[Public health clinic reorganization plans by local autonomous governments].
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Health Facilities↗
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The nonprofit sector's response to the AIDS epidemic: community-based services in San Francisco.
Community-based organizations in San Francisco have played a key role in providing social support services and public health information to those affected by acquired immune deficiency syndrome (AIDS). These services have helped minimize the economic impact of the epidemic by reducing the level and expense of hospitalization of AIDS patients. During fiscal year 1984-85, the three largest community-based groups in San Francisco provided more than 80,000 hours of social support and counseling services, responded to over 30,000 telephone inquiries and letters, and distributed nearly 250,000 pieces of literature. Home-based hospice care was provided to 165 AIDS patients at an average cost per day of $94 per patient. Community-based organizations require a significant level of funding from government and private sources. Local government in San Francisco has provided 62 per cent of the revenues for these groups. At the same time, they are not viable without a steady stream of volunteer labor. More than 130,000 hours were donated this past year. There are intrinsic limits to the current dependency on unpaid labor and contributions made by private charity and local government which will eventually require increased support and intervention at the state and federal levels.
Acquired Immunodeficiency Syndrome↗
Influence of socioeconomic factors on attaining targets for reducing teenage pregnancies.
OBJECTIVE: To determine the rate of pregnancy and outcome in teenagers in areas of different socioeconomic conditions, and to assess the implication for achievement of government and local targets in reducing unwanted pregnancies in teenagers. DESIGN: Records of pregnancies were obtained from hospital discharge files and rates of live and still births and abortions calculated for each postcode sector. Postcodes were grouped by categories of deprivation and by local government district. SETTING: Tayside, Scotland. SUBJECTS: Teenage girls admitted to National Health Service hospitals for delivery or abortion in 1980-90. MAIN OUTCOME MEASURES: Conception in girls aged under 16 by area of residence and relative proportion leading to live births or terminations. Rate of different outcomes in girls under the age of 20 by area of residence. RESULTS: The pregnancy rate in girls aged under 16 was three times as high, and in all girls under 20 six times as high in the most deprived areas as in the most affluent areas. The proportion of teenage pregnancies ending in abortions was higher in the affluent areas, where two out of three ended in abortion compared with one out of four in the deprived areas. CONCLUSIONS: Although there was a higher pregnancy rate in teenagers in more deprived areas, the proportion ending in abortion was greater in more affluent areas, possibly due to social and parental pressure. The wide geographical variation in patterns of teenage pregnancy indicates the need for a small area rather than a regional approach to setting targets and devising measures of achieving them.
Abortion, Legal↗
Health practices and indices of a poor urban population in Indonesia. Part I: Patterns of health service utilization.
This first section in a two-part study of health indices and practices among residents living in a Jakarta slum describes the use of public and private primary health care services in relation to socioeconomic and health status. As problems associated with urban poverty rapidly increase in developing countries, it is important to study the ethnic and economic diversity which exists in slums and shanty towns: results of such studies should inform the development of effective strategies for outreach and service delivery. Through a survey of 690 mothers and 593 children, we found that 1) poorer residents were more likely than relatively affluent ones to rely on local government clinics (posyandus) for primary health care; 2) regular posyandu users were more likely than non-users to be fully immunized and to use ORT correctly; 3) delivery in hospital was common among all residents, but especially among the more affluent; and 4) prevalence of contraception was high and not associated with socioeconomic status or type of primary health care service used. Strengthening primary health care services at the government's local health posts could benefit all groups in the community if wealthier residents participated more in the posyandus. Standards of care in the private sector should also be improved.
Child Welfare↗
[Statistical data on motor handicapped children, aged 0-18 years, based on a national survey].
A computer-based data processing was made at 6762 motor handicapped children. The data were obtained by questionnaires about the health status, educational, social level and rehabilitation of these children. The authors could state the use of therapeutical equipment, the further need for rehabilitation--specialists and the waiting list for the admission to institutions. The number of registered children was 2.4% of the specific population. The aim of the study was to promote the activity of local self governments, local--and national social security--and health authorities competent in the rehabilitation for the social integration of the Hungarian 0-18 years old motor handicapped persons.
