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PubMed2002

Promoting physical activity in women: evaluation of a 2-year community-based intervention in Sydney, Australia.

Women are less likely than men to reach recommended levels of physical activity and have unequal access to active leisure time. Studies in Australia have consistently found that women are only half as likely as men to be adequately active. A community-based multi-strategic health promotion intervention, 'Concord, A Great Place to be Active', was implemented from 1997 to 1999. It aimed to increase the physical activity levels of women aged 20-50 years living in the Concord Local Government Area (LGA), an inner-western region of Sydney, Australia. A key feature of this intervention was a partnership between Concord Council (the local government) and the Central Sydney Health Promotion Unit (CSHPU). The project was evaluated using qualitative and quantitative methods. Key informant interviews and focus groups were conducted to inform the development of the intervention and to assess the impact of the project on Concord Council. Pre- and post-intervention telephone surveys of the target group were also conducted. Following the intervention, there was a statistically significant (6.4%) reduction in the proportion of sedentary women. Further, there were a number of positive enhancements in the Council's capacity to promote physical activity in the community. These findings demonstrate that a community-based intervention targeting a specific population can achieve positive changes in physical activity and that a local government has the capacity to be involved in and sustain physical activity interventions.

Adult↗

PubMed2005

New South Wales trends in mortality differentials between small rural and urban communities over a 25-year period, 1970-1994.

OBJECTIVE: To identify trends in premature mortality differences between urban and small rural communities in NSW over a 25-years period. DESIGN: A longitudinal population-based study. ABS population and death data by local government area, sex and age for the period 1970 to 1994, were used to derive mortality measures for urban and small rural communities in NSW. SETTING: NSW local government areas categorised by the Rural and Remote Metropolitan Area Classification system as 'capital city' (the Sydney Statistical Division) and 'other rural area' and 'other remote area'. SUBJECTS: All persons aged 0-74 years resident in the aforementioned NSW local government areas between 1970 and 1994 inclusive. MAIN OUTCOME MEASURE: Whether premature mortality differentials have widened, narrowed or remained the same over the study period and the magnitude of any identified changes. RESULT: There was a decrease in premature mortality rates for men and women in both urban and small rural communities. However, the decline was less in small rural communities, with the differential between small rural and urban areas increasing 2-3% every 5 years. CONCLUSIONS: Differences in age structure, proportion of indigenous and migrant populations between small rural communities and urban NSW can not fully account for the increasing differential. Other possible explanatory factors include socioeconomic status and different exposures and practices in rural areas.

Adolescent↗

PubMedDate not supplied

The city government's role in community health improvement.

Amid increasing pressures to address complex issues not traditionally assigned to localities, Healthy Cities is seen as a powerful model for community improvement and quality-of-life enhancements for individuals and organizations willing to think beyond the traditional local government management models and responsibilities. As a model for community-oriented government, it offers opportunities for fostering a return to "barnraising" concepts, civic responsibility, participation, tailoring solutions to local circumstances, and the transition of local government to governance models.

City Planning↗

PubMed1998

Metropolitan governance, residential segregation, and mortality among African Americans.

OBJECTIVES: This study tested the hypothesis that the degree to which local government is metropolitanized is associated with mortality rates for African Americans and with residential segregation, which has itself previously been shown to be positively associated with mortality among African Americans. METHODS: One hundred fourteen US standard metropolitan statistical areas were examined. The primary dependent variable was the age-adjusted, race- and sex-specific all-cause mortality rate, averaged for 1990 and 1991. The 2 primary independent variables were residential segregation, as measured by the index of dissimilarity, and metropolitanization of government, as measured by the central city's elasticity score. RESULTS: Mortality rates for male and female African Americans were lower in metropolitan statistical areas with more metropolitanized local governments and lower levels of residential segregation. Mortality for male and female Whites was not associated in either direction with residential segregation. White male mortality showed no association with level of metropolitanization, but lower White female mortality rates were associated with less metropolitanization. CONCLUSIONS: This study suggests the need for further research into whether policy changes in areas not traditionally thought of as "health policy" areas can improve the health of urban minorities.

Black or African American↗

PubMed1999

A Quantitative Method for Estimating Probable Public Costs of Hurricanes.

