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Protection vs. protectionism?

Dadian MJ

Aidscaptions, 1997 Jun;4(1):9.
PMID: 12321033
Matched MeSH terms: Taxes*
Fulltext Developing a strategy for cardiovascular disease: surveillance, prevention and healthcare

William Cairns Steward Smith

Int J Public Health Res, 2014;4(1):425-430.
MyJurnal

Introduction Cardiovascular diseases are a major component of non-communicable
diseases and include coronary heart disease, stroke and peripheral vascular
disease. Public health strategies to address cardiovascular disease require
three elements: surveillance, health promotion, and individual health care.

Methods Surveillance includes monitoring of mortality and morbidity as well as
surveys to monitor risk factors levels in the community. Data on mortality
from cardiovascular diseases are readily available and analysed by age and
sex specific rates looking are secular trends, geographical and ethnical group
variations and international comparisons. However many deaths from
cardiovascular disease occur suddenly and the cause of death may be
registered without autopsy or any other validation. Cardiovascular morbidity
information is more difficult to collate and interpret as it is closely related to
availability and access to health care. Periodic surveys of cardiovascular risk
factors are essential in monitoring the underlying trends in blood pressure,
smoking, cholesterol, obesity, and diabetes as they predict future trends, and
support planning for prevention and healthcare.

Results Prevention and health promotion activities are informed by the levels and
trends in cardiovascular disease and its risk factors. There has been debate
about population health promotion and individual health care strategies, but
both are necessary. Cigarette smoking, nutrition and physical exercise are the
main behaviours to be addressed but these are complex and require
multifaceted approaches. Education alone is insufficient to change health
behaviours and health promotion needs to look to changing attitudes.
Legislation, taxation and other fiscal interventions have been shown to be
effective however these can be difficult for legislators as there are other
competing interests, particularly in the area of nutrition and tobacco. Creating
health promoting environments that make healthy behaviour choices easier
can be beneficial.

Conclusions Health care interventions are also effective in reducing the burden of
cardiovascular disease. A balanced approach of health promotion and
individual health care is recommended in the development of a strategy for
cardiovascular disease.

Matched MeSH terms: Taxes
Controlling water pollution in developing and transition countries--lessons from three successful cases

Kathuria V

J Environ Manage, 2006 Mar;78(4):405-26.
PMID: 16171929

The policy prescription for solving environmental problems of developing countries and countries-in-transition (CIT) is slowly getting polarized into two viewpoints. One group of researchers and policy advocates including multilateral organizations upholds extensive use of market based instruments (MBIs) in these countries. The other group argues that institutions need to be built first or the policy makers should select the incremental or tiered approach taking into account the existing capabilities. The group also insists that the financial, institutional and political constraints make environmental regulation in these countries more problematic than in industrialized countries. In the short-run, the immediate needs of the developing countries can be addressed effectively by learning lessons from the difficulties encountered by a few successful cases and accordingly evolving an appropriate policy instrument. In this paper an attempt has been made to highlight three such cases from three different parts of the world--Malaysia (Asia-pacific), Poland (Eastern Europe) and Colombia (Latin America). The paper looks into what policy instruments led to a fall in water pollution levels in these countries and what role did MBIs play in this pollution mitigation? The case studies suggest that it is a combination of instruments--license fee, standards, charge and subsidies--reinforced by active enforcement that led to an overall improvement in environment compliance.

Matched MeSH terms: Taxes
Approaches for controlling illicit tobacco trade--nine countries and the European Union

Ross H, Husain MJ, Kostova D, Xu X, Edwards SM, Chaloupka FJ, et al.

MMWR Morb Mortal Wkly Rep, 2015 May 29;64(20):547-50.
PMID: 26020137

An estimated 11.6% of the world cigarette market is illicit, representing more than 650 billion cigarettes a year and $40.5 billion in lost revenue. Illicit tobacco trade refers to any practice related to distributing, selling, or buying tobacco products that is prohibited by law, including tax evasion (sale of tobacco products without payment of applicable taxes), counterfeiting, disguising the origin of products, and smuggling. Illicit trade undermines tobacco prevention and control initiatives by increasing the accessibility and affordability of tobacco products, and reduces government tax revenue streams. The World Health Organization (WHO) Protocol to Eliminate Illicit Trade in Tobacco Products, signed by 54 countries, provides tools for addressing illicit trade through a package of regulatory and governing principles. As of May 2015, only eight countries had ratified or acceded to the illicit trade protocol, with an additional 32 needed for it to become international law (i.e., legally binding). Data from multiple international sources were analyzed to evaluate the 10 most commonly used approaches for addressing illicit trade and to summarize differences in implementation across select countries and the European Union (EU). Although the WHO illicit trade protocol defines shared global standards for addressing illicit trade, countries are guided by their own legal and enforcement frameworks, leading to a diversity of approaches employed across countries. Continued adoption of the methods outlined in the WHO illicit trade protocol might improve the global capacity to reduce illicit trade in tobacco products.

