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At least 163 records · Page 9Linked to original sources
PubMed2006

Management of agricultural nonpoint source pollution in China: current status and challenges.

Water quality in China shows an overall trend of deterioration in recent years. Nonpoint source pollution from agricultural and rural regions is the leading source of water pollution. The agricultural nonpoint source pollutants are mainly from fertilization of cropland, excessive livestock and poultry breeding and undefined disposal of daily living wastes in rural areas. Agricultural nonpoint sources contribute the main source of pollution to most watersheds in China, but they are ignored in management strategy and policy. Due to the lack of full understanding of water pollution control and management and the lack of perfect water quality standard systems and practical legislative regulations, agricultural nonpoint source pollution will become one of the biggest challenges to the sustainable development of rural areas and to society as a whole. The system for agricultural nonpoint source pollution control in China should include an appropriate legislation and policy framework, financing mechanisms, monitoring system, and technical guidelines and standards. The management of agricultural nonpoint source pollution requires multidisciplinary approaches that will involve a range of government departments, institutions and the public.

Agriculture↗
PubMed2003

Joint occupational and environmental pollution prevention strategies: a model for primary prevention.

Occupational and environmental health issues are not always considered simultaneously when attempting to reduce or eliminate hazardous materials from our environment. Methods used to decrease exposure to hazardous chemicals in the workplace often lead to increased exposure in the environment and to the community outside the workplace. Conversely, efforts to control emissions of hazardous chemicals into the environment often lead to increased exposure to the workers inside the plant. There are government regulations in place that ensure a safe work environment or a safe outside environment; however, there is little integration of both approaches when considering the public's health as a whole. This article examines some of the reasons behind this dichotomy, focusing on the regulatory and policy frameworks with respect to workplace and environment that have resulted in the inability of the Occupational Safety and Health Administration (OSHA) and the Environmental Protection Agency (EPA) to coordinate their efforts to protect public health. The components of the Pollution Prevention Act and its potential to serve as a model for integrating occupational and environmental health are discussed. Limitations regarding enforcement of pollution prevention, as well as its disconnection from the work environment are equally highlighted. The article finishes by examining the barriers to integrating the occupational and environmental health paradigms and the promotion of primary prevention in public health.

Journal Article↗
PubMed2000

People, pesticides, and the environment: who bears the brunt of backward policy in South Africa?

Whereas international trends show that many developed countries are adopting policies that promote pesticide reduction, use of pesticides in South Africa continues to expand. In particular, macroeconomic policies encourage pesticides use among emergent small-scale black farmers, while potential exposures of workers on commercial farms remain high. Despite having legal controls that seem to conform to international standards, the present health and environmental impacts of pesticide use in South Africa are substantial and generally underestimated. The reasons lie in the fragmentation of regulatory mechanisms as well as the absence of public awareness and participation in policy-making related to pesticides. Failure to enforce existing legislation, an ambivalent relationship between government and industry, and the existence of a "pesticide culture" will continue to prevent implementation of meaningful control measures. As a result, it is marginalized groups, such as small-scale farmers and farm workers, who bear the brunt of policies that have not kept pace with a growing international awareness of the hazards of widespread pesticide use for human health and for the environment. Opportunities for fundamental transformation of the legal and policy framework relating to pesticides in order to promote environmental justice are explored.

Journal Article↗
PubMedDate not supplied

Checklist of Health Promotion Environments at Worksites (CHEW): development and measurement characteristics.

PURPOSE: Health promotion policy frameworks, recent theorizing, and research all emphasize understanding and mobilizing environmental influences to change particular health-related behaviors in specific settings. The workplace is a key environmental setting. The Checklist of Health Promotion Environments at Worksites (CHEW) was designed as a direct observation instrument to assess characteristics of worksite environments that are known to influence health-related behaviors. METHODS: The CHEW is a 112-item checklist of workplace environmental features hypothesized to be associated, both positively and negatively, with physical activity, healthy eating, alcohol consumption, and smoking. The three environmental domains assessed are (1) physical characteristics of the worksite, (2) features of the information environment, and (3) characteristics of the immediate neighborhood around the workplace. The conceptual rationale and development studies for the CHEW are described, and data from observational studies of 20 worksites are reported. RESULTS: The data on CHEW-derived environmental attributes showed generally good reliability and identified meaningful sets of variables that plausibly may influence health-related behaviors. With the exception of one information environment attribute, intraclass correlation coefficients ranged from 0.80 to 1.00. Descriptive statistics on selected physical and information environment characteristics indicated that vending machines, showers, bulletin boards, and signs prohibiting smoking were common across worksites. Bicycle racks, visible stairways, and signs related to alcohol consumption, nutrition, and health promotion were relatively uncommon. CONCLUSIONS: These findings illustrate the types of data on environmental attributes that can be derived, their relevance for program planning, and how they can characterize variability across worksites. The CHEW is a promising observational measure that has the potential to assess environmental influences on health behaviors and to evaluate workplace health promotion programs.

