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Improving urban health.

New York's public health priorities initiative, Communities Working Together for a Healthier New York, creates a framework for communities, including urban areas, to identify and address their most pressing public health problems. It is both a call to action and a guide for the state's communities. The priorities identified in this initiative were the product of extensive public input across the state. Interestingly, the priorities identified by rural counties were consistent with those identified in the New York City workshop. To a great extent, urban and rural dwellers have the same health problems, such as teenage pregnancy, substance abuse, and tobacco use, although to different degrees. Accordingly, we need to recognize that we are a global society, in which the line separating urban and rural has thinned, if not disappeared. Improving health status in our communities, whether urban or rural, requires broad-based collaboration. It requires setting special interests aside and focusing on the good of the whole community. It requires sharing resources and expertise, as was done in the asthma study. By developing a shared vision of what our health priorities are, by forming partnerships in our communities to address them, and by employing the use of effective and innovative interventions, we will improve health status in our communities.

Adolescent↗

Urban health policy.

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Financing, Government↗

The missing voice: impacts of health system change on low-income communities.

Unique problems in obtaining adequate health care face poor urban communities. These include the rising number of uninsured, abuses in the managed-care system, the unwillingness of private providers to deliver health care for either Medicaid recipients or the uninsured, and an insufficient supply of primary care physicians in minority neighborhoods. If the managed-care system is to bring decent health care to poor urban communities, it must avoid the mistakes of the past. The health care system must be community based, oriented toward primary care, sufficiently funded, and universally accessible. There needs to be better coordination between medical schools and community health requirements and better support for public health facilities. Without adequate health care for the poor, urban living will eventually become more onerous for all.

Forecasting↗

[Using the synergies between strategic environmental evaluation and HIA to advance the integration of environmental and health issues in public decision-making processes].

The Geneva rule was the first one in Switzerland to introduce the concept of Strategic Environmental Assessment (SEA). This assessment constitutes a decision making aid which describes the process set up to allow evaluation of potential environmental impact and comparison of possible variants, recommends the choice for the best option and suggests the precautions to take. It presents much resemblances to HIA. In this case therefore the application of SEA in the urban planning project MICA has been presented. It is in this framework that a first experience of integration HIA to the SEA process was realized. In an additional way to SEA, HIA is focused on the following fields of potential impact: transport and movements, housing, public facilities, water management.

City Planning↗

Health Impact Assessment: how the Canton of Ticino makes health a common issue.

HIA is based on the theory of health determinants, which recognizes that well-being is determined by a wide range of economic, social and environmental factors, by heredity and medical intervention. The intended HIA procedure represents a new approach to the evaluation of all cantonal policies in order to assess their potential health impacts and to improve the quality of governmental decisions, through recommendations to enhance predicted positive health impacts and minimize negative ones.

Environment↗

A programme for Health Impact Assessment in Brighton and Hove.

HIA is based on the theory of health determinants, which recognizes that well-being is determined by a wide range of economic, social and environmental factors, by heredity and medical intervention. The intended HIA procedure represents a new approach to the evaluation of all local authority policies in order to assess their potential health impacts and to improve the quality of governmental decisions, through recommendations to enhance predicted positive health impacts and minimize negative ones.

Decision Support Techniques↗

Maximum waiting-time guarantee--an attempt to reduce waiting lists in Sweden.

In Sweden, as in most countries with publicly financed health services, long waiting lists for some surgical procedures have been a serious quality problem on the health policy agenda. To reduce waiting lists, the Swedish Government and the Federation of County Council agreed on an initiative to offer a maximum waiting-time guarantee for 12 procedures during 1992. Patients awaiting procedures are guaranteed a waiting time no longer than 3 months from the physician's decision to treat/operate. The initial agreement was to be in force for 1 year, and a grant of 500 million SEK (USD 70 million) was appropriated for the initiative. The guarantee has been prolonged by annual decisions to be in force 1993 through 1995. However, no extra resources were set aside for these years. This article describes the background and the introduction of the guarantee. and discusses some of the major results during the first 2 years. Generally, waiting lists decreased substantially during 1991 and 1992. By the end of 1992 only a few departments were unable to serve patients within 3 months. During 1993 the reduction in the waiting lists ceased, and waiting lists for some procedures showed a tendency to increase by the end of the year. The overall successful result, in terms of waiting lists and waiting times, seems to have been achieved mainly by increased production, improved administration of the waiting lists, and a change in attitudes toward waiting lists. The expectation that the guarantee would lead to a more even use of resources across the country has not been realised since it appears that hospital departments chose to expand their own activities rather than use the new opportunity offered by the guarantee to refer patients to other hospitals.

Coronary Angiography↗

Primary health care and health education in Japan.

In this paper, the substance of the Alma Ata Declaration on Primary Health Care is discussed. Minimum requirements and working goals of Primary Health Care are reviewed. The health status of the Japanese people, and the medical and health delivery systems in Japan are considered, with reference to the Alma Ata Declaration. While the Alma Ata Declaration sets forth the goal of health for all by the year 2000, there is doubt as to whether, even in the developed countries, we will reach this goal. Health indices have improved considerably, but problems of delivery of medical care and health care still remain. Major problems discussed here are the regional disparity in availability of medical manpower and facilities, and the consequent disparity in health indices; sky-rocketing medical costs; the changing needs of Japan's aging population; and socialized medical care, and the lack of integration of insurance schemes. The most significant problem in delivery of Primary Medical Care in Japan is the lack of integration of health and medical services. This is discussed at length. In addition, the importance of health education to community health planning in Primary Health Care is discussed.

Delivery of Health Care↗

What is participatory research?

Research strategies which emphasize participation are increasingly used in health research. Breaking the linear mould of conventional research, participatory research focuses on a process of sequential reflection and action, carried out with and by local people rather than on them. Local knowledge and perspectives are not only acknowledged but form the basis for research and planning. Many of the methods used in participatory research are drawn from mainstream disciplines and conventional research itself involves varying degrees of participation. The key difference between participatory and conventional methodologies lies in the location of power in the research process. We review some of the participatory methodologies which are currently being popularized in health research, focusing on the issue of control over the research process. Participatory research raises personal, professional and political challenges which go beyond the bounds of the production of information. Problematizing "participation', we explore the challenges and dilemmas of participatory practice.

Community Participation↗

Translating effective clinic-based physical activity interventions into practice.

An increasing number of studies report on the efficacy of physical activity interventions conducted in, or in conjunction with, clinical settings. This article reviews the status of the literature with regard to translation to practice and describes methods that will heighten the likelihood of translation. In general, few physical activity programs have been designed for translation, and the diffusion models underlying most reported programs have relied on an assumption of linear diffusion into practice. However, recent developments are encouraging and examples are provided of programs that utilize relationship or systems approaches to translation.

Cooperative Behavior↗

Development of a state medical surge plan, part I: the procedures, process, and lessons learned or confirmed.

In 2003, the Utah Department of Health received funding from the Health Resources and Services Administration to develop a medical surge plan. The plan was designed to increase the number of available hospital beds in the state by 1250 beds, including 125 beds for patients with burns or trauma patients. Interested parties were contacted and a coordinating group composed of Utah Department of Health and University of Utah Health Sciences Center representatives was formed, who were responsible for developing the plan. This article is Part I of a 2-part series that discusses the planning process and identification of a group of stakeholders who served as a planning task force, and concludes with a summary of lessons learned or confirmed during the planning process. Part II will discuss the content of the medical surge plan.

Advisory Committees↗