Showing papers in "World Medical & Health Policy in 2010"

Volunteered Geographic Information and Crowdsourcing Disaster Relief: A Case Study of the Haitian Earthquake

Abstract: This paper outlines the ways in which information technologies (ITs) were used in the Haiti relief effort, especially with respect to web-based mapping services. Although there were numerous ways in which this took place, this paper focuses on four in particular: CrisisCamp Haiti, OpenStreetMap, Ushahidi, and GeoCommons. This analysis demonstrates that ITs were a key means through which individuals could make a tangible difference in the work of relief and aid agencies without actually being physically present in Haiti. While not without problems, this effort nevertheless represents a remarkable example of the power and crowdsourced online mapping and the potential for new avenues of interaction between physically distant places that vary tremendously.

Global Perspectives of Pharmacy Education and Practice.

Abstract: Pharmacists have been shown to reduce morbidity and mortality, reduce medication errors, improve rational use and prescribing of medicines, and increase access to health care and medicines. Unfortunately, in many countries there is a severe shortage of appropriately-trained pharmacists and pharmaceutical human resources. The WHO UNESCO FIP Pharmacy Education Taskforce is steering sustainable pharmacy education and pharmacy workforce action to support and strengthen local, national, regional and international efforts. The Taskforce advocates for a needs-based approach, which aims to meet the pharmaceutical needs of the local population. This paper explains the concept of needs-based education, describes the work of the Pharmacy Education Taskforce, and explores key issues in pharmacy education development and quality assurance.

Developing an Instrument for Measuring Human Dignity and Its Relationship to Health in Palestinian Refugees

Abstract: This study was conducted in an attempt to asses a recently developed instrument to measure dignity and examine how it affects health status. In this study it was expected that those who scored lower on this dignity scale (under development) were more likely to also have lower health status. A cross-sectional survey was conducted during the month of July, 2006, among 404 adult Palestinian refugees to examine the association between dignity and health. Health was assessed using the SF-36 questionnaire. Dignity was assessed using an instrument consisting of four themes; autonomy, self-respect, worthiness, and self-esteem. Results show a positive association between health and dignity levels. Four of the models assessed physical health; of them, role limitation due to physical health, pain, and general health appear to statistically significantly improve per one unit improvement in dignity scores (OR = 1.045, 1.068, and 1.104, respectively, with p-values <0.001). Four other models assessed mental health; of those, energy/fatigue and emotional problems appear to statistically significantly improve per unit increase in dignity scores (OR = 1.094, 1.066, respectively, with p-values <0.001).

Medical Refugees and the Future of Health Tourism

Abstract: Health tourism presents American policymakers with a perplexing situation, which requires an examination of the implications of such tourism on trade and economics, especially when considering the role of the General Agreement on Trade in Services (GATS). Currently, the issue of health tourism, or the means by which consumers seek health services abroad, and its policy implications has yet to gain the attention of policymakers in the United States and the international community. By reviewing existing literature and relevant international treaties, it becomes apparent that the expanding popularity of health tourism necessitates exploring the potential implications of health tourism. Further, in assessing its impact, policymakers must examine questions related to quality, performance, and accountability of those facilities hosting health tourists.

Disease Mongering in Psychiatry: Is It Fact or Fiction?

Abstract: Disease mongering starts at the top of recent accusations being hurled at psychiatry. It is used to refer to the attempts by pharmaceutical companies or others who have similar interests, to enlarge the market for a treatment by convincing people that they are sick and need medical intervention. This paper critically analyses the ‘for’ and ‘against’ arguments of disease mongering in psychiatric disorders, both new and old, such as Bipolar disorders, ADHD, Restless legs syndrome, Premenstrual dysphoric disorder, female sexual dysfunction, social phobia, metabolic syndrome and road rage disorder.

