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PubMed2001

Classification, disability and the public health agenda.

Depression is a common and disabling illness. For some time the disability has been relatively neglected by those interested in public health. Public health priorities have largely been determined by statistics on mortality. The World Health Organization has argued for some time that public health should be concerned with 'adding life to years' as well as 'adding years to life'. This article will argue that depression should be a key priority for public health research.

Anxiety↗
PubMed1999

Are women disfavoured in the estimation of disability adjusted life years and the global burden of disease?

Addressing women's health goes beyond merely producing gender-disaggregated data. A women's perspective on health issues involves an analysis based on knowledge of broader gender differences than those that can be attributed to biology alone. Women and men live different lives. It is therefore important to evaluate whether women's health issues are disfavoured by known health burden estimators in general use. The Global Burden of Disease and Disability Adjusted Life Years framework was presented to the public health community by the World Bank in 1993. The data presented are applied for the year 1990. The estimators have been criticized for not being able to address social inequity within populations, and for failure to predict how serious the HIV/AIDS epidemic would be. Some of the critical voices have also centred around how the methodology will affect the way women's health priorities are incorporated; however, the debate is still in its infancy. This paper examines this new concept of measuring health burdens from a women's health perspective.

Adolescent↗
PubMed2003

Tools of the trade: a comparative analysis of approaches to priority setting in healthcare.

In many countries, local managers and clinicians have been given responsibility to set health priorities and allocate resources accordingly. Although tools have been suggested for use in aiding this process, knowledge of these tools within health regions is lacking and comparative analysis in the literature is limited. Several approaches to priority setting are critiqued from both practical and theoretical perspectives, and a tangible way forward for such activity is provided. The approaches analysed include: needs assessment, core services, economic evaluation including quality-adjusted life year league tables, and programme budgeting and marginal analysis (PBMA). Needs assessment fails to recognize underlying economic principles of opportunity cost and the margin, while core services ignores the margin and has had limited impact in practice. Economic evaluations can consider marginal costs and benefits, but cannot always be used to inform decisions in a timely manner. PBMA is based on underlying economic principles and can pragmatically respond to objectives related to both efficiency and equity. Although PBMA is not without challenges, from an economic perspective, it does seem to "get the thinking right", and, importantly, as a process, can incorporate some of the other approaches to priority setting discussed in this paper.

Budgets↗
PubMed1998

Emergency medicine in Russia.

Russia has undergone sweeping political and social reforms within the past 5 years. The economic and social reforms heralded by the "new openness" of perestroika have led to a restructuring of medicine as well. Changes include the emergence of "for profit" organizations and acute care facilities, the introduction of private health insurance, modifications in the medical education system, and realignment of health priorities with a new trend toward primary care.

Economics↗
PubMed1996

The distribution of resources in health care.

Perceived advances in medicine lead to raised public expectations of care. Resources are finite, but governments can choose how they spend health service funds. Decisions on health "priorities' have implications for nursing practice as well as patient choice.

Decision Making, Organizational↗
PubMed2006

Funding of North Carolina tobacco control programs through the Master Settlement Agreement.

Changing political and economic forces in 1 tobacco-dependent state, North Carolina, demonstrate how the interplay between these forces and public health priorities has shaped current allocation of Master Settlement Agreement funds. Allocation patterns demonstrate lawmakers' changing priorities in response to changes in the economic climate; some of the agreement's funds targeted to tobacco farmers appear to reflect objectives favored by tobacco manufacturers. Funds earmarked for health have underfunded youth tobacco prevention and tobacco control initiatives, and spending for tobacco farmers in North Carolina has not lived up to the rhetoric that accompanied the original agreement. We discuss the implications of these findings for future partnerships between public health advocates and workers as well as tobacco control strategies.

Adolescent↗
PubMed2004

Estimating rural households' willingness to pay for health insurance.

In many developing countries limited health budgets are a serious problem. Innovative ways to raise funds for the provision of health services, for example, through health care insurance, have a high priority. Health care insurance for rural households shields such patients from unexpected high costs of care. However, there are questions about whether, and how much, rural households are willing to pay to purchase such insurance, as well as the factors determining willingness to pay. In recent years the Iranian government has tried to improve health and medical services to rural areas through a health insurance program. This study was conducted to estimate rural households' demand and willingness to pay for health insurance. A contingent valuation method (CVM) was applied using an iterative bidding game technique. Data has been collected from a sample of 2,139 households across the country.

