allied stakeholders should engage in continual capacity building among healthcare providers. Furthermore, other studies should be conducted at different levels of health facilities across the country to capture new insights on the satisfaction of homogenous sub-groups of patients.</p>","PeriodicalId":74613,"journal":{"name":"Public health challenges","volume":"3 3","pages":"e70002"},"PeriodicalIF":0.0,"publicationDate":"2024-09-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12039742/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144268083","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"A Situational Overview of Prenatal Screening Services in Bhutan.","authors":"Yeshey Dorjey, Tashi Gyeltshen, Thinley Dorji, Don Eliseo Lucero-Prisno, Mimi Lhamu Mynak, Sonam Gyamtsho, Tashi Tshomo, Phurb Dorji","doi":"10.1002/puh2.70001","DOIUrl":"10.1002/puh2.70001","url":null,"abstract":"<p><p>Prenatal genetic testing is to determine the possibility of the fetus having a genetic aberration or birth defect. Prenatal screening consists of serum analytes screening with or without nuchal translucency (NT) scanning or with cell-free DNA (CfDNA) screening. Prenatal screening is recommended for all pregnant women regardless of the duration of pregnancy and maternal age or baseline risk. It is not advisable to screen with serum analytes and CfDNA concurrently to avoid discordant results. In developed countries, prenatal testing has been a part of routine antenatal care for a long time with adopting newer methods of screening and testing. In Bhutan, since the integration of the Safe Motherhood Program into primary healthcare in 1994, there has been an unprecedented improvement in obstetric care services. Almost all pregnant women attend antenatal and postnatal care, and 98.5% of deliveries are attended by trained health workers. The maternal mortality has reduced to 53 in 2023 from 770 per 100,000 live births in 1984 and the neonatal dealth has reduced to 15.2 per 1000 live births in 2023. However, despite improvements in the care of pregnant women, many babies are detected with congenital anomalies, syndromes, and birth defects during the postnatal period. Bhutan, being an underdeveloped country, could not initiate any form of prenatal testing program except for the anatomical scanning performed at 18-22 weeks of gestation. Early ultrasound dating scans, limited anomaly scanning, and growth scanning are offered to all pregnant women. There is a need to start centralized prenatal testing services in Bhutan to provide a comprehensive package of obstetric care to pregnant women. In addition, legal rights for parents to terminate severely deformed fetuses or severe genetic diseases before 24 weeks of pregnancy need to be established.</p>","PeriodicalId":74613,"journal":{"name":"Public health challenges","volume":"3 3","pages":"e70001"},"PeriodicalIF":0.0,"publicationDate":"2024-08-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12039625/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144268070","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Birth Weight and Labor Market Outcomes: Findings From Tohoku Medical Megabank Data.","authors":"Midori Matsushima, Taku Obara, Mami Ishikuro, Naoki Nakaya, Atsushi Hozawa, Shinichi Kuriyama","doi":"10.1002/puh2.221","DOIUrl":"10.1002/puh2.221","url":null,"abstract":"<p><strong>Background: </strong>Epidemiological and economic literature has revealed that low birth weight (LBW) is related to poor health conditions and a broader range of negative socio-economic outcomes, including academic achievement, income levels, and working status. However, Japanese evidence for labor outcomes is particularly lacking, as is the question of whether the impact of LBW on adulthood worsens when disasters occur. We aimed to reveal the impact on LBW on labor outcomes during the disaster recovery phase.</p><p><strong>Methods: </strong>We used a cross-sectional data set of 4156 national health insurance holders, males aged 40-60 years, from the Miyagi and Iwate prefectures during the earthquake recovery phase. Employing a multinomial probit and logistic model, we estimated the impact of LBW on the employment status, changes in income, and the propensity to face a decline in income with a job change.</p><p><strong>Results: </strong>The very low birth weights (VLBWs) have a disadvantage in all labor market outcomes. Compared to the non-LBWs, the VLBWs were 15.2% less likely to be full-time/self-employed and 17.1% more likely to be contingent/temporary/part-time workers. Moreover, 32.9% are more likely to face a decline in income and approximately 3.7 times more likely to change jobs leading to income decline. The LBWs were likely to face a decline in income by 8.6% and 4.6%, respectively, but no other significant effects were found on other outcomes.