jakartaglobe - Linda Rullis sold her motorcycle and borrowed money from relatives to cover neo-natal treatment for her daughter, who was born after only 24 weeks of pregnancy, barely weeks within the threshold of survival. The baby girl is now one year old and weighs 5.1kg.

"I insisted on taking her home after she had been treated for four months because I couldn't afford the treatment anymore," Rullis, 30, told IRIN. "When she was born she weighed only 690g, but luckily she seems to be doing just fine now."

The World Health Organization defines any birth before 37 weeks (259 days) of pregnancy as pre-term, while a full-term pregnancy is anywhere from 37 to 41 weeks.

A recent multi-agency report ranked Indonesia among 10 countries worldwide with the highest number of pre-term births, where 15.5 babies out of every 100 live births are born too early — about 676,000 babies annually.

Globally some 15 million infants — more than one in 10 births — are born too early each year, and more than one million die shortly after birth. Countless others suffer some type of lifelong physical, neurological, or educational disability, according to the report.

Indonesia's rank in the ninth position puts it above Pakistan and below Mauritania. Belarus, Ecuador, Latvia and Finland have among the lowest rates of too-early births among countries that provided the UN data.

"The dominant cause of pre-term births in Indonesia is infections, including vaginal and renal infections," said Ali Sungkar, an obstetrician-gynaecologist and lecturer at the medical school of the University of Indonesia in Jakarta, the capital.

"Most of those mothers who give birth to pre-term babies come from low socio-economic backgrounds. They have low body mass index and suffer from anaemia," he told IRIN.

Smoking, alcohol consumption and depression also contribute to pre-term births, and once a woman delivers an infant prematurely, she is more likely to do so again Sungkar said.

He estimated that such births cost the state 10 times more per child than full-term deliveries, and "the government won't have the money to cover all the costs," but added that there was little research available on this.

Indonesia has no universal health insurance, but poor people can get free medical treatment if they present the necessary documents. Patients usually cover around 73 percent of their health costs out of their own pockets, according to government data reported to WHO in 2009.

20 million vulnerable

More than 76 million of Indonesia's 240 million people are covered by Jamkesmas, a health-fee waiver for the poor, but a legislator recently told local media that an estimated 20 million poor people are not covered because their data cannot be verified.

The government has said it will increase the number of people eligible for Jamkesmas to 86.4 million in 2013, in line with updated data collected by the Central Bureau of Statistics. An amount of 7.4 trillion rupiah (US$791 million) has been allocated to health subsidies for 2012, with each qualified family entitled to up to 2.5 million rupiah ($266).

Sungkar said antenatal care played a key role in preventing pre-term births and more training should be given to midwives and clinic personnel. The Indonesia Health Profile 2010 noted that four out of 10 pregnant women do not make the recommended four antenatal visits.

Ivan Sini, an obstetrician-gynaecologist who practices in a private hospital in Jakarta, said a lack of financial resources and poor healthcare infrastructure were among the obstacles to curbing pre-term births.

"Puskesmas [government-run community health clinics] and referral health systems are not evenly available throughout the country," Sini pointed out. "Even with limited budgets, the government should be able to expand the reach of these peripheral services."

In 2007 the country had less than 23 health workers per 10,000 residents, the minimum number needed to provide life-saving care, according to WHO.

A Health Ministry expert in health financing, Triono Soendoro, recently told state media that Indonesia's health system was facing challenges in reforming health management, improving infrastructure, and reaching people living in the more remote parts of the far-flung archipelago.

Gulfnews - Manila: The Government has enforced screening procedures at the country's international airports following reports of an outbreak of a fatal disease in neighbouring Cambodia.

Presidential Spokesperson Edwin Lacierda, in an interview aired on the government-run dzRB on Saturday said that the Department of Health, through the National Epidemiology Centre (NEC), is currently monitoring the possible entry into the country of a fatal respiratory disease that has killed at least 60 children in Cambodia under seven years old.

"Arriving passengers can expect tighter screening at the airports," Lacierda said, adding that experts are still trying to determine the nature of this mysterious disease.

He said Health Secretary Enrique Ona had already issued instructions to the Bureau of Quarantine to be more vigilant in carrying out routine screening procedures at all international airports.

