The relationship between health and economic growth has traditionally been viewed as a simple relationship: economic growth promotes health through the creation of sanitary infrastructure, better nutrition and housing, and better access to high quality services. However, new research has demonstrated that good health and nutrition are not only products but also conditions for sustainable economic growth: they reduce poverty; protect family assets; increase labor productivity; and improve educational performance. This evidence motivated the creation in 2000 of the Commission on Macroeconomics and Health. The report of this commission demonstrated that a 10% improvement in life expectancy at birth is associated with an annual economic growth of 0.3% to 0.4%. These findings contributed to the recent increase in global financial investments in health and nutrition. However, in order to meet the health and nutritional challenges of the 21st century we need not only more money for health but also more health for the money. The design and implementation of evidence-based policies may improve the performance of health and nutritional systems, as shown by the Oportunidades program. This health and nutritional program was created in Mexico, but similar versions have been implemented in almost 20 countries in the developing world. This experience shows that globalization can turn knowledge-based policies into international public goods that can then be brought to the domestic policy agenda to address local problems. Such application, in turn, feeds back into the global pool of experience, thus generating a process of shared learning.

Biography

Dr. Julio Frenk became dean of the Harvard School of Public Health on January 1, 2009. Dr. Frenk holds an MD from the National Autonomous University of Mexico, and an MPH, MA (Sociology) and Ph.D. from the University of Michigan.
Dr. Frenk was founding director of the Center for Public Health Research in Mexico's Ministry of Health from 1984 to 1987, and from 1987 to 1992, founding director-general of the National Institute of Public Health in Mexico, guiding its emergence as one of the developing world's most respected and innovative centers of education and research in public health.
At HSPH, he was a Visiting Professor from 1992 to 1993 and again from 2007 to 2008. He served from 1995 to 1998 as executive vice president of the Mexican Health Foundation and director of its Center for Health and the Economy. From 1998 to 2000, he served as Executive Director of Evidence and Information for Policy at WHO.
As Minister of Health of Mexico from 2000 to 2006, Dr. Frenk pursued an ambitious agenda to reform the nation's health system, with an emphasis on redressing social inequality and establishing a program of comprehensive national health insurance, known as Seguro Popular. After completing his term, Dr. Frenk served as a senior fellow in the global health program of the Bill & Melinda Gates Foundation and as president of the Carso Health Institute in Mexico City. He is currently chair of the board of the Institute for Health Metrics and Evaluation at the University of Washington.
A member of the U.S. Institute of Medicine and the National Academy of Medicine of Mexico, he has served on the editorial boards of more than a dozen publications, and has been associated with the faculties of the University of Michigan and several universities in Mexico.

This paper discusses the determinants of health. It considers fetal origins, early family influences, and later life influences as they affect cognition, personality, and health endowments. Evidence from interventions will also be discussed.

Biography

James J. Heckman shared the 2000 Nobel Memorial Prize in Economic Sciences.
He is the Henry Schultz Distinguished Service Professor of Economics at the University of Chicago, where he has served since 1973. He directs the Economics Research Center and the Center for Social Program Evaluation at the Harris School for Public Policy. In addition, he is the Professor of Science and Society in University College Dublin and a Senior Research Fellow at the American Bar Foundation.
Heckman received his B.A. in mathematics from Colorado College in 1965 and his Ph.D. in economics from Princeton University in 1971. His work has been devoted to the development of a scientific basis for economic policy evaluation, with special emphasis on models of individuals and disaggregated groups, and to the problems and possibilities created by heterogeneity, diversity, and unobserved counterfactual states. He developed a body of new econometric tools that address these issues. His research has given policymakers important new insights into areas such as education, job-training, the importance of accounting for general equilibrium in the analysis of labor markets, antidiscrimination law, and civil rights. His recent research focuses on inequality, human development and lifecycle skill formation, with a special emphasis on the economics of early childhood.
Heckman has received numerous awards for his work, including the John Bates Clark Award of the American Economic Association in 1983, the 2005 and 2007 Dennis Aigner Award for Applied Econometrics from the Journal of Econometrics, the 2007 Theodore W. Schultz Award from the American Agricultural Economics Association, the 2005 Jacob Mincer Award for Lifetime Achievement in Labor Economics, and the 2005 Ulysses Medal from the University College Dublin. He is also a member of the National Academy of Sciences, USA; a member of the American Philosophical Society; a fellow of the American Academy of Arts and Sciences; the Econometric Society; the Society of Labor Economics; the American Statistical Association; and the International Statistical Institute.

