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PubMed2002

Life course health development: an integrated framework for developing health, policy, and research.

The life course health development (LCHD) framework organizes research from several fields into a conceptual approach explaining how individual and population health develops and how developmental trajectories are determined by interactions between biological and environmental factors during the lifetime. This approach thus provides a construct for interpreting how people's experiences in the early years of life influence later health conditions and functional status. By focusing on the relationship between experiences and the biology of development, the LCHD framework offers a better understanding of how diseases occur. By suggesting new strategies for health measurement, service delivery, and research, as well as for improving health outcomes, this framework also supports health care-purchasing strategies to develop health throughout life and to build human health capital.

Guidelines as Topic↗
PubMed1997

Policy research for disease prevention: challenges and practical recommendations.

Policy approaches to health promotion and disease prevention hold great potential, as several community-based projects have illustrated. Policy interventions, despite their wide-spread use, frequently lack a systematic framework for implementation and evaluation. The authors propose a four-stage framework for the formation and evaluation of public health policy. The stages are identification of health risks and preventive options; intervention development; policy development; and policy enactment and assurance. A strong focus on evaluation is included within the framework. In addition, a series of practical implications and recommendations are given under the broad headings of evaluation issues and linkages. It is hoped that the issues described will lead to more systematic implementation and evaluation of public health policy measures.

Health Policy↗
PubMed2002

Pain management, controlled substances, and state medical board policy: a decade of change.

Physicians' concerns about regulatory scrutiny and the possibility of unwarranted investigation by regulatory agencies negatively affect their prescribing of opioid analgesics to treat pain. Indeed, some state medical boards have rejected prescribing practices that are considered acceptable by today's standards. This article describes a ten-year program of research, education, and policy development implemented by the Pain & Policy Studies Group aimed at updating and clarifying state medical board policies on the use of opioid analgesics to treat pain, including cancer and chronic noncancer pain. Following surveys of medical board members and educational workshops, state medical board policies began an initial period of change, drawing on guidelines from other states, particularly in California. The next phase of policy development was marked by the introduction of Model Guidelines by the Federation of State Medical Boards of the U.S. The Model Guidelines address professional standards for the appropriate prescribing of opioid analgesics for pain management, as well as physicians' fears of regulatory scrutiny. Although most state medical boards have adopted regulations, guidelines, or policy statements relating to controlled substances and pain management, to date ten boards have adopted the Model Guidelines, while ten more have adopted the Model Guidelines in part. Further actions are recommended so that state medical boards can address inadequate pain management and physician concerns about regulatory scrutiny.

Analgesics, Opioid↗
PubMed2006

A review of major influences on current public health policy in developed countries in the second half of the 20th century.

Public health policy underwent substantial transformation during the latter half of the 20th century. The landmark statement was the 1948 World Health Organization (WHO) constitution, which identified good health as a fundamental right and gave the responsibility to governments to achieve it for all their people. However, following World War II, developed countries made substantial investment in health care with less attention paid to public health. The importance of public health was slowly recognised over the period from 1970 to 2000 with the publication of several reports from different organisations. The first authoritative policy statement that the important determinants of health lay outside health care was in the Lalonde Report from Canada. These ideas were subsequently expressed in the WHO Alma-Ata declaration and were emphasised a year later by the US Surgeon General. The idea of setting goals for health improvement also began in the 1970s. The Lalonde Report and the United Kingdom Black Report recommended that targets be used, but the first explicitly stated health targets were set by the US in 1979. WHO also identified the need for such targets at this time, but did not introduce them until 1984. Since then health targets have become a central feature of public health policy in developed countries. The Ottawa Conference on Health Promotion in 1986 championed the view that health promotion was central to achieving health goals internationally. It helped clarify the types of actions needed: that individuals need to be provided with the supportive environment and economic resources to be able to lead healthy lives. In a further development, the Healthy Cities Project was launched with the specific aim of involving political decision-makers in building a strong lobby for public health at the local level. The Healthy Cities Project illustrates how to provide means and opportunity for interventions to be implemented in communities. Concerns with inequalities in health were emphasised in the WHO declaration of Alma-Ata, and were the focus of the United Kingdom Black Report. The Jakarta Conference on Health Promotion in 1997 urged international action on poverty, as it is the major threat to health. International acceptance of the need to tackle inequalities took longer than the acceptance of health targets, but it is now an important feature of public health policy. The advent of the 21st century marked the coming of age of public health. The renewed version of 'Health for All', 'Health for All in the 21st Century', emphasised the one constant goal of WHO that all individuals should achieve their full health potential. Public health is now regarded internationally as being a priority with this WHO goal being adopted as the overarching goal of policy. The challenges it faces in tackling problems such as obesity, inequalities in health, smoking, alcohol and substance abuse are great and will require policies which tackle the economic, social and environmental determinants of health.

