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PubMed2000

[Is there agreement on the determination of public health priorities in Europe?].

Inspired by the WHO document, "Health for All in the Year 2000", and by the WHO European office's definition of 38 health objectives, several European countries have begun defining their health priorities. An analysis of the definition of these priorities shows that there exist common points among them. However, each country constructed its own process for decision making that was unique to its situation and implemented different strategies for engaging its citizens in their processes.

Decision Making, Organizational↗
PubMedDate not supplied

Americans' health priorities: curing cancer and controlling costs.

In this paper we provide a comprehensive examination of Americans' priorities within both health and health care. We find that Americans do have a clear set of priorities in each of these areas. Americans rated cancer, human immunodeficiency virus (HIV)/acquired immunodeficiency syndrome (AIDS), and heart disease, and medical research to address these conditions, as top priorities among eighty health problems. However, they did not rank many leading causes of death very high as serious problems. On the issue of health care, problems of costs, prescription drugs, and the uninsured top the list. Americans are very concerned about emerging international infectious diseases that they believe threaten their health.

Attitude to Health↗
PubMed2001

Women living long, living well: community driven women's health priorities.

The Office on Women's Health of the Department of Health and Human Services led an effort to seek feedback on women's health issues. The response showed that women in communities nationwide focused less on individual organ-specific health issues than on broader strategies they thought were critical to improving and sustaining women's health programs. This article summarizes the result of those discussions as expressed in the "Women Living Long, Living Well" framework.

Community-Institutional Relations↗
PubMedDate not supplied

Containing the spread of HIV infection: a world health priority.

The World Health Organization (WHO) estimates that the world total of AIDS cases will reach 300,000 by the end of 1988 and 500,000 to 3 million over the next 5 years. AIDS is of special concern to developing countries with their limited, stressed health care systems and the other serious health problems of their populations. Also, AIDS usually strikes the young and productive adults that the economies of these countries can least afford to lose. The Surgeon General of the Public Health Service has challenged the United Nations to make the world's blood supply safe by 1991. Private and public sector leaders could come together, apply the technology and resources available in industrialized countries, and achieve a victory in this facet of the AIDS pandemic. The WHO's global strategy has led to the establishment of national AIDS committees in 151 countries and the preparation of 70 short-term (6-12 months) plans and 25 medium-term (3-5 years) plans for national AIDS control programs.

Acquired Immunodeficiency Syndrome↗
PubMed2000

Setting health priorities in a Swiss canton: what do different methods tell us?

STUDY OBJECTIVE: Despite excellent mortality indicators, there is clear evidence that the health status of the population of Geneva could be improved if more attention and resources were devoted to prevention strategies. To identify a set of robust health priorities an original approach was used triangulating results between three methods. METHODS: The study calculated potential years of life lost, disability adjusted years of life lost, and conducted a Delphi survey to gather the opinion of health professionals and the general public. MAIN RESULTS: Several health conditions were unanimously selected by all three methods as top priorities: cardiovascular diseases, AIDS, respiratory cancer, breast cancer for women, suicide and traffic accidents. In addition, two determinants-alcohol abuse and tobacco abuse-for which a clear conceptual link could be established between all methods were chosen. Connections between priorities identified through the DALY and the Delphi method lead to further inclusion of chronic back pain and depression. Some issues solely identified through the Delphi survey were included as they were consistently considered important by professionals and the lay public alike-violence in the family, unemployment, social exclusion. CONCLUSIONS: These results indicate that health priorities, and by extension health care priorities, would benefit from using a mix of quantitative and qualitative research methods. The triangulation of results allows for a broader perspective and makes results more acceptable.

Attitude↗
PubMed1994

Violent oppression: implications for mental health priorities in South Africa.

This study explores the complex nature of mental health challenges and priorities in a post-apartheid South Africa. Special reference is made to indigenous people's experiences of poverty, racism, sexism and the machinery of political repression as critical bases for determining the priorities in mental health services. Whilst the provision of mental health services for all is sought by mental health professionals and legal systems in Western countries and other African states, South Africa has not developed a coherent sociolegal policy which aims at preventing, alleviating and healing mental health problems for all its citizens. Research gathered through a phenomenological approach amongst the oppressed seeks to define the terrain of people's psychological problems. Although data used are deduced mainly from the 'oppressed' on one white owned farm, questions raised and conclusions drawn address national as opposed to regional solutions, and also facilitate thinking about mental health priorities for all South Africans living under similar conditions. Commonly experienced problems are the effects of organized violence, child and adolescent problems, the prevalence of alcohol and drug use, depression, lack of facilities for the disabled and psychological care for homeless children, families and the youth. Participants were ignorant about mental health services, they experienced them as inaccessible and they were generally suspicious of an lacked faith in mental health workers. The author proposes broad future mental health options, like the restoration of family life in oppressed communities, the training of lay counsellors and the introduction of community mental health programmes. A suggestion is made that health workers in community mental health centres should adopt an advocacy position against all forms of unfair practices and violence and lobby for the protection of human rights.

