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Healthcare Access and Quality Index based on mortality from causes amenable to personal health care in 195 countries and territories, 1990–2015: a novel analysis from the Global Burden of Disease Study 2015
2017
National levels of personal health-care access and quality can be approximated by measuring mortality rates from causes that should not be fatal in the presence of effective medical care (ie, amenable mortality). Previous analyses of mortality amenable to health care only focused on high-income countries and faced several methodological challenges. In the present analysis, we use the highly standardised cause of death and risk factor estimates generated through the Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) to improve and expand the quantification of personal health-care access and quality for 195 countries and territories from 1990 to 2015.
We mapped the most widely used list of causes amenable to personal health care developed by Nolte and McKee to 32 GBD causes. We accounted for variations in cause of death certification and misclassifications through the extensive data standardisation processes and redistribution algorithms developed for GBD. To isolate the effects of personal health-care access and quality, we risk-standardised cause-specific mortality rates for each geography-year by removing the joint effects of local environmental and behavioural risks, and adding back the global levels of risk exposure as estimated for GBD 2015. We employed principal component analysis to create a single, interpretable summary measure–the Healthcare Quality and Access (HAQ) Index–on a scale of 0 to 100. The HAQ Index showed strong convergence validity as compared with other health-system indicators, including health expenditure per capita (r=0·88), an index of 11 universal health coverage interventions (r=0·83), and human resources for health per 1000 (r=0·77). We used free disposal hull analysis with bootstrapping to produce a frontier based on the relationship between the HAQ Index and the Socio-demographic Index (SDI), a measure of overall development consisting of income per capita, average years of education, and total fertility rates. This frontier allowed us to better quantify the maximum levels of personal health-care access and quality achieved across the development spectrum, and pinpoint geographies where gaps between observed and potential levels have narrowed or widened over time.
Between 1990 and 2015, nearly all countries and territories saw their HAQ Index values improve; nonetheless, the difference between the highest and lowest observed HAQ Index was larger in 2015 than in 1990, ranging from 28·6 to 94·6. Of 195 geographies, 167 had statistically significant increases in HAQ Index levels since 1990, with South Korea, Turkey, Peru, China, and the Maldives recording among the largest gains by 2015. Performance on the HAQ Index and individual causes showed distinct patterns by region and level of development, yet substantial heterogeneities emerged for several causes, including cancers in highest-SDI countries; chronic kidney disease, diabetes, diarrhoeal diseases, and lower respiratory infections among middle-SDI countries; and measles and tetanus among lowest-SDI countries. While the global HAQ Index average rose from 40·7 (95% uncertainty interval, 39·0–42·8) in 1990 to 53·7 (52·2–55·4) in 2015, far less progress occurred in narrowing the gap between observed HAQ Index values and maximum levels achieved; at the global level, the difference between the observed and frontier HAQ Index only decreased from 21·2 in 1990 to 20·1 in 2015. If every country and territory had achieved the highest observed HAQ Index by their corresponding level of SDI, the global average would have been 73·8 in 2015. Several countries, particularly in eastern and western sub-Saharan Africa, reached HAQ Index values similar to or beyond their development levels, whereas others, namely in southern sub-Saharan Africa, the Middle East, and south Asia, lagged behind what geographies of similar development attained between 1990 and 2015.
This novel extension of the GBD Study shows the untapped potential for personal health-care access and quality improvement across the development spectrum. Amid substantive advances in personal health care at the national level, heterogeneous patterns for individual causes in given countries or territories suggest that few places have consistently achieved optimal health-care access and quality across health-system functions and therapeutic areas. This is especially evident in middle-SDI countries, many of which have recently undergone or are currently experiencing epidemiological transitions. The HAQ Index, if paired with other measures of health-system characteristics such as intervention coverage, could provide a robust avenue for tracking progress on universal health coverage and identifying local priorities for strengthening personal health-care quality and access throughout the world.
Bill & Melinda Gates Foundation.
Journal Article
Bait : the food chain just got flipped
by
Rendall, Kimble film director
,
Mulcahy, Russell, 1953- writer
,
Tonkin, Phoebe, 1989- actor
in
Tsunamis Australia Queensland Drama
,
Tiger shark Australia Queensland Drama
,
Survival Australia Queensland Drama
2000
\"Supermarket shoppers battle man-eating sharks when a tsunami plunges a coastal resort under water, and the perfect predator gets a whole new stalking ground. Queensland, Australia: The weather is perfect, the water is blue, and the vacationers at a luxury resort file into an underground supermarket to stock up for another day in paradise. Just then, an armed madman bursts in with an itchy trigger finger and a desperate gleam in his eye. Little do the frightened hostages realize, he will soon be the least of their worries; the waters around Queensland are rising fast, and before long the store will be completely submerged. When that happens, the aisles will be filled with hungry tiger sharks in search of a fresh meal. Now, in order to avoid becoming the Catch of the Day, the desperate shoppers must band together, and show the sharks who's really at the top of the food chain\"--Allmovie.com, viewed November 20, 2017.
Increased Incidence of Melioidosis in Far North Queensland, Queensland, Australia, 1998–2019
by
Gair, Richard
,
Stewart, James
,
Horne, Peter
in
Australia
,
bacteria
,
Burkholderia pseudomallei
2021
During January 1998-December 2019, the annual incidence of melioidosis in Far North Queensland, Queensland, Australia, more than doubled. Because climate and prevalence of predisposing medical conditions remained stable during that time, we hypothesize that the increased incidence was caused by urban expansion and increased construction, resulting in greater exposure to Burkholderia pseudomallei.
Journal Article
Performing place, practising memories
2012,2022
During the 1970s a wave of 'counter-culture' people moved into rural communities in many parts of Australia. This study focuses in particular on the town of Kuranda in North Queensland and the relationship between the settlers and the local Aboriginal population, concentrating on a number of linked social dramas that portrayed the use of both public and private space. Through their public performances and in their everyday spatial encounters, these people resisted the bureaucratic state but, in the process, they also contributed to the cultivation and propagation of state effects.
Local Hollywood
by
O'Regan, Tom
,
Goldsmith, Ben
,
Ward, Susan
in
Electronic digital computers
,
Microcomputers
,
PERFORMING ARTS
2010,2011
The pioneering story of Australia's own Hollywood. Hollywood films and television programs are watched by a global audience. While many of these productions are still made in southern California, the last twenty years have seen new production centers emerge in the US, Canada and other locations worldwide. Global Hollywood has been made possible by this growing number of Local Hollywoods: locations equipped with the requisite facilities, resources and labor, as well as the political will and tax incentives, to attract and retain high-budget, Hollywood-standard projects. This new book gives an unprecedented insight into how the Gold Coast became the first outpost of Hollywood in Australia. When a combination of forces drove Hollywood studios and producers to work outside California, the Gold Coast's unique blend of government tax support, innovative entrepreneurs and diverse natural settings made it a perfect choice to host Hollywood productions. Local Hollywood makes an essential contribution to the field of film and media studies, as well as giving film buffs a behind-the-scenes tour of the film industry.