Child health: politics and priorities.
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Public health workforce: challenges and policy issues.
This paper reviews the challenges facing the public health workforce in developing countries and the main policy issues that must be addressed in order to strengthen the public health workforce. The public health workforce is diverse and includes all those whose prime responsibility is the provision of core public health activities, irrespective of their organizational base. Although the public health workforce is central to the performance of health systems, very little is known about its composition, training or performance. The key policy question is: Should governments invest more in building and supporting the public health workforce and infrastructure to ensure the more effective functioning of health systems? Other questions concern: the nature of the public health workforce, including its size, composition, skills, training needs, current functions and performance; the appropriate roles of the workforce; and how the workforce can be strengthened to support new approaches to priority health problems.The available evidence to shed light on these policy issues is limited. The World Health Organization is supporting the development of evidence to inform discussion on the best approaches to strengthening public health capacity in developing countries. WHO's priorities are to build an evidence base on the size and structure of the public health workforce, beginning with ongoing data collection activities, and to map the current public health training programmes in developing countries and in Central and Eastern Europe. Other steps will include developing a consensus on the desired functions and activities of the public health workforce and developing a framework and methods for assisting countries to assess and enhance the performance of public health training institutions and of the public health workforce.
Editorial↗
Control of Chagas disease in Brazil.
Chagas disease (South American trypanosomiasis) is a chronic but often fatal disease endemic throughout much of Latin America. Serological surveys suggest around 24 million people seropositive for the causative agent, Trypanosoma cruzi (Fig. 1), with over 65 million living in the endemic areas and at risk to infection. In Brazil, over 25 million people are considered at risk, and control of the disease constitutes one of Brazil's public health priorities. Treatment or vaccination against T. cruzi is impossible at the public health level because suitable drugs or vaccines are not available. But it is well recognized that transmission can be interrupted by eliminating the domestic vectors - blood-sucking reduviid bugs of the subfamily Triatominae. In Brazil, eradication of Triatoma infestans - the major domestic vector of T. cruzi - is now seen as a feasible target by the Ministry of Health. However, although other domestic vectors can also be controlled, they will retain their sylvatic ecotopes from which they can reinvade houses. In this article, Joao Carlos Pinto Dias explains the current Brazilian policy, high-lighting the successful elimination of T. infestans from much of the southern part of the country.
Journal Article↗
[Years of life lost by mortality: a component of the burden of disease].
INTRODUCTION: The register of death by cause, sex and age groups of residents in 1994 in Rio Grande do Sul (RS) and Santa Catarina (SC), two Brazilian southern states, were studied to calculate the years of life lost (YLL), one of the two components that summarize disability adjusted life years (DALY), in RS, SC and Brazil. METHODS: The methodology employed is the same used in the Global Burden of Disease study to quantify the mortality component (YLL) of DALY in the world. RESULTS: The results show that the greatest proportion and rates caused by Group II (Noncommunicable diseases), linked with more advanced stages of the epidemiological transition, in RS, SC and Brazil. But in both states and especially in Brazil, Group I (Communicable, maternal, perinatal and nutritional conditions) causes an important proportion of YLL. The Group III (Injuries) was the second more important group in RS and SC and the third in Brazil. Road traffic accidents are particularly important in SC, where the intentional injury rate is half than the one in RS. The leading causes of YLL were road traffic accidents, ischemic heart disease and cerebrovascular disease in SC, and ischemic heart disease, cerebrovascular disease and road traffic accidents in RS. CONCLUSIONS: Death certification in the southern region of Brazil has a complete coverage and miscoded death proportion is small, providing a reliable mortality information. DALY allow comparing fatal and nonfatal health outcomes to determine the importance of different diseases and to establish health priorities. DALY are also an useful tool to identify disadvantaged groups, target health interventions and provide information for social control of resource allocation.
Adolescent↗
Cardiovascular mortality in Korea: a country experiencing epidemiologic transition.
