Showing papers on "International health published in 2013"

Fair society, healthy lives

Abstract: The final report of the World Health Organization Commission on the Social Determinants of Health (CSDH), published in 2008, affirmed that social injustice was killing on a grand scale, with a toxic combination of 'poor social policies and programmes, unfair economic arrangements, and bad politics' being responsible for producing and reinforcing health inequalities. It provided a comprehensive evidence-based discussion of pervasive inequalities of health in many countries, demonstrating the presence of a social gradient in health outcomes associated with the unfair distribution of the social determinants of health. The social determinants of health include the conditions in which people are born, grow, live, work and age, and the fundamental drivers of these conditions: the distribution of power; money; and resources. Following publication of the CSDH report and recommendations for action, the UK Government commissioned a Strategic Review of Health Inequalities in England. This article provides an overview and reflection on the findings from the CSDH and the Strategic Review of Health Inequalities in England, reviewing the case for putting fairness at the heart of all policy making. In the process, it highlights the need for action on the social determinants of health in order to address health inequalities and the social gradient in health outcomes.

High-reliability health care: getting there from here

Abstract: Almost fourteen years have passed since the institute of Medicine's report “To Err Is Human” galvanized a national movement to improve the quality and safety of health care (Kohn, Corrigan, and Donaldson 2000). Isolated examples of improvement now can be found, and some of the results are impressive (Dixon-Woods et al. 2011; Pronovost et al. 2006, 2010). Measured against the magnitude of the problems, however, the overall impact has been underwhelming. Every year, millions of people suffer the adverse effects of health care–associated infections and harmful medication errors (Aspden et al. 2007; Klevans et al. 2007). More people are harmed by errors during transitions from one health care setting to another (Bodenheimer 2008; Forster et al. 2003). Operations on the wrong patient or the wrong body part continue to take place, perhaps as often as fifty times per week in the United States (estimated from: Minnesota Department of Health 2013). Fires break out in our operating rooms during surgery, perhaps as frequently as six hundred times a year, often seriously injuring the patient (ECRI Institute 2013). The frequency and severity of these failings stand in particularly sharp contrast to the extraordinary successes that industries outside health care have had in achieving and sustaining remarkable levels of safety. Commercial air travel, nuclear power, and even amusement parks are pertinent examples. Organizations in these and other industries have been the subject of scholarly study, seeking to understand what characteristics and behaviors create the conditions that produce such exemplary performance or “high reliability” (Reason 1997; Weick and Sutcliffe 2007). Could health care become highly reliable as well? What would health care organizations have to do differently to achieve this goal? To address these questions, a team at the Joint Commission has worked closely with experts in high reliability from academia and industry. We combined this knowledge with an understanding of health care quality and safety that derives from our daily work with the more than 20,000 U.S. health care organizations that we accredit or certify. In an earlier article, we discussed the historical context of the challenge of high-reliability health care and described the broad outlines of a conceptual framework that might enable health care organizations to chart a path toward high reliability (Chassin and Loeb 2011). In this article, we report the further elaboration of that work in the form of a practical framework that individual health care organizations can use to evaluate their readiness for and progress toward the goal of high reliability. The framework describes four stages of maturity that define milestones on this road for each of fourteen specific characteristics of health care organizations. Although some elements of this framework may be relevant to many different kinds of health care organizations, we developed it specifically for hospitals. Indeed, the most serious problems with the quality of health care are found in hospitals, and some hospitals are already working toward becoming highly reliable.

What It Will Take To Achieve The As-Yet-Unfulfilled Promises Of Health Information Technology

Abstract: A team of RAND Corporation researchers projected in 2005 that rapid adoption of health information technology (IT) could save the United States more than $81 billion annually. Seven years later the empirical data on the technology’s impact on health care efficiency and safety are mixed, and annual health care expenditures in the United States have grown by $800 billion. In our view, the disappointing performance of health IT to date can be largely attributed to several factors: sluggish adoption of health IT systems, coupled with the choice of systems that are neither interoperable nor easy to use; and the failure of health care providers and institutions to reengineer care processes to reap the full benefits of health IT. We believe that the original promise of health IT can be met if the systems are redesigned to address these flaws by creating more-standardized systems that are easier to use, are truly interoperable, and afford patients more access to and control over their health data. Providers must ...

