| 1. |
- Feigin, Valery L., et al.
(författare)
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Global, regional, and national burden of stroke and its risk factors, 1990-2019 : a systematic analysis for the Global Burden of Disease Study 2019
- 2021
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Ingår i: Lancet Neurology. - : Elsevier. - 1474-4422 .- 1474-4465. ; 20:10, s. 795-820
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Tidskriftsartikel (refereegranskat)abstract
- Background Regularly updated data on stroke and its pathological types, including data on their incidence, prevalence, mortality, disability, risk factors, and epidemiological trends, are important for evidence-based stroke care planning and resource allocation. The Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) aims to provide a standardised and comprehensive measurement of these metrics at global, regional, and national levels. Methods We applied GBD 2019 analytical tools to calculate stroke incidence, prevalence, mortality, disability-adjusted life-years (DALYs), and the population attributable fraction (PAF) of DALYs (with corresponding 95% uncertainty intervals [UIs]) associated with 19 risk factors, for 204 countries and territories from 1990 to 2019. These estimates were provided for ischaemic stroke, intracerebral haemorrhage, subarachnoid haemorrhage, and all strokes combined, and stratified by sex, age group, and World Bank country income level. Findings In 2019, there were 12.2 million (95% UI 11.0-13.6) incident cases of stroke, 101 million (93.2-111) prevalent cases of stroke, 143 million (133-153) DALYs due to stroke, and 6.55 million (6.00-7.02) deaths from stroke. Globally, stroke remained the second-leading cause of death (11.6% [10.8-12.2] of total deaths) and the third-leading cause of death and disability combined (5.7% [5.1-6.2] of total DALYs) in 2019. From 1990 to 2019, the absolute number of incident strokes increased by 70.0% (67.0-73.0), prevalent strokes increased by 85.0% (83.0-88.0), deaths from stroke increased by 43.0% (31.0-55.0), and DALYs due to stroke increased by 32.0% (22.0-42.0). During the same period, age-standardised rates of stroke incidence decreased by 17.0% (15.0-18.0), mortality decreased by 36.0% (31.0-42.0), prevalence decreased by 6.0% (5.0-7.0), and DALYs decreased by 36.0% (31.0-42.0). However, among people younger than 70 years, prevalence rates increased by 22.0% (21.0-24.0) and incidence rates increased by 15.0% (12.0-18.0). In 2019, the age-standardised stroke-related mortality rate was 3.6 (3.5-3.8) times higher in the World Bank low-income group than in the World Bank high-income group, and the age-standardised stroke-related DALY rate was 3.7 (3.5-3.9) times higher in the low-income group than the high-income group. Ischaemic stroke constituted 62.4% of all incident strokes in 2019 (7.63 million [6.57-8.96]), while intracerebral haemorrhage constituted 27.9% (3.41 million [2.97-3.91]) and subarachnoid haemorrhage constituted 9.7% (1.18 million [1.01-1.39]). In 2019, the five leading risk factors for stroke were high systolic blood pressure (contributing to 79.6 million [67.7-90.8] DALYs or 55.5% [48.2-62.0] of total stroke DALYs), high body-mass index (34.9 million [22.3-48.6] DALYs or 24.3% [15.7-33.2]), high fasting plasma glucose (28.9 million [19.8-41.5] DALYs or 20.2% [13.8-29.1]), ambient particulate matter pollution (28.7 million [23.4-33.4] DALYs or 20.1% [16.6-23.0]), and smoking (25.3 million [22.6-28.2] DALYs or 17.6% [16.4-19.0]). Interpretation The annual number of strokes and deaths due to stroke increased substantially from 1990 to 2019, despite substantial reductions in age-standardised rates, particularly among people older than 70 years. The highest age-standardised stroke-related mortality and DALY rates were in the World Bank low-income group. The fastest-growing risk factor for stroke between 1990 and 2019 was high body-mass index. Without urgent implementation of effective primary prevention strategies, the stroke burden will probably continue to grow across the world, particularly in low-income countries.
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| 2. |
- Lozano, Rafael, et al.
