Health Care Systems Around the World: A Comparative Guide

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Sarah E. Boslaugh

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    About the Author

    Sarah E. Boslaugh, Ph.D., M.P.H., has over 20 years of experience in statistical analysis, grant writing, and teaching; her employers and clients have included the New York City Public Schools, Montefiore Medical Center, Saint Louis University, and Washington University School of Medicine. She served as editor-in-chief for the Encyclopedia of Epidemiology (SAGE, 2007), and has published three additional books: An Intermediate Guide to SPSS Programming: Using Syntax for Data Management (SAGE, 2004), Secondary Data Sources for Public Health: A Practical Guide (Cambridge University Press, 2007), and Statistics in a Nutshell (O'Reilly, 2nd ed., 2012).

    Boslaugh received her Ph.D. in measurement and evaluation from the City University of New York Graduate Center and her M.P.H. from Saint Louis University. She is currently a grant writer and journalist for the Center for Sustainable Journalism at Kennesaw State University (Georgia); as a journalist, she specializes in data-based articles and explaining statistical principles to the general public. Her research interests include comparative health care delivery systems, quality of life measurement, and gender and sexuality issues in health care delivery. In her spare time, she reviews films and books for PopMatters (http://www.popmatters.com) and Playback St. Louis (http://www.playbackstl.com).

    Introduction

    Everyone has an interest in health, as reflected in truisms such as “at least you've got your health” and “if you've got your health, you've got just about everything.” If all people have an interest in health, at least their own health and that of their families, it then follows that every government has an interest in health care delivery because the many wonderful achievements of modern medicine are only useful when they are delivered to the people who need them.

    There are many different ways to organize and deliver health care to a population, and to some extent, each country's method of organizing health care delivery is unique and based on its specific situation, including its history and culture, the amount of money it has to spend, and the value it places on different outcomes It is not surprising that public discussions about health care often become heated because the demand for health services is theoretically unlimited, yet no government has unlimited resources Designing and running a health care system therefore requires making difficult choices that are almost guaranteed not to please everyone, at least not all the time

    Discussions about health and health care often draw on two key statements from international organizations that formed after the conclusion of World War II. The first is the definition of health, as stated in the Preamble to the Constitution of the World Health Organization (WHO), adopted in 1946 and entering into force in 1948:

    Health is a state of complete physical, mental, and social well-being and not merely the absence of disease or infirmity.

    This broad definition of health has been adopted in principle by many nations that have integrated social services systems including not only medical care but also other services, such as old-age pensions and income support Other nations prefer to maintain a number of separate services, each with its own sources of funding and eligibility requirements. Both systems can produce good results or bad results—the details of how a specific system is organized and executed are crucial when making comparisons.

    The second statement comes from the Universal Declaration of Human Rights proclaimed in 1948 by the United Nations General Assembly:

    Everyone has the right to a standard of living adequate for the health and well-being of himself and of his family, including food, clothing, housing, and medical care and necessary social services and the right to security in the event of unemployment, sickness, disability, widowhood, old age or other lack of livelihood in circumstances beyond his control

    Some governments include the right to health in their constitutions, while in others it is a tacit expectation that those who need medical care will receive it. Again, it would be incorrect to assume that the population whose constitution declares health to be a human right do in fact fare better than people living in countries where this is not explicitly stated: Instead, it is necessary to look at how each nation's health care delivery functions in practice and at the health outcomes for each nation

    Making comparisons across countries is always a tricky matter because any two nations may differ on a vast number of characteristics, including level of development, geography and climate, political history, and social values. Looking at how different countries organize their health care systems, and what kind of results they achieve, is no different—some countries simply have more resources than others, and some have enjoyed long periods of peace and prosperity, while others have been engaged in lengthy wars or periods of civil unrest or subject to periodic environmental threats (hurricanes, earthquakes, extended periods of drought), which play little or no role elsewhere, and so on. National values also play a role—in some nations, equal access to services is a first principle, while in others, values such as choice or personal responsibility are considered more important

    Many studies comparing health care systems have been published, but for the reasons cited above, these studies usually confine themselves to a small group of countries that are similar to each other. For instance, many useful studies have been published comparing health care delivery systems and outcomes in western European countries or comparing systems and outcomes in developing countries in sub-Saharan Africa. This book takes a different approach to the subject: It provides basic information about health care organization and outcomes, organized into 10 categories, for 193 countries around the world:

    • Emergency health services
    • Insurance
    • Costs of hospitalization
    • Access to health care
    • Cost of drugs
    • Health care facilities
    • Major health issues
    • Health care personnel
    • Government role in health care
    • Public health programs

    The purpose is not to provide the final answer on any question regarding health care delivery but to facilitate comparisons among countries and raise questions that may lead to further, more detailed, investigations.

    Characterizing the health care delivery system for any country is a tricky task because, not only is every country different, but many countries use a mix of systems adapted to the needs and values of their populations as well as the availability of resources. However, several basic models have been identified, and keeping these in mind may help in understanding the choices made within a particular country, as well as when making comparisons across countries

    One way to deliver health care services is through a national health service such as that of the United Kingdom (which, strictly speaking, is four national health services, for England, Scotland, Wales, and Northern Ireland, respectively) A national health service is typically funded out of general tax revenues and organized at the national level A second way to organize health care is through a social insurance system, funded through payroll taxes; this type of health care system began in Germany in the 1880s and is used in many European countries today Canada provides a good example of a national health insurance or single-payer system: Health care is delivered by independent providers and institutions but is paid for through tax revenues; some single-payer systems also allow individuals to hold private insurance to supplement that provided by the state

    In a private insurance system, individuals and households purchase insurance from private providers, and care is paid for through some combination of insurance payments and copayments This system may show the greatest variation across countries—for instance, in the United States, most people with private insurance receive it as a benefit of employment, coverage is optional, insurance companies can refuse to cover individuals, and there are great variations in terms of the costs of insurance and what services are covered, while in the Netherlands, purchase of a health insurance policy is mandatory, insurance companies are tightly regulated by the national government, and companies are required to provide insurance for anyone who lives in a coverage area

    Even within a specific model, many other questions remain For instance, how should those who provide health care services be paid? In some countries, doctors, nurses, and other professionals are employed by the state and receive salaries; in other countries, some or all of these professionals may be paid according to the number of patients they see and the services they provide. Similarly, there are many ways hospitals are funded, from global budgets to payments based on services provided (often based on a schedule of payments for different diagnoses) to simple payments based on the number of beds occupied over the period of a year.

    There are also many ways to provide medicines to people, and to pay for them—in some systems, prescription drugs are provided without charge (this is often limited to drugs listed on a national formulary) as part of the national health system; in some systems, some or all medicines are heavily subsidized, but patients are still required to pay something for them; and in some systems, the marketplace is allowed to set the price for each drug. Some countries tightly regulate which drugs may be sold within their borders, while others accept any drug that has achieved basic standards for health and efficacy. As with the different models for providing care, there is not a single best way to answer any of these questions, but consideration of the different options may help clarify the advantages and disadvantages of each.

    Health care delivery seems fated to remain a topic of interest in the future, and more rather than less attention will be focused on the different ways to organize care and the strong and weak points of each type of system. Rising costs are an issue around the world as the advances of medical science provide more and more ways to improve health but at a cost that may be unsustainable. Improvements in a nation's health can also create more issues that must be dealt with—for instance, as many developing countries have adopted effective measures to prevent and treat infectious disease, thus reducing the toll taken by diseases such as tuberculosis and influenza, they find themselves facing a much higher incidence of chronic diseases, such as cancer and diabetes, and their health systems must adapt to this new reality. Even industrialized countries with high standards of care face questions of resource allocation, requiring them to decide what services take priority over others. Ultimately, however, the necessity to make such decisions is based on what can only be called a positive trend—thanks in large part to modern systems of health care, life expectancy is increasing globally, and that is something to be thankful for.

    Sarah E.Boslaugh

    Country Rankings

    The country rankings provide a list of the top 10 and bottom 10 countries in rank order on different measures related to health and health care systems. The purpose is to give the reader opportunities to compare how different countries, which are similar in some factors, provide health care to their citizens, with the proviso that many factors may influence both a country's health care system and the health of its population. Unless otherwise noted, all information is from the CIA World Factbook (2012 edition).