Developed Countries↗
PubMed2000

Ecological antibiotic policy.

Development of resistance to antibiotics is a major problem worldwide. The normal oropharyngeal flora, the intestinal flora and the skin flora play important roles in this development. Within a few days after the onset of antibiotic therapy, resistant Escherichia coli, Haemophilus influenzae and Staphylococcus epidermidis can be detected in the normal flora of volunteers or patients. Horizontal spread of the resistance genes to other species, e.g. SALMONELLA: spp., Staphylococcus aureus and Streptococcus pneumoniae, occurs by conjugation or transformation. An ecologically sound antibiotic policy favours the use of antibiotics with little or no impact on the normal flora. Prodrug antibiotics which are not active against the bacteria in the mouth and the intestine (before absorption) and which are not excreted to a significant degree via the intestine, saliva or skin are therefore preferred. Prodrugs such as pivampicillin, bacampicillin, pivmecillinam and cefuroxime axetil are favourable from an ecological point of view. Experience from Scandinavia supports this, since resistance to mecillinam after 20 years of use is low (about 5%) and stable.

Journal Article↗
PubMed2000

Ecological antibiotic policy.

Development of resistance to antibiotics is a major problem worldwide. The normal oropharyngeal flora, the intestinal flora and the skin flora play important roles in this development. Within a few days after the onset of antibiotic therapy, resistant Escherichia coli, Haemophilus influenzae and Staphylococcus epidermidis can be detected in the normal flora of volunteers or patients. Horizontal spread of the resistance genes to other species, e.g. Salmonella spp., Staphylococcus aureus and Streptococcus pneumoniae, occurs by conjugation or transformation. An ecologically sound antibiotic policy favours the use of antibiotics with little or no impact on the normal flora. Prodrug antibiotics which are not active against the bacteria in the mouth and the intestine (before absorption) and which are not excreted to a significant degree via the intestine, saliva or skin are therefore preferred. Prodrugs such as pivampicillin, bacampicillin, pivmecillinam and cefuroxime axetil are favourable from an ecological point of view. Experience from Scandinavia supports this, since resistance to mecillinam after 20 years of use is low (about 5%) and stable.

Animals↗
PubMed1995

Genetic information and life insurance: a proposal for an ethical European policy.

Developments in molecular biology will enable development of tests for genetic predisposition to multifactorial diseases. People identified with increased risk might be able to prevent or delay the onset of illness by medical treatment and/or changing their environmental exposure. But tests might also help organizations, such as employers, insurers, and government bodies, to minimize their future economic risks. This article searches for an ethical and feasible European policy for the use of genetic information in life insurance. It first argues that genetic information is not so relevantly different from at least one other kind of medical information, that of HIV infection, that it justifies unlike policy treatment. European life insurance is then claimed to be a non-primary social good which should be handled by the private market. The problem of adverse selection is argued to be a reasonably serious threat. Insurers should therefore be allowed to demand some genetic risk information in order to secure the sustainability of insurance schemes. However, the moral principles and values of autonomy, privacy, non-discrimination, non-deterrence, solidarity and confidentiality, put limits on insurers justified information demands. The article ends up advocating a regime of limited community-rated private life insurance, first proposed by a Dutch committee. It stipulates that insurers should be forbidden to demand genetic tests as a condition for an insurance contract, but be allowed to ask for existing genetic information when the sought insurance cover is above a certain limit.

Confidentiality↗
PubMed2006

The impact of context on evidence utilization: a framework for expert groups developing health policy recommendations.