Matched MeSH terms: Taxes
Fulltext WHO key access antibiotics price, availability and affordability in private sector pharmacies in Pakistan

Saleem Z, Saeed H, Akbar Z, Saeed A, Khalid S, Farrukh L, et al.

Cost Eff Resour Alloc, 2021 Feb 16;19(1):10.
PMID: 33593366 DOI: 10.1186/s12962-021-00263-x

BACKGROUND: Poor availability and unaffordability of key access antibiotics may increase antimicrobial resistance in the community by promoting inappropriate antibiotic selection and abridged therapy compliance.
OBJECTIVE: To check the prices, availability, and affordability of the World Health Organization (WHO) key access antibiotics in private sector pharmacies of Lahore, Pakistan.
METHODOLOGY: A survey of WHO key access antibiotics from WHO essential medicine list 2017 was conducted in private sector pharmacies of 4 different regions of Lahore employing adapted WHO/HAI methodology. The comparison of prices and availability between originator brands (OB) and lowest price generics (LPG) were conducted followed by the effect of medicine price differences on patient's affordability. The data were analyzed using a preprogrammed WHO Microsoft excel workbook.
RESULTS: The mean availability of OB products was 45.20% and the availability of LPGs was 40.40%. The OBs of co-amoxiclav, clarithromycin and metronidazole and LPGs of azithromycin and ciprofloxacin were easily available (100%) in all private sector pharmacies. Whereas, antibiotics like chloramphenicol, cloxacillin, nitrofurantoin, spectinomycin, and cefazolin were totally unavailable in all the surveyed pharmacies. The OBs and LPGs with high MPRs were ceftriaxone (OB; 15.31, LPG; 6.38) and ciprofloxacin (OB; 12.42, LPG; 5.77). The median of brand premium obtained was 38.7%, which varied between the lowest brand premium of 3.97% for metronidazole and highest for ceftriaxone i.e. 140%. The cost of standard treatment was 0.5 day's wage (median) if using OB and 0.4 day's wage (median) for LPG, for a lowest paid unskilled government worker. Treatment with OB and LPG was unaffordable for ciprofloxacin (OB; 2.4, LPG; 1.1) & cefotaxime (OB; 12.7, LPG; 8.1).
CONCLUSION: There is dire need to properly implement price control policies to better regulate fragile antibiotic supply system so that the availability of both OB and LPG of key access antibiotics should be increased. The prices could be reduced by improving purchasing efficiency, excluding taxes and regulating mark-ups. This could increase the affordability of patients to complete their antibiotic therapy with subsequent reduction in antimicrobial resistance.

Matched MeSH terms: Taxes
Fulltext Unrecorded acohol and acohol-related harm in rural Sabah, Malaysia: a socio-economically deprived region with expensive beer and cheap local spirits

Shoesmith WD, Oo Tha N, Naing KS, Abbas RB, Abdullah AF

Alcohol Alcohol, 2016 Nov;51(6):741-746.
PMID: 26903070

Aims: To identify the characteristics of current drinker and risky alcohol-drinking pattern by profiles in Malaysia.
Methods: We analyzed data from the National Health and Morbidity Survey 2011. It was a cross-sectional population-based with two stages stratified random sampling design. A validated Alcohol Use Disorder Identification Test Malay questionnaire was used to assess the alcohol consumption and its alcohol related harms. Analysis of complex survey data using Stata Version 12 was done for descriptive analysis on alcohol use and risky drinking by socio-demography profiles. Logistic regression analysis was used to measure the association of risky drinking status with the socio- demography characteristics.
Results: The prevalence of current alcohol use was 11.6% [95% confidence interval (CI): 10.5, 12.7], among them 23.6% (95% CI: 21.0, 26.4) practiced risky drinking. The onset for alcohol drinking was 21 years old (standard deviation 7.44) and majority preferred Beer. Males significantly consumed more alcohol and practiced risky drinking. Current alcohol use was more prevalent among urbanites, Chinese, those with high household income, and high education. Conversely, risky drinking was more prevalent among rural drinkers, Bumiputera Sabah and Sarawak, low education and low household income. The estimated odds of risky drinking increased by a factor of 3.5 among Males while a factor of 2.7 among Bumiputera Sabah and Sarawak. Education status and household income was not a significant predictor to risky drinking.
Conclusion: There was an inverse drinking pattern between current drinker and risky drinking by the socio-demography profiles. Initiating early screening and focused intervention might avert further alcohol related harms and dependence among the risky drinkers.
Study name: National Health and Morbidity Survey (NHMS-2011)

Matched MeSH terms: Taxes