No let-up

The Philippines has several gateways to the country, these include the primary entry point, the three-terminal Ninoy Aquino International Airport, the Clark in Pampanga, Laoag International Airport in the north, as well as the Cebu, Iloilo, Kalibo International Airport and the Bangoy International Airport in Davao.

The World Health Organisation (WHO) informed the Philippines about the disease after Cambodia reported several dozen deaths traced to the disease.

"Although a causative agent remains to be formally identified, all [available] samples were found negative for H5N1 and other influenza viruses, Sars, and Nipah virus," the WHO report said. No sign of illness were reported among hospital staff who took care of the patients.

"We are more vigilant in screening passengers at the country's international airports because of this latest news and there will be no let-up until this has been contained," Ona said.

Zambotimes - PHUKET, 3 July 2012 – The Thailand Ministry of Public Health is hosting the 11th ASEAN Health Minister Meetings (11th AHMM) and related meetings from 2-6 July 2012 in Phuket. Joined by 13 countries, the meeting this year emphasizes five main topics, namely: global severe problem on Chronic Non-Communicable Diseases Control and Prevention; Building Universal Health Coverage; Tobacco Control; AIDS in Urban area; and Emergency Disaster Management.

The following main topics will be discussed in three main meetings: 1) ASEAN Health Ministers Meeting (AHMM) of 10 ASEAN Member States; 2) the 5th ASEAN Plus Three (China, Japan, and South Korea) Health Ministers Meeting; and 3) the 4th ASEAN Plus China Health Ministers Meeting.

H.E. Mr. Wittaya Buranasiri, Minister of Public Health, stated that the theme this year would be "ASEAN Community 2015: Opportunities and Challenges to Health." The series of meetings aim to seek strategies to increase positive and reduce negative health effects that could happen after the implementation of ASEAN Community, including the cooperation with China, Japan, and South Korea.

Dr. Paijit Warachit, Permanent Secretary of the Ministry of Public Health, advised that the meeting will consist of two parts; the Senior Officials Meeting (SOM) and the AHMM. Recommendations from SOM will be considered and endorsed to be assigned as ASEAN policies to solve prioritised public health issues.

"There will also be a Retreat Session among 10 ASEAN Health Ministers to make acquaintances for future informal communication channel," said Dr. Suwit Wibulpolprasert, Senior Advisor on Disease Control. The session will be held in three small groups discussing the issues of Non-Communicable Diseases (NCD): diabetes, hypertension, cancer, and heart disease, which are ASEAN and world's major problems.

Dr. Sopon Mekthon, Deputy Permanent Secretary of the Ministry of Public Health, Thailand, stated that aside from meetings about policies, there will be side meetings of professionals and academics on crucial issues such as: Field Epidemiology Training Network of ASEAN plus Three, universal health coverage for the success of universal health coverage system building in ASEAN, and an AIDS problem-solving meeting to achieve 3 ASEAN Declaration of Commitments: Getting to Zero New HIV Infections, Zero Discrimination, and Zero AIDS-Related Deaths.

Expected participants of these meetings include: Health Ministers, Permanent Secretary of the Ministry of Public Health, executive staff, and high level academics from ASEAN Member States plus China, Japan, and South Korea.

ScienceDaily (July 2, 2012) — A special July/August issue of the Journal of Public Health Management and Practice (JPHMP), dedicated to public health financing, suggests that a rebalancing of the US healthcare investment in clinical care and public health initiatives is needed to improve the health of the population and reduce overall costs.

(http://journals.lww.com/jphmp/pages/default.aspx)."If we fail to strengthen our public health system now, we can look forward to falling further behind other developed nations and it will become more and more difficult to restore our health and competitiveness," according to Steven M. Teutsch, MD, MPH, of the Los Angeles County Department of Public Health and colleagues.

Investing in Public Health Is Imperative to National Health and the Economy

The lack of attention to public health and prevention has serious consequences not only for the nation's health but also the economy. A healthy workforce is essential to "sustain economic growth and continued gains in labor force participation and longevity," Teutsch and colleagues believe. Coverage for medical treatment is essential -- but the dollars invested in clinical care far exceed its contributions to the nation's health. Medical care accounts for only 10 to 20 percent of the factors that shape health, but accounts for about 97 percent of all health spending, according to Teutsch and coauthors.