A substantial improvement in life expectancy and morbidity at middle and late ages has been observed throughout the twentieth century, notably in the reduction of inter-urban differentials in mortality and disease prevalence. The improvement in urban environments occurred relatively quickly— 84% of the difference in the infant mortality rate in urban wards in 1900 was gone by 1950— suggesting that genetic or evolutionary theories are inadequate to explain the increases in health and longevity indicated over the last century. This paper reports on some preliminary findings on the influence of changes in early socioeconomic and epidemiological environments on later life, health, and longevity.

Biography

Robert William Fogel received his B.A. from Cornell University, his M.A. from Columbia University, and his Ph.D., in Economics, from Johns Hopkins University. He has held faculty positions at the University of Rochester, Cambridge University, and Harvard University. He is currently the Charles R. Walgreen Distinguished Service Professor of American Institutions and the director of the Center for Population Economics in the Graduate School of Business, as well as a member of both the Department of Economics and the Committee on Social Thought, at the University of Chicago. He is also a research associate at the National Bureau of Economic Research. In 1993, he received the Nobel Prize in Economics (with Douglass C. North). During his graduate work under Simon Kuznets, he became interested in combining the study of economics and history to understand long-term technological and institutional change. Early work focused on railroads and economic growth in American history, which was followed by analyses of the economics of American slavery (jointly with S. L. Engerman) published as Time on the Cross: The Economics of American Negro Slavery (1974) and Without Consent or Contract: The Rise and Fall of American Slavery (4 vols., 1989-1992). In 2000, he published a reinterpretation of America’s current prosperity, material and spiritual, The Fourth Great Awakening and the Future of Egalitarianism. The Slavery debates, 1952 1990: A retrospective (2004) provided a personal assessment of the twentieth-century debates over American slavery. Beginning in the mid-1970s he began to study the secular decline in mortality and the improvement in health and nutrition. Since the mid-1980s he has focused on the changing pattern of aging over the life cycle in the United States. The latest findings from this project were published in The Escape from Hunger and Premature Death 1700-2100: Europe, America, and the Third World (2004). He has been selected as the Indispensable Person of the Year for 2006 by the Alliance for Aging Research for his contributions to the study of health and aging. His other current research includes an examination of the role of Simon Kuznets in twentieth-century economic thought and the development of the discipline of economics during the twentieth century.

Humankind faces a daunting array of health challenges in the 21st century. Sir Richard will present a four-part scheme for understanding these challenges under the following headings:
• Mind the Gap,
• Sex and Chickens,
• The World’s Biggest Muddle; and
• Eating More AND Less.

Dr. Feachem will briefly describe the major issues under each of these headings before turning to the parallel challenges posed by the current pandemic of under-nutrition and the juxtaposed pandemic of over-nutrition. Sir Richard will describe how each of these great 21st century challenges in global health represent a global public good of the utmost priority. Particularly with regard to the second and fourth heading above, Dr. Feachem will propose that new and innovative forms of global collaboration and architecture are required, and that countries are largely unable to overcome these problems through individual or unilateral action.

For these forms of collaboration to be created and to prosper, new levels of trust must be created among countries and cultures.

Biography

Richard G.A. Feachem is Professor of Global Health at both the University of California, San Francisco and the University of California, Berkeley, and Director of the Global Health Group at UCSF Global Health Sciences. He is also a Visiting Professor at London University and an Honorary Professor at the University of Queensland.
From 2002 to 2007, Sir Richard served as founding Executive Director of the Global Fund to Fight AIDS, Tuberculosis and Malaria.
From 1999 to 2002, Professor Feachem was the founding Director of the Institute for Global Health at UCSF and UC Berkeley. From 1995 until 1999 he was Director for Health, Nutrition and Population at the World Bank. Previously, he was Dean of the London School of Hygiene and Tropical Medicine. Professor Feachem served as Chairman of the Foundation Council of the Global Forum for Health Research; Treasurer of the International AIDS Vaccine Initiative; Council Member of Voluntary Service Overseas; and on numerous other committees. He was a member of the Commission on Macroeconomics and Health, and the Commission on HIV and Governance in Africa.
Professor Feachem holds a Doctor of Science degree in Medicine from the University of London, and a PhD in Environmental Health from the University of New South Wales. In 2007 he was awarded an Honorary Doctorate in Engineering by the University of Birmingham. He is a Fellow of the Royal Academy of Engineering and an Honorary Fellow of the Faculty of Public Health Medicine of the Royal College of Physicians and of the American Society of Tropical Medicine and Hygiene. In 2002 he was elected to membership of the Institute of Medicine of the US National Academy of Sciences. Sir Richard was knighted by Her Majesty Queen Elizabeth II in 2007.