    Outcomes
    Life Expectancy at Birth (Highest)

    Monaco

    Japan

    Singapore

    San Marino

    Andorra

    Australia

    Italy

    Liechtenstein

    Canada

    France

    Life Expectancy at Birth (Lowest)

    Chad

    Guinea-Bissau South Africa Swaziland Afghanistan

    Central African Republic

    Somalia

    Zimbabwe

    Lesotho

    Mozambique

    Infant Mortality (Highest)

    Afghanistan

    Niger

    Mali

    Somalia

    Central African Republic

    Guinea-Bissau

    Chad

    Angola

    Burkina Faso

    Malawi

    Infant Mortality (Lowest)

    Monaco

    Japan

    Singapore

    Sweden

    Iceland

    Italy

    Spain

    France

    Finland

    Norway

    Maternal Mortality (Highest)

    Afghanistan

    Somalia

    Chad

    Guinea-Bissau

    Liberia

    Burundi

    Sierra Leone

    Central African Republic

    Nigeria

    Mali

    Maternal Mortality (Lowest)

    Greece

    Ireland

    Austria

    Sweden

    Belgium

    Denmark

    Iceland

    Italy

    Spain

    Slovakia

    Children Under Age 5 Underweight (Highest)

    India

    Yemen

    Bangladesh

    Timor-Leste (East Timor)

    Niger

    Burundi

    Nepal

    Burkina Faso

    Madagascar

    Ethiopia

    Children Under Age 5 Underweight (Lowest)

    Chile

    Germany

    United States

    Belarus

    Bulgaria

    Bosnia and Herzegovina

    Macedonia

    Serbia

    Czech Republic

    Jamaica

    Adult HIV Prevalence Rate (Highest)

    Swaziland

    Botswana

    Lesotho

    South Africa

    Zimbabwe

    Zambia

    Namibia

    Mozambique

    Malawi

    Uganda

    Adult HIV Prevalence Rate (Lowest)

    (Countries with the lowest HIV prevalence rates are not listed because there are so many tied at the low end)

    Adult Prevalence of Obesity (Highest)

    Tonga

    Kiribati

    Saudi Arabia

    United States

    United Arab Emirates

    Egypt

    Kuwait

    New Zealand

    Seychelles

    Fiji

    Adult Prevalence of Obesity (Lowest)

    Vietnam

    Laos

    Madagascar

    Indonesia

    China

    Japan

    South Korea

    Eritrea

    Philippines

    Singapore

    Health Services
    Physician Density Per 1,000 (Highest)

    San Marino

    Cuba

    Greece

    Monaco

    Belarus

    Austria

    Georgia

    Russia

    Italy

    Norway

    Physician Density Per 1,000 (Lowest)

    Tanzania

    Liberia

    Sierra Leone

    Malawi

    Niger

    Ethiopia

    Bhutan

    Rwanda

    Mozambique

    Burundi

    Hospital Bed Density Per 1,000 (Highest)

    Japan

    North Korea

    South Korea

    Belarus

    Russia

    Ukraine

    Germany

    Azerbaijan

    Austria

    Barbados

    Hospital Bed Density Per 1,000 (Lowest)

    Cambodia

    Ethiopia

    Madagascar

    Guinea

    Niger

    Senegal

    Uganda

    Sierra Leone

    Côte d'Ivoire

    Mauritania

    Percent of Births Attended by Skilled Health Personnel (Lowest)

    (Data from the Population Reference Bureau)

    Ethiopia

    Afghanistan

    Chad

    Bangladesh

    Timor-Leste (East Timor)

    Nepal

    Laos

    Haiti

    Eritrea

    Niger

    Percent of Births Attended by Skilled Health Personnel (Highest)

    (Countries with the highest percent of births attended by skilled personnel are not listed because many countries are tied at 100 percent)

    Total Health Expenditure as a Percentage of GDP (Highest)

    Malta

    United States

    Mexico

    Niue

    Lesotho

    Sierra Leone

    Burundi

    Timor-Leste (East Timor)

    Kenya

    Nauru

    Total Health Expenditure as a Percentage of GDP (Lowest)

    North Korea

    Burma

    Equatorial Guinea

    Turkmenistan

    India

    Qatar

    Marshall Islands

    Pakistan

    United Arab Emirates

    Syria

    Congo, Republic of the

    Demographics
    Birth Rate (Highest)

    Niger

    Uganda

    Mali

    Zambia

    Burkina Faso

    Ethiopia

    Somalia

    Burundi

    Malawi

    Congo, Republic of the

    Birth Rate (Lowest)

    Monaco

    Hong Kong

    Singapore

    Germany

    Japan

    South Korea

    Czech Republic

    Austria

    Slovenia

    Taiwan

    Death Rate (Highest)

    South Africa

    Russia

    Ukraine

    Lesotho

    Chad

    Guinea-Bissau

    Central African Republic

    Afghanistan

    Somalia

    Bulgaria

    Death Rate (Lowest)

    Qatar

    United Arab Emirates

    Kuwait

    Bahrain

    Jordan

    Saudi Arabia

    Brunei

    Singapore

    Libya

    Oman

    Population Growth Rate (Highest)

    Qatar

    Zimbabwe

    Niger

    Uganda

    Ethiopia

    Burundi

    Burkina Faso

    United Arab Emirates

    Zambia

    Madagascar

    Population Growth Rate (Lowest)

    Moldova

    Jordan

    Syria

    Bulgaria

    Estonia

    Montenegro

    Ukraine

    Latvia

    Russia

    Serbia

    Human Development Index (Highest)

    (Data from the United Nations Development Programme)

    Norway

    Australia

    Netherlands

    United States

    New Zealand

    Canada

    Ireland

    Liechtenstein

    Germany

    Sweden

    Human Development Index (Lowest)

    (Data from the United Nations Development Programme)

    Congo, Democratic Republic of the Niger

    Burundi

    Mozambique

    Chad

    Liberia

    Burkina Faso

    Sierra Leone

    Central African Republic

    Guinea

    The Global Gender Gap (Most Equal)

    (Data from the World Economic Forum)

    Iceland

    Norway

    Finland

    Sweden

    Ireland

    New Zealand

    Denmark

    Philippines

    Lesotho

    Switzerland

    The Global Gender Gap (Least Equal)

    (Data from the World Economic Forum)

    Yemen

    Chad

    Pakistan

    Mali

    Saudi Arabia

    Côte d'Ivoire

    Morocco

    Benin

    Oman

    Nepal

    GDP Per Capita (Purchasing Power Parity Basis, Highest)

    Liechtenstein

    Qatar

    Luxembourg

    Bermuda

    Singapore

    Norway

    Brunei

    United Arab Emirates

    United States

    Switzerland

    GDP Per Capita (Purchasing Power Parity Basis, Lowest)

    Congo, Democratic Republic of the

    Liberia

    Burundi

    Zimbabwe

    Somalia

    Eritrea

    Sierra Leone

    Niger

    Central African Republic

    Madagascar

    Malawi

    Distribution of Family Income (Most Equal)

    Sweden Montenegro

    Hungary

    Denmark

    Norway

    Austria

    Malta

    Luxembourg

    Slovakia

    Kazakhstan

    Distribution of Family Income (Most Unequal)

    Namibia

    South Africa

    Lesotho

    Botswana

    Sierra Leone

    Central African Republic

    Haiti

    Bolivia

    Honduras

    Colombia

    Population (Largest)

    China India

    United States

    Indonesia

    Brazil

    Pakistan

    Nigeria

    Bangladesh

    Russia

    Japan

    Population (Smallest)

    Nauru

    Tuvalu

    Palau

    Monaco

    San Marino

    Liechtenstein

    Saint Kitts and Nevis

    Dominica

    Andorra

    Antigua and Barbuda

    Urbanization (High)

    (Data from the Population Reference Bureau)

    Singapore

    Malta

    Nauru

    Qatar

    Bahrain

    Monaco

    Belgium

    Kuwait

    Venezuela

    Argentina

    Urbanization (Low)

    (Data from the Population Reference Bureau)

    Burundi

    Papua New Guinea

    Trinidad and Tobago

    Malawi

    Uganda

    Liechtenstein

    Sri Lanka

    Niger

    Ethiopia

    Nepal

    Rate of Urbanization (Highest)

    (Data from the Population Reference Bureau)

    Burundi

    Liberia

    Laos

    Eritrea

    Afghanistan

    Maldives

    Malawi

    Congo, Democratic Republic of the

    Timor-Leste (East Timor)

    Burkina Faso

    Rate of Urbanization (Lowest)

    (Data from the Population Reference Bureau)

    Moldova

    Montenegro

    Ukraine

    Georgia

    Slovenia

    Russia

    Latvia

    Lithuania

    Poland

    Armenia

    Geographic Area (Largest)

    Russia

    Canada

    United States

    China

    Brazil

    Australia

    India

    Argentina

    Kazakhstan

    Algeria

    Geographic Area (Smallest)

    Monaco

    Nauru

    Tuvalu

    San Marino

    Liechtenstein

    Saint Kitts and Nevis

    Maldives

    Malta

    Grenada

    Saint Vincent and the Grenadines

    Comparative Health System Information

    (From the World Health Report 2000)

    The World Health Organization's (WHO's) World Health Report 2000 included rankings of the health systems of its member countries on a number of factors. Although these rankings should be interpreted with caution due to their age, they represent an unprecedented effort to evaluate the world's health systems and provide a useful snapshot of their functioning at that time.

    WHO Overall Health System Performance (Best)

    France Italy

    San Marino

    Andorra

    Malta

    Singapore

    Spain

    Oman

    Austria

    Japan

    WHO Overall Health System Performance (Worst)

    Myanmar

    Central African Republic

    Congo, Democratic Republic of the

    Nigeria

    Liberia

    Malawi

    Mozambique

    Lesotho

    Zambia

    Angola

    WHO Disability-Adjusted Life Expectancy (Highest)

    Japan

    Australia

    France

    Sweden

    Spain

    Italy

    Greece

    Switzerland

    Monaco

    Andorra

    WHO Disability-Adjusted Life Expectancy (Lowest)

    Sierra Leone

    Niger

    Malawi

    Zambia

    Botswana

    Uganda

    Rwanda

    Zimbabwe

    Mali

    Ethiopia

    WHO Responsiveness of Health System (Highest)

    United States

    Switzerland

    Luxembourg

    Denmark

    Germany

    Japan

    Canada

    Norway

    Netherlands

    Sweden

    WHO Responsiveness of Health System (Lowest)

    Somalia

    Niger

    Mozambique

    Uganda

    Mali

    Eritrea

    Nepal

    Guinea-Bissau

    Central African Republic

    Chad

    WHO Fairness of Financial Contribution to Health Systems (Highest)

    Colombia

    Luxembourg

    Belgium

    Djibouti

    Denmark

    Ireland

    Germany

    Norway

    Japan

    Finland

    WHO Fairness of Financial Contribution to Health Systems (Lowest)

    Sierra Leone

    Myanmar

    Brazil

    China

    Viet Nam

    Nepal

    Russian Federation

    Peru

    Cambodia

    Cameroon

    Chronology

    2635–2155 b.c.e.: During the Old Kingdom in Egypt, texts contain the names of at least 50 physicians.

    ca. 1700 b.c.e.: The Code of Hammurabi includes sections on the liability of physicians for failed surgical procedures and also on physicians' compensation; in both cases, the amount of the penalty or payment is based on the status of the patient, not the difficulty of the medical procedure

    ca. 1600 b.c.e.: Tablets believed to be a collection of Mesopotamian medical knowledge over several centuries include guides for diagnosing diseases and conditions including fevers, worms, venereal disease, neurological conditions, and skin lesions

    ca. 1500 b.c.e.: An ancient Egyptian text, the Ebers Papyrus, describes illnesses resembling schizophrenia, dementia, and depression

    ca. 1400 b.c.e.: An ancient Indian text, the Atharva Veda, describes mental illness as being caused by an imbalance of humors

    ca. 1000 b.c.e.: In China, the Yellow Emperor's Classic of Internal Medicine describes epilepsy and dementia.