The Global Role of the Doctor in Healthcare

Abstract: Medical care is deficient in many parts of the world, while in richer countries the costs and complexities of health care are rising unsustainably. Thus, societies need to understand what it is that only doctors can do and what can or should be done by other members of the healthcare team. The duty of doctors to examine their accountability to society as a whole is critical, in order not to continue blindly to do what has always been done. We argue that doctors may not need, in the future to undertake all their traditional roles, while other new roles may emerge instead. A synthesis of these elements is necessary to propose a policy and philosophy for the future global role of the doctor. Only when we have defined this, is the stage set for medical education to produce a person equipped to fulfill that role.

Revisiting Structural Adjustment Programs in Sub-Saharan Africa: A Long-Lasting Impact on Child Health

Abstract: The process of globalization, particularly in developing countries, has been significantly accelerated through the global economic policies implemented by major international financial institutions such as the International Monetary Fund (IMF) and the World Bank. While the primary goal of these neoliberal policies was geared towards financial stability and economic development, there is evidence of negative impacts of these policies on the health of the population in the countries of the third world. This paper explores this issue by reviewing Structural Adjustment Programs (SAPs) and their impact on child health in Sub-Saharan Africa (SSA). It examines the possible pathways and causal links between SAPs and child health in SSA. We argue that the adoption of SAPs by countries in SSA and the market-driven approach to healthcare has played a detrimental role in worsening indicators of child health in the region. The paper underscores the importance of looking beyond the indicators of purely economic growth when global macroeconomic policies are implemented. Linking specific macroeconomic policies with health opens up avenues for investigation of the conditions required for healthier populations. Besides the general indicators of population health, particular attention should be given to the often neglected, yet too sensitive to the impact of economic policies, indicators of child health. The paper highlights the value of healthy public policy and the role of the World Health Organization (WHO) and the United Nations Children's Fund (UNICEF) in adding health to the agenda of policymakers across sectors and levels of government. It concludes by promoting the value of effective global action in the face of the global economy and trade.

The Middle of Nowhere

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Use of the balanced scorecard to assess provincial hospital performance in Afghanistan.

Abstract: Objectives: An assessment of provincial hospitals in Afghanistan was carried out in 2007 to measure performance against the national standards and guidelines in the Essential Package of Hospital Services. Methods: Assessment instruments were developed through consultation with the Ministry of Public Health and key stakeholders. Teams of six persons spent three days at each of the 30 provincial hospitals. Results are displayed using a balanced score card approach. Results: Considerable variation exists across hospitals. Administrative management domains, patient satisfaction and community involvement tended to be higher scoring. Financial systems, quality and safety, and ethics and value domains and indicators were lower. Discussion: This assessment demonstrates a wide range of performance of provincial hospitals nationally. This may reflect the diversity of funding, funding levels, and characteristics of facilities. Despite these challenges the level of performance in many hospitals is surprisingly good. Conclusion: Assessment of hospital performance when displayed using the balanced score card approach can provide meaningful information for policy formulation and assist hospital management in improvement of services.

Geographical disparity in access to organ transplant in the United States and other western countries: a prolegomenon to a solution.

Abstract: Background: Disparities in access to and in outcome of organ transplantation are widely discussed topics among transplant researchers in many Western countries. Among various types of disparities examined in existing studies, “geographic disparity,” i.e., disparity due to a recipient's location, is most common. Despite a number of articles that acknowledge the existence of geographic disparities, the literature has been relatively silent about the historical and international efforts to address these issues. Literature discussing remedies or proposing analytical tools to identify remedies is even rarer. This paper investigates potential causes of geographic disparity and advocates possible methodological approaches to analyze and address the disparity. Methods: The paper conducts an in-depth review of geographic disparity and the policy efforts to reduce the disparity in the United States, Canada, France, Spain, the United Kingdom, and Australia. The current organ allocation systems in these countries are also reviewed and compared. Possible causes of the disparity and future analytical approaches are discussed based on the findings of these reviews. Findings: Geographic disparity in organ transplant service is ubiquitous in all countries studied. Many Western countries have a similar organ allocation system with some difference in the degree of interregional and national-level sharing enforced by the government. The organ allocation system in these countries tends to have some inherent mechanism to favor a “home region” where organs are harvested, implying that the locations of candidates matter in accessing a transplant. Geographic allocation boundaries prevalent in the United States were found to be another potential source of geographic disparity. Conclusions: Developing an equitable organ allocation system is a multifaceted problem. The allocation procedure needs to reflect priorities of urgent cases and some geographic areas, patient's severity level, waiting time, cold ischemia time (CIT) and associated travel distance, condition of and compatibility between organ and recipient, etc. Failing to reflect these factors adequately results in disparity of some sort. The implications of geographic boundaries in organ allocation need to be studied further. Utilization of relatively new methodological approaches, such as Geographic Information Systems (GIS) and system dynamic modeling, would help develop a system that allocates organs more equitably.

