Showing papers on "International health published in 2009"
TL;DR: Pivotal facets of primary health care are not in place and there is a substantial human resources crisis facing the health sector, so the new government needs to address these factors if health is to be improved and the Millennium Development Goals achieved in South Africa.
1,344 citations
TL;DR: This Report suggests that this Report provides the most detailed compilation of published and emerging evidence so far, and provides a basis for identification of the ways in which GHIs and health systems can interact to mutually reinforce their effects.
483 citations
TL;DR: In this paper, the authors examined the health implications of policies aimed at tackling climate change and provided evidence that mitigation strategies can have substantial benefits for both health and climate protection, which offers the possibility of policy choices that are potentially both more cost effective and socially attractive than are those that address these priorities independently.
437 citations
TL;DR: The development of health literacy policies will be facilitated by better evidence on the extent, patterns and impact of low health literacy, and what might be involved in improving it, but the current lack of consensus of definitions and measurement will first need to be overcome.
Abstract: 'Health literacy' refers to accessing, understanding and using information to make health decisions. However, despite its introduction into the World Health Organization's Health Promotion Glossary, the term remains a confusing concept. We consider various definitions and measurements of health literacy in the international and Australian literature, and discuss the distinction between the broader concept of 'health literacy' (applicable to everyday life) and 'medical literacy' (related to individuals as patients within health care settings). We highlight the importance of health literacy in relation to the health promotion and preventive health agenda. Because health literacy involves knowledge, motivation and activation, it is a complex thing to measure and to influence. The development of health literacy policies will be facilitated by better evidence on the extent, patterns and impact of low health literacy, and what might be involved in improving it. However, the current lack of consensus of definitions and measurement of health literacy will first need to be overcome.
405 citations
TL;DR: The World Health Organization (WHO) Global Oral Health Programme invites the international oral health research community to engage further in research capacity building in developing countries, and in strengthening the work so that research is recognized as the foundation of oral heath policy at global level.
Abstract: The World Health Organization (WHO) Global Oral Health Programme has worked hard over the past 5 years to increase the awareness of oral health worldwide as oral health is important component of general health and quality of life. Meanwhile, oral disease is still a major public health problem in high income countries and the burden of oral disease is growing in many low- and middle income countries. In the World Oral Health Report 2003, the WHO Global Oral Health Programme formulated the policies and necessary actions to the continuous improvement of oral health. The strategy is that oral disease prevention and the promotion of oral health needs to be integrated with chronic disease prevention and general health promotion as the risks to health are linked. The World Health Assembly (WHA) and the Executive Board (EB) are supreme governance bodies of WHO and for the first time in 25 years oral health was subject to discussion by those bodies in 2007. At the EB120 and WHA60, the Member States agreed on an action plan for oral health and integrated disease prevention, thereby confirming the approach of the Oral Health Programme. The policy forms the basis for future development or adjustment of oral health programmes at national level. Clinical and public health research has shown that a number of individual, professional and community preventive measures are effective in preventing most oral diseases. However, advances in oral health science have not yet benefited the poor and disadvantaged populations worldwide. The major challenges of the future will be to translate knowledge and experiences in oral disease prevention and health promotion into action programmes. The WHO Global Oral Health Programme invites the international oral health research community to engage further in research capacity building in developing countries, and in strengthening the work so that research is recognized as the foundation of oral heath policy at global level.
405 citations
TL;DR: The reform agenda aims to tackle major access and equity issues that affect health outcomes for people now; redesign the health system so that it is better positioned to respond to emerging challenges; and create an agile, responsive and self‐improving health system for long‐term sustainability.
Abstract: After extensive community and health industry consultation, the final report of the National Health and Hospitals Reform Commission, A healthier future for all Australians, was presented to the Australian Government on 30 June 2009. The reform agenda aims to tackle major access and equity issues that affect health outcomes for people now; redesign our health system so that it is better positioned to respond to emerging challenges; and create an agile, responsive and self-improving health system for long-term sustainability. The 123 recommendations are grouped in four themes: Taking responsibility: supporting greater individual and collective action to build good health and wellbeing. Connecting care: delivering comprehensive care for people over their lifetime, by strengthening primary health care, reshaping hospitals, improving subacute care, and opening up greater consumer choice and competition in aged care services. Facing inequities: taking action to tackle the causes and impact of health inequities, focusing on Aboriginal and Torres Strait Islander people, people in rural and remote areas, and access to mental health and dental services. Driving quality performance: having leadership and systems to achieve the best use of people, resources and knowledge, including "one health system" with national leadership and local delivery, revised funding arrangements, and changes to health workforce education, training and practice.