The Office of Minority Health

Abstract: Health disparity exists in the United States despite the medical advances and technological strides throughout the nation. The Office of Minority Health was established to ensure all Americans have the opportunity to live long, healthy, and productive lives. The Office of Minority Health is leading the charge by addressing concerns, promoting awareness, and creating programs for the reduction of poor health outcomes. “Poor health outcomes for the minority population are apparent when comparing their health indicators against those of the rest of the United States. Minority groups experience higher rates of illness, preventable diseases, and deaths” (About OMH). The Office of Minority Health web site contains health care information related to the awareness and elimination of health disparity in the United States.

Governance Challenges in Global Health

Abstract: In this article in the Global Health series, the authors argue for a coordinated (i.e., a governed) international response to a variety of health issues that affect people worldwide.

A National Action Plan To Support Consumer Engagement Via E-Health

Abstract: Patient-centered care is considered one pillar of a high-performing, high-quality health care system. It is a key component of many efforts to transform care and achieve better population health. Expansion of health information technology and consumer e-health tools—electronic tools and services such as secure e-mail messaging between patients and providers, or mobile health apps—have created new opportunities for individuals to participate actively in monitoring and directing their health and health care. The Office of the National Coordinator for Health Information Technology in the Department of Health and Human Services leads the strategy to increase electronic access to health information, support the development of tools that enable people to take action with that information, and shift attitudes related to the traditional roles of patients and providers. In this article we review recent evidence in support of consumer e-health and present the federal strategy to promote advances in consumer e-healt...

Universal health coverage and universal access

Abstract: Universal health coverage has been set as a possible umbrella goal for health in the post-2015 development agenda.1 Whether it is a means to an end or an end in itself and whether it is measureable are subjects of heated debate.2 In this issue of the Bulletin, Kutzin argues that universal health coverage not only leads to better health and to financial protection for households, but that it is valuable for its own sake.3 More recently, attention has shifted to just what the goal should be: whether universal coverage or universal access. This editorial focuses on this question. Universal health coverage is the goal that all people obtain the health services they need without risking financial hardship from unaffordable out-of-pocket payments.4 It involves coverage with good health services – from health promotion to prevention, treatment, rehabilitation and palliation – as well as coverage with a form of financial risk protection. A third feature is universality – coverage should be for everyone. Although many countries are far from attaining universal health coverage, all countries can take steps in this direction.3,4 Improving access is one such step. Universal health coverage is attained when people actually obtain the health services they need and benefit from financial risk protection. Access, on the other hand, is the opportunity or ability to do both of these things. Hence, universal health coverage is not possible without universal access, but the two are not the same. Access has three dimensions:5-8 Physical accessibility. This is understood as the availability of good health services within reasonable reach of those who need them and of opening hours, appointment systems and other aspects of service organization and delivery that allow people to obtain the services when they need them. Financial affordability. This is a measure of people’s ability to pay for services without financial hardship. It takes into account not only the price of the health services but also indirect and opportunity costs (e.g. the costs of transportation to and from facilities and of taking time away from work). Affordability is influenced by the wider health financing system and by household income. Acceptability. This captures people’s willingness to seek services. Acceptability is low when patients perceive services to be ineffective or when social and cultural factors such as language or the age, sex, ethnicity or religion of the health provider discourage them from seeking services. Services must be physically accessible, financially affordable and acceptable to patients if universal health coverage is to be attained. The requirement that services be physically accessible is fulfilled when these are available, of good quality and located close to people. Service readiness is said to exist when the inputs required to produce the services (e.g. buildings, equipment, health personnel, health products, technologies) are also available and of good quality. Financial affordability can be improved by reducing direct, out-of-pocket payments through insurance prepayments and pooling – e.g. the collection of government revenues and/or health insurance contributions to fund health services – or through demand-side stimuli such as conditional cash transfers and vouchers. Social and cultural accessibility can be enhanced by ensuring that health workers and the health system more generally treat all patients and their families with dignity and respect. Addressing the broader social determinants of health will also improve access to health services; differences in access in particular will be ameliorated by reducing poverty and income inequalities. Improvements in education will raise the average income, make health services more affordable and equip people with the awareness needed to demand and obtain the health services they need. Efforts to address these social determinants will help to reduce inequalities in income, service affordability and access to services, and this, in turn, will help to attenuate differences in health service coverage and in financial risk protection. These actions alone, however, will not guarantee that all people obtain the health services they need. Even if the services exist and people have access to them, they might not use them. They may be unaware, for instance, of having a condition requiring treatment (e.g. hypertension), of how health promotion or preventive services can benefit them, or of the availability of different types of health services or financial risk protection plans. Or they might not recognize that others’ health may be affected by their health-care decisions (e.g. if they fail to get treated for a communicable disease). In essence, universal health coverage is the obtainment of good health services de facto without fear of financial hardship. It cannot be attained unless both health services and financial risk protection systems are accessible, affordable and acceptable. Yet universal access, although necessary, is not sufficient. Coverage builds on access by ensuring actual receipt of services. Thus, universal health coverage and universal access to health services are complementary ideas. Without universal access, universal health coverage becomes an unreachable goal.

