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PubMed2001

Mental health in Europe: problems, advances and challenges.

OBJECTIVE: To describe mental health care needs and challenges across the WHO European region of 51 nations. METHOD: Based on morbidity and mortality data from HFA Statistical Database and Health2l, the policy framework of WHO Europe, major trends in mental health care needs, psychiatric reform and mental health promotion are discussed. RESULTS: There is a mortality crisis related to mental ill health in Eastern European populations of transition. Destigmatization is required to improve early intervention and humanization of services, and national mental health audits are needed to create the basis for national mental health planning, implementation and monitoring. There are both problems and advances in service restructuring, and comprehensive mental health promotion programmes, preventive and monitoring strategies are required. CONCLUSION: Partnerships between national and international organizations, especially WHO and the European Union, have to be strengthened to make progress on the way to integrated community mental health services.

Europe↗
PubMed1998

Health visiting and public health: back to our roots or a new branch?

The term 'public health nursing' has been introduced within the last decade into the UK without being adequately defined. In consequence, confusion has arisen over the use of the term 'public health' in relation to health visiting. It is not yet clear whether the introduction of the term 'public health nursing' into the UK is a positive step for health visiting, or if it threatens its core functions. The historical developments of the public health movement and health visiting were traced, in particular, the main strands that have led to current confusion over role identity. Analysis of the literature led to one suggestion as to the nature of the public health role for health visitors. This was examined within a social policy framework in order to understand its relevance to current NHS practice. Finally, the contemporary link between health visiting and public health is explored in order to assess whether the public health role represents a new development within health visiting, or an attempt to rediscover mainstream support from public health departments.

Journal Article↗
PubMed1999

Changing clinical practice: evidence-based primary care in Australia.

Evidence-based health care (EBHC) is a concept which in the past decade has gained momentum internationally. Its emphasis on linking practice and policy more closely to evidence from research and literature has challenged many assumptions and established practices in health care, whilst helping the move away from an over-reliance on medical authority and accumulated wisdom. Since the concepts of EBHC were first introduced their relevance for primary care has been examined and there has been active debate over the extent to which primary care should be restructured to accommodate these new concepts. Many argue, for example, that they devalue important but less measurable aspects of primary care. Furthermore, little is known about whether EBHC has changed practice in primary care, despite a range of implementation strategies having been put in place. This paper focuses on the response of primary care practitioners and policy makers to the challenges of EBHC in Australia. Government investment in EBHC infrastructure is detailed, and the implementation of EBHC is described from the perspective of primary care providers, individuals with chronic illnesses and other consumers of primary care services. Current issues facing Australian primary care in implementing EBHC include the relative paucity of direction from a policy framework, the dearth of multi-disciplinary primary care teams and the lack of experience in Australia of primary care health service reform.

Journal Article↗
PubMed2002

Education for community mental health nurses: a summary of the key debates.

A wide range of post-qualifying education courses exist for community mental health nurses (CMHNs) working in the UK. 'Specialist practitioner' courses emphasize shared learning between CMHNs and members of other community nursing branches. These programmes typically include course content drawing on the social and behavioural sciences, as well as on material more tailored to the clinical needs of practitioners. Such courses and their predecessors have been subject to criticism, however. Courses have been described as anachronistic, and failing to take account of recent advances in treatment modalities. In addition concerns about the generic focus of some programmes have also been raised. Educational alternatives, such as programmes preparing nurses and other mental health workers to provide 'psycho-social interventions' have, correspondingly, become increasingly popular. In this paper we explore some of the debates surrounding the education of CMHNs, and explore the context in which CMHNs work and in which educational programmes are devised. We consider the multidisciplinary environment in which CMHNs practise, the differing client groups with which CMHNs work, the developing policy framework in which mental health care is provided, demands for more user-responsive education, and the relationship between higher educational institutions and health care providers. We conclude the paper with a series of questions for CMHN educators and education commissioners.

Community Health Nursing↗
PubMed2006

Preachers, policies and power: the reproductive health of adolescent Aboriginal and Torres Strait Islander peoples in Australia.

