President's message: priorities for children's health care: how to achieve healthy people 2000 goals.
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Adolescent↗
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Biting the hand: foundation practices and priorities in health services research.
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Foundations↗
Priorities for health and personal social services.
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Community Health Services↗
[Health status indicators and the importance of their use in daily practice].
Health information undoubtedly has great social, political and economic importance. To have relevant information, it means to have basis for timely reporting, basis for action, and prerequisites for success. The purpose is to produce and use adequately appropriate information about health status, health risks and health outcomes in order to establish priorities. Health information should be useful and easy accessible to all potential users in every moment, from health care providers to the general public. Health indicators, as aggregated health statistical data, present measure instruments in this process, and because of that definition, development and implementation of basic set of health indicators at all levels (public health and clinic) must be the priority activity in the current moment of health sector reform in Bosnia and Herzegovina. Basic set of relevant and measurable indicators should be founded on different aspects of health and health care (health promotion, diseases prevention, clinical treatment, rehabilitation), monitoring and evaluation as a part of everyday's routine in health sector.
Bosnia and Herzegovina↗
[Selection of priorities in public health (author's transl)].
Identification of priorities is a major factor in an public health programme. We should avoid making a selection of priorities on a subjective basis, or basing a decision on temporary situations or the desire of influential personalities confusing personal interests with true priorities. The choice of priorities in health care must take into account two essential factors: 1) The impact of a disease on the population. It can be evaluated by studying:--the mortality rate and the increased life expectation resulting from the suppression of the disease;--the incidence of the disease;--the temporary or the permanent disablement it causes;--the incidence of complications. 2) The possibility of success of health programmes. The possibility of success depends on many factors: technical, logistic, political and psychological, which should be analysed in depth before establishing any priority programme. A public health programme can only be given priority rating when it combines maximum impact on the population with the highest chance of success. Priority rating can be attributed to a public health programme only when long term impact on the population and successful achievement can be combined.
Adolescent↗
Public participation in health planning and priority setting at the district level in Uganda.
OBJECTIVE: To explore the experiences of the public and leaders with participatory planning and priority setting in health, in a decentralized district in Uganda. METHODOLOGY: An exploratory qualitative approach, involving in-depth interviews with health planners at the national, district and community levels (n = 12), and five group discussions at community level with women (two groups), men, youths and adolescents (n = 51). The analysis adapted some principles from grounded theory. The five levels of the participation framework by Rifkin (1991) were used to assess the actual level of participation in the study population. RESULTS: Uganda has established structures for participatory planning. Within this context, district level respondents reported to have gained decision-making powers, but were concerned about the degree of financial independence they had. The national level respondents were concerned about the capacity of the districts to absorb their new roles. Actual involvement of the public in priority setting and poor communication between the different levels of the decentralization system, despite the existing structures, were additional concerns. Public participation is mainly through representatives. Majority participation is mainly at health benefits and programme activity levels. Decision-making, monitoring and evaluation, and implementation are still dominated by the locally elected leaders due to reported economic, social and cultural barriers that hinder the participation of the rest of the public.
Community Health Planning↗
Quality care is reform priority.
How health system reform will finally "shake out" in Pennsylvania remains a mystery to us all. This month, we consider that mystery and reform's most important provision--quality care.
Health Care Reform↗
Strengthening capacity in developing countries for evidence-based public health: the data for decision-making project.
Public health officials and the communities they serve need to: identify priority health problems; formulate effective health policies; respond to public health emergencies; select, implement, and evaluate cost-effective interventions to prevent and control disease and injury; and allocate human and financial resources. Despite agreement that rational, data-based decisions will lead to improved health outcomes, many public health decisions appear to be made intuitively or politically. During 1991-1996, the US Centers for Disease Control and Prevention implemented the US Agency for International Development funded Data for Decision-Making (DDM) Project. DDM goals were to: (a) strengthen the capacity of decision makers to identify data needs for solving problems and to interpret and use data appropriately for public health decisions; (b) enhance the capacity of technical advisors to provide valid, essential, and timely data to decision makers clearly and effectively; and (c) strengthen health information systems (HISs) to facilitate the collection, analysis, reporting, presentation, and use of data at local, district, regional, and national levels. Assessments were conducted to identify important health problems, problem-driven implementation plans with data-based solutions as objectives were developed, interdisciplinary, in-service training programs for mid-level policy makers, program managers, and technical advisors in applied epidemiology, management and leadership, communications, economic evaluation, and HISs were designed and implemented, national staff were trained in the refinement of HISs to improve access to essential data from multiple sources, and the effectiveness of the strategy was evaluated. This strategy was tested in Bolivia, Cameroon, Mexico, and the Philippines, where decentralization of health services led to a need to strengthen the capacity of policy makers and health officers at sub-national levels to use information more effectively. Results showed that the DDM strategy improved evidence-based public health. Subsequently, DDM concepts and practices have been institutionalized in participating countries and at CDC.
