Showing papers on "International health published in 2006"

US Department of Health and Human Services: a need for global health leadership in preparedness and health diplomacy.

Abstract: More than ever before the US Department of Health and Human Services (DHHS) needs to be a global health agency working to protect the health economic and security interests of US citizens through global collaboration and commitment to the public good. Public health preparedness extends beyond public health surveillance preparation for bioterrorism and political policy. Preparedness involves understanding the 21st-century world--its changing disease burden its changing demographics and its changing political and environmental substrata. It is the moral responsibility of the US government particularly through its lead health entity to address the high-disease burden global health challenges. DHHS agencies must work within multinational and bilateral structures to build consensus respond to global health threats and cultivate science to build a strong global public health infrastructure. Global health is both an economic priority and a security priority of the United States. Therefore the collective expertise of multiple disciplines must be harnessed to support the best approaches to the major global health challenges. The disciplines of epidemiology health policy economics law environmental science and certainly bioethics can make essential contributions to a comprehensive global health strategy. (excerpt)

Redefining Health Care: Creating Value-based Competition on Results

Abstract: A look at the North American health care system, issues of reform, value for money and services.

Disease control priorities in developing countries, second edition

Abstract: This is the second edition of the original 1993 publication on public health. The purpose of this book is to provide information about what works, specifically, the cost-effectiveness of health interventions in a variety of settings. Such information should influence the redesign of programs and the reallocation of resources, thereby helping to achieve the ultimate goal of reducing morbidity and mortality. As was the case with the first edition, this second edition of will serve an array of audiences. This second edition of Disease Control Priorities in Developing Countries (DCP2) seeks to update and improve guidance on the what-to-do questions in DCP1 and to address the institutional, organizational, financial, and research capacities essential for health systems to deliver the right interventions. DCP2 is the principal product of the Disease Control Priorities Project, an alliance of organizations designed to review, generate, and disseminate information on how to improve population health in developing countries. In addition to DCP2, the project produced numerous background papers, an extensive range of interactive consultations held around the world, and several additional major publications.

A cascade of disparities: health and health care access for people with intellectual disabilities.

Abstract: People with ID represent approximately 2% of the population and, as a group, experience poorer health than the general population. This article presents recent conceptualizations that begin to disentangle health from disability, summarizes the literature from 1999 to 2005 in terms of the cascade of disparities, reviews intervention issues and promising practices, and provides recommendations for future action and research. The reconceptualization of health and disability examines health disparity in terms of the determinants of health (genetic, social circumstances, environment, individual behaviors, health care access) and types of health conditions (associated, comorbid, secondary). The literature is summarized in terms of a cascade of disparities experienced by people with ID, including a higher prevalence of adverse conditions, inadequate attention to care needs, inadequate focus on health promotion, and inadequate access to quality health care services. Promising practices are reviewed from the perspective of persons with ID, providers of care and services, and policies that influence systems of care. Recommendations across multiple countries and organizations are synthesized as guidelines to direct future action. They call for promoting principles of early identification, inclusion, and self-determination of people with ID; reducing the occurrence and impact of associated, comorbid, and secondary conditions; empowering caregivers and family members; promoting healthy behaviors in people with ID; and ensuring equitable access to quality health care by people with ID. Their broadscale implementations would begin to reduce the health disparity experienced by people with ID.

The epidemiology of overweight and obesity: public health crisis or moral panic?

