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PubMed1996

What impact do annual public health reports have?

Each district health authority is required to produce an annual report on the health of their population. Although they consume considerable resources, there is little evidence as to their impact on their intended audiences. We describe the results of a postal survey of how these reports are viewed by health authority and local government managers in one region. Eighty-nine out of 139 responded (64%). Over half of the managers had read the reports in their entirety. Most were discussed by health authorities but few by relevant local government committees. There was some disagreement between directors of public health and other health authority managers about the impact of the reports on commissioning. The paper discusses the difficulties in evaluating the impact of annual public health reports. The survey reveals a fundamental disagreement about whether the intended audience should be health care purchasers or the public. This reflects an underlying tension about the role of public health and the debate about its independence.

Administrative Personnel↗

PubMed1999

A randomized community intervention trial to increase awareness and knowledge of the role of periconceptional folate in women of child-bearing age.

OBJECTIVES: To determine the effect of a consumer-directed information campaign to increase knowledge of folate for the prevention of neural tube defects among women of child-bearing age, and to measure women's recall of sources of information and knowledge about folate. DESIGN: A community randomized trial. SETTING: Three matched pairs of geographically distinct Local Government Areas in the state of Victoria, Australia. INTERVENTION: Printed information recommending folate intake to decrease the risk of neural tube defects was disseminated to women of child-bearing age in three of the Local Government Areas selected randomly. MAIN OUTCOME MEASURE: The proportion of women aware of the association between folate and spina bifida. RESULTS: Of 1197 women interviewed prior to the intervention, 12.4% (adjusted for the cluster and population sampling unit) were aware of folate and neural tube defects. After the intervention, there was not only a significant background increase of 3.4% (P=0.02) in folate awareness since the pre-intervention survey (n=603), but also a significant additional increase of 4.0% (P=0.04) owing to the intervention itself (n=603). Only 70% of women who were aware of folate knew the correct timing. CONCLUSIONS: The provision of printed educational material can increase folate awareness among women of child-bearing age. A comprehensive, long-term and ongoing health promotion campaign including such material, together with initiatives by relevant health service providers and the food industry, could best address the current low levels of folate awareness among women of child-bearing age.

Journal Article↗

PubMed2001

A Cost-Effective Model for Increasing Access to Mental Health Care at the Primary Care Level in Nigeria.

BACKGROUND: Although effective treatment modalities for mental health problems currently exist in Nigeria, they remain irrelevant to the 70% of Nigeria's 120 million people who have no access to modern mental health care services. The nation's Health Ministry has adopted mental health as the 9th component of Primary Health Care (PHC) but ten years later, very little has been done to put this policy into practice. Mental Health is part of the training curriculum of PHC workers, but this appears to be money down the drain. AIMS OF THE STUDY: To review the weaknesses and problems with existing mode of mental health training for PHC workers with a view to developing a cost-effective model for integration. METHODS: A review and analysis of current training methods and their impact on the provision of mental health services in PHC in a rural and an urban local government area in Nigeria were done. An analysis of tested approaches for integrating mental health into PHC was carried out and a cost-effective model for the Nigerian situation based on these approaches and the local circumstances was derived. RESULTS: Virtually no mental health services are being provided at the PHC levels in the two local government areas studied. Current training is not effective and virtually none of what was learnt appears to be used by PHC workers in the field. Two models for integrating mental health into PHC emerged from the literature. Enhancement, which refers to the training of PHC personnel to carry out mental health care independently is not effective on its own and needs to be accompanied by supervision of PHC staff. Linkage, which occurs when mental health professionals leave their hospital bases to provide mental health care in PHC settings, requires a large number of skilled staff who are unavailable in Nigeria. In view of past experiences in Nigeria and other countries, a mixed enhancement-linkage model for mental health in PHC appears to be the most cost-effective approach for these Nigerian communities. DISCUSSION: Nigeria is currently experiencing a 'double epidemic', and with high infant and maternal mortality rates, the burden of mental health problems is still invisible to policy makers. Meagre resources allocated to mental health need to be utilised maximally with cost-effective interventions. This mixed enhancement-linkage model draws on the strengths of both models, while taking into account their limitations. Concrete conclusions cannot be drawn until the model developed is fully tested. IMPLICATIONS FOR HEALTH CARE PROVISION AND USE: This model has the potential of making mental health services available, accessible and acceptable in these communities. This should reduce the burden of suffering for the mentally ill by providing treatment and restorative care, promoting mental health and preventing mental illness in the populace. IMPLICATIONS FOR HEALTH POLICY FORMULATION: The current mental health policy for Nigeria focuses on enhancement as the mode in which mental health can be successfully integrated into PHC and so far this has not been successful. Results emerging from this model can be presented to policy makers thereby supporting replication in other parts of the country. This could ultimately lead to a change in the mental health policy on training for mental health at the PHC level. IMPLICATIONS FOR FURTHER RESEARCH: Mental health services and mental health economics research are still at the stage of infancy in Nigeria. This study provides baseline information and should stimulate further research in these two vital areas.

