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PubMed2003

The contribution of the World Health Organization to a new public health and health promotion.

The author traces the development of the concept of health promotion from 1980s policies of the World Health Organization. Two approaches that signify the modernization of public health are outlined in detail: the European Health for All targets and the settings approach. Both aim to reorient health policy priorities from a risk factor approach to strategies that address the determinants of health and empower people to participate in improving the health of their communities. These approaches combine classic public health dictums with "new" strategies, some setting explicit goals to integrate public health with general welfare policy. Health for All, health promotion, and population health have contributed to this reorientation in thinking and strategy, but the focus of health policy remains expenditure rather than investment.

Canada↗
PubMed2003

Disparities in trends of hospitalization for potentially preventable chronic conditions among African Americans during the 1990s: implications and benchmarks.

OBJECTIVES: We compared trends in prevalence rates of preventable cardiovascular- and diabetes-related hospitalizations between African Americans and members of other major US racial/ethnic groups. METHODS: Standardized rates for 1991 to 1998 were derived from hospital and US census data for California. RESULTS: African Americans had significantly higher hospitalization rates in 1991, and discrepancies in rates continued to widen through 1998. Overall male and female rates were approximately 3 times higher for angina, 7 times higher for hypertension, between 7 and 8 times higher for congestive heart failure, and 10 times higher for diabetes. CONCLUSIONS: Widening disparities in cardiovascular- and diabetes-related health conditions were observed in this study, possibly owing to racial inequalities in provision of effective primary care.

Adult↗
PubMed2003

Health policy and the coloring of an American male crisis: a perspective on community-based health services.

Health services at the community level are organized and financed in such a way that men need access but encounter barriers to care such as poor service design, lack of insurance, and the absence of health literacy. Community health delivery systems may not be appropriate, effective, fit, or able to meet the needs they are charged to fill. Community-based health services, including health departments, are underfunded, understaffed, and unable to carry out their mission in a way that protects the health of the community. The current design for funding and delivering health care services excludes poor men, particularly men of color. Improving the health of men requires modifications in the way health care is financed, delivered, and managed.

Adult↗
PubMed2003

The built environment and its relationship to the public's health: the legal framework.

The built environment significantly affects the public's health. This was most obvious when infectious disease was the primary public health threat during the industrial revolution; unsanitary conditions and overcrowded urban areas facilitated the spread of infection. However, even today in the age of chronic diseases there remains an important connection between population health and the built environment. Physical spaces can expose people to toxins or pollutants and influence lifestyles that contribute to diabetes, coronary vascular disease, and asthma. Public health advocates can help shape the design of cities and suburbs in ways that improve public health, but to do so effectively they need to understand the legal framework. This article reviews the connection between public health and the built environment and then describes the legal pathways for improving the design of our built environment.

Building Codes↗
PubMed2004

Comparison of health status indicators in chicago: are Black-White disparities worsening?

OBJECTIVES: This study examined Chicago residents' progress toward the Healthy People 2000 goal of reducing racial disparities in health and compared the results with a recent analysis of US data. METHODS: Non-Hispanic Black-to-non-Hispanic White rate ratios were computed for 14 health status indicators for 1990 and for 1998. RESULTS: Nationally and in Chicago, indicators for both Blacks and Whites improved between 1990 and 1998; however, Whites consistently fared better. Nationally, gaps narrowed on 10 indicators; for Chicago, they widened on 10 indicators. CONCLUSIONS: Nationally, there is apparent progress in reducing Black-White disparities; this is not true for Chicago. Whether failure to reduce racial disparities is unique to Chicago or is common to other urban centers remains an open question with important implications.

Adolescent↗
PubMed2004

Reducing the public health burden from elevated blood pressure levels in the United States by lowering intake of dietary sodium.

