Background Recently there has been a significant increase in the number of systematic reviews addressing questions of prevalence. Key features of a systematic review include the creation of an a priori protocol, clear inclusion criteria, a structured and systematic search process, critical appraisal of studies, and a formal process of data extraction followed by methods to synthesize, or combine, this data. Currently there exists no standard method for conducting critical appraisal of studies in systematic reviews of prevalence data. Methods A working group was created to assess current critical appraisal tools for studies reporting prevalence data and develop a new tool for these studies in systematic reviews of prevalence. Following the development of this tool it was piloted amongst an experienced group of sixteen healthcare researchers. Results The results of the pilot found that this tool was a valid approach to assessing the methodological quality of studies reporting prevalence data to be included in systematic reviews. Participants found the tool acceptable and easy to use. Some comments were provided which helped refine the criteria. Conclusion The results of this pilot study found that this tool was well-accepted by users and further refinements have been made to the tool based on their feedback. We now put forward this tool for use by authors conducting prevalence systematic reviews.

Background Health is a complex phenomenon that can be studied from different approaches. Despite a growing research in the areas of Social Determinants of Health (SDH) and health equity, effects of macroeconomic policies on the social aspect of health are unknown in developing countries. This study aimed to determine the effect of macroeconomic policies on increasing of the social-health inequality in Iran. Methods This study was a mixed method research. The study population consisted of experts dealing with social determinants of health. A purposive, stratified and non-random sampling method was used. Semi-structured interviews were conducted to collect the data along with a multiple attribute decision-making method for the quantitative phase of the research in which the Technique for Order Preference by Similarity to Ideal Solution (TOPSIS) was employed for prioritization. The NVivo and MATLAB softwares were used for data analysis. Results Seven main themes for the effect of macroeconomic policies on increasing the social-health inequality were identified. The result of TOPSIS approved that the inflation and economic instability exert the greatest impact on social-health inequality, with an index of 0.710 and the government policy in paying the subsidies with a 0.291 index has the lowest impact on social-health inequality in the country. Discussion It is required to invest on the social determinants of health as a priority to reduce health inequality. Also, evaluating the extent to which the future macroeconomic policies impact the health of population is necessary.

Background During the last three decades, the Total Fertility Rate (TFR) in Iran has fallen considerably; from 6.5 per woman in 1983 to 1.89 in 2010. This paper analyzes the extent to which economic determinants at the micro and macro levels are associated with the number of children in Iranian households. Methods Household data from the 2010 Household Expenditure and Income Survey (HEIS) is linked to provincial data from the 2010 Iran Multiple-Indicator Demographic and Health Survey (IrMIDHS), the National Census of Population and Housing conducted in 1986, 1996, 2006 and 2011, and the 1985–2010 Iran statistical year books. Fertility is measured as the number of children in each household. A random intercept multilevel Poisson regression function is specified based on a collective model of intra-household bargaining power to investigate potential determinants of the number of children in Iranian households. Results Ceteris paribus (other things being equal), probability of having more children drops significantly as either real per capita educational expenditure or real total expenditure of each household increase. Both the low- and the high-income households show probabilities of having more children compared to the middle-income households. Living in provinces with either higher average amount of value added of manufacturing establishments or lower average rate of house rent is associated to higher probability of having larger number of children. Higher levels of gender gap indices, resulting in household’s wife’s limited power over household decision-making, positively affect the probability of having more children. Conclusion Economic determinants at the micro and macro levels, distribution of intra-household bargaining power between spouses and demographic covariates determined fertility behavior of Iranian households.

Evaluating the investment that healthcare organisations make in quality improvement requires knowledge of impact at multiple levels, including patient care, workforce and other organisational resources. The degree to which these resources help organisations to survive and thrive in the challenging contexts in which healthcare is designed and delivered is unknown. Investigating this question from the perspective of the Resource Based View (RBV) of the Firm may provide insights, although is not without challenge.

With the implementation of the Affordable Care Act (ACA), access to insurance and coverage of preventive care services has been expanded. By removing the barrier of shared costs for preventive care, it is expected that an increase in utilization of preventive care services will reduce the cost of chronic diseases. Early detection and treatment is anticipated to be less costly than treatment at full onset of chronic conditions. One concern of early detection of disease is the cost to treat. In reality, the confluence of early detection may result in greater overall expenditures. Even with improved access to preventive care benefits, cost-sharing of other health services remains a major component of insurance plans. In order to treat identified conditions or diseases, cost-sharing comes into play. With the greater adoption of cost-sharing insurance plans, expenditures on the part of enrollee are anticipated to rise. Once the healthcare recipients realize the implication of early identification and resultant treatment costs, enrollment in preventive care may decline. Healthcare legislation and regulation should consider the full spectrum of care and the microeconomic costs associated with preventive treatment. Although the system at large may not realize the immediate impact, behavioral shifts on the part of healthcare consumers may alter healthcare. Rather than the current status quo of treating presenting conditions, preventive treatment is largely anticipated to require more resources and may impact the consumer’s financial capacity. This report will explore how these two concepts are co-dependent, and highlight the need for continued reform.