Adolescent↗
The role of private organisations in welfare work. The historical perspective.
The Danish welfare measures originated in private initiatives. From the end of the last century, welfare activities have developed through private relief organisations and with support from the State, local governments, and counties. Since the 1960s, many institutions which had been built up by private relief organisations were actually taken over by local governments or counties. By way of illustration, the development of EGV DaneCare (the Danish Association for the Care of the Elderly), from its origin as a voluntary relief organisation based on voluntary work and collected funds, is described. From 1910, EGV was the pioneer within the field of, for example, old people's homes, winter shelters, and holidays in the country for elderly people. In the 1960s, EGV became a professional service organisation which assisted the local governments in developing a wide range of variegated offers within the work for elderly people. Assistance offered to the local governments became the organisation's principal project up to the 1980s. The population's confidence in the ability of the public authorities to cope with the social tasks was at the time undermined by increasing scepticism. That was why EGV founded the DaneAge Association, which soon became a national cause with more than 200,000 members. The DaneAge Association operates as an association independent of the public authorities pursuing both local and national policies concerning the elderly and implementing humanitarian initiatives based on voluntary work. Studies made by the DaneAge Association show, among other things, that 20 per cent of the people aged 60 and over need practical assistance.(ABSTRACT TRUNCATED AT 250 WORDS)
Charities↗
Subsidy supports inefficiency of local government-owned hospitals in Japan.
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Data Collection↗
[Public health functions, activities and structures: the role of large and middle-sized municipalities].
OBJECTIVE: The aim of this paper was to analyze how public health functions are covered in large or medium-sized cities in Catalonia (Spain) by assessing the role, activities and structure of local services. METHODS: Data were collected through a questionnaire with items on public health functions and activities and on the structure of municipal services. The study population comprised the 43 cities of Catalonia with a population above 25,000 (3% of towns and 70% of the population). Answers were obtained from 28 cities (65%), covering 60% of the population of Catalonia and all towns with a population above 50,000 inhabitants. RESULTS: The public health function in which local governments were least active was need assessment while they were more active in policy development and service delivery assurance. For public health activities, the role of local governments was relatively greater in health protection while few municipal services were active in epidemiological surveillance and substance abuse. Municipal public health expenditure per resident/year was estimated at 1,063 pesetas (approximately 6 Euros). Among the public health personnel, 72% worked full-time while the remaining (mainly members of the corps of health officers serving local administration) worked part-time. Local governments often mixed within the same structure public health services and services, mainly consumer affairs, environmental or social services. CONCLUSIONS: Local governments showed significant activity in public health. The volume of resources involved and management capacity were considerable. In some cities, some public health activities were perceived as not covered.
Delivery of Health Care↗
[Establishment and development of the self-governed health case system in the Austrian sector of Poland].
Transformation and development of organisational matters, characteristic for the 18th and 19th centuries, included the issue of public health care. The development of economy, social and medical sciences changed the understanding of joint responsibility of the state for public health. The Teresian-Josephine reforms in Austria, concerning public issues, including the sanitary-epidemiological matters, were enforced in the areas of Polish annexed territory in 1772 and 1795. The normative regulations for Galicia and Lodomeria from 1773, 1861, 1891 established the responsibilities and rights for medical practice, activities of sanitary institutions and general medical care for the society. Austrian sanitary legislation created central institutions and self-governed local structures, responsible for public health. Introduction of modern local administration had a deciding effect on the development of self-governed institutions in closed and open health care system. Apart from sanitary national administration, public health care matters were governed by local-governed authorities of the insurance sector and private subjects. This advanced decentralisation and handing of health care matters to local self-governments shaped the new system of public health care.
Austria↗
Public Law 100-259, 22 March 1988.