(författare)
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Measuring progress from 1990 to 2017 and projecting attainment to 2030 of the health-related Sustainable Development Goals for 195 countries and territories: a systematic analysis for the Global Burden of Disease Study 2017
- 2018
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Ingår i: The Lancet. - : Elsevier. - 1474-547X .- 0140-6736. ; 392:10159, s. 2091-2138
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Tidskriftsartikel (refereegranskat)abstract
- Background: Efforts to establish the 2015 baseline and monitor early implementation of the UN Sustainable Development Goals (SDGs) highlight both great potential for and threats to improving health by 2030. To fully deliver on the SDG aim of “leaving no one behind”, it is increasingly important to examine the health-related SDGs beyond national-level estimates. As part of the Global Burden of Diseases, Injuries, and Risk Factors Study 2017 (GBD 2017), we measured progress on 41 of 52 health-related SDG indicators and estimated the health-related SDG index for 195 countries and territories for the period 1990–2017, projected indicators to 2030, and analysed global attainment. Methods: We measured progress on 41 health-related SDG indicators from 1990 to 2017, an increase of four indicators since GBD 2016 (new indicators were health worker density, sexual violence by non-intimate partners, population census status, and prevalence of physical and sexual violence [reported separately]). We also improved the measurement of several previously reported indicators. We constructed national-level estimates and, for a subset of health-related SDGs, examined indicator-level differences by sex and Socio-demographic Index (SDI) quintile. We also did subnational assessments of performance for selected countries. To construct the health-related SDG index, we transformed the value for each indicator on a scale of 0–100, with 0 as the 2·5th percentile and 100 as the 97·5th percentile of 1000 draws calculated from 1990 to 2030, and took the geometric mean of the scaled indicators by target. To generate projections through 2030, we used a forecasting framework that drew estimates from the broader GBD study and used weighted averages of indicator-specific and country-specific annualised rates of change from 1990 to 2017 to inform future estimates. We assessed attainment of indicators with defined targets in two ways: first, using mean values projected for 2030, and then using the probability of attainment in 2030 calculated from 1000 draws. We also did a global attainment analysis of the feasibility of attaining SDG targets on the basis of past trends. Using 2015 global averages of indicators with defined SDG targets, we calculated the global annualised rates of change required from 2015 to 2030 to meet these targets, and then identified in what percentiles the required global annualised rates of change fell in the distribution of country-level rates of change from 1990 to 2015. We took the mean of these global percentile values across indicators and applied the past rate of change at this mean global percentile to all health-related SDG indicators, irrespective of target definition, to estimate the equivalent 2030 global average value and percentage change from 2015 to 2030 for each indicator. Findings: The global median health-related SDG index in 2017 was 59·4 (IQR 35·4–67·3), ranging from a low of 11·6 (95% uncertainty interval 9·6–14·0) to a high of 84·9 (83·1–86·7). SDG index values in countries assessed at the subnational level varied substantially, particularly in China and India, although scores in Japan and the UK were more homogeneous. Indicators also varied by SDI quintile and sex, with males having worse outcomes than females for non-communicable disease (NCD) mortality, alcohol use, and smoking, among others. Most countries were projected to have a higher health-related SDG index in 2030 than in 2017, while country-level probabilities of attainment by 2030 varied widely by indicator. Under-5 mortality, neonatal mortality, maternal mortality ratio, and malaria indicators had the most countries with at least 95% probability of target attainment. Other indicators, including NCD mortality and suicide mortality, had no countries projected to meet corresponding SDG targets on the basis of projected mean values for 2030 but showed some probability of attainment by 2030. For some indicators, including child malnutrition, several infectious diseases, and most violence measures, the annualised rates of change required to meet SDG targets far exceeded the pace of progress achieved by any country in the recent past. We found that applying the mean global annualised rate of change to indicators without defined targets would equate to about 19% and 22% reductions in global smoking and alcohol consumption, respectively; a 47% decline in adolescent birth rates; and a more than 85% increase in health worker density per 1000 population by 2030. Interpretation: The GBD study offers a unique, robust platform for monitoring the health-related SDGs across demographic and geographic dimensions. Our findings underscore the importance of increased collection and analysis of disaggregated data and highlight where more deliberate design or targeting of interventions could accelerate progress in attaining the SDGs. Current projections show that many health-related SDG indicators, NCDs, NCD-related risks, and violence-related indicators will require a concerted shift away from what might have driven past gains—curative interventions in the case of NCDs—towards multisectoral, prevention-oriented policy action and investments to achieve SDG aims. Notably, several targets, if they are to be met by 2030, demand a pace of progress that no country has achieved in the recent past. The future is fundamentally uncertain, and no model can fully predict what breakthroughs or events might alter the course of the SDGs. What is clear is that our actions—or inaction—today will ultimately dictate how close the world, collectively, can get to leaving no one behind by 2030.
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| 3. |
- Caggiani, Leonardo, et al.
(författare)
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Evaluating the Efficiency of Bike-Sharing Stations with Data Envelopment Analysis
- 2021
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Ingår i: Sustainability. - : MDPI AG. - 2071-1050. ; 13:2
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Tidskriftsartikel (refereegranskat)abstract
- This paper focuses on the efficiency evaluation of bike-sharing systems (BSSs) and develops an approach based on data envelopment analysis (DEA) to support the decisions regarding the performance evaluation of BSS stations. The proposed methodology is applied and tested for the Malmöbybike BSS in Malmö, Sweden. This was done by employing spatial analyses and data about the BSS usage trends as well as taking into account transport, land use, and socioeconomic context of the case study. The results of the application demonstrate consistency with the literature and highlight meaningful associations between the station relative efficiency and the urban context. More specifically, the paper provides in-depth knowledge about the preprocessing data, selection of input and output variables, and the underlying analytical approach to be potentially applied to other cases and urban contexts. Overall, the DEA-based methodology presented in this study could assist decision-makers and planners with developing operational strategies for planning and management of BSS stations and networks.
