20-Feb-2019: World Health Organization (WHO) releases global health expenditure report
The World Health Organization (WHO), on February 20, 2019, released a new report on global health expenditure, according to which, global spending on health increased in low- and middle-income countries by 6 per cent and in high income countries by 4 per cent. However, worryingly, the report also found that people were still paying too much out of their own pockets.
In low - and middle-income countries, health spending is undergoing a transformation. The reliance of people on public funding has increased. In most regions, reliance on out-of-pocket spending is gradually going down and has also been associated with a reduction in the share of domestic government revenues allocated to health.
While the total amount of aid that middle-income countries receive has increased, aid per capita, has fallen. In 2016, lower- and upper middle-income countries still received close to 57 per cent of global aid, and certain middle-income countries still received large amounts of aid in absolute terms. Therefore, there is an inverse relationship between a country’s income levels and the share of external aid as a health funding source.
The report analyses for the first time, data for a subset of countries not only on the basis of sources of spending but also on how the money was used — on primary health care and by specific disease priority and intervention category.
The roles of external and domestic funding are evolving; however, external funding is declining in middle-income countries. Governments account for less than 40 per cent of primary health care spending. There are huge variations across countries in public spending on primary health care, which is intended to give people access to quality care, including access to medicines, as needed. Governments would be expected to pay for these medicines from domestic sources.
The data indicates that nearly half of donor funds for health and about 20 per cent of public spending on health went to combat HIV/AIDS, malaria and tuberculosis. About one-third of domestic public spending went towards injuries and non-communicable diseases, which received comparatively little external funds.
Public spending on health is essential for achieving the Sustainable Development Goal (SDG) targets for health through sustainably funding common goods and subsidising services to the poorest segments of society. A health system that relies mainly on high levels of government funding, as well as a high share of public sources in overall health spending, generally provides better and more equitable access to services and better financial protection.
Health spending is transitioning globally, with a rapid increase in domestic spending, both out-of-pocket and publicly funded
- Two years into the Sustainable Development Goals era, global spending on health continues to rise. It was US$ 7.8 trillion in 2017, or about 10% of GDP and $1,080 per capita – up from US$ 7.6 trillion in 2016.
- The health sector continues to expand faster than the economy. Between 2000 and 2017, global health spending in real terms grew by 3.9% a year while the economy grew 3.0% a year.
- Middle income countries are rapidly converging towards higher levels of spending. In those countries, health spending rose 6.3% a year between 2000 and 2017 while the economy rose by 5.9% a year. Health spending in low income countries rose 7.8% a year.
- Across low income countries, the average health spending was only US$ 41 a person in 2017, compared with US$ 2,937 in high income countries – a difference of more than 70 times. High income countries account for about 80% of global spending, but the middle income country share increased from 13% to 19% of global spending between 2000 and 2017.
- Public spending represents about 60% of global spending on health and grew at 4.3% a year between 2000 and 2017. This growth has been decelerating in recent years, from 4.9% a year growth in 2000–2010 to 3.4% in 2010–2017.
- Aa the health sector grew, it became less reliant on out-of-pocket spending. Total out of pocket spending more than doubled in low and middle income countries from 2000 to 2017 and increased 46% in high income countries. But it grew more slowly than public spending in all income groups.
- Donor funding represents 0.2 % of health spending globally. It continues to be an important source in low income countries at 27% of health spending and 3% in lower middle income countries.
In countries with fast-growing economies, health spending increased dramatically as they moved up the income ladder
- Between 2000 and 2017, overall health spending dramatically increased in a group of 42 countries that experienced fast economic growth. On average, real health spending per capita grew by 2.2 times and increased by 0.6 percentage points as a share of GDP. For most, the growth of health spending was faster than that of GDP.
- In the 42 fast-growing economies government spending increased by 2 percentage points of GDP on average, yet in a third of the countries, fiscal capacity failed to expand despite economic growth.
- Most fast-growing countries embarked on the health financing transition, increasing their domestic public spending per capita, as a share of public expenditure and as a share of total health spending. In 17 of these countries, however, public spending on health fell as a share of current health spending, even as the economy was growing. Giving priority to health – or not – is clearly a political choice.
- In 2017, total aid to fast-growing countries still represents about 36% of total health aid, close to what low income countries received (40%). The data do not show a specific effect of aid on the health financing transition, with no observable substitution between aid and out of pocket spending.
Health institutions are transitioning from models of social health insurance to functions of health financing
- The number of countries with social health insurance(SHI) has gradually increased since 2000, with the number of WHO Member States implementing it reaching 126 in 2017, up from 113 in 2000.
