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432 Economic arguments in migration and health - a call for interdisciplinary action to bridge silos
Get PDFAim The fundamental human right to health is recognized in numerous international and national documents and reinforced by the UN Sustainable Development Goals. To achieve universal healthcare access, policymakers and stakeholders in migration and health require evidence on effective and sustainable solutions to overcome barriers, considering cost and context. While many high-income healthcare systems incorporate health economic criteria in reimbursement decisions, the evidence base for migrants remains limited. This study aimed to identify existing economic studies, assess expert perspectives on the role of economic arguments in migration health discussions, and determine key topics that need further exploration. Methods Using a semi-structured survey, we examined migration health experts’ perspectives on the relevance of economic considerations and identified key research questions in the field from their perspective. A rapid literature review was conducted in May 2023 across two databases, SCOPUS and WEB OF SCIENCE. The review articles and survey responses were analyzed using inductive thematic content analysis. Results The survey indicates that the most relevant concerns are healthcare costs and factors influencing health determinants, such as limited integration into the care system. The rapid literature review highlights cost as a key barrier to equitable healthcare, frequently mentioned as a challenge but often lacking comprehensive economic analysis. Conclusion These findings indicate it is time to bridge silos by proactively engaging economists and migration health researchers in interdisciplinary knowledge building to use more economically sound arguments and rigorous analyses as a basis for decision-making related to migration health
Assessing Sovereign Climaterelated Opportunities and Risks (ASCOR): progress note
Get PDFAssessing Sovereign Climate-related Opportunities and Risks (ASCOR) is an investor-led initiative launched to provide comprehensive and comparable assessments on how sovereigns are managing the low-carbon transition as well as the physical risks stemming from climate change. ASCOR aims to inform, support and facilitate investment decisionmaking, especially by sovereign bondholders, and enable a more explicit consideration of climate change at the national level. In 2023, following a public consultation, the Transition Pathway Initiative Centre (TPI Centre) at the London School of Economics (LSE), launched the ASCOR tool including the first assessments of 25 pilot countries. In 2024, a larger universe of 70 countries was assessed. This progress note announces the list of 85 countries that will be assessed in 2025, provides a description of the project’s timeline and explains recent amendments to the ASCOR methodology and dataset
Strengthening Mexico’s Climate Law: policy lessons from subnational and international experience
Get PDFDrawing on the outcomes of public participatory processes on climate change, and the reform to a new generation of nine subnational climate laws, as well as international experience, this report, available in English and Spanish, identifies opportunities to strengthen Mexico’s key national climate governance instrument: the General Law on Climate Change. The authors analyse the provisions against key ‘climate governance functions’ that need to be addressed to enable an effective response to the climate crisis. The report also provides insights for other countries that are revising their nationally determined contributions (NDCs) and looking to strengthen the domestic legal frameworks and institutions that deliver implementation. Conclusions from this study could be of particular interest to countries with a federal structure and those seeking to strengthen subnational leadership on climate change. The authors find that Mexico’s General Law addresses the climate governance functions to some extent, but there are opportunities to strengthen design elements of the law across the functions. Detailed recommendations for policymakers are provided
Utilising national early warning score as a track and trigger mechanism in hospital-at-home care for acutely ill patients
Get PDFBackground: The UK healthcare system faces challenges due to an ageing population and chronic bed shortages. An acute hospital-at-home (HaH) model of care can offer an alternative for acutely ill patients requiring hospital admission. However, monitoring thesepatients at home presents its own challenges. We used the National Early Warning Score (NEWS) for patients admitted to a HaH to identify deteriorating patients and ensure safe and timely transfer back to hospital when needed. Design: Retrospective observational cohort study of patients with selected medical conditions admitted to acute HaH, from an NHS district hospital, between 2014 and 2017. Results: Of the 502 patients admitted to HaH, 443 (88.2%) were successfully treated and discharged, 1 patient died at HaH (an expected death), and 58 (11.5%) required transfer back to hospital and no fatalities reported after transfer. The AUC for total NEWS was significantly lower for non-transferred patients (14.06) compared to transferred patients (24.71) (p < 0.001). 95% of patients treated at HaH rated their care as excellent or good, and 98% were likely to recommend the service Conclusion: The study confirms the safe and effective use of the NEWS to identify deteriorating patients in an acute HaH setting, enabling timely transfer back and demonstrating that HaH care can be extended to acutely ill patients. This service could serve as an alternative healthcare system for clinically selected patients. It optimizes resource utilization, reduces the burden on acute medicine departments, and enhances patient experience
Lion in a jungle or lion in a cage? Yojana beyond planning power and powerlessness in Bangalore, India
No full textThis article examines the relationship between planning, violations and powerlessness in Bangalore. It argues that although planning power is supposed to be produced in the public administration by urban planners and bureaucrats working with and through different protocols, it is never actually produced in reality. Engaging with this paradox and drawing on Latour and Nāgārjuna, this article suggests that planning power has no ontological substance and that planning is performatively constituted in real time by diverse collectives. I argue that the millions of observable everyday practices that mutually constitute the social, political and administrative cannot be explained, criticised or controlled by a single concept of ‘planning state power’ as a structural force. Instead, the article proposes Yojana as a context-sensitive vernacular concept to better understand the practice of planning in India and beyond
