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Memory First Aid: remote memory service and webinar-based dementia training for non-medical graduates in Nepal, India, Pakistan and Sri Lanka
- Arun Jha, Shehan Williams, Bhaweshwar Singh, Prabhat Pradhan, Khem Raj Bhatt, Muhammad Iqbal Afridi, Rahul Tomar, Kaushik Mukhopadhaya
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- Journal:
- BJPsych International / Volume 18 / Issue 1 / February 2021
- Published online by Cambridge University Press:
- 30 July 2020, E4
- Print publication:
- February 2021
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The prevalence of dementia is rising in low-resource countries, where specialist memory services are almost non-existent. The COVID-19 pandemic has created opportunities for innovative remote healthcare. Research shows a lack of dementia literacy and help-seeking behaviour for memory-related problems among older adults in South Asian countries. This paper proposes a remote memory service model and virtual dementia training in South Asian countries, called Memory First Aid (MFA). MFA offers help to a person experiencing memory difficulties until appropriate professional help is received. The MFA course is a 12-h webinar-based package consisting of four weekly modules. It covers dementia awareness and clinical features. The aim is to develop a non-medical workforce able to screen and assess older people with suspected dementia.
10 - Benefits and Costs of the Health Targets for the Post-2015 Development Agenda
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- By Prabhat Jha, Professor of Economics, Canada Research Chair of Health and Development at the University of Toronto, Canada and Founding Director of the Centre for Global Health Research, St. Michael's Hospital, Toronto, Canada, Ryan Hum, Special Lecturer, Faculty of Applied Science and Engineering, University of Toronto, Canada, Cindy L. Gauvreau, Post-Doctoral Fellow/ Economist, Centre for Global Health Research, St. Michael's Hospital, Toronto, Canada, Keely Jordan, Health Policy Analyst, University of California, San Francisco, USA
- Edited by Bjorn Lomborg, Copenhagen Business School
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- Book:
- Prioritizing Development
- Published online:
- 30 May 2018
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- 07 June 2018, pp 219-230
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Summary
Introduction
A variety of development priorities have been proposed for 2030 as Sustainable Development Goals (SDGs) to follow the highly-influential 2015 Millennium Development Goals (MDGs). These proposed goals cover a wide range of development objectives, including SDG3, “Ensure healthy lives and promote well-being for all at all ages.” Within the overarching health goal, many subgoals have been proposed, some of which are realistic and others that are not (Norheim et al., 2014). Common frameworks to evaluate these disparate goals are required by national governments and global agencies.
One proposed method to evaluate goals is benefit-cost analyses (BCAs), expressed as some monetary value of the benefits divided by the costs (benefit-cost ratios, or BCR) of achieving these benefits. A BCR greater than one for an assessed intervention indicates that it is socially beneficial compared to the next best use of the same resources. A ranking of interventions by the size of their BCRs is one step in allowing the prioritization according to the relative benefits they provide to society. (Note that a goal with a high societal benefit, such as universal education of girls, might not necessarily have a higher BCR than other interventions). In the case of health, high coverage of individual interventions are seldom achieved without an extensive delivery system comprising community outreach of services, first referral, and specialty hospitals, as well as supportive services for quality, patient safety, monitoring and evaluation, and other services (Jha and Laxminarayan, 2009). Moreover, some interventions (such as immunization) reduce deaths beyond the specific diseases they cover, by, for example, increasing the nutritional standing of children. The impact of increased access through universal healthcare is also not easily quantified through BCA. Therefore, traditional BCA, applied to individual interventions, fails to fully capture the cumulative and synergistic benefits or costs of implementation within a health system and in tandem with other health-promoting activities.
Thus, overall goals of reducing child and adult mortality are required as an overarching framework target. However, it should also be emphasized that within this framework, careful consideration be given to the specific subpopulation needs for each major age group (0–4, 5–49, and 50–69 years), as they differ in disease patterns.
