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PubMed2004

Water supply and sanitation in remote indigenous communities--priorities for health development.

OBJECTIVE: To review available national and State/Territory survey data on water supply and sanitation in remote Indigenous Australian communities and to discuss the findings in terms of priorities for health and infrastructure development. METHODS: Descriptive analysis of data on relevant variables from available data sources. RESULTS: All relevant published reports arose from only two data sources: the Community Housing and Infrastructure Needs Surveys, and from a Northern Territory-wide survey of community-owned dwellings. The data show that many communities do not have a reliable water supply and experience frequent and prolonged breakdown in sewerage systems. For example, 12% of communities of 50 people or more experienced five or more periods of water restrictions in a one-year period, and 10% of communities experienced sewage overflow or leakage 20 or more times in a one-year period. Items of basic household infrastructure regarded as essential for household hygiene are missing or not functional in many community-owned dwellings. For example, in about one-third of houses bathroom taps and toilet drainage required major repairs. CONCLUSION AND IMPLICATIONS: Given the widely accepted importance of water and sanitation to health, the data support the contention that poor environmental conditions are a major cause of poor health in remote communities and provide some measure at a national level of the magnitude of the problem. Action to ensure easy access to adequate quantities of water and secure sanitation should receive greater priority. There is need for better quality information systems to monitor progress, equity and accountability in the delivery of water and sanitation services.

Australia↗
PubMed2003

Justice and solidarity in priority setting in health care.

During the last decade a "technical" approach has become increasingly influential in health care priority setting. The various country reports illustrate, however; that non-technical considerations cannot be avoided. As they often remain implicit in health care package decisions, this paper aims to make these normative judgements an explicit part of the procedure. More specifically, it aims to integrate different models of distributive justice as well as the principle of solidarity in four different phases of a decision-making procedure, and to identify important moral choices which present themselves. First four important justice models are discussed, then a justification is given for their inclusion in a four-step decision making procedure. This is followed by a discussion of different justice and solidarity problems--with their inherent conceptual difficulties in each of these stages. The paper concludes with a summary of the major moral choices that are to be made in health care package decisions.

Decision Making, Organizational↗
PubMed1993

[Health care priorities].

This article describes the STAKES (National Research and Development Centre for Welfare and Health) Priorisation Project which started at the beginning of 1993. The project surveys ethical problems related to welfare and health care resource allocation. It searches for principles which could be applied in setting priorities whether they are aimed at service systems or individuals. A public debate has been instigated on choices, their justification and values which influence them. A conflict arises when medical advances have improved treatment possibilities and the needs have increased, but health care resources have remained on the same level or diminished. The role of nursing is to safeguard the rights of the patients. Now it is more important than ever to base nursing practice on ethical principles.

Consumer Advocacy↗
PubMed2003

National occupational health research priorities, agenda and strategy of Japan: invited report in NORA symposium 2001, USA.

An invited report on national occupational health research priorities, agenda and strategy of Japan was delivered in the NORA (National Occupational Research Agenda) Symposium 2001, USA. The third NORA Symposium was held by the US National Institute for Occupational Safety and Health (NIOSH) in Washington DC on June 27, 2001. The national conference in Japan entitled "Conference on Occupational Health Research Strategies in the 21st Century" was organized by the Japanese Ministry of Labour (Currently, Ministry of Health, Labour and Welfare) in the years 1998-2001, and the national occupational health research agenda and strategy for the next decade in Japan was identified. A total of 50 Conference members, i.e., representatives from various fields of occupational health in Japan, ranked 58 comprehensive research topics, yielding short-term (5-year) and long-term (6-10 year) priority research topics. Overall (10-year) priority research topics were calculated by combining the short-term and long-term priority scores. Together with the ranking by 145 extramural occupational health specialists, it was identified that work stress (i.e., one of the 58 research topics) was the first overall priority research topic for the next 10 years in Japan. Three other topics, i.e., elderly workers, women workers and maternity protection, and mental health and quality of work and life, were the second group of priority topics; and hazard and risk assessment and biological effect index were the third priority group. Based on the scores for the short-term and long-term priority research topics, all 58 research topics were classified into three key research areas with 18 key research issues (National Occupational Health Research Agenda, NOHRA). Finally, eight implementation measures of national strategy for the Japanese Government to promote occupational health research were introduced.