Bolivia↗
Priority for primary health care: its development and problems.
National health policies of many countries stress priority for primary health care (PHC). This emphasis has arisen as a reaction to large expenditures on hospitals and sophisticated technology in major cities of developing countries, while vast rural populations have been virtually ignored. The paradox developed from colonial and neo-colonial emulation of European and North American medical models. In 1978, an international conference of WHO/UNICEF at Alma-Ata, USSR defined the meaning of PHC, along with several principles of organization and equity under which it should be provided. To reach rural people with PHC, thousands of community health workers have been prepared and stationed in villages. Their training, however, is very brief and, with weak supervision, their performance has been disappointing. To achieve the WHO goal of "Health for All" through PHC requires greatly expanded education of public health leaders, who can supervise and inspire community personnel.
Global Health↗
An opportunity lost: HIV infections associated with lack of a national needle-exchange programme in the USA.
BACKGROUND: Our aim was to estimate the number of HIV infections that could have been prevented had needle-exchange programmes been implemented during the early stages of the AIDS epidemic in the USA. We also estimated the cost to the US health-care system to treat these preventable HIV infections. METHODS: The formula we used to calculate the annual number of preventable HIV infections accounted for the effectiveness and level of use of needle-exchange programmes, as well as sexual transmission to injection drug users (IDUs) and secondary transmission to their sexual partners and children. Data for the model were obtained from epidemiological and mathematical studies in peer-reviewed published research, government reports, and consultations with experts. Using data from Australia as a model, we calculated the number of HIV infections that could have been prevented by a national needle-exchange programme in the USA between 1987 and 1995. Cost calculations were based on the current US government estimate of the discounted lifetime cost of treating an HIV infection (US $55640). FINDINGS: Our conservative calculation of the number of HIV infections that could have been prevented ranged from 4394 (15% incidence reduction due to needle exchanges) to 9666 (33% incidence reduction). The cost to the US health-care system of treating these preventable HIV infections is between US $244 million and US $538 million, respectively. If current US policies are not changed, we estimate that an additional 5150-11329 preventable HIV infections could occur by the year 2000. INTERPRETATION: The failure of the federal government in the USA to implement a national needle-exchange programme, despite six government-funded reports in support of needle exchanges, may have led to HIV infection among thousands of IDUs, their sexual partners, and their children. Revoking the US government ban on funding for needle-exchange programmes and accelerating the growth of such programmes in the USA are urgent public-health priorities.
Cost of Illness↗
[Apprenticeships carried out by "health planning craftsmen" during the construction of regional health organisation sketches].
The decree of April 1996 established the second generation Regional Health Organisation Plans (SROS II) as a lever for health planning. One of the major issues at stake in their development is to promote the overall coverage of regional health priorities. This resulted in the need for apprenticeships on the part of "health planning designers". In order to better comprehend their opinion, a nationally selected sample was gathered to take into account the diversity in regional experiences, the differences in institutional partnership and the unity within the given place of the problem. Two series of 42 interviews at six month intervals were recorded and a thematic analysis was carried out according to a validated interview grid by the Social and Health Policies Analysis Laboratory (LAPSS) at the National School of Public Health (ENSP). This study demonstrates that the actors involved in health planning, who are few, should nevertheless develop skills centred on their multiple functions and tasks in order to adopt to new reforms within the context of an environment of significant economic and legal pressures. These professionals performed collective and organisational, and even cultural, apprenticeships which allowed for the mobalisation of initiatives, the integration of diversity in individual projects towards a capacity for responsible collective action and quality, all of which advocates for the modernisation of public action.
France↗
[Research and pharmaceutical development on the subject of communicable diseases in the intertropical region].
The development of the antimalarial drugs mefloquine and halofantrine in 1988 by American military research teams marked a start in the decline in investment in tropical disease research and drug development. The globalization of the market, increased clinical costs, and constraints on public health spending caused the pharmaceutical industry to concentrate on more profitable market segments (cardiovascular drugs, antineoplastics, anti-infection drugs, etc.). The market in developing countries represents a large volume, but a very low return because the added value is small, generic drugs are used and the state of the populations is impoverished. The ten or so drugs that have been developed recently result from chance (eflornithine), veterinary research (ivermectin), fortuitous analysis of traditional pharmacopoeia (artemether) or reevaluations of former drugs (amopyroquine). The deficiency of research and drug development for diseases of the intertropical zone has a direct negative effect on public health and also reveals health policy inconsistencies, particularly the incompatibility of the pharmaceutical industry's interests and international health priorities. The problem is also aggravated by the closed approach of external health assistance (official development aid) which aims to minimize costs by favoring primary health care.
