Showing papers on "International health published in 2000"

Health literacy as a public health goal: a challenge for contemporary health education and communication strategies into the 21st century

Abstract: SUMMARY Health literacy is a relatively new concept in health promotion. It is a composite term to describe a range of outcomes to health education and communication activities. From this perspective, health education is directed towards improving health literacy. This paper identifies the failings of past educational programs to address social and economic determinants of health, and traces the subsequent reduction in the role of health education in contemporary health promotion. These perceived failings may have led to significant underestimation of the potential role of health education in addressing the social determinants of health. A ‘health outcome model’ is presented. This model highlights health literacy as a key outcome from health education. Examination of the concept of health literacy identifies distinctions between functional health literacy, interactive health literacy and critical health literacy. Through this analysis, improving health literacy meant more than transmitting information, and developing skills to be able to read pamphlets and successfully make appointments. By improving people’s access to health information and their capacity to use it effectively, it is argued that improved health literacy is critical to empowerment. The implications for the content and method of contemporary health education and communication are then considered. Emphasis is given to more personal forms of communication, and community-based educational outreach, as well as the political content of health education, focussed on better equipping people to overcome structural barriers to health.

Understanding and addressing racial disparities in health care.

Abstract: Racial disparities in medical care should be understood within the context of racial inequities in societal institutions. Systematic discrimination is not the aberrant behavior of a few but is often supported by institutional policies and unconscious bias based on negative stereotypes. Effectively addressing disparities in the quality of care requires improved data systems, increased regulatory vigilance, and new initiatives to appropriately train medical professionals and recruit more providers from disadvantaged minority backgrounds. Identifying and implementing effective strategies to eliminate racial inequities in health status and medical care should be made a national priority.

Public Health Implications of Urban Agriculture

Abstract: The article presents the case for stronger public policies in support of urban gardening as a means to improve public health. It considers several beneficial aspects of gardening, such as food security, economic development, exercise, psychological and community well-being, and environmental stewardship. It also considers some of the public health problems associated with urban agriculture and suggests policies to ameliorate them. In the balance, urban gardening has potential as an important element of urban public health.

Policy and Practice Global public-private partnerships: part I - a new development in health?

Abstract: The proliferation of public–private partnerships is rapidly reconfiguring the international health landscape. This article (part I of two on the subject) traces the changing nature of partnership, and discusses the definitional and conceptual ambiguities surrounding the term. After defining global public–private partnerships (GPPPs) for health development, we analyse the factors which have led to the convergence of public and private actors and discuss the consequences of the trend toward partnership between UN agencies (including the World Bank) and commercial entities in the health sector. Generic factors such as globalization and disillusionment with the UN, and factors specific to the health sector, such as market failure in product development for orphan diseases, are examined. Reviewed are the interests, policies, practices and concerns of the UN, the private-for-profit sector, bilateral organizations, and governments of low-income countries with respect to public–private partnership. While GPPPs bring much needed resources to problems of international health, we highlight concerns regarding this new organizational format. Part II, which will be published in the May issue of the Bulletin, presents a conceptual framework for analysing health GPPPs and explores the issues raised.

Global public-private partnerships: Part I--A new development in health?

Abstract: The proliferation of public-private partnerships is rapidly reconfiguring the international health landscape. This article (part I of two on the subject) traces the changing nature of partnership, and discusses the definitional and conceptual ambiguities surrounding the term. After defining global public-private partnerships (GPPPs) for health development, we analyse the factors which have led to the convergence of public and private actors and discuss the consequences of the trend toward partnership between UN agencies (including the World Bank) and commercial entities in the health sector. Generic factors such as globalization and disillusionment with the UN, and factors specific to the health sector, such as market failure in product development for orphan diseases, are examined. Reviewed are the interests, policies, practices and concerns of the UN, the private-for-profit sector, bilateral organizations, and governments of low-income countries with respect to public-private partnership. While GPPPs bring much needed resources to problems of international health, we highlight concerns regarding this new organizational format. Part II, which will be published in the May issue of the Bulletin, presents a conceptual framework for analysing health GPPPs and explores the issues raised.

