Owen Smith - Böcker

First published in 2002. Routledge is an imprint of Taylor & Francis, an informa company.

Fifty years ago, health outcomes in the countries of Eastern Europe and Central Asia were not far behind those in Western Europe and well ahead of most other regions of the world. But progress since then has been slow. While life expectancy in the ECA region today is close to the global average, the gap with its western neighbours has doubled, and other middle-income regions have all surpassed ECA. Some countries in the region are doing better, but full convergence with the world's most advanced health systems is still a long way off. At the same time, survey evidence suggests that the health sector is the top priority for additional investment among populations across the region. The experience of high-income countries also suggests that popular demand for strong and accessible health systems will only grow over time. Yet these aspirations must be reconciled with current fiscal realities. In brief, health sector issues are a challenge here to stay for policy-makers across the ECA region. This report draws on new evidence to explore the development challenge facing health sectors in ECA, and highlights three key agendas to help policy-makers seeking to achieve more rapid convergence with the world's best performing health systems. The first is the health agenda, where the task is to strengthen public health and primary care interventions to help launch the 'cardiovascular revolution' that has taken place in the West in recent decades. The second is the financing agenda, in which growing demand for medical care must be satisfied without imposing undue burden on households or government budgets. The third agenda relates to broader institutional arrangements. Here there are some key reform ingredients common to most advanced health systems that are still missing in many ECA countries. A common theme in each of these three agendas is the emphasis on improving outcomes, or 'Getting Better'.

Health and economic development are interconnected. Over the past decades, the health sector has become an increasingly important component of the global economy, evidenced by the growing trend of health expenditures as a share of GDP. The interconnectivity of health and economic development and the cyclical nature of economic performance have emphasised the critical need to build health sector resilience to prepare for inevitable economic downturns. The objective of the book is to raise awareness of the challenges that health systems, in both developing and developed countries, face in times of economic crisis and provide an Assessment, Tracking and Mitigation (A.T. M.) framework by which governments and policy makers can meet the critical challenge of health sector stabilisation and resilience building. The A.T.M. framework emphasises the importance of the interdependence of these three pillars for effective crisis response and strengthening health system resilience to economic shocks. The framework proposes that, in order to be effective in mitigation, governments and policy makers must possess or develop: (i) Tools to assess the health sector vulnerability to economic crisis. (ii) Tools, information systems, and data sources to track system and population level effects quickly during the crisis. (iii) Ability to implement effective policies to mitigate effects when a crisis hits.In conclusion, while the links between health and the overall economy are increasingly understood and appreciated, the role of health in an economic downturn is still not well understood or planned for. This book builds on the lessons of the most recent global financial crisis, especially in Europe and Central Asia and proposes a more effective role for the health sector as part of a safety net function and as a stabiliser for the population during a crisis. To mitigate the impacts of crises on vulnerable populations and assume the role of a stabiliser, the health sector must use assessment tools to identify system vulnerabilities, track to detect early impacts, and build targeted systems that are prepared to meet the challenges of the future. The experience and instruments in the Social Protection sector offer lessons and opportunities for collaboration with health.