    5th century b.c.e.: The Greek philosopher Empedocles, writing in his treatise On Nature, says that the human body is created out of the elements of earth, ether, fire, and water and that health was created by the appropriate mixture of wet and dry and hot and cold

    460–377 b.c.e.: The Greek physician Hippocrates, sometimes termed the father of medicine, attributes human illness to natural factors, including environmental conditions, rather than divine intervention; the Hippocratic Oath is still used today

    ca. 312 b.c.e.: The Romans construct an aqueduct to supply potable water from distant streams and springs to the city of Rome

    ca. 1st century c.e.: Several Roman writers mention valetudinaria, rooms in imperial households reserved for the care of ill or exhausted slaves; archeological excavations later confirm these reports and also the existence of valetudinaria within military facilities

    ca. 1st century: The Greek physician Dioscorides writes an encyclopedia of medicinal substances, De Material Medica.

    ca. 200: The Roman physician Galen writes works that form the foundation of Western medicine for the next millennium

    314: The Church of the Synod of Ankyra creates a religious ritual to sanctify the separation of lepers from the rest of society

    499: Eusebius, bishop of Edessa (a city in Anatolia), orders that the city's poor be provided with food, shelter, and nursing care.

    6th century: A leper house is established in Franconia in southern Gaul to house and care for lepers.

    ca. 530: The Rule of St. Benedict includes the specification that monks should care for the ill and disabled among them; this principle is later extended to providing medical care for laypersons.

    603: Pope Gregory I founds a hospice in Jerusalem to care for ill pilgrims.

    ca. 707: An Islamic hospital is founded in Damascus, Syria.

    830: Plans for a monastery for the monks of St. Gall include an infirmary with separate rooms for monks requiring different levels of care and a guesthouse for lay visitors.

    874: A bimaristan (hospital) is founded in Cairo, Egypt.

    918: A bimaristan (hospital) is founded in western Baghdad; a second bimaristan is founded in eastern Baghdad in 981.

    ca. 980–1027: During his lifetime, the Iranian physician Abu Ali Sina (Avicenna) writes numerous books, including the Canon of Medicine and The Book of Healing.

    ca. 1080: Founding of a hospice, staffed by Benedictine monks, in Jerusalem; it is dedicated to St. John the Baptist.

    ca. 1100: The Knights of St. Lazarus establish a hospice to care for lepers in Jerusalem; similar houses subsequently established throughout Europe are referred to as “lazarrettos” or Houses of St. Lazarus.

    ca. 1136: Founding of the Pantocrator monastery in Constantinople, including five separate wards or dormitories for persons with different levels of disease.

    1179: The Third Lateran Council reinforces the segregation of lepers, banning them from attending parish churches and from burial in parish cemeteries 1247: The Order of the Star of Bethlehem builds a priory in London; it begins to admit mentally ill patients in the 1350s, making it the oldest psychiatric hospital in Europe; it is colloquially known as “Bedlam.”

    1257: Founding of the “Bürgerspital,” the oldest hospital in Vienna, Austria.

    1300s: In some European countries, craft guilds create mutual assistance associations, an early form of social insurance.

    1311: At the Council of Ravenna, one topic of discussion is the increasing corruption of monastic hospitals; Pope Clement V later prohibits clerics from profiting personally from the operation of these hospitals.

    1348: In response to the plague pandemic sweeping Europe, Jehan Jacme publishes a tractate exhorting European city leaders to assume responsibility for safeguarding the population against disease outbreaks.

    1348–1350: The Black Death (bubonic plague) sweeps Europe, killing an estimated quarter of the population.

    1496: Pox houses are established in several German cities to care for people suffering from morbus gallicus, probably a form of syphilis.

    1505: The city of Paris, France, assumes control of the Hotel Dieu, a hospital with more than 1,000 beds.

    1518: In Great Britain, King Henry VIII orders the founding of the Royal College of Physicians.

    1530: Emperor Charles V cedes Malta to the order of the Knights Hospitallers, an order founded to provide care for pilgrims to Jerusalem.

    1592: In response to a plague outbreak, public officials in London begin publishing the Bills of Mortality, listing the cause of death for deaths within the city.

    1637: Construction begins on the first hospital in Canada, the Hotel-Dieu de Quebec; it begins operation in 1639, staffed by members of the Augustines de la Misericorde de Jesus from France and, in 1644, is moved to its current site on the Rue du Palais.

    1644: The Hotel-Dieu de Montreal in Canada is founded by Jeanne Mance; the building is completed in 1645 and is run by Mance until it is taken over in 1659 by the Hospitallers of St. Joseph.

    1647: The Massachusetts Bay Colony establishes a quarantine for ships arriving in Boston harbor.

    1656: In an effort to control the plague, Roman officials quarantine Trastavere, a community on the Tiber floodplain in Rome, Italy.

    1659: The first known typhus outbreak in Canada.

    1720: Westminster Infirmary, the first voluntary hospital in England, opens.

    1736: Creation of the New York City Almshouse including a six-bed hospital ward; this facility will later become Bellevue Hospital.

    1747: James Lind demonstrates that consumption of citrus fruits is the best remedy for scurvy in small-sample clinical trials with British seamen comparing oranges and lemons with other substances, including seawater, garlic, and horseradish.

    1776: In order to encourage enlistment in the army, the U.S. Continental Congress provides pensions for disabled soldiers.

    1780s: Institutional mortality of more than 21 percent is reported for the Hospice de Charité and almost 25 percent for the Hotel Dieu, both in Paris, France.

    1784: Opening of the Allgemeines Krankenhaus (General Hospital) in Vienna, Austria.

    1792: In France, Philippe Pinel leads a reform effort for more humane treatment of people in mental hospitals.

    1796: Edward Jenner successfully vaccinates a child against smallpox using the cowpox virus.

    1811: The United States creates the first federal medical facility for disabled veterans.

    1821: Massachusetts General Hospital opens in Boston; from the start, founders emphasize the hospital's multiple roles of educating physicians, conducting research, and caring for the sick.

    1831: Canada creates a sanitation committee and strengthens quarantine laws in response to the threat of cholera being spread by immigrants from Europe.

    1832: La Grosse Ile, an island in the St. Lawrence River near Quebec City in Canada, becomes a quarantine station during a cholera epidemic; immigrants are examined at the island before being permitted to enter the mainland, but despite these efforts, the disease spreads to Montreal and Quebec City.

    1839: A group of physicians in Toronto, Canada, many of whom had been educated in Great Britain, are incorporated as the College of Physicians and Surgeons of Upper Canada.

    1840s: Working at the General Hospital of Vienna, Austria, Ignaz Semmelweis successfully reduces deaths from puerperal fever by requiring physicians to disinfect their hands between performing autopsies and delivering babies.

    1842: In England, Edwin Chadwick publishes the Report… on Inquiry Into the Sanitary Condition of the Laboring Population of Great Britain, calling for city engineers to create more healthful conditions in order to control disease.

    1846: Physicians successfully use ether to render patients unconscious during surgery.

    1847: A typhus epidemic in Ireland spreads to Canada as many Irish emigrate due to the so-called potato famine; despite efforts to examine immigrants at La Grosse Ile quarantine station, the disease spreads to Montreal and Quebec City.

    1851: The first International Sanitary Conference meets in Paris, France, to harmonize quarantine requirements among European countries.

    1854: During a cholera epidemic in London, England, John Snow traces the source of infection to a specific water pump in the city.

    1860: Florence Nightingale founds a training school for nurses at St. Thomas' Hospital in London, England.

    1861–1865: During the Civil War, American hospitals develop several innovative methods for treating patients, including the ward system (grouping beds for patients with similar ailments together in order to treat them more easily) and the development of specialty orthopedic care and the use of prosthetic limbs.

    1863: Founding of the International Committee of the Red Cross in Geneva, Switzerland, prompted by Henry Dunant's desire to aid those wounded in war without reference to which side they fought on.

    1863: During the American Civil War, the U. S. federal government creates the Invalid Corps to employ disabled veterans in war-related tasks; the name is change in 1864 to the Veteran Reserve Corps.

    1865: London, England, completes its sewage system.

    1866: In the United States, New York City creates the Metropolitan Board of Health, which later becomes the New York City Health Department.

    1867: Founding of the Canadian Medical Association.

    1867: Joseph Lister publishes a series of articles arguing for the use of carbolic acid to prevent infection during surgery.

    1867: In Great Britain, passage of the Metropolitan Poor Act requires workhouses (institutions housing the poor) to maintain hospitals separately from the main workhouse site.

