Showing papers on "International health published in 2011"

Interventions for preventing obesity in children (Review)

Abstract: Background Prevention of childhood obesity is an international public health priority given the significant impact of obesity on acute and chronic diseases, general health, development and well-being. The international evidence base for strategies that governments, communities and families can implement to prevent obesity, and promote health, has been accumulating but remains unclear. Objectives This review primarily aims to update the previous Cochrane review of childhood obesity prevention research and determine the effectiveness of evaluated interventions intended to prevent obesity in children, assessed by change in Body Mass Index (BMI). Secondary aims were to examine the characteristics of the programs and strategies to answer the questions "What works for whom, why and for what cost?" Search methods The searches were re-run in CENTRAL, MEDLINE, EMBASE, PsychINFO and CINAHL in March 2010 and searched relevant websites. Non-English language papers were included and experts were contacted. Selection criteria The review includes data from childhood obesity prevention studies that used a controlled study design (with or without randomisation). Studies were included if they evaluated interventions, policies or programs in place for twelve weeks or more. If studies were randomised at a cluster level, 6 clusters were required. Data collection and analysis Two review authors independently extracted data and assessed the risk of bias of included studies. Data was extracted on intervention implementation, cost, equity and outcomes. Outcome measures were grouped according to whether they measured adiposity, physical activity (PA)-related behaviours or diet-related behaviours. Adverse outcomes were recorded. A meta-analysis was conducted using available BMI or standardised BMI (zBMI) score data with subgroup analysis by age group (0-5, 6-12, 13-18 years, corresponding to stages of developmental and childhood settings). Main results This review includes 55 studies (an additional 36 studies found for this update). The majority of studies targeted children aged 6-12 years. The meta-analysis included 37 studies of 27,946 children and demonstrated that programmes were effective at reducing adiposity, although not all individual interventions were effective, and there was a high level of observed heterogeneity (I2=82%). Overall, children in the intervention group had a standardised mean difference in adiposity (measured as BMI or zBMI) of -0.15kg/m2 (95% confidence interval (CI): -0.21 to -0.09). Intervention effects by age subgroups were -0.26kg/m2 (95% CI:-0.53 to 0.00) (0-5 years), -0.15kg/m2 (95% CI -0.23 to -0.08) (6-12 years), and -0.09kg/m2 (95% CI -0.20 to 0.03) (13-18 years). Heterogeneity was apparent in all three age groups and could not explained by randomisation status or the type, duration or setting of the intervention. Only eight studies reported on adverse effects and no evidence of adverse outcomes such as unhealthy dieting practices, increased prevalence of underweight or body image sensitivities was found. Interventions did not appear to increase health inequalities although this was examined in fewer studies. Authors' conclusions We found strong evidence to support beneficial effects of child obesity prevention programmes on BMI, particularly for programmes targeted to children aged six to 12 years. However, given the unexplained heterogeneity and the likelihood of small study bias, these findings must be interpreted cautiously. A broad range of programme components were used in these studies and whilst it is not possible to distinguish which of these components contributed most to the beneficial effects observed, our synthesis indicates the following to be promising policies and strategies: · school curriculum that includes healthy eating, physical activity and body image · increased sessions for physical activity and the development of fundamental movement skills throughout the school week · improvements in nutritional quality of the food supply in schools · environments and cultural practices that support children eating healthier foods and being active throughout each day · support for teachers and other staff to implement health promotion strategies and activities (e.g. professional development, capacity building activities) · parent support and home activities that encourage children to be more active, eat more nutritious foods and spend less time in screen based activities However, study and evaluation designs need to be strengthened, and reporting extended to capture process and implementation factors, outcomes in relation to measures of equity, longer term outcomes, potential harms and costs. Childhood obesity prevention research must now move towards identifying how effective intervention components can be embedded within health, education and care systems and achieve long term sustainable impacts.