/ A method is presented for estimating probable public costs resulting from damage caused by hurricanes, measured as local government expenditures approved for reimbursement under the Stafford Act Section 406 Public Assistance Program. The method employs a multivariate model developed through multiple regression analysis of an array of independent variables that measure meteorological, socioeconomic, and physical conditions related to the landfall of hurricanes within a local government jurisdiction. From the regression analysis we chose a log-log (base 10) model that explains 74% of the variance in the expenditure data using population and wind speed as predictors. We illustrate application of the method for a local jurisdiction-Lee County, Florida, USA. The results show that potential public costs range from $4.7 million for a category 1 hurricane with winds of 137 kilometers per hour (85 miles per hour) to $130 million for a category 5 hurricane with winds of 265 kilometers per hour (165 miles per hour). Based on these figures, we estimate expected annual public costs of $2.3 million. These cost estimates: (1) provide useful guidance for anticipating the magnitude of the federal, state, and local expenditures that would be required for the array of possible hurricanes that could affect that jurisdiction; (2) allow policy makers to assess the implications of alternative federal and state policies for providing public assistance to jurisdictions that experience hurricane damage; and (3) provide information needed to develop a contingency fund or other financial mechanism for assuring that the community has sufficient funds available to meet its obligations. KEY WORDS: Hurricane; Public costs; Local government; Disaster recovery; Disaster response; Florida; Stafford Act

Journal Article↗

PubMed1998

Public, private and voluntary residential mental health care: is there a cost difference?

OBJECTIVES: To determine how public (NHS or local government), private (for-profit) and voluntary (non-profit) providers of residential mental health care compare. Do they support different clienteles? And do their services cost different amounts? METHODS: Based on a cross-sectional survey of residential care facilities and their residents in eight English and Welsh localities, the characteristics and costs of care in the different sectors (NHS, local government, private, voluntary) were compared. Variations in cost were examined in relation to residents' characteristics using multiple regression analyses, which also allowed standardisation of results before making inter-sectoral comparisons. RESULTS: Private and voluntary providers of residential care support different clienteles from the public sector. The patterns of inter-sectoral cost differences vary between London and non-London localities. In London, voluntary sector facilities may be more cost-efficient than the other sectors, but local government/private sector comparisons show no consistent difference. Outside London, the results suggest clear cost advantages for the private and voluntary sectors over the local government sector. CONCLUSIONS: Private and voluntary providers may have some economic advantages over their public counterparts. However, outcomes for residents were not studied, leaving unanswered the question of comparative cost-effectiveness.

Community Mental Health Services↗

PubMed2005

Swedish healthcare under pressure.

Swedish health care, run by local governments at both the regional (county) and the municipal levels, has been under pressure during the last 15 years, following increased scrutiny of performance and demand for cost-containment. Health-care expenditures per capita and levels of resource inputs have grown, but more slowly than in other EU countries. At the same time, the number of elderly people has increased, as have options for medical treatment. In the late 1980s, several local governments referred to long waiting-lists for elective treatment and anecdotal evidence of inefficiency and poor responsiveness when arguing for market-oriented reforms. A purchaser-provider split followed, and so did changes in the payment systems for health-care providers. According to the available evidence, these reforms yielded an increased volume of services in the short run; but traditional hierarchical management soon replaced the new incentives. Moreover, evidence suggests that changes introduced by the national government, and the deteriorating funding conditions together with a continued use of new medical technology, have had more far-reaching effects on health-care output and outcome than local-government reforms.

Financial Management↗

PubMed1995

Can a public health care system achieve equity? The Norwegian experience.

Equity in health care provision is an important policy goal in Norway. This article addresses equality in the services provided by primary care physicians. These services are the responsibility of local government financed mainly through public funding. Patient fees are low. The local government system results in geographical variation in the number of physicians relative to local health demands. The authors present the hypothesis that this generates inequalities in health care utilization. The system of government finance is based on the assumption that utilization of health services is independent of patient income. Therefore, variation in income is expected to have only a small impact on utilization. The authors estimate a demand model by combining extensive micro data with aggregate data on municipal supply. There is very little relationship between indicators of access and health care utilization. The estimated income elasticities approximate zero, supporting the argument that equality in utilization has been achieved. However, the authors results also raise the question of whether equality has been achieved at the cost of limiting supply of services for people who could afford to consume more, or to pay for services of higher quality.