This policy brief discusses preventive care benefits and cost-sharing included in health insurance provisions of the Affordable Care Act (ACA) legislation and highlights some consequences to Americans and the country in terms of healthcare costs and value.

McCoy and Singh rightly comment on how extraordinary it is to need to spell out the political nature, actions and motivations underlying global health policy (1), which articulates where they (and we) are coming from. Yet without such commentators, it would be easy for the global health community today to forget how political and macro-economic decisions in the 1980s and 90s gave oxygen to the social determinants that undermined the health of populations, especially in low-income countries. These fuelled the diseases that are the focus of today’s global health partnerships; and some of the same organisations played leading roles in setting the global health agenda then, as today.

Fiscal policies are an especially promising lever for reducing the burden of non-communicable diseases and injuries (1). On World No Tobacco Day 2014, World Health Organization (WHO) repeated with greater intensity its well-known proposal (2) on raising tobacco taxes to encourage users to stop or reduce consumption, and to prevent potential users from taking up smoking. Evidence as to why this is an effective strategy abounds (3). Despite concerns over manufacturers’ political influence, technical problems such as tax manipulation, and increased smuggling considerations, it is hoped that governments shall be scaling their efforts toward this direction in the next few years, by enforcing increases in specific excise taxes. A 2011 review of more than 100 econometric studies estimates that doubling inflation-adjusted prices should reduce consumption by about one third (4). In terms of revenue, WHO estimates that raising specific excise taxes on tobacco to double prices would raise about 100 billion US dollars per year worldwide, in addition to the approximately 300 billion US dollars that governments already collect on tobacco (5). Each country enforcing such taxes must decide how to allocate their share of this prospective additional revenue in advance. Careful consideration is particularly important; this is a chance for tobacco to atone, partly at least, for the damage it has inflicted throughout the years of its uncontrollable use.

Politics is not the ghost in the machine of global health policy. Conceptually, it makes little sense to argue otherwise, while history is replete with examples of individuals and movements engaging politically in global health policy. Were one looking for ghosts, a more likely candidate would be democracy, which is currently under attack by a new global health technocracy. Civil society movements offer an opportunity to breathe life into a vital, but dying, political component of global health policy.

The formulation of global health policy is political; and all institutions operating in the global health landscape are political. This is because policies and institutions inevitably represent certain values, reflect particular ideologies, and preferentially serve some interests over others. This may be expressed explicitly and consciously; or implicitly and unconsciously. But it’s important to recognise the social and political dimension of global health policy. In some instances however, the politics of global health policy may be actively denied or obscured. This has been described in the development studies literature as a form of ‘anti-politics’. In this article we describe four forms of anti-politics and consider their application to the global health sector.

Background Patient’s rights are worldwide considerations. Saudi Patient’s Bill of Rights (PBR) which was established in 2006 contained 12 items. Lack of knowledge regarding the Saudi PBR limits its implementation in health facilities. This study aimed to investigate the knowledge of health professions’ students at College of Applied Medical Sciences (CAMS) Riyadh Saudi Arabia regarding the existence and content of Saudi PBR as well as their attitude toward its ineffectiveness. Method A 3-parts survey was used to collect data from 239 volunteer students participated in the study. Data were analyzed by descriptive and analytical statistics using SPSS. Results Results showed that although the majority of students (96.7%) believe in the ineffectiveness of patient’s rights, half (52.3%) of them had perceptual knowledge regarding the existence of Saudi PBR and only 7.9% of them were knowledgeable about some items (1–4 items) of the bill. Privacy and confidentiality of patient was the most common known patient’s rights. Students’ academic level was not correlated to neither their knowledge regarding the bill existence or its content nor to their attitude toward the bill. The majority of the students (93%) reported that only one course within their curriculum was patient’s rights-course related. About one quarter (23.4%) of the students reported that teaching staff used to mention patient’s rights in their teaching sessions. Conclusion The Saudi health professions students at CAMS have positive attitude toward the ineffectiveness of patient’s rights nevertheless they showed limited knowledge regarding the existence of Saudi PBR and its contents. CAMS curriculums do not support the subject of patient’s rights.