Health disparities and health equity: the issue is justice

Abstract: Eliminating health disparities is a Healthy People goal. Given the diverse and sometimes broad definitions of health disparities commonly used, a subcommittee convened by the Secretary's Advisory Committee for Healthy People 2020 proposed an operational definition for use in developing objectives and targets, determining resource allocation priorities, and assessing progress. Based on that subcommittee's work, we propose that health disparities are systematic, plausibly avoidable health differences adversely affecting socially disadvantaged groups; they may reflect social disadvantage, but causality need not be established. This definition, grounded in ethical and human rights principles, focuses on the subset of health differences reflecting social injustice, distinguishing health disparities from other health differences also warranting concerted attention, and from health differences in general. We explain the definition, its underlying concepts, the challenges it addresses, and the rationale for applying it to United States public health policy.

Inequities in access to health care in South Africa

Abstract: Achieving equitable universal health coverage requires the provision of accessible, necessary services for the entire population without imposing an unaffordable burden on individuals or households. In South Africa, little is known about access barriers to health care for the general population. We explore affordability, availability, and acceptability of services through a nationally representative household survey (n = 4668), covering utilization, health status, reasons for delaying care, perceptions and experiences of services, and health-care expenditure. Socio-economic status, race, insurance status, and urban-rural location were associated with access to care, with black Africans, poor, uninsured and rural respondents, experiencing greatest barriers. Understanding access barriers from the user perspective is important for expanding health-care coverage, both in South Africa and in other low- and middle-income countries.

Primary Health Care in Canada: Systems in Motion

Abstract: Context: During the 1980s and 1990s, innovations in the organization, funding, and delivery of primary health care in Canada were at the periphery of the system rather than at its core. In the early 2000s, a new policy environment emerged. Methods: This policy analysis examines primary health care reform efforts in Canada during the last decade, drawing on descriptive information from published and gray literature and from a series of semistructured interviews with informed observers of primary health care in Canada. Findings: Primary health care in Canada has entered a period of potentially transformative change. Key initiatives include support for interprofessional primary health care teams, group practices and networks, patient enrollment with a primary care provider, financial incentives and blended-payment schemes, development of primary health care governance mechanisms, expansion of the primary health care provider pool, implementation of electronic medical records, and quality improvement training and support. Conclusions: Canada's experience suggests that primary health care transformation can be achieved voluntarily in a pluralistic system of private health care delivery, given strong government and professional leadership working in concert.

Health care system in Saudi Arabia: an overview.

Abstract: The government of Saudi Arabia has given high priority to the development of health care services at all levels: primary, secondary and tertiary. As a consequence, the health of the Saudi population has greatly improved in recent decades. However, a number of issues pose challenges to the health care system, such a shortage of Saudi health professionals, the health ministry's multiple roles, limited financial resources, changing patterns of disease, high demand resulting from free services, an absence of a national crisis management policy, poor accessibility to some health care facilities, lack of a national health information system, and the underutilization of the potential of electronic health strategies. This paper reviews the historical development and current structure of the health care system in Saudi Arabia with particular emphasis on the public health sector and the opportunities and challenges confronting the Saudi health care system.

The role of patient navigators in eliminating health disparities

Abstract: Despite many important efforts to increase equity in the US health care system, not all Americans have equal access to health care—or similar health outcomes. With the goal of lowering costs and increasing accessibility to health care, the nation's new health care reform legislation includes certain provisions that expand health insurance coverage to uninsured and underinsured populations, promote medical homes, and support coordination of care. These provisions may help narrow existing health care disparities. Many of the most vulnerable patients, however, may continue to have difficulty accessing and navigating the complex US health care delivery system. This article explores the unique role that patient navigation can play in improving health outcomes for racial and ethnic minorities, as well as other underserved populations, in the context of a changing healthcare environment. Patient navigators can not only facilitate improved health care access and quality for underserved populations through advocacy and care coordination, but they can also address deep-rooted issues related to distrust in providers and the health system that often lead to avoidance of health problems and non-compliance with treatment recommendations. By addressing many of the disparities associated with language and cultural differences and barriers, patient navigators can foster trust and empowerment within the communities they serve. Specific patient navigator activities are discussed, and metrics to evaluate program efforts are presented. Cancer 2011;117(15 suppl):3541–50. © 2011 American Cancer Society.