Abstract: National and international health organizations have focused increasingly on a perceived obesity epidemic said to pose drastic threats to public health. Indeed, some medical experts have gone so far as to predict that growing body mass will halt and perhaps even reverse the millennia-long trend of rising human life expectancy. 1 In response to such concerns public health agencies across the world have sprung into action, searching for policies or incentives to mitigate the alleged ‘disease’ of obesity. Yet even as the volume of alarm grows louder, a growing number of researchers, drawn from a broad array of academic disciplines, are calling these claims into question. The authors of this article come from this latter group. In our view the available scientific data neither support alarmist claims about obesity nor justify diverting scarce resources away from far more pressing public health issues. This article evaluates four central claims made by those who are calling for intensifying the war on fat: that obesity is an epidemic; that overweight and obesity are major contributors to mortality; that higher than average adiposity is pathological and a primary direct cause of disease; and that significant long-term weight loss is both medically beneficial and a practical goal. Given the limited scientific evidence for any of these claims, we suggest that the current rhetoric about an obesity-driven health crisis is being driven more by cultural and political factors than by any threat increasing body weight may pose to public health.

The World Health Organization and the Transition From “International” to “Global” Public Health

Abstract: Even a quick glance at the titles of books and articles in recent medical and public health literature suggests that an important transition is underway. The terms ‘global’, ‘globalization’, and their variants are everywhere, and in the specific context of international public health, ‘global’ seems to be emerging as the preferred authoritative term.1 As one indicator, the number of entries under the rubrics ‘global’ and ‘international’ health in PubMed shows that ‘global’ health is rapidly on the rise, seemingly on track to overtake ‘international’ health at some point in 2005 (see Table 5.1). Although universities, government agencies, and private philanthropies are all using the term in highly visible ways, the origin and meaning of the term ‘global health’ are still unclear.2

WHO Health Promotion Glossary: new terms.

Abstract: SUMMARY The WHO Health Promotion Glossary was written to facilitate understanding, communication and cooperation among those engaged in health promotion at the local, regional, national and global levels. Two editions of the Glossary have been released, the first in 1986 and the second in 1998, and continued revision of the document is necessary to promote consensus regarding meanings and to take account of developments in thinking and practice. In this update 10 new terms that are to be included in the Glossary are presented. Criteria for the inclusion of terms in the Glossary are that they differentiate health promotion from other health concepts, or have a specific application or meaning when used in relation to health promotion. The terms defined here are: burden of disease; capacity building; evidence-based health promotion; global health; health impact assessment; needs assessment; self-efficacy; social marketing; sustainable health promotion strategies, and; wellness. WHO will continue to periodically update the Health Promotion Glossary to ensure its relevance to the international health promotion community.

Working together for health. The World Health Report 2006.

Abstract: The World Health Report 2006 - Working together for health contains an expert assessment of the current crisis in the global health workforce and ambitious proposals to tackle it over the next ten years starting immediately The report reveals an estimated shortage of almost 43 million doctors midwives nurses and support workers worldwide The shortage is most severe in the poorest countries especially in sub-Saharan Africa where health workers are most needed Focusing on all stages of the health workers career lifespan from entry to health training to job recruitment through to retirement the report lays out a ten-year action plan in which countries can build their health workforces with the support of global partners

Contextualizing salutogenesis and Antonovsky in public health development

Abstract: More than 20 years have passed since the American-Israeli medical sociologist Aaron Antonovsky introduced his salutogenic theory 'sense of coherence' as a global orientation to view the world, claiming that the way people view their life has a positive influence on their health. Sense of coherence explains why people in stressful situations stay well and even are able to improve their health. The origin of salutogenesis derives from the interviews of Israeli women with experiences from the concentration camps of the Second World War who in spite of this stayed healthy. Sixty years after the Holocaust this paper aim to shed light on the salutogenic theory in the context of public health and health promotion. In addition, other approaches with salutogenic elements for the explanation of health are considered. A potential direction for public health of the early 21st century is proposed. The historical paradox is to honour the victims of the Holocaust and see the birth of post-modern public health and the salutogenic framework through the experience of its survivors in the ashes of Modernity.

Governance and Corruption in Public Health Care Systems

Abstract: What factors affect health care delivery in the developing world? Anecdotal evidence of lives cut tragically short and the loss of productivity due to avoidable diseases is an area of salient concern in global health and international development. This working paper looks at factual evidence to describe the main challenges facing health care delivery in developing countries, including absenteeism, corruption, informal payments, and mismanagement. The author concludes that good governance is important in ensuring effective health care delivery, and that returns to investments in health are low where governance issues are not addressed.