379 citations
TL;DR: In the Dutch context, country of birth can be considered a useful indicator for ethnicity if complemented with additional indicators to compensate for the drawbacks in certain conditions, and shed light on the mechanisms underlying the association between ethnicity and health.
Abstract: The relationship between ethnicity and health is attracting increasing attention in international health research. Different measures are used to operationalise the concept of ethnicity. Presently, self-definition of ethnicity seems to gain favour. In contrast, in the Netherlands, the use of country of birth criteria have been widely accepted as a basis for the identification of ethnic groups. In this paper, we will discuss its advantages as well as its limitations and the solutions to these limitations from the Dutch perspective with a special focus on survey studies. The country of birth indicator has the advantage of being objective and stable, allowing for comparisons over time and between studies. Inclusion of parental country of birth provides an additional advantage for identifying the second-generation ethnic groups. The main criticisms of this indicator seem to refer to its validity. The basis for this criticism is, firstly, the argument that people who are born in the same country might have a d...
315 citations
TL;DR: The author shows that what has been happening is not a reduction of state interventions but a change in the nature and character of those interventions, resulting from major changes in class (and race and gender) power relations in each country with establishment of an alliance between the dominant classes of developed and developing countries—a class alliance responsible for the promotion of its ideology, neoliberalism.
Abstract: This article analyzes the changes in health conditions and quality of life in the populations of developed and developing countries over the past 30 years, resulting from neoliberal policies developed by many governments and promoted by the World Bank, International Monetary Fund, World Health Organization, and other international agencies It challenges interpretations by the analysts of “globalization,” including the common assumption that states are disappearing The author shows that what has been happening is not a reduction of state interventions but a change in the nature and character of those interventions, resulting from major changes in class (and race and gender) power relations in each country, with establishment of an alliance between the dominant classes of developed and developing countries—a class alliance responsible for the promotion of its ideology, neoliberalism This is the cause of the enormous health inequalities in the world today The article concludes with a critical analysis of
314 citations
01 Jan 2009
TL;DR: The scope and concerns of public health are discussed in this article, where the authors present a framework for understanding the determinants of health and diseases in low and middle-income countries.
Abstract: SECTION 1: THE DEVELOPMENT OF THE DISCIPLINE OF PUBLIC HEALTH 11 The scope and concerns of public health 12 The history and development of public health in high-income countries 13 The history and development of public health in low- and middle-income countries 14 The development of the discipline of public health in countries in economic transition: India, Brazil, China SECTION 2: DETERMINANTS OF HEALTH AND DISEASE 21 A framework for understanding determinants of health 22 Globalization 23 Behavioural determinants of health and disease 24 Genomics and public health 25 Water and sanitation 26 Food and nutrition 27 Infectious diseases 28 The global environment 29 Health services as determinants of population health 210 Assessing health needs: the Global Burden of Disease approach SECTION 3: PUBLIC HEALTH POLICIES 31 Overview of policies and strategies 32 Public health policy in high-income countries 33 Health policy in low- and middle-income countries 34 Leadership in public health SECTION 4: PUBLIC HEALTH LAW AND ETHICS 41 The right to the highest attainable standard of health 42 Comparative national public health legislation 43 International public health instruments 44 Ethical principles and ethical issues in public health SECTION 5: INFORMATION SYSTEMS AND SOURCES OF INTELLIGENCE 51 Information systems in support of public health in high-income countries 52 Information systems and community diagnosis in low- and middle-income countries 53 Web-based public health information dissemination and evaluation SECTION 6: EPIDEMIOLOGICAL AND BIOSTATISTICAL APPROACHES 61 Epidemiology: the foundation of public health 62 Ecologic variables, ecologic studies, and multi-level studies in public health research 63 Cross-sectional studies 64 Principles of outbreak investigation 65 Case-control studies 66 Cohort studies 67 Methodology of intervention trials in individuals 68 Methodological issues in the design and analysis of community intervention trials 69 Community-based intervention studies in high-income countries 610 Community-based intervention trials in low- and middle-income countries 611 Clinical epidemiology 612 Validity and bias in epidemiological research 613 Causation and causal