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"Wolfson, Michael"
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Indicators for assessing the interoperability of health data in Canada
In Canada, federal, provincial, and territorial governments have embarked on a major effort to improve the interoperability of health data, as indicated by Bill C-72 making data blocking by commercial software vendors a criminal offense,1 endorsement of the Pan-Canadian Health Data Charter, and the billions of dollars of federal support (e.g., Canada Health Infoway) and fiscal transfers to the provinces and territories to improve access to and quality of data and health information. The interoperability of health data is the ability of patients, their health care providers, and researchers or analysts--subject to stringent confidentiality and security safeguards--to access patient health data. For patients and their carers, this is critical to ensure full communication, where failures can be deadly. For health services research and health care quality analyses, access to these data is critical for managing Canada's expensive health care sector more efficiently, both to ensure the best interventions are being applied, and to weed out overly costly and useless procedures.
Journal Article
Tor Seidel : the Dubai
Dubai was rapidly transformed by the discovery of oil in the 1950s. German artist Tor Seidel (born 1964) views this fragmented urban landscape from a distance. In his photographs, giant shopping malls spread out before the melancholy backdrop of abandoned, mammoth building projects.
Book
How to pay for national pharmacare
Canada has long been the only high-income country with a universal health insurance system that excludes universal coverage of prescription drugs. But the 2018 federal budget established the Advisory Council on the Implementation of National Pharmacare to recommend a remedy for this shortcoming of Canadian medicare. In addition to sorting out program details, such as which medications will be covered, the advisory committee must propose a mechanism for financing national pharmacare. Not merely of special interest to economists, financing mechanisms influence key pharmaceutical policy outcomes. Access to medicines is best facilitated when direct charges to patients are limited. Cost control is best achieved by single-payer systems that reduce administration costs and consolidate purchasing power. Financial equity is best promoted by systems that collect contributions in proportion to ability to pay and are independent of needs. As summarized in this article, the Parliamentary Budget Officer assumes that all but $500 million of the cost of drugs on the national formulary would be publicly financed.
Journal Article
Is Income Inequality a Determinant of Population Health? Part 1. A Systematic Review
This article reviews 98 aggregate and multilevel studies examining the associations between income inequality and health. Overall, there seems to be little support for the idea that income inequality is a major, generalizable determinant of population health differences within or between rich countries. Income inequality may, however, directly influence some health outcomes, such as homicide in some contexts. The strongest evidence for direct health effects is among states in the United States, but even that is somewhat mixed. Despite little support for a direct effect of income inequality on health per se, reducing income inequality by raising the incomes of the most disadvantaged will improve their health, help reduce health inequalities, and generally improve population health.
Journal Article
Polarization and the decline of the middle class: Canada and the U.S
Several recent studies have suggested that the distribution of income (earnings, jobs) is becoming more polarized. Much of the evidence presented in support of this view consists of demonstrating that the population share in an arbitrarily chosen middle income class has fallen. However, such evidence can be criticized as being range-specific—depending on the particular cutoffs selected. In this paper we propose a range-free approach to measuring the middle class and polarization, based on
partial
orderings. The approach yields two polarization curves which, like the Lorenz curve in inequality analysis, signal unambiguous increases in polarization. It also leads to an intuitive new index of polarization that is shown to be closely related to the Gini coefficient. We apply the new methodology to income and earnings data from the U.S. and Canada, and find that polarization is on the rise in the U.S. but is stable or declining in Canada. A cross-country comparison reveals the U.S. to be unambiguously more polarized than Canada.
Journal Article
Potential of polygenic risk scores for improving population estimates of women’s breast cancer genetic risks
Purpose
Breast cancer risk has conventionally been assessed using family history (FH) and rare high/moderate penetrance pathogenic variants (PVs), notably in
BRCA1/2
, and more recently
PALB2
,
CHEK2
, and
ATM
. In addition to these PVs, it is now possible to use increasingly predictive polygenic risk scores (PRS) as well. The comparative population-level predictive capability of these three different indicators of genetic risk for risk stratification is, however, unknown.
Methods
The Canadian heritable breast cancer risk distribution was estimated using a novel genetic mixing model (GMM). A realistically representative sample of women was synthesized based on empirically observed demographic patterns for appropriately correlated family history, inheritance of rare PVs, PRS, and residual risk from an unknown polygenotype. Risk assessment was simulated using the BOADICEA risk algorithm for 10-year absolute breast cancer incidence, and compared to heritable risks as if the overall polygene, including its measured PRS component, and PV risks were fully known.
Results
Generally, the PRS was most predictive for identifying women at high risk, while family history was the weakest. Only the PRS identified any women at low risk of breast cancer.
Conclusion
PRS information would be the most important advance in enabling effective risk stratification for population-wide breast cancer screening.
Journal Article