Public‐Private Partnership for TB Control in Bangladesh: Role of Private Medical Practitioners in the Management of TB Patients

Abstract: Background: Despite enormous efforts, Bangladesh has one of the highest burdens of tuberculosis (TB) in the world. Treatment in the private sector is common and popular among TB patients in South Asian countries, including Bangladesh, even though the quality of diagnosis and treatment of TB patients has been shown to be poor in several such countries. The Bangladesh National Tuberculosis Programme (NTP) has recently shown considerable interest in exploring policy options to address this problem. Consequently, the NTP and non-governmental organization (NGO) partners planned to develop a public-private partnership (PPP) model for effective involvement of private medical practitioners (PMPs) in TB control. However, there was a lack of solid data on TB case management practice by PMPs, which was needed to appraise the potential role and contribution of PMPs in TB control. The purpose of the study is therefore to assess the knowledge, attitudes, and practices of PMPs on TB control in an urban setting in Bangladesh in order to inform development of a public-private collaboration model.

The Ethical Obligations of Researchers in Protecting the Rights of Human Research Subjects

Abstract: Post World War II trials of Nazi crimes against humanity also exposed the horrific and deadly experiments conducted by the Nazi physicians on prisoners in the concentration camps. These trials resulted in the adoption of the “Nuremberg Code” for medical research, which was codified and adopted by the 18th World Medical Association (WMA) General Assembly, Helsinki, Finland, in June 1964. The “Declaration of Helsinki,” as it became known, and its amendments and clarifications represent a universal standard for the conduct of research and human subject care. Assurance of scientific integrity, appropriateness and utility of research, and protection of human subjects are at the core of ethical principles to be upheld regardless of the geographic location where research is conducted.

Health system strengthening beyond the MDGs for maternal and child health in Malawi: lessons from policy analysis.

Abstract: The article aims to draw the attention of advocators and policy makers in Malawi to consider the context of Malawi as they adopt and implement the components of health system strengthening. It analyzes the context of Maternal and Child Health (MCH) policies in Malawi from 1964 to 2008 and identifies constraints encountered in implementing MCH policies. In addition the article draws conclusion from the study results and makes recommendations. The study found out that the contextual factors that influence MCH policies in Malawi were similar to the constraints encountered in implementing the policies in the health system. Therefore the paper recommends that health systems strengthening that will sustain improved health outcomes beyond achieving the Millennium Development Goals (MDGs) need to take into consideration the influencing factors of the context in which health systems operate. Ultimately, health system strengthening for achieving MDGs should be regarded as means for achieving sustained health outcomes not an end in itself.

Social Capital and Health in Latin America: Ecological and Individual Level Analyses

Abstract: Background: Several studies have evaluated the relationship between social capital and health in North America and Western Europe, although data remain scarce in Latin America. We examined the associations between indicators of social capital and health outcomes in nine Latin American countries. Methods: Design: Cross-sectional ecological and individual-level analyses of the relationships between social capital and health outcomes. Setting: Nine Latin American countries (Argentina, Brazil, Chile, Colombia, Dominican Republic, Mexico, Peru, Uruguay, and Venezuela), included in the World Values Survey. Subjects: 14,591 adults over 18 years. Main outcome measures: life expectancy at birth, infant mortality rate, under-5 mortality rate, and maternal mortality rate (ecological analyses), and odds ratios of reporting good (as opposed to poor) self-rated health (individual-level analyses). Results: Trust was significantly correlated with life expectancy at the cross-national level (r=0.72, p=0.03), and marginally significantly correlated with the maternal mortality rate (r=−0.61, p=0.09). Neither voluntary group participation nor church attendance was correlated with aggregate population health indicators. At the individual level, higher trust was significantly correlated with better self-rated health in five of the nine countries. Group membership was correlated with better health in three countries. Church attendance was correlated with worse health in Mexico and the Dominican Republic. Conclusions: Our findings provide preliminary support for the relevance of social capital as a determinant of health in the Latin American region. However, further research is warranted on refining the measurement of social capital in this region.

