Numbers surround us every day, from the code used to communicate between mobile phones to the number of plates needed for lunch. It is easy to forget exactly how important these numbers really can be, especially when removed from the actual people or functions they represent. This year, I have been working as a Monitoring and Evaluation Officer for the Uganda Village Project, a NGO based out of the rural district of Iganga, Uganda. Throughout my year, I have seen numbers: HIV testing numbers, malaria bed net distribution numbers, family planning outreach numbers, obstetric fistula repair surgery numbers, among thousands more. In the daily deluge of information, I must constantly remind myself that these numbers, though aggregated for analysis, represent actual people and lifesaving situations. The 15 participants who received the Depo shot at the last outreach in Namunkesu represent 15 women who are planning their families for a brighter future for themselves and their own. The 150 participants who received HIV test results mean that there are 150 villagers in Bukaigo that can receive ART treatment if necessary, and sleep easier that night knowing their status. The people of these villages are the true representation of the numbers, but unfortunately the human story is too often divorced from them after collection in order to do mega-analyses and aggregation.

This past month I had the incredible opportunity to help lead an impact evaluation research project of the villages where UVP does their work. Currently they have worked in 24 villages out of a list of 70. Julius (my co-fellow) and I were tasked to collect data from 15 households in each village to see if the intervention villages differ from the non-intervention villages. It was a busy six weeks; we both were responsible for supervising a team of enumerators and worked Monday through Saturday 10 hours a day. All of the data collection happened in dry season, meaning better roads but also constant 95-degree temperatures (35 degrees Celsius). Despite the challenges, the collection went well and gave both Julius and I a chance to interact with the "numbers" we had been working with all year. Reading on a computer screen that a family has four children and the mother is using family planning is no substitute to seeing the pride and joy shining from her face when talking about her family's health and wellbeing. During our 36 days of data collection, I was able to see the numbers come alive, and it left me with a profound gratitude for the life-changing work my organization is doing. Not all numbers tell a happy story, sadly, and directly viewing the challenges also has left a deep impact on me, and an insatiable desire to do more.

The Iganga District is very rural and one of the poorest for the amount of access to health the populous should have; the main artery road from Nairobi to Kampala almost bisects the district. This has traditionally resulted in greater government investment, but also in a host of problems brought in by transportation workers and other migrants. With a large government hospital already in place in Iganga, and a private one being built, there is no reason that any women should give birth without an attendant, or for any life-threatening health situation to go untreated. We found lack of access to be the case time after time and were able to see firsthand the pain of sick family members or lost loved ones. This is unacceptable to me, and shows just how far we still have to go for health equity in rural locations around the world. Health should not be something that can only be accessed by those who have the means to pay for treatment, but should rather be shared by everyone, especially those in fragile economic situations.

How de we solve these issues? I am not sure if I have the answer for that, but I am confident that programs such as Global Health Corps, Uganda Village Project and their host of other partner organizations are working towards a viable solution. The Iganga District is changing: Overall health is increasing and people are generally more knowledgeable about healthy behaviors than they were 10 or 15 years ago. This change has come slowly though, and many thousands of lives have been negatively affected in the meanwhile. I may not have the solution, but I do have my experiences and skills that I continue to use to promote health equity and justice. The journey for a healthy world is far from over, and I am ecstatic that I am able to do my part to support that important voyage.

Numbers still surround me on a daily basis, but I can take satisfaction in knowing that they are no longer only numbers. I have seen the source of these numbers, and their stories and faces will continue to be present in my daily data use for as long as I work in this field.

source: http://www.huffingtonpost.com/

The World Health Organization (WHO) has admitted serious failings in its handling of the Ebola crisis, its leadership said in a statement seen by Reuters on Sunday.

"We have learned lessons of humility. We have seen that old diseases in new contexts consistently spring new surprises," said the statement, attributed to the WHO Director-General Margaret Chan and the deputy director-general and regional directors.

"We have taken serious note of the criticisms of the Organization that, inter alia, the initial WHO response was slow and insufficient, we were not aggressive in alerting the world ... we did not work effectively in coordination with other partners, there were shortcomings in risk communications and there was confusion of roles and responsibilities...," it said.

source: http://www.israelnationalnews.com/

Women should only give birth by caesarean section if it is medically necessary, the World Health Organisation warns.

