Since 2018, this Lancet Commission has sought to understand how to maximise synergies between the global health agendas of universal health coverage, health security, and health promotion, and what drives dis-synergies. By synergies the Commission is referring to an intervention, institutional capacity, or policy, that positively and substantially contributes to the achievement of two or more of these agendas in the areas where they intersect. We gathered data through desk reviews; case studies at the subnational, national, and global levels; consultation with two subregional bodies; and periodic Commissioner meetings both face to face and online to review, analyse, and synthesise data. Several key findings and implications for action arise from the analysis and the gathered data, particularly the in-depth country case studies, which provided several examples of these issues in action.


Full report  can be downloaded https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(22)01930-4/fulltext?dgcid=raven_jbs_etoc_email

Worth revisiting, in light of COVID, this quite perceptive article in the Lancet in 2015. Was anyone listening and are they now?

https://pfmboard.com/index.php?topic=7825.msg24925#
Ten essential reforms before the next pandemic. Re: Will Ebola change the game?
The  Lancet Vol.386 | Number 10009 | Nov 28, 2015

Interesting report linking health spending (or lack of it) to outcomes related to employment, inequality and GDP.

https://www.ippr.org/research/publications/health-and-prosperity

https://www.ippr.org/files/2022-04/health-and-prosperity-april22.pdf

Summary
The hidden personal cost of UK long-term sickness that cries out for a new national health mission
•   New health conditions cost people up to £2,200 on average from annual earnings – others in household also badly affected
•   Sickness is a key factor in around half of people leaving work
•   Better health would benefit economic prospects for all, but could boost women’s earnings twice as much as men’s
•   UK should aim to become the healthiest country in the world within 30 years, says IPPR Commission on Health and Prosperity
The UK’s poor record on health is taking a huge toll on people’s personal finances and job prospects, a landmark report of the IPPR Commission on Health and Prosperity exposes today.
The onset of illness costs people up to £2,200 of their annual earnings, according to an IPPR study of the most recent seven years of panel data from the UK Household Longitudinal Study. The data span five years before the pandemic broke out, and the first two since it began in early 2020. Researchers found that:
•   Someone with a new physical illness experienced on average a fall of around £1,800 in their annual earnings, before the pandemic. 
•   In the same period, those with a new mental illness faced an average fall in annual earnings of around £2,200.
•   Since 2020, someone with a new chronic physical illness experienced on average a £1,400 annual earnings fall, while the onset of a mental illness has meant an average annual earnings fall of around £1,700.
They also found that the onset of chronic illness since 2020 has also had an impact on others living in the same household as the newly unwell person, with their annual earnings falling by around £1,200 on average.
The study of the cost of poor health on employment and earnings is among the most ambitious ever undertaken.
It found that loss of earnings following sickness was driven by factors including people leaving their job, working fewer hours, or not returning to work when they might have done so if in better health. These are additional to other costs of sickness, such as paying for healthcare, increased energy usage, or the cost of travel to appointments.
For many, these costs prove life changing. Among those diagnosed with a long-term illness since the pandemic, two in five lost 10 per cent or more of their earnings. Chronic physical conditions are estimated to have driven 700,000 people to leave employment in the same period, forgoing all their earned income.
Job loss was the biggest driver of lost earnings. The report found that poor health was a factor for more than half those who left their jobs (56 per cent) before the pandemic, with a larger impact since. Among older adults, poor health often led to early retirement.
The report also found that people with lower incomes are likely to be worse affected by becoming ill. Following the onset of a chronic illness, around one in six of those already in the lowest income quartile left employment during the pandemic, compared to around one in 20 of those in the highest quartile.
This unequal impact is compounded by the fact that people on low incomes are more likely to experience sickness, and less likely to get the best possible care.
It found that the impact of lost income is also unequal by gender, region and ethnicity in the UK. According to a new analysis applied by IPPR, improvements in people’s health would have different impacts on the earnings of different groups. It found that:
•   Better health would improve the incomes of all women as a group at twice the rate of men
•   Levelling-up on health gaps would increase regional earnings most in Wales, the West Midlands and the North East
•   Workers from Bangladeshi or Pakistani backgrounds would benefit financially the most from better health
Much sickness in the UK is preventable – through better housing, better jobs, action on public health challenges like obesity, or access to the best treatments and social care. Yet UK governments have systematically failed to pull the right levers over the last three decades, the report says.
The IPPR Commission on Health and Prosperity – with commissioners including Lord Ara Darzi, Dame Sally Davies, Mayor Andy Burnham, Sir Oliver Letwin and Dr Halima Begum - challenges the government to do better on raising overall national health, and as a result to reap the wide economic benefits.
It calls for a new Health and Prosperity Act, modelled on the 2008 Climate Change Act. This would hardwire two ambitious new missions in law:
•   To make the UK the healthiest country in the world within 30 years;
•   To increase healthy life expectancy to beyond the state retirement age across every region.
Taken together, the report says, these could serve as a health equivalent of ‘net zero’.
As it stands, the UK has both a lower healthy life expectancy and a lower rate of improvement in healthy life expectancy than other high-income countries.

