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PubMedDate not supplied

Crossing the public-private sector divide with reproductive health in Cambodia: out-patient services in a local NGO and the national MCH clinic.

Set within the context of recent literature on the private-public divide in the health sector of developing countries generally and Asia specifically, this study considers the major government and the major indigenous non-government clinics offering out-patient reproductive health services in Phnom Penh, Cambodia. Reproductive health is of critical importance in Cambodia, which has one of the highest levels of unmet need for family planning in the developing world and suffers from what is arguably the most severe STD and HIV/AIDS problem in Asia. The study is unusual in that it examines and compares aspects of service delivery and pricing along with the socio-economic profile and health-seeking behaviour of clients self-selecting services in the two settings. The socio-economic status of clients was much higher than the norm in Cambodia but did not differ significantly between the two clinics. A few service indicators suggested that the quality of care was better in the NGO clinic. Underlying variables--such as the broader mandate of the public sector institution and the significant discrepancy between public and private sector salaries--offer an obvious explanation for these differences. The Ministry of Health in Cambodia has been developing policies related to the NGO sector, which has expanded rapidly in Cambodia during the 1990s, and it is struggling to increase staff remuneration within the public sector.

Adult↗
PubMedDate not supplied

Public health surveillance for chronic conditions: a scientific basis for decisions.

In this paper we investigate the important contribution of multiple public health surveillance systems to policy in chronic disease control and prevention. We show that, typically, surveillance for chronic diseases relies on multiple data sources, often created for another purpose. We also define the concept of burden for chronic conditions based on data from multiple sources. An example from a state illustrates a model for combining data for use in policy development. These applications illustrate the central role of statistical methods in ensuring the appropriate use of data from multiple surveillance systems.

Cardiovascular Diseases↗
PubMed2000

The greying world: a challenge for the twenty-first century.

As we approach the next millennium, an unprecedented rapid increase of total and relative numbers of older persons in both the developed and the developing world is being observed. The total aged population (aged more than 60 years) world-wide will rise from 605 million in the year 2000 to 1.2 billion in 2025. Population ageing is due to two factors: increased life expectancy and decreasing fertility rates. Public health interventions are major contributor to both. A significant consequence of ageing is the shift from communicable to non-communicable diseases. The World Health Organization (WHO) is addressing the multiple challenges posed by population ageing through integrated activities that include consolidation of databases, capacity building (research and training), advocacy and policy development. These are all approached through WHO perspectives on ageing and health: life-course, health promotion, socio-economic, community based, intergenerational, cultural, gender and ethical.

Aged↗
PubMedDate not supplied

A legal primer on affirmative action in nursing education.

Affirmative action policies are under challenge. To date, judicial concerns must be understood historically. The legal question is to define the conditions under which racial categories may be used for remedial or beneficial purposes to overcome the effects of past discrimination. Beyond exercising strict scrutiny over the use of racial classifications, courts have supported the diversification of academe. For nursing programs, the challenge is to develop policies and procedures to broaden participation without reliance on racial categories. The benefits of diversifying the nursing work force need not be discarded in response to judicial and political reaction to affirmative action.

Civil Rights↗
PubMed1993

Genetic screening technology: ethical issues in access to tests by employers and health insurance committees.

Whereas the introduction of new technologies previously has raised the ethical question of who ought to have access to a new procedure or device, genetic testing technology raises the new ethical question of to whom access to a new technology ought to be limited. In this article we discuss the implications of employers and private health insurance companies having access to genetic testing technology. Although there may be legitimate business interests in allowing employers and insurers to conduct genetic screening, there are other valid societal interests in regulating or limiting the use of this technology by third parties. Public policy developed in the area of new genetic technology must reflect such interests.

Employment↗
PubMed2006

Implementing national population-based action on physical activity--challenges for action and opportunities for international collaboration.