How to Find the Right Approach to Quality Measurement: Determinants of Quality and Its Measurement in Healthcare

Abstract: Measuring quality in health care is an important as well as frequent issue for polic makers and other parties. However, many attempts to measure quality fail. This paper analyzes typical reasons for failures and derives a set of determinants whose application decides on measurement success: the disease studied, the type of treatment studied, definition of “outcome,” purpose of quality measurement, time and location of treatment, measurement technique, and expected reasons for and amounts of quality differences. By discussing determinants in detail, a list of questions that should be answered before starting quality measurement is developed. Because determinants are equally important for investigators and policy makers, issues specific to the latter are discussed in an additional paragraph.

Medical and Public Health Civic Action Programs: using health engagement as a tool of foreign policy.

Abstract: The problem of failing states and the resulting increase in armed conflict has provoked a reexamination of foreign and security policies used to support the legitimacy of the state. One set of tools that are used in this instance are health engagement programs such as military Medical Civic Action Programs. This article examines the logic of the programs from the perspective of social contract theory and proposes criteria for developing these interventions in a manner consistent with the strategic goal of stabilizing the state. Case studies in Iraq and Bangladesh are used to illustrate proper planning and implementation of health engagement programs.

The Ecology of Health Policymaking and Reform in the U.S.A.

Abstract: This article demonstrates how constitutional, political, legal, economic, technological, social and cultural, physical, demographic, and global factors affect health policymaking in the U.S.A. The ecological factors that influence health policy in the U.S. are uniquely different from those of other countries. Therefore, even though a number of problems may be common to health systems worldwide, these problems may require different solutions in the different countries, or in different sections of the same country. The article concludes that the above ecological factors, individually or collectively, cause U.S. health policies to be inconsistent. For example, policies were adopted in the past to promote the concentrated interests of health providers. Recently, the rise of opposing concentrated interests, a lingering economic recession, a weakened resistance to change, and policy learning from the practices of other industrialized countries and from scholarly publications give us hope that reform, although still difficult to achieve, may finally be in sight.

Review of Cost Containment and Efficiency in National Health Systems: A Global Comparison

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Scientific Misconduct: The Perversion of Scientific Evidence for Policy Advocacy

Abstract: Science is increasingly being manipulated by those who try to use it to justify political choices based on their ethical preferences, and who are willing to act to suppress evidence of conflict between those preferences and the underlying reality. This problem is clearly seen in two policy domains, healthcare and climate policy. In the area of climate policy, recent revelations of emails from the government-sponsored Climate Research Unit at the University of East Anglia reveal a pattern of data suppression, manipulation of results, and efforts to intimidate journal editors to suppress contradictory studies and indicate that scientific misconduct has been used intentionally to manipulate a social consensus to support the researchers' advocacy of addressing a problem that may or may not exist. In healthcare policy, critics have long worried about the inordinate influence of pharmaceutical and medical device manufacturers on research to show the safety and viability of new products. Recent information, however, shows that government agencies may cause more problems in this area, a worrisome development considering that legislation currently before the U.S. Senate would allow federal agencies to punish organizations whose researchers publish results that conflict with what the agency feels is appropriate. That bill allows the withholding of funding to an institution where a researcher publishes findings not “within the bounds of and entirely consistent with the evidence,” a vague authorization that creates a tremendous tool that can be used to ensure self-censorship and conformity with bureaucratic preferences. As the research group Academy Health notes, “Such language to restrict scientific freedom is unprecedented and likely unconstitutional.”