Journal Article↗

PubMed1998

A hazard assessment of artificial tanning units.

As a result of increasing concern over the use of artificial tanning units, many local government recreation departments are phasing out the use of sunbeds on their premises, resulting in some clients switching to high street parlours about which little is known. An Environmental Health survey was conducted in all 32 tanning premises within a local government area (Perth & Kinross, Scotland). A number of significant problems emerged in the private sector. In this group, there was no form of cumulative UV exposure control in 89% of premises and 81% failed to give adequate advice and information to customers. We conducted UV spectral irradiation measurements in 38 tanning units using a double grating spectroradiometer. When a carcinogenic weighting factor was applied to these measurements, it was found that a 10 min exposure in a high intensity stand-up cabinet carried the same carcinogenic risk as approximately 30 min of local (56 degrees North) mid-day summer sunlight or 10 min of Mediterranean sunlight at mid-day. A questionnaire completed by 57 customers revealed a wide pattern of usage; 6 (10%) had more than 20 h exposure in the previous 12 months and 3 (5%) had made regular use of sunbeds for the previous 16 to 20 years. These results indicate that there is a need for continuing public education and surveillance of commercial artificial tanning units.

Beauty Culture↗

PubMed2003

Critical evaluation of the role of scientific analysis in UK local authority AQMA decision-making: method development and preliminary results.

Over the past 4 years, local government in the UK has undertaken a process of scientific review and assessment of air quality, which has culminated in a suite of designated air quality management areas (AQMAs) in over 120 of the 403 local authorities in England (including London), Scotland and Wales. Methods to identify specific pollution hot-spots have involved the use of advanced and complex air-quality dispersion modelling and monitoring techniques, and the UK government has provided guidance on both the general and technical methods for undertaking local air quality review and assessments. Approaches to implementing UK air quality policy, through the local air quality management (LAQM) process (Air Quality Strategy 2000) has not been uniform across the UK, as an inevitable consequence of non-prescriptive guidelines. This has led to a variety of outcomes with respect to how different tools and techniques have been applied, the interpretation of scientific uncertainty and the application of caution. A technique to appraise the scientific approaches undertaken by local government and to survey local government officers involved in the LAQM process have been devised, and a conceptual model proposed to identify the main influences in the process of determining AQMAs. Modelling tools used and the consideration of modelling uncertainty, error and model inputs have played a significant role in AQMA decision-making in the majority of local authorities declaring AQMAs in the UK.

Air Pollutants↗

PubMedDate not supplied

The ghost of Christmas past: health effects of poverty in London in 1896 and 1991.