Elevated blood pressure levels are a major cause of heart disease and stroke. Healthy People 2010 established objectives to reduce mortality from these diseases by 20% and to reduce the major causal factors associated with these elevated levels, such as excess sodium intake. The American public consumes far more sodium than is needed, most of which is added by food manufacturers and restaurants. In November 2002, the American Public Health Association adopted a policy resolution calling for a 50% reduction in sodium in the nation's food supply over the next 10 years. Such a reduction would greatly enhance the chances of attaining the Healthy People 2010 objectives and would save at least 150 000 lives annually. This issue warrants public health intervention.

Adult↗
PubMed2004

Town-level characteristics and smoking policy adoption in Massachusetts: are local restaurant smoking regulations fostering disparities in health protection?

OBJECTIVES: We identified and quantified differences in sociodemographic characteristics of communities relative to the strength of local restaurant smoking regulations in Massachusetts. METHODS: We examined the relationship between the strength of the 351 local restaurant smoking regulations in Massachusetts and a number of town-level characteristics, using a multinomial logistic regression model. RESULTS: Characteristics important to the adoption of stronger restaurant smoking regulations included higher education and per capita income, geographic region, voter support for a state cigarette tax initiative, board of health funding to promote clean indoor air policy making, and the presence of a bordering town with a strong regulation. CONCLUSIONS: The current pattern of smoke-free restaurant policy enactment fosters socioeconomic and geographic disparities in health protection, undermining an important national health goal.

Financing, Government↗
PubMed2004

Achieving national health objectives: the impact on life expectancy and on healthy life expectancy.

Our study quantifies the impact of achieving specific Healthy People 2010 targets and of eliminating racial/ethnic health disparities on summary measures of health. We used life table methods to calculate gains in life expectancy and healthy life expectancy that would result from achievement of Healthy People 2010 objectives or of current mortality rates in the Asian/Pacific Islander (API) population. Attainment of Healthy People 2010 mortality targets would increase life expectancy by 2.8 years, and reduction of population wide mortality rates to current API rates would add 4.1 years. Healthy life expectancy would increase by 5.8 years if Healthy People 2010 mortality and assumed morbidity targets were attained and by 8.1 years if API mortality and activity limitation rates were attained. Achievement of specific Healthy People 2010 targets would produce significant increases in longevity and health, and elimination of racial/ethnic health disparities could result in even larger gains.

Adolescent↗
PubMed2005

Health disparities: a barrier to high-quality care.

PURPOSE: Disparities in the treatment of cardiovascular disease, diabetes mellitus, and cancer among the sexes and racial groups and possible interventions are discussed. SUMMARY: The ongoing process to identify and reduce health disparities has engaged numerous federal agencies as they monitor the nation's progress toward policy-driven and health-related objectives. Cardiovascular disease disproportionately affects minority groups and is the leading cause of death among women in the United States, and both groups receive suboptimal care for the disease. Disparities in the treatment of diabetes mellitus in African Americans, women, patients with less than a high school education, and the elderly have been found. Many minority groups continue to suffer disproportionately from cancer. Racial disparities also exist in cancer screening and treatment. Minorities are underrepresented in clinical trials for multiple reasons, many of which may be related to cultural beliefs. At all levels of coinsurance, the poor are less likely to seek preventive care. Adherence to national screening and treatment guidelines, clinical trial recruitment and participation, addressing language and geographic barriers, and increasing access to insurance are part of the coordinated efforts required to reduce health disparities. Because pharmacists influence patients' health status directly through pharmaceutical care and indirectly by engaging patients in their treatment, it is essential for pharmacists to be able to provide culturally competent care. CONCLUSION: Despite significant efforts over the past several years, health disparities continue to exist, particularly among minority groups. Interventions aimed at eliminating these disparities should include ensuring cultural competence among health care providers and improving health literacy among patients.

Attitude of Health Personnel↗
PubMed2002

The World Health Report 2000: World Health Organization health policy steering off course-changed values, poor evidence, and lack of accountability.