</p><p><strong>Conclusions: </strong>The effects were apparent for the VLBW, but not so much for the LBW. The effects became larger during the disaster recovery phase, even though the regional economies were boosted.</p>","PeriodicalId":74613,"journal":{"name":"Public health challenges","volume":"3 3","pages":"e221"},"PeriodicalIF":0.0,"publicationDate":"2024-08-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12039555/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144268071","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Impact of Time and Handwashing on Infection Inference in Scenario-Based Exposures Among Adults and Children in Japan.","authors":"Fumikazu Furumi, Yumiko Nishio","doi":"10.1002/puh2.226","DOIUrl":"10.1002/puh2.226","url":null,"abstract":"<p><strong>Introduction: </strong>The COVID-19 pandemic has underscored the importance of preventive measures like handwashing and mask-wearing. However, preschoolers often struggle to comprehend disease transmission. This study examined how time and handwashing impact adults' and preschoolers' inferential processes related to infectious disease transmission.</p><p><strong>Methods: </strong>Thirty-eight Japanese adults aged 18-23 years (8 men; 30 women) and 36 Japanese children aged 5-6 years (15 boys; 21 girls) participated in this study. Participants were presented with scenarios involving an infectious individual who was present (1) at the same time, (2) immediately before, or (3) the previous day. Scenarios were presented via PowerPoint for adults and as a picture-story for preschoolers, with questions on infection likelihood pre- and post-handwashing.</p><p><strong>Results: </strong>Both age groups perceived a significantly higher likelihood of infection for same-time exposure than for other exposures. Preschoolers estimated a lower likelihood of infection than adults ( <math> <mrow><msubsup><mi>η</mi> <mi>p</mi> <mn>2</mn></msubsup> </mrow> </math>  = 0.25). Handwashing significantly reduced perceived infection risk, particularly for same-time ( <math> <mrow><msubsup><mi>η</mi> <mi>p</mi> <mn>2</mn></msubsup> </mrow> </math>  = 0.34) and immediately after ( <math> <mrow><msubsup><mi>η</mi> <mi>p</mi> <mn>2</mn></msubsup> </mrow> </math>  = 0.10) exposures.</p><p><strong>Conclusion: </strong>This study highlights the critical need for age-appropriate communication about infection prevention, particularly for young children. Preschoolers exhibited a more positive perception of infectious disease transmission, which necessitates reinforcing multiple preventive measures beyond handwashing. The findings underscore the importance of considering cognitive development and the influence of contemporary experiences like the COVID-19 pandemic when educating about disease transmission. Future research should further explore the relationship between cognitive development, individual differences, and infection reasoning to enhance public health strategies for varying age groups.</p>","PeriodicalId":74613,"journal":{"name":"Public health challenges","volume":"3 3","pages":"e226"},"PeriodicalIF":0.0,"publicationDate":"2024-08-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12039569/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144268085","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Disease Burden, Risk Factors, and Temporal Trends in Breast Cancer in Low- and Middle-Income Countries: A Global Study.","authors":"Mingjun Gao, Sofia Laila Wik, QinYao Yu, FanYu Xue, Sze Chai Chan, Shui Hang Chow, Yusuff Adebayo Adebisi, Claire Chenwen Zhong, Don Eliseo Lucero-Prisno, Martin Cs Wong, Junjie Huang","doi":"10.1002/puh2.223","DOIUrl":"10.1002/puh2.223","url":null,"abstract":"<p><strong>Introduction: </strong>Breast cancer poses significant health risks to women and strains healthcare systems extensively. In low- and middle-income countries (LMICs), limited resources and inadequate healthcare infrastructures further exacerbate the challenges of breast cancer prevention, treatment, and awareness.</p><p><strong>Methods: </strong>We examined the prevalence, risk factors, and trends of breast cancer in LMICs. Data on disability-adjusted life years (DALYs) and breast cancer risk factors were extracted from the Global Burden of Disease (GBD) databases for 203 countries or territories from 1990 to 2019. LMIC DALY rates were examined using joinpoint regression analysis.