This paper summarises recent past and current international developments on physical activity looking at the challenges and opportunities they pose. Key elements of the WHO's Global Strategy on Diet, Physical Activity and Health (GSDPAH) are summarised, focusing specifically on the physical activity components, and by drawing upon recent fora (Atlanta, October 2002; Miami, December 2004; Cascais, February 2005; Beijing, October 2005; Bogotá, November 2005), we outline the barriers and areas of support required for successful development and implementation of national, population-based action on physical activity. These gatherings focused particularly on the needs of developing countries, where to date little has been done to augment physical activity at a population level. Unless swift action is taken, these countries will soon suffer significantly from an increased prevalence of non communicable diseases (NCD). Existing initiatives and opportunities for national and international action on physical activity are identified. Specific actions are proposed for advocacy, communication and dissemination, networks and partnerships, fundraising, policy development and implementation, programme implementation and evaluation, surveillance and capacity building. The development of the Global Alliance for Physical Activity (GAPA) provides a structure for international collaboration.

Developing Countries↗
PubMed1991

Establishing incidence and administrative protocols for do not resuscitate orders.

An order not to resuscitate refers only to CPR and does not imply the omission of any other type of medical care. Institutional DNR policies should include specific statements reflecting resuscitation for those without DNR orders, the patients' wishes, medical conditions, roles of family, protocol describing the process for DNR orders, scope of DNR orders, and frequency of review of DNR orders. The most common reasons for not having written DNR protocols were that directors of nursing did not have guidelines for or did not feel qualified to develop policies, and that they were not sure of the legal implications of such policies. An interagency ethics committee can serve as an advisory committee, but all medical and nursing decisions should be made by the appropriate professional, based on agency policy.

Clinical Protocols↗
PubMed2004

Do physicians follow systemic treatment and funding policy guidelines?

BACKGROUND: The use of bisphosphonates for the prevention of skeletal related events in women with bone metastases from breast cancer is well established. We undertook an evaluation of bisphosphonate use in clinical practice in three Canadian cancer centres. In addition we assessed whether or not physicians at these centres are following their local treatment guidelines and funding policies. METHODS: Charts and electronic files of patients who had received either clodronate or pamidronate at any time between January 2000 and December 2001 at three Canadian cancer centres were retrospectively reviewed. RESULTS: There has been a marked improvement in the time between the diagnosis of bone metastases and the commencement of bisphosphonates from a median of 155 days in 1998 to 24 days in 2001. However, despite a local funding policy requiring that oral clodronate be the first bisphosphonate used, this was the case in only 67% of patients. In addition, despite one centre's guidelines recommending that bisphosphonates be stopped once the patient was progressing, 90% of their patients remained on bisphosphonates until they died. CONCLUSIONS: A considerable amount of effort is spent on the creation of "evidence based" treatment guidelines. Funding agencies develop policies based on these treatment guidelines, but often funding is more restrictive than the treatment guideline would suggest. It is clear from this review that physicians still appear to manage a substantial proportion of patients outside of funding policies, but within evidence based recommendations. Therefore, a need exists for either the creation of guidelines and policies that physicians will follow or the implementation of methods to ensure that restrictive policies are actually followed.

Adult↗
PubMed2004

Developments in National Physical Activity Policy: an international review and recommendations towards better practice.

Physical activity (PA) is increasingly considered an important public health issue and as such requires the development of good public health policy. This paper provides a summary of the literature on policy development and defines what a policy on PA may usefully comprise. The results of an international review of national level PA policies, using a defined set of criteria, are reported. Considerable similarities were found in the methods and approaches to policy development on PA across countries, with most adopting an intersectoral approach, with consultation and partnership between sectors occurring at a high level of government. The need for action across the lifespan is recognised, as is the need for multiple strategies across a variety of settings. A review of Australian PA policy found that, after promising strategic developments through Active Australia in the late 1990s, PA policy and the role of the federal health sector has become less clear, with PA policy existing now only as a component part integrated into other chronic disease prevention policy initiatives. Recommendations towards better practice in policy making are made with particular reference to developing a clearly defined integrated national PA policy in the Australian context.

Australia↗
PubMedDate not supplied

Rural women's credit systems: a Nigerian example.