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| 4. |
- Hamidi, Zahra, 1984-
(författare)
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Decomposing cycling potentials employing the motility framework
- 2021
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Ingår i: Journal of Transport Geography. - : Elsevier. - 0966-6923 .- 1873-1236. ; 91
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Tidskriftsartikel (refereegranskat)abstract
- The concept of motility, mobility capital, has been put forward to understand mobility from a more holistic perspective through incorporating subjective and objective as well as material and non-material aspects in the examination of individuals' mobility potentials. In this paper, building on a survey study in the two municipalities of Malmö and Gothenburg in Sweden, I developed a quantitative operationalization of motility in relation to cycling and employed GIS-based and statistical analyses to identify a set of appropriate indicators to measure the three dimensions of cycling motility namely access, competence, and appropriation. The analyses reveal three operational dimensions underlying the process of appropriating cycling to carry out daily trips. More specifically, individuals' perceptions of the functional and social suitability of cycling and its compatibility with their principles and values seem to be significant for the appropriation of a bike as a daily travel mode. Altogether, the findings support that the quantitative operationalization of cycling motility can deepen our understanding of the factors shaping individuals' cycling potentials and practices, hence offering valuable insights into the development of successful cycling interventions that create material and nonmaterial infrastructure, competences, and positive representations necessary for the appropriation of cycling.
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| 5. |
- Hamidi, Zahra
(författare)
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Examining Inequalities in Cycling Motility : A Pathway Towards Cycling Justice
- 2023
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- Realizing the environmental and social benefits of cycling requires effective policies that deliver increased and inclusive cycling. This thesis aims to contribute to the development of such policies by providing insights into what could make cycling achievable for more diverse social groups through engaging with theoretical perspectives from transport geography, the mobilities paradigm and social justice. In doing so the thesis examines the various elements that constitute an individual’s potential to use a bicycle and the connected inequalities.The thesis employs conceptions of accessibility and motility in combination with measures of inequality to examine the socio-spatial inequalities in cycling potentials. The first paper designs a new composite indicator based on Theil’s index of inequality and accessibility measures to study inequalities in bike-and-ride opportunities in Malmö. The second paper develops a quantitative operationalization of cycling motility by applying GIS-based and statistical analyses to empirical data collected using a survey study. Specifically, cycling motility is operationalized along three dimensions of access, competence, and appropriation. This is done by measuring cycling-related material and nonmaterial, as well as objective and subjective factors related to individuals and their social, cultural, and geographical environment.The subsequent papers put the concept of cycling motility in practice. The third paper builds on the approach developed in the second paper and examines inequalities in the cycling motility across different social groups from the three-dimensional justice lens of Nancy Fraser. Finally, the fourth paper provides insights into the relationships between individuals’ cycling motility and their realized mobility. The empirical findings highlight that such relationships vary across three urban contexts of Malmö, Gothenburg, and Beijing. Overall, the findings support that the operationalization of cycling motility is useful for studying individuals’ cycling potentials and capturing the connected between-individual differences, thereby helpful for development of policies that could realize the social and environmental potentials of cycling.
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| 6. |
- Hamidi, Zahra, 1984-, et al.
(författare)
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Inequalities in access to bike-and-ride opportunities : Findings for the city of Malmö
- 2019
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Ingår i: Transportation Research Part A. - : Elsevier. - 0965-8564 .- 1879-2375. ; 130, s. 673-688
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Tidskriftsartikel (refereegranskat)abstract
- Bike-and-ride – that is, integrating cycling and public transport in one trip – is an attractive combination, as cycling as an active and clean mode is faster than walking and more affordable and flexible than other alternative modes of transport. Using cycling as a feeder mode to public transport could potentially allow people to reach more opportunities and improve their mobility, and ultimately, their well-being. Therefore, it is relevant to investigate the inequalities in access to bike-and-ride options across population groups.In this context, we suggest assessing the inequalities in bicycle access to the main transport hubs of a city by developing a composite indicator based on accessibility measures and the Theil index of inequality. This indicator captures the role of both private and public bikes – part of a Bike Sharing System (BSS) – in accessing the existing public transport system. The novelty of our approach lies in bringing the distributional justice perspective in the accessibility evaluation of transport and analysing the inequalities within and between any arbitrarily defined population groups. Moreover, in addition to travel time by bike, this accessibility measure incorporates a series of bike-related features, such as the typology of bike lanes (separated from or shared with roads), the presence of a BSS in the network, and bike facilities (e.g., parking racks) in transport hubs.The proposed methodology is applied to a real case study of the city of Malmö, Sweden, to prove its efficacy and usefulness. In particular, we examine how the level of bicycle access to the major public transport destination (including train stations and regional bus hubs) varies across the population. While considering the contextual properties of the city of Malmö, the inequalities are analysed in relation to spatial dimension and social background of the population, it is possible to extend the proposed analysis by including further features of the population, such as income or gender, and apply the same approach to different contexts.
