To save content items to your account,
please confirm that you agree to abide by our usage policies.
If this is the first time you use this feature, you will be asked to authorise Cambridge Core to connect with your account.
Find out more about saving content to .
To save content items to your Kindle, first ensure email@example.com
is added to your Approved Personal Document E-mail List under your Personal Document Settings
on the Manage Your Content and Devices page of your Amazon account. Then enter the ‘name’ part
of your Kindle email address below.
Find out more about saving to your Kindle.
Note you can select to save to either the @free.kindle.com or @kindle.com variations.
‘@free.kindle.com’ emails are free but can only be saved to your device when it is connected to wi-fi.
‘@kindle.com’ emails can be delivered even when you are not connected to wi-fi, but note that service fees apply.
Every year, over 250,000 public authorities in the European Union (EU) spend about 14% of GDP on the purchase of services, works and supplies. Many are in the health sector, a sector in which public authorities are the main buyers in many countries. When these purchases exceed threshold values, EU public procurement rules apply. Public procurement is increasingly being promoted as a tool for improving efficiency and contributing to better health outcomes, and as a policy lever for achieving other government goals, such as innovation, the development of small and medium-sized enterprises, sustainable green growth and social objectives like public health and greater inclusiveness. In this paper, we describe the challenges that arise within health care systems with public procurement and identify potential solutions to them. We examined the tendering of pharmaceuticals, health technology, and e-health. In each case we identify a series of challenges relating to the complexity of the procurement process, imbalances in power on either side of transactions and the role of procurement in promoting broader public policy objectives. Finally, we recommend several actions that could stimulate better procurement, and suggest a few areas where further EU cooperation can be pursued.
The UK's relationship with the European Union (EU) is now embodied in two principal legal instruments: the EU–UK Trade and Cooperation Agreement, which formally entered into force on 1 May 2021; and the Withdrawal Agreement, with its Protocol on Ireland/Northern Ireland, which continues to apply. Using a ‘building blocks’ framework for analysis of national health systems derived from the World Health Organisation, this article examines the likely impacts in the UK of this legal settlement on the National Health Service (NHS), health and social care. Specifically, we determine the extent to which the trade, cooperation and regulatory aspects of those legal measures support positive impacts for the NHS and social care. We show that, as there is clear support for positive health and care outcomes in only one of the 17 NHS ‘building blocks’, unless mitigating action is taken, the likely outcomes will be detrimental. However, as the legal settlement gives the UK a great deal of regulatory freedom, especially in Great Britain, we argue that it is crucial to track the effects of proposed new health and social care-related policy choices in the months and years ahead.
In this article, we argue that the design and timing of regulatory responses, as well as the adherence of the population to the relevant rules, have a critical impact on the progression and public health consequences of the COVID-19 pandemic. This hypothesis is empirically tested using the example of Poland, a country that experienced, compared to its Western European neighbours, a relatively mild first phase of the pandemic. In this context, we compare Poland with selected countries, including France, Germany, Spain and the UK, and we supplement them with examples from other Visegrad Four (V4) countries – Czechia, Slovakia and Hungary. On that basis, we conclude that while the observed differences between the countries in the progression of the COVID-19 pandemic are the result of a multitude of complex and interrelated reasons (such as demographic structure, population density and connectivity or cultural factors), well-designed public health measures, which are implemented early as a part of the proactive strategy that anticipates and reacts quickly to changing circumstances, can effectively decrease the number of COVID-19 infections and related deaths, provided that the adherence of the relevant population is high.
It is easy to forget that one of the primary purposes of a health system should be to improve health (McKee et al., 2009). For decades, debates on health systems have been dominated by discussions of how much they cost to run (typically questioning whether they are affordable, as if there were an alternative in a civilized society) or how many resources they require (typically expressed in an arbitrary fashion as people, usually doctors and nurses, but not managers or physiotherapists, or facilities and items of furniture, usually hospitals, but not primary care clinics or beds and not examination couches). The nature of this discourse has meant that health systems have tended to be regarded as a cost to society from which there is little return instead of as an investment whereby appropriately directed expenditure leads to better health.
