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PubMed1994

National health care reform minus public health: a formula for failure.

Universal access to medical services will not address all important health needs. Impending health care reform, guided by public health strategies, could achieve many previously unattainable health goals. However, such a public health role seems unlikely. Public health reaches beyond the current popular notion of prevention focused on individual lifestyle, yet attention to public health authority has waned. The history of immunization, a personal health service effective only within a public health strategy, illustrates the dilemma. Britain required 40 years of National Health Service before it invoked a public health strategy to assure effective immunization. Reformed health care must perform certain functions systematically that in the past were optional for medical practitioners or left to health departments by default. Reformers must rebuild public health authority in states, to assure that medical services we will pay for under health care reform accomplish functions critical to the health of the public.

Health Care Reform↗
PubMed2003

Population health metrics: crucial inputs to the development of evidence for health policy.

Valid, reliable and comparable measures of the health states of individuals and of the health status of populations are critical components of the evidence base for health policy. We need to develop population health measurement strategies that coherently address the relationships between epidemiological measures (such as risk exposures, incidence, and mortality rates) and multi-domain measures of population health status, while ensuring validity and cross-population comparability.Studies reporting on descriptive epidemiology of major diseases, injuries and risk factors, and on the measurement of health at the population level - either for monitoring trends in health levels or inequalities or for measuring broad outcomes of health systems and social interventions - are not well-represented in traditional epidemiology journals, which tend to concentrate on causal studies and on quasi-experimental design. In particular, key methodological issues relating to the clear conceptualisation of, and the validity and comparability of measures of population health are currently not addressed coherently by any discipline, and cross-disciplinary debate is fragmented and often conducted in mutually incomprehensible language or paradigms. Population health measurement potentially bridges a range of currently disjoint fields of inquiry relating to health: biology, demography, epidemiology, health economics, and broader social science disciplines relevant to assessment of health determinants, health state valuations and health inequalities.This new journal will focus on the importance of a population based approach to measurement as a way to characterize the complexity of people's health, the diseases and risks that affect it, its distribution, and its valuation, and will attempt to provide a forum for innovative work and debate that bridge the many fields of inquiry relevant to population health in order to contribute to the development of valid and comparable methods for the measurement of population health and its determinants.

Journal Article↗
PubMedDate not supplied

[Health professionals' opinion of the Catalan Health Plan. Basis for a reflexion on the future].

OBJECTIVES: To know health professional's opinion of the Health Plan for Catalonia (Spain) in order to get news elements for the formulation and management of new plans. DESIGN: Combination of quantitative and qualitative methodologies. Postal survey to doctors and nurses (multistage randomised sample). 3.223 questionnaires were obtained (response rate: 34,1%). Interview to a selected sample of 41 health care professionals and managers. MEASUREMENTS AND MAIN RESULTS: 78,8% (IC95%: 1,4) of health professionals are familiar with the Health Plan, and for most of them it is valued as important. 28,9% (IC95%: 1,7) of the professionals who know the Plan consider that it has repercussions in their daily work and 51,8% (IC95%: 1,9) declare that it doesn't have any repercussions. Different issues such as the planning process, the contents, the dissemination strategy, as well as a the poor impact on the health budget are critised. Differences by age group and sex, care setting and type of health professional are observed. CONCLUSIONS: The implication of health professionals in the discussion, formulation and implementation of the Health Plan proposals needs to be improved. It will be necessary to make progress in identifying health problems and needs, in setting priorities and in the allocation of resources. To increase the multisectorial involvement and to develop marketing strategies directed to politicians, managers and health professionals will also be needed in order to increase the impact of the Health Plan on both the Health System and the other sectors involved in health. The role to be played by the Health Plan in the health system must be redefined and this will lead to redesigning the planning process and the implementation of health strategies.

Adult↗
PubMed2001

Health literacy in health systems: perspectives on patient self-management in Israel.