While total annual U.S. health spending is approximately $2.5 trillion, or about $8,100 per person, only $250 is related to public health. And while the U.S. spends twice as much per year as any other industrialized country, Andrew S. Rein, MS, and Lydia L. Ogden, PhD, MPP, of the Centers for Disease Control and Prevention state that that its health system ranks 37th in the world -- just behind Costa Rica.

They outline a multi-pronged -pronged solution to the chronic problem of public health underfunding in the United States, starting with efforts to increase productivity and efficiency. Suggestions include defining an essential minimum package of public health services and developing new approaches to address problems that contribute to poor health or stand in the way of health improvement, including high-cost but preventable conditions as obesity, diabetes, and smoking.

According to Patrick Bernet, guest editor of this special edition, "The U.S. needs to get the most out of the public health investment by focusing on programs that pay for themselves by decreasing illness and death, and through new public health partnerships at the state, local, and community levels."

Call to Increase Resources for Public Health

In addition, Teutsch and colleagues believe it's essential to establish "sufficient, stable, and sustainable" revenue to support public health efforts. To meet this end, they endorse the Institute of Medicine's recent proposal to institute a national medical care services tax. "A tax on medical services could slightly increase costs," they write, "but it has the potential to begin turning the tide of patients pushed into the system by preventable conditions."

Teutsch and coauthors add, "Although 2012 may not be a propitious time to increase spending, the United States cannot afford to delay as the costs of chronic conditions and an aging population skyrocket. The status quo is not working and we cannot afford to maintain it."

The special issue of Journal of Public Health Management and Practice also includes expert editorials on the importance of ensuring funding for public health research and measuring progress in public health finance. Rein and Ogden conclude, "This issue keeps us focused on critical issues of finance, so that public health can offer all it can for our future."

Indonesia's post-decentralization health system has seen an increase in public spending in health. About Rp 30 trillion (US$3.21 billion) is allocated for health in the current national budget, almost twice the amount allocated in 2006.

Nonetheless, this only accounts for 3.5 percent of the total budget, well below the 5 percent limit mandated by the 2009 Health Law. Likewise, average local government spending on health remains below the mandated minimum of 10 percent of the total budget. Why?

Obviously, there is no simple answer to this question, but perhaps the term "spending" implies something that should be kept at the minimum.

Hence, perhaps a different perspective on public health expenditure could be used as additional lines of arguments for increasing the government's spending on health.

Who knows? First, let me start by rewording the last phrase as "increasing the government's investment in health".

Investing in health is, of course, nothing new. A 1993 World Bank report carried the exact same title, but nonetheless, I think this is a good time for us to review some of the reasons why we want to invest in health.

Health can be viewed as an important investment in human capital that returns as an increase in the level of economic growth.

There are at least four mechanisms of increasing economic levels through which public health improvements can be considered: An increase in labor productivity, an increase in educational achievement, an increase in investment and a "demographic dividend".

Healthier people mean a healthier workforce with better labor productivity. It is quite obvious that a healthy employee has higher physical and mental capabilities to perform his or her job compared to sick counterparts.

Healthier employees would also miss fewer days of work and in turn would increase their value as a production input. In other words, health can be considered an important part of human capital.

As an example, the increase in per capita income in the UK and Korea was shown to be significantly influenced by the increase in the nutritional status of their labor forces.

An increase in educational attainment could also be expected from a healthy population. An increase in health translates to an increase in life expectancy and people who expect to live longer would expect a higher benefit of education and, hence, would have a higher incentive to enroll in schooling.

Improvements in health are also usually followed by a reduction in fertility, leading to a smaller family size and a shift in parents' focus to the improvement of their children's wellbeing, among other things, through education.

In addition, healthier children have higher learning ability and miss fewer days of school.

All in all, the increase in school participation would then lead to a higher quality, more productive workforce that contributes to higher economic growth.

In addition to schooling, people who expect to live longer have higher incentives to save and invest money for future use, whereas people with poorer health are not as motivated to save.