</p><p><strong>Results: </strong>Among the income groups, the lower middle-income category had the highest DALYs value, with 1787 years per 100,000 people. LMICs collectively accounted for 74% of the global burden of DALYs lost due to breast cancer in 2019. However, it remained relatively consistent in lower middle income countries (LMCs). In LMCs, the risk associated with metabolic syndromes was higher compared to that with behavioral factors alone. For the past three decades, breast cancer incidences increased significantly in LMCs (average annual percent change [AAPC]: 1.212, confidence intervals [CI]: 1.51-1.87, <i>p</i> < 0.001), upper middle income countries (AAPC: 1.701, CI: 1.12-1.48, <i>p</i> < 0.001), and low-income countries (AAPC: 1.002, CI: 1.57-1.68, <i>p</i> < 0.001).</p><p><strong>Conclusion: </strong>This research shows how breast cancer in LMICs is aggravated by low resources and healthcare infrastructure. To effectively combat breast cancer in these areas, future strategies must prioritize improvements in healthcare infrastructure, awareness campaigns, and early detection mechanisms.</p>","PeriodicalId":74613,"journal":{"name":"Public health challenges","volume":"3 3","pages":"e223"},"PeriodicalIF":0.0,"publicationDate":"2024-07-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12039552/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144268082","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Sugar‐Sweetened Beverages Taxation Plan in Indonesia: Call for Political Commitment","authors":"Risyad Abiyyu Siregar, Fona Qorina, Ayers Gilberth Ivano Kalaij, Hera Afidjati, Dhani Latifani, Muhammad Faisal Putro Utomo, Louisa Patricia Sophia, Azizah Salsabila Mahmud","doi":"10.1002/puh2.217","DOIUrl":"https://doi.org/10.1002/puh2.217","url":null,"abstract":"Indonesia is grappling with a rise in obesity and diabetes, partially driven by a high consumption of sugar‐sweetened beverages. The prevalence of obesity among adults more than doubled from 2007 to 2018, and diabetes rates have also increased. In response, the Indonesian government has proposed an excise tax on sugar‐sweetened beverages to reduce consumption. However, the implementation of this policy has repeatedly been delayed, with the latest postponement to 2024. Sugar‐sweetened beverages contribute significantly to chronic diseases, increasing the healthcare burden and reducing economic productivity. Taxation, a widely used public health strategy in the form of fiscal measures, can decrease consumption by raising prices, raising public awareness, encouraging product reformulation, and generating revenue. Despite its potential benefits, the proposed tax in Indonesia faces substantial political and commercial challenges. The president‐elect Prabowo Subanto has not explicitly supported the tax in his political manifesto, raising concerns about further delays due to industry lobbying. Successful implementation of the tax requires robust political will, public and civil society pressure, and effective cross‐sector cooperation. The government must ensure clear policy goals, equal application to domestic and foreign products, and supportive measures such as providing free drinking water alternatives. Transparent stakeholder consultations can build broad‐based support, whereas effective monitoring and evaluation frameworks are essential for compliance. To gain public support, allocating tax revenues to public health and social programs is crucial. Although initial resistance is expected, strong enforcement mechanisms can ensure adherence. With determined political commitment and public advocacy, the sugar‐sweetened beverage tax can significantly reduce obesity and diabetes rates, improving public health outcomes and economic productivity in Indonesia. This commentary provides an overview of the proposed tax, explores its challenges, and offers recommendations for successful implementation.","PeriodicalId":74613,"journal":{"name":"Public health challenges","volume":"51 28","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-07-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141644560","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Prevention and Management of Multimorbidity in Southeast Asia: A Narrative Review","authors":"Xiyu Feng, Haribondhu Sarma, Matthew Kelly","doi":"10.1002/puh2.218","DOIUrl":"https://doi.org/10.1002/puh2.218","url":null,"abstract":"Multimorbidity, the coexistence of two or more chronic conditions, presents a growing global challenge, particularly in low‐ and middle‐income countries such as Southeast Asia. This trend necessitates the development of sustainable integrated care models to prevent and manage multimorbidity effectively. However, progress in this area has been