Health systems will face new challenges in this millennium. Striking the balance between the best quality of care and optimal use of dwindling resources will challenge health policy makers, managers and practitioners. Increasingly, improvements in the outcomes of interventions for both acute and chronic patients will depend on partnerships between health service providers, the individual and their family. Patient education that incorporates self-management and empowerment has proven to be cost-effective. It is essential that health care providers promote informed decision making, and facilitate actions designed to improve personal capacity to exert control over factors that determine health and improve health outcomes. It is for these reasons that promoting health literacy is a central strategy for improving self-management in health. The different types of health literacy--functional, interactive and critical health literacy--are considered. The potential to improve health literacy at each of these levels has been demonstrated in practice among diabetics and other chronic disease patients in Clalit Health Services (CHS) in Israel is used as an example to demonstrate possibilities. The application of all three types of health literacy is expressed in: (i) developing appropriate health information tools for the public to be applied in primary, secondary and tertiary care settings, and in online and media information accessibility and appropriateness using culturally relevant participatory methods; (ii) training of health professionals at all levels, including undergraduate and in-service training; and (iii) developing and applying appropriate assessment and monitoring tools which include public/patient participatory methods. Health care providers need to consider where their patients are getting information on disease and self-management, whether or not that information is reliable, and inform their patients of the best sources of information and its use. The improved collaboration with patient and consumer groups, whose goals are to promote rights and self-management capabilities and advocate for improved health services, can be very beneficial.

Delivery of Health Care↗
PubMed2000

Agenda for women's health research. Improving women's musculoskeletal health.

Increased attention and resources focused on women's health during the past decade have resulted in new offices, policies, and programs of the Federal government. The Office of Research on Women's Health, established by the National Institutes of Health in 1990, is a focal point for all National Institutes of Health-supported efforts to improve women's health through biomedical and behavioral research. The Office of Research on Women's Health ensures women's appropriate inclusion in research studies supported by the National Institutes of Health. Through the development of a comprehensive agenda for research on women's health, the Office of Research on Women's Health encourages the consideration of gender issues and gender differences in health and disease in research sponsored by the National Institutes of Health. The importance of research to study and improve women's musculoskeletal health has become increasingly recognized. Clinicians, researchers, and representatives of professional and advocacy organizations concerned with women's musculoskeletal health participated in the development of the initial research agenda on women's health in 1991 and participated in the meetings to update and revise the agenda in 1996 and 1997. As a result of meetings convened to review and revise the agenda on women's health for the twenty-first century, many recommendations for additional research on women's musculoskeletal health have been developed and now are being implemented across the National Institutes of Health.

Female↗
PubMed2004

Adolescent mothers: resilience, family health work and health-promoting practices.

AIMS: This paper reports a study examining the relationships among mother's resilience, family health promotion (i.e. health work) and mother's health-promoting lifestyle practices in single-parent families led by adolescent mothers by testing hypotheses derived from the Developmental Model of Health and Nursing. BACKGROUND: Research on families led by adolescent mothers has focussed primarily on negative maternal and child outcomes while ignoring the capacities of these families, including their efforts to promote the health and well-being of both mothers and children. METHODS: This replication study was conducted with convenience sample of 41 adolescent mothers recruited using a variety of strategies. Mothers were asked to provide verbal responses to items on three study instruments: The Resilience Scale, a measure of mother's resilience, the Health Options Scale, a measure of family health work and the Health Promoting Lifestyle Profile a measure of mother's health promoting lifestyle practices, as well as a demographic questionnaire. RESULTS: Consistent with the theory, moderate positive relationships were observed between mothers' resilience and both family health work (r = 0.34, P = 0.01) and mothers' health-promoting lifestyle practices (r = 0.42, P < 0.001). As predicted, moderate correlations were also observed between health work and mother's health promoting lifestyle practices (r = 0.62, P < 0.001). With the effects of employment status and professional support held constant, mother's resilience and health work explained 30.2% of the variance in mother's health-promoting lifestyle practices. CONCLUSIONS: The study validates theoretical relationships among concepts in the developmental model of health and nursing and contributes to better understanding health promotion in families led by adolescent mothers.