Poor health also directly prevents saving because money is needed to pay for healthcare.

Evidence also shows that countries with a healthy workforce are more attractive for foreign direct investment. All would lead to an increase in economic growth.

The increase in a country's health status usually leads to a fast decline in mortality, but is not usually accompanied by a simultaneous decrease in fertility.

This delayed fertility decline would lead to a boom in the size of the population, and also a change in the population's age structure. The latter would eventually lead to a period of low dependency ratios, where the population's working age group is larger, a lot larger, than the non-working age group.

Considering that the working age group produces economic resources, whereas the very young and the very old use them, this period of low dependency ratios provides the community with a "demographic dividend" that promotes economic growth.

The economic growth of East Asian countries, for example, is attributable to this demographic dividend.

Evidence shows that the net effect of an increase in public health on economic growth is positive: the higher the health status, the higher the growth rate.

Of course, all of the above positive correlations assume that appropriate policies are available to capture the advantages of increases in public health, such as policies on education to accommodate an increase in school participation and economic policies to absorb the increasing size of the workforce.

For now, at least, suffice it to say that more spending, pardon, more "investment" in public health would be good for the economy.

Rendezvous.blogs.nytimes - A sobering statistic emerged on Thursday as the United States Supreme Court prepared to deliver its judgment on Obamacare.

It confirmed that the U.S. spends more per capita on publicly funded health care than almost every other country in the developed world. And that includes countries that provide free health care to all their citizens.

Figures published on Thursday by the Organization for Economic Co-operation and Development, a 34-nation grouping of advanced economies, showed that less than half of health spending in the U.S. was publicly financed compared with an O.E.C.D. average of 72.2 percent.

"However, the overall level of health spending in the United States is so high that public (i.e. government) spending on health per capita is still greater than in all other OECD countries, except Norway and the Netherlands," according to the Paris-based organization's Health Data 2012 report.

Combined public and private spending on health care in the U.S. came to $8,233 per person in 2010, more than twice as much as relatively rich European countries such as France, Sweden and Britain that provide universal health care.

Are Americans healthier as a result? The U.S. has fewer doctors per capita than comparable countries, and fewer hospital beds. But more is spent on advanced diagnostic equipment and health tests.

Life expectancy has risen in line with that in other developed countries, but the average American life span of 78.7 years in 2010 was below the O.E.C.D. average. Obesity in the U.S. was the highest in the 34-nation survey.

"Obesity's growing prevalence foreshadows increases in the occurrence of health problems (such as diabetes and cardiovascular diseases), and higher health care costs in the future," the O.E.C.D. said.

An earlier survey found that U.S. health care was overpriced and not always better than in comparable countries. "Sometimes treatments are provided which are unnecessary, or even undesirable," the organization said in a 2011 report on comparative health indicators.

"It does a lot of elective surgery," the survey said of the U.S. health care system, "the sort of activities where it is not always clear-cut about whether a particular intervention is necessary or not."

Advocates of state-funded universal health care might use such statistics to show free health care for all is not only fairer but also cheaper.

In defense of a Canadian health care system maligned during the Obamacare debate as "an inefficient socialistic enterprise," Tim Shufelt of Canada's Financial Post wrote: "Canadians pay much less per capita on health care than do Americans, while ranking higher among the most common measures of human health."

Canada's embrace of universal health care reflects sentiment in most countries where free treatment is regarded as a right.

"In Europe...the right of access to health care for all is considered normal," Pierre-Yves Dugua wrote in a Figaro blog, "as is a financing system based on compulsory contributions."

The economic arguments in favor of European-style systems have been evident in the domestic U.S. debate on Obamacare.

Commenting on the latest O.E.C.D. figures, an editorial in Gannett's The Advertiser noted: "America pays big-time money for health care and gets Third World results."

"The greatest public good comes from universal access to care that emphasizes prevention and health education," according to article. "The European systems, often socialized or with health insurers forced to offer basic plans to everyone, can do that. Ours doesn't."

Edition.cnn - The U.S. Supreme Court upheld President Barack Obama's sweeping health care legislation Thursday in a narrow 5-4 ruling that Obama says will provide up to 30 million additional Americans with health care.