BACKGROUND: The pattern of morbidity and mortality of cardiovascular disease (CVD) changes with epidemiologic transition. An understanding of this pattern in rapidly developing countries might provide important clues for the understanding of the epidemiological trends in CVD mortality. The objective of this paper was to address the changing pattern of CVD mortality in Korea during the period 1984-1999, and to examine the significant changes in associated major risk factors for CVD over a similar period. METHODS: For the purpose of this study, three main categories in CVD were reviewed: hypertensive heart disease, ischaemic heart disease, and cerebrovascular disease (stroke). The analyses of mortality were based on nationwide mortality data published by the National Statistical Office from 1984 to 1999. All the mortality rates were adjusted for age using the direct method. Changes in major CVD risk factors (blood pressure, cigarette smoking, serum total cholesterol and diet) were also reviewed during similar periods. FINDINGS: During the 15-year period investigated, the age-adjusted mortality from CVD decreased markedly. It decreased by 57% in males (from 172.2 to 73.0/100,000) and 48% in females (from 135.5 to 70.2/100,000). The age-adjusted mortality from stroke decreased while the proportion of ischaemic strokes among total stroke deaths increased. The proportion increased about 5.2 times in men and 4.9 times in women. The age-adjusted mortality from hypertensive heart disease decreased markedly. It decreased by 92% in men (from 51.6 to 4.1/100,000) and 84% in women (from 34.1 to 5.3/100,000). Also the age-adjusted mortality from ischaemic heart disease increased significantly. In 1999, the rates for men and women were 11.9 and 7.5/100,000, respectively. These rates were 3.8 and 3.6 times higher than the rates in 1984 for men and women, respectively. The changes of CVD risk factors in Korea observed during a similar period were a decrease in hypertension prevalence, although still present at a high level, an increase in serum total cholesterol level and intake of total fat along with a high, although decreasing, prevalence of cigarette smoking. INTERPRETATION: The mortality changes in Korea are consistent with the change that occurs during the transition from the age of receding pandemics to the age of degenerative and man-made diseases. This study has indicated that the change of CVD mortality was closely associated with the change in CVD risk factors. In order to avert the ongoing epidemic of CVD in developing countries, prevention and treatment of modifiable risk factors must become a high health priority.
Adult↗
Labor's critical role in workplace health and safety in California and beyond--as labor shifts priorities, where will health and safety sit?
Organized labor has been largely responsible for the health and safety protections many U.S. workers take for granted. This article provides a brief history of labor's influence on California's health and safety policies--sometimes with ripple effects beyond its borders. Six cases where various successful strategies were used are examined. These gains were achieved with strong support from international health and safety staff, and, on some issues, support from the state labor federation. But in most cases local union staff involvement was key. Now that labor mobilizes to build its shrinking membership--with only 1 out of 12 workers in the private sector organized--resources are being re-directed toward organizing. Understandably, health and safety advocates have expressed concern that worker protections may suffer. Time will tell, but there is evidence that health and safety demands are front and center in a number of current and upcoming organizing campaigns. Now more than ever, it is in health and safety professionals' interest to tie their research and clinical work into these emerging campaigns.
Agricultural Workers' Diseases↗
Priorities in primary health care. The views of patients, politicians and health care professionals.
A written inquiry was undertaken to explore the expectations towards primary care physicians (general practitioners), as expressed by patients, local health board members and health centre staff members. Treatment without delay was given top priority both by patients and board members, while continuity of care was considered most important by the health care professionals. Great similarity of opinions was expressed by patients and health board members, while staff members differed significantly in their views. A low degree of participation in the study by the politicians coincided with the authors' experience of lack of interest in the content of primary health care shown by health board members.
Adolescent↗
An assessment of the effect of data collection setting on the prevalence of health risk behaviors among adolescents.
PURPOSE: To examine the effect of data collection setting on the prevalence of priority health risk behaviors among adolescents. METHODS: Analyses were conducted using data from two national probability surveys of adolescents, the 1993 national school-based Youth Risk Behavior Survey (YRBS) and the 1992 household-based National Health Interview Survey (NHIS/YRBS). Forty-two items were worded identically on both surveys. RESULTS: Thirty-nine of the 42 identically worded items (93%) showed that the YRBS produced estimates indicating higher risk than the NHIS. Twenty-four of these comparisons yielded statistically significant differences. The prevalence estimates affected most were those for behaviors that are either illegal or socially stigmatized. CONCLUSIONS: School-based surveys produce higher prevalence estimates for adolescent health risk behaviors than do household-based surveys. Each has advantages and disadvantages, and both can play a role in assessing these behaviors.