Disseminating health information in developing countries: the role of the internet

Abstract: During a visit to India in March President Clinton watched a woman enter a village health centre, call up a web page on the computer, and get information on how to care for her baby.1 It is possible that this baby will have better health because of the availability of information on the internet. However, this possibility is underpinned by several assumptions, and the potential of information and communication technologies still has not been harnessed systematically to bring about important improvements in the health of populations, particularly among those who are poor and isolated in developing countries. This article explores the potential of advances in information and communication technologies to disseminate information and describes the availability of access to technology in developing countries. It also discusses issues of accuracy and the relevance of content. #### Summary points Information and communication technologies have not been harnessed systematically to improve the health of populations in developing countries These technologies empower those who use information by providing them with a choice of information to be accessed in their own time and by allowing them to put their own information on the web The current digital divide is more dramatic than any other inequity in health or income The quality of health information available on the web is inconsistent, and the visibility of research from developing countries is limited The way forward is to exploit the full interactivity of the internet, which allows rapid feedback and change to continuously mould information into useful knowledge Sources for this paper were obtained by searching Medline using the term dissemination and from visits to websites and links to related organisations known to be working in the areas of health research and information and communication technologies in developing countries. Information was also provided by key informants working in international health …

Managing health care organizations: where professionalism meets complexity science

Abstract: This article examines the intersection of professionalism and complexity science as a source of new insights for improving the health care industry from both a clinical and business point of view. Viewing health care organizations as professional complex adaptive systems suggests eight leadership tasks for addressing the circumstances that engulf health care. Managers who adopt this view will be able to create new levers for positive movement in their organizations.

Global public-private partnerships: part II - what are the health issues for global governance?

Abstract: This is the second of a two-part review of global public-private partnerships (GPPPs) for health development. Part I was published in the April issue of the Bulletin (Vol. 78, No. 4). The recent emergence of GPPPs is rapidly reconfiguring the international health landscape. While most multilateral and bilateral agencies are currently grappling with how to proceed, there is little information in the public domain concerning how individual partnerships work and to date very little consideration of the many implications of this trend. This paper differentiates between product-based, product development-based and issues/systems-based GPPPs and describes a number of examples of each type in the health sector. The benefits of these initiatives, not least the major resources which they harness for specific health problems, are identified. The final section of the paper explores the implications and dilemmas posed by GPPPs. It discusses whether or not shared goals can transcend conflicting values and mandates and how governance of partnership arrangements may transform and undermine certain attributes of multilateral organizations. The paper concludes that the current climate of goodwill between public and private sectors offers an opportunity that should not be missed: it can be used not only to foster new partnership but to ensure that partnership is truly in the interests of international public health.

Health literacy: a challenge for American patients and their health care providers

Abstract: Health literacy skills are increasingly important for both health and health care. Unfortunately many patients with the most extensive and complicated health care problems are at greatest risk for misunderstanding their diagnoses medications and instructions on how to take care of their medical problems. Much health promotion and patient education information has traditionally used printed materials written at reading levels at or above the 10th grade. Such material is not accessible to the millions of Americans with inadequate literacy. This paper gives an overview of the prevalence of poor health literacy skills in America and describes how poor health literacy affects their health care experience. (authors)

The Changing Nature of Rural Health Care

Abstract: ▪ Abstract The rural health care system has changed dramatically over the past decade because of a general transformation of health care financing, the introduction of new technologies, and the clustering of health services into systems and networks. Despite these changes, resources for rural health systems remain relatively insufficient. Many rural communities continue to experience shortages of physicians, and the proportion of rural hospitals under financial stress is much greater than that of urban hospitals. The health care conditions of selected rural areas compare unfavorably with the rest of the nation. The market and governmental policies have attempted to address some of these disparities by encouraging network development and telemedicine and by changing the rules for Medicare payments to providers. The public health infrastructure in rural America is not well understood but is potentially the most fragile aspect of the rural health care continuum.