The sexual abuses of Indigenous peoples are not a new phenomenon. Many historical documents attest to the active ruination of the sexual and reproductive health of Indigenous peoples in Australia; however, reproductive health is rarely considered to be an appropriate strategy through which Aboriginal and Torres Strait Islander people's lives can be improved. Reproductive health is essential for the replication and evolution of societies and therefore warrants close attention, especially as contemporary policy frameworks place Aboriginal and Torres Strait Islander women approximately 50 years behind non-Indigenous women in our capacities to practice individual autonomy in reproductive decision making, including the positive resolution of pregnancies and ensuring the health, dignity, security and autonomy of victims of gender-based violence. This paper is an examination of contemporary reproductive health issues for adolescents in Aboriginal and Torres Strait Islander communities and a call to action to assist young men and young women in particular to value and have every capacity to control their fertility.

Abortion, Legal↗
PubMed2004

Discharge reductions--value for money?

Through the Nuclear Liabilities Management Authority White Paper, the UK Government and the Regulators have signalled a commitment to further improving the operation of the regulatory regime and to its operating within the principles of proportionality, transparency, consistency and accountability which underpin the Government's approach to regulation in general. Particular emphasis is placed upon ensuring that there is greater consistency in the treatment of risk and hazard; proportionate and cost effective delivery of public, worker and environmental protection; and an open and transparently applied regulatory system. The paper uses the historical record of radioactive discharges from BNFL's Sellafield reprocessing site in the UK and seeks to identify what have been the key drivers for change, particularly over the past 20 years of significant discharge reductions. The paper examines the current context for ongoing and future discharges from the site, and the incorporation of the use of the concepts of best practicable environmental option and best practicable means. Intergovernmental commitments such as the OSPAR Sintra and Bremen statements and the developing UK policy framework are also considered, together with BNFL's work with a wide range of 'green' stakeholders. The paper outlines the principal components of BNFL's decision-making processes for discharge control and abatement; and how these interact with the relevant external pressures. It then analyses whether the overall drivers and outcomes align with the declared desire of the UK Government to ensure that the taxpayer receives value for money in the new national arrangements for managing historic nuclear liabilities.

Environmental Exposure↗
PubMed1996

The administration's responsibility to the consumer.

Biotechnology offers the promise of good jobs that produce products fulfilling the public's need for food, fiber and pharmaceuticals. It could provide a growing market for American products abroad, and it also offers the potential of environmentally sound solutions to some current problems. Government is therefore accountable for implementing policies to protect the public health, while at the same time promoting the growth and development of the industry. Such policies should stimulate research, ensure the safety of new products, protect the environment, encourage business to innovate and invest and lead to a literate public capable of holding those high technology jobs. Stewardship of the federal government's $70 billion annual investment in science and technology entails the following: 1) setting an overall policy framework and managing the effort efficiently within that framework; 2) supporting the conduct of fundamental science critical to achieving the stated goals; and 3) providing an environment that encourages private investment in innovation and technology development.

Biotechnology↗
PubMed2003

Reporting the dawn of the post-genomic era: who wants to live forever?

On the 26 June 2000 the teams involved in mapping the human genome announced to the world's media that they had completed the 'first draft'. This paper is a content analysis of UK press coverage of the announcement, particularly of the ethical, legal and social implications (ELSIs) contained therein. Widespread and highly visible coverage of the completion of the Human Genome Project (HGP) was characterised by press ambivalence towards, on the one hand, the optimistic future of post-genomic medicine and, on the other hand, the pessimistic vision of post-genomic society. Coverage of the positive medical implications characteristically echoed the exuberance felt by the champions of human genetic research, focusing on longevity and a cure for cancer. Articles on ELSIs either repeated long-standing concerns about genetic discrimination and the redesign of human life, or introduced more novel topics such as the commercialisation of genetic science, genetic determinism and 'living forever'. Press reports on the more novel ELSIs addressed the political and economic context of the science, its 'social value' and its complexity, issues that have often been lacking in media coverage of human genetics. However, as a contribution to public awareness and policy frameworks surrounding human genetic science, press coverage was deficient in important respects. The HGP's proponents were the press's key source of information about its ELSIs. Journalists addressed only a limited number of ELSIs, focusing on issues that were 'manageable' by regulation or legislation rather than concerns such as risk, clinical utility or opportunity costs. Furthermore, those articles that addressed the more novel concerns were often presented using sensationalist news values. As a media representation of science, coverage of the 'first draft' in the UK press demonstrated both 'source dependence' and a bias toward the legitimacy of science, although the coverage of the more novel ELSIs indicated some mistrust toward scientific governance.