U.S. Health in International Perspective: Shorter Lives, Poorer Health

Abstract: The United States is among the wealthiest nations in the world, but it is far from the healthiest. Although life expectancy and survival rates in the United States have improved dramatically over the past century, Americans live shorter lives and experience more injuries and illnesses than people in other high-income countries. The U.S. health disadvantage cannot be attributed solely to the adverse health status of racial or ethnic minorities or poor people: even highly advantaged Americans are in worse health than their counterparts in other, "peer" countries. In light of the new and growing evidence about the U.S. health disadvantage, the National Institutes of Health asked the National Research Council (NRC) and the Institute of Medicine (IOM) to convene a panel of experts to study the issue. The Panel on Understanding Cross-National Health Differences Among High-Income Countries examined whether the U.S. health disadvantage exists across the life span, considered potential explanations, and assessed the larger implications of the findings. U.S. Health in International Perspective presents detailed evidence on the issue, explores the possible explanations for the shorter and less healthy lives of Americans than those of people in comparable countries, and recommends actions by both government and nongovernment agencies and organizations to address the U.S. health disadvantage.

Social media engagement and public health communication: implications for public health organizations being truly "social".

Abstract: Social media are designed to be engaging, but often are used as a mechanism by public health organizations and practitioners for mass information dissemination rather than engaging audiences in true multi-way conversations and interactions. In this article we define and discuss social media engagement for public health communication. We examine different levels of engagement for public health communication and consider the potential risks, benefits, and challenges of truly embracing the social component in public health practice. Some implications of engagement for public health communication via social media are addressed, and recommendations for future work and research are proposed.

The Behavioral Economics of Health and Health Care

Abstract: People often make decisions in health care that are not in their best interest, ranging from failing to enroll in health insurance to which they are entitled, to engaging in extremely harmful behaviors. Traditional economic theory provides a limited tool kit for improving behavior because it assumes that people make decisions in a rational way, have the mental capacity to deal with huge amounts of information and choice, and have tastes endemic to them and not open to manipulation. Melding economics with psychology, behavioral economics acknowledges that people often do not act rationally in the economic sense. It therefore offers a potentially richer set of tools than provided by traditional economic theory to understand and influence behaviors. Only recently, however, has it been applied to health care. This article provides an overview of behavioral economics, reviews some of its contributions, and shows how it can be used in health care to improve people's decisions and health.

Comprehensive and integrated district health systems strengthening: the Rwanda Population Health Implementation and Training (PHIT) Partnership

Abstract: Background Nationally, health in Rwanda has been improving since 2000, with considerable improvement since 2005. Despite improvements, rural areas continue to lag behind urban sectors with regard to key health outcomes. Partners In Health (PIH) has been supporting the Rwanda Ministry of Health (MOH) in two rural districts in Rwanda since 2005. Since 2009, the MOH and PIH have spearheaded a health systems strengthening (HSS) intervention in these districts as part of the Rwanda Population Health Implementation and Training (PHIT) Partnership. The partnership is guided by the belief that HSS interventions should be comprehensive, integrated, responsive to local conditions, and address health care access, cost, and quality. The PHIT Partnership represents a collaboration between the MOH and PIH, with support from the National University of Rwanda School of Public Health, the National Institute of Statistics, Harvard Medical School, and Brigham and Women’s Hospital. Description of intervention The PHIT Partnership’s health systems support aligns with the World Health Organization’s six health systems building blocks. HSS activities focus across all levels of the health system — community, health center, hospital, and district leadership — to improve health care access, quality, delivery, and health outcomes. Interventions are concentrated on three main areas: targeted support for health facilities, quality improvement initiatives, and a strengthened network of community health workers. Evaluation design The impact of activities will be assessed using population-level outcomes data collected through oversampling of the demographic and health survey (DHS) in the intervention districts. The overall impact evaluation is complemented by an analysis of trends in facility health care utilization. A comprehensive costing project captures the total expenditures and financial inputs of the health care system to determine the cost of systems improvement. Targeted evaluations and operational research pieces focus on specific programmatic components, supported by partnership-supported work to build in-country research capacity. Discussion Building on early successes, the work of the Rwanda PHIT Partnership approach to HSS has already seen noticeable increases in facility capacity and quality of care. The rigorous planned evaluation of the Partnership’s HSS activities will contribute to global knowledge about intervention methodology, cost, and population health impact.