Do People Support Sin Taxes? A Population Survey of Attitudes

Abstract: Background: The rising costs of healthcare and the recognition that many chronic diseases are preventable by healthy lifestyles have led to inquiry about economic incentives for modifying behavior. The present work explored people’s attitudes towards a differential health insurance premium based on lifestyle. Methods: A random dial telephone survey of the Israeli population assessed the degree of agreement with a policy of differential taxing on health insurance premium with a discount for individuals maintaining a healthy lifestyle, such as nonsmoking or regular exercise. Results: A majority (66%) of respondents expressed support for a policy of differential taxing. Support was high across all sectors of society, including Arab Israelis (92%), Russians (71%), orthodox religious individuals (78%), persons with low education (72%) or low income (69%), smokers (51%), and sedentary people (65%).

Transportation and health: the good and the bad.

Abstract: Transportation has contributed in many ways to improve human life and well-being. From humanitarian assistance to rapid sharing, food and pharmaceutical transportation does benefit mankind in ways that are not always appreciated. Unfortunately, transportation can negatively impact human health in two broad ways: accidents and environmental pollution. It can also facilitate the spread of infectious diseases. Safe and responsible use of transportation technology is of concern to all users, operators, and technologists, including healthcare providers. Medical professionals should participate in safety and educational campaigns, bioengineering and human factors research, and advocacy of the timely introduction of health and safety policies for a more responsible operation of transportation and new technology insertion.

HIV: the hidden face of human trafficking.

Abstract: Human trafficking emerges as one of the most significant social, legal, medical, and public health crises of our time. A relatively under-explored facet of human trafficking is the victim' risk to become infected with HIV and other sexually transmitted pathogens. Several studies reported that significant percentages of trafficking victims are HIV-positive. In addition, some of the HIV-positive victims are co-infected with hepatitis B, tuberculosis, or syphilis. The large numbers of clients, together with the unprotected sexual relationships that many trafficking victims are forced to have, greatly heighten their risk to become infected. Furthermore, just like trafficking, HIV represents a taboo topic in many societies worldwide, and the marginalization of rescued trafficking victims by families and society significantly compounds their suffering and increases their susceptibility for further abuse. The interface between human trafficking and HIV represents an important area that needs to be explored in future studies, and should receive increased attention from public health officials.

Medical technology and the U.S. healthcare system: is this the road to abilene?

Abstract: The conventional wisdom that Americans are unwilling to discuss limits to healthcare resources or tolerate any restrictions on treatment choices presents a formidable barrier to implementing policies that would reduce healthcare cost growth. Typical explanations for the conventional wisdom are plentiful, but not entirely useful in providing guidance for appropriate policy responses. In this paper, we analyze an organizational theory known as the Abilene Paradox to explain the lack of public engagement and the paucity of research concerning public values and preferences on difficult healthcare issues such as the use of medical technology. The analysis suggests that one strategy for improving policymaking would be to expand on recent research efforts concerning public participation in decisions about medical technology. These efforts demonstrate that when structured, deliberative methods are employed, members of the public are both willing and able to engage as social decision makers for allocating limited resources.

A new approach to producing geographic profiles of HIV prevalence : an application to Malawi

Abstract: Sub-national estimates of HIV prevalence can inform the design of policy responses to the HIV epidemic. Such responses also benefit from a better understanding of the correlates of HIV status, including the association between HIV and geographical characteristics of localities. In recent years, several countries in Africa have implemented household surveys (such as Demographic and Health Surveys) that include HIV testing of the adult population, providing estimates of HIV prevalence rates at the sub-national level. These surveys are known to suffer from non-response bias, but are nonetheless thought to represent a marked improvement over alternatives such as sentinel surveys. At present, however, most countries are not in a position to regularly field such household surveys. This paper proposes a new approach to the estimation of HIV prevalence for relatively small geographic areas in settings where national population-based surveys of prevalence are not available. The proposed approach aims to overcome some of the difficulties with prevailing methods of deriving HIV prevalence estimates (at both national and sub-national levels) directly from sentinel surveys. The paper also outlines some of the limitations of the proposed approach.

