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Background Unhealthy alcohol use is a public health problem with significant health, social and economic impacts. Alcohol screening and brief intervention (ASBI) in adult primary care is an evidence-based approach enabling early identification and intervention of unhealthy alcohol use. However, large-scale implementation and sustainment of ASBI in routine clinical practice remains a challenge, and little is known about its population-level impact. Using electronic health record (EHR) data in a large integrated healthcare system in Northern California that implemented systematic ASBI in adult primary care in mid-2013, this observational study examined: 1) trajectories of ASBI performance over 5 years post systematic implementation, and 2) their associations with both later ASBI performance and alcohol use outcomes. Methods Using the health plan’s EHR data, we calculated annual screening rates of adults with a primary care visit, and brief intervention (BI) rates among those with a positive screen (i.e., reporting alcohol consumption exceeding the age and sex specific daily and weekly low-risk National Institute on Alcohol Abuse and Alcoholism guidelines), for 57 medical facilities from years 2014 to 2021. We conducted latent class growth analysis using annual screening and BI rates to characterize trajectories of ASBI performance from years 2014–2018. Multivariable mixed-effects models were fit to examine the associations of ASBI performance trajectories with later ASBI performance and facility-level alcohol use outcomes. Results Three distinct screening performance trajectory groups (low-, middle- and high-performance) and four distinct BI performance trajectory groups (low-, improving-, middle- and high-performance) were identified. Facilities in the low-BI-performance group had panels of patients living in more deprived neighborhoods compared to the other 3 BI performance groups. After accounting for repeated measures and adjusting for time and patient panel characteristics, we found that screening and BI performance trajectories during 2014–2018 were significantly associated with screening and BI rates 2019–2021, respectively. We also observed a steeper decline in percentages reporting “exceeding daily drinking limits” and “having 5 + binge drinking days” over time among patients of facilities in the improving- and high-BI-performance groups. Conclusions Early success in ASBI performance is associated with long-term sustainability and may be associated with long-term population-level drinking outcomes.

The last 10 years have seen a resurgence in interest and research around inequalities in the health sector. While a disproportionate share of the new research has focused on measuring inequality in the health sector, work is emerging on how to understand the causes of inequality and on identifying successful approaches for tackling the problem. This book summarizes the operational lessons emerging from this new focus. It is intended to be an operational resource for change agents within and outside government in low and middle countries committed to improve access and use of critical health services to income poor and social vulnerable populations.

The economic and social prospects are daunting for the 89 million out-of-school youth who comprise nearly half of all youth in Sub-Saharan Africa. Within the next decade, when this cohort becomes the core of the labor market, an estimated 40 million more youth will drop out, and will face an uncertain future with limited work and life skills. Furthermore, out-of-school youth often are policy orphans, positioned between sectors with little data, low implementation capacity, lack of interest in long-term sustainability of programs, insufficient funds, and little coordination across the different government agencies. This report provides a diagnostic analysis of the state of out-of-school youth in Sub-Saharan Africa, focusing on the 12- to 24-year-old cohort. This report also examines the decision path youth take as they progress through the education system and the factors that explain youth's school and work choices. It finds that individual and household characteristics, social norms, and characteristics of the school system all matter in understanding why youth drop out and remain out of school. In particular, six key factors characterize out-of-school youth: (i) most out-of-school youth drop out before secondary school; (ii) early marriage for female youth and (iii) rural residence increase the likelihood of being out of school; (iv) parental education level and (v) the number of working adults are important household factors; and (vi) lack of school access and low educational quality are binding supply-side constraints. Policy discussions on out-of-school youth are framed by these six key factors along with three entry points for intervention: retention, remediation, and integration. This report also reviews policies and programs in place for out-of-school youth across the continent. Ultimately, this report aims to inform public discussion, policy formulation, and development practitioners' actions working with youth in Sub-Saharan Africa.

Each year, millions of children in developing countries fall sick and die from diseases caused by polluted air, contaminated water and soil, and poor hygiene behavior. Repeated infectious also contribute to malnutrition in children, and subsequently impacts future learning and productivity. This book analyzes the linkages between malnutrition and environmental health, and assesses the burden of disease on young children, and its economic costs.

This report's objective is to develop the evidence base for policy making in relation to poverty reduction. It produces a diagnosis of the broad nature of the poverty problem and its trends in India, focusing on both consumption poverty and human development outcomes. It also includes attention in greater depth to three pathways important to inclusive growth and poverty reduction harnessing the potential of urban growth to stimulate rural-based poverty reduction, rural diversification away from agriculture, and tackling social exclusion. This report shows that urban growth, which has increasingly outpaced growth in rural areas, has helped to reduce poverty for urban residents directly. In addition, evidence appears of a much stronger link from urban economic growth to rural poverty reduction. Stronger links with rural poverty are due to a more integrated economy. Urban areas are a demand hub for rural producers, as well as a source of employment for the rural labor force. They are aiding the transformation of the rural economy out of agriculture. In urban areas, it is small and medium-size towns, rather than large cities, that appear to demonstrate the strongest urban-rural growth links. Urban growth also stimulates rural-urban migration. But although some increase in such migration has occurred over time, migration levels in India remain relatively low compared to other countries.

This book containes a series of “state of the art” essays on topics related to health and growth. The Commission on Growth and Development (CGD)--in preparing its own Growth Report--wished to take stock of the current state of knowledge and understanding of economic growth, and thus commissioned a series of essays on a range of thematic areas. One such area is health. The following questions are discussed in the book:Does investing in health raise economic growth? Can governments achieve rapid growth or high incomes without investing in health? What are the options and benefits of different analytic approaches to measuring the causal link between health and growth? Have medical advances influenced life expectancy levels? Do health investments lead to higher individual productivity? Why are investment in early childhood development and nutrition important? How do governments invest in improving health status? Why do all governments invest in health care services? Where should governments invest in health to improve the welfare and health status of the population? What are the pitfalls in public health care provision and finance? How can public investments raise health status and household productivity?

The heterogeneity of social structures and cultural identities in many developing countries, together with traditional hierarchies, rivalries, and deep-seated biases, has perpetuated inequities. Inclusive States: Social Policy and Structural Inequalities examines the role of the state and society in addressing structural inequalities and identifies a set of policy recommendations to redress them. This book defines structural inequality as a condition arising from unequal status attributed to a category of people in relation to others, a relationship perpetuated and reinforced by unequal relations in roles, functions, decision rights, and opportunities. Inclusive states are those that direct policies to address the needs of all, that respect the rights of citizens to exercise voice and influence on which services are provided and how they are delivered, and that have an interest in strengthening the social contract with their citizens. A central focus of policy remains a concern for equity, both to level the playing field to encourage social mobility and to ensure equity in the distributional effects of policy reforms and development interventions.