Health systems and services: the role of acute care

Abstract: As populations continue to grow and age, there will be increasing demand for acute curative services responsive to life-threatening emergencies, acute exacerbation of chronic illnesses and many routine health problems that nevertheless require prompt action. Emergency interventions and services should be integrated with primary care and public health measures to complete and strengthen health systems. This paper focuses on acute care within that context. First, we draw on standard World Health Organization (WHO) terminology to propose working terms to define “acute care”. Second, we highlight the fragmentation of service delivery that results from not adopting the proposed definition. Third, we show the potential contribution of acute care to integrated health systems designed to reduce all-cause morbidity and mortality. Finally, we propose key steps to further the development of acute care that leaders, researchers and health workers, who are the people responsible for maintaining strong national health systems, should consider taking.

Oxford handbook of public health practice

Abstract: This handbook is intended to be used by a wide variety of professionals in the public health domain, providing a practical and pocket-sized guide to public health skills and issues. We have therefore asked four Public Health professionals at different stages of their careers to give their views on this book. Public Health (2002) 116, 383–385.

Health promotion and the policy process

Abstract: 1. Framing public policy in health promotion: ubiquitous, yet elusive 2. Policy change theories in health promotion research: a review 3. Coalitions advocacy action and research for policy development 4. Policy change and the social determinants of health 5. Actor-Network Theory: The governance of intersectoral initiatives 6. Emerging theoretical frameworks for global health governance 7. Getting knowledge on 'wicked problems' in health promotion into action 8. Health policy networks: connecting the disconnected 9. Action theory and policy analysis: The ADEPT model 10. Health in All Policies from international ideas to local implementation: policies, systems and organizations 11. Wrap-up: practice a new health political science

Social media in public health

Abstract: Introduction or background While social media interactions are currently not fully understood, as individual health behaviors and outcomes are shared online, social media offers an increasingly clear picture of the dynamics of these processes. Sources of data Social media is becoming an increasingly common platform among clinicians and public health officials to share information with the public, track or predict diseases. Areas of agreement Social media can be used for engaging the public and communicating key public health interventions, while providing an important tool for public health surveillance. Areas of controversy Social media has advantages over traditional public health surveillance, as well as limitations, such as poor specificity, that warrant additional study. Growing points Social media can provide timely, relevant and transparent information of public health importance; such as tracking or predicting the spread or severity of influenza, west nile virus or meningitis as they propagate in the community, and, in identifying disease outbreaks or clusters of chronic illnesses. Areas timely for developing research Further work is needed on social media as a valid data source for detecting or predicting diseases or conditions. Also, whether or not it is an effective tool for communicating key public health messages and engaging both, the general public and policy-makers.

Perceived need for mental health care in Canada: Results from the 2012 Canadian Community Health Survey-Mental Health.

Abstract: Background Past research and national survey data on Canadians' perceived need for mental health care (MHC) have focused on unmet needs overall, and have not considered specific types of MHC needs or the extent to which needs are met. Data and methods Using data from the 2012 Canadian Community Health Survey-Mental Health, this article describes the prevalence of perceived MHC needs for information, medication, counselling and other services. The degree to which each type of need was met is explored. Associations between risk factors for having MHC needs and the extent to which needs were met are investigated. Results In 2012, an estimated 17% of the population aged 15 or older reported having had an MHC need in the past 12 months. Two-thirds (67%) reported that their need was met; for another 21%, the need was partially met; and for 12%, the need was unmet. The most commonly reported need was for counselling, which was also the least likely to be met. Distress was identified as a predictor of perceived MHC need status. Interpretation Many Canadians are estimated to have MHC needs, particularly for counselling. People with elevated levels of distress are significantly more likely to have unmet and partially met MHC needs than to have fully met MHC needs, regardless of the presence of mental or substance disorders.

Health Workforce Planning in OECD Countries

Abstract: Health workforce planning aims to achieve a proper balance between the supply and demand for different categories of health workers, in both the short and longer-term. Workforce planning in the health sector is particularly important, given the time and cost involved in training new doctors and other health professionals. In a context of tight budget constraints, proper health workforce planning is needed not only to guide policy decisions on entry into medical and nursing education programmes, but also to assess the impact of possible re-organisations in health service delivery to better respond to changing health care needs...

