Factors in creating sustainable intersectoral community mobilization for prevention of heart and lung disease.

PubMed

Bourdages, Josée; Sauvageau, Lyne; Lepage, Céline

2003-06-01

This paper describes factors facilitating and working against successful community mobilization in the implementation of an integrated prevention programme for cardiovascular disease and lung cancer in four community settings in Québec, Canada. Implementation evaluation data from several sources showed that over the 3-year period, mobilization was partly achieved in all four communities, although the degree of success varied. The data support those of previous studies showing that several factors are key to effective intersectoral community mobilization: (i) involvement of concerned and influential community members with a commitment to shared goals and a visible community focus; (ii) formation of multi-organization systems among appropriate organizations, recognizing their strengths, resources and competencies, and preserving both their autonomy and interdependence with an appreciation of divergent perspectives; (iii) development of decision-making mechanisms through the setting up of formal structural arrangements to facilitate decisions with clear leadership; (iv) clear definition of objectives, tasks, roles and responsibilities; and (v) official support and legitimization from participating agencies, government authorities, and organizations with adequate resources devoted to partnership building. This study also replicated a number of barriers to the creation of sustainable intersectoral community mobilization, notably the potentially destructive role of power conflicts among the key institutional partners.

International Networking for Sexuality Education: A Politically Sensitive Subject

ERIC Educational Resources Information Center

Steinhart, Katharina; von Kaenel, Andreas; Cerruti, Stella; Chequer, Pedro; Gomes, Rebeca; Herlt, Claudia; Horstick, Olaf

2013-01-01

In 2007, six countries (Argentina, Brazil, Chile, Paraguay, Peru and Uruguay) commenced work on a project to harmonise public policy on school sexuality education (SE) and the prevention of HIV. Inter-sectoral management committees for SE involving ministries of education, ministries of health and civil society were established, national policies…

Obstacles and Enablers on the Way towards Integrated Physical Activity Policies for Childhood Obesity Prevention: An Exploration of Local Policy Officials' Views

PubMed Central

Habraken, Jolanda M.; Kremers, Stef P. J.; van Oers, Hans; Schuit, Albertine J.

2016-01-01

Background. Limited physical activity (PA) is a risk factor for childhood obesity. In Netherlands, as in many other countries worldwide, local policy officials bear responsibility for integrated PA policies, involving both health and nonhealth domains. In practice, its development seems hampered. We explore which obstacles local policy officials perceive in their effort. Methods. Fifteen semistructured interviews were held with policy officials from health and nonhealth policy domains, working at strategic, tactic, and operational level, in three relatively large municipalities. Questions focused on exploring perceived barriers for integrated PA policies. The interviews were deductively coded by applying the Behavior Change Ball framework. Findings. Childhood obesity prevention appeared on the governmental agenda and all officials understood the multicausal nature. However, operational officials had not yet developed a tradition to develop integrated PA policies due to insufficient boundary-spanning skills and structural and cultural differences between the domains. Tactical level officials did not sufficiently support intersectoral collaboration and strategic level officials mainly focused on public-private partnerships. Conclusion. Developing integrated PA policies is a bottom-up innovation process that needs to be supported by governmental leaders through better guiding organizational processes leading to such policies. Operational level officials can assist in this by making progress in intersectoral collaboration visible. PMID:27668255

Obstacles and Enablers on the Way towards Integrated Physical Activity Policies for Childhood Obesity Prevention: An Exploration of Local Policy Officials' Views.

PubMed

Hendriks, Anna-Marie; Habraken, Jolanda M; Kremers, Stef P J; Jansen, Maria W J; van Oers, Hans; Schuit, Albertine J

Background . Limited physical activity (PA) is a risk factor for childhood obesity. In Netherlands, as in many other countries worldwide, local policy officials bear responsibility for integrated PA policies, involving both health and nonhealth domains. In practice, its development seems hampered. We explore which obstacles local policy officials perceive in their effort. Methods . Fifteen semistructured interviews were held with policy officials from health and nonhealth policy domains, working at strategic, tactic, and operational level, in three relatively large municipalities. Questions focused on exploring perceived barriers for integrated PA policies. The interviews were deductively coded by applying the Behavior Change Ball framework. Findings . Childhood obesity prevention appeared on the governmental agenda and all officials understood the multicausal nature. However, operational officials had not yet developed a tradition to develop integrated PA policies due to insufficient boundary-spanning skills and structural and cultural differences between the domains. Tactical level officials did not sufficiently support intersectoral collaboration and strategic level officials mainly focused on public-private partnerships. Conclusion . Developing integrated PA policies is a bottom-up innovation process that needs to be supported by governmental leaders through better guiding organizational processes leading to such policies. Operational level officials can assist in this by making progress in intersectoral collaboration visible.

Evaluation of partnership working in cities in phase IV of the WHO Healthy Cities Network.

PubMed

Lipp, Alistair; Winters, Tim; de Leeuw, Evelyne

2013-10-01

An intersectoral partnership for health improvement is a requirement of the WHO European Healthy Cities Network of municipalities. A review was undertaken in 59 cities based on responses to a structured questionnaire covering phase IV of the network (2003-2008). Cities usually combined formal and informal working partnerships in a pattern seen in previous phases. However, these encompassed more sectors than previously and achieved greater degrees of collaborative planning and implementation. Additional WHO technical support and networking in phase IV significantly enhanced collaboration with the urban planning sector. Critical success factors were high-level political commitment and a well-organized Healthy City office. Partnerships remain a successful component of Healthy City working. The core principles, purpose and intellectual rationale for intersectoral partnerships remain valid and fit for purpose. This applied to long-established phase III cities as well as newcomers to phase IV. The network, and in particular the WHO brand, is well regarded and encourages political and organizational engagement and is a source of support and technical expertise. A key challenge is to apply a more rigorous analytical framework and theory-informed approach to reviewing partnership and collaboration parameters.

[Constraints and opportunities for inter-sector health promotion initiatives: a case study].

PubMed

Magalhães, Rosana

2015-07-01

This article analyzes the implementation of inter-sector initiatives linked to the Family Grant, Family Health, and School Health Programs in the Manguinhos neighborhood in the North Zone of Rio de Janeiro, Brazil. The study was conducted in 2010 and 2011 and included document review, local observation, and 25 interviews with program managers, professionals, and staff. This was an exploratory case study using a qualitative approach that identified constraints and opportunities for inter-sector health experiences, contributing to the debate on the effectiveness of health promotion and poverty relief programs.

Construction of the food and nutrition security policy in Brazil: strategies and challenges in the promotion of intersectorality at the federal government level.

PubMed

Burlandy, Luciene

2009-01-01

This article analyzes institutional strategies of the Brazilian federal government that aim at promoting intersectorality in the field of Food and Nutrition Security (FNS), based on bibliographic review and document analysis. It is assumed that, although formal institutionality in this government level is not enough to promote intersectorality, it is important in process induction. It follows that the combination of different institutional mechanisms favors intersectorality, such as: the existence and location of councils integrated by government sectors and civil society in the presidency; political support by the presidency and inclusion of the issue as being strategic in the governmental agenda; assembly of institutional spaces that articulate the highest government spheres and that integrate technical levels; programs that integrate food production, commercialization, and consumption. Challenges concern interrelation with economic policy and the construction of budget agreed among sectors, integrated to policy management and monitoring.

The Inter-Sectoral Impact Model Intercomparison Project (ISI–MIP): Project framework

PubMed Central

Warszawski, Lila; Frieler, Katja; Huber, Veronika; Piontek, Franziska; Serdeczny, Olivia; Schewe, Jacob

2014-01-01

The Inter-Sectoral Impact Model Intercomparison Project offers a framework to compare climate impact projections in different sectors and at different scales. Consistent climate and socio-economic input data provide the basis for a cross-sectoral integration of impact projections. The project is designed to enable quantitative synthesis of climate change impacts at different levels of global warming. This report briefly outlines the objectives and framework of the first, fast-tracked phase of Inter-Sectoral Impact Model Intercomparison Project, based on global impact models, and provides an overview of the participating models, input data, and scenario set-up. PMID:24344316

Intersectoriality in Danish municipalities: corrupting the social determinants of health?

PubMed

Holt, Ditte H; Frohlich, Katherine L; Tjørnhøj-Thomsen, Tine; Clavier, Carole

2017-10-01

Action on the social determinants of health (SDH) through intersectoral policymaking is often suggested to promote health and health equity. This paper argues that the process of intersectoral policymaking influences how the SDH are construed and acted upon in municipal policymaking. We discuss how the intersectoral policy process legitimates certain practices in the setting of Danish municipal health promotion and the potential impact this can have for long-term, sustainable healthy public policy. Based on ethnographic fieldwork, we show how the intention of intersectoriality produces a strong concern for integrating health into non-health sectors to ensure productive collaboration. To encourage this integration, health is often framed as a means to achieve the objectives of non-health sectors. In doing so, the intersectoral policy process tends to favor smaller-scale interventions that aim to introduce healthier practices into various settings, e.g. creating healthy school environments for increased physical activity and healthy eating. While other more overarching interventions on the health impacts of broader welfare policies (e.g. education policy) tend to be neglected. The interventions hereby neglect to address more fundamental SDH. Based on these findings, we argue that intersectoral policymaking to address the SDH may translate into a limited approach to action on so-called 'intermediary determinants' of health, and as such may end up corrupting the broader SDH. Further, we discuss how this corruption affects the intended role of non-health sectors in tackling the SDH, as it may impede the overall success and long-term sustainability of intersectoral efforts. © The Author 2016. Published by Oxford University Press. All rights reserved. For Permissions, please email: journals.permissions@oup.com.

Disease Management Project Breast Cancer in Hesse - 5-Year Survival Data: Successful Model of Intersectoral Communication for Quality Assurance.

PubMed

Jackisch, C; Funk, A; König, K; Lubbe, D; Misselwitz, B; Wagner, U

2014-03-01

Introduction: The Disease Management Project Breast Cancer (DMP Breast Cancer) was first launched in Hesse in 2004. The project is supported by the health insurance companies in Hesse and the Professional Association of Gynaecologists in Hesse. The aim is to offer structured treatment programmes to all women diagnosed with breast cancer in Hesse by creating intersectoral cooperations between coordinating clinics, associated hospitals and gynaecologists in private practice who registered in the DMP programme. Method: Between 1 January 2005 and 30 June 2011, 13 973 women were enrolled in the DMP programme. Results: After data cleansing, survival rates were calculated for a total of 11 214 women. The 5-year overall survival (OS) rate was 86.3 %; survival rates according to tumour stage on presentation were 92.2 % (pT1) and 82.3 % (pT2), respectively. The impact of steroid hormone receptor status on survival (87.8 % for receptor-positive cancers vs. 78.9 % for receptor-negative cancers) and of age at first diagnosis on survival (≤ 35 years = 91 %) were calculated. Conclusion: The project showed that intersectoral cooperation led to significant improvements in the quality of treatment over time, as measured by quality indicators and outcomes after treatment.

Financing intersectoral health promotion programmes: some reasons why collaborators are collaborating as indicated by cost-effectiveness analyses.

PubMed

Johansson, Pia; Tillgren, Per

2011-03-01

Intersectoral collaboration is an important part of many health promotion programmes. The reasons for the local organisations to collaborate, i.e. to finance programmes, are presumably based on benefits they derive from the collaboration. The aim of this study is to discuss whether subsector financial analyses based on data from cost-effectiveness analyses reflect incentives of collaborating organisations in two intersectoral health promotion programmes. Within economics, financial incentives are important reasons for actions. The financial incentives of collaborators are exemplified with two subsector financial analyses containing avoided disease-related costs as estimated in two cost-effectiveness analyses, on an elderly safety promotion programme (Safe Seniors in Sundbyberg) and on a diabetes prevention programme (Stockholm Diabetes Prevention Program, SDPP) from Stockholm, Sweden. The subsector financial analyses indicate that there are financial incentives for the key local community organisation, i.e. the local authority, to collaborate in one of the programmes but not the other. There are no financial benefits for other important community organisations, such as non-governmental organisations. The reasons for collaborating organisations to collaborate within intersectoral health promotion programmes extend beyond financial benefits from averted disease. Thus, the reported subsector financial analyses are only partial reflections of the incentives of collaborators, but they might be used as a starting point for discussions on cost sharing among potential intersectoral collaborators.

How to engage across sectors: lessons from agriculture and nutrition in the Brazilian School Feeding Program.

PubMed

Hawkes, Corinna; Brazil, Bettina Gerken; Castro, Inês Rugani Ribeiro de; Jaime, Patricia Constante

2016-08-11

To provide insights for nutrition and public health practitioners on how to engage with other sectors to achieve public health goals. Specifically, this study provides lessons from the example of integrating family farming and a nutrition into a legal framework in Brazil on how to successfully shift other sectors toward nutrition goals. The study analyzed policy processes that led to a Brazilian law linking family farming with the National School Feeding Program. Main actors involved with the development of the law were interviewed and their narratives were analyzed using a well-established theoretical framework. The study provides five key lessons for promoting intersectorality. First, nutrition and health practitioners can afford to embrace bold ideas when working with other sectors. Second, they should engage with more powerful sectors (or subsectors) and position nutrition goals as providing solutions that meet the interests of these sector. Third is the need to focus on a common goal - which may not be explicitly nutrition-related - as the focus of the intersectoral action. Fourth, philosophical, political, and governance spaces are needed to bring together different sectors. Fifth, evidence on the success of the intersectoral approach increases the acceptance of the process. This study on policy processes shows how a convergence of factors enabled a link between family farming and school feeding in Brazil. It highlights that there are strategies to engage other sectors toward nutrition goals which provides benefits for all sectors involved.

Critical Stakeholder Determinants to the Implementation of Intersectoral Community Approaches Targeting Childhood Obesity

ERIC Educational Resources Information Center

van der Kleij, R. M. J. J.; Crone, M. R.; Reis, R.; Paulussen, T. G. W. M.

2016-01-01

Several intersectoral community approaches targeting childhood obesity (IACOs) have been launched in the Netherlands. Translation of these approaches into practice is however arduous and implementation. We therefore studied the implementation of five IACOs in the Netherlands for one-and-a-half years. IACO implementation was evaluated via an…

Blended and Co-Existing Worlds in Intersectoral Mobilities of European PhD Graduates in the Social Sciences and Humanities

ERIC Educational Resources Information Center

Millard, Debbie

2018-01-01

This paper argues that links between academia and other economic sectors are increasing, especially through intersectoral mobility of university graduates. Murray [(2010). "The Oncomouse that Roared: Hybrid Exchange Strategies as a Source of Distinction at the Boundary of Overlapping Institutions." "American Journal of…

Effectiveness of a systematic approach to promote intersectoral collaboration in comprehensive school health promotion-a multiple-case study using quantitative and qualitative data.

PubMed

Pucher, Katharina K; Candel, Math J J M; Krumeich, Anja; Boot, Nicole M W M; De Vries, Nanne K

2015-07-05

We report on the longitudinal quantitative and qualitative data resulting from a two-year trajectory (2008-2011) based on the DIagnosis of Sustainable Collaboration (DISC) model. This trajectory aimed to support regional coordinators of comprehensive school health promotion (CSHP) in systematically developing change management and project management to establish intersectoral collaboration. Multilevel analyses of quantitative data on the determinants of collaborations according to the DISC model were done, with 90 respondents (response 57 %) at pretest and 69 respondents (52 %) at posttest. Nvivo analyses of the qualitative data collected during the trajectory included minutes of monthly/bimonthly personal/telephone interviews (N = 65) with regional coordinators, and documents they produced about their activities. Quantitative data showed major improvements in change management and project management. There were also improvements in consensus development, commitment formation, formalization of the CSHP, and alignment of policies, although organizational problems within the collaboration increased. Content analyses of qualitative data identified five main management styles, including (1) facilitating active involvement of relevant parties; (2) informing collaborating parties; (3) controlling and (4) supporting their task accomplishment; and (5) coordinating the collaborative processes. We have contributed to the fundamental understanding of the development of intersectoral collaboration by combining qualitative and quantitative data. Our results support a systematic approach to intersectoral collaboration using the DISC model. They also suggest five main management styles to improve intersectoral collaboration in the initial stage. The outcomes are useful for health professionals involved in similar ventures.

Health in All Policies in South Australia: what has supported early implementation?

PubMed

Delany, Toni; Lawless, Angela; Baum, Frances; Popay, Jennie; Jones, Laura; McDermott, Dennis; Harris, Elizabeth; Broderick, Danny; Marmot, Michael

2016-12-01

Health in All Policies (HiAP) is a policy development approach that facilitates intersectoral responses to addressing the social determinants of health and health equity whilst, at the same time, contributing to policy priorities across the various sectors of government. Given that different models of HiAP have been implemented in at least 16 countries, there is increasing interest in how its effectiveness can be optimized. Much of the existing literature on HiAP remains descriptive, however, and lacks critical, empirically informed analyses of the elements that support implementation. Furthermore, literature on HiAP, and intersectoral action more generally, provides little detail on the practical workings of policy collaborations. This paper contributes empirical findings from a multi-method study of HiAP implementation in South Australia (SA) between 2007 and 2013. It considers the views of public servants and presents analysis of elements that have supported, and impeded, implementation of HiAP in SA. We found that HiAP has been implemented in SA using a combination of interrelated elements. The operation of these elements has provided a strong foundation, which suggests the potential for HiAP to extend beyond being an isolated strategy, to form a more integrated and systemic mechanism of policy-making. We conclude with learnings from the SA experience of HiAP implementation to inform the ongoing development and implementation of HiAP in SA and internationally. © The Author 2015. Published by Oxford University Press. All rights reserved. For Permissions, please email: journals.permissions@oup.com.

Health promotion: challenges revealed in successful practices

PubMed Central

Silva, Kênia Lara; de Sena, Roseni Rosângela; Belga, Stephanie Marques Moura Franco; Silva, Paloma Morais; Rodrigues, Andreza Trevenzoli

2014-01-01

OBJECTIVE To examine successful practices of health promotion in health, education, culture, welfare and sport, leisure, identifying the elements of success and challenges in the field. METHODS A qualitative study with data obtained from in-depth analysis that included participant observation, interviews with managers, coordinators, professionals and participants from 29 practices reported as successful for promoting health in six municipalities of the metropolitan region of Belo Horizonte, MG, Southeastern Brazil, in 2011. The variables of the study were concept, dimension, dissemination and ease of access, identified in practices guided by content analysis. RESULTS The results indicate a conceptual and methodological uncertainty about health promotion as evidenced by conflicting objects and contradictory purposes. The practices differ in size, coverage and ease of access, determined by inter-sector coordination and political and financial investment. CONCLUSIONS We identified challenges to health promotion focusing on vulnerable populations, limits to financing and intersectoral partnerships. PMID:24789640

Concepts in health promotion: the notion of relativism.

PubMed

de Leeuw, E

1989-01-01

'Health promotion' is a new and powerful concept. By some professionals in the field as well as by actors in the policy making spheres, though, the notion may be received with considerable scepticism. We have attributed this scepticism, as well as barriers to include notions of health promotion in day-to-day work, to a lack of knowledge of essential concepts in the health promotion context. In this article we first explore the quintessential nature of 'health' (a capacity of people, rather than an end product of medical care) before we set out to analyze some crucial components of health promotion: integral-ness, intersectorality, holism, and ecology. Integral intervention mixes appear to have synergetic, and therefore cost-effective, results. An intersectoral approach will be necessary to address all determinants of health in an adequate way. Alas, neither integral, nor intersectoral health programs have been documented in depth. The notions of holism and ecology seem to suffer from obscurantism and esoteric elitism, though commendable in their scope. Here, we introduce 'relativism' to combine various valuable approaches into one more comprehensive scheme. Moreover, a 'relativist' approach to health promotion might induce better and more fruitful cooperation among professions. Finally, some research gaps have been identified. Policy development studies remain to have top priority in development of health promotion. Better documentation of efforts in this field will be of crucial importance. Further development of, and research on how to apply relativist approaches may be recommended. Cooperation, and opening up a dialogue between different professions and actors is of great importance in this field.

Intersectorality and social participation as coping policies for health inequities-worldwide.

PubMed

Fiorati, Regina Celia; Arcêncio, Ricardo A; Segura Del Pozo, Javier; Ramasco-Gutiérrez, Milagros; Serrano-Gallardo, Pilar

To determine the impact that intersectoral policies and social participation, implemented worldwide, have had on the modification of the social determinants for health and on the reduction of social health inequities. A scoping review of the literature published in the period 2005-2015 was performed. The literature search was conducted on PubMed and Scielo databases. Two researchers reviewed each document. Data were analysed according to the intersectoral action and social participation variables and according to the theoretical frameworks of the Social Determinants Model of the Commission on Social Determinants of Health (CSDH) and the theoretical constructs of Social Capital (SC) and Life Course (LC). Out of 45 documents likely to be selected for final review, all of them based on title and abstract, 20 documents were eventually picked out and analysed; most them (n = 8) were conducted in all Latin America and Latin America's countries. Twelve documents reported intersectoral action associated with social participation in partnership with different institutions. Regarding theoretical frameworks, most of studies (n = 8) used CSDH and SC. In relation to health outcomes, the studies showed mainly: increased access to health and education, follow-up of pregnant women, increasing in prenatal examinations, reduction in malnutrition/child mortality, reduction in extreme poverty/hunger; reduction in epidemics/tuberculosis, control of alcohol/drug consumption, promotion of health/mental as well as basic sanitation improvements. Intersectoral and social participation experiences studied yielded positive outcomes regarding health status and quality of life in the communities in which such experiences were implemented. Copyright © 2017 SESPAS. Publicado por Elsevier España, S.L.U. All rights reserved.

Real options approach to inter-sectoral migration of U.S.farm labor

Treesearch

Gulcan Onel; Barry K. Goodwin

2014-01-01

The core of the literature on inter-sectoral labor migration is based on net present value models of investment in which individuals are assumed to migrate to take advantage of positive wage differentials. In this article, we argue that a real options approach, taken together with the adjustment costs associated with sectoral relocation, may provide a basis for...

Capturing Complexity: Integrating Health and Education Research to Inform Health-Promoting Schools Policy and Practice

ERIC Educational Resources Information Center

Rowling, Louise; Jeffreys, Vicki

2006-01-01

Despite the intersectoral nature of health promotion practice many programs limit their evidence base to health sector research and do not draw on evidence from other sectors' research in program design. To help ensure programs are relevant and acceptable to intersectoral partners and intended outcomes are of value to all sectors involved,…

Public Disorder, Private Boons? Inter-Sectoral Dynamics Illustrated by the Kenyan Case. PROPHE Working Paper Series. WP No. 9

ERIC Educational Resources Information Center

Otieno, Wycliffe; Levy, Daniel

2007-01-01

Within and beyond Africa, it is the public sector much more than the private sector that is the scene of strikes and other forms of disorder, conflict and difficulty. Yet the private sector can be much affected by the public problems. Effects may be simultaneously positive for the private sector and deleterious for the public sector. Although a…

"We're not short of people telling us what the problems are. We're short of people telling us what to do": An appraisal of public policy and mental health

PubMed Central

Petticrew, Mark; Platt, Stephen; McCollam, Allyson; Wilson, Sarah; Thomas, Sian

2008-01-01

Background There is sustained interest in public health circles in assessing the effects of policies on health and health inequalities. We report on the theory, methods and findings of a project which involved an appraisal of current Scottish policy with respect to its potential impacts on mental health and wellbeing. Methods We developed a method of assessing the degree of alignment between Government policies and the 'evidence base', involving: reviewing theoretical frameworks; analysis of policy documents, and nineteen in-depth interviews with policymakers which explored influences on, and barriers to cross-cutting policymaking and the use of research evidence in decisionmaking. Results Most policy documents did not refer to mental health; however most referred indirectly to the determinants of mental health and well-being. Unsurprisingly research evidence was rarely cited; this was more common in health policy documents. The interviews highlighted the barriers to intersectoral policy making, and pointed to the relative value of qualitative and quantitative research, as well as to the imbalance of evidence between "what is known" and "what is to be done". Conclusion Healthy public policy depends on effective intersectoral working between government departments, along with better use of research evidence to identify policy impacts. This study identified barriers to both these. We also demonstrated an approach to rapidly appraising the mental health effects of mainly non-health sector policies, drawing on theoretical understandings of mental health and its determinants, research evidence and policy documents. In the case of the social determinants of health, we conclude that an evidence-based approach to policymaking and to policy appraisal requires drawing strongly upon existing theoretical frameworks, as well as upon research evidence, but that there are significant practical barriers and disincentives. PMID:18793414

Using Primary Care to Address Violence against Women in Intimate Partner Relationships: Professional Training Needs.

PubMed

Torralbas-Fernández, Aida; Calcerrada-Gutiérrez, Marybexy

2016-10-01

Unified, prevention- and community-oriented, Cuba's National Health System is well positioned to address social problems such as gender violence against women. It is sometimes taken for granted that family doctors, family nurses and psychologists in the health system should be able to deal with such cases. However, some studies among these professionals have revealed misconceptions about intimate partner violence, an insufficient understanding of its causes, and greater tolerance of psychological violence than of physical and sexual violence. Cuba needs to train family doctors and clinical psychologists who are knowledgeable about the subject so that they can take part in the development and implementation of intersectoral education and prevention policies and programs, provide assistance to women who have been victims of violence, and work together with community members to create support networks that serve as monitoring mechanisms. Primary care is the ideal setting for raising awareness of the need for greater intersectoral action to systematically address violence against women. KEYWORDS Professional training, doctors, clinical psychologists, gender, spousal abuse, domestic violence, family violence, family relationships, Cuba.

Effects of Sectoral Diversity on Community Coalition Processes and Outcomes.

PubMed

Brown, Louis D; Wells, Rebecca; Jones, Eric C; Chilenski, Sarah Meyer

2017-07-01

Collaboration with diverse partners is challenging but essential for the implementation of prevention programs and policies. Increased communication with partners from diverse sectors may help community coalitions overcome the challenges that diversity presents. We examined these issues empirically in a study of 17 substance use prevention coalitions in Mexico. Building on coalition and workgroup literatures, we hypothesized that sectoral diversity would improve outcomes but undermine coalition processes. Conversely, we expected uniformly positive effects from higher levels of intersectoral communication. Data are from a 2015 survey of 211 members within the 17 community coalitions. Regression models used sectoral diversity and intersectoral communication to predict coalition processes (cohesion, leader-member communication, efficiency) and outcomes (community support, community improvement, sustainability planning). Sectoral diversity was negatively associated with coalition processes and was not associated with coalition outcomes. Intersectoral communication was positively associated with two of the three measures of coalition outcomes but not associated with coalition processes. Our findings concur with those from prior research indicating that sectoral diversity may undermine coalition processes. However, more communication between sectors may facilitate the coalition outcomes of community support and sustainability planning. Skilled team leaders and participatory decision making may also help coalitions promote intersectoral communication, thereby engaging diverse community sectors to implement preventive interventions and actualize sustained public health impact.

Intersectoral approaches and integrated services in achieving the right to health for refugees upon resettlement: a scoping review protocol.

PubMed

Javadi, Dena; Langlois, Etienne V; Ho, Shirley; Friberg, Peter; Tomson, Göran

2017-08-30

Global insecurity and climate change are exacerbating the need for improved management of refugee resettlement services. International standards hold states responsible for the protection of the right of non-citizens to an adequate standard of physical and mental health while recognising the importance of social determinants of health. However, programmes to protect refugees' right to health often lack coordination and monitoring. This paper describes the protocol for a scoping review to explore barriers and facilitators to the integration of health services for refugees; the content, process and actors involved in protecting refugee health; and the extent to which intersectoral approaches are leveraged to protect refugees' right to health on resettlement, especially for vulnerable groups such as women and children. Peer-reviewed (through four databases including MEDLINE, Web of Science, Global Health and PsycINFO) and grey literature were searched to identify programmes and interventions designed to promote refugee health in receiving countries. Two reviewers will screen articles and abstract data. Two frameworks for integration and intersectoral action will be applied to understand how and why certain approaches work while others do not and to identify the actors involved in achieving success at different levels of integration as defined by these frameworks. Findings from the scoping review will be shared in relevant conferences and meetings. A brief will be created with lessons learnt from successful programmes to inform decision making in design of refugee programmes and services. Ethical approval is not required as human subjects are not involved. Registered on Open Science Framework at https://osf.io/gt9ck/. © Article author(s) (or their employer(s) unless otherwise stated in the text of the article) 2017. All rights reserved. No commercial use is permitted unless otherwise expressly granted.

[Potential of Information and Communications Technology to Improve Intersectoral Processes of Care: A Case Study of the Specialised Outpatient Palliative Care].

PubMed

Meyer-Delpho, C; Schubert, H-J

2015-09-01

The added value of information and communications technologies should be demonstrated precisely in such areas of care in which the importance of intersectoral and interdisciplinary cooperation is particularly high. In the context of the accompanying research of a supply concept for palliative care patients, the potential of a digital documentation process was comparatively analysed with the conventional paper-based workflow. Data were collected in the form of a multi-methodological approach and processed for the project in 3 stages: (1) Development and analysis of a palliative care process with the focus on all relevant steps of documentation. (2) Questionnaire design and the comparative mapping of specific process times. (3) Sampling, selection, and analysis of patient records and their derivable insights of process iterations. With the use of ICT, the treatment time per patient is reduced by up to 53% and achieves a reduction in costs and workload by up to 901 min. The result of an up to 213% increase in the number of patient contacts allows a higher continuity of care. Although the 16% increase in documentation loyalty improves the usability of cross-team documented information, it partially extends the workload on the level of individual actors. By using a digital health record around 31% more patients could be treated with the same staffing ratio. The multi-stage analysis of the palliative care process showed that ICT has a decisive influence on the process dimension of intersectoral cooperation. Due to favourable organisational conditions the pioneering work of palliative care also provides important guidance for a successful use of ICT technologies in the context of innovative forms of care. © Georg Thieme Verlag KG Stuttgart · New York.

Intersectoral action for health equity as it relates to climate change in Canada: contributions from critical systems heuristics.

PubMed

Buse, Chris

2013-12-01

Intersectoral action (ISA) has been at the forefront of public health policy discussions since the 1970s. ISA incorporates a broader perspective of public health issues and coordinates efforts to address the social, political, economic and environmental contexts from which health determinants operate and are created. Despite being forwarded as a useful way to address and treat complex or 'wicked' problems, such policy issues are still often addressed within, rather than across, disciplinary silos and ISA has been documented to fail more often than it succeeds. This paper contributes to an understanding of ISA by outlining and applying critical systems heuristics (CSH) theory and methods. CSH theory and methods are described and discussed before applying them to the example of addressing climate change and health equity through public health practice. CSH thinking provides useful tools to engage stakeholders, question relations of power that may exist between collaborating partners, and move beyond power inequalities that guide ISA initiatives. CSH is a compelling framing that can improve an understanding of the collaborative relationships that are a prerequisite for engaging in ISA to address complex or 'wicked' policy problems such as climate change. © 2013 John Wiley & Sons Ltd.

One Health: a perspective from the human health sector.

PubMed

Kakkar, M; Hossain, S S; Abbas, S S

2014-08-01

Despite emerging consensus that the One Health concept involves multiple stakeholders, the human health sector has continued to view it from a predominantly human health security perspective. It has often ignored the concerns of other sectors, e.g. concerns that relate to trade, commerce, livelihoods and sustainable development, all of which are important contributors to societal well-being. In the absence of a culture of collaboration, clear One Health goals, conceptual clarity and operating frameworks, this disconnect between human health and One Health efforts has often impeded the translation of One Health from concept to reality, other than during emergency situations. If there are to be effective and sustainable One Health partnerships we must identify clear operating principles that allow flexible approaches to intersectoral collaborations. To convince technical experts and political leaders in the human health sector of the importance of intersectoral cooperation, and to make the necessary structural adjustments, we need examples of best practice models and trans-sectoral methods for measuring the risks, burden and costs across sectors. Informal collaborations between researchers and technical experts will play a decisive role in developing these methods and models and instilling societal well-being into the human health sector's view of One Health.

Economic considerations and health in all policies initiatives: evidence from interviews with key informants in Sweden, Quebec and South Australia.

PubMed

Pinto, Andrew D; Molnar, Agnes; Shankardass, Ketan; O'Campo, Patricia J; Bayoumi, Ahmed M

2015-02-18

Health in All Policies (HiAP) is a form of intersectoral action that aims to include the promotion of health in government initiatives across sectors. To date, there has been little study of economic considerations within the implementation of HiAP. As part of an ongoing program of research on the implementation of HiAP around the world, we examined how economic considerations influence the implementation of HiAP. By economic considerations we mean the cost and financial gain (or loss) of implementing a HiAP process or structure within government, or the cost and financial gain (or loss) of the policies that emerge from such a HiAP process or structure. We examined three jurisdictions: Sweden, Quebec and South Australia. Semi-structured telephone interviews were conducted with 12 to 14 key informants in each jurisdiction. Two investigators separately coded transcripts to identify relevant statements. Initial readings of transcripts led to the development of a coding framework for statements related to economic considerations. First, economic evaluations of HiAP are viewed as important for prompting HiAP and many forms of economic evaluation were considered. However, economic evaluations were often absent, informal, or incomplete. Second, funding for HiAP initiatives is important, but is less important than a high-level commitment to intersectoral collaboration. Furthermore, having multiple sources of funding of HiAP can be beneficial, if it increases participation across government, but can also be disadvantageous, if it exposes underlying tensions. Third, HiAP can also highlight the challenge of achieving both economic and social objectives. Our results are useful for elaborating propositions for use in realist multiple explanatory case studies. First, we propose that economic considerations are currently used primarily as a method by health sectors to promote and legitimize HiAP to non-health sectors with the goal of securing resources for HiAP. Second, allocating resources and making funding decisions regarding HiAP are inherently political acts that reflect tensions within government sectors. This study contributes important insights into how intersectoral action works, how economic evaluations of HiAP might be structured, and how economic considerations can be used to both promote HiAP and to present barriers to implementation.

Health impact assessment: assessing opportunities and barriers to intersectoral health improvement in an expanded European Union

PubMed Central

Lock, K.; McKee, M.

2005-01-01

On 1 May 2004 the European Union (EU) underwent unprecedented enlargement, from 15 to 25 countries, increasing its population by 20% to over 450 million. Although EU law has limited specific competence in the area of health, its influence on other policy sectors such as agriculture, trade, and employment has wide ranging implications for health. Yet with the exception of provisions on communicable disease control and food safety, public health considerations have played little part in negotiations on EU accession. This paper argues for an intersectoral public health approach in the expanded EU. It reviews the legal basis for assessing the health impacts of policy in the EU and, using health impact assessment as a case study, it examines how well the new member states may be prepared to tackle intersectoral public health action within the constraints imposed by EU policy. PMID:15831682

[The role of Integrating the Healthcare Enterprise (IHE) in telemedicine].

PubMed

Bergh, B; Brandner, A; Heiß, J; Kutscha, U; Merzweiler, A; Pahontu, R; Schreiweis, B; Yüksekogul, N; Bronsch, T; Heinze, O

2015-10-01

Telemedicine systems are today already used in a variety of areas to improve patient care. The lack of standardization in those solutions creates a lack of interoperability of the systems. Internationally accepted standards can help to solve the lack of system interoperability. With Integrating the Healthcare Enterprise (IHE), a worldwide initiative of users and vendors is working on the use of defined standards for specific use cases by describing those use cases in so called IHE Profiles. The aim of this work is to determine how telemedicine applications can be implemented using IHE profiles. Based on a literature review, exemplary telemedicine applications are described and technical abilities of IHE Profiles are evaluated. These IHE Profiles are examined for their usability and are then evaluated in exemplary telemedicine application architectures. There are IHE Profiles which can be identified as being useful for intersectoral patient records (e.g. PEHR at Heidelberg), as well as for point to point communication where no patient record is involved. In the area of patient records, the IHE Profile "Cross-Enterprise Document Sharing (XDS)" is often used. The point to point communication can be supported using the IHE "Cross-Enterprise Document Media Interchange (XDM)". IHE-based telemedicine applications offer caregivers the possibility to be informed about their patients using data from intersectoral patient records, but also there are possible savings by reusing the standardized interfaces in other scenarios.

Intervessel connectivity and relationship with patterns of lateral water exchange within and between xylem sectors in seven xeric shrubs from the great Sahara desert.

PubMed

Halis, Youcef; Mayouf, Rabah; Benhaddya, Mohamed Lamine; Belhamra, Mohamed

2013-03-01

The main objective of this study was to evaluate the role of intervessel contacts in determining the patterns of hydraulic integration both within and between xylem sectors. The degree of intervessel contacts and the lateral exchange capability within and between sectors were examined and correlated in different xeric shrubs. A dye injection method was used to detect the connections between vessels; an apoplastic dye was sucked through a known number of vessels and its distribution in the xylem network was followed. Hydraulic techniques were used to measure axial and tangential conductivity both within and between xylem sectors. The intra- and inter-sector integration indexes were then determined as the ratio of tangential to axial conductance. Species differed significantly in the degree of intervessel contacts, intra- and inter-sector integration index. In all cases, hydraulic integration was observed to be higher within sector than between sectors. From the correlation analyses, the intervessel contacts showed a very weak relationship with inter-sector integration index and a strong positive relationship with intra-sector integration index. Results suggested that (1) the factors affecting patterns of lateral flow within xylem sectors might be relatively different from those between sectors. (2) The degree of intervessel contacts was a major determinant of hydraulic integration within the same xylem sector. (3) Intervessel connectivity alone was a poor predictor of hydraulic integration between different sectors, implying a significant contribution of other anatomical, physiological and environmental factors in determining the patterns of integrated-sectored transport within woody stems.

Multi-sectoral action for child safety-a European study exploring implicated sectors.

PubMed

Scholtes, Beatrice; Schröder-Bäck, Peter; Förster, Katharina; MacKay, Morag; Vincenten, Joanne; Brand, Helmut

2017-06-01

Injury to children in Europe, resulting in both death and disability, constitutes a significant burden on individuals, families and society. Inequalities between high and low-income countries are growing. The World Health Organisation Health 2020 strategy calls for inter-sectoral collaboration to address injury in Europe and advocates the whole of government and whole of society approaches to wicked problems. In this study we explore which sectors (e.g. health, transport, education) are relevant for four domains of child safety (intentional injury, water, road and home safety). We used the organigraph methodology, originally developed to demonstrate how organizations work, to describe the governance of child safety interventions. Members of the European Child Safety Alliance, working in the field of child safety in 24 European countries, drew organigraphs of evidence-based interventions. They included the different actors involved and the processes between them. We analyzed the organigraphs by counting the actors presented and categorizing them into sectors using a pre-defined analysis framework. We received 44 organigraphs from participants in 24 countries. Twenty-seven sectors were identified across the four domains. Nine of the 27 identified sectors were classified as 'core sectors' (education, health, home affairs, justice, media, recreation, research, social/welfare services and consumers). This study reveals the multi-sectoral nature of child safety in practice. It provides information for stakeholders working in child safety to help them implement inter-sectoral child safety interventions taking a whole-of-government and whole-of-society approach to health governance. © The Author 2017. Published by Oxford University Press on behalf of the European Public Health Association. All rights reserved.

How Intersectoral Health Promotion Changes Professional Practices: A Case Study From Denmark.

PubMed

Christensen, Mads; Burau, Viola; Ledderer, Loni

2018-05-01

Intersectoral health promotion (IHP) has pushed health professions to engage in new tasks and interprofessional ways of working. We studied how care assistants from a nursing home and school teachers implemented a cookery project targeted at children ("Cool Beans") as an example of an IHP project in Denmark. Our aim was to examine the impact of the IHP project on the practices of the professions involved. We used a qualitative case study to investigate joint care and teaching situations with the two professions and their users. Our data consisted of documents, participatory observations, and informal interviews (17 hours) as well as semistructured interviews with professionals (n = 4). We used a sociological institutional framework to analyze the professional practices emerging in joint care and teaching situations and identified three themes of new professional activities: (1) "interplay" related to making different generations collaborate on the tasks involved in the cookery session; (2) "care" concerned with caregiving activities; and (3) "learning" focused on schooling on healthy food and cooking. We conclude that changes in professional practices occurred informally and were induced by the concrete activities in the cookery project. The specific, practical tasks of the IHP project thus offered an important leverage for future interprofessional collaborations.

Challenging urban health: towards an improved local government response to migration, informal settlements, and HIV in Johannesburg, South Africa

PubMed Central

Vearey, Joanna

2011-01-01

This article is a review of the PhD thesis undertaken by Joanna Vearey that explores local government responses to the urban health challenges of migration, informal settlements, and HIV in Johannesburg, South Africa. Urbanisation in South Africa is a result of natural urban growth and (to a lesser extent) in-migration from within the country and across borders. This has led to the development of informal settlements within and on the periphery of urban areas. The highest HIV prevalence nationally is found within urban informal settlements. South African local government has a ‘developmental mandate’ that calls for government to work with citizens to develop sustainable interventions to address their social, economic, and material needs. Through a mixed-methods approach, four studies were undertaken within inner-city Johannesburg and a peripheral urban informal settlement. Two cross-sectional surveys – one at a household level and one with migrant antiretroviral clients – were supplemented with semi-structured interviews with multiple stakeholders involved with urban health and HIV in Johannesburg, and participatory photography and film projects undertaken with urban migrant communities. The findings show that local government requires support in developing and implementing appropriate intersectoral responses to address urban health. Existing urban health frameworks do not deal adequately with the complex health and development challenges identified; it is essential that urban public health practitioners and other development professionals in South Africa engage with the complexities of the urban environment. A revised, participatory approach to urban health – ‘concept mapping’ – is suggested which requires a recommitment to intersectoral action, ‘healthy urban governance’ and public health advocacy. PMID:21686331

Time to dismiss the idea of a structural fix within government? An analysis of intersectoral action for health in Danish municipalities.

PubMed

Holt, Ditte H; Carey, Gemma; Rod, Morten H

2018-06-01

This paper examines the role of organizational structure within government(s) in attempts to implement intersectoral action for health in Danish municipalities. We discuss the implications of structural reorganization and the governance structures that are established in order to ensure coordination and integration between policy sectors. The paper is based on 49 interviews with civil servants from health and non-health sectors of 10 municipalities. Based on participants' experiences, cases have been described and analyzed in an iterative process consulting the literature on Health in All Policies and joined-up government. Continuous and frequent processes of reorganizing were widespread in the municipalities. However, they appeared to have little effect on policy change. The two most common governance structures established to transcend organizational boundaries were the central unit and the intersectoral committee. According to the experiences of participants, paradoxically both of these organizational solutions tend to reproduce the organizational problems they are intended to overcome. Even if structural reorganization may succeed in dissolving some sector boundaries, it will inevitably create new ones. It is time to dismiss the idea that intersectoral action for health can be achieved by means of a structural fix. Rather than rearranging organizational boundaries it may be more useful to seek to manage the silos which exist in any organization, e.g. by promoting awareness of their implications for public health action and by enhancing the boundary spanning skills of public health officers.

Harnessing opportunities for good governance of health impacts of mining projects in Mongolia: results of a global partnership.

PubMed

Pfeiffer, Michaela; Vanya, Delgermaa; Davison, Colleen; Lkhagvasuren, Oyunaa; Johnston, Lesley; Janes, Craig R

2017-06-27

The Sustainable Development Goals call for the effective governance of shared natural resources in ways that support inclusive growth, safeguard the integrity of the natural and physical environment, and promote health and well-being for all. For large-scale resource extraction projects -- e.g. in the mining sector -- environmental regulations and in particular environmental impact assessments (EIA) provide an important but insufficiently developed avenue to ensure that wider sustainable development issues, such as health, have been considered prior to the permitting of projects. In recognition of the opportunity provided in EIA to influence the extent to which health issues would be addressed in the design and delivery of mining projects, an international and intersectoral partnership, with the support of WHO and public funds from Canadian sources, engaged over a period of six years in a series of capacity development activities and knowledge translation/dissemination events aimed at influencing policy change in the extractives sector so as to include consideration of human health impacts. Early efforts significantly increased awareness of the need to include health considerations in EIAs. Coupling effective knowledge translation about health in EIA with the development of networks that fostered good intersectoral partnerships, this awareness supported the development and implementation of key pieces of legislation. These results show that intersectoral collaboration is essential, and must be supported by an effective conceptual understanding about which methods and models of impact assessment, particularly for health, lend themselves to integration within EIA. The results of our partnership demonstrate that when specific conditions are met, integrating health into the EIA system represents a promising avenue to ensure that mining activities contribute to wider sustainable development goals and objectives.

Realist evaluation of intersectoral oral health promotion interventions for schoolchildren living in rural Andean communities: a research protocol

PubMed Central

Talbot, Lise R; Gaboury, Isabelle

2017-01-01

Background Intersectoral collaboration, known to promote more sustainable change within communities, will be examined in an oral health promotion program (OHPP). In Peru, an OHPP was implemented by the Ministry of Health, to reduce the incidence of caries in schoolchildren. In rural Andean communities, however, these initiatives achieved limited success. The objectives of this project are: (1) to understand the context and the underlying mechanisms associated with Peruvian OHPP's current effects among school children living in rural Andean communities and (2) to validate a theory explaining how and under which circumstances OHP intersectoral interventions on schoolchildren living in rural Andean communities produce their effects. Methods and analysis Through a realist evaluation, the context, underlying mechanisms and programme outcomes will be identified. This process will involve five different steps. In the first and second steps, a logic model and an initial theory are developed. In the third step, data collection will permit measurement of the OHHP's outcomes with quantitative data, and exploration of the elements of context and the mechanisms with qualitative data. In the fourth and fifth steps, iterative data analysis and a validation process will allow the identification of Context-Mechanism-Outcome configuration, and validate or refine the initial theory. Ethics and dissemination This research project has received approval from the Comité d’éthique de la recherche en santé chez l'humain du Centre hospitalier universitaire de Sherbrooke. The initial theory and research results will be published in relevant journals in public health and oral health. They will also be presented at realist evaluation and health promotion international conferences. PMID:28237962

XVth World Conference of the International Union for Health Promotion and Education, Makuhari, Japan, 20-25 August 1995. Conference report.

PubMed

Westaway, M S

1995-09-01

This article briefly highlights information provided by speakers at the World Conference of the International Union for Health Promotion and Education. The conference took place during August 1995, in Makuhari, Japan. One paper focused on health education in Japan, which would not be suitable for health promotion efforts in South Africa. Another paper focused on intersectoral efforts for health, policy, and networking. This paper addressed an issue important for all countries; the need for better communication among people working in health fields and improved outreach. A paper focusing on strengthening community action was presented. South Africa, as well as Japan, must work to involve communities in health service management. The author found that the paper on policy, practice, and research for health promotion and education was relevant to South Africa. Policymakers and practitioners tend to rely on precedence, intuition, personal experience, and political experience. Academic research funding does not support research that is relevant to policymakers and practitioners. The papers on healthy cities research were stimulating and had practical input. The proposed model involved a 3-phase and 14-step process of choosing a topic for an intervention, analyzing the intervention's political environment, and planning the political aspects of intervention. Another model of intersectoral action was spiral shaped and centered problem definition, direction setting, and structuring between networking and interorganizational relations. Four papers from Botswana focused on reproductive health. Other papers focused on teenage pregnancy.

Inter-Sectoral Bisphenol A (BPA) Flows in the 2012 Chinese Economy.

PubMed

Jiang, Daqian; Chen, Wei-Qiang; Liu, Wei; Chertow, Marian

2017-08-01

Bisphenol A (BPA), a widely used petrochemical compound, has become an emerging global environmental management challenge because its leakage is associated with potential environmental and human health impacts. Until now, available BPA statistics have been limited to the products that directly use BPA. In this study, we delineate direct and indirect BPA flows for the 2012 Chinese economy. We find that construction, production of educational and recreational products, and automobile manufacturing are the most BPA-intensive sectors in terms of total BPA flows (300, 157, and 130 Gg total BPA flows, respectively). The public management and health sectors, however, incur significant indirect BPA flows, defined as embedded and inter-sectoral BPA placed into use, even though direct BPA use by these sectors is limited. By revealing the currently overlooked indirect BPA flows, this study reveals data gaps that are highly relevant to improving the accuracy of estimated BPA flows and losses. The method used herein is transferrable to other emerging and environmentally relevant materials, thereby providing the holistic understanding needed for cities, regions, or nations to design effective policy interventions.

The essential elements of health impact assessment and healthy public policy: a qualitative study of practitioner perspectives.

PubMed

Harris, Patrick John; Kemp, Lynn Amanda; Sainsbury, Peter

2012-01-01

This study uses critical realist methodology to identify the essential and contingent elements of Health Impact Assessment (HIA) and Healthy Public Policy (HPP) as operationalised by practitioners. Data collection-qualitative interviews and a workshop were conducted with HIA and HPP practitioners working in differing contexts. Critical realist analytical questions identified the essential elements of HIA and HPP, the relationship between them, and the influences of public policy and other contingencies on the practice of both. Nine interviews were conducted with purposively sampled participants working in Europe, USA and Australasia. 17 self-selected participants who worked in Europe, South East Asia and Australasia attended the workshop. The results clarify that HIA and HPP are different but mutually supporting. HIA has four characteristics: assessing a policy proposal to predict population health and equity impacts, a structured process for stakeholder dialogue, making recommendations and flexibly adapting to the policy process. HPP has four characteristics: concern with a broad definition of health, designing policy to improve people's health and reduce health inequities, intersectoral collaboration and influencing the policy cycle from inception to completion. HIA brings to HPP prediction about a policy's broad health impacts, and a structured space for intersectoral engagement, but is one approach within a broader suite of HPP activities. Five features of public policy and seven contingent influences on HIA and HPP practice are identified. This study clarifies the core attributes of HIA and HPP as separate yet overlapping while subject to wider influences. This provides the necessary common language to describe the application of both and avoid conflated expectations of either. The findings present the conceptual importance of public policy and the institutional role of public health as distinct and important influences on the practice of HIA and HPP.

Delivering a primary care-based social prescribing initiative: a qualitative study of the benefits and challenges.

PubMed

Skivington, Kathryn; Smith, Mathew; Chng, Nai Rui; Mackenzie, Mhairi; Wyke, Sally; Mercer, Stewart W

2018-05-21

Social prescribing is a collaborative approach to improve inter-sectoral working between primary health care and community organisations. The Links Worker Programme (LWP) is a social prescribing initiative in areas of high deprivation in Glasgow, Scotland, that is designed to mitigate the negative impacts of the social determinants of health. To investigate issues relevant to implementing a social prescribing programme to improve inter-sectoral working to achieve public health goals. Qualitative interview study with community organisation representatives and community links practitioners (CLPs) in LWP areas. Audiorecordings of semi-structured interviews with 30 community organisation representatives and six CLPs were transcribed verbatim and analysed thematically. Participants identified some benefits of collaborative working, particularly the CLPs' ability to act as a case manager for patients, and their position in GP practices, which operated as a bridge between organisations. However, benefits were seen to flow from new relationships between individuals in community organisations and CLPs, rather than more generally with the practice as a whole. Challenges to the LWP were related to capacity and funding for community organisations in the context of austerity. The capacity of CLPs was also an issue given that their role involved time-consuming, intensive case management. Although the LWP appears to be a fruitful approach to collaborative case management, integration initiatives such as social prescribing cannot be seen as 'magic bullets'. In the context of economic austerity, such approaches may not achieve their potential unless funding is available for community organisations to continue to provide services and make and maintain their links with primary care. © British Journal of General Practice 2018.

Continuous Cash Benefit (BCP) for disabled individuals: access barriers and intersectoral gaps.

PubMed

Vaitsman, Jeni; Lobato, Lenaura de Vasconcelos Costa

2017-11-01

The 1988 Constitution approved the Continuous Cash Benefit (BCP) directed to elders and disabled persons with a household per capita income of 25% of the minimum wage, and around 4 million people received this benefit in 2015. The design of BPC for disabled persons involves organizations of social security, social welfare and health. This paper discusses how some intersectoral coordination mechanisms gaps between these areas produce access barriers to potential beneficiaries. Results stem from a qualitative study performed with physicians, administrative staff and social workers from the National Institute of Social Security (INSS) and of the Social Welfare Reference Center (CRAS) in three municipalities of different Brazilian regions. Intersectoral coordination and cooperation are more structured at the Federal level. At the local level, they rely on informal and horizontal initiatives, which produce immediate but discontinuous solutions. The role of the CRAS remains contingent on the implementation. The need to establish institutionalized mechanisms for coordination and cooperation between social welfare, health and social insurance to improve the implementation and reduce barriers to access to the BCP is apparent.

A patient with autism and severe depression: medical and ethical challenges for an adolescent medicine unit.

PubMed

Skinner, S Rachel; Ng, Cindy; McDonald, Ann; Walters, Tamara

2005-10-17

An adolescent with autism and intellectual disability presented with severe depression related to menstruation. Because of the complex medical, psychiatric and ethical issues involved, her care was coordinated by a hospital-based adolescent medicine unit. After trials of other therapies over an extended period and interdisciplinary and intersectoral case conferencing, it was decided that hysterectomy was the most appropriate management. This case highlights the complexity of adolescent health care in a tertiary hospital, the importance of intersectoral cooperation between hospital and community, and the integral role of interdisciplinary care of adolescent patients with chronic conditions.

Health impact assessment needs in south-east Asian countries.

PubMed Central

Caussy, Deoraj; Kumar, Priti; Than Sein, U.

2003-01-01

A situation analysis was undertaken to assess impediments to health impact assessment (HIA) in the South-East Asia Region of WHO (SEARO). The countries of the region were assessed on the policy framework and procedures for HIA, existing infrastructure required to support HIA, the capacity for undertaking HIA, and the potential for intersectoral collaboration. The findings show that environmental impact assessment (EIA) is being used implicitly as a substitute for HIA, which is not explicitly or routinely conducted in virtually all countries of the Region. Therefore, policy, infrastructure, capacity, and intersectoral collaboration need strengthening for the routine implementation of HIA. PMID:12894329

Leadership in practice: an analysis of collaborative leadership in the conception of a virtual ward.

PubMed

Stockham, Alayne

2016-09-30

The National Health Service (NHS) in the UK is evolving to meet the needs of society, but success depends on effective leadership. The World Health Organization identified intersectoral and multidisciplinary working as key to improving the quality and sustainability of the service, highlighting the need for a new leadership style. This article describes how collaborative leadership was used to successfully implement a virtual ward in the primary care setting in south-east Powys, Wales. The author describes the leadership style and addresses strategies used to manage the change process. The journey demonstrates how collaborative leadership and working collectively enabled a new service to be developed, and established a mutual respect for different professionals' roles.

Strengthening health promotion in Australian workplaces.

PubMed

Fisher, K J; Deeds, S; Siebel, R; Allen, J

1997-01-01

The Australian workplace has emerged as an important venue for influencing the health of employees through regulations and behaviour change programs. Recent surveys have highlighted a growth in this activity but the effectiveness of these programs in changing unhealthy work practices and policies is questionable. The need for strengthening programs by stronger designs and evaluation, and addressing organisational factors and employee participation in planning and implementation processes is documented. Efforts in that direction in Queensland are cited, Building on these existing foundations, redirecting existing resources, and building intersectoral cooperation in public-private partnerships hold a creative, exemplary vision of the future for Australian workplace programming.

Understanding the role of intersectoral convergence in the delivery of essential maternal and child nutrition interventions in Odisha, India: a qualitative study.

PubMed

Kim, Sunny S; Avula, Rasmi; Ved, Rajani; Kohli, Neha; Singh, Kavita; van den Bold, Mara; Kadiyala, Suneetha; Menon, Purnima

2017-02-02

Convergence of sectoral programs is important for scaling up essential maternal and child health and nutrition interventions. In India, these interventions are implemented by two government programs - Integrated Child Development Services (ICDS) and National Rural Health Mission (NRHM). These programs are designed to work together, but there is limited understanding of the nature and extent of coordination in place and needed at the various administrative levels. Our study examined how intersectoral convergence in nutrition programming is operationalized between ICDS and NRHM from the state to village levels in Odisha, and the factors influencing convergence in policy implementation and service delivery. Semi-structured interviews were conducted with state-level stakeholders (n = 12), district (n = 19) and block officials (n = 66), and frontline workers (FLWs, n = 48). Systematic coding and content analysis of transcripts were undertaken to elucidate themes and patterns related to the degree and mechanisms of convergence, types of actions/services, and facilitators and barriers. Close collaboration at state level was observed in developing guidelines, planning, and reviewing programs, facilitated by a shared motivation and recognized leadership for coordination. However, the health department was perceived to drive the agenda, and different priorities and little data sharing presented challenges. At the district level, there were joint planning and review meetings, trainings, and data sharing, but poor participation in the intersectoral meetings and limited supervision. While the block level is the hub for planning and supervision, cooperation is limited by the lack of guidelines for coordination, heavy workload, inadequate resources, and poor communication. Strong collaboration among FLWs was facilitated by close interpersonal communication and mutual understanding of roles and responsibilities. Congruent or shared priorities and regularity of actions between sectors across all levels will likely improve the quality of coordination, and clear roles and leadership and accountability are imperative. As convergence is a means to achieving effective coverage and delivery of services for improved maternal and child health and nutrition, focus should be on delivering all the essential services to the mother-child dyads through mechanisms that facilitate a continuum of care approach, rather than sectorally-driven, service-specific delivery processes.

Multi-Sectoral Action for Addressing Social Determinants of Noncommunicable Diseases and Mainstreaming Health Promotion in National Health Programmes in India

PubMed Central

Arora, Monika; Chauhan, Kavita; John, Shoba; Mukhopadhyay, Alok

2011-01-01

Major noncommunicable diseases (NCDs) share common behavioral risk factors and deep-rooted social determinants. India needs to address its growing NCD burden through health promoting partnerships, policies, and programs. High-level political commitment, inter-sectoral coordination, and community mobilization are important in developing a successful, national, multi-sectoral program for the prevention and control of NCDs. The World Health Organization's “Action Plan for a Global Strategy for Prevention and Control of NCDs” calls for a comprehensive plan involving a whole-of-Government approach. Inter-sectoral coordination will need to start at the planning stage and continue to the implementation, evaluation of interventions, and enactment of public policies. An efficient multi-sectoral mechanism is also crucial at the stage of monitoring, evaluating enforcement of policies, and analyzing impact of multi-sectoral initiatives on reducing NCD burden in the country. This paper presents a critical appraisal of social determinants influencing NCDs, in the Indian context, and how multi-sectoral action can effectively address such challenges through mainstreaming health promotion into national health and development programs. India, with its wide socio-cultural, economic, and geographical diversities, poses several unique challenges in addressing NCDs. On the other hand, the jurisdiction States have over health, presents multiple opportunities to address health from the local perspective, while working on the national framework around multi-sectoral aspects of NCDs. PMID:22628911

Cross-sector collaborations in Aboriginal and Torres Strait Islander childhood disability: a systematic integrative review and theory-based synthesis.

PubMed

Green, Anna; DiGiacomo, Michelle; Luckett, Tim; Abbott, Penelope; Davidson, Patricia Mary; Delaney, Joanne; Delaney, Patricia

2014-12-18

Aboriginal and Torres Strait Islander children in Australia experience a higher prevalence of disability and socio-economic disadvantage than other Australian children. Early intervention is vital for improved health outcomes, but complex and fragmented service provision impedes access. There have been international and national policy shifts towards inter-sector collaborative responses to disability, but more needs to be known about how collaboration works in practice. A systematic integrative literature review using a narrative synthesis of peer-reviewed and grey literature was undertaken to describe components of inter- and intra-sector collaborations among services to Aboriginal and Torres Strait Islander children with a disability and their families. The findings were synthesized using the conceptual model of the ecological framework. Thirteen articles published in a peer-reviewed journal and 18 articles from the grey literature met inclusion criteria. Important factors in inter- and intra-sector collaborations identified included: structure of government departments and agencies, and policies at the macro- (government) system level; communication, financial and human resources, and service delivery setting at the exo- (organizational) system level; and relationships and inter- and intra-professional learning at the meso- (provider) system level. The policy shift towards inter-sector collaborative approaches represents an opportunity for the health, education and social service sectors and their providers to work collaboratively in innovative ways to improve service access for Aboriginal and Torres Strait Islander children with a disability and their families. The findings of this review depict a national snapshot of collaboration, but as each community is unique, further research into collaboration within local contexts is required to ensure collaborative solutions to improve service access are responsive to local needs and sustainable.

Spilt milk: an inter-sectoral partnership that failed to advance milk security for low-income lone mothers in Nova Scotia, Canada.

PubMed

McIntyre, Lynn; Glanville, N Theresa; Hilchie-Pye, Andrea

2011-03-01

Canadian agricultural policy supports higher milk prices. Consequently, poor families lack sufficient funds to purchase adequate quantities of milk. Low-income lone mothers in the Canadian province of Nova Scotia suggested their preferred strategies for improved access to milk. We then built inter-sectoral support for a policy intervention to address their recommendations. Our research-to-action process led to a policy dialogue focusing on an electronic smart card that would permit the delivery of lower-priced milk to poor households. While all agreed that milk insecurity was an important issue, the project ultimately failed because of the entrenched positions of influential stakeholder groups.

The essential elements of health impact assessment and healthy public policy: a qualitative study of practitioner perspectives

PubMed Central

Harris, Patrick John; Kemp, Lynn Amanda; Sainsbury, Peter

2012-01-01

Objectives This study uses critical realist methodology to identify the essential and contingent elements of Health Impact Assessment (HIA) and Healthy Public Policy (HPP) as operationalised by practitioners. Design Data collection—qualitative interviews and a workshop were conducted with HIA and HPP practitioners working in differing contexts. Data analysis Critical realist analytical questions identified the essential elements of HIA and HPP, the relationship between them, and the influences of public policy and other contingencies on the practice of both. Participants Nine interviews were conducted with purposively sampled participants working in Europe, USA and Australasia. 17 self-selected participants who worked in Europe, South East Asia and Australasia attended the workshop. Results The results clarify that HIA and HPP are different but mutually supporting. HIA has four characteristics: assessing a policy proposal to predict population health and equity impacts, a structured process for stakeholder dialogue, making recommendations and flexibly adapting to the policy process. HPP has four characteristics: concern with a broad definition of health, designing policy to improve people's health and reduce health inequities, intersectoral collaboration and influencing the policy cycle from inception to completion. HIA brings to HPP prediction about a policy's broad health impacts, and a structured space for intersectoral engagement, but is one approach within a broader suite of HPP activities. Five features of public policy and seven contingent influences on HIA and HPP practice are identified. Conclusions This study clarifies the core attributes of HIA and HPP as separate yet overlapping while subject to wider influences. This provides the necessary common language to describe the application of both and avoid conflated expectations of either. The findings present the conceptual importance of public policy and the institutional role of public health as distinct and important influences on the practice of HIA and HPP. PMID:23166121

Intersectoral interagency partnerships to promote financial capability in older people.

PubMed

Hean, Sarah; Fenge, Lee Ann; Worswick, Louise; Wilkinson, Charlie; Fearnley, Stella

2012-09-01

From the second quarter of 2008, the UK economy entered a period of economic decline. Older people are particularly vulnerable during these times. To promote ways in which older people can be better supported to maintain their financial well-being, this study explored the sources older people utilize to keep themselves financially informed. Interviews with older people (n = 28) showed that older people access trusted sources of information (e.g. healthcare professionals) rather than specialist financial information providers (e.g. financial advisors) which highlighted the need for interagency working between financial services in the private, public and voluntary sectors. An example of how such interagency partnerships might be achieved in practice is presented with some recommendations on directions for future research into interagency working that spans public, private and voluntary sectors.

Health promotion in Brazil.

PubMed

Buss, Paulo Marchiori; de Carvalho, Antonio Ivo

2007-01-01

The evolution of health promotion within the Brazilian health system is examined, including an assessment of the intersectoral and development policies that have influenced the process. Particular attention is paid to the legal characteristics of the Unified Health System. Human resources formation and research initiatives in health promotion are outlined, with a summary of the obstacles that need to be overcome in order to ensure the effective implementation of health promotion in the future. Up to the end of the 20th Century health promotion was not used as a term in the Brazilian public heath context. Health promoting activities were concentrated in the area of health education, although targeting the social determinants of health and the principle of intersectoral action were part of the rhetoric. The situation has changed during the last decade, with the publication of a national policy of health promotion, issued by the Ministry of Health and jointly implemented with the States and Municipals Health Secretaries. More recently there has been a re-emergence of the discourse on the social determinants of health and the formation of intersectoral public policies as the basis of a comprehensive health promotion. Health promotion infrastructure, particularly around human resources and financing, requires strengthening in order to ensure capacity and sustainability in health promotion practice.

The potential of eHealth in otorhinolaryngology-head and neck surgery: patients' perspectives.

PubMed

Holderried, Martin; Ernst, C; Holderried, F; Rieger, M; Blumenstock, G; Tropitzsch, A

2017-07-01

The use of modern information and communication technologies (ICT) in daily life has significantly increased during the last several years. These essential online technologies have also found their way into the healthcare system. The use of modern ICT for health reasons can be summarized by the term 'eHealth'. Despite the potential importance of eHealth in the field of otorhinolaryngology (ORL), there is little understanding of patients' attitudes towards the deeper integration of these technologies into intersectoral care. The aim of this study was to gain a better understanding of patients' attitudes towards the use of modern ICT for intersectoral communication and information transfer in the field of ORL. Therefore, a structured interview was developed by an interdisciplinary team of otorhinolaryngologists, public health researchers, and information technology (IT) specialists. Overall, 211 ORL patients were interviewed at the Department of Otorhinolaryngology-Head and Neck Surgery, Tuebingen University Hospital, Germany, and 203 of these patients completed the interview. This study revealed ORL patients' perspectives on the potential of eHealth, especially for appointment scheduling, appointment reminders, and intersectoral communication of personal medical information. Furthermore, this study provides evidence that data security and the impacts of eHealth on the physician-patient relationship and on treatment quality warrant special attention in future research.

Implementation of Urban Health Equity Assessment and Response Tool: a Case of Matsapha, Swaziland.

PubMed

Makadzange, Kevin; Radebe, Zamahlubi; Maseko, Nokuthula; Lukhele, Voyivoyi; Masuku, Sabelo; Fakudze, Gciniwe; Mengestu, Tigest Ketsela; Prasad, Amit

2018-04-03

Equity in health implies that ideally everyone could attain their full health potential and that no one should be disadvantaged from achieving this potential because of their social position or other socially determined circumstances. Making cities and human settlements inclusive, safe, resilient and sustainable contributes towards ensuring healthy lives and promoting well-being for all at all ages in dignity, equality and in a healthy environment. This paper illustrates a case of applying the Urban Health Equity Assessment and Response Tool (Urban HEART) in a small town in Africa. It describes the process followed, facilitating factors and challenges faced. A descriptive single-case study design using qualitative research methods was adopted to collect data from purposively selected respondents. The study revealed that residents of the Matsapha peri-urban informal settlements faced challenges with conditions of daily living which impacted negatively on their health. There were health equity gaps. The application of the tools was facilitated by the formation of an all-inclusive team, intersectoral collaboration and incorporating strategies for improving urban health equity into existing programmes and projects. Urban HEART is a simple and easy to use valuable tool for pursuing the goal of health equity towards attaining sustainable development through evidence-based approaches for intersectoral action and community involvement.

Understanding similarities in the local implementation of a healthy environment programme: insights from policy studies.

PubMed

Clavier, Carole; Gendron, Sylvie; Lamontagne, Lise; Potvin, Louise

2012-07-01

This paper reports findings from an evaluation of the local implementation of a procedural public health programme whose objective is to create healthy environments (HE) for vulnerable families in the province of Quebec (Canada) through the funding of local projects. Considering the potential issue of programme-context interaction, our research question was the following: Does the procedural nature of this HE programme result in variation between local cases in terms of the types of projects and collaborations it subsidizes? Given that the creation of healthy environments requires intersectoral health action to address social determinants of health, the data were analysed with respect to intersectorality and cooperation. Results of this qualitative multiple case study (n = 8), for the period 2004-2009, show that the majority of subsidized projects were in the health and social services sector and focused on parenting, parent-child attachment, nutrition and the social networks of families. Only a few initiatives reached beyond the health and social services sector to address social health determinants such as education, housing and transportation. Membership and mandates of the local groups responsible for programme implementation also showed little intersectorality. The limited variation between these eight cases can be attributed to the configuration of the local networks, as well as to specific issues in urban and rural areas. To explain the overall similarity of results across cases, we turned to the literature on policy instruments which suggests that particular characteristics of a programme may produce effects that are independent of its intended objective. In our study, several programme mechanisms, such as those framing the definition of «healthy environment» and budget management rules, could have encouraged the local development of initiatives that focus on individual skills related to parenting and attachment rather than the development of intersectoral health action to address social determinants of health. Copyright © 2012 Elsevier Ltd. All rights reserved.