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| 7. |
- Hamidi, Zahra, 1984-, et al.
(författare)
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Insamling och organisering av cykeldata på nationell nivå : Rekommendationer för vägen framåt
- 2024
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Rapport (övrigt vetenskapligt/konstnärligt)abstract
- För att bidra till utvecklingen av ett hållbart samhälle genom ökad och säker cykling, krävs det att cykelrelaterade planer och strategier grundas i evidensbaserad kunskap och forskning. För att åstadkomma detta behövs validerade och tillräckligt omfattande cykeldata och syftet med den här förstudien är att bidra till utvecklingen av tillförlitliga metoder för datainsamling och validering för cykeldata på nationell nivå. I rapporten presenteras behoven av cykeldata, olika typer av mätutrustning och mätmetoder och exempel på digitala plattformar för samordning, presentation och analys av cykeldata. Det beskrivs också vilka aspekter som är viktiga för validering av mätutrustning och data samt en början till riktlinjer för validering. Rapporten resulterar i sju rekommendationer som sammanfattar de steg som behövs för att säkerställa att rätt cykeldata och cykeldata med tillräcklig god kvalitet för sitt syfte tillhandahålls. De sju rekommendationerna avser (i) samordning av insamling och analys av data, (ii) grundläggande databehov, (iii) organisering av befintliga data, (iv) mål och målstyrning, (v) validering av mätutrustning, (vi) mätnoggrannhet och (vii) utveckling av metodik för analys av befintliga mätningar.
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| 8. |
- Hamidi, Zahra, 1984-, et al.
(författare)
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Shaping sustainable travel behaviour : Attitude, skills, and access all matter
- 2020
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Ingår i: Transportation Research Part D. - : Elsevier. - 1361-9209 .- 1879-2340. ; 88
-
Tidskriftsartikel (refereegranskat)abstract
- Drawing on the conceptualisation of motility as the capacity to be mobile, this paper employs statistical and GIS-based analyses to explore the associations between travel mode choice and mobility-related attitudes, skills and opportunities to access transport modes. The study builds on survey data and spatial data from three urban contexts of Beijing, Gothenburg and Malmo to analyse both individual-level and contextual factors influencing sustainable travel behaviour. The results indicate that despite varying contexts, the three dimensions of attitude, skills and access significantly explain individuals' travel behaviour and their choice to travel by public transport, bicycle or car. Among the studied travel modes, cycling appears to be a competitive mode when the travel distances are within 5 km. In all three urban contexts, individuals who have greater environmental awareness are more likely to travel by public transport or cycling if the physical conditions facilitate using these modes. Good access to public transport is likely to increase the usage of both cycling and public transport and reduce car use. Favourable conditions for cycling within 2 km and 5 km radius can positively encourage people to use a bicycle as a feeder mode for public transport. Overall, our findings demonstrate that for mobility policies to increase individuals' motility in relation to sustainable travel modes and encourage a travel behaviour shift towards using alternatives to cars, planners need to take more holistic approaches and design policies that deal with the three motility dimensions in an integrated manner and avoid focusing on a single dimension in isolation.
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| 9. |
- Hamidi, Zahra
(författare)
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Thinking about Uneven Cycling Motility in a Social Justice Frame
- 2023
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Annan publikation (övrigt vetenskapligt/konstnärligt)abstract
- The positive benefits of cycling cannot be realized in the absence of inclusive policies that improve cycling possibilities for all in society and effectively increase cycling. A more comprehensive understanding of the factors shaping individuals’ potential to cycle and the way the vary across social groups could provide valuable insights to support crafting such policies that could make cycling accessible for more diverse groups in society. Employing the motility framework this study examines the inequalities in cycling potential among individuals living in the municipalities of Gothenburg and Malmö in Sweden. Moreover, it adopts Nancy Fraser’s three-dimensional justice lens to explore the links between social groups’ differences in terms of cycling motility and sources of injustice in cycling practices and policies. The findings indicate that age and income are associated with significant variations in all three dimensions of cycling motility (i.e., access portfolio, competence, and appropriation). Additionally, the significant inequalities observed among the social groups in terms of cycling motility indicators could be traced to broader injustices in society – namely maldistribution, misrecognition, and misrepresentation. The paper argues that justice in cycling motility requires recognizing the diversity of needs and preferences, redistributing cycling-related resources, and including more voices in planning and decisionmaking.