inference 614 Systematic reviews and meta-analysis 615 Statistical methods 616 Mathematical models of transmission and control 617 Public health surveillance SECTION 7: SOCIAL SCIENCE TECHNIQUES 71 Sociology and psychology in public health 72 Demography and public health 73 Health promotion, health education, and the public health 74 Cost-effectiveness analysis: concepts and applications 75 Governance and management of public health programmes 76 Public health sciences and policy in high-income countries 77 Public health sciences and policy in low- and middle-income countries SECTION 8: ENVIRONMENTAL AND OCCUPATIONAL HEALTH SCIENCES 81 Environmental health issues in public health 82 Radiation and public health 83 Control of microbial threats: population surveillance, vaccine studies, and the microbiological laboratory 84 The science of human exposures to contaminants in the environment 85 Occupational health 86 Ergonomics and public health 87 Toxicology and risk assessment in the analysis and management of environmental risk 88 Risk perception and communication SECTION 9: MAJOR HEALTH PROBLEMS 91 Gene-environment interactions and public health 92 Cardiovascular and cerebrovascular diseases 93 Neoplasms 94 Chronic obstructive pulmonary disease and asthma 95 Obesity 96 The epidemiology and prevention of diabetes mellitus 97 Public mental health 98 Dental public health 99 Musculoskeletal diseases 910 Neurological diseases, epidemiology and public health 911 The transmissable spongiform encephalopathies 912 Sexually transmitted infections 913 Acquired immunodeficiency syndrome 914 Tuberculosis 915 Malaria 916 Chronic hepatitis and other liver disease 917 Emerging and re-emerging infections SECTION 10: PREVENTION AND CONTROL OF PUBLIC HEALTH HAZARDS 101 Tobacco 102 Drug abuse 103 Alcohol 104 Injury prevention and control: the public health approach 105 Interpersonal violence prevention: a recent public health mandate 106 Collective violence: war 107 Urban health in low- and middle-income countries 108 Public health aspects of bioterrorism SECTION 11: PUBLIC HEALTH NEEDS OF POPULATION GROUPS 111 The changing family 112 Women, men and health 113 Child health 114 Adolescent health 115 Ethnic minorities and indigenous peoples 116 People with disabilities 117 Health of older people 118 Forced migrants and other displaced populations SECTION 12: PUBLIC HEALTH FUNCTIONS 121 Need: what is it and how do we measure it? 122 Needs assessment: a practical approach 123 Socio-economic inequalities in health in high-income countries: the facts and the options 124 Reducing health inequalities in low- and middle-income countries 125 Prevention and control of chronic, non-communicable diseases 126 Principles of infectious disease control 127 Population screening and public health 128 Environmental health practice 129 Structures and strategies for public health intervention 1210 Strategies for health services 1211 Public health workers 1212 Planning for and responding to public health needs in emergencies and disasters SECTION 13: THE FUTURE OF PUBLIC HEALTH 131 Private support of public health 132 Global health agenda for the 21st century
293 citations
TL;DR: All residents can receive global health training and be afforded the accreditation and programmatic support to participate in safe international rotations, with feasible and appropriate administrative steps.
Abstract: Increasing international travel and migration have contributed to globalization of diseases. Physicians today must understand the global burden and epidemiology of diseases, the disparities and inequities in global health systems, and the importance of cross-cultural sensitivity. To meet these needs, resident physicians across all specialties have expressed growing interest in global health training and international clinical rotations. More residents are acquiring international experience, despite inadequate guidance and support from most accreditation organizations and residency programs. Surveys of global health training, including international clinical rotations, highlight the benefits of global health training as well as the need for a more coordinated approach. In particular, international rotations broaden a resident's medical knowledge, reinforce physical examination skills, and encourage practicing medicine among underserved and multicultural populations. As residents recognize these personal and professional benefits, a strong majority of them seek to gain international clinical experience. In conclusion, with feasible and appropriate administrative steps, all residents can receive global health training and be afforded the accreditation and programmatic support to participate in safe international rotations. The next steps should address accreditation for international rotations and allowance for training away from continuity clinics by residency accreditation bodies, and stipend and travel support for six or more weeks of call-free elective time from residency programs.
282 citations
TL;DR: The findings are that the volume of official development assistance for health is frequently inflated; and that data on private sources of global health finance are inadequate but indicate a large and important role of private actors.
