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The extent to which policies are genuinely responsive to public opinion is a key indicator of democratic performance. The media plays an agenda-setting role between the public and the legislators, serving as a mechanism through which policies can be responsive to the public. Existing literature has explored policy responsiveness, the media's agenda-setting power, and how the media's effect on the political agenda is contingent on socio-political contextual factors. However, the literature has yet to provide rigorous empirical evidence with chronological precision that policies do respond to media attention. This study examines the driving forces behind the responsiveness of energy development policies to media discourse with a novel methodological approach. Using a machine-learning approach, the author analyses thousands of state-level media reports and legislation featuring hydraulic fracturing ('fracking') issues in 15 US states from 2007 to 2017. To model legislation's responsiveness to media reports, the author identifies topic models for prevalent topics in news articles published in the period leading up to the proposal of a bill. Logistic regression models are estimated with political and socio-economic factors as the predictor variables and whether the bill targets prevalent topics in the news as the dependent variable. The findings suggest that state government ideology, legislators' partisan affiliations, and unemployment rates predict state-level policy responsiveness to media attention on fracking issues. This study advances our understanding of policymaking's democratic implications for unconventional energy development and highlights how policymakers can respond strategically to media attention.

AbstractLocal public managers are mobile in their career trajectories. While the extant public administration literature has predominantly examined this topic from a leadership turnover perspective, few studies have approached the career trajectories of local managers from a holistic, system-level angle. This article draws upon the vacancy chain literature and frames local managers' interconnected career trajectories within a nationwide professional job market, which we term "leadership turnover chains." We examine factors influencing the formation of such leadership turnover chains among cities. With a dataset containing information from the resumes of 517 US local managers across 28 years, we employ panel dyadic logistic regressions to analyze the leadership turnover chains among cities. Our findings suggest that managers are more likely to move among dyads of cities that are geographically close and with similar levels of economic prosperity, population size, racial diversity, and political climate. A promotion intercity turnover tends to take place from a populous city to a less populous city, while a demotion intercity turnover exhibits an opposite pattern. This study contributes to the theory of leadership turnover of local managers, highlighting a macro vacancy chain perspective on their career trajectories.

AbstractThe way in which public policies are composed may lead to conflicts that manifest in an extended policymaking duration. This paper explores the associations between policy composition and the relative duration for policies to be adopted in 15 U.S. state legislatures. We treat policy passage duration as an indicator of policy conflicts in the legislative process. We adapt the institutional grammar tool (IGT) to examine how 168 oil and gas development policies are composed and gauge the association between the content of these policies and the speed of their adoption. We find policies that are more stringent, contain more constitutive rules, target issues related to oil and gas operations or tax and finance take relatively longer to pass. These findings offer theoretical insights into the relationships between policy composition and policy adoption duration. They also provide methodological insights on measuring policy design components using a semi‐automated application of the IGT.

Financial resources are an essential input to health systems—at a minimum, these are necessary to purchase medicines and supplies, build health facilities, and pay health workers. However, limited financial resources are a universal constraint faced by all health systems. WHO has identified health financing as one of the six key building blocks of health systems and adequate financing is essential to the other five blocks.1 Health financing systems are tasked not only with raising sufficient financial resources to fund the health system, but doing so in a way that promotes equity.2 Health systems funded according to one's ability to pay, such as those based on income taxes, promote both financial equity and better health.3 Over-reliance on out-of-pocket spending diminishes access to care for those who are uninsured or underinsured, and risks exacerbating the burden of ill health and increasing poverty due to the high cost of care.4 The recognised importance of financial protection has led to its inclusion as one of two pillars of universal health coverage, alongside coverage of core health services, as outlined in Sustainable Development Goal 3. ; Los recursos financieros son un insumo esencial para los sistemas de salud; como mínimo, son necesarios para comprar medicamentos y suministros, construir instalaciones de salud y pagar a los trabajadores de salud. Sin embargo, los recursos financieros limitados son una restricción universal que enfrentan todos los sistemas de salud. La OMS ha identificado el financiamiento de la salud como uno de los seis componentes clave de los sistemas de salud, y un financiamiento adecuado es esencial para los otros cinco bloques.1 Los sistemas de financiamiento de la salud tienen la tarea no solo de recaudar recursos financieros suficientes para financiar el sistema de salud, sino también de hacerlo. una forma que promueve la equidad.2 Los sistemas de salud financiados de acuerdo con la capacidad de pago de una persona, como los que se basan en impuestos a la renta, promueven tanto la equidad financiera como una mejor salud.3 La excesiva dependencia de los gastos de bolsillo disminuye el acceso a la atención para aquellos quienes no tienen seguro o tienen un seguro insuficiente, y los riesgos que exacerban la carga de la mala salud y el aumento de la pobreza debido al alto costo de la atención4. La importancia reconocida de la protección financiera ha llevado a su inclusión como uno de los dos pilares de la cobertura de salud universal, junto con la cobertura de servicios básicos de salud, tal como se describe en el Objetivo 3 de Desarrollo Sostenible.

