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PubMed1996

The meaning of older adults' health appraisals: congruence with health status and determinant of mortality.

This study explored open-ended responses regarding attributions underlying health appraisals made by older adults, resulting in five categories (physical health, attitudinal/behavioral, externally focused, health transcendence, nonreflective). The older the respondents, the less likely they were to focus on physical aspects of their health. Health optimists were the most likely to make attitudinal/behavioral or health transcendent attributions, while poor-health realists were most likely to mention physical health aspects and least likely to make attitudinal or behavioral attributions. While poor-health realists were at the highest risk of dying within a three-year period, health optimists were significantly less likely to die than poor-health realists, in spite of sharing similar health status. Respondents who were unable to identify underlying attributions were significantly more likely to die than were those identifying any other attribution. In conclusion, health attributions provide unique insight into the complex relationship between older adults' health appraisals, health status, and mortality.

Age Factors↗

PubMed1998

Self-rated health and adverse health outcomes: an exploration and refinement of the trajectory hypothesis.

OBJECTIVES: To examine the hypothesis that the relationship between poor self-rated health and adverse health outcomes simply reflects self-assessments of declining health trajectories rather than current health status. METHODS: A 12-month follow-up of 786 disadvantaged adults aged 50-99 years old was conducted. Baseline markers of poor self-rated health and declining health trajectory were used to predict 12-month follow-up reports of the expectations of being hospitalized within one year, being placed in a nursing home within five years, and dying within ten years. Hierarchical multivariable logistic regression was used with poor self-rated health entered first, standard epidemiologic covariates entered next, and declining health trajectory entered last. RESULTS: Poor self-rated health was not independently associated with expectations for being hospitalized, but declining health trajectory independently increased the risk of such expectations by 65-88%. Neither poor self-rated health nor declining health trajectory were independently associated with expectations for being placed in a nursing home, but both were independently associated with expectations for dying, increasing such expectations by 70-105%. DISCUSSION: The relationship between poor self-rated health and adverse outcomes is not a simple reflection of unmeasured self-assessments of impending decline or doom. Rather, the effects of poor self-rated health and declining health trajectory appear to be independent and complementary.

Aged↗

PubMed2005

Racial and ethnic differences in the mental health problems and use of mental health care.

OBJECTIVES: We compared rates of mental health problems and use of mental health care across multiple racial and ethnic groups using secondary data from a large, nationally representative survey. METHODS: We pooled cross-sectional data from the 2001-2003 National Surveys on Drug Use and Health. Our sample included 134,875 adults classified as white, African American, American Indian/Alaskan Native, Asian, Mexican, Central and South American, Puerto Rican, other Hispanic-Latino, or those with multiple race and ethnicities. For each group, we estimate the past year probability of: (1) having 1 or more mental health symptoms in the past year, (2) having serious mental illness in the past year, (3) using mental health care, (4) using mental health care conditional on having mental health problems, (5) reporting unmet need for mental health care, and (6) reporting unmet need for mental health care conditional on having mental health problems. RESULTS: We found significantly higher rates of mental health problems and higher self-reported unmet need relative to whites among American Indian/Alaskan Natives and lower rates of mental health problems and use of mental health care among African American, Asian, Mexican, Central and South American, and other Hispanic-Latino groups. These differences generally were robust to the inclusion of clinical and socio demographic covariates. CONCLUSIONS: Overall, our study shows wide variation in mental health morbidity and use of mental health care across racial and ethnic groups in the United States. These results can help to focus efforts aimed at understanding the underlying causes of the differences we observe.

Adult↗

PubMed2006

Improving the health of people with intellectual disabilities: outcomes of a health screening programme after 1 year.

BACKGROUND: People with intellectual disabilities (IDs) have a higher level of health needs, a higher level of which is unmet, compared with the general population. Health screening can detect unmet health needs, but it is unknown whether it effects beneficial health outcomes in the longer term. People with IDs are reliant on health management by proxy and there are many potential access barriers that may prevent health needs identified at screening from subsequently being met. This study aims to determine whether health gains can be detected 1 year after a health screening programme specific to the needs of adults with IDs. METHODS: A total of 50 participants offered the health screen intervention were individually matched for gender, age and level of IDs with 50 control participants who received standard treatment only. Outcome measures after 1 year were semi-structured review of medical case notes, and semi-structured assessment with the people with IDs and their carer. RESULTS: During the 1-year period, the incidence of health need detection was more than twice as great for intervention, compared with control participants (mean number of new needs was 4.80 compared with 2.26; P < 0.001), and the level of met new health needs was greater (mean of 3.56 compared with 2.26; P = 0.001). The level of met health promotion needs was also greater (P < 0.001), and more health monitoring needs were met for intervention compared with control participants (P = 0.039). CONCLUSIONS: This is the first study to demonstrate sustained benefits in health outcomes from a clinical intervention for adults with IDs compared with standard treatment alone. Its routine implementation is feasible, and would reduce health inequalities.