Aged↗
PubMed1991

Setting health care priorities in Oregon. Cost-effectiveness meets the rule of rescue.

The Oregon Health Services Commission recently completed work on its principal charge: creation of a prioritized list of health care services, ranging from the most important to the least important. Oregon's draft priority list was criticized because it seemed to favor minor treatments over lifesaving ones. This reaction reflects a fundamental and irreconcilable conflict between cost-effectiveness analysis and the powerful human proclivity to rescue endangered life: the "Rule of Rescue." Oregon's final priority list was generated without reference to costs and is, therefore, more intuitively sensible than the initial list. However, the utility of the final list is limited by its lack of specificity with regard to conditions and treatments. An alternative approach for setting health care priorities would circumvent the Rule of Rescue by carefully defining necessary indications for treatment. Such an approach might be applied to Oregon's final list in order to achieve better specificity.

Cost-Benefit Analysis↗
PubMed1995

Consulting the public about health service priorities.

Consulting the public is an important component of commissioning health services. Somerset Health Authority has devised a method of consultation using eight focus groups meeting three times a year. Each group consists of 12 people, and together the groups are demographically representative of Somerset's population. The groups are asked about issues that are concerning the health authority, and their views have influenced health authority decisions. Each group is given some background information before the meeting, together with more information at the meeting. The discussions are tape recorded and analysed for qualitative information, but the groups are also asked to score certain priorities. The groups have been found to be representative, valid, and focused on community rather than individual values. Health authorities wanting to know the values people attach to health services should adopt this qualitative approach to consultation.

Adolescent↗
PubMed1976

The development of priorities for health services research. The National Center, 1974-76.

The priorities published by the National Center for Health Services Research/DHEW in 1975 were the result of more than a year of consultation between federal officials and members of the research community. The process of priority development emerged from an interpretation of the history of the National Center, of health services research as an activity, and of the previous experience of various research agencies. This paper is a combined memoir and intellectual history of the priority development process in the National Center by a participant who, because of his position, was somewhat detached from events.

Health Services↗
PubMedDate not supplied

[Women's health and the cooperation of Canadian voluntary medical relief workers in Afghanistan].

Canadians are increasingly being asked to become involved in international health research and intervention projects. Recently, Quebec clinicians were asked to support a project to build and run a tertiary and highly-specialized hospital for women and children, in Kabul, the capital of Afghanistan. The goal of this paper was to analyze the challenges raised by participation in such a project. The major lesson learned was the need to resist the temptation to provide aid when it involves an attractive but ineffective intervention. The current public health priority in Afghanistan is to provide as much of the population as possible with access to a nearby health centre, for primary health care and safe deliveries. When analyzing the implications of Canadian clinicians' commitment to this project, we considered three major public health challenges: public health priorities, hospital care organization and health care financing. The results indicated that, given the current Afghani context, this project was neither relevant nor appropriate and had undesirable repercussions on the population and the health care system.

Afghanistan↗
PubMed1998

Tensions in setting health care priorities for South Africa's children.

The new South African constitution commits the government to guarantee "basic health services" for every child under 18. Primary health care for pregnant women and children under six and elements of essential primary health care have received priority. At present, there is little analysis of the moral considerations involved in making choices about more advanced or costly health care which may, arguably, also be "basic". This paper illustrates some of the tensions in setting priorities for a just macro-allocation of children's health care, given the realities of need and scarce resources, and the commitment to equality of basic opportunities.

Adult↗
PubMedDate not supplied

Aiding priority setting in health care: is there a role for the contingent valuation method?

The paper discusses some methodological and measurement aspects with the contingent valuation (CV) method which appear to create problems when eliciting preferences for the relative social valuation of alternative health care programmes. After pointing to biases which tend to exaggerate the true valuations, emphasis is placed on framing issues when applied to health care. Thereafter the paper discusses the extent to which preferences elicited through one's willingness to pay can be used to infer how the respondent would prioritize between the health care programmes in question. New empirical evidence is presented which suggest discrepancies between a CV ranking and the ranking expressed when making a direct ordinal comparison.

Bias↗