Adolescent↗

PubMed1997

Medical assessment for licensing of taxi drivers by Scottish local authorities.

In the UK, licensing of taxi drivers is dealt with by local government authorities. In Scotland, before the recent reorganization of local government, taxi licensing was under the jurisdiction of District Councils, so a telephone survey was conducted of all 52 mainland Scottish District Councils to ascertain the procedures which were being employed in assessing medical fitness to drive a taxi, for which there is no national standard. Medical enquiries relevant to fitness to drive were being made by 41 (79%) of local authorities, but in 38 (73%) this was limited to a single question about health. No enquiry regarding health status was being made by 11 (21%) District Councils (all serving < 100,000 population size). Only three Scottish District Councils conducted a routine medical examination of all applicants. Thirteen of the 15 large (> 100,000 population size), and 20 of the 21 medium-sized (50,000-100,000) Scottish District Councils carried out medical examinations either when a relevant medical disorder was declared by the applicant, or when the applicant was above a defined age (which varied between local authorities). The small local authorities (population < 50,000) examined only those applicants who declared medical disorders. This survey has shown considerable variation and limitations in the approach of the previously existing Scottish District Councils to the assessment of medical fitness to drive of applicants for taxi licences. It is suggested that national standards and guidelines are required for medical fitness to drive in relation to taxi licensing.

Automobile Driving↗

PubMed2004

The public policy aspects of biological monitoring: budget and land-use planning implications at the county level.

Montgomery County, Maryland faces a growing problem that confronts local governments across the country: the cumulative impacts that population growth and the resulting land-use changes are having on local streams and their accompanying ecosystems. County officials found they needed an affordable tool to serve as a report card for stream health, and began a biomonitoring program in 1994. By 1997 county officials had monitored all 23 watersheds within the county's boundaries, and in 1998 the county published its first Countywide Stream Protection Strategy (CSPS). The County uses the CSPS to prioritize its watershed restoration efforts to those areas most in need of immediate remediation. Six primary programs now support or require the use of information from Montgomery County's biomonitoring program. And, the lessons learned from Montgomery County can help other county and local governments develop similar programs of their own.

Animals↗

PubMed2003

Overview of devolution of health services in the Philippines.

INTRODUCTION: In 1991 the Philippines Government introduced a major devolution of national government services, which included the first wave of health sector reform, through the introduction of the Local Government Code of 1991. The Code devolved basic services for agriculture extension, forest management, health services, barangay (township) roads and social welfare to Local Government Units. In 1992, the Philippines Government devolved the management and delivery of health services from the National Department of Health to locally elected provincial, city and municipal governments. AIM: The aim of this review is to (i) Provide a background to the introduction of devolution to the health system in the Philippines and to (ii) describe the impact of devolution on the structure and functioning of the health system in defined locations. METHOD: International literature was reviewed on the subjects of decentralization. Rapid appraisals of health management systems were conducted in both provinces. Additional data were accessed from the rural health information system and previous consultant reports. RESULTS: Subsequent to the introduction of devolution, quality and coverage of health services declined in some locations, particularly in rural and remote areas. It was found that in 1992-1997, system effects included a breakdown in management systems between levels of government, declining utilization particularly in the hospital sector, poor staff morale, a decline in maintenance of infrastructure and under financing of operational costs of services. CONCLUSION: The aim of decentralization is to widen decision-making space of middle level managers, enhance resource allocations from central to peripheral areas and to improve the efficiency and effectiveness of health services management. The findings of the historical review of devolution in the Philippines reveals some consistencies with the international literature, which describe some negative effects of decentralization, and provide a rationale for the Philippines in undertaking a second wave of reform in order to 'make devolution work'.

Journal Article↗

PubMed2005

Income distribution, public services expenditures, and all cause mortality in US States.