Adolescent↗
PubMed2004

[Foreign minors in the protection system of the Autonomous Community of Aragón (Spain)].

OBJECTIVES: To determine the prevalence of foreign minors in protection centers, their demographic characteristics, and reasons for entry, as well as the relation with geographic area, family, social and health risk factors, and high-priority health needs. PATIENTS AND METHODS: We performed a retrospective cross-sectional study over an 11-year period (1992-2002). The health and socio-familial reports of 1,619 minors who were admitted to protection centers were reviewed and those from a foreign country were included. Compilation of information, definition of concepts, and health assessments were performed according to standard protocols. RESULTS: Two hundred forty-one foreign minors (males 66.4 %) with a mean age (SD) of 11 (3.2) years (adolescents 64.7 %, infants-preschoolers 26.1 %) were admitted during the study period. The prevalence was 4.6 times higher than that expected. Origin: Africa 68.9 % (Maghreb 56.4 %, sub-Saharan 12.5 %), Europe 23.6 % (west 14.5 %, east 9.1 %), Latin-America 5.4 %, and Asia 2.1 %. Reasons for entry, demography and relation with geographic area were as follows: 1. Being an abandoned illegal immigrant 41.1 % (all male adolescents, 98 % from the Maghreb); 2. Maltreatment 33.2 % (passive maltreatment-to-active ratio 2.3:1, no difference by sex, age mode 2 years; Asia 80 %; Europe 61.5 %, west-to-east ratio 4.8:1, gypsy ethnicity from Portugal and Rumania 90.3 %; Latin-America 38.4 %; Africa 21.7 %, no difference by geographic area); 3. Temporary incapacity for their care 18.7 % (female-to-male ratio 1.8:1, age mode 1 year; Latin-America 38.4 %, Africa 18.1 %, Europe 17.5 %); 4. Other causes 7 %. RISK FACTORS: at least one (78.4 %) and more than one (33.6 %); housing problems and especially living in a single parent family. Health disorders: at least one (65.1 %); disabling disease (2.1 %); main problems: dental (36.3 %), immunization (27.6 %), dermatologic (19.1 %), growth and nutrition (13.7 %), and infectious and parasitic diseases (13.3 %). CONCLUSIONS: Being a minor immigrant in a foreign country with problems of documentation, housing or family regrouping and especially if there are language, cultural or racial (ethnic minorities) barriers is a major risk factor for living in a situation of vulnerability, risk or neglect/abandonment that requires social protection measures. Continuous follow-up by the social services of the adoptive community is required for the prevention and early detection of children in need of protection.

Adolescent↗
PubMed2006

Caring for a common future: medical schools' social accountability.

ORIGINS AND CONTEXT: The concept of 'the social accountability of medical schools' is moving from the peripheral preoccupation of a few to a more central concern of medical schools themselves. Born of concerns about the professionalism and relevance of both the institutions and their graduates, it is seen increasingly as an urgent call to focus the considerable social resources vested in academic health science institutions on addressing the priority health concerns of the societies they serve. For a profession embedded in an ethos of service, this would seem an obvious transition. However, as with any movement towards transformative change, it runs the risk of being more mantra and rhetoric than mandate and responsibility. NEEDED RESPONSE: Proceeding from the assumption that good intentions alone are not enough, this paper seeks to outline the historical development and some current expression of the concept throughout the world. The sadly divergent wealth and health status of modern societies calls for very different actions by medical schools across the spectrum from the least endowed to the wealthiest of schools. In a profession claiming centuries of cohesive commitment to the welfare of others, it is increasingly urgent that the current generation of medical educators converge on a relevant set of principles and coherent activities. TOOLS FOR THE TASK: While recognising that they are closely intertwined, the paper outlines the difference between the social accountability of the institutions themselves and the social accountability of the graduates they produce. It outlines both individual examples and the international initiatives that are fostering and facilitating institutional collaborations to bring both progress and optimism to this daunting task. It provides connections to practical resources for those who are committed to that task. Other papers in this series add further practical insights into the central role that medical educators must play if we are to fulfil the responsibilities we carry with the privilege of our profession.

Curriculum↗
PubMed2003

Reducing domestic exposure to environmental tobacco smoke: a review of attitudes and behaviours.

