New evidence compiled by the World Health Organization and the World Bank shows that the COVID-19 pandemic is likely to halt two decades of global progress towards Universal Health Coverage. The organizations also reveal that more than half a billion people are being pushed or pushed further into extreme poverty because they have to pay for health services out of their own pockets.
The findings are contained in two complementary reports, launched on Universal Health Coverage Day, highlighting the devastating impact of COVID-19 on people’s ability to obtain health care and pay for it.
In 2020, the pandemic disrupted health services and stretched countries’ health systems beyond their limits as they struggled to deal with the impact of COVID-19. As a result, for example, immunization coverage dropped for the first time in ten years, and deaths from TB and malaria increased.
The pandemic also triggered the worst economic crisis since the 1930s, making it increasingly difficult for people to pay for care. Even before the pandemic, half a billion people were being pushed (or pushed still further) into extreme poverty because of payments they made for health care. The organizations expect that that number is now considerably higher.
“There is no time to spare,” said Dr Tedros Adhanom Ghebreyesus, WHO Director-General. “All governments must immediately resume and accelerate efforts to ensure every one of their citizens can access health services without fear of the financial consequences. This means strengthening public spending on health and social support, and increasing their focus on primary health care systems that can provide essential care close to home.”
He added: “Prior to the pandemic, many countries had made progress. But it was not robust enough. This time we must build health systems that are strong enough to withstand shocks, such as the next pandemic and stay on course towards universal health coverage.”
The new WHO/World Bank reports also warn that financial hardship is likely to become more intense as poverty grows, incomes fall, and governments face tighter fiscal constraints.
“Even before the COVID-19 pandemic struck, almost 1 billion people were spending more than 10 per cent of their household budget on health,” said Juan Pablo Uribe, Global Director for Health, Nutrition and Population, World Bank. “This is not acceptable, especially since the poorest people are hit hardest. Within a constrained fiscal space, governments will have to make tough choices to protect and increase health budgets,” he added.
In the first two decades of this century, many governments had made progress on service coverage. In 2019, prior to the pandemic, 68 per cent of the world’s population was covered by essential health services, such as pre-and post-natal care and reproductive health services; immunization services; treatment for diseases like HIV, TB and malaria; and services to diagnose and treat noncommunicable diseases like cancer, heart conditions, and diabetes.
But they had not made such advances in ensuring affordability. As a result, the poorest groups and those living in rural areas are the least able to obtain health services, and the least likely to be able to cope with the consequences of paying for them. Up to 90 percent of all households incurring impoverishing out-of-pocket health spending are already at or below the poverty line – underscoring the need to exempt poor people from out-of-pocket health spending, backing such measures with health financing policies that enable good intentions to be realized in practice.
Besides the prioritizing of services for poor and vulnerable populations, supported through targeted public spending and policies that protect individuals from financial hardship, it will also be crucial to improve the collection, timeliness and disaggregation of data on access, service coverage, out-of-pocket health spending and total expenditure. Only when countries have an accurate picture of the way that their health system is performing, can they effectively target action to improve the way it meets the needs of all people.
Together, these two new reports offer both a warning and guideposts to all countries as they strive to build back better from COVID-19 and keep their populations safe, healthy, and financially secure.
High blood pressure? A heart app prescribes musical therapy
By ANTHONY KING
The opening of a Beethoven symphony thrills the heart – but not just figuratively. While music touches us emotionally, it stimulates the heart physically and can lower blood pressure.
More than one in five people aged 15 years and over in the EU have reported having high blood pressure, which can lead to failure in the heart, kidneys or brain. Lowering blood pressure even slightly can reduce the risks of cardiovascular disease.
From the Science and Technology of Music and Sound Laboratory in Paris to King’s College London, Professor Elaine Chew is developing an app for smartphones to boost heart health as part of an EU-funded project called HEART.FM.
‘We’re creating an app that will monitor people’s response as they listen to music and then tailor that music to benefit them,’ said Chew, a professor of engineering at King’s who collaborates with St Bartholomew’s Hospital in London.
The app uses measurements of the person’s heart and artificial intelligence algorithms to create a listening regimen that regulates blood pressure.
While HEART.FM stands to help people today, another EU-funded project called GOING VIRAL looks back at how public perceptions and uses of music in Europe have evolved through the course of disease outbreaks over the past four centuries.