The following article looks in detail at a rotating credit system used by rural women of Nigeria. This system, which women use to ensure the availability of cash to meet their family's financial needs, has analogues throughout the world. This close study of behavior--in this instance, about how women form groups to save and why--reveals rural women's roles in the family and the economic priorities created by these roles. This kind of information, rarely recorded or attended to, is an indispensable base for learning about how women are affected by and affect development policy. Further, understanding the mode of operation of this credit system and its value to the women who organized it provides guidance for the design the projects that work and are meaningful to women.

Accounts Payable and Receivable↗
PubMed1995

Setting priorities and selecting topics for clinical practice guidelines.

Setting priorities and selecting topics are important steps in guidelines development, but they have received relatively little attention to date. Responses from a survey of guidelines stakeholders in Canada suggest that the health burden of a clinical condition on the population is an important factor in priority setting. Economic considerations, cast as either costs of treatment to the health care system or the economic burden of illness to society, are given varying importance by different stakeholder groups. Drawing on the literature and the survey results, the authors propose a framework for priority setting. Important issues requiring consideration include the role of public and community participation, the need for and appropriate emphasis on quantitative data regarding current practice and its variation, and mechanisms to link guidelines to health-policy development and management of the health care system.

Canada↗
PubMed1994

Equitable distribution in pediatric heart transplantation. Arguments in favor of a national list.

The disparity between the supply and demand for pediatric donor hearts remains the major constraint in pediatric heart transplantation. This disparity draws attention to the importance of an equitable distribution policy for pediatric hearts. An examination of the policy on pediatric heart distribution shows that although a governmental task force recommended that these organs be allocated according to a national list, the current policy, developed by the United Network of Organ Sharing, emphasizes the local distribution of pediatric hearts. The decision to allocate organs locally was based on both theoretical and practical concerns about national distribution. In analyzing these concerns, we conclude not only that a national list may be a more equitable means of distribution but also that the arguments against a national list no longer justify a policy favoring local distribution. We suggest, therefore, that the time has come to reconsider implementation of a national list for pediatric heart distribution.

Child↗
PubMed2004

An addiction agency's collaboration with the drinks industry: Moo Joose as a case study.

AIM: This paper analyses a partnership between an addiction agency and the drinks industry in Australia, with special reference to concerns held by public health advocates for such projects. METHOD: Public health anxieties regarding collaboration between the drugs sector and the drinks industry are identified. A projected partnership between the Alcohol and Drug Foundation--Queensland (ADFQ) and the liquor industry in Australia is reviewed. The partnership involves the creation of a new organization, Alcohol Education Australia Ltd. (AEA), which states as its aim the education of consumers in responsible drinking. In order to assess the impact of the partnership an examination is undertaken of the AEA's stated mission and objectives, of relevant policy development by ADFQ and of ADFQ's intervention in support of an alcohol manufacturer which was putting a case to a licensing authority. FINDINGS: The results indicate the partnership advances the interests of the drinks industry rather than public health. The mission and objectives of Alcohol Education Australia Ltd subordinate public health goals to industry aims and the host organization, the ADFQ, has changed its policy and practice to accommodate the drinks industry. CONCLUSION: The partnership between the ADFQ and the drinks industry indicates the difficulty faced by addiction organizations in maintaining an uncompromising public health orientation when in partnership with the alcohol industry.

Alcohol Drinking↗
PubMed2000

Toward totally smokefree schools and beyond: the Crown Public Health Smokefree Schools Grant Program.

A three-year small grants scheme in Canterbury and the West Coast, New Zealand aims to influence the health promoting climate of schools by adopting totally smokefree policies. The Smokefree Environments Act of 1990 established the legal imperative for school policies. The principles of the Treaty of Waitangi and the strategies of the Ottawa Charter provide the programmatic and evaluation framework. Evaluation indicators include the organizational and policy context, status of school smoking policies, reasons for participation, stakeholder involvement, the value of additional funding, and the extent of media coverage. Partnerships among local smokefree partners, schools and whanau/communities, and between the health and education sectors are a priority. Interim findings indicate the Crown Public Health Smokefree Schools Grant program has positively influenced policy development toward totally smokefree schools. Based on these results and the changing environment, the smokefree efforts are being integrated into the broader context of health promoting schools.