One final post to close this diary. The signed book draw took place this week. The winner was a graduate student at Georgia State University and the book is already on its way.

Thanks to Mauro for the opportunity to write this diary. And thanks to you for reading it.

Best wishes,
Gary

The third edition of Financial Management and Accounting in the Public Sector is published on 14 March 2023. It has changed in many ways since the first edition came out almost 12 years ago.

The enclosed PDF shows the table of contents for the first and third editions.

You can see that chapters 1 to 9 of both editions are broadly the same in terms of subject matter although the titles have changed. They still keep to the sequence of an introductory chapter, then budgeting, then chapters relating to execution and finally chapters relating to accountability, evaluation and auditing. The third edition, however, makes this thread much more evident in the text. It also moves quite a lot of material about accounting from chapter 1 to chapter 8

The 12-year gap between the editions means that the data used for tables and charts has been updated. There are also references to more recent books, reports and articles to ensure the new edition feels like a current book, and not just an old book in a new cover.

A lot of material has been removed. The first edition included many references to British local government. It included explanations of the council tax levied by British local government and the history of the District Audit Service.

Including this sort of material reflected the fact that I started my career in local government and I think like a local government officer. I think that the local level of public administration is the most important because that is where the services are delivered, whether by a local council, a school board, a charity operating health clinics, or whatever. However, I have to recognise that readers of the book wanted something that focused more on central government and was more international.

New material was added for the second edition and yet more has been added in the third. The third edition has about 100 more pages than the first.

The most notable additions are references to the COVID-19 pandemic and its relevance to PFM practices. The third edition also has more material about public procurement as a result of re-focusing the chapter on all procurement and not just public-private partnerships.

There is more material in the auditing chapter, too. Again, it is less British and more general, and it also has more material about the process of auditing (such as an explanation of how Audit Risk can be assessed).

**WIN A SIGNED COPY OF THE BOOK**

To celebrate the publication of the third edition I am going to give away a signed paperback copy of the book. To be in with a chance go to <https://pages.garybandy.co.uk/signed-book> and let me have your email address. The competition is open until 31 March 2023. After that, I will select a winner at random from all the entries and then contact the winner to ask for their postal address. Good luck.

January to July 2022

The original deadline for the manuscript was December 2021. The pressure of (paying) work meant I missed it, and the revised one of March 2022. Indeed, I had barely started by then. I got a further extension to July 2022 and focused on the book 5 days a week from April.

When I started work on the third edition by digging out the manuscript for the 2nd edition. It turned out to be 150,000 words and there was little prospect of adding new material about COVID-19 and also cutting the book to 130,000 words. The first thing was to get permission to increase the word limit to 150,000.

Having the view that the second edition was a much better book than the first edition, I did not expect to need much time to update the existing chapters and drop in some new material. I was wrong. I spent more than 200 hours on the manuscript.

Some parts needed a lot more work than others. Chapter 1, the introduction to the main concepts of public financial management, was completely re-written to reflect the new-found importance of PFM during the COVID-19 pandemic. Chapter 9, on auditing, also had a major re-write because I have learned a lot about auditing since 2014. Chapter 10 was deleted. Deleting it was easy enough but there was a lot of wrestling in my mind before I made the decision. I spent time and effort to write the chapter and it’s hard for anyone to throw away something they have invested in. I reached the conclusion, though, that it did not add much value and something had to give if I was to hit the 150,000 words limit.

The remaining chapters needed more updating than I had anticipated. In part that is because a book published in 2023 can’t be based only on books and articles written more than ten years earlier. I needed to include up-to-date views about PFM. It was also because one item of feedback about the 2nd edition was a request for more exercises. I therefore wrote some new exercises for every chapter and included suggested answers in a section at the back of the book.

Finally, on 8 August 2022 I sent the manuscript files to my editor, for the copyediting and typesetting processes to be commissioned.

March 2023

I am writing this diary entry just a few weeks after I got a message that the typesetters had finished and the book is “in press” and one day after my “author copies” arrived (see photo). Later this month it will be in readers’ hands. If you want it you can get a 20% discount if you buy it at https://www.routledge.com/Financial-Management-and-Accounting-in-the-Public-Sector/Bandy/p/book/9781032157306 using the code AFL01. This is valid until 30 June 2023.

Conclusion: has it been worth it?

From the point of view of business, no. I earn royalties from sales but it is a niche topic and the annual sales are in hundreds, not hundreds of thousands. If I converted my cumulative royalties into an hourly rate for the hundreds of hours I spent writing the book they would fall well below the UK’s minimum wage.

But there are a lot of qualitative benefits that more than make up for that. First, I can tell people I am a published author. People recognise what an achievement that is even if they have absolutely no interest in PFM and would never read my book.

Second, all the editions are published in the UK and USA and that means the copyright libraries, including the British Library and the Library of Congress, have copies. And they’ll have them long after I’m dead.

Third, it’s a great feeling when you’re teaching a class to be able to give your own book as a prize for a test or a task.

And lastly, it has led to opportunities. It has made my name more widely known as both an expert in PFM and someone who can write clearly about it. This has helped me to land some very interesting and rewarding assignments. I hope that continues with the third edition.