- The spending flowing through SHI schemes accounted for more than 5% of public spending on health in 97 countries.
- The share of SHI in current health spending varied from 1% to 2% in low income countries, 4.5% to 8.5% in lower middle and 16% to 20% in upper middle income countries.
- The growth of SHI health spending is greater in the 42 fast-economic growth countries, which moved to upper income status between 2000 and 2017. Their average share of current health expenditure flowing through SHI arrangements increased by 6 percentage points, from 11% in 2000 to 17% in 2017.
- About two-thirds of countries with SHI use government budget transfers as a funding source.
- SHI spending has grown, but what that means for progress towards universal health coverage is unclear. At similar levels of GDP and government health spending per capita, countries with SHI arrangements do not seem to have better population coverage with health services.
Primary health care is the route to making the financing transition work for universal health coverage
- Measurement of primary health care (PHC) spending is improving: country-specific data on primary health care spending are now available for 88 countries, up from 50 in 2018; and 45 countries have more than one year of data.
- Across the 88 countries, PHC spending ranges from 33% to 88% of health spending. Per capita spending is higher in wealthier countries, but PHC takes a greater share of health spending in low and middle income countries.
- The priority governments give to PHC varies from 42% in upper middle income countries to 55% in lower middle income countries and 65% in low income countries.
- Yet only a third of total PHC spending comes from governments. The lower the country income, the lower the public share: in low income countries private sources represent half of PHC spending. Across all income groups, governments provide very limited funding for medicines.
- Development assistance funds 20%–40% of PHC spending in low income countries. This is mostly a consequence of funds channeled through categorical programs, with little funding going through integrated services.
11-May-2020: 2020 Global Nutrition Report: Action on equity to end malnutrition
The COVID-19 pandemic has exposed the weakness of food and health systems, disproportionately impacting already vulnerable populations. As inequalities and malnutrition continue to sweep the world, the 2020 Global Nutrition Report stresses that the need to address malnutrition in all its forms by tackling injustices in food and health systems is now more urgent than ever.
India is among 88 countries that are likely to miss global nutrition targets by 2025. It states that India will miss targets for all four nutritional indicators for which there are data available — stunting among under-five children, anaemia among women of reproductive age, childhood overweight and exclusive breastfeeding.
- Between 2000 and 2016, underweight rates have decreased from 66.0% to 58.1% for boys and 54.2% to 50.1% in girls. However, this is still high compared with the average of 35.6% for boys and 31.8% for girls in Asia.
- 37.9% of children under five are stunted and 20.8% are wasted, compared with the Asia average of 22.7% and 9.4% respectively.
- India is identified as among the three worst countries, along with Nigeria and Indonesia, for steep within-country disparities on stunting, where the levels varied four-fold across communities.
- Stunting level in Uttar Pradesh is over 40% and the rate among individuals in the lowest income group is more than double those in the highest income group at 22.0% and 50.7%, respectively.
- In addition, stunting prevalence is 10.1% higher in rural areas compared with urban areas.
- One in two women of reproductive age is anaemic, while at the same time, the rate of overweight and obesity continues to rise, affecting almost a fifth of the adults, at 21.6% of women and 17.8% of men.
Double burden: Most countries in the world must now be equipped to fight both sides of malnutrition at the same time.
Progress is too slow. One in nine people are still hungry or undernourished, while 149 million children under 5 years of age are still affected by stunting globally. Meanwhile, our world has transitioned to one in which more people of all ages are obese than underweight, with one in three people either overweight or obese.
Despite these figures, countries are often unprepared to face the global nutrition crisis. Strong government coordination on nutrition is often lacking; lower income countries tend to deprioritize overweight, obesity and diet-related chronic diseases.
Financial commitments also don’t match the scale and nature of the issue: increases in domestic resources for nutrition have been marginal at best, and obesity and overweight have been largely ignored in aid allocations.
Gerda Verburg, UN Assistant Secretary General, Scaling Up Nutrition Movement Coordinator and member of the GNR’s stakeholder group, said: “2020 must represent a turning point for nutrition. As we look to reinforce our resilience to global stresses, nutrition must become a key component of any emergency or long-term response. Investing in nutrition, renewing and expanding commitments, and strengthening accountability has now become urgent if we want to prepare our systems for future shocks, and avoid a reversal of gain.”
New perspective: redirecting resources to communities and people most affected is the right and the smartest thing to do.
Global and national patterns hide significant inequalities within countries and populations, with vulnerable groups being the most affected. The Report found clear links between levels of malnutrition and population characteristics like location, age, sex, education and wealth, while conflict and other forms of fragility compound the problem.