An Overview of the Normative Economics of the Health Sector

Abstract: This chapter provides an overview of normative analysis in the health sector in recent decades. It surveys two distinct, but related, literatures. The first is normative analysis of the operation of health care and health care insurance markets, market failure, and the scope for non-market institutional arrangements to improve the efficiency and equity of the financing, funding, organization and delivery of health care. The second is the debate about the most appropriate normative framework within which to carry out normative analysis in the health sector, focusing on the welfarist and extra-welfarist frameworks. This is a debate about assumptions and methods. Although the rival frameworks share the broad conclusion that market failure pervades the health sector, the diagnoses regarding nature of that failure sometimes differ and, more importantly, the prescriptions to improve efficiency and equity often differ. Because it is not always clear what writers mean by “welfare economics” and “extra-welfarism,” I briefly summarize key concepts of efficiency and key assumptions and elements of each framework. The three subsequent sections then analyze the nature of health care as an economic commodity and the implications of these characteristics both for the operation of health care and health care insurance markets and for the methods of normative economic analysis. Section 4 surveys prominent approaches to analyzing equity in health care. Section 5 examines the methods of normative analysis as applied to evaluate individual health care services. Finally, I end with some observations on recent discussions of the role of normative economic analysis in policy making and of health economists as policy advisors.

New world views: preparing physicians in training for global health work.

Abstract: BACKGROUND AND OBJECTIVES To determine the impact of international health experiences on physicians in training, we studied 60 US medical students who participated in an International Health Fellowship Program (IHFP). METHODS In 1995 and 1996, US medical students were selected to participate in the IHFP, which included training at three US medical schools and at seven medical schools in developing countries. The program included a 2-week preparatory course at a US school and a 6- to 8-week field experience. Evaluative data were collected prior to the course, after the course, after the field experience, and 1-2 years later. RESULTS A total of 60 students were selected from 145 applicants. At the end of the fellowship, a majority of participants noted that the exposure affected them in the following ways: changed world views; increased cultural sensitivity; enhanced community, social, and public health awareness; enhanced clinical and communication skills; more appropriate resource utilization; changes in career plans; and a greater understanding of the challenges of working in areas with scarce resources. After the international field experience, students more strongly agreed with the importance of oral rehydration, communication skills, and patient education. According to student self-assessments, the IHFP significantly improved core medical skills. Ninety-six percent of participants recommended international health experiences for other students. CONCLUSIONS This study of IHFP fellows demonstrates multiple significant impacts of international health experiences on US medical students in training. The knowledge, attitudes, and skills gained through international health experiences are important for medical practice in the United States and abroad. Given the high interest of medical students in international health and the potential for positive educational impacts, medical schools should increase the availability of high-quality international experiences.

To boldly go....

Abstract: The threshold of the new millennium offers an opportunity to celebrate remarkable past achievements and to reflect on promising new directions for the field of public health. Despite historic achievements, much will always remain to be done (this is the intrinsic nature of public health). While every epoch has its own distinct health challenges, those confronting us today are unlike those plaguing public health a century ago. The perspectives and methods developed during the infectious and chronic disease eras have limited utility in the face of newly emerging challenges to public health. In this paper, we take stock of the state of public health in the United States by (1) describing limitations of conventional US public health, (2) identifying different social philosophies and conceptions of health that produce divergent approaches to public health, (3) discussing institutional resistance to change and the subordination of public health to the authority of medicine, (4) urging a move from risk factorology to multilevel explanations that offer different types of intervention, (5) noting the rise of the new "right state" with its laissez-faire attitude and antipathy toward public interventions, (6) arguing for a more ecumenical approach to research methods, and (7) challenging the myth of a value-free public health.