Adolescent↗
Implementation of a smoke-free policy on school premises and tobacco control as a priority among municipal health promotion activities: nationwide survey in Japan.
We conducted a nationwide survey to evaluate the effect of implementing a smoke-free policy in municipalities that forbid teachers to smoke on school premises. Questionnaires were mailed to 3207 municipalities throughout Japan. After we adjusted for population size and the standardized mortality ratio for male lung cancer, we found that assigning a high priority to tobacco control in municipal health promotion activities was significantly associated with implementation of school tobacco-control policies (odds ratio = 1.50, 95% confidence interval=1.24, 1.81).
Adolescent↗
Change in adult health following medical priority rehousing.
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Disability Evaluation↗
Cancer screening in older adults in an era of genomics and longevity.
OBJECTIVES: To provide an overview of cancer genomics and cancer screening in older adults with a focus on breast, prostate, and colon cancers. DATA SOURCES: Journal articles, research articles, and web sites. CONCLUSION: Cancer screening in older populations is often in the context of one or more co-morbid conditions, cancer survivorship, genomic information, and competing health priorities. The field of cancer screening has outgrown the tools available to enable health care providers and older adults to make informed cancer screening decisions. Research is needed to develop clinical screening tools that integrate age, cancer risk, life expectancy, and comorbidity. IMPLICATIONS FOR NURSING PRACTICE: Health care providers are faced with opportunities and challenges in the prevention and early detection of cancer in older Americans.
Aged↗
Building healthy tribal nations in Montana and Wyoming through collaborative research and development.
We describe a collaborative approach to reducing health disparities affecting Montana and Wyoming tribal nations while promoting health-protective practices and interventions among these populations. Under the auspices of the Montana-Wyoming Tribal Leaders Council, a consortium has undertaken activities to (1) establish the research infrastructure necessary for conducting ongoing health disparities research, (2) develop a target research agenda that addresses tribally identified priority health issues and tests the feasibility of interventions, (3) develop increased research skills and cultural competency through mentoring activities, and (4) develop effective collaborative relationships. All research projects are user-defined and -authorized, and participation is voluntary.
Health Promotion↗
Local health departments and the challenge of chronic disease: lessons from California.
The essential role local health departments have played in the control of infectious diseases has not been matched with an equivalent contribution in prevention of chronic diseases. Local health departments have attempted to define and build that capacity, but they have been confronted with budget cuts and competing public health priorities, most notably bioterrorism preparedness. This article is based on interviews with local health officials and describes some of the common ways local health departments in California have forged ahead to develop the capacity to engage in comprehensive approaches to chronic disease prevention in spite of the challenges. Additionally, the article highlights future considerations that need to be addressed if these promising trends in chronic disease prevention are to become more widespread.
California↗
Reconstructing a health system and a profession: priorities of Iraqi nurses in the Kurdish region.
To evaluate nurses' priorities for health system reconstruction and professional development in Iraq, a survey of 744 Iraqi nurses was conducted, with the research process managed via the Internet. Seven definite priorities emerged along with significant differences in priorities related to years of experience, age, speciality area of nursing practice, gender, level of education, and geographic location of practice. Results indicate that nurses should be included in health system reconstruction processes and that support for the development of the nursing profession should be included in the plan for overall reconstruction.
Attitude of Health Personnel↗
[Centralized purchasing of essential drugs, a priority for the health care systems of developing countries].
Health sector reform is a key priority of many governments throughout the world. Drug supply systems are a major element of public health policy design in Africa, where 90% of drugs are imported. The WHO Essential Drugs Program and the UNICEF sponsored Bamako Initiative have, since the late 1980s, promoted the rational use of essential drugs and attempted to ensure a sustainable drug supply through the implementation of cost recovery schemes and quality assurance mechanisms in public health services. A new market for drugs is emerging within this framework and there is growing competition for its control. Government medical stores are all too often bankrupt and the private sector is expensive, catering mainly for the middle to upper classes of urban areas. An intermediate alternative. Essential Drugs Purchasing Offices (EDPOs), has been proposed to balance social objectives and economic constraints. Some of the experimental strategies have given promising results. However, their implementation raises a number of questions: What is the role of the EDPO? Should it promote public health issues in general or focus purely on drug availability? What is the most appropriate legal status? Public or private? For profit or not? How should the investment capital be structured? In drugs or in funds? With ample provision or a tight budget? How should drug purchases be managed? Where should drugs be purchased? How much? How often? According to which procedures? How should the distribution of drugs be organized? Supplying everyone? Pushing supplies or pulling purchasers in? The answers to these questions, analysis of the reasons for success and failure and the dissemination of the information gathered should identify priorities for action and future research and define a framework for expansion. These are the objectives of the "Concerted Action for the Development of EDPO in Sub-Saharan African Countries" which is supported by the European Union (DG XII).
