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Objective To develop a new method for estimating the cost to governments of enacting public health legislation. Methods We adopted a central government perspective in estimating costs. The parliamentary cost of legislative acts and regulations in New Zealand was calculated from the proportion of parliamentary time devoted to law-making (i.e. sitting days in the debating chamber), and the cost of associated policy advice from government agencies was calculated from the proportion of documented policy issues related to law-making. The relative costs of acts and regulations were estimated from the number of pages in the legislation. Findings We estimated that, between 1999 and 2010, 26.7% of parliamentary resources and 16.7% of policy advice from government agencies were devoted to generating new laws in New Zealand. The mean cost of an act was 2.6 million United States dollars (US$; 95% uncertainty interval, UI: 1.5 to 4.4 million) and the mean cost of a regulation was US$ 382 000 (95% UI: 221 000 to 665 000). For comparison, the average cost of a bill enacted by the 50 state governments in the United States of America between 2008 and 2009 was US$ 980 000. Conclusion We were able to estimate the cost of new legislation in New Zealand. Our method for estimating this cost seemed to capture the main government costs involved and appears to be generally applicable to other developed countries. Ideally such costs should be included in economic evaluations of public health interventions that involve new legislation. Objectit Mettre au point une nouvelle methode d'estimation du cout de la promulgation de lois de sante publique pour les gouvernements. Methodes Nous avons adopte la perspective du gouvernement central pour l'estimation des couts. Le cout parlementaire des reglements et actes Iegislatifs en Nouvelle-Zelande a ete calcule au prorata du temps parlementaire consacre a l'elaboration des lois (plus precisement en jours de seance dans la chambre des debats), et le cout des conseils politiques associes fournis par les agences gouvernementales a ete calcule au prorata des publications politiques documentees relatives a l'elaboration des lois. Les couts relatifs des lois et reglements ont ete estimes a partir du nombre de pages contenues dans la Iegislation. Resultats Nous avons estime qu'entre 1999 et 2010, 26,7% des ressources parlementaires et 16,7% des conseils politiques des agences gouvernementales ont ete alloues a la proposition de nouvelles lois en Nouvelle-Zelande. Le cout moyen d'une loi etait de 2,6 millions de dollars americains (intervalle d'incertitude de 95%, II:1,5 a 4,4 millions), et le cout moyen d'un reglement etait de 382 000 $ (II de 95%: 221 000 a 665 000). A titre de comparaison, le cout moyen d'un projet de loi adopte par les 50 gouvernements federaux des Etats-Unis d'Amerique entre 2008 et 2009 etait de 980 000 $. Conclusion Nous avons ete en mesure d'estimer le cout de la nouvelle Iegislation en Nouvelle-Zelande. Notre methode d'estimation de ce cout semblait englober les principaux couts gouvernementaux concernes et parait etre globalement applicable a d'autres pays developpes. Dans l'ideal, de tels couts devraient etre inclus dans les evaluations economiques des interventions de sante publique qui impliquent une nouvelle legislation. Objetivo Desarrollar un metodo nuevo para calcular el coste que supondria a los gobiernos la promulgacion de una legislacion sobre sanidad publica. Metodos Hemos adoptado la perspectiva de un gobierno central para calcular los costes. El coste parlamentario de los actos legislativos y reglamentos en Nueva Zelandia se calculo en funcion de la proporcion de tiempo parlamentario consagrado a la creacion de la ley (es decir, de los dias de sesion en la camara de debate) y el coste del asesoramiento sobre politicas por parte de las agencias gubernamentales se calculo a partir de la proporcion de cuestiones politicas documentadas relacionadas con la creacion de la ley. Los costes relativos de las leyes y los reglamentos se calcularon en funcion del numero de paginas en la legislacion. Resultados Se calculo que, entre los anos 1999 y 2010, se dedico el 26,7% de los recursos parlamentarios y el 16,7% del asesoramiento politico procedente de las agencias gubernamentales a la creacion de nuevas leyes en Nueva Zelandia. El coste medio de una ley fue de US$ 2,6 millones (95% intervalo de incertidumbre, II: entre 1,5 y 4,4 millones) y el coste medio de un reglamento fue de US$ 382 000 (95% II: de 221 000 a 66.5 000). A modo de comparativa, el coste medio de un proyecto de ley promulgado por los 50 estados miembros de los Estados Unidos de America entre 2008 y 2009 fue de US$ 980 000. Conclusion Hemos podido calcular el coste de una nueva legislacion en Nueva Zelandia. Nuestro metodo para calcular este coste abarco los principales gastos gubernamentales implicados y podria aplicarse a otros paises desarrollados. Lo ideal seria que dichos costes se incluyeran en las evaluaciones economicas de aquellas intervenciones de la sanidad publica que implicaran unalegislacion nueva., Introduction There is strong scientific evidence that the law can help improve public health. A recent publication identified 65 systematic reviews of studies on the effectiveness of a total of [...]