Abstract: Global health funding has increased in recent years. This has been accompanied by a proliferation in the number of global health actors and initiatives. This paper describes the state of global heath finance, taking into account government and private sources of finance, and raises and discusses a number of policy issues related to global health governance. A schematic describing the different actors and three global health finance functions is used to organize the data presented, most of which are secondary data from the published literature and annual reports of relevant actors. In two cases, we also refer to currently unpublished primary data that have been collected by authors of this paper. Among the findings are that the volume of official development assistance for health is frequently inflated; and that data on private sources of global health finance are inadequate but indicate a large and important role of private actors. The fragmented, complicated, messy and inadequately tracked state of global health finance requires immediate attention. In particular it is necessary to track and monitor global health finance that is channelled by and through private sources, and to critically examine who benefits from the rise in global health spending.
TL;DR: International health policy, in the form of a Framework Convention on Alcohol Control, is needed to counterbalance the global conditions promoting alcohol-related harm and to support and encourage national action.
TL;DR: A broad, new definition of public health literacy is outlined, defined as the degree to which individuals and groups can obtain, process, understand, evaluate, and act on information needed to make public health decisions that benefit the community.
TL;DR: An analysis of 1094 global health grants awarded between January, 1998, and December, 2007 found that the total value of these grants was US$8.95 billion, of which $5.82 billion (65%) was shared by only 20 organisations, and just over a third of funding was allocated to research and development, or to basic science research.
TL;DR: Mary Moran and colleagues survey global investment into research and development of new pharmaceutical products to prevent, manage, or cure diseases of the developing world.
Abstract: The need for new pharmaceutical tools to prevent and treat neglected diseases is widely accepted [1]. The creation of a vaccine for HIV/AIDS, more effective diagnostics for tuberculosis (TB), and better treatments for leishmaniasis and sleeping sickness would greatly improve health in the developing world in line with the United Nations Millennium Development Goals. However, funders wishing to invest in this vitally important area currently face an information gap.
There is little consensus on what constitutes a neglected disease or what new products are required [2]. Health research funding figures have been published by the Council on Health Research for Development and the Global Forum for Health Research [3,4], but these do not disaggregate product-related research and development (R&D) or neglected disease investments.
Specific R&D investment data are available for some neglected diseases—including annual surveys of HIV/AIDS and TB funding since 2000 and 2005, respectively [5,6], and a one-off survey of malaria R&D funding published in 2005 [7]—but these cannot readily be compared since each survey uses different methodologies and covers different diseases, products, donors, and countries. For most neglected diseases, there is simply no information.
In order to address these information deficits, the Bill & Melinda Gates Foundation commissioned the George Institute for International Health to conduct five sequential annual surveys of global investment into R&D of new pharmaceutical products to prevent, manage, or cure diseases of the developing world. This article summarises key data from the first G-FINDER report (http://www.thegeorgeinstitute.org/prpppubs).
TL;DR: It is concluded that China should consider changing the provider payment method from fee- for-service to a prospective payment method such as DRG or capitation with pay-for-performance, and to develop purchasing agencies that represent the interests of the population so as to enhance competition.
TL;DR: In the two decades since the fall of the Berlin Wall, former communist countries in Europe have pursued wide-ranging changes to their health systems as discussed by the authors, including an almost universal switch to health insurance systems, a growing reliance on out-of-pocket payments (both formal and informal), and efforts to strengthen primary health care, often with a model of family medicine delivered by general practitioners.
Book•
06 Nov 2009TL;DR: This call for greater investment in nutrition comes at a time when global efforts to strengthen health systems provide a unique opportunity to scale up integrated packages of health and nutrition interventions, with common delivery platforms, and lower costs.
Abstract: Undernutrition imposes a staggering cost worldwide, both in human and economic terms. It is responsible for the deaths of more than 3.5 million children each year (more than one-third of all deaths among children under five) and the loss of billions of dollars in forgone productivity and avoidable health care spending. Individuals lose more than 10 percent of lifetime earnings, and many countries lose at least 2-3 percent of their gross domestic product to undernutrition. The current economic crisis and its potential impact on the poor make investing in child nutrition more urgent than ever to protect and strengthen human capital in the most vulnerable developing countries. This report offers suggestions on how to raise these resources. It is an investment we must make. It will yield high returns in the form of thriving children, healthier families, and more productive workers. This investment is essential to make progress on the nutrition and child mortality Millennium Development Goals (MDGs) and to protect critical human capital in developing economies. The human and financial costs of further neglect will be high. This call for greater investment in nutrition comes at a time when global efforts to strengthen health systems provide a unique opportunity to scale up integrated packages of health and nutrition interventions, with common delivery platforms, and lower costs. The report has benefited from the expertise of many international agencies, nongovernmental organizations, and research institutions. The cooperation of so many practitioners is evidence of a growing recognition of the need to invest in nutrition interventions, and a growing consensus about how to deliver effective programs.