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| 10. |
- Hamidi, Zahra, 1984-
(författare)
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Thinking about Uneven Cycling Motility in a Social Justice Frame
-
Tidskriftsartikel (övrigt vetenskapligt/konstnärligt)abstract
- The positive benefits of cycling cannot be realized in the absence of inclusive policies that improve cycling possibilities for all in society and effectively increase cycling. A more comprehensive understanding of the factors shaping individuals’ potential to cycle and the way the vary across social groups could provide valuable insights to support crafting such policies that could make cycling accessible for more diverse groups in society. Employing the motility framework this study examines the inequalities in cycling potential among individuals living in the municipalities of Gothenburg and Malmö in Sweden. Moreover, it adopts Nancy Fraser’s three-dimensional justice lens to explore the links between social groups’ differences in terms of cycling motility and sources of injustice in cycling practices and policies. The findings indicate that age and income are associated with significant variations in all three dimensions of cycling motility (i.e., access portfolio, competence, and appropriation). Additionally, the significant inequalities observed among the social groups in terms of cycling motility indicators could be traced to broader injustices in society – namely maldistribution, misrecognition, and misrepresentation. The paper argues that justice in cycling motility requires recognizing the diversity of needs and preferences, redistributing cycling-related resources, and including more voices in planning and decisionmaking.
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| 11. |
- Hultén, John, et al.
(författare)
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Förändrade förutsättningar för framtidens kollektivtrafik
- 2017
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Rapport (övrigt vetenskapligt/konstnärligt)abstract
- Övergripande samhällsförändringar påverkar förutsättningarna för framtidens kollektivtrafik. Det påverkar t.ex. var människor väljer att bo och arbeta, hur företag organiserar sin verksamhet, och vilka metoder som används för att omsätta politiska beslut i praktik handling. Vi kan aldrig med säkerhetuttala oss om vad som kommer att ske i framtiden. Men genom att resonera kring trender och mottrender utifrån observationer i samtiden kan vi ändå förbereda oss för möjliga utvecklingsvägar. Den här rapporten syftar till att, utifrån befintlig forskning, identifiera ett antal trender och mottrendersom kan komma att påverka kollektivtrafiken på medellång och lång sikt.Som alltid när det gäller framtiden finns det stora osäkerheter om vad som faktiskt kan komma att hända. När vi skriver om framtiden hamnar vi lätt i en situation där vi extrapolerar en historisk utveckling eller fastnar i nuets förbannelse, dvs. överdriver vikten av sådana frågor som råkar varaviktiga just nu. Trots svårigheterna finns det ett stort värde i att fundera över samhällsförändringar och problematisera hur de kan påverka förutsättningarna för kollektivtrafiken framöver. Rapporten har författats av forskare inom K2 – Nationellt kunskapscentrum för kollektivtrafik. Den har tagits fram i samarbete med Trafikförvaltningen vid Stockholms läns landsting inom ramen för Trafikförvaltningens arbete med en ny omvärldsanalys. Medförfattare är Alexander Paulsson, fil dr i företagsekonomi, K2/VTI, Bengt Holmberg, professor emeritus i trafikplanering, K2/Lunds universitet, Christina Scholten, fil dr i kulturgeografi och ekonomisk geografi, K2/Malmö högskola, Erik Ronnle, doktorand i företagsekonomi, K2/Lunds universitet, Fredrik Pettersson, fil dr i miljö- och energisystem, K2/Lunds universitet, Gert Paulsson, docent i företagsekonomi, K2/Lunds universitet,Helena Svensson, tekn dr i trafikplanering, K2/Lunds universitet, Jean Ryan, doktorand i trafikplanering, K2/Lunds universitet, John Hultén, fil dr i statsvetenskap, K2 (redaktör), Vanessa Stjernborg, fil dr i trafikplanering, K2/Malmö högskola och Zahra Hamidi, doktorand i urbana studier, K2/Malmö högskola.
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| 12. |
- Kircher, Katja, 1973-, et al.
(författare)
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Aktivt resande och uppmärksamhet : vilka krav ställer trafikmiljön på barns och ungdomars uppmärksamhet?
- 2023
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Rapport (övrigt vetenskapligt/konstnärligt)abstract
- Projektet undersöker hur barns ålder påverkar deras förmåga till uppmärksamhet i trafiken när de cyklar och går till skolan. Datamaterialet utgörs av svaren på en enkät om skolvägar (432 elever från 45 olika skolor), en semi-kontrollerad fältstudie där barnens beteende på väg till skolan loggades (20 fotgängare, 42 cyklister), samt en observationsstudie i olika korsningar (609 fotgängare, 277 cyklister). Resultaten tyder på att trafikmiljön snarare än barns ålder påverkar hur väl kraven på uppmärksamhet uppfylls i en situation. Detta går hand i hand med tidigare forskning som visar att det till stor del beror på trafikmiljön om det är säkert att vistas där, och att det inte finns någon allmän åldersgräns för när det är lämpligt att röra sig i trafiken. Snarare spelar utformningen av miljön en betydande roll för hur väl kraven på uppmärksamhet kan hanteras. Det visade sig också ha betydelse om eleverna rörde sig i grupp eller själva och hur grupperna var sammansatta både i termer av ålder och färdsätt. Resultaten från datainsamlingarna visar att utformning av infrastruktur, vart man är på väg, trafikslag och trafikregler påverkar vilka områden som är viktiga att titta åt för att säkerställa att vägen är fri. Genom att lägga till sådan information i ett geografiskt informationssystem (GIS) kan man systematiskt undersöka hur förändringar i infrastrukturen påverkar kraven på uppmärksamheten för olika trafikslag och i olika situationer. En första implementation har gjorts i projektet för att visa på potentialen för ett GIS-verktyg som tar hänsyn till krav på uppmärksamhet. Ett sådant verktyg skulle underlätta för planerare och andra som gestaltar trafikmiljöer så att dessa kan utformas på ett sätt som är tryggt och trafiksäkert för barn och unga. Sammantaget visar resultaten att trafikmiljön snarare än ålder och kognitiv mognad sätter ramarna för vem som kan eller bör vistas i transportsystemet. Utgångspunkten att barn inte är kapabla att vistas i trafiken behöver nyanseras.