Differences across communities and at the sub-national level are striking: wasting in children under 5 years of age can be up to nine times higher between communities within countries, four times for stunting, and three times for overweight and obesity.
If no action is taken, the effects of the pandemic will only make it harder for vulnerable populations to protect themselves against malnutrition. Malnutrition affects our immune system, leaving us more susceptible to infection, and the socio-economic impact of the pandemic could in turn drive malnutrition globally.
Gaps in food systems: Poor diets are not simply a matter of personal food choices.
The Report calls for a change in food systems. According to the Report, existing agriculture systems still focus on staple grains like rice, wheat and maize, rather than producing a broader range of more diverse and healthier foods, such as fruits, nuts and vegetables.
Fresh or perishable foods are less accessible and affordable in many parts of the world compared to staple grains. In Burkina Faso, egg calories are 15 times more expensive than calories from staples, whereas they are 1.9 times more expensive in the United States.
Processed foods, especially ultra-processed food, are available, cheap and intensively marketed, with sales high and growing fast in many parts of the world. In sub-Saharan Africa, the growth of supermarket chains is diminishing the role of informal traders and has affected people’s food choices. These changes demand policy and planning resources to promote desirable nutrition outcomes.
Solutions have started to emerge across the world and are being implemented by a fast-growing number of countries such as India, Nigeria, Peru and Thailand, among others. These include: increased public investment for healthier food products, support for shorter supply chains for fresh-food delivery programmes, use of fiscal instruments such as taxes on sugar-sweetened beverages (now in 73 countries), limiting advertising of junk food, and food reformulation, or the use of front-of-pack labelling (FOPL) to inform consumers and influence industry behaviour adopted by Chile and the UK. However, much more remains to be done.
Venkatesh Mannar, Co-Chair of the Report and Special Adviser on Nutrition to the Tata Cornell Agriculture & Nutrition Initiative, said: “At a time when COVID-19 has further revealed the gaps in our food systems, we now have a unique opportunity to act in coordination to address them and ensure that healthy and sustainably produced food is the most accessible, affordable and desirable choice for all.”
Universal Health Coverage: an opportunity to make nutrition care universally available as a basic, live-saving and cost-effective health service.
Malnutrition in all its forms has become the leading cause of poor health and death, and the rapid rise of diet-related chronic diseases is putting an immense strain on health systems. But despite this assessment, nutrition actions only represent a minuscule portion of national health budgets although they can be highly cost-effective or even cost-saving solutions. The recent Transformation of Aspirational Districts initiative in India is one example of successful integration and delivery of equitable nutrition services as part a broader healthcare transformation effort.
In most countries, health checks do not cover diet quality and national surveys rarely comprehensively assess diets and the nutritional status of populations. The distribution of trained nutrition professionals is inequitable, and these experts are not widely accessible. Globally, the median number of nutrition professionals stands at 2.3 per 100,000 people, 0.9 per 100,000 people in Africa, and some countries have none.
Renata Micha, Co-Chair of the Report and Research Associate Professor at the Friedman School of Nutrition Science and Policy at Tufts University, said: “Good nutrition is an essential defence strategy to protect populations against epidemics, relieve the burden on our health systems and ultimately save lives. The findings of the 2020 Global Nutrition Report make clear that tackling malnutrition should be at the centre of our global health response.”
About: The Global Nutrition Report (GNR) is the world’s leading independent assessment of the state of global nutrition. We provide the best available data, in-depth analysis and expert opinion rooted in evidence to help drive action on nutrition where it is urgently needed.
A multi-stakeholder initiative comprised of global institutions, the GNR is led by experts in the field of nutrition. The GNR was established in 2014 following the first Nutrition for Growth summit, as an accountability mechanism to track progress against global nutrition targets and the commitments made to reach them.
Through a comprehensive report, interactive Country Nutrition Profiles and Nutrition for Growth Commitment Tracking, the GNR sheds light on the burden of malnutrition and highlights progress and working solutions to tackle malnutrition around the world.
In 2012, the World Health Assembly identified six nutrition targets for maternal, infant and young child nutrition to be met by 2025. These require governments to:
- Reduce stunting by 40% in children under five
- Reduce prevalence of anaemia by 50% among women in the age group of 19-49
- Ensure 30% reduction in low-birth weight
- Ensure no increase in childhood overweight
- Increase the rate of exclusive breastfeeding in the first six months up to at least 50%
- Reduce and maintain childhood wasting to less than 5%.
The Global Nutrition Report was conceived following the first Nutrition for Growth Initiative Summit (N4G) in 2013. The first report was published in 2014. This report is produced by the Independent Expert Group of the Global Nutrition Report, supported by the Global Nutrition Report Stakeholder Group.
