Hebe N. Gouda
University of Queensland
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International Journal of Health Services | 2015
Devi Sridhar; Martin McKee; Gorik Ooms; Claudia Beiersmann; Eric A. Friedman; Hebe N. Gouda; Peter S. Hill; Albrecht Jahn
Universal Health Coverage (UHC) is widely considered one of the key components for the post-2015 health goal. The idea of UHC is rooted in the right to health, set out in the International Covenant on Economic, Social, and Cultural Rights. Based on the Covenant and the General Comment of the Committee on Economic, Social, and Cultural Rights, which is responsible for interpreting and monitoring the Covenant, we identify 6 key legal principles that should underpin UHC based on the right to health: minimum core obligation, progressive realization, cost-effectiveness, shared responsibility, participatory decision making, and prioritizing vulnerable or marginalized groups. Yet, although these principles are widely accepted, they are criticized for not being specific enough to operationalize as post-2015 indicators for reaching the target of UHC. In this article, we propose measurable and achievable indicators for UHC based on the right to health that can be used to inform the ongoing negotiations on Sustainable Development Goals. However, we identify 3 major challenges that face any exercise in setting indicators post-2015: data availability as an essential criterion, the universality of targets, and the adaptation of global goals to local populations.
BMC Public Health | 2012
Hebe N. Gouda; Julia Critchley; John Powles; Simon Capewell
BackgroundReasons for the widespread declines in coronary heart disease (CHD) mortality in high income countries are controversial. Here we explore how the type of metric chosen for the analyses of these declines affects the answer obtained.MethodsThe analyses we reviewed were performed using IMPACT, a large Excel based model of the determinants of temporal change in mortality from CHD. Assessments of the decline in CHD mortality in the USA between 1980 and 2000 served as the central case study.ResultsAnalyses based in the metric of number of deaths prevented attributed about half the decline to treatments (including preventive medications) and half to favourable shifts in risk factors. However, when mortality change was expressed in the metric of life-years-gained, the share attributed to risk factor change rose to 65%. This happened because risk factor changes were modelled as slowing disease progression, such that the hypothetical deaths averted resulted in longer average remaining lifetimes gained than the deaths averted by better treatments. This result was robust to a range of plausible assumptions on the relative effect sizes of changes in treatments and risk factors.ConclusionsTime-based metrics (such as life years) are generally preferable because they direct attention to the changes in the natural history of disease that are produced by changes in key health determinants. The life-years attached to each death averted will also weight deaths in a way that better reflects social preferences.
Bulletin of The World Health Organization | 2016
Nicola C. Richards; Hebe N. Gouda; Jo Durham; Rasika Rampatige; Anna Rodney; Maxine Whittaker
Noncommunicable diseases (NCDs) are a major cause of preventable disability worldwide.1 While actions to monitor NCDs have gained significant momentum in the global health agenda, similar developments to monitor and manage the growing burden of NCD-related disability have been relatively slow. The global NCD action plan was developed to support country efforts in addressing the devastating social, economic and public health impacts of NCDs.2 The NCD action plan includes nine voluntary targets and a monitoring framework. However, the monitoring framework has been criticized for its focus on mortality while neglecting adequate measures of morbidity and disability.3 This has resulted from focusing on existing data within health information systems, rather than on identifying appropriate data for measuring disease burden. Indeed, the issue of the chronicity of NCDs seems absent in most monitoring and evaluation frameworks, with an implicit assumption that the only outcome of interest for countries is premature mortality.
PLOS Neglected Tropical Diseases | 2009
Jeremiah Ngondi; Fiona E. Matthews; Mark Reacher; Jonathan D. King; Carol Brayne; Hebe N. Gouda; Paul M. Emerson
Background Uncontrolled trachoma is a leading cause of blindness. Current global trachoma burden summary measures are presented as disability adjusted life years but have limitations due to inconsistent methods and inadequate population-based data on trachomatous low vision and blindness. We aimed to describe more completely the burden of blinding trachoma in Southern Sudan using health expectancies. Methodology/Principal Findings Age and gender specific trachomatous trichiasis (TT) prevalence was estimated from 11 districts in Southern Sudan. The distribution of visual acuity (VA) in persons with TT was recorded in one district. Sudan life tables, TT prevalence, and VA were used to calculate Trichiasis Free Life Expectancy (TTFLE) and Trichiasis Life Expectancy (TTLE) using the Sullivan method. TTLE was broken down by VA to derive TTLE with normal vision, TTLE with low vision, and TTLE with blindness. Total life expectancy at birth in 2001 was 54.2 years for males and 58.1 for females. From our Sullivan models, trichiasis life expectancy at the age of 5 years was estimated to be 7.0 (95% confidence interval [CI] = 6.2–7.8) years (12% [95% CI = 11–14] of remaining life) for males and 10.9 (95% CI = 9.9–11.9 ) years (18% [95% CI = 16–20] of remaining life) for females. Trichiasis life expectancy with low vision or blindness was 5.1 (95% CI = 3.9–6.4) years (9% [95% CI = 7–11] of remaining life) and 7.6 (95% CI = 6.0–9.1) years (12% [95% CI = 10–15] of remaining life) for males and females, respectively. Women were predicted to live longer and spend a greater proportion of their lives with disabling trichiasis, low vision, and blindness compared to men. Conclusions The study shows the future burden associated with doing nothing to control trachoma in Southern Sudan, that is, a substantial proportion of remaining life expectancy spent with trichiasis and low vision or blindness for both men and women, with a disproportionate burden falling on women.