Objective To explore a risk factor approach for identifying preventive interventions that require more in-depth economic assessment, including cost-effectiveness analyses. Methods A three-step approach was employed to: (i) identify the risk factors that contribute most substantially to disability-adjusted life years (DALYs); (ii) re-rank these risk factors based on the availability of effective preventive interventions warranting further cost-effectiveness analysis (and in some instances on evidence from existing cost-effectiveness analyses); and (iii) re-rank these risk factors in accordance with their relative contribution to health inequalities. Health inequalities between the Maori and non-Maori populations in New Zealand were used by way of illustration. Findings Seven of the top 10 risk factors prioritized for research on preventive interventions in New Zealand were also among the 10 risk factors most highly ranked as contributing to DALYs in high-income countries of the World Health Organization's Western Pacific Region. The final list of priority risk factors included tobacco use; alcohol use; high blood pressure; high blood cholesterol; overweight/obesity, and physical inactivity. All of these factors contributed to health inequalities. Effective interventions for preventing all of them are available, and for each risk factor there is at least one documented cost-saving preventive intervention. Conclusion The straightforward approach to prioritizing risk factors described in this paper may be applicable in many countries, and even in those countries that lack the capacity to perform additional cost-effectiveness analyses, this approach will still make it possible to determine which cost-effective interventions should be implemented in the short run. [TEXT NOT REPRODUCIBLE IN ASCII.] Prioriser les facteurs de risque pour identifier les interventions preventives a evaluer economiquement Objectif Etudier une approche fondee sur les facteurs de risque pour identifier les interventions preventives necessitant une evaluation economique plus approfondie, y compris des analyses de rentabilite. Methodes Une approche en trois etapes a ete utilisee pour (i) identifier les facteurs de risque contribuant en grande partie aux annees de vie corrigees du facteur invalidite (AVCI), (ii) reclasser ces facteurs de risque en fonction de la disponibilite des interventions preventives efficaces justifiant une analyse supplementaire de rentabilite (et, dans certains cas, sur la base de preuves provenant d'analyses de rentabilite existantes), et (iii) reclasser ces facteurs de risque en fonction de leur contribution relative aux inegalites de sante. Les inegalites de sante entre les populations maories et non maories en Nouvelle-Zelande ont ete utilisees a titre d'illustration. Resultats Sept des dix principaux facteurs de risque priorises pour la recherche sur les interventions preventives en Nouvelle-Zelande figuraient egalement parmiles dix facteurs de risque contribuant le plus aux AVCI dans les pays a revenu eleve de la region du Pacifique occidental de l'Organisation mondiale de la Sante. La liste definitive des facteurs de risque prioritaires incluait le tabagisme, la consommation d'alcool, l'hypertension arterielle, l'hypercholesterolemie, le surpoids/l'obesite et l'inactivite physique. Tous ces facteurs contribuaient a des inegalites de sante. Des interventions efficaces pour prevenir chacun d'eux sont disponibles, et il existe au moins une intervention preventive plus economique connue pour chaque facteur de risque. Conclusion L'approche simple de priorisation des facteurs de risque decrite dans cet article peut etre applicable dans de nombreux pays. Meme dans les pays qui n'ont pas la capacite d'effectuer des analyses de rentabilite complementaires, cette approche permettra de determiner quelles interventions rentables devraient etre mises en ceuvre a court terme. [TEXT NOT REPRODUCIBLE IN ASCII.] Determinacion de la prioridad de los factores de riesgo con el fin de identificar las intervenciones preventivas para la evaluacion economica Objetivo Explorar una estrategia en relacion con los factores de riesgo que permita la identificacion de las intervenciones preventivas que requieran una evaluacion economica de mayor profundidad, incluyendo los analisis de rentabilidad. Metodos Se aplico una estrategia en tres etapas con el fin de (i) identificar los factores de riesgo que contribuyen de manera mas significativa a los anos de vida ajustados