Who is Paying for Health Care in Eastern Europe and Central Asia

Abstract: Informal payments in the health sector in Eastern Europe and Central Asia (ECA) is emerging as a fundamental aspect of health care financing and as a major impediment to health care reform. Private payments to public doctors, nurses, and other health personnel are essentially an informal market for health care occurring within the confines of public health care service networks. These expenditures are also outside the financial controls, policy rubric, and audits of countries' health care systems. Like the informal sector, it is often illegal and unreported, and despite the terminology, is a form of corruption. 'Who is Paying for Health Care in Eastern Europe and Central Asia?' outlines the key policy issues, summarizes available data on the scope and nature of informal payments across ECA and spells out the policy implications and possible strategies to address the problem.

Who has osteoporosis? A conflict between clinical and public health perspectives.

Abstract: NEARLY A decade ago, our group published a Perspective in this journal entitled, “How Many Women Have Osteoporosis?” (1) The article pointed out that the size of the osteoporosis problem could be addressed either with respect to the number of people with low bone mineral density (BMD), a useful in vivo surrogate for “abnormalities in the amount and architectural arrangement of bone tissue leading to impaired skeletal strength,” (2) or in terms of the number of people experiencing characteristic osteoporosis-related fractures, especially those of the hip, spine, or distal forearm. In either instance, a precise delineation of the affected population was limited by the data available at that time, which were restricted almost entirely to white women. However, since that report, an enormous amount of new information has been published about this important problem. In particular, there are now refined estimates of the lifetime risk of osteoporotic fractures that take account of the rising incidence rates observed in some populations as well as improvements in life expectancy. Even more important has been development by the World Health Organization (WHO) of an operational definition of osteoporosis based on bone density (3) that has fostered better estimates of the prevalence of osteoporosis, including a wealth of new data on the prevalence of osteoporosis in men and nonwhite women. On the other hand, the advent of novel densitometric techniques has revealed significant discrepancies in the prevalence estimates depending on which technology is used, and this, in turn, has raised questions about how osteoporosis should be defined. (4) The resulting controversy has exposed a conflict between the need to document the magnitude of the public health problem represented by osteoporosis as opposed to the clinician’s need to assess fracture risk in individual patients. Vitriolic attacks on the WHO criteria are a reflection of this growing conflict in perspectives. (5)

International Public Health: Diseases Programs Systems And Policies

Abstract: By emphasizing diseases, programs, health systems, and health policies, this detailed revision helps readers understand the wide range of global public health issues and the various approaches nations adopt to deal with them. This title explores the public health problems facing low- and middle-income countries today, and identifies their three greatest challenges: reproductive health, infectious disease, and nutrition.

Primary health care networks in the Islamic Republic of Iran.

Abstract: The progress towards achieving health for all in the Islamic Republic of Iran is reported in this paper with particular reference to primary health care networks. The establishment of the networks is outlined and the vital elements within the system described, such as the community health workers (behvarz) and the health information system. Areas of achievement are reviewed.

Strengthening health research capacity in developing countries: a critical element for achieving health equity.

Abstract: # Strengthening health research capacity in developing countries: a critical element for achieving health equity {#article-title-2} Equity in health as the core value of health for all advocated by the Alma Ata declaration has not been achieved. Poverty is widening and inequity prevails.1 New illnesses have burdened and strained health systems. Rapid growth of private medical services, medical technology, and uncontrolled insurance markets in many developing countries with relatively rapid private sector growth have resulted in unwanted consequences, highlighted by the economic crisis in Asia.2 The rising number of international organisations and institutions involved in global health has eroded national sovereignty. The migration of health professionals from the public to the private sector and from developing to developed countries has diminished their ability undertake research and implement research findings.3 It has also limited developing countries' ability to participate in the political debates and decisions on global health governance. Greater support of research for development is needed and health equity must be adopted as a core value. #### Summary points Health inequity is widening between and within countries Research capacity in developing countries is weak As a result developing countries are unable to participate effectively in national and international health policy development International and national cooperation and collaboration is needed to strengthen research capacity for health development Health policy should be informed by a wide range of stakeholders and underpinned by sound evidence Greater solidarity and commitment to tackling global health inequity is needed Health research capacity is the ability to define problems, set objectives and priorities, build sustainable institutions and organisations, and identify solutions to key national health problems.4 This definition encompasses research capacity at the levels of individuals, research groups, institutions, and nations. Research capacity can broadly be divided into four domains: skills and competencies; scientific activities; outcomes; and impacts on policies and programmes.5 Measures on process, outcome, and impact are necessary to …

Mental health policy development in Africa.