Conditions for addressing environmental determinants of health behavior in intersectoral policy networks: A fuzzy set Qualitative Comparative Analysis.

PubMed

Peters, D T J M; Verweij, S; Grêaux, K; Stronks, K; Harting, J

2017-12-01

Improving health requires changes in the social, physical, economic and political determinants of health behavior. For the realization of policies that address these environmental determinants, intersectoral policy networks are considered necessary for the pooling of resources to implement different policy instruments. However, such network diversity may increase network complexity and therefore hamper network performance. Network complexity may be reduced by network management and the provision of financial resources. This study examined whether network diversity - amidst the other conditions - is indeed needed to address environmental determinants of health behavior. We included 25 intersectoral policy networks in Dutch municipalities aimed at reducing overweight, smoking, and alcohol/drugs abuse. For our fuzzy set Qualitative Comparative Analysis we used data from three web-based surveys among (a) project leaders regarding network diversity and size (n = 38); (b) project leaders and project partners regarding management (n = 278); and (c) implementation professionals regarding types of environmental determinants addressed (n = 137). Data on budgets were retrieved from project application forms. Contrary to their intentions, most policy networks typically addressed personal determinants. If the environment was addressed too, it was mostly the social environment. To address environmental determinants of health behavior, network diversity (>50% of the actors are non-public health) was necessary in networks that were either small (<16 actors) or had small budgets (<€183,172), when both were intensively managed. Irrespective of network diversity, environmental determinants also were addressed by small networks with large budgets, and by large networks with small budgets, when both provided network management. We conclude that network diversity is important - although not necessary - for resource pooling to address environmental determinants of health behavior, but only effective in the presence of network management. Our findings may support intersectoral policy networks in improving health behaviors by addressing a variety of environmental determinants. Copyright © 2017. Published by Elsevier Ltd.

Malaria vector control: from past to future.

PubMed

Raghavendra, Kamaraju; Barik, Tapan K; Reddy, B P Niranjan; Sharma, Poonam; Dash, Aditya P

2011-04-01

Malaria is one of the most common vector-borne diseases widespread in the tropical and subtropical regions. Despite considerable success of malaria control programs in the past, malaria still continues as a major public health problem in several countries. Vector control is an essential part for reducing malaria transmission and became less effective in recent years, due to many technical and administrative reasons, including poor or no adoption of alternative tools. Of the different strategies available for vector control, the most successful are indoor residual spraying and insecticide-treated nets (ITNs), including long-lasting ITNs and materials. Earlier DDT spray has shown spectacular success in decimating disease vectors but resulted in development of insecticide resistance, and to control the resistant mosquitoes, organophosphates, carbamates, and synthetic pyrethroids were introduced in indoor residual spraying with needed success but subsequently resulted in the development of widespread multiple insecticide resistance in vectors. Vector control in many countries still use insecticides in the absence of viable alternatives. Few developments for vector control, using ovitraps, space spray, biological control agents, etc., were encouraging when used in limited scale. Likewise, recent introduction of safer vector control agents, such as insect growth regulators, biocontrol agents, and natural plant products have yet to gain the needed scale of utility for vector control. Bacterial pesticides are promising and are effective in many countries. Environmental management has shown sufficient promise for vector control and disease management but still needs advocacy for inter-sectoral coordination and sometimes are very work-intensive. The more recent genetic manipulation and sterile insect techniques are under development and consideration for use in routine vector control and for these, standardized procedures and methods are available but need thorough understanding of biology, ethical considerations, and sufficiently trained manpower for implementation being technically intensive methods. All the methods mentioned in the review that are being implemented or proposed for implementation needs effective inter-sectoral coordination and community participation. The latest strategy is evolution-proof insecticides that include fungal biopesticides, Wolbachia, and Denso virus that essentially manipulate the life cycle of the mosquitoes were found effective but needs more research. However, for effective vector control, integrated vector management methods, involving use of combination of effective tools, is needed and is also suggested by Global Malaria Control Strategy. This review article raises issues associated with the present-day vector control strategies and state opportunities with a focus on ongoing research and recent advances to enable to sustain the gains achieved so far.

[Problem areas and examples of best practice in intersectoral medication treatment--a literature review].

PubMed

Mehrmann, Lena; Ollenschläger, Günter

2014-01-01

Transitions between the outpatient and inpatient sector are a critical phase in medication treatment. This article provides an overview of published problem areas and examples of best practice in the intersectoral medication treatment. Data with regard to related problem areas and examples of best practice was collected in August 2011 by a systematic literature research. The relevant literature was identified using the following databases and search engines: MEDLINE, The Cochrane Library, EMBASE, Google, and Google Scholar. Additionally, a hand search was done on the websites of SpringerLink and Thieme Connect. The initial search yielded a total of 4,409 records which were further selected in two screening steps and analysed according to their relevance. Of the remaining 63 records, 3 exclusively described problem areas, 11 of them examples of best practice, and 49 provided information on both problem areas and examples of best practice with regard to intersectoral medication treatment. Among other things, problem areas include varying legal regulations in inpatient and outpatient medication treatment, drug therapy interruptions after hospital discharge, or deficits in communication and continuity of care. Examples of best practice are projects, programmes, initiatives, recommendations, and points to consider with respect to medication reconciliation, pharmaceutical support, or transitions of care. Problem areas as well as examples of best practice are mainly focused on the transition from inpatient to outpatient care. Copyright © 2013. Published by Elsevier GmbH.

[Child protection network and the intersector implementation of the circle of security as alternatives to medication].

PubMed

Becker, Ana Laura Martins M M; de Souza, Paulo Haddad; de Oliveira, Mônica Martins; Paraguay, Nestor Luiz Bruzzi B

2014-09-01

To describe the clinical history of a child with aggressive behavior and recurring death-theme speech, and report the experience of the team of authors, who proposed an alternative to medication through the establishment of a protection network and the inter-sector implementation of the circle of security concept. A 5-year-old child has a violent and aggressive behavior at the day-care. The child was diagnosed by the healthcare center with depressive disorder and behavioral disorder, and was medicated with sertraline and risperidone. Side effects were observed, and the medications were discontinued. Despite several actions, such as talks, teamwork, psychological and psychiatric follow-up, the child's behavior remained unchanged. A unique therapeutic project was developed by Universidade Estadual de Campinas' Medical School students in order to establish a connection between the entities responsible for the child's care (daycare center, healthcare center, and family). Thus, the team was able to develop a basic care protection network. The implementation of the inter-sector circle of security, as well as the communication and cooperation among the teams, produced very favorable results in this case. This initiative was shown to be a feasible and effective alternative to the use of medication for this child. Copyright © 2014 Sociedade de Pediatria de São Paulo. Publicado por Elsevier Editora Ltda. All rights reserved.

Health museums or theme parks: a new approach to intersectoral collaboration.

PubMed

Seymour, H; Ashton, J; Edwards, P

1986-01-01

This paper is an outline of a proposed initiative on intersectoral collaboration in health promotion--collaboration between health, tourist, cultural and entertainment sectors to provide a powerful mass educational experience about the human mind and body. There has been a recent rise in interest in using the technology of museums, science centres, exploratories and theme parks for the promotion of health. This revival is shown to have a historical tradition in the health education museum started in this century in Europe 75 years ago at the Deutsches Hygiene Museum and then spreading to the USA. The proposed Body, Mind, City Museum planned for Liverpool acts as a future model for a new type of health Museum; a mixture of science exploratorium and a Walt Disney-style them park. It is intended that "hand-on" exhibits using interactive video, computers, games and experiences will be used to test people's own capacities or to describe biological functions or processes. This will be combined with park rides and simulations with their inherent appeal of fun, movement and surprise, for example the ride through the blood vessels and the "walk-through brain". This type of venture has a number of special features and advantages; it is truly intersectoral, it may be self-financing, and it can provide a mass audience with a powerful individual experience.

Process and impact evaluation of the Greater Christchurch Urban Development Strategy Health Impact Assessment

PubMed Central

Mathias, Kaaren R; Harris-Roxas, Ben

2009-01-01

Background despite health impact assessment (HIA) being increasingly widely used internationally, fundamental questions about its impact on decision-making, implementation and practices remain. In 2005 a collaboration between public health and local government authorities performed an HIA on the Christchurch Urban Development Strategy Options paper in New Zealand. The findings of this were incorporated into the Greater Christchurch Urban Development Strategy; Methods using multiple qualitative methodologies including key informant interviews, focus groups and questionnaires, this study performs process and impact evaluations of the Christchurch HIA including evaluation of costs and resource use; Results the evaluation found that the HIA had demonstrable direct impacts on planning and implementation of the final Urban Development Strategy as well as indirect impacts on understandings and ways of working within and between organisations. It also points out future directions and ways of working in this successful collaboration between public health and local government authorities. It summarises the modest resource use and discusses the important role HIA can play in urban planning with intersectoral collaboration and enhanced relationships as both catalysts and outcomes of the HIA process; Conclusion as one of the few evaluations of HIA that have been published to date, this paper makes a substantial contribution to the literature on the impact, utility and effectiveness of HIA. PMID:19344529

The new United Nations approach to sustainable development post-2015: Findings from four overviews of systematic reviews on interventions for sustainable development and health.

PubMed

Galvão, Luiz A C; Haby, Michelle M; Chapman, Evelina; Clark, Rachel; Câmara, Volney Magalhães; Luiz, Ronir Raggio; Becerra-Posada, Francisco

2016-03-01

Objective To identify reported interventions that facilitate sustainable development and have had a positive impact on health in four areas: sustainable food production; sustainable energy use; sustainable jobs ("decent work"); and prevention of toxic exposure to chemicals. Methods Systematic review methods were used to synthesize evidence from multiple systematic reviews and economic evaluations. A comprehensive search was conducted of at least 14 databases and 8 websites for each of the four overviews, using pre-defined protocols, including clear inclusion criteria. To qualify as "sustainable," interventions needed to aim (explicitly or implicitly) to positively impact at least two dimensions of the integrated framework for sustainable development and had to include measures of health impact. Results In total, 47 systematic reviews and 10 economic evaluations met the inclusion criteria. The most promising interventions, such as agricultural policies, were identified for each of the four topics. While the evidence for the interventions is not strong because of the limited number of studies, there is no evidence of a definite negative impact on health. The only possible exception is that of taxes and subsidies-though this intervention also has the potential to be pro-equity with higher relative impacts for lower income groups. Conclusions The evidence found for effective interventions is useful for guiding countries toward the best options for non-health sector interventions that can positively impact health. This overviews shows that intersectoral work benefits every sector involved.

Revitalising primary healthcare requires an equitable global economic system - now more than ever.

PubMed

Sanders, David; Baum, Fran E; Benos, Alexis; Legge, David

2011-08-01

The promised revitalisation of primary healthcare (PHC) is happening at a time when the contradictions and unfairness of the global economic system have become clear, suggesting that the current system is unsustainable. In the past two decades, one of the most significant impediments to the implementation of comprehensive PHC has been neoliberal economic policies and their imposition globally. This article questions what will be required for PHC to flourish. PHC incorporates five key principles: equitable provision of services, comprehensive care, intersectoral action, community involvement and appropriate technology. This article considers intersectoral action and comprehensiveness and their potential to be implemented in the current global environment. It highlights the constraints to intersectoral action through a case study of nutrition in the context of globalisation of the food chain. It also explores the challenges to implementing a comprehensive approach to health that are posed by neoliberal health sector reforms and donor practices. The paper concludes that even well-designed health systems based on PHC have little influence over the broader economic forces that shape their operation and their ability to improve health. Reforming these economic forces will require greater regulation of the national and global economic environment to emphasise people's health rather than private profit, and action to address climate change. Revitalisation of PHC and progress towards health equity are unlikely without strong regulation of the market. The further development and strengthening of social movements for health will be key to successful advocacy action.

What is the difference between a 2, 3, 4, or 5 °C world and how good are we at telling this difference? Results from ISI-MIP the first Inter-Sectoral Impact Model Intercomparison Project

NASA Astrophysics Data System (ADS)

Frieler, K.; Huber, V.; Piontek, F.; Schewe, J.; Serdeczny, O.; Warszawski, L.

2012-12-01

The Inter-sectoral Impact Model Intercomparison Project (ISI-MIP) aims to synthesize the state-of-the-art knowledge of climate change impacts at different levels of global warming. Over 25 climate impact modelling teams from around the world, working within the agriculture, water, biomes, infrastructure and health sectors, are collaborating to find answers to the question "What is the difference between a 2, 3, 4, or 5 °C world and how good are we at telling this difference?". The analysis is based on common, bias-corrected climate projections, and socio-economic pathways. The first, fast-tracked phase of the ISI-MIP has a focus on global impact models. The project's experimental design is formulated to distinguish the uncertainty introduced by the impact models themselves, from the inherent uncertainty in the climate projections and the variety of plausible socio-economic futures. Novel metrics, developed to emphasize societal impacts, will be used to identify regional 'hot-spots' of climate change impacts, as well as to quantify the cross-sectoral impact of the increasing frequency of extreme events in future climates. We present here first results from the Fast-Track phase of the project covering impact simulations in the biomes, agriculture and water sectors, in which the societal impacts of climate change are quantified for different levels of global warming. We also discuss the design of the scenario set-up and impact indicators chosen to suit the unique cross-sectoral, multi-model nature of the project.

[The mental health promotion of children and teenagers in vulnerability and social violence: the challenges for an intersectoral network].

PubMed

Passos, Izabel Christina Friche; Vieira, Kelly; Moreira, Laura; Rodrigues, Flávia; Amorim, Margarete; Santos, Cláudia; Abreu, Ana; Gomes, Lucas; Mendes, Luciana; Lima, Isabella; Moura, Francisco; França, Cassandra; Ferraz, Cláudia

This paper presents and discusses the results of an intervention research conducted in Ouro Preto, Brazil from August 2014 to March 2016. The main objective was to contribute to the development of an intersectoral and interdisciplinary network to face psychosocial vulnerabilities of children and teenagers, especially related to sexual violence and drug use. To achieve this, we identified the difficulties faced by the Sistema de Garantia de Direitos Humanos da Criança e do Adolescente (SGDHCA) implemented by the municipality which take care of this population. We also identified protective and promotion factors accomplished to empower them. The methodology used combines Deleuze and Guattari Cartography, Institutional Analysis and the Cross Training. This latter methodology was developed by a group of researchers of Douglas Institute, in Montreal, which we met through scientific co-operation with our laboratory. On account of the practical-theoric and co-participative activities with the professional network of Ouro Preto, we produced a detailed diagnosis of the SGDHCA and a document proposing short, medium and long-term strategies. As final result, we intend to help the local collective-the Forum Intersetorial da Infância e Juventude-to develop a work plan from the proposed actions. In this paper we will concentrate the potential of the methodology used by presenting outcome from two important moments of the research: the discussions of successful and unsuccessful cases that elucidate the network operation and the potential and difficulties arising from the Rotation Positional, important technical of the Cross Training.

78 FR 18961 - Gulf of Mexico Fishery Management Council; Public Meetings

Federal Register 2010, 2011, 2012, 2013, 2014

2013-03-28

... Management for Recreational Red Snapper; discuss Red Snapper 5-year IFQ Review and IFQ Inter-sector Trading... Migratory Pelagic Zones; and, receive a summary of South Atlantic Council Motions and Recommendations for...

Interventions to Promote an Integrated Approach to Public Health Problems: An Application to Childhood Obesity

PubMed Central

Hendriks, Anna-Marie; Gubbels, Jessica S.; De Vries, Nanne K.; Seidell, Jaap C.; Kremers, Stef P. J.; Jansen, Maria W. J.

2012-01-01

Experts stress the need to bring the childhood obesity epidemic under control by means of an integrated approach. The implementation of such an approach requires the development of integrated enabling policies on public health by local governments. A prerequisite for developing such integrated public health policies is intersectoral collaboration. Since the development of integrated policies is still in its early stages, this study aimed to answer the following research question: “What interventions can promote intersectoral collaboration and the development of integrated health policies for the prevention of childhood obesity?” Data were collected through a literature search and observations of and interviews with stakeholders. Based on a theoretical framework, we categorized potential interventions that could optimize an integrated approach regarding children's physical activity and diet. The intervention categories included education, persuasion, incentivization, coercion, training, restriction, environmental restructuring, modeling, and enablement. PMID:22792120

Assessing Inter-Sectoral Climate Change Risks: The Role of ISIMIP

NASA Technical Reports Server (NTRS)

Rosenzweig, Cynthia; Arnell, Nigel W.; Ebi, Kristie L.; Lotze-Campen, Hermann; Raes, Frank; Rapley, Chris; Smith, Mark Stafford; Cramer, Wolfgang; Frieler, Katja; Reyer, Christopher P. O.;

When Clock Time Governs Interaction: How Time Influences Health Professionals' Intersectoral Collaboration.

PubMed

Bendix Andersen, Anne; Beedholm, Kirsten; Kolbæk, Raymond; Frederiksen, Kirsten

2018-06-01

When setting up patient pathways that cross health care sectors, professionals in emergency units strive to fulfill system requirements by creating efficient patient pathways that comply with standards for length of stay. We conducted an ethnographic field study, focusing on health professionals' collaboration, of 10 elderly patients with chronic illnesses, following them from discharge to their home or other places where they received health care services. We found that clock time not only governed the professionals' ways of collaborating, but acceleration of patient pathways also became an overall goal in health care delivery. Professionals' efforts to save time came to represent a "monetary value," leading to speedier planning of patient pathways and consequent risks of disregarding important issues when treating and caring for elderly patients. We suggest that such issues are significant to the future planning and improvement of patient pathways that involve elderly citizens who are in need of intersectoral health care delivery.

Nutrition and food security policy in the Islamic Republic of Iran: situation analysis and roadmap towards 2021.

PubMed

Damari, Behzad; Abdollahi, Zahra; Hajifaraji, Majid; Rezazadeh, Arezoo

2018-05-03

All government policies and programmes for food and nutrition security should include providing healthy food, as well as providing economic and social availability for all people. This study aimed to analyse the current situation of Iranian food and nutrition security and establish a road map towards 2021. The applied methods were situation analysis and a mixed qualitative-quantitative method. The conceptual method used for developing this national document encompassed three areas: sustainable food supply, food safety and nutrition. The outcomes of the Iranian food and nutrition security system in the past three decades include development of management infrastructure and improvement in food and nutrition security status. However, analysis of current programmes showed that there were some overlapping, intertwining and parallel works in the responsibilities of related organizations in the field of supervision of food safety (from production to supply). The national document produced as the outcome of this paper was communicated by the Iranian Ministry of Health in 2012 and has been running for 2 years. Selected ministries are responsible for implementation of 20 national programmes by the end of the 5th Economic, Social and Cultural Development Programme (2016-2011). The consensus of stakeholders by the end of the 6th Development Programme (2021) is to put all of the provinces in a safe or very safe situation in terms of food and nutrition security. The most important challenge in establishing national documents is to make them operational. This aim was achieved by an intersectoral nutrition and food security working group, which produced a general memorandum of understanding with the main organizations, the media, universities and private sector. Copyright © World Health Organization (WHO) 2018. Some rights reserved. This work is available under the CC BY-NC-SA 3.0 IGO license (https://creativecommons.org/licenses/by-nc-sa/3.0/igo).

The Brazilian school feeding programme: an example of an integrated programme in support of food and nutrition security.

PubMed

Sidaner, Emilie; Balaban, Daniel; Burlandy, Luciene

2013-06-01

The present paper analyses the advances and challenges of the school feeding programme in Brazil (PNAE), as part of the Brazilian experience building up an integrated food and nutrition security national system. It explores the role of policy and regulatory frameworks in constructing quality service delivery and intersectoral integration. Review of PNAE and federal government technical documents and studies, legislation, minutes of meetings and official documents of the National Council of Food and Nutrition Security from 2003 to 2011. Food insecurity has decreased significantly in Brazil in the last decade, indicating that appropriate choices were made in terms of public policies and institutional arrangements, which other countries can learn from. Brazil food and nutrition security system; school feeding; school food. Brazil's integrated food and nutrition security policy approach promoted intersectorality in the food system, articulating actions to guarantee access to healthy food and to strengthen family farming. The quality of school meals has progressively improved; in particular, the availability of fruits and vegetables increased. However, national standards regarding menu composition have not yet been met. Regulations were an important factor, along with the policy approach linking food production, nutrition, health and education. Challenges are related to conflict of interests and to farmers' insufficient capacity to meet supply requirements and comply with technical procedures. Local food production, school meals and nutrition education can be linked through integrated programmes and policies, improving access to healthier foods. Government leadership, strong legislation, civil society participation and intersectoral decision making are determinant.

Field evaluation of smart sensor vehicle detectors at intersections - volume 1 : normal weather conditions.

DOT National Transportation Integrated Search

2012-10-01

Microwave-based vehicle detection products from two manufacturers were selected for field testing and : evaluation: Wavetronix and Intersector. The two systems were installed by the manufacturer/distributor at a : signalized intersection. Initial eva...

A CASE STUDY OF ENVIRONMENTAL DATA MANAGEMENT

EPA Science Inventory

In order to support our ongoing research in watershed ecology and global climate change, we gather and analyze environmental data from several government agencies. This case study demonstrates a researcher’s approach to accessing, organizing, and using intersectoral data. T...

Mental health policy in Kenya -an integrated approach to scaling up equitable care for poor populations.

PubMed

Kiima, David; Jenkins, Rachel

2010-06-28

Although most donor and development agency attention is focussed on communicable diseases in Kenya, the importance of non-communicable diseases including mental health and mental illness is increasingly apparent, both in their own right and because of their influence on health, education and social goals. Mental illness is common but the specialist service is extremely sparse and primary care is struggling to cope with major health demands. Non health sectors e.g. education, prisons, police, community development, gender and children, regional administration and local government have significant concerns about mental health, but general health programmes have been surprisingly slow to appreciate the significance of mental health for physical health targets. Despite a people centred post colonial health delivery system, poverty and global social changes have seriously undermined equity. This project sought to meet these challenges, aiming to introduce sustainable mental health policy and implementation across the country, within the context of extremely scarce resources. A multi-faceted and comprehensive programme which combined situation appraisal to inform planning, sustained intersectoral policy dialogue at national and regional level; establishment of a health sector system for coordination, supervision and training of at each level (national, regional, district and primary care); development workshops; production of toolkits, development of guidelines and standards; encouragement of intersectoral liaison at national, regional, district and local levels; public education; and integration of mental health into health management systems. The programme has achieved detailed situation appraisal, epidemiological needs assessment, inclusion of mental health into the health sector reform plans, and into the National Package of Essential Health Interventions, annual operational plans, mental health policy guidelines to accompany the general health policy, tobacco legislation, adaptation of the WHO primary care guidelines for Kenya, primary care training, construction of a quality system of roles and responsibilities, availability of medicines at primary care level, some strengthening of intersectoral liaison with police, prisons and schools, and public education about mental health. The project has demonstrated the importance of using a multi-faceted and comprehensive programme to promote sustainable system change, key elements of which include a focus on the use of rapid appropriate assessment and treatment at primary care level, strengthening the referral system, interministerial and intersectoral liaison, rehabilitation, social inclusion, promotion and advocacy to mobilize community engagement.

Migrant labor supply in a booming non-renewable resource economy: Cure and transmission mechanism for de-industrialization?

NASA Astrophysics Data System (ADS)

Nulle, Grant Mark

This paper challenges the determinism that booming resource economies suffer from de-industrialization, the "Dutch Disease". For several decades, economists have attempted to explain how a sudden surge in mineral and energy extraction affects an economy's output and employment from an aggregate and sectoral perspective. Economic theory shows that a "boom" in mineral and energy production is welfare enhancing to the economy experiencing it. However, the phenomenon also induces inter-sectoral adjustments among non-renewable resource (NRR), traditional traded, and non-traded industries that tend to crowd out traditional export sectors such as agriculture and manufacturing. In turn, this paper asks two fundamental questions: 1) Can the inter-sectoral adjustments wrought by a boom in NRR production be mitigated in the resource-abundant economy experiencing it; 2) Can the inter-sectoral adjustments be exported to a neighboring non-resource economy by movements in migrant labor supply? The theoretical model and empirical estimation approach presented in this paper introduces an endogenous migrant labor supply response to booms in NRR output to test the extent traditional tradable sectors shrink in the NRR-abundant economy during the boom and if such effects are exported to a neighboring jurisdiction. Using data at the U.S. county level, the empirical results show that booming economies experience positive and statistically significant rates of real income and traded sector job growth during the boom, attributable to the influx of migrant labor. By contrast, little evidence is found that non-booming counties adjacent to the booming counties experience declines in income or job growth because of labor supply outflows. Instead, the results suggest the larger the number of potential "donor" counties that can supply labor to the booming economies, the more likely the transmission of booming economy effects, namely evidence of de-industrialization, is diffused across all of the donor counties that actually yielded migrant labor. Overall, the results indicate that a shrinking traditional traded sector during a NRR boom is by no means inevitable in an NRR-abundant economy, contrary to the stylized facts. Additionally, when investigating the total and inter-sectoral effects of a resource boom, economists must extend their investigation to the labor migration channel and the effects of the boom on both neighboring non-resource producing economies and economies even further afield.

Coping with child violencein primary care: how do professionals perceive it?

PubMed

Egry, Emiko Yoshikawa; Apostólico, Maíra Rosa; Morais, Teresa Christine Pereira; Lisboa, Caroline Carapiá Ribas

2017-01-01

to know the perception of health professionals working in primary care about child violence, since this has increased progressively in the world, requiring every effort to intervene. this is a qualitative, descriptive and exploratory study performed through interviews with professionals in primary care in a health district of São Paulo. The Alceste tool was used for analysis of data from the speeches. perceptions of professionals point to the limits and difficulties of the care network with coping; need for intersectoral action; violence situations identified within the caresetting; and causes and effects of violence on child development. there is need for qualified training of workers, health network organization for the provision of quantity and quality of care services, and financial resources for coping with child violence.

Modelling of labour productivity loss due to climate change: HEAT-SHIELD

NASA Astrophysics Data System (ADS)

Kjellstrom, Tord; Daanen, Hein

2016-04-01

Climate change will bring higher heat levels (temperature and humidity combined) to large parts of the world. When these levels reach above thresholds well defined by human physiology, the ability to maintain physical activity levels decrease and labour productivity is reduced. This impact is of particular importance in work situations in areas with long high intensity hot seasons, but also affects cooler areas during heat waves. Our modelling of labour productivity loss includes climate model data of the Inter-Sectoral Impact Model Inter-comparison Project (ISI-MIP), calculations of heat stress indexes during different months, estimations of work capacity loss and its annual impacts in different parts of the world. Different climate models will be compared for the Representative Concentration Pathways (RCPs) and the outcomes of the 2015 Paris Climate Conference (COP21) agreements. The validation includes comparisons of modelling outputs with actual field studies using historical heat data. These modelling approaches are a first stage contribution to the European Commission funded HEAT-SHIELD project.

Building a Workforce for Future Health Systems: Reflections from Health Policy and Systems Research.

PubMed

Javadi, Dena; Tran, Nhan; Ghaffar, Abdul

2018-05-24

The era of the Sustainable Development Goals calls for multidisciplinary research and intersectoral approaches to addressing health challenges. This presents a unique opportunity for multidisciplinary fields concerned with complex systems. Those working in system-oriented fields such as health policy and systems research (HPSR) and health services research must be forward-thinking in optimizing their collective ability to address these global challenges. The objective of this commentary was to share reflections on challenges and strategies in managing the HPSR workforce in order to stimulate dialogue and cross-learning across similar fields. The following strategies are discussed here: definitional clarity of expected competencies and coordination across HPS researchers, national investment in HPSR, institutional capacity for coproduction of knowledge across different types of actors, and participatory leadership. Creative approaches in training, financing, developing, and leading the diverse workforce required to strengthen health systems can pave the way for its full-time and part-time members to work together. © Health Research and Educational Trust.

Neglected diseases of neglected populations: Thinking to reshape the determinants of health in Latin America and the Caribbean

PubMed Central

2005-01-01

Background People living in poverty throughout the developing world are heavily burdened with neglected communicable diseases and often marginalized by the health sector. These diseases are currently referred to as Neglected Diseases of Neglected Populations. The neglected diseases create social and financial burdens to the individual, the family, the community, and the nation. Discussion Numerous studies of successful individual interventions to manage communicable disease determinants in various types of communities have been published, but few have applied multiple interventions in an integrated, coordinated manner. We have identified a series of successful interventions and developed three hypothetical scenarios where such interventions could be applied in an integrated, multi-disease, inter-programmatic, and/or inter-sectoral approach for prevention and control of neglected diseases in three different populations: a slum, an indigenous community, and a city with a mix of populations. Summary The objective of this paper is to identify new opportunities to address neglected diseases, improve community health and promote sustainable development in neglected populations by highlighting examples of key risk and protective factors for neglected diseases which can be managed and implemented through multi-disease-based, integrated, inter-programmatic, and/or inter-sectoral approaches. Based on a literature review, analysis and development of scenarios we visualize how multiple interventions could manage multiple disease problems and propose these as possible strategies to be tested. We seek to stimulate intra- and inter-sectoral dialogue which will help in the construction of new strategies for neglected diseases (particularly for the parasitic diseases) which could benefit the poor and marginalized based on the principle of sustainability and understanding of key determinants of health, and lead to the establishment of pilot projects and activities which can contribute to the achievement of the Millennium Development Goals. PMID:16283932

Realist evaluation of intersectoral oral health promotion interventions for schoolchildren living in rural Andean communities: a research protocol.

PubMed

Bergeron, Dave A; Talbot, Lise R; Gaboury, Isabelle

2017-02-24

Intersectoral collaboration, known to promote more sustainable change within communities, will be examined in an oral health promotion program (OHPP). In Peru, an OHPP was implemented by the Ministry of Health, to reduce the incidence of caries in schoolchildren. In rural Andean communities, however, these initiatives achieved limited success. The objectives of this project are: (1) to understand the context and the underlying mechanisms associated with Peruvian OHPP's current effects among school children living in rural Andean communities and (2) to validate a theory explaining how and under which circumstances OHP intersectoral interventions on schoolchildren living in rural Andean communities produce their effects. Through a realist evaluation, the context, underlying mechanisms and programme outcomes will be identified. This process will involve five different steps. In the first and second steps, a logic model and an initial theory are developed. In the third step, data collection will permit measurement of the OHHP's outcomes with quantitative data, and exploration of the elements of context and the mechanisms with qualitative data. In the fourth and fifth steps, iterative data analysis and a validation process will allow the identification of Context-Mechanism-Outcome configuration, and validate or refine the initial theory. This research project has received approval from the Comité d'éthique de la recherche en santé chez l'humain du Centre hospitalier universitaire de Sherbrooke. The initial theory and research results will be published in relevant journals in public health and oral health. They will also be presented at realist evaluation and health promotion international conferences. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://www.bmj.com/company/products-services/rights-and-licensing/.

An analysis of the sectorial influence of CSI300 stocks within the directed network

NASA Astrophysics Data System (ADS)

Mai, Yong; Chen, Huan; Meng, Lei

2014-02-01

This paper uses the Partial Correlation Planar maximally filtered Graph (PCPG) method to construct a directed network for the constituent stocks underlying the China Securities Index 300 (CSI300). We also analyse the impact of individual stocks. We find that the CSI300 market is a scale-free network with a relatively small power law exponent. The volatility of the stock prices has significant impact on other stocks. In the sectorial network, the industrial sector is the most influential one over other sectors, the financial sector only has a modest influence, while the telecommunication services sector’s influence is marginal. In addition, such inter-sector influence displays quarterly stability.

Improving Access to Emergency Contraception Pills through Strengthening Service Delivery and Demand Generation: A Systematic Review of Current Evidence in Low and Middle-Income Countries

PubMed Central

Dawson, Angela; Tran, Nguyen-Toan; Westley, Elizabeth; Mangiaterra, Viviana; Festin, Mario

2014-01-01

Objectives Emergency contraception pills (ECP) are among the 13 essential commodities in the framework for action established by the UN Commission on Life-Saving Commodities for Women and Children. Despite having been on the market for nearly 20 years, a number of barriers still limit women's access to ECP in low- and middle-income countries (LMIC) including limited consumer knowledge and poor availability. This paper reports the results of a review to synthesise the current evidence on service delivery strategies to improve access to ECP. Methods A narrative synthesis methodology was used to examine peer reviewed research literature (2003 to 2013) from diverse methodological traditions to provide critical insights into strategies to improve access from a service delivery perspective. The studies were appraised using established scoring systems and the findings of included papers thematically analysed and patterns mapped across all findings using concept mapping. Findings Ten papers were included in the review. Despite limited research of adequate quality, promising strategies to improve access were identified including: advance provision of ECP; task shifting and sharing; intersectoral collaboration for sexual assault; m-health for information provision; and scale up through national family planning programs. Conclusion There are a number of gaps in the research concerning service delivery and ECP in LMIC. These include a lack of knowledge concerning private/commercial sector contributions to improving access, the needs of vulnerable groups of women, approaches to enhancing intersectoral collaboration, evidence for social marketing models and investment cases for ECP. PMID:25285438

Learning together: a Canada-Cuba research collaboration to improve the sustainable management of environmental health risks.

PubMed

Spiegel, Jerry; Garcia, Maricel; Bonet, Mariano; Yassi, Annalee

2006-01-01

To build a national Cuban capacity for training environmental health professionals directly linked to the needs of policy-makers and communities. The University of Manitoba and University of British Columbia collaborated with an established training centre in Cuba (the Instituto Nacional de Higiene y Epidemiologia--INHEM) and new centres in the Central (Santa Clara) and Eastern (Santiago) regions of the country. Cuba. In the mid-1990s, a comprehensive curriculum (masters and diploma programs) was collaboratively developed, applying interactive teaching methods, and was delivered through a series of workshops and other interactions in Cuba, and short-term visits to Canada by Cuban PhD students. The collaboration was successful in fulfilling capacity-building targets (over 50 Masters graduates, 467 Diploma graduates, over 30 trained core faculty in all regional centres as well as new curriculum and new accredited regional programs). Alongside this, a number of collaborative community-based research projects were undertaken in all three regions (drinking water in Santiago; housing and urban renewal, and dengue control in Havana; and tourism-related effects, and effective intersectoral management of population health determinants in Santa Clara). The collaboration led to adopting new strategies for challenges such as a dengue epidemic in 2002, and new research on the effectiveness of intersectoral management of risks of particular interest to both Cuban and Canadian policy-makers. It triggered an ambitious collaboration between the Canadian-Cuban team and colleagues in Ecuador in order to build a similar national network there, built on South-South and North-South links.

The diamond level health promoting schools (DLHPS) program for reduced child obesity in Thailand: lessons learned from interviews and focus groups.

PubMed

Phaitrakoon, Jaruwan; Powwattana, Arpaporn; Lagampan, Sunee; Klaewkla, Jeeranun

2014-01-01

Overweight and obesity prevalence among children is increasing globally. Health promoting school policy has been initiated in Thailand to tackle this problem. The schools that best conduct obesity management programs are rated as diamond level health promoting schools (DLHPS). However, the methods used by these schools and their efficacies have not been well-documented. This qualitative study aims to analyze the processes and activities used by four DLHPSs in obesity management programs. In-depth interviews were used to obtain information from school directors, teachers, and cooks, whereas focus group discussions were used for students. School-based obesity management programs have resulted from health promoting school policy and the increasing prevalence of overweight students. Teamwork has been a key strategy in program implementation. Policy diffusion and division of labor have been effected by school directors. A monitoring process is put in place to ensure program delivery. The most evident success factor in the present study has been intersectoral cooperation. Challenges have included confusion about the criteria in obtaining the DLHPS status, parental involvement, and students' resistance to consume vegetables and other healthy foods. From the student focus groups discussions, three activities were most valued: class health and nutrition learning; provision of healthy foods and drinks, together with removal of soft drinks and seasoning from the cafeteria; and exercise for health. Intersectoral cooperation is the key success factor for the operationality of DLHPS, especially in making healthy foods available and physical activity the norm, at school and home.

School Health Programs in Australia - A Special Insert.

ERIC Educational Resources Information Center

Nader, Philip R.; Rissel, Chris; Rowling, Louise; Marshall, Bernard J.; Sheehan, Margaret M.; Northfield, Jeff R.; Maher, Shelley; Carlisle, Rachel; St. Leger, Lawrence H.; Stewart, Donald E.; Parker, Elizabeth; Gillespie, Amaya; Stokes, Helen; Mukherjee, Dev; Nutbeam, Don; Mitchell, Anne; Ollis, Debbie; Watson, Jan

2000-01-01

Eight papers on Australia's school health programs discuss: creating health promoting schools in the United States; intersectoral collaboration for developing a national framework for health promoting schools; school-based health promotion nationwide; auditing health promoting schools policy documentation; the nature of health service/school…

Managing integrated oncology treatment in virtual networks.

PubMed

Stanicki, Verena; Becker, Matthias; Böckmann, Britta

2015-01-01

Interdisciplinary and intersectoral coordinated healthcare management based on Clinical Practice Guidelines is essential to achieve high quality in oncological networks. The objective of our research project is to create a cookbook, which can be used by oncological networks as a template. The cookbook is based on guideline-compliant care processes. To develop these care processes, the three S3-guidelines breast, colon and prostate carcinoma have been formalized. The thus-obtained platform-independent process fragments were transformed into an underlying metamodel, which is based on HL7 and can be used for modeling clinical pathways. Additional, qualitative guided interviews were chosen to capitalize on the experts' (e.g. chief residents, resident specialists) wide knowledge and experience in oncological health care management. One of these use cases (tumor board scheduling) is developed for a healthcare management platform which is linked to a national electronic case record. The projected result of our approach is a cookbook which shows, how the treatment can be controlled by interdisciplinary and intersectoral care processes in an oncological network.

Gross national happiness as a framework for health impact assessment

DOE Office of Scientific and Technical Information (OSTI.GOV)

Pennock, Michael, E-mail: michael.pennock@viha.c; Ura, Karma

The incorporation of population health concepts and health determinants into Health Impact Assessments has created a number of challenges. The need for intersectoral collaboration has increased; the meaning of 'health' has become less clear; and the distinctions between health impacts, environmental impacts, social impacts and economic impacts have become increasingly blurred. The Bhutanese concept of Gross National Happiness may address these issues by providing an over-arching evidence-based framework which incorporates health, social, environmental and economic contributors as well as a number of other key contributors to wellbeing such as culture and governance. It has the potential to foster intersectoral collaborationmore » by incorporating a more limited definition of health which places the health sector as one of a number of contributors to wellbeing. It also allows for the examination of the opportunity costs of health investments on wellbeing, is consistent with whole-of-government approaches to public policy and emerging models of social progress.« less

Equity, sustainability and governance in urban settings.

PubMed

Rice, Marilyn; Hancock, Trevor

2016-03-01

In this commentary the urban setting is explored from the perspective of ecological sustainability and social equity. Urban-related issues are highlighted related to social inequality, deficits in urban infrastructures, behavior-related illnesses and risks, global ecological changes, and urban sprawl. Approaches to addressing these issues are described from the perspective of urban governance, urban planning and design, social determinants of health, health promotion, and personal and community empowerment. Examples of successful strategies are provided from Latin America, including using participatory instruments (assessments, evaluation, participatory budgeting, etc.), establishing intersectoral committees, increasing participation of civil society organizations, and developing virtual forums and networks to channel participatory and collaborative processes. A way forward is proposed, using the urban setting to show the imperative of creating intersectoral policies and programs that produce environments that are both healthy and sustainable. It will be important to include new forms of social participation and use social media to facilitate citizen decision-making and active participation of all sectors of society, especially excluded groups. © The Author(s) 2015.

Lessons learned from the application of a participatory evaluation methodology to healthy municipalities, cities and communities initiatives in selected countries of the Americas.

PubMed

Rice, Marilyn; Franceschini, Maria Cristina

2007-01-01

Health promotion has made significant strides in the past few decades in the Americas. Creating a healthy and supportive setting, also known as the settings approach, continues to be one of the most widely used health promotion strategies. Interest in evaluating the effectiveness of these strategies has been increasing greatly in the past few years. Participatory evaluation holds great promise for helping to generate this evidence and promote understanding of the factors that affect, positively or negatively, the advances of health promotion in the Region. During 2004-2006, a Participatory Evaluation methodology was introduced into several countries in the Americas through formal trainings conducted by the Pan American Health Organization (PAHO) in collaboration with country partners. This article summarizes the main lessons learned from the application of the participatory evaluation methodology in various countries in Latin America and the Caribbean. Factors affecting the evaluation of the initiatives were identified at multiple levels (individual, community, organizational, political, economic, etc.). Specific issues that were addressed included the political context, turnover of personnel in key institutions, concerns related to the effectiveness of participatory processes, and the existence of strong and sustained leadership at the country level. These factors are intertwined and affect each other in very complex ways, a fact that was reflected in the municipalities' experiences with participatory evaluation. Challenges included the ability to secure resources for the evaluation, the time needed to conclude the process, and working in an intersectoral manner. However, participating municipalities reported that the process of implementing a participatory evaluation and working with various stakeholders had an empowering effect: communities and stakeholders were more willing and interested in participating in health promotion initiatives in a sustained manner; alliances and intersectoral collaboration were strengthened; communication channels were opened; and municipalities were stimulated to review their planning and implementation processes in order to more appropriately incorporate health promotion principles. The article concludes with recommendations to improve the planning and implementation process of participatory evaluation efforts.

Polish Higher Education: Intersectoral Distinctiveness

ERIC Educational Resources Information Center

Musial, Joanna

2014-01-01

This study analyzes degrees of differences between the private and public sectors of Polish higher education. It finds them to be strong: Polish private institutions function very differently from Polish public institutions and these differences correspond with those found in the literature on higher education elsewhere in the world. Polish…

Development of a Comprehensive Hospital-Based Elder Abuse Intervention: An Initial Systematic Scoping Review

PubMed Central

Du Mont, Janice; Macdonald, Sheila; Kosa, Daisy; Elliot, Shannon; Spencer, Charmaine; Yaffe, Mark

2015-01-01

Introduction Elder abuse, a universal human rights problem, is associated with many negative consequences. In most jurisdictions, however, there are no comprehensive hospital-based interventions for elder abuse that address the totality of needs of abused older adults: psychological, physical, legal, and social. As the first step towards the development of such an intervention, we undertook a systematic scoping review. Objectives Our primary objective was to systematically extract and synthesize actionable and applicable recommendations for components of a multidisciplinary intersectoral hospital-based elder abuse intervention. A secondary objective was to summarize the characteristics of the responses reviewed, including methods of development and validation. Methods The grey and scholarly literatures were systematically searched, with two independent reviewers conducting the title, abstract and full text screening. Documents were considered eligible for inclusion if they: 1) addressed a response (e.g., an intervention) to elder abuse, 2) contained recommendations for responding to abused older adults with potential relevance to a multidisciplinary and intersectoral hospital-based elder abuse intervention; and 3) were available in English. Analysis The extracted recommendations for care were collated, coded, categorized into themes, and further reviewed for relevancy to a comprehensive hospital-based response. Characteristics of the responses were summarized using descriptive statistics. Results 649 recommendations were extracted from 68 distinct elder abuse responses, 149 of which were deemed relevant and were categorized into 5 themes: Initial contact; Capacity and consent; Interview with older adult, caregiver, collateral contacts, and/or suspected abuser; Assessment: physical/forensic, mental, psychosocial, and environmental/functional; and care plan. Only 6 responses had been evaluated, suggesting a significant gap between development and implementation of recommendations. Discussion To address the lack of evidence to support the recommendations extracted in this review, in a future study, a group of experts will formally evaluate each recommendation for its inclusion in a comprehensive hospital-based response. PMID:25938414

Educational Affordances and Learning Design in Music Software Development

ERIC Educational Resources Information Center

Cheng, Lee; Leong, Samuel

2017-01-01

Although music software has become increasingly affordable and widely adopted in today's classrooms, concerns have been raised about a lack of consideration for users' needs during the software development process. This paper examines intra- and inter-sectoral communication pertaining to software development and music education to shed light on…

[Human resources for health in Ecuador's new model of care].

PubMed

Espinosa, Verónica; de la Torre, Daniel; Acuña, Cecilia; Cadena, Cristina

2017-06-08

Describe strategies implemented by Ecuador's Ministry of Public Health (MPH) to strengthen human resources for health leadership and respond to the new model of care, as a part of the reform process in the period 2012-2015. A documentary review was carried out of primary and secondary sources on development of human resources for health before and after the reform. In the study period, Ecuador developed a new institutional and regulatory framework for developing human resources for health to respond to the requirements of a model of care based on primary health care. The MPH consolidated its steering role by forging strategic partnerships, implementing human resources planning methods, and making an unprecedented investment in health worker training, hiring, and wage increases. These elements constitute the initial core for development of human resources for health policy and a health-services study program consistent with the reform's objectives. Within the framework of the reform carried out from 2012 to 2015, intersectoral work by the MPH has led to considerable achievements in development of human resources for health. Notable achievements include strengthening of the steering role, development and implementation of standards and regulatory instruments, creation of new professional profiles, and hiring of professionals to implement the comprehensive health care model, which helped to solve problems carried over from the years prior to the reform.

Modelling the social and structural determinants of tuberculosis: opportunities and challenges

PubMed Central

Boccia, D.; Dodd, P. J.; Lönnroth, K.; Dowdy, D. W.; Siroka, A.; Kimerling, M. E.; White, R. G.; Houben, R. M. G. J.

2017-01-01

INTRODUCTION: Despite the close link between tuberculosis (TB) and poverty, most mathematical models of TB have not addressed underlying social and structural determinants. OBJECTIVE: To review studies employing mathematical modelling to evaluate the epidemiological impact of the structural determinants of TB. METHODS: We systematically searched PubMed and personal libraries to identify eligible articles. We extracted data on the modelling techniques employed, research question, types of structural determinants modelled and setting. RESULTS: From 232 records identified, we included eight articles published between 2008 and 2015; six employed population-based dynamic TB transmission models and two non-dynamic analytic models. Seven studies focused on proximal TB determinants (four on nutritional status, one on wealth, one on indoor air pollution, and one examined overcrowding, socioeconomic and nutritional status), and one focused on macro-economic influences. CONCLUSIONS: Few modelling studies have attempted to evaluate structural determinants of TB, resulting in key knowledge gaps. Despite the challenges of modelling such a complex system, models must broaden their scope to remain useful for policy making. Given the intersectoral nature of the interrelations between structural determinants and TB outcomes, this work will require multidisciplinary collaborations. A useful starting point would be to focus on developing relatively simple models that can strengthen our knowledge regarding the potential effect of the structural determinants on TB outcomes. PMID:28826444

Estimating mortality using data from civil registration: a cross-sectional study in India

PubMed Central

Rao, Chalapati; Lakshmi, PVM; Prinja, Shankar; Kumar, Rajesh

2016-01-01

Abstract Objective To analyse the design and operational status of India’s civil registration and vital statistics system and facilitate the system’s development into an accurate and reliable source of mortality data. Methods We assessed the national civil registration and vital statistics system’s legal framework, administrative structure and design through document review. We did a cross-sectional study for the year 2013 at national level and in Punjab state to assess the quality of the system’s mortality data through analyses of life tables and investigation of the completeness of death registration and the proportion of deaths assigned ill-defined causes. We interviewed registrars, medical officers and coders in Punjab state to assess their knowledge and practice. Findings Although we found the legal framework and system design to be appropriate, data collection was based on complex intersectoral collaborations at state and local level and the collected data were found to be of poor quality. The registration data were inadequate for a robust estimate of mortality at national level. A medically certified cause of death was only recorded for 965 992 (16.8%) of the 5 735 082 deaths registered. Conclusion The data recorded by India’s civil registration and vital statistics system in 2011 were incomplete. If improved, the system could be used to reliably estimate mortality. We recommend improving political support and intersectoral coordination, capacity building, computerization and state-level initiatives to ensure that every death is registered and that reliable causes of death are recorded – at least within an adequate sample of registration units within each state. PMID:26769992

An Intersectoral Response to Children with Complex Health Care Needs

ERIC Educational Resources Information Center

Young, Wendy; Earle, Jasmin; Dadebo, Mark

2004-01-01

The purpose of this paper is to stimulate debate on how to define and enact public responsibility to children with complex health care needs and their families. We present a program, developed using the Auditor General's framework for accountability that involves Community Care Access Centres, schools and Saint Elizabeth Health Care, a complex…

Does Russia Need Sex Education? The Views of Stakeholders in Three Russian Regions

ERIC Educational Resources Information Center

Gevorgyan, Ruzanna; Schmidt, Elena; Wall, Martin; Garnett, Geoffrey; Atun, Rifat; Maksimova, Svetlana; Davidenko, Ludmila; Renton, Adrian

2011-01-01

Objective: To investigate the attitudes of the main stakeholders towards the introduction of sex education in schools in Russia. Design: Qualitative semi-structured interview study. Setting: Altai Krai, Volgograd Oblast, Moscow, Russian Federation. Participants: One hundred and fifty-three interviews with Intersectoral HIV/AIDS Committee members,…

Two Different Organizational Reactions: The University Sector in Argentina and Colombia and the Neoliberal Proposal

ERIC Educational Resources Information Center

Rabossi, Marcelo

2009-01-01

The neoliberal reform arrived at the market of higher education with the intention of introducing private dynamics into public organizations. Through this strategy, the objective was to improve efficiency by promoting intra- and intersectoral competition. The introduction of performance funding shifted the concept of accountability for…

Challenges and Opportunities for Advancing Work on Climate Change and Public Health.

PubMed

Gould, Solange; Rudolph, Linda

2015-12-09

Climate change poses a major threat to public health. Strategies that address climate change have considerable potential to benefit health and decrease health inequities, yet public health engagement at the intersection of public health, equity, and climate change has been limited. This research seeks to understand the barriers to and opportunities for advancing work at this nexus. We conducted semi-structured in-depth interviews (N = 113) with public health and climate change professionals and thematic analysis. Barriers to public health engagement in addressing climate change include individual perceptions that climate change is not urgent or solvable and insufficient understanding of climate change's health impacts and programmatic connections. Institutional barriers include a lack of public health capacity, authority, and leadership; a narrow framework for public health practice that limits work on the root causes of climate change and health; and compartmentalization within and across sectors. Opportunities include integrating climate change into current public health practice; providing inter-sectoral support for climate solutions with health co-benefits; and using a health frame to engage and mobilize communities. Efforts to increase public health sector engagement should focus on education and communications, building leadership and funding, and increasing work on the shared root causes of climate change and health inequities.

Challenges and Opportunities for Advancing Work on Climate Change and Public Health

PubMed Central

Gould, Solange; Rudolph, Linda

2015-01-01

Climate change poses a major threat to public health. Strategies that address climate change have considerable potential to benefit health and decrease health inequities, yet public health engagement at the intersection of public health, equity, and climate change has been limited. This research seeks to understand the barriers to and opportunities for advancing work at this nexus. We conducted semi-structured in-depth interviews (N = 113) with public health and climate change professionals and thematic analysis. Barriers to public health engagement in addressing climate change include individual perceptions that climate change is not urgent or solvable and insufficient understanding of climate change’s health impacts and programmatic connections. Institutional barriers include a lack of public health capacity, authority, and leadership; a narrow framework for public health practice that limits work on the root causes of climate change and health; and compartmentalization within and across sectors. Opportunities include integrating climate change into current public health practice; providing inter-sectoral support for climate solutions with health co-benefits; and using a health frame to engage and mobilize communities. Efforts to increase public health sector engagement should focus on education and communications, building leadership and funding, and increasing work on the shared root causes of climate change and health inequities. PMID:26690194

A health in all policies approach to promote active, healthy lifestyle in Israel

PubMed Central

2013-01-01

In December 2011, Israel launched the National Program to Promote Active, Healthy Lifestyle, an inter-ministerial, intersectoral effort to address obesity and its contribution to the country’s burden of chronic disease. This paper explores the National Program according to the “Health in All Policies” (HiAP) strategy for health governance, designed to engage social determinants of health and curb health challenges at the causal level. Our objective is twofold: to identify where Israel’s National Program both echoes and falls short of Health in All Policies, and to assess how the National Program can be utilized to enrich the Health in All Policies research-base. We review Health in All Policies’ evolution, why it developed and how it is diverges from other approaches to intersectoriality in health. We describe why obesity and related chronic diseases necessitate an intersectoral response, cite obstacles and gaps to implementation and list examples of HiAP-type initiatives from around the world. We then analyze Israel’s National Program as it relates to Health in All Policies, and propose directions through which the initiative may constitute a useful case study. We contend that joint planning, implementation and to a limited extent, budgeting, between the Ministries of Health, Education and Culture and Sport reflect an HiAP-approach, as does integrating health into the policymaking of other ministries. To further incorporate health in all Israeli policies, we suggest leveraging the Health Ministry’s presence on governmental and non-governmental committees in areas like building, land-use and urban planning, institutional food policy and environmental health, and focusing on knowledge translation according to the policy needs, strengths and limitations of other sectors. Finally, we suggest studying the National Program’s financing, decision-making and evaluation mechanisms in order to complement existing research on the implementation of Health in All Policies and intersectoral action for health. PMID:23607681

Why and How Political Science Can Contribute to Public Health? Proposals for Collaborative Research Avenues

PubMed Central

Gagnon, France; Bergeron, Pierre; Clavier, Carole; Fafard, Patrick; Martin, Elisabeth; Blouin, Chantal

2017-01-01

Written by a group of political science researchers, this commentary focuses on the contributions of political science to public health and proposes research avenues to increase those contributions. Despite progress, the links between researchers from these two fields develop only slowly. Divergences between the approach of political science to public policy and the expectations that public health can have about the role of political science, are often seen as an obstacle to collaboration between experts in these two areas. Thus, promising and practical research avenues are proposed along with strategies to strengthen and develop them. Considering the interdisciplinary and intersectoral nature of population health, it is important to create a critical mass of researchers interested in the health of populations and in healthy public policy that can thrive working at the junction of political science and public health. PMID:28949461

Adolescent health promotion and the School Health Program: complexity in the articulation of health and education.

PubMed

Brasil, Eysler Gonçalves Maia; Silva, Raimunda Magalhães da; Silva, Maria Rocineide Ferreira da; Rodrigues, Dafne Paiva; Queiroz, Maria Veraci Oliveira

2017-01-01

Objective To analyze the context of health promotion with adolescents in the health and education interface focusing on the actions of the Brazilian School Health Program. Qualitative study conducted in 2015 with professionals working in the Regional Executive Coordination IV, in Fortaleza, Ceará. The data obtained in the interview were processed in the ALCESTE program. 17 health professionals and 22 education professionals participated in the study. The organization of spontaneous demand causes disharmony in the scheduled visits and health actions in the school. The difficulties in the implementation of the School Health Program were demonstrated by the lack of knowledge, the lack of planning among the sectors and the different demarcations in the territory. The professionals' lack of knowledge regarding the program and the lack of action planning confirm the disarticulation of the education and health sectors, although they indicate the possibilities of this inter-sectoral practice.

Professional development programs in health promotion: tools and processes to favor new practices.

PubMed

Torres, Sara; Richard, Lucie; Guichard, Anne; Chiocchio, François; Litvak, Eric; Beaudet, Nicole

2017-06-01

Developing innovative interventions that are in sync with a health promotion paradigm often represents a challenge for professionals working in local public health organizations. Thus, it is critical to have both professional development programs that favor new practices and tools to examine these practices. In this case study, we analyze the health promotion approach used in a pilot intervention addressing children's vulnerability that was developed and carried out by participants enrolled in a public health professional development program. More specifically, we use a modified version of Guichard and Ridde's (Une grille d'analyse des actions pour lutter contre les inégalités sociales de santé. In Potvin, L., Moquet, M.-J. and Jones, C. M. (eds), Réduire les Inégalités Sociales en Santé. INPES, Saint-Denis Cedex, pp. 297-312, 2010) analytical grid to assess deductively the program participants' use of health promotion practices in the analysis and planning, implementation, evaluation, sustainability and empowerment phases of the pilot intervention. We also seek evidence of practices involving (empowerment, participation, equity, holism, an ecological approach, intersectorality and sustainability) in the intervention. The results are mixed: our findings reveal evidence of the application of several dimensions of health promotion (equity, holism, an ecological approach, intersectorality and sustainability), but also a lack of integration of two key dimensions; that is, empowerment and participation, during various phases of the pilot intervention. These results show that the professional development program is associated with the adoption of a pilot intervention integrating multiple but not all dimensions of health promotion. We make recommendations to facilitate a more complete integration. This research also shows that the Guichard and Ridde grid proves to be a thorough instrument to document the practices of participants. © The Author 2015. Published by Oxford University Press. All rights reserved. For Permissions, please email: journals.permissions@oup.com.

Dynamics of Russian Employers' Perceptions on the Training Quality of Specialists in the System of Secondary Vocational Education

ERIC Educational Resources Information Center

Vlasova, Tatiana; Krasnova, Evgenia; Abraukhova, Valentina; Safontseva, Natalya

2018-01-01

The paper deals with the evaluation of specialists' professional training quality within the framework of intersectoral, transborder, public and private models of social partnership described in theories by foreign and Russian scientists. Special attention is paid to providing methodological grounds for cooperation between the total subjects…

School Psychologists' Views on Challenges in Facilitating School Development through Intersectoral Collaboration

ERIC Educational Resources Information Center

Moolla, Nadeen; Lazarus, Sandy

2014-01-01

The role of school psychologists has been debated and contested nationally and internationally for many decades, with an emphasis on the need for a paradigm shift in professional roles. Psychologists may be employed in the private sector, in nongovernmental organisations, in higher education institutions, and by the state. Those employed by the…

How to Tackle Key Challenges in the Promotion of Physical Activity among Older Adults (65+): The AEQUIPA Network Approach

PubMed Central

Forberger, Sarah; Bammann, Karin; Bauer, Jürgen; Boll, Susanne; Bolte, Gabriele; Brand, Tilman; Hein, Andreas; Koppelin, Frauke; Lippke, Sonia; Meyer, Jochen; Pischke, Claudia R.; Voelcker-Rehage, Claudia; Zeeb, Hajo

2017-01-01

The paper introduces the theoretical framework and methods/instruments used by the Physical Activity and Health Equity: Primary Prevention for Healthy Ageing (AEQUIPA) prevention research network as an interdisciplinary approach to tackle key challenges in the promotion of physical activity among older people (65+). Drawing on the social-ecological model, the AEQUIPA network developed an interdisciplinary methodological design including quantitative/qualitative studies and systematic reviews, while combining expertise from diverse fields: public health, psychology, urban planning, sports sciences, health technology and geriatrics. AEQUIPA tackles key challenges when promoting physical activity (PA) in older adults: tailoring of interventions, fostering community readiness and participation, strengthening intersectoral collaboration, using new technological devices and evaluating intervention generated inequalities. AEQUIPA aims to strengthen the evidence base for age-specific preventive PA interventions and to yield new insights into the explanatory power of individual and contextual factors. Currently, the empirical work is still underway. First experiences indicate that the network has achieved a strong regional linkage with communities, local stakeholders and individuals. However, involving inactive persons and individuals from minority groups remained challenging. A review of existing PA intervention studies among the elderly revealed the potential to assess equity effects. The results will add to the theoretical and methodological discussion on evidence-based age-specific PA interventions and will contribute to the discussion about European and national health targets. PMID:28375177

How to Tackle Key Challenges in the Promotion of Physical Activity among Older Adults (65+): The AEQUIPA Network Approach.

PubMed

Forberger, Sarah; Bammann, Karin; Bauer, Jürgen; Boll, Susanne; Bolte, Gabriele; Brand, Tilman; Hein, Andreas; Koppelin, Frauke; Lippke, Sonia; Meyer, Jochen; Pischke, Claudia R; Voelcker-Rehage, Claudia; Zeeb, Hajo

2017-04-04

The paper introduces the theoretical framework and methods/instruments used by the Physical Activity and Health Equity: Primary Prevention for Healthy Ageing (AEQUIPA) prevention research network as an interdisciplinary approach to tackle key challenges in the promotion of physical activity among older people (65+). Drawing on the social-ecological model, the AEQUIPA network developed an interdisciplinary methodological design including quantitative/qualitative studies and systematic reviews, while combining expertise from diverse fields: public health, psychology, urban planning, sports sciences, health technology and geriatrics. AEQUIPA tackles key challenges when promoting physical activity (PA) in older adults: tailoring of interventions, fostering community readiness and participation, strengthening intersectoral collaboration, using new technological devices and evaluating intervention generated inequalities. AEQUIPA aims to strengthen the evidence base for age-specific preventive PA interventions and to yield new insights into the explanatory power of individual and contextual factors. Currently, the empirical work is still underway. First experiences indicate that thenetwork has achieved a strong regional linkage with communities, local stakeholders and individuals. However, involving inactive persons and individuals from minority groups remained challenging. A review of existing PA intervention studies among the elderly revealed the potential to assess equity effects. The results will add to the theoretical and methodological discussion on evidence-based age-specific PA interventions and will contribute to the discussion about European and national health targets.

Engaging with Schools and Increasing Primary School Students' Interest in Science: An Intersectoral Collaboration

ERIC Educational Resources Information Center

Willsher, Kerre; Penman, Joy

2011-01-01

This paper discusses an initiative called "Scientists in Schools" which was implemented with a group of seventy (n=70) Year 4 and Year 7 students studying in a local school in regional South Australia with the primary objective of raising awareness and interest in the study of sciences. Mezirow's critical reflection was used by the…

Constitutional Law Fundamentals of the State Administration of the Social Sphere in the Republic of Kazakhstan

ERIC Educational Resources Information Center

Khamzin, Amangeldy Sh.; Khamzina, Zhanna A.; Oryntayev, Zhambyl K.; Alshurazova, Raushan A.; Sherimkulova, Gulbanu D.; Yermukhametova, Saulegul R.

2016-01-01

The study deals with a comprehensive analysis of constitutional fundamentals of state administration of the social sphere in the Republic of Kazakhstan. The content of the constitutional law social sphere institution is unfolded by means of the inter-sectoral analysis of legal regulations of which it consists and the inter-disciplinary study of…

Perspectives of Fijian Policymakers on the Obesity Prevention Policy Landscape

PubMed Central

Hendriks, Anna-Marie; Delai, Mere Y.; Thow, Anne-Marie; Gubbels, Jessica S.; De Vries, Nanne K.; Kremers, Stef P. J.; Jansen, Maria W. J.

2015-01-01

In Fiji and other Pacific Island countries, obesity has rapidly increased in the past decade. Therefore, several obesity prevention policies have been developed. Studies show that their development has been hampered by factors within Fiji's policy landscape such as pressure from industry. Since policymakers in the Fijian national government are primarily responsible for the development of obesity policies, it is important to understand their perspectives; we therefore interviewed 15 policymakers from nine Fijian ministries. By applying the “attractor landscape” metaphor from dynamic systems theory, we captured perceived barriers and facilitators in the policy landscape. A poor economic situation, low food self-sufficiency, power inequalities, inappropriate framing of obesity, limited policy evidence, and limited resource sharing hamper obesity policy developments in Fiji. Facilitators include policy entrepreneurs and policy brokers who were active when a window of opportunity opened and who strengthened intersectoral collaboration. Fiji's policy landscape can become more conducive to obesity policies if power inequalities are reduced. In Fiji and other Pacific Island countries, this may be achievable through increased food self-sufficiency, strengthened intersectoral collaboration, and the establishment of an explicit functional focal unit within government to monitor and forecast the health impact of policy changes in non-health sectors. PMID:26380307

Free solar lanterns to below poverty line girls in India: a step toward achieving millennium development goals.

PubMed

Garg, Rajesh

2014-01-01

Development sectors like health cannot function in isolation. Intersectoral coordination between various departments helps in bringing a positive change in the health-seeking behavior of society in the long run. The decision by the Government of India to provide free solar lanterns (lamps) to the school-going girls of below poverty line families is a welcome step in this context. This initiative would help in reducing the number of school dropout girls and thus help in improving the health indicators that are directly related to women's education. Thus it is an initiative that will help in attainment of Millennium Development Goals through women's education and empowerment. Along with that, the environment-friendly approach will definitely have an impact on health of the girls by switching from kerosene/wood stoves to solar lantern light. Also this initiative would pave the path of real "intersectoral coordination" in the health sector in India that is marred with watertight functioning of various departments. There is an urgent need to popularize the scheme and involve different stakeholders like corporate houses, media, nongovernment organizations, multinational welfare agencies, and local governing bodies for ensuring the availability and utilization of solar lanterns in India.

A tool for exploring the dynamics of innovative interventions for public health: the critical event card.

PubMed

Figueiro, Ana Claudia; de Araújo Oliveira, Sydia Rosana; Hartz, Zulmira; Couturier, Yves; Bernier, Jocelyne; do Socorro Machado Freire, Maria; Samico, Isabella; Medina, Maria Guadalupe; de Sa, Ronice Franco; Potvin, Louise

2017-03-01

Public health interventions are increasingly represented as complex systems. Research tools for capturing the dynamic of interventions processes, however, are practically non-existent. This paper describes the development and proof of concept process of an analytical tool, the critical event card (CEC), which supports the representation and analysis of complex interventions' evolution, based on critical events. Drawing on the actor-network theory (ANT), we developed and field-tested the tool using three innovative health interventions in northeastern Brazil. Interventions were aimed to promote health equity through intersectoral approaches; were engaged in participatory evaluation and linked to professional training programs. The CEC developing involve practitioners and researchers from projects. Proof of concept was based on document analysis, face-to-face interviews and focus groups. Analytical categories from CEC allow identifying and describing critical events as milestones in the evolution of complex interventions. Categories are (1) event description; (2) actants (human and non-human) involved; (3) interactions between actants; (4) mediations performed; (5) actions performed; (6) inscriptions produced; and (7) consequences for interventions. The CEC provides a tool to analyze and represent intersectoral internvetions' complex and dynamic evolution.

Balancing authority, deference and trust across the public–private divide in health care: Tuberculosis health visitors in western Maharashtra, India

PubMed Central

Kielmann, Karina; Datye, Vinita; Pradhan, Anagha; Rangan, Sheela

2014-01-01

While concepts such as ‘partnership’ are central to the terminology of private–public mix (PPM), little attention has been paid to how social relations are negotiated among the diverse actors responsible for implementing these inter-sectoral arrangements. India's Revised National Tuberculosis Control Programme (RNTCP) has used intermediary agents to facilitate the involvement of private providers in the expansion of Directly Observed Therapy, Short-Course (DOTS). We examine the roles of tuberculosis health visitors (TB HVs) in mediating working relationships among private providers, programme staff and patients that underpin a PPM-DOTS launched by the RNTCP in western Maharashtra. In addition to observations and informal interactions with the programme and participating health providers, researchers conducted in-depth interviews with senior programme officers and eight TB HVs. Framed by a political discourse of clinical governance, working relationships within the PPM are structured by the pluralistic context, social and professional hierarchies and paternalism of health care in India. TB HVs are at the nexus of these relationships, yet remain undervalued partly because accountability is measured through technical rather than social outcomes of the ‘partnership’. Close attention to the dynamics of power relations in working practices within the health system can improve accountability and sustainability of partnerships. PMID:25147003

[AIDS, stigma and unemployment: implications for health services].