INTRODUCTION: The objective of this paper is to investigate the relation between state and local government expenditures on public services and all cause mortality in 48 US states in 1987, and determine if the relation between income inequality and mortality is conditioned on levels of public services available in these jurisdictions. METHODS: Per capita public expenditures and a needs adjusted index of public services were examined for their association with age and sex specific mortality rates. OLS regression models estimated the contribution of public services to mortality, controlling for median income and income inequality. RESULTS: Total per capita expenditures on public services were significantly associated with all mortality measures, as were expenditures for primary and secondary education, higher education, and environment and housing. A hypothetical increase of 100 US dollars per capita spent on higher education, for example, was associated with 65.6 fewer deaths per 100,000 for working age men (p<0.01). The positive relation between income inequality and mortality was partly attenuated by controls for public services. DISCUSSION: Public service expenditures by state and local governments (especially for education) are strongly related to all cause mortality. Only part of the relation between income inequality and mortality may be attributable to public service levels.

Adult↗

PubMed1997

Health policy development in wartime: establishing the Baito health system in Tigray, Ethiopia.

This paper documents health experiences and the public health activities of the Tigray People's Liberation Front (TPLF). The paper provides background data about Tigray and the emergence of its struggle for a democratic Ethiopia. The origins of the armed struggle are described, as well as the impact of the conflict on local health systems and health status. The health-related activities and public health strategies of the TPLF are described and critiqued in some detail, particular attention is focused on the development of the baito system, the emergent local government structures kindled by the TPLF as a means of promoting local democracy, accountability, and social and economic development. Important issues arise from this brief case-study, such as how emerging health systems operating in wartime can ensure that not only are basic curative services maintained, but preventive and public health services are developed. Documenting the experiences of Tigray helps identify constraints and possibilities for assisting health systems to adapt and cope with ongoing conflict, and raises possibilities that in their aftermath they leave something which can be built upon and further developed. It appears that promoting effective local government may be an important means of promoting primary health care.

Communicable Disease Control↗

PubMed2001

From river to ridge: a blueprint for sustainable management in the Georges River catchment.

Research on sustainable transport and water projects, conducted in North America during 1999, identified four key considerations common to a number of projects. These four considerations are the preconditions necessary to achieve sustainability in a given location. These preconditions (BAPP) are boundary definition, administrative alignment, protection of non-urban lands, and the participation of all interested parties. This paper considers the perceived attitudes of various catchment stakeholders and focuses on planners and planning. The results of questionnaire surveys based on BAPP concepts suggest that local government is perceived as having the highest priority for protection of riparian lands and waterways (as individual Councils and Regional Organisations of Councils). Thus local government is the preferred arena for coordination, responsibility and jurisdiction of waterways and riparian land. The opportunity exists to examine the differing roles of local and state government. The paper concludes by outlining the implications of this research for land use planning and institutional structures in sustainable river management.

Agriculture↗

PubMed2004

[A nationwide survey of municipalities' policy for smoking control and its implementation in relation to its priority grading by public health officers].

PURPOSE: The purpose of this study was to investigate the present situation regarding implementation of smoking control programs and to clarify relations with public health officers' attitudes toward smoking control measures. METHODS: A questionnaire form was mailed to the 3,207 local municipalities throughout Japan. The items included in the form were the contents of the smoking control programs, educational activities for passive smoking prevention, interaction with the media to spread education and awareness, and public health officers' attitudes toward smoking control measures. RESULTS: Of 3,207 municipalities, 2,570 (80.1%) responded. Over 95% of local municipalities were undertaking smoking control programs. Among the programs carried out in practice, dividing areas into smoking and non-smoking sections in local government office buildings had the highest proportion of support (80%). On the other hand, complete prohibition of smoking in local government office buildings and non-smoking support programs were conducted by less than 20%. The dissemination of education activities were executed in 60 percent of government office buildings, and 36% of schools, but only 20% of athletic gyms, hospitals, and other facilities. Sixty percent of public health officers recognized the importance of smoking control programs. A non-smoking support program and complete prohibition of smoking in government office buildings were more likely to be executed in for local municipalities with a higher priority for smoking control programs. No significant association was found between attitudes regarding program importance and the division of areas into smoking and non-smoking sections in government office buildings. CONCLUSIONS: Our results suggest that promotion of smoking control measures in local municipalities may be dependent on the public health officers' attitude toward the issues. High priority should be given to assisting public health officials and other key personnel in recognizing the importance of implementing smoking control measures for attaining better health.