The global health body issued guidance on Friday suggesting the "ideal rate" of caesarean births was between 10 per cent and 15 per cent, suggesting unnecessary operations could be "putting women and their babies at risk of short and long-term health problems".

About one in four babies are born each year by caesarean section just in the UK, according to the latest figures, and current National Institute for Health and Clinical Excellence guidelines allow for expectant mothers to choose to have one, irrespective of need.

The WHO cited United Nations-backed studies suggesting there is "no evidence" the death rate decreases when the C-section rate goes beyond 10 per cent of births.

In a statement, it warned "caesarean sections can cause significant complications, disability or death, particularly in settings that lack the facilities to conduct safe surgeries or treat potential complications.

"Across a population, the effects of caesarean section rates on maternal and newborn outcomes such as stillbirths or morbidities like birth asphyxia are still unknown."

More research on the impact of caesarean section on women's psychological and social well-being is still needed.

"Due to their increased cost, high rates of unnecessary caesarean sections can pull resources away from other services in overloaded and weak health systems."

Dr Marleen Temmerman, director of WHO's Department of Reproductive Health and Research, said: "These conclusions highlight the value of caesarean section in saving the lives of mothers and newborns.

"They also illustrate how important it is to ensure a caesarean section is provided to the women in need - and to not just focus on achieving any specific rate.

"We urge the healthcare community and decision-makers to reflect on these conclusions and put them into practice at the earliest opportunity."

source: http://www.smh.com.au/

Electronic health records vendors make the process of sharing patient information too expensive and complicated for hospitals and doctors, a problem that affects THE QUALITY and cost of care.

That's the conclusion reached by the Office of the National Coordinator for Health Information Technology (ONC), the U.S. government agency that oversees the country's health IT efforts.

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Health IT vendors slammed for hampering the exchange of patient data
Electronic health records vendors make the process of sharing patient information too expensive and
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In a report released Friday, the ONC outlined challenges that health care providers face as they attempt to exchange patient data.

Among the issues identified: Health IT vendors charge high fees to set up interfaces for hospitals and labs to share patient data. They also force customers to use proprietary technology and refuse to publish APIs (application programming interfaces).

Sharing health data electronically is essential if technology is going to be used to deliver better and more affordable care, the ONC said in a blog post. "Information blocking" by IT vendors hinders this process, the ONC said. The agency didn't call out specific companies.

It's unclear how widespread this problem is, the ONC said. It's difficult to get a more accurate assessment of the problem because vendors contractually forbid customers from discussing topics related to costs and restrictions.

Still, from the information that the ONC has collected, "it is readily apparent that some providers and developers are engaging in information blocking."

Last year the ONC received 60 complaints about information blocking and reviewed anecdotal evidence from news reports and public testimony. The ONC also conducted interviews with health care providers, IT vendors and other stakeholders.

"We are becoming increasingly concerned about these practices, which devalue taxpayer INVESTMENTS in health IT and are fundamentally incompatible with efforts to transform the nation's health system," the ONC post said, adding that data blocking may become more pervasive as technology plays a greater role in health care.

Health care providers were also taken to task for not sharing patient data with each other. Hospitals may block information in an effort "to control referrals and enhance their market dominance," the ONC said.

Some hospitals cite privacy and security regulations to explain why they can't share information "in circumstances in which they do not in fact impose restrictions," the ONC said.

The ONC heard about cases where health care organizations and vendors allegedly joined forces to complicate the sharing of information with third-party care providers.

Congress requested the report last December over fears that health IT vendors were profiting from keeping data locked up. The U.S. government has offered financial incentives for care providers to store patient medical information in EHRs instead of using paper files.

Resolving the problem of health information blocking may involve a multi-pronged approach, including new federal legislation, requiring more vendor transparency about software costs and restrictions, assisting law enforcement investigations of information blocking and encouraging interoperability and data sharing via incentives.

source: http://www.computerworld.com/

On April 7, World Health Day, India's Prime Minister Narendra Modi tweeted "Govt is working tirelessly to realise the dream of a Healthy India where every citizen has access to proper & affordable healthcare."