Delivery of a model HIV prevention and health promotion train-the-trainer program in India by homeopathy and ayurveda practitioners and educators.

Abstract: Purpose: To evaluate the effectiveness of a one-day and three-day train-the-trainer HIV/AIDS program delivered to homeopathy and ayurveda practitioners and educators. Introduction: The purpose of the training was to assess (a) the change in knowledge of and attitudes regarding HIV/AIDS at three and six months following the training, and (b) the number of secondary trainees trained by the primary trainees. Methods: Participants included 202 physicians of homeopathy and ayurveda in northern India. A total of 96 physicians of homeopathy and ayurveda were trained as primary trainees in the one-day program, and 106 were trained in the three-day program. Knowledge of and attitudes toward HIV/AIDS were measured by a modified 21-item questionnaire. The one-day training program covered epidemiology of the disease, transmission, and clinical presentation with a case-study approach. The three-day training added the social, ethical, and legal impact of being HIV-infected along with health counselor and participant role plays. Results: Findings revealed that both the one-day and three-day primary trainees significantly increased their HIV/AIDS knowledge and attitude scores from pretest to immediate posttest with ongoing improvement in both groups over the three- and six-month period. A total of 26% of primary trainees in the one-day program trained secondary trainees, and 36% of primary trainees in the three-day program trained secondary trainees. Conclusions: A train-the-trainer approach can improve the knowledge and attitude scores of ayurveda and homeopathy practitioners and educators as well as increase the number of secondary trainees. Increasing the number of trained providers to reinforce HIV prevention messages has policy implications for the Indian System of Medicine, which serves nearly 2.5 million HIV-infected patients.

Aging Research: Translating Scientific Discovery into Clinical Intervention

Abstract: The world population is aging, and at a steadily increasing rate. In many ways people are not only living longer, but healthier. However, the challenges of an aging population, for individuals and society, are also increasingly evident: a significant percentage of older Americans report functional problems, rates of morbidity from heart disease and hypertension are still high, and exponential growth in Alzheimer's disease is predicted without new and more effective treatments. This article highlights some of the National Institute on Aging's research, including basic studies in genetics and the biological determinants of aging, translational studies in Alzheimer's disease, studies to reduce disease and disability among older adults, and studies of the social and behavioral aspects of aging and Comparative Effectiveness Research (CER). The revolution in longevity brings with it an increased urgency to understand aging. A broad-based effort across key areas—basic biology, epidemiology, translational and clinical medicine, and social and behavioral factors—is critical to discovering new ways to support better health and maintain independence for older people.

Health and economic gains: what is at stake in South Africa's health reform?

Abstract: Background: Health reform is on the agenda of the recently elected South African president. A National Health Insurance Scheme (NHI), a single-payer and universal health insurance plan, is the foremost option under consideration. This study examines the health and economic gains that South Africa may have at stake in health reform. Method: This descriptive study estimates the avoidable mortality rate in South Africa, or deaths that occur prematurely and could have been prevented with proper treatment for select conditions. The study also estimates the disability-adjusted life years (DALYs) associated with these premature deaths. The study compares the avoidable mortality rate in South Africa with the rates in countries falling into three overlapping groups: (1) countries with similar national health spending as South Africa, (2) countries with similar national health spending and universal health insurance coverage, and (3) countries with similar national health spending, universal health insurance coverage, and single-payer systems. Data: The source of data for avoidable mortality estimates is the World Health Organization (WHO) mortality database reporting the number of registered deaths in 2005. The source of data for the associated DALYs is the Mortality and Burden of Disease Estimate for WHO Member States in 2004. Results: South Africa could potentially gain up to 184,085 lives and reduce the burden of disease by 14.2 million DALYs by avoiding premature deaths under a single-payer system like the NHI. Meeting United Nations Millennium Development Goals could save an additional 32,190 lives. In addition to health reform, a healthy, productive, and skilled workforce is necessary to reach these goals, but the country's skilled-labor unemployment rate is high and its investment in health-professional training is low. Conclusion: Reform could impact health and economic growth via a healthier, productive workforce and demand for quality healthcare.