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PubMedDate not supplied

Behavior, lifestyle, and socioeconomic variables as determinants of health status: implications for health policy development.

Health promotion has become an official health policy of this country, and it is being pursued through efforts to change individuals' health-related behavior. This approach is based on the assumption that it is in fact an individual's behavior that most directly determines his or her health status. But how good is the evidence that supports this assumption? Specifically, is the evidence sufficient for this assumption to outweigh the long-standing finding that social and economic conditions have a strong relationship to health status? The major support for the behavior approach derives from the coronary heart disease risk-factor studies and the Alameda County Study. In a series of reports over time, the relationship between individuals' health practices and their health status generally, as well as that between heart disease and cancer specifically, have been established by these studies. These observations, however, have not been confirmed when deliberate efforts have been made to change those practices. The evidence in support of the importance of social and economic conditions to health status has been documented through a long series of studies in this country, which have found a direct relationship between individuals' socioeconomic status and their health status. This relationship, however, has not in this country been tested by intervention. Only a few studies have examined the interrelationship between these two approaches to health promotion, but the evidence to date has failed to suggest that either one is the mediator of the other. We must, therefore, conclude that pursuing a policy of health promotion based on either approach to the exclusion of the other would indeed be short-sighted health policy.

Cardiovascular Diseases↗
PubMed1980

The determinants of Canadian health policy.

Because health policy is the result of a tremendous variety of shifting forces, it is necessary to be eclectic in the approach used to study it. Analyzing the Canadian case in this broad perspective reveals that the influence of ideological and institutional forces, and principal actors is more important than most commentators believe, and that the dynamism in health policy formulation has resulted in a great deal of internal conflict as well as politicization and provincialization.

Canada↗
PubMed1982

Ideology: social policy, health and health services: a field of complex interactions.

As in any area of socio-economic reality, ideological interpretations influence our understanding of matters to health and health policy. Ideologies simplify and fudge issues. Yet ideologies, social movements and social research relate to each other in complex ways, and there are also innovative and creative aspects to this relationship. After a brief general discussion of ideologies, the paper examines the significant insights gained from analysing the role of ideologies (dominant, radical and subordinate) in class societies: much of this is relevant, by analogy, to the field of health. Various explanations of health and ill-health are then discussed. While capitalist socio-economic organization has undoubtedly had negative health effects, capitalist societies are neither as uniform nor as unreformable as Marxist analysis (and ideology) suggests. Similarly, there is exaggeration in Illich's description of the ills of industrialism. Yet his concept of the medicalization of health helps to understand how the dominant conception of medicine and ideologies dominant among health professionals interact to create institutions--also in wider areas of health planning--that express the power of physicians and benefit elites. These effects are particularly acute in capitalist societies. As for the problems and achievements in health of so-called socialist countries, these are frequently presented through rose-coloured spectacles, thereby hindering a realistic assessment of alternative policies for moving towards Health for All by the Year 2000, WHO's current organizing make-shift and contradiction, especially with regard to the ideas of 'political will' and 'community participation'. The paper ends with a discussion of the latter concept. In practice this may mean little more than co-option and contribution, or it may give people a genuine chance to influence what deeply affects them. It does not help to erase such fundamental differences by the ideological language of international compromise.

Health Policy↗
PubMed2006

Representation strategies in public participation in health policy: the Aboriginal Community Health Council.

Within Canada's Aboriginal population, an ongoing health promotion strategy has been the facilitation of community participation in the development and application of health policy. The Calgary Health Region's Aboriginal Community Health Council has provided a setting for involving the local Aboriginal population in health policy and program development for over a decade. This paper represents the results of a case study to identify the Council's strategies for this work. Data sources included documents, such as meeting minutes and other reports; key informant interviews with past and present Council members and health region representatives; and participant observation of Council functions. Although direct membership in the Council provided a core approach for representing the community, other strategies were actively utilized to involve the public. These included building links and partnerships with community organizations, networking, consultation activities and the identification of special needs groups.

Canada↗
PubMed1998

Alcohol, cardiovascular diseases and public health policy.