TL;DR: This article developed a definition for global health and then presented four principal contributions of anthropologists to global health: (a) ethnographic studies of health inequities in political and economic contexts; (b) analysis of the impact on local worlds of the assemblages of science and technology that circulate globally; (c) interrogation, analysis, and critique of international health programs and policies; and (d) analyses of the health consequences of the reconfiguration of the social relations of global health development.
Abstract: This article addresses anthropology's engagement with the emerging discipline of global health. We develop a definition for global health and then present four principal contributions of anthropology to global health: (a) ethnographic studies of health inequities in political and economic contexts; (b) analysis of the impact on local worlds of the assemblages of science and technology that circulate globally; (c) interrogation, analysis, and critique of international health programs and policies; and (d) analysis of the health consequences of the reconfiguration of the social relations of international health development.
TL;DR: The results for the transition core outcome from the 2005–2006 National Survey of Children With Special Health Care Needs are described, which shows 41% of youth with special health care needs met the core performance outcome for transition.
Abstract: OBJECTIVES. Many youth with special health care needs have difficulties transferring to adult medical care. To address this, the Maternal and Child Health Bureau has made receipt of transition services a core performance outcome for community-based systems of care for youth with special health care needs. In this article we describe the results for the transition core outcome from the 2005–2006 National Survey of Children With Special Health Care Needs. We also describe changes in the measurement strategy for this outcome since the first National Survey of Children With Special Health Care Needs in 2001. METHODS. In the nationally representative, cross-sectional 2005–2006 National Survey of Children With Special Health Care Needs, parent or guardian respondents of 18198 youth with special health care needs (aged 12–17) were asked if they have had discussions with their child9s health care providers about (1) future adult providers, (2) future adult health care needs, (3) changes in health insurance, and (4) encouraging their child to take responsibility for his or her care. All 4 components had to be met for the youth to meet the overall transition core outcome. Those who had not had transition discussions reported if such discussions would have been helpful. RESULTS. Overall, 41% of youth with special health care needs met the core performance outcome for transition. Forty-two percent had discussed shifting care to an adult provider, 62% discussed their child9s adult health care needs, and 34% discussed upcoming changes in health insurance. Most (78%) respondents said that providers usually or always encourage their child to take responsibility for his or her health. Non-Hispanic black or Hispanic race/ethnicity, lower income level, not speaking English, and not having a medical home reduced the odds of meeting the transition core outcome. CONCLUSIONS. Current performance on the transition core outcome leaves much room for improvement. Many parents feel that having transition-related discussions with their health care providers would be helpful. Future clinical and policy-level research should be directed at identifying barriers to, and recommending content for, health transition discussions.
TL;DR: A review of major ethical issues is presented, how they pertain to students, and a framework is outlined to help guide students in their work.
Abstract: As a result of increased interest in global health, more and more medical students and trainees from the ‘developed world’ are working and studying in the ‘developing world’. However, while opportunities to do this important work increase, there has been insufficient development of ethical guidelines for students. It is often assumed that ethics training in developed world situations is applicable to health experiences globally. However, fundamental differences in both clinical and research settings necessitate an alternative paradigm of analysis. This article is intended for teachers who are responsible for preparing students prior to such experiences. A review of major ethical issues is presented, how they pertain to students, and a framework is outlined to help guide students in their work.
Book•
02 Jun 2009
TL;DR: This most widely used textbook in the field has been thoroughly revised and updated to reflect changes in the health care industry and the renewed focus on health care information technology initiatives.
Abstract: This most widely used textbook in the field has been thoroughly revised and updated to reflect changes in the health care industry and the renewed focus on health care information technology initiatives. Two new chapters cover Federal efforts to enhance quality of patient care through the use of health care information technology and strategy considerations. Additionally, reflecting the increased focus on global health, the book features an international perspective on health care information technology. Case studies of organizations experiencing management-related information system challenges have been updated and several new cases have been added. These reality-based cases are designed to stimulate discussion among students and enable them to apply concepts in the book to real-life scenarios. The book's companion Web site features lecture slides, a test bank, and other materials to enhance students' understanding.
TL;DR: Actors in the health care sector must recognize and reverse the sector's propensity to generate health inequity and strengthen its role in working with other sectors of government to act collectively on the deep-rooted causes of poor and inequitable health.