OBJECTIVES: To compare the extent to which late 20th century patterns of mortality in London are predicted by contemporary patterns of poverty and by late 19th century patterns of poverty. To test the hypothesis that the pattern of mortality from causes known to be related to deprivation in early life can be better predicted by the distribution of poverty in the late 19th century than by that in the late 20th century. DESIGN: Data from Charles Booth's survey of inner London in 1896 were digitised and matched to contemporary local government wards. Ward level indices of relative poverty were derived from Booth's survey and the 1991 UK census of population. All deaths which took place within the surveyed area between 1991 and 1995 were identified and assigned to contemporary local government wards. Standardised mortality ratios for various causes of death were calculated for each ward for all ages, under age 65, and over age 65. Simple correlation and partial correlation analysis were used to estimate the contribution of the indices of poverty from 1896 and 1991 in predicting ward level mortality ratios in the early 1990s. SETTING: Inner London. RESULTS: For many causes of death in London, measures of deprivation made around 1896 and 1991 both contributed strongly to predicting the current spatial distribution. Contemporary mortality from diseases which are known to be related to deprivation in early life (stomach cancer, stroke, lung cancer) is predicted more strongly by the distribution of poverty in 1896 than that in 1991. In addition, all cause mortality among people aged over 65 was slightly more strongly related to the geography of poverty in the late 19th century than to its contemporary distribution. CONCLUSIONS: Contemporary patterns of some diseases have their roots in the past. The fundamental relation between spatial patterns of social deprivation and spatial patterns of mortality is so robust that a century of change in inner London has failed to disrupt it.

Cause of Death↗

PubMed1999

Population characteristics of markets of safety-net and non-safety-net hospitals.

RESEARCH OBJECTIVES: To compare and contrast the markets of urban safety-net (USN) hospitals with the markets of other urban hospitals. STUDY DESIGN: To develop profiles of the actual inpatient markets of hospitals, we linked 1994 patient-level information from hospital discharge abstracts from nine states with 1990 data at the ZIP code level from the US Census Bureau. Each hospital's market was characterized by its racial and ethnic composition, median household income, poverty rate, and educational attainment. Measures of hospital competition were also calculated for each hospital. The analysis compared the market profiles of USN hospitals to those of other urban hospitals. We also compared the level of hospital competition and financial status of USN and other urban hospitals. PRINCIPAL FINDINGS: The markets of USN hospitals had higher proportions of racial and ethnic minorities and non-English-speaking residents. Adults residing in markets of USN hospitals were less educated. Families living in markets of USN hospitals had lower incomes and were more likely to be living at or below the federal poverty level. USN hospitals and other urban hospitals faced similar levels of competition and had similar margins. However, USN hospitals were more dependent on Medicare disproportionate share payments and on state and local government subsidies to remain solvent. CONCLUSION: USN hospitals disproportionately serve vulnerable minority and low-income communities that otherwise face financial and cultural barriers to health care. USN hospitals are dependent on the public subsidies they receive from federal, state, and local governments. Public policies and market pressures that affect the viability of USN hospitals place the access to care by vulnerable populations at risk. Public policy that jeopardizes public subsidies places in peril the financial health of these institutions. As Medicare and Medicaid managed care grow, USN hospitals may lose these patient revenues and public subsidies based on their Medicaid and Medicare patient volumes. The loss of these funds would hinder the ability of USN hospitals to finance uncompensated care for uninsured and underinsured patients.

Demography↗

PubMed1999

Reducing coronary heart disease in the Australian Coalfields: evaluation of a 10-year community intervention.

Coronary heart disease is a leading cause of death in Australia with the Coalfields district of New South Wales having one of the country's highest rates. Identification of the Coalfields epidemic in the 1970's led to the formation of a community awareness program in the late 1980's (the healthy heart support group) followed by a more intense community action program in 1990, the Coalfields Healthy Heartbeat (CHHB). CHHB is a coalition of community members, local government officers, health workers and University researchers. We evaluate the CHHB program, examining both the nature and sustainability of heart health activities undertaken, as well as trends in risk factor levels and rates of coronary events in the Coalfields in comparison with nearby local government areas. Process data reveal difficulties mobilising the community as a whole; activities had to be selected for interested subgroups such as families of heart disease patients, school children, retired people and women concerned with family nutrition and body maintenance. Outcome data show a significantly larger reduction in case fatality for Coalfields men (although nonfatal heart attacks did not decline) while changes in risk factors levels were comparable with surrounding areas. We explain positive responses to the CHHB by schools, heart attack survivors and women interested in body maintenance in terms of the meaning these subgroups find in health promotion discourses based on their embodied experiences. When faced with a threat to one's identity, health discourse suddenly becomes meaningful along with the regimens for health improvement. General public disinterest in heart health promotion is examined in the context of historical patterns of outsiders criticising the lifestyle of miners, an orientation toward communal rather than individual responsibility for health (i.e. community 'owned' emergency services and hospitals) and anger about risks from environmental hazards imposed by industrialists.