Systems thinking and modeling for public health practice.

Abstract: Many public health workers will regard this issue of the Journal, devoted to the theme of systems thinking and modeling, as a welcome affirmation that our endeavors to protect the public’s health do indeed depend on more than the sum of their parts. As Midgley observes, “The whole concept of public health is founded on the insight that health and illness have causes or conditions that go beyond the biology and behavior of the individual human being.”1(p466) Animated by this systemic insight, public health leaders have worked for more than a century to identify and transform the processes that leave people vulnerable to afflictions of all sorts. As this work has evolved, our understanding of population health dynamics—and of our power to navigate change—has improved through innovations in the concepts, methods, and moral frameworks that shape the field. The present exploration of systems thinking and modeling, therefore, springs from the very core of our discipline, adding to our repertoire novel and far-reaching tools that the pioneers of public health work could scarcely have imagined.

The politics of public health policy.

Abstract: Politics, for better or worse, plays a critical role in health affairs. The purpose of this article is to articulate a role for political analysis of public health issues, ranging from injury and disease prevention to health care reform. It begins by examining how health problems make it onto the policy agenda. Perceptions regarding the severity of the problem, responsibility for the problem, and affected populations all influence governmental responses. Next, it considers how bounded rationality, fragmented political institutions, resistance from concentrated interests, and fiscal constraints usually lead political leaders to adopt incremental policy changes rather than comprehensive reforms even when faced with serious public health problems. It then identifies conditions under which larger-scale transformation of health policy can occur, focusing on critical junctures in policy development and the role of policy entrepreneurs in seizing opportunities for innovation. Finally, it reviews the challenges confronting officials and agencies who are responsible for implementing and administering health policies. Public health professionals who understand the political dimensions of health policy can conduct more realistic research and evaluation, better anticipate opportunities as well as constraints on governmental action, and design more effective policies and programs.

The practice of travel medicine: guidelines by the Infectious Diseases Society of America.

Abstract: David R. Hill, Charles D. Ericsson, Richard D. Pearson, Jay S. Keystone, David O. Freedman, Phyllis E. Kozarsky, Herbert L. DuPont, Frank J. Bia, Philip R. Fischer, and Edward T. Ryan National Travel Health Network and Centre and Department of Infectious and Tropical Diseases, London School of Hygiene and Tropical Medicine, London, England; Department of Medicine, University of Toronto, and Center for Travel and Tropical Medicine, Toronto General Hospital, Toronto, Ontario, Canada; Department of Internal Medicine, Clinical Infectious Diseases, University of Texas Medical School at Houston, Department of Internal Medicine, St. Luke’s Hospital, and Center for Infectious Diseases, University of Texas at Houston School of Public Health, and Department of Medicine, Baylor College of Medicine, Houston, Texas; Departments of Medicine and Pathology, Division of Infectious Diseases and International Health, University of Virginia School of Medicine, Charlottesville, Virginia; Departments of Medicine and Epidemiology, Division of Geographic Medicine, University of Alabama at Birmingham, Birmingham; Department of Medicine, Infectious Diseases, Emory University School of Medicine, and 16 Division of Global Migration and Quarantine, Centers for Disease Control and Prevention, Atlanta, Georgia; Department of Medicine and Laboratory Medicine, Yale Medical School, New Haven, Connecticut; Department of Pediatrics, Division of General Pediatric and Adolescent Medicine, Mayo Clinic College of Medicine, and Mayo Eugenio Litta Children’s Hospital, Mayo Clinic, Rochester, Minnesota; and Department of Medicine, Division of Infectious Diseases, Harvard Medical School, Harvard School of Public Health, and Tropical and Geographic Medicine Center, Massachusetts General Hospital, Boston, Massachusetts

Distrust of the health care system and self-reported health in the United States.

