Marzenna Anna Weresa
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Christina Ciecierski
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Lidia Filus
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The third decade of the 21st century has brought new challenges to healthcare systems as well as to the design and implementation of public health policies at both global and country levels. Indeed, the challenges of the COVID-19 pandemic, and its adverse consequences also accentuated the burden of issues recognized prior to the COVID-19 outbreak such as changing demographics including an aging population in developed countries, rising rates of cancer incidence and cardiovascular disease, poor consumer health behavior, negative health impacts of digital technologies and harmful effects of environmental pollution on health. Such issues bring unknown risks to public health. Under rapidly changing external environments, existing paradigms and research methods may no longer be relevant for the mapping of arising problems and the search for solutions. New challenges require creative interdisciplinary approaches. Because health is a key component of human capital, it can be a driver of both development and societal cohesion. This book takes an interdisciplinary approach and applies a variety of conceptual frameworks and mathematical models to explore a wide range of health-related issues. A total of ten chapters report detailed research findings that are based on a variety of unique publicly available data sets subjected to various methods including conceptual modeling, statistical and econometric modeling, hierarchical cluster analysis and an indicator based approach. As such, the book provides examples of how different health-related problems can be studied by combining the efforts of economists, epidemiologists and mathematicians. Three main themes emerge in this book including: (1) risk factors of disease in the European Union (EU) and the United States (US), (2) aspects of the functioning of health care systems in developed countries, including their institutional frameworks and financing, and (3) selected performance measures of the pharmaceutical sector as seen from both a global and country perspective. The analyses presented in the book contribute to the existing health literature by integrating patient treatment with the economic determinants of health care outcomes, including population density, access to financing and institutional frameworks. The book also provides new evidence regarding the pharmaceutical industry including innovation, international trade and company performance.

The key findings that result from the research are as follows:

  • There are racial and ethnic disparities in lung cancer incidence rates, mortality, and stage at diagnosis in the US, and these are higher in the State of Illinois when compared to national averages. These disparities reflect social, economic, and environmental inequalities and correspond with the patterns of concentration of communities with high poverty levels and high rates of smoking.

  • The European Union is not homogenous in terms of the effect of risk factors for lung cancer. Four different patterns of potentially modifiable risk factors for cancer emerge and encompass tobacco use, alcohol consumption, air pollution, socio-economic status, and public expenditures on health care.

  • Foodborne diseases affect countries at different levels. Low- and middle- income nations are most impacted by such diseases, but there has been a growing number of incidence in high-income countries, including the US. There is a positive association between the consumption of animal products and foodborne diseases.

  • There are various institutional traits and pathways to patient care within the healthcare systems in developed countries. Singapore and Sweden appear to be most effective in increasing system efficiency. However, healthcare systems require change and a value-based approach seems to be the best solution because it is based on clinical and cost-effectiveness.

  • Under the 2020 Framework Program, the EU has been increasing investments in the health research, demographic change and wellbeing. Nonetheless, there is a striking discrepancy in funds allocation between Western European and Central and Eastern European countries, with the former absorbing a vast portion of EU investments. This trend may result in a widening gap in health-related research between Western and Eastern Europe, thus limiting the development of connections, knowledge and competencies needed for discovering and implementing innovative solutions in health.

  • Limited financial access has proved to be associated with adverse public health outcomes in the United States. “Banking deserts” are characterized by low self-reported health status.

  • Advances in healthcare highly depend on innovations, including new developments in the pharmaceutical industry and their success in international markets. The US has the largest export market share of pharmaceuticals, followed by the EU. China however, is dynamically growing in this area as it has successfully leveraged financial resources to strengthen its high-technology industries, including pharmaceuticals. Another success feature of the Chinese economy is the country’s strategy towards clusters development in the pharmaceutical and biotech industries. Nevertheless, although both China and the US hold relative specializations in overall medical exports, they do not reveal comparative advantages in the trade of pharmaceuticals used for tackling the COVID-19 pandemic.

Results from the studies contained in this book yield a variety of implications for public health policy and lend implications for the direction of health care reform in a post-pandemic era.

In terms of the chapters contained in the first section of the book, findings indicate that improvements in disease prevention and management can be better implemented through a deeper understanding and ability to alter social, economic, and cultural determinants of health. There is the urgent need for interventions at the national and local level to address disparities in both lung cancer care and the burden of zoonotic foodborne diseases on populations. Given the heterogeneity in disease risk factors across countries, a ‘one-size-fits-all’ policy may not be effective. Systemic interventions tailored to the specific needs of individual countries appears to be most effective. Furthermore, a holistic, problem-oriented and targeted approach to public health policy should be considered.

When it comes to policy recommendations for the functioning of healthcare systems in developed countries presented in the second section of this book, reforms to the management structures of healthcare systems are necessary. These reforms can move in two directions. First, following the example of developed countries (i.e. Sweden), a system of subsidies for less wealthy and rural regions may help to reduce disparities in access to health care. Second, to monitor and improve the performance of healthcare systems while transforming them into value-based personalized solutions, key performance indicators for the health sector should be designed and used to measure efficiency in financing, organization and management.

The third section of the book examines the pharmaceutical sector and how it relates to public support of innovation. Recent tensions in public health and the growing role of pharmaceuticals due to the COVID-19 pandemic may drive governments to pioneer new policy incentives and increase experimentation with policy intervention in order to jeopardize their medical industries and make them less dependent from international suppliers.

In closing, there is an acute need to better track the impact of different policy interventions. This requires the development of adequate evaluation methodologies that capture both the direct and indirect effects of policy interventions. Furthermore, coherence among different policy levels (local, regional, national) seems to be important when making policy interventions more effective.

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