Adolescent↗
PubMed1998

Reported health, lifestyles, and use of health care of first generation immigrants in The Netherlands: do socioeconomic factors explain their adverse position?

OBJECTIVE: Differences in health, lifestyles, and use of health care between groups of varying ethnic origin can have important implications for preventive and curative health care. This paper studies whether socioeconomic factors explain ethnic differences in these outcomes. DESIGN: Data on health status, lifestyles, and use of health care were obtained from interviews with 3296 people aged 16-64 years (response: 60.6%), among whom were 848 first generation immigrants. Ethnic differences in these outcomes were examined with and without adjustment for socioeconomic factors, using logistic regression. SETTING: General population of Amsterdam, the Netherlands. MAIN OUTCOME MEASURES: Health status (self rated health, General Health Questionnaire, functional limitations), lifestyles (smoking, alcohol), and use of health care (general practice, pharmaceuticals, hospitalisations). MAIN RESULTS: Immigrants from Turkey, Morocco and (former) Dutch colonies report a poorer health and a higher use of health care, especially primary health care among the elderly. An adverse socioeconomic position partially explains the poor health of these immigrants. In turn, their poor health explains most of their higher use of health care. CONCLUSIONS: Cultural factors and poor living conditions seem to contribute to the poor health of immigrants, besides an adverse socioeconomic position. The pressure on various health services will increase in future because of the relatively high increase in immigrants' needs at older ages and their presently low mean age.

Adolescent↗
PubMed2006

Health disparities and health equity: concepts and measurement.

There is little consensus about the meaning of the terms "health disparities," "health inequalities," or "health equity." The definitions can have important practical consequences, determining the measurements that are monitored by governments and international agencies and the activities that will be supported by resources earmarked to address health disparities/inequalities or health equity. This paper aims to clarify the concepts of health disparities/inequalities (used interchangeably here) and health equity, focusing on the implications of different definitions for measurement and hence for accountability. Health disparities/inequalities do not refer to all differences in health. A health disparity/inequality is a particular type of difference in health (or in the most important influences on health that could potentially be shaped by policies); it is a difference in which disadvantaged social groups-such as the poor, racial/ethnic minorities, women, or other groups who have persistently experienced social disadvantage or discrimination-systematically experience worse health or greater health risks than more advantaged social groups. ("Social advantage" refers to one's relative position in a social hierarchy determined by wealth, power, and/or prestige.) Health disparities/inequalities include differences between the most advantaged group in a given category-e.g., the wealthiest, the most powerful racial/ethnic group-and all others, not only between the best- and worst-off groups. Pursuing health equity means pursuing the elimination of such health disparities/inequalities.

Delivery of Health Care↗
PubMed2005

[The relations of socioeconomic status to health status, health behaviors in the elderly].

OBJECTIVES: To analyze the relationships of socioeconomic status(SES) to health status and health behaviors in the elderly. METHODS: Data were obtained from self-administered questionnaire of 4,587 persons, older than 65 years, living in a community. We measured the sociodemographic characteristics, socioeconomic status, health status (subjective health status, acute disease, admission experience, dental state, chronic disease etc.), activities of daily living (ADL), instrumental activities of daily living (IADL), and mini-mental state examination-Korean (MMSE-K). Binary and multinominal logistic regression analyses were employed to analyze factors affecting on the socioeconomic status of the elderly. RESULTS: With regard to the SES and health status, those with a low SES had poorer subjective health states and lower satisfaction about their physical health. Also, acute disease experiences, admission rates and tooth deciduation rates were higher in those of low SES. In the view of physical and cognitive functions, the ADL, IADL and MMSE-K scores were also lower in those of low SES. However, with regard to health behaviors, lower smoking and alcohol drinking rates were found in the low SES group, and a similar trend was shown with regular physical exercise, eating breakfast, and regular physical health check-up. From these findings, we surmise that those with low SES have a poorer health condition and less money to spend on health, therefore, they can not smoke or drink alcohol, exercise and or have a physical health check-up. CONCLUSION: This study suggests that socioeconomic status plays an important role in health behaviors and status of the elderly. Low socioeconomic status bring about unhealthy behavior and poor health status in the elderly. Therefore, more specific target oriented(esp. low SES persons) health promotion activities for the elderly are very important to improve not only their health status, but their health inequity also.