    1867: In Canada, jurisdiction over public health is divided by the Constitution Act into federal and provincial responsibilities, the former being responsible for border quarantine and the latter for creating and running hospitals.

    1869: Massachusetts creates the first state public health department in the United States.

    1872: Dr Stephen Smith, commissioner of the Metropolitan Health Board of New York City, founds the American Public Health Association.

    1873: In the United States, the federal government creates the Marine Health Service, the forerunner of the U.S. Public Health Service.

    1874: The first nursing school in Canada is established at the General and Marine Hospital in St. Catharines, Ontario.

    1881: A nursing school based on the principles established by Florence Nightingale is founded at the Toronto General Hospital in Canada.

    1881: Founding of the U. S. American Red Cross by Clara Barton; the same year, the first local chapter is founded in Dansville, New York, and the American Red Cross delivers its first disaster relief services to victims of forest fires in Michigan.

    1882: Ontario, Canada, establishes a provincial board of health.

    1883: Germany enacts a mandatory national health insurance program.

    1883: Sir Francis Galton coins the term eugenics.

    1885: A major smallpox epidemic in Montreal leads to riots, as some believe the disease was spread by vaccination, a practice not yet universal in Canada.

    1887: The U.S. Marine Hospital creates one of the world's first bacteriological laboratories.

    1890: A nursing school based on the principles established by Florence Nightingale is founded at the Montreal General Hospital in Canada.

    1893: Lillian Wald creates the profession of public health nursing by founding the Henry Street Settlement in New York City in the United States.

    1896: In Germany, Emil Kraepelin begins the modern process of classifying mental illness by distinguishing between mania and paranoia.

    1906: The U.S. Congress passes the Pure Food and Drug Act, authorizing the government to monitor purity and safety of food and drugs.

    1908: The United States creates a workmen's compensation system for federal employees.

    1909: The U.S. insurance company Metropolitan Life hires Lee Frankel, an industrial social worker, to write pamphlets promoting health education; the first, centering on tuberculosis prevention, is distributed to more than 10,000 individuals.

    1910: About half of all U.S. physicians are members of the American Medical Association (AMA); the approximately 70,000 members of the AMA at this time comprise a substantial increase from the approximately 8,000 members in 1901.

    1910: Abraham Flexner issues a report highly critical of the state of American medical education, which leads to the creation of higher standards and the closing of numerous medical schools.

    1912: In the United States, the Progressive Party and its candidate Teddy Roosevelt endorse social and health insurance as part of its platform.

    1913: Founding of the American College of Surgeons.

    1916: In the United States, the Council on Medical Education recommends that medical schools require students to have completed one year of college; in 1918, this is increased to two years of college.

    1917: As the United States enters World War I, the federal government establishes a new system of benefits for veterans, including insurance, vocational rehabilitation, and disability compensation.

    1918: In the United States, the federal government makes its first state grants for public health services.

    1918: A report by the American College of Surgeons states that only 13 percent of U. S. hospitals meet its standards; by 1932, more than 90 percent meet them.

    1919: Canada creates a federal department of health to set standards for food and medicines, enforce quarantines, and cooperate with voluntary organizations and the provinces; the department was created in part in response to the influenza pandemic of 1918.

    1919: The International Federation of Red Cross and Red Crescent Societies is founded in Paris, France (as the League of Red Cross Societies).

    1919: In the United States, a commission from the state of Illinois reports that, for most people, the primary cost of illness is not medical treatment but lost wages.

    1919: The University of British Columbia creates Canada's first university degree program for nurses.

    1926: Joseph Goldberger demonstrates that pellagra, a disease endemic in the American South, is caused by a deficiency of niacin, after previously establishing that consumption of a diet based primarily on corn (typical of the poor in the South) was associated with pellagra.

    1928: In London, Sir Andrew Fleming discovers penicillin and observes that it destroys colonies of bacteria; however, regular use of the drug does not begin until the 1940s.

    1929: Baylor University develops a health insurance plan for hospital care for a group of Dallas, Texas, teachers; this plan is a precursor of the Blue Cross system.

    1929: Atlantic City, New Jersey, hosts the first International Hospital Congress; observers note that American hospitals provide more clinical education and are used by a broader range of social classes than those in Europe.

    1930: In the United States, Congress creates the Veterans Administration to consolidate services provided to military veterans.

    1930: In the United States, 70 percent of graduates from medical schools also hold bachelor's degrees; by 1945, this is increased to 80 percent.

    1932: The U.S. Public Health Service begins the Tuskegee Study, observing the course of syphilis in African Americans while not informing them of their disease nor providing medical treatment; the study ends in 1972, long after penicillin had become available, and prompts creation of the National Research Act in 1974.

    1933: The American Hospital Association approves private hospital insurance.

    1933: In the United States, the hospital bed occupancy rate falls to 55 percent as fewer people can pay for care due to the Great Depression.

    1935: In the United States, passage of the Social Security Act creates a system of old-age and survivors' pensions funded by contributions from employees and employers, but it does not include health insurance.

    1938: The U. S. Technical Committee on Medical Care publishes its report, A National Health Program.

    1938: In Italy, the physician Ugo Cerletti begins using electroshock therapy to treat depression.

    1941: The American Red Cross begins collecting blood for the military under the National Blood Donor Services, directed by Dr Charles Drew.

    1941: The Netherlands adopts a mandatory national social health insurance system.

    1941–1945: Wage and price controls on American employers during World War II prompt many to offer health benefits as additional compensation.

    1943: In the United States, clinical trials begin for penicillin; once proven effective, production is scaled up in the next few years to supply the military, and the price drops substantially ($0.55 in 1946 for one dose versus $20.00 for one dose in 1943).

    1944: U.S. President Franklin Roosevelt mentions the right to medical care in his State of the Union address.

    1945: U.S. President Harry Truman proposes creation of a national universal health insurance program; it is opposed by the American Medical Association and denounced by a subcommittee of the House of Representatives as a communist plot.

    1945: The United Nations (UN) creates the United Nations Children's Fund (UNICEF) to provide food, clothing, and health care to impoverished children.

    1945: During meetings to establish the UN, representatives from Brazil and China propose creation of an international health organization, first called the Interim Commission; in 1948, it becomes the World Health Organization (WHO).

    1946: In the United States, creation of the Communicable Disease Center (CDC), later the Centers for Disease Control and Prevention 1947: Writing in the British Medical Journal, Austin Bradford Hill argues that medical practices should be evaluated using statistical methods.

    1948: The first modern clinical trial is conducted in the United Kingdom; it demonstrates that streptomycin is an effective therapy for tuberculosis.

    1948: The American Red Cross opens a blood collection center in Rochester, New York. It is the first such center created in the United States under the civilian National Blood Program.

    1948: Great Britain founds the National Health Service (NHS).

    1949: In the United States, the National Labor Relations Board rules that unions are permitted to negotiate benefit packages for their members, including health insurance and pension plans.

    1950: Dr Jonas Salk introduces the Salk vaccine for polio.

    1952: In the United Kingdom, the NHS begins charging one shilling for prescriptions.

    1954: In Boston, Massachusetts, physicians Joseph Murray and John Merrill carry out the first successful living donor transplant with a kidney obtained from the patient's identical twin.

    1957: Canada passes the Hospital Insurance and Diagnostic Act of 1957, giving the Canadian government authority to create a universal coverage plan for hospital, laboratory, and radiology services; this is the first part of the current Canadian national health insurance plan.

    1958: In the United States, almost three-quarters of citizens have private health insurance.

    1958: In the United Kingdom, the NHS launches a program to immunize everyone aged 14 and younger against polio and diphtheria.

    1960s: Development of antipsychotic drugs allows many psychiatric patients to be released from asylums and treated in community mental health facilities instead.

    1961: In Canada, the Royal Commission on Health Services is created to study the Canadian health care system; its 1964 report becomes the cornerstone of the contemporary health system in Canada.

    1962: In the United States, the Migrant Health Act funds medical clinics for migrant workers.

    1964: The U. S. Surgeon General's report on smoking and health lends weight to efforts to control the advertising and sale of tobacco products.

    1965: In the United States, the Medicare and Medicaid programs are created as part of the Social Security Act of 1965; Medicare provides federal funding for health insurance for persons age 65 and older, the disabled, and those with end-stage renal disease, while Medicaid is a joint federal-state program providing funding for insurance for the poor.

    1965: In the United Kingdom, the NHS drops charges for prescriptions; the charges are reinstated in 1968.

    1965: In the United States, only 37 percent of U. S. physicians are general practitioners versus 84 percent in 1940.

    1966: Henry Beecher publishes a research article in the New England Journal of Medicine identifying 22 biomedical studies he believed were unethical due to issues such as lack of consent and harm caused to the subject of the research.

    1966: In the United States, the first collection of the Household Component of the Medical Expenditure Panel Study (MEPS) occurs; data collected includes health status, conditions, and utilization; health care expenditures; and health insurance coverage.

    1966: Canada passes the Medical Care Act of 1966, extending health insurance to cover physician services; this is the second part of the current Canadian national health insurance plan.

    1971: Founding of Doctors Without Borders (Médi-cins sans Frontières) in France to respond to flooding in Bangladesh and war and famine in Biafra (Nigeria).

    1971: In the United States, tobacco advertising is banned on television 1973: In the United States, the federal Health Maintenance Organization Act spurs the development of health maintenance organizations (HMOs) across the country.

    1974: In response to the Tuskegee Study, which became public knowledge in 1974, the U.S. Congress passes the National Research Act, requiring creation of Institutional Review Boards (IRBs) to ensure ethical conduct of research.

