SPH Scholarly Articles

Economic uncertainty negatively impacts employment and production. However, little is known about the associations between uncertainty shocks and health over time. We employ a time-series econometric model to analyze the propagation patterns of uncertainty shocks on mortality, using daily data from the Economic Policy Uncertainty Index and the UK national death registry. We observe immediate increases in suicide, drug poisoning deaths, and in cardiovascular mortality at weekly horizons. Suicide and drug poisoning deaths rise by up to 2.3%, with the positive association persisting for three weeks before returning to baseline by week six. Cardiovascular mortality rises by 0.9%, persists for one week, and increases modestly again during weeks five and six. Our results demonstrate transmission patterns of uncertainty shocks across causes of death, reflecting both individual and systemic responses during uncertain times.

Energy-dense, nutrient-poor foods are prevalent across Harvard's cafes, vending machines, and grab-and-go locations, making it challenging for busy students, faculty, and staff to consistently choose healthier options. Nationally, 44% of college students report being overweight or obese, over 60% consume sugary drinks daily, and only 19% eat adequate fruit and 29% adequate vegetables. Among college freshmen, only 4% meet refined grain recommendations, one-third meet added sugar guidelines, and fewer than half adhere to saturated fat limits. Disparities exist by income, gender, and race/ethnicity. Lower-income students are more likely to make less healthy food choices, and males generally make poorer dietary choices than females. Nationally, non-Hispanic Black adults experience the highest obesity prevalence at 49.9%. These patterns underscore structural and environmental drivers of poor diet quality.

On September 5, 2023, Hong Kong’s Court of Final Appeal ruled in Sham Tsz Kit v Secretary for Justice that the legislature must create an alternative legal framework within two years to allow same-sex couples to manage their civil affairs. However, the court declined to recognise same-sex marriage, unanimously holding that the gendered marriage provisions in the constitutional documents, as a lex specialis, override broader guarantees of privacy and equality. While lex specialis is traditionally used to resolve normative conflicts, its application in human rights contexts remains contested. This article argues that the court’s reliance on lex specialis is theoretically flawed and inconsistent with international human rights jurisprudence. Instead, a proportionality test should be adopted to adjudicate conflicts between constitutional rights. Through a close reading of Sham, this article contributes to broader debates on constitutional interpretation and LGBTQ+ rights in Hong Kong.

This policy brief was developed as part of the collaboration between the Harvard Health Systems Innovation Lab and the Changing Diabetes in Children (CDiC) program, in collaboration with and supported by Novo Nordisk. The analysis currently focuses on the 30 countries where CDiC is active. The brief presents results on opportunities to expand fiscal space for health. A technical report and manuscript with detailed methodology and findings are forthcoming.

Introduction: Iron-folic acid (IFA) and calcium supplementation are recommended during pregnancy; however, calcium may inhibit iron absorption. While recent trials have shown daily low-dose 500 mg calcium supplementation to be noninferior to the recommended high-dose 1500 mg regimen for prevention of preeclampsia, its effects on maternal anaemia and iron status remain unclear. Methods: We conducted two individually randomized, non-inferiority trials in India and Tanzania (N=11,000 each) comparing daily 500 mg to 1500 mg calcium supplementation during pregnancy. All participants received standard IFA (60 mg iron) and were counselled to take calcium supplements several hours apart from the IFA. All participants had haemoglobin measured at baseline and at 32 weeks of gestation, while a random subset of participants had ferritin quantified at the same time points. Using an intention-to-treat approach, we assessed effects of 500 mg compared to 1500 mg calcium supplementation on mean haemoglobin and inflammation-adjusted serum ferritin concentrations using generalised linear models, and on anaemia, and iron deficiency anaemia using log-binomial models. Results: Third-trimester haemoglobin and serum ferritin were measured in 8,953 and 1,336 participants in India, respectively. In Tanzania, 8,496 participants had haemoglobin and 882 had ferritin assessed. In both trials, there was no difference between 500 and 1500 mg calcium supplementation on third-trimester haemoglobin [India: mean difference (MD) 0.01 (95% confidence intervals (CIs): -0.03, 0.04); Tanzania: MD -0.02 (95% CIs: -0.07, 0.03)], anaemia [India: relative risk (RR) 1.01 (95% CIs: 0.95, 1.07); Tanzania: RR 1.00 (95% CIs: 0.96, 1.05)], or iron deficiency anaemia [India: RR 1.20 (95% CIs: 0.93, 1.57); Tanzania: RR 0.94 (95% CIs: 0.77, 1.15)]. Conclusion: Low and high-dose calcium supplementation showed no differences in third-trimester hematologic outcomes. Future studies should assess co-administering or combining calcium and IFA into a single tablet on adherence and maternal iron status.