Operational Health Information Exchanges Show Substantial Growth, But Long-Term Funding Remains A Concern

Abstract: Policy makers are actively promoting the electronic exchange of health information to improve the quality and efficiency of health care. We conducted a national survey of organizations facilitating health information exchange, to assess national progress. We found that 30 percent of hospitals and 10 percent of ambulatory practices now participate in one of the 119 operational health information exchange efforts across the United States, substantial growth from prior surveys. However, we also found that 74 percent of health information exchange efforts report struggling to develop a sustainable business model. Our findings suggest that despite progress, there is a substantial risk that many current efforts to promote health information exchange will fail when public funds supporting these initiatives are depleted.

The European Health Report 2012: Charting the Way to Well-being

Abstract: Like its predecessors, the 2012 European health report describes both the overall improvements in health in the WHO European Region and their uneven distribution within and between countries. It breaks new ground, however, by helping both to define well-being, a goal of Europe’s new health policy, Health 2020, and to map the way towards achieving it. By describing health in Europe, this report provides policy-makers and public health professionals with the epidemiological evidence base that underpins Health 2020 and its six overarching targets. In addition, it sets out the agreed approach to monitoring progress towards Health 2020, outlines the collaborative agenda to address the challenges ahead and makes the case for measuring well-being as a marker of progress in health.

Collecting and Applying Data on Social Determinants of Health in Health Care Settings

Abstract: Despite strong evidence linking patients' social circumstances to their health, little guidance exists for health care practitioners and institutions on addressing social needs in clinical settings. Current approaches to social determinants generally focus on population-level and policy interventions; these overlook individual and clinical innovations within health care that can address patients' social circumstances. This article proposes a framework for how social determinants interventions in the health care system can be construed across 3 tiers—patient, institution, and broader population—and describes ways to collect data and target interventions at these levels.

Promoting oral health of children through schools--results from a WHO global survey 2012.

Abstract: This paper reviews the range of school-based approaches to oral health and describes what is meant by a Health Promoting School. The paper then reports the results of a World Health Organization global survey of school-based health promotion. Purposive sampling across 100 countries produced 108 evaluations of school oral health projects spread across 61 countries around the globe. The Ottawa Charter for Health Promotion noted that schools can provide a supportive environment for promoting children’s health. However, while a number of well-known strategies are being applied, the full range of health promoting actions is not being used globally. A greater emphasis on integrated health promotion is advised in place of narrower, disease- or project-specific approaches. Recommendations are made for im proving this situation, for further research and for specifying an operational framework for sharing experiences and research.

Early implementation of WHO recommendations for the retention of health workers in remote and rural areas.

Abstract: The maldistribution of health workers between urban and rural areas is a policy concern in virtually all countries. It prevents equitable access to health services, can contribute to increased health-care costs and underutilization of health professional skills in urban areas, and is a barrier to universal health coverage. To address this long-standing concern, the World Health Organization (WHO) has issued global recommendations to improve the rural recruitment and retention of the health workforce. This paper presents experiences with local and regional adaptation and adoption of WHO recommendations. It highlights challenges and lessons learnt in implementation in two countries - the Lao People's Democratic Republic and South Africa - and provides a broader perspective in two regions - Asia and Europe. At country level, the use of the recommendations facilitated a more structured and focused policy dialogue, which resulted in the development and adoption of more relevant and evidence-based policies. At regional level, the recommendations sparked a more sustained effort for cross-country policy assessment and joint learning. There is a need for impact assessment and evaluation that focus on the links between the rural availability of health workers and universal health coverage. The effects of any health-financing reforms on incentive structures for health workers will also have to be assessed if the central role of more equitably distributed health workers in achieving universal health coverage is to be supported.

Behavioral Health and Health Care Reform Models: Patient-Centered Medical Home, Health Home, and Accountable Care Organization

Abstract: Discussions of health care delivery and payment reforms have largely been silent about how behavioral health could be incorporated into reform initiatives. This paper draws attention to four patient populations defined by the severity of their behavioral health conditions and insurance status. It discusses the potentials and limitations of three prominent models promoted by the Affordable Care Act to serve populations with behavioral health conditions: the Patient-Centered Medical Home, the Health Home initiative within Medicaid, and the Accountable Care Organization. To incorporate behavioral health into health reform, policymakers and practitioners may consider embedding in the reform efforts explicit tools—accountability measures and payment designs—to improve access to and quality of care for patients with behavioral health needs.