Public health policy should aim to reduce the harm done by alcohol use, whilst recognizing its real and perceived benefits. The reduced risk of coronary heart disease (CHD) with the consequent reduction of mortality for some people in older age is one such benefit. The increased risk of sudden coronary death from acute alcohol intoxication is one such harm. A number of policies have been demonstrated to be effective in the reduction of the harm done by alcohol use, at least in industrialized countries. These are: enforcement of a minimum drinking age; drink-drive deterrence; enforced prevention of intoxication in public drinking places; controls on access to alcohol, including restrictions on numbers of licensed premises and hours and days of sale; and taxation policy to regulate the affordability of alcohol. Many of these strategies seem unlikely to have a direct effect on drinking relevant for reduced risk of CHD, but are likely to have a direct beneficial effect on drinking relevant for sudden coronary death. The level of alcohol consumption associated with the lowest mortality rate for a population will vary depending on patterns of ill health and causes of death. In countries with high rates of CHD the per capita level may be in the order of about three litres of absolute alcohol per year among drinking adults. In countries with low rates of CHD, the level is likely to be substantially lower. Many countries in which alcohol is readily available are consuming at a level substantially above three litres per capita of drinking adults per year and in these countries public health policy should continue to advise action to reduce per capita consumption.

Adult↗
PubMed1993

A review of Fife's food and health policy.

Fife Health Board published its food and health policy in May 1986, introduced a board-wide food and health strategy in 1987, and carried out a comprehensive review of its implementation in 1990. Other health boards currently considering their strategies may benefit by learning from Fife's experience. A number of base-line studies were carried out between 1987 and 1989 before the policy was implemented. Further surveys have monitored progress. Positive features of the programme included the introduction of a comprehensive food and health policy throughout the health board, the establishment of base-line measurements for future outcome evaluation, and the enthusiastic support of a wide range of people. Negative features included some opposition from a number of health service staff to its introduction, lukewarm support from public leaders for its proposed public launch, and a patchy response from the education sector. Although it is still too early to be confident of the success of policy in terms of outcome measures, there is some evidence that the first phase of its introduction may have had some success within the health service. Alternative strategies are now required to tackle some of the areas where the introduction was less successful.

Community Health Services↗
PubMed2003

[What does prevention and rehabilitation research contribute to health policy?].

Rational health policy calls for a close collaboration between health-related political organizations and scientific communities, in particular public health sciences and health economics. Based on selected examples, this contribution highlights the benefits of primary and secondary prevention measures with re-spect to two widely distributed chronic diseases, coronary heart disease and depressive disorders. These examples refer to (1) lifestyle changes in secondary prevention of coronary heart disease, (2) theory-based measures of worksite health promotion, and (3)early detection and optimised treatment of depressive disorders. The relevance of interdisciplinary research on prevention and rehabilitation is emphasized by increasing pressures that arise from the current health care system.

Cooperative Behavior↗
PubMed1997

Health policy as a fuzzy concept: methodological problems encountered when evaluating health policy reforms in an international perspective.

Investigating health policy reforms at a national level is a troublesome task, since it is difficult to establish exactly when a certain policy change took place and it is also difficult to determine the content of the reform. In this paper three main causes are distinguished that contribute to the 'fuzziness' surrounding reforms. Firstly, ordinary mistakes occur, even experts err. Secondly, in some countries responsibility for (part of the) health care system is delegated to the regional level, causing regional variations which lead to uninterpretable effects at country-level health care system descriptions. Thirdly policy reforms are often not a straightforward process. Implementations can be characterized as a gradual process which can be disturbed at any point in time. For example, the use of framework legislation, effects of public discussions and law enforcement problems contribute to the fuzziness. To strengthen the validity of information from secondary sources (often the best available and linguistically accessible sources) the use of primary sources and expert consultation highly recommended, respectively giving insight in formal rules and initial intentions of policy measures and in the impact of reforms at performance level. The fuzziness can be captured into an index (reform implementation index), containing the gathered information and thus facilitating statistical analyses controlling for process-information.

Belgium↗
PubMed1997

Worry about health status among the elderly: patient management and health policy implications.

Health care reform depends on reducing inappropriate utilization and improving access. Elderly people, major consumers of primary care, are a place to begin reforms, but progress has been slow. We combined primary care screening questions for objective (medical condition as wellness) and subjective (perception of health as worry) health in a study of 767 elderly people in Youngstown, Ohio. The worried well (31.2%), a group likely to consume medical care inappropriately, and unconcerned ill (4.4%), a group likely to avoid seeking necessary medical care, account for more than one-third of the elderly. The unconcerned well (57.0%) and worried ill (6.9%) pose fewer problems. Family physicians can predict utilization and access problems for targeted groups (older people, minorities, and women), along with health beliefs and other indicators of health status. Although findings in this study are preliminary, they do point to positive uses in health policy and patient management. Extensive usage of the sure would require financial reimbursement to health care providers.