To back up that claim, India started its first national air quality index on Monday, belatedly following a World Health Organization (WHO) report last May that found 13 of the world's 20 most air-polluted cities are in India. Of the 1,600 cities studied, the Indian capital New Delhi had the world's dirtiest air with an annual average of 153 micrograms of small particulates (PM2.5) per cubic meter. According to the WHO, a shocking 627,000 Indians die each year due to pollution. The new index will initially cover ten cities and will subsequently be extended to 60. There are already around 247 Indian cities that have some air-quality monitoring mechanisms in place, including at least 16 with online real-time monitoring capabilities, but the "voluminous data" is often hard for people to understand. Government officials say the new index will track eight pollutants and then provide one consolidated number with color-coded associated health impacts, which will all be displayed online. The public can then see whether it would be safer to stay indoors or to refrain from strenuous activity outdoors, notes the BBC. But aside from issuing new rules on the disposal of waste from construction work (a major source of air pollution), the government has not done much to actually reduce air pollution.

More promising is Indradhanush, a massive immunization campaign aimed at inoculating 90% of the country's children against seven preventable diseases by 2020. It began on Tuesday and will run through July. Health officials said the campaign would focus on diseases for which vaccines are available, including diphtheria, whooping cough, tetanus, measles, hepatitis B, and Japanese encephalitis. The Indian government provides free immunizations through its national public health system, yet overall vaccination rates in the country remain frustratingly low. Only 44% of children aged 1 to 2 years have received basic inoculations, with significantly less in rural districts, according to a National Family Health survey. And while India has made enormous strides in the past few decades in reducing mortality from these diseases, there is still far more work to be done.

Another sector in which India lags behind is food safety – the theme of this year's World Health Day. The WHO has calculated that nearly 700,000 people die each year in South Asian countries alone from contaminated food and water. Toxic pesticides and antibiotics are the norm rather than the exception in food. The Centre for Science and Environment (CSE) said on Tuesday that pesticide use and management in India is largely unregulated, and food contaminated with pesticide residues is freely used by unsuspecting consumers. "Pesticides are linked to long-term health effects such as endocrine disruption, birth defects and cancer. Besides raw agriculture produce, pesticides have been found in packaged food products such as soft drinks, bottled water and in human tissues in India," CSE noted. And while street food's microbiological contamination is a concern, just as troubling is its most common replacement — processed and packaged food full of chemical additives whose long-term risks are unknown, as well as sky-high levels of salt, sugar, and fat.

Modi's "Make in India" campaign needs to be joined by a "Make India Healthy" campaign.

source: http://blogs.blouinnews.com/

World Health Day is April 7, and people around the globe are turning their attention to health issues. The global infant mortality rate of 33.6 deaths per 1,000 live births in 2013 has followed a long-term downward trend. Similarly, life expectancy has improved dramatically in recent decades. The improvements were uneven, however, and health conditions continue to vary widely between nations.

In order to assess the overall state of a country's health, 24/7 Wall St. reviewed a host of factors broadly categorized as health indicators, access measures, or the economy. The healthiest country, Qatar, led the countries reviewed with the highest overall score, while the least healthy country, Sudan, received the lowest score. These are the most and least healthy countries worldwide.

Negative health outcomes were far less common in the healthiest countries than in the least healthy ones. Chief among them, life expectancy, tended to be far higher in the nations with the strongest overall health measures. Life expectancy at birth in all of the healthiest countries exceeded the global expectancy of approximately 70 years. A child born in Iceland is expected to live longer than 80 years, the highest life expectancy in the world.

According to Gaetan Lafortune, senior economist at the OECD Health Division, life expectancy is perhaps the best way to measure the health of a nation. However, a range of indicators is necessary to capture the complex picture of a national population's health. Similarly, no single measure can explain a health outcome like life expectancy. Rather, only a wide range of behaviors, infrastructure characteristics, and economic factors can explain the strong or weak health outcomes in a nation.

For example, seven of the healthiest nations reported less than 10 incidents of tuberculosis per 100,000 people in 2013, a fraction of the global rate of 126 incidents of tuberculosis per 100,000 people. While lung diseases and other poor health outcomes were far less common in these nations, risk factors such as smoking were not necessarily less prevalent. The residents of the healthiest nations were actually more likely than most nations reviewed to report a smoking habit.