Portugal. Health system review.

Abstract: This analysis of the Portuguese health system reviews recent developments in organization and governance, health financing, health care provision, health reforms and health system performance. Overall health indicators such as life expectancy at birth and at age 65 years have shown a notable improvement over the last decades. However, these improvements have not been followed at the same pace by other important dimensions of health: child poverty and its consequences, mental health and quality of life after 65. Health inequalities remain a general problem in the country. All residents in Portugal have access to health care provided by the National Health Service (NHS), financed mainly through taxation. Out-of-pocket payments have been increasing over time, not only co-payments, but particularly direct payments for private outpatient consultations, examinations and pharmaceuticals. The level of cost-sharing is highest for pharmaceutical products. Between one-fifth and one-quarter of the population has a second (or more) layer of health insurance coverage through health subsystems (for specific sectors or occupations) and voluntary health insurance (VHI). VHI coverage varies between schemes, with basic schemes covering a basic package of services, whereas more expensive schemes cover a broader set of services, including higher ceilings of health care expenses. Health care delivery is by both public and private providers. Public provision is predominant in primary care and hospital care, with a gate-keeping system in place for access to hospital care. Pharmaceutical products, diagnostic technologies and private practice by physicians constitute the bulk of private health care provision. In May 2011, the economic crisis led Portugal to sign a Memorandum of Understanding with the International Monetary Fund, the European Commission and the European Central Bank, in exchange for a loan of 78 billion euros. The agreed Economic and Financial Adjustment Programme included 34 measures aimed at increasing cost-containment, improving efficiency and increasing regulation in the health sector. Reforms implemented since 2011 by the Ministry of Health include: improving regulation and governance, health promotion (launch of priority health programmes such as for diabetes and mental health), rebalancing the pharmaceutical market (new rules for price setting, reduction in the prices of pharmaceuticals, increasing use of generic drugs), expanding and coordinating long-term and palliative care, and strengthening primary and hospital care.

Encyclopedia of environmental health

Abstract: Environmental health has evolved over time into a complex, multidisciplinary field. Many of the key determinants and solutions to environmental health problems lie outside the direct realm of health and are strongly dependent on environmental changes, water and sanitation, industrial development, education, employment, trade, tourism, agriculture, urbanization, energy, housing and national security. Environmental risks, vulnerability and variability manifest themselves in different ways and at different time scales. While there are shared global and transnational problems, each community, country or region faces its own unique environmental health problems, the solution of which depends on circumstances surrounding the resources, customs, institutions, values and environmental vulnerability. This work contains critical reviews and assessments of environmental health practices and research that have worked in places and thus can guide programs and economic development in other countries or regions. "The Encyclopedia of Environmental Health" seeks to conceptualize the subject more clearly, to describe the best available scientific methods that can be used in characterizing and managing environmental health risks, to extend the field of environmental health through new theoretical perspectives and heightened appreciation of social, economic and political contexts, and to encourage a richer analysis in the field through examples of diverse experiences in dealing with the health-environment interface. "The Encyclopedia of Environmental Health" contains numerous examples of policy options and environmental health practices that have worked and thus can guide programs in other countries or regions. It includes a wide range of tools and strategies that can assist communities and countries in assessing environmental health conditions, monitoring progress of intervention implementation and evaluating outcomes. Key Features: provides a comprehensive overview of existing knowledge in this emerging field; articles contain summaries and assessments of environmental health practices and research, providing a framework for further research; and, places environmental health in the broader context of environmental change and related ecological, political, economic, social, and cultural issues.