Abstract: Entrenched poor health and health inequity are important public health problems. Conventionally, solutions to such problems originate from the health care sector, a conception reinforced by the dominant biomedical imagination of health. By contrast, attention to the social determinants of health has recently been given new force in the fight against health inequity. The health care sector is a vital determinant of health in itself and a key resource in improving health in an equitable manner. Actors in the health care sector must recognize and reverse the sector's propensity to generate health inequity. The sector must also strengthen its role in working with other sectors of government to act collectively on the deep-rooted causes of poor and inequitable health.
University of Washington1, University of Minnesota2, University of Utah3, University of Pennsylvania4, Group Health Cooperative5, United States Department of Veterans Affairs6, University of California, San Francisco7, Vanderbilt University8, University of Oklahoma9, University of Maryland, Baltimore10, American Cancer Society11, Kaiser Permanente12, University of Iowa13
TL;DR: The role of obtaining family history information in the primary care setting, the validity of such information, and whether the information affects health outcomes must be clarified are clarified.
Abstract: National Institutes of Health consensus and state-of-the science statements are prepared by independent panels of health professionals and public representatives on the basis of 1) the results of a systematic literature review prepared under contract with the Agency for Healthcare Research and Quality (AHRQ); 2) presentations by investigators working in areas relevant to the conference questions during a 2-day public session; 3) questions and statements from conference attendees during open discussion periods that are part of the public session; and 4) closed deliberations by the panel during the remainder of the second day and morning of the third. This statement is an independent report of the panel and is not a policy statement of the National Institutes of Health or the U.S. government. The statement reflects the panel's assessment of medical knowledge available at the time the statement was written. Thus, it provides a "snapshot in time" of the state of knowledge on the conference topic. When reading the statement, keep in mind that new knowledge is inevitably accumulating through medical research.
Book•
24 Dec 2009
TL;DR: This report calls for the United States to take the lead, working with global health organizations, to establish a global zoonotic disease surveillance system that better integrates the human and animal health sectors for improved early detection and response.
Abstract: H1N1 ("swine flu"), SARS, mad cow disease, and HIV/AIDS are a few examples of zoonotic diseases-diseases transmitted between humans and animals. Zoonotic diseases are a growing concern given multiple factors: their often novel and unpredictable nature, their ability to emerge anywhere and spread rapidly around the globe, and their major economic toll on several disparate industries.Infectious disease surveillance systems are used to detect this threat to human and animal health. By systematically collecting data on the occurrence of infectious diseases in humans and animals, investigators can track the spread of disease and provide an early warning to human and animal health officials, nationally and internationally, for follow-up and response. Unfortunately, and for many reasons, current disease surveillance has been ineffective or untimely in alerting officials to emerging zoonotic diseases.Sustaining Global Surveillance and Response to Emerging Zoonotic Diseases assesses some of the disease surveillance systems around the world, and recommends ways to improve early detection and response. The book presents solutions for improved coordination between human and animal health sectors, and among governments and international organizations.Parties seeking to improve the detection and response to zoonotic diseases--including U.S. government and international health policy makers, researchers, epidemiologists, human health clinicians, and veterinarians--can use this book to help curtail the threat zoonotic diseases pose to economies, societies, and health.
TL;DR: New findings from the 2005–2006 National Survey of Children with Special Health Care Needs regarding parental perceptions of the extent to which children with special health care needs (CSHCN) have access to a medical home suggest care synonymous with the principles underlying the medical home is not yet in place for a significant number of CSHCN and their families.
Abstract: OBJECTIVE. This article reports new findings from the 2005–2006 National Survey of Children with Special Health Care Needs (NS-CSHCN) regarding parental perceptions of the extent to which children with special health care needs (CSHCN) have access to a medical home. METHODS. Five criteria were analyzed to describe the extent to which CSHCN receive care characteristic of the medical home concept. Data on 40840 children included in the NS-CSHCN were used to assess the presence of a medical home, as indicated by achieving each of the 5 criteria. RESULTS. Results of the survey indicate that (1) approximately one half of CSHCN receive care that meets all 5 criteria established for a medical home; (2) access to a medical home is affected significantly by race/ethnicity, income, health insurance status, and severity of the child9s condition; (3) parents of children who do have a medical home report significantly less delayed or forgone care and significantly fewer unmet needs for health care and family support services; and (4) limited improvements have occurred since success rates were first measured by using the 2001 NS-CSHCN. CONCLUSIONS. The findings suggest that, although some components of the medical home concept have been achieved for most CSHCN, care synonymous with the principles underlying the medical home is not yet in place for a significant number of CSHCN and their families.