Aged↗
PubMed1995

[Health personnel staffing requirements for health examination for the age of 1 1/2 in municipalities in Japan].

Municipalities in Japan offer health education, health counseling, health examination, and home visit services for each development stage of children and for their mothers. In order to determine personnel staffing requirements for the health examination for the age of 1 1/2 as of 1989, data from a questionnaire survey in 1990 conducted by the Ministry of Health and Welfare, was analyzed. Questionnaires were sent to all municipalities and there were 3,198 responses for the response rate of 97.9%. Results showed that in 1989, 98.9% of the 3,012 municipalities were able to independently perform health examinations for 1 and half year old, and in only 0.9% these examination were performed by clinical hospitals. In the large cities designated by the Government, the health personnel system adequately supported these health examination. However due to lack of health personnel, rural towns and villages with small populations required public health nurses to be assisted by other staff, such as health workers or volunteers. And particularly they required help by public health nurses from prefectural Health Centers. For example, in those areas with populations less than 3,000, 53% of the total volume of the work required to be performed by public health nurses during the health examination had to be covered by assistance from prefectural public health nurses. While in cities with more than 300,000 population large numbers of health personnel were assigned to examinations of children, the large number of children processed resulted in inadequate time for each child/mother pair. Further study of quality levels of the examinations need to be performed.

Child Health Services↗
PubMed2004

Gender differences in health: a Canadian study of the psychosocial, structural and behavioural determinants of health.

Gender-based inequalities in health have been frequently documented. This paper examines the extent to which these inequalities reflect the different social experiences and conditions of men's and women's lives. We address four specific questions. Are there gender differences in mental and physical health? What is the relative importance of the structural, behavioural and psychosocial determinants of health? Are the gender differences in health attributable to the differing structural (socio-economic, age, social support, family arrangement) context in which women and men live, and to their differential exposure to lifestyle (smoking, drinking, exercise, diet) and psychosocial (critical life events, stress, psychological resources) factors? Are gender differences in health also attributable to gender differences in vulnerability to these structural, behavioural and psychosocial determinants of health? Multivariate analyses of Canadian National Population Health Survey data show gender differences in health (measured by self-rated health, functional health, chronic illness and distress). Social structural and psychosocial determinants of health are generally more important for women and behavioural determinants are generally more important for men. Gender differences in exposure to these forces contribute to inequalities in health between men and women, however, statistically significant inequalities remain after controlling for exposure. Gender-based health inequalities are further explained by differential vulnerabilities to social forces between men and women. Our findings suggest the value of models that include a wide range of health and health-determinant variables, and affirm the importance of looking more closely at gender differences in health.

Adult↗
PubMed2001

The health and health behaviors of people who do not drink alcohol.

BACKGROUND: Compared to abstention, moderate drinking has been linked to better health, and heavy and hazardous drinking to increased morbidity and mortality. Many studies have failed to account for heterogeneity in health and drinking history among nondrinkers, however. If former drinkers quit in response to ill health, this could increase the risk in the nondrinker category and underestimate the effects of alcohol if illnesses leading to abstention are alcohol-related. In addition, health behaviors may vary with drinking status, affecting health outcomes often attributed to drinking. METHODS: Survey data were collected from a probability sample of a large health maintenance organization's membership. Regression analyses assess the relationship between drinking status (adjusting for covariates), mental and physical health and functioning, and health behaviors. RESULTS: Former drinkers and lifelong abstainers had worse health and functioning than current drinkers and, comparatively, former drinkers had worse health than lifelong abstainers. Former drinkers did not differ from light-to-moderate drinkers in regard to health behaviors (except for smoking), although lifelong abstainers and heavier drinkers were less likely to use preventive care or try to improve their health behaviors. CONCLUSIONS: Consistent with hypotheses that former drinkers may stop drinking because of poor health, former drinkers were less healthy than current drinkers and had slightly worse health than lifelong abstainers, compared to light-to-moderate drinkers. Former drinkers did not appear to be at risk because of poorer health behaviors (except smoking), but lifelong abstainers and heavier drinkers might benefit from outreach designed to increase use of preventive care and improve health behaviors.