United Kingdom (England): health system review

Abstract: The Health Systems in Transition (HiT) profiles are country-based reports that provide a detailed description of a health system and of policy initiatives in progress or under development. HiTs examine different approaches to the organization, financing and delivery of health services and the role of the main actors in health systems; describe the institutional framework, process, content and implementation of health and health care policies; and highlight challenges and areas that require more in-depth analysis. Various indicators show that the health of the population has improved over the last few decades. However, inequalities in health across socioeconomic groups have been increasing since the 1970s. The main diseases affecting the population are circulatory diseases, cancer, diseases of the respiratory system and diseases of the digestive system. Risk factors such as the steadily rising levels of alcohol consumption, the sharp increases in adult and child obesity and prevailing smoking levels are among the most pressing public health concerns, particularly as they reflect the growing health inequalities among different socioeconomic groups. Health services in England are largely free at the point of use. The NHS provides preventive medicine, primary care and hospital services to all those ordinarily resident. Over 12% of the population is covered by voluntary health insurance schemes, known in the United Kingdom as private medical insurance (PMI), which mainly provides access to acute elective care in the private sector. Responsibility for publicly funded health care rests with the Secretary of State for Health, supported by the Department of Health. The Department operates at a regional level through 10 strategic health authorities (SHAs), which are responsible for ensuring the quality and performance of local health services within their geographic area. Responsibility for commissioning health services at the local level lies with 151 primary care organizations, mainly primary care trusts (PCTs), each covering a geographically defined population. Health services are mainly financed from public sources, primarily general taxation and national insurance contributions (NICs). Some care is funded privately through PMI, some user charges, cost sharing and direct payments for health care delivered by NHS and private providers. While the reform programme that developed since 1997 proved to be massive in its scope, some basic features of the English NHS, such as its taxation-funding base, the predominantly public provision of services and division between purchasing (commissioning) and care delivery functions, remain unchanged. Nevertheless, in addition to the unprecedented level of financial resources allocated to the NHS since 2000, the most important reform measures included the introduction of the payment by results (PbR) hospital payment system; the expanded use of private sector provision; the introduction of more autonomous management of NHS hospitals through foundation trusts (FTs); the introduction of patient choice of hospital for elective care; new general practitioner (GP), consultant and dental services contracts; the establishment of the National Institute for Health and Clinical Excellence (NICE); and the establishment of the Care Quality Commission (CQC) to regulate providers and monitor quality of services. The English NHS faces future challenges as 2010 draws to a close, with significant restrictions on expenditure and a newly elected government that has announced its intention to introduce further widespread reform.

Health inequalities and welfare state regimes: theoretical insights on a public health ‘puzzle’

Abstract: Welfare states are important determinants of health. Comparative social epidemiology has almost invariably concluded that population health is enhanced by the relatively generous and universal welfare provision of the Scandinavian countries. However, most international studies of socioeconomic inequalities in health have thrown up something of a public health ‘puzzle’ as the Scandinavian welfare states do not, as would generally be expected, have the smallest health inequalities. This essay outlines and interrogates this puzzle by drawing upon existing theories of health inequalities—artefact, selection, cultural–behavioural, materialist, psychosocial and life course—to generate some theoretical insights. It discusses the limits of these theories in respect to cross-national research; it questions the focus and normative paradigm underpinning contemporary comparative health inequalities research; and it considers the future of comparative social epidemiology.

Sistema de salud de México

Abstract: This paper describes the Mexican health system. In part one, the health conditions of the Mexican population are discussed, with emphasis in those emerging diseases that are now the main causes of death, both in men and women: diabetes, ischaemic heart disease, cerebrovascular diseases and cancer. Part two is devoted to the description of the basic structure of the system: its main institutions, the population coverage, the health benefits of those affiliated to the different heath institutions, its financial sources, the levels of financial protection in health, the availability of physical, material and human resources for health, and the stewardship functions displayed by the Ministry of Health and other actors. This part also discusses the role of citizens in the monitorization and evaluation of the health system, as well as the levels of satisfaction with the rendered health services. In part three the most recent innovations and its impact on the performance of the health system are discussed. Salient among them are the System of Social Protection in Health and the Popular Health Insurance. The paper concludes with a brief analysis of the short- and middle-term challenges faced by the Mexican health system.