    1974: In the United States, the federal government establishes the Women, Infants, and Children (WIC) program to provide nutritious food to low-income women, infants, and children.

    1975: Doctors Without Borders establishes its first large-scale program to aid Cambodians fleeing the Pol Pot regime.

    1979: The National Commission for the Protection of Research Subjects of Biomedical and Behavioral Research (United States) publishes the Belmont Report, identifying three basic principles necessary for the ethical conduct of research: respect for persons, beneficence, and justice.

    1979: Announcement of the successful eradication of smallpox, a fact confirmed by WHO in 1980.

    1980: In the United Kingdom, the Black Report finds that social class remains related to health outcomes, such as life expectancy and infant mortality, despite the efforts of the National Health Services (NHS).

    1981: The Morbidity and Mortality Weekly Report, published by the U.S. Centers for Disease Control and Prevention, reports five cases of a rare type of pneumonia; these patients are among the first identified cases of acquired immune deficiency syndrome (AIDS).

    1983: San Francisco General Hospital establishes a ward for AIDS patients dedicated to research on the disease as well as patient care

    1984: In the United States, the Centers for Disease Control and Prevention begins collecting data in 15 states with the Behavioral Risk Factor Surveillance System, a survey designed to collect information on health behaviors such as smoking, exercise, and eating habits; by 1995, all 50 states plus Puerto Rico, Guam, and the U. S. Virgin Islands take part in the annual survey.

    1984: In Canada, physicians are prohibited from charging fees greater than those specified in provincial benefit schedules.

    1986: In the United States, the Emergency Medical Treatment and Active Labor Act (EMTALA) requires hospitals to treat patients with medical emergencies without regard to their insurance status or ability to pay

    1986: Ian Chalmers and colleagues at Oxford University in the United Kingdom publish the first medical systematic review of perinatal interventions

    1987: Fluoxetine (Prozac) offers better, safer treatment for depression and other mental illnesses, including panic disorder and anxiety disorders; it is the first of many selective serotonin reuptake inhibitor (SSRI) drugs introduced to the pharmaceutical marketplace

    1988: Doctors Without Borders establishes its first mental health program to serve survivors of an earthquake in Armenia

    1988: The NHS in the United Kingdom introduces a national program of screening for breast cancer

    1990: In the United States, tobacco smoking is banned on all domestic airplane flights.

    1993: Founding of the Cochrane Review, a leading source of information about clinical effectiveness and controlled trials of medical interventions

    1993: In the United States, the Family and Medical Leave Act mandates large employers to allow 12 weeks of unpaid leave for employees for reasons such as the birth of a child, a serious health condition, or the need to care for an ill family member; the law covers approximately 40 to 50 percent of the population

    1996: In the United States, the first collection of the Insurance Component of the Medical Expenditure Panel Survey (MEPS) occurs It gathers information from households and employers about employer-based health insurance

    1999: Doctors Without Borders launches a campaign to increase access to essential medicines by the world's poor

    2000: Doctors Without Borders begins providing antiretroviral therapy to persons with human immunodeficiency virus and acquired immune deficiency syndrome (HIV/AIDS) in Thailand; the following year, the program is extended to Cambodia, Guatemala, Cameroon, Kenya, Malawi, and South Africa

    2001: WHO launches the Measles Initiative in partnership with UNICEF, the Centers for Disease Control and Prevention, the United Nations Foundation, and the American Red Cross

    2001: In the United Kingdom, tobacco advertising on billboards is banned, and tobacco companies are banned from sponsoring most sporting activities by 2003.

    2004: WHO adopts a Global Strategy on Diet, Physical Activity, and Health

    2005: The European Commission creates the Executive Agency for Public Health Programs to improve community health programs in the European Union through means such as supporting scientific research and collaboration, implementing public health programs, and awarding grants and contracts

    2006: Doctors Without Borders creates a surgical program in Jordan to care for victims of the Iraq War as physicians are unable to operate safely in Iraq.

    2008: In the United Kingdom, patients are allowed to seek treatment in any clinic or hospital that meets NHS standards.

    2010: In the United States, the Affordable Care Act becomes law; 2010 changes include tax credits for small businesses and nonprofit organizations, creation of a program to provide insurance to individuals with preexisting conditions, allowing young adults to remain covered by a parent's health plan until they turn 26, prohibition of the practice of rescission (retroactively cancelling insurance coverage) in the absence of fraud, and broadening of Medicaid eligibility; various other phases become active from 2011 to 2014.

    2011: In the United States, a Center for Medicare & Medicaid Innovation is created to develop methods to provide quality care at lower cost.

    2012: The U. S. Supreme Court hears arguments on the constitutionality of the Affordable Care Act.

    2012: In the United Kingdom, the British Social Attitudes Survey estimates that public satisfaction with the NHS fell from 70 percent in 2010 to 58 percent in 2011, the largest fall since the survey began in 1983.

    2012: In the United States, the medical loss ratio (MLR) requires insurance companies to spend at least 80 percent (85 percent for large plans) of collected premiums on providing care or making quality improvements.

    2013: In the United States, states are required to pay physicians for services delivered to Medicaid patients at rates at least as high as the rate for Medicare patients.

    2014: In the United States, the final provisions of the Affordable Care Act are scheduled to take effect, including the creation of insurance exchanges to offer health insurance policies to people who do not receive coverage from their employers and requiring most people to purchase a basic health insurance policy or pay a penalty.

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    World Health Organization, Regional Office for Europe. Emergency Medical Services Systems in the European Union: Report of an Assessment Project Co-ordinated by the World Health Organization. Copenhagen, Denmark: WHO, 2008. http://www.euro.who.int/__data/assets/pdf_file/0016/114406/E92038.pdf (Accessed April 2012).
    World Health Organization. Regional Office for South-East Asia. http://www.searo.who.int (Accessed June 2012).
    World Health Organization, Regional Office for South-East Asia, Regional Office for the Western Pacific. Social Health Insurance: Selected Case Studies from Asia and the Pacific. SEARO Regional Publication No. 42. New Delhi, India: SEARO, 2005. http://www.wpro.who.int/publications/docs/searpno42.pdf (Accessed May 2012).
    World Health Organization. Regional Office for the Western Pacific Region. http://www.wpro.who.int/en/ (Accessed April 2012).
    World Health Organization. WHO 2011 Global Tuberculosis Control. Geneva, Switzerland: WHO, 2011. http://www.who.int/tb/publications/global_report/en (Accessed April 2012).
    World Health Organization. WHO's Activities in Emergencies and Humanitarian Action. Geneva, Switzerland: WHO, 2010. http://www.who.int/hac/publications/hac_overview2010_may11.pdf (Accessed June 2012).
    World Health Organization. World Directory of Medical Schools (with 2007 updates). http://www.who.int/hrh/wdms/en (Accessed June 2012).
    World Health Organization. World Health Statistics 2011. Geneva, Switzerland: WHO, 2011. http://www.who.int/whosis/whostat/2011/en/index.html (Accessed April 2012).
    Xu, Ke, David B.Evans, KeiKawabata, RiadhZeramdini, JanKlavus, and Christopher J. L.MurrayHousehold Catastrophic Health Expenditure: A Multicountry Analysis.” The Lancet, v. 362 (July 12, 2003).