The quality of a nation's infrastructure and health system are closely related to a low prevalence of disease. Doctors were far more available in the healthiest countries than in the least healthy ones, for example. The prevalence of physicians in seven of the healthiest countries was at least double the global ratio of 1.52 physicians per 1,000 people. In all of the least healthy countries, on the other hand, there was less than one doctor per 1,000 people.

The quality of infrastructure is also very important for the health of a country's residents. "Access to clean water in particular is absolutely crucial to avoid all sorts of diseases that lead to death for children and adults," Lafortune said. In all of the healthiest countries, drinking water is treated before it reaches residents' homes In half of the least healthy countries, less than half of the drinking water consumed in rural areas was treated.

Health care spending and the availability of resources are also major determining factors of nationwide health. As Lafortune noted, "It is not too good for your health to be poor." Poor people — in any country — will be in worse health and live shorter lives than rich people.

All of the healthiest nations spent more than $2,000 per capita on health annually, versus the global expenditure of just over $1,000 per capita. With only one exception — Equatorial Guinea — the least healthy nations spent far less than the global figure. In fact, health care expenditures in seven of the least healthy countries was less than $100 per capita.

Of course, high spending does not guarantee strong health outcomes. Annual health spending in the United States totalled $8,895 per capita, more than the spending of all but two other countries reviewed. Yet, the health of U.S. residents was rated worse than 33 other nations.

As Lafortune explained, the return from health spending is far higher in countries already spending very little. For example, immunization rates — which were as low as 25% in the Central African Republic for measles — can be increased dramatically with little resources. "As spending goes up, what becomes more important is the efficiency of the spending," Lafortune said.

In many of the least healthy countries, living conditions are so poor that "unhealthy" may actually be an understatement. Recent regional violent conflicts may account for a country's exceptionally low life expectancy much more than other unhealthy behaviors, for example. Four of the least healthy countries — Mozambique, Guinea-Bissau, Yemen, and Sudan — have all been through at least one civil war since 1990. Haiti, while not exactly war torn, is still recovering from a devastating earthquake in 2010 as well as a cholera epidemic that emerged in the aftermath of the natural disaster.

These are the most healthy countries in the world.

10. Australia

> Life expectancy: 79.9 (5th highest)
> Infant mortality rate (per 1,000 live births): 3.4 (21st lowest)
> Health expenditure per capita: $6,140 (6th highest)
> Unemployment rate: 5.7% (58th lowest)

Based on an assessment of healthy behaviors and outcomes, access to health services, and various economic factors, Australia is the 10th healthiest country in the world. The country's strong national health care system compared to most countries largely explains its ranking. There were about 3.3 physicians per 1,000 Australians in 2011, the 26th highest such ratio out of the 174 nations reviewed, and well more than twice the global prevalence of just over 1.5 physicians per 1,000 people. In addition, annual health spending totalled $6,140 per capita, sixth highest of all countries reviewed and nearly six times the global expenditure of $1,030 per capita. Partly as a result, country residents had among the world's longest life expectancies at nearly 80 years in 2012. However, Australia also had a relatively high obesity rate, at 28.6%, and a relatively high alcohol consumption rate.

9. Sweden

> Life expectancy: 79.9 (5th highest)
> Infant mortality rate (per 1,000 live births): 2.4 (8th lowest)
> Health expenditure per capita: $5,319 (10th highest)
> Unemployment rate: 8.1% (62nd highest)

Like in most of the healthiest countries, Sweden has universal health coverage, with patient fees covering only a very small percentage of health costs. The country's annual health expenditures totalled $5,319 per capita, the 10th highest spending worldwide. The high health care spending and strong coverage have resulted in good health outcomes compared to most countries. There were just two infant mortalities per 1,000 live births and four maternal deaths per 100,000 live births in Sweden, both nearly the lowest such rates worldwide. Swedes also live longer than most people, with a life expectancy at birth of roughly 80 years. Compared to other healthy countries, however, Sweden's 2013 unemployment rate of 8.1% was relatively high.