Ethiopia's health extension program: improving health through community involvement

Abstract: The Health Extension Program is one of the most innovative community-based health programs in Ethiopia. It is based on the assumption that access to and quality of primary health care in rural communities can be improved through transfer of health knowledge and skills to households. Since it became operational in 2004-2005, the Program has had a tangible effect on the thinking and practices of rural people regarding disease prevention, family health, hygiene and environmental sanitation. It has enabled Ethiopia to increase primary health care coverage from 76.9% in 2005 to 90% in 2010.

Oxford Textbook of Public Health

Abstract: SECTION 1: THE DEVELOPMENT OF THE DISCIPLINE OF PUBLIC HEALTH 1.1 The scope and concerns of public health 1.2 The history and development of public health in high-income countries 1.3 The history and development of public health in low- and middle-income countries 1.4 The development of the discipline of public health in countries in economic transition: India, Brazil, China SECTION 2: DETERMINANTS OF HEALTH AND DISEASE 2.1 A framework for understanding determinants of health 2.2 Globalization 2.3 Behavioural determinants of health and disease 2.4 Genomics and public health 2.5 Water and sanitation 2.6 Food and nutrition 2.7 Infectious diseases 2.8 The global environment 2.9 Health services as determinants of population health 2.10 Assessing health needs: the Global Burden of Disease approach SECTION 3: PUBLIC HEALTH POLICIES 3.1 Overview of policies and strategies 3.2 Public health policy in high-income countries 3.3 Health policy in low- and middle-income countries 3.4 Leadership in public health SECTION 4: PUBLIC HEALTH LAW AND ETHICS 4.1 The right to the highest attainable standard of health 4.2 Comparative national public health legislation 4.3 International public health instruments 4.4 Ethical principles and ethical issues in public health SECTION 5: INFORMATION SYSTEMS AND SOURCES OF INTELLIGENCE 5.1 Information systems in support of public health in high-income countries 5.2 Information systems and community diagnosis in low- and middle-income countries 5.3 Web-based public health information dissemination and evaluation SECTION 6: EPIDEMIOLOGICAL AND BIOSTATISTICAL APPROACHES 6.1 Epidemiology: the foundation of public health 6.2 Ecologic variables, ecologic studies, and multi-level studies in public health research 6.3 Cross-sectional studies 6.4 Principles of outbreak investigation 6.5 Case-control studies 6.6 Cohort studies 6.7 Methodology of intervention trials in individuals 6.8 Methodological issues in the design and analysis of community intervention trials 6.9 Community-based intervention studies in high-income countries 6.10 Community-based intervention trials in low- and middle-income countries 6.11 Clinical epidemiology 6.12 Validity and bias in epidemiological research 6.13 Causation and causal inference 6.14 Systematic reviews and meta-analysis 6.15 Statistical methods 6.16 Mathematical models of transmission and control 6.17 Public health surveillance SECTION 7: SOCIAL SCIENCE TECHNIQUES 7.1 Sociology and psychology in public health 7.2 Demography and public health 7.3 Health promotion, health education, and the public health 7.4 Cost-effectiveness analysis: concepts and applications 7.5 Governance and management of public health programmes 7.6 Public health sciences and policy in high-income countries 7.7 Public health sciences and policy in low- and middle-income countries SECTION 8: ENVIRONMENTAL AND OCCUPATIONAL HEALTH SCIENCES 8.1 Environmental health issues in public health 8.2 Radiation and public health 8.3 Control of microbial threats: population surveillance, vaccine studies, and the microbiological laboratory 8.4 The science of human exposures to contaminants in the environment 8.5 Occupational health 8.6 Ergonomics and public health 8.7 Toxicology and risk assessment in the analysis and management of environmental risk 8.8 Risk perception and communication SECTION 9: MAJOR HEALTH PROBLEMS 9.1 Gene-environment interactions and public health 9.2 Cardiovascular and cerebrovascular diseases 9.3 Neoplasms 9.4 Chronic obstructive pulmonary disease and asthma 9.5 Obesity 9.6 The epidemiology and prevention of diabetes mellitus 9.7 Public mental health 9.8 Dental public health 9.9 Musculoskeletal diseases 9.10 Neurological diseases, epidemiology and public health 9.11 The transmissable spongiform encephalopathies 9.12 Sexually transmitted infections 9.13 Acquired immunodeficiency syndrome 9.14 Tuberculosis 9.15 Malaria 9.16 Chronic hepatitis and other liver disease 9.17 Emerging and re-emerging infections SECTION 10: PREVENTION AND CONTROL OF PUBLIC HEALTH HAZARDS 10.1 Tobacco 10.2 Drug abuse 10.3 Alcohol 10.4 Injury prevention and control: the public health approach 10.5 Interpersonal violence prevention: a recent public health mandate 10.6 Collective violence: war 10.7 Urban health in low- and middle-income countries 10.8 Public health aspects of bioterrorism SECTION 11: PUBLIC HEALTH NEEDS OF POPULATION GROUPS 11.1 The changing family 11.2 Women, men and health 11.3 Child health 11.4 Adolescent health 11.5 Ethnic minorities and indigenous peoples 11.6 People with disabilities 11.7 Health of older people 11.8 Forced migrants and other displaced populations SECTION 12: PUBLIC HEALTH FUNCTIONS 12.1 Need: what is it and how do we measure it? 12.2 Needs assessment: a practical approach 12.3 Socio-economic inequalities in health in high-income countries: the facts and the options 12.4 Reducing health inequalities in low- and middle-income countries 12.5 Prevention and control of chronic, non-communicable diseases 12.6 Principles of infectious disease control 12.7 Population screening and public health 12.8 Environmental health practice 12.9 Structures and strategies for public health intervention 12.10 Strategies for health services 12.11 Public health workers 12.12 Planning for and responding to public health needs in emergencies and disasters SECTION 13: THE FUTURE OF PUBLIC HEALTH 13.1 Private support of public health 13.2 Global health agenda for the 21st century