Health Education↗

PubMed2006

[Features of the USA Cancer Registries Amendment Act viewed from the status quo in Japan].

Features of the USA Cancer Registries Amendment Act can be summarized in two brief sentences as follows. 1. The Federal Government gives financial and technical support to regional cancer registration programs of states according to application of local governments or academic or non-profit organizations nominated by local government. 2. The qualifications that should be fulfilled by state governments to receive support are stipulated clearly. The following effects of this law were expected. 1. The Federal Government would take the role enforcing programs already ongoing in individual states without modifying the operating foundation of the programs drastically. 2. Registration items, and immediacy and comprehensiveness of data would rapidly become standardized. 3. State legislatures were led to decide the state law indicating that cancer registration could be made without obtaining consent of patients suffering from cancer individually. 4. The law led to the commencement of regional registration programs in states where there had been no such programs beforehand. It is indicated that the following items are additionally necessary of a similar legislative arrangement is to be made in Japan. 1. To make it an obligation of the physician (medical institution) to make official notification of patients with cancer. 2. Effective utilization of death information. 3. Establishment of a system of hospital-based cancer registration. 4. A means to inform patients with cancer and the nation widely about the program. 5. Determine roles of medical institutions in prefectures where no cancer registration is performed. 6. Establish penal regulations to punish individuals who divulge personal information.

Humans↗

PubMed2002

Environmental management of small-scale and artisanal mining: the Portovelo-Zaruma goldmining area, southern Ecuador.

This paper considers technical measures and policy initiatives needed to improve environmental management in the Portovelo-Zaruma mining district of southern Ecuador. In this area, gold is mined by a large number of small-scale and artisanal operators, and discharges of cyanide and metal-laden tailings have had a severe impact on the shared Ecuadorian-Peruvian Puyango river system. It is shown to be technically possible to confine mining waste and tailings at a reasonable cost. However, the complex topography of the mining district forces tailings management to be communal, where all operators are connected to one central tailings impoundment. This, in turn, implies two things: (i) that a large number of operators must agree to pool resources to bring such a facility into reality; and (ii) that miners must move away from rudimentary operations that survive on a day-to-day basis, towards bigger, mechanized and longer-term sustainable operations that are based on proven ore reserves. It is deemed unlikely that existing environmental regulations and the provision of technical solutions will be sufficient to resolve the environmental problems. Important impediments relate to the limited financial resources available to each individual miner and the problems of pooling these resources, and to the fact that the main impacts of pollution are suffered downstream of the mining district and, hence, do not affect the miners themselves. Three policy measures are therefore suggested. First, the enforcement of existing regulations must be improved, and this may be achieved by the strengthening of the central authority charged with supervision and control of mining activities. Second, local government involvement and local public participation in environmental management needs to be promoted. Third, a clear policy should be defined which promotes the reorganisation of small operations into larger units that are strong enough to sustain rational exploration and environmental obligations. The case study suggests that mining policy in lesser-developed countries should develop to enable small-scale and artisanal miners to form entities that are of a sufficiently large scale to allow adequate and cost-effective environmental protection.

Cost-Benefit Analysis↗

PubMed1991

The quest for wholeness: health care strategies among the residents of council-built hostels in Cape Town.

The 1980s in South Africa have witnessed an extraordinary interest by health care professionals in the relevance of health care and healing systems outside the dominant biomedical system. The debate centres around the most effective way of incorporating "these other forms" of healing into the dominant system in the best interest of the patient. It is essentially a debate amongst professionals based on their perceptions of "the best interest" without any significant input from the "patients" who are the object of their concern. This paper attempts to bring into focus "patients" perceptions of different health care systems, their access to them and the rationale behind their choice of therapy. The experience of acute symptoms, especially pain, identifies an illness episode and initiates therapeutic action. Biomedical services are, most often, the first choice of the hostel dwellers. Hostel dwellers, although poor, are often prepared to pay for the services of the private biomedical practitioner. In some cases they have no other biomedical option, the lengthy delays encountered at the local government hospitals and clinics are costly for poorly paid unskilled labourers. The local government services, unlike the private practitioner, are not available at times convenient to working people.

Adult↗