Ethics↗
PubMed1995

Structural adjustment and drought in Zambia.

While drought is not uncommon in Zambia, the country is now facing the worst drought in history. The monetary and social costs will be enormous. Although it is too early to measure the economic and social costs of the drought on Zambia, it is obvious that the impact is catastrophic on a country whose economy is under pressure. The drought will affect the structural adjustment programme (SAP) unveiled by the new government which has embraced the market economy. The country has imported, and will continue to import, large quantities of maize and other foodstuffs, a situation likely to strain the balance of payments. Earlier targets with regard to export earnings, reductions in the budget deficit, and GDP growth as contained in the Policy Framework Paper (PFP) are no longer attainable due to the effects of the drought.

Disasters↗
PubMed2000

Bilateral health aid: lessons from Europe.

OBJECTIVE: The objective of this study is to document current issues in policy and planning for development assistance in health from the perspective of key bilateral aid donors in Europe, and to explore its relevance for Australia. METHODOLOGY: This study is based on seventy-seven interviews and documentary analysis undertaken between July and December 1999 with policy, technical and field staff of major European bilateral aid donors, the World Health Organisation (WHO), and key academic institutions. Notes were taken of interviews, and relevant documentation collected. Forty-five key interviews were tape recorded and transcribed for analysis. RESULTS: The shift towards program and Sector Wide Approaches in development assistance reflects broader political changes in Europe since the collapse of the Communist block. Increasingly, achieving an impact on poverty is seen as linked to better governance, improved policy frameworks, and collaboration between donors and partner governments, and between donors themselves, reflected in the broad support for Sector Wide Approaches to development assistance. CONCLUSIONS: These perspectives bring new demands to donors such as Australia: structural changes, procedural changes, collaborative approaches to programs, closer relationships with counterparts. IMPLICATIONS: The uncertainty in which health sector reform operates necessitates a reflective and adaptive approach to management of aid, and responsiveness to monitoring and evaluation and the development of new knowledge. Given Australia's strategic positioning in its sphere of influence, the experience from Europe should inform the development of our own future directions.

Australia↗
PubMed2004

Sharing death and dying: advance directives, autonomy and the family.

This paper critically examines the liberal model of decision making for the terminally ill and contrasts it with the familial model that can be found in some Asian cultures. The contrast between the two models shows that the liberal model is excessively patient-centered, and misconceives and marginalises the role of the family in the decision making process. The paper argues that the familial model is correct in conceiving the last journey of one's life as a sharing process rather than a process of exercising one's prior or counterfactual choice, and concludes by suggesting a policy framework for the practice of familialism that can answer the liberal challenge that familialism cannot safeguard the patient from abuse and neglect.

Advance Directive Adherence↗
PubMed2006

Britain's genetically modified crop controversies: the Agriculture and Environment Biotechnology Commission and the negotiation of 'uncertainty'.

The genetically modified crop controversies in Britain between 1997 and 2004 involved tensions surrounding the role of science in policy. The author of the paper was a member of the Agriculture and Environment Biotechnology Commission, a novel government advisory body created in 2000, which played a central role in negotiating new policy frameworks. The commission was also a key influence in the creation and execution of the three-pronged official 'GM dialogue' in 2002 and 2003. New understandings of 'uncertainty', both scientific and social, emerged as a result. The outcomes have relevance for the future political handling of other technological fields, including human genetics.

Biotechnology↗
PubMed2006

Agricultural biodiversity, nutrition, and health: making a difference to hunger and nutrition in the developing world.