The Lancet | 2017
Claire E. Brolan; Hebe N. Gouda; Carla AbouZahr; Alan D. Lopez
1084 www.thelancet.com Vol 389 March 18, 2017 Civil registration and vital statistics (CRVS) systems and the data they generate will be crucial for monitoring implementation of the Sustainable Development Goals (SDGs) in countries, as well as for other national and regional health and development agendas. It is the continuity, completeness, and relevance at local administrative levels that distinguish CRVS information from other population data sources. In 2015, the Lancet Counting Births and Deaths Series responded to an earlier Lancet Series, Who Counts? that described the neglect of global CRVS systems as “the single most critical failure of development over the past 30 years”. Notably, the 2015 Series showed how CRVS systems are an essential component for global achievement of the Millennium Development Goals. Although global health commentators typically focus on CRVS systems to support global health policy goals, improving national CRVS systems can be justified for reasons beyond health. Adapting David Stuckler and Martin McKee’s five metaphors on global health, we identify five global policy metaphors that underline the centrality of CRVS systems for development: CRVS as public health, sustainable development, investment, human rights, and good governance (panel). With policy decisionmaking processes difficult to define, and subject to sensitive in-country trade-offs unrelated to the health portfolio, securing support for CRVS can “crucially depend on which metaphor is dominant”. Beyond health: five global policy metaphors for civil registration and vital statistics 8 Rodrigo GJ, Neffin H, Castro-Rodriguez JA. Efficacy and safety of subcutaneous omalizumab vs placebo as add on therapy to corticosteroids for children and adults with asthma: a systematic review. Chest 2011; 139: 28–35. 9 Maselli DJ, Singh H, Diaz J, Peters JI. Efficacy of omalizumab in asthmatic patients with IgE levels above 700IU/ml: a retrospective study. Ann Allergy Asthma Immunol 2013; 110: 457–61. 10 Leckie MJ, ten Brinke A, Khan J, et al. Effects of an interleukin-5 blocking monoclonal antibody on eosinophils, airway hyper-responsiveness, and the late asthmatic response. Lancet 2000; 356: 214–18. 11 Nair P, Pizzichini M, Kjarsgaard M, et al. Mepolizumab for prednisone-dependent asthma with sputum eosinophilia. N Engl J Med 2009; 360: 985–93. 12 Haldar, P Brightling C, Hargadon B, et al. Mepolizumab and exacerbations of refractory eosinophilic asthma. N Engl J Med 2009; 360: 973–84. 13 Ortega HG, Liu MC, Pavord ID, et al. Mepolizumab treatment in patients with severe eosinophilic asthma. N Engl J Med 2014; 371: 1198–207. 14 Castro M, Zangrilli J, Wechsler ME, et al. Reslizumab for inadequately controlled asthma with elevated blood eosinophil counts: results from two multicentre, parallel, double-blind, randomised, placebo-controlled, phase 3 trials. Lancet Respir Med 2015; 3: 355–66. 15 FitzGerald JM, Bleecker ER, Nair P, et al. Benralizumab, an anti-interleukin-5 receptor alpha monoclonal antibody, as add-on treatment for patients with severe, uncontrolled, eosinophilic asthma (CALIMA): a randomised, double-blind, placebo-controlled phase 3 trial. Lancet 2016; 388: 2128–41. 16 Charriot J, Vachier I, Halimi L, et al. Future treatment for asthma. Euro Respir Rev 2016; 25: 77–92. 17 Pavord ID, Bafadhel M. Exhaled nitric oxide and blood eosinophilia: independent markers of preventable risk. J Allergy Clin Immunol 2013; 132: 828. 18 ClinicalTrials.gov. Controlling and Preventing Asthma Progression and Severity in Kids (CASK). NCT02570984. https://clinicaltrials.gov/ct2/show/ NCT02570984 (accessed Nov 8, 2016). 19 Zafari Z, Lynd LD, FitzGerald JM, Sadatsafavi M. Economic and health effect of full adherence to controller therapy in adults with uncontrolled asthma: a simulation study. J Allergy Clin Immunol 2014; 134: 908–15.
Social Science & Medicine | 2016
Hebe N. Gouda; Angela Kelly-Hanku; L. Wilson; Seri Maraga; Ian Riley
Verbal autopsy (VA) methods usually involve an interview with a recently bereaved individual to ascertain the most probable cause of death when a person dies outside of a hospital and/or did not receive a reliable death certificate. A number of concerns have arisen around the ethical and social implications of the use of these methods. In this paper we examine these concerns, looking specifically at the cultural factors surrounding death and mourning in Papua New Guinea, and the potential for VA interviews to cause emotional distress in both the bereaved respondent and the VA fieldworker. Thirty one semi-structured interviews with VA respondents, the VA team and community relations officers as well as observations in the field and team discussions were conducted between June 2013 and August 2014. While our findings reveal that VA participants were often moved to cry and feel sad, they also expressed a number of ways they benefited from the process, and indeed welcomed longer transactions with the VA interviewers. Significantly, this paper highlights the ways in which VA interviewers, who have hitherto been largely neglected in the literature, navigate transactions with the participants and make everyday decisions about their relationships with them in order to ensure that they and VA interviews are accepted by the community. The role of the VA fieldworker should be more carefully considered, as should the implications for training and institutional support that follow.