Adolescent↗
PubMedDate not supplied

National service frameworks: what are they?

This article describes policy developments surrounding the creation of national service frameworks. The national service framework for mental health is used as an example to highlight the content of the framework and the way it has been received.

Evidence-Based Medicine↗
PubMed1988

Designing health insurance information for the Medicare beneficiary: a policy synthesis.

Can Medicare beneficiaries make rational and informed decisions about their coverage under the Medicare program? Recent policy developments in the Medicare program have been based on the theory of competition in medical care. One of the key assumptions of the competitive model is the free flow of adequate information, enabling the consumer to make an informed choice from among the various sellers of a particular product. Options for Medicare beneficiaries in supplementing their basic Medicare coverage include the purchase of private supplementary insurance policies or enrollment in a Medicare HMO. These consumers, in a complex health insurance market, have only limited information available to them because many health plans do not make adequate comparable product information available. Moreover, since the introduction of the Medicare HMO option, the long-range plan for management of the Medicare budget has become based on the large-scale voluntary enrollment of beneficiaries into capitated health plans. The policy instrument that has been used to improve beneficiary decisions on how to supplement Medicare coverage is the informational or educational program. This synthesis presents findings regarding the relative effectiveness of different types of health insurance information programs for the Medicare beneficiary in an effort to promote practical use of the most effective types of information.

Community Participation↗
PubMed2006

The Calman-Hine report: a personal retrospective on the UK's first comprehensive policy on cancer services.

Calman-Hine was the first comprehensive cancer report to be produced in the UK, and set out principles for cancer care and the clinical organisation for service delivery. It advocated a change from a generalist model (eg, care given by general surgeons and physicians) that was supported by specialists to a fully specialist service. The process of policy development was innovative and the report was accepted widely throughout the UK. However, implementation, which began at a time of organisational change across the UK National Health Service (NHS), was not addressed sufficiently in the years immediately after publication. Consequently, change was more variable both geographically and within a single location and took longer than necessary. Evidence from research, routine data, and external assessments suggest that the policy was eventually successful and a worthwhile change. Well thought out and sustained mechanisms for policy implementation are as crucial as well-designed policies, and government health reforms can conflict with specific policies for quality improvement.

Health Policy↗
PubMed1996

Deaths related to Hurricane Andrew in Florida and Louisiana, 1992.

BACKGROUND: Information about circumstances leading to disaster-related deaths helps emergency response coordinators and other public health officials respond to the needs of disaster victims and develop policies for reducing the mortality and morbidity of future disasters. In this paper, we describe the decedent population, circumstances of death, and population-based mortality rates related to Hurricane Andrew, and propose recommendations for evaluating and reducing the public health impact of natural disasters. METHODS: To ascertain the number and circumstances of deaths attributed to Hurricane Andrew in Florida and Louisiana, we contacted medical examiners in 11 Florida counties and coroners in 36 Louisiana parishes. RESULTS: In Florida medical examiners attributed 44 deaths to the hurricane. The mortality rate for directly-related deaths was 4.4 per 1 000 000 population and that for indirectly-related deaths was 8.5 per 1 000 000 population. In Louisiana, coroners attributed 11 resident deaths to the hurricane. Mortality rates were 0.6 per 1000 000 population for deaths directly related to the storm and 2.8 for deaths indirectly related to the storm. Six additional deaths occurred among non-residents who drowned in international waters in the Gulf of Mexico. In both Florida and Louisiana, mortality rates generally increased with age and were higher among whites and males. CONCLUSIONS: In addition to encouraging people to follow existing recommendations, we recommend emphasizing safe driving practices during evacuation and clean-up, equipping shelters with basic medical needs for the population served, and modifying zoning and housing legislation. We also recommend developing and using a standard definition for disaster-related deaths, and using population-based statistics to describe the public health effectiveness of policies intended to reduce disaster-related mortality.

Adolescent↗