en funcion de la discapacidad (AVAD); (ii) volver a clasificar estos factores de riesgo en base a la disponibilidad de intervenciones preventivas eficaces que justifiquen la realizacion de analisis de rentabilidad adicionales (y, en algunos casos, en base a las evidencias procedentes de los analisis de rentabilidad existentes); y (iii) volver a clasificar estos factores de riesgo de acuerdo con su contribucion relativa a las desigualdades sanitarias. A modo de ilustracion, se analizaron las desigualdades sanitarias entre las poblaciones maories y no maories de Nueva Zelanda. Resultados Siete de los 10 factores de riesgo prioritarios para la investigacion sobre las intervenciones preventivas en Nueva Zelanda tambien se encontraron entre los 10 factores de riesgo con mayor calificacion en cuanto a su contribucion a los AVAD en paises de ingresos altos de la Region del Pacifico Occidental de la Organizacion Mundial de la Salud. En la lista definitiva de los factores de riesgo prioritarios se incluyeron el tabaquismo, el consumo de alcohol, la presion arterial alta, un nivel elevado de colesterol, el sobrepeso/obesidad y el sedentarismo. Todos estos factores contribuyeron a las desigualdades sanitarias. Se han desarrollado intervenciones eficaces para prevenir todos estos factores, y para cada factor de riesgo se ha documentado al menos una intervencion preventiva destinada al ahorro de costes. Conclusion La sencilla estrategia consistente en establecer la prioridad de los factores de riesgo descritos en este documento puede ser aplicable en muchos paises, e incluso en aquellos paises que carezcan de la capacidad necesaria para llevar a cabo los analisis de rentabilidad adicionales, esta estrategia tambien permitira determinar que intervenciones rentables se han de aplicar a corto plazo., Introduction Most countries seek to improve the health of their populations while reducing health inequalities. They must therefore deploy their health sector resources, which are often scarce, in a manner [...]

To authenticate to the full-text of this article, please visit this link: http://dx.doi.org/10.1111/j.1745-7939.2009.01164.x Byline: Anna Stevenson (1), Jamie Pearce (2), Tony Blakely (3), Vivienne Ivory (3), Karen Witten (4) Keywords: health; health inequality; neighbourhood; New Zealand Abstract: Abstract Over the past two decades, there has been a resurgence of interest into place-based influences on health. Researchers have identified that various characteristics of neighbourhoods exert an influence on the health outcomes and behaviours of local residents. Understanding the processes linking places to health provides considerable potential for a range of policy interventions. We review the New Zealand-based neighbourhoods and health research. Consideration is given to the types of neighbourhood characteristics, as well the range of health outcomes that have been studied. Finally, we suggest some priorities for further research into the mechanisms underpinning neighbourhood influences on health in New Zealand. Author Affiliation: (1)Community and Public Health, Canterbury District Health Board, Christchurch, New Zealand; (2)Institute of Geography, School of GeoSciences, University of Edinburgh, Edinburgh, UK; (3)Health Inequalities Research Programme, University of Otago, Wellington, New Zealand; (4)Centre for Social and Health Outcomes Research and Evaluation, Massey University, Auckland, New Zealand Article note: Anna Stevenson is a public health physician who works with Christchurch City Council and the Canterbury District Health Board on urban design issues; Jamie Pearce is a reader in Human Geography at the University of Edinburgh, UK, and co-director of the GeoHealth Laboratory, Department of Geography, University of Canterbury; Tony Blakely is research professor of Public Health at the Wellington School of Medicine and Health Sciences, University of Otago and the director of the Health Inequalities Research Programme (HIRP); Vivienne Ivory is a research fellow on the HIRP, Wellington School of Medicine and Health Sciences, University of Otago; Karen Witten is associate professor at the Centre for Social and Health Outcomes Research and Evaluation (SHORE), Massey University, Auckland., E-mail: jamie.pearce@ed.ac.uk; jamie.pearce@canterbury.ac.nz

Abstract Ethnicity is often assumed to be a stable construct. However, much research in New Zealand has shown growth in the number of people reporting multiple ethnicities and changes in [...]