Chapter 10 - Benefits and Costs of the Health Targets for the Post-2015 Development Agenda
- Edited by Bjorn Lomborg, Copenhagen Business School
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- Book:
- Prioritizing Development
- Published online:
- 30 May 2018
- Print publication:
- 07 June 2018, pp 219-230
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In this chapter, we attempt to provide a BCR for an overall outcome of reducing premature mortality in low- and lower-middle-income countries by 40% by 2030 (40x30). This method quantifies the value of a broad-based expansion of health care resources for services and interventions rather than an incremental intervention-by-intervention approach. We propose this outcome as a new sub goal of SDG3 (Norheim et al. 2014). By focussing on mortality we do not mean to deny the importance of the sub goals to reduce disability and suffering, such as that aimed at improving mental health or palliative care. However, the burden of disability and suffering as captured in the disability-adjusted life year (DALY) in low- and middle-income countries (LMICs), is relatively smaller than mortality (Jha 2014), especially in lower-income countries (Murray et al. 2012). Because most causes of premature mortality are highly correlated with those of disability, a reduction in the former will result in a reduction of the latter. However, the benefits of healthy years gained takes into account (albeit crudely) the ratio of disability to mortality.
3 - Chronic Disease
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- By Prabhat Jha, University of Toronto, Rachel Nugent, University of Washington, Stéphane Verguet, University of Washington, David Bloom, Harvard University, Ryan Hum, University of Toronto
- Edited by Bjørn Lomborg
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- Book:
- Global Problems, Smart Solutions
- Published online:
- 05 June 2014
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- 14 November 2013, pp 137-185
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Eighty percent of global deaths from heart disease, stroke, cancer, and other chronic diseases occur in low- and middle-income countries. This chapter discusses priorities for control of these chronic diseases as an input into the 2012 Copenhagen Consensus. This chapter and the accompanying Chapter 7 on infectious disease control build on the results of the 2008 Copenhagen Consensus chapter on disease control (Jamison et al., 2008), and is best read as an extension of the latter chapter.
This chapter also draws on the framework and findings of the Disease Control Priorities Project (DCP2). The DCP2 engaged over 350 authors and among its outputs were estimates of the cost-effectiveness of 315 interventions, including about 100 interventions for chronic diseases. These estimates vary a good deal in their thoroughness and in the extent to which they provide regionally-specific estimates of both cost and effectiveness. Taken as a whole, however, they represent a comprehensive canvas of chronic disease control opportunities. This chapter identifies five key priority interventions for chronic disease in developing countries which chiefly address heart attacks, strokes, cancer, and tobacco-related respiratory disease. These interventions are chosen from among many because of their cost-effectiveness, the size of the disease burden they address, their implementation ease, and other criteria. Separate but related 2008 Copenhagen Consensus chapters dealt with other major determinants of chronic diseases such as nutrition, (Behrman et al., 2007), air pollution (Larsen et al., 2008) and education (Orazem et al., 2008). The health-related chapters for the 2012 Copenhagen Consensus focus on infectious diseases (Jamison et al., 2012), sanitation and water (Rijsberman and Zwane, 2012), education (Orazem, 2012), hunger and undernutrition (Hoddinott et al., 2012) and population growth (Kohler, 2012).
7 - Infectious Disease, Injury, and Reproductive Health
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- By Dean T. Jamison, University of Washington, Prabhat Jha, University of Toronto, Ramanan Laxminarayan, Development and Environment, Resources for the Future, Toby Ord, University of Oxford
- Edited by Bjørn Lomborg
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- Global Problems, Smart Solutions
- Published online:
- 05 June 2014
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- 14 November 2013, pp 390-438
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This chapter identifies key priorities for the control of infectious disease, injury, and reproductive health problems for the 2012 Copenhagen Consensus. It draws directly upon the disease control paper (Jamison et al., 2008) from the 2008 Copenhagen Consensus 2008 and the AIDS vaccine paper for the 2011 Copenhagen Consensus RethinkHIV project (Hecht and Jamison, 2012). This chapter updates the evidence and adjusts the conclusions of the previous work in light of subsequent research and experience. For the 2012 Copenhagen Consensus NCDs are being treated in a separate paper (Jha et al., 2012, Chapter 3 in this volume) that complements this one. This chapter's conclusions emphasize investments in control of infection. That said, one of the six investment areas advanced – essential surgery – addresses both the complications of childbirth and injury, and points to the potential for substantial disease burden reduction in these domains.