Objective: Hypertensive disorders of pregnancy (HDP) cause 10-15% of maternal deaths globally. Calcium-supplementation can prevent preeclampsia in low- and middle-income countries (LMICs) with low dietary calcium intake, but data on acceptability and adherence to high-dose supplementation (≥1000 mg/d) in public health programs is limited. Setting: We evaluated the acceptability and adherence to routine antenatal calcium-supplementation among pregnant women and healthcare providers in urban Bangalore. Design: An open-label study of 1000mg/d calcium-supplementation was conducted among 275 pregnant women, enrolled ≤20 weeks of gestation attending routine-antenatal-care (ANC), and followed-up until delivery. A mixed-methods approach was used to assess perception, acceptability, and factors influencing calcium-supplementation. Focus group discussions (FGDs) were conducted with pregnant women and healthcare workers. Result: After the first-month of taking calcium, post recruitment, 13.4% reported to have disliked the calcium supplement and this decreased to 7.9% in third trimester. Overall, 157 (57.3%) had ≥75% adherence to the calcium-supplementation regimen. Disliking calcium pills at first ANC follow-up (OR:3.5, 95%; CI:1.58–7.57) or the third trimester visit (OR:7.5, 95%; CI:2.38–23.40) was significantly associated with <75% adherence to calcium-supplementation. FGDs in third trimester identified enablers such as self-perceived benefits, family, and healthcare worker support, while barriers included preference for private clinics (which did not provide free-calcium-supplements), the size and number of calcium tablets/day. Conclusion: Achieving high adherence to calcium-supplementation was challenging during pregnancy. Interventions and strategies supporting pregnant women, while considering the roles of families and healthcare systems, should be assessed to enhance the effective implementation of calcium-supplementation during pregnancy.

The purpose of this paper is to provide a narrative review of many aspects of the outward facing work of congregations and faith-based organizations. While the majority of the paper is spent on the review, the final portion of the paper outlines the importance of equipping faith communities to better describe and assess the impact of their own work and the value of establishing common metrics such that congregations and faith-based organizations can facilitate greater learning about best practices within and between themselves. We further suggest that efforts to understand how churches flourish must include the outward facing work of faith communities to gain a more comprehensive understanding of how faith motivates and sustains care for the larger community. Finally, while many of these suggestions are put forward for the benefit of faith communities and organizations themselves, we point to important ways in which such efforts can make a meaningful contribution to broader policy discussions about the role of faith communities as partners in the promotion of community health and well-being.

This report reflects on the experiences of the 5th annual Harvard Health Systems Innovation Lab’s Hackathon, held on April 5th and 6th, 2024. The event, themed ‘Building High-Value Health Systems: Harnessing Digital Health and Artificial Intelligence’, took place across eight global Hubs: Boston, Buenos Aires, Kyiv, Lima, Chiclayo, London, Santiago, and São Paulo. Organized under the guidance of Professor Rifat Atun and a dedicated team, the Hackathon aimed to foster innovation in healthcare systems by bringing together diverse participants to develop practical solutions to critical health challenges.

The Hackathon featured three tracks: Cardiovascular Diseases and Diabetes, Cancer, and Mental Health. Out of over 1100 applications, about 500 participants were selected to join the hackathon across all Hubs. Participants, supported by mentors, developed and pitched their solutions to local and global judging panels. All teams pitched to the local judges, with 20 teams advancing to the global judging. The global judges selected the final winning teams, who joined the HSIL Venture Incubation Program.

Key recommendations for future hackathons include early engagement with Hubs, supporting new hubs through partnerships with experienced ones, leveraging social media for participant recruitment, and building strong partnerships for support of teams during and after the Hackathon. Participant feedback indicated high satisfaction, with an overall event rating of 4.32 out of 5.

The 2024 HSIL Hackathon successfully facilitated collaboration, innovation, and knowledge exchange, reinforcing its mission to create ventures that add value to health systems globally. Future hackathons will focus on strengthening partnerships and expanding the network of hubs to enhance global impact.

This report highlights and studies a major trend already underway in most health systems: the imperative to achieve better health outcomes and curb rising healthcare costs. Among G20+ nations, the major challenges that confront health systems and which drive this shift include, among others, unsustainable cost increases, rising citizen demand for health services, poor uptake of innovations, widening disparities in access to individual and public health services, and worsening inequalities in health outcomes.