Objectives: To explore the contributions of socio-economic and demographic factors to ethnic disparity among older adult (65+) all cause and cause-specific mortality differentials among Maori, Pacific, Asians and non-Maori, non-Pacific non-Asian (nMnPnA) in New Zealand. Methods: We used univariate and multivariable Poisson regression models on linked New Zealand census and mortality data for older adults (65 years and above) (2001 to 2004, 1.3 million person years) with a comprehensive set of socio-economic indicators (education, income, car access, housing tenure, neighourhood deprivation). Results: After controlling for the differences in age structure, Maori and Pacific males had a higher relative risk of dying than nMnPnA (RR=1.88 (95% CI: 1.74, 2.04) and RR=1.75 (95% CI: 1.54, 1.99) respectively) while Asian males had lower risk of dying (RR=0.66, 95% CI: 0.57, 0.76). For females, the pattern was similar. The mortality gap between ethnic groups was mediated in part by socio-economic factors. The five socio-economic factors appear to account for greater than 40% of the excess mortality for Maori and Pacific men and about 34% for Maori females and 48% for Pacific females compared to nMnPnA men and nMnPnA women respectively. However, for Asian people, adjusting for socio-economic factors actually increases the relative gaps in mortality compared to nMnPnA by 18% for male and 71% for females. Conclusion: The results demonstrate that clear ethnic mortality gradients persist into old age and the mortality level of most groups was influenced by varying distribution of socio-economic factors. To reduce ethnic differences in old age mortality, inequalities as a result of socioeconomic position should be reduced. Keywords: Ethnicity, socio-economic status, mortality, ageing, New Zealand

Background An increasing number of countries are implementing taxes on unhealthy foods and drinks to address the growing burden of dietary-related disease, but the cost-effectiveness of combining taxes on unhealthy foods and subsidies on healthy foods is not well understood. Methods and Findings Using a population model of dietary-related diseases and health care costs and food price elasticities, we simulated the effect of taxes on saturated fat, salt, sugar, and sugar-sweetened beverages and a subsidy on fruits and vegetables, over the lifetime of the Australian population. The sizes of the taxes and subsidy were set such that, when combined as a package, there would be a negligible effect on average weekly expenditure on food ( Conclusions With potentially large health benefits for the Australian population and large benefits in reducing health sector spending on the treatment of non-communicable diseases, the formulation of a tax and subsidy package should be given a more prominent role in Australia's public health nutrition strategy., Author(s): Linda J. Cobiac 1,*, King Tam 2, Lennert Veerman 2, Tony Blakely 3 Introduction The relationship between non-communicable diseases and consumption of unhealthy foods and drinks is well known, [...]

To review research evidence on the effectiveness of monetary incentives in modifying dietary behavior, we conducted a systematic review of randomized, controlled trials (RCTs) identified from electronic bibliographic databases and reference lists of retrieved relevant articles. Studies eligible for inclusion met the following criteria: RCT comparing a form of monetary incentive with a comparative intervention or control; incentives were a central component of the study intervention and their effect was able to be disaggregated from other intervention components; study participants were community-based; and outcome variables included anthropometric or dietary assessment measures. Data were extracted on study populations, setting, interventions, outcome variables, trial duration, and follow-up. Appraisal of trial methodological quality was undertaken based on comparability of baseline characteristics, randomization method, allocation concealment, blinding, follow-up, and use of intention-to-treat analysis. Four RCTs were identified as meeting the inclusion criteria. All four trials demonstrated a positive effect of monetary incentives on food purchases, food consumption, or weight loss. However, the trials had some methodological limitations including small sample sizes and short durations. In addition, no studies to date have assessed effects according to socioeconomic or ethnic group or measured the cost-effectiveness of such schemes. Monetary incentives are a promising strategy to modify dietary behavior, but more research is needed to address the gaps in evidence. In particular, larger, long-term RCTs are needed with population groups at high risk of nutrition-related diseases. Key words: diet, incentives, intervention doi: 10.1301/nr.2006.dec.518-531