HPR2 A case study: how England implemented its first Population Health Agreement
No full textObjectives A first-of-its-kind Population Health Agreement (PHA) between the National Health Service (NHS) and Novartis aimed to improve the management of cardiovascular disease by supplying Inclisiran to 300,000 patients in primary care. The drug is recommended for the prevention of secondary heart disease in patients who are unresponsive to statins. We investigate the agreement's effectiveness by analyzing dispensed doses and exploring the key implementation challenges and successes. Methods We collected monthly Inclisiran dispensing data, broken down by Integrated Care Board (ICB), from OpenPrescribing.net, covering November 2021 to February 2025. To supplement this, we performed a rapid review of existing evidence on Inclisiran, which included clinical trial data, the National Institute for Health and Care Excellence (NICE) recommendation, and relevant media releases and editorials. Finally, we conducted semi-structured interviews with stakeholders directly involved in the implementation of the agreement. Results The analysis reveals a significant shortfall in the PHA’s objective, with only 64,163 Inclisiran doses administered in its first three years, far below the 300,000 patient target. Semi-structured interviews revealed several key barriers. Firstly, as a first-in-class product subject to additional safety monitoring, medical practitioners were hesitant to prescribe it in primary care. Secondly, physicians were not mandated to prescribe the drug, as it was not included in the General Medical Services contract. Thirdly, some stakeholders believed that the NICE's decision-making process was influenced by political pressure. Finally, NHS England was perceived to have pressured GPs to prescribed Inclisiran. Conclusions The initial PHA fell short of the ambitious targets set by NHS England and Novartis. To secure better outcomes in the future, we recommend that similar agreements account for doctors' willingness to prescribe new medications and offer appropriate financial incentives within primary care. The low uptake achieved by NHS England might make manufacturers hesitant to enter into similar deals
HPR10 A strategic national framework for managed entry agreements to access innovative and breakthrough medications in Saudi Arabia
No full textObjectives Recently, there has been increased interest in adopting managed entry agreements (MEAs) as a tool to overcome access paradoxes for innovative and breakthrough therapies. However, efficient implementation requires integrating MEAs into a country’s formal pricing, reimbursement, and market access policies. This research proposes a national MEA framework for innovative and breakthrough therapies and identifies strategic enablers for optimal MEAs implementation in Saudi Arabia. Methods A half-day multi-stakeholder workshop was convened in Riyadh, Saudi Arabia, with official representatives from governmental, semi-governmental, and private sectors (including pharmaceutical manufacturers), all holding roles in pharmaceutical pricing, reimbursement, or market access. A predefined and validated set of questions was used to guide the discussion, supplemented by follow-up props and prompts to elicit more insights from the participants. Thematic analysis was applied to identify strategic enablers for MEAs implementation and to inform the framework design. Results Ten themes emerged from the analysis, crucially informing the framework design. These themes included: access to innovative medications; stakeholder views about MEAs; early dialogue; prioritization of MEAs for pharmaceutical products; the regulatory landscape; designing a technical framework for MEAs; innovative pharmaceutical payment models; health system governance; challenges for successful implementation; and stakeholder engagement. Two models were developed under the national framework, namely a price reduction model and an uncertainty mitigation model. Conclusions MEAs are considered strategic levers that enable Saudi Arabia’s health system to overcome access paradoxes for innovative and breakthrough therapies, including advanced therapeutic medicinal products and oncology medications; workshop participants prioritized these therapies for outcome-based agreements. While more complex innovative and breakthrough medications emerge, adopting agile and evidence-adaptive MEAs is essential to remain fit-for-purpose and maintain health system sustainability in Saudi Arabia
The material basis of gender-based violence and its circuits: a political economy perspective on post-war Bosnia and Herzegovina
No full textBringing into dialogue the continuum of violence and circuits of violence perspectives, this chapter provides a structural explanation of post-conflict gender-based violence against women. Homing in on the political economy of post-conflict transition, it argues that the intersections between local and global dynamics and between formal and informal actors in post-conflict society account for a material basis of enduring violence against women. This argument challenges the existing scholarship and questions the conceptual separation of the global and local and of the formal and informal processes of post-war political and economic transition and of their protagonists. The analysis of femicide and other forms of gender-based violence against women in post-conflict Bosnia and Herzegovina demonstrates how women’s marginalised socio-economic position increases their vulnerability to male dominance and violence, while attesting to the gendered nature of the post-war politico-economic transitions. This argument is examined empirically with reference to the cumulative effects of the interrelated dynamics of economic governance failures, neoliberal transition, informality and criminal economy in the aftermath of war
The duty to secure and the Just war
No full textRita Floyd’s work on securitisation and the just war is original and creative, but the version of the just war she employs – the analytical approach to just war theory – limits the applicability of her ideas