Africa↗
Prenatal knowledge and informational priorities of pregnant adolescents.
One hundred and forty-six indigent pregnant adolescents (12 to 18 years of age) were asked to complete a questionnaire concerning their prenatal care priorities (Scale I) and their knowledge of correct perinatal behaviors (Scale II). On Scale I, over 75% of teens considered parenting skills, infant care, and diet extremely important. On Scale II correctly answered items focused on the need to avoid substance abuse and smoking during pregnancy, visit the doctor, and eat balanced meals. The mean number of correct answers, however, was only 11.8 out of a total possible scale of 18 items. Less than 50% correctly answered statements about the effects of weight gain and other health behaviors on risk for high blood pressure and toxemia, safety of laxatives during pregnancy, possibility of becoming pregnant again before resuming menstruation, and the safety of various physical activities. Performance on both knowledge and health priority scales showed correct health information was limited to basic concrete facts. Abstract and technical aspects of health care did not appear to be easily assimilated.
Adolescent↗
Cultural barriers to cancer screening among African American women: a critical review of the qualitative literature.
There have been numerous studies demonstrating the enormous cancer burden for African American women and the impact of structural barriers in the dissemination of cancer control interventions. Few of these studies have dealt with the influence of cultural factors in the success or failure of intervention research. The purpose of this review is to provide a critical appraisal of qualitative studies that inform on social-cultural factors in cancer screening programs for African American women, and to evaluate the extent to which general methodologic criteria have been used in these studies. The article discusses the theoretical underpinnings of social science qualitative methodologies, including ethnography, hermeneutics, ethnomethodology, and symbolic interactionism. Published qualitative studies from 1980 to 1996 on cancer screening among African American women are critically reviewed. Among the themes identified were bruises as contributory to breast cancer development; the low priority women placed on personal preventive screening behaviors in the context of other family health priorities; and the importance of female friends, relatives, and social networks in the flow of cancer information. The importance of qualitative approaches to cancer prevention and control programs and policies is threefold: (a) collection of greater depth of information, (b) identification of processes and relations among behaviors, and (c) framing of variables and hypotheses for quantitative research. Greater emphasis on methodologic rigor will be necessary, however, if qualitative studies of cancer screening are to effectively inform the development of research, programs, and policies.
Black or African American↗
The diabetes health care of Aboriginal people in South Australia (Part 1).
Although type 2 diabetes is a recognised health priority in South Australia, Aboriginal people with diabetes do not utilise the mainstream diabetes health services on a regular basis for health care. This means that Aboriginal clients have the potential to develop diabetes-related problems and, furthermore, are not in a position to make informed decisions about health care issues. This lack of client empowerment is contrary to the goals of contemporary diabetes health care and, as a result, Aboriginal clients suffer the consequences of ineffective management with a compromised lifestyle. To identify how this situation might be improved, a qualitative study funded by Diabetes Australia was undertaken in South Australia. The overall goal was, firstly, to identify the reasons why Aboriginal people with diabetes do not attend mainstream health agencies on a regular basis and secondly, if possible, to improve attendance. Thus, Aboriginal health professionals (n = 43) were recruited from the 8 statistical divisions of South Australia and interviewed about Aboriginal diabetes health care issues. In Part 1 of this series, the research findings indicated the beliefs and attitudes held by clients about diabetes, their lack of knowledge about management issues, their responses to diabetes, the effects of diabetes on their lifestyle and the strategies that diabetes health professionals used to help their clients deal with diabetes health issues. In Part 2 the research findings indicated the importance of the Aboriginal health worker to the successful diabetes management of Aboriginal clients, the constraints that affect the delivery of diabetes health care and the recommendations made by health professionals to improve the standard of diabetes health services.
Australia↗