8. Singapore

> Life expectancy: 79.9 (5th highest)
> Infant mortality rate (per 1,000 live births): 2.2 (5th lowest)
> Health expenditure per capita: $2,426 (22nd highest)
> Unemployment rate: 2.8% (13th lowest)

The small island nation of Singapore has a remarkably strong economy. Less than 3% of Singapore's workforce was unemployed in 2013, one of the lowest unemployment rates worldwide. Also, Singapore's GDP per capita of $55,182 in 2013 was one of the higher economic outputs worldwide. In addition to a strong economy, Singapore fares especially well in health measures. The nation's obesity rate of 6.2% was among the lower rates worldwide, and especially low compared to the healthiest countries. A child born in 2013 was also expected to live roughly 80 years, tied for the fifth highest life expectancy worldwide. While the city-state's health care system is universal, like many other especially healthy countries, it is a unique system. Residents are subject to a forced savings rate, and funds for medical expenses are saved in a Medisave Account. Catastrophic health insurance enrollment is automatic for all residents as well, although people can opt out.

7. Austria

> Life expectancy: 78.4 (20th highest)
> Infant mortality rate (per 1,000 live births): 3.2 (15th lowest)
> Health expenditure per capita: $5,407 (9th highest)
> Unemployment rate: 4.9% (45th lowest)

Health care spending in Austria totalled about $5,400 per capita annually, ninth highest out of all countries reviewed. Like many other healthy countries, the relatively high level of health care expenditure helps increase the number of physicians and quality of health care. There were nearly five doctors per 1,000 Austrians in 2011, the fourth highest ratio globally. As in most of the healthiest nations, the Austrian government controls most functions of the country's health care system. While Austria is one of the healthiest countries, nearly half of adult Austrians reported a smoking habit in 2011, one of the higher smoking rates worldwide.

6. Iceland

> Life expectancy: 81.6 (the highest)
> Infant mortality rate (per 1,000 live births): 1.6 (tied-the lowest)
> Health expenditure per capita: $3,872 (16th highest)
> Unemployment rate: 5.6% (56th lowest)

Iceland, by population, is the smallest of the 10 healthiest countries. Iceland is the sixth healthiest country worldwide partly because it had the highest life expectancy, which at 81.6 years was also a full year longer than Switzerland, the country with the second highest life expectancy. About 18% of adult Iceland women smoked, the 88th highest rate of all countries, while 19% of all adult males smoked, 17th highest of all countries. Iceland also had the lowest infant mortality rate, at just 1.6 deaths per 1,000 live births. Iceland's low infant mortality rate came even though a relatively low 91% of children aged 12 to 23 months received DPT — diphtheria, pertussis (whooping cough), and tetanus — and measles vaccines.

5. Japan

> Life expectancy: 79.9 (4th highest)
> Infant mortality rate (per 1,000 live births): 2.1 (3rd lowest)
> Health expenditure per capita: $4,752 (11th highest)
> Unemployment rate: 4.0% (32nd lowest)

With 127 million people, Japan is the most populous of the 10 healthiest countries in the world. Ironically, it had the highest death rate of the top 10 countries, at 10 per 1,000 people. About one quarter of the nation's population was over 65 last year, a testament to the longevity and health of Japanese people. One factor contributing to the strong overall health rating is Japan's adult obesity rate of 3.3%, which was seventh best in the world and the best out of the 10 healthiest countries. Despite its high ranking, Japan has relatively high smoking rates for both males and females and one of the higher rates of CO2 emissions, at 9.2 metric tons per capita, almost twice the global average of 4.9 metric tons per capita. Japan's tuberculosis rate of 18 per 100,000 people was far below the global rate of 126 per 100,000 people.

4. Luxembourg

> Life expectancy: 79.1 (16th highest)
> Infant mortality rate (per 1,000 live births): 1.6 (tied-the lowest)
> Health expenditure per capita: $7,452 (4th highest)
> Unemployment rate: 5.9% (63rd lowest)

With the fourth highest per capita health care spending, Luxembourg, the only grand duchy in the world also has the fourth best health results, suggesting a link between health spending and outcomes. Luxembourg had the lowest mortality rates for both infants and children under five years old. But like most of the 10 healthiest countries, Luxembourg has a relatively high death rate. Though it is reasonably strong, the country's overall health ranking is likely held back by its residents' relatively high alcohol consumption of 11.9 liters per capita, and relatively high obesity rate of 23.1%.