Personal or household income predicts mortality risk, with each additional dollar of income conferring a slightly smaller decrease in the mortality risk. Regardless of whether levels of income inequality in a society impact on mortality rates over and above this individual-level association (i.e., the 'income inequality hypothesis'), the current consensus is that narrowing income distributions will probably improve overall health status and reduce socio-economic inequalities in health. Our objective was to quantify this impact in a national population using 1.3 million 25-59-year-old respondents to the New Zealand 1996 census followed-up for mortality over 3 years. We modelled 10-40% shifts of everyone's income to the mean income (equivalent to 10-40% reductions in the Gini coefficient). The strength of the income-mortality association was modelled using rate ratios from Poisson regression of mortality on the logarithm of equivalised household income, adjusted for confounders of age, marital status, education, car access, and neighbourhood socio-economic deprivation. Overall mortality reduced by 4-13% following 10-40% shifts in everyone's income, respectively. Inequalities in mortality reduced by 12-38% following 10-40% shifts in everyone's income. Sensitivity analyses suggested that halving the strength of the income-mortality association (i.e., assuming our multivariable estimate still overestimated the causal income mortality association) would result in 2 6% reductions in overall mortality and 6-19% reductions in inequalities in mortality in this New Zealand setting. Many commentators have noted the non-linear association of income with mortality predicts that narrowing the income distribution will both reduce overall mortality rates and reduce inequalities in mortality. Quantifying such reductions can only be done with considerable uncertainty. Nevertheless, we tentatively suggest that the gains in overall mortality will be modest (although still potentially worthwhile from a policy perspective) and the reductions in inequalities in mortality will be more substantial. Keywords: Income redistribution; Income; Mortality; Modelling; Inequality; New Zealand

Background: Ethnicity and socio-economic position are important determinants of colorectal cancer (CRC) mortality. In this paper, we determine trends in colorectal cancer mortality by ethnicity and socioeconomic position in New Zealand. Methods: Cohort studies of the entire New Zealand population for 1981-84, 1986-89, 1991-94 and 1996-99 (linking Census and mortality datasets) allowed direct determination of trends in CRC mortality by income and education. For ethnicity, we used routine unlinked Census and mortality data, but with correction factors applied for undercounting of Maori and Pacific deaths. Results: Ethnicity: CRC mortality trends varied markedly. There were small (10-20%) decreases among non-Maori non-Pacific people, a 50% increase among Maori, and up to 10-fold increase among Pacific people. By 1996-99, all three ethnic groups had similar CRC mortality. Socio-economic position: For females, differences in CRC mortality by education and income increased over time e.g. poor females had a 40% higher CRC mortality than rich females in 1996-99, compared with no difference in 1981-84 (p for trend 0.04). In men, increases in inequality were seen by income but not education. Conclusion: The observed ethnic trends probably reflect differential trends in exposure to etiological risk factors. Social inequalities in colorectal cancer mortality appear to be increasing.

The aim of this paper is to determine the extent of undercounting of Maori and Pacific deaths in New Zealand during the 1980s and 1990s, and to calculate corrected ethnic mortality and life expectancy trends. We calculated adjustment ratios for undercounting of Maori and Pacific deaths (and over-counting of non-M/iori non-Pacific (nMnP) deaths) using the linked census-mortality data. These ratios were then used to calculate corrected mortality rates and life expectancies. Maori deaths were underestimated by a quarter, and Pacific deaths by a third, during the 1980s and early 1990s. Undercounting was minor in the late 1990s following alignment of ethnicity collection on mortality data to approximate the census. Corrected mortality rates demonstrated 30% (males) and 26% (females) decreases among nMnP from 1980-84 to 1996-99, smaller decreases among Maori (8% and 7%) and no clear change among Pacific people (9% decrease for males, 4% increase for females). The gap in life expectancy increased from an average of 7.7 years in 1980-84 to 10.8 years in 1996-99 for Maori, and from 3.3 to 7.7 years for Pacific people, in comparison to nMnP people. Deaths among 45-64 and 65 plus year olds, and cardiovascular disease and cancer deaths, were the