Aged↗
PubMed1993

National health policy: back to the future. Ad Hoc Committee on National Health Policy American Speech-Language-Hearing Association.

After an extensive review of the literature and discussion of both national and state proposed health plans, the committee arrived at the following conclusions: 1. The issues that prompted development of the 1971 American Speech-Language-Hearing Association's (ASHA) Position Statement on National Health Care have not been resolved or altered. 2. Few significant national health plans or policies are being supported by the Bush Administration other than managed-care plans. 3. A national health policy will be driven by the development of state health policies and plans. 4. Implementation of national or state health plans will affect both professions at all service provision sites, including public schools. 5. Five general models apply to all existing or proposed national and state health policies or plans: single payer (e.g., a Canadian-style plan) minimum basic benefits ("play or pay") expanded Medicare or Medicaid benefits rationed healthcare (e.g., Oregon plan) managed care (e.g., health maintenance organizations) 6. There will be continued efforts to eliminate Medicaid mandates. 7. ASHA needs to advocate for the inclusion of rehabilitative services as basic rather than optional services in all health plans. 8. ASHA must advocate for adequate access to quality care regardless of healthcare or education provider setting.

American Speech-Language-Hearing Association↗
PubMed1989

The health status of Cuba: recommendations for epidemiologic investigation and public health policy.

The health status of Cuba is described in comparison with Costa Rica and, in some instances, the United States. Recommendations are made for epidemiologic studies and for specific health policies to lower death rates from diarrhea and enteritis, cardiovascular disease, cancer, and injuries. Rapid expansion of training and research in epidemiology and biostatistics is emphasized, and specific goals for health outcomes for the year 2000 are suggested.

Adolescent↗
PubMed2001

[Policy science and health policy].

Policy science provides the analytical frameworks to examine (1) the process of policy formation and implementation (Issue definition, Agenda setting, Alternative development, Decision and implementation, and Appraisal); (2) the initial and final shapes of policy content (Temporal and special distribution of costs and benefits, Selection of administrative organizations, and Choice of instruments to secure policy compliance); and (3) the effects and efficiencies of policy (Expected and unexpected effects of policy, beneficial and adverse ones). These three aspects are closely associated, and determine the functions of policy in society. Overseas, the application of policy science framework to health issues has thus far produced substantive knowledge which helps to improve both the policy making and policy designs, and at the same time, has provided good opportunities on which the workings of health and policy, both at the social and individual levels, are explored. The paper first outlines the themes and frameworks of political science, and then, introduces their application to the field of health. Issues associated with human life and health have special characteristics that distinguish them from those of other market commodities: special values placed on life and health, information inequality between service providers and consumers, and externalities, leading to a variety of moral hazards and market failures. Furthermore, there are some conflicts in values and technical opinions in society, regarding both the ends and means of health policies. In addition to the main topics in the field, empirical studies, from Japan or from other countries, are also summarized. Finally, future research needs and expectations are addressed.

Efficiency, Organizational↗
PubMed2002

Correctional health care: implications for public health policy.

"Correctional Health Care: Implications for Public Health Policy" is the first in a series of articles that examines the special health care needs of persons who are incarcerated in America's correctional facilities. The intent of the series is to gain a better understanding about the unmet health needs of incarcerated persons, the importance of addressing the health service delivery system in correctional facilities, and the implications that may arise from neglecting to address these health issues on health outcomes for individual detainees and society at-large when detainees transition back into the community. This article provides a descriptive overview of the corrections population, their sociodemographics, health care needs, and health concerns that are in need of improvement. This article also offers recommendations for public policy consideration to improve the overall health of inmates and society at large.

Health Policy↗
PubMed1992

Epidemiology and Health for All. The role of epidemiology in a health policy.

World Health Organization's goal Health for All is the starting point for a most ambitious health policy ever. The paper analyzes the role of epidemiology in the Organization's work, particularly in the Health for All development. During WHO's early years, epidemiology helped to design and carry out major public health campaigns against such scourges of the humanity as yaws, tuberculosis, malaria and small pox. When the Organization during the 1960s began to emphasize the need to develop the infrastructure of health care, health services research partly replaced epidemiology as WHO's main scientific allay. After the Health for All policy was launched in 1987, epidemiology has again played a major role in establishing the scientific background of the policy. The European experiences show how the epidemiologists can help WHO to identify the most important health problems and set achievable and measurable targets for them. The paper concludes that epidemiology serves to identify problems, show ways to solve them, monitor the changes in the situation and evaluate the achievements.

Epidemiology↗