3. Switzerland

> Life expectancy: 80.6 (2nd highest)
> Infant mortality rate (per 1,000 live births): 3.6 (24th lowest)
> Health expenditure per capita: $8,980 (2nd highest)
> Unemployment rate: 4.4% (40th lowest)

With the second highest life expectancy of all nations, Switzerland is the third healthiest country in the world. Switzerland had 3.9 physicians per 1,000 people, the ninth highest ratio of the 172 nations reviewed. The country ranked high overall despite a relatively high death rate of nine deaths per 1,000 people as well as prevalent risk factors. The per capita alcohol consumption in Switzerland of 10.7 liters was almost 73% higher than the global average. Also, an estimated 22% of adult females and 31% of adult males smoked. The incidence of tuberculosis in Switzerland of 6.5 cases per 100,000 people was 16th highest in the world. Despite these habits, Switzerland's population remains very healthy, perhaps due to its health care expenditure. An annual $8,980 per capita was spent on health in the country, the second highest globally.

2. Norway

> Life expectancy: 79.5 (9th highest)
> Infant mortality rate (per 1,000 live births): 2.3 (6th lowest)
> Health expenditure per capita: $9,055 (the highest)
> Unemployment rate: 3.5% (22nd lowest)

Norway spends more on health care per capita than any other country. The country's annual health care spending totalled $9,055, ahead of Switzerland's $8,980 and the United States' $8,895. Norway had a relatively high death rate of 8.4 deaths per 1,000 people, six times that of Qatar. Norway's infant mortality rate, its mortality rate for those under five, and life expectancy rate at birth all ranked within the top 10 of all nations, however. While the country fared relatively poorly on health measures, its economy is very strong, and residents have some of the best access to health professionals and facilities in the world. Norway had the second best access to services, reflecting clean water and that its entire population had access to electricity. There were also nearly four physicians per 1,000 people in the country, one of the highest shares.

1. Qatar

> Life expectancy: 77.6 (28th highest)
> Infant mortality rate (per 1,000 live births): 7.0 (44th lowest)
> Health expenditure per capita: $2,029 (25th highest)
> Unemployment rate: 0.5% (2nd lowest)

While Qatar topped 24/7 Wall St.'s health rankings, it was the only country of the 10 healthiest not to have a national health care system. As the emirate is transitioning to a universal system, however, the health of its population may become even better. Qatar plans to have its entire population covered by the end of this year. With 7.7 physicians per 1,000 people, more than any other country, the country's health system is already very good. Qatar fared very well in health, access, and economic measures, largely on the strength of its relatively low overall death rate of 1.4 deaths per 1,000 people and relatively low maternal mortality rate. The small Middle Eastern country, which is about the size of Connecticut, took steps to protect its citizens from diseases with 99% of children receiving the DPT and measles vaccines. As in several other prosperous and healthy nations, Qatar had the second-highest obesity rate in the world.

Methodology

To determine the most and least healthy countries, 24/7 Wall St. collected data on 21 measures on more than 170 countries. These measures were grouped into three categories: health, access, and economy.

While our index aspires to be comprehensive, many measures are also interrelated. To account for interdependence, our index was created using a geometric mean rather than the traditional arithmetic mean. We then used the geometric mean of each index to calculate a country's overall score. Potential scores ranged from one to 172, with lower values indicating better scores.

One challenge was data availability for all 172 countries. We addressed this challenge in two ways. The data is for the most recent year available but also needed to be no older than 2010. Secondly, data had to be available for at least 75% of countries. In addition, we only considered countries with at least 150,000 people.

The health category captured both outcomes and residents' behaviors in each country. Infant mortality, fertility, maternal mortality, and the incidence of various diseases came from the World Bank. We used the World Bank's life expectancy figure for males as a proxy for life expectancies for all people because it is much more widely available in the countries reviewed. Smoking rates and the percentage of children with certain immunizations also came come the World Bank. Lastly, we considered per capita alcohol consumption and adult obesity rates from the World Health Organization (WHO).