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| 13. |
- Micah, Angela E., et al.
(författare)
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Tracking development assistance for health and for COVID-19 : a review of development assistance, government, out-of-pocket, and other private spending on health for 204 countries and territories, 1990-2050
- 2021
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Ingår i: The Lancet. - : Elsevier. - 0140-6736 .- 1474-547X. ; 398:10308, s. 1317-1343
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Forskningsöversikt (refereegranskat)abstract
- Background The rapid spread of COVID-19 renewed the focus on how health systems across the globe are financed, especially during public health emergencies. Development assistance is an important source of health financing in many low-income countries, yet little is known about how much of this funding was disbursed for COVID-19. We aimed to put development assistance for health for COVID-19 in the context of broader trends in global health financing, and to estimate total health spending from 1995 to 2050 and development assistance for COVID-19 in 2020. Methods We estimated domestic health spending and development assistance for health to generate total health-sector spending estimates for 204 countries and territories. We leveraged data from the WHO Global Health Expenditure Database to produce estimates of domestic health spending. To generate estimates for development assistance for health, we relied on project-level disbursement data from the major international development agencies' online databases and annual financial statements and reports for information on income sources. To adjust our estimates for 2020 to include disbursements related to COVID-19, we extracted project data on commitments and disbursements from a broader set of databases (because not all of the data sources used to estimate the historical series extend to 2020), including the UN Office of Humanitarian Assistance Financial Tracking Service and the International Aid Transparency Initiative. We reported all the historic and future spending estimates in inflation-adjusted 2020 US$, 2020 US$ per capita, purchasing-power parity-adjusted US$ per capita, and as a proportion of gross domestic product. We used various models to generate future health spending to 2050. Findings In 2019, health spending globally reached $8. 8 trillion (95% uncertainty interval [UI] 8.7-8.8) or $1132 (1119-1143) per person. Spending on health varied within and across income groups and geographical regions. Of this total, $40.4 billion (0.5%, 95% UI 0.5-0.5) was development assistance for health provided to low-income and middle-income countries, which made up 24.6% (UI 24.0-25.1) of total spending in low-income countries. We estimate that $54.8 billion in development assistance for health was disbursed in 2020. Of this, $13.7 billion was targeted toward the COVID-19 health response. $12.3 billion was newly committed and $1.4 billion was repurposed from existing health projects. $3.1 billion (22.4%) of the funds focused on country-level coordination and $2.4 billion (17.9%) was for supply chain and logistics. Only $714.4 million (7.7%) of COVID-19 development assistance for health went to Latin America, despite this region reporting 34.3% of total recorded COVID-19 deaths in low-income or middle-income countries in 2020. Spending on health is expected to rise to $1519 (1448-1591) per person in 2050, although spending across countries is expected to remain varied. Interpretation Global health spending is expected to continue to grow, but remain unequally distributed between countries. We estimate that development organisations substantially increased the amount of development assistance for health provided in 2020. Continued efforts are needed to raise sufficient resources to mitigate the pandemic for the most vulnerable, and to help curtail the pandemic for all. Copyright (C) 2021 The Author(s). Published by Elsevier Ltd.
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| 14. |
- Murray, Christopher J. L., et al.