Equity, social determinants and public health programmes – the case of oral health

Abstract: The WHO Commission on Social Determinants of Health issued the 2008 report 'Closing the gap within a generation - health equity through action on the social determinants of health' in response to the widening gaps, within and between countries, in income levels, opportunities, life expectancy, health status, and access to health care. Most individuals and societies, irrespective of their philosophical and ideological stance, have limits as to how much unfairness is acceptable. In 2010, WHO published another important report on 'Equity, Social Determinants and Public Health Programmes', with the aim of translating knowledge into concrete, workable actions. Poor oral health was flagged as a severe public health problem. Oral disease and illness remain global problems and widening inequities in oral health status exist among different social groupings between and within countries. The good news is that means are available for breaking poverty and reduce if not eliminate social inequalities in oral health. Whether public health actions are initiated simply depends on the political will. The Ottawa Charter for Health Promotion (1986) and subsequent charters have emphasized the importance of policy for health, healthy environments, healthy lifestyles, and the need for orientation of health services towards health promotion and disease prevention. This report advocates that oral health for all can be promoted effectively by applying this philosophy and some major public health actions are outlined.

Digital Infrastructure for the Learning Health System: The Foundation for Continuous Improvement in Health and Health Care: Workshop Series Summary

Abstract: Like many other industries, health care is increasingly turning to digital information and the use of electronic resources. The Institute of Medicine's Roundtable on Value & Science-Driven Health Care hosted three workshops to explore current efforts and opportunities to accelerate progress in improving health and health care with information technology systems.

The Nigerian health care system: Need for integrating adequate medical intelligence and surveillance systems.