main contributors to these disparities. The economic reforms in New Zealand during the 1980s and early 1990s impacted harder upon Maori and Pacific people in terms of unemployment and income, and are a likely explanation for the diverging mortality trends in this period. Both behavioural factors and health services probably also play a role, but in the absence of trend data by ethnicity, their contribution to diverging mortality trends is unknown. Internationally, our study demonstrates marked undercounting of Maori and Pacific deaths. We strongly encourage researchers and custodians of vital statistics in other countries to investigate the possibility of undercounting of deaths by ethnicity. Keywords: Mortality; New Zealand; Ethnic groups; Socio-economic factors; Health services; Risk factors; Numerator-denominator bias; Maori

We explored the contribution of stage at diagnosis to ethnic disparities in cancer survival in New Zealand. We linked 115811 adult patients with invasive cancer registered on the cancer registry (1994 to 2002) to mortality data. Age-standardized, 5-year relative survival rates were lowest for Maori, intermediate for Pacific people (otherwise known as Pacific Islanders), and highest for non-Maori/non-Pacific people for many cancers. Stage at diagnosis accounted for only part of these differences. Possible factors responsible for ethnic inequalities might include access to specialized cancer services and the quality of care received. doi: 10.2105/AJPH.2004. 053678)

Objective To estimate the individual-level association of income poverty with being underweight, using tobacco, drinking alcohol, having access only to unsafe water and sanitation, being exposed to indoor air pollution and being obese. Methods Using survey data for as many countries as possible, we estimated the relative risk association between income or assets and risk factors at the individual level within 11 medium- and low-income subregions of WHO. WHO and The World Bank data on the prevalence of risk factors and income poverty (defined as living on < US$ 1.00 per day, US$ 1-2.00 per day and > US$ 2.00 per day) were analysed to impute the association between poverty and risk factors for each subregion. The possible effect of poverty reduction on the prevalence of risk factors was estimated using population-attributable risk percentages. Findings There were strong associations between poverty and malnutrition among children, having access only to unsafe water and sanitation, and being exposed to indoor air pollution within each subregion (relative risks were twofold to threefold greater for those living on < US$ 1.00 per day compared with those living on > US$ 2.00 per day). Associations between poverty and obesity, tobacco use and alcohol use varied across subregions. If everyone living on < US$ 2.00 per day had the risk factor profile of those living on > US$ 2.00 per day, 51% of exposures to unimproved water and sanitation could be avoided as could 37% of malnutrition among children and 38% of exposure to indoor air pollution. The more realistic, but still challenging, Millennium Development Goal of halving the number of people living on < US$ 1.00 per day would achieve much smaller reductions. Conclusion To achieve large gains in global health requires both poverty eradication and public health action. The methods used in this study may be useful for monitoring pro-equity progress towards Millennium Development Goals. Keywords Poverty; Health status; Socioeconomic factors; Child nutrition disorders/epidemiology/economics; Water supply/economics; Sanitation/economics; Air pollution, Indoor/economics; Smoking/epidemiology/economics; Alcohol drinking/epidemiology/economics; Obesity/epidemiology/economics; World health; Risk factors (source: MeSH, NLM). Objectif Estimer l'association au niveau individuel entre pauvrete des revenus d'une part et maigreur, tabagisme, alcoolisme, absence d'acces a une eau saine et a des equipements sanitaires convenables, exposition a la pollution de l'air interieur et obesite, d'autre part. Methodes A l'aide de donnees d'enquete relatives au plus grand nombre possible de pays, les auteurs ont estime l'association correspondant au risque relatif entre le revenu ou les ressources et les facteurs de risque au niveau individuel dans 11 sous-regions de l'OMS a revenus moyens et faibles. Ils ont analyse les donnees de l'OMS et de la Banque mondiale sur la prevalence des facteurs de risque et du niveau de pauvrete (defini comme le fait de disposer pourvivre de moins de US $1,00 parjour, de US $1 a 2,00 par jour ou de plus de US $ 2,00 par jour) pour evaluer l'association entre pauvrete et facteurs de risque pour chaque sous-region. Ils ont estime l'effet eventuel d'une reduction de la pauvrete sur la prevalence des facteurs de risque a l'aide des pourcentages