Abstract: CONTEXT: Despite theoretical concerns that health care related distrust may lead to poor health outcomes by interfering with effective health care, little is currently known about the prevalence or outcomes of distrust of the health care system in the United States

How health care systems can begin to address the challenge of limited literacy

Abstract: The growing literacy and health literature calls attention to the ways in which the U.S. health care system is inadequate and even unjust, not only for the estimated 90 million U.S. adults with limited literacy, but for many other users to the system. We have presented 3 overarching principles for health system transformation that focus on promoting productive interactions between patients and providers, reorganizing health care delivery, and embracing a community level and ecological perspective. We believe that instituting such changes could improve the quality of care not only for patients with limited literacy, but for all health care consumers, and could contribute to the development of a more “health literate” society.

Health on the Internet: implications for health promotion

Abstract: The aim of this article is to discuss the implications of health on the Internet for health promotion, focusing in particular on the concept of empowerment. Empowering aspects of health on the Internet include the enabling of advanced information and knowledge retrieval, anonymity and convenience in accessing information, creation of social contacts and support independent of time and space, and challenging the expert-lay actor relationship. The disempowering aspects of health on the Internet are that it involves a shift towards the expert control and evaluation of sources of health information, that it widens the gap between 'information-rich' and 'information-poor' users, thus reproducing existing social divisions, and that the increase in medicalization and healthism results in increased anxiety and poorer health. The health promotive and empowering strategies presented in this article are directed at strengthening people's ability to evaluate different information sources in relation to their own interests and needs rather than in relation to scientific and/or professional standards.

Decentralization In Health Care: Strategies And Outcomes

Abstract: Decentralization has become a popular management strategy in many European health care systems. The term describes a wide variety of power transfer arrangements and accountability systems. The logic of decentralization is grounded in an intrinsically powerful idea; that smaller organizations, properly structured and steered, are inherently more agile and accountable than larger organizations. In a world where large organizations control wide swathes of both public and private sector activity, the possibility of establishing more locally operated, locally responsible institutions holds out great attraction. This text explores the capacity and impact of decentralization within European health care systems. It examines both the theoretical underpinnings as well as recent practical experiences, drawing upon both published literature and evidence collected directly from the field. The book also assesses the appropriateness of management processes within health systems for implementing a successful decentralization strategy. "Decentralization in Health Care" will appeal to health policy makers, postgraduates taking courses in health services management, HR, health policy and health economics, and human resource professionals.

The neglected tropical diseases: The ancient afflictions of stigma and poverty and the prospects for their control and elimination

Abstract: The World Health Organizations and other international health agencies identify a select group of 13 tropical infections as the neglected tropical diseases (NTDs). These diseases, which include leprosy, kala-azar, river blindness, guinea worm, schistosomiasis, hookworm and lymphatic fi lariasis, strike the world’s poorest people living in remote and rural areas of low-income countries in Sub-Saharan Africa, Asia and the Americas. They infl ict suffering by causing life-long disabilities, disfi gurement, reduced economic productivity, and social stigma (WHO, 2003). Unlike better-known global health threats such as HIV-AIDS, malaria, and tuberculosis, the NTDs do not receive enough international attention. Instead, they are neglected diseases among forgotten people found only in the setting of geographic isolation and intense poverty (Molyneux, 2004). Impoverished and marginalized populations with the NTDs represent the lowest priority markets for U.S. and European pharmaceutical manufacturers. The NTDs do not occur in the industrialized world or even among the substantial wealthy and middle-classes in developing countries. They are not a signifi cant health risk for foreign travelers or the military. This is in contrast to the more substantial commercial markets for HIV-AIDS, malaria and tuberculosis (“the big three”). The recent creation of massive funding schemes for the big three, such as The Global Fund to Fight AIDS, Tuberculosis, and Malaria, and the U.S. President’s Emergency Plan for AIDS Relief provides additional fi nancial incentives, as well as a certain amount of panache and luster. In contrast, the commercial market for NTD drug

