Towards the Sustainable Development Goals: implications for health systems in the Western Pacific

Adopted by the General Assembly of the United Nations in 2015, the Sustainable Development Goals (SDGs) build on the lessons learned from the Millennium Development Goals that had guided development efforts for the preceding 15 years. The World Health Organization (WHO) Western Pacific Region made remarkable progress towards the Millennium Development Goals, but also experienced some challenges and shortcomings. This paper argues that the SDGs incorporate these complexities and aim to capture the many ways in which equitable and robust development is shaped by factors which are linked to each other. The SDGs place greater emphasis on a broader range of determinants of health, including poverty reduction, education, and reducing inequality, thereby reflecting that health influences and is influenced by progress on all goals and targets. Drawing on recent World Health Organization frameworks, the paper suggests options for advancing the SDGs in the Western Pacific. It argues that universal health coverage is core to achieving the SDGs and enacting the principle of leaving no-one behind, and outlines new ways of working within and outside of the health sector as well as appropriate capabilities of the health sector to drive the agenda. The SDGs place renewed demands on Member States and their partners. The strengths of the SDG framework lie in the emphasis on collaboration and joint action to solve shared problems, on collective accountability and the public interest, on tackling the determinants of health, and notably on the primacy of reaching those left furthest behind.

Effects of Diabetic Case Management on Knowledge, Self-Management Abilities, Health Behaviors, and Health Service Utilization for Diabetes in Korea

PURPOSE: This study aimed to evaluate the effects of a case management program for diabetics, using a pre-post comparison design. MATERIALS AND METHODS: The study population comprised 6007 diabetics who received case management intervention in 2006 and were sampled nationwide in Korea. Before and after the intervention, the study population answered questions regarding their knowledge of diabetes, self-management ability, and health behaviors. Body mass index (BMI) was also calculated. Healthcare service utilization for diabetes was extracted from health insurance claim data from 2005 to 2007. RESULTS: The case management program significantly improved the study population's knowledge of diabetes and ability to self-manage nutrition, blood glucose monitoring, foot and oral care, and medications. This program also significantly changed the study population's health behaviors regarding smoking, alcohol drinking, and exercise, and BMI was positively affected. In the over-serviced subgroup, there was a significant decrease in the number of consultations (mean=7.0; SD=19.5) after intervention. Conversely, in the under-serviced subgroup, there was a significant increase in the number of consultations (mean=3.2; SD=7.9) and the days of prescribed medication (mean=66.4; SD=120.3) after intervention. CONCLUSION: This study showed that the case management program led the study population to improve their knowledge, self-management ability, health behaviors, and utilization of health care. It is necessary in future studies to evaluate the appropriateness of healthcare usage and clinical outcome by using a control group to determine the direct effectiveness of this case management program.