Health Behavior↗
PubMed1994

Managed cooperation, not competition: a proposal for implementing national health reform.

National health reform should be implemented in a policy framework that encourages cooperation--not competition--to promote efficiency while extending universal coverage. "Managed cooperation" is defined here as a national health system built on collaborative efforts between purchasers, providers, consumers, and government through voluntary collective action, like the structural cooperation seen in the Japanese economy between government and the private sector. Six partnerships are encouraged: (1) government-industry, (2) purchaser-provider, (3) physician-hospital, (4) public-private data sharing, (5) consumer-provider, and (6) community health. Structural and legal barriers to cooperation, such as antitrust and malpractice reform, should be reduced or eliminated to encourage collaborative initiatives under national health reform.

Antitrust Laws↗
PubMed2001

The assessment of poorly performing doctors: the development of the assessment programmes for the General Medical Council's Performance Procedures.

BACKGROUND: Modernization of medical regulation has included the introduction of the Professional Performance Procedures by the UK General Medical Council in 1995. The Council now has the power to assess any registered practitioner whose performance may be seriously deficient, thus calling registration (licensure) into question. Problems arising from ill health or conduct are dealt with under separate programmes. METHODS: This paper describes the development of the assessment programmes within the overall policy framework determined by the Council. Peer review of performance in the workplace (Phase 1) is followed by tests of competence (Phase 2) to reflect the relationship between clinical competence and performance. The theoretical and research basis for the approach are presented, and the relationship between the qualitative methods in Phase 1 and the quantitative methods in Phase 2 explored. CONCLUSIONS: The approach is feasible, has been implemented and has stood legal challenge. The assessors judge and report all the evidence they collect and may not select from it. All their judgements are included and the voice of the lay assessor is preserved. Taken together, the output from both phases forms an important basis for remediation and training should it be required.

Clinical Competence↗
PubMed2002

Nursing shortages and evidence-based interventions: a case study from Scotland.

In this report, key aspects of change in the labour market for nurses in Scotland are examined, and an integrated policy framework intended to improve nurse recruitment, retention and utilization is outlined. The purpose of this article is to provide an overview of the dynamics of the nursing labour market in Scotland and to draw some more general messages from the evidence base on the effectiveness of interventions to improve recruitment and retention of nursing staff. The paper has three main elements: it provides a backdrop of key trends in the Scottish nursing labour market; it summarizes issues related to planning and nursing shortages, including an assessment of the utility of current indicators of recruitment and retention difficulties; and it reviews the main potential interventions to address nurse recruitment and retention difficulties, drawing from key research/evidence from UK and other English language sources. Five main interventions are examined: integrating the planning of the healthcare workforce; improving recruitment; incentives to improve retention; improving staff deployment; and improving utilization/skill mix.

Education, Nursing↗
PubMed2003

Factors associated with health-compromising behavior among the homeless.

This exploratory study examined a set of sociodemographic, risk, and protective factors associated with health-compromising behavior among the homeless. One hundred and sixty-one homeless adults living in a midsize, southern metropolitan area were surveyed. Information was collected using structured in-depth interviews that assessed residential and event histories, life circumstances, mental and physical health symptoms, and health-related risk behaviors (drug and alcohol use, risky sexual practices, sleeping outdoors, aggressive behavior, and weapon possession). Descriptive results showed differences in health-compromising behavior for ascribed characteristics such as age, race, and gender. Younger people, nonwhites, and men took more risks. Multivariate results indicated that while sociodemographic risk factors were important predictors of health-compromising behavior for people who are homeless, other variables, including childhood memories, victimization, and local nativism, were also significant. The implications of these findings are explored in the larger context of a social policy framework.

Adult↗
PubMedDate not supplied

A community outreach service for people with COPD.

This paper describes the development and evaluation of a nurse-led interagency community outreach service for patients with chronic obstructive pulmonary disease. The service improved the quality of life of the patients who accessed it. However, difficulties in maintaining the service arose from the historical structure of care delivery and policy frameworks.