de risque attribuable des populations. Resultats Il existait de fortes associations entre pauvrete et malnutrition chez les enfants n'ayant acces qu'a de l'eau et des equipements sanitaires insalubres et exposes 9 la pollution de l'air interieur dans chaque sous-region (les risques relatifs etaient deux a trois fois plus eleves pour ceux vivant avec moins de US $1 par jour que pour ceux vivant avec plus de US $ 2 par jour). Les associations entre pauvrete d'une part et obesite, tabagisme ou alcoolisme d'autre part etaient variables d'une sous-region l'autre. Si toutes les personnes disposant de moins de US $ 2,00 par jour presentaient le profil de facteurs de risque de celles vivant avec plus de US $ 2,00 par jour, 51% des expositions a de l'eau et a un reseau sanitaire non traites, 37 % des cas de malnutrition infantile et 38 % des expositions & la pollution de l'air interieur pourraient etre evites. L'objectif de developpement du Millenaire, certes plus realiste, mais encore difficile a atteindre, consistant a reduire d'un facteur deux le nombre de personnes vivant avec moins de US $ 1,00 par jour, permettrait d'obtenir des diminutions plus faibles de ces nombres de cas. Conclusion L'obtention d'ameliorations consequentes de la sante dans le monde exige a la fois l'eradication de la pauvrete et des mesures de sante publique. Les methodes employees dans cette etude peuvent etre utiles a la surveillance des progres en faveur de l'equite dans la realisation des objectifs de developpement du Millenaire. Mots cles Pauvrete; Etat sanitaire; Facteur socioeconomique; Troubles nutrition enfant/economie; Alimentation eau/economie; Assainissement/economie; Pollution air ambiant/economie; Tabagisme/economie; Consommation alcool/economie; Obesite/economie; Sante mondiale; Facteur risque (source: MeSH, INSERM). Objetivo Estimar la relacion individual existente entre la pobreza de ingresos y la insuficiencia ponderal, el consumo de tabaco, el consumo de alcohol, el hecho de no disponer mas que de agua y saneamiento insalubres, la exposicion a aire contaminado en interiores y la obesidad. Metodos Usando datos encuestales para el maximo numero de paises posible, estimamos el riesgo relativo de asociacion de los ingresos o el patrimonio a factores de riesgo particulares en 11 subregiones de la OMS de ingresos bajos y medios. Se analizaron datos de la OMS y del Banco Mundial sobre la prevalencia de los factores de riesgo y la pobreza de ingresos (definida distinguiendo la subsistencia con menos de US$1,00 diarios, con US$1,00-2,00 diarios y con mas de US$ 2,00 diarios) a fin de determinar la relacion entre pobreza y factores de riesgo para cada subregion. El posible efecto de la reduccion de la pobreza en la prevalencia de los factores de riesgo se estimo a partir de los porcentajes de riesgo atribuible poblacionales. Resultados Se detecto una estrecha relacion entre la pobreza y la malnutricion infantil, el hecho de no disponer mas que de agua y saneamiento insalubres, y la exposicion a aire contaminado en interiores dentro de cada subregion (los riesgos relativos fueron entre dos y tres veces mayores entre quienes vivian con menos de US$1,00 al dia queen quienes subsistian con m& de US$ 2,00 al dia). El grado de asociacion de la pobreza a la obesidad, el consumo de tabaco y el consumo de alcohol diferia de una subregion a otra. Si todas las personas que viven con menos de US$ 2,00 al dia tuvieran el mismo perfil de factores de riesgo que las que viven con mas de US$ 2,00 diarios, se podrian evitar el 51% de los casos de exposicion a sistemas de abastecimiento de agua y saneamiento no mejorados, asi como el 37% de la malnutricion infantil y el 38% de la exposicion a aire contaminado en locales cerrados. El mas realista, pero con todo dificil, de los Objetivos de Desarrollo del Milenio de reducir a la mitad el n0mero de personas con menos de US$ 1,00 al dia se traduciria en disminuciones mucho menores. Conclusion Para conseguir grandes avances en el terreno de la salud mundial se requieren medidas tanto de erradicacion de la pobreza como de salud publica. Los metodos empleados en este estudio podrian ayudar a vigilar los progresos en equidad hacia los Objetivos de Desarrollo del Milenio. Palabras clave Pobreza; Estado de salud; Factores socioeconomicos; Trastornos de la nutricion del nino/economia; Abastecimiento de agua/economia; Saneamiento/economia; Contaminacion del aire interior/economia; Tabaquismo/economia; Consumo de bebidas alcoholicas/economia; Obesidad/economia; Salud mundial; Factores de riesgo (fuente: DeCS, BIREME). [TEXT NOT REPRODUCIBLE IN ASCII.], Introduction There is a large body of research conducted in richer countries on the socioeconomic determinants of health that contrasts health and disease status among individuals of varying socioeconomic positions [...]