(författare)
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Population and fertility by age and sex for 195 countries and territories, 1950–2017: a systematic analysis for the Global Burden of Disease Study 2017
- 2018
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Ingår i: The Lancet. - 1474-547X .- 0140-6736. ; 392:10159, s. 1995-2051
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Tidskriftsartikel (refereegranskat)abstract
- Background: Population estimates underpin demographic and epidemiological research and are used to track progress on numerous international indicators of health and development. To date, internationally available estimates of population and fertility, although useful, have not been produced with transparent and replicable methods and do not use standardised estimates of mortality. We present single-calendar year and single-year of age estimates of fertility and population by sex with standardised and replicable methods. Methods: We estimated population in 195 locations by single year of age and single calendar year from 1950 to 2017 with standardised and replicable methods. We based the estimates on the demographic balancing equation, with inputs of fertility, mortality, population, and migration data. Fertility data came from 7817 location-years of vital registration data, 429 surveys reporting complete birth histories, and 977 surveys and censuses reporting summary birth histories. We estimated age-specific fertility rates (ASFRs; the annual number of livebirths to women of a specified age group per 1000 women in that age group) by use of spatiotemporal Gaussian process regression and used the ASFRs to estimate total fertility rates (TFRs; the average number of children a woman would bear if she survived through the end of the reproductive age span [age 10–54 years] and experienced at each age a particular set of ASFRs observed in the year of interest). Because of sparse data, fertility at ages 10–14 years and 50–54 years was estimated from data on fertility in women aged 15–19 years and 45–49 years, through use of linear regression. Age-specific mortality data came from the Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) 2017 estimates. Data on population came from 1257 censuses and 761 population registry location-years and were adjusted for underenumeration and age misreporting with standard demographic methods. Migration was estimated with the GBD Bayesian demographic balancing model, after incorporating information about refugee migration into the model prior. Final population estimates used the cohort-component method of population projection, with inputs of fertility, mortality, and migration data. Population uncertainty was estimated by use of out-of-sample predictive validity testing. With these data, we estimated the trends in population by age and sex and in fertility by age between 1950 and 2017 in 195 countries and territories. Findings: From 1950 to 2017, TFRs decreased by 49·4% (95% uncertainty interval [UI] 46·4–52·0). The TFR decreased from 4·7 livebirths (4·5–4·9) to 2·4 livebirths (2·2–2·5), and the ASFR of mothers aged 10–19 years decreased from 37 livebirths (34–40) to 22 livebirths (19–24) per 1000 women. Despite reductions in the TFR, the global population has been increasing by an average of 83·8 million people per year since 1985. The global population increased by 197·2% (193·3–200·8) since 1950, from 2·6 billion (2·5–2·6) to 7·6 billion (7·4–7·9) people in 2017; much of this increase was in the proportion of the global population in south Asia and sub-Saharan Africa. The global annual rate of population growth increased between 1950 and 1964, when it peaked at 2·0%; this rate then remained nearly constant until 1970 and then decreased to 1·1% in 2017. Population growth rates in the southeast Asia, east Asia, and Oceania GBD super-region decreased from 2·5% in 1963 to 0·7% in 2017, whereas in sub-Saharan Africa, population growth rates were almost at the highest reported levels ever in 2017, when they were at 2·7%. The global average age increased from 26·6 years in 1950 to 32·1 years in 2017, and the proportion of the population that is of working age (age 15–64 years) increased from 59·9% to 65·3%. At the national level, the TFR decreased in all countries and territories between 1950 and 2017; in 2017, TFRs ranged from a low of 1·0 livebirths (95% UI 0·9–1·2) in Cyprus to a high of 7·1 livebirths (6·8–7·4) in Niger. The TFR under age 25 years (TFU25; number of livebirths expected by age 25 years for a hypothetical woman who survived the age group and was exposed to current ASFRs) in 2017 ranged from 0·08 livebirths (0·07–0·09) in South Korea to 2·4 livebirths (2·2–2·6) in Niger, and the TFR over age 30 years (TFO30; number of livebirths expected for a hypothetical woman ageing from 30 to 54 years who survived the age group and was exposed to current ASFRs) ranged from a low of 0·3 livebirths (0·3–0·4) in Puerto Rico to a high of 3·1 livebirths (3·0–3·2) in Niger. TFO30 was higher than TFU25 in 145 countries and territories in 2017. 33 countries had a negative population growth rate from 2010 to 2017, most of which were located in central, eastern, and western Europe, whereas population growth rates of more than 2·0% were seen in 33 of 46 countries in sub-Saharan Africa. In 2017, less than 65% of the national population was of working age in 12 of 34 high-income countries, and less than 50% of the national population was of working age in Mali, Chad, and Niger. Interpretation: Population trends create demographic dividends and headwinds (ie, economic benefits and detriments) that affect national economies and determine national planning needs. Although TFRs are decreasing, the global population continues to grow as mortality declines, with diverse patterns at the national level and across age groups. To our knowledge, this is the first study to provide transparent and replicable estimates of population and fertility, which can be used to inform decision making and to monitor progress. Funding: Bill & Melinda Gates Foundation.
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| 15. |
- Paulsson, Alexander, 1980-, et al.