Adult↗

PubMedDate not supplied

Historical and political overview.

There are more than 10 million local government workers in the United States. Municipal workers are exposed to a wide variety of serious chemical, biological, physical, ergonomic, and safety hazards. Decisions made by legislative bodies and policy makers historically have had a severe impact on the health and safety of local government workers. In over half of the states, city workers are not covered by safety and health programs approved by the Occupational Safety and Health Administration. They also lack universal coverage under laws providing union recognition and the right to collectively bargain over working conditions. Collective action in the workplace and the political arena remains the most important vehicle for municipal workers to secure safe working conditions.

Accidents, Occupational↗

PubMed2000

Two separate tracks? A national multivariate analysis of differences between public and private substance abuse treatment programs.

OBJECTIVE: This study describes differences between public and private substance abuse treatment programs. METHOD: Data from the National Drug and Alcoholism Treatment Unit Survey (NDATUS) were analyzed with regression models that evaluated the association between ownership and program characteristics. RESULTS: Programs operated by state and local government and nonprofit agencies had more staff, but federal and for-profit programs employed more psychologists and medical doctors. We found that, in most treatment settings, for-profit programs were smaller and more likely to specialize in providing treatment in a single setting. Methadone maintenance programs were larger when operated under for-profit ownership, however. For-profit programs received more funding from private insurance and client fees. CONCLUSIONS: We found substantial differences between public and private programs, but this division was not strictly dichotomous. Federal programs differed from public programs operated by state and local governments. Programs operated by nonprofit agencies had characteristics that placed them between private for-profit and public programs. State and local agencies are contracting with private managed behavioral health care organizations to provide sub stance abuse treatment and other mental health care. The characteristics of for-profit programs may represent the future direction of substance abuse treatment.

Humans↗

PubMed1993

Flexible benefits, choice, and work force diversity.

This Issue Brief evaluates the prevalence of flexible benefits plans and their ability to achieve cost management goals and to meet the needs of diverse employee groups. In addition, it examines flexible benefits plans' current legislative and regulatory status and typical plan design features. Sec. 125 of the Internal Revenue Code allows employers to provide employees with a choice among benefits, including moving otherwise taxable cash compensation to the pre-tax purchase of benefits, without requiring them to include the value of the noncash benefits in their adjusted gross income unless they choose taxable options. Although the percentage of full-time employees in medium and large private establishments who are eligible for cafeteria plans has not increased appreciably, the percentage of employees eligible for freestanding flexible spending accounts (FSAs) nearly tripled between 1988 and 1991. Generally, the proportion of employers sponsoring cafeteria plans or FSAs increases with employer size. Recent surveys show that 27 percent of employers with 1,000 or more employees offered choice-making plans in 1991, 48 percent of firms offered health care FSAs, and 54 percent offered dependent care FSAs, either in conjunction with cafeteria plans or as a stand-alone option. Ten percent of full-time employees in private firms employing 100 or more workers were eligible to participate in cafeteria plans in 1991. Only 5 percent of full-time employees in state and local governments and 1 percent of similar employees in small private establishments were eligible for cafeteria plans in 1990. Recent Bureau of Labor Statistics' surveys show that, among full-time employees, 27 percent in private establishments with 100 or more employees, 28 percent in state and local governments, and 6 percent in small private establishments were eligible to participate in freestanding FSAs. In 1992, 21 percent of eligible employees contributed to a health care FSA, and only 3 percent of eligible employees contributed to a dependent care FSA. Contributions to health care FSAs averaged $651, and those to dependent care FSAs averaged $2,959. National health reform could have a significant impact on these plans if the tax treatment of health benefits is changed. Taxation of health benefits in excess of a standard benefits package would fundamentally reduce the ability to use FSAs.