PubMed

Garrido, Pedro B; Paiva, Vera; do Nascimento, Vanda L V; Sousa, João B; Santos, Naila J S

2007-12-01

To analyze the effect of the stigmatization and discrimination process in the work environment on the routine healthcare and well-being of men living with HIV/AIDS. Qualitative study with 17 men living with HIV, conducted in 2002. Testimonies given in a group to discuss the difficulties concerning discrimination in the work environment were studied, by means of discursive practice analysis. The group, originating from a specialized center for HIV/AIDS treatment in the city of São Paulo, represented a segment of previous research. The discussion among participants pointed out the fact that antiretroviral treatment requires frequent visits to medical assistance services, resulting in absences and delays at work. To show medical certificates to justify absences at work, even without indicating AIDS, can lead to dismissal. Unemployed, many are barred during medical examinations and have their right to confidentiality violated. As a last resource, the request for retirement results in a humiliating or discriminatory scene during the medical inspection. Assistance planned with the patients' participation enables the broadening of psychosocial attention and the consideration of the needs of both employed and unemployed patients, acknowledging that the stigma limits care, affecting mental health and the evolution of infection. To reduce the effect of stigma and discrimination is something that requires intersectoral political articulation and will contribute to reach goals that are globally recognized as fundamental to control the epidemic.

Alumni survey of Masters of Public Health (MPH) training at the Hanoi School of Public Health

PubMed Central

Le, Linh Cu; Bui, Quyen Tu; Nguyen, Ha Thanh; Rotem, Arie

2007-01-01

Background 1) To elicit the opinions of the Public Health alumni of the MPH program; 2) To assess the applicability of the knowledge and skills acquired; 3) To identify the frequency of the public health competencies that the alumni performed. Methods We requested 187 graduates to complete a self-administered questionnaire and conducted in-depth interviews with 8 alumni as well as a focus group discussion with 14 alumni. Results In total 79.1% (148) of the MPH graduates completed and returned the questionnaire. Most alumni (91%) agreed that the MPH curriculum corresponded with the working requirements of public health professionals; and nearly all were satisfied with what they have learnt (96%). Most respondents said that the MPH program enabled them to develop relevant professional skills (95%) and that they were satisfied with the curriculum (90%). Notably fewer respondents (73%) felt that the MPH program structure was balanced and well designed. Most alumni (64.3%) were satisfied with Hanoi School of Public Health (HSPH) full-time lecturers; but even more (83%) were satisfied with visiting lecturers. The most commonly selected of the 34 pre-identified public health competencies were: applying computer skills (66.4%), planning and managing health programs (47.9%), communicating with the community and/or mobilizing the community to participate in health care (43.2%). Overall, the MPH alumni felt that HSPH emphasized research methods at the expense of some management and operational competencies. The most important challenges at work identified by the alumni were insufficient skills in: data analysis, decision making, inter-sectoral cooperation development, English language and training. Conclusion The training program should be reviewed and revised to meet the needs of its graduates who enter diverse situations and positions. English language skills were identified as top priority for further emphasis. The training program should comply with a more advanced accreditation system and standards. PMID:17949491

Universal health coverage and intersectoral action for health: key messages from Disease Control Priorities, 3rd edition

PubMed Central

Jamison, Dean T; Adeyi, Olusoji; Anand, Shuchi; Atun, Rifat; Bertozzi, Stefano; Bhutta, Zulfiqar; Binagwaho, Agnes; Black, Robert; Blecher, Mark; Bloom, Barry R; Brouwer, Elizabeth; Bundy, Donald A P; Chisholm, Dan; Cieza, Alarcos; Cullen, Mark; Danforth, Kristen; de Silva, Nilanthi; Debas, Haile T; Donkor, Peter; Dua, Tarun; Fleming, Kenneth A; Gallivan, Mark; Garcia, Patricia J; Gawande, Atul; Gaziano, Thomas; Gelband, Hellen; Glass, Roger; Glassman, Amanda; Gray, Glenda; Habte, Demissie; Holmes, King K; Horton, Susan; Hutton, Guy; Jha, Prabhat; Knaul, Felicia M; Kobusingye, Olive; Krakauer, Eric L; Kruk, Margaret E; Lachmann, Peter; Laxminarayan, Ramanan; Levin, Carol; Looi, Lai Meng; Madhav, Nita; Mahmoud, Adel; Mbanya, Jean Claude; Measham, Anthony; Medina-Mora, María Elena; Medlin, Carol; Mills, Anne; Mills, Jody-Anne; Montoya, Jaime; Norheim, Ole; Olson, Zachary; Omokhodion, Folashade; Oppenheim, Ben; Ord, Toby; Patel, Vikram; Patton, George C; Peabody, John; Prabhakaran, Dorairaj; Qi, Jinyuan; Reynolds, Teri; Ruacan, Sevket; Sankaranarayanan, Rengaswamy; Sepúlveda, Jaime; Skolnik, Richard; Smith, Kirk R; Temmerman, Marleen; Tollman, Stephen; Verguet, Stéphane; Walker, Damian G; Walker, Neff; Wu, Yangfeng; Zhao, Kun

2018-01-01

The World Bank is publishing nine volumes of Disease Control Priorities, 3rd edition (DCP3) between 2015 and 2018. Volume 9, Improving Health and Reducing Poverty, summarises the main messages from all the volumes and contains cross-cutting analyses. This Review draws on all nine volumes to convey conclusions. The analysis in DCP3 is built around 21 essential packages that were developed in the nine volumes. Each essential package addresses the concerns of a major professional community (eg, child health or surgery) and contains a mix of intersectoral policies and health-sector interventions. 71 intersectoral prevention policies were identified in total, 29 of which are priorities for early introduction. Interventions within the health sector were grouped onto five platforms (population based, community level, health centre, first-level hospital, and referral hospital). DCP3 defines a model concept of essential universal health coverage (EUHC) with 218 interventions that provides a starting point for country-specific analysis of priorities. Assuming steady-state implementation by 2030, EUHC in lower-middle-income countries would reduce premature deaths by an estimated 4·2 million per year. Estimated total costs prove substantial: about 9·1% of (current) gross national income (GNI) in low-income countries and 5·2% of GNI in lower-middle-income countries. Financing provision of continuing intervention against chronic conditions accounts for about half of estimated incremental costs. For lower-middle-income countries, the mortality reduction from implementing the EUHC can only reach about half the mortality reduction in non-communicable diseases called for by the Sustainable Development Goals. Full achievement will require increased investment or sustained intersectoral action, and actions by finance ministries to tax smoking and polluting emissions and to reduce or eliminate (often large) subsidies on fossil fuels appear of central importance. DCP3 is intended to be a model starting point for analyses at the country level, but country-specific cost structures, epidemiological needs, and national priorities will generally lead to definitions of EUHC that differ from country to country and from the model in this Review. DCP3 is particularly relevant as achievement of EUHC relies increasingly on greater domestic finance, with global developmental assistance in health focusing more on global public goods. In addition to assessing effects on mortality, DCP3 looked at outcomes of EUHC not encompassed by the disability-adjusted life-year metric and related cost-effectiveness analyses. The other objectives included financial protection (potentially better provided upstream by keeping people out of the hospital rather than downstream by paying their hospital bills for them), stillbirths averted, palliative care, contraception, and child physical and intellectual growth. The first 1000 days after conception are highly important for child development, but the next 7000 days are likewise important and often neglected. PMID:29179954

Universal health coverage and intersectoral action for health: key messages from Disease Control Priorities, 3rd edition.

PubMed

Jamison, Dean T; Alwan, Ala; Mock, Charles N; Nugent, Rachel; Watkins, David; Adeyi, Olusoji; Anand, Shuchi; Atun, Rifat; Bertozzi, Stefano; Bhutta, Zulfiqar; Binagwaho, Agnes; Black, Robert; Blecher, Mark; Bloom, Barry R; Brouwer, Elizabeth; Bundy, Donald A P; Chisholm, Dan; Cieza, Alarcos; Cullen, Mark; Danforth, Kristen; de Silva, Nilanthi; Debas, Haile T; Donkor, Peter; Dua, Tarun; Fleming, Kenneth A; Gallivan, Mark; Garcia, Patricia J; Gawande, Atul; Gaziano, Thomas; Gelband, Hellen; Glass, Roger; Glassman, Amanda; Gray, Glenda; Habte, Demissie; Holmes, King K; Horton, Susan; Hutton, Guy; Jha, Prabhat; Knaul, Felicia M; Kobusingye, Olive; Krakauer, Eric L; Kruk, Margaret E; Lachmann, Peter; Laxminarayan, Ramanan; Levin, Carol; Looi, Lai Meng; Madhav, Nita; Mahmoud, Adel; Mbanya, Jean Claude; Measham, Anthony; Medina-Mora, María Elena; Medlin, Carol; Mills, Anne; Mills, Jody-Anne; Montoya, Jaime; Norheim, Ole; Olson, Zachary; Omokhodion, Folashade; Oppenheim, Ben; Ord, Toby; Patel, Vikram; Patton, George C; Peabody, John; Prabhakaran, Dorairaj; Qi, Jinyuan; Reynolds, Teri; Ruacan, Sevket; Sankaranarayanan, Rengaswamy; Sepúlveda, Jaime; Skolnik, Richard; Smith, Kirk R; Temmerman, Marleen; Tollman, Stephen; Verguet, Stéphane; Walker, Damian G; Walker, Neff; Wu, Yangfeng; Zhao, Kun

2018-03-17

The World Bank is publishing nine volumes of Disease Control Priorities, 3rd edition (DCP3) between 2015 and 2018. Volume 9, Improving Health and Reducing Poverty, summarises the main messages from all the volumes and contains cross-cutting analyses. This Review draws on all nine volumes to convey conclusions. The analysis in DCP3 is built around 21 essential packages that were developed in the nine volumes. Each essential package addresses the concerns of a major professional community (eg, child health or surgery) and contains a mix of intersectoral policies and health-sector interventions. 71 intersectoral prevention policies were identified in total, 29 of which are priorities for early introduction. Interventions within the health sector were grouped onto five platforms (population based, community level, health centre, first-level hospital, and referral hospital). DCP3 defines a model concept of essential universal health coverage (EUHC) with 218 interventions that provides a starting point for country-specific analysis of priorities. Assuming steady-state implementation by 2030, EUHC in lower-middle-income countries would reduce premature deaths by an estimated 4·2 million per year. Estimated total costs prove substantial: about 9·1% of (current) gross national income (GNI) in low-income countries and 5·2% of GNI in lower-middle-income countries. Financing provision of continuing intervention against chronic conditions accounts for about half of estimated incremental costs. For lower-middle-income countries, the mortality reduction from implementing the EUHC can only reach about half the mortality reduction in non-communicable diseases called for by the Sustainable Development Goals. Full achievement will require increased investment or sustained intersectoral action, and actions by finance ministries to tax smoking and polluting emissions and to reduce or eliminate (often large) subsidies on fossil fuels appear of central importance. DCP3 is intended to be a model starting point for analyses at the country level, but country-specific cost structures, epidemiological needs, and national priorities will generally lead to definitions of EUHC that differ from country to country and from the model in this Review. DCP3 is particularly relevant as achievement of EUHC relies increasingly on greater domestic finance, with global developmental assistance in health focusing more on global public goods. In addition to assessing effects on mortality, DCP3 looked at outcomes of EUHC not encompassed by the disability-adjusted life-year metric and related cost-effectiveness analyses. The other objectives included financial protection (potentially better provided upstream by keeping people out of the hospital rather than downstream by paying their hospital bills for them), stillbirths averted, palliative care, contraception, and child physical and intellectual growth. The first 1000 days after conception are highly important for child development, but the next 7000 days are likewise important and often neglected. Copyright © 2018 Elsevier Ltd. All rights reserved.

Artificial intelligence applications of fast optical memory access

NASA Astrophysics Data System (ADS)

Henshaw, P. D.; Todtenkopf, A. B.

The operating principles and performance of rapid laser beam-steering (LBS) techniques are reviewed and illustrated with diagrams; their applicability to fast optical-memory (disk) access is evaluated; and the implications of fast access for the design of expert systems are discussed. LBS methods examined include analog deflection (source motion, wavefront tilt, and phased arrays), digital deflection (polarization modulation, reflectivity modulation, interferometric switching, and waveguide deflection), and photorefractive LBS. The disk-access problem is considered, and typical LBS requirements are listed as 38,000 beam positions, rotational latency 25 ms, one-sector rotation time 1.5 ms, and intersector space 87 microsec. The value of rapid access for increasing the power of expert systems (by permitting better organization of blocks of information) is illustrated by summarizing the learning process of the MVP-FORTH system (Park, 1983).

The Gateway Paper--context and configuration of the proposed health reforms in Pakistan.

PubMed

Nishtar, Sania

2006-12-01

As an opening of a dialogue on health reforms in Pakistan, the Gateway Paper presents a viewpoint on its proposed directions making a strong case for systems reforms, which need to scope beyond the healthcare system. Positioning the reform process to strengthen Pakistan's health policy cycle, the paper articulates a roadmap for a paradigm shift to achieve health outcomes in Pakistan with major structural reorganization within the health system. The proposed reform points in the four areas namely, reforms within the health sector, overarching measures, reconfiguration of health within an inter-sectoral scope and generating evidence for reforms. Reforms within the health sector focus on developing new models of service delivery and health financing which can enable the state to leverage the private sector outreach to deliver health-related public goods on the one hand and maximize the outreach of the State's health care delivery mechanisms through mainstreaming the role of the private sector on the other, albeit with safeguards. In addition, these call for strengthening the stewardship role to regulate these arrangements. The second area of reform focuses on overarching measures; these include developing frameworks for public-private partnerships which will enable the bringing together of organizations with the mandate to offer public goods and those that could facilitate this goal through the provision of resources, technical expertise or outreach; mainstreaming health into the country's social protection strategy in order to address issues of access and affordability for the poor and introducing civil service and public service reform focused on good governance, accountability, breakdown of institutional corruption which are critical to improving health outcomes. The third area of reform involves broadening health to its inter-sectoral scope, redefinition of objectives and targets within the health sector and garnering support from across the sectors to forester inter-sectoral action particularly with reference to the social determinant of health. The fourth area of reform focuses on generation of evidence around which several priority areas for health systems and policy research have been flagged. The Gateway Paper also underscores the need to develop norms and standards and points to institution mechanisms which need to be created to support the reform process.

Exploring models for the roles of health systems’ responsiveness and social determinants in explaining universal health coverage and health outcomes

PubMed Central

Bonsel, Gouke J.

2016-01-01

Background Intersectoral perspectives of health are present in the rhetoric of the sustainable development goals. Yet its descriptions of systematic approaches for an intersectoral monitoring vision, joining determinants of health, and barriers or facilitators to accessing healthcare services are lacking. Objective To explore models of associations between health outcomes and health service coverage, and health determinants and health systems responsiveness, and thereby to contribute to monitoring, analysis, and assessment approaches informed by an intersectoral vision of health. Design The study is designed as a series of ecological, cross-country regression analyses, covering between 23 and 57 countries with dependent health variables concentrated on the years 2002–2003. Countries cover a range of development contexts. Health outcome and health service coverage dependent variables were derived from World Health Organization (WHO) information sources. Predictor variables representing determinants are derived from the WHO and World Bank databases; variables used for health systems’ responsiveness are derived from the WHO World Health Survey. Responsiveness is a measure of acceptability of health services to the population, complementing financial health protection. Results Health determinants’ indicators – access to improved drinking sources, accountability, and average years of schooling – were statistically significant in particular health outcome regressions. Statistically significant coefficients were more common for mortality rate regressions than for coverage rate regressions. Responsiveness was systematically associated with poorer health and health service coverage. With respect to levels of inequality in health, the indicator of responsiveness problems experienced by the unhealthy poor groups in the population was statistically significant for regressions on measles vaccination inequalities between rich and poor. For the broader determinants, the Gini mattered most for inequalities in child mortality; education mattered more for inequalities in births attended by skilled personnel. Conclusions This paper adds to the literature on comparative health systems research. National and international health monitoring frameworks need to incorporate indicators on trends in and impacts of other policy sectors on health. This will empower the health sector to carry out public health practices that promote health and health equity. PMID:26942516

Exploring models for the roles of health systems' responsiveness and social determinants in explaining universal health coverage and health outcomes.

PubMed

Valentine, Nicole Britt; Bonsel, Gouke J

2016-01-01

Intersectoral perspectives of health are present in the rhetoric of the sustainable development goals. Yet its descriptions of systematic approaches for an intersectoral monitoring vision, joining determinants of health, and barriers or facilitators to accessing healthcare services are lacking. To explore models of associations between health outcomes and health service coverage, and health determinants and health systems responsiveness, and thereby to contribute to monitoring, analysis, and assessment approaches informed by an intersectoral vision of health. The study is designed as a series of ecological, cross-country regression analyses, covering between 23 and 57 countries with dependent health variables concentrated on the years 2002-2003. Countries cover a range of development contexts. Health outcome and health service coverage dependent variables were derived from World Health Organization (WHO) information sources. Predictor variables representing determinants are derived from the WHO and World Bank databases; variables used for health systems' responsiveness are derived from the WHO World Health Survey. Responsiveness is a measure of acceptability of health services to the population, complementing financial health protection. Health determinants' indicators - access to improved drinking sources, accountability, and average years of schooling - were statistically significant in particular health outcome regressions. Statistically significant coefficients were more common for mortality rate regressions than for coverage rate regressions. Responsiveness was systematically associated with poorer health and health service coverage. With respect to levels of inequality in health, the indicator of responsiveness problems experienced by the unhealthy poor groups in the population was statistically significant for regressions on measles vaccination inequalities between rich and poor. For the broader determinants, the Gini mattered most for inequalities in child mortality; education mattered more for inequalities in births attended by skilled personnel. This paper adds to the literature on comparative health systems research. National and international health monitoring frameworks need to incorporate indicators on trends in and impacts of other policy sectors on health. This will empower the health sector to carry out public health practices that promote health and health equity.

Implementation of eMental Health care: viewpoints from key informants from organizations and agencies with eHealth mandates.

PubMed

Wozney, Lori; Newton, Amanda S; Gehring, Nicole D; Bennett, Kathryn; Huguet, Anna; Hartling, Lisa; Dyson, Michele P; McGrath, Patrick

2017-06-02

The use of technology such as computers, tablets, and smartphones to improve access to and the delivery of mental health care (eMental Health care) is growing worldwide. However, despite the rapidly expanding evidence base demonstrating the efficacy of eMental Health care, its implementation in clinical practice and health care systems remains fragmented. To date, no peer-reviewed, key-informant studies have reported on the perspectives of decision-makers concerned with whether and how to implement eMental Health care. From September to November 2015, we conducted 31 interviews with key informants responsible for leadership, policy, research, and/ or information technology in organizations influential in the adoption of technology for eMental Health care. Deductive and inductive thematic analyses of transcripts were conducted using the Behavior Change Wheel as an organizing framework. Frequency and intensity effect sizes were calculated for emerging themes to further explore patterns within the data. Key informant responses (n = 31) representing 6 developed countries and multiple organizations showed consensus on common factors impacting implementation: individual and organizational capacities (e.g., computer literacy skills [patients and providers], knowledge gaps about cyber security, limited knowledge of available services); motivational drivers of technology-based care (e.g., extending care, data analytics); and opportunities for health systems to advance eMental Health care implementation (e.g., intersectoral research, rapid testing cycles, sustainable funding). Frequency effect sizes showed strong associations between implementation and credibility, knowledge, workflow, patient empowerment, electronic medical record (EMR) integration, sustained funding and intersectoral networks. Intensity effect sizes showed the highest concentration of statements (>10% of all comments) related to funding, credibility, knowledge gaps, and patient empowerment. This study provides previously unavailable information about key informant perspectives on eMental Health care implementation. The themes that emerged, namely the need to intensify intersectoral research, measure/monitor readiness to implement, define cost-utility benchmarks, raise awareness about available technologies, and test assumptions that 'proven' technologies will be easily integrated can inform the design and evaluation of eMental Health care implementation models.

Applying a basic development needs approach for sustainable and integrated community development in less-developed areas: report of ongoing Iranian experience.

PubMed

Asadi-Lari, M; Farshad, A A; Assaei, S E; Vaez Mahdavi, M R; Akbari, M E; Ameri, A; Salimi, Z; Gray, D

2005-06-01

Despite considerable achievements in the provision of basic developmental facilities in terms of drinking water, access to primary healthcare services, high-quality and nutritious food, social services, and proper housing facilities, there are many rural and slum communities in Iran where these essential needs remain unfulfilled. Lack of equity is prominent, as large differences exist in underprivileged provinces. New policies developed in the past two decades have resulted in substantial achievements in meeting population needs and reducing the socio-economic gap; nevertheless, poverty levels, unemployment due to a large increase in the birth rate in the early 1980s, and lack of community participation are matters yet to be addressed. To overcome these deficiencies, a basic development needs approach was adopted to promote the concept of community self-help and self-reliance through intersectoral collaboration, creating an environment where people could take an active part in the development process, with the Iranian government providing the necessary support to achieve the desired level of development. Following firm commitment from the Iranian government and technical support from the World Health Organization Regional Office, basic development needs was assigned a high priority in health and health-related sectors, reflected in the third National Masterplan (2001-2005). A comprehensive intersectoral plan was designed, and pilot projects were commenced in three villages. Each village elected a representative, and committee clusters were formed to run and monitor projects identified by a process of local needs assessment and priority assignment. In each region, a variety of needs were elicited from these assessments, which were actively supported by local authorities. A basic development needs approach was found to be a reliable discipline to improve community participation, needs-led resource allocation and intersectoral co-operation in community development, particularly in underprivileged areas. Iran's initial experience of basic development needs has gained widespread public support but will require periodical evaluation as it is introduced into other rural and urban regions across the country.

Measuring the progress of capacity building in the Alberta Policy Coalition for Cancer Prevention.

PubMed

Raine, Kim D; Sosa Hernandez, Cristabel; Nykiforuk, Candace I J; Reed, Shandy; Montemurro, Genevieve; Lytvyak, Ellina; MacLellan-Wright, Mary-Frances

2014-07-01

The Alberta Policy Coalition for Cancer Prevention (APCCP) represents practitioners, policy makers, researchers, and community organizations working together to coordinate efforts and advocate for policy change to reduce chronic diseases. The aim of this research was to capture changes in the APCCP's capacity to advance its goals over the course of its operation. We adapted the Public Health Agency of Canada's validated Community Capacity-Building Tool to capture policy work. All members of the APCCP were invited to complete the tool in 2010 and 2011. Responses were analyzed using descriptive statistics and t tests. Qualitative comments were analyzed using thematic content analysis. A group process for reaching consensus provided context to the survey responses and contributed to a participatory analysis. Significant improvement was observed in eight out of nine capacity domains. Lessons learned highlight the importance of balancing volume and diversity of intersectoral representation to ensure effective participation, as well as aligning professional and economic resources. Defining involvement and roles within a coalition can be a challenging activity contingent on the interests of each sector represented. The participatory analysis enabled the group to reflect on progress made and future directions for policy advocacy. © 2013 Society for Public Health Education.

Case Study of an Aboriginal Community-Controlled Health Service in Australia

PubMed Central

Baum, Fran; Lawless, Angela; Labonté, Ronald; Sanders, David; Boffa, John; Edwards, Tahnia; Javanparast, Sara

2016-01-01

Abstract Universal health coverage provides a framework to achieve health services coverage but does not articulate the model of care desired. Comprehensive primary health care includes promotive, preventive, curative, and rehabilitative interventions and health equity and health as a human right as central goals. In Australia, Aboriginal community-controlled health services have pioneered comprehensive primary health care since their inception in the early 1970s. Our five-year project on comprehensive primary health care in Australia partnered with six services, including one Aboriginal community-controlled health service, the Central Australian Aboriginal Congress. Our findings revealed more impressive outcomes in several areas—multidisciplinary work, community participation, cultural respect and accessibility strategies, preventive and promotive work, and advocacy and intersectoral collaboration on social determinants of health—at the Aboriginal community-controlled health service compared to the other participating South Australian services (state-managed and nongovernmental ones). Because of these strengths, the Central Australian Aboriginal Congress’s community-controlled model of comprehensive primary health care deserves attention as a promising form of implementation of universal health coverage by articulating a model of care based on health as a human right that pursues the goal of health equity. PMID:28559679

Why and How Political Science Can Contribute to Public Health? Proposals for Collaborative Research Avenues.

PubMed

Gagnon, France; Bergeron, Pierre; Clavier, Carole; Fafard, Patrick; Martin, Elisabeth; Blouin, Chantal

2017-04-05

Written by a group of political science researchers, this commentary focuses on the contributions of political science to public health and proposes research avenues to increase those contributions. Despite progress, the links between researchers from these two fields develop only slowly. Divergences between the approach of political science to public policy and the expectations that public health can have about the role of political science, are often seen as an obstacle to collaboration between experts in these two areas. Thus, promising and practical research avenues are proposed along with strategies to strengthen and develop them. Considering the interdisciplinary and intersectoral nature of population health, it is important to create a critical mass of researchers interested in the health of populations and in healthy public policy that can thrive working at the junction of political science and public health. © 2017 The Author(s); Published by Kerman University of Medical Sciences. This is an open-access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/4.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

Public Health Activist Skills Pyramid: A Model for Implementing Health in All Policies.

PubMed

Damari, Behzad; Ehsani Chimeh, Elham

2017-01-01

Affecting public health for society requires various competencies. In fact, the prerequisite for the implementation of health in all policies should be effectiveness of public health activists (PHAs) in these competencies. This study aims to determine the competencies of the activists in public health. The present qualitative study reviewed the literature and adopted qualitative methods like content analysis, stakeholder interviews, and conducted focus group discussions with related experts. In each stage, the required competencies were extracted through drawing the main action processes of a PHA. Thereafter, the authors reached an ultimately best-suited working model by classifying and approving extracted competencies. The competencies comprise a pyramid set of three main categories of basic, specialized/professional, and individual updating competencies. Personal management, communication, teamwork, project management, ability to apply principles and concepts of public health, anatomy, physiology, and pathology in the organizations of the society should be included in the basic category. Specialized skills should include ability to plan, public participation, intersectoral collaboration, social marketing, working with the media/media friendly attitude, advocacy, research management and knowledge translation, evaluation of health programs, network establishment and management, deployment and institutionalization, operational research, empowerment and consultation, and protocol and service pack design. Last but not least, individual updating is defined as being informed of the latest scientific articles and reports about health and its situation in different countries as well as determinants that affect health. Implementation of this pyramid requires design and establishment of specific centers for transferring effective public health competencies. This pyramid has also functional use for the revision of educational curriculums in all health study fields. Moreover, it is helpful in designing virtual health education courses and the update of employees in entire parts of society pertaining to the health sector.

Mental health care roles of non-medical primary health and social care services.

PubMed

Mitchell, Penny

2009-02-01

Changes in patterns of delivery of mental health care over several decades are putting pressure on primary health and social care services to increase their involvement. Mental health policy in countries like the UK, Australia and New Zealand recognises the need for these services to make a greater contribution and calls for increased intersectoral collaboration. In Australia, most investment to date has focused on the development and integration of specialist mental health services and primary medical care, and evaluation research suggests some progress. Substantial inadequacies remain, however, in the comprehensiveness and continuity of care received by people affected by mental health problems, particularly in relation to social and psychosocial interventions. Very little research has examined the nature of the roles that non-medical primary health and social care services actually or potentially play in mental health care. Lack of information about these roles could have inhibited development of service improvement initiatives targeting these services. The present paper reports the results of an exploratory study that examined the mental health care roles of 41 diverse non-medical primary health and social care services in the state of Victoria, Australia. Data were collected in 2004 using a purposive sampling strategy. A novel method of surveying providers was employed whereby respondents within each agency worked as a group to complete a structured survey that collected quantitative and qualitative data simultaneously. This paper reports results of quantitative analyses including a tentative principal components analysis that examined the structure of roles. Non-medical primary health and social care services are currently performing a wide variety of mental health care roles and they aspire to increase their involvement in this work. However, these providers do not favour approaches involving selective targeting of clients with mental disorders.

Intersectoral planning for city health development.

PubMed

Green, Geoff

2012-04-01

The article reviews the evolution and process of city health development planning (CHDP) in municipalities participating in the European Network of Healthy Cities organized by the European Region of the World Health Organization. The concept of CHDP combines elements from three theoretical domains: (a) health development, (b) city governance, and (c) urban planning. The setting was the 77 cities which participated in Phase IV (2003-2008) of the network. Evidence was gathered principally from a general evaluation questionnaire sent to all network cities. CHDPs are strategic documents giving direction to municipalities and partner agencies. Analysis revealed a trend away from "classic" CHDPs with a primary focus on health development towards ensuring a health dimension to other sector plans, and into the overarching strategies of city governments. Linked to the Phase IV priority themes of Healthy aging and healthy urban planning, cities further developed the concept and application of human-centered sustainability. More work is required to utilize cost-benefit analysis and health impact assessment to unmask the synergies between health and economic prosperity.

[Proposal of an index for government measures to deal with domestic violence against children and adolescents].

PubMed

Deslandes, Suely; Mendes, Corina Helena Figueira; Pinto, Liana Wernersbach

2015-08-01

The article discusses the development of the Index for Dealing with Family Violence to assess municipal strategies related to this violation of children's and adolescents' rights. Development of the index involved a preliminary analysis of indicators from previous studies and a technical expert group. Four indicators were selected: the existence of a municipal plan for dealing with violence against children and adolescents; the existence of an inter-sector flow for treating and following up on children and adolescents in situations of family violence; number of guardianship councils in relation to the municipality's population; and the existence of standardized instruments in municipal school, social work, and health systems for reporting situations of violence against children and adolescents. The databank from a previous study was used in an exercise to apply the indicator in four Brazilian state capitals. The indicator can serve as a tool for monitoring and mobilizing efforts to implement measures for dealing with family violence.

[An analysis of psychosocial care for adolescents in crisis based on their therapeutic itineraries].

PubMed

Pereira, Melissa de Oliveira; Sá, Marilene de Castilho; Miranda, Lilian

2014-10-01

This study analyzes the care provided to adolescents in crisis in a municipality in Greater Metropolitan Rio de Janeiro, Brazil. The article reports on a qualitative health study that used Therapeutic Itinerary and Life Narratives as the methodological resources. The principal theoretical reference was psychoanalyst René Kaës. Based on the adolescents' own verbal accounts, the study aimed to grasp the collective realities that could potentially shed light on the different types of logic and professional practices applied to care for adolescents in psychosocial crisis situations. The underlying assumption was that an approach to the dialectical nature of the crisis required maintaining a framework that would allow establishing a space for transition within which to develop the necessary conditions for disruptive and paradoxical elements to be elaborated. However, crisis care in the context studied here proved to be hampered by infrastructure issues, institutional rigidity, and fragmentation of activities, with little orientation towards inter-sector work.

A game of Chinese whispers in Malaysia: contextual analysis of child road safety education.

PubMed

Puvanachandra, Prasanthi; Kulanthayan, Subramaniam; Hyder, Adnan A

2012-11-01

In 2006, the Malaysian government began implementing road safety education (RSE) programs in primary schools, involving numerous stakeholders. We interviewed 19 stakeholders. Thematic analysis led to the identification of four themes: road traffic injuries (RTIs) among children in Malaysia, the role of RSE, factors affecting successful implementation, and intersectoral involvement. The latter was identified as a significant strength of the overall approach to implementation, and is one of the first examples in Malaysia and in the region of such an approach. Lack of official documentation surrounding ownership, funding responsibilities, and roles among the various sectors led to resistance from some groups. Although we know from scientific studies what works in terms of reducing RTIs, the more important question is how such interventions can be successfully and sustainably implemented, particularly in low- and middle-income countries (LMIC). The results of this study permit stronger understanding of issues surrounding the implementation of RTI interventions in LMIC.

Health sector governance: should we be investing more?

PubMed Central

Fryatt, Robert; Bennett, Sara; Soucat, Agnes

2017-01-01

Governance is central to improving health sector performance and achieving Universal Health Coverage (UHC). However, the growing body of research on governance and health has not yet led to a global consensus on the need for more investment in governance interventions to improve health. This paper aims to summarise the latest evidence on the influence of governance on health, examines how we can assess governance interventions and considers what might constitute good investments in health sector governance in resource constrained settings. The paper concludes that agendas for improving governance need to be realistic and build on promising in-country innovation and the growing evidence base of what works in different settings. For UHC to be achieved, governance will require new partnerships and opportunities for dialogue, between state and non-state actors. Countries will require stronger platforms for effective intersectoral actions and more capacity for applied policy research and evaluation. Improved governance will also come from collective action across countries in research, norms and standards, and communicable disease control. PMID:29225938

Health sector governance: should we be investing more?

PubMed

Fryatt, Robert; Bennett, Sara; Soucat, Agnes

2017-01-01

Governance is central to improving health sector performance and achieving Universal Health Coverage (UHC). However, the growing body of research on governance and health has not yet led to a global consensus on the need for more investment in governance interventions to improve health. This paper aims to summarise the latest evidence on the influence of governance on health, examines how we can assess governance interventions and considers what might constitute good investments in health sector governance in resource constrained settings. The paper concludes that agendas for improving governance need to be realistic and build on promising in-country innovation and the growing evidence base of what works in different settings. For UHC to be achieved, governance will require new partnerships and opportunities for dialogue, between state and non-state actors. Countries will require stronger platforms for effective intersectoral actions and more capacity for applied policy research and evaluation. Improved governance will also come from collective action across countries in research, norms and standards, and communicable disease control.

Can inequality be tamed through boundary work? A qualitative study of health promotion aimed at reducing health inequalities.

PubMed

Pedersen, Pia Vivian; Hjelmar, Ulf; Høybye, Mette Terp; Rod, Morten Hulvej

2017-07-01

This paper examines the organisational dynamics that arise in health promotion aimed at reducing health inequalities. The paper draws on ethnographic fieldwork among public health officers in Danish municipalities and qualitative interviews from an evaluation of health promotion programmes targeting homeless and other marginalised citizens. Analytically, we focus on 'boundary work', i.e. the ways in which social and symbolic boundaries are established, maintained, transgressed and negotiated, both at the administrative level and among frontline professionals. The paper discusses three types of boundary work: (i) demarcating professional domains; (ii) setting the boundaries of the task itself; and (iii) managing administrative boundaries. The main argument is that the production, maintenance and transgression of these three types of boundaries constitute central and time-consuming aspects of the practices of public health professionals, and that boundary work constitutes an important element in professional practices seeking to 'tame a wicked problem', such as social inequalities in health. A cross-cutting feature of the three types of boundary work is the management of the divide between health and social issues, which the professionals seemingly seek to uphold and transgress at the same time. The paper thus contributes to ongoing discussions of intersectoral action to address health inequalities. Furthermore, it extends the scope and application of the concept of boundary work in the sociology of public health by suggesting that the focus in previous research on professional demarcation be broadened in order to capture other types of boundaries that shape, and are shaped by, professional practices. Copyright © 2017 Elsevier Ltd. All rights reserved.

[Cooperation between nursing homes and intellectual disability care services : State of affairs in Flanders].

PubMed

Campens, J; Schiettecat, T; Vervliet, M; Van Heck, L; Lesseliers, J; Goethals, I; De Witte, N

2017-10-01

Considering the increasing life expectancy of people with intellectual disabilities (ID), the importance of cooperation between services for people with ID and elderly care services has been stressed in Flanders and the Netherlands, as well as internationally. However, the prevalence, intensity and content of such a cooperation are yet unknown. In order to gain information to address this issue, an online-survey was delivered to directors of all nursing homes in Flanders (n = 781). 229 surveys were completed.In more than 75% of the nursing homes, people with ID were among the residents over the past decade. However, at the same time a lack of expertise has been identified as a barrier to provide them optimal care and support. Hence, the respondents point out that a cooperation with ID care services could be beneficial. Nevertheless, those partnerships only arose in a quarter of the nursing homes so far, primarily for the purpose of exchange of expertise. Intersectoral multidisciplinary consultations and intersectoral care team consultations have been taking place as well, be it mainly in the context of a persons' transition from an ID care service to a nursing home. Until now, radical cooperations which involve an exchange of staff, seem to be rather rare.

Inter-sectoral comparison of model uncertainty of climate change impacts in Africa

NASA Astrophysics Data System (ADS)

van Griensven, Ann; Vetter, Tobias; Piontek, Franzisca; Gosling, Simon N.; Kamali, Bahareh; Reinhardt, Julia; Dinkneh, Aklilu; Yang, Hong; Alemayehu, Tadesse

2016-04-01

We present the model results and their uncertainties of an inter-sectoral impact model inter-comparison initiative (ISI-MIP) for climate change impacts in Africa. The study includes results on hydrological, crop and health aspects. The impact models used ensemble inputs consisting of 20 time series of daily rainfall and temperature data obtained from 5 Global Circulation Models (GCMs) and 4 Representative concentration pathway (RCP). In this study, we analysed model uncertainty for the Regional Hydrological Models, Global Hydrological Models, Malaria models and Crop models. For the regional hydrological models, we used 2 African test cases: the Blue Nile in Eastern Africa and the Niger in Western Africa. For both basins, the main sources of uncertainty are originating from the GCM and RCPs, while the uncertainty of the regional hydrological models is relatively low. The hydrological model uncertainty becomes more important when predicting changes on low flows compared to mean or high flows. For the other sectors, the impact models have the largest share of uncertainty compared to GCM and RCP, especially for Malaria and crop modelling. The overall conclusion of the ISI-MIP is that it is strongly advised to use ensemble modeling approach for climate change impact studies throughout the whole modelling chain.

Child survival in England: Strengthening governance for health.

PubMed

Wolfe, Ingrid; Mandeville, Kate; Harrison, Katherine; Lingam, Raghu

2017-11-01

The United Kingdom, like all European countries, is struggling to strengthen health systems and improve conditions for child health and survival. Child mortality in the UK has failed to improve in line with other countries. Securing optimal conditions for child health requires a healthy society, strong health system, and effective health care. We examine inter-sectoral and intra-sectoral policy and governance for child health and survival in England. Literature reviews and universally applicable clinical scenarios were used to examine child health problems and English policy and governance responses for improving child health through integrating care and strengthening health systems, over the past 15 years. We applied the TAPIC framework for analysing policy governance: transparency, accountability, participation, integrity, and capacity. We identified strengths and weaknesses in child health governance in all the five domains. However there remain policy failures that are not fully explained by the TAPIC framework. Other problems with successfully translating policy to improved health that we identified include policy flux; policies insufficiently supported by delivery mechanisms, measurable targets, and sufficient budgets; and policies with unintended or contradictory aspects. We make recommendations for inter-sectoral and intra-sectoral child health governance, policy, and action to improve child health in England with relevant lessons for other countries. Copyright © 2017 The Author(s). Published by Elsevier B.V. All rights reserved.

Prevention, control, and elimination of neglected diseases in the Americas: Pathways to integrated, inter-programmatic, inter-sectoral action for health and development

PubMed Central

Holveck, John C; Ehrenberg, John P; Ault, Steven K; Rojas, Rocio; Vasquez, Javier; Cerqueira, Maria Teresa; Ippolito-Shepherd, Josefa; Genovese, Miguel A; Periago, Mirta Roses

2007-01-01

Background In the Latin America and Caribbean region over 210 million people live below the poverty line. These impoverished and marginalized populations are heavily burdened with neglected communicable diseases. These diseases continue to enact a toll, not only on families and communities, but on the economically constrained countries themselves. Discussion As national public health priorities, neglected communicable diseases typically maintain a low profile and are often left out when public health agendas are formulated. While many of the neglected diseases do not directly cause high rates of mortality, they contribute to an enormous rate of morbidity and a drastic reduction in income for the most poverty-stricken families and communities. The persistence of this "vicious cycle" between poverty and poor health demonstrates the importance of linking the activities of the health sector with those of other sectors such as education, housing, water and sanitation, labor, public works, transportation, agriculture, industry, and economic development. Summary The purpose of this paper is three fold. First, it focuses on a need for integrated "pro-poor" approaches and policies to be developed in order to more adequately address the multi-faceted nature of neglected diseases. This represents a move away from traditional disease-centered approaches to a holistic approach that looks at the overarching causes and mechanisms that influence the health and well being of communities. The second objective of the paper outlines the need for a specific strategy for addressing these diseases and offers several programmatic entry points in the context of broad public health measures involving multiple sectors. Finally, the paper presents several current Pan American Health Organization and other institutional initiatives that already document the importance of integrated, inter-programmatic, and inter-sectoral approaches. They provide the framework for a renewed effort toward the efficient use of resources and the development of a comprehensive integrated solution to neglected communicable diseases found in the context of poverty, and tailored to the needs of local communities. PMID:17229324

Traditional Chinese medicine research in the post-genomic era: good practice, priorities, challenges and opportunities.

PubMed

Uzuner, Halil; Bauer, Rudolf; Fan, Tai-Ping; Guo, De-An; Dias, Alberto; El-Nezami, Hani; Efferth, Thomas; Williamson, Elizabeth M; Heinrich, Michael; Robinson, Nicola; Hylands, Peter J; Hendry, Bruce M; Cheng, Yung-Chi; Xu, Qihe

2012-04-10

GP-TCM is the 1st EU-funded Coordination Action consortium dedicated to traditional Chinese medicine (TCM) research. This paper aims to summarise the objectives, structure and activities of the consortium and introduces the position of the consortium regarding good practice, priorities, challenges and opportunities in TCM research. Serving as the introductory paper for the GP-TCM Journal of Ethnopharmacology special issue, this paper describes the roadmap of this special issue and reports how the main outputs of the ten GP-TCM work packages are integrated, and have led to consortium-wide conclusions. Literature studies, opinion polls and discussions among consortium members and stakeholders. By January 2012, through 3 years of team building, the GP-TCM consortium had grown into a large collaborative network involving ∼200 scientists from 24 countries and 107 institutions. Consortium members had worked closely to address good practice issues related to various aspects of Chinese herbal medicine (CHM) and acupuncture research, the focus of this Journal of Ethnopharmacology special issue, leading to state-of-the-art reports, guidelines and consensus on the application of omics technologies in TCM research. In addition, through an online survey open to GP-TCM members and non-members, we polled opinions on grand priorities, challenges and opportunities in TCM research. Based on the poll, although consortium members and non-members had diverse opinions on the major challenges in the field, both groups agreed that high-quality efficacy/effectiveness and mechanistic studies are grand priorities and that the TCM legacy in general and its management of chronic diseases in particular represent grand opportunities. Consortium members cast their votes of confidence in omics and systems biology approaches to TCM research and believed that quality and pharmacovigilance of TCM products are not only grand priorities, but also grand challenges. Non-members, however, gave priority to integrative medicine, concerned on the impact of regulation of TCM practitioners and emphasised intersectoral collaborations in funding TCM research, especially clinical trials. The GP-TCM consortium made great efforts to address some fundamental issues in TCM research, including developing guidelines, as well as identifying priorities, challenges and opportunities. These consortium guidelines and consensus will need dissemination, validation and further development through continued interregional, interdisciplinary and intersectoral collaborations. To promote this, a new consortium, known as the GP-TCM Research Association, is being established to succeed the 3-year fixed term FP7 GP-TCM consortium and will be officially launched at the Final GP-TCM Congress in Leiden, the Netherlands, in April 2012. Copyright © 2012 Elsevier Ireland Ltd. All rights reserved.

[Provincial public center for crisis intervention and psycho-social rehabilitation. A path towards communitary suicidology].

PubMed

Martínez, Carlos

2014-01-01

This work on the systematic comprehensive approach towards the Prevention and Postvencion of Suicide started to develop back in mid 2011 in Río Gallegos, capital of Santa Cruz Province. The first step on this development was a Pilot Plan for the Training of Professionals and also field intervention. The Center for Crisis Intervention and Psycho-social Rehabilitation was founded eight months later. The case-client in crisis plus family group- undergoes quantitative and qualitative evaluation by means of a triage system, all of which allows starting intensive face-to-face and also phone follow up according to the Crisis Intervention Model. Such intervention is developed by means of the participation in the "Grupo Sostén", the Adolescents Group if the client fits into that age, and also family relationship interviews as well as Multi-family meetings open to the Community. There is also a Community Team in the Center which performs collective assessment in schools, in conjunction with the "Equidad en Redes" Educational Specialty Team, belonging to the Provincial Education Council. The approach takes place on the field, and works as a screening step for the early detection of risk. Such risk is dealt with by means of short term intervention group programs involving the whole of the educational community. When facing situations of committed suicide there are interventions in communities to the interior of the province, fundamentally through the Hospital Team which works as the cluster convener for the social intersectoral frame-work.

Professional groups driving change toward patient-centred care: interprofessional working in stroke rehabilitation in Denmark.

PubMed

Burau, Viola; Carstensen, Kathrine; Lou, Stina; Kuhlmann, Ellen

2017-09-16

Patient-centred care based on needs has been gaining momentum in health policy and the workforce. This creates new demand for interprofessional teams and redefining roles and tasks of professionals, yet little is known on how to implement new health policies more effectively. Our aim was to analyse the role and capacity of health professions in driving organisational change in interprofessional working and patient-centred care. A case study of the introduction of interprofessional, early discharge teams in stroke rehabilitation in Denmark was conducted with focus on day-to-day coordination of care tasks and the professional groups' interests and strategies. The study included 5 stroke teams and 17 interviews with different health professionals conducted in 2015. Professional groups expressed highly positive professional interest in reorganised stroke rehabilitation concerning patients, professional practice and intersectoral relations; individual professional and collective interprofessional interests strongly coincided. The corresponding strategies were driven by a shared goal of providing needs-based care for patients. Individual professionals worked independently and on behalf of the team. There was also a degree of skills transfer as individual team members screened patients on behalf of other professional groups. The study identified supportive factors and contexts of patient-centred care. This highlights capacity to improve health workforce governance through professional participation, which should be explored more systematically in a wider range of healthcare services.

Association between maternal socioeconomic factors and nutritional outcomes in children under 5 years of age.

PubMed

Géa-Horta, Tatiane; Felisbino-Mendes, Mariana Santos; Ortiz, Renzo Joel Flores; Velasquez-Melendez, Gustavo

To estimate the association between maternal socioeconomic factors and the occurrence of nutritional outcomes in children under five years of age in a representative sample of the Brazilian population. This was a cross-sectional study that evaluated data from the latest National Survey of Children and Women's Demographics and Health, carried out in Brazil in 2006-2007. Maternal employment and maternal level of schooling were the main exposures. The following nutritional outcomes in children were considered: height/age <-2 standard deviations (SD) for short stature and BMI/age >2SD for overweight. Generalized estimating equations (GEE) were utilized as the regression method. After adjustments, it was observed that children whose mothers had low level of schooling had a higher chance of having short stature (OR=3.97, 95% CI, 1.23-12.80) and children whose mothers worked outside the home were more likely to have excess weight (OR=1.57, 95% CI, 1.02-2.42). Maternal employment was not associated with short stature in children (OR=1.09, 95% CI, 0.67-1.77). Maternal level of schooling was associated with short stature in children and maternal employment with overweight, indicating the need to take into account the socioeconomic factors when proposing programs and strategies aimed at health and nutrition improvement of children, considering inter-sectoral interventions. Copyright © 2016 Sociedade Brasileira de Pediatria. Published by Elsevier Editora Ltda. All rights reserved.

Animal use for science in Europe.

PubMed

Daneshian, Mardas; Busquet, Francois; Hartung, Thomas; Leist, Marcel

2015-01-01

To investigate long-term trends of animal use, the EU animal use statistics from the 15 countries that have been in the EU since 1995 plus respective data from Switzerland were analyzed. The overall number of animals used for scientific purposes in these countries, i.e., about 11 million/year, remained relatively constant between 1995 and 2011, with net increases in Germany and the UK and net decreases in Belgium, Denmark, Italy, Finland, the Netherlands and Sweden. The relatively low and constant numbers of experimental animals used for safety assessment (toxicology, 8%) may be due to the particularly intensive research on alternative methods in this area. The many efficiently working NGOs, multiple initiatives of the European Parliament, and coordinated activities of industry and the European Commission may have contributed to keeping the animal numbers in this field in check. Basic biological science, and research and development for medicine, veterinary and dentistry together currently make up 65% of animal use in science. Although the total numbers have remained relatively constant, consumption of transgenic animals has increased drastically; in Germany transgenic animals accounted for 30% of total animal use in 2011. Therefore, more focus on alternatives to the use of animals in biomedical research, in particular on transgenic animals, will be important in the future. One initiative designed to provide inter-sector information exchange for future actions is the "MEP - 3Rs scientists pairing scheme" initiated in 2015 by CAAT-Europe and MEP Pietikäinen.

Prayer Camps and Biomedical Care in Ghana: Is Collaboration in Mental Health Care Possible?

PubMed Central

Arias, Daniel; Taylor, Lauren; Ofori-Atta, Angela; Bradley, Elizabeth H.

2016-01-01

Background Experts have suggested that intersectoral partnerships between prayer camps and biomedical care providers may be an effective strategy to address the overwhelming shortage of mental health care workers in Africa and other low-income settings. Nevertheless, previous studies have not explored whether the prayer camp and biomedical staff beliefs and practices provide sufficient common ground to enable cooperative relationships. Therefore, we sought to examine the beliefs and practices of prayer camp staff and the perspective of biomedical care providers, with the goal of characterizing interest in—and potential for—intersectoral partnership between prayer camp staff and biomedical care providers. Methods We conducted 50 open-ended, semi-structured interviews with prophets and staff at nine Christian prayer camps in Ghana, and with staff within Ghana’s three public psychiatric hospitals. We used the purposive sampling method to recruit participants and the constant comparative method for qualitative data analysis. Results Prayer camp staff expressed interest in collaboration with biomedical mental health care providers, particularly if partnerships could provide technical support introducing medications in the prayer camp and address key shortcomings in their infrastructure and hygienic conditions. Nevertheless, challenges for collaboration were apparent as prayer camp staff expressed strong beliefs in a spiritual rather than biomedical explanatory model for mental illness, frequently used fasting and chained restraints in the course of treatment, and endorsed only short-term use of medication to treat mental illness—expressing concerns that long-term medication regimens masked underlying spiritual causes of illness. Biomedical providers were skeptical about the spiritual interpretations of mental illness held by faith healers, and were concerned by the use of chains, fasting, and the lack of adequate living facilities for patients in prayer camps; many, however, expressed interest in engaging with prayer camps to expand access to clinical care for patients residing in the camps. Conclusions The findings demonstrate that biomedical care providers are interested in engaging with prayer camps. Key areas where partnerships may best improve conditions for patients at prayer camps include collaborating on creating safe and secure physical spaces and delivering medication for mental illness to patients living in prayer camps. However, while prayer camp staff are willing to engage biomedical knowledge, deeply held beliefs and routine practices of faith and biomedical healers are difficult to reconcile Additional discussion is needed to find the common ground on which the scarce resources for mental health care in Ghana can collaborate most effectively. PMID:27618551

Climate change projections of heat stress in Europe: From meteorological variables to impacts on productivity

NASA Astrophysics Data System (ADS)

Casanueva, Ana; Kotlarski, Sven; Liniger, Mark A.

2017-04-01

Future climate change is likely to have important impacts in many socio-economic sectors. In particular, higher summer temperatures or more prolonged heat waves may be responsible for health problems and productivity losses related to heat stress, especially affecting people exposed to such situations (e.g. working under outside settings or in non-acclimatized workplaces). Heat stress on the body under work load and consequently their productivity loss can be described through heat stress indices that are based on multiple meteorological parameters such as temperature, humidity, wind and radiation. Exploring the changes of these variables under a warmer climate is of prime importance for the Impacts, Adaptation and Vulnerability communities. In particular, the H2020 project HEAT-SHIELD aims at analyzing the impact of climate change on heat stress in strategic industries in Europe (manufacturing, construction, transportation, tourism and agriculture) within an inter-sectoral framework (climate scientists, biometeorologists, physiologists and stakeholders). In the present work we explore present and future heat stress over Europe using an ensemble of the state-of-the-art RCMs from the EURO-CORDEX initiative. Since RCMs cannot be directly used in impact studies due to their partly substantial biases, a standard bias correction method (empirical quantile mapping) is applied to correct the individual variables that are then used to derive heat stress indices. The objectives of this study are twofold, 1) to test the ability of the separately bias corrected variables to reproduce the main characteristics of heat stress indices in present climate conditions and 2) to explore climate change projections of heat stress indices. We use the wet bulb globe temperature (WBGT) as primary heat stress index, considering two different versions for indoor (or in the shade, based on temperature and humidity conditions) and outdoor settings (including also wind and radiation). The WBGT is the most widely used heat stress index for working people and can be easily interpreted by means of ISO standards. Within the HEAT-SHIELD project, climate change projections of the WBGT will be used to assess the impact of climate change on workers' health and productivity.

Implementation of health impact assessment in Danish municipal context.

PubMed

Kraemer, Stella Rebecca Johnsdatter; Nikolajsen, Louise Theilgaard; Gulis, Gabriel

2014-12-01

Implementation of Health Impact Assessment (HIA) in Danish municipalities has been analyzed using the Roger's Diffusion of Innovation Theory. Municipalities were chosen from among those who presented their health policies on websites according to the status of inclusion of HIA into health policy. Qualitative interviews were conducted in 6 municipalities (3 with HIA inducted in their health policy and 3 without it) gathering information on knowledge and attitudes to HIA, barriers to its implementation, social system and communication channels used or expected to be used for implementation of HIA. No significant differences were found among analyzed municipalities by status of HIA inclusion into health policy. Among barriers; a lack of tools with general validity, a lack of intersectoral working culture, balance between centralized versus participatory way of working and organizational structure of a municipality, and a lack of capacities were enlisted as most relevant. The last one is a crucial factor of an internal social system of a municipality. With regards to communication channels, reporting and presentation skills of implementers and doers are of key importance. Systematic and sustainable capacity building is needed to achieve high level implementation of HIA in Danish municipalities. Development of validated tools, most importantly screening tools with focus on priorities of national public health policy would enhance implementation on municipal level.

The 2018 Inter-agency field manual on reproductive health in humanitarian settings: revising the global standards.

PubMed

Foster, Angel M; Evans, Dabney P; Garcia, Melissa; Knaster, Sarah; Krause, Sandra; McGinn, Therese; Rich, Sarah; Shah, Meera; Tappis, Hannah; Wheeler, Erin

2017-11-01

Since the 1990s, the Inter-agency field manual on reproductive health in humanitarian settings (IAFM) has provided authoritative guidance on reproductive health service provision during different phases of complex humanitarian emergencies. In 2018, the Inter-Agency Working Group on Reproductive Health in Crises will release a new edition of this global resource. In this article, we describe the collaborative and inter-sectoral revision process and highlight major changes in the 2018 IAFM. Key revisions to the manual include repositioning unintended pregnancy prevention within and explicitly incorporating safe abortion care into the Minimum Initial Service Package (MISP) chapter, which outlines a set of priority activities to be implemented at the outset of a humanitarian crisis; stronger guidance on the transition from the MISP to comprehensive sexual and reproductive health services; and the addition of a logistics chapter. In addition, the IAFM now places greater and more consistent emphasis on human rights principles and obligations, gender-based violence, and the linkages between maternal and newborn health, and incorporates a diverse range of field examples. We conclude this article with an outline of plans for releasing the 2018 IAFM and facilitating uptake by those working in refugee, crisis, conflict, and emergency settings.

Nudging for Prevention in Occupational Health and Safety in South Africa Using Fiscal Policies.

PubMed

de Jager, Pieter; Rees, David; Kisting, Sophia; Kgalamono, Spo; Ndaba, Mpume; Stacey, Nicolas; Tugendhaft, Aviva; Hofman, Karen

2017-08-01

Currently, in some countries occupational health and safety policy and practice have a bias toward secondary prevention and workers' compensation rather than primary prevention. Particularly, in emerging economies, research has not adequately contributed to effective interventions and improvements in workers' health. This article, using South Africa as a case study, describes a methodology for identifying candidate fiscal policy interventions and describes the policy interventions selected for occupational health and safety. It is argued that fiscal policies are well placed to deal with complex intersectoral health problems and to focus efforts on primary prevention. A major challenge is the lack of empirical evidence to support the effectiveness of fiscal policies in improving workers' health. A second challenge is the underprioritization of occupational health and safety partly due to the relatively small burden of disease attributed to occupational exposures. Both challenges can and should be overcome by (i) conducting policy-relevant research to fill the empirical gaps and (ii) reconceptualizing, both for policy and research purposes, the role of work as a determinant of population health. Fiscal policies to prevent exposure to hazards at work have face validity and are thus appealing, not as a replacement for other efforts to improve health, but as part of a comprehensive effort toward prevention.

Managing Water-Food-Energy Futures in the Canadian Prairies

NASA Astrophysics Data System (ADS)

Wheater, H. S.; Hassanzadeh, E.; Nazemi, A.; Elshorbagy, A. A.

2016-12-01

The water-food-energy nexus is a convenient phrase to highlight competing societal uses for water and the need for cross-sectoral policy integration, but this can lead to oversimplification of the multiple dimensions of water (and energy) management. In practice, water managers must balance (and prioritize) demands for water for many uses, including environmental flows, and reservoir operation often involves managing conflicting demands, for example to maximize retention for supply, reduce storage to facilitate flood control, and constrain water levels and releases for habitat protection. Agriculture and water quality are also inextricably linked: irrigated agriculture requires appropriate water quality for product quality and certification, but agriculture can be a major source of nutrient pollution, with impacts on human and ecosystem health, drinking water treatment and amenity. And energy-water interactions include energy production (hydropower and cooling water for thermal power generation) and energy consumption (e.g. for pumping and water and wastewater treatment). These dependencies are illustrated for the Canadian prairies, and a risk-based approach to the management of climate change is presented. Trade-offs between economic benefits of hydropower and irrigation are illustrated for alternative climate futures, including implications for freshwater habitats. The results illustrate that inter-sector interactions vary as a function of climate and its variability, and that there is a need for policy to manage inter-sector allocations as a function of economic risk.

[Advances in early childhood development: from neurons to big scale programs].

PubMed

Pérez-Escamilla, Rafael; Rizzoli-Córdoba, Antonio; Alonso-Cuevas, Aranzazú; Reyes-Morales, Hortensia

Early childhood development (ECD) is the basis of countries' economic and social development and their ability to meet the Sustainable Development Goals (SDGs). Gestation and the first three years of life are critical for children to have adequate physical, psychosocial, emotional and cognitive development for the rest of their lives. Nurturing care and protection of children during gestation and early childhood are necessary for the development of trillions of neurons and trillions of synapses necessary for development. ECD requires access to good nutrition and health services from gestation, responsive caregiving according to the child's developmental stage, social protection and child welfare, and early stimulation and learning opportunities. Six actions are recommended to improve national ECD programs: expand political will and funding; create a supportive, evidence-based policy environment; build capacity through inter-sectoral coordination; ensure fair and transparent governance of programs and services; increase support for multidisciplinary research; and promote the development of leaders. Mexico has made significant progress under the leadership of the Health Ministry, but still faces significant challenges. The recent creation of a national inter-sectoral framework to enable ECD with support of international organizations and the participation of civil society organizations can help overcome these challenges. Copyright © 2017 Hospital Infantil de México Federico Gómez. Publicado por Masson Doyma México S.A. All rights reserved.

Critical stakeholder determinants to the implementation of intersectoral community approaches targeting childhood obesity.

PubMed

van der Kleij, R M J J; Crone, M R; Reis, R; Paulussen, T G W M

2016-12-01

Several intersectoral community approaches targeting childhood obesity (IACOs) have been launched in the Netherlands. Translation of these approaches into practice is however arduous and implementation. We therefore studied the implementation of five IACOs in the Netherlands for one-and-a-half years. IACO implementation was evaluated via an adapted version of the MIDI questionnaire, consisting of 18 theory-based constructs. A response rate of 62% was obtained. A hierarchical multivariate linear regression model was used to analyse our data; the final regression model predicted 65% of the variance in adherence. Higher levels of self-efficacy, being an implementer embedded in community B, and having more than 1 year of experience with IACO implementation were associated with higher degrees of adherence. Formal ratification of implementation by management and being prescribed a higher number of activities were related to lower degrees of adherence. We advise that, when designing implementation strategies, emphasis should be placed on the enhancement of professionals' self-efficacy, limitation of the number of activities prescribed and allocation of sufficient time to get acquainted and experienced with IACO implementation. Longitudinal studies are needed to further evaluate interaction between and change within critical determinants while progressing through the innovation process. © The Author 2016. Published by Oxford University Press. All rights reserved. For permissions, please email: journals.permissions@oup.com.

Determining the competences of community based workers for disability-inclusive development in rural areas of South Africa, Botswana and Malawi.

PubMed

Lorenzo, Theresa; van Pletzen, Ermien; Booyens, Margaret

2015-01-01

Persons with disabilities and their families still live with stigma and a high degree of social exclusion especially in rural areas, which are often poorly resourced and serviced. Community-based workers in health and social development are in an ideal position to assist in providing critical support for some of those most at risk of neglect in these areas. This article analyses the work of community disability workers (CDWs) in three southern African countries to demonstrate the competencies that these workers acquired to make a contribution to social justice for persons with disabilities and their families. It points to some gaps and then argues that these competencies should be consolidated and strengthened in curricula, training and policy. The article explores local experiences and practices of CDWs so as to understand and demonstrate their professional competencies and capacity to deliver disability-inclusive services in rural areas, ways that make all information, activities and programs offered accessible and available to persons with disabilities. A qualitative interpretive approach was adopted, informed by a life history approach. Purposive sampling was used to select 16 CDWs who had at least 5 years experience of disability-related work in a rural area. In-depth interviews with CDWs were conducted by postgraduate students in Disability Studies. An inductive and interpretative phenomenological approach was used to analyse data. Three main themes with sub-categories emerged demonstrating the competencies of CDWs. First, integrated management of health conditions and impairments within a family focus comprised 'focus on the functional abilities' and 'communication, information gathering and sharing'. Second, negotiating for disability-inclusive community development included four sub-categories, namely 'mobilising families and community leaders', 'finding local solutions with local resources', 'negotiating retention and transitions through the education system' and 'promoting participation in economic activities'. Third, coordinated and efficient intersectoral management systems involved 'gaining community and professional recognition' and the ability to coordinate efforts ('it's not a one-man show'). The CDWs spoke of their commitment to fighting the inequities and social injustices that persons with disabilities experienced. They facilitate change and manage the multiple transitions experienced by the families at different stages of the disabled person's development. Disability-inclusive development embraces a philosophy of social inclusion and a set of values that seeks to protect the human dignity and rights of persons with disabilities. It requires a workforce equipped with skills to work intersectorally and in a cross-disciplinary manner in order to operationalise the community-based rehabilitation guidelines that are designed to promote delivery of services in remote and rural areas. CDWs potentially have a unique set of competencies that enables them to facilitate disability-inclusive community development in rural areas. The themes reveal how the CDWs contribute to building relationships that restore the humanity and dignity of persons with disabilities in their family and community. These competencies draw from different disciplines which necessitates recognition of the CDWs as a cross-disciplinary profession.

Does Integration Help Adapt to Climate Change? Case of Increased US Corn Yield Volatility

NASA Astrophysics Data System (ADS)

Verma, M.; Diffenbaugh, N. S.; Hertel, T. W.

2012-12-01

In absence of of new crop varieties or significant shifts in the geography of corn production, US national corn yields variation could double by the year 2040 as a result of climate change and without adaptation this could lead the variability in US corn prices to quadruple (Diffenbaugh et al. 2012). In addition to climate induced price changes, analysis of recent commodity price spikes suggests that interventionist trade policies are partly to blame. Assuming we cannot much influence the future climate outcome, what policies can we undertake to adapt better? Can we use markets to blunt this edge? Diffenbaugh et al. find that sale of corn- ethanol for use in liquid fuel, when governed by quotas such as US Renewable Fuel Standard (RFS), could make US corn prices even more variable; in contrast the same food-fuel market link (we refer to it as intersectoral link) may well dampen price volatility when the sale of corn to ethanol industry is driven by higher future oil prices. The latter however comes at the cost of exposing corn prices to the greater volatility in oil markets. Similarly intervention in corn trade can make US corn prices less or more volatile by distorting international corn price transmission. A negative US corn yield shock shows that domestic corn supply falls and domestic prices to go up irrespective of whether or not markets are integrated. How much the prices go up depends on how much demand adjusts to accommodate the supply shock. Based on the forgoing analysis, one should expect that demand would adjust more readily when markets are integrated and therefore reduce the resulting price fluctuation. Simulation results confirm this response of corn markets. In terms of relative comparisons however a policy driven intersectoral integration is least effective and prices rise much more. Similarly, a positive world oil price shock makes the US oil imports expensive and with oil being used to produce gasoline blends, it increases the price of gasoline and reduces its demand. In the presence of domestic integration, ethanol production rises to substitute oil in the gasoline blend and thereby increases the corn demand and prices. However if one takes into account increase in corn price due to increased production costs (increase in oil price increases fertilizer prices - a major input into corn production) and reduced corn prices due to reduced fuel demand and therefore reduced ethanol additive demand; the prices can go either way. Our initial simulations show that they do in fact go down with mandate driven integration. This raises some more general questions: Whether integration (intersectoral and international) can be an effective strategy for adapting to climate change? And which of the four adaptation options - RFS or oil price driven domestic integration, full corn tariff liberalization or restricting tariff manipulation by partners - would be more effective in comparison to other adaptation (including no adaptation) scenarios? We implement the alternative adaptation strategies, while sampling from the same corn yield and oil price distributions and compare the resulting corn price variations to the base case where no such adaptation has been undertaken. Our initial results suggest that intersectoral integration is more effective form of adaptation than international one, but only if driven by market forces and not mandates.

Tackling health inequalities: moving theory to action

PubMed Central

Signal, Louise; Martin, Jennifer; Reid, Papaarangi; Carroll, Christopher; Howden-Chapman, Philippa; Ormsby, Vera Keefe; Richards, Ruth; Robson, Bridget; Wall, Teresa

2007-01-01

Background This paper reports on health inequalities awareness-raising workshops conducted with senior New Zealand health sector staff as part of the Government's goal of reducing inequalities in health, education, employment and housing. Methods The workshops were based on a multi-method needs assessment with senior staff in key health institutions. The workshops aimed to increase the knowledge and skills of health sector staff to act on, and advocate for, eliminating inequalities in health. They were practical, evidence-based, and action oriented and took a social approach to the causes of inequalities in health. The workshops used ethnicity as a case study and explored racism as a driver of inequalities. They focused on the role of institutionalized racism, or racism that is built into health sector institutions. Institutional theory provided a framework for participants to analyse how their institutions create and maintain inequalities and how they can act to change this. Results Participants identified a range of institutional mechanisms that promote inequalities and a range of ways to address them including: undertaking further training, using Māori (the indigenous people) models of health in policy-making, increasing Māori participation and partnership in decision making, strengthening sector relationships with iwi (tribes), funding and supporting services provided 'by Māori for Māori', ensuring a strategic approach to intersectoral work, encouraging stronger community involvement in the work of the institution, requiring all evaluations to assess impact on inequalities, and requiring the sector to report on progress in addressing health inequalities. The workshops were rated highly by participants, who indicated increased commitment to tackle inequalities as a result of the training. Discussion Government and sector leadership were critical to the success of the workshops and subsequent changes in policy and practice. The use of locally adapted equity tools, requiring participants to develop action plans, and using a case study to focus discussion were important to the success for the training. Using institutional theory was helpful in analysing how drivers of inequalities, such as racism, are built into health institutions. This New Zealand experience provides a model that may be applicable in other jurisdictions. PMID:17910778

Evaluation of risk factor reduction in a European City Network.

PubMed

Farrington, Jill L; Faskunger, Johan; Mackiewicz, Karolina

2015-06-01

There is a substantial and growing burden of premature mortality caused by non-communicable diseases (NCDs) globally. This paper evaluates the preventive efforts of the WHO European Healthy Cities Network during its fifth phase (2009-13), specifically for four behavioural risk factors (tobacco use, alcohol abuse, unhealthy diet and physical inactivity). Drawing on case studies, questionnaire responses and other materials, it notes which cities were involved, what worked and did not, the triggers for action, challenges met and lessons learnt. Few cities appeared to have taken comprehensive approaches to NCD prevention across multiple risk factors, or have combined population- and individual-level interventions. Work on healthy food and diet predominantly focused on children in educational or care settings, and few cities appeared to take a comprehensive approach to tackling obesity. Partnerships were a strong feature for all the NCD risk factor work, and were frequently extensive, being most diverse for the Healthy Diet and Food work. There were strong examples of engagement with communities, also involved in co-designing and shaping projects. Equity also featured strongly and there were multiple examples of how attention had been paid to the social determinants of health. There was evidence that cities continue to be significant innovative forces within their countries and drivers of change, and the mutual dependency of the national and local levels was highlighted. Interventions to promote physical activity have shifted focus from specific events and projects to being more integrated with other policy areas and based on intersectoral collaboration. © The Author 2015. Published by Oxford University Press. All rights reserved. For Permissions, please email: journals.permissions@oup.com.