Every health system today has some linkage between health-care resources and human well-being, but an ever growing body of research has shown that this linkage is very loose, indeed, and enormously wasteful of real resources. Within that linkage, the individual’s role in managing his or her own health, in particular, has yet to be engaged to its full potential.
This presentation will provide a broad overview of this terrain and explore where in the chain of production processes – the production of health care, the production of health, and the production of human happiness (utility) – public policy might constructively intervene to enhance the overall productivity of real resources used in health systems to generate human well being.

Biography

Recognized as one of the nation’s leading authorities on health care economics, Reinhardt has been a member of the Institute of Medicine of the National Academy of Sciences since 1978. He is a past president of the Association of Health Services Research. From 1986 to 1995 he served as a commissioner on the Physician Payment Review Committee, established in 1986 by Congress to advise it on issues related to the payment of physicians. He is a senior associate of the Judge Institute for Management of Cambridge University, UK, and a trustee of Duke University, and the Duke University Health System. Reinhardt is or was a member of numerous editorial boards, among them the Journal of Health Economics, the Milbank Memorial Quarterly, Health Affairs, the New England Journal of Medicine, and the Journal of the American Medical Association. Ph.D. Yale University.

Malnutrition and obesity co-exist across the world. In developed countries the former gave rise to welfare states following investigations, by social reformers such as Seebohn Rowntree and Charles Booth in England, which deployed social surveys and statistical analysis. Subsequently epidemics of tobacco and alcohol consumption induced premature death and high levels of morbidity for populations. As these epidemics are constrained or wane, a new form of oral gratification and addiction has developed: obesity. How can the adverse health effects of this be mitigated as commercial enterprises strive for legitimate profits and market share? Is it inevitable that policy changes will involve altering the incentives faced by consumers? How will such interventions be evaluated to inform policy choices?

Biography

Alan Maynard is a Professor of Health Economics in the Department of Health Sciences and the Hull-York Medical School, University of York, England. He was the founding director of the Centre for Health Economics at York. He is a Fellow of the UK Academy of Medical Sciences and has been awarded honorary doctorates by the Universities of Aberdeen and Northumbria. He is an Adjunct Professor in the Centre for Health Economics, Research and Evaluation at the Technology University, Sydney, Australia. He has worked as a consultant for the World Bank, the European Union, the UK Department for International Development and the World Health Organisation in over twenty countries. He has been involved in health service management for over 25 years and since 1997 has been Chairman of York Hospitals NHS Foundation Trust. This hospital has 700 beds and provides acute care for a local population of over 350,000.

Disease Management has been introduced in the USA in the early 90’s as a tool mainly for cost containment within the health maintenance organisations. This was not immediately a success. In Europe, this evolution was observed, but not followed, due to a different organisation of the healthcare system. The typical vertical approach in most European systems with separate budgets for each stakeholder, was a main obstacle to introduce this new care and organisational paradigm.
Different variables changed in the meantime :
- demographic evolution, and alarming dependency ratio
- epidemiological changes (chronic diseases and dependency)
- shortage of medical staff , and changing of roles
- general availability of ICT in general and telemedecine tools particularly
- budget restrictions
- technological explosion
Telemedicine and ICT on itself get hardly structurally implemented in Europe, as neither payers and medical providers have been integrated at the concept.

Independent Mutualities (AIM) prepares the launch of a new initiative of disease management for chronic diseases in cooperation with the local doctors associations. In a second phase, instead of risk insurance, risk management and individual prevention will be introduced. Structured interventions for the health insurance funds members are planned for better managing the most common chronic diseases, with screening – intake assessment – education – coaching – monitoring and compliance control, supported by financial incentives and multimedia development. Interventions for the health care providers, specifically the general practitioners, also with financial incentives are developed.

Nutrition disorders will be amongst the common diseases and risks, with obesity and undernutrition as the most important ones. A public health program specifically for the elder population could support this initiative.

Biography

Jan Van Emelen (MD) graduated in 1975 as a general practitioner at the KULeuven, and ever since never stopped educating himself in various aspects of health care, such as tropical diseases, nutrition, statistics and epidemiology, decision making in health care and occupational medicine.