Aminoquinolines↗
Toxic agent and radiation control: progress toward objectives for the nation for the year 1990.
In 1980, the Department of Health and Human Services set national prevention objectives for 1990 in 15 health priority areas, 1 of which is the control of toxic agents and radiation. Ten objectives related to this area are priorities for the national control effort. Progress is reviewed on those priorities within the responsibilities of the Public Health Service. Six key program elements, or types of support activities, are deemed essential to preventing, identifying, and controlling toxic agent and radiation threats. Significant progress has been made toward achieving objectives for which all key program elements have been successfully implemented to provide the requisite know-how, manpower, and tools. Important advances have been made in reducing the blood lead levels of the population, reducing unnecessary exposure to medical X-rays, evaluating the toxicities of chemicals in toxic waste dumps, and improving the scientific and technical information base and its availability for prevention and control efforts. The most important priority for the forseeable future will be to expand our knowledge of potential health risks posed by toxic agents and radiation. Expanded surveillance systems and data bases are essential to determining the extent of the problems in terms of human health effects and for measuring the impact of prevention programs. Emphasis on the activities embodied in the key elements will encourage the expansion of the knowledge base and its effective application to prevention and control problems.
Environmental Health↗
Priority setting for health research: lessons from developing countries. The Working Group on Priority Setting.
Research resources for addressing health problems of developing countries remain disproportionately low compared with the tremendous disease burdens borne by these countries. There is a need to focus these scarce resources on research that will optimize health benefits and lead to equity. This paper reviews processes and methods that have been used for setting research priorities. Past and current processes have focused on expert-driven research agenda, emphasizing scientific autonomy and global analyses. Methods for setting priorities have focused on the metrics of disease burdens, while less attention has been placed on who sets priorities and how choices are made. The paper proposes a strategy of priority setting, based on lessons learned from essential national health research (ENHR) approaches attempted in several developing countries. With equity in health and development as its goal, the proposed model is demand-driven, and involves multi-dimensional inputs and multiple stakeholders. Various steps of the process are discussed: getting participants involved; gathering evidence and information; determining criteria for priority setting; and implementation and evaluation. The paper concludes with a discussion of the gap between national research priorities and the research agenda set at regional and global levels, an issue that needs to be satisfactorily addressed in the future.
Developing Countries↗
Priorities for reproductive health: assessing need in the older population in the Asia-Pacific region.
Best practice in healthcare entails the identification of priority health needs so that scarce resources can be most appropriately deployed in the development of services. In this light, the priorities for health of older women and men in the Asia-Pacific region are considered in terms of reproductive health. A broader definition of "reproductive health" is used here, which considers conditions that affect the reproductive systems of older women and men. Although previous fertility history may influence some of these conditions, such as breast or cervical cancer or uterine prolapse, others -- including sexually transmitted diseases and impotence -- emerge as independent factors; that is, they relate directly to past and/or current sexual activity. Regional and country-specific survey data and the estimates of deaths and disease burden provided by the Global Burden of Disease Inquiry Project show that a component of the overall health problems of older women relate directly to pregnancy and the practice of unsafe sex. The lack of data for other conditions that affect the reproductive systems of older women and men is noted, as is the importance of further research if an individual's health needs are to be fully met. It is argued that healthcare and health services alone cannot meet some of the health needs of the older population; broader political and social change are required.
Adult↗
Priority setting in health care: learning from international experience.
Priority setting in health care is not new but it is an issue of growing importance. In publicly financed health care systems, the combination of constrained resources and increasing demands has led policy makers to address this issue more directly than in the past. This is exemplified by experience in Oregon, the Netherlands, New Zealand, Sweden and the UK. In each of these systems, policy makers have taken the initiative to set priorities on a more explicit basis. This paper compares and contrasts experience in these systems and identifies a number of emerging themes. The work done so far can be likened to an exercise in policy learning in which policy makers have tried out a range of approaches and have adjusted course several times in the process. Priority setting is not amenable to once and for all solutions and the issues involved must be kept under continuous review.
Advisory Committees↗
Federal advocacy for anorexia nervosa: an American model.
Advocacy efforts aimed at influencing federal policy are needed to strengthen accessible resources for anorexia nervosa (AN) and to improve treatment and prevention. Federal advocacy in the United States is spearheaded by the Eating Disorders Coalition for Research, Policy, and Action (EDC) whose mission is to advance the federal recognition of eating disorders as a public health priority.
Anorexia Nervosa↗
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↗