This US Act does the following with respect to sex and age discrimination and abortion funding: amends Title IX (Prohibition of Sex Discrimination) of the Education Amendments of 1972 to define the phrase "program or activity" and the term "program" to mean all of the operations of the following entities, any part of which is extended Federal financial assistance: 1) a department, agency, special purpose district, or other instrumentality of a State or local government; 2) a State or local government entity which distributes such assistance and the agency or department to which such assistance is extended; 3) a college, university, or other postsecondary institution, or public system of higher education; 4) a local educational agency, system of vocational education, or other school system; and 5) a corporation, partnership, or other private organization or certain sole proprietorships. The Act also states that such terms do not include any operation of an entity which is controlled by a religious organization and that nothing in such Act shall be construed to: 1) require or prohibit any person or entity to provide or pay for an abortion or 2) permit a penalty to be imposed on any person because such person is seeking or has received any benefit or service related to a legal abortion. The Act also amends the Rehabilitation Act of 1973, the Age Discrimination Act of 1975, and the Civil Rights Act of 1964 to define the phrase "program or activity" to mean all of the activities of the aforementioned entities. The Act further states that this Act does not require any individual or hospital or other institution, program, or activity that receives Federal financial assistance to perform or pay for an abortion.
Abortion, Induced↗
A perspective on local-level governance in multiunit systems.
The traditional functions of the hospital board are affected significantly when the institution is part of a multiunit system. The local board in multiunit systems often does not have the unrestricted ability to define its mission and goals and typically does not have total responsibility and authority for selecting, appointing, and evaluating the performance of the hospital's CEO. Some type of system-level involvement in shaping and/or approving the local institution's strategic plan and budget is common. Local boards generally have retained the principal role in the appointment and credentialing of medical staff members. In general, the continuing growth of multiunit systems has profound implications for the present and future role of local-level governance, but that role continues to have great importance and must be defined carefully.
Budgets↗
[Cooperation between public health nurses of Kanagawa Prefecture and those of local municipal governments].
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Humans↗
Is there a gray peril? Retirement politics in Florida.
Using data from Florida, the most significant destination for Sunbelt retirees, three hypotheses concerning the political impact of retirement migration on the Sunbelt were tested. Surveys of local government officials and socioeconomic data about local government regarding 103 municipalities and 62 counties suggested that aging persons, although politically active, are seldom involved in organized advocacy or political opposition to local policies that are largely beneficial to other interests.
Aged↗
Demographic changes and local public expenditure in a macroeconomic perspective. Some Norwegian examples.
The impact of demographic aging and changes in the age structure on local government expenditures for social services in Norway is analyzed and projected. "To model the production of the local government sector, we have developed a macro model which reflects the coverage of different services according to demographic characteristics and standards defined as man-hours per client.... The results of a simulation show that demographic changes are of minor importance for local government expenditures in most sectors when compared to changes in standard and coverage rates....Results [also] indicate that a shift in standards and coverages in different client sectors would have rather important effects on the Norwegian economy."
Age Distribution↗
Australian trends in mortality by socioeconomic status using NSW small area data, 1970-89.
This ecological study examines trends in socioeconomic differentials in mortality in New South Wales, Australia, over a 20-year period (1970-89). The proportion unskilled was used as the indicator of socioeconomic status and its selection justified. Using census data aggregated by Local Government Area, the relationship between mortality and socioeconomic status was examined using quintiles based on the proportion unskilled in the population. Local Government Areas were also sorted into quintiles using mortality rates (0-74 years) to describe change in mortality differentials over time. Socioeconomic differentials were more evident in the relatively homogeneous Local Government Areas within the Sydney Statistical Division than in the remaining NSW Statistical Divisions which are more heterogeneous and predominantly rural. Although there has been an overall decline in mortality for males and females, and for high and low status groups, over this period the relative socioeconomic differentials have not declined. For the most recent period (1985-89) there appears to be some widening of differentials for males. The NSW state trends are generally similar to those reported for Britain and for other industrialised countries, suggesting that this is a common trend and that policies to reduce inequalities have not been effective.
Adolescent↗
Impact evaluation of efforts to eliminate iodine deficiency disorders in Nigeria.
