Implementing priority setting frameworks: Insights from leading researchers.

In spite of a substantial literature developing frameworks for policymakers to use in resource allocation decisions in healthcare, there remains limited published work reporting on the implementation or evaluation of such frameworks in practice. This paper presents findings of a targeted survey of 18 leading researchers around the implementation and evaluation of priority-setting exercises. Approximately one third of respondents knew of situations where recommendations of priority-setting exercises had been implemented, one third knew that recommendations had not been implemented and the final third responded that they did not know whether recommendations had been adopted.

Africanizing the social determinants of health: embedded structural inequalities and current health outcomes in sub-Saharan Africa.

There is a growing interest in health policy in the social determinants of health. This has increased the demand for a paradigm shift within the discipline of health economics from health care economics to health economics. While the former involves what is essentially a medical model that emphasizes the maximization of individual health outcomes and considers the social organization of the health system as merely instrumental, the latter emphasizes that health and its distribution result from political, social, economic, and cultural structures.

Neoliberalism is bad for our health.

This paper examines some of the concerns that arise from the impact of neoliberalism on health and health care. It also examines the way that global institutions such as the World Health Organization and the World Trade Organization, having been captured by neoliberalism, fail to act decisively to reduce poverty and inequality and thereby do all too little to promote population health at a global level. The paper argues for a greater community focus, with health care systems being seen more as social institutions and placing more power over decision making in the hands of a critically-informed citizenry.

Social health insurance: to each according to his needs; from each according to his means--but what might that mean?

Despite the substantial literature on the financing and benefit incidence of social health insurance, the principles underlying such schemes are little debated. This article examines one of these key principles: to each according to his needs; from each according to his means. The authors discuss both sides of this principle at a conceptual level.

People's policies for the health of the poor globally.

In this paper, we argue that the dominant role played by governments of the developed countries in global health policies is a critical but often an ignored factor in contributing to the lack of progress in global health. The solution to this challenge lies in efforts to 'democratise' global decision making and to argue for a greater say of the poor globally in policies affecting them. Although there are potentially many ways to achieve this, the paper proposes 'communitarian claims' as one way to have the voice of people globally involved and to make decisions about how best to allocate resources globally.

Claims on health care: a decision-making framework for equity, with application to treatment for HIV/AIDS in South Africa.

Trying to determine how best to allocate resources in health care is especially difficult when resources are severely constrained, as is the case in all developing countries. This is particularly true in South Africa currently where the HIV epidemic adds significantly to a health service already overstretched by the demands made upon it. This paper proposes a framework for determining how best to allocate scarce health care resources in such circumstances.

Prevention before profits: a levy on food and alcohol advertising.

The recent interest in health promotion and disease prevention has drawn attention to the role of the alcohol and junk-food industries. Companies supplying, producing, advertising or selling alcohol or junk food (ie, foods with a high content of fat, sugar or salt) do so to generate profits. Even companies marketing "low-carbohydrate" beers, "mild" cigarettes, or "high-fibre" sugary cereals are not primarily concerned about population health, more so increased sales and profits.

A communitarian approach to public health.

This paper argues that there is a need to move yet further than has already been suggested by some from the individual to the collective as a base for public health. A communitarian approach is one way to achieve this. This has the advantage of allowing not only the community's voice to have a say in setting the values for public health but also more formally the development of a constitution on which public health might then be built.

Equity and efficiency in HIV-treatment in South Africa: the contribution of mathematical programming to priority setting.

The HIV-epidemic is one of the greatest public health crises to face South Africa. A health care response to the treatment needs of HIV-positive people is a prime example of the desirability of an economic, rational approach to resource allocation in the face of scarcity. Despite this, almost no input based on economic analysis is currently used in national strategic planning.

Is it not time for health economists to rethink equity and access?

This article considers two key issues in health economics regarding the question of equity. First, why have health economists not resolved better the issue of what are equity and access? Second, the paper draws attention to the relative lack of analyses of equity concerns outside of health care. The question of whose values should prevail in equity is also addressed.

South Africa: a 21st century apartheid in health and health care?

The current crisis in health and health care in South Africa results from a combination of factors: the legacy of apartheid; issues of poverty, income inequality and AIDS; and the more recent influence of neoliberal economic policies and globalisation. The legacy of apartheid has meant that both health and health care are skewed along racial lines, and 60% of health care expenditure goes largely to the 14% of the population who have private health insurance. A more equitable distribution of health care resources will result from the promised National Health Insurance, the details of which are still being debated.

Issues in the measurement of social determinants of health.

This article focuses on the measurement of the social determinants of health, and specifically on issues relating to two key variables relevant to the analysis of public health information: poverty and inequality. Although the paper has been written from the perspective of economics, the discipline of the two authors, it is also of relevance to researchers in other disciplines. It is argued that there is a need to ensure that, when considering measurement in this largely neglected area of research, sufficient thought is given to the relationships that are being examined or assessed.

Equity in health care and institutional trust: a communitarian view.

Communitarianism acknowledges and values, and not just instrumentally, the bonds that unite and identify communities. Communitarians also value community per se. This paper argues that trust is likely to be stronger in communities where these bonds are greater.