This paper reviews research on attitudes and behaviours towards environmental tobacco smoke (ETS), with a special focus on child health and the indoor environment. Research needs and ways forward to encourage reductions in domestic ETS levels are discussed. Published material was identified through online literature searches (Medline, Toxline, Cancerlit, Biosis, Embase, Enviroline, Sociological Abstracts, Social Science Citation Index, Academic Index and Psychinfo). The literature search strategy employed search terms such as "passive smoking" or "environmental tobacco smoke" with "attitude" or "awareness" and other synonyms. Additional publications were identified by citation chasing and expert advice. Focusing on the UK, studies that provided survey-derived data about attitudes and behaviours in relation to ETS exposure in the indoor environment were selected for review. Published studies from other countries were also included when they provided information pertinent to this review. Most people are aware of the health risks associated with ETS exposure, and there is a high level of support for smoking restrictions in public places to protect non-smokers from ETS. However, although there is concern among both non-smoking and smoking parents about children and second-hand smoke, many people allow children to be exposed to ETS in the home. The review suggests that traditional health promotion campaigns have had only limited success in encouraging ETS risk reduction measures in the home. Because ETS is a public health priority, particularly in relation to child health, the barriers to the uptake of such measures need to be explored in detail to inform the future promotion of reductions in domestic levels of ETS.

Attitude to Health↗
PubMed1999

Partnerships in healthcare: a Commonwealth perspective.

This article briefly outlines the nature and characteristics of partnership, and points to the need to build partnerships through deliberate efforts, since they do not occur by simply bringing people and/or resources together. It identifies some of the reasons why partnerships in health are invaluable in meeting the priority health needs of populations, and the importance which the Commonwealth places on partnerships given the unique characteristics which are common to its member countries. The article then uses practical examples to illustrate the value of partnerships in health at the national, regional and international level. For the benefit of front-line healthcare providers, some suggestions are given of how partnerships could be used to enhance the services which they give to the communities they serve.

Communication↗
PubMedDate not supplied

Collaborative needs assessment and systems development in Alabama: Process and products.

This article describes the implementation of a collaborative project and its results, involving a department of maternal and child health (DMCH) in a school of public health and a state department of public health. The state received a federal grant to enhance systems development for women and children. Adequate information regarding the existing system of health care was lacking. The state contracted with the DMCH for assistance in designing and conducting a needs assessment, whose purpose was to (1) identify strengths and weaknesses in the state system of care, (2) provide baseline information for targeting resources and measuring change, and (3) initiate an on-going process of assessment and evaluation of need. The DMCH collected data about financial and nonfinancial barriers to care from state-level health agency and organization experts, county-level service personnel, and consumers. The contributions to understanding the needs of the state offered by the information garnered in the three surveys helped the state in setting immediate and long-range objectives. The presence of the school of public health and the focus of its particular DMCH on assisting state agencies provided an atmosphere in which the state could ask for assistance and the university could respond in a way that was useful and relevant to the state's needs. Medical Subject Headings (MeSH): assessment, health planning, health priorities, interprofessional relations, program planning, public health.

Alabama↗
PubMed1995

Women's health as a priority.

Funding for the NIH Women's Health Initiative is allocated by Congress on an annual basis. Since the 1994 elections, which dramatically changed the balance of power and priorities in the U.S. Congress, some individuals have voiced concern over the future of this project. Pharmacists can ensure that funding for this research continues by contacting their congressional representative to express their views directly. They can also join forces with other pharmacists through their national and state pharmacy associations. Law makers and persons responsible for funding decisions are interested in and responsive to the positions taken by professional groups. Pharmacists can improve the health of their female patients by encouraging them to make healthy lifestyle changes (e.g., stop smoking, exercise regularly, reduce fat intake, maintain recommended body weight, obtain a Pap test annually, have mammograms at recommended intervals, and perform monthly breast self-examinations). Pharmacists should urge women who might benefit from HRT to talk about it with their physicians. Pharmacists are a valuable source of information about the advantages and disadvantages of HRT. The exclusion of women from clinical and epidemiologic studies has left clinicians with inadequate information about the best approach to preventing and treating many women's health problems. During the past decade, the efforts of various individuals, government agencies, and professional organizations have brought about policy changes that broaden opportunities for inclusion of women in clinical trials as well as increased funding for women's health research. The Women's Health Initiative and other research currently being conducted will yield valuable information that can be used to improve the health of women.

Cause of Death↗