(författare)
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Förändrade förutsättningar för framtidens kollektivtrafik : Trender och mottrender
- 2016
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Rapport (övrigt vetenskapligt/konstnärligt)abstract
- Rapporten syftar till att, utifrån befintlig forskning, identifiera trender och mottrender som kan komma att påverka kollektivtrafiken på medellång och lång sikt. Analysen har genomförts utifrån sex olika områden som identifierats i samarbete med Trafikförvaltningen vid Stockholms läns landsting. I rapporten konstateras att globala krafter påverkar kollektivtrafiken på flera sätt, genom framväxten av en global marknad för kollektivtrafikaktörer och genom demografiska och ekonomiska förändringar som förändrar behovet av kollektivtrafik. Demografiska förändringar medför att Sverige befolkning antar en delvis ny skepnad med en växande befolkning och med fortsatt stark dragningskraft till storstadsregionerna. Det finns osäkerheter kring hur eventuella beteendeförändringar bland yngre befolkningsgrupper kommer att påverka transportsystemet. Fortsatt urbanisering, i världen men också i Sverige, ställer stora krav på att samordnad planering så att de möjligheter ökad koncentration gerkan tillvaratas och de negativa konsekvenserna kan mildras. Hållbarhetsbegreppet håller på att breddas till att, utöver miljö, i ökad utsträckning också inkludera ekonomiska och sociala dimensioner. Det påverkar synen på kollektivtrafikens roll för att uppnå hållbarhetsmål i samhället. Informationsteknikens utveckling i kombination med ambitioner att uppnå en mer hållbar mobilitet skapar drivkrafter för ett ökat fokus på hela resan, där nya mobilitetstjänster kan fungera som komplement eller supplement till kollektivtrafiken. I rapporten konstateras avslutningsvis att kraven på kostnadseffektivitet i offentlig verksamhet kommer att fortsätta forma hur kollektivtrafiken organiseras och styrs, men att det ännu är för tidigt att säga om någon ny, enhetlig modell ersätter New Public Management som dominerat inriktningen de senaste decennierna. Ökad samverkan på frivillig grund och mellan självständiga aktörer kommer sannolikt vara centralt under överskådlig tid.
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| 16. |
- Stanaway, Jeffrey D., et al.
(författare)
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Global, regional, and national comparative risk assessment of 84 behavioural, environmental and occupational, and metabolic risks or clusters of risks for 195 countries and territories, 1990-2017: A systematic analysis for the Global Burden of Disease Study 2017
- 2018
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Ingår i: The Lancet. - 1474-547X .- 0140-6736. ; 392:10159, s. 1923-1994
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Tidskriftsartikel (refereegranskat)abstract
- Background The Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) 2017 comparative risk assessment (CRA) is a comprehensive approach to risk factor quantification that offers a useful tool for synthesising evidence on risks and risk-outcome associations. With each annual GBD study, we update the GBD CRA to incorporate improved methods, new risks and risk-outcome pairs, and new data on risk exposure levels and risk- outcome associations. Methods We used the CRA framework developed for previous iterations of GBD to estimate levels and trends in exposure, attributable deaths, and attributable disability-adjusted life-years (DALYs), by age group, sex, year, and location for 84 behavioural, environmental and occupational, and metabolic risks or groups of risks from 1990 to 2017. This study included 476 risk-outcome pairs that met the GBD study criteria for convincing or probable evidence of causation. We extracted relative risk and exposure estimates from 46 749 randomised controlled trials, cohort studies, household surveys, census data, satellite data, and other sources. We used statistical models to pool data, adjust for bias, and incorporate covariates. Using the counterfactual scenario of theoretical minimum risk exposure level (TMREL), we estimated the portion of deaths and DALYs that could be attributed to a given risk. We explored the relationship between development and risk exposure by modelling the relationship between the Socio-demographic Index (SDI) and risk-weighted exposure prevalence and estimated expected levels of exposure and risk-attributable burden by SDI. Finally, we explored temporal changes in risk-attributable DALYs by decomposing those changes into six main component drivers of change as follows: (1) population growth; (2) changes in population age structures; (3) changes in exposure to environmental and occupational risks; (4) changes in exposure to behavioural risks; (5) changes in exposure to metabolic risks; and (6) changes due to all other factors, approximated as the risk-deleted death and DALY rates, where the risk-deleted rate is the rate that would be observed had we reduced the exposure levels to the TMREL for all risk factors included in GBD 2017.
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| 17. |
- Zhao, Chunli, et al.
(författare)
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Potential of demand responsive transport for young people in Sweden
- 2024
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Ingår i: Transportation Research Part A. - : Elsevier. - 0965-8564 .- 1879-2375. ; 184
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Tidskriftsartikel (refereegranskat)abstract
- Demand responsive transport (DRT) is an intermediate form of public transport which is provided based on users’ demand. The study explores the potential of DRT for meeting young people’s travel needs, focusing on school and leisure journeys. Our results, building on a survey study in Sweden, suggest that DRT services offering a door-to-door journey and the flexibility of pick-up times could be competitive not only with intermodal transport alternative and conventional public transport modes but also with feeder modes to public transport such as cycling. DRT exhibits more potential in rural areas than urban areas, especially in areas with poor public transport service provision. To attract young people and maintain them as regular users: DRT needs to provide a high-quality service that can compete successfully with cars; system design features and measures aiming to improve safety and security for young people, particularly when traveling to leisure activities, are among the most essential attributes.
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