Effects of the institutionalization of primary health care.
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The 1972 Primary Health Care Act in Finland has generally been considered very successful. In many respects this may be true. From an administrative point of view, however, this act has not worked satisfactorily. Data are given on the bureaucratic inertia introduced by the new planning system mandated by the act, and some general criticism is offered of the claims of success made by public health officials.
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The President's Committee on Health Education was created by Richard M. Nixon in September 1971 and submitted its final report in September 1973. The committee resulted from the convergence of (1) a perceived national domestic policy need in response to escalating medical costs, (2) Nixon's personal and political ambitions, and (3) the dynamic political context of the late 1960s and early 1970s. Its work led to both private and public initiatives designed to influence the public's health through education; its findings and recommendations also laid the foundation for the National Consumer Health Information and Health Promotion Act of 1976 and thus contributed significantly to the development of subsequent national policy in health promotion and disease prevention. This paper places the work and contributions of the committee into historical perspective by analyzing the committee's origins and methods and the underlying politics that shaped its work and final report. The impact of the President's Committee is traced from the emergence of health education in the early 1970s as a potentially cost-effective alternative to medical care to the pivotal role health education now plays in health promotion and disease prevention efforts.
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Stephen C. Hanson's article, "Health Planning: The Fourth Generation," (Hospital and Health Services Administration 27/4, 1982, pp. 55-65) comments on the possible "downsizing" of Health System Agencies (HSAs) because of severe budget cuts. Hanson suggests that they shift from regulatory to planning agencies. A relatively recent development in Ontario, Canada, involves the establishment of area-wide planning agencies known as district health councils (DHCs) which may provide a model for HSAs of the future. Although DHCs operate in a government-sponsored healthcare system and are advisory rather than regulatory in nature, the DHC concept can be adapted to HSAs in order to become true planning agencies. This article outlines the salient features of the Ontario DHC Program and compares its similarities and differences with Hanson's "Fourth Generation" model of HSAs. While Hanson proposes a model, Ontario's experience for which comparisons and insights are offered has gone beyond the conceptualization stage and has been operating for over ten years. The DHC Program is still evolving, tentative in some areas, and searching for the most appropriate role and means in other areas. As HSAs will be transformed out of necessity, a close look at the Ontario DHC program may prove to be both instructive and timely.
One in every five persons is an adolescent (10-19 years of age). What happens, or does not happen, during the second decade of life has implications that last throughout a lifetime and affect both individual and public health. What sets adolescents apart from children is the increasing autonomy they demonstrate. Their own decisions, behaviours and relationships increasingly determine their health and development. Moreover, adolescence brings with it expanded capacities--for abstract thought and contemplating the future, for empathy and idealism, for critical thought including the questioning of self and others, and for reproduction. Yet the use of these new capacities is dependent on the environment in which adolescents live. So while adolescents display more self-reliance than children, they lack the status and resources of adults. Indeed, they are often dependent on adults to meet many of their basic needs. The consolidation of knowledge and experience acquired through the WHO/UNFPA/UNICEF Study Group on Programming for Adolescent Health is presented in this report. Verified by research, the report describes the guiding concepts and major interventions that are necessary components for country programming for adolescent health and development. The report asserts the value of addressing the health and development of adolescents simultaneously. It indicates the emerging evidence that actions to meet adolescents' needs for development also discourage them from adopting high-risk behaviours and protect them from the situations that lead to the major health problems. The report is illustrated by examples of programming efforts from around the world.
BACKGROUND: The new Medicare items that cover care plans and multidisciplinary case conferences for patients with complex and chronic medical conditions have introduced new challenges in primary health care. General practitioners may be required to develop new skills if they are to work effectively with other professionals and carers where health is not their only priority. OBJECTIVES: This paper reports briefly on findings from a particular research project into the key factors that contribute to effective multidisciplinary teams. Principles from this research that can be applied to GPs being involved in multidisciplinary care plans and case conferences will be examined. DISCUSSION: Key factors discussed include the importance of efficiency, flexibility, an holistic view of the patient, communication and personal and professional characteristics that contribute to a successful outcome in multidisciplinary patient care.
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The International Code of Marketing of Breast Milk Substitutes came into existence in 1981. The Innocenti Declaration was signed in 1990 for protection, promotion and support of breastfeeding. A significant development took place with the enactment of "Infant Milk Substitutes, Infant Foods and Feeding Bottles Act 1992". The establishment of the Breastfeeding Promotion Network of India (BPNI) in 1991 led to several significant initiatives in partnership with Association for Consumers Action on Safety and Health (ACASH) and several other NGOs and professional associations. After 10 years of movement, a meeting of the key partners was thought of to review the ongoing initiative to protect, promote and support breastfeeding. In the meeting the partners discussed objectives, key issues, advocacy and policy development, training and capacity development, communication and social mobilisation, community action and intervention, monitoring, evaluation and research. It was hoped that this would provide the necessary impetus for concerted action to be taken by different partners at all levels to organise "baby friendly communities" a reality in India where young children's rights to breastfeeding for survival, growth and development would be fulfilled in partnership with families and communities.
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