Activities of Daily Living↗
PubMed2004

Availability and estimates of veterinary antimicrobial use in British Columbia.

The amount of antimicrobial use is a significant selection pressure that alters the frequency of antimicrobial resistance. This paper summarizes attempts to estimate the weight of antimicrobial purchases in British Columbia for use in animals. The data reported here do not capture all sources of veterinary antimicrobial use in British Columbia. This paper highlights how information deficits on veterinary drug use complicate the development of an evidence-based policy framework for combating antimicrobial resistance.

Animals↗
PubMed2005

Local coverage initiatives: solution or band-aid for the uninsured?

This issue brief surveys health coverage expansion initiatives that are operating on the county or local level, often without the benefit of federal funding. The paper explores the circumstances that have made these initiatives possible and considers the ongoing barriers that local policymakers face in sustaining the programs. Descriptions of four initiatives illustrate the range and variety of programs in operation today and offer both best practices and lessons learned for other communities. The paper also includes a brief analysis of the key elements that make up a successful coverage initiative. Finally, this issue brief considers the role of local and county-based initiatives in the context of overall health care delivery in the national policy framework, highlighting the prospects for sustainability and replication on a broader scale.

California↗
PubMedDate not supplied

Legal foundations for a national public health agency in Canada.

This commentary addresses some of the key legal challenges associated with establishing a national public health agency in Canada. These include issues related to privacy and confidentiality of personal health information in the public health context, constraints on the jurisdiction and powers of a national agency, the need to respect individual rights and freedoms in an outbreak situation, and international cooperation in infectious disease control. The authors are part of a research initiative, comprised of experts in law, public health policy and medicine, that is currently analyzing legal considerations that may influence the mandate of a national public health agency in regard to infectious disease activities. This article discusses critical issues raised at a meeting in August 2004 that brought the research team together with key federal and provincial policy-makers and members of the public health community. The commentary emphasizes that law sets the foundation for public health activities, and the promise of a national public health agency will only be realized if significant legal issues are examined early on to ensure the agency is built on a robust legal and policy framework.

Canada↗
PubMed2005

Desperately seeking donors: the 'saviour sibling' decision in Quintavalle v Human Fertilisation and Embryology Authority (UK).

The recent House of Lords decision in Quintavalle v Human Fertilisation and Embryology Authority has raised difficult and complex issues regarding the extent to which embryo selection and reproductive technology can be used as a means of rectifying genetic disorders and treating critically ill children. This comment outlines the facts of Quintavalle and explores how the House of Lords approached the legal, ethical and policy issues that arose out of the Human Fertilisation and Embryology Authority's (UK) decision to allow reproductive and embryo technology to be used to produce a 'saviour sibling' whose tissue could be used to save the life of a critically ill child. Particular attention will be given to the implications of the decision in Quintavalle for Australian family and medical law and policy. As part of this focus, the comment explores the current Australian legislative and policy framework regarding the use of genetic and reproductive technology as a mechanism through which to assist critically ill siblings. It is argued that the present Australian framework would appear to impose significant limits on the medical uses of genetic technology and, in this context, would seem to reflect many of the principles that were articulated by the House of Lords in Quintavalle.

Australia↗
PubMed2005

Health sector reform and equity: a study at a family health center affiliated to health insurance organization in Alexandria.

The 1990's witnessed a wave of reform in health systems of many countries. Health sector reform (HSR) initiatives aimed at improving health status, utilizers' satisfaction, as well as equity and accessibility of care. This study aims at exploring the question of whether there is a socioeconomically- based differential access to services provided by a family health center applying HSR. A total of 248 utilizers were randomly selected and interviewed. An access index comprised of eight elements was developed to measure access and its corollary equity. Results demonstrated that the majority belonged to the low middle socio-economic class and one- quarter belonged to the low class. Approximately 9/10 of utilizers had high access to the services offered. Mean access index score for all utilizers was above the 90% mark. ANOVA analysis of mean access index according to socio-economic class revealed that there is no statistically significant disparity among various socio-economic classes regarding their access to care. However, it was demonstrated that higher classes had a higher opinion concerning the completeness of physical examination during the initial visit than lower classes. It was recommended to establish an appropriate policy framework to assure optimal standards of equity, preferably a 100% of high access as measured through the access index devised in this study.

Adolescent↗
PubMed1996

The Canadian Heart Health Initiative: a countrywide cardiovascular disease prevention strategy.