The World Health Report 2000 on health systems has raised concerns about its political biases, its methods and indicators, and its lack of reliable data. Tracing the origins of the Report, this article argues that it counteracts many of the concerns that gave rise to preparation of the Report in the first place. The mutually agreed-upon value-base, expressed in the Health for All strategy, has been largely abandoned. The Report includes contradictory messages, and many of its recommendations are not evidence-based. Furthermore, the ranking of countries according to their health systems' performance is not useful for health-policy-making, even if the methods and data could be improved. Because the member states and governing bodies of the WHO were not consulted during the production of the Report, the WHO secretariat has not received a mandate to change the value-base of the WHO's health policy or the aims of the Report. The WHO should return to its mandate as a normative intergovernmental U.N. agency on health.

Communicable Disease Control↗
PubMed2002

The long and difficult road to Alma-Ata: a personal reflection.

This account of the events leading up to the Alma-Ata Conference in September 1978 (covering the years 1970 to 1978) is based on the author's recollections and his recent research of World Health Organization documents. The author builds his story around four themes: why the Soviets, in particular, wanted the conference; why the new WHO director-general did not; the time and energy lost by holding the conference; and what might have happened if it had not been held. The story involves not only people and their political and health ideologies but also reflections on the continuing question of how best to improve the health of commuunities. The account reveals how Alna-Ata constrained attempts by the new leadership of WHO to transform the way in which the organization fulfilled its international health responsibilities.

Congresses as Topic↗
PubMed2003

Reflections on the twenty-fifth anniversary of the Alma-Ata Declaration.

The Alma-Ata Declaration on Primary Health Care of 1978-based on the World Health Assembly's resolution of 1977 on Health for All by the Year 2000--was a watershed in the concepts and practices of public health as a scientific discipline; it was endorsed by every country in the world, rich and poor. According to the Declaration, health is a fundamental right, to be guaranteed by the state; people should be the prime movers in shaping their health services, using and enlarging upon the capacities developed in their societies; health services should operate as an integral whole, with promotive, preventive, curative, and rehabilitative components; and any western medical technology used in non-western societies must conform to the cultural, social, economic, and epidemiological conditions of the individual countries. Since Alma-Ata, a syndicate of the rich countries and the ruling elites of the poor countries, aided by the WHO, World Bank, World Trade Organization, and other international institutions, has done much to overturn the Declaration's primary health care initiatives. The WHO's recent attempt to regain some credibility, its Commission on Macroeconomics and Health, ignored the primary health care principles of the Alma-Ata Declaration. A struggle for these principles will have to be part of the larger struggle, by like-minded individuals working in individual countries, for a just world order.

Developed Countries↗
PubMed2005

Designing written medication instructions: effective ways to help older adults self-medicate.

One of the goals of Healthy People 2010 is for 95% of patients who are ordered medication to receive written medication instructions. The declining physical condition often associated with advanced age, lower literacy levels, and education among members of the current elderly cohorts, and increasingly complex medication regimes for chronic illness affect the ability of many older adults to learn. This article addresses Geragogy, the art and science of helping older adults learn, complimentary theories of learning, and examples of how they can be used to guide the construction of appropriate written medication instructions for older adults.

Aged↗
PubMed2006

The road to population health: using Healthy People 2010 in nursing education.

Healthy People 2010: Understanding and Improving Health and corresponding state health improvement plans provide roadmaps for planning, monitoring, and evaluating population health improvement in the United States. These documents offer relevant guidance for nursing education because they address health workforce education specifically, use a population perspective, and include evidence-based action priorities. However, information about how these documents are used in nursing education is limited. This article discusses the relevance of national and state health planning documents for nursing education. Nurse educators are encouraged to reflect on the alignment of current nursing education efforts with national and state health planning agendas. Suggestions for future use of national and state population health improvement planning documents in guiding strategic, curricular, and course planning are offered.

Community Health Planning↗