All this work builds on the results of the Disease Control Priorities Project (DCPP). The DCPP engaged over 350 authors and estimated the cost-effectiveness of 315 interventions. These estimates vary a good deal in their thoroughness and in the extent to which they provide regionally-specific estimates of both cost and effectiveness. Taken as a whole, however, they represent a comprehensive canvas of disease control opportunities. We will combine this body of knowledge with the results from research and operational experience in the subsequent four years.
Chapter 7 - Human Health: The Twentieth-Century Transformation of Human Health – Its Magnitude and Value
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- By Dean T. Jamison, University of Washington, Prabhat Jha, University of Toronto, Varun Malhotra, University of Toronto, Stéphane Verguet, University of Washington
- Edited by Bjørn Lomborg, Copenhagen Business School
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- Book:
- How Much Have Global Problems Cost the World?
- Published online:
- 05 June 2014
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- 10 October 2013, pp 207-246
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I have tried always to remember a simple truth about the past that the historically inexperienced are prone to forget. Most people in the past either died young or expected to die young, and those who did not were repeatedly bereft of those they loved . . . the power of death cut people off in their prime and made life seem precarious and filled with grief. It also meant that most of the people who built civilizations of the past were young when they made their contributions.
– Niall Ferguson, Civilization: The West and the Rest (2011, pp. xxii–xxiii)Ferguson refers to a past with mortality far higher than today, a past in which people not only died young but lived with frequent illness, undernutrition and (for women) the often debilitating consequences of high fertility. This past was not so very long ago. Section 1 will present long trends in life expectancy in the country where it is highest. From a period of virtually no change in mortality prior to 1790, improvements became rapid in the nineteenth century and extremely rapid in the period 1880–1960. During this latter period life expectancy in the leading country increased by 3.2 years per decade. And, as this chapter will document, not only did the leading country rapidly improve but much of the rest of the world converged toward the leader.
3 - Disease control
- Edited by Bjørn Lomborg, Copenhagen Business School
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- Book:
- Global Crises, Global Solutions
- Published online:
- 05 June 2012
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- 09 July 2009, pp 126-179
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Introduction
This Challenge paper identifies priorities for disease control as an input into the 2008 Copenhagen Consensus project (hereafter, CC08). As such, it updates the evidence and differs somewhat in its conclusions from the communicable disease paper (Mills and Shilcutt 2004) prepared for the 2004 Copenhagen Consensus, which Lomborg (2006) summarizes.
Our analysis builds on the results of the Disease Control Priorities Project (DCPP). The DCPP engaged over 350 authors and among its outputs were estimates of the cost-effectiveness of 315 interventions. These estimates vary a good deal in their thoroughness and in the extent to which they provide region-specific estimates of both cost and effectiveness. Taken as a whole, however, they represent a comprehensive canvas of disease control opportunities. Some interventions are clearly low priority. Others are attractive and worth doing, but either address only a relatively small proportion of disease burden or are simply not quite as attractive as a few key interventions. This chapter identifies seven priority interventions in terms of their cost-effectiveness, the size of the disease burden they address, and other criteria. Separate but related papers for CC08 deal with malnutrition (Horton et al. 2008, see chapter 6 in this volume), with water and sanitation (Hutton 2007), with air pollution (Larsen et al. 2008, see chapter 1 in this volume), and with education (Orazem et al., 2008, see chapter 4 in this volume).