The access category was designed to measure the availability of specific resources that are critical to the health of a nation's people. We looked at the share of a country's population with access to clean water, clean air, and electricity — all data from the World Bank. Additionally, we looked at the concentration of physicians in each country as a proxy for how easily residents can access health care.

Economic conditions also have an impact on health and health outcomes. The economy category included per capita health expenditure by public and private sources, as well as poverty and unemployment rates. All economic data came from the World Bank.

source: http://www.usatoday.com/

The House of Representatives is investigating the performance of the Healthcare and Social Security Agency (BPJS Kesehatan) as the agency has run into financial difficulties as a result of soaring insurance claims.

House Commission IX overseeing health and welfare said that it had set up a working committee that would assess BPJS Kesehatan in order to decide whether it would allow the agency to hike premiums for subscribers. "We will form a working committee on BPJS Kesehatan that will be ready later this month," Commission IX head Dede Yusuf told The Jakarta Post on Thursday.

The commission decided to set up the committee after BPJS Kesehatan asked for House approval for its request to raise the premiums of the National Health Insurance (JKN) program.

Dede said there were measures that the government should take before it increased the premiums.

"We have to evaluate the numbers because when I checked with hospitals, it turns out that most of patients covered by the BPJS are not those subsidized by the government. It means many poor patients are unaware of the program," he said.

Low-income patients, known as Contribution Assistance Recipients (PBI) have a proportion of their premiums paid by the government and together with disabled people, they make up the first category of BPJS Kesehatan participants.

The second group are the Non-PBI participants, consisting of wage-earning workers and their family members, as well as unemployed workers and their family members. They have to pay for their own premiums ranging from Rp 25,500 (US$1.96) per month to get healthcare services in third-class facilities, to Rp 42,500 for second class and Rp 59,500 for first class.

Dede said the House also found irregularities in the data on participants. "Much data doesn't make sense. A small businessman who has two motorcycles is registered as a PBI participant, while those truly in need are not registered," he said.

"So our point is not to totally reject the rise in premiums, but to fix the data first," he added.

Taking the irregularities into account, the House working committee would look at problems with BPJS Kesehatan management and see if it could be fixed without having to resort to hiking premiums.

"With such an audit, hopefully BPJS Kesehatan can save up to 10 percent. I know that because I heard from regional branches of BPJS Kesehatan that they could save more money if they could prevent wasteful spending made by health-service providers and patients themselves," Dede said.

BPJS Kesehatan expects to remain in the red throughout this year, with its claim ratio expected to hover around 100 percent. The claim ratio is the difference between the hospitals' bills for health services provided and the premiums collected by the agency from participants registered in the program.

The agency receives premiums from tax funds to finance low-income people in the scheme, as well as premiums paid by employees and their employers, and those individually registered with the program.

The agency has reported a deficit between claims it has paid and the premiums it has received. In 2014, the deficit stood at Rp 1.54 trillion, with Rp 42.6 trillion paid out in claims and Rp 41.06 trillion received in premium payments.

The agency also suffers from low compliance among premium payers, where they only pay the premiums when they are sick and stop paying once they have recovered.

BPJS Kesehatan finance director Riduan said that the agency could suffer a deficit of Rp 11.71 trillion if it did not raise the premiums it charged to subscribers.

The agency has proposed raising the premiums for PBI participants from Rp 19,225 per month to Rp 27,500 per person per month in 2016.

Some lawmakers in Commission IX flatly rejected the premium rise as they believed it would make it harder for non-PBI participants to pay their premiums.

However, Bambang Purwoko of the National Social Security Board (DJSN), tasked with monitoring the JKN program, said that if Indonesian people could afford to buy cigarettes regularly, then surely they would be able to afford a rise in premiums for something as important as health insurance.

"We have no trouble in buying cigarettes regularly. So it's strange if we complain [about paying health insurance premiums],". he told the Post.

source: http://www.thejakartapost.com

The scientists behind a recent World Health Organization study which concluded the herbicide glyphosate "probably" causes cancer, say they stand behind their assessment. The comments come in response to criticisms from Monsanto Co., who said the study was based on "junk science". The main ingredient in Monsanto's Round Up product is glyphosate. Monsanto executives said they are reviewing their options as they move forward.