Adolescent↗
PubMed2000

When providers and community leaders define health priorities: the results of a Delphi survey in the canton of Geneva.

The Delphi method was used to determine the health priorities in one Swiss canton. The opinion of various groups concerned, either as health professionals or as representatives of the general population, was gathered to identify the health determinants and health problems perceived as most important, to clarify the reasons for these choices, and to recommend interventions to be undertaken in order to improve the situation in the identified priority areas. Five panels, including health professionals as well as selected leaders of community groups with no direct involvement in health, were given the opportunity to reply to two rounds of questionnaires. There was a high convergence of opinion on health determinants and problems to be given priority between panels and between the first and second round. Priorities identified are mainly physical problems (cardiovascular disease, respiratory and breast cancer, AIDS, injuries due to road accidents, chronic back pain), psychosocial disorders (depression, suicide, violence in the family, stress), and problems of substance abuse (alcohol and tobacco). Unemployment and social isolation were chosen because of their perceived impact on health. Very few interventions were proposed in the medical technical or research areas. This may be due partly to the fact that good quality care is widely available and accessible in Geneva, whereas preventive programmes have not received enough attention in the past. Through the identified priorities and the proposed activities, a new vision of health emerges which gives more importance to psychosocial problems and the social environment. In this context, health promotion is seen as essential, acknowledging that sustained change in individual behaviours can only occur if the social and cultural context is taken into consideration. In conclusion, the results of this survey show that the Delphi method is a useful tool to reach consensus on health priorities and corresponding activities among a variety of actors.

Delphi Technique↗
PubMed2002

Whose priorities count? Comparison of community-identified health problems and Burden-of-Disease-assessed health priorities in a district in Uganda.

OBJECTIVES: The aim of the study was to compare health problems as defined quantitatively by the Burden of Disease study to those defined by the community. The secondary aim was to explore the potential for using qualitative participatory methodologies as tools for planing and priority setting. DESIGN: Interviews and group discussions with a purposely sampled set of community members (n = 51) and community leaders(n = 6). The Nominal group technique, as well as in-depth interviews, were used to identify major health problems - as perceived by the community. Epidemiological data on the major health problems were derived from the national Burden of Disease study. RESULTS: Community perceived health problems were similar to those identified by the burden of disease study. Reasons given for the ranking included prevalence, fatality, social and cultural stigma. Social stigma and cultural values were not considered in the burden of disease studies. However, socially stigmatized diseases were considered to be more serious compared to non-stigmatised conditions, in spite of their low prevalence. Poverty and lack of knowledge were the perceived major causes of ill-health in the community. CONCLUSIONS: Qualitative approaches like the nominal group technique may be useful in eliciting community values that could supplement quantitative information like that elicited by the Burden of Disease study. Such a mixed approach would capture both epidemiologicaly assessed and community felt needs in the priority setting process.

Adolescent↗
PubMed2004

Health sector policy in the first decade of Nepal's multiparty democracy. Does clear enunciation of health priorities matter?

Nepal experienced a significant political regime shift in 1990 from the partyless Panchyat system to the present multiparty form of democracy. While political instability existed in the decade of the 1990s, reflected in the approximately one government per year, there had been continued enunciation of health policy priorities toward the rural sector, as reflected in the Nepal National Health Policy, 1991 (NHP (1991)) and subsequent plans. The objective of the paper is to assess whether clear enunciation of health priorities have translated into beneficial health outcomes, reflected in reduction of the child death rate, child morality rate, infant mortality rate and increase in the life expectancy rate. This question is assessed empirically over the 10-year period of fiscal year 1989/1990 to 1999/2000 using mainly secondary data published by His Majesty's Government of Nepal (HMG/N), through the perspectives of input-output model and extension of health services, along with an indicative regression of a Nepalese health production function. The results (i.e. empirical observations) suggest that while there have been clear enunciation of health priorities, there have not been significant positive effects on health sector outcomes. The paper ends with a number of recommendations and concludes with the necessity for effective and appropriate implementation.

Adult↗
PubMed2006

Setting health priorities across nations: more convergence than divergence?