America doesn't have universal health care coverage -- what the World Health Organization (WHO) calls "a widely shared political aim of most countries" -- but neither do most other countries.

Nearly 50 countries have attained universal or near-universal health coverage by 2008, according to the International Labor Organization. Several well-known examples exist like the UK, which has the National Health Service, and the Canadian public health care system.

Here are more examples of countries have implemented near-universal health care.

Brazil

Free health care coverage is recognized as a citizen's right in Brazil.

Brazilians have both a private and public health care system, which was overhauled in 1988. The Sistema Único de Saúde, a nationalized program, provides primary health care, while a network of public and contracted hospitals delivers specialist care.

About 80 percent of Brazil's population relies on public care, while the wealthiest 20% can afford private health care, according to a Center for Strategic and International Studies report.

Since the 1990s, Brazil has also provided universal access to HIV/AIDS drugs.

During the three decades since the nation's major health care changes, infant mortality decreased and life expectancy increased by 10.6 years, according to a 2011 article in medical journal The Lancet.

But the system hasn't been without problems, according to the Center for Strategic and International Studies report, which alluded to gaps in the quality of care between various Brazilian regions.

Rwanda

Since establishing a national health plan in 1999, Rwanda has insured about 91% of its population with health care -- a greater percentage than the United States.

Rwanda has been dubbed "Africa's Singapore" by The Economist for its transformation since a devastating genocide in 1994.

Watch Fareed Zakaria talk with Rwanda's president

The country has three health insurance plans, one for government employees, another for the military, and the third for the remaining population. The country commits about 20% of its annual spending to health, which is funded by tax revenues, insurance premiums and financial support from international donations, according to a WHO report.

Since introducing health insurance, Rwanda has seen lower childhood mortality rates; more people are also receiving medical attention. But the country faces challenges from an increase in health services and making contributions more affordable for its poorest citizens, according to a WHO report.

Thailand

By law, Thailand requires all patients to be covered by health insurance, regardless of their ability to pay.

The WHO uses Thailand as an example of a low- or middle-income country that has been able to extend health coverage to all citizens.

Introduced in 2002 as the "30-bhat scheme," (which is less than $1), the plan added about 14 million previously uninsured people to the Thai system.

Prescription drugs, hospitalizations and services like chemotherapy, surgery and emergency care are free to patients, according to a WHO report.

But the addition of millions of people to a health care system strained the existing structures, prompting criticisms of long waits, poor quality of service and shortage of service.

South Korea

South Korea passed a law in 1977, mandating health insurance for industrial workers. During its rapid economic growth, health care became a priority for the government, which created the National Health Insurance. The system extended to universal coverage by 1989.

The government merged more than 300 individual insurers into a single national fund, according to a WHO report.

Korea's single-payer program has "been successful in mobilizing resources for health care, rapidly extending population coverage, effectively pooling public and private resources to purchase health care for the entire population, and containing health care expenditure," according to a report published in Health Policy Plan.

But another report published in Health Affairs said that the public funding is limited, leaving "beneficiaries with relatively high payments." South Korea's expenditure on health care is 6.3% of the country's gross domestic product, compared with 18% in the United States.

Moldova

The Eastern European country became independent with the fall of the Soviet Union in 1991. By 2004, it began a mandatory health insurance program with the aim of providing the entire population with basic health care.

Employed Moldovans chip in a portion of their income through a payroll tax or a flat-rate contribution. Others who are unemployed or not working are insured by the government.

Its National Health Insurance Company is the sole buyer of health care services and organizes emergency, primary and secondary care locally, according to a report by the European Observatory on Health Systems and Policies, a joint partnership between European governments and the World Health Organization.

Kuwait

Kuwait's level of health care is comparable to average European standards, according to the WHO's profile of the Middle Eastern country.

The country began building up its health care system as it gained wealth from oil revenues. By the 1950s, the government implemented free comprehensive health care. This resulted in declines in general mortality and infant deaths, the report said. "Free health care was so extensive that it even included veterinary medicine," according to a local WHO report.

Kuwait faces an aging population as well as an epidemic of diabetes, heart disease and obesity-related complications that place great demands on its health care system.