Adult↗

PubMed2004

Embodied health movements: new approaches to social movements in health.

Social movements organised around health-related issues have been studied for almost as long as they have existed, yet social movement theory has not yet been applied to these movements. Health social movements (HSMs) are centrally organised around health, and address: (a) access to or provision of health care services; (b) health inequality and inequity based on race, ethnicity, gender, class and/or sexuality; and/or (c) disease, illness experience, disability and contested illness. HSMs can be subdivided into three categories: health access movements seek equitable access to health care and improved provision of health care services; constituency-based health movements address health inequality and health inequity based on race, ethnicity, gender, class and/or sexuality differences; and embodied health movements (EHMs) address disease, disability or illness experience by challenging science on etiology, diagnosis, treatment and prevention. These groups address disproportionate outcomes and oversight by the scientific community and/or weak science. This article focuses on embodied health movements, primarily in the US. These are unique in three ways: 1) they introduce the biological body to social movements, especially with regard to the embodied experience of people with the disease; 2) they typically include challenges to existing medical/scientific knowledge and practice; and 3) they often involve activists collaborating with scientists and health professionals in pursuing treatment, prevention, research and expanded funding. This article employs various elements of social movement theory to offer an approach to understanding embodied health movements, and provides a capsule example of one such movement, the environmental breast cancer movement.

Breast Neoplasms↗

PubMed2001

Health educators' role in promoting health literacy and advocacy for the 21st century.

This article discusses the relationship between health literacy and advocacy for health and health education, cites achievement of advocacy as a critical outcome of health education, and identifies health advocacy competencies for both students and health educators. The paper also delineates a role for health education in developing health-literate citizens and in training health educators to advocate for health and health education. The article draws on recent initiatives in comprehensive school health education and coordinated school health programs to identify content and strategies for developing health advocacy skills among elementary, middle, and senior high school students. The article provides a variety of approaches and strategies for developing advocacy skills among preservice and inservice health educators.

Consumer Advocacy↗

PubMed1996

Accounting for the public's health: an introduction to selected papers from a U.S. conference on "measuring social inequalities in health".

Accounting for, and being accountable to, the public's health requires carefully documenting and analyzing social inequalities in health. Controversies abound over which measures of socioeconomic position to use, at which points in time, and at what level-e.g., individual, household, and neighborhood. Important debates also concern how to analyze these data and relate them to inequalities involving race/ethnicity and gender. Addressing these complex issues is particularly timely in the light of persistent- and even widening- social inequalities in health. To improve tools for evaluating socioeconomic gradients in health, in 1994 the U.S. Public Health Service and National Institutes of Health sponsored a conference on Measuring Social Inequalities in Health. This introduction to the Section on Social Inequalities in Health introduces five articles presented by participants at the conference. Topics include: a historical review of efforts to measure socioeconomic inequalities in health in the U.S. between 1990 and 1950; income dynamics and health; measuring inequalities in health among nonemployed persons; analyzing links between racial/ethnic and socioeconomic disparities in health; and using neighborhood-based socioeconomic data in public health research. Together, these five articles point to a new emphasis on refining methodologies to assess relationships between social position and health and their expression in population patterns of social inequalities in health.

Ethnicity↗

PubMed1989

A commentary on "Achieving Health for All: a Framework for Health Promotion".

