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Biomedical subjects

R Beaglehole

Publications and source records attributed to R Beaglehole.

At least 73 records · Page 4Linked to original sources
PubMed1992

Setting national health goals and targets in the context of a fiscal crisis: the politics of social choice in New Zealand.

The setting of national health goals and targets in New Zealand has taken place in the context of fiscal crisis. The mandate for State intervention for social goals has also been under a sustained ideological challenge. These circumstances, together with other developments within the New Zealand health service, prepared the way for the development of the first set of health goals and targets. Six criteria were used to identify health problems for which goals and targets could be set. Ten areas were included, and specific, timed and quantified targets were set in each area for the year 2000 with shorter term targets for 1995. The Minister of Health gave priority to three areas: tobacco control, secondary prevention of cervical cancer, and reduction of road accident injury and death. An important aspect of the program is that the goals and targets are to be the focus of the annual contract between the Minister of Health (the primary funder of health care) and the Area Health Boards (the primary providers of health care). A matrix of policy options is presented for resource allocation and public health. The case study described represents one solution to the set of policy choices presented by fiscal and ideological challenge; the "new managerialism" has been allied with the "new public health." The authors argue that a combination of ideological renewal and fiscal probity has preserved a vigorous role for the State in health and health care. This matrix of policy options also underlines the necessity to consider health outcomes, as well as organizational goals, in the evaluation of the performance of health systems.

Cost Control↗
PubMed1991

Mortality from coronary heart disease and incidence of acute myocardial infarction in Auckland, Newcastle and Perth.

OBJECTIVE: To confirm the existence of regional differences in coronary death rates in Australia and New Zealand and to determine whether or not these are associated with parallel differences in the incidence of acute myocardial infarction. DESIGN: Descriptive epidemiological study. SETTING: Community based study. SUBJECTS: Residents of Auckland, Newcastle and Perth aged 25-64 years admitted to hospital for acute myocardial infarction or dying from coronary heart disease between 1983 and 1987. MAIN OUTCOME MEASURES: Definite acute myocardial infarction or coronary death classified according to the criteria of the World Health Organization MONICA project. RESULTS: This study confirms the marked variation, evident from official statistics, in mortality rates from ischaemic heart disease between Newcastle (high), Auckland and Perth (low). A different pattern is observed for the incidence of acute myocardial infarction and there are also obvious differences between centres in the case fatality ratios for all acute coronary events combined. Newcastle has the highest rate for all coronary events, particularly in women. Auckland is characterised by substantially higher case fatality ratios compared with the two Australian cities. This is due especially to higher rates of coronary death outside hospital. Perth, which has the lowest mortality rates and case fatality ratios in both men and women, has rates for admission to hospital for acute myocardial infarction and all cases of ischaemic heart disease that are disproportionately high in relation to the corresponding mortality rates. CONCLUSION: The differences in case fatality ratios between these three centres are not readily explained by artefacts related to enumeration or classification. Rather, they are most likely related to differences in the natural history of ischaemic heart disease in the three populations. Differences in medical management may also contribute to the substantial variation in mortality rates.

Adult↗
PubMed1991

Alcohol consumption and risk of coronary heart disease.

OBJECTIVE: To investigate the hypothesis that the apparent protective effect of habitual alcohol consumption on coronary heart disease is due to drinkers at high risk of coronary heart disease becoming non-drinkers. DESIGN: Case-control population based study. Data were obtained from interviews with patients with non-fatal myocardial infarction and their controls and with the next of kin of those who had died of coronary heart disease and their controls. SETTING: Auckland, New Zealand. SUBJECTS: Two groups of cases were studied. The first comprised 227 men and 72 women with non-fatal myocardial infarction identified from a population based surveillance programme for coronary heart disease; controls were 525 men and 341 women randomly selected from the same population group and matched for age and sex. The second group comprised 128 men and 30 women who had died of coronary heart disease and had been identified from the surveillance programme; controls were a sample of the previous control group and comprised 330 men and 214 women matched for age and sex. All participants were aged 25-64 years and without diagnosed coronary heart disease. MAIN OUTCOME MEASURES: Regular alcohol consumption; high density lipoprotein cholesterol and low density lipoprotein concentrations. RESULTS: Men with myocardial infarction and men who had died of coronary heart disease were more likely to have been never drinkers (had never drunk more than once a month) than controls (18% v 12% and 23% v 13% respectively). After possible confounding factors had been controlled for, people in all categories of drinking (up to more than 56 drinks per week) had at least a 40% reduction in risk of fatal and non-fatal coronary heart disease compared with never drinkers. Former drinkers also had a lower risk of non-fatal myocardial infarction than never drinkers (relative risks 0.41 and 0.10 in men and women respectively) but a similar risk of death from coronary heart disease. The reduction in risk was consistently greater in women than in men in all drinking categories but there was no clear dose-response effect in either sex. CONCLUSIONS: The results support the hypothesis that light and moderate alcohol consumption reduces the risk of coronary heart disease. This protective effect in this population was not due to the misclassification of former drinkers with a high risk of coronary heart disease as non-drinkers.

Adult↗
PubMed1991

The diet of Auckland men and women aged 25-64 years.

The dietary intake of a sample of 537 men and 372 women aged 25-64 years, randomly selected from the Auckland general electoral rolls, was assessed in order to describe current nutritional patterns in Auckland and to compare dietary intakes between men and women. A 118 item food frequency questionnaire was given to each participant to recall usual intake over the previous three months. After adjusting for energy intake, men consumed significantly more fat and cholesterol than women, consistent with their increased intake of red meat (median serves per month = 28 for men, 23 for women) and their greater tendency to eat fried meat (80.3% v 71.7%) and to drink full cream milk (82.7% v 70.7%). In contrast, women consumed more carbohydrate and fibre than men after adjusting for energy, consistent with their increased intake of vegetables (median serves per month = 136 for women, 116 for men) and fruit (median serves per month = 71 for women, 39 for men). These dietary differences between men and women may partly explain the increased coronary heart disease rates in men.