The 1987 Report of the federal/provincial working group on cardiovascular disease prevention entitled "Promoting Heart Health in Canada" was developed about the time the new concepts for health promotion were emerging in government policy. The public health strategy supported in "Promoting Heart Health in Canada" captured the approach advocated in the Ottawa Charter for health promotion: need for environmental, intersectorial approaches and healthy public policy. The implementation of this policy framework had led to the Canadian Heart Health Initiative. It provided a step by step approach to the implementation of the ten provincial heart health programs. Key assets for the Initiative include the development of effective partnerships with over 300 organizations at the provincial, national and international levels; a large database on risk factors and over 40 demonstration communities which should contribute to interventional knowledge in the area of prevention. The heart health model provides an approach to address increasingly complex health issues that we can expect to face in the year 2000.

Canada↗
PubMed1997

Alcohol, tobacco and cannabis use among Nova Scotia adolescents: implications for prevention and harm reduction.

OBJECTIVE: To characterize adolescent drug use in terms of a risk continuum and to explore the rationale for harm reduction as a potential approach for school-based drug prevention. DESIGN: Self-reported surveys, in 1991 and 1996, of adolescent students concerning their use of drugs, especially alcohol, tobacco and cannabis, and the harmful consequences of such use. SETTING: Nova Scotia. PARTICIPANTS: A total of 3452 (in 1991) and 3790 (in 1996) junior and high school students in randomly selected classes in the public school system. OUTCOME MEASURES: Prevalence of drug use and patterns of multiple drug use and of alcohol- and drug-related problems; independent risk factors for multiple drug use. The risk continuum for the response to alcohol problems was used as a policy framework. RESULTS: The prevalence of cigarette smoking and the use of hallucinogens and stimulants was markedly higher in 1996 than in 1991. Over one-fifth (21.9%) of the students reported multiple drug use of alcohol and tobacco and cannabis in the 12 months before the 1996 survey. The 3 main subgroups--nonusers, users of alcohol only and users of multiple drugs--had distinct patterns of use, numbers of problems and risk factors. In all, 27.1% of the students had experienced at least 1 alcohol-related problem and 6% had experienced at least 1 drug-related problem in the 12 months before the 1996 survey. CONCLUSION: There is a need for integrated school- and community-based drug prevention programs, with goals, strategies and outcome measures capturing the full spectrum of patterns of use and levels of risk among subgroups of the adolescent student population.

Adolescent↗
PubMed1976

Child health in America: toward a rational public policy.

Analysis of currently available data on mortality and morbidity indicates that the major organic illnesses of childhood, and their developmental consequences, are susceptible in part to the technical interventions of American medical science. Environmental forces, however, exert a powerful impact on the health of children in the United states, manifested both in the disproportionate toll of most organic diseases on poor and nonwhite populations and in such increasingly important symptoms of familial, social, and behavioral distress as child abuse, accidents, and childhood suicide. Review of the nature, quality, and distribution of child health services demonstrates a systemic inability to reach and treat the children most in need of them. A rational basis for child health policy includes: appropriate concepts of health, disease, and preventive and therapeutic intervention; a capacity to acknowledge, to measure, and to act on the familial and environmental, as well as the medical, sources of illness; an orientation to the developmental and social implications of good and poor child health; and a commitment to enable all children to receive health services. The data and this policy framework lead to these program recommendations: the channeling of resources into a more rational system which guarantees equity and access; a planning and program implementation mechanism which addresses the health needs of diverse local populations and which makes real the advocacy concept; a screening, evaluation, and surveillance methodology; a delivery system which both applies preventive and curative health technology and addresses basic life needs of children; and a coherent program for the training, assignment, and supervision of the several kinds of manpower which such a system would require.

Adolescent↗
PubMed1998

The geographical assignment of cancer units: patient accessibility as an optimal allocation problem.

The seminal report A Policy Framework for Commissioning Cancer Services provides the foundation for a major reorganisation of cancer service provision in England and Wales. One central recommendation of the report, the establishment of a tier of specialised cancer units in each Health Authority Region has raised the fundamental question of where those units are to be located. In particular, a declared objective of the report is for services to be planned to maximise their accessibility to patients. This paper demonstrates a classical method (location-allocation modelling) by which the accessibility criterion can be used to determine the optimal number, location and capacity of units for a given cancer site. The method is illustrated with reference to cervical cancer in Trent Health Authority Region. The implications of the method for the guidance of access-related decisions on the placement of cancer services are considered, and the wider relevance of the method to the organisation of service provision in other branches of medicine is suggested.

Algorithms↗