Promoting Mental Health and Preventing Mental Illness in General Practice.

PubMed

Thomas, Steve; Jenkins, Rachel; Burch, Tony; Calamos Nasir, Laura; Fisher, Brian; Giotaki, Gina; Gnani, Shamini; Hertel, Lise; Marks, Marina; Mathers, Nigel; Millington-Sanders, Catherine; Morris, David; Ruprah-Shah, Baljeet; Stange, Kurt; Thomas, Paul; White, Robert; Wright, Fiona

2016-01-01

This paper calls for the routine integration of mental health promotion and prevention into UK General Practice in order to reduce the burden of mental and physical disorders and the ensuing pressure on General Practice. The proposals & the resulting document (https://ethicscharity.files.wordpress.com/2015/09/rcgp_keymsg_150925_v5.pdf) arise from an expert 'Think Tank' convened by the London Journal of Primary Care, Educational Trust for Health Improvement through Cognitive Strategies (ETHICS Foundation) and the Royal College of General Practitioners. It makes 12 recommendations for General Practice: (1) Mental health promotion and prevention are too important to wait. (2) Work with your community to map risk factors, resources and assets. (3) Good health care, medicine and best practice are biopsychosocial rather than purely physical. (4) Integrate mental health promotion and prevention into your daily work. (5) Boost resilience in your community through approaches such as community development. (6) Identify people at increased risk of mental disorder for support and screening. (7) Support early intervention for people of all ages with signs of illness. (8) Maintain your biopsychosocial skills. (9) Ensure good communication, interdisciplinary team working and inter-sectoral working with other staff, teams and agencies. (10) Lead by example, taking action to promote the resilience of the general practice workforce. (11) Ensure mental health is appropriately included in the strategic agenda for your 'cluster' of General Practices, at the Clinical Commissioning Groups, and the Health and Wellbeing Board. (12) Be aware of national mental health strategies and localise them, including action to destigmatise mental illness within the context of community development.

The Business Emergency Operations Center (BEOC) - A Model for Inter-Agency and Inter-Sector Communication and Collaboration

DTIC Science & Technology

2011-06-01

of Observe, Orient, Decide, Act (OODA) and Sense, Interpret, Decide, Act ( SIDA ) loops is important to understand and research as part of this...C2 process loops, OODA, developed by John Boyd, (Coram 2002, Lind 1985) and/or SIDA , (Haeckel 2001) are functioning at multiple levels and the...model of C2 is grounded in OODA and SIDA loops addressed earlier in this paper. During exercises, the salient activity of moving through the process

[Impact of the new system of resource allocation on French public healthcare establishments].

PubMed

Accary-Bézard, Catherine

2012-06-01

The reform of the tarification according to activity is now in place with a "T2A" rate said to be 100%, ie the hospitals are paid based on the national tariffs for a stay in hospital. The reform will continue with a list of stays for which, each year, a single tariff between the public sector and the private sector is applied. This single tariff results from the "inter-sector tariff convergence" policy which is applied.

Reports on boys’, youth’s and men’s health in Canadian newspapers: Now what?

PubMed Central

Zanchetta, Margareth Santos; Byam, Aaron Andrew; Solomon, Donna; Jalili, Katayoon; Haag, Carlos; Tallarico, Silvia

2017-01-01

Background: This media content analysis explored the Canadian newspapers reporting on men's health, and their contribution to public understanding of the social determinants of men’s health and lifestyles. Methods: A media content analysis of 44 news articles on boys’, youth’s and men’s health,published from 2010 to 2014 by three national newspapers (The Globe and Mail, National Post,and Metro News). Results: Data indicated that the predominant discourse consists of informative and awareness messages, mostly about men’s prostate and sexual health. Very little health news content referred to working conditions, education and income, all of which are significant social determinants of health (SDH). This may reflect the current state of health research, which does not adequately incorporate the effects of these determinants. It may also indicate a reproduction of dominant health knowledge and understanding of masculinity. Little content was found on policy solutions to other publicized health issues, such as limited access to health services or inter-sectoral collaborations; this reflects a lack of government action and a lack of citizen engagement toward the creation of a concerted men’s health policy. Conclusion: Despite the acknowledged importance of the media in promoting access to health information and indirectly contributing to improve the general public’s level of health literacy, it is also necessary to remember that there must be a greater attention to the structural constraints imposed by socioeconomic inequalities. Future studies should explore media discourses about men’s unequal access to health care services and citizens’ awareness of ways to overcome those inequalities shortcomings. PMID:28695103

Innovations in Doctoral Training and Research on Tinnitus: The European School on Interdisciplinary Tinnitus Research (ESIT) Perspective.

PubMed

Schlee, Winfried; Hall, Deborah A; Canlon, Barbara; Cima, Rilana F F; de Kleine, Emile; Hauck, Franz; Huber, Alex; Gallus, Silvano; Kleinjung, Tobias; Kypraios, Theodore; Langguth, Berthold; Lopez-Escamez, José A; Lugo, Alessandra; Meyer, Martin; Mielczarek, Marzena; Norena, Arnaud; Pfiffner, Flurin; Pryss, Rüdiger C; Reichert, Manfred; Requena, Teresa; Schecklmann, Martin; van Dijk, Pim; van de Heyning, Paul; Weisz, Nathan; Cederroth, Christopher R

2017-01-01

Tinnitus is a common medical condition which interfaces many different disciplines, yet it is not a priority for any individual discipline. A change in its scientific understanding and clinical management requires a shift toward multidisciplinary cooperation, not only in research but also in training. The European School for Interdisciplinary Tinnitus research (ESIT) brings together a unique multidisciplinary consortium of clinical practitioners, academic researchers, commercial partners, patient organizations, and public health experts to conduct innovative research and train the next generation of tinnitus researchers. ESIT supports fundamental science and clinical research projects in order to: (1) advancing new treatment solutions for tinnitus, (2) improving existing treatment paradigms, (3) developing innovative research methods, (4) performing genetic studies on, (5) collecting epidemiological data to create new knowledge about prevalence and risk factors, (6) establishing a pan-European data resource. All research projects involve inter-sectoral partnerships through practical training, quite unlike anything that can be offered by any single university alone. Likewise, the postgraduate training curriculum fosters a deep knowledge about tinnitus whilst nurturing transferable competencies in personal qualities and approaches needed to be an effective researcher, knowledge of the standards, requirements and professionalism to do research, and skills to work with others and to ensure the wider impact of research. ESIT is the seed for future generations of creative, entrepreneurial, and innovative researchers, trained to master the upcoming challenges in the tinnitus field, to implement sustained changes in prevention and clinical management of tinnitus, and to shape doctoral education in tinnitus for the future.

Reports on boys', youth's and men's health in Canadian newspapers: Now what?

PubMed

Zanchetta, Margareth Santos; Byam, Aaron Andrew; Solomon, Donna; Jalili, Katayoon; Haag, Carlos; Tallarico, Silvia

2017-01-01

Background: This media content analysis explored the Canadian newspapers reporting on men's health, and their contribution to public understanding of the social determinants of men's health and lifestyles. Methods: A media content analysis of 44 news articles on boys', youth's and men's health,published from 2010 to 2014 by three national newspapers (The Globe and Mail, National Post,and Metro News). Results: Data indicated that the predominant discourse consists of informative and awareness messages, mostly about men's prostate and sexual health. Very little health news content referred to working conditions, education and income, all of which are significant social determinants of health (SDH). This may reflect the current state of health research, which does not adequately incorporate the effects of these determinants. It may also indicate a reproduction of dominant health knowledge and understanding of masculinity. Little content was found on policy solutions to other publicized health issues, such as limited access to health services or inter-sectoral collaborations; this reflects a lack of government action and a lack of citizen engagement toward the creation of a concerted men's health policy. Conclusion: Despite the acknowledged importance of the media in promoting access to health information and indirectly contributing to improve the general public's level of health literacy, it is also necessary to remember that there must be a greater attention to the structural constraints imposed by socioeconomic inequalities. Future studies should explore media discourses about men's unequal access to health care services and citizens' awareness of ways to overcome those inequalities shortcomings.

Measurement and simulation of the relatively competitive advantages and weaknesses between economies based on bipartite graph theory.

PubMed

Guan, Jun; Xu, Xiaoyu; Wu, Shan; Xing, Lizhi

2018-01-01

The input-output table is very comprehensive and detailed in describing the national economic systems with abundant economic relationships, which contain supply and demand information among various industrial sectors. The complex network, a theory, and method for measuring the structure of a complex system can depict the structural characteristics of the internal structure of the researched object by measuring the structural indicators of the social and economic systems, revealing the complex relationships between the inner hierarchies and the external economic functions. In this paper, functions of industrial sectors on the global value chain are to be distinguished with bipartite graph theory, and inter-sector competitive relationships are to be extracted through resource allocation process. Furthermore, quantitative analysis indices will be proposed under the perspective of a complex network, which will be used to bring about simulations on the variation tendencies of economies' status in different situations of commercial intercourses. Finally, a new econophysics analytical framework of international trade is to be established.

Obesity and public policies: the Brazilian government's definitions and strategies.

PubMed

Dias, Patricia Camacho; Henriques, Patrícia; Anjos, Luiz Antonio Dos; Burlandy, Luciene

2017-07-27

The study analyzes national strategies for dealing with obesity in Brazil in the framework of the Brazilian Unified National Health System (SUS) and the Food and Nutritional Security System (SISAN). Based on the document analysis method, we examined government documents produced in the last 15 years in the following dimensions: definitions of obesity, proposed actions, and strategies for linkage between sectors. In the SUS, obesity is approached as both a risk factor and a disease, with individual and social/environmental approaches aimed at changing eating practices and physical activity. In the SISAN, obesity is also conceived as a social problem involving food insecurity, and new modes of producing, marketing, and consuming foods are proposed to change eating practices in an integrated way. Proposals in the SUS point to an integrated and intra-sector approach to obesity, while those in SISAN emphasize the problem's inter-sector nature from an expanded perspective that challenges the prevailing sector-based institutional structures.

Measurement and simulation of the relatively competitive advantages and weaknesses between economies based on bipartite graph theory

PubMed Central

Guan, Jun; Xu, Xiaoyu; Wu, Shan

2018-01-01

The input-output table is very comprehensive and detailed in describing the national economic systems with abundant economic relationships, which contain supply and demand information among various industrial sectors. The complex network, a theory, and method for measuring the structure of a complex system can depict the structural characteristics of the internal structure of the researched object by measuring the structural indicators of the social and economic systems, revealing the complex relationships between the inner hierarchies and the external economic functions. In this paper, functions of industrial sectors on the global value chain are to be distinguished with bipartite graph theory, and inter-sector competitive relationships are to be extracted through resource allocation process. Furthermore, quantitative analysis indices will be proposed under the perspective of a complex network, which will be used to bring about simulations on the variation tendencies of economies’ status in different situations of commercial intercourses. Finally, a new econophysics analytical framework of international trade is to be established. PMID:29813083

Engagement of Sectors Other than Health in Integrated Health Governance, Policy, and Action.

PubMed

de Leeuw, Evelyne

2017-03-20

Health is created largely outside the health sector. Engagement in health governance, policy, and intervention development and implementation by sectors other than health is therefore important. Recent calls for building and implementing Health in All Policies, and continued arguments for intersectoral action, may strengthen the potential that other sectors have for health. This review clarifies the conceptual foundations for integral health governance, policy, and action, delineates the different sectors and their possible engagement, and provides an overview of a continuum of methods of engagement with other sectors to secure integration. This continuum ranges from institutional (re)design to value-based narratives. Depending on the lens applied, different elements can be identified within the continuum. This review is built on insights from political science, leadership studies, public health, empirical Health in All Policy research, knowledge and evidence nexus approaches, and community perspectives. Successful integration of health governance, policy, and action depends on integration of the elements on the continuum.

Dilemmas in providing resilience-enhancing social services to long-term social assistance clients. A qualitative study of Swedish social workers

PubMed Central

2012-01-01

Background Long-term recipients of social assistance face barriers to social and economic inclusion, and have poorer health and more limited opportunities for improving their health than many other groups in the population. During recent decades there have been changes in Swedish social policy, with cutbacks in public benefits and a re-emphasis on means-tested policies. In this context, it is important to investigate the necessary conditions for social workers to offer social assistance and services, as well as the mediating role of social workers between public policies and their clients. Swedish social services aim to promote social inclusion by strengthening the individual´s own resources. We investigated the issues that arise when providing social services to long-term social assistance clients within the framework of resilience, which focuses on the processes leading to positive functioning in adverse conditions. Methods Interviews were conducted with 23 social workers in Stockholm and analysed by qualitative content analysis. Results The main theme to emerge from the interviews concerned the constraints that the social workers faced in providing social services to social assistance clients. The first subtheme focused on dilemmas in the interaction between social workers and clients resulting from the dual role of exercising authority and supporting and building trust with clients. Working conditions of social workers also played a crucial role. The second subtheme addressed the impact of the societal context, such as labour market opportunities and coordination between authorities. Conclusions Overall, we found that social workers to a great extent tried to find individual solutions to structural problems. To provide resilience-enhancing social services to long-term social assistance clients with varying obstacles and needs requires a constructive working environment, supportive societal structures and inter-sectoral cooperation between different authorities. PMID:22789127

India's NCD strategy in the SDG era: are there early signs of a paradigm shift?

PubMed

Mondal, Shinjini; Van Belle, Sara

2018-04-25

The Sustainable Development Goals (SDGs) are seen in most corners as the embodiment of a more inclusive and holistic development approach, key to addressing the numerous and urgent challenges the world faces. In the health realm, a true SDG approach will require a five-fold paradigm shift according to Buse and Hawkes. This article explores whether early traces of this paradigm shift can already be witnessed in the Indian context, focusing on Non-Communicable Diseases (NCDs) more in particular. By now, NCDs make up a large health burden in India, both individually and on the health system. Inspired by an SDG vision, tackling NCDs will require a comprehensive approach rooted in preventive, curative and rehabilitative services. In India, some early momentum in this respect can already be witnessed, certainly in addressing the first two challenges identified by Buse and Hawkes, leadership and intersectoral coherence, and a shift from treatment to prevention. A central plan addressing health through an inter-sectoral approach has shaped the trajectory so far, moving away from silos to engagement with sectors beyond health. New guidelines addressing comprehensive primary healthcare propose a community outreach and preventive approach for NCDs. At a broader level, NCD prevention is also closely linked to tackling the so called "commercial determinants of health" and will require among others strong (central and state level) regulation, teaming up with global advocacy networks and capitalizing on global frameworks, where they exist. Strong political leadership will be indispensable for this, and is according to Buse and Hawkes closely linked to seeing health as a right and the government as accountable when it comes to providing for the right to health through its policies and actions. National stewardship will thus be key, via a more adaptive network governance structure with the central level coordinating with the state level to ensure implementation, while also engaging with other stakeholders, sectors, the private sector and civil society. As one can expect, networked governance, necessary for the battle against NCDs, is a work in progress in India. In sum, some of the early (paradigm shift) signs are encouraging, but by and large it is still too early to assess whether a real paradigm shift has taken place.

A Web-Based Computer-Tailored Alcohol Prevention Program for Adolescents: Cost-Effectiveness and Intersectoral Costs and Benefits

PubMed Central

2016-01-01

Background Preventing excessive alcohol use among adolescents is important not only to foster individual and public health, but also to reduce alcohol-related costs inside and outside the health care sector. Computer tailoring can be both effective and cost-effective for working with many lifestyle behaviors, yet the available information on the cost-effectiveness of computer tailoring for reducing alcohol use by adolescents is limited as is information on the costs and benefits pertaining to sectors outside the health care sector, also known as intersectoral costs and benefits (ICBs). Objective The aim was to assess the cost-effectiveness of a Web-based computer-tailored intervention for reducing alcohol use and binge drinking by adolescents from a health care perspective (excluding ICBs) and from a societal perspective (including ICBs). Methods Data used were from the Alcoholic Alert study, a cluster randomized controlled trial with randomization at the level of schools into two conditions. Participants either played a game with tailored feedback on alcohol awareness after the baseline assessment (intervention condition) or received care as usual (CAU), meaning that they had the opportunity to play the game subsequent to the final measurement (waiting list control condition). Data were recorded at baseline (T0=January/February 2014) and after 4 months (T1=May/June 2014) and were used to calculate incremental cost-effectiveness ratios (ICERs), both from a health care perspective and a societal perspective. Stochastic uncertainty in the data was dealt with by using nonparametric bootstraps (5000 simulated replications). Additional sensitivity analyses were conducted based on excluding cost outliers. Subgroup cost-effectiveness analyses were conducted based on several background variables, including gender, age, educational level, religion, and ethnicity. Results From both the health care perspective and the societal perspective for both outcome measures, the intervention was more costly and more effective in comparison with CAU. ICERs differed for both perspectives, namely €40 and €79 from the health care perspective to €62 and €144 for the societal perspective per incremental reduction of one glass of alcohol per week and one binge drinking occasion per 30 days, respectively. Subgroup analyses showed, from both perspectives and for both outcome measures, that the intervention was cost-effective for older adolescents (aged 17-19 years) and those at a lower educational level and, from a health care perspective, the male and nonreligious adolescent subgroups. Conclusions Computer-tailored feedback could be a cost-effective way to target alcohol use and binge drinking among adolescents. Including ICBs in the economic evaluation had an impact on the cost-effectiveness results of the analysis. It could be worthwhile to aim the intervention specifically at specific subgroups. Trial Registration Nederlands Trial Register: NTR4048; http://www.trialregister.nl/trialreg/admin/rctview.asp?TC=4048 (Archived by Webcite at http://www.webcitation.org/6c7omN8wG) PMID:27103154

The importance of intersectoral factors in promoting equity-oriented universal health coverage: a multilevel analysis of social determinants affecting neonatal infant and under-five mortality in Bangladesh.

PubMed

Huda, Tanvir M; Tahsina, Tazeen; El Arifeen, Shams; Dibley, Michael J

2016-01-01

Health is multidimensional and affected by a wide range of factors, many of which are outside the health sector. To improve population health and reduce health inequality, it is important that we take into account the complex interactions among social, environmental, behavioural, and biological factors and design our health interventions accordingly. This study examines mortality differentials in children of different age groups by key social determinants of health (SDH) including parental education and employment, mother's level of autonomy, age, asset index, living arrangements (utilities), and other geographical contextual factors (area of residence, road conditions). We used data from the two rounds of Bangladesh Health and Demographic Survey, a nationally representative sample survey of the population residing in Bangladesh. Multilevel logistic models were used to study the impact of SDH on child mortality. The study found that the mother's age, the education of both parents, the mother's autonomy to take decisions about matters linked to the health of her child, the household socio-economic conditions, the geographical region of residence, and the condition of the roads were significantly associated with higher risks of neonatal, infant, and under-five mortality in Bangladesh. The study findings suggest there are complex relationships among different SDH. Thus larger intersectoral actions will be needed to reduce disparities in child health and mortality and achieve meaningful progress towards equity-oriented universal health coverage.

Developing a Return to Work Intervention for Breast Cancer Survivors with the Intervention Mapping Protocol: Challenges and Opportunities of the Needs Assessment

PubMed Central

Fassier, Jean-Baptiste; Lamort-Bouché, Marion; Broc, Guillaume; Guittard, Laure; Péron, Julien; Rouat, Sabrina; Carretier, Julien; Fervers, Béatrice; Letrilliart, Laurent; Sarnin, Philippe

2018-01-01

Return to work (RTW) is an important step for breast cancer survivors (BCSs). However, they face many barriers that affect particularly women with low socioeconomic status (SES). Health care, workplace, and insurance actors lack knowledge and collaborate poorly. No intervention to date has proven effective to reduce social disparities in employment after breast cancer. The intervention mapping (IM) protocol is being used in France to develop, implement, and evaluate an intervention to facilitate and sustain RTW after breast cancer [FAciliter et Soutenir le retour au TRAvail après un Cancer du Sein (FASTRACS) project]. The research question of this study was to elicit the needs for RTW after breast cancer from various stakeholders’ point of view. The aim of this study was to describe the process and the preliminary results of the needs assessment of the FASTRACS project. Different methods were followed to (a) establish and work with a planning group and (b) conduct a needs assessment to create a logic model of the problem. A planning group was organized to gather the stakeholders with the research team. A review of the literature and indicators was conducted to identify the magnitude of the problem and the factors influencing RTW. A qualitative inquiry was conducted with 12 focus groups and 48 individual semi-structured interviews to explore the needs and experience of the stakeholders. The results of these tasks were the proposition of a charter of partnership to structure the participative process, a review of the scientific evidence and indicators, and the description by the stakeholders of their needs and experience. Many stakeholders disagreed with the concept of “early intervention.” They advocated for a better support of BCSs during their RTW, emphasized as a process. Anticipation, intersectoral collaboration, and workplace accommodation were mentioned to fit the needs of the BCS and their environment. A logic model of the problem was elaborated from these data. The ability of the model to consider specific characteristics of women with low SES is discussed, with a view to developing the FASTRACS intervention through the next steps of the IM protocol. PMID:29527521

Developing a Return to Work Intervention for Breast Cancer Survivors with the Intervention Mapping Protocol: Challenges and Opportunities of the Needs Assessment.

PubMed

Fassier, Jean-Baptiste; Lamort-Bouché, Marion; Broc, Guillaume; Guittard, Laure; Péron, Julien; Rouat, Sabrina; Carretier, Julien; Fervers, Béatrice; Letrilliart, Laurent; Sarnin, Philippe

2018-01-01

Return to work (RTW) is an important step for breast cancer survivors (BCSs). However, they face many barriers that affect particularly women with low socioeconomic status (SES). Health care, workplace, and insurance actors lack knowledge and collaborate poorly. No intervention to date has proven effective to reduce social disparities in employment after breast cancer. The intervention mapping (IM) protocol is being used in France to develop, implement, and evaluate an intervention to facilitate and sustain RTW after breast cancer [ FAciliter et Soutenir le retour au TRAvail après un Cancer du Sein (FASTRACS) project]. The research question of this study was to elicit the needs for RTW after breast cancer from various stakeholders' point of view. The aim of this study was to describe the process and the preliminary results of the needs assessment of the FASTRACS project. Different methods were followed to (a) establish and work with a planning group and (b) conduct a needs assessment to create a logic model of the problem. A planning group was organized to gather the stakeholders with the research team. A review of the literature and indicators was conducted to identify the magnitude of the problem and the factors influencing RTW. A qualitative inquiry was conducted with 12 focus groups and 48 individual semi-structured interviews to explore the needs and experience of the stakeholders. The results of these tasks were the proposition of a charter of partnership to structure the participative process, a review of the scientific evidence and indicators, and the description by the stakeholders of their needs and experience. Many stakeholders disagreed with the concept of "early intervention." They advocated for a better support of BCSs during their RTW, emphasized as a process. Anticipation, intersectoral collaboration, and workplace accommodation were mentioned to fit the needs of the BCS and their environment. A logic model of the problem was elaborated from these data. The ability of the model to consider specific characteristics of women with low SES is discussed, with a view to developing the FASTRACS intervention through the next steps of the IM protocol.

Why physicians and nurses ask (or don’t) about partner violence: a qualitative analysis

PubMed Central

2012-01-01

Background Intimate partner violence (IPV) against women is a serious public health issue and is associated with significant adverse health outcomes. The current study was undertaken to: 1) explore physicians’ and nurses’ experiences, both professional and personal, when asking about IPV; 2) determine the variations by discipline; and 3) identify implications for practice, workplace policy and curriculum development. Methods Physicians and nurses working in Ontario, Canada were randomly selected from recognized discipline-specific professional directories to complete a 43-item mailed survey about IPV, which included two open-ended questions about barriers and facilitators to asking about IPV. Text from the open-ended questions was transcribed and analyzed using inductive content analysis. In addition, frequencies were calculated for commonly described categories and the Fisher’s Exact Test was performed to determine statistical significance when examining nurse/physician differences. Results Of the 931 respondents who completed the survey, 769 (527 nurses, 238 physicians, four whose discipline was not stated) provided written responses to the open-ended questions. Overall, the top barriers to asking about IPV were lack of time, behaviours attributed to women living with abuse, lack of training, language/cultural practices and partner presence. The most frequently reported facilitators were training, community resources and professional tools/protocols/policies. The need for additional training was a concern described by both groups, yet more so by nurses. There were statistically significant differences between nurses and physicians regarding both barriers and facilitators, most likely related to differences in role expectations and work environments. Conclusions This research provides new insights into the complexities of IPV inquiry and the inter-relationships among barriers and facilitators faced by physicians and nurses. The experiences of these nurses and physicians suggest that more supports (e.g., supportive work environments, training, mentors, consultations, community resources, etc.) are needed by practitioners. These findings reflect the results of previous research yet offer perspectives on why barriers persist. Multifaceted and intersectoral approaches that address individual, interpersonal, workplace and systemic issues faced by nurses and physicians when inquiring about IPV are required. Comprehensive frameworks are needed to further explore the many issues associated with IPV inquiry and the interplay across these issues. PMID:22721371

Describing the impact of health research: a Research Impact Framework

PubMed Central

Kuruvilla, Shyama; Mays, Nicholas; Pleasant, Andrew; Walt, Gill

2006-01-01

Background Researchers are increasingly required to describe the impact of their work, e.g. in grant proposals, project reports, press releases and research assessment exercises. Specialised impact assessment studies can be difficult to replicate and may require resources and skills not available to individual researchers. Researchers are often hard-pressed to identify and describe research impacts and ad hoc accounts do not facilitate comparison across time or projects. Methods The Research Impact Framework was developed by identifying potential areas of health research impact from the research impact assessment literature and based on research assessment criteria, for example, as set out by the UK Research Assessment Exercise panels. A prototype of the framework was used to guide an analysis of the impact of selected research projects at the London School of Hygiene and Tropical Medicine. Additional areas of impact were identified in the process and researchers also provided feedback on which descriptive categories they thought were useful and valid vis-à-vis the nature and impact of their work. Results We identified four broad areas of impact: I. Research-related impacts; II. Policy impacts; III. Service impacts: health and intersectoral and IV. Societal impacts. Within each of these areas, further descriptive categories were identified. For example, the nature of research impact on policy can be described using the following categorisation, put forward by Weiss: Instrumental use where research findings drive policy-making; Mobilisation of support where research provides support for policy proposals; Conceptual use where research influences the concepts and language of policy deliberations and Redefining/wider influence where research leads to rethinking and changing established practices and beliefs. Conclusion Researchers, while initially sceptical, found that the Research Impact Framework provided prompts and descriptive categories that helped them systematically identify a range of specific and verifiable impacts related to their work (compared to ad hoc approaches they had previously used). The framework could also help researchers think through implementation strategies and identify unintended or harmful effects. The standardised structure of the framework facilitates comparison of research impacts across projects and time, which is useful from analytical, management and assessment perspectives. PMID:17049092

Outcomes of Interorganizational Networks in Canada for Chronic Disease Prevention: Insights From a Concept Mapping Study, 2015

PubMed Central

Kernoghan, Alison; Riley, Barbara; Popp, Janice; Best, Allan; Milward, H. Brinton

2015-01-01

Introduction We conducted a mixed methods study from June 2014 to March 2015 to assess the perspectives of stakeholders in networks that adopt a population approach for chronic disease prevention (CDP). The purpose of the study was to identify important and feasible outcome measures for monitoring network performance. Methods Participants from CDP networks in Canada completed an online concept mapping exercise, which was followed by interviews with network stakeholders to further understand the findings. Results Nine concepts were considered important outcomes of CDP networks: enhanced learning, improved use of resources, enhanced or increased relationships, improved collaborative action, network cohesion, improved system outcomes, improved population health outcomes, improved practice and policy planning, and improved intersectoral engagement. Three themes emerged from participant interviews related to measurement of the identified concepts: the methodological difficulties in measuring network outcomes, the dynamic nature of network evolution and function and implications for outcome assessment, and the challenge of measuring multisectoral engagement in CDP networks. Conclusion Results from this study provide initial insights into concepts that can be used to describe the outcomes of networks for CDP and may offer foundations for strengthening network outcome-monitoring strategies and methodologies. PMID:26583571

["Healthy Region Lower Rhine ... against Stroke": the concept and implementation of an intersectoral public health programme 2003-2008].

PubMed

Rau, Rüdiger; Rumpeltin, Carsten; Hoop, Renate; Pfeiffer, Holger; Drees, Jeannette; Paas, Birgit; Schmitz-Buhl, Gabriele; Geraedts, Max

2009-01-01

When the Public Health Service Act of North Rhine-Westphalia (OGDG-NRW) came into effect local health conferences (KGK) were established in both rural and urban districts. These conferences are designed to optimize medical and social healthcare at the local level. In 2001 KGK managers from six neighbouring districts founded the Network Healthy Lower Rhine. From 2003 to 2008 this network was able to implement the "Healthy Lower Rhine ... against Stroke" programme. The initiative primarily aims at improving community knowledge of stroke with regard to 1) proper action ("Stroke is a medical emergency, so call the emergency number 112!") and 2) stroke warning signs. Eventually these steps are intended 3) to reduce prehospital delays. Before the program started a project plan was developed including evaluation approaches. The central elements of the concept include local health targets, intersectoral collaboration and networking, 5-year programme duration, social marketing and a communication strategy. Initially, a needs assessment was conducted using local expert panels, surveys on community knowledge, and clinical data sampling to assess healthcare quality. Subsequently, a package of measures with a "two-level implementation model" was prepared. Normative evaluation consisted of self-reflection within the network-team. The summative evaluation was based on two approaches: surveys on community knowledge of stroke (city of Düsseldorf and district of Wesel) as well as data sample collection in hospitals on health care quality. The central elements of the concepts were implemented. Community surveys revealed similar deficits in community knowledge of stroke in the city of Dusseldorf (2000 and 2004) and in the district of Wesel (2002 and 2008). Knowledge of proper action (call 112 in case of stroke) significantly improved in the Dusseldorf community from 32.5% of correct statements in 2000 to 50.6% correct answers in 2004 and, finally, in 2008 to 69% correct answers in the Wesel district. Hospitals in the district of Wesel collected three-month samples of data on prehospital times in 2003 (before the initiative was started) and in 2005. There was no significant change: the portion of 28% of patients being hospitalized within a three-hour window after the onset of stroke symptoms remained unchanged. Due to medical progress and demographic changes stroke remains a paramount issue of public health in Germany. With its programme "Healthy Lower Rhine ... against Stroke" the Network Healthy Lower Rhine provides a strategy for launching and implementing a complex and intersectoral public health intervention.

Prayer Camps and Biomedical Care in Ghana: Is Collaboration in Mental Health Care Possible?

PubMed

Arias, Daniel; Taylor, Lauren; Ofori-Atta, Angela; Bradley, Elizabeth H

2016-01-01

Experts have suggested that intersectoral partnerships between prayer camps and biomedical care providers may be an effective strategy to address the overwhelming shortage of mental health care workers in Africa and other low-income settings. Nevertheless, previous studies have not explored whether the prayer camp and biomedical staff beliefs and practices provide sufficient common ground to enable cooperative relationships. Therefore, we sought to examine the beliefs and practices of prayer camp staff and the perspective of biomedical care providers, with the goal of characterizing interest in-and potential for-intersectoral partnership between prayer camp staff and biomedical care providers. We conducted 50 open-ended, semi-structured interviews with prophets and staff at nine Christian prayer camps in Ghana, and with staff within Ghana's three public psychiatric hospitals. We used the purposive sampling method to recruit participants and the constant comparative method for qualitative data analysis. Prayer camp staff expressed interest in collaboration with biomedical mental health care providers, particularly if partnerships could provide technical support introducing medications in the prayer camp and address key shortcomings in their infrastructure and hygienic conditions. Nevertheless, challenges for collaboration were apparent as prayer camp staff expressed strong beliefs in a spiritual rather than biomedical explanatory model for mental illness, frequently used fasting and chained restraints in the course of treatment, and endorsed only short-term use of medication to treat mental illness-expressing concerns that long-term medication regimens masked underlying spiritual causes of illness. Biomedical providers were skeptical about the spiritual interpretations of mental illness held by faith healers, and were concerned by the use of chains, fasting, and the lack of adequate living facilities for patients in prayer camps; many, however, expressed interest in engaging with prayer camps to expand access to clinical care for patients residing in the camps. The findings demonstrate that biomedical care providers are interested in engaging with prayer camps. Key areas where partnerships may best improve conditions for patients at prayer camps include collaborating on creating safe and secure physical spaces and delivering medication for mental illness to patients living in prayer camps. However, while prayer camp staff are willing to engage biomedical knowledge, deeply held beliefs and routine practices of faith and biomedical healers are difficult to reconcile Additional discussion is needed to find the common ground on which the scarce resources for mental health care in Ghana can collaborate most effectively.

Promoting Mental Health and Preventing Mental Illness in General Practice

PubMed Central

Thomas, Steve; Jenkins, Rachel; Burch, Tony; Calamos Nasir, Laura; Fisher, Brian; Giotaki, Gina; Gnani, Shamini; Hertel, Lise; Marks, Marina; Mathers, Nigel; Millington-Sanders, Catherine; Morris, David; Ruprah-Shah, Baljeet; Stange, Kurt; Thomas, Paul; White, Robert; Wright, Fiona

2016-01-01

Abstract This paper calls for the routine integration of mental health promotion and prevention into UK General Practice in order to reduce the burden of mental and physical disorders and the ensuing pressure on General Practice. The proposals & the resulting document (https://ethicscharity.files.wordpress.com/2015/09/rcgp_keymsg_150925_v5.pdf) arise from an expert ‘Think Tank’ convened by the London Journal of Primary Care, Educational Trust for Health Improvement through Cognitive Strategies (ETHICS Foundation) and the Royal College of General Practitioners. It makes 12 recommendations for General Practice: (1) Mental health promotion and prevention are too important to wait. (2) Work with your community to map risk factors, resources and assets. (3) Good health care, medicine and best practice are biopsychosocial rather than purely physical. (4) Integrate mental health promotion and prevention into your daily work. (5) Boost resilience in your community through approaches such as community development. (6) Identify people at increased risk of mental disorder for support and screening. (7) Support early intervention for people of all ages with signs of illness. (8) Maintain your biopsychosocial skills. (9) Ensure good communication, interdisciplinary team working and inter-sectoral working with other staff, teams and agencies. (10) Lead by example, taking action to promote the resilience of the general practice workforce. (11) Ensure mental health is appropriately included in the strategic agenda for your ‘cluster’ of General Practices, at the Clinical Commissioning Groups, and the Health and Wellbeing Board. (12) Be aware of national mental health strategies and localise them, including action to destigmatise mental illness within the context of community development. PMID:28250821

Environmental pollution as engine of industrialization

NASA Astrophysics Data System (ADS)

Antoci, Angelo; Galeotti, Marcello; Sordi, Serena

2018-05-01

This paper analyzes the dynamics of a small open economy with two sectors (a farming sector and an industrial one), heterogeneous agents (workers and entrepreneurs) and free inter-sectoral labor mobility. Labor productivity in the first sector is negatively affected by environmental pollution generated by both sectors, whereas in the second sector it is positively affected by physical capital accumulated by entrepreneurs. Through a global analysis of the non-linear three-dimensional dynamic system of the model we derive conditions under which industrialization generates a decline in workers' revenues in both sectors.

Antimicrobial resistance-a threat to the world's sustainable development.

PubMed

Jasovský, Dušan; Littmann, Jasper; Zorzet, Anna; Cars, Otto

2016-08-01

This commentary examines how specific sustainable development goals (SDGs) are affected by antimicrobial resistance and suggests how the issue can be better integrated into international policy processes. Moving beyond the importance of effective antibiotics for the treatment of acute infections and health care generally, we discuss how antimicrobial resistance also impacts on environmental, social, and economic targets in the SDG framework. The paper stresses the need for greater international collaboration and accountability distribution, and suggests steps towards a broader engagement of countries and United Nations agencies to foster global intersectoral action on antimicrobial resistance.

Health in All Policies: From rhetoric to implementation and evaluation - the Finnish experience.

PubMed

Ståhl, Timo

2018-02-01

The principles of the Health in All Policies (HiAP) approach are not new. Their international roots can be traced back to 1978 and the Alma-Ata Declaration and the 1986 Ottawa Charter. In Finland, the roots of HiAP go back to 1972 when the Economic Council of Finland, chaired by the Prime Minister, launched the 'Report of the working group exploring the goals of health'. The paper discusses the history, rationale, and implementation of the principles underlying the umbrella concept of HiAP. A rationale for implementing a new concept - HiAP in 2006 during the Finnish European Union presidency - is given. The focus here will be on implementation of HiAP. International material supporting the implementation is introduced and practical examples from Finland presented. The Benchmarking System for Health Promotion Capacity Building is introduced, since it has been used as a primary source of information for monitoring and evaluating HiAP in Finland at the local level. The experience from Finland clearly indicates that HiAP as an approach and as a way of working requires long-term commitment and vision. For working across sectors it is crucial to have data on health and health determinants and analyses of the links between health outcomes, health determinants, and policies across sectors and levels of governance. Intersectoral structures, processes, and tools for the identification of problems and solutions, decisions, and implementation across sectors are prerequisites of HiAP. Legislative backing has proven to be useful, especially in providing continuation and sustainability.

Effective/efficient mental health programs for school-age children: a synthesis of reviews.

PubMed

Browne, Gina; Gafni, Amiram; Roberts, Jacqueline; Byrne, Carolyn; Majumdar, Basanti

2004-04-01

The prevalence of mental health problems, some of which seem to be occurring among younger cohorts, leads researchers and policy-makers to search for practical solutions to reduce the burden of suffering on children and their families, and the costs to society both immediate and long term. Numerous programs are in place to reduce or alleviate problem behaviour or disorders and/or assist positive youth development. Evaluated results are dispersed throughout the literature. To assess findings and determine common elements of effective children's services, a literature search was undertaken for evidence-based evaluations of non-clinical programs for school-age children. Prescriptive comments aim to inform service-providers, policy-makers and families about best practices for effective services such as: early, long-term intervention including reinforcement, follow-up and an ecological focus with family and community sector involvement; consistent adult staffing; and interactive, non-didactic programming adapted to gender, age and cultural needs. Gaps are identified in our understanding of efficiencies that result from effective programs. Policy implications include the need to develop strategies for intersectoral interventions, including: new financing arrangements to encourage (not penalize) interagency cooperation and, to ensure services reach appropriate segments of the population; replication of best practices; and publicizing information about benefits and cost savings. In many jurisdictions legislative changes could create incentives for services to collaborate on service delivery. Joint decision-making would require intersectoral governance, pooling of some funding, and policy changes to retain savings at the local level. Savings could finance expansion of services for additional youth.

Practice of One Health approaches: bridges and barriers in Tanzania.

PubMed

Kayunze, Kim A; Kiwara, Angwara; Lyamuya, Eligius; Kambarage, Dominic M; Rushton, Jonathan; Coker, Richard; Kock, Richard

2014-04-23

The practice of one health approaches in human and animal health programmes is influenced by type and scope of bridges and barriers for partnerships. It was thus essential to evaluate the nature and scope of collaborative arrangements among human, animal, and wildlife health experts in dealing with health challenges which demand inter-sectoral partnership. The nature of collaborative arrangement was assessed, and the respective bridges and barriers over a period of 12 months (July 20011 to June 2012) were identified. The specific objectives were to: (1) determine the proportion of health experts who had collaborated with other experts of disciplines different from theirs, (2) rank the general bridges for and barriers against collaboration according to the views of the health experts, and (3) find the actual bridges for and barriers against collaboration among the health experts interviewed. It was found that 27.0% of animal health officers interviewed had collaborated with medical officers while 12.4% of the medical officers interviewed had collaborated with animal health experts. Only 6.7% of the wildlife officers had collaborated with animal health experts. The main bridges for collaboration were instruction by upper level leaders, zoonotic diseases of serious impacts, and availability of funding. The main barriers for collaboration were lack of knowledge about animal/human health issues, lack of networks for collaboration, and lack of plans to collaborate. This thus calls for the need to curb barriers in order to enhance inter-sectoral collaboration for more effective management of risks attributable to infectious diseases of humans and animals.

The SARE tool for rabies control: Current experience in Ethiopia.

PubMed

Coetzer, A; Kidane, A H; Bekele, M; Hundera, A D; Pieracci, E G; Shiferaw, M L; Wallace, R; Nel, L H

2016-11-01

The Stepwise Approach towards Rabies Elimination (SARE) tool was developed through a joint effort of the Food and Agriculture Organization (FAO) of the United Nations and the Global Alliance for Rabies Control (GARC), to provide a standard mechanism for countries to assess their rabies situation and measure progress in eliminating the disease. Because the African continent has the highest per capita death rate from rabies, and Ethiopia is estimated to have the second largest number of rabies deaths of all African countries, Ethiopia undertook a self-assessment by means of the Stepwise Approach towards Rabies Elimination (SARE) tool. In February 2016, the Ethiopian government hosted an intersectoral consultative meeting in an effort to assess the progress that has been made towards the control and elimination of canine rabies. The SARE assessment identified a number of critical gaps, including poor inter-sectoral collaboration and limited availability and access to dog vaccine, while the existence of a surveillance system for rabies and legislation for outbreak declaration and response were among the strengths identified. The SARE tool enabled key criteria to be prioritized, thereby accelerating the National Strategy and ensuring that Ethiopia will progress rapidly in line with the goals set by the global community for the elimination of human rabies deaths by 2030. Although the analysis showed that Ethiopia is still in the early stages of rabies control (Stage 0.5/5), the country shows great promise in terms of developing a SARE-guided National Rabies Prevention and Control Strategy. Copyright © 2016 Elsevier B.V. All rights reserved.

Intersectoral collaboration for physical activity in Korean Healthy Cities.

PubMed

Kang, Eunjeong

2016-09-01

Intersectoral collaboration (ISC) is important in the health field because the complexity of determinants of health makes it difficult for one institution to resolve all health issues. Promotion of physical activity can especially benefit from a multi-sectoral approach. Despite so much emphasis on its importance in both primary health and health promotion, ISC has been underachieved in the field. This study aimed to examine the characteristics and level of ISC among physical activity programs in Healthy Cities as compared to non-Healthy Cities. I conducted a postal survey where 24 people from Healthy Cities and 72 people from non-Healthy Cities participated. The survey included questions to measure the level of ISC as well as to determine ISC partners and activities. Among the entire 393 physical activity programs, 336 (85.5%) had some kind of collaboration with one or more partners. The percentage having one or more partners was greater in Healthy Cities than in non-Healthy Cities. However, there were no statistical differences between the two groups in terms of the level of ISC within a municipal organization. Collaboration activities of the other departments were mostly supportive, such as providing a venue, recruiting participants and publicizing, and other kinds of administrative support. To strengthen ISC in Korean Healthy Cities, various actions including providing a legal basis, specific and substantive supports, financial incentives, and organizational recognitions will be helpful as well as the development of partnerships with other departments in urban planning, transport, urban design, and communication. © The Author 2015. Published by Oxford University Press. All rights reserved. For Permissions, please email: journals.permissions@oup.com.

Perceptions of partnership. A documentary analysis of Health Improvement Programmes.

PubMed

Elston, J; Fulop, N

2002-07-01

Health Improvement Programmes (HImPs) are at the heart of the UK government's partnership agenda for the National Health Service (NHS). This paper assesses the nature of HImP partnerships in England by analysing 50/99 first-round HImP strategies (randomly selected). The documentary analysis quantifies the structures and mechanisms of partnership, the degree of inter-sectoral participation and the extent of voluntary sector involvement.Three-quarters of responding health authorities (37/50) appear to have set up formal partnership structures to produce the HImP, or are planning to do so. After health authorities, local authorities (47/50) appear to be most involved in contributing to the HImP, particularly social services departments. Within the NHS 'family', acute and community trusts (43/50) appear to be the most involved, with Primary Care Groups (PCGs) contributing less (39/40). Community Health Councils (CHCs) appear to be similarly involved (40/50). The voluntary sector appear to be involved in all but four HImPs, mainly through umbrella organisations represented on strategic partnership boards (34/50). User and carer and community groups appear to participate far less. Lack of endorsement of HImPs by partner organisations, poor delineation of responsibilities and absence of transparency in resource allocation suggest that ownership of, and commitment to HImPs may be weak. HImPs appear to have focused on creating structures rather than developing aspects of partnership process. If levels of inter-sectoral involvement and voluntary sector participation are to be maintained or increased in future, Primary Care Trusts (PCTs) will need to develop a strategic approach to partnership.

Mapping primary health care renewal in South America.

PubMed

Acosta Ramírez, Naydú; Giovanella, Ligia; Vega Romero, Roman; Tejerina Silva, Herland; de Almeida, Patty Fidelis; Ríos, Gilberto; Goede, Hedwig; Oliveira, Suelen

2016-06-01

Primary health care (PHC) renewal processes are currently ongoing in South America (SA), but their characteristics have not been systematically described. The study aimed to describe and contrast the PHC approaches being implemented in SA to provide knowledge of current conceptions, models and challenges. This multiple case study used a qualitative approach with technical visits to health ministries in order to apply key-informant interviews of 129 PHC national policy makers and 53 local managers, as well as field observation of 57 selected PHC providers and document analysis, using a common matrix for data collection and analysis. PHC approaches were analysed by triangulating sources using the following categories: PHC philosophy and conception, service provision organization, intersectoral collaboration and social participation. Primary health care models were identified in association with existing health system types and the dynamics of PHC renewal in each country. A neo-selective model was found in three countries where coverage is segmented by private and public regimes; here, individual and collective care are separated. A comprehensive approach similar to the Alma-Ata model was found in seven countries where the public sector predominates and individual, family and community care are coordinated under the responsibility of the same health care team. The process of implementing a renewed PHC approach is affected by how health systems are funded and organized. Both models face many obstacles. In addition, care system organization, intersectoral coordination and social participation are weak in most of the countries. © The Author 2016. Published by Oxford University Press. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com.

Enhancing Schistosomiasis Control Strategy for Zimbabwe: Building on Past Experiences

PubMed Central

Chimbari, Moses J.

2012-01-01

Schistosoma haematobium and Schistosoma mansoni are prevalent in Zimbabwe to levels that make schistosomiasis a public health problem. Following three national surveys to map the disease prevalence, a national policy on control of schistosomiasis and soil transmitted helminths is being developed. This paper reviews the experiences that Zimbabwe has in the area of schistosomiasis control with a view to influence policy. A case study approach to highlight key experiences and outcomes was adopted. The benefits derived from intersectoral collaboration that led to the development of a model irrigation scheme that incorporates schistosomiasis control measures are highlighted. Similarly, the benefits of using plant molluscicides and fish and duck biological agents (Sargochromis codringtonii and Cairina moschata) are highlighted. Emphasis was also placed on the importance of utilizing locally developed water and sanitation technologies and the critical human resource base in the area of schistosomiasis developed over years. After synthesis of the case studies presented, it was concluded that while there is a need to follow the WHO recommended guidelines for schistosomiasis control it is important to develop a control strategy that is informed by work already done in the country. The importance of having a policy and local guidelines for schistosomiasis control is emphasized. PMID:22655171

Holding fast: the experience of collaboration in a competitive environment.

PubMed

Fear, Heather; Barnett, Pauline

2003-03-01

Collaboration is one of the cornerstones of health promotion, with the literature indicating a range of circumstances under which it can either succeed or be undermined. In New Zealand in the 1990s, a market structure for health made collaboration of all kinds exceptionally difficult. This paper traces the efforts of a group of nutrition agencies (Agencies for Nutrition Action) to defy the popular wisdom and persist with collaborative efforts. The agencies were unsuccessful in their attempts to develop joint campaigns, but were very successful in advocacy and intersectoral action that did not threaten the position of individual agencies in the competitive environment. It is possible that the collaboration could have been more effective if agencies had been willing to surrender some autonomy and commit themselves to supporting a more independent new organization. However, this would have compromised not only their individual integrity but also their commitment to a relationship of equals. In 'holding fast' to a belief in health promotion, the ANA resisted being coopted by a now discredited market system, and emerged with its integrity and that of its participating agencies intact. ANA is now well positioned to work within an emerging policy environment that is more supportive of health promotion.

The experience of SARS-related stigma at Amoy Gardens.

PubMed

Lee, Sing; Chan, Lydia Y Y; Chau, Annie M Y; Kwok, Kathleen P S; Kleinman, Arthur

2005-11-01

Severe Acute Respiratory Syndrome (SARS) possesses characteristics that render it particularly prone to stigmatization. SARS-related stigma, despite its salience for public health and stigma research, has had little examination. This study combines survey and case study methods to examine subjective stigma among residents of Amoy Gardens (AG), the first officially recognized site of community outbreak of SARS in Hong Kong. A total of 903 residents of AG completed a self-report questionnaire derived from two focus groups conducted toward the end of the 3-month outbreak. Case studies of two residents who lived in Block E, the heart of the SARS epidemic at AG, complement the survey data. Findings show that stigma affected most residents and took various forms of being shunned, insulted, marginalized, and rejected in the domains of work, interpersonal relationships, use of services and schooling. Stigma was also associated with psychosomatic distress. Residents' strategies for diminishing stigma varied with gender, age, education, occupation, and proximity to perceived risk factors for SARS such as residential location, previous SARS infection and the presence of ex-SARS household members. Residents attributed stigma to government mismanagement, contagiousness of the mysterious SARS virus, and alarmist media reporting. Stigma clearly decreased, but never completely disappeared, after the outbreak. The findings confirm and add to existing knowledge on the varied origins, correlates, and impacts of stigma. They also highlight the synergistic roles of inconsistent health policy responses and risk miscommunication by the media in rapidly amplifying stigma toward an unfamiliar illness. While recognizing the intrinsically stigmatizing nature of public health measures to control SARS, we recommend that a consistent inter-sectoral approach is needed to minimize stigma and to make an effective health response to future outbreaks.

New norms new policies: Did the Adelaide Thinkers in Residence scheme encourage new thinking about promoting well-being and Health in All Policies?

PubMed

Baum, Fran; Lawless, Angela; MacDougall, Colin; Delany, Toni; McDermott, Dennis; Harris, Elizabeth; Williams, Carmel

2015-12-01

Health systems have long been criticised for focussing on curing rather than preventing disease. This paper examines to what extent the Adelaide Thinkers in Residence (ATiR) scheme contributed to the change in norms whereby promoting well-being and a strategy to achieve this - Health in All Policies (HiAP)--was adopted by the South Australian (SA) State Government from 2007. The data presented in this paper are drawn from a five year (2012-2016) detailed mixed methods case study of the SA HiAP initiative which involved document analysis, interviews and workshops with public servants and political actors. We adapt the framework used by Finnemore and Sikkink (1998) which explains how norm changes can lead to political changes in international affairs. We also use Kingdon's concept of policy entrepreneurs to determine whether these ideas moved to an implementable initiative with the help of both a specific ATiR program on HiAP and the broader TiR scheme which promoted a series of innovations relevant to health. The process involved the ATiR reinforcing the work of local norm entrepreneurs with that of powerful external policy entrepreneurs, adapting the discourse about the value of prevention and promoting well-being so that it fitted with the dominant economic one. The powerful organisational platform of the ATiR, which was under the Department of the Premier and Cabinet and linked to the South Australian Strategic Plan (SASP) was used to advance these ideas. The case study offers important lessons for other jurisdictions on how to shift policy to encourage intersectoral approaches to health. Copyright © 2015 Elsevier Ltd. All rights reserved.

Performance-based financing as a health system reform: mapping the key dimensions for monitoring and evaluation

PubMed Central

2013-01-01

Background Performance-based financing is increasingly being applied in a variety of contexts, with the expectation that it can improve the performance of health systems. However, while there is a growing literature on implementation issues and effects on outputs, there has been relatively little focus on interactions between PBF and health systems and how these should be studied. This paper aims to contribute to filling that gap by developing a framework for assessing the interactions between PBF and health systems, focusing on low and middle income countries. In doing so, it elaborates a general framework for monitoring and evaluating health system reforms in general. Methods This paper is based on an exploratory literature review and on the work of a group of academics and PBF practitioners. The group developed ideas for the monitoring and evaluation framework through exchange of emails and working documents. Ideas were further refined through discussion at the Health Systems Research symposium in Beijing in October 2012, through comments from members of the online PBF Community of Practice and Beijing participants, and through discussion with PBF experts in Bergen in June 2013. Results The paper starts with a discussion of definitions, to clarify the core concept of PBF and how the different terms are used. It then develops a framework for monitoring its interactions with the health system, structured around five domains of context, the development process, design, implementation and effects. Some of the key questions for monitoring and evaluation are highlighted, and a systematic approach to monitoring effects proposed, structured according to the health system pillars, but also according to inputs, processes and outputs. Conclusions The paper lays out a broad framework within which indicators can be prioritised for monitoring and evaluation of PBF or other health system reforms. It highlights the dynamic linkages between the domains and the different pillars. All of these are also framed within inter-sectoral and wider societal contexts. It highlights the importance of differentiating short term and long term effects, and also effects (intended and unintended) at different levels of the health system, and for different sectors and areas of the country. Outstanding work will include using and refining the framework and agreeing on the most important hypotheses to test using it, in relation to PBF but also other purchasing and provider payment reforms, as well as appropriate research methods to use for this task. PMID:24073625

Is the Alma Ata vision of comprehensive primary health care viable? Findings from an international project

PubMed Central

Labonté, Ronald; Sanders, David; Packer, Corinne; Schaay, Nikki

2014-01-01

Background The 4-year (2007–2011) Revitalizing Health for All international research program (http://www.globalhealthequity.ca/projects/proj_revitalizing/index.shtml) supported 20 research teams located in 15 low- and middle-income countries to explore the strengths and weaknesses of comprehensive primary health care (CPHC) initiatives at their local or national levels. Teams were organized in a triad comprised of a senior researcher, a new researcher, and a ‘research user’ from government, health services, or other organizations with the authority or capacity to apply the research findings. Multiple regional and global team capacity-enhancement meetings were organized to refine methods and to discuss and assess cross-case findings. Objective Most research projects used mixed methods, incorporating analyses of qualitative data (interviews and focus groups), secondary data, and key policy and program documents. Some incorporated historical case study analyses, and a few undertook new surveys. The synthesis of findings in this report was derived through qualitative analysis of final project reports undertaken by three different reviewers. Results Evidence of comprehensiveness (defined in this research program as efforts to improve equity in access, community empowerment and participation, social and environmental health determinants, and intersectoral action) was found in many of the cases. Conclusions Despite the important contextual differences amongst the different country studies, the similarity of many of their findings, often generated using mixed methods, attests to certain transferable health systems characteristics to create and sustain CPHC practices. These include:  Well-trained and supported community health workers (CHWs) able to work effectively with marginalized communities Effective mechanisms for community participation, both informal (through participation in projects and programs, and meaningful consultation) and formal (though program management structures) Co-partnership models in program and policy development (in which financial and knowledge supports from governments or institutions are provided to communities, which retain decision-making powers in program design and implementation) Support for community advocacy and engagement in health and social systems decision making These characteristics, in turn, require a political context that supports state responsibilities for redistributive health and social protection measures. PMID:25150030

Is the Alma Ata vision of comprehensive primary health care viable? Findings from an international project.

PubMed

Labonté, Ronald; Sanders, David; Packer, Corinne; Schaay, Nikki

2014-01-01

The 4-year (2007-2011) Revitalizing Health for All international research program (http://www.globalhealthequity.ca/projects/proj_revitalizing/index.shtml) supported 20 research teams located in 15 low- and middle-income countries to explore the strengths and weaknesses of comprehensive primary health care (CPHC) initiatives at their local or national levels. Teams were organized in a triad comprised of a senior researcher, a new researcher, and a 'research user' from government, health services, or other organizations with the authority or capacity to apply the research findings. Multiple regional and global team capacity-enhancement meetings were organized to refine methods and to discuss and assess cross-case findings. Most research projects used mixed methods, incorporating analyses of qualitative data (interviews and focus groups), secondary data, and key policy and program documents. Some incorporated historical case study analyses, and a few undertook new surveys. The synthesis of findings in this report was derived through qualitative analysis of final project reports undertaken by three different reviewers. Evidence of comprehensiveness (defined in this research program as efforts to improve equity in access, community empowerment and participation, social and environmental health determinants, and intersectoral action) was found in many of the cases. Despite the important contextual differences amongst the different country studies, the similarity of many of their findings, often generated using mixed methods, attests to certain transferable health systems characteristics to create and sustain CPHC practices. These include:1. Well-trained and supported community health workers (CHWs) able to work effectively with marginalized communities2. Effective mechanisms for community participation, both informal (through participation in projects and programs, and meaningful consultation) and formal (though program management structures)3. Co-partnership models in program and policy development (in which financial and knowledge supports from governments or institutions are provided to communities, which retain decision-making powers in program design and implementation)4. Support for community advocacy and engagement in health and social systems decision makingThese characteristics, in turn, require a political context that supports state responsibilities for redistributive health and social protection measures.

Operationalisation of service quality in household waste collection.

PubMed

Schulte, Nico Alexander; Gellenbeck, Klaus; Nelles, Michael

2017-04-01

Since 2007, there has been intensive discussion at European and national levels concerning the standardisation of services including those in the sector of waste management. The drafts of the European standard prEN 16250 and the German preliminary standard DIN SPEC 1108 are intended to establish a uniform definition of corresponding services and their (minimum) service levels. Their binding application in practice requires that systematic inspections be provided to ascertain to what degree a service has been carried out as agreed upon. However, both standardisation projects give only a few examples of potential quality characteristics and offer no concrete information concerning methods of measurement. Because intersectoral or cross-service quality inspections do not exist, there is a need for the development of specific quality inspections. The study introduced in this article examines the question of how the service quality of door-to-door waste collection can be systematically measured. To this end, the quality concept applied to the process of waste collection was first concretised and then operationalised using indicators. Based upon this, the methods of the quality inspections were developed and subjected to a trial of their applicability in a German waste management company. The methods for measuring and evaluating take into account, in addition to the different boundary conditions of collection, also the possible customer influence on the collection process and consequently on the service performed by the collection crew. In order to avoid time- and therefore cost-intensive exhaustive surveys, a multilevel random-controlled selection of survey units was developed, too. Based on the analysis of the measurement data, it was possible to determine specific time requirement values for the regular performance of the data surveys, as well as minimum sample sizes as a function of the number of container locations of the waste collection tours. On the basis of this information, it has been possible to make initial statements concerning the personnel requirement for quality inspections. Moreover, it is possible to make recommendations concerning the daily working-time schedule for a quality manager in order to achieve the most efficient performance of quality inspections possible. Copyright © 2017 Elsevier Ltd. All rights reserved.

Interorganisational Integration: Healthcare Professionals’ Perspectives on Barriers and Facilitators within the Danish Healthcare System

PubMed Central

Godtfredsen, Nina Skavlan; Frølich, Anne

2016-01-01

Introduction: Despite many initiatives to improve coordination of patient pathways and intersectoral cooperation, Danish health care is still fragmented, lacking intra- and interorganisational integration. This study explores barriers to and facilitators of interorganisational integration as perceived by healthcare professionals caring for patients with chronic obstructive pulmonary disease within the Danish healthcare system. Methods: Seven focus groups were conducted in January through July 2014 with 21 informants from general practice, local healthcare centres and a pulmonary department at a university hospital in the Capital Region of Denmark. Results and discussion: Our results can be grouped into five influencing areas for interorganisational integration: communication/information transfer, committed leadership, patient engagement, the role and competencies of the general practitioner and organisational culture. Proposed solutions to barriers in each area hold the potential to improve care integration as experienced by individuals responsible for supporting and facilitating it. Barriers and facilitators to integrating care relate to clinical, professional, functional and normative integration. Especially, clinical, functional and normative integration seems fundamental to developing integrated care in practice from the perspective of healthcare professionals. PMID:27616948

Air Emissions Damages from Municipal Drinking Water Treatment Under Current and Proposed Regulatory Standards.

PubMed

Gingerich, Daniel B; Mauter, Meagan S

2017-09-19

Water treatment processes present intersectoral and cross-media risk trade-offs that are not presently considered in Safe Drinking Water Act regulatory analyses. This paper develops a method for assessing the air emission implications of common municipal water treatment processes used to comply with recently promulgated and proposed regulatory standards, including concentration limits for, lead and copper, disinfection byproducts, chromium(VI), strontium, and PFOA/PFOS. Life-cycle models of electricity and chemical consumption for individual drinking water unit processes are used to estimate embedded NO x , SO 2 , PM 2.5 , and CO 2 emissions on a cubic meter basis. We estimate air emission damages from currently installed treatment processes at U.S. drinking water facilities to be on the order of $500 million USD annually. Fully complying with six promulgated and proposed rules would increase baseline air emission damages by approximately 50%, with three-quarters of these damages originating from chemical manufacturing. Despite the magnitude of these air emission damages, the net benefit of currently implemented rules remains positive. For some proposed rules, however, the promise of net benefits remains contingent on technology choice.

The role of health promotion: between global thinking and local action.

PubMed

King, Lesley

2006-12-01

The persistence of health inequities provides an ongoing challenge for health promotion. The dictum 'think globally, act locally' fails to recognise the significance of infrastructure and policy in linking global issues and local practices as a means of addressing health inequities. Commentary and opinion. Through analytic tools and methods, health promotion has much to contribute to facilitating health-improving changes in social, economic and physical environments. Local actions provide excellent illustrations of organisational change and intersectoral action, and present the possibility that such actions could be widely implemented. While this has occurred on some issues, this is not usually the case. Political support, policy and infrastructure are required to link global ideas and local actions and overcome the impasse. Media advocacy is one example of an approach with potential to make these links and mobilise political support. Reframing media and political discussion, away from the dichotomy of individual responsibility and government intervention and towards acknowledging the social context of human behaviour, could contribute to policy and social environments with greater capacity to address inequities.

[An assessment of the Family Health Program in municipalities of Northeast Brazil: old and new challenges].

PubMed

Rocha, Paulo de Medeiros; Uchoa, Alice da Costa; Rocha, Nadja de Sá Pinto Dantas; Souza, Elizabethe Cristina Fagundes de; Rocha, Marconi de Lima; Pinheiro, Themis Xavier de Albuquerque

2008-01-01

This article presents part of the results from the Baseline Studies, an evaluative research conducted in 21 municipalities with more than 100,000 inhabitants each, in three States of Northeast Brazil. The overall objective was to assess experiences in the implementation of the Family Health Program (FHP), with a focus on inductions in the PROESF. An implementation analysis was performed, using the case study method. The analysis focused on these dimensions: political-institutional, health organization, and comprehensive care. Outstanding advances included: prioritize the FHP in high-risk areas; institutional learning, with qualification of managers and teams; definition of institutional levels for regulating the FHP; and health team-user bonds and positive perceptions concerning the program. Challenges included: strengthening of local policy and decision-making capacity; allocation of primary care resources; greater employment security for human resources; effective implementation of the health care network; strengthening of social participation; upgrading of monitoring and evaluation for decision-making; receptivity; waiting lines for tests, appointments, and hospital admissions; implementation of teamwork; health promotion and inter-sector activities.

Approach Towards an Evidence-Oriented Knowledge and Data Acquisition for the Optimization of Interdisciplinary Care in Dentistry and General Medicine.

PubMed

Seitz, Max W; Haux, Christian; Knaup, Petra; Schubert, Ingrid; Listl, Stefan

2018-01-01

Associations between dental and chronic-systemic diseases were observed frequently in medical research, however the findings of this research have so far found little relevance in everyday clinical treatment. Major problems are the assessment of evidence for correlations between such diseases and how to integrate current medical knowledge into the intersectoral care of dentists and general practitioners. On the example of dental and chronic-systemic diseases, the Dent@Prevent project develops an interdisciplinary decision support system (DSS), which provides the specialists with information relevant for the treatment of such cases. To provide the physicians with relevant medical knowledge, a mixed-methods approach is developed to acquire the knowledge in an evidence-oriented way. This procedure includes a literature review, routine data analyses, focus groups of dentists and general practitioners as well as the identification and integration of applicable guidelines and Patient Reported Measures (PRMs) into the treatment process. The developed mixed methods approach for an evidence-oriented knowledge acquisition indicates to be applicable and supportable for interdisciplinary projects. It can raise the systematic quality of the knowledge-acquisition process and can be applicable for an evidence-based system development. Further research is necessary to assess the impact on patient care and to evaluate possible applicability in other interdisciplinary areas.

Prerequisites for effective condom promotion campaigns.

PubMed

Spencer, B

1992-01-01

Before delving ahead to promote the acceptance and use of condoms, planners should make sure the institutional environment for the process is as favorable as possible. This may include lobbying officials to abolish import duties, legislation, or codes of practice which prohibit advertising. It may also be necessary to provide professional education. The author highly recommends intersectoral collaboration in both the promotion of health and the marketing of products. The following basic marketing concepts are stressed and briefly discussed: ensure the appropriate good quality product; plan and maintain wide distribution; promote through whatever means possible; and fix the right price.

Web-based access, aggregation, and visualization of future climate projections with emphasis on agricultural assessments

NASA Astrophysics Data System (ADS)

Villoria, Nelson B.; Elliott, Joshua; Müller, Christoph; Shin, Jaewoo; Zhao, Lan; Song, Carol

2018-01-01

Access to climate and spatial datasets by non-specialists is restricted by technical barriers involving hardware, software and data formats. We discuss an open-source online tool that facilitates downloading the climate data from the global circulation models used by the Inter-Sectoral Impacts Model Intercomparison Project. The tool also offers temporal and spatial aggregation capabilities for incorporating future climate scenarios in applications where spatial aggregation is important. We hope that streamlined access to these data facilitates analysis of climate related issues while considering the uncertainties derived from future climate projections and temporal aggregation choices.

Antimicrobial resistance—a threat to the world’s sustainable development

PubMed Central

Jasovský, Dušan; Littmann, Jasper; Zorzet, Anna; Cars, Otto

2016-01-01

This commentary examines how specific sustainable development goals (SDGs) are affected by antimicrobial resistance and suggests how the issue can be better integrated into international policy processes. Moving beyond the importance of effective antibiotics for the treatment of acute infections and health care generally, we discuss how antimicrobial resistance also impacts on environmental, social, and economic targets in the SDG framework. The paper stresses the need for greater international collaboration and accountability distribution, and suggests steps towards a broader engagement of countries and United Nations agencies to foster global intersectoral action on antimicrobial resistance. PMID:27416324

Impact of MPH programs: contributing to health system strengthening in low- and middle-income countries?

PubMed

Zwanikken, Prisca A C; Alexander, Lucy; Scherpbier, Albert

2016-08-22

The "health workforce" crisis has led to an increased interest in health professional education, including MPH programs. Recently, it was questioned whether training of mid- to higher level cadres in public health prepared graduates with competencies to strengthen health systems in low- and middle-income countries. Measuring educational impact has been notoriously difficult; therefore, innovative methods for measuring the outcome and impact of MPH programs were sought. Impact was conceptualized as "impact on workplace" and "impact on society," which entailed studying how these competencies were enacted and to what effect within the context of the graduates' workplaces, as well as on societal health. This is part of a larger six-country mixed method study; in this paper, the focus is on the qualitative findings of two English language programs, one a distance MPH program offered from South Africa, the other a residential program in the Netherlands. Both offer MPH training to students from a diversity of countries. In-depth interviews were conducted with 10 graduates (per program), working in low- and middle-income health systems, their peers, and their supervisors. Impact on the workplace was reported as considerable by graduates and peers as well as supervisors and included changes in management and leadership: promotion to a leadership position as well as expanded or revitalized management roles were reported by many participants. The development of leadership capacity was highly valued amongst many graduates, and this capacity was cited by a number of supervisors and peers. Wider impact in the workplace took the form of introducing workplace innovations such as setting up an AIDS and addiction research center and research involvement; teaching and training, advocacy, and community engagement were other ways in which graduates' influence reached a wider target grouping. Beyond the workplace, an intersectoral approach, national reach through policy advisory roles to Ministries of Health, policy development, and capacity building, was reported. Work conditions and context influenced conduciveness for innovation and the extent to which graduates were able to have effect. Self-selection of graduates and their role in selecting peers and supervisors may have resulted in some bias, some graduates could not be traced, and social acceptability bias may have influenced findings. There was considerable impact at many levels; graduates were perceived to be able to contribute significantly to their workplaces and often had influence at the national level. Much of the impact described was in line with public health educational aims. The qualitative method study revealed more in-depth understanding of graduates' impact as well as their career pathways.