Adult↗
PubMed2001

The health and well-being of adolescents: a school-based population study of the self-report Child Health Questionnaire.

PURPOSE: To evaluate a new generic measure of adolescent health status, the self-report version of the Child Health Questionnaire (CHQ), and provide population-based data. Furthermore, we aimed to examine the impact of common adolescent illness and health concerns on their health and well-being. METHODS: A stratified, two-stage, random cluster sampling design was used to obtain a cross-sectional sample of subjects through schools. A written questionnaire included the 80-item 12-scale self-report CHQ and items measuring health concerns, illnesses/health conditions, and sociodemographics. RESULTS: A total of 2361 adolescents participated (response rate of 70%). Reliability was high: Tests of internal consistency and discriminant validity reported 90% of item-scale correlations >.4; all scales had Cronbach alpha coefficients >.7. Adolescents with illnesses/conditions or health concerns reported lower scores and larger differences for content-related scales, supporting content and construct validity. Statistically significant age and gender trends were observed for Mental Health, Self-Esteem, General Health, and Family Cohesion scales. Health status worsened as health concerns increased (X(2) linear trend, p =.00) with deterioration in health of 5-20% on all scales for emotional health concerns (40% of sample). CONCLUSIONS: The self-report CHQ is a reliable and seemingly valid measure of health and well-being for adolescent health research, although additional measures may be required where scales have high ceiling values. The significantly lower scores reported by adolescents with illness and/or health concerns lend support to the use of standardized health measures and longitudinal research to further examine the impact of adolescent comorbidities and their causal determinants.

Adolescent↗
PubMed2004

Health visiting: the public health role.

BACKGROUND: United Kingdom (UK) government policy advocates the development of a family-centred public health role for health visitors. Studies have suggested that barriers and constraints exist to hinder the development of a public health role. However, few of these have considered the issues from a practitioner perspective. AIM: The aim of the study was to examine the constraints on developing a family-centred public health role in a health visiting service. METHODS: An exploratory study was carried out using focus groups with 27 health visitors in one primary health care trust in North West England. Data were transcribed and analysed to identify themes. FINDINGS: Elements of practice that contributed to public health were identified, along with constraints on the development of a family-centred public health role. Three themes were generated from the health visitor focus group discussions as a framework for addressing the constraints: connecting to public health, clarifying the role and changing practice. CONCLUSIONS: The study sets out the challenge faced in developing the public health roles of practitioners. Leadership is essential for clarifying the public health role, developing networks between public health and practitioners, and supporting change in practice. Despite the limitations of the study, its findings, together with evidence from previous literature, suggest that there are common issues that face health visiting services in the UK as they seek to develop the public health role.

Attitude of Health Personnel↗
PubMed2004

Effects of a national health promotion project on knowledge, perception, and competency of health care workers in Korea.

The purpose of this study was to measure the effect of the demonstration health promotion projects on whether knowledge, perceptions, and competencies of health care workers in health centers improved as a result of participating in the health promotion projects. A total of 1,955 community health care workers were recruited for the study. Health care workers from 18 demonstration health centers (n = 728) were assigned to the study group. The remaining 1,227 health care workers from 36 health centers, who have not participated in the demonstration projects, were assigned to the control group. Mailed-out questionnaires were used to measure knowledge and perceptions related to health promotion programs, and competencies in carrying out health promotion programs of health care workers for both groups. The results indicated that knowledge, perception, and competency of health care workers who participated in the demonstration projects were significantly higher than those who had not; but at the same time, those participants of demonstration projects might be under stress due to the extra assignments required by the projects. For effective health promotion programs, there is a need to supplement the staff in the health centers to take charge of health promotion programs.