Abstract: Mental health issues are usually given very low priority in health service policies. Although this is changing, African countries are still confronted with so many problems caused by communicable diseases and malnutrition that they have not waken up to the impact of mental disorders. Every country must formulate a mental health policy based on its own social and cultural realities. Such policies must take into account the scope of mental health problems, provide proven and affordable interventions, safeguard patients' rights, and ensure equity.

WHO Framework Convention on Tobacco Control: a global ‘‘good’’ for public health

Abstract: Although the application of legal instruments to international health issues - relative to other areas of international concern - is still at a rudimentary stage of development, the transnational health impacts of globalization provide a rationale for the codification and implementation of global norms to deal with shared problems. The experience of promulgating international agreements in other areas closely related to international health - the environment, for example - demonstrates how evidence-based international agreements can effectively address a range of problems that cross national boundaries. The framework convention-protocol approach is a legally binding, incremental approach to international law-making that has frequently been employed to deal with environmental threats, and is now being adapted to serve purely public health ends. Experience with the recently initiated WHO Framework Convention on Tobacco Control provides a case study of how transnational public health problems can be addressed by an international legal approach. Scientific evidence in public health and economics has provided the foundation for the elaboration of this evidence-based strategy. The present tobacco epidemic poses a range of transnational challenges that are best addressed through coordinated action. In this article, it is argued that the proposed Convention has the potential to be a global ‘‘good’’ for public health - i.e. it has the potential to yield important global public health benefits - and that it represents a test case for more active involvement of the public health community in international law-making.

The politics of health in Europe

Abstract: Health politics the health care state in Europe, 1880-1980 national health services - Italy, Sweden and the UK social insurance systems - France and Germany reform and restructuring doctors and states the users of health care health, the public and public health.

The European Network of Health Promoting Schools – an alliance of health, education and democracy

Abstract: Operating within the “settings” approach of the Ottawa Charter, the European Network of Health Promoting Schools has, since its launch in 1992, been the most powerful catalyst for the development of the health‐promoting school concept across Europe. Founded on a partnership between the European Union, Council of Europe and the World Health Organization, it is now established in 40 countries right across Europe. Its principles have been determined by a range of key meetings, conferences and documents, while the evaluation of its practice increasingly suggests that it is highly effective. The network is based on the principles of empowerment, partnership, democracy, equity, action competence and sustainability, and sees key areas for action as being teacher education, links with parents and the community, and evaluation, to move health promotion in schools on to a sound evidence base. Targets for the future development of the network include extending it to the few remaining countries that still fall outsid...

Networking Health: Prescriptions for the Internet

Abstract: Consumer health websites have garnered considerable media attention, but only begin to scratch the surface of the more pervasive transformations the Internet could bring to health and health care. Networking Health examines ways in which the Internet may become a routine part of health care delivery and payment, public health, health education, and biomedical research. Building upon a series of site visits, this book: * Weighs the role of the Internet versus private networks in uses ranging from the transfer of medical images to providing video-based medical consultations at a distance. * Reviews technical challenges in the areas of quality of service, security, reliability, and access, and looks at the potential utility of the next generation of online technologies. * Discusses ways health care organizations can use the Internet to support their strategic interests and explores barriers to a broader deployment of the Internet. * Recommends steps that private and public sector entities can take to enhance the capabilities of the Internet for health purposes and to prepare health care organizations to adopt new Internet-based applications.