1. Global Institutions in Health Peter C. Smith Imperial College Business School and Institute for Global Health

2. Global Institutions in Health Funding and Development – World Bank – International Monetary Fund – Global Fund Coordinating, informing & technical support – World Health Organization – European Commission Forum and Advocacy – Global Health Council – World Economic Forum – Organization for Economic Cooperation and Development – Commonwealth Fund

3. Millennium Development Goals (2000) to eradicate extreme poverty and hunger; to achieve universal primary education; to promote gender equality and empower women; to reduce child mortality; to improve maternal health; to combat HIV/AIDS, malaria, and other diseases; to ensure environmental sustainability; and to develop a global partnership for development.

8. World Health Report 2000 The health system: “… all the activities whose primary purpose is to promote, restore or maintain health.”

9. WHO 2000 Efficiency Rankings

10. WHR 2000 Composite Indicator of Attainment Overall health outcomes (measured by disability- adjusted life expectancy) Inequality in health (measured by an index based on child mortality) Overall health system responsiveness, reflecting respect for persons and client orientation (as assessed by a panel of 1,791 key informants in 35 countries) Inequality in health system responsiveness (as assessed by the key informants) Fairness of financing (measured by an index based on the proportion of non-food expenditure spent on health care).

11. The WHO approach to setting weights Ask 1,006 internet respondents from 125 countries to score the five aspects of performance on a 100 point scale Consistency across respondents But do they understand what is required? – Relative value of an additional unit of achievement, at all levels of performance, given the chosen scales of measurement.

12. Objections in principle  nations legitimately have different objectives and priorities;  nations operate in different environmental, economic and political circumstances;  the composite is not helpful as it offers no policy guidance;  the methodology is too complex to understand and explain;  many countries do not have the capacity to interpret the implications of the index;  media coverage may be unhelpful or misleading.

13. Tallinn Charter, 2008  “We, the member states, commit ourselves to: o Promote shared values of solidarity, equity and participation... o Invest in health systems, and foster investment across sectors that influence health... o Promote transparency and be accountable... o Make health systems more responsive... o Engage stakeholders... o Foster cross-country learning and cooperation... o Ensure that health systems are prepared and able to respond to crises...”

15. AMI hospital costs (€) Tiemann, O. (2008), Variations in Hospitalisation Costs for Acute Myocardial Infarction: A Comparison across Europe, Health Economics, 17S.

16. Appendectomy hospital costs (€) Schreyögg, J. (2008), A micro-costing approach to estimating hospital costs for appendectomy in a cross-European context, Health Economics, 17S.

17. Hip replacement hospital costs (€) Stargardt, T. (2008), Health Service Costs in Europe: Cost and Reimbursement of Primary Hip Replacement in Nine Countries, Health Economics, 17S.

21. Life expectancy at birth Males Females

22. Total expenditure on health as % GDP Source OECD HEALTH DATA 2008, June 08

23. Trends in out-of-pocket: % total health expenditure Source: OECD Health Data 2009

24. OECD Health care quality indicators project 1.Breast cancer five-year survival rate 2.Mammography screening rate 3.Cervical cancer five-year survival rate 4.Cervical cancer screening rate 5.Colorectal cancer five-year survival rate 6.Incidence of vaccine preventable diseases (Pertussis, measles, and hepatitis B) 7.Coverage for basic vaccination programme, age 2, (Pertussis, measles, and hepatitis B) 8.Asthma mortality rate, ages 5-39 9. In-hospital mortality rate within 30 days of hospital admission for acute myocardial infarction 10. In-hospital mortality rate within 30 days of hospital admission for stroke 11. Waiting times for surgery after hip fracture, over age 65 12. Influenza vaccination, over age 65 13. Smoking rate 14. Retinal exams in diabetics 15. Asthma admission rate Sandra Garcia Armesto, Maria Luisa Gil Lapetra, Lihan Wei, Edward Kelley and the Members of the HCQI Expert Group (2007) “Health care quality indicators project 2006: data collection update report”, Paris: OECD.

25. Health at a Glance OECD Indicators https://www.oecd.org/health /hcqi

26. OECD Rankings CountryUnexplained life years added Australia2.5 Canada-0.7 France0.4 Germany Hungary-3.1 Iceland2.6 Netherlands-0.3 Norway-1.5 Sweden0.5 Switzerland-0.4 UK0.0 USA-4.0 After adjusting for determinants of life expectancy – Health care spending – Education – GDP – Pollution – Alcohol – Tobacco – Diet Joumard, I., C. Andre, C. Nicq and O. Chatal (2008) Health status determinants: lifestyle, environment, health care resources and efficiency. Economics Department WorkingPaper 627. Paris: OECD.

28. Access to Doctor When Sick or Need Medical Attention Percent AUS CAN GER NETH NZ UK US Source: 2007 Commonwealth Fund International Health Policy Survey. Data collection: Harris Interactive, Inc. C. Schoen, R. Osborn, M. Doty, M. Bishop, J. Peugh, N. Murukutla, “Toward Higher-Performance Health Systems: Adults’ Health Care Experiences in Seven Countries, 2007,” Health Affairs Web Exclusive (Oct. 31, 2007).

29. Doctor-Patient Communication Percent reported doctor:AUSCANGERNETHNZUKUS Always knows important information about your medical history 69677871696362 Always explains things so you can understand 797571 807170 Always spends enough time with you 73597071695956 Always tells you about your treatment options and involves you in decisions about your treatment 6662 60675461 Source: 2007 Commonwealth Fund International Health Policy Survey. Data collection: Harris Interactive, Inc. C. Schoen, R. Osborn, M. Doty, M. Bishop, J. Peugh, N. Murukutla, “Toward Higher-Performance Health Systems: Adults’ Health Care Experiences in Seven Countries, 2007,” Health Affairs Web Exclusive (Oct. 31, 2007).

30. Commonwealth Fund, May 2007 MIRROR, MIRROR ON THE WALL:AN INTERNATIONAL UPDATE ON THE COMPARATIVE PERFORMANCE OF AMERICAN HEALTH CARE Karen Davis, Cathy Schoen, Stephen C. Schoenbaum, Michelle M. Doty, Alyssa L. Holmgren, Jennifer L. Kriss, and Katherine K. Shea

31. Some concluding comments Objectives of international agencies Culture and history Opportunities and constraints – Obama health reforms (CMWF) – Swine flu (WHO) Governance and bureaucracy