Adult↗
PubMed2003

An analysis of the role of health care in reducing socioeconomic inequalities in health: the case of the Netherlands.

The aim of this article is to analyze the role of the health care system in reducing socioeconomic inequalities in health in countries with good access to health services, using the Dutch example. In the past, health care has contributed substantially to reducing a number of health problems in the population, paticularly health problems leading to mortality. Data on trends in mortality from selected conditions by socioeconomic group show that both higher and lower socioeconomic groups have profited from these mortality reductions, probably because of largely equal access to essential health car services, and that absolute inequalities in mortality from these conditions have declined notably. The current situation is still one of largely equal financial access to health care services, with relatively small differences between socioeconomic groups in health care utilization, after adjustment for differences in prevalence of health problems. There is no evidence that inequalities in health care utilization contribute to a widening of socioeconomic inequalities in health. Financing of the health care system, however, is slightly regressive, and out-of-pocket payments contribute to the poor financial situation of the chronically ill. For the future, three possible contributions of the health care system to reducing socioeconomic inequalities in health are described: preservation of equal access to high-quality health care; development of specific care packages for lower socioeconomic groups; promotion and support of intersectoral activities.

Delivery of Health Care↗
PubMed2003

Summary health statistics for U.S. adults: National Health Interview Survey, 2000.

OBJECTIVES: This report presents health statistics from the 2000 National Health Interview Survey for the civilian noninstitutionalized adult population, classified by sex, age, race and Hispanic origin, poverty status, and region of residence for chronic condition prevalence, health status and limitations in activity, health care access and utilization, health behaviors, and human immunodeficiency virus (HIV) testing. Also, health statistics by education, income, health insurance coverage, marital status, and place of residence are presented for health status and limitations in activity, health care access and utilization, health behaviors, and knowledge and attitudes toward HIV. SOURCE OF DATA: The NHIS is a multistage probability sample survey conducted annually by interviewers of the U.S. Census Bureau for the National Center for Health Statistics, Centers for Disease Control and Prevention, and is representative of the civilian noninstitutionalized U.S. population. Sociodemographic data are collected for everyone in the family during face-to-face interviews with adults present at the time of the interview. The health information for adults in this report was obtained from one randomly selected adult per family. HIGHLIGHTS: In 2000, 64% of adults 18 years of age and over reported excellent or very good health. Eighteen percent of adults under 65 years of age had no health insurance coverage, and 14% of adults did not have a usual place of health care. Eleven percent of adults had ever been told by a doctor or health professional that they had heart disease, and 20% had been told on two or more visits that they had hypertension. Nearly a quarter of adults were current smokers, and 22% were former smokers. Sixty percent did not engage in any leisure-time vigorous physical activity, and, based on estimates of body mass index, 35% were overweight and 21% were obese.

Activities of Daily Living↗
PubMed1998

[Community health promotion policy for women by health reports?].

It is the declared aim of any national health policy to assist in the development of life styles and environments, in cooperation with other institutions, that would promote the overall health of the population. The Federal German provincial ("Land") governments and municipal as well as county administrations have been preparing health reports for this purpose during the last few years. The question is whether these reports adequately ensure the promotion of health among women in particular. Our conclusion is that this is not yet the case. The purpose of the following article is to describe and assess the present state of the problem and policy formulation. To this end we evaluated and synopsized 16 provincial and urban reports via document analysis. The health reports show that, although they do include problem definitions in relation to the health situation of women, they fail to formulate health targets for them. The reports are neither coordinated with health policy executives, nor do public health administrations cooperate with any other sectors of the administration to formulate and translate into reality a policy that would promote the health of women. On assessing the health reports in respect of their ranking within the Public Health Action Cycle for a health-promoting policy we must conclude that in their present form they are unsuitable both for defining health promotion problems and for formulating health policies with particular reference to women as an important target group. These health reports, as they are now being prepared and presented, lack clear definition and orientation with regard to appropriate action.

Female↗