Giardiasis is a severe intestinal parasitic disease caused by Giardia lamblia, which inflicts many people in poor regions and is the most common parasitic infection in the United States. Current standard care drugs are associated with undesirable side effects, treatment failures, and an increasing incidence of drug resistance. As follow-up to a high-throughput screening of an approved drug library, which identified compounds lethal to G. lamblia trophozoites, we have determined the minimum lethal concentrations of 28 drugs and advanced 10 of them to in vivo studies in mice. The results were compared to treatment with the standard care drug, metronidazole, in order to identify drugs with equal or better anti-Giardia activities. Three drugs, fumagillin, carbadox, and tioxidazole, were identified. These compounds were also potent against metronidazole-resistant human G. lamblia isolates (assemblages A and B), as determined in in vitro assays. Of these three compounds, fumagillin is currently an orphan drug used within the European Union to treat microsporidiosis in immunocompromised individuals, whereas carbadox and tioxidazole are used in veterinary medicine. A dose-dependent study of fumagillin in a giardiasis mouse model revealed that the effective dose of fumagillin was ∼100-fold lower than the metronidazole dose. Therefore, fumagillin may be advanced to further studies as an alternative treatment for giardiasis when metronidazole fails.

A World Turned Upside Down looks at children's experiences during war from a psychological and social ecological perspective, offering thoughtful observations and dispelling myths about the realities of growing up in conflict situations. In addition, each contributor points to ways to foster well-being and nurture the kinds of social connections that can liberate children from the pathologies of war

INTRODUCTION: In recent years, China has increased its international engagement in health. Nonetheless, the lack of data on contributions has limited efforts to examine contributions from China. Existing estimates that track development assistance for health (DAH) from China have relied primarily on one dataset. Furthermore, little is known about the disbursing agencies especially the multilaterals through which contributions are disbursed and how these are changing across time. In this study, we generated estimates of DAH from China from 2007 through 2017 and disaggregated those estimates by disbursing agency and health focus area. METHODS: We identified the major government agencies providing DAH. To estimate DAH provided by each agency, we leveraged publicly available development assistance data in government agencies' budgets and financial accounts, as well as revenue statements from key international development agencies such as the WHO. We reported trends in DAH from China, disaggregated contributions by disbursing bilateral and multilateral agencies, and compared DAH from China with other traditional donors. We also compared these estimates with existing estimates. RESULTS: DAH provided by China grew dramatically, from US$323.1 million in 2007 to $652.3 million in 2017. During this period, 91.8% of DAH from China was disbursed through its bilateral agencies, including the Ministry of Commerce ($3.7 billion, 64.1%) and the National Health Commission ($917.1 million, 16.1%); the other 8.2% was disbursed through multilateral agencies including the WHO ($236.5 million, 4.1%) and the World Bank ($123.1 million, 2.2%). Relative to its level of economic development, China provided substantially more DAH than would be expected. However, relative to population size and government spending, China's contributions are modest. CONCLUSION: In the current context of plateauing in the growth rate of DAH contributions, China has the potential to contribute to future global health financing, especially financing for health ...

Achieving universal health coverage (UHC) requires health financing systems that provide prepaid pooled resources for key health services without placing undue financial stress on households. Understanding current and future trajectories of health financing is vital for progress towards UHC. We used historical health financing data for 188 countries from 1995 to 2015 to estimate future scenarios of health spending and pooled health spending through to 2040.We extracted historical data on gross domestic product (GDP) and health spending for 188 countries from 1995 to 2015, and projected annual GDP, development assistance for health, and government, out-of-pocket, and prepaid private health spending from 2015 through to 2040 as a reference scenario. These estimates were generated using an ensemble of models that varied key demographic and socioeconomic determinants. We generated better and worse alternative future scenarios based on the global distribution of historic health spending growth rates. Last, we used stochastic frontier analysis to investigate the association between pooled health resources and UHC index, a measure of a country's UHC service coverage. Finally, we estimated future UHC performance and the number of people covered under the three future scenarios.