    Resource Guide

    Blank, Robert H. and ViolaBurau. Comparative Health Policy.
    3rd ed
    . New York: Palgrave Macmillan, 2010.
    Intended primarily for students, Comparative Health Policy provides a relatively brief (310 pages) and readable introduction to major issues in health care policy. The book focuses on the health care systems of Australia, Germany, Japan, New Zealand, the Netherlands, Sweden, Singapore, Taiwan, the United Kingdom, and the United States, so it is most useful for those interested in health care organization in countries that have already achieved a high level of development and less so for developing countries. Chapters are organized around topics, including the context of health care; funding, provision, and governance; priorities and resource allocation; the medical profession; home health care; and public health.
    The Commonwealth Fund http://www.commonwealthfund.org
    The Commonwealth Fund is a private foundation created by Anna M. Harkness in 1918 to “enhance the common good” (according to the fund's Web page). The fund's focus today is on creating health care systems that are more efficient and higher quality and offer better access than existing systems, particularly for vulnerable populations, such as low-income people and the uninsured; topics covered by Commonwealth Fund reports include health policy reform, health care delivery, health care quality, health insurance, payment reform, and vulnerable populations. The fund's emphasis is on the United States, but it also produces reports and studies on international health policy. Commonwealth Fund publications, surveys, and so on, are available for viewing or download from the Web site, as is information about fellowships and grants available from the Commonwealth Fund.
    Glied, Sherry and Peter C.Smith, eds. The Oxford Handbook of Health Economics. New York: Oxford University Press, 2011. http://dx.doi.org/10.1093/oxfordhb/9780199238828.001.0001
    The Oxford handbook includes 38 essays written by international guest contributors covering a broad range of topics relevant to the many ways health care may be organized and delivered. Some essays provide overviews of broad topics, such as “Health Systems in Industrialized Countries” (by Bianca K. Frogner, Peter S. Hussey, and Gerard F. Anderson) and “Socioeconomic Status and Health: Dimensions and Mechanisms” (by David M. Cutler, Adriana Lleras-Muney, and Tom Vogl), while others are more specific, for example, “Health Utility Measurement” (by Donna Rowen and John Brazier) and “Provider Payment and Incentives” (by John B. Christianson and Douglas Conrad).
    This monthly peer-reviewed journal, founded in 1981, focuses on health care policy and research Some issues are focused on particular topics (for example, cancer care, substance abuse treatment, or health disparities), while others carry articles on a variety of topics. The focus is primarily on the United States, but international issues are also covered, and some international articles compare health systems or outcomes across countries. Some free content is available from the Health Affairs Web site, including a general blog, another covering grants, and “Health Policy Briefs” (summaries of relevant information on topics such as workplace wellness programs and the influence of public reporting of quality and costs on consumer choice).
    International Association of National Public Health Instituteshttp://www.ianphi.org
    The International Association of National Public Health Institutes (IANPHI) is an international organization dedicated to promoting stronger national public health institutes and more coordinated public health systems globally while also serving as a professional organization for the directors of national public health institutes. It was created in 2006, has 79 members (from 74 countries, representing all regions of the world), and is supported through dues and a grant from the Bill and Melinda Gates Foundation. The IANPHI Web site includes profiles of member organizations, descriptions of IANPHI projects, news and events relevant to international public health, resources including case studies of how different national public health institutes were created, the IANPHI's Framework for the Creation and Development of National Public Health Institutes (a 2007 publication downloadable in PDF format), public health multimedia resources, and links to other relevant Web sites.
    The International Social Security Associationhttp://www.issa.int/Observatory/Country-Profiles
    The International Social Security Association (ISSA) is an international organization dedicated to promoting social security systems through providing information and encouraging networking among those involved in social security. The ISSA was founded in 1927 in response to the rapid growth of social insurance after the conclusion of World War I and is headquartered at the International Labour Office in Geneva, Switzerland. As of 2012, the ISSA had 335 member organizations in 157 countries, including institutions, government departments, and agencies. The observatory provides profiles of national social security programs in more than 170 countries and territories; most data is collected by surveys carried out by the ISSA and the U.S. Social Security Administration, with other information provided by the Organisation for Economic Co-operation and Development (OECD), the International Organization of Pension Supervisors, and national social security officials. Reports are organized within geographic regions (Africa, the Americas, Asia and the Pacific, and Europe) for each country. Separate sections provide basic statistical information on each country and its social security scheme, a more detailed description of the country's schemes (divided into Family Benefits; Old Age, Disability, and Survivors; Sickness and Mortality; Unemployment; and Work Injury), a timeline of reforms, and links to further resources.
    Joint United Nations Programme on HIV/AIDShttp://www.unaids.org/en
    The mission of the Joint United Nations Programme on HIV/AIDS (UNAIDS) is to promote universal access to human immunodeficiency virus (HIV) prevention, care, support, and treatment and to achieve these goals by 2015. Specific goals include reducing sexual transmission, eliminating new infections among children, preventing transmission among drug users, avoiding acquired immune deficiency syndrome (AIDS)-related tuberculosis deaths, eliminating inequalities in access to preventive and treatment services, eliminating travel restrictions, and eliminating discrimination against people who are HIV positive. The Web site includes a searchable database of HIV-and AIDS-related indicators with the ability to create customized, graphical displays. It also includes press releases, statistical reports, country reports, fact sheets, and multimedia presentations about HIV and AIDS.
    Organisation for Economic Co-operation and Developmenthttp://www.oecd.org
    The Organisation for Economic Co-operation and Development (OECD) is an international organization dedicated to providing a forum for governments to share information and seek common solutions and to promoting policies to improve the well-being of people in all countries through economic growth and social development, while also being mindful of the environmental results of development. The OECD was founded in 1961, is headquartered in Paris, and as of 2012, had a membership of 34 countries in all regions of the world, controlled a budget of 347 million euros, and produced about 250 publications a year. The OECD regularly monitors national and global events (in both member and nonmember countries), collects and analyzes data, and issues recommendations. Regular OECD publications include the OECD Economic Outlook (four issues per year), the OECD Factbook, OECD Economic Surveys (produced every two years for OECD countries plus Brazil, Russia, India, Indonesia, China, and South Africa), and the OECD Yearbook. The OECD also produces numerous special reports and books, and most OECD information is available in a variety of formats, including free access on the Web site, free downloads, and hard copy (for purchase).
    A peer-reviewed, open-access journal published by the Public Library of Science, the focus is on articles that are likely to influence public health policy or clinical health practice and on the diseases and risk factors that, on a global basis, cause the greatest loss of years of healthy life. Articles are published under a Creative Commons Attribution License, so they may be freely downloaded. Articles cover a broad range of topics from molecular biology to nutrition to public health and nutrition, and many have an international focus.
    Save the Children is an independent organization dedicated to improving children's lives, both in the United States and around the world. It was founded in 1932 in the United States, modeled after an English organization of the same name founded after World War I; it currently operates in more than 50 countries. Of particular interest in comparative health studies are Save the Children's annual State of the World's Mothers report, which highlights the conditions faced by women, children, and mothers in different countries around the world. Data on a number of international indicators relevant to the health and status of women and children is included in the report, and countries are ranked on three composite scales (the women's index, the mother's index, and the children's index) within three development groups (more developed, less developed, and least developed) according to the conditions presented for each demographic group.
    United Nations Development Project Human Development Reportshttp://hdr.undp.org/en
    The goal of the Human Development Reports produced by the United Nations Human Development Report Office (HDRO) is to advance human development, freedom, and opportunities globally. The HDRO challenges policies that constrain human development, advocates for practical policy changes, and promotes new ideas to advance human development. Data for the International Human Development Indicators (used in the Human Development Index, or HDI, as well as other indices) is available from the Web site, along with various data tools to visualize the data, compare trends over time, and contrast human development in different countries. The Human Development Reports are available for the years 1990 to 2012; some are country specific, while others cover many countries, and they address a variety of topics, including democratic governance; economic reform and public finance; gender; environment and energy; education, knowledge, and culture; human security and conflicts; millennial goals and international cooperation; poverty and inequality; public health; and societal groups and social inclusions. Information on the Web site may be searched by key word or accessed through indices arranged by country or topic.
    World Health Organization Countrieshttp://www.who.int/countries/en
    This section of the World Health Organization's (WHO) Web site organizes information alphabetically by country. The specific information available for each country differs, and much of the information is also available from other sources, but this is a handy way to get an overview of each country and to access the available information from various WHO reports and sources. For each country, basic statistics and a map are presented, as well as the country health profile comparing the country to the average for its region on statistics such as immunization rates, the health workforce, and adult risk factors. Other information typically available includes the country's regional profile, information about disease crises and outbreaks, collaborating centers, data about mortality and the burden of disease, the national health accounts (expenditures for health), and information about immunizations, nutrition, and risk factors such as alcohol, road injuries, and tobacco use.
    World Health Organization Global Health Observatory Data Repositoryhttp://apps.who.int/ghodata
    This convenient online interface accesses WHO's World Health Statistics 2011 and more than 50 data sets on a variety of global health topics, including mortality, burden of disease, health systems, environmental health, and the Millennium Development Goals. The interface includes a free-text search as well as a hierarchical index organized by topics (for example, HIV/AIDS, immunization, neglected tropical diseases, tobacco control). The default search on any topic retrieves all countries and all related indicators; users can then filter the data by region and years and also export data sets as an Excel spreadsheet, CSV file, or HTML file. Definitions are provided for many of the statistics, and many of the individual data points include explanatory notes as well, making this Web site a rich resource for anyone interested in global health.