The links between agriculture and health: an intersectoral opportunity to improve the health and livelihoods of the poor.

PubMed Central

Hawkes, Corinna; Ruel, Marie

2006-01-01

Agriculture and health are linked in many ways. First, agriculture is essential for good health: it produces the world's food, fibre and materials for shelter; in many countries it is also an important source of livelihood among the poor. At the same time, agriculture can be linked with poor health, including malnutrition, malaria, foodborne illnesses, human immunodeficiency virus/acquired immunodeficiency syndrome (HIV/AIDS), livestock-related diseases, chronic diseases and occupational ill-health. Health also affects agriculture: people's health status influences the demand for agricultural outputs, and in agricultural communities, poor health reduces work performance, reducing income and productivity and perpetuating a downward spiral into ill-health. This paper presents an overview of the bidirectional links between agriculture and health with a focus on the developing world. It develops a conceptual framework that brings together the various links between agriculture and health into a single broad framework. The framework comprises the core components of the agricultural supply chain (producers, systems and outputs), key health concerns and the mechanisms of common interaction between the agricultural and health components: income, labour, environment and access -- all key social determinants of health. These links between agriculture and health present an opportunity for the two sectors to work together to find solutions to each other's problems. Yet the health and agricultural sectors remain poorly coordinated. Leadership from global health and agricultural institutions is needed to build policies and good governance to facilitate integration, while capacity building is needed at all levels to help translate the conceptual links into comprehensive action on the ground. Health and agricultural researchers likewise need to work more closely together to achieve common goals. PMID:17242835

A stitch in time saves nine? A repeated cross-sectional case study on the implementation of the intersectoral community approach Youth At a Healthy Weight.

PubMed

van der Kleij, Rianne M J J; Crone, Mathilde R; Paulussen, Theo G W M; van de Gaar, Vivan M; Reis, Ria

2015-10-08

The implementation of programs complex in design, such as the intersectoral community approach Youth At a Healthy Weight (JOGG), often deviates from their application as intended. There is limited knowledge of their implementation processes, making it difficult to formulate sound implementation strategies. For two years, we performed a repeated cross-sectional case study on the implementation of a JOGG fruit and water campaign targeting children age 0-12. Semi-structured observations, interviews, field notes and professionals' logs entries were used to evaluate implementation process. Data was analyzed via a framework approach; within-case and cross-case displays were formulated and key determinants identified. Principles from Qualitative Comparative Analysis (QCA) were used to identify causal configurations of determinants per sector and implementation phase. Implementation completeness differed, but was highest in the educational and health care sector, and higher for key than additional activities. Determinants and causal configurations of determinants were mostly sector- and implementation phase specific. High campaign ownership and possibilities for campaign adaptation were most frequently mentioned as facilitators. A lack of reinforcement strategies, low priority for campaign use and incompatibility of own goals with campaign goals were most often indicated as barriers. We advise multiple 'stitches in time'; tailoring implementation strategies to specific implementation phases and sectors using both the results from this study and a mutual adaptation strategy in which professionals are involved in the development of implementation strategies. The results of this study show that the implementation process of IACOs is complex and sustainable implementation is difficult to achieve. Moreover, this study reveals that the implementation process is influenced by predominantly sector and implementation phase specific (causal configurations of) determinants.

Attitudes Toward e-Health: The Otolaryngologists' Point of View.

PubMed

Holderried, Martin; Hoeper, Ansgar; Holderried, Friederike; Blumenstock, Gunnar; Ernst, Christian; Tropitzsch, Anke

2018-06-01

Online communication and the number of e-health applications have noticeably increased. However, little is known about the otolaryngologists' use behavior and their attitudes toward the potential of e-health. The aims of the study were to evaluate the documentation, information, and communication technologies used by otolaryngologists and to get a better understanding of their attitudes toward the potential of e-health for cross-sectoral patient care. A survey was developed and tested by otolaryngologists, healthcare-information technology experts, and health services researchers. A total of 334 otolaryngologists in private practice were asked to participate in this cross-sectional study. In total, 234 of them took part in the study, and 157 returned completed questionnaires. Statistical analysis was performed by using crosstabs, including chi-square tests, and multivariate logistic regressions. Results and Materials: Digital technologies are widely used by otolaryngologists (e.g., 89.6% use an electronic health record). However, the majority of intersectoral communication is still based on analogue techniques (e.g., fax use in 63.7%). From the otolaryngologists' perspectives, the potential of e-health for intersectoral care is mostly in appointment scheduling, further referrals to hospitals, and automated appointment reminders. The physicians' attitudes toward e-health are associated with their Internet use behavior in daily life (odds ratio = 4.30, confidence interval 1.11-16.64, p = 0.035) but not with their demographics. The otolaryngologists are well prepared and have an overall positive attitude toward e-health for deeper use in cross-sectoral care. Therefore, e-health in otolaryngology needs more attention and resources for further studies, especially with a focus on quality and safety of care.

Development and implementation of FRESH--a post-secondary nutrition education program incorporating population strategies, experiential learning and intersectoral partnerships.

PubMed

Matthews, June I; Zok, Anne V; Quenneville, Emily P M; Dworatzek, Paula D N

2014-07-11

The FRESH (Food Resources and Education for Student Health) peer nutrition education program engages undergraduate and graduate students in experiential learning to improve the campus food and nutrition environment and promote healthy behaviours among university students. University students in general, and graduate and undergraduate food and nutrition students as program designers and peer educators, respectively. Large university campus in southwestern Ontario. A peer nutrition education program, utilizing multiple population strategies and intersectoral partnerships, was created by and for university students with faculty and food service personnel as mentors. The population health strategies employed were building awareness and program branding; developing personal skills through peer nutrition education and hands-on cooking demonstrations; and creating supportive environments through incentive programs for fruit and dairy as well as point-of-purchase menu labelling. The program has reached students, staff and faculty through over 60 interactive FRESH displays and education sessions. Website and social media have also had a significant reach with over 4,000 website visits and 277 Facebook "likes". FRESH has also improved the food environment for over 5,000 students in residence, e.g., 1,931 FRESH Fruit/Dairy Cards have been returned for free fruit/milk cartons. Graduate students in Foods and Nutrition continue to participate every year (cumulative n=60) in ongoing program development. Peer educators have developed enhanced leadership, public speaking and group facilitation skills, and the ability to creatively apply what they have learned in the classroom to new contexts. Increased nutrition knowledge and an improved food environment could, over the long term, support improved university student health.

Lessons from the Chilean earthquake: how a human rights framework facilitates disaster response.

PubMed

Arbour, MaryCatherine; Murray, Kara; Arriet, Felipe; Moraga, Cecilia; Vega, Miguel Cordero

2011-07-14

The earthquake of 2010 in Chile holds important lessons about how a rights-based public health system can guide disaster response to protect vulnerable populations. This article tells the story of Chile Grows With You (Chile Crece Contigo), an intersectoral system created three years before the earthquake for protection of child rights and development, and its role in the disaster response. The creation of Chile Grows With You with an explicit rights-oriented mandate established intersectoral mechanisms, relationships, and common understanding between governmental groups at the national and local levels. After the earthquake, Chile Grows With You organized its activities according to its founding principles: it provided universal access and support for all Chilean children, with special attention and services for those at greatest risk. This tiered approach involved public health and education materials for all children and families; epidemiologic data for local planners about children in their municipalities at-risk before the earthquake; and an instrument developed to assist in the assessment and intervention of children put at risk by the earthquake. This disaster response illustrates how a rights-based framework defined and operationalized in times of stability facilitated organization, prioritization, and sustained action to protect and support children and families in the acute aftermath of the earthquake, despite a change in government from a left-wing to a right-wing president, and into the early recovery period. Copyright © 2011 Arbour, Murray, Arriet, Moraga, and Vega. This is an open access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/3.0/), which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original author and source are credited.

Consultation and remediation in the north: meeting international commitments to safeguard health and well-being.

PubMed

Banfield, Laura; Jardine, Cynthia G

2013-01-01

International commitments exist for the safeguarding of health and the prevention of ill health. One of the earliest commitments is the Declaration of Alma-Ata (1978), which provides 5 principles guiding primary health care: equity, community participation, health promotion, intersectoral collaboration and appropriate technology. These broadly applicable international commitments are premised on the World Health Organization's multifaceted definition of health. The environment is one sector in which these commitments to safeguarding health can be applied. Giant Mine, a contaminated former gold mine in the Northwest Territories, Canada, represents potential threats to all aspects of health. Strategies for managing such threats usually involve an obligation to engage the affected communities through consultation. To examine the remediation and consultation process associated with Giant Mine within the context of commitments to safeguard health and well-being through adapting and applying the principles of primary health care. Semi-structured interviews with purposively selected key informants representing government proponents and community members were conducted. in reviewing themes which emerged from a series of interviews exploring the community consultation process for the remediation of Giant Mine, the principles guiding primary health were mapped to CONSULTATION IN the North: (a) "equity" is the capacity to fairly and meaningfully participate in the consultation; (b) "community participation" is the right to engage in the process through reciprocal dialogue; (c) "health promotion" represents the need for continued information sharing towards awareness; (d) "intersectoral collaboration" signifies the importance of including all stakeholders; and (e) "appropriate technology" is the need to employ the best remediation actions relevant to the site and the community. Within the context of mining remediation, these principles form an appropriate framework for viewing consultation as a means of meeting international obligations to safeguard health.

Risk of Zika virus transmission in the Euro-Mediterranean area and the added value of building preparedness to arboviral threats from a One Health perspective.

PubMed

Escadafal, Camille; Gaayeb, Lobna; Riccardo, Flavia; Pérez-Ramírez, Elisa; Picard, Marie; Dente, Maria Grazia; Fernández-Pinero, Jovita; Manuguerra, Jean-Claude; Jiménez-Clavero, Miguel-Ángel; Declich, Silvia; Victoir, Kathleen; Robert, Vincent

2016-12-03

In the alarming context of risk of Zika virus (ZIKV) transmission in the Euro-Mediterranean area, there is a need to examine whether capacities to detect, diagnose and notify ZIKV infections in the region are in place and whether ongoing capacity-building initiatives are filling existing gaps.The MediLabSecure network, created in 2014, comprises 55 laboratories of virology and medical entomology and 19 public health institutions in 19 countries in the Balkans, North-Africa, the Middle-East and the Black Sea regions. It aims to set up awareness, risk assessment, monitoring and control of emerging and re-emerging vector-borne viruses. We here examine the actions and strategies that MediLabSecure has been implementing and how they will contribute to the prevention and control of the ZIKV threat in the Euro-Mediterranean area.Capacity-building for arbovirus diagnostics is a major objective of the project and follows a methodological rather than disease-driven approach. This enables the implementation of laboratory trainings on techniques that are common to several arboviruses, including ZIKV, and putting into action appropriate diagnostic tools in the target region.Moreover, by its One Health approach and the interaction of its four sub-networks in human virology, animal virology, medical entomology and public health, MediLabSecure is fostering intersectoral collaboration, expertise and sharing of information. The resulting exchanges (methodological, communication and operational) across disciplines and across countries, dedicated research on intersectoral collaboration and increasing diagnostic capacities are providing new paths and tools to public health professionals to face emerging viral threats such as a ZIKV epidemic in the Euro-Mediterranean region.

Health-Related Resource-Use Measurement Instruments for Intersectoral Costs and Benefits in the Education and Criminal Justice Sectors.

PubMed

Mayer, Susanne; Paulus, Aggie T G; Łaszewska, Agata; Simon, Judit; Drost, Ruben M W A; Ruwaard, Dirk; Evers, Silvia M A A

2017-09-01

Intersectoral costs and benefits (ICBs), i.e. costs and benefits of healthcare interventions outside the healthcare sector, can be a crucial component in economic evaluations from the societal perspective. Pivotal to their estimation is the existence of sound resource-use measurement (RUM) instruments; however, RUM instruments for ICBs in the education or criminal justice sectors have not yet been systematically collated or their psychometric quality assessed. This review aims to fill this gap. To identify relevant instruments, the Database of Instruments for Resource Use Measurement (DIRUM) was searched. Additionally, a systematic literature review was conducted in seven electronic databases to detect instruments containing ICB items used in economic evaluations. Finally, studies evaluating the psychometric quality of these instruments were searched. Twenty-six unique instruments were included. Most frequently, ICB items measured school absenteeism, tutoring, classroom assistance or contacts with legal representatives, police custody/prison detainment and court appearances, with the highest number of items listed in the Client Service Receipt Inventory/Client Sociodemographic and Service Receipt Inventory/Client Service Receipt Inventory-Children's Version (CSRI/CSSRI/CSRI-C), Studying the Scope of Parental Expenditures (SCOPE) and Self-Harm Intervention, Family Therapy (SHIFT) instruments. ICBs in the education sector were especially relevant for age-related developmental disorders and chronic diseases, while criminal justice resource use seems more important in mental health, including alcohol-related disorders or substance abuse. Evidence on the validity or reliability of ICB items was published for two instruments only. With a heterogeneous variety of ICBs found to be relevant for several disease areas but many ICB instruments applied in one study only (21/26 instruments), setting-up an international task force to, for example, develop an internationally adaptable instrument is recommended.

ISI-MIP: The Inter-Sectoral Impact Model Intercomparison Project

NASA Astrophysics Data System (ADS)

Huber, V.; Dahlemann, S.; Frieler, K.; Piontek, F.; Schewe, J.; Serdeczny, O.; Warszawski, L.

2013-12-01

The Inter-Sectoral Impact Model Intercomparison Project (ISI-MIP) aims to synthesize the state-of-the-art knowledge of climate change impacts at different levels of global warming. The project's experimental design is formulated to distinguish the uncertainty introduced by the impact models themselves, from the inherent uncertainty in the climate projections and the variety of plausible socio-economic futures. The unique cross-sectoral scope of the project provides the opportunity to study cascading effects of impacts in interacting sectors and to identify regional 'hot spots' where multiple sectors experience extreme impacts. Another emphasis lies on the development of novel metrics to describe societal impacts of a warmer climate. We briefly outline the methodological framework, and then present selected results of the first, fast-tracked phase of ISI-MIP. The fast track brought together 35 global impact models internationally, spanning five sectors across human society and the natural world (agriculture, water, natural ecosystems, health and coastal infrastructure), and using the latest generation of global climate simulations (RCP projections from the CMIP5 archive) and socioeconomic drivers provided within the SSP process. We also introduce the second phase of the project, which will enlarge the scope of ISI-MIP by encompassing further impact sectors (e.g., forestry, fisheries, permafrost) and regional modeling approaches. The focus for the next round of simulations will be the validation and improvement of models based on historical observations and the analysis of variability and extreme events. Last but not least, we discuss the longer-term objective of ISI-MIP to initiate a coordinated, ongoing impact assessment process, driven by the entire impact community and in parallel with well-established climate model intercomparisons (CMIP).

Impact of the Jamaican birth cohort study on maternal, child and adolescent health policy and practice.

PubMed

McCaw-Binns, A; Ashley, D; Samms-Vaughan, M

2010-01-01

The Jamaica Perinatal Morbidity and Mortality Survey (JPMMS) was a national study designed to identify modifiable risk factors associated with poor maternal and perinatal outcome. Needing to better understand factors that promote or retard child development, behaviour and academic achievement, we conducted follow-up studies of the birth cohort. The paper describes the policy developments from the JPMMS and two follow-up rounds. The initial study (1986-87) documented 94% of all births and their outcomes on the island over 2 months (n = 10 508), and perinatal (n = 2175) and maternal deaths (n = 62) for a further 10 months. A subset of the birth cohort, identified by their date of birth through school records, was seen at ages 11-12 (n = 1715) and 15-16 years (n = 1563). Findings from the initial survey led to, inter alia, clinic-based screening for syphilis, referral high-risk clinics run by visiting obstetricians, and the redesign and construction of new labour wards at referral hospitals. The follow-up studies documented inadequate academic achievement among boys and children attending public schools, and associations between under- and over-nutrition, excessive television viewing (>20 h/week), inadequate parental supervision and behavioural problems. These contributed to the development of a television programming code for children, a National Parenting Policy, policies aimed at improving inter-sectoral services to children from birth to 5 years (Early Childhood Commission) and behavioural interventions of the Violence Prevention Alliance (an inter-sectoral NGO) and the Healthy Lifestyles project (Ministry of Health). Indigenous maternal and child health research provided a local evidence base that informed public policy. Collaboration, good communication, being vigilant to opportunities to influence policy, and patience has contributed to our success.

Can biomedical and traditional health care providers work together? Zambian practitioners' experiences and attitudes towards collaboration in relation to STIs and HIV/AIDS care: a cross-sectional study

PubMed Central

Kaboru, Berthollet Bwira; Falkenberg, Torkel; Ndubani, Phillimon; Höjer, Bengt; Vongo, Rodwell; Brugha, Ruairi; Faxelid, Elisabeth

2006-01-01

Background The World Health Organization's World health report 2006: Working together for health underscores the importance of human resources for health. The shortage of trained health professionals is among the main obstacles to strengthening low-income countries' health systems and to scaling up HIV/AIDS control efforts. Traditional health practitioners are increasingly depicted as key resources to HIV/AIDS prevention and care. An appropriate and effective response to the HIV/AIDS crisis requires reconsideration of the collaboration between traditional and biomedical health providers (THPs and BHPs). The aim of this paper is to explore biomedical and traditional health practitioners' experiences of and attitudes towards collaboration and to identify obstacles and potential opportunities for them to collaborate regarding care for patients with sexually transmitted infections (STIs) and HIV/AIDS. Methods We conducted a cross-sectional study in two Zambian urban sites, using structured questionnaires. We interviewed 152 biomedical health practitioners (BHPs) and 144 traditional health practitioners (THPs) who reported attending to patients with STIs and HIV/AIDS. Results The study showed a very low level of experience of collaboration, predominated by BHPs training THPs (mostly traditional birth attendants) on issues of safe delivery. Intersectoral contacts addressing STIs and HIV/AIDS care issues were less common. However, both groups of providers overwhelmingly acknowledged the potential role of THPs in the fight against HIV/AIDS. Obstacles to collaboration were identified at the policy level in terms of legislation and logistics. Lack of trust in THPs by individual BHPs was also found to inhibit collaboration. Nevertheless, as many as 40% of BHPs expressed an interest in working more closely with THPs. Conclusion There is indication that practitioners from both sectors seem willing to strengthen collaboration with each other. However, there are missed opportunities. The lack of collaborative framework integrating maternal health with STIs and HIV/AIDS care is at odds with the needed comprehensive approach to HIV/AIDS control. Also, considering the current human resources crisis in Zambia, substantial policy commitment is called for to address the legislative obstacles and the stigma reported by THPs and to provide an adequate distribution of roles between all partners, including traditional health practitioners, in the struggle against HIV/AIDS. PMID:16846497

Performance-based financing as a health system reform: mapping the key dimensions for monitoring and evaluation.

PubMed

Witter, Sophie; Toonen, Jurrien; Meessen, Bruno; Kagubare, Jean; Fritsche, György; Vaughan, Kelsey

2013-09-29

Performance-based financing is increasingly being applied in a variety of contexts, with the expectation that it can improve the performance of health systems. However, while there is a growing literature on implementation issues and effects on outputs, there has been relatively little focus on interactions between PBF and health systems and how these should be studied. This paper aims to contribute to filling that gap by developing a framework for assessing the interactions between PBF and health systems, focusing on low and middle income countries. In doing so, it elaborates a general framework for monitoring and evaluating health system reforms in general. This paper is based on an exploratory literature review and on the work of a group of academics and PBF practitioners. The group developed ideas for the monitoring and evaluation framework through exchange of emails and working documents. Ideas were further refined through discussion at the Health Systems Research symposium in Beijing in October 2012, through comments from members of the online PBF Community of Practice and Beijing participants, and through discussion with PBF experts in Bergen in June 2013. The paper starts with a discussion of definitions, to clarify the core concept of PBF and how the different terms are used. It then develops a framework for monitoring its interactions with the health system, structured around five domains of context, the development process, design, implementation and effects. Some of the key questions for monitoring and evaluation are highlighted, and a systematic approach to monitoring effects proposed, structured according to the health system pillars, but also according to inputs, processes and outputs. The paper lays out a broad framework within which indicators can be prioritised for monitoring and evaluation of PBF or other health system reforms. It highlights the dynamic linkages between the domains and the different pillars. All of these are also framed within inter-sectoral and wider societal contexts. It highlights the importance of differentiating short term and long term effects, and also effects (intended and unintended) at different levels of the health system, and for different sectors and areas of the country. Outstanding work will include using and refining the framework and agreeing on the most important hypotheses to test using it, in relation to PBF but also other purchasing and provider payment reforms, as well as appropriate research methods to use for this task.

Tackling health inequalities: moving theory to action.

PubMed

Signal, Louise; Martin, Jennifer; Reid, Papaarangi; Carroll, Christopher; Howden-Chapman, Philippa; Ormsby, Vera Keefe; Richards, Ruth; Robson, Bridget; Wall, Teresa

2007-10-03

This paper reports on health inequalities awareness-raising workshops conducted with senior New Zealand health sector staff as part of the Government's goal of reducing inequalities in health, education, employment and housing. The workshops were based on a multi-method needs assessment with senior staff in key health institutions. The workshops aimed to increase the knowledge and skills of health sector staff to act on, and advocate for, eliminating inequalities in health. They were practical, evidence-based, and action oriented and took a social approach to the causes of inequalities in health. The workshops used ethnicity as a case study and explored racism as a driver of inequalities. They focused on the role of institutionalized racism, or racism that is built into health sector institutions. Institutional theory provided a framework for participants to analyse how their institutions create and maintain inequalities and how they can act to change this. Participants identified a range of institutional mechanisms that promote inequalities and a range of ways to address them including: undertaking further training, using Māori (the indigenous people) models of health in policy-making, increasing Māori participation and partnership in decision making, strengthening sector relationships with iwi (tribes), funding and supporting services provided 'by Māori for Māori', ensuring a strategic approach to intersectoral work, encouraging stronger community involvement in the work of the institution, requiring all evaluations to assess impact on inequalities, and requiring the sector to report on progress in addressing health inequalities. The workshops were rated highly by participants, who indicated increased commitment to tackle inequalities as a result of the training. Government and sector leadership were critical to the success of the workshops and subsequent changes in policy and practice. The use of locally adapted equity tools, requiring participants to develop action plans, and using a case study to focus discussion were important to the success for the training. Using institutional theory was helpful in analysing how drivers of inequalities, such as racism, are built into health institutions. This New Zealand experience provides a model that may be applicable in other jurisdictions.

Comparative analysis of aging policy reforms in Argentina, Chile, Costa Rica, and Mexico.

PubMed

Calvo, Esteban; Berho, Maureen; Roqué, Mónica; Amaro, Juan Sebastián; Morales, Fernando; Rivera, Emiliana; Gutiérrez Robledo, Luis Miguel F; López, Elizabeth Caro; Canals, Bernardita; Kornfeld, Rosa

2018-04-16

This investigation uses case studies and comparative analysis to review and analyze aging policy in Argentina, Chile, Costa Rica, and Mexico, and uncovers similarities and relevant trends in the substance of historical and current aging policy across countries. Initial charity-based approaches to poverty and illness have been gradually replaced by a rights-based approach considering broader notions of well-being, and recent reforms emphasize the need for national, intersectoral, evidence-based policy. The results of this study have implications for understanding aging policy in Latin America from a welfare regime and policymakers' perspective, identifying priorities for intervention, and informing policy reforms in developing countries worldwide.

Paradise lost: an introduction to the geography of water pollution in Puerto Rico.

PubMed

Hunter, J M; Arbona, S I

1995-05-01

Rapid industrialization has transformed the agricultural economy of Puerto Rico, creating employment opportunities and raising standards of living. Success, however, is marred by widespread pollution that outstrips the infrastructural capacity necessary for the preservation of environmental quality and of human health. The result today is a landfill crisis, a heritage of toxic dumps, and an advancing tide of pollution. Rivers and reservoirs are nearly ubiquitously affected and groundwaters, long thought to be naturally protected, show evidence of increasing contamination. Limestone aquifers are at particular risk. Public awareness and inter-sectoral political leadership are urgently needed to reverse the trend towards environmental deterioration.

Traffic accidents in Iran, a decade of progress but still challenges ahead.

PubMed

Lankarani, Kamran B; Sarikhani, Yaser; Heydari, Seyed Taghi; Joulaie, Hasan; Maharlouei, Najmeh; Peimani, Payam; Ahmadi, Seyed Mehdi; Khorasani-Zavareh, Davoud; Soori, Hamid; Davoudi-Kiakalayeh, Ali; Masoumi, Gholamreza

2014-01-01

Iran has had incremental incidence of traffic accident mortality since introduction of mechanization about a century ago. But the newest data from Iran show decrease in the absolute number of deaths, death per 10,000 vehicles and death per 100, 000 populations. Despite its huge impact on health and economy, research in the field of traffic crashes is still scant and there are still deficiencies in problem oriented research on traffic accidents. Actual cooperation of policy makers, executive bodies and academician could build platform for intersectoral discussion of different aspects of traffic accidents and could reduce burden of traffic accidents.

[Health and indigenous peoples in Brazil: the challenge of professional training and continuing education of workers in intercultural contexts].

PubMed

Diehl, Eliana Elisabeth; Pellegrini, Marcos Antonio

2014-04-01

This article discusses training and continuing medical education for indigenous health workers and health professionals in indigenous health under the guidelines of the Brazilian National Healthcare Policy for Indigenous Peoples, which is currently behind schedule and incomplete as part of the official government agenda. Based on inter-sector proposals for health training by the Ministries of Health and Education, the article highlights the case of indigenous healthcare, emphasizing that government initiatives in this area still need to incorporate the concept of continuing education, a powerful tool for fostering intercultural dialogue and orienting health practices.

Past and future weather-induced risk in crop production

NASA Astrophysics Data System (ADS)

Elliott, J. W.; Glotter, M.; Russo, T. A.; Sahoo, S.; Foster, I.; Benton, T.; Mueller, C.

2016-12-01

Drought-induced agricultural loss is one of the most costly impacts of extreme weather and may harm more people than any other consequence of climate change. Improvements in farming practices have dramatically increased crop productivity, but yields today are still tightly linked to climate variation. We report here on a number of recent studies evaluating extreme event risk and impacts under historical and near future conditions, including studies conducted as part of the Agricultural Modeling Intercomparison and Improvement Project (AgMIP), the Inter-Sectoral Impacts Model Intercomparison Project (ISI-MIP) and the UK-US Taskforce on Extreme Weather and Global Food System Resilience.

Comparison of mosquito control programs in seven urban sites in Africa, the Middle East, and the Americas.

PubMed

Impoinvil, Daniel E; Ahmad, Sajjad; Troyo, Adriana; Keating, Joseph; Githeko, Andrew K; Mbogo, Charles M; Kibe, Lydiah; Githure, John I; Gad, Adel M; Hassan, Ali N; Orshan, Laor; Warburg, Alon; Calderón-Arguedas, Olger; Sánchez-Loría, Victoria M; Velit-Suarez, Rosanna; Chadee, Dave D; Novak, Robert J; Beier, John C

2007-10-01

Mosquito control programs at seven urban sites in Kenya, Egypt, Israel, Costa Rica, and Trinidad are described and compared. Site-specific urban and disease characteristics, organizational diagrams, and strengths, weaknesses, obstacles and threats (SWOT) analysis tools are used to provide a descriptive assessment of each mosquito control program, and provide a comparison of the factors affecting mosquito abatement. The information for SWOT analysis is collected from surveys, focus-group discussions, and personal communication. SWOT analysis identified various issues affecting the efficiency and sustainability of mosquito control operations. The main outcome of our work was the description and comparison of mosquito control operations within the context of each study site's biological, social, political, management, and economic conditions. The issues identified in this study ranged from lack of inter-sector collaboration to operational issues of mosquito control efforts. A lack of sustainable funding for mosquito control was a common problem for most sites. Many unique problems were also identified, which included lack of mosquito surveillance, lack of law enforcement, and negative consequences of human behavior. Identifying common virtues and shortcomings of mosquito control operations is useful in identifying "best practices" for mosquito control operations, thus leading to better control of mosquito biting and mosquito-borne disease transmission.

Clearing the air and breathing freely: the health politics of air pollution and asthma.

PubMed

Brown, Phil; Mayer, Brian; Zavestoski, Stephen; Luebke, Theo; Mandelbaum, Joshua; McCormick, Sabrina

2004-01-01

This study examines the growing debate around environmental causes of asthma in the context of federal regulatory disputes, scientific controversy, and environmental justice activism. A multifaceted form of social discovery of the effect of air pollution on asthma has resulted from multipartner and multiorganizational approaches and from intersectoral policy that deals with social inequality and environmental justice. Scientists, activists, health voluntary organizations, and some government agencies and officials have identified various elements of the asthma and air pollution connection. To tackle these issues, they have worked through a variety of collaborations and across different sectors of environmental regulation, public health, health services, housing, transportation, and community development. The authors examine the role of activist groups in discovering the increased rates of asthma and framing it as a social and environmental issue; give an overview of the current knowledge base on air pollution and asthma, and the controversies within science; and situate that science in the regulatory debate, discussing the many challenges to the air quality researchers. They then examine the implications of the scientific and regulatory controversies over linking air pollution to increases in asthma. The article concludes with a discussion of how alliances between activists and scientists lead to new research strategies and innovations.

Comparison of mosquito control programs in seven urban sites in Africa, the Middle East, and the Americas

PubMed Central

Impoinvil, Daniel E.; Ahmad, Sajjad; Troyo, Adriana; Keating, Joseph; Githeko, Andrew K.; Mbogo, Charles M; Kibe, Lydiah; Githure, John I.; Gad, Adel M.; Hassan, Ali N.; Orshan, Laor; Warburg, Alon; Calderón-Arguedas, Olger; Sánchez-Loría, Victoria M.; Velit-Suarez, Rosanna; Chadee, Dave D.; Novak, Robert J.; Beier, John C.

2007-01-01

Mosquito control programs at seven urban sites in Kenya, Egypt, Israel, Costa Rica, and Trinidad are described and compared. Site-specific urban and disease characteristics, organizational diagrams, and strengths, weaknesses, obstacles and threats (SWOT) analysis tools are used to provide a descriptive assessment of each mosquito control program, and provide a comparison of the factors affecting mosquito abatement. The information for SWOT analysis is collected from surveys, focus group discussions, and personal communication. SWOT analysis identified various issues affecting the efficiency and sustainability of mosquito control operations. The main outcome of our work was the description and comparison of mosquito control operations within the context of each study site’s biological, social, political, management, and economic conditions. The issues identified in this study ranged from lack of inter-sector collaboration to operational issues of mosquito control efforts. A lack of sustainable funding for mosquito control was a common problem for most sites. Many unique problems were also identified, which included lack of mosquito surveillance, lack of law enforcement, and negative consequences of human behavior. Identifying common virtues and shortcomings of mosquito control operations is useful in identifying “best practices” for mosquito control operations, thus leading to better control of mosquito biting and mosquito-borne disease transmission. PMID:17316882

The BC Educator Pathway Collaborative Framework: creating the foundation for nursing education capacity.

PubMed

Semeniuk, Patricia; Mildon, Barbara; Purkis, Mary Ellen; Thorne, Sally; Wejr, Patricia

2010-05-01

This paper describes the conceptual structure and organizational framework of the Educator Pathway Project (EPP), which is a unique collaborative capacity-building project creating infrastructure for integrating nursing practice learning and development throughout the service and education sectors in British Columbia. Since 2005, two major health authorities, two universities and the provincial nurses' bargaining association have been engaged in an intensive and dynamic partnership to conceptualize and fundamentally change intersectoral directions and possibilities. This unique initiative has required considerable investment and commitment among all partner organizations, resulting in a clear, shared vision of systemwide support of nursing. With the EPP now in its final year of funding, we are beginning to document its elements and interpret its significant impact on nurses and their workplaces across the regions. In this paper, we describe the overall program design, explain the collaborative partnership mechanisms through which we have been implementing the project and articulate a range of processes through which we are working together to enact significant system-level adjustments aimed at a genuine practice-education continuum. As part of sustaining a strong nursing workforce, we believe that nursing practice and education leaders across Canada are ready to employ this kind of creative approach towards realizing our common goals.

[Family Health Teams in Ontario: Ideas for Germany from a Canadian Primary Care Model].

PubMed

Ulrich, Lisa-R; Pham, Thuy-Nga Tia; Gerlach, Ferdinand M; Erler, Antje

2017-07-11

The German healthcare system is struggling with fragmentation of care in the face of an increasing shortage of general practitioners and allied health professionals, and the time-demanding healthcare needs of an aging, multimorbid patient population. Innovative interprofessional, intersectoral models of care are required to ensure adequate access to primary care across a variety of rural and urban settings into the foreseeable future. A team approach to care of the complex multimorbid patient population appears particularly suitable in attracting and retaining the next generation of healthcare professionals, including general practitioners. In 2014, the German Advisory Council on the Assessment of Developments in the Health Care System highlighted the importance of regional, integrated care with community-based primary care centres at its core, providing comprehensive, population-based, patient-centred primary care with adequate access to general practitioners for a given geographical area. Such centres exist already in Ontario, Canada; within Family Health Teams (FHT), family physicians work hand-in-hand with pharmacists, nurses, nurse practitioners, social workers, and other allied health professionals. In this article, the Canadian model of FHT will be introduced and we will discuss which components could be adapted to suit the German primary care system. © Georg Thieme Verlag KG Stuttgart · New York.

[Health impact assessment: one way to introduce health in all policies. SESPAS Report 2010].

PubMed

Esnaola, Santiago; Bacigalupe, Amaia; Sanz, Elvira; Aldasoro, Elena; Calderón, Carlos; Zuazagoitia, Juan; Cambra, Koldo

2010-12-01

Health impact assessment is a predictive tool to support decisions in policy-making. Current experience shows that health impact assessment could play an important role in the development of the Health in All Policies strategy. This strategy has been extensively used in other European countries and in a wide range of policy and administrative sectors. Health impact assessment is hardly ever mandatory and is frequently carried out separately from other impact assessments. The use of this process in Spain is relatively new, limited and fundamentally based on local level experiences and the screening of regional interventions. The current normative and organizational reform of public health in Spain provides an excellent opportunity to promote the development of health impact assessment. Some of the barriers to the development of this process are related to the biomedical model of health prevailing among health professionals, politicians, and the general population, political disaffection, lack of assessment culture, underdevelopment of community participation processes, and insufficient intersectoral work. Health impact assessment provides an opportunity to move toward improving the population's health and reducing inequalities in health. Consequently, political commitment, as well as investment in education and research, is needed to introduce and develop health impact assessment in all administrative settings and policy sectors. Copyright © 2010 SESPAS. Published by Elsevier Espana. All rights reserved.

Bangladesh arsenic mitigation programs: lessons from the past

PubMed Central

Milton, Abul Hasnat; Hore, Samar Kumar; Hossain, Mohammad Zahid; Rahman, Mahfuzar

2012-01-01

Ensuring access to safe drinking water by 2015 is a global commitment by the Millennium Development Goals (MDGs). In Bangladesh, significant achievements in providing safe water were made earlier by nationwide tubewell-installation programme. This achievement was overshadowed in 1993 by the presence of arsenic in underground water. A total of 6 million tubewells have been tested for arsenic since then, the results of which warranted immediate mitigation. Mitigation measures included tubewell testing and replacing; usage of deeper wells; surface water preservation and treatment; use of sanitary dug wells, river sand and pond sand filters; rainwater collection and storage; household-scale and large-scale arsenic filtrations; and rural pipeline water supply installation. Shallow tubewell installation was discouraged. Efforts have been made to increase people's awareness. This paper describes the lessons learned about mitigation efforts by the authors from experience of arsenic-related work. In spite of national mitigation plans and efforts, a few challenges still persist: inadequate coordination between stakeholders, differences in inter-sectoral attitudes, inadequate research to identify region-specific, suitable safe water options, poor quality of works by various implementing agencies, and inadequate dissemination of the knowledge and experiences to the people by those organizations. Issues such as long-time adaptation using ground water, poor surface water quality including bad smell and turbidity, and refusal to using neighbor's water have delayed mitigation measures so far. Region-specific mitigation water supply policy led by the health sector could be adopted with multisectoral involvement and responsibility. Large-scale piped water supply could be arranged through Public Private Partnerships (PPP) in new national approach. PMID:22558005

Bangladesh arsenic mitigation programs: lessons from the past.

PubMed

Milton, Abul Hasnat; Hore, Samar Kumar; Hossain, Mohammad Zahid; Rahman, Mahfuzar

2012-01-01

Ensuring access to safe drinking water by 2015 is a global commitment by the Millennium Development Goals (MDGs). In Bangladesh, significant achievements in providing safe water were made earlier by nationwide tubewell-installation programme. This achievement was overshadowed in 1993 by the presence of arsenic in underground water. A total of 6 million tubewells have been tested for arsenic since then, the results of which warranted immediate mitigation. Mitigation measures included tubewell testing and replacing; usage of deeper wells; surface water preservation and treatment; use of sanitary dug wells, river sand and pond sand filters; rainwater collection and storage; household-scale and large-scale arsenic filtrations; and rural pipeline water supply installation. Shallow tubewell installation was discouraged. Efforts have been made to increase people's awareness. This paper describes the lessons learned about mitigation efforts by the authors from experience of arsenic-related work. In spite of national mitigation plans and efforts, a few challenges still persist: inadequate coordination between stakeholders, differences in inter-sectoral attitudes, inadequate research to identify region-specific, suitable safe water options, poor quality of works by various implementing agencies, and inadequate dissemination of the knowledge and experiences to the people by those organizations. Issues such as long-time adaptation using ground water, poor surface water quality including bad smell and turbidity, and refusal to using neighbor's water have delayed mitigation measures so far. Region-specific mitigation water supply policy led by the health sector could be adopted with multisectoral involvement and responsibility. Large-scale piped water supply could be arranged through Public Private Partnerships (PPP) in new national approach.

[A community education strategy to promote participation in dengue prevention in Cuba].

PubMed

Sánchez, Lizet; Pérez, Dennis; Alfonso, Lázara; Castro, Marta; Sánchez, Luis Manuel; Van der Stuyft, Patrick; Kourí, Gustavo

2008-07-01

To document the process and analyze the results of implementing a strategy aimed at increasing community participation in the fight against the dengue mosquito vector. From May 2002 to May 2004, an intervention was implemented to advance social action against dengue in three districts of the municipality of Playa, La Habana, Cuba. A learning group and community working groups (CWG) were organized in each location. A community education model was followed that combines putting the plan of action into practice, with sessions to reflect and learn from the results, and then reworking of the actions for subsequent stages. Diagnostic tools were developed for communities, preventative actions, communication, surveillance, and evaluation. Changes in participation were identified by applying the content analysis technique to the documents and through interviews with key informants. The community work advanced at a pace relative to the abilities and interests of each community with different areas of focus: healthy community, environmental risk, and entomological risk. Positive changes in the concept of participation were obtained, according to the five areas evaluated: leadership, needs assessment, organization, management, and mobilization of resources. At the end of two years of intervention, the rate of Aedes aegypti larvae and pupae deposits found per 100 households had declined 79% and cases of dengue were not detected in any of the districts. This strategy reduced mosquito vector infestation levels by increasing community participation in decision-making and strengthening the competencies of the medical teams and CWGs so that they lead participative processes in the community and raised confidence in their ability to achieve change with the appropriate resources and intersectoral support.

Housing, health and master planning: rules of engagement.

PubMed

Harris, P; Haigh, F; Thornell, M; Molloy, L; Sainsbury, P

2014-04-01

Knowledge about health focussed policy collaboration to date has been either tactical or technical. This article focusses on both technical and tactical issues to describe the experience of cross-sectoral collaboration between health and housing stakeholders across the life of a housing master plan, including but not limited to a health impact assessment (HIA). A single explanatory case study of collaboration on a master plan to regenerate a deprived housing estate in Western Sydney was developed to explain why and how the collaboration worked or did not work. Data collection included stakeholder interviews, document review, and reflections by the health team. Following a realist approach, data was analysed against established public policy theory dimensions. Tactically we did not know what we were doing. Despite our technical knowledge and skills with health focussed processes, particularly HIA, we failed to appreciate complexities inherent in master planning. This limited our ability to provide information at the right points. Eventually however the HIA did provide substantive connections between the master plan and health. We use our analysis to develop technical and tactical rules of engagement for future cross-sectoral collaboration. This case study from the field provides insight for future health focussed policy collaboration. We demonstrate the technical and tactical requirements for future intersectoral policy and planning collaborations, including HIAs, with the housing sector on master planning. The experience also suggested how HIAs can be conducted flexibly alongside policy development rather than at a specific point after a policy is drafted. Copyright © 2014 The Royal Society for Public Health. All rights reserved.

Implementing One Health as an integrated approach to health in Rwanda.

PubMed

Nyatanyi, Thierry; Wilkes, Michael; McDermott, Haley; Nzietchueng, Serge; Gafarasi, Isidore; Mudakikwa, Antoine; Kinani, Jean Felix; Rukelibuga, Joseph; Omolo, Jared; Mupfasoni, Denise; Kabeja, Adeline; Nyamusore, Jose; Nziza, Julius; Hakizimana, Jean Leonard; Kamugisha, Julius; Nkunda, Richard; Kibuuka, Robert; Rugigana, Etienne; Farmer, Paul; Cotton, Philip; Binagwaho, Agnes

2017-01-01

It is increasingly clear that resolution of complex global health problems requires interdisciplinary, intersectoral expertise and cooperation from governmental, non-governmental and educational agencies. 'One Health' refers to the collaboration of multiple disciplines and sectors working locally, nationally and globally to attain optimal health for people, animals and the environment. One Health offers the opportunity to acknowledge shared interests, set common goals, and drive toward team work to benefit the overall health of a nation. As in most countries, the health of Rwanda's people and economy are highly dependent on the health of the environment. Recently, Rwanda has developed a One Health strategic plan to meet its human, animal and environmental health challenges. This approach drives innovations that are important to solve both acute and chronic health problems and offers synergy across systems, resulting in improved communication, evidence-based solutions, development of a new generation of systems-thinkers, improved surveillance, decreased lag time in response, and improved health and economic savings. Several factors have enabled the One Health movement in Rwanda including an elaborate network of community health workers, existing rapid response teams, international academic partnerships willing to look more broadly than at a single disease or population, and relative equity between female and male health professionals. Barriers to implementing this strategy include competition over budget, poor communication, and the need for improved technology. Given the interconnectedness of our global community, it may be time for countries and their neighbours to follow Rwanda's lead and consider incorporating One Health principles into their national strategic health plans.

Outcomes of Interorganizational Networks in Canada for Chronic Disease Prevention: Insights From a Concept Mapping Study, 2015.

PubMed

Willis, Cameron; Kernoghan, Alison; Riley, Barbara; Popp, Janice; Best, Allan; Milward, H Brinton

2015-11-19

We conducted a mixed methods study from June 2014 to March 2015 to assess the perspectives of stakeholders in networks that adopt a population approach for chronic disease prevention (CDP). The purpose of the study was to identify important and feasible outcome measures for monitoring network performance. Participants from CDP networks in Canada completed an online concept mapping exercise, which was followed by interviews with network stakeholders to further understand the findings. Nine concepts were considered important outcomes of CDP networks: enhanced learning, improved use of resources, enhanced or increased relationships, improved collaborative action, network cohesion, improved system outcomes, improved population health outcomes, improved practice and policy planning, and improved intersectoral engagement. Three themes emerged from participant interviews related to measurement of the identified concepts: the methodological difficulties in measuring network outcomes, the dynamic nature of network evolution and function and implications for outcome assessment, and the challenge of measuring multisectoral engagement in CDP networks. Results from this study provide initial insights into concepts that can be used to describe the outcomes of networks for CDP and may offer foundations for strengthening network outcome-monitoring strategies and methodologies.

Institutionalizing Health Impact Assessment: A consultation with experts on the barriers and facilitators to implementing HIA in Italy.

PubMed

Linzalone, Nunzia; Ballarini, Adele; Piccinelli, Cristiano; Viliani, Francesca; Bianchi, Fabrizio

2018-07-15

A Health Impact Assessment (HIA) is an evidence-based methodology that includes health promotion and protection goals in decision-making. HIA has been introduced and/or institutionalized to various extents in different countries. In order to promote HIA and preventive health assessments in Italy, a research methodology was followed to identify specific obstacles or facilitators. The experiences of various countries reported in the literature were analyzed in terms of facilitating or hindering the introduction and institutionalization of HIA. A consultation with the proponents of projects and plans in Italy was carried out with a multi-approach methodology in order to characterize the national context. A general implementation plan was drawn up from the international experiences. In Italy this is not yet in place. Specific areas of intervention need to be addressed, including: 1) data availability; 2) tools and methods; 3) engagement of stakeholders; 4) capacity building. The research suggests that the institutionalization of HIA in Italy rests on the government's commitment to providing specific legislation regarding HIA so that skills, intersectoral coordination and dedicated budgets can be built and maintained. Copyright © 2018 Elsevier Ltd. All rights reserved.

Diseases of comfort: primary cause of death in the 22nd century

PubMed Central

Choi, B.; Hunter, D.; Tsou, W.; Sainsbury, P.

2005-01-01

Objective: To describe the concept, causes, and prevention and control strategies of diseases of comfort. Methods: Brokered by a senior research scientist specialised in knowledge translation, a chair, a president, and a past president of national public health associations contributed their views on the subject. Results: Diseases of comfort have emerged as a price of living in a modern society. It is inevitable that these diseases will become more common and more disabling if human "progress" and civilisation continue toward better (more comfortable) living, without necessarily considering their effects on health. Modern technology must be combined with education, legislation, intersectoral action, and community involvement to create built and social environments that encourage, and make easy, walking, physical activity, and nutritious food choices, to reduce the health damaging effects of modern society for all citizens and not only the few. Conclusions: Public health needs to be more passionate about the health issues caused by human progress and adopt a health promotion stance, challenging the assumptions behind the notion of social "progress" that is giving rise to the burden of chronic disease and developing the skills to create more health promoting societies in which individual health thrives. PMID:16286489

Scoping review: national monitoring frameworks for social determinants of health and health equity

PubMed Central

Pedrana, Leo; Pamponet, Marina; Walker, Ruth; Costa, Federico; Rasella, Davide

2016-01-01

Background The strategic importance of monitoring social determinants of health (SDH) and health equity and inequity has been a central focus in global discussions around the 2011 Rio Political Declaration on SDH and the Millennium Development Goals. This study is part of the World Health Organization (WHO) equity-oriented analysis of linkages between health and other sectors (EQuAL) project, which aims to define a framework for monitoring SDH and health equity. Objectives This review provides a global summary and analysis of the domains and indicators that have been used in recent studies covering the SDH. These studies are considered here within the context of indicators proposed by the WHO EQuAL project. The objectives are as follows: to describe the range of international and national studies and the types of indicators most frequently used; report how they are used in causal explanation of the SDH; and identify key priorities and challenges reported in current research for national monitoring of the SDH. Design We conducted a scoping review of published SDH studies in the PubMed® database to obtain evidence of socio-economic indicators. We evaluated, selected, and extracted data from national scale studies published from 2004 to 2014. The research included papers published in English, Italian, French, Portuguese, and Spanish. Results The final sample consisted of 96 articles. SDH monitoring is well reported in the scientific literature independent of the economic level of the country and magnitude of deprivation in population groups. The research methods were mostly quantitative and many papers used multilevel and multivariable statistical analyses and indexes to measure health inequalities and SDH. In addition to the usual economic indicators, a high number of socio-economic indicators were used. The indicators covered a broad range of social dimensions, which were given consideration within and across different social groups. Many indicators included in the WHO EQuAL framework were not common in the studies in this review due to their intersectoral and interdisciplinary nature. Conclusions Our review illustrates that the attention to SDH monitoring has grown in terms of its importance and complexity within the scientific health literature. We identified a need to make indicators more wide-ranging in order to include a broader range of social conditions. The WHO EQuAL framework can provide intersectoral and interdisciplinary means of building a more comprehensive standardised approach to monitoring the SDH and improving equity in health. PMID:26853896

Glossary for the implementation of Health in All Policies (HiAP).

PubMed

Freiler, Alix; Muntaner, Carles; Shankardass, Ketan; Mah, Catherine L; Molnar, Agnes; Renahy, Emilie; O'Campo, Patricia

2013-12-01

Health in All Policies (HiAP) is becoming increasingly popular as a governmental strategy to improve population health by coordinating action across health and non-health sectors. A variety of intersectoral initiatives may be used in HiAP that frame health determinants as the bridge between policies and health outcomes. The purpose of this glossary is to present concepts and terms useful in understanding the implementation of HiAP as a cross-sectoral policy. The concepts presented here were applied and elaborated over the course of case studies of HiAP in multiple jurisdictions, which used key informant interviews and the systematic review of literature to study the implementation of specific HiAP initiatives.

Institutions and the implementation of tobacco control in Brazil.

PubMed

Lencucha, Raphael; Drope, Jeffrey; Bialous, Stella Aguinaga; Richter, Ana Paula; Silva, Vera Luiza da Costa E

2017-10-19

This research examines the institutional features of Brazil's National Commission for the Implementation of the Framework Convention on Tobacco Control (CONICQ) and how these institutional features have facilitated and hindered its ability to foster intersectoral tobacco control. In particular, we evaluate the key institutional features of CONICQ starting from when it was one of the key drivers of change and improvements in early tobacco control policies, which helped to make Brazil a world leader in this area. We also examine how the committee has evolved, as tobacco control has improved and particularly elucidate some of the major challenges that it faces to bring together often disparate government sectors to generate public health policies.

Disclosure experience in a convenience sample of quebec-born women living with HIV: a phenomenological study

PubMed Central

2012-01-01

Background In Canada, there has been a considerable increase in the number of women infected with the human immunodeficiency virus (HIV). Within a stigmatized social context, disclosure of HIV positivity is still a prevailing concern among women. Little is known about the global understanding of how French-speaking, Quebec-born women living with HIV, live their serostatus disclosure experience. The aim of this qualitative study is to describe and understand the disclosure experience of these women. Methods We conducted semi-structured interviews with seven women. A convenience sample of French-speaking, Quebec-born women was chosen because they all responded to the criteria of wishing to share their disclosure experience. The mean age of the participants was 46 years old (SD±12). They lived with HIV for an average of 10 years; time since diagnosis varied from 8 months to 23 years. Two out of four mothers had given birth to HIV positive children. Data analysis proposed by van Manen was performed to discover the essential themes of the experience. Results Seven themes were identified to understand the experience of disclosure in women: 1) Respecting for self and confidants; 2) Feeling apprehension; 3) Exercising control to ensure protection; 4) Deliberately engaging in a process of disclosure/non-disclosure; 5) Exposing oneself to stigma and social exclusion; 6) Suffering internally; and 7) Benefitting from the positive effects of one’s decision. For these women, disclosing their HIV status meant: Living the ambivalence of a paradoxical process of revealing/concealing, in a state of profound suffering, exacerbated by stigma, while also being enriched by the benefits attained. Conclusions Understanding the experience of disclosure in WLHIV is important to guide actions in the practice to support and accompany these women in their unique reality. Health professionals have to broaden their role and work on individual, interpersonal, inter-organizational and intersectoral levels. Mobilization of actors from different sectors would facilitate the implementation of pertinent and opportune interventions. PMID:23078352

Trajectory Orientation: A Technology-Enabled Concept Requiring a Shift in Controller Roles and Responsibilities

NASA Technical Reports Server (NTRS)

Leiden, Ken; Green, Steven

2000-01-01

The development of a decision support tool (DST) for the en-route domain with accurate conflict prediction time horizons of 20 minutes has introduced an interesting problem. A 20 minute time horizon for conflict prediction often results in the predicted conflict occurring one or more sectors downstream from the sector controller who "owns" (i-e., is responsible for the safe separation of aircraft) one or both of the aircraft in the conflict pair. Based on current roles and responsibilities of today's en route controllers, the upstream controller would not resolve this conflict. In most cases, the downstream controller would wait until the conflicting aircraft entered higher sector before resolving the conflict. This results in a delay of several minutes from the time when the conflict was initially predicted. This delay is inefficient from both a controller workload and user's cost of operations perspective. Trajectory orientation, a new concept for facilitating an efficient, conflict-free flight path across several sectors while conforming to metering or miles-in-trail spacing, is proposed as an alternative to today's sector-oriented method. This concept necessitates a fundamental shift in thinking about inter-sector coordination. Instead of operating independently, with the main focus on protecting their internal airspace, controllers would work cooperatively, depending on each other for well-planned, conflict-free flow of aircraft. To support the trajectory orientation concept, a long time horizon (15 to 20 minutes) for conflict prediction and resolution would most likely be a primary requirement. In addition, new tools, such as controller-pilot data link will be identified to determine their necessity and applicability for trajectory orientation. Finally, with significant controller participation from selected Air Route Traffic Control Centers, potential shifts in R-side/D-side roles and responsibilities as well as the creation of a new controller position for multi-sector planning will be examined to determine the most viable solutions.

Public health human resources: a comparative analysis of policy documents in two Canadian provinces

PubMed Central

2014-01-01

Background Amidst concerns regarding the capacity of the public health system to respond rapidly and appropriately to threats such as pandemics and terrorism, along with changing population health needs, governments have focused on strengthening public health systems. A key factor in a robust public health system is its workforce. As part of a nationally funded study of public health renewal in Canada, a policy analysis was conducted to compare public health human resources-relevant documents in two Canadian provinces, British Columbia (BC) and Ontario (ON), as they each implement public health renewal activities. Methods A content analysis of policy and planning documents from government and public health-related organizations was conducted by a research team comprised of academics and government decision-makers. Documents published between 2003 and 2011 were accessed (BC = 27; ON = 20); documents were either publicly available or internal to government and excerpted with permission. Documentary texts were deductively coded using a coding template developed by the researchers based on key health human resources concepts derived from two national policy documents. Results Documents in both provinces highlighted the importance of public health human resources planning and policies; this was particularly evident in early post-SARS documents. Key thematic areas of public health human resources identified were: education, training, and competencies; capacity; supply; intersectoral collaboration; leadership; public health planning context; and priority populations. Policy documents in both provinces discussed the importance of an educated, competent public health workforce with the appropriate skills and competencies for the effective and efficient delivery of public health services. Conclusion This policy analysis identified progressive work on public health human resources policy and planning with early documents providing an inventory of issues to be addressed and later documents providing evidence of beginning policy development and implementation. While many similarities exist between the provinces, the context distinctive to each province has influenced and shaped how they have focused their public health human resources policies. PMID:24564931

Reliability ensemble averaging of 21st century projections of terrestrial net primary productivity reduces global and regional uncertainties

NASA Astrophysics Data System (ADS)

Exbrayat, Jean-François; Bloom, A. Anthony; Falloon, Pete; Ito, Akihiko; Smallman, T. Luke; Williams, Mathew

2018-02-01

Multi-model averaging techniques provide opportunities to extract additional information from large ensembles of simulations. In particular, present-day model skill can be used to evaluate their potential performance in future climate simulations. Multi-model averaging methods have been used extensively in climate and hydrological sciences, but they have not been used to constrain projected plant productivity responses to climate change, which is a major uncertainty in Earth system modelling. Here, we use three global observationally orientated estimates of current net primary productivity (NPP) to perform a reliability ensemble averaging (REA) method using 30 global simulations of the 21st century change in NPP based on the Inter-Sectoral Impact Model Intercomparison Project (ISIMIP) business as usual emissions scenario. We find that the three REA methods support an increase in global NPP by the end of the 21st century (2095-2099) compared to 2001-2005, which is 2-3 % stronger than the ensemble ISIMIP mean value of 24.2 Pg C y-1. Using REA also leads to a 45-68 % reduction in the global uncertainty of 21st century NPP projection, which strengthens confidence in the resilience of the CO2 fertilization effect to climate change. This reduction in uncertainty is especially clear for boreal ecosystems although it may be an artefact due to the lack of representation of nutrient limitations on NPP in most models. Conversely, the large uncertainty that remains on the sign of the response of NPP in semi-arid regions points to the need for better observations and model development in these regions.

Compiling mortality statistics from civil registration systems in Viet Nam: the long road ahead.

PubMed

Rao, Chalapati; Osterberger, Brigitta; Anh, Tran Dam; MacDonald, Malcolm; Chúc, Nguyen Thi Kim; Hill, Peter S

2010-01-01

Accurate mortality statistics, needed for population health assessment, health policy and research, are best derived from data in vital registration systems. However, mortality statistics from vital registration systems are not available for several countries including Viet Nam. We used a mixed methods case study approach to assess vital registration operations in 2006 in three provinces in Viet Nam (Hòa Bình, Thùa Thiên-Hué and Bình Duong), and provide recommendations to strengthen vital registration systems in the country. For each province we developed life tables from population and mortality data compiled by sex and age group. Demographic methods were used to estimate completeness of death registration as an indicator of vital registration performance. Qualitative methods (document review, key informant interviews and focus group discussions) were used to assess administrative, technical and societal aspects of vital registration systems. Completeness of death registration was low in all three provinces. Problems were identified with the legal framework for registration of early neonatal deaths and deaths of temporary residents or migrants. The system does not conform to international standards for reporting cause of death or for recording detailed statistics by age, sex and cause of death. Capacity-building along with an intersectoral coordination committee involving the Ministries of Justice and Health and the General Statistics Office would improve the vital registration system, especially with regard to procedures for death registration. There appears to be strong political support for sentinel surveillance systems to generate reliable mortality statistics in Viet Nam.

Estimates of performance in the rate of decline of under-five mortality for 113 low- and middle-income countries, 1970-2010.

PubMed

Verguet, Stéphane; Jamison, Dean T

2014-03-01

BACKGROUND; Measuring country performance in health has focused on assessing predicted vs observed levels of outcomes, an indicator that varies slowly over time. An alternative is to measure performance in terms of the rate of change in how a selected outcome compares to what would be expected given contextual determinants. Rates of change in health indicators can prove more sensitive than levels to changes in social, intersectoral or health policy context. It is thus similar to the growth rate of gross domestic product in the economic context. We assess performance in the rate of change (decline) of under-five mortality for 113 low- and middle-income countries. For 1970-2010, we study the evolution in rates of decline of under-five mortality. For each decade, we define performance as the average of the difference between the observed rate of decline and a rate of decline predicted by a model controlling for the contextual factors of income, female education levels, decade and geographical location. In the 1970s, the top performer in the rate of decline of under-five mortality was Costa Rica. In the 2000s, the top performer was Turkey. Overall, performance in rates of decline correlated little with performance in levels of under-five mortality. A major transition in performance between decades suggests a change in underlying determinants and we report the magnitude of these transitions. For example, heavily AIDS impacted countries, such as Botswana, experienced major drops in performance between the 1980s and the 1990s and some, including Botswana, experienced major compensatory improvements between the 1990s and the 2000s. Rate-based measures of country performance in health provide a starting point for assessments of the importance of health system, social and intersectoral determinants of performance.

Crossing institutional boundaries: mapping the policy process for improved control of endemic and neglected zoonoses in sub-Saharan Africa.

PubMed

Okello, Anna; Welburn, Susan; Smith, James

2015-07-01

The recent adoption of the World Health Assembly Resolution 66.12 for neglected tropical diseases (NTDs) in May 2013 is an important turning point for advocacy regarding a number of endemic zoonotic infections, defined by the World Health Organization as the neglected zoonotic diseases (NZDs). In addition to NTD-listed zoonoses such as rabies, echinococcosis (hydatid disease), leishmaniasis, Human African trypanosomiasis (sleeping sickness) and Taenia solium cysticercosis, the NZDs also include important bacterial zoonoses such as anthrax, bovine tuberculosis and brucellosis. To date, analysis of the processes that prioritize, develop and deliver zoonoses control programmes in many low- and middle-income countries is lacking, despite its potential to highlight significant evidence gaps and institutional constraints to the intersectoral approach required for their control. Policy process analysis was conducted via a series of semi-structured interviews with key policy actors within various ministries and institutes in Uganda and Nigeria. The study concluded that despite the rhetoric around 'linear' models of health policy development promoting consultation with a wide range of national stakeholders, the decision-making process for zoonotic disease control appears instead overtly influenced by the external political economy of trending pandemic threats, often overlooking national and regional zoonoses priorities. The inclusion of political systems remains a key factor in the zoonoses analysis matrix, enhancing our understanding of the intersectoral and transdisciplinary approaches required for their control. The authors consider policy process analysis to be a fundamental first step of any attempt to holistically strengthen human and animal health systems in a development context, particularly regarding the promotion of integrated control policies for regionally important zoonoses under the growing One Health movement. Published by Oxford University Press in association with The London School of Hygiene and Tropical Medicine © The Author 2014; all rights reserved.

Application of eco-friendly tools and eco-bio-social strategies to control dengue vectors in urban and peri-urban settings in Thailand

PubMed Central

Kittayapong, Pattamaporn; Thongyuan, Suporn; Olanratmanee, Phanthip; Aumchareoun, Worawit; Koyadun, Surachart; Kittayapong, Rungrith; Butraporn, Piyarat

2012-01-01

Background Dengue is considered one of the most important vector-borne diseases in Thailand. Its incidence is increasing despite routine implementation of national dengue control programmes. This study, conducted during 2010, aimed to demonstrate an application of integrated, community-based, eco-bio-social strategies in combination with locally-produced eco-friendly vector control tools in the dengue control programme, emphasizing urban and peri-urban settings in eastern Thailand. Methodology Three different community settings were selected and were randomly assigned to intervention and control clusters. Key community leaders and relevant governmental authorities were approached to participate in this intervention programme. Ecohealth volunteers were identified and trained in each study community. They were selected among active community health volunteers and were trained by public health experts to conduct vector control activities in their own communities using environmental management in combination with eco-friendly vector control tools. These trained ecohealth volunteers carried out outreach health education and vector control during household visits. Management of public spaces and public properties, especially solid waste management, was efficiently carried out by local municipalities. Significant reduction in the pupae per person index in the intervention clusters when compared to the control ones was used as a proxy to determine the impact of this programme. Results Our community-based dengue vector control programme demonstrated a significant reduction in the pupae per person index during entomological surveys which were conducted at two-month intervals from May 2010 for the total of six months in the intervention and control clusters. The programme also raised awareness in applying eco-friendly vector control approaches and increased intersectoral and household participation in dengue control activities. Conclusion An eco-friendly dengue vector control programme was successfully implemented in urban and peri-urban settings in Thailand, through intersectoral collaboration and practical action at household level, with a significant reduction in vector densities. PMID:23318236

Application of eco-friendly tools and eco-bio-social strategies to control dengue vectors in urban and peri-urban settings in Thailand.

PubMed

Kittayapong, Pattamaporn; Thongyuan, Suporn; Olanratmanee, Phanthip; Aumchareoun, Worawit; Koyadun, Surachart; Kittayapong, Rungrith; Butraporn, Piyarat

2012-12-01

Dengue is considered one of the most important vector-borne diseases in Thailand. Its incidence is increasing despite routine implementation of national dengue control programmes. This study, conducted during 2010, aimed to demonstrate an application of integrated, community-based, eco-bio-social strategies in combination with locally-produced eco-friendly vector control tools in the dengue control programme, emphasizing urban and peri-urban settings in eastern Thailand. Three different community settings were selected and were randomly assigned to intervention and control clusters. Key community leaders and relevant governmental authorities were approached to participate in this intervention programme. Ecohealth volunteers were identified and trained in each study community. They were selected among active community health volunteers and were trained by public health experts to conduct vector control activities in their own communities using environmental management in combination with eco-friendly vector control tools. These trained ecohealth volunteers carried out outreach health education and vector control during household visits. Management of public spaces and public properties, especially solid waste management, was efficiently carried out by local municipalities. Significant reduction in the pupae per person index in the intervention clusters when compared to the control ones was used as a proxy to determine the impact of this programme. Our community-based dengue vector control programme demonstrated a significant reduction in the pupae per person index during entomological surveys which were conducted at two-month intervals from May 2010 for the total of six months in the intervention and control clusters. The programme also raised awareness in applying eco-friendly vector control approaches and increased intersectoral and household participation in dengue control activities. An eco-friendly dengue vector control programme was successfully implemented in urban and peri-urban settings in Thailand, through intersectoral collaboration and practical action at household level, with a significant reduction in vector densities.

Strengthening the implementation of Health in All Policies: a methodology for realist explanatory case studies.

PubMed

Shankardass, Ketan; Renahy, Emilie; Muntaner, Carles; O'Campo, Patricia

2015-05-01

To address macro-social and economic determinants of health and equity, there has been growing use of intersectoral action by governments around the world. Health in All Policies (HiAP) initiatives are a special case where governments use cross-sectoral structures and relationships to systematically address health in policymaking by targeting broad health determinants rather than health services alone. Although many examples of HiAP have emerged in recent decades, the reasons for their successful implementation--and for implementation failures--have not been systematically studied. Consequently, rigorous evidence based on systematic research of the social mechanisms that have regularly enabled or hindered implementation in different jurisdictions is sparse. We describe a novel methodology for explanatory case studies that use a scientific realist perspective to study the implementation of HiAP. Our methodology begins with the formulation of a conceptual framework to describe contexts, social mechanisms and outcomes of relevance to the sustainable implementation of HiAP. We then describe the process of systematically explaining phenomena of interest using evidence from literature and key informant interviews, and looking for patterns and themes. Finally, we present a comparative example of how Health Impact Assessment tools have been utilized in Sweden and Quebec to illustrate how this methodology uses evidence to first describe successful practices for implementation of HiAP and then refine the initial framework. The methodology that we describe helps researchers to identify and triangulate rich evidence describing social mechanisms and salient contextual factors that characterize successful practices in implementing HiAP in specific jurisdictions. This methodology can be applied to study the implementation of HiAP and other forms of intersectoral action to reduce health inequities involving multiple geographic levels of government in diverse settings. Published by Oxford University Press in association with The London School of Hygiene and Tropical Medicine © The Author 2014; all rights reserved.

A collaborative initiative for the containment of antimicrobial resistance in Mexico.

PubMed

Zaidi, Mussaret B; Dreser, Anahi; Figueroa, Inda Marcela

2015-04-01

Antimicrobial resistance exacts worldwide an increasingly significant clinical and economic toll. Despite the international calls for urgent action, antimicrobial use and resistance have been low on the Mexican government's policy agenda. In early 2010, a multidisciplinary group of experts launched a national initiative for containment of antimicrobial resistance that was endorsed by major medical, veterinary and public health institutions. The initiative called for seven priority actions including the creation of an ad hoc intersectoral advisory group, a requirement that human and veterinary antibiotics be dispensed only with prescription, and the establishment of effective surveillance systems. A consensus document was disseminated among key decision-makers at the ministries of Health and Agriculture and the legislature. The Ministry of Health (MoH) enacted a decree effective as of August 2010, which enforced the regulations that required medical prescriptions for the sale of human antibiotics. While the information disseminated by the MoH did focus on the dangers of self-medication, it failed to highlight the inherent perils of antibiotic resistance or the consequences of antibiotic use in food-animals. Following the decree, there was a surge of medical offices controlled by retail pharmacies. In the veterinary sector, voluntary guidelines were developed for good husbandry practices, including antibiotic use in food animals; five antimicrobials for use in food-animals were banned. No intersectoral advisory group or surveillance systems were established. This study describes a bottom-top approach in Mexico for the development of a national strategy to improve antibiotic use and contain antimicrobial resistance. Its experiences suggest that, in countries such as Mexico that lack strong regulatory systems and surveillance capacities, a more systemic approach is warranted. Future efforts should begin with early involvement of key stakeholders and informing policy makers, professionals and the population at large about the critical importance of antibiotic resistance. © 2014 Blackwell Verlag GmbH.

