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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
Interactions between the atmosphere, cryosphere, and ecosystems at northern high latitudes
by
Castarède, Dimitri
,
Berninger, Frank
,
Roldin, Pontus
in
1993
,
Aerosol
,
aerosol-climate interactions
2019
The Nordic Centre of Excellence CRAICC (Cryosphere–Atmosphere Interactions in a Changing Arctic Climate), funded by NordForsk in the years 2011–2016, is the largest joint Nordic research and innovation initiative to date, aiming to strengthen research and innovation regarding climate change issues in the Nordic region. CRAICC gathered more than 100 scientists from all Nordic countries in a virtual centre with the objectives of identifying and quantifying the major processes controlling Arctic warming and related feedback mechanisms, outlining strategies to mitigate Arctic warming, and developing Nordic Earth system modelling with a focus on short-lived climate forcers (SLCFs), including natural and anthropogenic aerosols. The outcome of CRAICC is reflected in more than 150 peer-reviewed scientific publications, most of which are in the CRAICC special issue of the journal Atmospheric Chemistry and Physics. This paper presents an overview of the main scientific topics investigated in the centre and provides the reader with a state-of-the-art comprehensive summary of what has been achieved in CRAICC with links to the particular publications for further detail. Faced with a vast amount of scientific discovery, we do not claim to completely summarize the results from CRAICC within this paper, but rather concentrate here on the main results which are related to feedback loops in climate change–cryosphere interactions that affect Arctic amplification.
Journal Article
Bio-based polymers and composites
2005,2011
This book systematically describes the green engineering, chemistry and manufacture of bio-based polymers and composites derived from plants. This book gives a thorough introduction to bio-based material resources, availability, sustainability, bio-based polymer formation, extraction and refining technologies, and the need for integrated research and multi-disciplinary working teams. It provides an in-depth description of adhesives, resins, plastics, and composites derived from plant oils, proteins, starches, and natural fibers in terms of structures, properties, manufacturing, and product performance. This is an excellent book for scientists, engineers, graduate students and industrial researchers in the field of bio-based materials.
A Review of Pumped Hydro Storage Systems
by
Nikolaos, Papadakis C.
,
Marios, Fafalakis
,
Dimitris, Katsaprakakis
in
Alternative energy sources
,
Capital costs
,
Electricity
2023
With the increasing global demand for sustainable energy sources and the intermittent nature of renewable energy generation, effective energy storage systems have become essential for grid stability and reliability. This paper presents a comprehensive review of pumped hydro storage (PHS) systems, a proven and mature technology that has garnered significant interest in recent years. The study covers the fundamental principles, design considerations, and various configurations of PHS systems, including open-loop, closed-loop, and hybrid designs. Furthermore, the review highlights the crucial role of PHS systems in integrating renewable energy sources, mitigating peak load demands, and enhancing grid stability. An in-depth analysis of current and emerging trends, technical challenges, environmental impacts, and cost-effectiveness is also provided to identify potential areas for future research and development. The paper concludes by offering a perspective on the challenges and opportunities that PHS systems present, underlining their potential to significantly contribute to a sustainable and reliable energy future.
Journal Article
Encyclopedia of marine mammals
by
Thewissen, J. G. M
,
Perrin, W. F
,
Würsig, Bernd G
in
Aquatic mammals
,
Encyclopedias
,
Marine mammals
2009,2008
Model Predictive Control (MPC) for Enhancing Building and HVAC System Energy Efficiency: Problem Formulation, Applications and Opportunities
by
Bernardini, Daniele
,
Bemporad, Alberto
,
Serale, Gianluca
in
Algorithms
,
Building automation
,
building management system (BMS)
2018
In the last few years, the application of Model Predictive Control (MPC) for energy management in buildings has received significant attention from the research community. MPC is becoming more and more viable because of the increase in computational power of building automation systems and the availability of a significant amount of monitored building data. MPC has found successful implementation in building thermal regulation, fully exploiting the potential of building thermal mass. Moreover, MPC has been positively applied to active energy storage systems, as well as to the optimal management of on-site renewable energy sources. MPC also opens up several opportunities for enhancing energy efficiency in the operation of Heating Ventilation and Air Conditioning (HVAC) systems because of its ability to consider constraints, prediction of disturbances and multiple conflicting objectives, such as indoor thermal comfort and building energy demand. Despite the application of MPC algorithms in building control has been thoroughly investigated in various works, a unified framework that fully describes and formulates the implementation is still lacking. Firstly, this work introduces a common dictionary and taxonomy that gives a common ground to all the engineering disciplines involved in building design and control. Secondly the main scope of this paper is to define the MPC formulation framework and critically discuss the outcomes of different existing MPC algorithms for building and HVAC system management. The potential benefits of the application of MPC in improving energy efficiency in buildings were highlighted.
Journal Article
Multi-Criteria Decision-Making (MCDM) for the Assessment of Renewable Energy Technologies in a Household: A Review
by
Streimikiene, Dalia
,
Zavadskas, Edmundas Kazimieras
,
Siksnelyte-Butkiene, Indre
in
Alternative energy sources
,
Decision making
,
household
2020
Different power generation technologies have different advantages and disadvantages. However, if compared to traditional energy sources, renewable energy sources provide a possibility to solve the climate change and economic decarbonization issues that are so relevant today. Therefore, the analysis and evaluation of renewable energy technologies has been receiving increasing attention in the politics of different countries and the scientific literature. The household sector consumes almost one third of all energy produced, thus studies on the evaluation of renewable energy production technologies in households are very important. This article reviews the scientific literature that have used multiple-criteria decision-making (MCDM) methods as a key tool to evaluate renewable energy technologies in households. The findings of the conducted research are categorized according to the objectives pursued and the criteria on which the evaluation was based are discussed. The article also provides an overview and in-depth analysis of MCDM methods and distinguishes the main advantages and disadvantages of using them to evaluate technologies in households.
Journal Article