Objectives: To revise and update the New Zealand Socio-economic Index (NZSEI) in the light of methodological issues in its construction, and to develop an imputation method for use where occupational information is not available. Methods: Data were drawn from the following New Zealand national surveys: 1996 Population Census; 1996/97 and 1997/98 Household Economic Surveys; 1996/97 Household Health Survey. Three sets of statistical analyses were applied: alternating least squares to generate socio-economic scores; cluster and discriminant function analyses to identify cut-points; and regression and logistic regression to develop and test imputation methods. Results: Socio-economic scores for the full-time workforce in 1996 showed a different distribution, but much the same occupational ordering, as in 1991. The introduction of part-time workers and income adjustment multipliers for self-employed workers significantly affected scores for management and agricultural titles. The application of cluster and discriminant function analyses generated six groupings that were relatively distinct occupationally. An imputation method based on an averaging of scores within age/qualification categories was found to achieve acceptable results. Conclusions: Methodological improvements in the construction of the NZSEI have enhanced its empirical robustness, while a simple imputation technique has widened the potential application of the scale.

Background: Measuring population health and costs effects of liberalizing access to electronic nicotine delivery systems (ENDS) is an evolving field with high persisting uncertainty. A critical area of uncertainty for policy-makers are estimates of net harms from ENDS relative to cigarettes, therefore, we model these harms using updated estimates incorporating disease specificity.Methods: We use updated estimates of relative harm of vaping vs smoking, based upon relevant biomarker studies to model the impact of liberalizing access to ENDS in New Zealand (NZ), relative to a ban (where ENDS are not legally available), in an existing proportional multi-state life-table model of 16 tobacco-related diseases.Results: This modeling suggests that ENDS liberalization results in an expected gain of 195 000 quality-adjusted life-years (QALYs) over the remainder of the NZ population's lifespan. There was wide uncertainty in QALYs gained (95% uncertainty interval [UI] = -8000 to 406 000) with a 3.2% probability of net health loss (based upon the number of simulation runs returning positive QALY gains). The average per capita health gain was 0.044 QALYs (equivalent to an extra 16 days of healthy life). Health system cost-savings were expected to be NZ$2.8 billion (US$2.1 billion in 2020 US$; 95%UI: -0.3 to 6.2 billion [2011 NZ$]), with an estimated 3% chance of a net increase in per capita cost.Conclusions: This updated modeling around liberalizing ENDs in NZ, still suggests likely net health and cost-saving benefits-but of lesser magnitude than previous work and with a small possibility of net harm to population health.Implications: This study found evidence using updated biomarker studies that ENDS liberalization could result in QALY gains across the New Zealand population lifespan that are also cost-saving to the health system. Governments should include the information from these types of modeling studies in their decision-making around potentially improving access to ENDS for existing smokers, while at the same further reducing access to tobacco. [ABSTRACT FROM AUTHOR]

We examined the association of income inequality measured at the metropolitan area (MA) and county levels with individual self-rated health. Individual-level data were drawn from 259,762 respondents to the March Current Population Survey in 1996 and 1998. Income inequality and average income were calculated from 1990 census data, the former using Gini coefficients. Multi-level logistic regression models were used. Controlling for sex, age, race, and individual-level household income, respondents living in high, medium-high, and medium-low income inequality MAs had odds ratios of fair/poor self-rated health of 1.20 (95% confidence interval 1.04-1.38), 1.07 (0.95-1.21), and 1.02 (0.91-1.15), respectively, compared to people living in the MAs with the lowest income inequality. However, we found only a small association of MA-level income inequality with fair/poor health when controlling further for average MA household income: odds ratios were 1.10 (0.95-1.28), 1.01 (0.89-1.14), and 1.00 (0.89-1.12), respectively. Likewise, we found only a small association of county-level income inequality with self-rated health--although only 40.7% of the sample had an identified county on CPS data. Regarding the association of state-level income inequality with fair/poor health, we found the association to be considerably stronger among non-metropolitan (i.e. rural) compared to metropolitan residents. Keywords: Income inequality; Socio-economic factors; Confounding factors; Multi-level studies; Self-rated health; Health status