Abstract: Objectives : As an important element of national security, public health not only functions to provide adequate and timely medical care but also track, monitor, and control disease outbreak. The Nigerian health care had suffered several infectious disease outbreaks year after year. Hence, there is need to tackle the problem. This study aims to review the state of the Nigerian health care system and to provide possible recommendations to the worsening state of health care in the country. To give up-to-date recommendations for the Nigerian health care system, this study also aims at reviewing the dynamics of health care in the United States, Britain, and Europe with regards to methods of medical intelligence/surveillance. Materials and Methods : Databases were searched for relevant literatures using the following keywords: Nigerian health care, Nigerian health care system, and Nigerian primary health care system. Additional keywords used in the search were as follows: United States (OR Europe) health care dynamics, Medical Intelligence, Medical Intelligence systems, Public health surveillance systems, Nigerian medical intelligence, Nigerian surveillance systems, and Nigerian health information system. Literatures were searched in scientific databases Pubmed and African Journals OnLine. Internet searches were based on Google and Search Nigeria. Results : Medical intelligence and surveillance represent a very useful component in the health care system and control diseases outbreak, bioattack, etc. There is increasing role of automated-based medical intelligence and surveillance systems, in addition to the traditional manual pattern of document retrieval in advanced medical setting such as those in western and European countries. Conclusion : The Nigerian health care system is poorly developed. No adequate and functional surveillance systems are developed. To achieve success in health care in this modern era, a system well grounded in routine surveillance and medical intelligence as the backbone of the health sector is necessary, besides adequate management couple with strong leadership principles.

Congenital chagas disease: Recommendations for diagnosis, treatment and control of newborns, siblings and pregnant women

Abstract: In May 2010, the sixty-third World Health Assembly adopted resolution WHA63.20 on the control and elimination of Chagas disease, highlighting the need “to promote the development of public health measures in disease-endemic and disease non-endemic countries, with special focus on endemic areas, for the early diagnosis of congenital transmission and management of cases” [1]. This article summarizes the recommendations of the Technical Group IVa on “Prevention and Control of Congenital Transmission and Case Management of Congenital Infections” of the World Health Organization's Programme on Control of Chagas disease (infection with Trypanosoma cruzi). The present recommendations derive from those obtained in the meetings listed in Box 1. Box 1. Meetings from Which the Present Recommendations Derive Meeting ULB (Belgium)/UMSS (Bolivia)), Cochabamba, Bolivia, November 6–8, 2002: “Congenital Infection with Trypanosoma cruzi: From Mechanisms of Transmission to Strategies for Diagnosis And Control”, Carlier Y and Torico F, Revista da Sociedade Brasileira de Medicina Tropical 2003, 6: 767–771. Meeting PAHO/CLAP/ULB (Belgium)/IRD (France), Montevideo, Uruguay, June 24–25, 2004: “Congenital Chagas Disease: Its Epidemiology and Management”, http://www.paho.org/English/AD/DPC/CD/dch-chagas-congenita-2004.htm Meeting PAHO/CLAP/ULB (Belgium), Montevideo, Uruguay, May 17–18, 2007: “Information, Education and Communication in Congenital Chagas Disease”, http://www.paho.org/English/AD/DPC/CD/dch-congenita-iec-07.doc Meeting WHO, Geneva, Switzerland, July 4–6, 2007: “Revisiting Chagas Disease: From a Latin American Health Perspective to a Global Health Perspective” Meeting of the WHO TG IVa (congenital and paediatric Chagas disease), New Orleans, Louisiana, United States, December 11, 2008, satellite meeting to the ASTMH 57th annual meeting Meeting of the 6th European Congress of Tropical Medicine and International Health, Verona, Italy, September 6–10, 2009: “Chagas Disease in Europe” Meeting of WHO-HQ and the WHO regional office for Europe, Geneva, Switzerland, December 17–18, 2009: “Consultation on Chagas Disease in Europe”

Reducing Racial And Ethnic Disparities: The Action Plan From The Department Of Health And Human Services

Abstract: The Department of Health and Human Services (HHS) recently unveiled the most comprehensive federal commitment yet to reducing racial and ethnic health disparities. The 2011 HHS Action Plan to Reduce Racial and Ethnic Health Disparities not only responds to advice previously offered by stakeholders around the nation, but it also capitalizes on new and unprecedented opportunities in the Affordable Care Act of 2010 to benefit diverse communities. The Action Plan advances five major goals: transforming health care; strengthening the infrastructure and workforce of the nation's health and human services; advancing Americans' health and well-being; promoting scientific knowledge and innovation; and upholding the accountability of HHS for making demonstrable progress. By mobilizing HHS around these goals, the Action Plan moves the country closer to realizing the vision of a nation free of disparities in health and health care.