In November 1986, the Minister of National Health and Welfare released a discussion paper called Achieving Health for All: A Framework for Health Promotion. The aim of this document is to present a new vision for health in Canada and to propose health promotion as a process to improve health for all Canadians. A framework of health challenges, health promotion mechanisms and implementation strategies is presented as a model to guide health programs and policies. Achieving Health for All builds upon the concepts and principles of health and health promotion that have been developing in Canada and other countries over the last 10-15 years. This article reviews the strengths and limitations of the framework and suggests its use in conjunction with the Ottawa Charter for Health Promotion, which was released in November, 1986. Implications of the framework for The Canadian Dietetic Association and dietitian/nutritionists are also presented. Dietetic and nutrition professionals are challenged to become familiar with the concepts and principles of Achieving Health for All and to assume a leadership role in promoting food and nutrition programs and policies as part of this new vision for health for all Canadians.

Canada↗

PubMed2001

The Sandyford Initiative: creating added value to health and health care.

The Sandyford Initiative in Glasgow brings together Family Planning, Genitourinary Medicine and the Centre for Women's Health in a new partnership which aims to provide integrated health and social care in a manner which reflects a social model of health. The Steve Retson Project for Gay Men's Sexual Health is also situated within the Sandyford, providing clinical services within the context of a social model of health. The Initiative is managed by the Greater Glasgow Primary Care NHS Trust but has been developed as a result of joint working between three main services, Greater Glasgow Health Board, Glasgow City Council and a number of voluntary organisations. By working to a social model of health, the intention is to ensure that the detection and management of health problems takes into account the social and economic determinants of health and that the provision and practice of health care reflects the social needs of the user. As such the Initiative is expected to make a significant contribution to the sexual health of men and women and the general and reproductive health of women in the Greater Glasgow area and beyond. The core of the Initiative is housed in premises tailored to the needs of the services and their users although satellite services are being planned. In addition to the core clinical and non-clinical care there are services designed to respond to the needs of specific groups such as young people, black and ethnic minority communities and disabled people, in order to improve access and uptake by previously marginalised groups. It is recognised that often the relationship between health and social service providers and their users becomes strained. Implementation of the Sandyford Initiative is intended to inspire confidence and contribute effectively to improving health and managing complex health problems.

Delivery of Health Care, Integrated↗

PubMed2004

[Domestic violence as a women's health issue--activities of health professionals in Thailand].

OBJECTIVES: This paper reports the results of a qualitative study on domestic violence (DV) and interventions against DV in Khon Kaen province in northeastern Thailand. We analyzed the roles of health professionals for identifying, treating and supporting abused women, and examined a network model of DV interventions in developing countries. METHODS: We interviewed abused women, health professionals, staff of the government and legal authorities, community health workers and other relevant people in Khon Kaen city and surrounding areas. We analyzed the health consequences of DV, and the roles of health professionals and other actors regarding care and assistance for abused women. We also visited and observed homes of the victims and health facilities where those women were treated. RESULTS AND DISCUSSION: We interviewed 4 abused women in a slum area. One of the women was identified by a nurse of a nearby health center and a social worker when they visited homes in the area. Another woman was successfully supported by nurses of the health center, a community leader and a Buddhist monk. Health professionals played important roles in identifying, treating and protecting abused women. The Khon Kaen provincial hospital established an One-Stop Crisis Center (OSCC) to provide counseling, care and protection for physically or sexually abused women, with a team consisting of doctors, nurses and social workers who were trained in the care of abused women. The Nampol community hospital in a suburban area also established an OSCC to work together with health centers and communities for effective intervention. OSCC team members pointed out several problems: insufficient mental care, shortage of staff, and the difficulty of caring for women coming to the hospital at night or early in the morning. In Thailand, a legal framework against DV has yet to be established and government agencies are not greatly involved in DV interventions. Health professionals play leading roles in identifying, treating and supporting abused women in Thailand. It is important to provide relevant training for health professionals and to develop cooperation networks with government staff and legal authorities, community health workers, and community leaders. Legal frameworks for protecting and supporting DV victims are often insufficient in developing countries, while health care systems tend to be more reliable. Taking into account the social background, health professionals in developing countries can be expected to continue to play the most important role in looking after abused women.

Adolescent↗

PubMedDate not supplied

The Health-Grant University: a comprehensive national health education plan.

