James Macinko

Summary: Building fair, equitable, and beneficial partnerships between institutions collaborating in research in low- and middle-income countries (LMIC) and high-income countries (HIC) has become an integral part of research capacity building in global health in recent years. Authors offer an example of an academic collaboration between the University of California Los Angeles, Center for Health Policy and Research (UCLA CHPR) and the University of Philippines, Manila, College of Public Health (UPM CPH) that sought to build an equitable partnership between research institutions.

The partnership was built on a project to build capacity for research and produce data for policy action for the prevention and care of non-communicable diseases (NCDs) through primary health care in the Philippines. The specific objectives of the project were to: (1) locally adapt the Primary Care Assessment Tool for the Philippines and use the adapted tool to measure facility-level primary care delivery, (2) conduct focus group discussions (FGDs) to gather qualitative observations regarding primary care readiness and capacity, and (3) conduct a comprehensive population-based health survey among adults on NCDs and prior health care experience.

Findings: Authors describe the progression of the two institutions' partnership to carry out the project (described above) and the elements that helped build a stronger connection between the institutions, such as mutual goal setting, cultural bridging, collaborative teams, and capacity building. This example, which can be used as a model depicting new directionality and opportunities for LMIC-HIC academic partnerships, was written based on the review of shared project documents, including study protocols, and written and oral communications with the project team members, including the primary investigators. The innovation of this partnership includes: LMIC-initiated project need identification, LMIC-based funding allocation, a capacity-building role of the HIC institution, and the expansion of scope through jointly offered courses on global health.

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• Journal Article: Evolving Academic and Research Partnerships in Global Health: A Capacity-Building Partnership to Assess Primary Healthcare in the Philippines

Summary: While California as a whole has made significant progress over the past three decades in reducing rates of cigarette smoking, progress across communities in the state has been uneven. Using the 2014–2019 California Health Interview Survey (CHIS) combined adult data and existing state, county, and city tobacco control policies and neighborhood-level data on social drivers of health, this brief examines variations in local tobacco policies and their relationship with smoking behaviors, particularly among priority populations disproportionately impacted by tobacco.

Findings: In 2019, more than 60% of California cities still had weak or no local tobacco policies. Inequities in protection by tobacco control policies persist across priority populations, especially in areas with low neighborhood socioeconomic status (NSES). Reductions in adult cigarette smoking were greater in cities with strong local tobacco policies than in those with weak or no policies. Strong local policies were also associated with decreased smoking rates among adult (18+) populations disproportionately impacted by the tobacco epidemic, thereby reducing social inequalities in cigarette smoking. This study also found that the positive effect of local tobacco control policies on current adult smoking rates was further enhanced when the state-level tobacco policy (i.e., raising the tax from $0.87 to $2.87 per pack) was enacted in April 2017. 

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• Policy Brief: State and Local Tobacco Control Policies Are Associated with Decreasing Cigarette Smoking Rates and Disparities
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• Policy Brief: The Changing Landscape: Tobacco and Marijuana Use Among Young Adults in California
• Policy Brief: Health at Risk: Policies Are Needed to End Cigarette, Marijuana, and E-Cigarette Secondhand Smoke in Multi-Unit Housing in Los Angeles

​Summary: Brazil has a universal national health service that exists alongside a supplementary private sector used by about 30% of the population. Older adults are generally more likely than younger ones to have a private health plan in Brazil, despite having lower income on average. In this study, researchers investigate the effects of having a private health plan on health expenditures, utilization and quality of care among Brazilian adults aged 50 and over who participate in the Brazilian Longitudinal Study of Aging (ELSI-Brazil).

Findings: Results show that health care expenditures are overwhelmingly concentrated among the upper two deciles of consumption, but ratios of out-of-pocket expenditures to household consumption are similar among those with public (9.4%) and private (10.4%) coverage. Health care utilization (doctor visits) is slightly higher among those with private health plans and is associated with health care expenditures that are more than four times per doctor visit higher than those incurred by older adults who use the public sector.

Greater utilization among private health plan users is attenuated and no longer statistically significant once the endogeneity of private health plan coverage is accounted for using an instrumental variable approach. While there is no discernable difference in the technical quality of care (proxied by the presence of undiagnosed hypertension), a measure of the quality of provision of health care that focuses on timeliness and other organizational features of healthcare delivery is consistently higher among those with private health plans. This perceived convenience comes at a significantly higher cost to individuals and to society through reimbursement of private health plan premiums through tax credits.

 

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• Journal Article: Private Health Insurance, Healthcare Spending and Utilization Among Older Adults: Results from the Brazilian Longitudinal Study of Aging

​Summary: Trust, particularly during emergencies, is essential for effective health care delivery and health policy implementation. Authors used data from the 2018 Wellcome Global Monitor survey (comprising nationally representative samples from 144 countries) to examine levels and correlates of trust in governments and health workers and attitudes toward vaccines. 

Findings: Only one-quarter of global respondents expressed "a lot" of trust in their government (trust was more common among people with less schooling, those living in rural areas, those who were financially comfortable, and those who were older), and fewer than half of respondents globally said that they trust doctors and nurses "a lot." People’s trust in these institutions was correlated with trust in health or medical advice from them, and with more positive attitudes toward vaccines. Vaccine enthusiasm varied substantially across regions, with safety being the most common concern. Policymakers should understand that the public may have varying levels of trust in different institutions and actors. Although much attention is paid to crafting public health messages, it may be equally important, especially during a pandemic, to identify appropriate, trusted messengers to deliver those messages more effectively to different target populations.

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• Journal Article: Trust In Governments And Health Workers Low Globally, Influencing Attitudes Toward Health Information, Vaccines