In the 17th century, music was believed by many people in Europe to have the power to stop or even prevent an outbreak of the plague, according to Professor Marie Louise Herzfeld-Schild, who leads GOING VIRAL and is a musicologist at the University of Music and Performing Arts Vienna.
The two projects show how popular views of music have changed since the days of Handel, and the heightened power of music when combined with modern technology.
Chew has a personal connection to the project. She had suffered from an irregular heartbeat, which was successfully treated. The experience made Chew conscious of her own and others’ heart health.
‘Medicine made it possible for me to have a much better quality of life and it led me to rethink the purpose of what it is I do,’ she said.
A professional-level piano player herself, Chew has since 2018 studied how people’s hearts respond to music, starting with patients who have pacemakers.
A pacemaker is used to treat some abnormal rhythms – called arrhythmias – that can cause the heart to beat too slowly, too fast or irregularly. The pacemaker enables a patient’s heart to beat regularly by sending electrical pulses to it.
Chew and colleagues at St Bartholomew’s Hospital discovered some good news: the recovery time between beats of the hearts of people with pacemakers could be modulated by music. In general, quicker recovery times signal stress, while longer ones indicate relaxation or calm.
Chew is drawing on the findings of her work involving pacemaker patients to develop the HEART.FM app for a much broader group of people.
‘People enjoy music as a pleasurable pastime – the difference here is that we are monitoring how the body responds,’ she said.
HEART.FM’s goal is to fingerprint the cardiovascular responses of people listening to music. Chew often hooks up students to the testing device and then sends them data from the app so they can see their own physiological response to music.
The app in development would be downloaded onto a smartphone by users to track their heart’s rhythmical responses to music and to guide them on a therapeutic path to lower blood pressure. The plan is to make the app globally available for download from app stores.
Under GOING VIRAL, funded by the European Research Council, Herzfeld-Schild is interested in how Europeans of bygone eras felt about music.
Her project is investigating and comparing the emotional experiences that people had from music during three epochs of disease outbreaks in Vienna: plague in 1679 and 1713, cholera in 1831 and flu in 1918-19.
Herzfeld-Schild believes that emotional experiences differ through the periods of history.
‘The way we navigate the world emotionally is bound to our upbringing and what we learned about the world,’ she said. ‘That changes how we feel about music.’
During the plague outbreaks, people in western Europe often blamed the planets and believed music could influence them and, as a result, end or ward off the pestilence.
At the same time, there was also a belief that contaminated items could make you sick. Records exist of people burning instruments or sheet music.
‘Music in that context was dangerous,’ said Herzfeld-Schild. ‘Religion was quite important, so people understand the plague to be a punishment from God.’
Alternatively, they would blame Jews or foreigners from the East, she said.
During the 1700s, perceptions in Europe evolved again to embrace the idea of music as a source of listening bliss.
‘The idea of a universal kind of “true” music and that music is good for everyone begins in the 18th century,’ said Herzfeld-Schild. ‘Also, in the late 18th century, there arises this idea of music as a kind of religious experience, like a revelation, or escape from this bleak life.’
By the time of the cholera outbreak in the 19th century, medical practices and popular attitudes to music had shifted. Once people realised that this disease had its origins in dirty water, charity balls were run in Vienna for cholera victims and even featured new music from the composer Johann Strauss.
The final outbreak that Herzfeld-Schild will investigate is the so-called Spanish flu, which started in 1918. It came when some people could buy early versions of gramophones and listen to music in their own homes.
This was a tumultuous time for Austria because the first flu outbreak coincided with the end of the First World War, collapse of the monarchy and disappearance of the Habsburg Empire.
‘There’s really a lack of knowledge about how music was perceived emotionally during these times of diseases,’ said Herzfeld-Schild.
During the Covid-19 pandemic that started in 2020, she noticed that people seemed to assume a shared experience with those who faced disease outbreaks in earlier eras. But this supposition seemed wrong to Herzfeld-Schild based on her study of the history of music, medicine and emotions for more than a decade.
‘From everything I know, right now, the emotional experiences of music during pandemics have been different throughout times and throughout places,’ she said. ‘I’m sure it was very different for people in the past.’
Research in this article was funded via the EU’s European Research Council (ERC). This article was originally published in Horizon, the EU Research and Innovation Magazine.