TL;DR: The mechanisms that determine funding flows to local agencies may place some communities at a disadvantage in securing resources for public health activities, and the extent of variation in public health agency spending levels across communities and over time is examined.
Abstract: Geographic variation in health care spending within the United States has long been a source of policy concern because it implies large inefficiencies and inequities in resource use (Wennberg and Gittelsohn 1973). The greater-than-twofold differences in health care spending observed across U.S. communities persist after accounting for differences in medical care prices (Welch et al. 1993; Skinner and Fisher 1997;), socioeconomic status (SES), and illness burden (Wennberg and Cooper 1998; Fisher et al. 2000;). Moreover, several recent studies suggest that residents of high-spending regions do not enjoy superior health outcomes compared with their counterparts in low-spending regions (Fisher et al. 2003a,b;). Medical care represents only one class of resources used to improve health and control disease, and studies suggest that these resources account for only about half of the gains in life expectancy realized during the past half-century (Brown et al. 1991; Trust for America's Health [TFAH] 2006; Sensenig 2007;). By comparison, public health resources support activities designed to promote health and prevent disease and disability at the population level, such as efforts to monitor community health status, investigate and control disease outbreaks, educate the public about health risks and prevention strategies, enforce public health laws and regulations like those concerning tobacco use or food preparation, and inspect and assure the safety and quality of water, air, and other resources necessary for good health (Institute of Medicine [IOM] 1988). These activities may account for gains in health and life expectancy that are not attributable to medical care. As such, geographic variation in public health resources may contribute to gaps and inequities in population health. Relatively little is known, however, about the extent and nature of geographic variation in public health spending.
Although no uniform system of accounts exists to track public health spending at national, state, or local levels, available estimates suggest that less than 5 percent of the nation's health-related spending is devoted to public health activities (Brown et al. 1991; TFAH 2006; Sensenig 2007;). Public health activities are supported through a patchwork of local, state, federal, and nongovernmental funding mechanisms that vary widely across states and communities (Gerzoff, Gordon, and Richards 1996; Gordon, Gerzoff, and Richards 1997; TFAH 2006;). These mechanisms give rise to large geographic disparities in spending for public health services. The National Association of State Budget Officers (NASBO) estimated that state governments' per-capita spending on public health activities varied by a factor of >30 in 2003, ranging from >U.S.$400 per person in Alaska and Hawaii to U.S.$200 per capita in 2005, with the median local public health agency spending about U.S.$30 per person (National Association of County and City Health Officials [NACCHO] 2006).
On balance, very little empirical evidence exists about the extent and nature of geographic variation in public health spending (Carande-Kulis, Getzen, and Thacker 2007). The lack of uniform data on public health spending has hampered research on this topic. The NASBO and more recently the TFAH have used information from state budget documents to produce estimates of state governmental spending on public health activities, but differences in state accounting and reporting conventions cause significant errors and inconsistencies in estimates (NASBO 2005; TFAH 2006;). Other studies have classified the public health expenditures of individual state or local governments using standardized accounting protocols, but these individual assessments do not support systematic comparisons of spending across communities and over time (Barry et al. 1998; Budetti and Lapolla 2008;). Estimates of federal, state, and local governmental expenditures on public health activities are included in the National Health Expenditure Accounts maintained by the U.S. Centers for Medicare and Medicaid Services (CMS), using data collected by the U.S. Census of Governments. These estimates, however, are widely considered to be incomplete because they include expenditures for a relatively narrow set of governmental activities and because they exclude expenditures on personal health services commonly provided by public health agencies, such as immunizations, chronic disease screening, and communicable disease control (Sensenig 2007). Completely lacking in the literature are estimates of the resources expended on public health activities by nongovernmental organizations such as community hospitals, community-based organizations, health insurers, and employers (Mays, Halverson, and Kaluzny 1998; Mays et al. 2000;).
This paper uses a recently compiled longitudinal dataset on local governmental public health agencies to examine how public health spending levels vary across communities and change over time. Following similar studies of variation in medical spending, we focus on three primary questions of interest: (1) what are the demographic, socioeconomic, and institutional characteristics of high-spending and low-spending communities? (2) What characteristics are associated with growth and decline in spending levels over time? (3) What types of communities are most likely to experience reductions in public health spending? Answers to these questions will help policy makers at all levels of government anticipate resource needs and make better decisions about how to allocate scarce public health resources.