Community Participation↗

PubMed1994

A nationwide survey of day-care for children with mental retardation in Japan.

We conducted the first nationwide survey on day-cares (DCs) for mentally retarded preschoolers in Japan by sending a questionnaire to 686 such facilities, 460 (67.1%) of which responded. There were three types of DCs. Type I was a small facility, financed by a local government but not established by the Child Welfare Act. Type II was a non-residential facility founded by the Act and usually run by a private welfare organization. Type III was a unit in a large rehabilitation center for various handicapped persons established and run by a local government. We proposed a model DC having 9 staff members to be placed nearby consumers to improve the early treatment system for mentally retarded children in Japan.

Child↗

PubMed2001

Am I my brother's (or customer's or tenant's) keeper? Economic and ethical aspects to the California Supreme Court's struggle with the issue of landowner's standard of care.

The Supreme Court of California has ruled on several cases involving the question of to what extent a possessor of land is liable for the harm to customers or tenants occurring when a third party commits a criminal act against the customers or tenants present on the land. This paper reviews the historical development of this aspect of negligence law and analyzes the ethical and economic efficiency implications of ascribing legal responsibility for such crimes to: a) local government, b) the possessor of land, c) the customer, and d) the criminal. For example, is there an effort by the judicial system to substitute deterrence from criminal acts provided by possessors of land (i.e., specific deterrence) for the general deterrence traditionally provided through the use of police powers by local government? Analysis indicates that specific deterrence may be more effective in changing the location of criminal acts than in reducing the level of criminal activities. Also, the expense of complying with the legal responsibilities of protecting customers and clients may be especially high in high-crime, low-income areas, thus forcing commercial establishments to move or go out of business. Thus, we have a troubling tradeoff: compensating individual crime victims in a high-crime area could ultimately deprive the residents of basic economic opportunities.

California↗

PubMedDate not supplied

A review of health-based comparative risk assessments in the United States.

Comparing the risks posed by specific environmental hazards has become attractive to policy makers and legislative bodies as an aid to budgeting and other policy decisions. This paper reviews the human health-based findings from the first federal comparative risk assessment project and subsequent reviews conducted by 15 states and local government agencies in the United States. Methods are described on conducting comparative risk assessments that include substantive involvement of the public and special interest organizations. A consolidation of the comparative risk assessments of 15 states revealed good agreement with federal health-based environmental hazard priorities and partial agreement with local-government health departments. In descending order of priority, indoor air pollutants (excluding radon), criteria air pollutants, hazardous air pollutants, indoor radon, lead contamination, inactive hazardous waste sites, and drinking water at the tap are the highest ranked environmental hazards to human health.

Air Pollutants↗

PubMed2001

The increasing knowledge of the role of periconceptional folate in Victorian women of child-bearing age: follow-up of a randomised community intervention trial.

OBJECTIVES: To determine the changes since 1996 in knowledge of folate for the prevention of neural tube defects (NTDs) among women of child-bearing age and measure the residual effect of an earlier consumer-directed information campaign. DESIGN: A community, randomised trial with three matched pairs of geographically distinct local government areas in Victoria. INTERVENTION: Printed information recommending folate intake to decrease the risk of NTDs was disseminated in 1997 to women of child-bearing age. MAIN OUTCOME MEASURE: The proportion of women aware of the association between folate and spina bifida was established in 1996, 1997 and 2000 (approximately 200 respondents per local government area in each survey). RESULTS: 12.5% (adjusted for population sampling fraction) of 1,196 women interviewed in 1996, prior to the intervention, were aware of folate and NTDs. Independent surveys after the intervention in 1997 and again in 2000 showed that this had increased to 17.4% (n=1204) and 30.2% (n=1227) respectively. The intervention had a significant impact on folate awareness (a 4% difference in 1997 and a residual 3.3% in 2000, ORadj=1.24, 95% CI 1.19-1.37, p=0.007). CONCLUSIONS AND IMPLICATIONS: There has been a continuing increased awareness of folate in women of child-bearing age since 1996. Within this setting, the provision of printed educational material in a brief intervention in 1997 has caused enduring increased awareness of the association between folate and NTDs. The need for ongoing health promotion action on folate remains.