The Report acts as a report card on the world’s nutrition—globally, regionally, and country by country—and on efforts to improve it.
It assesses progress in meeting Global Nutrition Targets established by the World Health Assembly. The World Health Organization (WHO) is a Global Nutrition Report Partner.
5-Dec-2018: Global Nutrition Report (GNR) 2018 released.
GNR 2018 is a peer-reviewed, independently produced annual publication on the state of the world’s nutrition.
The Global Nutrition Report was conceived following the first Nutrition for Growth Initiative Summit (N4G) in 2013. The first series was published in 2014.
Key Findings:
- Malnutrition is responsible for more ill health than any other cause.
- Children under five years of age face multiple burdens: 8 million are stunted, 50.5 million are wasted and 38.3 million are overweight.
- Meanwhile 20 million babies are born of low birth weight each year.
- Overweight and obesity among adults are at record levels with 9% of adults overweight or obese.
- One third of all women of reproductive age have anaemia and women have a higher prevalence of obesity than men. Millions of women are still underweight.
Yet significant steps are being made to address malnutrition.
- Globally, stunting among children has declined and there has been a slight decrease in underweight women.
- Many countries are set to achieve at least one of the targets set by the global community to track progress on nutritional status to 2025.
- Donors have met the funding commitment made at the Nutrition for Growth (N4G) Summit in 2013, but globally there is still a significant financing gap.
Indian Scenario:
A third of the world’s stunted children under five — an estimated 46.6 million who have low height for age — live in India. A quarter of the children display wasting (that is, low weight for height) as well.
District-level data show high and very high levels of stunting mainly in central and northern India (more than 30% and 40%, respectively), but less than 20% in almost the entire south.
Only 21% of the packaged foods available to children in India are rated as being healthy.
24-Jan-2023: WHO Report on Global Trans Fat Elimination
A new report from the World Health Organization (WHO) has found;
- 5 billion people globally remain unprotected from harmful trans fats
- Consumption of trans fats responsible for up to 500,000 premature deaths from heart disease every year
- WHO called for the global elimination of industrially produced trans fats in 2018
- Elimination target set for 2023
- 43 countries have implemented best-practice policies for tackling trans-fat in food
- 2.8 billion people protected globally
- Many countries in America and Europe have phased the substance out with bans on partially hydrogenated oils
- No low-income countries have adopted such measures
- 9 of the 16 countries with the highest estimated proportion of coronary heart disease deaths caused by trans-fat intake do not have a best-practice policy
- Best-practices in trans-fat elimination policies follow specific criteria established by WHO and limit industrially produced trans-fat in all settings
- Two best-practice policy alternatives: mandatory national limit of 2 grams of industrially produced trans-fat per 100 grams of total fat in all foods; mandatory national ban on the production or use of partially hydrogenated oils as an ingredient in all foods.
What are Trans Fats?
- Trans fat or trans-fatty acids are unsaturated fatty acids
- Naturally-occurring trans-fat come from ruminants (cows and sheep)
- Industrially-produced trans-fat is formed in an industrial process that adds hydrogen to vegetable oil converting the liquid into a solid, resulting in “partially hydrogenated” oil (PHO)
- Trans fats have been linked to an increased risk of heart disease, diabetes, and obesity
Challenges in Eliminating Trans Fat:
- Trans fats are a cheap and easy way to stabilise and extend the shelf life of food products
- Many small and medium-sized food manufacturers may not have the resources or technical expertise to reformulate their products to remove trans fats
- Trans fats are often used in food service and restaurant settings, which can be harder to regulate than retail food products
- Changing consumer habits and taste preferences can be difficult
- Some countries or regions may have limited infrastructure and resources to monitor and enforce the ban of trans fats
Initiatives to Eliminate Trans Fat:
India
- Eat Right Movement
- Swachh Bharat Yatra
- Heart Attack Rewind
- The Food Safety and Standards Authority of India (FSSAI) has stated that all food items should contain less than 2% of trans fat from Jan 2022
Global
- WHO released REPLACE, a step-by-step guide for the elimination of industrially-produced trans-fatty acids from the global food supply
- REPLACE provides six strategic actions for eliminating trans fats.
- Review dietary sources of industrially-produced trans fats and the landscape for required policy change.
- Promote the replacement of industrially-produced trans fats with healthier fats and oils.
- Legislate or enact regulatory actions to eliminate industrially-produced trans fats.
- Assess and monitor trans fats content in the food supply and changes in trans-fat consumption in the population.
- Create awareness of the negative health impact of trans fats among policymakers, producers, suppliers, and the public.
- Enforce compliance of policies and regulations.