Although the need for universal and better health education has been recognized, no nationwide comprehensive program has been established. Consequently, we are proposing founding a national program of statewide health education networks, comparable in some ways to the Cooperative Extension Services of Land-Grant and Sea-Grant Universities. One institution in each state would qualify for designation as the State Health-Grant University, and all other public and private colleges located throughout the state would be encouraged to appoint one faculty member to serve as the health educator for the corresponding service area. Each health educator would receive an adjunct appointment at the health-grant university and would be required to participate in special training sessions and to master progressive health education strategies. The health educator would link the academic world and the community, educating the community about health and disease prevention and the significance of lifestyle. By catalyzing and coordinating efforts with teachers, ministers, nurses, physicians, business leaders, and others, the health educator would make an important contribution to the community. By addressing disease prevention and health maintenance, the Health-Grant University Program would strive to motivate the community to achieve greater individual health initiatives, while helping develop skills for personal health management and providing access to needed health services. Federal legislation would be required to create a national commission to coordinate the program, but community volunteers would make the program cost-effective and self-sustaining.

Health Education↗

PubMed1982

Health education for social change: a strategy for public health in the US.

Health education aimed mainly at changing individual behaviour and lifestyle faces growing challenges. Recent research suggests that broader economic, social and environmental forces are the determinants of many diseases and of behaviours that contribute to ill health. Furthermore, health education programmes seeking only to change behaviour have not been particularly effective in making significant improvements in morbidity or mortality. Finally, behavior change strategies locate the problem within the individual, leading to a tendency to blame the victim for the disease. This paper offers an alternative approach to health education, an approach which seeks to involve citizens in identifying and addressing social and environmental threats to health. From the practices of the women's health movement, the movement for occupational safety and health and the environmental movement in the United States in the last decade, an expanded foundation for health education is suggested. The following principles are illustrated: 1. Health education programmes must include informational, behavioural, political, legal and economic components; 2. Health education for social change recognizes the political character of health and disease; 3. Health education efforts can be rooted in popular struggles for a more just and humane society. 4. Health education activities should address people's day-to-day concerns about their lives and their health. The paper concludes with some specific recommendations on how health educators can include action for social change in their practice.

Behavior↗

PubMed1986

The place of primary health care in a comprehensive health system.

UNLABELLED: In considering the place of Primary Health Care in a comprehensive health system, we must first consider what is meant by the term 'comprehensive'. Comprehensive systems take into account all phases of life from infancy to old age, and integrate all aspects of being, including physical, psychological, mental, social, environmental, political and so on. It is the task of those who deliver the primary health care system to evaluate and prioritize health needs in specific populations, and to implement programs which honor the community's unique priorities, taking into account all phases and aspects of life. Drawing upon data collected from a comprehensive field survey of community health activities in Hiketa, in Kagawa Prefecture in Shikoku, and other similar surveys carried out in Japan, as well as references such as the Report of the International Conference on Primary Health Care (Alma Ata), and the World Health Organization Global Strategy for Health for All by the Year 2000, this background paper will outline the critical aspects to be considered in implementation of primary health care in comprehensive health systems, as a context for further discussion. Aspects to be considered are as follows: Community representation and participation Evaluation of health needs Prioritization of health needs IMPLEMENTATION: consultation with specialists IMPLEMENTATION: utilization of local resources IMPLEMENTATION: health education IMPLEMENTATION: support of local government IMPLEMENTATION: co-ordination of laymen, specialists, officials and others Evaluation Follow through. Illustrative examples will be used to highlight problems and solutions as each aspects is considered.

Community Health Services↗

PubMed2000

Health sector reform and reproductive health in Latin America and the Caribbean: strengthening the links.

Many countries in Latin America and the Caribbean (LAC) are currently reforming their national health sectors and also implementing a comprehensive approach to reproductive health care. Three regional workshops to explore how health sector reform could improve reproductive health services have revealed the inherently complex, competing, and political nature of health sector reform and reproductive health. The objectives of reproductive health care can run parallel to those of health sector reform in that both are concerned with promoting equitable access to high quality care by means of integrated approaches to primary health care, and by the involvement of the public in setting health sector priorities. However, there is a serious risk that health reforms will be driven mainly by financial and/or political considerations and not by the need to improve the quality of health services as a basic human right. With only limited changes to the health systems in many Latin American and Caribbean countries and a handful of examples of positive progress resulting from reforms, the gap between rhetoric and practice remains wide.

Caribbean Region↗

PubMed2004

Towards advanced risk-sharing in health care financing: with a focus on the potential of social health insurance in developing countries.