As a result, many G20+ countries seek to transform their health systems to deliver both ‘value for money and value for many’. However, to date, most initiatives designed to achieve this objective have occurred at the departmental or organizational level and have yet to improve the performance of health systems as a whole to achieve large-scale population-level impact.

This study adopts a systems lens to explore how G20+ countries are embracing a value orientation and the policies, programs, innovations, and institutional arrangements they are introducing to improve the efficiency, effectiveness, equity, and responsiveness of health services, and thereby create value at the system level.

The Health Systems Innovation Lab at Harvard University (HSIL) has developed the Harvard High-Value Health System Model (HVHS) that draws upon nearly three decades of health systems research, engagement with large global health initiatives, and empirical data to analyze and characterize the shift underway from a systems perspective. The HVHS model consists of 10 interdependent components that include (I) digital data systems, (II) analytics, (III) cost measurement systems, (IV) outcomes measurement systems (V) benchmarking, (VI) integrated care pathways with bundled services, (VII) value-based payment models, (VIII) value-based procurement, (IX) integrated provider networks, and (X) strategic change and innovation ecosystems. The study finds that while all countries appear to be embracing some of the 10 components, no single country has yet to advance decisively in all components and to the fullest extent, to achieve the HVHS transition.

This study applies the HSIL framework to examine the progress of G20+ countries in transitioning to a HVHS, identify areas for improvement, and share best practices to accelerate progress. The research team surveyed experts, conducted interviews, and performed desk research to gather data on the progress of G20+ countries in relation to each component.

The study found that while G20+ countries are certainly progressing towards the HVHS model, the level of progress in each of the 10 components varies substantially across countries. For each component, we ascertain whether a country has demonstrated major, moderate, or some progress that could benefit from accelerated progression.

The components in which countries are experiencing major progress are digital data and strategic change programs. Meanwhile, the components related to analytics and cost and measurement systems registered the moderate progress. The components of value-based payment models and value-based procurement represent areas in which accelerated progression is needed. Most countries have established national policies on health data ownership and usage, and healthcare providers are widely utilizing digital data systems. However, there is still an opportunity to accelerate the use of existing data systems and deploy analytics at scale to improve policy and practice to create greater value. Additionally, less than 50% of the countries studied have established performance datasets that enable comparisons by regions or providers. The analysis also revealed that the countries studied have made slower progress in other areas, such as aligning financial incentives and establishing systems for regular measurement of costs and outcomes. Nonetheless, the study identified multiple examples of valuable initiatives that could inspire other governments to focus on specific components to improve and accelerate their transition to HVHS.

We discuss three strategies that G20+ countries could pursue when transitioning to the HVHS model, and provide examples, namely: (I) Extension: extending scope—from one to multiple HVHS components—followed by expansion of scale—from a small initiative to a health-system wide intervention—; (II) Expansion: expanding scale followed by extension of scope, and; (III) Transformation: a hybrid approach that simultaneously combines extension with expansion with the introduction of system level transformations. While most countries appear to follow the expansion and extension strategies, fewer embark on a transformational approach.

In pursuing these strategies, countries should invest in five critical enablers that could help accelerate the transition to the HVHS Model: • Development of a National HVHS Transition Strategy (NHTS): high-level strategic documents that recognize commitment to the HVHS model and align a nation’s vision for its health system transformation with national political, economic, and social objectives. • Leadership: the demonstration of distributed leadership across all major stakeholders involved in health systems instead of the zero-sum game that currently characterizes it. • Financing: expanded fiscal space and innovative financing measures to invest in NHTS and potentially transformative demonstration projects. • Global benchmarking and cross-learning: the development of a global HVHS data set and case study library to understand better health system transition in G20+ countries and promote cross-learning about what works and what does not among G20+ nations. • Innovation: the creation of an enabling ecosystem that promotes the design, introduction, and scale-up of value-based innovations in health systems and system level receptivity to innovation uptake and diffusion.

The transition to a high-value health system is a critical goal for all G20+ countries to optimize health system functions and deliver high-value health services to citizens. The findings of this study provide valuable information to inform this transition. We propose that the G20+ countries conduct this survey annually to provide ongoing information about the group’s evolution in the path of a value-based health system. There is valuable experience among the group of G20+ countries in different components that should encourage cooperation and cross-learning initiatives to achieve a faster transition to a HVHS.