Adult↗
PubMed1991

Coronary heart disease mortality in Auckland Maori and Europeans.

This paper investigates the differential between Maori and European coronary heart disease mortality in Auckland by analysing data from an Auckland register of coronary heart disease. The age standardised coronary heart disease mortality rate for Maori men is 1.6 times higher than for European men, and the rate for Maori women is 4.2 times higher than that of European women. Maori mortality is disproportionately high for women, and for the younger age groups. Maori and European who died of definite myocardial infarction in Auckland between 1983-86 showed little difference in severity of coronary artery occlusion at post mortem, and the likelihood of cardiomyopathy contributing a major part to Maori heart disease mortality is small.

Adult↗
PubMed1991

The Auckland diet: results from a seven day food diary.

Dietary intakes of 113 men and women aged 50-66 years, sampled from the Auckland electoral roll, were measured by a prospective seven day dietary diary. The mean intakes of percentage of energy due to fat and saturated fat were 32% and 16% in men and 34% and 15% in women. Compared with earlier New Zealand dietary studies, which used different methods, there has been an apparent decrease in both the absolute amount and proportion of cholesterol and saturated fat. The absolute and relative amount of protein consumed appears to have remained stable while carbohydrate intake has increased. In comparison with current guidelines for dietary fat intake there remains a need for further improvement in the typical New Zealand adult diet.

Aged↗
PubMed1991

Validation of a three-month physical activity recall questionnaire with a seven-day food intake and physical activity diary.

We assessed the validity of a three-month physical activity questionnaire. The validation instrument was a seven-day self-report diary of physical activity and food intake, given to 113 randomly selected persons. We obtained Spearman correlations of 0.60, 0.48, and 0.91 and kappa scores of 0.36, 0.23, and 0.62 from the physical activity recall and diary for moderate, vigorous, and total activity. We conclude that the three-month recall questionnaire reasonably reflects activity in this community-based sample.

Diet↗
PubMed1991

Potential misclassification in studies of physical activity.

Regular physical activity is associated with a reduced risk of coronary heart disease, although debate still occurs over the level of intensity required for cardioprotection. The use in epidemiological studies of the arbitrarily defined categories of light, moderate, and hard, as proxy measures of relative intensity has administrative merit but risks potential misclassification, particularly in women and the elderly. This potential misclassification is the result of the inappropriate categorizing of activity based upon absolute intensity values regardless of age or gender. Coronary heart disease is more common in the elderly and recent activity more important than remote for cardiac benefit. It is thus essential to resolve the issue of the level(s) of exercise intensity needed to provide health benefits. Only when this information is available will it be possible to give rational and safe public health advice.

Age Factors↗
PubMed1991

Science, advocacy and health policy: lessons from the New Zealand tobacco wars.

The New Zealand Smoke-Free Environments Act was passed in August 1990 and is a central component of a comprehensive tobacco control policy. The passage of the Act was preceded by a long campaign. The essential components of this campaign were: international scientific evidence and the estimates of tobacco-caused mortality in New Zealand; activists groups supported by established health charities and the health professions; a sympathetic Health Department bureaucracy; a committed and powerful Minister of Health; and a relatively weak industry. The legislation passed despite adverse timing, the absence of bipartisan political support, and the pressure of industry-supported sports lobby groups. The campaign provides a model for other health issues in New Zealand and lessons for the tobacco wars elsewhere.

Health Policy↗
PubMed1990

Coronary heart disease among Pacific Island people in New Zealand.

Coronary heart disease is the leading cause of death in New Zealand. Death rates are higher among the Maori than the European population but rates have been declining in both groups over recent years. The occurrence of coronary heart disease among the Pacific Island population in New Zealand is unknown. Data from the National Health Statistics Centre (NHSC) and the Auckland coronary or stroke (ARCOS) study were used to describe the occurrence of coronary heart diseases among Pacific Island people. Age standardised mortality rates show that coronary heart disease is an important cause of death among Pacific Island men. Death rates have declined between 1973-77 and 1978-82 but this trend did not continue among men in the 1983-86 period. Age standardised mortality rates from coronary heart disease from the ARCOS data are 175/100,000 and 52/100,000 for Pacific Island men and women compared with 325/100,000 and 141/100,000 for Maori men and women. Age standardised rates for European men and women are 154/100,000 and 36/100,000 respectively.

Adult↗
PubMed1990

Trends in cardiovascular risk factors in Auckland, 1982 to 1987.

This paper examines trends in Auckland over a five year period (1982-87) in the major cardiovascular risk factors: serum total cholesterol, blood pressure and cigarette smoking; trends in body mass index are also presented. The data came from two independent random samples of European people aged 40-64 years chosen from the central Auckland electoral rolls in 1982 (915 men and 476 women) and 1986-88 (503 men and 359 women); response rates were over 80% in both surveys. In the five year period self reported smoking declined by 22% in men and 10% in women; the decline was particularly marked in upper socioeconomic men and women aged 55-64 years. There were no consistent changes in either blood pressure or body mass index levels. Serum cholesterol levels, after adjustment for the change in laboratory methods, declined by approximately 1% in both men and women. Cardiovascular risk factor levels remain high in Auckland; comprehensive population based prevention programmes, such as Heartbeat (New Zealand), are urgently required in New Zealand.

Adult↗