Pandemic shock must propel stronger health systems in Latin America and the Caribbean
Strengthening health systems in Latin America and the Caribbean in the wake of COVID-19 must be a priority, according to a new World Bank publication entitled “Building Resilient Health Systems in Latin America and the Caribbean: Lessons Learned from the COVID-19 Pandemic”. Investing in cost-effective interventions such as high-performing primary health care and better public health surveillance systems can build resilience against future pandemics. More investments are also needed to address pressures on health care services exacerbated by COVID-19, including mental health services, and to lay the ground for better human development outcomes and economic growth.
“The pandemic has shown that health systems need to be well funded and able to deal with shocks and surges,” said Juan Pablo Uribe, Global Director for Health, Nutrition and Population, World Bank. “Many countries in Latin America and the Caribbean have developed effective, innovative measures, including the expansion of telemedicine and telehealth services, increased the use of data in decision-making and new public-private partnerships that have expanded access to care during pandemic peaks. These innovations can be catalyzed, and propel broader, lasting reforms for better resilience in the health sector”.
Despite improvements in health care over the last 30 years, the Covid-19 pandemic encountered a region that faced many systemic challenges. Most healthcare systems in LAC underperform compared to the average for the Organization for Economic Cooperation and Development (OECD). Healthcare fragmentation is a key source of waste in the region, leading to duplication of tasks, substantially reducing system efficiency, and exacerbating inequalities. On average, health spending, although it grew in recent years, stands at only 25 percent of OECD countries’ expenditure per capita adjusted for purchasing power.
Limited health system capacity also impaired countries’ abilities to deal with shocks and surges in demands, as underinvestment in public health before the pandemic left health systems in LAC severely underprepared. The region has had one of the highest global rates of deaths and excess mortality due to COVID-19, and the pandemic has led to a significant increase of mental health conditions.
The publication was launched during an event organized by the Government of Chile and the World Bank, with the presence of the health and finance ministers of the region, high-level officials, and representatives of international organizations to discuss the challenges faced by health systems in the aftermath of the pandemic. The event culminated in a joint statement about the importance of investing in resilient health systems and mental health to strengthen human capital and the economy in Latin America and the Caribbean.
“For Chile it is very relevant to host this meeting, which is in line with the priorities of President Gabriel Boric’s government in Health, where we are working on three strategic lines for this period: reducing waiting times; Mental Health, which has worsened especially with the pandemic; and moving towards the reform of a Universal Health system that recognizes universal primary care as a central element, with a community approach, of favoring care and access through different mechanisms,” said Chile’s Minister of Health, Ximena Aguilera.
Since the outset of the pandemic, the World Bank has doubled its financial support to the health sector in the region. The World Bank’s Health, Nutrition and Population (HNP) portfolio in LAC totals US$ 3.9bn in commitments (29 operations), of which US$2.3bn (18 operations) are specifically aimed at strengthening the resiliency of health systems in the region. The World Bank is supporting new lending operations in Argentina, Chile, Colombia, the Dominican Republic, and Honduras via planned investments in primary healthcare, telemedicine, and health information and surveillance systems that are expected to contribute to the ability of health systems to effectively respond to future shocks including those related to climate change.
Baby foods take centre stage in push for more safety and quality
By DANIELA DE LORENZO
If we are what we eat, as the saying goes, food quality is key to our health. And as food production and trade increase in response to greater global demand, controls on safety and quality have become even more vital.
The impact of diet on health is hard to overstate. Obesity worldwide has almost tripled since 1975 and, in Europe, affects almost 60% of adults and nearly one in three children. Diabetes is also on the rise and Europe has a markedly high number of children with type 1 – 295 000 in 2021.
Eating a varied and healthy diet can enhance overall well-being and reduce the risk of long-term illness. In addition, consumers are demanding greater food-chain transparency following food-fraud incidents such as the contamination of infant milk formula with melamine in 2008, the discovery of fipronil in eggs in 2017 and sporadic outbreaks of salmonella.
‘Food safety systems in Europe are generally effective, but we believe that it is possible to further improve the safety and quality levels,’ said Dr Erwan Engel, research director at the French National Institute for Agriculture, Food and Environment (INRAE).
Engel coordinates the EU-funded SAFFI project that brings together major research organisations and infant-food producers from Europe and China. With babies, children and young people being more vulnerable and needing high-quality nutrition to grow, the project is investigating ways to ensure greater safety in production.