Recently, various theories of convergence of health care systems have been presented. This review of several dimensions of health priority setting in nine countries sheds light on the interrelationship between convergence and embeddedness. It reconfirms that within a co-existence of convergence and divergence, there are clusters of convergence, primarily at the ideational and social value levels. However, our findings suggest that the variation across different substantive levels is less clear cut than suggested by others. Moreover, the variation between different procedural aspects of convergence appears more significant. Certain ideas involving the need for rationing, the role of market mechanisms, and cost containment have gained recognition by health policy makers across countries, but this has not guaranteed their adoption. Our analysis demonstrates that despite these signs of a convergence at the conceptual level, policy content and the preferred policy instruments for implementing such policy continue to vary widely across these countries.

Developed Countries↗
PubMed2004

[Maltreated gypsy children: social and health risk factors and high-priority health care needs].

OBJECTIVES: To determine the prevalence of maltreated gypsy children admitted to centers of protection, as well as their demographic characteristics, type of maltreatment, frequency of associated social and health risk factors, frequent health problems and whether there are differences between these children and the general population of maltreated children. PATIENTS AND METHODS: We performed a retrospective cross-sectional cohort study over an 8-year period (1995-2002). The social and health reports of the maltreated children admitted to protection centers were reviewed and those belonging to the gypsy ethnic group were included. Information collection, definition of concepts and health assessments were performed according to nationwide methodologies, studies and directives. A descriptive and comparative statistical study was performed. RESULTS: During the study period, 873 children were admitted, of whom 74 were from the gypsy ethnic group (a prevalence of 8.5 %, 1.7 times higher than that expected). Demography: mean age: 6.9 years (5.7 SDU); age group 0-5 years age: 56.7 %; females: 51.3 %. No significant demographic differences were observed in gypsy children compared with the general population of maltreated children. However, factors that were significantly more frequent in gypsy children were the prevalence of passive maltreatment (p = 0.0133; odds ratio [OR]: 2.4; 95 % confidence interval [CI]: 1.2-4.9), belonging to families with more than one social and health risk factor (p = 0.0000; OR: 30.5; 95 % CI: 9.4-99.1) with problems of delinquency (p = 0.0000; OR: 11.7; 95 % CI: 6.3-21.7) and with a history drug/alcohol abuse (p = 0.0000; OR: 3.4; 95 % CI: 1.9-6), presenting at least one health problem (p = 0.0000; OR: 6.9; 95 % CI: 2.7-17.3), absent or incomplete immunizations (p = 0.0000; OR: 4.9; 95 % CI: 3-8.1), disabilities (p = 0.0012; OR: 2.9; 95 % CI: 1.5-5.9) especially of neurological origin (p = 0.0000; OR: 4.8; 95 % CI: 2-11.4), psychomotor developmental delay in children younger than 6 years (p = 0.0330; OR: 2.4; 95 % CI: 1-5.3) and behavioral disorders in adolescents (p = 0.0005; OR: 4.7; 95 % CI: 1.8-12.1). CONCLUSIONS: There is a significant association between maltreatment of gypsy children and the presence in their family of social and health risk factors such as delinquency and mental health problems related to drug addiction/alcoholism. The health status of these children is significantly different from that observed in maltreated children from the general population, with a greater incidence of neurological disabilities and problems and diseases related to chronic neglect and/or abandonment of the child's health, socio-educational and psycho-emotional needs. These children are admitted to centers of protection more frequently than their theoretical risk would predict.

Adolescent↗
PubMed1978

Setting health priorities: a review of concepts and approaches.

The setting of health priorities is primarily concerned with the equitable distribution of resources and is now more than ever an important part of strategic planning within the National Health Service (NHS). The basic information which can be used to assist in such decision-making and the process by which different agencies become involved are important aspects of priority-setting; this article is based on a major review of the research literature on these aspects and provides a discussion and an analysis of experience within health and other fields. From this material a number of possible approaches to priority-setting are identified and discussed. The article concludes that, before it can be decided how priorities should be set in the future, outstanding questions about how far rational approaches are feasible, about who is to be involved and what role they should play, and about how far such decisions are to be taken nationally or locally will need further consideration.

Decision Making↗
PubMed2005

Health priorities and public preferences: the relative importance of past health experience and future health prospects.

We explore people's choices where the preference for those with worse future health prospects and the preference for the young over the old conflict. The empirical study used scenarios with four attributes: past years, past health, future years without treatment, and future health without treatment. One hundred respondents ranked various patient groups described in these terms. The results suggest a strong effect of past years: younger groups (40-year-olds) were always chosen over older ones (60-year-olds). Past health was significant in one question but not the other and future health and years without treatment were both non-significant.

Adolescent↗