Adolescent↗

PubMed2006

State-level variations in income-related inequality in health and health achievement in the US.

The objective of this study was to examine state-level variations in income-related inequality in health and overall health achievement in the US. Data that were representative of the US and each state in 2001 were extracted from the Current Population Survey 2001. Income-related inequality in health and health achievement were measured by Health Concentration and Health Achievement Indices, respectively. Significant variations were found across states in income-related inequality in health and health achievement. In particular, states in the south and east regions, on average, experienced a higher degree of health inequality and lower health achievement. About 80% of the state-level variation in health achievement could be explained by demographics, economic structure and performance, and state and local government spending and burden. In contrast, medical care resource indicators were not found to contribute to health achievement in states. States with better health achievement were more urbanized, had lower proportions of minority groups, females and the elderly, fewer individuals below the poverty line, larger primary industry, and lower unemployment rates. Also, per capita state and local government spending, particularly the proportion spent on public health, was positively associated with better health achievement. Because of the direct implications of health level and distribution in resource allocation and social norms, states with a lower level of health achievement need to prioritize efforts in increasing and reallocating resources to diminish health inequality and to improve population health.

Financing, Government↗

PubMed2001

Subnational sources of toxicology information: state, territorial, tribal, county, municipal, and community resources online.

The rapid assimilation data and information on the Internet and the World Wide Web (WWW) is reflected in the development of these electronic services by state, county, local, and other subnational agencies, departments, offices, bureaus, and intergovernmental bodies. The content of state and territorial, tribal, county, and local government Web pages varies considerably. However, information about health and the environment are among the most frequently posted resources by subnational government bodies. This article describes the environmental health and toxicology-related data and information resources provided by government agencies and representative associations for subnational government bodies. Standard reference sources for identifying subnational government bodies are described with particular reference to those in electronic and digital formats. Means for identifying and locating electronic resources are described for appropriate subnational environmental quality, environmental (public) health agencies, occupational health and safety, toxicology-related agencies and departments, emergency response, fish consumption advisories, and cancer registries are provided. Professional organizations of state, county, municipal (local) governments and intergovernmental bodies are also described.

Environmental Health↗

PubMed1997

Hepatitis B immunisation coverage of infants born to chronic carrier mothers in Victoria.

Infants born to HBsAg- (hepatitis B surface antigen) carrier mothers are highly likely to become chronic hepatitis B (HB) carriers themselves unless their status is recognised at birth and they are immunised with three doses of HB vaccine, the first within 48 hours of birth, concurrent with hepatitis B immune globulin (HBIG). This study was designed to determine how many infants born in Victoria to carrier mothers completed three doses of HB vaccine. We sent the names of all infants of HBsAg-carrier mothers notified in Victoria between 1.7.91 and 30.6.92 to the appropriate local government immunisation providers and requested information on how many doses of HB vaccine, DTP (diphtheria-tetanus-pertussis) or CDT (combined diphtheria-tetanus), and OPV (oral polio vaccine) they had received. The HBsAg-carrier prevalence of women giving birth in Victoria in 1991-92 was at least 0.52%. Of the 336 infants notified, 239 (71.1%) were recorded in local government records. Of these 239, 90.8% received at least two doses and 80.8% received at least three doses of hepatitis B vaccine. There was no significant difference in the number who received three doses of HB vaccine compared with three doses of DTP or CDT vaccine. Of the entire cohort of 336, only 57.4% were documented as being completely immunised against hepatitis B. HB immunisation coverage for these infants needs to be improved. The high rate of loss to follow-up, especially between the maternity hospital and the community, is disturbing. Mechanisms for intensive prospective follow-up of these infants should be developed to prevent loss to follow-up and to encourage full immunisation against HB. Improving HB immunisation coverage of infants in high HBsAg-prevalence ethnic groups and introduction of universal infant HB immunisation may lead to increased coverage of infants of carriers by serving as back-up mechanisms for those lost to follow-up.

Carrier State↗