Tracing the policy implementation of commitments made by national governments and other entities at the Third Global Forum on Human Resources for Health

PubMed Central

van de Pas, Remco; Veenstra, Anika; Gulati, Daniel; Van Damme, Wim; Cometto, Giorgio

2017-01-01

We conducted a follow-up analysis of the implementation of the Human Resources for Health (HRH) commitments made by country governments and other actors at the Third Global Forum on HRH in 2013. Since then member states of the WHO endorsed Universal Health Coverage as the main policy objective whereby health systems strengthening, including reinforcement of the health workforce, can contribute to several Sustainable Development Goals. Now is the right time to trace the implementation of these commitments and to assess their contribution to broader global health objectives. The baseline data for this policy tracing study consist of the categorisation and analysis of the HRH commitments conducted in 2014. This analysis was complemented in application of the health policy triangle as its main analytical framework. An online survey and a guideline for semistructured interviews were developed to collect data. Information on the implementation of the commitments is available in 49 countries (86%). The need for multi-actor approaches for HRH policy development is universally recognised. A suitable political window and socioeconomic situation emerge as crucial factors for sustainable HRH development. However, complex crises in different parts of the world have diverted attention from investment in HRH development. The analysis indicates that investment in the health workforce and corresponding policy development relies on political leadership, coherent government strategies, institutional capacity and intersectoral governance mechanisms. The institutional capacity to shoulder such complex tasks varies widely across countries. For several countries, the commitment process provided an opportunity to invest in, develop and reform the health workforce. Nevertheless, the quality of HRH monitoring mechanisms requires more attention. In conclusion, HRH challenges, their different pathways and the intersectorality of the required responses are a concern for all the countries analysed. There is hence a need for national governments and stakeholders across the globe to share responsibilities and invest in this vital issue in a co-ordinated manner. PMID:29104768

[School readiness and community mobilization: study retrospective in a Montreal area].

PubMed

Laurin, Isabelle; Bilodeau, Angèle; Chartrand, Sébastien

2012-02-22

This article presents a modelling of the collective decision-making process by which a community-based population-level intervention transformed the organization of early childhood services in a Montréal community from 2001 to 2006. Multisectoral players from a childhood/family issue table. The chosen territory is one of the most multi-ethnic and poorest neighbourhoods of Montréal. The intervention being examined is Understanding the Early Years (UEY), a Canada-wide initiative aiming to strengthen communities' capacity to use quality information to support the thought process relating to the organization of early childhood services. Twelve Canadian regions took part, including Montréal. The time chart for the collective decision-making process presents the events that significantly influenced the procedure: establishment of an intersectoral working committee, production of a portrait of the neighbourhood, think tank, development and implementation of the Passage maison-école [home-to-school] and Femmes-Relais [relay women] projects, retreats, and inclusion of school readiness as a priority focus area in the neighbourhood's three-year action plan. Also presented are the contextual factors that influenced decision making: the neighbourhood's cooperation and coordination history, the researcher's involvement, financial support and shared leadership. The benefits of UEY-Montréal in this territory extended beyond 2006. With respect to current priorities for action in early childhood, this territory is a good example of mobilization for school readiness.

Building expert agreement on the importance and feasibility of workplace health promotion interventions for nurses and midwives: A modified Delphi consultation.

PubMed

Perry, Lin; Nicholls, Rachel; Duffield, Christine; Gallagher, Robyn

2017-11-01

To use a Delphi panel to determine the relative importance and feasibility of workplace health promotion interventions to promote and support the health of the Australian nursing and midwifery workforce. The nursing workforce experiences rates of ill health above that of other workforces, yet there is little investment in workplace health promotion. The study used a modified Delphi design conducted between September and November 2015. Eleven of 19 purposively selected expert panellists discussed, rated and provided feedback through two rounds of an electronic questionnaire about the relative importance and feasibility of 46 workplace health promotion interventions and processes for nurses and midwives. Scores for importance and feasibility were calculated and ranked and a composite score of importance multiplied by feasibility. Mental health strategies were prioritized as the most important and feasible of the intervention topics, followed closely by healthy eating and physical activity interventions; smoking cessation ranked lowest. The most highly ranked interventions targeted healthy eating, stress management and resilience training. Highest ranked processes to support development of a healthy work environment included intersectoral collaboration and employee wellness groups. Study findings prompt consideration of health promotion opportunities to support nurses' health and well-being. Findings identified key workplace health promotion priorities and provide direction for policy makers and managers to promote nursing and midwifery workforce health. © 2017 John Wiley & Sons Ltd.

Peru: population and policy.

PubMed

Sobrevilla, L A

1987-06-01

Peru's 1985 Population Policy Law states as its second objective that individuals and couples should be well informed and provided with the education and health services that will assist them in making responsible decisions about the number and spacing of their children. Thus, the law establishes a firm basis for IEC programs. With regard to population education, the purpose of the law is to create awareness through all educational channels of the reciprocal influence of population dynamics and socioeconomic development and to promote positive attitudes toward small family size. The law promotes the use of the communications media to educate and inform about population issues. The National Population Council, which coordinates and supervises the IEC activities of public sector agencies, has issued publications and audiovisual materials, conducted meetings with government officials and opinion leaders, and promoted awareness of population policy as a key part of development planning. In 1984, the Council organized the First National Seminar on Communication and Population to review activities, set the basis for intersectoral coordination, unify criteria, and review population policy concepts and language. The Ministry of Health carries out IEC activities as part of its family planning services program. In addition, the Ministry of Education has organized a national population education program that aims to revise school curricula to include a greater emphasis on population dynamics and family life education. The activities of a number of private institutions complement the IEC work public sector organizations.

Increasing the uptake of long-acting and permanent methods of family planning: A qualitative study with village midwives in East Java and Nusa Tenggara Barat Provinces, Indonesia.

PubMed

Titaley, Christiana R; Wijayanti, Ratna U; Damayanti, Rita; Setiawan, Agus Dwi; Dadun; Dachlia, Dini; Siagian, Ferdinand; Suparno, Heru; Saputri, Dwi Astuti Yunita; Harlan, Sarah; Wahyuningrum, Yunita; Storey, Douglas

2017-10-01

this analysis aims to explore midwives' insights into the provision of long-acting and permanent methods of contraception (LAPMs) in the selected areas of East Java and Nusa Tenggara Barat (NTB) Provinces, Indonesia. a qualitative study using in-depth interviews was conducted with 12 village midwives from 12 villages, to explore their perceptions and experiences in delivering family planning services. the study was carried out in May-June 2013, as part of the baseline assessment in the Improving Contraceptive Method Mix (ICMM) study. We interviewed 12 village midwives working in 12 villages in six study districts: Tuban, Kediri, and Lumajang Districts in East Java Province; and Lombok Barat, Lombok Timur, and Sumbawa Districts in NTB Province. an interview guideline was used in all interviews. It covered several topics, such as community perceptions of LAPMs, availability of contraception and related equipment, availability of human resources, and midwives' efforts to improve LAPM coverage. All interviews were recorded and transcribed. Content and thematic analyses were carried out by grouping and coding the information based on the identified themes and topics. according to village midwives interviewed in this study, community-level acceptance of LAPMs has increased over time; however, some still prefer using short-acting methods for a long period. The reasons include lack of awareness about the benefits and side effects of LAPMs, fear of surgical procedures, rumored consequences (for example, that LAPMs would limit women's ability to perform hard physical labor), and religious beliefs. There were several challenges reported by village midwives in delivering LAPM services, such as confusion about midwives' eligibility to provide LAPM services, lack of Contraceptive Technology Update (CTU) and counseling trainings, and shortage of supporting equipment (such as exam tables and IUD and implant insertion kits). There were several strategies implemented by village midwives to improve LAPM use, including strengthening the counseling services, accompanying clients to higher health facilities to obtain LAPM services, and providing services for groups of clients. All village midwives emphasized the importance of strengthening collaboration among stakeholders to increase the uptake of LAPM services. as midwives are the main family planning providers in Indonesia, efforts to address their challenges is essential. Enabling a supportive policy environment, strengthening promotional activities, increasing the number of training programs designed for village midwives-in addition to enhancing inter-sectoral collaboration-are some recommendations to improve LAPM uptake in study areas. Copyright © 2017 Elsevier Ltd. All rights reserved.

Dilemmas in providing resilience-enhancing social services to long-term social assistance clients. A qualitative study of Swedish social workers.

PubMed

Marttila, Anneli; Johansson, Eva; Whitehead, Margaret; Burström, Bo

2012-07-12

Long-term recipients of social assistance face barriers to social and economic inclusion, and have poorer health and more limited opportunities for improving their health than many other groups in the population. During recent decades there have been changes in Swedish social policy, with cutbacks in public benefits and a re-emphasis on means-tested policies. In this context, it is important to investigate the necessary conditions for social workers to offer social assistance and services, as well as the mediating role of social workers between public policies and their clients. Swedish social services aim to promote social inclusion by strengthening the individual's own resources. We investigated the issues that arise when providing social services to long-term social assistance clients within the framework of resilience, which focuses on the processes leading to positive functioning in adverse conditions. Interviews were conducted with 23 social workers in Stockholm and analysed by qualitative content analysis. The main theme to emerge from the interviews concerned the constraints that the social workers faced in providing social services to social assistance clients. The first subtheme focused on dilemmas in the interaction between social workers and clients resulting from the dual role of exercising authority and supporting and building trust with clients. Working conditions of social workers also played a crucial role. The second subtheme addressed the impact of the societal context, such as labour market opportunities and coordination between authorities. Overall, we found that social workers to a great extent tried to find individual solutions to structural problems. To provide resilience-enhancing social services to long-term social assistance clients with varying obstacles and needs requires a constructive working environment, supportive societal structures and inter-sectoral cooperation between different authorities.

[User embracement in the Family Health Strategy in Brazil: an integrative review].

PubMed

Garuzi, Miriane; Achitti, Maria Cecília de Oliveira; Sato, Cintia Ayame; Rocha, Suelen Alves; Spagnuolo, Regina Stella

2014-02-01

To review the literature regarding the application of the notion of user embracement and to identify the contributions of this concept for primary health care practices in Brazil. We carried out an integrative review of the literature regarding primary health care. The following databases were searched: LILACS, SciELO, and MEDLINE, covering the period from 2006 to 2010. The following search terms were used in LILACS and SciELO: "acolhimento" and "programa saúde da família" and "saúde". For MEDLINE, the terms "user embracement" and "family health program" and "health" were used. The review was performed in November 2010. We identified 21 articles meeting the inclusion criteria, all of which described studies carried out in Brazil. The articles were divided into three empirical categories: integration and embracement; primary care work process; and evaluation of services. These are complementary categories that converge to two main views of embracement: the first sees embracement as a means of reorganizing the primary health care environment, and the second sees embracement as an attitude towards users. The review also shows that embracement may be a management tool that supports the Unified Health System and is associated with the principles of comprehensiveness and universality. Embracement is able to create a bond between health care workers and users. It promotes self-care, a better understanding of disease, as well as user co-responsibility for treatment. In addition, it facilitates universal access, strengthens multiprofessional and intersectoral work, qualifies care, humanizes practices, and encourages actions to combat prejudice. Nevertheless, the perspective of health care users regarding embracement deserves more attention and should be the focus of future studies.

Actionable knowledge and strategic decision making for bio- and agroterrorism threats: building a collaborative early warning culture.

PubMed

Mårtensson, Per-Åke; Hedström, Lars; Sundelius, Bengt; Skiby, Jeffrey E; Elbers, Armin; Knutsson, Rickard

2013-09-01

Current trends in biosecurity and cybersecurity include (1) the wide availability of technology and specialized knowledge that previously were available only to governments; (2) the global economic recession, which may increase the spread of radical non-state actors; and (3) recent US and EU commission reports that reflect concerns about non-state actors in asymmetric threats. The intersectoral and international nature of bioterrorism and agroterrorism threats requires collaboration across several sectors including intelligence, police, forensics, customs, and other law enforcement organizations who must work together with public and animal health organizations as well as environmental and social science organizations. This requires coordinated decision making among these organizations, based on actionable knowledge and information sharing. The risk of not sharing information among organizations compared to the benefit of sharing information can be considered in an "information sharing risk-benefit analysis" to prevent a terrorism incident from occurring and to build a rapid response capability. In the EU project AniBioThreat, early warning is the main topic in work package 3 (WP 3). A strategy has been generated based on an iterative approach to bring law enforcement agencies and human and animal health institutes together. Workshops and exercises have taken place during the first half of the project, and spin-off activities include new preparedness plans for institutes and the formation of a legal adviser network for decision making. In addition, a seminar on actionable knowledge was held in Stockholm, Sweden, in 2012, which identified the need to bring various agency cultures together to work on developing a resilient capability to identify early signs of bio- and agroterrorism threats. The seminar concluded that there are a number of challenges in building a collaborative culture, including developing an education program that supports collaboration and shared situational awareness.

Statistical emulators of maize, rice, soybean and wheat yields from global gridded crop models

DOE PAGES

Blanc, Élodie

2017-01-26

This study provides statistical emulators of crop yields based on global gridded crop model simulations from the Inter-Sectoral Impact Model Intercomparison Project Fast Track project. The ensemble of simulations is used to build a panel of annual crop yields from five crop models and corresponding monthly summer weather variables for over a century at the grid cell level globally. This dataset is then used to estimate, for each crop and gridded crop model, the statistical relationship between yields, temperature, precipitation and carbon dioxide. This study considers a new functional form to better capture the non-linear response of yields to weather,more » especially for extreme temperature and precipitation events, and now accounts for the effect of soil type. In- and out-of-sample validations show that the statistical emulators are able to replicate spatial patterns of yields crop levels and changes overtime projected by crop models reasonably well, although the accuracy of the emulators varies by model and by region. This study therefore provides a reliable and accessible alternative to global gridded crop yield models. By emulating crop yields for several models using parsimonious equations, the tools provide a computationally efficient method to account for uncertainty in climate change impact assessments.« less

Public Health Responses to a Dengue Outbreak in a Fragile State: A Case Study of Nepal

PubMed Central

Griffiths, Karolina; Banjara, Megha Raj; O'Dempsey, T.; Munslow, B.; Kroeger, Axel

2013-01-01

Objectives. The number of countries reporting dengue cases is increasing worldwide. Nepal saw its first dengue outbreak in 2010, with 96% of cases reported in three districts. There are numerous policy challenges to providing an effective public health response system in a fragile state. This paper evaluates the dengue case notification, surveillance, laboratory facilities, intersectoral collaboration, and how government and community services responded to the outbreak. Methods. Qualitative data were collected through 20 in-depth interviews, with key stakeholders, and two focus-group discussions, with seven participants. Results. Limitations of case recognition included weak diagnostic facilities and private hospitals not incorporated into the case reporting system. Research on vectors was weak, with no virological surveillance. Limitations of outbreak response included poor coordination and an inadequate budget. There was good community mobilization and emergency response but no routine vector control. Conclusions. A weak state has limited response capabilities. Disease surveillance and response plans need to be country-specific and consider state response capacity and the level of endemicity. Two feasible solutions for Nepal are (1) go upwards to regional collaboration for disease and vector surveillance, laboratory assistance, and staff training; (2) go downwards to expand upon community mobilisation, ensuring that vector control is anticipatory to outbreaks. PMID:23690789

Prioritising coastal zone management issues through fuzzy cognitive mapping approach.

PubMed

Meliadou, Aleka; Santoro, Francesca; Nader, Manal R; Dagher, Manale Abou; Al Indary, Shadi; Salloum, Bachir Abi

2012-04-30

Effective public participation is an essential component of Integrated Coastal Zone Management implementation. To promote such participation, a shared understanding of stakeholders' objectives has to be built to ultimately result in common coastal management strategies. The application of quantitative and semi-quantitative methods involving tools such as Fuzzy Cognitive Mapping is presently proposed for reaching such understanding. In this paper we apply the Fuzzy Cognitive Mapping tool to elucidate the objectives and priorities of North Lebanon's coastal productive sectors, and to formalize their coastal zone perceptions and knowledge. Then, we investigate the potential of Fuzzy Cognitive Mapping as tool for support coastal zone management. Five round table discussions were organized; one for the municipalities of the area and one for each of the main coastal productive sectors (tourism, industry, fisheries, agriculture), where the participants drew cognitive maps depicting their views. The analysis of the cognitive maps showed a large number of factors perceived as affecting the current situation of the North Lebanon coastal zone that were classified into five major categories: governance, infrastructure, environment, intersectoral interactions and sectoral initiatives. Furthermore, common problems, expectations and management objectives for all sectors were exposed. Within this context, Fuzzy Cognitive Mapping proved to be an essential tool for revealing stakeholder knowledge and perception and understanding complex relationships. Copyright © 2011 Elsevier Ltd. All rights reserved.

Ethical issues in healthcare financing.

PubMed

Maharaj, S R; Paul, T J

2011-07-01

The four goals of good healthcare are to relieve symptoms, cure disease, prolong life and improve quality of life. Access to healthcare has been a perpetual challenge to healthcare providers who must take into account important factors such as equity, efficiency and effectiveness in designing healthcare systems to meet the four goals of good healthcare. The underlying philosophy may designate health as being a basic human right, an investment, a commodity to be bought and sold, a political demand or an expenditure. The design, policies and operational arrangements will usually reflect which of the above philosophies underpin the healthcare system, and consequently, access. Mechanisms for funding include fee-for-service, cost sharing (insurance, either private or government sponsored) free-of-fee at point of delivery (payments being made through general taxes, health levies, etc) or cost-recovery. For each of these methods of financial access to healthcare services, there are ethical issues which can compromise the four principles of ethical practices in healthcare, viz beneficence, non-maleficence, autonomy and justice. In times of economic recession, providing adequate healthcare will require governments, with support from external agencies, to focus on poverty reduction strategies through provision of preventive services such as immunization and nutrition, delivered at primary care facilities. To maximize the effect of such policies, it will be necessary to integrate policies to fashion an intersectoral approach.

The impact of the Bolsa Família Program on food consumption: a comparative study of the southeast and northeast regions of Brazil.

PubMed

Sperandio, Naiara; Rodrigues, Cristiana Tristão; Franceschini, Sylvia do Carmo Castro; Priore, Silvia Eloiza

2017-06-01

The aim of this study was to evaluate the impact of the Bolsa Família Program (PBF) on food consumption in the northeast and southeast regions of Brazil. The database was obtained from the individual food consumption module of the Household Budget Survey conducted in 2008-09. Consumption was assessed through two food records. The food was categorized into four groups: fresh or minimally processed food; culinary ingredients; processed food; and ultra-processed food. To analyze the impact, the propensity score matching method was used, which compares the individual recipients and non-recipients of the PBF in relation to a group of socioeconomic characteristics. After the propensity score was calculated, the impact of the PBF was estimated through the nearest-neighbor matching algorithm. In both regions, more than 60% of the daily total calories consumed by PBF recipients came from foods that had not undergone industrial processing. The recipients of PBF had a low level of consumption of processed and ultra-processed food in both regions, and an increased level of consumption of fresh or minimally processed food in the northeast. The results indicate the importance of adopting intersectoral policies in parallel to the PBF in order to strengthen healthy eating practices.

Statistical emulators of maize, rice, soybean and wheat yields from global gridded crop models

DOE Office of Scientific and Technical Information (OSTI.GOV)

Blanc, Élodie

This study provides statistical emulators of crop yields based on global gridded crop model simulations from the Inter-Sectoral Impact Model Intercomparison Project Fast Track project. The ensemble of simulations is used to build a panel of annual crop yields from five crop models and corresponding monthly summer weather variables for over a century at the grid cell level globally. This dataset is then used to estimate, for each crop and gridded crop model, the statistical relationship between yields, temperature, precipitation and carbon dioxide. This study considers a new functional form to better capture the non-linear response of yields to weather,more » especially for extreme temperature and precipitation events, and now accounts for the effect of soil type. In- and out-of-sample validations show that the statistical emulators are able to replicate spatial patterns of yields crop levels and changes overtime projected by crop models reasonably well, although the accuracy of the emulators varies by model and by region. This study therefore provides a reliable and accessible alternative to global gridded crop yield models. By emulating crop yields for several models using parsimonious equations, the tools provide a computationally efficient method to account for uncertainty in climate change impact assessments.« less

A Decade of Monitoring HIV Epidemics in Nigeria: Positioning for Post-2015 Agenda.

PubMed

Akinwande, Oluyemisi; Bashorun, Adebobola; Azeez, Aderemi; Agbo, Francis; Dakum, Patrick; Abimiku, Alashle; Bilali, Camara; Idoko, John; Ogungbemi, Kayode

2017-07-01

Nigeria accounts for 9% of the global HIV burden and is a signatory to Millennium Development Goals as well as the post-2015 Sustainable Development Goals. This paper reviews maturation of her HIV M&E system and preparedness for monitoring of the post-2015 agenda. Using the UNAIDS criteria for assessing a functional M&E system, a mixed-methods approach of desk review and expert consultations, was employed. Following adoption of a multi-sectoral M&E system, Nigeria experienced improved HIV coordination at the National and State levels, capacity building for epidemic appraisals, spectrum estimation and routine data quality assessments. National data and systems audit processes were instituted which informed harmonization of tools and indicators. The M&E achievements of the HIV response enhanced performance of the National Health Management Information System (NHMIS) using DHIS2 platform following its re-introduction by the Federal Ministry of Health, and also enabled decentralization of data management to the periphery. A decade of implementing National HIV M&E framework in Nigeria and the recent adoption of the DHIS2 provides a strong base for monitoring the Post 2015 agenda. There is however a need to strengthen inter-sectoral data linkages and reduce the rising burden of data collection at the global level.

A Web-Based Computer-Tailored Alcohol Prevention Program for Adolescents: Cost-Effectiveness and Intersectoral Costs and Benefits.

PubMed

Drost, Ruben M W A; Paulus, Aggie T G; Jander, Astrid F; Mercken, Liesbeth; de Vries, Hein; Ruwaard, Dirk; Evers, Silvia M A A

2016-04-21

Preventing excessive alcohol use among adolescents is important not only to foster individual and public health, but also to reduce alcohol-related costs inside and outside the health care sector. Computer tailoring can be both effective and cost-effective for working with many lifestyle behaviors, yet the available information on the cost-effectiveness of computer tailoring for reducing alcohol use by adolescents is limited as is information on the costs and benefits pertaining to sectors outside the health care sector, also known as intersectoral costs and benefits (ICBs). The aim was to assess the cost-effectiveness of a Web-based computer-tailored intervention for reducing alcohol use and binge drinking by adolescents from a health care perspective (excluding ICBs) and from a societal perspective (including ICBs). Data used were from the Alcoholic Alert study, a cluster randomized controlled trial with randomization at the level of schools into two conditions. Participants either played a game with tailored feedback on alcohol awareness after the baseline assessment (intervention condition) or received care as usual (CAU), meaning that they had the opportunity to play the game subsequent to the final measurement (waiting list control condition). Data were recorded at baseline (T0=January/February 2014) and after 4 months (T1=May/June 2014) and were used to calculate incremental cost-effectiveness ratios (ICERs), both from a health care perspective and a societal perspective. Stochastic uncertainty in the data was dealt with by using nonparametric bootstraps (5000 simulated replications). Additional sensitivity analyses were conducted based on excluding cost outliers. Subgroup cost-effectiveness analyses were conducted based on several background variables, including gender, age, educational level, religion, and ethnicity. From both the health care perspective and the societal perspective for both outcome measures, the intervention was more costly and more effective in comparison with CAU. ICERs differed for both perspectives, namely €40 and €79 from the health care perspective to €62 and €144 for the societal perspective per incremental reduction of one glass of alcohol per week and one binge drinking occasion per 30 days, respectively. Subgroup analyses showed, from both perspectives and for both outcome measures, that the intervention was cost-effective for older adolescents (aged 17-19 years) and those at a lower educational level and, from a health care perspective, the male and nonreligious adolescent subgroups. Computer-tailored feedback could be a cost-effective way to target alcohol use and binge drinking among adolescents. Including ICBs in the economic evaluation had an impact on the cost-effectiveness results of the analysis. It could be worthwhile to aim the intervention specifically at specific subgroups. Nederlands Trial Register: NTR4048; http://www.trialregister.nl/trialreg/admin/rctview.asp?TC=4048 (Archived by Webcite at http://www.webcitation.org/6c7omN8wG).

Vernetztes regionales Engagement - Das Beispiel Heilbronn-Franken

NASA Astrophysics Data System (ADS)

Suarsana, Laura; Glückler, Johannes

2016-03-01

At a regional scale, a variety of actors from all three sectors of private, public and civil society act together in a philanthropic field. This article deals with the question of how cooperation in charitable action unfolds in this field. Using the example of the region of Heilbronn-Franconia, the empirical case unpacks the dominance of local and regional forms of philanthropy and reconstructs two successful examples of intersectoral collaboration. However, the analysis also demonstrates the limits of the external designability that are due to the individuality of charitable actors, their diverse objectives and the contextuality of the regional environment. The realization of synergies through regional governance therefore succeeds only by respecting the dedication and self-determination of philanthropic commitment and by creating legitimate and sensitive structures of moderation and facilitation.

Nurse-led multidisciplinary initiatives to improve outcomes and reduce hospital admissions for older adults: The Care coordination through Emergency Department, Residential Aged Care and Primary Health Collaboration project.

PubMed

Marsden, Elizabeth; Craswell, Alison; Taylor, Andrea; Coates, Kaye; Crilly, Julia; Broadbent, Marc; Glenwright, Amanda; Johnston, Colleen; Wallis, Marianne

2018-04-03

This article describes the Care coordination through Emergency Department, Residential Aged Care and Primary Health Collaboration (CEDRiC) project. CEDRiC is designed to improve the health outcomes for older people with an acute illness. It attempts this via enhanced primary care in residential aged care facilities, focused and streamlined care in the emergency department and enhanced intersectoral communication and referral. Implementing this approach has the potential to decrease inappropriate hospital admissions while improving care for older people in residential aged care and community settings. This article discusses an innovative way of caring for older adults in an ageing population utilising the existing evidence. A formal evaluation is currently underway. © 2018 AJA Inc.

City leadership for health and sustainable development: the World Health Organization European Healthy Cities Network.

PubMed

Tsouros, Agis

2009-11-01

This paper provides an overview of European Healthy Cities Network (EHCN) organized by the WHO Regional Office Europe. The focus is on the third of five phases covering the period 1998-2002. Fifty-six cities were members of the WHO-EHCN and over 1000 European cities were members of national networks. Association with WHO has given municipalities legitimacy to move into a domain often associated with health service. Equity and community participation are core values. City mayors provide political leadership. Intersectoral cooperation underpins a Healthy Cities approach. The WHO Regional Office for Europe supports WHO-EHCN, providing guidance and technical leadership. Cities' processes and structures are prerequisits for improvements in health and are central to the evaluation of Phase III of the WHO-EHCN.

Empowering young girls for health and development.

PubMed

Lal, S; Saini, R K; Khanna, P; Malik, J S

1991-01-01

Yuvati Vikas Kendra (YVK) model of empowering young girls in the age bracket of 7-19 years could raise the level of awareness and generate self-esteem and self-confidence in over 50% of young girls over a period of six months of operation. The YVK model was utilised by 37-55% of enrolled girls in different age brackets; thus these centres functioned well below their installed capacity. Functional inter-sectoral linkages have to be developed for better impact and better coverage. Data based information from other models of empowerment such as schools, non-formal system of education and Integrated Child Development Services Scheme, is called for to choose different alternatives for our country, as no uniform system can succeed in this vast country. Diversified modes and approaches for empowerment of young girls are needed.

Prevalence of pediculosis capitis in children from a rural school in Yucatan, Mexico.

PubMed

Manrique-Saide, Pablo; Pavía-Ruz, Norma; Rodríguez-Buenfil, Jorge C; Herrera Herrera, Roodeth; Gómez-Ruiz, Pilar; Pilger, Daniel

2011-01-01

We conducted an analytical cross-sectional survey to estimate the prevalence of and factors associated with active head lice infestation. In total 140 children, aged 6 to 16-years, from a public school in rural Yucatan, Mexico, were examined by wet-combing. A structured questionnaire was used to collect information on individuals and the conditions in the surrounding environment. Head lice infestation was found in 19 out of the 140 children tested (13.6%) and this was associated with both lower income (OR 9.9, 95% CI 2.15-45.79, p = 0.003) and a higher frequency of hair washing (OR 8, 95% CI 1.58-50, p = 0.012). Intersectoral control programs that take into account the socioeconomic differences of children should be implemented.

Why Did Zika Not Explode in Cuba? The Role of Active Community Participation to Sustain Control of Vector-Borne Diseases.

PubMed

Castro, Marta; Pérez, Dennis; Guzman, Maria G; Barrington, Clare

2017-08-01

As the global public health community develops strategies for sustainable Zika prevention and control, assessment of the Cuban response to Zika provides critical lessons learned. Cuba's early and successful response to Zika, grounded in the country's long-standing dengue prevention and control program, serves as a model of rapid mobilization of intersectoral efforts. Sustaining this response requires applying the evidence generated within the Cuban dengue program that active community participation improves outcomes and is sustainable and cost-effective. There is also a need for implementation science efforts to assess the transferability of lessons learned from Zika prevention and control to other pathogens and from one context to another in addition to how to take these efforts to scale.

[Healthy Cities projects].

PubMed

Takano, Takehito

2002-05-01

This is a review article on "Healthy Cities". The Healthy Cities programme has been developed by the World Health Organization (WHO) to tackle urban health and environmental issues in a broad way. It is a kind of comprehensive policy package to carry out individual projects and activities effectively and efficiently. Its key aspects include healthy public policy, vision sharing, high political commitment, establishment of structural organization, strategic health planning, intersectoral collaboration, community participation, setting approach, development of supportive environment for health, formation of city health profile, national and international networking, participatory research, periodic monitoring and evaluation, and mechanisms for sustainability of projects. The present paper covered the Healthy Cities concept and approaches, rapid urbanization in the world, developments of WHO Healthy Cities, Healthy Cities developments in the Western Pacific Region, the health promotion viewpoint, and roles of research.

Bangladesh becomes "success story".

PubMed

1999-01-01

The State Minister for Health and Family of Bangladesh, Dr. Mohammed Amanullah, highlighted some of the successes being achieved by his country in lowering fertility and improving the lives of the people since the 1994 International Conference on Population and Development. Some of these successes include practical measures to eliminate violence against women; introduction of a quota for women in public sector employment; and launching of the Health and Population Sector Program to provide a one-stop, full range of essential reproductive health, family planning and child health services through an integrated delivery mechanism. Moreover, the Minister informed the Forum participants that their success is attributable to many factors which include support from the government, from non-governmental organizations, civil society, mass media, religious and other community leaders, intersectoral collaboration, microcredit and income-generation activities.

Sustainable development goals for health promotion: a critical frame analysis.

PubMed

Spencer, Grace; Corbin, J Hope; Miedema, Esther

2018-05-25

The Sustainable Development Goals (SDGs) lay the foundations for supporting global health and international development work for the next 15 years. Thirty years ago, the Ottawa Charter defined health promotion and outlined key principles for global action on health, including the importance of advocating, enabling and mediating for health equity. Advocacy underscores a human right to health and suggests political action to support its attainment. Enabling speaks to health promotion's focus on the empowerment of people and communities to take control over their health and aspirations. Mediation draws attention to the critical intersectoral partnerships required to address health and social inequities. Underpinned by this approach, the aim of this paper is to consider how key health promotion principles, namely, rights, empowerment and partnership feature (and are framed) within the SDGs and to consider how these framings may shape future directions for health promotion. To that end, a critical frame analysis of the Transforming Our World document was conducted. The analysis interrogated varying uses and meanings of partnerships, empowerment and rights (and their connections) within the SDGs. The analysis here presents three framings from the SDGs: (1) a moral code for global action on (in)equity; (2) a future orientation to address global issues yet devoid of history; and (3) a reductionist framing of health as the absence of disease. These framings raise important questions about the underpinning values of the SDGs and pathways to health equity - offering both challenges and opportunities for defining the nature and scope of health promotion.

Building partnerships to address the HIV epidemic.

PubMed

Chua, A C; Leo, Y S; Lee, C C

2008-05-01

Batam is one of the islands comprising the Riau Province in Indonesia, and is closest to Singapore. It is a popular destination of many Singaporeans. Surveillance reports among commercial sex workers conducted in Batam showed the prevalence rate of human immunodeficiency virus (HIV) is 16.2 percent. At the end of 2006, the total number of HIV-infected Singaporeans was 3,060, the majority being infected via heterosexual transmission. The aim of the Indonesian government is to rapidly scale up HIV treatment to those needing it. One of the factors critical to the rapid scale-up is healthcare worker training. An intersectoral collaboration addressing the issue of HIV care and treatment with a hospital in Batam was created. The first activity of the collaboration was a two-day HIV training course conducted in February 2007. The aim of the course was to provide a basic understanding of HIV, as well as knowledge on common opportunistic infections that may present to a general hospital or clinical setting. 34 doctors from 23 institutions in Batam and three doctors from two hospitals in the Riau Islands attended the two-day HIV training course. The participants found the training very useful and highly relevant. This first HIV training provided a foundation to build on further HIV education. It is our belief that through the HIV training programme, there will be more awareness of HIV among the various medical institutions in Batam. As the HIV epidemic knows no borders, working with neighbouring countries is one strategy that deserves attention.

Insights from the evaluation of a provincial healthy eating strategy in Nova Scotia, Canada.

PubMed

Sim, S Meaghan; Kirk, Sara F L

2013-10-01

Healthy Eating Nova Scotia represents the first provincial comprehensive healthy eating strategy in Canada and a strategy that is framed within a population-health model. Five years after strategy launch, our objective was to evaluate Healthy Eating Nova Scotia to determine perceptions of strategy implementation and strategy outputs. The focus of the current paper is on the findings of this evaluation. We conducted an evaluation of the strategy through three activities that included a document review, survey of key stakeholders and in-depth interviews with key strategy informants. The findings from each of the activities were integrated to determine what has worked well with strategy implementation, what could be improved and what outputs have resulted. The evaluation was conducted in the Canadian province of Nova Scotia. Participants for this evaluation included survey respondents (n 120) and key informants (n 16). A total of 156 documents were also reviewed. Significant investments have been made towards inter-sectoral partnerships and resourcing that has provided the necessary leadership and momentum for the strategy. Policy development has been leveraged through the strategy primarily in the health and education sectors and is perceived as a visible success. Clarity of human resource roles and funding within the context of a provincial strategy may be beneficial for continued strategy implementation, as is expansion of policy development. Known to be the first evaluation of its kind, these findings and related considerations will be of interest to policy makers developing and implementing similar strategies in their own jurisdictions.

[Respiratory symptoms associated with air pollution in five localities of Bogotá, 2008-2011, a dynamic cohort study].

PubMed

Sarmiento, Rodrigo; Hernández, Luis Jorge; Medina, Edna Katalina; Rodríguez, Natalia; Reyes, Jesús

2015-08-01

High levels of air pollution increase respiratory morbidity in children under five years of age. To know the incidence of respiratory symptoms and its associated factors in five localities of Bogota. A dynamic cohort study was undertaken with a sample size of 3,278 children from five localities split into two groups according to the degree of exposure to particulate matter. Monitoring was conducted at the outbreak of ten respiratory symptoms through a diary of those symptoms. Statistical analysis included incidence rate ratio (IRR) calculations and Poisson regression models for each assessed symptom. Cough was more frequent in the highly exposed group (lRR=1.23, Cl 95% 1.13-1.34). The most exposed group had higher incidence of expectoration (lRR=1.64, Cl= 95% 1.47-1.84). Wheezing was associated with high exposure to particulate matter (RR=2.29, Cl 95% 1.78-3.00), cottage industries (RR=1.29, Cl 95% 1.01-1.68) and age (RR=0.95, Cl 95% 0.94-0.96). Risk attributable to air pollution exposure fluctuated according to symptoms from 37% for nocturnal wheezing (Cl 95% 26-47.8) to 10.6 for cough (Cl 95% 6.3-15%). Extradomiciliary air pollution effects are potentiated by socioeconomic living and working conditions of people in Bogota. A broader conceptual public health approach and the strengthening of intersector actions are required to reduce health effects of air pollution.

From partnerships to networks: new approaches for measuring U.S. National Heritage Area effectiveness.

PubMed

Laven, Daniel N; Krymkowski, Daniel H; Ventriss, Curtis L; Manning, Robert E; Mitchell, Nora J

2010-08-01

National Heritage Areas (NHAs) are an alternative and increasingly popular form of protected area management in the United States. NHAs seek to integrate environmental objectives with community and economic objectives at regional or landscape scales. NHA designations have increased rapidly in the last 20 years, generating a substantial need for evaluative information about (a) how NHAs work; (b) outcomes associated with the NHA process; and (c) the costs and benefits of investing public moneys into the NHA approach. Qualitative evaluation studies recently conducted at three NHAs have identified the importance of understanding network structure and function in the context of evaluating NHA management effectiveness. This article extends these case studies by examining quantitative network data from each of the sites. The authors analyze these data using both a descriptive approach and a statistically more robust approach known as exponential random graph modeling. Study findings indicate the presence of transitive structures and the absence of three-cycle structures in each of these networks. This suggests that these networks are relatively ''open,'' which may be desirable, given the uncertainty of the environments in which they operate. These findings also suggest, at least at the sites reported here, that the NHA approach may be an effective way to activate and develop networks of intersectoral organizational partners. Finally, this study demonstrates the utility of using quantitative network analysis to better understand the effectiveness of protected area management models that rely on partnership networks to achieve their intended outcomes.

Integrating nutrition security with treatment of people living with HIV: lessons from Kenya.

PubMed

Byron, Elizabeth; Gillespie, Stuart; Nangami, Mabel

2008-06-01

The increased caloric requirements of HIV-positive individuals, undesirable side effects of treatment that may be worsened by malnutrition (but alleviated by nutritional support), and associated declines in adherence and possible increased drug resistance are all justifications for developing better interventions to strengthen the nutrition security of individuals receiving antiretroviral treatment. To highlight key benefits and challenges relating to interventions aimed at strengthening the nutrition security of people living with HIV who are receiving antiretroviral treatment. Qualitative research was undertaken on a short-term nutrition intervention linked to the provision of free antiretroviral treatment for people living with HIV in western Kenya in late 2005 and early 2006. Patients enrolled in the food program while on treatment regimens self-reported greater adherence to their medication, fewer side effects, and a greater ability to satisfy increased appetite. Most clients self-reported weight gain, recovery of physical strength, and the resumption of labor activities while enrolled in dual (food supplementation and treatment) programs. Such improvements were seen to catalyze increased support from family and community. These findings provide further empirical support to calls for a more holistic and comprehensive response to the coexistence of AIDS epidemics with chronic nutrition insecurity. Future work is needed to clarify ways of bridging the gap between short-term nutritional support to individuals and longer-term livelihood security programming for communities affected by AIDS. Such interdisciplinary research will need to be matched by intersectoral action on the part of the agriculture and health sectors in such environments.

A multistakeholder platform to promote health and prevent noncommunicable diseases in the region of the Americas: the Pan American Health Organization partners forum for action.

PubMed

Hospedales, C James; Jané-Llopis, Eva

2011-08-01

Noncommunicable diseases (NCDs) and obesity are the most serious health problem facing the countries of the Americas in terms of avoidable deaths as well as costs to governments, families, and business. The main causes are ageing of the population, and widespread risks such as tobacco use, unhealthy diet, physical inactivity, and harmful use of alcohol, linked to major changes in the way we live and work, to public policies, cultural norms, and private sector forces. Underlying determinants are globalization, urbanization, poverty, education, gender, ethnicity, and access to health services. Yet, approximately 80% of cardiovascular disease and diabetes, and 40% of cancer, are preventable through a range of cost-effective population and individual measures for those at high risk of living with NCDs. However, the multisectoral nature of NCDs requires a cross-sector response to succeed. Several governments have commenced intersectoral efforts, and civil society and private sector also have many initiatives, but the responses are fragmented and skewed. The Partners Forum is being launched by the Pan American Health Organization in collaboration with the World Economic Forum and a set of partners including member states, partners in civil society, and partners in the private sector, as a multisector platform to catalyze, recognize, and scale up collaborative action to promote health and prevent and control NCDs at regional, subregional, and country level. The principles of partnership and lessons learned from other partnership experiences are being used in its design.

Designing an evaluation for a multiple-strategy community intervention: the North Coast Stay on Your Feet program.

PubMed

van Beurden, E; Kempton, A; Sladden, T; Garner, E

1998-02-01

Evaluation of the North Coast Stay on Your Feet falls prevention program is described as a case study of a comprehensive evaluation design for multi-strategic community interventions. Qualitative and quantitative methods were used to evaluate the program at formative, process and outcome levels. Formative evaluation used literature review, focus groups, mail-out and telephone survey methods to gather evidence from publications, older people, health workers, local business, media and government bodies. It included an analysis of demographic and hospital databases and identified incidence, causal pathways, knowledge, attitudes, behaviour, consequences and effectiveness of potential strategies. Process evaluation employed auditing, monitoring and telephone surveys to maintain an inventory of intervention activities and to track the reach of the program. Outcome evaluation involved a longitudinal study of intervention and control cohorts, surveyed before, during and after the intervention by telephone to monitor changes in knowledge, attitudes, risk and falls incidence. The survey instrument was designed for both formative and outcome evaluation, and analysis reflected the research design by incorporating repeat measures and adjusting for bias and confounding. Outcome validity was cross-checked via hospital admission rates. A novel, integrated framework for presenting inputs, activities and outcomes from all stages of the program is described. This framework facilitated feedback to stakeholders and enabled subsequent rapid adjustment of the intervention. Rigorous evaluation combined with clear presentation of findings helped to engender intersectoral support and obtain funding grants for extended implementation and evaluation. It also helped Stay on Your Feet to become a model for other falls prevention programs within Australia and internationally.

Inter-sectoral costs and benefits of mental health prevention: towards a new classification scheme.

PubMed

Drost, Ruben M W A; Paulus, Aggie T G; Ruwaard, Dirk; Evers, Silvia M A A

2013-12-01

Many preventive interventions for mental disorders have costs and benefits that spill over to sectors outside the healthcare sector. Little is known about these "inter-sectoral costs and benefits" (ICBs) of prevention. However, to achieve an efficient allocation of scarce resources, insights on ICBs are indispensable. The main aim was to identify the ICBs related to the prevention of mental disorders and provide a sector-specific classification scheme for these ICBs. Using PubMed, a literature search was conducted for ICBs of mental disorders and related (psycho)social effects. A policy perspective was used to build the scheme's structure, which was adapted to the outcomes of the literature search. In order to validate the scheme's international applicability inside and outside the mental health domain, semi-structured interviews were conducted with (inter)national experts in the broad fields of health promotion and disease prevention. The searched-for items appeared in a total of 52 studies. The ICBs found were classified in one of four sectors: "Education", "Labor and Social Security", "Household and Leisure" or "Criminal Justice System". Psycho(social) effects were placed in a separate section under "Individual and Family". Based on interviews, the scheme remained unadjusted, apart from adding a population-based dimension. This is the first study which offers a sector-specific classification of ICBs. Given the explorative nature of the study, no guidelines on sector-specific classification of ICBs were available. Nevertheless, the classification scheme was acknowledged by an international audience and could therefore provide added value to researchers and policymakers in the field of mental health economics and prevention. The identification and classification of ICBs offers decision makers supporting information on how to optimally allocate scarce resources with respect to preventive interventions for mental disorders. By exploring a new area of research, which has remained largely unexplored until now, the current study has an added value as it may form the basis for the development of a tool which can be used to calculate the ICBs of specific mental health related preventive interventions.

Assessing the impacts of 1.5°C of global warming - The Inter-Sectoral Impact Model Intercomparison Project (ISIMIP) approach

NASA Astrophysics Data System (ADS)

Zhao, F.; Frieler, K.; Warszawski, L.; Lange, S.; Schewe, J.; Reyer, C.; Ostberg, S.; Piontek, F.; Betts, R. A.; Burke, E.; Ciais, P.; Deryng, D.; Ebi, K. L.; Emanuel, K.; Elliott, J. W.; Galbraith, E. D.; Gosling, S.; Hickler, T.; Hinkel, J.; Jones, C.; Krysanova, V.; Lotze-Campen, H.; Mouratiadou, I.; Popp, A.; Tian, H.; Tittensor, D.; Vautard, R.; van Vliet, M. T. H.; Eddy, T.; Hattermann, F.; Huber, V.; Mengel, M.; Stevanovic, M.; Kirsten, T.; Mueller Schmied, H.; Denvil, S.; Halladay, K.; Suzuki, T.; Lotze, H. K.

2016-12-01

In Paris, France, December 2015 the Conference of Parties (COP) to the United Nations Framework Convention on Climate Change (UNFCCC) invited the IPCC to provide a "special report in 2018 on the impacts of global warming of 1.5°C above pre-industrial levels and related global greenhouse gas emission pathways". In Nairobi, Kenya, April 2016 the IPCC panel accepted the invitation. Here we describe the model simulations planned within the Inter-Sectoral Impact Model Intercomparison Project (ISIMIP) to address the request by providing tailored cross-sectoral consistent impacts projections. The protocol is designed to allow for 1) a separation of the impacts of the historical warming starting from pre-industrial conditions from other human drivers such as historical land use changes (based on pre-industrial and historical impact model simulations), 2) a quantification of the effects of an additional warming to 1.5°C including a potential overshoot and long term effects up to 2300 in comparison to a no-mitigation scenario (based on the low emissions Representative Concentration Pathway RCP2.6 and a no-mitigation scenario RCP6.0) keeping socio-economic conditions fixed at year 2005 levels, and 3) an assessment of the climate effects based on the same climate scenarios but accounting for parallel changes in socio-economic conditions following the middle of the road Shared Socioeconomic Pathway (SSP2) and differential bio-energy requirements associated with the transformation of the energy system to reach RCP2.6 compared to RCP6.0. To provide the scientific basis for an aggregation of impacts across sectors and an analysis of cross-sectoral interactions potentially damping or amplifying sectoral impacts the protocol is designed to provide consistent impacts projections across a range of impact models from different sectors (global and regional hydrological models, global gridded crop models, global vegetation models, regional forestry models, global and regional marine ecosystem and fisheries models, global and regional coastal infrastructure models, energy models, health models, and agro-economic models).

Assessing the impacts of 1.5°C of global warming - The Inter-Sectoral Impact Model Intercomparison Project (ISIMIP) approach

NASA Astrophysics Data System (ADS)

Frieler, Katja; Warszawski, Lila; Zhao, Fang

2017-04-01

In Paris, France, December 2015 the Conference of Parties (COP) to the United Nations Framework Convention on Climate Change (UNFCCC) invited the IPCC to provide a "special report in 2018 on the impacts of global warming of 1.5°C above pre-industrial levels and related global greenhouse gas emission pathways". In Nairobi, Kenya, April 2016 the IPCC panel accepted the invitation. Here we describe the model simulations planned within the Inter-Sectoral Impact Model Intercomparison Project (ISIMIP) to address the request by providing tailored cross-sectoral consistent impacts projections. The protocol is designed to allow for 1) a separation of the impacts of the historical warming starting from pre-industrial conditions from other human drivers such as historical land use changes (based on pre-industrial and historical impact model simulations), 2) a quantification of the effects of an additional warming to 1.5°C including a potential overshoot and long term effects up to 2300 in comparison to a no-mitigation scenario (based on the low emissions Representative Concentration Pathway RCP2.6 and a no-mitigation scenario RCP6.0) keeping socio-economic conditions fixed at year 2005 levels, and 3) an assessment of the climate effects based on the same climate scenarios but accounting for parallel changes in socio-economic conditions following the middle of the road Shared Socioeconomic Pathway (SSP2) and differential bio-energy requirements associated with the transformation of the energy system to reach RCP2.6 compared to RCP6.0. To provide the scientific basis for an aggregation of impacts across sectors and an analysis of cross-sectoral interactions potentially damping or amplifying sectoral impacts the protocol is designed to provide consistent impacts projections across a range of impact models from different sectors (global and regional hydrological models, global gridded crop models, global vegetation models, regional forestry models, global and regional marine ecosystem and fisheries models, global and regional coastal infrastructure models, energy models, health models, and agro-economic models).

Identifying mechanisms for facilitating knowledge to action strategies targeting the built environment.

PubMed

Fazli, Ghazal S; Creatore, Maria I; Matheson, Flora I; Guilcher, Sara; Kaufman-Shriqui, Vered; Manson, Heather; Johns, Ashley; Booth, Gillian L

2017-01-03

In recent years, obesity-related diseases have been on the rise globally resulting in major challenges for health systems and society as a whole. Emerging research in population health suggests that interventions targeting the built environment may help reduce the burden of obesity and type 2 diabetes. However, translation of the evidence on the built environment into effective policy and planning changes requires engagement and collaboration between multiple sectors and government agencies for designing neighborhoods that are more conducive to healthy and active living. In this study, we identified knowledge gaps and other barriers to evidence-based decision-making and policy development related to the built environment; as well as the infrastructure, processes, and mechanisms needed to drive policy changes in this area. We conducted a qualitative thematic analysis of data collected through consultations with a broad group of stakeholders (N = 42) from Southern Ontario, Canada, within various sectors (public health, urban planning, and transportation) and levels of government (federal, provincial, and municipalities). Relevant themes were classified based on the specific phase of the knowledge-to-action cycle (research, translation, and implementation) in which they were most closely aligned. We identified 5 themes including: 1) the need for policy-informed and actionable research (e.g. health economic analyses and policy evaluations); 2) impactful messaging that targets all relevant sectors to create the political will necessary to drive policy change; 3) common measures and tools to increase capacity for monitoring and surveillance of built environment changes; (4) intersectoral collaboration and alignment within and between levels of government to enable collective actions and provide mechanisms for sharing of resources and expertise, (5) aligning public and private sector priorities to generate public demand and support for community action; and, (6) solution-focused implementation of research that will be tailored to meet the needs of policymakers and planners. Additional research priorities and key policy and planning actions were also noted. Our research highlights the necessity of involving stakeholders in identifying inter-sectoral solutions to develop and translate actionable research on the built environment into effective policy and planning initiatives.

Assessing the impacts of 1.5 °C global warming - simulation protocol of the Inter-Sectoral Impact Model Intercomparison Project (ISIMIP2b)

NASA Astrophysics Data System (ADS)

Frieler, Katja; Lange, Stefan; Piontek, Franziska; Reyer, Christopher P. O.; Schewe, Jacob; Warszawski, Lila; Zhao, Fang; Chini, Louise; Denvil, Sebastien; Emanuel, Kerry; Geiger, Tobias; Halladay, Kate; Hurtt, George; Mengel, Matthias; Murakami, Daisuke; Ostberg, Sebastian; Popp, Alexander; Riva, Riccardo; Stevanovic, Miodrag; Suzuki, Tatsuo; Volkholz, Jan; Burke, Eleanor; Ciais, Philippe; Ebi, Kristie; Eddy, Tyler D.; Elliott, Joshua; Galbraith, Eric; Gosling, Simon N.; Hattermann, Fred; Hickler, Thomas; Hinkel, Jochen; Hof, Christian; Huber, Veronika; Jägermeyr, Jonas; Krysanova, Valentina; Marcé, Rafael; Müller Schmied, Hannes; Mouratiadou, Ioanna; Pierson, Don; Tittensor, Derek P.; Vautard, Robert; van Vliet, Michelle; Biber, Matthias F.; Betts, Richard A.; Bodirsky, Benjamin Leon; Deryng, Delphine; Frolking, Steve; Jones, Chris D.; Lotze, Heike K.; Lotze-Campen, Hermann; Sahajpal, Ritvik; Thonicke, Kirsten; Tian, Hanqin; Yamagata, Yoshiki

2017-11-01

In Paris, France, December 2015, the Conference of the Parties (COP) to the United Nations Framework Convention on Climate Change (UNFCCC) invited the Intergovernmental Panel on Climate Change (IPCC) to provide a special report in 2018 on the impacts of global warming of 1.5 °C above pre-industrial levels and related global greenhouse gas emission pathways. In Nairobi, Kenya, April 2016, the IPCC panel accepted the invitation. Here we describe the response devised within the Inter-Sectoral Impact Model Intercomparison Project (ISIMIP) to provide tailored, cross-sectorally consistent impact projections to broaden the scientific basis for the report. The simulation protocol is designed to allow for (1) separation of the impacts of historical warming starting from pre-industrial conditions from impacts of other drivers such as historical land-use changes (based on pre-industrial and historical impact model simulations); (2) quantification of the impacts of additional warming up to 1.5 °C, including a potential overshoot and long-term impacts up to 2299, and comparison to higher levels of global mean temperature change (based on the low-emissions Representative Concentration Pathway RCP2.6 and a no-mitigation pathway RCP6.0) with socio-economic conditions fixed at 2005 levels; and (3) assessment of the climate effects based on the same climate scenarios while accounting for simultaneous changes in socio-economic conditions following the middle-of-the-road Shared Socioeconomic Pathway (SSP2, Fricko et al., 2016) and in particular differential bioenergy requirements associated with the transformation of the energy system to comply with RCP2.6 compared to RCP6.0. With the aim of providing the scientific basis for an aggregation of impacts across sectors and analysis of cross-sectoral interactions that may dampen or amplify sectoral impacts, the protocol is designed to facilitate consistent impact projections from a range of impact models across different sectors (global and regional hydrology, lakes, global crops, global vegetation, regional forests, global and regional marine ecosystems and fisheries, global and regional coastal infrastructure, energy supply and demand, temperature-related mortality, and global terrestrial biodiversity).

Health in All Policies in South Australia—Did It Promote and Enact an Equity Perspective?

PubMed Central

Harris, Elizabeth; Baum, Fran; Delany-Crowe, Toni; MacDougall, Colin

2017-01-01

Mobilising cross-sectoral action is helpful in addressing the range of social determinants that contribute to health inequities. The South Australian Health in All Policies (SA HiAP) approach was implemented from 2007 to stimulate cross-sector policy activity to address the social determinants of health to improve population wellbeing and reduce health inequities. This paper presents selected findings from a five year multi-methods research study of the SA HiAP approach and draws on data collected during interviews, observation, case studies, and document analysis. The analysis shows that SA HiAP had dual goals of facilitating joined-up government for co-benefits (process focus); and addressing social determinants of health and inequities through cross-sectoral policy activity (outcomes focus). Government agencies readily understood HiAP as providing tools for improving the process of intersectoral policy development, while the more distal outcome-focused intent of improving equity was not well understood and gained less traction. While some early rhetorical support existed for progressing an equity agenda through SA HiAP, subsequent economic pressures resulted in the government narrowing its priorities to economic goals. The paper concludes that SA HiAP’s initial intentions to address equity were only partially enacted and little was done to reduce inequities. Emerging opportunities in SA, and internationally, including the UN Sustainable Development Goals, may revive interest in addressing equity. PMID:29068400

Social determinants of leprosy in a hyperendemic State in North Brazil

PubMed Central

Monteiro, Lorena Dias; Mota, Rosa Maria Salani; Martins-Melo, Francisco Rogerlândio; Alencar, Carlos Henrique; Heukelbach, Jorg

2017-01-01

ABSTRACT OBJECTIVE To identify the socioeconomic, demographic, operational, and health service-related factors associated with the occurrence of leprosy in a hyperendemic State in North Brazil. METHODS This is an ecological study based on secondary data from the Sistema de Informações de Agravos de Notificação in municipalities of the State of Tocantins from 2001 to 2012. Units of analysis were the 139 municipalities of the State. Negative binomial log linear regression models were used to estimate incidence rate ratios. RESULTS In bivariate analysis, the incidence rate ratios were significantly higher for municipalities with higher income ratio of the poorest 20.0% (1.47; 95%CI 1.19–1.81) and better Municipal Human Development Index (1.53; 95%CI 1.14–2.06). In multivariate analysis, the incidence rate ratios were significantly higher in municipalities with higher proportion of immigrants (1.31; 95%CI 1.11–1.55) and higher proportion of households with waste collection (1.37; 95%CI 1.11–1.69). There was a significant reduction in the incidence rate ratio with increased coverage of the Bolsa Família Program (0.98; 95%CI 0.96–0.99). CONCLUSIONS Control programs need to focus on activities in municipalities of greater social vulnerability with intersectoral investment for the improvement of the living conditions of the population. PMID:28746575

Exploring perceptions of instructors about childbirth preparation training courses: A qualitative study

PubMed Central

Otogara, Marzieh; Karimi-Shahanjarini, Akram; Hazavehei, Seyed Mohammad Mehdi; Poorolajal, Jalal; Radnia, Nahid; Akrami, Forouzan; Bagheri, Fahimeh

2017-01-01

Background Childbirth preparation training courses on maternal and neonatal health increase awareness, and capability of pregnant women in overcoming fear and anxiety and managing labor pains. Objective To identify the affecting factors and barriers of these courses from the perspective of their instructors. Methods This qualitative study of the content analysis type, has been conducted on 16 certified teachers of the training courses of the Hamadan city in 2015. Data were collected by semi-structured in-depth interviews and were then analyzed by using MAXQDA10 application. Results Participants’ experiences are indicated on three main themes including the objectives of the course, facilitators and barriers. The main objectives of the course were reported as to improve maternal and newborn health, promote natural childbirth and preparedness for parenting and breastfeeding. The main facilitators of the successful implementation include observing educational standards, strengthening the communication and relationship between mothers and staff, mobilization, and the role of instructor. The major barriers are reported as inadequate support from management system, insufficient intra-sector collaboration, poor attitude of obstetricians and physicians, inadequate access, theory-practice gap and not intended to labor naturally. Conclusion The results of our study show that multiple factors are involved in the participation of pregnant women in antenatal classes. Promoting natural childbirth requires intra-sector and inter-sectoral collaboration, as well as the community participation. PMID:28607658

[Agroecology and health promotion in Brazil].

PubMed

Azevedo, Elaine de; Pelicioni, Maria Cecília Focesi

2012-04-01

Research how specialists in health promotion and agroecology understand the concepts in those areas of common guidelines and how the relationship between such concepts is conceived. METHODS. Qualitative research. Fourteen specialists in the two areas were interviewed about the relationship between the agrofood system and health, concepts of agroecology and health promotion, and the relevance of including agroecology in public health training courses and vice-versa. There is little dialogue between the fields of study that were considered similar, food quality being the main interface between the areas. agroecology appeared to be a system of healthy food production, but the study showed other connections: agroecology and empowerment, a spur to autonomy and quality of life, and better socioeconomic conditions for the farmer; agroecology and environmental health; agroecology and community involvement; agroecology, territoriality, and cultural rescue [translator's note: this is a term for measures taken to revitalize or preserve imperiled indigenous cultures]; and agroecology, local foods, and low costs of production. Health promotion already was linked in effect to practices oriented to healthy lifestyles. The specialists appeared favorable toward including knowledge about public health in agroecology and vice-versa. Agroecology and health promotion contribute to one another and are complementary, and bringing them closer together can lead to an enriched discussion about rural health and the concept of public policies that focus on this theme, thereby stimulating actions for improvement and intersectoral practices.

“It Is an Eye-Opener That There Is a Relationship between Rehabilitation and HIV”: Perspectives of Physiotherapists and Occupational Therapists in Kenya and Zambia on the Role of Rehabilitation with Adults and Children Living with HIV

PubMed Central

Cameron, Cathy; Mweshi, Margaret; Nkandu, Esther Munalula; Okidi, Carlius; Tattle, Stephen; Yates, Tammy

2016-01-01

Purpose: To present the perspectives of rehabilitation providers—physiotherapists and occupational therapists—in Kenya and Zambia on the role of rehabilitation in the care of adults and children living with HIV. Methods: This qualitative, interpretivist study was part of a broader project to adapt a Canadian e-module on HIV-related disability for rehabilitation providers in Sub-Saharan Africa (SSA). Focus groups, demographic questionnaires, and knowledge–attitude–belief surveys were conducted with rehabilitation providers in Kenya and Zambia. Focus group data were analyzed inductively using an iterative content analysis. Results: Sixty-three rehabilitation providers (52 physiotherapists, 11 occupational therapists) participated in 10 focus groups in Nyanza Province, Kenya, and Lusaka, Zambia. The participants described the role of rehabilitation in HIV care in terms of missed opportunities related to (1) HIV disclosure; (2) inter-professional and inter-sectoral collaboration; (3) community-based rehabilitation; (4) training for rehabilitation providers; (5) pediatric rehabilitation; and (6) the connections among disability, HIV, and poverty. Conclusions: The results point to the need for HIV policy and practice leaders to develop new models of care that recognize the crucial role of rehabilitation in the long-term management of HIV to address the shifting needs of the 25 million people living longer with HIV in SSA. PMID:27909379

Tailoring Water, Sanitation, and Hygiene (WASH) Targets for Soil-Transmitted Helminthiasis and Schistosomiasis Control.

PubMed

Campbell, Suzy J; Biritwum, Nana-Kwadwo; Woods, Geordie; Velleman, Yael; Fleming, Fiona; Stothard, J Russell

2018-01-01

The World Health Organization's (WHO) 2015-2020 Global Strategy on water, sanitation, and hygiene (WASH) and neglected tropical diseases (NTDs) encourages integration, whilst maintaining existing structured NTD investments, and acceleration towards Sustainable Development Goal (SDG) targets. Accordingly, SDG-associated and WASH-NTD indicators have been developed, commencing important intersectoral dialogue, alongside opportunities for future disease-specific refinements. The rationale for soil-transmitted helminthiasis (STH)- and schistosomiasis-specific WASH considerations, and a traffic-light figure, are presented here to indicate where current international definitions may, or may not, suffice. Certain unique aspects in control dynamics and parasitic lifecycles, however, necessitate additional implementation research with more appropriate measurement indicators developed to record programmatic interventions and to define strategic priorities more effectively. Copyright © 2017 The Authors. Published by Elsevier Ltd.. All rights reserved.

Community participation in disease control.

PubMed

Bermejo, A; Bekui, A

1993-05-01

The main determinants of community participation in disease control programmes are identified and a framework with eleven variables is developed. Attention is drawn to the political background, community characteristics, the managerial capacity of the provider and the epidemiology of the disease. The framework is designed to guide health professionals in the systematic assessment and monitoring of participation in disease control programmes. Analysis of the Ghanaian Guinea Worm Eradication Programme and the Nicaraguan Tuberculosis Control Programme are presented as case studies. They show that political support does not guarantee community participation in disease control programmes and stress the importance of other determinants such as commitment to PHC, intersectoral coordination, the project approach and human resources. The relevance of the epidemiology of the disease in determining what degree of community participation will be most effective is highlighted by the case studies.

[Children's health protection in the state political system].

PubMed

Baranov, A A; Iakovleva, T V; Lapin, Iu E

2011-01-01

The system of children's health protection in this country still lacks an adequate legal basis. Its improvement should be considered as a function of the state realized through legal regulation of public relations for the benefit of each child based on the legislatively fixed government policy in the sphere of children's health care. Such an approach may strengthen the role of this sphere in the intersectoral relations and implies the extension of pediatrics toward interaction with the spheres of politics and law. It reflects the understanding that physiological processes behind regulation of the functioning of the child's organism in the course of its development need an adequate support from the outside through regulation of public relations on behalf of children. The definition of state policy in the sphere of children's health care is proposed and its basic principles are considered.

Integration and collaboration in public health--a conceptual framework.

PubMed

Axelsson, Runo; Axelsson, Susanna Bihari

2006-01-01

With the increasing differentiation of organisations involved in the pursuit of public health, there is also a growing need for inter-organisational integration. Starting from the concepts of differentiation and integration, this article is attempting a theoretical reconstruction based on published research on inter-organisational integration in public health and related welfare services. Different forms of integration are defined and related to each other in a conceptual framework, which is in itself an integration of different theoretical perspectives. According to this framework, integration in the field of public health requires inter-organisational collaboration across different sectors of the society. Such intersectoral collaboration can be organised mainly in the form of multidisciplinary teams across the boundaries of different organisations and sectors. Such an organisation is fragile and volatile, however, which means that it needs a lot of management support in order to survive.

[Psychosocial aspects and accidents in land transport].

PubMed

Morales-Soto, Nelson; Alfaro-Basso, Daniel; Gálvez-Rivero, Wilfredo

2010-06-01

Road traffic accidents are a public health problem in Peru, having caused 35 596 deaths in Peru between 1998 and 2008. Lima is the most affected region, presenting 61.7% of the accidents, the annual cost reached one thousand million dollars, equivalent to a third part of the investment in health. Available studies give emphasis to the protagonists--the drivers, the pedestrians--or to equipment and roads; the laws have been modified and containment plans for accidents have been implemented, but the incidence remains the same. We raise the possibility of exploring behavioral and social factors that could be relevant in the genesis of the problem, revising those related to current disorder in transport, the behaviors of drivers and pedestrians and the permissiveness of society in general particularly of the authority. We propose research and a multidisciplinary and intersectoral intervention.

Teachers' social representations on drug use in a secondary school.

PubMed

Martini, Jussara Gue; Furegato, Antonia Regina Ferreira

2008-01-01

Increased concern regarding drug abuse among adolescents contributes to the elaboration of prevention programs at schools. This investigation aims to know teachers' social representations, regarding drug abuse, in a secondary school in Florianopolis, SC, Brazil. A total of 16 teachers of the 5th to 8th grades participated in the study. Data were collected through associations elaborated by teachers in response to the expression: drugs use/abuse. The teacher's representations are organized around a central concept - the vulnerable other: a needy adolescent, who becomes drugs user, highlighting the family, everyday coping, and the school's (in)visibility in prevention actions, as factors related. The complexity of factors involving drugs production, distribution and its commercialization, demands the implementation of actions that go beyond the scopes of education and health. The elaboration of inter-sector prevention programs considering local characteristics is necessary.

[Challenges for the construction of 'Health and Environment "in view of its Thematic Group in the Brazilian Association of Collective Health].

PubMed

Augusto, Lia Giraldo da Silva; Tambellini, Anamaria Testa; de Miranda, Ary Carvalho; Carneiro, Fernando Ferreira; Castro, Hermano; Porto, Marcelo Firpo de Souza; Rigotto, Raquel Maria; Schütz, Gabriel Eduardo

2014-10-01

'Health and Environment' is the nucleus of knowledge and practices surrounding the relations between society and nature, mediated by the mode of production and human labor, which help to understand the determination of the health-disease process of different social classes and groups. This paper discusses the challenges to build this field from the perspective of its Thematic Group of the Association of Collective Health. The three core themes of the 2nd Brazilian Symposium on Environmental Health are taken as the theoretical framework for analysis. A timeline of the group's trajectory, in its historical context, helps to identify the contemporary challenges. Among the main challenges identified, the challenge of building an interdisciplinary, intersectoral and participatory scientific practice, which could build knowledge and dialogue with social movements, is highlighted.

Structure and dynamics of stock market in times of crisis

NASA Astrophysics Data System (ADS)

Zhao, Longfeng; Li, Wei; Cai, Xu

2016-02-01

Daily correlations among 322 S&P 500 constituent stocks are investigated by means of correlation-based (CB) network. By using the heterogeneous time scales, we identify global expansion and local clustering market behaviors during crises, which are mainly caused by community splits and inter-sector edge number decreases. The CB networks display distinctive community and sector structures. Graph edit distance is applied to capturing the dynamics of CB networks in which drastic structure reconfigurations can be observed during crisis periods. Edge statistics reveal the power-law nature of edges' duration time distribution. Despite the networks' strong structural changes during crises, we still find some long-duration edges that serve as the backbone of the stock market. Finally the dynamical change of network structure has shown its capability in predicting the implied volatility index (VIX).

Why physicians and nurses ask (or don't) about partner violence: a qualitative analysis.