Other than breast milk, infant formulas and baby foods are the most important part of a child’s diet in the first year of life. Preventing microbial or chemical contamination in the processing chain is a priority.
60 million mouths
SAFFI is addressing food for the EU’s 15 million and China’s 45 million children under the age of three. The partners are focusing on four popular infant-food lines: formula, sterilised mixed vegetables with meat or fish, infant cereals and fruit purees.
The project has carried out tests on the premises of five participating international infant-food companies – Netherlands-based FrieslandCampina, HiPP in Germany, Greek producer YIOTIS and two Chinese companies, Beingmate and YFFC.
The aim is to identify the main risks from both microbial hazards, including bacteria, and potential chemical contaminants in the food chain.
Chemical contaminants include environmental pollutants such as dioxins or lead, crop-treatment residues like pesticides and substances generated during processing including furan.
‘We need to convince the industry that it is important to focus on chemicals too,’ said Engel. ‘Although the effects on health are not as immediate as for microbes, they can still be significant in the longer term.’
SAFFI also aims to help food producers and authorities predict where potential problems could arise and, as a result, reduce the threat of contamination at every stage of production.
Classical processes based on thermal treatments, for instance, could be replaced with pulse combustion dryers, radio frequency heating and high-pressure processing, which are better at sterilising foods while maintaining the optimal nutritional value of fresh products.
‘We check the effectiveness of these innovative processing technologies to control the growth, inhibition and inactivation of pathogens, as well as their ability to slow food degradation and limit the integration of certain chemicals,’ said Engel.
The food and drinks sector, which includes foods for infants, is a major contributor to the EU economy with exports of €110 billion in 2019. By investing in training and sharing know-how, SAFFI will help to improve safety standards in the EU and China and reduce potential barriers to trade.
It will cooperate with other research projects under the EU-China Food, Agriculture and Biotechnology (FAB) Flagship Initiative, with all seeking continued improvement in food safety control.
Such cooperation can increase EU-China commerce and give European food companies greater opportunities to expand on the international market. In addition, the standards laid down by SAFFI in the infant-food sector could be extended to other food categories, according to Engel.
When it comes to health, food variety and quality also count. A balanced diet can help prevent illnesses from arising in the first place. It can also enable people with serious diseases to heal and have more stable lives.
However, people respond differently to the same foods or nutrients, depending on genetic and lifestyle factors. These include stress, exercise levels, individual microbiome composition and exposure to environmental toxins.
The EU-funded NUTRISHIELD project has set out to create personalised diets tailored to individual biomarkers, with a particular focus on children with obesity and/or diabetes and on lactating mothers.
The project is analysing a range of biomarkers related to nutrition and health disorders, taking into account the way each child responds to different nutrients and food types.
NUTRISHIELD involves research and clinical partners from across Europe. The project is coordinated by a Swiss company called Alpes Lasers, which has developed specialised mid-infrared laser technology for use in clinical settings.
‘Unlike current processes used to analyse body fluids, laser technology can work with very small samples of urine – a necessity when little patients can only produce minimal quantities,’ said Miltos Vasileiadis, business developer and project manager at Alpes Lasers.
The company has provided project partners with laser technology used to build analysers for urine, breath and human milk. Samples collected are analysed at a molecular level, allowing nutritionists to give detailed, personalised and easy-to-follow advice.
This may include the amount of each food group an individual needs and how often, how much exercise and sleep are necessary and even which particular variety of fruit or grain is required for proper nutrition.
A study on young diabetes patients is running at the San Raffaele Hospital in Milan, Italy, while the Health Research Institute Hospital La Fe in Valencia, Spain is working with lactating mothers and newborns. Studies conducted at Radboud University in the Netherlands aim to understand how nutrition can assist and enhance cognitive development in children.
The tools developed by NUTRISHIELD are designed to be portable and easy to use, making biomarker analysis faster and more cost-effective. In the longer term, these could be used in different medical settings to assist patients of any age.
The EU’s FOOD 2030 research and innovation policy aims to transform food systems and ensure everyone has enough affordable, nutritious and safe food to live a healthy life.
The initiative covers the entire food system, linking primary production sectors (such as agriculture and fisheries) to food processing, retail and distribution, packaging, waste and recycling, catering services and consumption.
Research in this article was funded by the EU. This article was originally published in Horizon, the EU Research and Innovation Magazine.
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