hampered, especially in underdeveloped regions, by various barriers, including the epidemiology of multimorbidity, how to get different specialists and doctors to work together most availably and manage the multiple medication issues and how to develop cost‐effective approaches to reduce the health burden of multimorbidity. Preventive measures in Southeast Asia, which could tackle multiple components which commonly comprise multimorbidity, include enhancing health literacy and health promotion through school‐ and community‐based educational activities, primary healthcare and related policies on employing taxes on tobacco, alcohol and sugary beverages. The social determinants of health‐encompassing poverty and low education may also influence research on multimorbidity. Moreover, stakeholder engagements involving national governments, World Health Organization (WHO) and Association of Southeast Asian Nations (ASEAN) are crucial. Management strategies focus on integrated care models, including patient‐centred primary healthcare, digital healthcare technologies, and medication management to control polypharmacy. Although research on multimorbidity in Southeast Asia is increasing, translating findings into practical measures was limited. Future efforts should prioritize evidence‐based approaches to prevent and manage multimorbidity effectively, addressing challenges like health system focusing on single chronic disease treatment independently, resource limitations, healthcare provider shortages and individual adherence issues. These ways promise to enhance the quality of life and health outcomes in this region.","PeriodicalId":74613,"journal":{"name":"Public health challenges","volume":"41 28","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-07-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141645008","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Improving Sustainable Financing for Universal Health Coverage in Bhutan: Exploring Policy Options and Financial Strategies","authors":"Ugyen Tshering, Jayendra Sharma, Dorji Tshering, Tandin Dendup","doi":"10.1002/puh2.216","DOIUrl":"https://doi.org/10.1002/puh2.216","url":null,"abstract":"Deeply rooted in its developmental philosophy of gross national happiness (GNH), Bhutan's healthcare system strives towards achieving a shared goal of universal health coverage (UHC). Despite being primarily financed by the government, the health system faces a plethora of challenges. To overcome these hurdles and achieve UHC goals, expanding the fiscal space for health and improving operational efficiency are crucial. This article aims to address Bhutan's evolving healthcare landscape and advance the achievement of UHC through two policy options. The first policy option focuses on the dual objective of improving health outcomes and promoting financial sustainability by leveraging health taxes, whereas the second option emphasizes reinforcing a systematic health technology assessment (HTA) in the Bhutanese health system. First, drawing lessons from global experiences, the policy brief recommends leveraging health taxes to reduce societal and healthcare costs and enhance financial sustainability in the health sector. Considering Bhutan's high prevalence of tobacco and alcohol consumption, and taking opportunity from the ongoing Goods and Services Tax (GST) reform, continued advocacy on health taxes is essential, and soft earmarking the health taxes may be considered to finance a broader array of public health programmes, particularly focusing on the promotion of healthy lifestyle, health screening and outreach public health activities. Second, the integration of HTA into policymaking and decision‐making processes is essential for effective resource allocation in UHC. Nurturing and strengthening the existing HTA governance structure under the Ministry of Health (MoH) and establishing a dedicated multidisciplinary HTA Committee will ensure informed decision‐making and resource optimization. HTA evidence should inform the revision of health service standards, clinical guidelines development, procurement decisions and healthcare priorities. These policy options can assist the country in improving financial sustainability, enhancing effective resource allocation and utilization and improving healthcare delivery, aligning with its vision of GNH and ultimately accelerating progress towards achieving UHC.","PeriodicalId":74613,"journal":{"name":"Public health challenges","volume":" 732","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-07-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141669254","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}