    Glossary

    • Active immunity: Immunity provided through vaccination or by contracting the disease; with active immunity, a person's immune system produces antibodies against a disease, and the protection is generally permanent.
    • Acute disease: A disease that is short-lived and generally develops quickly; examples include strep throat and influenza.
    • Adolescent fertility rate: The annual number of births for women aged 15 to 19 years divided by the number of women aged 15 to 19 years in a population; usually expressed per 1,000.
    • Adverse selection: The tendency of an individual or group to choose to join a health care utilization pool only when they expect their utilization to be above average for the group; the classic example is a healthy person who does not buy insurance until he or she has a need for services.
    • Age rating: A method used by insurance companies (when legal) to charge different rates for individuals of different ages.
    • Age-adjusted mortality rate: A mortality rate statistically adjusted to facilitate comparison of mortality across populations by removing the effect of differing age distributions in the different populations.
    • Age-specific mortality rate: A mortality rate for a particular age group, such as persons aged 20 to 29 years.
    • Aid effectiveness: As defined by the Paris Declaration, a measure of how well development aid succeeds in achieving targets.
    • Aid in kind: Aid by provision of goods or services (for example, food) rather than money.
    • Appropriate care: Medical care that is safe and effective, based on the best available evidence, which meets priorities for the allocation of resources with the needs of the entire population taken into account.
    • Arbovirus: A virus transmitted by an arthropod, such as a tick or mosquito; examples include yellow fever, dengue fever, and West Nile virus.
    • Attack rate: The proportion of a population that develops an acute condition (for example, a specified disease) during a specified time period; the attack rate is calculated by the number of new cases during the time period divided by the population at the start of the period and is usually expressed per 1,000 or per 100,000.
    • Births attended by skilled personnel: A measure of health service coverage in a country, calculated by dividing the number of births in a time period attended by doctors, nurses, or midwives by the total number of live births in the same period.
    • Body mass index (BMI): An index used to calculate rates of the underweight, overweight, and obese; calculated by dividing weight in kilograms by squared height in meters.
    • Burden of disease: The difference between a situation in which everyone in a country lives into old age without illness or disability and the current situation in the country.
    • Capitation: A method of funding hospitals or health care providers based on the number and types of services provided or the number of patients on the patient list for the provider.
    • Case management: A method of organizing and coordinating medical and other services required by a person; normally provided to people with complex social and health needs who require expensive care or who are members of a vulnerable population subgroup.
    • Catastrophic health insurance plan: A type of insurance that typically has a high deductible or only covers expensive types of treatment (for example, hospitalization).
    • Cause-specific mortality rate: The mortality rate from some specific cause, such as lung cancer or an automobile accident.
    • Centers for Medicare and Medicaid Services: In the United States, the federal agency that manages the Medicare and Medicaid programs; it was formerly known as the Health Care Financing Administration (HCFA).
    • Children's Health Insurance Program (CHIP): A U.S. program to provide insurance to children (and in some states, pregnant women) whose families cannot afford private coverage but earn too much to qualify for Medicare.
    • Chronic disease: A disease that lasts for a long time and typically has a slow onset, such as arthritis or cancer.
    • Clinical practice guidelines: Recommendations based on scientific evidence to guide patients and health care professionals in selecting appropriate treatment or intervention for a condition.
    • COBRA: A U.S. law that allows an employee to keep an employer-provided health plan after the conclusion of employment; usually the employee pays the full cost of the plan plus an administrative fee.
    • Cohort: A group of individuals who have some well-defined common experience. Examples include being born in a particular year or being exposed to some health risk.
    • Common source outbreak: An outbreak of disease due to individuals being exposed to the same source of harmful influence (rather than spreading from person to person).
    • Communicable disease: An infectious disease that can be passed from one person to another or from an animal to a person.
    • Community immunity:See herd immunity.
    • Community rating: In insurance, charging the same premiums to everyone within a geographic area without differences due to health status, age, gender, and so on.
    • Consensus building: A method of achieving overall agreement on some issue or policy among the stakeholders involved.
    • Corruption Perceptions Index: An index published by Transparency International, assigning each country a score based on the perception of corruption in the public sector; scores range from 0 (very corrupt) to 10 (very clean).
    • Cost sharing: Various methods by which an individual pays part of the costs of medical treatment covered by insurance; cost sharing includes coinsurance (paying a percentage of the cost), deductibles (paying the costs up to a certain total), and copayments (paying a specified cost per service).
    • Cost-benefit analysis: A type of economic analysis in which the costs and benefits of some course of action (such as a type of surgery or other treatment) are expressed in monetary terms; often used to compare different courses of action or to decide if a particular course of action is worth taking.
    • Crude birth rate: The number of live births during a time period divided by the population during the period (usually the population at the period midpoint) and expressed per 1,000.
    • Deductible: In insurance, the amount that a person must pay for medical treatment before the insurance policy begins to pay for the care.
    • Demand for health services: The willingness to use (and perhaps pay for) health care services.
    • Demographic information: Information describing a person or group of persons (for example, a community), which may include both inherent (for example, race or gender) and descriptive (for example, income or geographic location) factors.
    • Dengue fever: A viral disease transmitted by mosquitoes (Aedes aegypti) and characterized by fever and severe headache, leading to death in approximately 5 percent of cases.
    • Dependent: A person related to another and for whom insurance coverage may be extended; examples include partners, spouses, and children.
    • Diagnosis-related group (DRG): A method of funding hospitals for care based on services provided based on a list of closely defined diseases, injuries, procedures, and so on.
    • Disability adjusted life year (DALY): A measure of disease burden in which the years of life lost due to premature mortality (YLL) and the years of life lost due to disability (YLD) are added together; the sum of DALYs across a population is the burden of disease.
    • Disease management: A method for coordinating services for a specific medical condition, with the focus on the disease rather than on the individual patient (the latter would be case management).
    • Donut hole: A colloquial term for the fact that, in Medicare Part D (in the United States), there is a gap in the coverage for prescription drugs so that an insured person must pay all the costs within a certain range. The insurance provides coverage up to a certain annual amount, and after a higher annual amount is reached; the part between those two amounts is the donut hole.
    • DPT3: A combination diptheria and pertussis vaccine on the list of recommended child vaccines.
    • Economy of scale: A principle in economics in which the cost of a production of a unit of something (for example, a medication) declines as output decreases because the fixed costs are relatively constant for larger or smaller production runs.
    • Effectiveness: A measure of how well an intervention (such as a prescription drug or course of therapy) produces the desired effect in the intended conditions of use (as opposed to a clinical trial or other artificial situation).
    • Efficiency: A measure of how well an intervention or procedure produces the intended results under ideal conditions (for example, during a clinical trial).
    • Emergency Medical Treatment and Active Labor Act (EMTALA): A 1986 U.S. federal law requiring hospitals to treat patients with medical emergencies without regard to their insurance status or ability to pay.
    • Endemic: The constant presence of a health condition (for example, malaria) or risk factor in a geographic area or population.
    • Entitlement program: A program in which everyone meeting specified standards (for example, age or disability) is legally entitled to benefits provided by the program.
    • Epidemic: An occurrence of a higher than usual number of cases of a health condition, often disease or injury, in an area or population.
    • Epidemic triad: The three components of infectious disease: an agent, a host, and an environment bringing the agent and host together.
    • Epidemiology: The study of disease occurrence (or occurrence of other health events) in populations, including the factors related to the occurrence of disease and methods to control it.
    • Evaluation: A systematic, objective method of determining how well a course of action succeeded in its goals.
    • Exclusive provider organization (EPO): A type of health insurance plan that only reimburses care received from providers within its network.
    • Expressed demand for health services: The willingness to use (and perhaps pay for) health care services as measured by actual use, contrasted with potential demand.
    • Fee for service: A method of paying for medical care in which providers are paid according to the number of services (for example, office visits) they perform.
    • Fetal mortality rate: The number of fetal deaths in a geographic area in a given period divided by the number of live births and fetal deaths for the same area and year; usually expressed as per 1,000.
    • Flexible spending account (FSA): A type of health insurance program in which a specified amount of money from an individual's paycheck is deposited in an account to be used for medical expenses.
    • Gatekeeper: A person, often a primary care physician, who is the first point of contact for an individual seeking care and has the authority to refer the person to specialist care.
    • Gender Inequality Index: An index calculated by the United Nations Development Programme including three dimensions: reproductive health (maternal mortality and adolescent fertility), empowerment (parliamentary representation and educational attainment), and labor market (labor force participation).
    • Gini coefficient (Gini index): A measure of the distribution of income in a country; a lower Gini index means greater income equality (a country with perfect equality would have a Gini index of 0) and a higher Gini index greater inequality (a country with perfect inequality would have a Gini index of 100).
    • Global burden of disease (GBD): An estimate, on a global level, of the difference between a situation in which everyone in the world lives to old age without illness or disability and the current global situation; the World Healch Organization reports the GBD based on the disability and mortality from 107 diseases and 10 risk factors.
    • Global Gender Gap Index: An index published annually by the World Economic Forum evaluating the status of women in each country in terms of economic, political, educational, and health criteria and ranging in theory from 1.0 (most equal) to 0.0 (least equal); it is focused on gaps between men and women rather than levels, and on outcomes rather than inputs.
    • Gross domestic product (GDP): The value of all final goods and services produced by a country in a year.
    • Gross domestic product (GDP) per capita: GDP divided by the population at midyear.
    • Harmonization: One of the principles of aid effectiveness; it means that donor activities and contributions are coordinated, that information is shared, and that donors attempt to avoid duplication and achieve collective effectiveness.
    • Health expenditures: Expenditures to promote, restore, or maintain human health through the application of medical, nursing, or related knowledge and technology.
    • Health indicator: A statistic, such as the mortality rate, used to evaluate the health of a population, the effectiveness of a health care system, and so on.
    • Health insurance: A type of insurance in which the insurer pledges to compensate either the insured person or the provider of health services if specific conditions occur (for example, the person has an illness or injury that is covered by the health insurance policy).
    • Health services: Services meant to contribute to improved health, including diagnostic, treatment, and rehabilitation services (not limited to medical services).
    • Hepatitis A: A viral disease spread through fecal-contaminated food and water, which causes jaundice, fever, and diarrhea.
    • Herd immunity: The ability of a community or other group of people to resist infection with a particular disease (for example, measles) because most of the population is immune to the disease.
    • Hib3: The immunization for haemophilus influenzae type b, a bacterial disease that is a particular threat to children under age 5.
    • Hospital bed density: The number of hospital beds per 1,000 population, used as a measure of the availability of inpatient care.
    • Human capital: The skills and capabilities of individuals in a country, including those gained by training and education.
    • Human Development Index (HDI): An index developed by the UNDP and combining measures of education, living standards, and health; scores rank from 0 (low) to 1 (high).
    • Human immunodeficiency virus/acquired immune deficiency syndrome (HIV/AIDS) adult prevalence rate: The percentage of persons aged 15 to 19 years in a country who are HIV positive or have AIDS.