Should the same evidence lead to the same decision outcomes in different decision-making contexts? In order to improve comprehension of this issue, this study considers how context influences evidence utilization in the development of health policy recommendations. We used an embedded multiple case study design to study how four expert groups formulated policy recommendations for breast, cervical, colorectal, and prostate cancer screening in Ontario, Canada. We interviewed expert group members and analysed meeting agendas/minutes, interim/final reports and other case-related documents. Our analyses revealed varying policy objectives; the use, neglect, or overextended consideration of three key decision support tools; the varying skills/abilities of expert group members in using different decision support tools; the varying impact of effect modifiers, resource constraints and political interests; and the differing development/consideration of context-specific evidence to address uncertainty in the external decision-making context. While more work is needed to determine if these findings are generalizable beyond cancer screening policy, we believe the central challenge for evidence-based policy is not to develop international evidence, but rather to develop more systematic, rigorous, and global methods for identifying, interpreting, and applying evidence in different decision-making contexts. Our analyses suggest that identification of evidence must distinguish between different policy objectives in order to link a broad conceptualization of evidence to appropriate policy questions. Interpretation of evidence must acknowledge the varying nature of evidence for different policy objectives, balancing existing emphasis on evidentiary quality with more sophisticated methods for assessing the generalizability of evidence. The application of evidence must also acknowledge different policy objectives, appropriately employing rule-based grading schemes and agreement-based consensus methods that are sensitive to the nature of the evidence and contexts involved.

Breast Neoplasms↗
PubMedDate not supplied

Medicare's coverage of colorectal cancer drugs: a case study in evidence development and policy.

Payers point to the lack of unbiased evidence for making coverage decisions for new and often costly technologies. This paper provides a case study of a new approach to developing information to meet the needs of a payer: Medicare's coverage with evidence development (CED) policy. Medicare's decision to condition coverage of cancer therapies on clinical trial participation is an early application of CED and signals Medicare's interest in developing evidence on new technologies for beneficiaries. This paper reviews the rationale and challenges Medicare faces in applying its CED policy and discusses the implications of payers' using and generating evidence.

Antineoplastic Agents↗
PubMed2002

Clinic closure brings power to a community. Lessons learned to inform health policy.

Development of a community clinic as a campus/community partnership served as a model for community empowerment in a unique demonstration project in a rural state. The purpose was to provide primary health care and illustrate the impact of expert faculty practice with extremely vulnerable populations. Advanced practice students in a variety of disciplines participated with faculty in health care delivery in an underserved area.

Community Health Centers↗
PubMed2003

Impact of nutrition behaviour research on nutrition programmes and nutrition policy.

Development of a society is interrelated with research. Innovation in food and nutritional sciences enable citizens to live in conditions of food security. Current dietary goals can be reached by understanding the biopsychosocial background of human nutrition behaviour. Examples of diffusion of such findings into practice are presented with emphasis on Germany and the activities of AGEV (the Working Association of Nutritional Behaviour), which was founded 25 years ago. Nutrition behaviour research should strengthen the focus on practical applications of its findings, since the prevalence of nutrition-related problems, like obesity in children and the estrangement on food and nutrition, is increasing.

Food Preferences↗
PubMed2001

[The fight against bacteria: the antibiotics policy].

Development of bacterial resistance towards antibiotics is no longer a local phenomenon. It has by now become a European and global problem, as a result of unjustified and unprofessional administration of antibiotics in gratuitously high quantities, not only in the medicinal practice, but also in the agriculture. The resistant bacteria may spread from animals to humans, transmitted by the food-chain. A recent danger includes the appearance of the vancomycin-resistant strains (VRSA) besides the methycillin-resistant Staphylococcus aureus (MRSA) infections. The number of the vancomycin-resistant Enterococci (VRE) is also expected to grow in the future. The present paper reports the results of the international activities in the past decades, which is related to the fight against resistant bacteria. Such research involves the production of synthetic compounds, the development of semi-synthetic beta-lactam-, aminocyclitol-, macrolide-, and glycopeptide antibiotics, as well as the introduction of new enzyme-inhibitory substances. Elaboration of basic principles of the rational application of antimicrobial agents is an increasingly urgent need along with the establishment of national and European data bases in which the supply and consumption of related medicines are registered and kept under control.

Amikacin↗