This study focuses on spending at the local level because local public health agencies—rather than their state and federal counterparts—assume primary responsibility for directly implementing public health activities in most communities (DeFriese et al. 1981; Halverson et al. 1996;). Most federal and state grants for public health activities, and significant private funding, are channeled through local public health agencies (Mays et al. 2004b; NACCHO 2006;). Moreover, these agencies frequently work to mobilize and coordinate the public health activities of other organizations in the community (Mays, Halverson, and Kaluzny 1998; IOM 2002;). As such, these agencies provide valuable settings in which to study the determinants and consequences of public health spending in the United States.
TL;DR: Urgent national and international action is necessary to address the tensions arising from increasing human demand for fish and seafood, and rapidly declining marine ecosystem health.
Abstract: Background Health recommendations advocating increased fish consumption need to be placed in the context of the potential collapse of global marine capture fisheries.Methods Literature overview.Results In economically developed countries, official healthy eating advice is to eat more fish, particularly that rich in omega-3 oils. In many less economically developed countries, fish is a key human health asset, contributing >20% of animal protein intake for 2.6 billion people. Marine ecologists predict on current trends that fish stocks are set to collapse in 40 years, and propose increased restrictions on fishing, including no-take zones, in order to restore marine ecosystem health. Production of fishmeal for aquaculture and other non-food uses (22 MT in 2003) appears to be unsustainable. Differences in fish consumption probably contribute to within-country and international health inequalities. Such inequalities are likely to increase if fish stocks continue to decline, while increasing demand for fish will accelerate declines in fish stocks and the health of marine ecosystems.Conclusions Urgent national and international action is necessary to address the tensions arising from increasing human demand for fish and seafood, and rapidly declining marine ecosystem health.
Book•
01 Jan 2009
TL;DR: The New Public Health is a contemporary application of a broad range of evidencebased scientific, technological, and management systems implementing measures to improve the health of individuals and populations, relevant to all countries, developing, transitional, or industrialized.
Abstract: The New Public Health has established itself as a solid textbook throughout the world. Translated into 7 languages, The New Public Health distinguishes itself from other public health textbooks, which are either highly locally oriented or, if international, lack the specificity of local issues relevant to students' understanding of applied public health in their own setting. Following the "gold standard" of knowledge set by the Council for Education in Public Health, the new edition includes: * 40% new material, including all new tables, figures, data, and chapter bibliographies * Updates based on the 2005 accreditation criteria of the Council for Education in Public Health (CEPH), as will feedback received from an extensive survey of professors using NPH1 * Multiple case studies, chapter-ending bibliographies, and "recommended readings" * Companion website features an Instructors' Guide, PowerPoint lectures slides by the authors on topics related to the chapters, Case Studies, and Links to key websites for continuous updating of material for study and research The second edition of The New Public Health provides a unified approach to public health appropriate for all masters' level students and practitioners - specifically for courses in MPH programs, community health and preventive medicine programs, community health education programs, community health nursing programs, as well as programs for other medical professionals such as pharmacy, physiotherapy, and other public health courses. Specific courses include: Fundamentals of Public Health, Introduction to Public Health Policy, Philosophy of Public Health, History of Public Health, Public Health and Healthcare Management, New Technologies and Public Health, Genetics and Biotechnologies, Bio-preparedness and others. * 40% new material, including all new tables, figures, data, and chapter bibliographies * Updates based on the 2005 accreditation criteria of the Council for Education in Public Health (CEPH) * Multiple case studies, chapter-ending bibliographies, and "recommended readings" * Includes detailed companion website featuring and instructors' guide, PowerPoint slides, case studies and much more
TL;DR: It is argued that historians of global health and policymakers need to interact further so that historians are exposed to the contemporary problems of globalhealth and policymakers better understand the historical complexity of extracting ‘lessons’ from the past.
Abstract: International1 health funders, leaders and researchers frequently cite ‘successes’ in this field as validation for past labours and justification for future endeavours. However, the question of what constitutes success – from both historical and contemporary perspectives – has been inadequately analysed. This paper reviews and periodises understandings of success in international/global health during the past century and a half, mapping out shifts and continuities over time. It then turns to the implications of these changing conceptualisations for current and future global health ideologies, strategies and activities. It concludes by arguing that historians of global health and policymakers need to interact further so that historians are exposed to the contemporary problems of global health and policymakers better understand the historical complexity of extracting ‘lessons’ from the past.