BACKGROUND: In spite of the strides made globally in reducing hunger, the problems of micronutrient deficiencies and coexisting obesity and related cardiovascular and degenerative diseases constitute a formidable challenge for the future. Attempts to reverse this trend with single-nutrient intervention strategies have met with limited success, resulting in renewed calls for food-based approaches. The deployment of agricultural biodiversity is an approach that entails greater use of local biodiversity to ensure dietary diversity. OBJECTIVE: To outline a new strategy proposed by the International Plant Genetic Resources Institute (IPGRI) that employs agricultural biodiversity as the primary resource for food security and health. METHODS: The authors carried out a meta-analysis to review and assemble existing information on the nutritional and healthful properties of traditional foods based on a diverse set of case studies and food composition and nutritional analysis studies. The methods highlight particular examples of foods where analysis of nutrient and non-nutrient composition reveals important traits to address the growing problems of malnutrition associated with the rise of chronic diseases. Finally, the authors analyze social, economic, and cultural changes that undermine the healthful components of traditional diets. RESULTS: Based on this multidisciplinary and comparative approach, the authors suggest a holistic food-based approach that combines research to assess and document nutritional and healthful properties of traditional foods, investigating options in which nutritionally valuable traditional foods can contribute to better livelihoods, and ways that awareness and promotional campaigns can identify healthful components of traditional diets that fit the needs of urban and market-oriented consumers. CONCLUSIONS: There is an urgent need for agricultural research centers, national agricultural research systems, universities, and community-based organizations to work together under a shared policy framework with the aim of developing a strong evidence base linking biodiversity, nutrition, and health. Although these initiatives are still ongoing, the gains realized in small-scale and local pilot efforts have encouraged IPGRI to work with local partners toward the implementation of scale-up efforts in various regions.

Biodiversity↗
PubMed2006

Staffing in postnatal units: is it adequate for the provision of quality care? Staff perspectives from a state-wide review of postnatal care in Victoria, Australia.

BACKGROUND: State-wide surveys of recent mothers conducted over the past decade in Victoria, one state of Australia, have identified that women are consistently less satisfied with the care they received in hospital following birth compared with other aspects of maternity care. Little is known of caregivers' perspectives on the provision ofhospital postnatal care: how care is organised and provided in different hospitals; what constrains the provision of postnatal care (apart from funding) and what initiatives are being undertaken to improve service delivery. A state-widereview of organisational structures and processes in relation to the provision of hospital postnatal care in Victoria was undertaken. This paper focuses on the impact of staffing issues on the provision of quality postnatal care from the perspective of care providers. METHODS: A study of care providers from Victorian public hospitals that provide maternity services was undertaken. Datawere collected in two stages. Stage one: a structured questionnaire was sent to all public hospitals in Victoria that provided postnatal care (n = 73), exploring the structure and organisation of care (e.g. staffing, routine observations, policy framework and discharge planning). Stage two: 14 maternity units were selected and invited to participate in a more in-depth exploration of postnatal care. Thirty-eight key informant interviews were undertaken with midwives (including unit managers, associate unit managers and clinical midwives) and a medical practitioner from eachselected hospital. RESULTS: Staffing was highlighted as a major factor impacting on the provision of quality postnatal care. There were significant issues associated with inadequate staff/patient ratios; staffing mix; patient mix; prioritisation of birth suites over postnatal units; and the use of non-permanent staff. Forty-three percent of hospitals reported having only midwives (i.e. no non-midwives) providing postnatal care. Staffing issues impact on hospitals' ability to provide continuity of care. Recruitment and retention of midwives are significant issues, particularly in rural areas. CONCLUSION: Staffing in postnatal wards is a challenging issue, and varies with hospital locality and model of care. Staff/patient ratios and recruitment of midwives in rural areas are the two areas that appear to have the greatest negative impact on staffing adequacy and provision of quality care. Future research on postnatal care provision should include consideration of any impact on staff and staffing.

Adult↗
PubMed2006

Swiss residents' arguments for and against a career in medicine.

BACKGROUND: In some Western countries, the medical profession is continuously losing prestige, doctors are claiming of high demands, low rewards, and difficult structural working conditions. This study aimed to investigate the arguments given by Swiss residents for and against a career in medicine. METHODS: As part of a prospective cohort study of Swiss medical school graduates on career development, 567 fourth-year residents were asked to answer the free-response item of what arguments there still were in favour of or against a career in medicine. They also indicated whether they would choose the medical profession all over again (yes/no). The statements were transcribed, content categories inductively formulated, and their descriptions written down in a code manual. Arguments were encoded according to the code manual and assigned to eight content categories (Mayring's content analysis). Frequency distributions were given for categories and tested with Chi2-tests for differences in gender, speciality fields, and whether or not the respondent would again choose a career in medicine. RESULTS: The 567 participants made 1,640 statements in favour of and 1,703 statements against a career in medicine. The content analysis of the residents' answers yielded eight categories with arguments both for and against a career in medicine. Of all "statements for" responses, 70% fell into the two top-ranking categories of Personal experiences in day-to-day working life (41.2%) and Interpersonal experiences in professional relationships (28.8%). The top-ranking category of the "statements against" arguments was General work-related structural conditions (32%), followed by Social prestige and health-policy aspects (21%). Main arguments in favour of a career in medicine were interdisciplinary challenge, combination of basic sciences and interpersonal concerns, helping suffering people, guarantee of a secure job; arguments against comprised high workload, time pressure, emotional stress, poorly structured continuing education, increasing bureaucracy, work-life imbalance, low income, and decreasing social prestige. The statements revealed few differences depending on gender, medical field, and attitude towards choosing the medical profession again; one out of five young doctors would not do so. CONCLUSION: Residents' chief complaint is deteriorating structural working conditions, including unfavourable work-life balance. Making medicine an attractive profession again will require sustainable changes in health-policy framework and social reward.