PubMed

Beynon, Charlene E; Gutmanis, Iris A; Tutty, Leslie M; Wathen, C Nadine; MacMillan, Harriet L

2012-06-21

Intimate partner violence (IPV) against women is a serious public health issue and is associated with significant adverse health outcomes. The current study was undertaken to: 1) explore physicians' and nurses' experiences, both professional and personal, when asking about IPV; 2) determine the variations by discipline; and 3) identify implications for practice, workplace policy and curriculum development. Physicians and nurses working in Ontario, Canada were randomly selected from recognized discipline-specific professional directories to complete a 43-item mailed survey about IPV, which included two open-ended questions about barriers and facilitators to asking about IPV. Text from the open-ended questions was transcribed and analyzed using inductive content analysis. In addition, frequencies were calculated for commonly described categories and the Fisher's Exact Test was performed to determine statistical significance when examining nurse/physician differences. Of the 931 respondents who completed the survey, 769 (527 nurses, 238 physicians, four whose discipline was not stated) provided written responses to the open-ended questions. Overall, the top barriers to asking about IPV were lack of time, behaviours attributed to women living with abuse, lack of training, language/cultural practices and partner presence. The most frequently reported facilitators were training, community resources and professional tools/protocols/policies. The need for additional training was a concern described by both groups, yet more so by nurses. There were statistically significant differences between nurses and physicians regarding both barriers and facilitators, most likely related to differences in role expectations and work environments. This research provides new insights into the complexities of IPV inquiry and the inter-relationships among barriers and facilitators faced by physicians and nurses. The experiences of these nurses and physicians suggest that more supports (e.g., supportive work environments, training, mentors, consultations, community resources, etc.) are needed by practitioners. These findings reflect the results of previous research yet offer perspectives on why barriers persist. Multifaceted and intersectoral approaches that address individual, interpersonal, workplace and systemic issues faced by nurses and physicians when inquiring about IPV are required. Comprehensive frameworks are needed to further explore the many issues associated with IPV inquiry and the interplay across these issues.

Optimization model for the allocation of water resources based on the maximization of employment in the agriculture and industry sectors

NASA Astrophysics Data System (ADS)

Habibi Davijani, M.; Banihabib, M. E.; Nadjafzadeh Anvar, A.; Hashemi, S. R.

2016-02-01

In many discussions, work force is mentioned as the most important factor of production. Principally, work force is a factor which can compensate for the physical and material limitations and shortcomings of other factors to a large extent which can help increase the production level. On the other hand, employment is considered as an effective factor in social issues. The goal of the present research is the allocation of water resources so as to maximize the number of jobs created in the industry and agriculture sectors. An objective that has attracted the attention of policy makers involved in water supply and distribution is the maximization of the interests of beneficiaries and consumers in case of certain policies adopted. The present model applies the particle swarm optimization (PSO) algorithm in order to determine the optimum amount of water allocated to each water-demanding sector, area under cultivation, agricultural production, employment in the agriculture sector, industrial production and employment in the industry sector. Based on the results obtained from this research, by optimally allocating water resources in the central desert region of Iran, 1096 jobs can be created in the industry and agriculture sectors, which constitutes an improvement of about 13% relative to the previous situation (non-optimal water utilization). It is also worth mentioning that by optimizing the employment factor as a social parameter, the other areas such as the economic sector are influenced as well. For example, in this investigation, the resulting economic benefits (incomes) have improved from 73 billion Rials at baseline employment figures to 112 billion Rials in the case of optimized employment condition. Therefore, it is necessary to change the inter-sector and intra-sector water allocation models in this region, because this change not only leads to more jobs in this area, but also causes an improvement in the region's economic conditions.

Geriatric Cooperatives in Southwestern Ontario: A novel way of increasing inter-sectoral partnerships in the care of older adults with responsive behaviours.

PubMed

Gutmanis, Iris; Hillier, Loretta M

2018-01-01

Established in 2010, Geriatric Cooperatives support the evolving Behavioural Supports Ontario (BSO) programme in the South West Local Health Integration Network. Geriatric Cooperatives bring together members representing relevant cross-sectoral services and are tasked with identifying system gaps associated with the BSO target population as well as developing work plans specific to their local area, leveraging local capacity, and co-ordinating and improving linkages between sectors and services. The purpose of this study was to evaluate the partnerships formed over time within these Cooperatives in order to inform their ongoing development and sustainability. In 2012 and in 2015, Geriatric Cooperative members were invited to complete the Partnership Self-Assessment Tool (PSAT), a valid and reliable tool for evaluating collaborative processes and identifying areas in need of improvement. Scoring the PSAT involves the calculation of mean scores (ranging from 1 to 5) for each of six dimensions describing effective collaboration; higher mean scores reflect better functioning. Two psychometrically sound versions of the PSAT exist; the shorter version (PSAT-S) scores fewer items in three dimensions. Survey response rates for the three Cooperatives that were evaluated in both 2012 and 2015 were 70% in 2012 and 36% in 2015; 57% of members who completed the survey in 2015 were new Cooperative members. Both years, more than 25% of respondents selected "don't know" for three of the nine items used to score the administration and management dimension. Both PSAT and PSAT-S mean dimension scores across both years reflected that more effort is needed to maximise collaborative potential. Use of the PSAT has promoted a better understanding of how partnerships are functioning. Knowledge of where more work is required along with effective strategies to overcome weak areas and gaps in functioning has the potential to ensure that these Cooperatives are successful. © 2017 John Wiley & Sons Ltd.

Health impact assessment in a network of European cities.

PubMed

Ison, Erica

2013-10-01

The methodology of health impact assessment (HIA) was introduced as one of four core themes for Phase IV (2003-2008) of the World Health Organization European Healthy Cities Network (WHO-EHCN). Four objectives for HIA were set at the beginning of the phase. We report on the results of the evaluation of introducing and implementing this methodology in cities from countries across Europe with widely differing economies and sociopolitical contexts. Two main sources of data were used: a general questionnaire designed for the Phase IV evaluation and the annual reporting template for 2007-2008. Sources of bias included the proportion of non-responders and the requirement to communicate in English. Main barriers to the introduction and implementation of HIA were a lack of skill, knowledge and experience of HIA, the newness of the concept, the lack of a legal basis for implementation and a lack of political support. Main facilitating factors were political support, training in HIA, collaboration with an academic/public health institution or local health agency, a pre-existing culture of intersectoral working, a supportive national policy context, access to WHO materials about or expertise in HIA and membership of the WHO-EHCN, HIA Sub-Network or a National Network. The majority of respondents did not feel that they had had the resources, knowledge or experience to achieve all of the objectives set for HIA in Phase IV. The cities that appear to have been most successful at introducing and implementing HIA had pre-existing experience of HIA, came from a country with a history of applying HIA, were HIA Sub-Network members or had made a commitment to implementing HIA during successive years of Phase IV. Although HIA was recognised as an important component of Healthy Cities' work, the experience in the WHO-EHCN underscores the need for political buy-in, capacity building and adequate resourcing for the introduction and implementation of HIA to be successful.

Canadian initiatives to prevent hypertension by reducing dietary sodium.

PubMed

Campbell, Norm R C; Willis, Kevin J; L'Abbe, Mary; Strang, Robert; Young, Eric

2011-08-01

Hypertension is the leading risk for premature death in the world. High dietary sodium is an important contributor to increased blood pressure and is strongly associated with other important diseases (e.g., gastric cancer, calcium containing kidney stones, osteoporosis, asthma and obesity). The average dietary sodium intake in Canada is approximately 3400 mg/day. It is estimated that 30% of hypertension, more than 10% of cardiovascular events and 1.4 billion dollars/year in health care expenses are caused by this high level of intake in Canada. Since 2006, Canada has had a focused and evolving effort to reduce dietary sodium based on actions from Non Governmental Organizations (NGO), and Federal and Provincial/Territorial Government actions. NGOs initiated Canadian sodium reduction programs by developing a policy statement outlining the health issue and calling for governmental, NGO and industry action, developing and disseminating an extensive health care professional education program including resources for patient education, developing a public awareness campaign through extensive media releases and publications in the lay press. The Federal Government responded by striking a Intersectoral Sodium Work Group to develop recommendations on how to implement Canada's dietary reference intake values for dietary sodium and by developing timelines and targets for foods to be reduced in sodium, assessing key research gaps with funding for targeted dietary sodium based research, developing plans for public education and for conducting evaluation of the program to reduce dietary sodium. While food regulation is a Federal Government responsibility Provincial and Territorial governments indicated reducing dietary sodium needed to be a priority. Federal and Provincial Ministers of Health have endorsed a target to reduce the average consumption of sodium to 2300 mg/day by 2016 and the Deputy Ministers of Health have tasked a joint committee to review the recommendations of the Sodium Work Group and report back to them.

The Goal : Health for All The Commitment : All for Health*

PubMed Central

Singh, Ajai R.; Singh, Shakuntala A.

2004-01-01

Primary Health Care was the means by which Health for All by the Year 2000 AD was to be achieved. And Health for All was possible only if All were mobilised for Health. This meant not just governments and medical establishments, but people themselves. Primary health care is essentially health care made universally accessible to individuals and families in the community by means acceptable to them, through their full participation and at a cost the community and country can afford. And in working for such positive health, the role of health experts or doctors is the same as that of a gardener faced with insects, moulds and weeds. Their work is never done. Primary health care is a health conscious people's movement. Its implementation depends on knowledge of proper disposal of services and a persistent demand from an active and quality conscious consumer-the public. Strong political will, community participation and intersectoral coordination are its basic principles. However, the National Health Policy of India, 1983, was hardly debated in both houses when tabled. Both NHP 1983 and 2002 failed to confer the status of a Right to health, while most other nations are planning newer strategies to put Right to Health and Medical Services into practical use. Community participation in health is an aphorism that awaits genuine realisation in many countries of the world, notably of the third world. India, unfortunately, is no exception. Progressive Five Year Plans in India have reduced percentage spending over health as a part of GDP, which is an alarming state of affairs. Public awareness and activism alone can remedy this alarming condition. The people should not forget that health is not only a commodity that a benevolent government/ institution/ individual bestows on them. It has to be earned and maintained by the individual himself. Health problems cannot be solved in isolation. They will ultimately be part of our struggle for an egalitarian society, because better health care is a sign of a more evolved one. PMID:22815614

Canadian Initiatives to Prevent Hypertension by Reducing Dietary Sodium

PubMed Central

Campbell, Norm R. C.; Willis, Kevin J.; L’Abbe, Mary; Strang, Robert; Young, Eric

2011-01-01

Hypertension is the leading risk for premature death in the world. High dietary sodium is an important contributor to increased blood pressure and is strongly associated with other important diseases (e.g., gastric cancer, calcium containing kidney stones, osteoporosis, asthma and obesity). The average dietary sodium intake in Canada is approximately 3400 mg/day. It is estimated that 30% of hypertension, more than 10% of cardiovascular events and 1.4 billion dollars/year in health care expenses are caused by this high level of intake in Canada. Since 2006, Canada has had a focused and evolving effort to reduce dietary sodium based on actions from Non Governmental Organizations (NGO), and Federal and Provincial/Territorial Government actions. NGOs initiated Canadian sodium reduction programs by developing a policy statement outlining the health issue and calling for governmental, NGO and industry action, developing and disseminating an extensive health care professional education program including resources for patient education, developing a public awareness campaign through extensive media releases and publications in the lay press. The Federal Government responded by striking a Intersectoral Sodium Work Group to develop recommendations on how to implement Canada’s dietary reference intake values for dietary sodium and by developing timelines and targets for foods to be reduced in sodium, assessing key research gaps with funding for targeted dietary sodium based research, developing plans for public education and for conducting evaluation of the program to reduce dietary sodium. While food regulation is a Federal Government responsibility Provincial and Territorial governments indicated reducing dietary sodium needed to be a priority. Federal and Provincial Ministers of Health have endorsed a target to reduce the average consumption of sodium to 2300 mg/day by 2016 and the Deputy Ministers of Health have tasked a joint committee to review the recommendations of the Sodium Work Group and report back to them. PMID:22254122

Barriers to and facilitators of the implementation of health promoting hospitals in Taiwan: a top-down movement in need of ground support.

PubMed

Lee, Chiachi Bonnie; Chen, Michael S; Wang, Ying Wei

2014-01-01

This study investigates barriers to and facilitators of health promoting hospitals (HPH) in Taiwan. The findings are based on a cross-sectional questionnaire survey involving 55 hospitals committed to health promotion (HP) as of the end of 2009, and 52 of them completed the questionnaire. The five most reported barriers are inadequate national health insurance coverage of HP, staff detachment, incoherence of government policies, weak inter-sectoral link and resistance to change. The five most reported facilitators are support from hospital superintendents, support from unit/department directors, HP-inclusive hospital development mission and goals, funding from the government, founding of HP-related committees, resources and healthy policies. The study also found that organizational capacity building (OCB) had a significantly negative association with the number of barriers and a positive association with the number of facilitators. Stepwise linear regressions further found that OCB in structure was a significant predictor of the fewer number of barriers and that in-staff participation was a significant predictor of the more perceived facilitators. It also confirmed the significant role of organizational capacity building and that of coordinators in the effective implementation of HPH. The transformational factors as well as transactional factors are very much at work as facilitators, but the transactional factors are trapped in a less-than-friendly environment. Comprehensive support from transformational factors as well as transactional factors is essential and further support for daily routine operations and staff participation are required to sustain the implementation of HPH in Taiwan. Copyright © 2012 John Wiley & Sons, Ltd.

An introduction to the healthy corner store intervention model in Canada.

PubMed

Mah, Catherine L; Minaker, Leia M; Jameson, Kristie; Rappaport, Lissie; Taylor, Krystal; Graham, Marketa; Moody, Natalie; Cook, Brian

2017-09-14

The majority of Canadians' food acquisition occurs in retail stores. Retail science has become increasingly sophisticated in demonstrating how consumer environments influence population-level diet quality and health status. The retail food environment literature is new but growing rapidly in Canada, and there is a relative paucity of evidence from intervention research implemented in Canada. The healthy corner store model is a comprehensive complex population health intervention in small retail stores, intended to transform an existing business model to a health-promoting one through intersectoral collaboration. Healthy corner store interventions typically involve conversions of existing stores with the participation of health, community, and business sector partners, addressing business fundamentals, merchandising, and consumer demand. This article introduces pioneering experiences with the healthy corner store intervention in Canada. First, we offer a brief overview of the state of evidence within and outside Canada. Second, we discuss three urban and one rural healthy corner store initiatives, led through partnerships among community food security organizations, public health units, academics, and business partners, in Manitoba, Ontario, and Newfoundland and Labrador. Third, we synthesize the promising practices from these local examples, including aspects of both intervention science (e.g., refinements in measuring the food environment) and community-based practice (e.g., dealing with unhealthy food items and economic impact for the retailer). This article will synthesize practical experiences with healthy corner stores in Canada. It offers a baseline assessment of promising aspects of this intervention for health and health equity, and identifies opportunities to strengthen both science and practice in this area of retail food environment work.

Exploring the partnership networks of churches and church-affiliated organisations in health promotion.

PubMed

Ayton, Darshini; Carey, Gemma; Joss, Nerida; Keleher, Helen; Smith, Ben

2012-01-01

Health promotion professionals often work with community organisations and voluntary associations, including churches and church-affiliated organisations, to reduce health inequities within communities. How voluntary and church-affiliated organisations form intersectoral relationships and partnerships, and the challenges they face in doing so, has been well researched. However, there is a need to investigate further the extent to which local churches collaborate or form partnerships with other actors, such as government, peak bodies and welfare organisations. This paper reports a Victorian-based mapping exercise of partnerships and funding involving document analysis of the annual reports from 126 organisations and 35 interviews conducted with church-affiliated organisations and local churches. The discussion begins with the exploration of the nature of, and the reason why churches partner with other sectors. The paper also examines funding sources and partnership pathways that churches access to undertake the activities and programs they conduct. Interview themes highlight the value to churches of the sharing of expertise and resources, the provision of support to communities, a shared ethos of social justice and the empowerment of vulnerable populations. The findings about the extent to which local churches are involved in partnerships across society, and the extent of public and private funds they draw on to provide resources and assistance to local communities, indicate that churches are now a key player not just in welfare provision but also in health promotion activities. The findings contribute to the understanding of church activities in relation to health promotion and will assist organisations who may be potential partners to consider their collaborative efforts in the health promotion field.

Health impact assessment of an urban regeneration project: opportunities and challenges in the context of a southern European city.

PubMed

Bacigalupe, A; Esnaola, S; Calderón, C; Zuazagoitia, J; Aldasoro, E

2010-11-01

Social values and the political context have an influence on the use and spread of health impact assessment (HIA). In Spain, there is little experience in HIA but some regional governments are already introducing it. The aim of this article is to describe the health impacts of a local regeneration project to improve accessibility in a neighbourhood of Bilbao (Spain), and discuss the main difficulties, opportunities and challenges of the process, considering the specificities of the social and political context. A concurrent and prospective assessment, based on a broad model of health, was carried out following the Merseyside guidelines. A literature review, community profiling and qualitative data collection were undertaken. Profound involvement of members of the community and key informants was judged as essential in the HIA process. The overall expected effect of the new lifts, roads, park and the rainwater collection system was positive. Uncertain or negative impacts were identified in some of those areas, and also concerning the burying of four high-voltage power lines. Historical and current characteristics of the community were highly influential on the way local people perceived the project and its impacts. Likewise, the way in which processes of planning and implementation were developing also played an important role. The spread of HIA in southern European countries will depend on the progressive introduction of values underlying HIA, as well as on the promotion of intersectoral work, a better knowledge of the social model of health and community's participation in policy making.

Perception of quality of life of a group of individuals subjected to bariatric surgery.

PubMed

Salazar-Maya, Ángela María; Hoyos-Duque, Teresa Nury; Bojanini-Acevedo, Lucas

2014-01-01

The study sought to identify the state of health and quality of life of post-bariatric surgery patients. This was a cross-sectional study conducted in 2012 with the participation of 338 individuals attending the private practice of a bariatric surgeon from Medellín (Colombia). With prior signed informed consent, the survey was filled out by each patient. The information gathered was sociodemographic in nature along with the World Health Organization's Quality of Life Brief Questionnaire (WHOQoL-Bref). It was found that 82.2% were women and mean age was 41 ± 12 years. Gastric bypass was practiced on 79.6% of the cases. Mean weight before surgery was 106.3 ± 17.5 Kg and after surgery it was 73.2 ± 13.4 Kg. Nine of every 10 participants classified their quality of life and state of health between extremely well and quite well. Quality of life was better in men, in those younger than 40 years of age, in those from socio-economic levels 4 to 6, and in those with educational level above the secondary (high school). As a consequence of the important and rapid weight loss occurring during the first months after surgery, most of the participants perceived having a good quality of life and were satisfied with their health status. For nursing, it is a challenge to implement educational programs and projects, bearing in mind the sociocultural diversity of the individuals and communities, through interdisciplinary and inter-sector work, which contributes to the well-being of obese individuals subjected to bariatric surgery and their families.

Water, ecology and health: ecosystems as settings for promoting health and sustainability.

PubMed

Parkes, Margot W; Horwitz, Pierre

2009-03-01

Despite the proposed ecological and systems-based perspectives of the settings-based approach to health promotion, most initiatives have tended to overlook the fundamental nature of ecosystems. This paper responds to this oversight by proposing an explicit re-integration of ecosystems within the healthy settings approach. We make this case by focusing on water as an integrating unit of analysis. Water, on which all life depends, is not only an integral consideration for the existing healthy settings (schools, hospitals, workplaces) but also highlights the ecosystem context of health and sustainability. A focus on catchments (also know as watersheds and river basins) exemplifies the scaled and upstream/downstream nature of ecosystems and draws into sharp focus the cross-sectoral and transdisciplinary context of the social and environmental determinants of health. We position this work in relation to the converging agendas of health promotion and ecosystem management at the local, regional and global scales--and draw on evidence from international initiatives as diverse as the WHO Commission on Social Determinants of Health, and the Millennium Ecosystem Assessment. Using water as a vehicle for understanding the systemic context for human wellbeing, health promotion and disease prevention draws inevitable attention to key challenges of scale, intersectoral governance and the complementary themes of promoting resilience and preventing vulnerability. We conclude by highlighting the importance of building individual and institutional capacity for this kind of integration--equipping a new generation of researchers, practitioners and decision-makers to be conversant with the language of ecosystems, capable of systemic thought and focused on settings that can promote both health and sustainability.

Entrepreneurialism and health-promoting retail food environments in Canadian city-regions.

PubMed

Mah, Catherine L; Hasdell, Rebecca; Minaker, Leia M; Soo, Stephanie D; Cook, Brian; Demaio, Alessandro R

2017-09-02

The retail sector is a dynamic and challenging component of contemporary food systems with an important influence on population health and nutrition. Global consensus is clear that policy and environmental changes in retail food environments are essential to promote healthier diets and reduce the burden of obesity and non-communicable diseases. In this article, we explore entrepreneurialism as a form of social change-making within retail food environments, focusing on small food businesses. Small businesses face structural barriers within food systems. However, conceptual work in multiple disciplines and evidence from promising health interventions tested in small stores suggest that these retail places may have a dual role in health promotion: settings to strengthen regional economies and social networks, and consumer environments to support healthier diets. We will discuss empirical examples of health-promoting entrepreneurialism based on two sets of in-depth interviews we conducted with public health intervention actors in Toronto, Canada, and food entrepreneurs and city-region policy actors in St. John's, Canada. We will explore the practices of entrepreneurialism in the retail food environment and examine the implications for population health interventions. We contend that entrepreneurialism is important to understand on its own and also as a dimension of population health intervention context. A growing social scientific literature offers a multifaceted lens through which we might consider entrepreneurialism not only as a set of personal characteristics but also as a practice in networked and intersectoral cooperation for public and population health. © The Author 2017. Published by Oxford University Press. All rights reserved. For Permissions, please email: journals.permissions@oup.com.

River Water Pollution Status and Water Policy Scenario in Ethiopia: Raising Awareness for Better Implementation in Developing Countries.

PubMed

Awoke, Aymere; Beyene, Abebe; Kloos, Helmut; Goethals, Peter L M; Triest, Ludwig

2016-10-01

Despite the increasing levels of pollution in many tropical African countries, not much is known about the strength and weaknesses of policy and institutional frameworks to tackle pollution and ecological status of rivers and their impacts on the biota. We investigated the ecological status of four large river basins using physicochemical water quality parameters and bioindicators by collecting samples from forest, agriculture, and urban landscapes of the Nile, Omo-Gibe, Tekeze, and Awash River basins in Ethiopia. We also assessed the water policy scenario to evaluate its appropriateness to prevent and control pollution. To investigate the level of understanding and implementation of regulatory frameworks and policies related to water resources, we reviewed the policy documents and conducted in-depth interviews of the stakeholders. Physicochemical and biological data revealed that there is significant water quality deterioration at the impacted sites (agriculture, coffee processing, and urban landscapes) compared to reference sites (forested landscapes) in all four basins. The analysis of legal, policy, and institutional framework showed a lack of cooperation between stakeholders, lack of knowledge of the policy documents, absence of enforcement strategies, unavailability of appropriate working guidelines, and disconnected institutional setup at the grass root level to implement the set strategies as the major problems. In conclusion, river water pollution is a growing challenge and needs urgent action to implement intersectoral collaboration for water resource management that will eventually lead toward integrated watershed management. Revision of policy and increasing the awareness and participation of implementers are vital to improve ecological quality of rivers.

Health in All (Foreign) Policy: challenges in achieving coherence.

PubMed

Labonté, Ronald

2014-06-01

Health in All Policies (HiAP) approach is generally perceived as an intersectoral approach to national or sub-national public policy development, such that health outcomes are given full consideration by non-health sectors. Globalization, however, has created numerous 'inherently global health issues' with cross-border causes and consequences, requiring new forms of global governance for health. Although such governance often includes both state and non-state (private, civil society) actors in agenda setting and influence, different actors have differing degrees of power and authority and, ultimately, it is states that ratify intergovernmental covenants or normative declarations that directly or indirectly affect health. This requires public health and health promotion practitioners working within countries to give increased attention to the foreign policies of their national governments. These foreign policies include those governing national security, foreign aid, trade and investment as well as the traditional forms of diplomacy. A new term has been coined to describe how health is coming to be positioned in governments' foreign policies: global health diplomacy. To become adept at this nuanced diplomatic practice requires familiarity with the different policy frames by which health might be inserted into the foreign policy deliberations, and thence intergovernmental/global governance negotiations. This article discusses six such frames (security, trade, development, global public goods, human rights, ethical/moral reasoning) that have been analytically useful in assessing the potential for greater and more health-promoting foreign policy coherence: a 'Health in All (Foreign) Policies' approach. © The Author 2014. Published by Oxford University Press. All rights reserved. For Permissions, please email: journals.permissions@oup.com.

Urban governance and the systems approaches to health-environment co-benefits in cities.

PubMed

Oliveira, Jose A Puppim de; Doll, Christopher N H; Siri, José; Dreyfus, Magali; Farzaneh, Hooman; Capon, Anthony

2015-11-01

The term "co-benefits" refers to positive outcomes accruing from a policy beyond the intended outcome, often or usually in other sectors. In the urban context, policies implemented in particular sectors (such as transport, energy or waste) often generate multiple co-benefits in other areas. Such benefits may be related to the reduction of local or global environmental impacts and also extend into the area of public health. A key to identifying and realising co-benefits is the adoption of systems approaches to understand inter-sectoral linkages and, in particular, the translation of this understanding to improved sector-specific and city governance. This paper reviews a range of policies which can yield health and climate co-benefits across different urban sectors and illustrates, through a series of cases, how taking a systems approach can lead to innovations in urban governance which aid the development of healthy and sustainable cities.

Health promotion and cardiovascular disease prevention in sub-Saharan Africa.

PubMed

Sampson, Uchechukwu K A; Amuyunzu-Nyamongo, Mary; Mensah, George A

2013-01-01

Recent population studies demonstrate an increasing burden of cardiovascular disease (CVD) and related risk factors in sub-Saharan Africa (SSA). The mitigation or reversal of this trend calls for effective health promotion and preventive interventions. In this article, we review the core principles, challenges, and progress in promoting cardiovascular health with special emphasis on interventions to address physical inactivity, poor diet, tobacco use, and adverse cardiometabolic risk factor trends in SSA. We focus on the five essential strategies of the Ottawa Charter for Health Promotion. Successes highlighted include community-based interventions in Ghana, Nigeria, South Africa, and Mauritius and school-based programs in Kenya, Namibia, and Swaziland. We address the major challenge of developing integrated interventions, and showcase partnerships opportunities. We conclude by calling for intersectoral partnerships for effective and sustainable intervention strategies to advance cardiovascular health promotion and close the implementation gap in accordance with the 2009 Nairobi Call to Action on Health Promotion. © 2013.

Global progress in prevention of cardiovascular disease

PubMed Central

2017-01-01

Although there is measurable global progress in prevention of cardiovascular disease (CVD), it has been highly uneven and inadequate, particularly in low- and middle-income countries. Voluntary global targets have helped to galvanize attention, resources and accountability on tobacco use, harmful use of alcohol, unhealthy diet and physical inactivity which are the major behavioural drivers of CVD. Many obstacles and challenges continue to impede the progress of cardiovascular prevention. The inclusion of noncommunicable diseases (NCDs) in the sustainable development agenda as a specific target, offers an unprecedented opportunity to further advance the global progress of cardiovascular prevention. In order to seize this opportunity, a paradigm shift is required in the way key challenges to cardiovascular prevention are addressed. Such an approach must provide leadership for intersectoral policy coherence, identify effective means of tackling commercial determinants of behavioural risk factors, use rights based arguments, enhance public engagement and ensure accountability. PMID:28529920

New U.N. program promotes multisectoral approach to AIDS prevention. Q and A [with Peter Piot].

PubMed

1996-05-01

The new joint United Nations (UN) Program on HIV/AIDS (UNAIDS) coordinates the HIV/AIDS activities of its six co-sponsors: the UN Children's Fund (UNICEF), the UN Development Program (UNDP), the UN Population Fund (UNFPA), the UN Educational, Scientific, and Cultural Organization (UNESCO), the World Health Organization (WHO), and the World Bank. In this interview, UNAIDS Executive Director Peter Piot discusses the program's goals and challenges. The UNAIDS program will be more multisectoral in scope than other efforts, involving all sectors of society that can affect the course of the epidemic or are affected by it. This includes the health and education sectors; ministries of trade, finance, planning, and development; nongovernmental and community organizations; people living with HIV and AIDS; research institutions; and the business sector. In each country, the UN agencies will form a "Theme Group on HIV/AIDS" to formulate intersectoral strategies.

Understanding the competitive advantage of TPP-related nations from an econophysics perspective: Influence caused by China and the United States

NASA Astrophysics Data System (ADS)

Xing, Lizhi; Guan, Jun; Dong, Xianlei; Wu, Shan

2018-07-01

A new analytical framework of relatively competitive advantages of economies is established in this paper, which involves distinguishing functions of industrial sectors on the global value chain with bipartite graph theory and extracting inter-sector competitive relations through resource allocation process. Furthermore, it introduces network-based quantitative indices to measure the competitive advantage on the level of industrial sector and country respectively, taking scarcity of industrial resources into consideration. Finally, it carries out scenario simulation to analyze impacts on 13 TPP-related countries' competitiveness under four kinds of scenarios. Results show that a TPP without both the United States and China will undermine the two countries' competitiveness, and China's impact on GVC will be truly weaken if a TPP agreement led by the United States is reached and vice versa. Anyway, A TPP including both these two countries would serve the mutual interests

Overcoming environmental deterioration through defensive expenditures: field evidence from Bahía del Tóbari (Sonora, México) and implications for coastal impact assessment.

PubMed

Escofet, A; Bravo-Peña, L C

2007-08-01

The costs of the maneuvers that fishermen and shrimp farmers have to undertake in a coastal scenario where both the access to navigable waters and water quality have decreased were interpreted as defensive expenditures. Maneuvers were prompted by profound changes in water circulation and siltation mode imposed by major shifts in regional and local land-use patterns. In coastal scenarios under heavy land-based discharges and local geomorphic modifications, local users with little chance to move away may modify their routines in order to maintain existing levels of utility. The concept of defensive expenditures could be used to assess social responses to adverse changes in environmental and resource conditions, as a means to distinguish stages in which local sectors respond individually from qualitatively different stages in which intersectoral events are more conspicuous.

Public–nonprofit partnership performance in a disaster context: the case of Haiti.

PubMed

Nolte, Isabella M; Boenigk, Silke

2011-01-01

During disasters, partnerships between public and nonprofit organizations are vital to provide fast relief to affected communities. In this article, we develop a process model to support a performance evaluation of such intersectoral partnerships. The model includes input factors, organizational structures, outputs and the long-term outcomes of public–nonprofit partnerships. These factors derive from theory and a systematic literature review of emergency, public, nonprofit, and network research. To adapt the model to a disaster context, we conducted a case study that examines public and nonprofit organizations that partnered during the 2010 Haiti earthquake. The case study results show that communication, trust, and experience are the most important partnership inputs; the most prevalent governance structure of public–nonprofit partnerships is a lead organization network. Time and quality measures should be considered to assess partnership outputs, and community, network, and organizational actor perspectives must be taken into account when evaluating partnership outcomes.

Defining and Assessing Public Health Functions: A Global Analysis.

PubMed

Martin-Moreno, Jose M; Harris, Meggan; Jakubowski, Elke; Kluge, Hans

2016-01-01

Given the broad scope and intersectoral nature of public health structures and practices, there are inherent difficulties in defining which services fall under the public health remit and in assessing their capacity and performance. The aim of this study is to analyze how public health functions and practice have been defined and operationalized in different countries and regions around the world, with a specific focus on assessment tools that have been developed to evaluate the performance of essential public health functions, services, and operations. Our review has identified nearly 100 countries that have carried out assessments, using diverse analytical and methodological approaches. The assessment processes have evolved quite differently according to administrative arrangements and resource availability, but some key contextual factors emerge that seem to favor policy-oriented follow-up. These include local ownership of the assessment process, policymakers' commitment to reform, and expert technical advice for implementation.

Network formation in a multi-asset artificial stock market

NASA Astrophysics Data System (ADS)

Wu, Songtao; He, Jianmin; Li, Shouwei; Wang, Chao

2018-04-01

A multi-asset artificial stock market is developed. In the market, stocks are assigned to a number of sectors and traded by heterogeneous investors. The mechanism of continuous double auction is employed to clear order book and form daily closed prices. Simulation results of prices at the sector level show an intra-sector similarity and inter-sector distinctiveness, and returns of individual stocks have stylized facts that are ubiquitous in the real-world stock market. We find that the market risk factor has critical impact on both network topology transition and connection formation, and that sector risk factors account for the formation of intra-sector links and sector-based local interaction. In addition, the number of community in threshold-based networks is correlated negatively and positively with the value of correlation coefficients and the ratio of intra-sector links, which are respectively determined by intensity of sector risk factors and the number of sectors.

Controlling the Topological Sector of Magnetic Solitons in Exfoliated Cr 1 / 3 NbS 2 Crystals

DOE Office of Scientific and Technical Information (OSTI.GOV)

Wang, Lin; Chepiga, N.; Ki, D. -K.

Here, we investigate manifestations of topological order in monoaxial helimagnet Cr 1/3NbS 2 by performing transport measurements on ultrathin crystals. Upon sweeping the magnetic field perpendicularly to the helical axis, crystals thicker than one helix pitch (48 nm) but much thinner than the magnetic domain size (similar to 1 mu m) are found to exhibit sharp and hysteretic resistance jumps. We also show that these phenomena originate from transitions between topological sectors with a different number of magnetic solitons. This is confirmed by measurements on crystals thinner than 48 nm-in which the topological sector cannot change-that do not exhibit anymore » jump or hysteresis. These results show the ability to deterministically control the topological sector of finite-size Cr 1/3NbS 2 and to detect intersector transitions by transport measurements.« less

Controlling the Topological Sector of Magnetic Solitons in Exfoliated Cr 1 / 3 NbS 2 Crystals

DOE PAGES

Wang, Lin; Chepiga, N.; Ki, D. -K.; ...

2017-06-23

Here, we investigate manifestations of topological order in monoaxial helimagnet Cr 1/3NbS 2 by performing transport measurements on ultrathin crystals. Upon sweeping the magnetic field perpendicularly to the helical axis, crystals thicker than one helix pitch (48 nm) but much thinner than the magnetic domain size (similar to 1 mu m) are found to exhibit sharp and hysteretic resistance jumps. We also show that these phenomena originate from transitions between topological sectors with a different number of magnetic solitons. This is confirmed by measurements on crystals thinner than 48 nm-in which the topological sector cannot change-that do not exhibit anymore » jump or hysteresis. These results show the ability to deterministically control the topological sector of finite-size Cr 1/3NbS 2 and to detect intersector transitions by transport measurements.« less

Evolving water management institutions in Mexico

NASA Astrophysics Data System (ADS)

Hearne, Robert R.

2004-12-01

Mexico's water management institutions are undergoing a gradual but dramatic change that corresponds to other changes in Mexican society. Implementing these changes has led to the creation of new institutions, including river basin councils, state water commissions, aquifer management committees, and water user associations. Established institutions such as the National Water Commission have accepted new roles. Some of these changes can be considered to be superficial, but this institutional change is impressive. Successful practices can be identified. These include the transfer of the management of large irrigation districts to the users, the periodic practice of establishing a national water plan, the cautious approach to private sector participation in water supply and sanitation, and the national registry of water use. Remaining challenges include weak river basin and aquifer management organizations, overexploitation of key aquifers, polluted surface water, and the inability of water markets to facilitate intersectoral water transfers.

Commentary: Prevention of violence against children: a framework for progress in low- and middle-income countries.

PubMed

Chandran, Aruna; Puvanachandra, Prasanthi; Hyder, Adnan A

2011-02-01

Violence against children has been the least reported, studied, and understood area of child injuries. Initial awareness emerged from international conferences and resolutions, followed by national policies and statements. More effective responses around the world will require action. Although previous calls for action have pointed to important activities (gathering of baseline data, passing of legal reforms, and providing services to those who experience violence), the agenda is limited. Data collection needs to be continuous, systematic, and sustainable, and should enable ongoing evaluation of intervention programs. An inter-sectoral approach to violence against children incorporating public health, criminal justice, social services, education, non-governmental organizations, media, and businesses is imperative if the growing burden is to be mitigated. Thus we offer a framework, building on earlier recommendations, to focus on four domains: national surveillance, intervention research, legislation and policy, and partnerships and collaboration.

Assessing agricultural risks of climate change in the 21st century in a global gridded crop model intercomparison

PubMed Central

Rosenzweig, Cynthia; Elliott, Joshua; Deryng, Delphine; Ruane, Alex C.; Müller, Christoph; Arneth, Almut; Boote, Kenneth J.; Folberth, Christian; Glotter, Michael; Khabarov, Nikolay; Neumann, Kathleen; Piontek, Franziska; Pugh, Thomas A. M.; Schmid, Erwin; Stehfest, Elke; Yang, Hong; Jones, James W.

2014-01-01

Here we present the results from an intercomparison of multiple global gridded crop models (GGCMs) within the framework of the Agricultural Model Intercomparison and Improvement Project and the Inter-Sectoral Impacts Model Intercomparison Project. Results indicate strong negative effects of climate change, especially at higher levels of warming and at low latitudes; models that include explicit nitrogen stress project more severe impacts. Across seven GGCMs, five global climate models, and four representative concentration pathways, model agreement on direction of yield changes is found in many major agricultural regions at both low and high latitudes; however, reducing uncertainty in sign of response in mid-latitude regions remains a challenge. Uncertainties related to the representation of carbon dioxide, nitrogen, and high temperature effects demonstrated here show that further research is urgently needed to better understand effects of climate change on agricultural production and to devise targeted adaptation strategies. PMID:24344314

The global burden of obesity and the challenges of prevention.

PubMed

Seidell, Jacob C; Halberstadt, Jutka

2015-01-01

The prevalence of obesity is increasing at an alarming rate in many parts of the world. About 2 billion people are overweight and one third of them obese. The plight of the most affected populations, like those in high-income countries in North America, Australasia and Europe, has been well publicized. However, the more recent increases in population obesity in low- and middle-income countries that are now increasingly being observed have been less recognized. Based on the existing prevalence and trend data and the epidemiological evidence linking obesity with a range of physical and psychosocial health conditions, it is reasonable to describe obesity as a public health crisis that severely impairs the health and quality of life of people and adds considerably to national health-care budgets. Intersectoral action to manage and prevent obesity is urgently required to reverse current trends.

Assessing Agricultural Risks of Climate Change in the 21st Century in a Global Gridded Crop Model Intercomparison

NASA Technical Reports Server (NTRS)

Rosenzweig, Cynthia E.; Elliott, Joshua; Deryng, Delphine; Ruane, Alex C.; Mueller, Christoph; Arneth, Almut; Boote, Kenneth J.; Folberth, Christian; Glotter, Michael; Khabarov, Nikolay

2014-01-01

Here we present the results from an intercomparison of multiple global gridded crop models (GGCMs) within the framework of the Agricultural Model Intercomparison and Improvement Project and the Inter-Sectoral Impacts Model Intercomparison Project. Results indicate strong negative effects of climate change, especially at higher levels of warming and at low latitudes; models that include explicit nitrogen stress project more severe impacts. Across seven GGCMs, five global climate models, and four representative concentration pathways, model agreement on direction of yield changes is found in many major agricultural regions at both low and high latitudes; however, reducing uncertainty in sign of response in mid-latitude regions remains a challenge. Uncertainties related to the representation of carbon dioxide, nitrogen, and high temperature effects demonstrated here show that further research is urgently needed to better understand effects of climate change on agricultural production and to devise targeted adaptation strategies.

Integrated vector management: the Zambian experience.

PubMed

Chanda, Emmanuel; Masaninga, Fred; Coleman, Michael; Sikaala, Chadwick; Katebe, Cecilia; Macdonald, Michael; Baboo, Kumar S; Govere, John; Manga, Lucien

2008-08-27

The Zambian Malaria Control Programme with the Roll Back Malaria (RBM) partners have developed the current National Malaria Strategic Plan (NMSP 2006-2011) which focuses on prevention based on the Integrated Vector Management (IVM) strategy. The introduction and implementation of an IVM strategy was planned in accordance with the World Health Organization (WHO) steps towards IVM implementation namely Introduction Phase, Consolidation Phase and Expansion Phase. IVM has created commitment for Legal and Regulatory policy review, monitoring, Research and a strong stewardship by the chemical suppliers. It has also leveraged additional resources, improved inter-sectoral collaboration, capacity building and enhanced community participation which facilitated a steady scaling up in coverage and utilisation of key preventive interventions. Thus, markedly reducing malaria incidence and case fatalities in the country. Zambia has successfully introduced, consolidated and expanded IVM activities. Resulting in increased coverage and utilization of interventions and markedly reducing malaria-related morbidity and mortality while ensuring a better protection of the environment.

Culture Circles in adolescent empowerment for the prevention of violence

PubMed Central

Monteiro, Estela Maria Leite Meirelles; Neto, Waldemar Brandão; de Lima, Luciane Soares; de Aquino, Jael Maria; Gontijo, Daniela Tavares; Pereira, Beatriz Oliveira

2015-01-01

An action research based on Paulo Freire's Culture Circles was developed to implement a health education intervention involving adolescents, in collective knowledge construction about strategies for the prevention of violence. The data collection in the Culture Circles involved 11 adolescents and included observation and field diary, photographic records and recording. The educational action aroused a critical socio-political and cultural position in the adolescents towards the situations of vulnerability to violence, including the guarantee of human rights, justice and the combat of inequities; changes in the social relations, combat against discrimination and intolerance; expansion of access and reorientation of health services through intersectoral public policies. The intervention empowered the group of adolescents for the prevention of violence and permitted the inclusion of health professionals in the school context, from an interdisciplinary perspective, contributing to the establishment of social support and protection networks. PMID:25931647

Canada's public health system: is the pace of progress sufficient?

PubMed

Lozon, Jeffrey C; Alikhan, L Miin

2007-01-01

Tilson and Berkowitz review the Institute of Medicine reports that catalyzed the serious re-examination of the United States public health enterprise. For Canada, a similar catalyst stemmed from the lessons learned during the 2003 severe acute respiratory syndrome outbreak. While strong policy statements of commitment to strengthen the public health system are a necessary first step to stewarding change, they are insufficient without defined accountabilities, operationalized relationships and supporting legislation. Investments in critical enablers of sustainable reform, such as inter-sectoral partnerships, human capacity building and an electronic backbone, are also required. To support the value added by public health functions and services, both from a health benefit and economic perspective, a performance management system is necessary. While the 2004 establishment of the Public Health Agency of Canada was a progressive step, persistent political will and leadership are required to ensure this agency's effectiveness and preparedness before the next crisis hits.

Testing a model of facilitated reflection on network feedback: a mixed method study on integration of rural mental healthcare services for older people.

PubMed

Fuller, Jeffrey; Oster, Candice; Muir Cochrane, Eimear; Dawson, Suzanne; Lawn, Sharon; Henderson, Julie; O'Kane, Deb; Gerace, Adam; McPhail, Ruth; Sparkes, Deb; Fuller, Michelle; Reed, Richard L

2015-11-11

To test a management model of facilitated reflection on network feedback as a means to engage services in problem solving the delivery of integrated primary mental healthcare to older people. Participatory mixed methods case study evaluating the impact of a network management model using organisational network feedback (through social network analysis, key informant interviews and policy review). A model of facilitated network reflection using network theory and methods. A rural community in South Australia. 32 staff from 24 services and 12 senior service managers from mental health, primary care and social care services. Health and social care organisations identified that they operated in clustered self-managed networks within sectors, with no overarching purposive older people's mental healthcare network. The model of facilitated reflection revealed service goal and role conflicts. These discussions helped local services to identify as a network, and begin the problem-solving communication and referral links. A Governance Group assisted this process. Barriers to integrated servicing through a network included service funding tied to performance of direct care tasks and the lack of a clear lead network administration organisation. A model of facilitated reflection helped organisations to identify as a network, but revealed sensitivity about organisational roles and goals, which demonstrated that conflict should be expected. Networked servicing needed a neutral network administration organisation with cross-sectoral credibility, a mandate and the resources to monitor the network, to deal with conflict, negotiate commitment among the service managers, and provide opportunities for different sectors to meet and problem solve. This requires consistency and sustained intersectoral policies that include strategies and funding to facilitate and maintain health and social care networks in rural communities. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://www.bmj.com/company/products-services/rights-and-licensing/

Simulated vs. empirical weather responsiveness of crop yields: US evidence and implications for the agricultural impacts of climate change

DOE PAGES

Mistry, Malcolm N.; Wing, Ian Sue; De Cian, Enrica

2017-07-10

Global gridded crop models (GGCMs) are the workhorse of assessments of the agricultural impacts of climate change. Yet the changes in crop yields projected by different models in response to the same meteorological forcing can differ substantially. Through an inter-method comparison, we provide a first glimpse into the origins and implications of this divergence—both among GGCMs and between GGCMs and historical observations. We examine yields of rainfed maize, wheat, and soybeans simulated by six GGCMs as part of the Inter-Sectoral Impact Model Intercomparison Project-Fast Track (ISIMIP-FT) exercise, comparing 1981–2004 hindcast yields over the coterminous United States (US) against US Departmentmore » of Agriculture (USDA) time series for about 1000 counties. Leveraging the empirical climate change impacts literature, we estimate reduced-form econometric models of crop yield responses to temperature and precipitation exposures for both GGCMs and observations. We find that up to 60% of the variance in both simulated and observed yields is attributable to weather variation. A majority of the GGCMs have difficulty reproducing the observed distribution of percentage yield anomalies, and exhibit aggregate responses that show yields to be more weather-sensitive than in the observational record over the predominant range of temperature and precipitation conditions. In conclusion, this disparity is largely attributable to heterogeneity in GGCMs' responses, as opposed to uncertainty in historical weather forcings, and is responsible for widely divergent impacts of climate on future crop yields.« less

Simulated vs. empirical weather responsiveness of crop yields: US evidence and implications for the agricultural impacts of climate change

DOE Office of Scientific and Technical Information (OSTI.GOV)

Mistry, Malcolm N.; Wing, Ian Sue; De Cian, Enrica

Global gridded crop models (GGCMs) are the workhorse of assessments of the agricultural impacts of climate change. Yet the changes in crop yields projected by different models in response to the same meteorological forcing can differ substantially. Through an inter-method comparison, we provide a first glimpse into the origins and implications of this divergence—both among GGCMs and between GGCMs and historical observations. We examine yields of rainfed maize, wheat, and soybeans simulated by six GGCMs as part of the Inter-Sectoral Impact Model Intercomparison Project-Fast Track (ISIMIP-FT) exercise, comparing 1981–2004 hindcast yields over the coterminous United States (US) against US Departmentmore » of Agriculture (USDA) time series for about 1000 counties. Leveraging the empirical climate change impacts literature, we estimate reduced-form econometric models of crop yield responses to temperature and precipitation exposures for both GGCMs and observations. We find that up to 60% of the variance in both simulated and observed yields is attributable to weather variation. A majority of the GGCMs have difficulty reproducing the observed distribution of percentage yield anomalies, and exhibit aggregate responses that show yields to be more weather-sensitive than in the observational record over the predominant range of temperature and precipitation conditions. In conclusion, this disparity is largely attributable to heterogeneity in GGCMs' responses, as opposed to uncertainty in historical weather forcings, and is responsible for widely divergent impacts of climate on future crop yields.« less

Urban regeneration as population health intervention: a health impact assessment in the Bay of Pasaia (Spain).

PubMed

Serrano, Elena; Larrañaga, Isabel; Morteruel, Maite; Baixas de Ros, María Dolores; Basterrechea, Mikel; Martinez, Dolores; Aldasoro, Elena; Bacigalupe, Amaia

2016-09-15

An important health issue in urban areas is how changes arising from the regeneration of city-areas affect social determinants of health and equity. This paper examines the impacts attributable to a new fish market and to delays in the regeneration of a port area in a deteriorated region of the Bay of Pasaia (Spain). Potential differential impacts on local residents and socially vulnerable groups were evaluated to determine health inequalities. An in-depth, prospective and concurrent Health-Impact-Assessment (HIA) focused on equity was conducted by the regional Public Health Department, following the Merseyside guidelines. Data from different sources was triangulated and impacts were identified using qualitative and quantitative methods. The intervention area is characterised by poor social, environmental, and health indicators. The distinctness of the two projects generates contrasting health and inequality impacts: generally positive for the new fish market and negative for the port area. The former creates recreational spaces and improves urban quality and social cohesion. By contrast, inaction and stagnation of the project in the port area perpetuates deterioration, a lack of safety, and poor health, as well as increased social frustration. In addition to assessing the health impacts of both projects this HIA promoted intersectoral partnerships, boosted a holistic and positive view of health and incorporated health and equity into the political discourse. Community-level participatory action enabled public health institutions to respond to new urban planning challenges and responsibilities in a more democratic manner.

The role of nutrition in integrated early child development in the 21st century: contribution from the Maternal and Child Nutrition journal.

PubMed

Pérez-Escamilla, Rafael; Moran, Victoria Hall

2017-01-01

Even though it is widely recognized that early childhood development (ECD) is one of the most important predictors of future social capital and national productivity, the recently published ECD Lancet Series reports that about 250 million children under 5 years are at risk of not reaching their developmental potential, mainly as a result of poverty and social injustice. So why is this and what will it take to reverse this situation? The purpose of this special issue is to highlight important contributions from previously published articles in Maternal & Child Nutrition to the field of nutrition and ECD. The collection of papers presented in this special issue collectively indicates that although nutrition-specific interventions are essential for child development, they are not sufficient by themselves for children to reach their full developmental potential. This is because ECD is influenced by many other factors besides nutrition, including hand washing/sanitation, parenting skills, psychosocial stimulation, and social protection. Future research should focus on mixed-methods implementation science seeking to understand how best to translate evidence-based integrated ECD packages into effective intersectoral policies and programs on a large scale. In addition to health and nutrition, these programs need to consider and include responsive parenting (including responsive feeding), learning stimulation, education, and social protection. Future studies should also address if and how childhood obesity affects human physical, socioemotional, and cognitive development. © 2016 John Wiley & Sons Ltd.

Assessing the incremental effects of combining economic and health interventions: the IMAGE study in South Africa

PubMed Central

Ferrari, Giulia; Abramsky, Tanya; Watts, Charlotte; Hargreaves, James; Morison, Linda; Phetla, Godfrey; Porter, John; Pronyk, Paul

2009-01-01

Abstract Objective To explore whether adding a gender and HIV training programme to microfinance initiatives can lead to health and social benefits beyond those achieved by microfinance alone. Methods Cross-sectional data were derived from three randomly selected matched clusters in rural South Africa: (i) four villages with 2-year exposure to the Intervention with Microfinance for AIDS and Gender Equity (IMAGE), a combined microfinance–health training intervention; (ii) four villages with 2-year exposure to microfinance services alone; and (iii) four control villages not targeted by any intervention. Adjusted risk ratios (aRRs) employing village-level summaries compared associations between groups in relation to indicators of economic well-being, empowerment, intimate partner violence (IPV) and HIV risk behaviour. The magnitude and consistency of aRRs allowed for an estimate of incremental effects. Findings A total of 1409 participants were enrolled, all female, with a median age of 45. After 2 years, both the microfinance-only group and the IMAGE group showed economic improvements relative to the control group. However, only the IMAGE group demonstrated consistent associations across all domains with regard to women’s empowerment, intimate partner violence and HIV risk behaviour. Conclusion The addition of a training component to group-based microfinance programmes may be critical for achieving broader health benefits. Donor agencies should encourage intersectoral partnerships that can foster synergy and broaden the health and social effects of economic interventions such as microfinance. PMID:20072767

Simulated vs. empirical weather responsiveness of crop yields: US evidence and implications for the agricultural impacts of climate change

NASA Astrophysics Data System (ADS)

Mistry, Malcolm N.; Wing, Ian Sue; De Cian, Enrica

2017-07-01

Global gridded crop models (GGCMs) are the workhorse of assessments of the agricultural impacts of climate change. Yet the changes in crop yields projected by different models in response to the same meteorological forcing can differ substantially. Through an inter-method comparison, we provide a first glimpse into the origins and implications of this divergence—both among GGCMs and between GGCMs and historical observations. We examine yields of rainfed maize, wheat, and soybeans simulated by six GGCMs as part of the Inter-Sectoral Impact Model Intercomparison Project-Fast Track (ISIMIP-FT) exercise, comparing 1981-2004 hindcast yields over the coterminous United States (US) against US Department of Agriculture (USDA) time series for about 1000 counties. Leveraging the empirical climate change impacts literature, we estimate reduced-form econometric models of crop yield responses to temperature and precipitation exposures for both GGCMs and observations. We find that up to 60% of the variance in both simulated and observed yields is attributable to weather variation. A majority of the GGCMs have difficulty reproducing the observed distribution of percentage yield anomalies, and exhibit aggregate responses that show yields to be more weather-sensitive than in the observational record over the predominant range of temperature and precipitation conditions. This disparity is largely attributable to heterogeneity in GGCMs’ responses, as opposed to uncertainty in historical weather forcings, and is responsible for widely divergent impacts of climate on future crop yields.

Involving local health departments in community health partnerships: evaluation results from the partnership for the public's health initiative.

PubMed

Cheadle, Allen; Hsu, Clarissa; Schwartz, Pamela M; Pearson, David; Greenwald, Howard P; Beery, William L; Flores, George; Casey, Maria Campbell

2008-03-01

Improving community health "from the ground up" entails a comprehensive ecological approach, deep involvement of community-based entities, and addressing social determinants of population health status. Although the Centers for Disease Control and Prevention, the Office of the Surgeon General, and other authorities have called for public health to be an "inter-sector" enterprise, few models have surfaced that feature local health departments as a key part of the collaborative model for effecting community-level change. This paper presents evaluation findings and lessons learned from the Partnership for the Public's Health (PPH), a comprehensive community initiative that featured a central role for local health departments with their community partners. Funded by The California Endowment, PPH provided technical and financial resources to 39 community partnerships in 14 local health department jurisdictions in California to promote community and health department capacity building and community-level policy and systems change designed to produce long-term improvements in population health. The evaluation used multiple data sources to create progress ratings for each partnership in five goal areas related to capacity building, community health improvement programs, and policy and systems change. Overall results were generally positive; in particular, of the 37 partnerships funded continuously throughout the 5 years of the initiative, between 25% and 40% were able to make a high level of progress in each of the Initiative's five goal areas. Factors associated with partnership success were also identified by local evaluators. These results showed that health departments able to work effectively with community groups had strong, committed leaders who used creative financing mechanisms, inclusive planning processes, organizational changes, and open communication to promote collaboration with the communities they served.

Occupational health profile of workers employed in the manufacturing sector of India.

PubMed

Suri, Shivali; Das, Ranjan

2016-01-01

The occupational health scenario of workers engaged in the manufacturing sector in India deserves attention for their safety and increasing productivity. We reviewed the status of the manufacturing sector, identified hazards faced by workers, and assessed the existing legislations and healthcare delivery mechanisms. From October 2014 to March 2015, we did a literature review by manual search of pre-identified journals, general electronic search, electronic search of dedicated websites/databases and personal communication with experts of occupational health. An estimated 115 million workers are engaged in the manufacturing sector, though the Labour Bureau takes into account only one-tenth of them who work in factories registered with the government. Most reports do not mention the human capital employed neither their quality of life, nor occupational health services available. The incidence of accidents were documented till 2011, and industry-wise break up of data is not available. Occupational hazards reported include hypertension, stress, liver disease, diabetes, tuberculosis, eye/ hearing problems, cancers, etc. We found no studies for manufacturing industries in glass, tobacco, computer and allied products, etc. The incidence of accidents is decreasing but the proportion of fatalities is increasing. Multiple legislations exist which cover occupational health, but most of these are old and have not been amended adequately to reflect the present situation. There is a shortage of manpower and occupational health statistics for dealing with surveillance, prevention and regulation in this sector. There is an urgent need of a modern occupational health legislation and an effective machinery to enforce it, preferably through intersectoral coordination between the Employees' State Insurance Corporation, factories and state governments. Occupational health should be integrated with the general health services.

Everywhere in Japan: an international approach to working with commercial gay businesses in HIV prevention.

PubMed

Sherriff, Nigel; Koerner, Jane; Kaneko, Noriyo; Shiono, Satoshi; Takaku, Michiko; Boseley, Ross; Ichikawa, Seiichi

2017-06-01

In the UK and Japan, there is concern regarding rising rates of annual new HIV infections among Men who have Sex with Men (MSM). Whilst in the UK and Europe, gay businesses are increasingly recognized as being important settings through which to deliver HIV prevention and health promotion interventions to target vulnerable populations; in Japan such settings-based approaches are relatively underdeveloped. This article draws on qualitative data from a recently completed study conducted to explore whether it is feasible, acceptable and desirable to build on the recent European Everywhere project for adaptation and implementation in Japan. A series of expert workshops were conducted in Tokyo, Nagoya and Osaka with intersectoral representatives from Japanese and UK non-governmental organizations (NGOs), gay businesses, universities and gay communities (n = 46). Further discussion groups and meetings were held with NGO members and researchers from the Japanese Ministry of Health, Labour and Welfare's Research Group on HIV Prevention Policy, Programme Implementation and Evaluation among MSM (n = 34). The results showed that it is desirable, feasible and acceptable to adapt and implement a Japanese version of Everywhere. Such a practical, policy-relevant, settings-based HIV prevention framework for gay businesses may help to facilitate the necessary scale up of prevention responses among MSM in Japan. Given the high degree of sexual mobility between countries in Asia, there is considerable potential for the Everywhere Project (or its Japanese variant) to be expanded and adapted to other countries within the Asia-Pacific region. © The Author 2015. Published by Oxford University Press. All rights reserved. For Permissions, please email: journals.permissions@oup.com.

Compliance with driver's license laws and illegal licensing among commercial bus drivers in Lagos, Nigeria: policy implications and evidence for action.

PubMed

Okafor, I P; Odeyemi, K A; Dolapo, D C; Adegbola, A A

2014-09-01

To determine the level of compliance with driver's license laws among commercial bus drivers in Lagos, Nigeria. Two intercity motor parks were selected by simple random sampling and all consenting minibus drivers participated in the study. Key Informant Interviews (KIIs) were also conducted with selected officials in the driver training and licensing authorities. Compliance with the minimum age for driving was high (93.6%), so also was having driving test prior to driver's license procurement (83.3%). Formal driver training and VA testing were very low, (26.1% and 32.9% respectively) Overall, only 9.3% of them were found to have fulfilled all the pre-license obligations before obtaining their first driver's license. The odds of a driver with a secondary education having formal driver training is 3.33 times higher than those with no education (OR 3.33, 95% CI 1.01-11.35). Drivers who were 60 years or older were 3.62 times more likely to be compliant than those who were between 20-29 years (OR 3.62, 95% CI 0.56-29.19). For the 98.3% of them who possessed valid licenses, 52.3% of them obtained them illegally. All the key officials saw RTIs as a serious public health problem but faced several challenges in the course of their work. Overall compliance with pre-license regulations was very poor. There is need for a review and strict enforcement of driver's license laws to improve compliance. Also vital are fostering inter-sectoral collaboration and improvement in the operations of all establishments involved in driver training and license procurement in Nigeria.

The making of evidence-informed health policy in Cambodia: knowledge, institutions and processes.

PubMed

Liverani, Marco; Chheng, Kannarath; Parkhurst, Justin

2018-01-01

In global health discussions, there have been widespread calls for health policy and programme implementation to be informed by the best available evidence. However, recommendations in the literature on knowledge translation are often decontextualised, with little attention to the local systems of institutions, structures and practices which can direct the production of evidence and shape whether or how it informs health decisions. This article explores these issues in the country setting of Cambodia, where the Ministry of Health has explicitly championed the language of evidence-based approaches to policy and planning. Research for this paper combined multiple sources and material, including in-depth interviews with key informants in Phnom Penh and the analysis of documentary material and publications. Data collection and analysis focused on two key domains in evidence advisory systems: domestic capacities to generate health policy-relevant evidence and institutional mechanisms to monitor, evaluate and incorporate evidence in the policy process. We identified a number of structural arrangements that may increasingly work to facilitate the supply of health-related data and information, and their use to inform policy and planning. However, other trends and features appear to be more problematic, including gaps between research and public health priorities in the country, the fragmented nature of research activities and information systems, the lack of a national policy to support and guide the production and use of evidence for health policy, and challenges to the use of evidence for intersectoral policy-making. In Cambodia, as in other low/middle-income countries, continued investments to increase the supply and quality of health data and information are needed, but greater attention should be paid to the enabling institutional environment to ensure relevance of health research products and effective knowledge management.

The Bright Elusive Butterfly of Value in Health Technology Development Comment on "Providing Value to New Health Technology: The Early Contribution of Entrepreneurs, Investors, and Regulatory Agencies".

PubMed

Greenhalgh, Trisha; Fahy, Nick; Shaw, Sara

2017-05-29

The current system of health technology development is characterised by multiple misalignments. The "supply" side (innovation policy-makers, entrepreneurs, investors) and the "demand" side (health policy-makers, regulators, health technology assessment, purchasers) operate under different - and conflicting - logics. The system is less a "pathway" than an unstable ecosystem of multiple interacting sub-systems. "Value" means different things to each of the numerous actors involved. Supply-side dynamics are built on fictions; regulatory checks and balances are designed to assure quality, safety and efficacy, not to ensure that technologies entering the market are either desirable or cost-effective. Assessment of comparative and cost-effectiveness usually comes too late in the process to shape an innovation's development. We offer no simple solutions to these problems, but in the spirit of commencing a much-needed public debate, we suggest some tentative ways forward. First, universities and public research funders should play a more proactive role in shaping the system. Second, the role of industry in forging long-term strategic partnerships for public benefit should be acknowledged (though not uncritically). Third, models of "responsible innovation" and public input to research priority-setting should be explored. Finally, the evidence base on how best to govern inter-sectoral health research partnerships should be developed and applied. © 2018 The Author(s); Published by Kerman University of Medical Sciences. This is an open-access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/4.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

Global feasibility assessment of interrupting the transmission of soil-transmitted helminths: a statistical modelling study.

PubMed

Brooker, Simon J; Nikolay, Birgit; Balabanova, Dina; Pullan, Rachel L

2015-08-01

Emphasis is being given to the control of neglected tropical diseases, including the possibility of interrupting the transmission of soil-transmitted helminths (STH). We evaluated the feasibility by country of achieving interruption of the transmission of STH. Based on a conceptual framework for the identification of the characteristics of a successful STH control programme, we assembled spatial data for a range of epidemiological, institutional, economic, and political factors. Using four different statistical methods, we developed a composite score of the feasibility of interrupting STH transmission and undertook a sensitivity analysis of the data and methods. The most important determining factors in the analysis were underlying intensity of STH transmission, current implementation of control programmes for neglected tropical diseases, and whether countries receive large-scale external funding and have strong health systems. The composite scores suggested that interrupting STH transmission is most feasible in countries in the Americas and parts of Asia (eg, Argentina [range of composite feasibility scores, depending on scoring method, 9·4-10·0], Brazil [8·7- 9·7], Chile [8·84-10·0], and Thailand [9·1-10·0]; there was perfect agreement between the four methods), and least feasible in countries in sub-Saharan Africa (eg, Congo [0·4-2·7] and Guinea [2·0-5·6]; there was full agreement between methods), but there were important exceptions to these trends (eg, Ghana [7·4-10·0]; there was agreement between three methods). Agreement was highest between the scores derived with the expert opinion and principal component analysis weighting schemes (Pearson correlation coefficient, r=0·98). The largest disagreement was between benefit-of-the-doubt-derived and principal-component-analysis-derived weighting schemes (r=0·74). The interruption of STH transmission is feasible, especially in countries with low intensity of transmission, supportive household environments, strong health systems, and the availability of suitable delivery platforms and in-country funds, but to achieve local elimination of STH an intersectoral approach to STH control will be needed. Bill & Melinda Gates Foundation and Wellcome Trust. Copyright © 2015 Brooker et al. Open Access article distributed under the terms of CC BY-NC-ND. Published by Elsevier Ltd.. All rights reserved.

Addressing the socioeconomic determinants of adolescent health: experiences from the WHO/HBSC Forum 2007.

PubMed

Koller, Theadora; Morgan, Antony; Guerreiro, Ana; Currie, Candace; Ziglio, Erio

2009-09-01

Over the past 25 years, the WHO collaborative cross-national Health Behaviour in School-aged Children (HBSC) study has been accumulating evidence that provides insights into how to promote the health and well-being of young people. HBSC has increased understanding of the determinants of young people's health, particularly in relation to the social contexts in which they live, learn and play. The study now spans 43 countries and regions in Europe and North America. HBSC provides intelligence for the development and evaluation of public health policy and practice at national, sub-national and international levels. However, the mere existence of evidence does not automatically change policy nor necessarily improve the lives of young people. Effective mechanisms to ensure use of evidence in policy-making and practice are needed. The WHO/HBSC Forum series is a platform designed to facilitate the translation of evidence into action. Forum processes convene researchers, policy-makers and practitioners from across Europe to analyse data, review policies and interventions, and identify lessons learned to improve the health of adolescents through actions that address the social contexts that influence their health. Each Forum process consists of case studies produced by interdisciplinary teams in countries and regions, cross-country evidence reviews, a European consultation, an outcomes statement within a final publication, and a Web-based knowledge platform. In addition to emphasizing the translation of research into action, the Forum series focuses on increasing know-how to scale up intersectoral policies and interventions; reduce health inequities; and involve young people in the design, implementation and evaluation of policies and interventions. Interviews with selected participants in the 2007 Forum process revealed that national-level impacts of involvement were: brokering new or strengthening existing working relationships among members of case study drafting teams and national delegations to events; feeding into the formulation of national policy or practice design; and enabling the comparison of information systems, policies, interventions, and working methods with other countries and against the evidence base, thus providing encouragement for new and/or validation of existing activities. The WHO/HBSC Forum series is an evolving platform. The methodology for each Forum process incorporates lessons learnt through past Fora - within resource constraints - and is based on the principles of efficiency and effectiveness. Areas requiring further development, identified through the aforementioned interviews and based on the reflections of co-organizers, include identification of means to ensure systematic, appropriate and meaningful youth involvement; maximization of the usefulness of the European consultation; and definition of a budget line and framework for evaluation of the process' impact at country level.

A nutrition/health mindset on commercial Big Data and drivers of food demand in modern and traditional systems.

PubMed

Dubé, Laurette; Labban, Alice; Moubarac, Jean-Claude; Heslop, Gabriela; Ma, Yu; Paquet, Catherine

2014-12-01

Building greater reciprocity between traditional and modern food systems and better convergence of human and economic development outcomes may enable the production and consumption of accessible, affordable, and appealing nutritious food for all. Information being key to such transformations, this roadmap paper offers a strategy that capitalizes on Big Data and advanced analytics, setting the foundation for an integrative intersectoral knowledge platform to better inform and monitor behavioral change and ecosystem transformation. Building upon the four P's of marketing (product, price, promotion, placement), we examine digital commercial marketing data through the lenses of the four A's of food security (availability, accessibility, affordability, appeal) using advanced consumer choice analytics for archetypal traditional (fresh fruits and vegetables) and modern (soft drinks) product categories. We demonstrate that business practices typically associated with the latter also have an important, if not more important, impact on purchases of the former category. Implications and limitations of the approach are discussed. © 2014 New York Academy of Sciences.

[Violence against children: revealing the characteristics of emergency treatment, Brazil, 2006 and 2007].

PubMed

Mascarenhas, Márcio Dênis Medeiros; Malta, Deborah Carvalho; Silva, Marta Maria Alves da; Lima, Cheila Marina; Carvalho, Mércia Gomes Oliveira de; Oliveira, Vera Lídia Alves de

2010-02-01

The aim of this article was to describe the profile of emergency care for injuries resulting from violence against children (< 10 years of age) treated Surveillance System for Violence and Accidents (VIVA) of the Ministry of Health, for 30 consecutive days in 2006 and 2007 in selected cities of Brazil. The 518 children in the sample were predominantly male (60.6%), aged 5-9 years (52.1%), and black (71.2%). The majority (55%) of the cases occurred in the home, 34.2% involved sharp objects, and 68.7% evolved to discharge. The most frequent form of violence was physical aggression (67.4%), involving beating, sharp objects, and firearms. The other types of violence included neglect (32%), psychological abuse (9.5%), and sexual assault (3.5%). The aggressors were largely male (48.1%) and family members of the victim (36.3%). The study shows children's vulnerability to situations of violence. It is necessary to develop specific strategies for inter-sector care and social mobilization to intervene in this problem.

Developments in damage assessment by Marie Skłodowska-Curie TRUSS ITN project

NASA Astrophysics Data System (ADS)

González, A.