The basic principles of migration health: Population mobility and gaps in disease prevalence

Abstract: Currently, migrants and other mobile individuals, such as migrant workers and asylum seekers, are an expanding global population of growing social, demographic and political importance. Disparities often exist between a migrant population's place of origin and its destination, particularly with relation to health determinants. The effects of those disparities can be observed at both individual and population levels. Migration across health and disease disparities influences the epidemiology of certain diseases globally and in nations receiving migrants. While specific disease-based outcomes may vary between migrant group and location, general epidemiological principles may be applied to any situation where numbers of individuals move between differences in disease prevalence. Traditionally, migration health activities have been designed for national application and lack an integrated international perspective. Present and future health challenges related to migration may be more effectively addressed through collaborative global undertakings. This paper reviews the epidemiological relationships resulting from health disparities bridged by migration and describes the growing role of migration and population mobility in global disease epidemiology. The implications for national and international health policy and program planning are presented.

The privatization of health care in Europe: an eight-country analysis.

Abstract: This article presents an analysis of recent changes in the public-private mix in health care in eight European countries. The leading question is to what extent a process of privatization in health care can be observed. The framework for the analysis of privatization draws on the idea that there are multiple public/private boundaries in health care. The overall picture that emerges from our analysis is diverse, but there is evidence that health care in Europe has become somewhat more private. The growth of the public fraction in health care spending has come to an end since the 1980s, and in a few countries the private fraction even increased substantially. We also found some evidence for a shift from public to private in health care provision. Furthermore, there are signs of privatization in health care management and operations, as well as investments. Specific attention is spent on the identification of factors that push privatization forward and factors that work as a barrier to privatization.

The Global Public Health Intelligence Network and Early Warning Outbreak Detection: A Canadian Contribution to Global Public Health

Abstract: The recent SARS epidemic has renewed widespread concerns about the global transmission of infectious diseases. In this commentary, we explore novel approaches to global infectious disease surveillance through a focus on an important Canadian contribution to the area--the Global Public Health Intelligence Network (GPHIN). GPHIN is a cutting-edge initiative that draws on the capacity of the Internet and newly available 24/7 global news coverage of health events to create a unique form of early warning outbreak detection. This commentary outlines the operation and development of GPHIN and compares it to ProMED-mail, another Internet-based approach to global health surveillance. We argue that GPHIN has created an important shift in the relationship of public health and news information. By exiting the pyramid of official reporting, GPHIN has created a new monitoring technique that has disrupted national boundaries of outbreak notification, while creating new possibilities for global outbreak response. By incorporating news within the emerging apparatus of global infectious disease surveillance, GPHIN has effectively responded to the global media's challenge to official country reporting of outbreak and enhanced the effectiveness and credibility of international public health.

Social stigma and mental health among rural-to-urban migrants in China: A conceptual framework and future research needs.

Abstract: There are over 100 million individuals in China who have migrated from rural villages to urban areas for jobs or better lives without permanent urban residency (i.e., "rural-to-urban migrants"). Our preliminary data from ongoing research among rural-to-urban migrants in China suggest that the migrant population is strongly stigmatized. Moreover, it appears that substantial numbers of these migrants experience mental health symptoms (e.g., depression, anxiety, hostility, social isolation). While the population potentially affected is substantial (more than 9% of the entire population or about one-quarter of the rural labour force in mainland China) and our data seem to indicate that the issue is pervasive in this population, there is limited literature on the topic in China or elsewhere. Therefore, in the current article, we utilize secondary data from public resources (i.e., scientific literature, governmental publications, public media) and our own qualitative data to explore the issues of stigmatization and mental health, to propose a conceptual model for studying the association between the stigmatization and mental health among this population, and to identify some future needs of research in this area.

Breast cancer in limited-resource countries: health care systems and public policy.