He started his career working as a physician in Congo and Ecuador working for ABOS (the Belgian administration for development cooperation), WHO and Development Assistance, a research unit on development studies.
From 1900 till 1999 he was involved in occupational health within the Belgian labor administration.
From 1999 on, he has been assigned as governmental advisor and expert in health care and social protection.

Since 2003, Jan Van Emelen is Director Innovation of the Independent Mutualities, where he coordinates innovative pilot projects, in collaboration with other parties on health care and health care systems. Specifically Disease Management is his main occupation, at the national Belgian level, but also as president of the international working group on disease management hosted by AIM (Association Internationale de la Mutualité).

A major reason why many countries are failing to make progress in improving health outcomes is a shortage of motivated health personal. However, the cost and feasibility of dramatically increasing medical personnel is beyond the feasibility of many countries. An alternative is to consider paying medical care for performance (P4P). P4P provides incentive payments to medical care providers for improvements in performance measured by specific utilization and quality of care indicators. P4P can affect health care in two ways; first by providing incentives for providers to put more effort into specific activities, and second by increasing the amount of resources available to finance the delivery of services. While the approach holds promise for improving health system performance, there is little rigorous evidence of its effectiveness, especially in low-income settings.
In 2006, Rwanda began paying for performance at the primary health center level in order to improve maternal and child health outcomes. This study examines the impact of the incentives in the Rwandan P4P scheme on prenatal care utilization, the quality of prenatal care, institutional delivery, and child preventive care utilization using data produced from a prospective quasi-experimental evaluation nested into the program rollout.
We find that P4P had a large and significant positive impact on institutional deliveries and preventive care visits by young children, and improved the quality of prenatal care measured by process indicators of the clinical content of care and tetanus toxoid vaccination. We also find that P4P is associated with increases in child height and weight. However, we find no effect on the number of women completing 4 prenatal care visits or on the number of children fully immunized.
Our results provide evidence to support the hypothesis that financial performance incentives can improve both the use of and the quality of maternal and child health services as well child health outcomes.

Biography

Professor Paul J. Gertler is the Li Ka Shing Distinguished Professor of Economics and Director of the Graduate Program in Health Management at the University of California, Berkeley. After earning a PhD in Economics from the University of Wisconsin, Madison in 1985, Dr. Gertler joined the Department of Health Policy and Management at Harvard University. He left the position in 1989 for the RAND Corporation as a Senior Economist. In 1994, he returned to Harvard University as a visiting professor in the Department of Economics, and was appointed to the faculty at University of California, Berkeley in 1996.

In August 2004, Dr. Gertler joined the World Bank as Chief Economist of the Human Development Network. In this position, Dr. Gertler led the Human Development Network’s agenda of developing an evidence-based for policy advice to developing countries on what works to improve human development and reduce poverty. His work directly contributed to the Bank’s agenda to improve key development outcomes in the areas of education, health, HIV/AIDS, social protection, children and youth.

Dr. Gertler has received multiple awards, including the Kenneth Arrow Award in Health Economics (1996); Academic Career Leadership Award, United States National Institutes on Health (1998); and a Global Development Network Award (2002). He has also published more than 75 journal articles and books on a wide variety of subjects.

Information is crucial to the delivery of efficient and effective health care and the promotion of health. Most immediately, it serves as a fundamental resource for securing appropriate treatment and good outcomes for patients. However, information in the form of performance data is more generally a key resource for securing managerial, political and democratic control of the health system - in short to improving its governance. There have recently been astonishing developments in the scope, nature and timeliness of performance data made available in all developed health systems. The overarching goal of such initiatives has been a desire to enhance the accountability of the health system to patients, citizens, and their representatives. Yet, notwithstanding the large number of experiments under way, there remain many unresolved debates about how best to design and use such data. This paper will examine some of the initiatives currently in place, assess their relevance to the promotion of better nutrition and health of the population, and discuss whether they might lead to improved health system efficiency.

Biography

Peter C. Smith has recently been appointed Professor of Health Policy at Imperial College, London. Before that he was Professor of Economics and Director of the Centre for Health Economics at the University of York. He is a mathematics graduate from the University of Oxford, and started his academic career in the public health department at the University of Cambridge. Professor Smith has published widely on the financing and performance of health systems, and was founding editor of the journal Health Care Management Science. He has a special interest on the links between research evidence and policy. Professor Smith has served on numerous UK governmental advisory committees on finance, workforce and productivity issues. He has also acted as consultant to many overseas ministries and international agencies, including the OECD, the World Health Organization, the International Monetary Fund, the European Commission and the World Bank.