Social Science & Medicine | 2017
Hebe N. Gouda; Abraham D. Flaxman; Claire E. Brolan; Rohina Joshi; Ian Riley; Carla AbouZahr; Sonja Firth; Rasika Rampatige; Alan D. Lopez
Verbal autopsy (VA) methods are designed to collect cause-of-death information from populations where many deaths occur outside of health facilities and where death certification is weak or absent. A VA consists of an interview with a relative or carer of a recently deceased individual in order to gather information on the signs and symptoms the decedent presented with prior to death. These details are then used to determine and assign a likely cause-of-death. At a population level this information can be invaluable to help guide prioritisation and direct health policy and services. To date VAs have largely been restricted to research contexts but many countries are now venturing to incorporate VA methods into routine civil registration and vital statistics (CRVS) systems. Given the sensitive nature of death, however, there are a number of ethical, legal and social issues that should be considered when scaling-up VAs, particularly in the cross-cultural and socio-economically disadvantaged environments in which they are typically applied. Considering each step of the VA process this paper provides a narrative review of the social context of VA methods. Harnessing the experiences of applying and rolling out VAs as part of routine CRVS systems in a number of low and middle income countries, we identify potential issues that countries and implementing institutions need to consider when incorporating VAs into CRVS systems and point to areas that could benefit from further research and deliberation.
Faculty of Health; School of Public Health & Social Work | 2016
Jo Durham; Vanphanom Sychareun; Anna Rodney; Hebe N. Gouda; Nicola Richards; Rasika Rampatige; Maxine Whittaker
The Convention on the Rights of Persons with Disabilities provides an opportunity to strengthen disability-related health information. This study analysed the health information system in Lao PDR and sought evidence of interventions to improve disability-related health information. The study was based on a literature review and key informant interviews (N = 17) informed by the Health Metrics Networks Framework and Standards and the Performance of Routine Information System Management framework. The Lao health information system is in an embryonic stage with health data often incomplete, inaccurate and poorly used. Indicators related to disability or functioning are not included, and capacity to diagnose the health condition of disability is limited. No studies of health information interventions were found. As a State Party to the CRPD, the Lao PDR has a legal obligation to collect health-related information on people with disabilities. Given the nascent stage of development of the health information system in the Lao PDR and diagnostic capacity, indicators related to basic functioning and access to services should be integrated into household level surveys. As the health information system further develops, small, incremental changes in the type of disability information and rehabilitation and the way it is collected can be implemented. Copyright
BMC Medicine | 2015
Hebe N. Gouda; Nicola C. Richards; Robert Beaglehole; Ruth Bonita; Alan D. Lopez
BackgroundNon-communicable diseases (NCDs) place enormous burdens on individuals and health systems. While there has been significant global progress to guide the development of national NCD monitoring programs, many countries still struggle to adequately establish critical information systems to prioritise NCD control approaches.DiscussionIn this paper, we use the recent experience of the Pacific as a case study to highlight four key lessons about prioritising strategies for health information system development for monitoring NCDs: first, NCD interventions must be chosen strategically, taking into account local disease burden and capacities; second, NCD monitoring efforts must align with those interventions so as to be capable of evaluating progress; third, in order to ensure efficiency and sustainability, NCD monitoring strategies must be integrated into existing health information systems; finally, countries should monitor the implementation of key policies to control food and tobacco industries.SummaryPrioritising NCD interventions to suit local needs is critical and should be accompanied by careful consideration of the most appropriate and feasible monitoring strategies to track and evaluate progress.
BMC Public Health | 2014
Hebe N. Gouda; John Powles
ObjectivesEpidemiology is often described as ‘the science of public health’. Here we aim to assess the extent that epidemiological methods, as covered in contemporary standard textbooks, provide tools that can assess the relative magnitude of public health problems and can be used to help rank and assess public health priorities.Study DesignNarrative literature review.MethodsThirty textbooks were grouped into three categories; pure, extended or applied epidemiology, were reviewed with attention to the ways the discipline is characterised and the nature of the analytical methods described.ResultsPure texts tend to present a strict hierarchy of methods with those metrics deemed to best serve aetiological inquiry at the top. Extended and applied texts employ broader definitions of epidemiology but in most cases, the metrics described are also those used in aetiological inquiry and may not be optimal for capturing the consequences and social importance of injuries and disease onsets.ConclusionsThe primary scientific purpose of epidemiology, even amongst ‘applied’ textbooks, is aetiological inquiry. Authors do not readily extend to methods suitable for assessing public health problems and priorities.