Abstract: As the largest cancer killer of women around the globe, breast cancer adversely impacts countries at all levels of economic development. Despite major advances in the early detection, diagnosis, and treatment of breast cancer, health care ministries face multitiered challenges to create and support health care programs that can improve breast cancer outcomes. In addition to the financial and organizational problems inherent in any health care system, breast health programs are hindered by a lack of recognition of cancer as a public health priority, trained health care personnel shortages and migration, public and health care provider educational deficits, and social barriers that impede patient entry into early detection and cancer treatment programs. No perfect health care system exists, even in the wealthiest countries. Based on inevitable economic and practical constraints, all health care systems are compelled to make trade-offs among four factors: access to care, scope of service, quality of care, and cost containment. Given these trade-offs, guidelines can define stratified approaches by which economically realistic incremental improvements can be sequentially implemented within the context of resource constraints to improve breast health care. Disease-specific “vertical” programs warrant “horizontal” integration with existing health care systems in limited-resource countries. The Breast Health Global Initiative (BHGI) Health Care Systems and Public Policy Panel defined a stratified framework outlining recommended breast health care interventions for each of four incremental levels of resources (basic, limited, enhanced, and maximal). Reallocation of existing resources and integration of a breast health care program with existing programs and infrastructure can potentially improve outcomes in a cost-sensitive manner. This adaptable framework can be used as a tool by policymakers for program planning and research design to make best use of available resources to improve breast health care in a given limited-resource setting.

Economic barriers to better mental health practice and policy.

Abstract: Mental health systems in many countries are seriously under-developed, yet mental health problems not only have huge consequences for quality of life, but – particularly in low- and middle-income countries – contribute to continued economic burden and reinforce poverty. This paper discusses economic barriers to improving the availability, accessibility, efficiency and equity of mental health care in low- and middle-income countries. Six sets of barriers are identified: an information barrier, resource insufficiency, resource distribution, resource inappropriateness, resource inflexibility and resource timing. Overcoming these barriers will be a major task, although there is no shortage of suggestions for action. The paper discusses broadening the evidence base, improving mental health literacy, tackling stigma, improving financing mechanisms, prioritizing and protecting mental health care budgets, emphasizing mental health promotion through the development of resilience, exploring routes to improved equity, experimenting with new arrangements for purchasing and delivering services, improving coordination between agencies and professionals at both macro- and micro-levels, building alliances between public and private sectors, and training and mobilizing primary care services to improve identification and treatment of mental health problems.

Ethics and governance of global health inequalities

Abstract: Background: A world divided by health inequalities poses ethical challenges for global health. International and national responses to health disparities must be rooted in ethical values about health and its distribution; this is because ethical claims have the power to motivate, delineate principles, duties and responsibilities, and hold global and national actors morally responsible for achieving common goals. Theories of justice are necessary to define duties and obligations of institutions and actors in reducing inequalities. The problem is the lack of a moral framework for solving problems of global health justice. Aim: To study why global health inequalities are morally troubling, why efforts to reduce them are morally justified, how they should be measured and evaluated; how much priority disadvantaged groups should receive; and to delineate roles and responsibilities of national and international actors and institutions. Discussion and conclusions: Duties and obligations of international and state actors in reducing global health inequalities are outlined. The ethical principles endorsed include the intrinsic value of health to well-being and equal respect for all human life, the importance of health for individual and collective agency, the concept of a shortfall from the health status of a reference group, and the need for a disproportionate effort to help disadvantaged groups. This approach does not seek to find ways in which global and national actors address global health inequalities by virtue of their self-interest, national interest, collective security or humanitarian assistance. It endorses the more robust concept of “human flourishing” and the desire to live in a world where all people have the capability to be healthy. Unlike cosmopolitan theory, this approach places the role of the nation-state in the forefront with primary, though not sole, moral responsibility. Rather shared health governance is essential for delivering health equity on a global scale.