In this paper, we analyse the major health financing methods and the contribution they can make to improving access to health care among all of a country's population groups. Risk-sharing in health financing is proposed as a powerful method to achieve this improvement. The larger the degree of risk-sharing in a health financing system, the less people will have to bear the financial consequences of their own health risks, and the more they are likely to have access to needed care. Ideally countries should attempt to introduce 'advanced' risk-sharing aiming at equal access among individuals to an adequate package of health services. There are two major ways to implement advanced risk-sharing: general tax revenue may be main source of financing health services, or else social health insurance may be established. An important finding is that about 60% of the world's countries still need to pursue efforts towards the introduction of advanced risk-sharing. We further focus on the potential of social health insurance as an advanced risk-sharing method. In fact, there is recent interest in developing countries such as Côte d'Ivoire, Indonesia, Iran and Kenya in this particular health financing mechanism. Compared to health financing via general tax revenue, social health insurance spreads the immediate burden of financing among various groups, including the workers, the self-employed, enterprises and Government. Time and tedious discussions between these groups may be needed, however, before a consensus is reached, not only on the relative burden of financing but also on ways to achieve overall population coverage. It is suggested that action-research be used to test the adequacy of initial social health insurance policies.

Delivery of Health Care↗

PubMed2004

Aboriginal health in Aboriginal hands: development, delivery and evaluation of a training programme for Aboriginal health workers to promote the musculoskeletal health of Indigenous people living in a rural community.

CONTEXT: Indigenous Australians living in rural communities suffer from multiple musculoskeletal problems that significantly impair their activities of daily living. They commonly report physical disability and 'having learned to live with their pain'. A pilot, accredited musculoskeletal training program in the form of a sports massage course was designed and implemented in an attempt to address modifiable, commonly-presenting musculoskeletal conditions in this community. ISSUE: Sports massage was taught to 20 participant Aboriginal Health workers (AHWs) and community Elders at Durri Aboriginal Corporation, New South Wales, Australia. Sports massage was chosen as the vehicle for skills development because sport was widely valued in the community. The participants were taught a variety of theoretical and massage skills in the 2 week course using the informal 'round table' techniques developed by Booroongen Djugun College, NSW, Australia. The course was evaluated positively by participants. Because the course was developed according to community guidelines it had high cultural acceptability. LESSONS: Sports massage skills have been adapted for treatment of patients with chronic illness and stress within the community. Development of the course according to community needs was essential for acceptance, as was the active involvement of AHWs in all phases. For sustainability, such courses require appropriate funding.

Journal Article↗

PubMed1995

Post-stroke rehabilitation: assessment, referral, and patient management. U.S. Department of Health and Human Services Public Health Service. Agency for Health Care Policy and Research.

This Quick Reference Guide for Clinicians contains highlights from Post-Stroke Rehabilitation, Clinical Practice Guideline No. 16, which was developed by a multidisciplinary, private-sector panel comprised of health care professionals and a consumer representative. The Quick Reference Guide for Clinicians is an example of how a clinician might implement the panel's findings and recommendations on the overall management of stroke patients who need post-stroke rehabilitation programs or services before returning to a family or other living environment. Topics include medical management of patients, systematic assessment and evaluation of patients throughout acute care and rehabilitation, referring patients to appropriate rehabilitation programs, managing the rehabilitation process, discharging patients from rehabilitation programs, and reintegrating patients into family and community environments.

Cerebrovascular Disorders↗

PubMed2005

[Prevention of diseases and health monitoring by the local public health services. Tasks and prospects].

For many years prevention of disease and health promotion have been central activities of the public health services in Germany. But especially within these areas of activity there have been difficulties in understanding "old"versus"new"in relation to public health. Previously it was not possible to generate common standards for the public health service for prevention, health promotion and health monitoring due to the regional diversity of legislation within the single provinces. However, these activities could demonstrate the strength of public health services in these fields. The forthcoming law on prevention provides a framework for strengthening the public health services through defining qualitative standards for eligible preventive measures and at the same time making clear the competences of public health services that should be available. Thus public health services could become one of the central players at the local level in the strengthening of prevention and health promotion in the future. The quality of planning and outcome of eligible preventive measures will strongly depend on the local health monitoring system. If the forthcoming law does not make use of the competence of public health services in identifying healthy and socially disadvantaged settings, a white-collar orientation of preventive and health promotion activities may be expected.

Germany↗