We study the link between fiscal austerity and Nazi electoral success. Voting data from a thousand districts and a hundred cities for four elections between 1930 and 1933 show that areas more affected by austerity (spending cuts and tax increases) had relatively higher vote shares for the Nazi Party. We also find that the localities with relatively high austerity experienced relatively high suffering (measured by mortality rates) and these areas’ electorates were more likely to vote for the Nazi Party. Our findings are robust to a range of specifications including an instrumental variable strategy and a border-pair policy discontinuity design.
Sometimes it seems that the hospital is the health system. Whether in popular culture, such as the American television series ER, in political and popular discourse, with its focus on opening and closing of hospitals, in statistical databases that give prominence to numbers of hospital beds, or in budgetary breakdowns, showing that the bulk of health service spending is concentrated in hospitals, it is clear that the hospital is seen as being at the heart of the health system (McKee & Healy, 2002). Even when the many other components of the health system are recognized, the hospital typically sits at the top of the pyramid. This is perhaps inevitable. Hospitals are highly visible. They are large buildings, well signposted, and adorned with the symbols of health care, such as red crosses. When politicians wish to make a statement on health services, they typically find a convenient hospital as a backdrop. Hospitals are also important for the public, not just when they are ill, but by providing reassurance that they will be cared for nearby if they become ill in the future. They play other roles too, as settings for the education of the next generation of health workers and through their contribution to the local economy. So even though they are only one part of the overall health system, they are an important part, and are recognized as such by almost everyone.
Almost every aspect of society today has been shaped by technological developments. Take the nature of the modern state. The historian Philip Bobbitt describes how the introduction of gunpowder to Europe rendered the medieval city states, protected by high walls, obsolete. Gutenberg’s invention of the printing press, allowing for the cheap distribution of information to the masses, paved the way for the Reformation and later for revolutions. The discovery of magnetism, and thus the compass, made it possible to establish global networks, enabling exchange of people and ideas and, ultimately, the system of international trade that prevails today. The invention of the steam engine, powering both railways and mines, paved the way for the industrial revolution and, with it, the growth of major cities. These examples illustrate how technological advances have created huge societal changes that rippled out into further cycles of innovation, driving the shift from local feudalism to a global post-industrial society.
We evaluate the extent to which Coca-Cola tried to influence research in the Global Energy Balance Network, as revealed by correspondence between the company and leading public health academics obtained through Freedom-of-Information (FOI) requests.
US state FOI requests were made in the years 2015–2016 by US Right to Know, a non-profit consumer and public health group, obtaining 18 030 pages of emails covering correspondence between The Coca-Cola Company and public health academics at West Virginia University and University of Colorado, leading institutions of the Global Energy Balance Network. We performed a narrative, thematic content analysis of 18 036 pages of Coca-Cola Company’s emails, coded between May and December 2016, against a taxonomy of political influence strategies.
Emails identified two main strategies, regarding information and messaging and constituency building, associated with a series of practices and mechanisms that could influence public health nutrition. Despite publications claiming independence, we found evidence that Coca-Cola made significant efforts to divert attention from its role as a funding source through diversifying funding partners and, in some cases, withholding information on the funding involved. We also found documentation that Coca-Cola supported a network of academics, as an ‘email family’ that promoted messages associated with its public relations strategy, and sought to support those academics in advancing their careers and building their affiliated public health and medical institutions.
Coca-Cola sought to obscure its relationship with researchers, minimise the public perception of its role and use these researchers to promote industry-friendly messaging. More robust approaches for managing conflicts of interest are needed to address diffuse and obscured patterns of industry influence.
Hospitals today face a huge number of challenges, including new patterns of disease, rapidly evolving medical technologies, ageing populations and continuing budget constraints. This book is written by clinicians for clinicians and hospital managers, and those who design and operate hospitals. It sets out why hospitals need to change as the patients they treat and the technology to treat them changes. In a series of chapters by leading authorities in their field, it challenges existing models, reviews best practice from many countries and presents clear policy recommendations for policymakers and hospital administrators. It covers the main patient groups and conditions as well as those departments that make modern effective care possible, in imaging and laboratory medicine. Each chapter looks at patient pathways, aspects of workforce, required levels of specialisation and technology, and the opportunities and challenges for optimising the delivery of services in the hospital of the future. This title is also available as Open Access on Cambridge Core.