Adult↗
PubMed1990

The politics of universal access: the Massachusetts Health Security Act of 1988.

This article analyzes the passage of an unprecedented state law, promising every resident access to affordable health insurance. The Massachusetts Health Security Act of 1988 was the product of a set of political and financial pressures that had been developing for nearly a decade. Hospital, insurance, and business interests were unable to reach a new accommodation on hospital payment. This logjam created the opportunity for a policy breakthrough, but did not inherently lend itself to progressive reform. It was consumer activism that forced the traditional powers in health policy to address the interests of the uninsured. By imposing a more public-interest agenda on the process, consumers were able to change the configuration of the stalemate, but could not resolve it. The particular terms of the stalemate, however, made possible a new, more aggressive role for state government in health policy. Unable to satisfy their competing interests within a policy framework that had universal access as a goal, traditionally powerful interest groups found themselves increasingly dependent on the state to broker a new agreement. While the many concessions made to these groups are likely to prove to be the bill's undoing, the unraveling of the agreement will not end the story. The same pressures which led to passage of the Massachusetts law and which are now causing other states to act will continue to exert their effect until a more durable solution is found.

Health Services Accessibility↗
PubMed2004

Important to investigate the dynamics of the stigma process.

Studies have shown that the stigma of the most common mental disorder, namely depression, expose people with these disorders to a substantial amount of stigmatization in the workplace. Apart from the descriptive assessment of the magnitude of stigma, it is also important to investigate the dynamics of the stigma process. Agreeing with Dr. Stuart, three approaches to research on stigma and the workplace are proposed. The first is the dimension of social stigma, i.e., knowledge, attitudes and practices of employers. The second is the perspectives of the patients, i.e., self- stigmatization. The third is legal and policy frameworks, i.e., structural discrimination.

Humans↗
PubMed2004

Introduction: The provision of animal health services in a changing world.

In the future, animal health services in developing countries will need to operate in a continuously changing policy, institutional and commercial environment. Firstly, the changing policies and priorities of national policy-makers regarding public and private sector roles, reinforced in Africa by the donors, have reduced funding and support for the large number of tasks that animal health services have traditionally performed, and there is continuing pressure from policy-makers to focus on what the public sector can do best. Secondly, poverty reduction has become one of the main criteria guiding the allocation of official development assistance, which has major implications for the main target clientele of veterinary services. Thirdly, population growth, increasing income and urbanisation are causing a marked increase in demand for livestock products in the developing world. As a result, the entire livestock commodity chain is undergoing major structural changes, which has significant implications for the definition and control of food safety standards. Fourthly, globalisation, and increasing trade and travel have greatly increased the risk of disease transmission between different countries and continents. Veterinary institutions in the developing world need to adapt to these challenges. They will have to be able to focus on the essential public sector roles. At the same time they must deliver those essential services to the poor, and provide the policy framework to ensure that the inevitable structural changes in the commodity chain take place in an equitable and sustainable fashion, with an acceptable level of health risk for the consumer. According to the weight given to these different objectives, changes in the institutional set-up need to be considered. This issue of the Scientific and Technical Review addresses these challenges. It begins by reviewing the basic economic characteristics underlying the provision of animal health services, and then examines the alternative delivery systems that are emerging in the developing world and their strengths and weaknesses. The implications for food safety and trade are specifically highlighted. Also included are the practical experiences of countries, from all along the development continuum, that have introduced alternative systems. This paper deals with implications for the future, and while the growing importance of veterinary care for companion animals is acknowledged, the focus is on veterinary services for food animals.

Africa↗