OBJECTIVE: : The objective of the present review is to assess the impact of universal salt iodisation in Nigeria during the last five years, with reference to some of the sentinel sites studied previously during a 1995 multi-centre study. DESIGN, SETTING AND SUBJECTS: : The method of goitre classification by palpation was employed using the new internationally accepted method in which the classification is simply graded as 0, 1 or 2. The multistage random sampling method was used and states and local government areas were already selected by virtue of their known status for iodine deficiency disorders (IDD). Schools were randomly chosen in each local government area and children aged 8-12 years in each school were determined. A percentage of the children was then included in the study to give a sample size greater than the minimum number allotted to the school. A total of 2372 schoolchildren (1420 males and 952 females) in 11 local government areas were examined; urine samples were collected from 537 children and analysed for urinary excretion of iodine. The method known as the Sandell-Kolthoff reaction was adopted, in which the iodide in the urine samples catalyses the reduction of ceric ammonium sulphate (yellow colour) to the cerous form (colourless) in the presence of arsenious acid. The degree of reduction in colour intensity of the yellow ceric ammonium sulphate is proportional to the iodine content in the urine sample. RESULTS: : The results from this study show that the median urinary iodine excretion for this sampled population in Nigeria, drawn mostly from IDD-endemic areas, is 14.65 microgram dl-1 with a mean value of 13.39 microgram dl-1. CONCLUSION: : This finding would suggest that Nigeria, in general terms, has achieved the goal of universal salt iodisation and should now focus its attention on constant monitoring in order to sustain this iodisation level.
Child↗
Family planning measures, February 1988.
In early 1988, family planning (FP) measures were announced by Mr. Liang Jimin, spokesman for the Chinese State FP Commission. The major points of the measures include: 1) stressing the leading role of the recent reform in general, 2) stabilizing FP policies, and 3) strengthening the organizational frameworks at the grassroots level and improving program performance in backward regions. The policies were explained in detail as follows: "1) to introduce a 'FP contract responsibility system' throughout the country, in order to guarantee the fulfillment of government targets of population plans, such as contracts between governments at different levels, contracts between local government and FP departments; 2) to include the performance of local FP programs as one of the criteria for evaluating the achievements of government officials at various levels, such as relevant provisions in officials' term contracts; 3) to sign FP contracts between couples at reproductive ages and local governments, such as local governments responsible for allocating birth quotas, providing contraceptive equipment and services, and paying incentives and subsidies; the couples would be responsible for using contraceptives and planning births; 4) to improve social security schemes with respect to FP, such as old-age pensions for couples with one child who have undertaken sterilization, only-child life insurance, and contraceptive operation insurance; 5) to increase the proportion of only children among all births and strictly control the quota of authorized second-births in rural areas; 6) to improve education and FP services by relying on community FP associations or "Key Households of FP", to help increase the use rate and reduce the failure rate of contraceptives, increase the quality of contraceptive operations, and reduce the incidence of induced abortion; 7) to adopt measures to eliminate early marriage and early reproduction and introduce population education in middle schools; 8) to enact new laws and regulations, such as 'regulations concerning FP administration at the grassroots level units' and 'regulations concerning FP administration of the highly mobile population'; 9) to increase international exchange and cooperation and import advanced technology and equipment for contraception."
Adult↗
A health impact assessment of an environmental management plan: the impacts on physical activity and social cohesion.
ISSUE ADDRESSED: This article describes a prospective health impact assessment (HIA) on a local government environmental management plan, the Shellharbour Foreshore Management Plan (SFM Plan). The health outcomes of interest were physical activity and social cohesion. METHODS: The procedures undertaken include: screening; scoping; assessment of potential health impacts; negotiation; and decision-making. The potential positive and negative health impacts of the SFM Plan were assessed and opportunities to enhance the positive and mitigate the negative were identified. RESULTS: Implementation of the SFM Plan was supported as the HIA showed a potential to benefit the health of local residents and visitors to the Shellharbour Foreshore area by increasing physical activity and social cohesion. CONCLUSION: The HIA provided a useful framework for establishing a collaborative relationship between the local government and health sector. It improved the local government's understanding of the inter-relationship between the environment and physical activity and social cohesion and enabled health authorities to have an impact on a capital works program to maximise health gain.
Community Health Planning↗