Aaron Blair, a scientist emeritus at the National Cancer Institute and lead author of the study, told Reuters,"There was sufficient evidence in animals, limited evidence in humans and strong supporting evidence showing DNA mutations and damaged chromosomes." The WHO's International Agency for Research on Cancer (IARC) published their study of glyphosate on March 20, finding that the popular herbicide may contribute to non-hodgkins lymphoma.

IARC report was published in The Lancet Oncology detailing evaluations of organophosphate pesticides and herbicides. The report concluded that there was "limited evidence of carcinogenicity in humans for non-Hodgkin lymphoma." The evidence for this conclusion was pulled from studies of exposure to the chemical in the US, Canada and Sweden published since 2001.

The researchers found "convincing evidence that glyphosate can also cause cancer in laboratory animals." The report points out that the United States Environmental Protection Agency (US EPA) had originally classified glyphosate as possibly carcinogenic to humans in 1985. The IARC Working Group evaluated the original EPA findings and more recent reports before concluding "there is sufficient evidence of carcinogenicity in experimental animals." Despite the WHO's findings, the EPA approved Monsanto's use of glyphosate as recently as 2013.

The battle around glyphosate is also closely linked to the debate around Genetically Engineered or Modified foods. The herbicide is typically used on GM crops such as corn and soybeans that have been specifically modified to survive the harmful effects of the herbicide. Corporations like Monsanto are heavily invested in the success of the chemical. The herbicide has been found in food, water, and in the air in areas where it has been sprayed.

In 2014 Anti-Media reported on a study published in the International Journal of Environmental Research and Public Health which claims to have found a link between glyphosate and the fatal Chronic Kidney Disease of Unknown origin (CKDu), which largely affects rice farmers in Sri Lanka and other nations. In response Sri Lanka has banned glyphosate and Brazil is considering doing the same.

Sri Lanka's Minister of Special Projects S.M. Chandrasena stated that President Mahinda Rajapaksa issued a directive to ban glyphosate sales in the country. "An investigation carried out by medical specialists and scientists have revealed that kidney disease was mainly caused by glyphosate. President Mahinda Rajapaksa has ordered the immediate removal of glyphosate from the local market soon after he was told of the contents of the report."

The researchers believe glyphosate could be helping carry toxic heavy metals present in certain agri-chemicals to the kidneys. Chronic kidney disease of unknown etiology (CKDu) was first seen in the north central areas of Sri Lanka in the 1990s and has taken an estimated 20,000 lives. Before being pushed by Monsanto for use as herbicide, glyphosate was a de-scaling agent to clean mineral deposits in hot water systems.

Although the paper did not offer new scientific evidence, the researchers proposed a theory for how CKDu is spread. The researchers believe that glyphosate is contributing to a rise of heavy metals in drinking water. Dr. Channa Jayasumana, lead author of the study said, "glyphosate acts as a carrier or a vector of these heavy metals to the kidney." Glyphosate itself is not the toxic agent, however when combined with metals in the ground water the herbicide becomes extremely toxic to the kidneys.

In recent years there has been a spike in CKDu patients in farming areas of El Salvador, Nicaragua, and Costa Rica.

The Minister stated that a new national program would be launched encouraging Sri Lankan farmers to use organic fertilizer. The Ministry of Agriculture is hoping to plant 100,000 acres of land throughout the country using organic methods.

Monsanto spokesman Thomas Helscher stated,"There are no epidemiologic studies suggesting that exposures to glyphosate-based products are associated with renal disorders either in Sri Lanka or elsewhere. The paper presents a theory, the theory has not been tested, and there are a significant number of publications supported by data that make the Jayasumana hypothesis quite unlikely to be correct." Despite promises from Monsanto, the evidence indicating dangers related to glyphosate continue to pile up.

With the USDA's decision late last year to approve a new batch of genetically modified corn and soybean seeds designed to be resistant to glyphosate, we should expect to see an increase in herbicide use overall, and with it, many disastrous health effects. In fact, the approval by the USDA now partners DOW Chemical and Monsanto together, a move which will only further entrench the control that corporate entities have over governments.

source: http://www.globalresearch.ca/