BACKGROUND: Comprehensive and comparable estimates of health spending in each country are a key input for health policy and planning, and are necessary to support the achievement of national and international health goals. Previous studies have tracked past and projected future health spending until 2040 and shown that, with economic development, countries tend to spend more on health per capita, with a decreasing share of spending from development assistance and out-of-pocket sources. We aimed to characterise the past, present, and predicted future of global health spending, with an emphasis on equity in spending across countries. METHODS: We estimated domestic health spending for 195 countries and territories from 1995 to 2016, split into three categories-government, out-of-pocket, and prepaid private health spending-and estimated development assistance for health (DAH) from 1990 to 2018. We estimated future scenarios of health spending using an ensemble of linear mixed-effects models with time series specifications to project domestic health spending from 2017 through 2050 and DAH from 2019 through 2050. Data were extracted from a broad set of sources tracking health spending and revenue, and were standardised and converted to inflation-adjusted 2018 US dollars. Incomplete or low-quality data were modelled and uncertainty was estimated, leading to a complete data series of total, government, prepaid private, and out-of-pocket health spending, and DAH. Estimates are reported in 2018 US dollars, 2018 purchasing-power parity-adjusted dollars, and as a percentage of gross domestic product. We used demographic decomposition methods to assess a set of factors associated with changes in government health spending between 1995 and 2016 and to examine evidence to support the theory of the health financing transition. We projected two alternative future scenarios based on higher government health spending to assess the potential ability of governments to generate more resources for health. FINDINGS: Between 1995 and 2016, health spending grew at a rate of 4·00% (95% uncertainty interval 3·89-4·12) annually, although it grew slower in per capita terms (2·72% [2·61-2·84]) and increased by less than $1 per capita over this period in 22 of 195 countries. The highest annual growth rates in per capita health spending were observed in upper-middle-income countries (5·55% [5·18-5·95]), mainly due to growth in government health spending, and in lower-middle-income countries (3·71% [3·10-4·34]), mainly from DAH. Health spending globally reached $8·0 trillion (7·8-8·1) in 2016 (comprising 8·6% [8·4-8·7] of the global economy and $10·3 trillion [10·1-10·6] in purchasing-power parity-adjusted dollars), with a per capita spending of US$5252 (5184-5319) in high-income countries, $491 (461-524) in upper-middle-income countries, $81 (74-89) in lower-middle-income countries, and $40 (38-43) in low-income countries. In 2016, 0·4% (0·3-0·4) of health spending globally was in low-income countries, despite these countries comprising 10·0% of the global population. In 2018, the largest proportion of DAH targeted HIV/AIDS ($9·5 billion, 24·3% of total DAH), although spending on other infectious diseases (excluding tuberculosis and malaria) grew fastest from 2010 to 2018 (6·27% per year). The leading sources of DAH were the USA and private philanthropy (excluding corporate donations and the Bill & Melinda Gates Foundation). For the first time, we included estimates of China's contribution to DAH ($644·7 million in 2018). Globally, health spending is projected to increase to $15·0 trillion (14·0-16·0) by 2050 (reaching 9·4% [7·6-11·3] of the global economy and $21·3 trillion [19·8-23·1] in purchasing-power parity-adjusted dollars), but at a lower growth rate of 1·84% (1·68-2·02) annually, and with continuing disparities in spending between countries. In 2050, we estimate that 0·6% (0·6-0·7) of health spending will occur in currently low-income countries, despite these countries comprising an estimated 15·7% of the global population by 2050. The ratio between per capita health spending in high-income and low-income countries was 130·2 (122·9-136·9) in 2016 and is projected to remain at similar levels in 2050 (125·9 [113·7-138·1]). The decomposition analysis identified governments' increased prioritisation of the health sector and economic development as the strongest factors associated with increases in government health spending globally. Future government health spending scenarios suggest that, with greater prioritisation of the health sector and increased government spending, health spending per capita could more than double, with greater impacts in countries that currently have the lowest levels of government health spending. INTERPRETATION: Financing for global health has increased steadily over the past two decades and is projected to continue increasing in the future, although at a slower pace of growth and with persistent disparities in per-capita health spending between countries. Out-of-pocket spending is projected to remain substantial outside of high-income countries. Many low-income countries are expected to remain dependent on development assistance, although with greater government spending, larger investments in health are feasible. In the absence of sustained new investments in health, increasing efficiency in health spending is essential to meet global health targets. FUNDING: Bill & Melinda Gates Foundation. ; Bill & Melinda Gates Foundation ; Sí