    • Ibrahim Index: An index produced by the Mo Ibrahim Foundation that evaluates the quality of governance of African countries using 84 indicators in the categories of safety and rule of law, human rights and participation, human development, and sustainable economic opportunity; the theoretical range is from 100 (best) to 0 (worst).
    • Immunity: Protection from infection with a disease.
    • Improved sanitary facilities: Use of facilities such as flush toilets to a piped sewer system, septic tank, or pit latrine; a composting toilet; a ventilated, improved latrine; or a pit latrine with a slab.
    • Improved sources of drinking water: Water from sources likely to guarantee its quality, including water piped into a home; drawn from a public tap; drawn from a tube well, borehole, or protected dug well; drawn from a protected spring; and collected rainwater.
    • Incidence: A measure of the new cases of a condition, such as a specific illness or injury, in a specified period and in a specified population.
    • Infant mortality rate: The rate of death for children aged less than 1 year; a statistic often used as a measure of the quality of a national health care system. Infant mortality is calculated as the number of deaths in this age group over a specified period of time (usually one year) divided by the number of live births in the same period and expressed per 1,000.
    • Internally displaced person: A person who has left his or her home for reasons similar to those of a refugee (for example, a well-founded fear of prosecution for reasons such as race, religion, or political opinion) but remains within his or her own country.
    • Irrational demand for health services: Demand for health services not corresponding to an actual need; contrasted with rational demand, which does correspond to an actual need for health services.
    • Japanese encephalitis: A viral disease spread by mosquitoes (Culex tritaeniorhynchus) that leads to fatality in approximately 30 percent of cases.
    • Leishmaniasis: A disease transmitted by sand flies, which transmit the parasite leishmania, resulting in chronic skin lesions; endemic in 88 countries, with most cases occurring in Brazil, Afghanistan, Iran, Peru, Syria, and Saudi Arabia.
    • Life course approach: A method of looking at the results of a health system over the course of a lifetime and with regard to the interaction of risk and protective factors at different stages of life.
    • Life expectancy at birth: An estimate of the average number of years a person is expected to live based on current age and assuming that the mortality rates current when the life expectancy is calculated continue to apply.
    • Lifetime limit: The maximum amount that an insurance policy will pay over the course of a person's lifetime or the number of times a service will be covered; not all policies include lifetime limits, but those that do may specify limits in different categories (for example, $1 million total claims or a single gastric bypass).
    • Long-term care: Services provided to people who cannot perform activities of daily living (ADLs) such as bathing or dressing themselves; long-term care includes medical and nonmedical services and may be provided in a variety of settings, including the individual's home or in a nursing home or other care facility.
    • Marginal cost: In economics, the cost of producing one more unit of something.
    • Maternal mortality index: The rate of maternal deaths (death while pregnant or within 42 days of pregnancy termination for any reason related to or aggravated by the pregnancy or pregnancy management) in a country in a given period of time divided by the number of live births in the country in the same period; usually expressed per 100,000 live births. Measuring maternal mortality is difficult in many countries and may be estimated using multiple sources of information, including household surveys, verbal autopsy, and records review.
    • MCV: The vaccine for measles, a highly infectious viral disease characterized by red spots on the skin.
    • Microinsurance: Insurance developed for low-income people who are not covered by conventional insurance policies; microinsurance policies are usually characterized by low premiums and low levels of coverage.
    • Mortality rate: A statistic expressing the frequency of death during some time period (often a year), calculated by dividing the number of deaths in that period by the population during that period (the latter is often the population at the midpoint of the period).
    • Mumps: A contagious viral illness characterized by swelling of the salivary glands.
    • National health accounts: Information about the health expenditures in a country; this often includes facts such as total health expenditures, private and public health expenditures, out-of-pocket expenditures, and so on.
    • Neonatal mortality rate: The mortality rate for children less than 28 days old, calculated by dividing the number of deaths in this age group over a specified period by the number of live births in the same period and expressed per 1,000.
    • Net migration rate: The difference between the number of people immigrating to and emigrating from a country in a given year and generally expressed as per 1,000 population; a positive rate means more people are entering the country than leaving it, a negative rate that more people are leaving than entering.
    • Notifiable disease: A disease that must be reported to public health authorities, as prescribed by law.
    • Opportunity cost: In economics, the value of opportunities not taken as the result of choosing a particular choice of action; sometimes defined as the cost of not taking the next best alternative course of action.
    • Organisation for Economic Co-operation and Development (OECD): An international organization promoting policies that will improve human economic and social well-being.
    • Outbreak: A term sometimes used in preference to epidemic in order to prevent public panic; an outbreak is the occurrence of more than the expected number of cases of a health condition (for example, disease or injury) in a population or geographic area in a given period.
    • Out-of-pocket limits: The maximum that an individual or family will be required to pay for medical services in a given year, including deductibles, copayments, and coinsurance.
    • Out-of-pocket payments: Payments by the person receiving a good or service; in health care, services or products (for example, a physician visit or prescription drug) often require an out-of-pocket payment as well as partial subsidy by an insurer or the government.
    • Pandemic: An epidemic that occurs in multiple countries.
    • Paris Declaration on Aid Effectiveness: A 2005 international agreement specifying five principles intended to promote effective aid: (1) ownership of development policies by the partner countries, (2) alignment between the donors' support and the development policies of the partner countries, (3) harmonization among the donor countries, (4) managing for results (that is, the focus is on measurable development results, and these results are evaluated), and (5) mutual accountability among donors, partners, and countries.
    • Passive immunity: Immunity acquired by antibodies produced by another person or animal (for example, babies are protected by maternal antibodies during their first months of life); protection is usually limited and diminishes over time.
    • People-centered care: Care centered around the needs of individual patients and communities rather than on treating a disease in the abstract.
    • Percent urbanization: The projected rate of change in urbanization; a positive rate means more people are expected to live in urban areas in the future, while a negative rate means that fewer are expected to live in urban areas.
    • Performance-based payments: Sometimes called P4P or pay for performance, a method of paying health service providers based on their meeting particular standards (or paying bonuses based on meeting a standard); may also apply to health systems or entire countries.
    • Pertussis: A bacterial disease sometimes called whooping cough due to the convulsive cough associated with it.
    • Point of service (POS): A type of insurance plan in which the patient chooses a primary care provider from within the insurer's network; that provider can make referrals to specialists within or outside the network, but the patient typically pays more for care received outside the network.
    • Population growth rate: The average annual percentage change estimated for a country's population, calculated using the birth and death rates and the net migration rate.
    • Postneonatal mortality rate: The mortality rate for children from age 28 days to less than 1 year, calculating by dividing the number of deaths in this age group for a specified period (usually one year) by the number of live births in the same period and expressed per 1,000.
    • Preferred provider organization (PPO): A type of health insurance in which you pay less for treatment received from providers and hospitals within a network, as opposed to providers and hospitals outside the network.
    • Prevalence rate: The number of total cases of a disease in a population and time period; contrasted with incidence, which is the number of new cases.
    • Preventive services: Medical services intended to prevent illness or detect it at an early stage, including immunizations, screenings, and patient education.
    • Primary care: Medical care and preventive services for common illnesses, usually provided by general practice physicians, nurses, and so on.
    • Primary prevention: Measures intended to help a person avoid a health problem; examples include immunization against a disease and education to encourage the use of automobile safety belts.
    • Private health insurance: A type of health insurance in which the cost of a policy is based on either individual or group risks; an example of group risk would be the risk for all the employees of a particular company, who are provided with insurance as a benefit of their employment.
    • Propagated outbreak: An outbreak of disease that is spread from one person to another.
    • Public health services: Services intended to benefit an entire population, such as the provision of a municipal sewage and water system; contrasted with medical care, which is focused on benefiting the individual patient.
    • Purchasing power parity (PPP): A method of comparing costs or prices across countries, based on the international dollar, an economic construct whose purchasing power in the country in question equals the purchasing power of one U.S. dollar in the United States. It is used to account for differences in cost levels across countries and for fluctuations in exchange rates.
    • Race-specific mortality rate (ethnic-specific mortality rate): The mortality rate for a particular racial or ethnic group, for example, African Americans or Hispanic Americans.
    • Rational demand for health services:See irrational demand for health services.
    • Recurrent costs: Costs for items that are regularly purchased and last less than a year; in a health care system, recurrent costs could include (among other things) salaries, pharmaceuticals, and other supplies.
    • Refugee: According to the United Nations (UN), a person living outside his or her habitual residence due to a well-founded fear of persecution due to reasons including race, religion, nationality, social group, or political opinion and who is unable to return home for that reason.
    • Rescission: Cancelling a health insurance policy retroactively, whether for intentional fraud or for unintentional errors in the application process.
    • Risk adjustment: A method used by insurers (where legal) to consider previous patterns of health care utilization, health history, and current health when enrolling individuals in a health insurance plan.
    • Risk pooling: In insurance, the practice of spreading risk across members of a group (for example, persons employed by a company or residents of a country).
    • Secondary attack rate: The frequency of new cases of a disease among persons who are contacts of persons known to have the disease.
    • Secondary care: Standard hospital care, including general medicine and surgery, pediatrics, and obstetrics.
    • Secondary prevention: Measures intended to detect a disease before clinical symptoms have developed, such as screening tests for tuberculosis or prostate cancer.
    • Stakeholder: Someone or something (for example, an organization) who has an interest in the outcome of some situation.
    • Tertiary care: Advanced and specialized hospital care and posthospital rehabilitation.
    • Tertiary prevention: Measures intended to minimize the effects of an already-established disease and to restore the patient to the highest possible level of functioning.
    • Total fertility rate: The average number of children a cohort of women would have if the fertility rate for a given period applied throughout their entire reproductive period; expressed as the number of children per woman and used to estimate future population growth in a country.
    • Transparency International: An international organization with chapters in more than 100 countries, which promotes corruption-free government, business, and civil society and publishes the Corruption Perceptions Index.
    • United States Agency for International Development (USAID): A federal agency that administers civilian foreign aid.
    • Universal coverage: In health insurance, the guaranteed provision of specified benefits for everyone within a population (for example, the citizens or residents of a country).
    • Urban population: The percentage of the population of a country living in urban areas, using the definition of “urban” provided by the country.
    • USD: U.S. dollars; this is the ISO 4127 currency code. When other currencies are cited, the ISO 4127 code is also used, and the currency is generally that of the country in question (for example, AFN = Afghanistan Afghani, EUR = euro).
    • Years of life lost (YLL): A measure of the impact of premature death on a population, calculated as the difference between current life expectancy or a particular age (for example, 55 years) and the actual age of death.
    • Yellow fever: A viral disease spread by mosquitoes and prevalent only in sub-Saharan Africa and tropical South America.

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