Chile

The Chilean constitution guarantees rights to health protection.

Chileans can opt for public care or get coverage from private health insurance companies. Wealthier citizens can buy insurance from the Instituciones de Salud Previsional or obtain coverage through their employer. A 7% income tax funds the public health care system, the Fondo Nacional de Salud, according to an analysis of health care reform in Chile.

Public care includes free medical, dental and midwifery services, which are run locally. Private insurance tends to focus on specialist treatment.

The existence of both public-private insurance has created inequities of care, prompting reform efforts in 2000 to increase equality across the country.

Chile has guaranteed universal access to quality treatment for some conditions including certain cancers, HIV/AIDS, pneumonia, depression and dental care, which has improved care for the poor, according to the WHO.

China

China announced an overhaul of its health system in 2009 to bring safe, affordable basic health services to all residents -- a tall order for a country containing 1.3 billion people.

The government committed about $126 billion to reform the quality and efficiency of its health care, and ensure affordable and quality medication.

But the issue of equity in health care persists. "There are still significant disparities in health status between regions, urban and rural areas, and among population groups," according to the WHO.

China has seen increased life expectancy and reductions in infant deaths, but health observers stated in the WHO report the need to improve delivery of care.

Pharmpro.com - The United Nations Conference on Sustainable Development (Rio+20) has adopted a series of measures that have the potential to contribute to a more equitable, cleaner, greener, and more prosperous world - and recognizes the important linkages between health and development.

"The Future We Want" conference outcome document, agreed upon by member states attending the 20-22 June conference, highlights the fact that better health is a "precondition for, an outcome of, and an indicator of sustainable development".

"This focus on the links between health and sustainable development is critical," said Dr Margaret Chan, Director-General of the World Health Organization WHO. "Healthy people are better able to learn, be productive and contribute to their communities. At the same time, a healthy environment is a prerequisite for good health."

The outcome document also emphasizes the importance of universal health coverage to enhancing health, social cohesion and sustainable human and economic development. And it acknowledges that the global burden and threat of non-communicable diseases (NCDs) constitutes one of the major sustainable development challenges of the 21st century.

The document states: "We are convinced that action on the social and environmental determinants of health, both for the poor and the vulnerable and the entire population, is important to create inclusive, equitable, economically productive and healthy societies. We call for the full realization of the right to the enjoyment of the highest attainable standard of physical and mental health".

Health-related development issues covered in detail in the outcome document include:

- Access to better energy services including sustainable cooking and heating solutions, which can significantly reduce childhood pneumonia and adult cardiopulmonary disease deaths from indoor air pollution;

- Greater focus on urban planning measures including more sustainable, energy-efficient housing and transport - which can significantly reduce many NCD risks, e.g. cardiopulmonary diseases from air pollution, health risks from physical inactivity and traffic injury;

- Better sanitation in cities and villages to protect against the spread of communicable diseases;

- Sustainable food systems that combat hunger and contribute to better health and nutrition;

- More sustainable water usage, meeting basic needs for safe drinking-water and stewardship of water supplies to grow food;

- Assurance that all jobs and workplaces meet minimum safety and health standards to reduce cancer, chronic lung diseases, injuries and early deaths.

Rio+20 also underlined the vital need for universal health coverage (including policies to prevent, protect and promote public health). Currently, 150 million people worldwide suffer severe financial hardship each year because they fall ill and cannot afford to pay for the services or medicines they need to recover. Universal health coverage can therefore fight poverty and build more resilient and prosperous communities.

An outcome of the 1992 Rio Conference (The 1992 UN Conference on Environment and Development) was Agenda 21, a comprehensive plan for global and local action.

Chapter Six of this document focused on 'Protecting and Promoting Human Health'. Over the past 20 years, WHO has worked in the five areas outlined in that chapter: meeting primary health care needs particularly in rural areas; control of communicable diseases; protecting vulnerable groups; meeting the urban health challenge; and reducing environmental health risks, which are often exacerbated by unsustainable development. The Organization will continue this work and scale up efforts to help countries aiming to achieve universal health coverage and prevent and treat noncommunicable diseases.