2017-05-01

The growth of cities, the impacts of climate change and the massive cost of providing new infrastructure provide the impetus for TRUSS (Training in Reducing Uncertainty in Structural Safety), a €3.7 million Marie Skłodowska-Curie Action Innovative Training Network project funded by EU’s Horizon 2020 programme, which aims to maximize the potential of infrastructure that already exists (http://trussitn.eu). For that purpose, TRUSS brings together an international, inter-sectoral and multidisciplinary collaboration between five academic and eleven industry institutions from five European countries. The project covers rail and road infrastructure, buildings and energy and marine infrastructure. This paper reports progress in fields such as advanced sensor-based structural health monitoring solutions - unmanned aerial vehicles, optical backscatter reflectometry, monitoring sensors mounted on vehicles, … - and innovative algorithms for structural designs and short- and long-term assessments of buildings, bridges, pavements, ships, ship unloaders, nuclear components and wind turbine towers that will support infrastructure operators and owners in managing their assets.

Environmental health impacts associated with rapid urbanisation in South Africa.

PubMed

von Schirnding, Y; Yach, D

There is an urgent need for epidemiological assessments of environmental factors associated with rapid urbanisation in developing countries. Unlike the process in developed countries, urbanisation in the developing world is often associated with urban poverty, particularly on the periphery of the city where informal settlement areas develop. Population growth rates in these areas are frequently higher than in the city itself, and access to basic environmental amenities is frequently lacking. In Africa, ill-health conditions associated with rapid urbanisation, such as diarrhoea and acute respiratory infections, continue to be major causes of childhood deaths. An account is given of research being conducted in South Africa to address such problems, as well as problems related to inner-city decay, such as childhood lead exposure. There is a critical need for better inter-sectoral co-ordination between the health sector and other sectors such as housing and planning, in preventing negative health impacts associated with rapid urbanisation in the future.

Barriers and Facilitators to Integrating Health Service Responses to Intimate Partner Violence in Low- and Middle-Income Countries: A Comparative Health Systems and Service Analysis.

PubMed

Colombini, Manuela; Dockerty, Colleen; Mayhew, Susannah H

2017-06-01

This systematic review synthesizes 11 studies of health-sector responses to intimate partner violence (IPV) in low- and middle-income countries. The services that were most comprehensive and integrated in their responsiveness to IPV were primarily in primary health and antenatal care settings. Findings suggest that the following facilitators are important: availability of clear guidelines, policies, or protocols; management support; intersectoral coordination with clear, accessible on-site and off-site referral options; adequate and trained staff with accepting and empathetic attitudes toward survivors of IPV; initial and ongoing training for health workers; and a supportive and supervised environment in which to enact new IPV protocols. A key characteristic of the most integrated responses was the connection or "linkages" between different individual factors. Irrespective of their service entry point, what emerged as crucial was a connected systems-level response, with all elements implemented in a coordinated manner. © 2017 The Population Council, Inc.

The Millennium Development Goals: experiences, achievements and what's next

PubMed Central

Lomazzi, Marta; Borisch, Bettina; Laaser, Ulrich

2014-01-01

The Millennium Development Goals (MDGs) are eight international development goals to be achieved by 2015 addressing poverty, hunger, maternal and child mortality, communicable disease, education, gender inequality, environmental damage and the global partnership. Most activities worldwide have focused on maternal and child health and communicable diseases, while less attention has been paid to environmental sustainability and the development of a global partnership. Up to now, several targets have been at least partially achieved: hunger reduction is on track, poverty has been reduced by half, living conditions of 200 million deprived people enhanced, maternal and child mortality as well as communicable diseases diminished and education improved. Nevertheless, some goals will not be met, particularly in the poorest regions, due to different challenges (e.g. the lack of synergies among the goals, the economic crisis, etc.). The post-2015 agenda is now under discussion. The new targets, whatever they will be called, should reflect today's political situation, health and environmental challenges, and an all-inclusive, intersectoral and accountable approach should be adopted. PMID:24560268

Mapping Collaborative Relations among Canada's Chronic Disease Prevention Organizations

PubMed Central

Hanusaik, Nancy; Maximova, Katerina; Paradis, Gilles; O'Loughlin, Jennifer L.

2016-01-01

In the field of chronic disease prevention (CDP), collaborations between organizations provide a vital framework for intersectoral engagement and exchanges of knowledge, expertise and resources. However, little is known about how the structures of preventive health systems actually articulate with CDP capacity and outcomes. Drawing upon data from the Public Health Organizational Capacity Study – a repeat census of all public health organizations in Canada – we used social network analysis to map and examine interorganizational collaborative relationships in the Canadian preventive health system. The network of relationships obtained through our study shows that provincial boundaries remain a major factor influencing collaborative patterns. Not only are collaborations scarce on the interprovincial level but they are also mostly limited to links with federal and multi-provincial organizations. Given this finding, federal or multi-provincial organizations that occupy central bridging positions in the Canadian CDP collaborative structure should serve as key players for shaping CDP practices in the country. PMID:27585030

Barriers and Facilitators to Integrating Health Service Responses to Intimate Partner Violence in Low‐ and Middle‐Income Countries: A Comparative Health Systems and Service Analysis

PubMed Central

Colombini, Manuela; Dockerty, Colleen; Mayhew, Susannah H.

2017-01-01

This systematic review synthesizes 11 studies of health‐sector responses to intimate partner violence (IPV) in low‐ and middle‐income countries. The services that were most comprehensive and integrated in their responsiveness to IPV were primarily in primary health and antenatal care settings. Findings suggest that the following facilitators are important: availability of clear guidelines, policies, or protocols; management support; intersectoral coordination with clear, accessible on‐site and off‐site referral options; adequate and trained staff with accepting and empathetic attitudes toward survivors of IPV; initial and ongoing training for health workers; and a supportive and supervised environment in which to enact new IPV protocols. A key characteristic of the most integrated responses was the connection or “linkages” between different individual factors. Irrespective of their service entry point, what emerged as crucial was a connected systems‐level response, with all elements implemented in a coordinated manner. PMID:28422291

The pandemic of physical inactivity: global action for public health.

PubMed

Kohl, Harold W; Craig, Cora Lynn; Lambert, Estelle Victoria; Inoue, Shigeru; Alkandari, Jasem Ramadan; Leetongin, Grit; Kahlmeier, Sonja

2012-07-21

Physical inactivity is the fourth leading cause of death worldwide. We summarise present global efforts to counteract this problem and point the way forward to address the pandemic of physical inactivity. Although evidence for the benefits of physical activity for health has been available since the 1950s, promotion to improve the health of populations has lagged in relation to the available evidence and has only recently developed an identifiable infrastructure, including efforts in planning, policy, leadership and advocacy, workforce training and development, and monitoring and surveillance. The reasons for this late start are myriad, multifactorial, and complex. This infrastructure should continue to be formed, intersectoral approaches are essential to advance, and advocacy remains a key pillar. Although there is a need to build global capacity based on the present foundations, a systems approach that focuses on populations and the complex interactions among the correlates of physical inactivity, rather than solely a behavioural science approach focusing on individuals, is the way forward to increase physical activity worldwide.

Integration of Water, Sanitation, and Hygiene for the Prevention and Control of Neglected Tropical Diseases: A Rationale for Inter-Sectoral Collaboration

PubMed Central

Jacobson, Julie; Abbott, Daniel; Addiss, David G.; Amnie, Asrat G.; Beckwith, Colin; Cairncross, Sandy; Callejas, Rafael; Colford, Jack M.; Emerson, Paul M.; Fenwick, Alan; Fishman, Rebecca; Gallo, Kerry; Grimes, Jack; Karapetyan, Gagik; Keene, Brooks; Lammie, Patrick J.; MacArthur, Chad; Lochery, Peter; Petach, Helen; Platt, Jennifer; Prabasi, Sarina; Rosenboom, Jan Willem; Roy, Sharon; Saywell, Darren; Schechtman, Lisa; Tantri, Anupama; Velleman, Yael; Utzinger, Jürg

2013-01-01

Improvements of water, sanitation, and hygiene (WASH) infrastructure and appropriate health-seeking behavior are necessary for achieving sustained control, elimination, or eradication of many neglected tropical diseases (NTDs). Indeed, the global strategies to fight NTDs include provision of WASH, but few programs have specific WASH targets and approaches. Collaboration between disease control programs and stakeholders in WASH is a critical next step. A group of stakeholders from the NTD control, child health, and WASH sectors convened in late 2012 to discuss opportunities for, and barriers to, collaboration. The group agreed on a common vision, namely “Disease-free communities that have adequate and equitable access to water and sanitation, and that practice good hygiene.” Four key areas of collaboration were identified, including (i) advocacy, policy, and communication; (ii) capacity building and training; (iii) mapping, data collection, and monitoring; and (iv) research. We discuss strategic opportunities and ways forward for enhanced collaboration between the WASH and the NTD sectors. PMID:24086781

European Healthy Cities come to terms with health network governance.

PubMed

de Leeuw, Evelyne; Kickbusch, Ilona; Palmer, Nicola; Spanswick, Lucy

2015-06-01

A focus on good governance in the WHO European network of Healthy Cities mirrors the WHO Region's strategic emphasis-its member states in the Health 2020 strategy espouse governance for health as key. Healthy Cities adopted governance as a key value and approach to delivering specific health programmes and policies. This article reviews the extent to which they actually introduce and align governance concepts and approaches with their local government commitments. Healthy Cities show that better participation, policy-making and intersectoral action result from an emphasis on governance. This happens across the designated cities and is not limited to a certain class (in terms of population or geographical location) or the time they have been designated. The support of WHO in driving the governance agenda seems important, but no data are available to show that European Healthy Cities are different from other urban environments. © The Author 2015. Published by Oxford University Press. All rights reserved. For Permissions, please email: journals.permissions@oup.com.

Health 2020--achieving health and development in today's Europe.

PubMed

Jakab, Zsuzsanna; Tsouros, Agis D

2014-06-01

The 21st-century health landscape is shaped by growing global, regional and local interdependence and an increasingly complex array of interlinking factors that influence health and well-being. Most of today's major public health challenges, including noncommunicable diseases, antimicrobial resistance, health inequalities and the health effects of austerity measures in some countries, cannot be addressed effectively without intersectoral and coordinated action at supranational, national and local levels. The 53 countries of the WHO European Region developed and adopted a European policy framework and strategy for the 21st century (Health 2020) as a common, evidence-informed policy framework to support and encourage coordinated action by policy-makers at all levels and in all sectors to improve population health and well-being. This article presents the development process of Health 2020 and its main strategic goals, objectives and content. Further, we describe what is needed to successfully implement Health 2020 in countries and how can WHO provide technical assistance to countries that embark on developing health policy aligned with the Health 2020 policy framework.

The Millennium Development Goals: experiences, achievements and what's next.

PubMed

Lomazzi, Marta; Borisch, Bettina; Laaser, Ulrich

2014-01-01

The Millennium Development Goals (MDGs) are eight international development goals to be achieved by 2015 addressing poverty, hunger, maternal and child mortality, communicable disease, education, gender inequality, environmental damage and the global partnership. Most activities worldwide have focused on maternal and child health and communicable diseases, while less attention has been paid to environmental sustainability and the development of a global partnership. Up to now, several targets have been at least partially achieved: hunger reduction is on track, poverty has been reduced by half, living conditions of 200 million deprived people enhanced, maternal and child mortality as well as communicable diseases diminished and education improved. Nevertheless, some goals will not be met, particularly in the poorest regions, due to different challenges (e.g. the lack of synergies among the goals, the economic crisis, etc.). The post-2015 agenda is now under discussion. The new targets, whatever they will be called, should reflect today's political situation, health and environmental challenges, and an all-inclusive, intersectoral and accountable approach should be adopted.

Integration of water, sanitation, and hygiene for the prevention and control of neglected tropical diseases: a rationale for inter-sectoral collaboration.

PubMed

Freeman, Matthew C; Ogden, Stephanie; Jacobson, Julie; Abbott, Daniel; Addiss, David G; Amnie, Asrat G; Beckwith, Colin; Cairncross, Sandy; Callejas, Rafael; Colford, Jack M; Emerson, Paul M; Fenwick, Alan; Fishman, Rebecca; Gallo, Kerry; Grimes, Jack; Karapetyan, Gagik; Keene, Brooks; Lammie, Patrick J; Macarthur, Chad; Lochery, Peter; Petach, Helen; Platt, Jennifer; Prabasi, Sarina; Rosenboom, Jan Willem; Roy, Sharon; Saywell, Darren; Schechtman, Lisa; Tantri, Anupama; Velleman, Yael; Utzinger, Jürg

2013-01-01

Improvements of water, sanitation, and hygiene (WASH) infrastructure and appropriate health-seeking behavior are necessary for achieving sustained control, elimination, or eradication of many neglected tropical diseases (NTDs). Indeed, the global strategies to fight NTDs include provision of WASH, but few programs have specific WASH targets and approaches. Collaboration between disease control programs and stakeholders in WASH is a critical next step. A group of stakeholders from the NTD control, child health, and WASH sectors convened in late 2012 to discuss opportunities for, and barriers to, collaboration. The group agreed on a common vision, namely "Disease-free communities that have adequate and equitable access to water and sanitation, and that practice good hygiene." Four key areas of collaboration were identified, including (i) advocacy, policy, and communication; (ii) capacity building and training; (iii) mapping, data collection, and monitoring; and (iv) research. We discuss strategic opportunities and ways forward for enhanced collaboration between the WASH and the NTD sectors.

Mapping Collaborative Relations among Canada's Chronic Disease Prevention Organizations.

PubMed

Contandriopoulos, Damien; Hanusaik, Nancy; Maximova, Katerina; Paradis, Gilles; O'Loughlin, Jennifer L

2016-08-01

In the field of chronic disease prevention (CDP), collaborations between organizations provide a vital framework for intersectoral engagement and exchanges of knowledge, expertise and resources. However, little is known about how the structures of preventive health systems actually articulate with CDP capacity and outcomes. Drawing upon data from the Public Health Organizational Capacity Study - a repeat census of all public health organizations in Canada - we used social network analysis to map and examine interorganizational collaborative relationships in the Canadian preventive health system. The network of relationships obtained through our study shows that provincial boundaries remain a major factor influencing collaborative patterns. Not only are collaborations scarce on the interprovincial level but they are also mostly limited to links with federal and multi-provincial organizations. Given this finding, federal or multi-provincial organizations that occupy central bridging positions in the Canadian CDP collaborative structure should serve as key players for shaping CDP practices in the country. Copyright © 2016 Longwoods Publishing.

A salmonella data bank for routine surveillance and research.

PubMed

Talaska, T

1994-01-01

A salmonella data bank has been established in the State of Brandenburg, Germany, with due steps being taken to ensure the protection of personal data. The system of data collection and rapid return of information to the local health and veterinary services have become essential elements in intersectoral cooperation in case investigation, disease prevention, and epidemiological research. A number of issues, particularly those concerning the pathways of infection, characteristics of clusters of cases, and the infection of different population strata can now be examined and monitored. An important feature of the data bank is its accessibility by local as well as central state services using a PC-based program and the wide interdisciplinary circulation of regular reports. Preliminary results on the data volume, age distribution of cases, and salmonella isolation rates in different population strata are presented. The data bank supports studies on marketing and purchasing patterns of agricultural products representing potential vehicles of infection, and it should encourage investigations to trace the reservoirs of infection and contamination points along the food chain.

Case−Control Study of Risk Factors for Meningococcal Disease in Chile

PubMed Central

Matute, Isabel; González, Claudia; Delgado, Iris; Poffald, Lucy; Pedroni, Elena; Alfaro, Tania; Hirmas, Macarena; Nájera, Manuel; Gormaz, Ana; López, Darío; Loayza, Sergio; Ferreccio, Catterina; Gallegos, Doris; Fuentes, Rodrigo; Vial, Pablo; Aguilera, Ximena

2017-01-01

An outbreak of meningococcal disease with a case-fatality rate of 30% and caused by predominantly serogroup W of Neisseria meningitidis began in Chile in 2012. This outbreak required a case−control study to assess determinants and risk factors for infection. We identified confirmed cases during January 2012−March 2013 and selected controls by random sampling of the population, matched for age and sex, resulting in 135 case-patients and 618 controls. Sociodemographic variables, habits, and previous illnesses were studied. Analyses yielded adjusted odds ratios as estimators of the probability of disease development. Results indicated that conditions of social vulnerability, such as low income and overcrowding, as well as familial history of this disease and clinical histories, especially chronic diseases and hospitalization for respiratory conditions, increased the probability of illness. Findings should contribute to direction of intersectoral public policies toward a highly vulnerable social group to enable them to improve their living conditions and health. PMID:28628448

Contexts, Mechanisms, and Outcomes That Matter in Dutch Community-Based Physical Activity Programs Targeting Socially Vulnerable Groups.

PubMed

Herens, Marion; Wagemakers, Annemarie; Vaandrager, Lenneke; van Ophem, Johan; Koelen, Maria

2017-09-01

This article presents a practitioner-based approach to identify key combinations of contextual factors (C) and mechanisms (M) that trigger outcomes (O) in Dutch community-based health-enhancing physical activity (CBHEPA) programs targeting socially vulnerable groups. Data were collected in six programs using semi-structured interviews and focus groups using a timeline technique. Sessions were recorded, anonymized, and transcribed. A realist synthesis protocol was used for data-driven and thematic analysis of CMO configurations. CMO configurations related to community outreach, program sustainability, intersectoral collaboration, and enhancing participants' active lifestyles. We have refined the CBHEPA program theory by showing that actors' passion for, and past experiences with, physical activity programs trigger outcomes, alongside their commitment to socially vulnerable target groups. Project discontinuity, limited access to resources, and a trainer's stand-alone position were negative configurations. The authors conclude that local governance structures appear often to lack adaptive capacity to accommodate multilevel processes to sustain programs.

Network Connectedness, Sense of Community, and Risk Perception of Climate Change Professionals in the Pacific Islands Region

NASA Astrophysics Data System (ADS)

Corlew, L. K.; Keener, V. W.; Finucane, M.

2013-12-01

The Pacific Regional Integrated Sciences and Assessments (Pacific RISA) Program conducted social network analysis research of climate change professionals (broadly defined) who are from or work in Hawaii and the U.S.-Affiliated Pacific Islands (USAPI) region. This study is supported by the National Oceanic and Atmospheric Administration (NOAA) and the Pacific Islands Climate Science Center (PICSC) to address an identified need for a resource that quantifies the region's collaborative network of climate change professionals, and that supports the further development of cross-regional and inter-sectoral collaborations for future research and adaptation activities. A survey was distributed to nearly 1,200 people who are from and/or work in climate change related fields in the region. The Part One Survey questions (not confidential) created a preferential attachment network by listing major players in Hawaii and the USAPI, with additional open fields to identify important contacts in the greater professional network. Participants (n=340) identified 975 network contacts and frequency of communications (weekly, monthly, seasonally, yearly, at least once ever). Part Two Survey questions (confidential, n=302) explored climate change risk perceptions, Psychological Sense of Community (PSOC), sense of control over climate change impacts, sense of responsibility to act, policy beliefs and preferences regarding climate change actions, concern and optimism scales about specific impacts, and demographic information. Graphical representations of the professional network are being developed for release in September 2013 as a free online tool to promote and assist collaboration building among climate professionals in the region. The graphs are partitioned according to network 'hubs' (high centrality), participant location, and profession to clearly identify network strengths and opportunities for future collaborations across spatial and professional boundaries. For additional analyses, scores are assigned for participant degree centrality, betweenness centrality, and Eigenvector centrality from the Part One Survey, as well as PSOC, control, responsibility, risk perceptions, concern, optimism, and policy preferences from the Part Two Survey. Statistical interaction analyses explore factors motivating connectedness within the network, as well as climate change research and adaptation needs and priorities of participants.

Assessing HIV risk in workplaces for prioritizing HIV preventive interventions in Karnataka State, India.

PubMed

Halli, Shiva S; Buzdugan, Raluca; Ramesh, B M; Gurnani, Vandana; Sharma, Vivek; Moses, Stephen; Blanchard, James F

2009-09-01

To develop a model for prioritizing economic sectors for HIV preventive intervention programs in the workplace. This study was undertaken in Karnataka state, India. A 3-stage survey process was undertaken. In the first stage, we reviewed secondary data available from various government departments, identified industries in the private sector with large workforces, and mapped their geographical distribution. In the second stage, an initial rapid risk assessment of industrial sectors was undertaken, using key-informant interviews conducted in relation to a number of enterprises, and in consultation with stakeholders. In the third stage, we used both quantitative (polling booth survey) and qualitative methods (key informant interviews, in-depth interviews, focus group discussions) to study high-risk sectors in-depth, and assessed the need and feasibility of HIV workplace intervention programs. The highest risk sectors were found to be mining, garment/textile, sugar, construction/infrastructure, and fishing industries. Workers in all sectors had at best partial knowledge about HIV/AIDS, coupled with common misconceptions about HIV transmission. There were intersector and intrasector variations in risk and vulnerability across different geographical locations and across different categories of workers. This has implications for the design and implementation of workplace intervention programs. There is tremendous scope for HIV preventive interventions in workplaces in India. Given the variation in HIV risk across economic sectors and limited available resources, there will be increased pressure to prioritize intervention efforts towards high-risk sectors. This study offers a model for rapidly assessing the risk level of economic sectors for HIV intervention programs.

The global burden of disease attributable to low consumption of fruit and vegetables: implications for the global strategy on diet.

PubMed Central

Lock, Karen; Pomerleau, Joceline; Causer, Louise; Altmann, Dan R.; McKee, Martin

2005-01-01

OBJECTIVE: We estimated the global burden of disease attributable to low consumption of fruit and vegetables, an increasingly recognized risk factor for cardiovascular disease and cancer, and compared its impact with that of other major risk factors for disease. METHODS: The burden of disease attributable to suboptimal intake of fruit and vegetables was estimated using information on fruit and vegetable consumption in the population, and on its association with six health outcomes (ischaemic heart disease, stroke, stomach, oesophageal, colorectal and lung cancer). Data from both sources were stratified by sex, age and by 14 geographical regions. FINDINGS: The total worldwide mortality currently attributable to inadequate consumption of fruit and vegetables is estimated to be up to 2.635 million deaths per year. Increasing individual fruit and vegetable consumption to up to 600 g per day (the baseline of choice) could reduce the total worldwide burden of disease by 1.8%, and reduce the burden of ischaemic heart disease and ischaemic stroke by 31% and 19% respectively. For stomach, oesophageal, lung and colorectal cancer, the potential reductions were 19%, 20%, 12% and 2%, respectively. CONCLUSION: This study shows the potentially large impact that increasing fruit and vegetable intake could have in reducing many noncommunicable diseases. It highlights the need for much greater emphasis on dietary risk factors in public health policy in order to tackle the rise in noncommunicable diseases worldwide, and suggests that the proposed intersectoral WHO/FAO fruit and vegetable promotion initiative is a crucial component in any global diet strategy. PMID:15744402

Internationalization of medical education in Iran: A way towards implementation of the plans of development and innovation in medical education

PubMed Central

SHAMSI GOOSHKI, EHSAN; POURABBASI, ATA; AKBARI, HAMID; REZAEI, NIMA; ARAB KHERADMAND, ALI; KHEIRY, ZAHRA; PEYKARI, NILOUFAR; MOMENI JAVID, FATEREH; HAJIPOUR, FIROUZEH; LARIJANI, BAGHER

2018-01-01

Introduction: Academic institutions are the most important organizations for implementation of internationalization policies and practices for integrating an international, intercultural and global dimension in higher education system. Also, a globally increasing demand for higher education has been seen in the past two decades so that the number of students enrolled in higher education institutions in the worldwide nation-states has increased dramatically. The National Plan of International Development of Medical Education was designed with the aim of identifying available potentials in all the universities of medical sciences, encouraging the development of international standards of medical education, and planning for the utilization of the existing capacity in Islamic republic of Iran. Methods: Authors have tried to review the several aspects of international activities in higher education in the world and describe national experiences and main policies in globalization of medical education in Iran within implementation of the National Plan for Development and Innovation in Medical Education. Results: The findings of some global experiences provide the policy makers with clear directions in order to develop internationalization of higher education. Conclusion: The Program for International Development of Medical Education was designed by the Deputy of Education in the Ministry of Health and the effective implementation of this Program was so important for promotion of Iranian medical education. But there were some challenges in this regard; addressing them through inter-sectoral collaboration is one of the most important strategies for the development of internationalization of education in the field of medical sciences. PMID:29344529

Reducing vector-borne disease by empowering farmers in integrated vector management.

PubMed

van den Berg, Henk; von Hildebrand, Alexander; Ragunathan, Vaithilingam; Das, Pradeep K

2007-07-01

Irrigated agriculture exposes rural people to health risks associated with vector-borne diseases and pesticides used in agriculture and for public health protection. Most developing countries lack collaboration between the agricultural and health sectors to jointly address these problems. We present an evaluation of a project that uses the "farmer field school" method to teach farmers how to manage vector-borne diseases and how to improve rice yields. Teaching farmers about these two concepts together is known as "integrated pest and vector management". An intersectoral project targeting rice irrigation systems in Sri Lanka. Project partners developed a new curriculum for the field school that included a component on vector-borne diseases. Rice farmers in intervention villages who graduated from the field school took vector-control actions as well as improving environmental sanitation and their personal protection measures against disease transmission. They also reduced their use of agricultural pesticides, especially insecticides. The intervention motivated and enabled rural people to take part in vector-management activities and to reduce several environmental health risks. There is scope for expanding the curriculum to include information on the harmful effects of pesticides on human health and to address other public health concerns. Benefits of this approach for community-based health programmes have not yet been optimally assessed. Also, the institutional basis of the integrated management approach needs to be broadened so that people from a wider range of organizations take part. A monitoring and evaluation system needs to be established to measure the performance of integrated management initiatives.

What must be the Pillars of Iran’s Health System in 2025? Values and Principles of Health System Reform Plan

PubMed Central

RAJABI, Fateme; ESMAILZADEH, Hamid; ROSTAMIGOORAN, Narges; MAJDZADEH, Reza

2013-01-01

Background: Preparing long term reformatory plan for the health system, like other macro plans, requires guiding principles which is according to the values, and as a bridge, connect the ideals and values to the goals. This study was designed with the purpose of explaining the values and principles of health system, and as a pre-requisite to compilation of Iran’s health system reform plan at 2025. Method: The document of values and principles of health system reform plan for 2025 was developed by reviewing the literature and receiving the opinions of senior experts of health system, and was criticized in focus group discussion sessions of experts and decision makers. Results: The values of Iran are: dignity of human, the right to maximum attainable level of health, comprehensive health, equity and social cohesion. The principles of this health system include: institutionalizing the ethical values, responsiveness and accountability, equitable access (utilization), prevention and health promotion, community participation, inter-sectoral collaboration, integrated stewardship, benefit from innovation and desired technology, human resources promotion and excellence and harmony. Conclusion: Based on the perception of cultural and religious teachings in Iran, protecting of human dignity and human prosperity are the ultimate social goal. In this sense, health and healthy humans, in its holistic concept (physical, mental, social health and spiritual) are the center and development in any form should lead to the human prosperity in a way that each of the individuals could enjoy the maximum attainable level of health in its holistic meaning and in a faire manner. PMID:23515322

Vector control for malaria and other mosquito-borne diseases. Report of a WHO study group.

PubMed

1995-01-01

Since the Ministerial Conference on Malaria in 1992, which acknowledged the urgent need for worldwide commitment to malaria control, efforts have been directed to implementation of a Global Malaria Control Strategy. Vector control, an essential component of malaria control, has become less effective in recent years, partly as a result of poor use of alternative control tools, inappropriate use of insecticides, lack of an epidemiological basis for interventions, inadequate resources and infrastructure, and weak management. Changing environmental conditions, the behavioural characteristics of certain vectors, and resistance to insecticides have added to the difficulties. This report of a WHO Study Group provides guidelines for the planning, implementation and evaluation of cost-effective and sustainable vector control in the context of the Global Malaria Control Strategy. It reviews the available methods - indoor residual spraying, personal protection, larval control and environmental management - stressing the need for selective and flexible use of interventions according to local conditions. Requirements for data collection and the appropriate use of entomological parameters and techniques are discussed and priorities identified for the development of local capacity for vector control and for operational research. Emphasis is placed both on the monitoring and evaluation of vector control to ensure cost-effectiveness and on the development of strong managerial structures, which can support community participation and intersectoral collaboration and accommodate the control of other vector-borne diseases. The report concludes with recommendations aimed at promoting the targeted and efficient use of vector control in preventing and controlling malaria, thereby reducing the threat to health and socioeconomic development in many tropical countries.

Tuberculosis Notification by Private Sector' Physicians in Tehran.

PubMed

Ahmadi, Ayat; Nedjat, Saharnaz; Gholami, Jaleh; Majdzadeh, Reza

2015-01-01

A small proportion of physicians adhere to tuberculosis (TB) notification regulations, particularly in the private sector. In most developing countries, the private sector has dominance over delivering services in big cities. In such circumstances deviation from the TB treatment protocol is frequently happening. This study sought to estimate TB notification in the private sector and settle on determinants of TB notification by private sector physicians. A population-based study has been conducted; private physicians at their clinics were interviewed. The total number of 443 private sectors' physicians has been chosen by the stratified random sampling method. Appropriate descriptive analysis was used to describe the study's participants. Logistic regression was used for bivariable and multivariable analysis. The response rate of the study was 90.06 (399%). Among responders, who had stated that they were suspicious of TB over the recent year, 62 (16.45%) stated that they reported cases of TB at least once during the same period. Having reporting requirements and the number of visited patients was significantly related to TB suspicious (odds ratio = 2.84, confidence interval: 1.62-5, P < 0.01). Workplace and access to relevant resources are associated with TB notification (P < 0.05). In poor resource settings with a high burden of TB, the public health administration can promote notification activities in the private sector by simple and quick interventions. It seems that a considerable fraction of private sector physicians, not all of them, will notify TB if they are provided with primary information and primary resources. To optimize the TB notification, however, intersectoral interventions are more likely to be successful.

Integrated vector management: a critical strategy for combating vector-borne diseases in South Sudan.

PubMed

Chanda, Emmanuel; Govere, John M; Macdonald, Michael B; Lako, Richard L; Haque, Ubydul; Baba, Samson P; Mnzava, Abraham

2013-10-25

Integrated vector management (IVM) based vector control is encouraged by the World Health Organization (WHO). However, operational experience with the IVM strategy has mostly come from countries with relatively well-established health systems and with malaria control focused programmes. Little is known about deployment of IVM for combating multiple vector-borne diseases in post-emergency settings, where delivery structures are less developed or absent. This manuscript reports on the feasibility of operational IVM for combating vector-borne diseases in South Sudan. A methodical review of published and unpublished documents on vector-borne diseases for South Sudan was conducted via systematic literature search of online electronic databases, Google Scholar, PubMed and WHO, using a combination of search terms. Additional, non-peer reviewed literature was examined for information related to the subject. South Sudan is among the heartlands of vector-borne diseases in the world, characterized by enormous infrastructure, human and financial resource constraints and a weak health system against an increasing number of refugees, returnees and internally displaced people. The presence of a multiplicity of vector-borne diseases in this post-conflict situation presents a unique opportunity to explore the potential of a rational IVM strategy for multiple disease control and optimize limited resource utilization, while maximizing the benefits and providing a model for countries in a similar situation. The potential of integrating vector-borne disease control is enormous in South Sudan. However, strengthened coordination, intersectoral collaboration and institutional and technical capacity for entomological monitoring and evaluation, including enforcement of appropriate legislation are crucial.

Integrated vector management: a critical strategy for combating vector-borne diseases in South Sudan

PubMed Central

2013-01-01

Background Integrated vector management (IVM) based vector control is encouraged by the World Health Organization (WHO). However, operational experience with the IVM strategy has mostly come from countries with relatively well-established health systems and with malaria control focused programmes. Little is known about deployment of IVM for combating multiple vector-borne diseases in post-emergency settings, where delivery structures are less developed or absent. This manuscript reports on the feasibility of operational IVM for combating vector-borne diseases in South Sudan. Case description A methodical review of published and unpublished documents on vector-borne diseases for South Sudan was conducted via systematic literature search of online electronic databases, Google Scholar, PubMed and WHO, using a combination of search terms. Additional, non-peer reviewed literature was examined for information related to the subject. Discussion South Sudan is among the heartlands of vector-borne diseases in the world, characterized by enormous infrastructure, human and financial resource constraints and a weak health system against an increasing number of refugees, returnees and internally displaced people. The presence of a multiplicity of vector-borne diseases in this post-conflict situation presents a unique opportunity to explore the potential of a rational IVM strategy for multiple disease control and optimize limited resource utilization, while maximizing the benefits and providing a model for countries in a similar situation. Conclusion The potential of integrating vector-borne disease control is enormous in South Sudan. However, strengthened coordination, intersectoral collaboration and institutional and technical capacity for entomological monitoring and evaluation, including enforcement of appropriate legislation are crucial. PMID:24156749

Does expanding fiscal space lead to improved funding of the health sector in developing countries?: lessons from Kenya, Lagos State (Nigeria) and South Africa

PubMed Central

Doherty, Jane; Kirigia, Doris; Okoli, Chijioke; Chuma, Jane; Ezumah, N; Ichoku, Hyacinth; Hanson, Kara; McIntyre, Diane

2018-01-01

ABSTRACT Background: The global focus on promoting Universal Health Coverage has drawn attention to the need to increase public domestic funding for health care in low- and middle-income countries. Objectives: This article examines whether increased tax revenue in the three territories of Kenya, Lagos State (Nigeria) and South Africa was accompanied by improved resource allocation to their public health sectors, and explores the reasons underlying the observed trends. Methods: Three case studies were conducted by different research teams using a common mixed methods approach. Quantitative data were extracted from official government financial reports and used to describe trends in general tax revenue, total government expenditure and government spending on the health sector and other sectors in the first decade of this century. Twenty-seven key informant interviews with officials in Ministries of Health and Finance were used to explore the contextual factors, actors and processes accounting for the observed trends. A thematic content analysis allowed this qualitative information to be compared and contrasted between territories. Findings: Increased tax revenue led to absolute increases in public health spending in all three territories, but not necessarily in real per capita terms. However, in each of the territories, the percentage of the government budget allocated to health declined for much of the period under review. Factors contributing to this trend include: inter-sectoral competition in priority setting; the extent of fiscal federalism; the Ministry of Finance’s perception of the health sector’s absorptive capacity; weak investment cases made by the Ministry of Health; and weak parliamentary and civil society involvement. Conclusion: Despite dramatic improvements in tax revenue collection, fiscal space for health in the three territories did not improve. Ministries of Health must strengthen their ability to motivate for larger allocations from government revenue through demonstrating improved performance and the relative benefits of health investments. PMID:29768107

Climate impacts on human livelihoods: where uncertainty matters in projections of water availability

NASA Astrophysics Data System (ADS)

Lissner, T. K.; Reusser, D. E.; Schewe, J.; Lakes, T.; Kropp, J. P.

2014-03-01

Climate change will have adverse impacts on many different sectors of society, with manifold consequences for human livelihoods and well-being. However, a systematic method to quantify human well-being and livelihoods across sectors is so far unavailable, making it difficult to determine the extent of such impacts. Climate impact analyses are often limited to individual sectors (e.g. food or water) and employ sector-specific target-measures, while systematic linkages to general livelihood conditions remain unexplored. Further, recent multi-model assessments have shown that uncertainties in projections of climate impacts deriving from climate and impact models as well as greenhouse gas scenarios are substantial, posing an additional challenge in linking climate impacts with livelihood conditions. This article first presents a methodology to consistently measure Adequate Human livelihood conditions for wEll-being And Development (AHEAD). Based on a transdisciplinary sample of influential concepts addressing human well-being, the approach measures the adequacy of conditions of 16 elements. We implement the method at global scale, using results from the Inter-Sectoral Impact Model Intercomparison Project (ISI-MIP) to show how changes in water availability affect the fulfilment of AHEAD at national resolution. In addition, AHEAD allows identifying and differentiating uncertainty of climate and impact model projections. We show how the approach can help to put the substantial inter-model spread into the context of country-specific livelihood conditions by differentiating where the uncertainty about water scarcity is relevant with regard to livelihood conditions - and where it is not. The results indicate that in many countries today, livelihood conditions are compromised by water scarcity. However, more often, AHEAD fulfilment is limited through other elements. Moreover, the analysis shows that for 44 out of 111 countries, the water-specific uncertainty ranges are outside relevant thresholds for AHEAD, and therefore do not contribute to the overall uncertainty about climate change impacts on livelihoods. The AHEAD method presented here, together with first results, forms an important step towards making scientific results more applicable for policy-decisions.

Climate impacts on human livelihoods: where uncertainty matters in projections of water availability

NASA Astrophysics Data System (ADS)

Lissner, T. K.; Reusser, D. E.; Schewe, J.; Lakes, T.; Kropp, J. P.

2014-10-01

Climate change will have adverse impacts on many different sectors of society, with manifold consequences for human livelihoods and well-being. However, a systematic method to quantify human well-being and livelihoods across sectors is so far unavailable, making it difficult to determine the extent of such impacts. Climate impact analyses are often limited to individual sectors (e.g. food or water) and employ sector-specific target measures, while systematic linkages to general livelihood conditions remain unexplored. Further, recent multi-model assessments have shown that uncertainties in projections of climate impacts deriving from climate and impact models, as well as greenhouse gas scenarios, are substantial, posing an additional challenge in linking climate impacts with livelihood conditions. This article first presents a methodology to consistently measure what is referred to here as AHEAD (Adequate Human livelihood conditions for wEll-being And Development). Based on a trans-disciplinary sample of concepts addressing human well-being and livelihoods, the approach measures the adequacy of conditions of 16 elements. We implement the method at global scale, using results from the Inter-Sectoral Impact Model Intercomparison Project (ISI-MIP) to show how changes in water availability affect the fulfilment of AHEAD at national resolution. In addition, AHEAD allows for the uncertainty of climate and impact model projections to be identified and differentiated. We show how the approach can help to put the substantial inter-model spread into the context of country-specific livelihood conditions by differentiating where the uncertainty about water scarcity is relevant with regard to livelihood conditions - and where it is not. The results indicate that livelihood conditions are compromised by water scarcity in 34 countries. However, more often, AHEAD fulfilment is limited through other elements. The analysis shows that the water-specific uncertainty ranges of the model output are outside relevant thresholds for AHEAD for 65 out of 111 countries, and therefore do not contribute to the overall uncertainty about climate change impacts on livelihoods. In 46 of the countries in the analysis, water-specific uncertainty is relevant to AHEAD. The AHEAD method presented here, together with first results, forms an important step towards making scientific results more applicable for policy decisions.

Implementation of an Intersectoral Program to Eliminate Human and Canine Rabies: The Bohol Rabies Prevention and Elimination Project

PubMed Central

Lapiz, Stella Marie D.; Miranda, Mary Elizabeth G.; Garcia, Romulo G.; Daguro, Leonida I.; Paman, Meydalyn D.; Madrinan, Frederick P.; Rances, Polizena A.; Briggs, Deborah J.

2012-01-01

Background The province of Bohol, located in the Visayas islands region in the Philippines has a human population of 1.13 million and was the 4th highest region for human rabies deaths in the country, averaging 10 per year, prior to the initiation of the Bohol Rabies Prevention and Elimination Project (BRPEP). Aims The BRPEP was initiated in 2007 with the goal of building a sustainable program that would prevent human rabies by eliminating rabies at its source, in dogs, by 2010. This goal was in line with the Philippine National Rabies Program whose objective is to eliminate rabies by 2020. Methods The intersectoral BRPEP was launched in 2007 and integrated the expertise and resources from the sectors of agriculture, public health and safety, education, environment, legal affairs, interior and local government. The program included: increasing local community involvement; implementing dog population control; conducting mass dog vaccination; improving dog bite management; instituting veterinary quarantine; and improving diagnostic capability, surveillance and monitoring. Funding was secured from the national government, provincial, municipal and village units, dog owners, NGOs, the regional office of the WHO, the UBS Optimus Foundation, and the Global Alliance for Rabies Control. The BRPEP was managed by the Bohol Rabies Prevention and Eradication Council (BRPEC) under the jurisdiction of the Governor of Bohol. Parallel organizations were created at the municipal level and village level. Community volunteers facilitated the institution of the program. Dog population surveys were conducted to plan for sufficient resources to vaccinate the required 70% of the dogs living in the province. Two island-wide mass vaccination campaigns were conducted followed by “catch up” vaccination campaigns. Registration of dogs was implemented including a small fee that was rolled back into the program to maintain sustainability. Children were educated by introducing rabies prevention modules into all elementary schools in Bohol. Existing public health legislation at the national, provincial, and municipal level strengthened the enforcement of activities. A Knowledge, Attitude and Practices (KAP) survey was conducted in 2009 to evaluate the educational knowledge of the population. Increased surveillance was instituted to ensure that dogs traveling into and out of the province were vaccinated against rabies. Human and animal cases of rabies were reported to provincial and national authorities. Key Results Within the first 18 months of the BRPEP, human rabies deaths had decreased annually from 0.77 to 0.37 to zero per 100,000 population from 2007–2009. Between October 2008 and November 2010 no human and animal cases were detected. Increased surveillance on the island detected one suspected human rabies case in November 2010 and one confirmed case of canine rabies in April 2011. Two mass vaccination campaigns conducted in 2007 and 2008 successfully registered and vaccinated 44% and 70% of the dogs on the island. The additional surveillance activities enabled a mobilization of mop up vaccination activities in the region where the human and canine case was located. Due to the increased effective and continuous surveillance activities, rabies was stopped before it could spread to other areas on the island. The program costs totaled USD 450,000. Registration fees collected to maintain the program amounted to USD 105,740 and were re-allocated back into the community to sustain the program. PMID:23236525

ERICA: prevalence of healthy eating habits among Brazilian adolescents

PubMed Central

Barufaldi, Laura Augusta; Abreu, Gabriela de Azevedo; Oliveira, Juliana Souza; dos Santos, Debora França; Fujimori, Elizabeth; Vasconcelos, Sandra Mary Lima; de Vasconcelos, Francisco de Assis Guedes; Tavares, Bruno Mendes

2016-01-01

ABSTRACT OBJECTIVE To describe the prevalence of eating habits considered healthy in adolescents according to sex, age, education level of the mother, school type, session of study, and geographic region. METHODS The assessed data come from the Study of Cardiovascular Risks in Adolescents (ERICA), a cross-sectional, national and school-based study. Adolescents of 1,247 schools of 124 Brazilian municipalities were evaluated using a self-administered questionnaire with a section on aspects related to eating behaviors. The following eating behaviors were considered healthy: consuming breakfast, drinking water, and having meals accompanied by parents or legal guardians. All prevalence estimates were presented proportionally, with their respective 95% confidence intervals. The Chi-square test was used to evaluate the differences in healthy eating habits prevalences according to other variables. The module survey of the Stata program version 13.0 was used to analyze complex data. RESULTS We evaluated 74,589 adolescents (72.9% of the eligible students). Of these, 55.2% were female, average age being 14.6 years (SD = 1.6). Among Brazilian adolescents, approximately half of them showed healthy eating habits when consuming breakfast, drinking five or more glasses of water a day, and having meals with parents or legal guardians. All analyzed healthy eating habits showed statistically significant differences by sex, age, type of school, session of study, or geographic region . CONCLUSIONS We suggest that specific actions of intersectoral approach are implemented for the dissemination of the benefits of healthy eating habits. Older female adolescents (15 to 17 years old) who studied in public schools, resided in the Southeast region, and whose mothers had lower education levels, should be the focus of these actions since they present lower frequencies concerning the evaluated healthy habits. PMID:26910548

Linking evidence to action on social determinants of health using Urban HEART in the Americas.

PubMed

Prasad, Amit; Groot, Ana Maria Mahecha; Monteiro, Teofilo; Murphy, Kelly; O'Campo, Patricia; Broide, Emilia Estivalet; Kano, Megumi

2013-12-01

To evaluate the experience of select cities in the Americas using the Urban Health Equity Assessment and Response Tool (Urban HEART) launched by the World Health Organization in 2010 and to determine its utility in supporting government efforts to improve health equity using the social determinants of health (SDH) approach. The Urban HEART experience was evaluated in four cities from 2010-2013: Guarulhos (Brazil), Toronto (Canada), and Bogotá and Medellín (Colombia). Reports were submitted by Urban HEART teams in each city and supplemented by first-hand accounts of key informants. The analysis considered each city's networks and the resources it used to implement Urban HEART; the process by which each city identified equity gaps and prioritized interventions; and finally, the facilitators and barriers encountered, along with next steps. In three cities, local governments spearheaded the process, while in the fourth (Toronto), academia initiated and led the process. All cities used Urban HEART as a platform to engage multiple stakeholders. Urban HEART's Matrix and Monitor were used to identify equity gaps within cities. While Bogotá and Medellín prioritized among existing interventions, Guarulhos adopted new interventions focused on deprived districts. Actions were taken on intermediate determinants, e.g., health systems access, and structural SDH, e.g., unemployment and human rights. Urban HEART provides local governments with a simple and systematic method for assessing and responding to health inequity. Through the SDH approach, the tool has provided a platform for intersectoral action and community involvement. While some areas of guidance could be strengthened, Urban HEART is a useful tool for directing local action on health inequities, and should be scaled up within the Region of the Americas, building upon current experience.

ERICA: prevalence of healthy eating habits among Brazilian adolescents.

PubMed

Barufaldi, Laura Augusta; Abreu, Gabriela de Azevedo; Oliveira, Juliana Souza; dos Santos, Debora França; Fujimori, Elizabeth; Vasconcelos, Sandra Mary Lima; de Vasconcelos, Francisco de Assis Guedes; Tavares, Bruno Mendes

2016-02-01

OBJECTIVE To describe the prevalence of eating habits considered healthy in adolescents according to sex, age, education level of the mother, school type, session of study, and geographic region. METHODS The assessed data come from the Study of Cardiovascular Risks in Adolescents (ERICA), a cross-sectional, national and school-based study. Adolescents of 1,247 schools of 124 Brazilian municipalities were evaluated using a self-administered questionnaire with a section on aspects related to eating behaviors. The following eating behaviors were considered healthy: consuming breakfast, drinking water, and having meals accompanied by parents or legal guardians. All prevalence estimates were presented proportionally, with their respective 95% confidence intervals. The Chi-square test was used to evaluate the differences in healthy eating habits prevalences according to other variables. The module survey of the Stata program version 13.0 was used to analyze complex data. RESULTS We evaluated 74,589 adolescents (72.9% of the eligible students). Of these, 55.2% were female, average age being 14.6 years (SD = 1.6). Among Brazilian adolescents, approximately half of them showed healthy eating habits when consuming breakfast, drinking five or more glasses of water a day, and having meals with parents or legal guardians. All analyzed healthy eating habits showed statistically significant differences by sex, age, type of school, session of study, or geographic region . CONCLUSIONS We suggest that specific actions of intersectoral approach are implemented for the dissemination of the benefits of healthy eating habits. Older female adolescents (15 to 17 years old) who studied in public schools, resided in the Southeast region, and whose mothers had lower education levels, should be the focus of these actions since they present lower frequencies concerning the evaluated healthy habits.

Diversity, Adaptability and Ecosystem Resilience

NASA Astrophysics Data System (ADS)

Keribin, Rozenn; Friend, Andrew

2013-04-01

Our ability to predict climate change and anticipate its impacts depends on Earth System Models (ESMs) and their ability to account for the high number of interacting components of the Earth System and to gauge both their influence on the climate and the feedbacks they induce. The land carbon cycle is a component of ESMs that is still poorly constrained. Since the 1990s dynamic global vegetation models (DGVMs) have become the main tool through which we understand the interactions between plant ecosystems and the climate. While DGVMs have made it clear the impacts of climate change on vegetation could be dramatic, predicting the dieback of rainforests and massive carbon losses from various ecosystems, they are highly variable both in their composition and their predictions. Their treatment of plant diversity and competition in particular vary widely and are based on highly-simplified relationships that do not account for the multiple levels of diversity and adaptability found in real plant ecosystems. The aim of this GREENCYCLES II project is to extend an individual-based DGVM to treat the diversity of physiologies found in plant communities and evaluate their effect if any on the ecosystem's transient dynamics and resilience. In the context of the InterSectoral Impacts Model Intercomparison Project (ISI-MIP), an initiative coordinated by a team at the Potsdam Institute for Climate Impact Research (PIK) that aims to provide fast-track global impact assessments for the IPCC's Fifth Assessment Report, we compare 6 vegetation models including 4 DGVMs under different climate change scenarios and analyse how the very different treatments of plant diversity and interactions from one model to the next affect the models' results. We then investigate a new, more mechanistic method of incorporating plant diversity into the DGVM "Hybrid" based on ecological tradeoffs mediated by plant traits and individual-based competition for light.

Developing and implementing mental health policy in Zanzibar, a low income country off the coast of East Africa

PubMed Central

2011-01-01

Background The Zanzibar Ministry of Health and Social Welfare, concerned about mental health in the country, requested technical assistance from WHO in 1997. Aims This article describes the facilitation over many years by a WHO Collaborating Centre, of sustainable mental health developments in Zanzibar, one of the poorest countries in the world, using systematic approaches to policy design and implementation. Methods Based on intensive prior situation appraisal and consultation, a multi-faceted set of interventions combining situation appraisal to inform planning; sustained policy dialogue at Union and state levels; development of policy and legislation, development of strategic action plans, establishment of intersectoral national mental health implementation committee, establishment of national mental health coordination system, integration of mental health into primary care, strengthening of primary-secondary care liaison, rationalisation and strengthening of secondary care system, ensuring adequate supply of medicines, use of good practice guidelines and health information systems, development of services for people with intellectual disability, establishment of formal mechanism for close liaison between the mental health services and other governmental, non-governmental and traditional sectors, mental health promotion, suicide prevention, and research and development. Results The policy and legislation introduced in 1999 have resulted in enhanced mental health activities over the ensuing decade, within a setting of extreme low resource. However, advances ebb and flow and continued efforts are required to maintain progress and continue mental health developments. Lessons learnt have informed the development of mental health policies in neighbouring countries. Conclusions A multi-faceted and comprehensive programme can be effective in achieving considerable strengthening of mental health programmes and services even in extremely low resource settings, but requires sustained input and advocacy if gains are to be maintained and enhanced. PMID:21320308

Effectiveness of Muskaan Ek Abhiyan (the smile campaign) for strengthening routine immunization in bihar, India.

PubMed

Goel, Sonu; Dogra, Vishal; Gupta, Satish Kumar; Lakshmi, P Vm; Varkey, Sherin; Pradhan, Narottam; Krishna, Gopal; Kumar, Rajesh

2012-02-01

In Bihar State, proportion of fully immunized children was only 19% ;in Coverage Evaluation Survey of 2005. In October 2007, a special campaign called Muskaan Ek Abhiyan (The Smile Campaign) was launched under National Rural Health Mission to give a fillip to the immunization program. To evaluate improvement in the performance and coverage of the Routine Immunization Program consequent to the launch of Muskaan Ek Abhiyan The main strategies of the Muskaan campaign were reviewing and strengthening immunization micro-plans, enhanced inter-sectoral coordination between the Departments of Health, and Women and Child Development, increased involvement of women groups in awareness generation, enhanced political commitment and budgetary support, strengthening of monitoring and supervision mechanisms, and provision of performance based incentive to service providers. Immunization Coverage Evaluation Surveys conducted in various states of India during 2005 and 2009 were used for evaluation of the effect of Muskaan campaign by measuring the increase in immunization coverage in Bihar in comparison to other Empowered Action Group (EAG) states using the difference-in-difference method. Interviews of the key stakeholders were also done to substantiate the findings. The proportion of fully immunized 12-23 month old children in Bihar has increased significantly from 19% ;in 2005 to 49% ;in 2009. The coverage of BCG also increased significantly from 52.8% to 82.3%, DPT-3 from 36.5 to 59.3%, OPV-3 from 27.1% ;to 61.6% ;and measles from 28.4 to 58.2%. In comparison to other states, the coverage of fully immunized children increased significantly from 16 to 26% ;in Bihar. There was a marked improvement in immunization coverage after the launch of the Campaign in Bihar. Therefore, best practices of the Campaign may be replicated in other areas where full immunization coverage is low.

Concerns and future challenges of health literacy in the Nordic countries - From the point of view of health promotion practitioners and researchers.

PubMed

Ringsberg, K C; Olander, E; Tillgren, P; Thualagant, N; Trollvik, A

2018-02-01

Health literacy is an essential social determinant for promoting and maintaining the health of a population. From a health promotion perspective, explore health literacy issues, concerns and future challenges among Nordic practitioners and researchers. Data were collected in a workshop at the 8 th Nordic Health Promotion Conference, and in a literature review, with articles from five databases. The search included title and abstract with the search terms health literacy* and health literacy as a MeSH term and all the Nordic countries. Qualitative and quantitative analysis were used. Twenty-five persons participated in the workshop. The discussions were summarized in six themes: concept of health literacy in national language; risk of victim blaming; measuring health literacy; content in school curricula on health literacy; new technologies for information and communication; communication and collaboration between different actors in support of health. Forty-three articles on health literacy were identified, mainly conducted within three fields: development, test and adaptation of instruments for measuring health literacy; measurement of health literacy among patients, or other defined target groups and on populations; and developing and evaluating methods/tools for the training of personnel groups or different target groups. There is a need for further studies providing a more in-depth understanding of the health literacy concept, knowledge on how to measure health literacy, ethical aspects, application in intersectoral collaboration as well as the adaptation to new technologies for information and communication in education supporting health literacy. As health literacy is an essential social health determinant, a concern and a future challenge must be, to make the health literacy concept familiar and visible in health promotion policies, research and practice such as health education.

How to integrate social care services into primary health care? An experience from Iran

PubMed Central

Montazeri, Ali; Riazi-Isfahani, Sahand; Damari, Behzad

2016-01-01

Background: Social issues have prominent effects on the peoples' physical and mental health and on the health risk factors. In Iran, many organizations provide social care services to their target population. This study aimed to explore the roles and functions of Primary Health Care (PHC) system in providing social care services in Iran. Methods: This was a qualitative study, for which data were collected via three sources: A review of the literature, in-depth interviews and focus group discussions with experts and stakeholders. The main objective was to find a way to integrate social care into the Iranian PHC system. A conventional content analysis was performed to explore the data. Results: Overall, 20 experts were interviewed and the acquired data were classified into four major categories including priorities, implementation, requirements and stewardship. The main challenges were the existing controversies in the definition of social care, social service unit disintegration, multiple stewards for social care services, weaknesses of rules and regulations and low financing of the public budget. Social care services can be divided into two categories: Basic and advanced. Urban and rural health centers, as the first level of PHC, could potentially provide basic social care services for their defined population and catchment areas such as detecting social harms in high risk individuals and families and providing counseling for people in need. They can also refer the individuals to receive advanced services. Conclusion: Iran has a successful history of establishing the PHC System especially in rural areas. This network has an invaluable capacity to provide social health services. Establishing these services needs some prerequisites such as a reform PHC structure, macro support and technical intersectoral collaboration. They should also be piloted and evaluated before they could be implemented in the whole country. PMID:27683649

A Research Agenda for Helminth Diseases of Humans: Social Ecology, Environmental Determinants, and Health Systems

PubMed Central

Gazzinelli, Andrea; Correa-Oliveira, Rodrigo; Yang, Guo-Jing; Boatin, Boakye A.; Kloos, Helmut

2012-01-01

In this paper, the Disease Reference Group on Helminth Infections (DRG4), established in 2009 by the Special Programme for Research and Training in Tropical Diseases (TDR), with the mandate to review helminthiases research and identify research priorities and gaps, focuses on the environmental, social, behavioural, and political determinants of human helminth infections and outlines a research and development agenda for the socioeconomic and health systems research required for the development of sustainable control programmes. Using Stockols' social-ecological approach, we describe the role of various social (poverty, policy, stigma, culture, and migration) and environmental determinants (the home environment, water resources development, and climate change) in the perpetuation of helminthic diseases, as well as their impact as contextual factors on health promotion interventions through both the regular and community-based health systems. We examine these interactions in regard to community participation, intersectoral collaboration, gender, and possibilities for upscaling helminthic disease control and elimination programmes within the context of integrated and interdisciplinary approaches. The research agenda summarises major gaps that need to be addressed. PMID:22545168

Integrating surveillance data on water-related diseases and drinking-water quality; action-research in a Brazilian municipality.

PubMed

Queiroz, Ana Carolina Lanza; Cardoso, Laís Santos de Magalhães; Heller, Léo; Cairncross, Sandy

2015-12-01

The Brazilian Ministry of Health proposed a research study involving municipal professional staff conducting both epidemiological and water quality surveillance to facilitate the integration of the data which they collected. It aimed to improve the intersectoral collaboration and health promotion activities in the municipalities, especially regarding drinking-water quality. We then conducted a study using the action-research approach. At its evaluation phase, a technique which we called 'the tree analogy' was applied in order to identify both possibilities and challenges related to the proposed interlinkage. Results showed that integrating the two data collection systems cannot be attained without prior institutional adjustments. It suggests therefore the necessity to unravel issues that go beyond the selection and the interrelation of indicators and compatibility of software, to include political, administrative and personal matters. The evaluation process led those involved to re-think their practice by sharing experiences encountered in everyday practice, and formulating constructive criticisms. All this inevitably unleashes a process of empowerment. From this perspective, we have certainly gathered some fruit from the Tree, but not necessarily the most visible.

Melanins and melanogenesis: from pigment cells to human health and technological applications.

PubMed

d'Ischia, Marco; Wakamatsu, Kazumasa; Cicoira, Fabio; Di Mauro, Eduardo; Garcia-Borron, Josè Carlos; Commo, Stephane; Galván, Ismael; Ghanem, Ghanem; Kenzo, Koike; Meredith, Paul; Pezzella, Alessandro; Santato, Clara; Sarna, Tadeusz; Simon, John D; Zecca, Luigi; Zucca, Fabio A; Napolitano, Alessandra; Ito, Shosuke

2015-09-01

During the past decade, melanins and melanogenesis have attracted growing interest for a broad range of biomedical and technological applications. The burst of polydopamine-based multifunctional coatings in materials science is just one example, and the list may be expanded to include melanin thin films for organic electronics and bioelectronics, drug delivery systems, functional nanoparticles and biointerfaces, sunscreens, environmental remediation devices. Despite considerable advances, applied research on melanins and melanogenesis is still far from being mature. A closer intersectoral interaction between research centers is essential to raise the interests and increase the awareness of the biomedical, biomaterials science and hi-tech sectors of the manifold opportunities offered by pigment cells and related metabolic pathways. Starting from a survey of biological roles and functions, the present review aims at providing an interdisciplinary perspective of melanin pigments and related pathway with a view to showing how it is possible to translate current knowledge about physical and chemical properties and control mechanisms into new bioinspired solutions for biomedical, dermocosmetic, and technological applications. © 2015 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.

Strategies to strengthen public health inputs to water policy in response to climate change: an Australian perspective.

PubMed

Goater, Sarah; Cook, Angus; Hogan, Anthony; Mengersen, Kerrie; Hieatt, Arron; Weinstein, Philip

2011-03-01

Under current climate change projections, the capacity to provide safe drinking water to Australian communities will be challenged. Part of this challenge is the lack of an adaptive governance strategy that transcends jurisdictional boundaries to support integrated policy making, regulation, or infrastructural adaptation. Consequently, some water-related health hazards may not be adequately captured or forecast under existing water resource management policies to ensure safe water supplies. Given the high degree of spatial and temporal variability in climate conditions experienced by Australian communities, new strategies for national health planning and prioritization for safe water supplies are warranted. The challenges facing public health in Australia will be to develop flexible and robust governance strategies that strengthen public health input to existing water policy, regulation, and surveillance infrastructure through proactive risk planning, adopting new technologies, and intersectoral collaborations. The proposed approach could assist policy makers avert or minimize risk to communities arising from changes in climate and water provisions both in Australia and in the wider Asia Pacific region.

Analysis of inter-country input-output table based on bibliographic coupling network: How industrial sectors on the GVC compete for production resources

NASA Astrophysics Data System (ADS)

Guan, Jun; Xu, Xiaoyu; Xing, Lizhi

2018-03-01

The input-output table is comprehensive and detailed in describing national economic systems with abundance of economic relationships depicting information of supply and demand among industrial sectors. This paper focuses on how to quantify the degree of competition on the global value chain (GVC) from the perspective of econophysics. Global Industrial Strongest Relevant Network models are established by extracting the strongest and most immediate industrial relevance in the global economic system with inter-country input-output (ICIO) tables and then have them transformed into Global Industrial Resource Competition Network models to analyze the competitive relationships based on bibliographic coupling approach. Three indicators well suited for the weighted and undirected networks with self-loops are introduced here, including unit weight for competitive power, disparity in the weight for competitive amplitude and weighted clustering coefficient for competitive intensity. Finally, these models and indicators were further applied empirically to analyze the function of industrial sectors on the basis of the latest World Input-Output Database (WIOD) in order to reveal inter-sector competitive status during the economic globalization.

Direct-to-consumer genetic testing: good, bad or benign?

PubMed

Caulfield, T; Ries, N M; Ray, P N; Shuman, C; Wilson, B

2010-02-01

A wide variety of genetic tests are now being marketed and sold in direct-to-consumer (DTC) commercial transactions. However, risk information revealed through many DTC testing services, especially those based on emerging genome wide-association studies, has limited predictive value for consumers. Some commentators contend that tests are being marketed prematurely, while others support rapid translation of genetic research findings to the marketplace. The potential harms and benefits of DTC access to genetic testing are not yet well understood, but some large-scale studies have recently been launched to examine how consumers understand and use genetic risk information. Greater consumer access to genetic tests creates a need for continuing education for health care professionals so they can respond to patients' inquiries about the benefits, risks and limitations of DTC services. Governmental bodies in many jurisdictions are considering options for regulating practices of DTC genetic testing companies, particularly to govern quality of commercial genetic tests and ensure fair and truthful advertising. Intersectoral initiatives involving government regulators, professional bodies and industry are important to facilitate development of standards to govern this rapidly developing area of personalized genomic commerce.

STOCK Market Differences in Correlation-Based Weighted Network

NASA Astrophysics Data System (ADS)

Youn, Janghyuk; Lee, Junghoon; Chang, Woojin

We examined the sector dynamics of Korean stock market in relation to the market volatility. The daily price data of 360 stocks for 5019 trading days (from January, 1990 to August, 2008) in Korean stock market are used. We performed the weighted network analysis and employed four measures: the average, the variance, the intensity, and the coherence of network weights (absolute values of stock return correlations) to investigate the network structure of Korean stock market. We performed regression analysis using the four measures in the seven major industry sectors and the market (seven sectors combined). We found that the average, the intensity, and the coherence of sector (subnetwork) weights increase as market becomes volatile. Except for the "Financials" sector, the variance of sector weights also grows as market volatility increases. Based on the four measures, we can categorize "Financials," "Information Technology" and "Industrials" sectors into one group, and "Materials" and "Consumer Discretionary" sectors into another group. We investigated the distributions of intrasector and intersector weights for each sector and found the differences in "Financials" sector are most distinct.

Assessing health impact assessment: multidisciplinary and international perspectives

PubMed Central

Krieger, N; Northridge, M; Gruskin, S; Quinn, M; Kriebel, D; Davey, S; Bassett, M; Rehkopf, D; Miller, C

2003-01-01

Health impact assessment (HIA) seeks to expand evaluation of policy and programmes in all sectors, both private and public, to include their impact on population health. While the idea that the public's health is affected by a broad array of social and economic policies is not new and dates back well over two centuries, what is new is the notion—increasingly adopted by major health institutions, such as the World Health Organisation (WHO) and the United Kingdom National Health Services (NHS)—that health should be an explicit consideration when evaluating all public policies. In this article, it is argued that while HIA has the potential to enhance recognition of societal determinants of health and of intersectoral responsibility for health, its pitfalls warrant critical attention. Greater clarity is required regarding criteria for initiating, conducting, and completing HIA, including rules pertaining to decision making, enforcement, compliance, plus paying for their conduct. Critical debate over the promise, process, and pitfalls of HIA needs to be informed by multiple disciplines and perspectives from diverse people and regions of the world. PMID:12933768

The El-Tal El-Kebir story: an example of social accountability from Egypt.

PubMed

Talaat, Wagdy; el-Wazir, Yasser

2012-01-01

In 1985, the Faculty of Medicine at Suez Canal University responded to a request from the people of El-Tal El-Kebir, a district in Ismailia Governorate, Egypt, to assist them in addressing their poor health statistics. After an initial visit, the team realized that any long-term solution in dealing with and improving their community health problems needed a true inter-sectoral collaborative approach, with the involvement of other sectors such as agriculture, veterinary medicine, and education. The team also realized that establishing a true partnership with the community as well as the local governmental agencies was indispensible in order to maintain any long-term effects. In this article, we will describe how the medical school mobilized other sectors to improve the community health. The methodology adopted during this example of providing community outreach services was concordant with the principles of social accountability, which was later described by the World Health Organization. Our multi-sectoral team has established several projects for enhancing community participation in solving their own health problems. Medical schools can lead a community development project in collaboration with the community.

Propagation of economic shocks in input-output networks: A cross-country analysis

NASA Astrophysics Data System (ADS)

Contreras, Martha G. Alatriste; Fagiolo, Giorgio

2014-12-01

This paper investigates how economic shocks propagate and amplify through the input-output network connecting industrial sectors in developed economies. We study alternative models of diffusion on networks and we calibrate them using input-output data on real-world inter-sectoral dependencies for several European countries before the Great Depression. We show that the impact of economic shocks strongly depends on the nature of the shock and country size. Shocks that impact on final demand without changing production and the technological relationships between sectors have on average a large but very homogeneous impact on the economy. Conversely, when shocks change also the magnitudes of input-output across-sector interdependencies (and possibly sector production), the economy is subject to predominantly large but more heterogeneous avalanche sizes. In this case, we also find that (i) the more a sector is globally central in the country network, the larger its impact; (ii) the largest European countries, such as those constituting the core of the European Union's economy, typically experience the largest avalanches, signaling their intrinsic higher vulnerability to economic shocks.

[Participation and creativity as tools of analysis of public policies].

PubMed

Cordeiro, Joselma Cavalcanti; Villasante, Tomás Rodriguez Pietro; de Araújo, José Luiz do Amaral Correa

2010-07-01

In the context of current globalization, important modifications of the international relations and of the ideological, technical, and cultural components in the administration of the States are expressed by non-legitimate public action principles which account for social iniquity and the weakening of the role of the State. Regardless of its political origin or ideological orientation, the economic development plans and programs exhibit a prevailing uniformity. The challenge today implies mobilizing in local capacities with the objective of changing the quality of public action through the adoption of new development strategies able to integrate new social dimensions with other mechanisms of action. One of them, the intersectoral action, demands the structural revision of the administrative and cultural frontiers of the public and private social agents as a means of making a new tentative sociopolitical arrangement. The complexity of politics, projects and programs is taken as a methodological landmark based on the following theoretical presuppositions: integrality, social networks, and sociopraxis, constructing a participative process of knowledge to a political analysis in search of a change in the approach of the sociopolitical processes, starting from local social networks.

Reston ebolavirus in humans and animals in the Philippines: a review.

PubMed

Miranda, Mary Elizabeth G; Miranda, Noel Lee J

2011-11-01

The 2008 Reston ebolavirus infection event in domestic pigs has triggered continuing epidemiologic investigations among Philippine health and veterinary agencies in collaboration with international filovirus experts. Prior to this, there were only 3 known and documented Reston ebolavirus outbreaks in nonhuman primates in the world, all traced back to a single geographic source in the Philippines in a monkey breeding/export facility. The first one in 1989 was the first-ever Ebola virus that emerged outside of Africa and was also the first known natural infection of Ebola virus in nonhuman primates. When it was first discovered among laboratory monkeys in the United States, the source was immediately traced back to the farm located in the Philippines. The second outbreak was in 1992-93. The third episode in 1996 was the last known outbreak before Reston ebolavirus reemerged in pigs in 2008. The isolated outbreaks involving 2 animal species bring forth issues requiring further investigations, and highlight the significance of intersectoral collaboration to effectively address zoonoses prevention and control/response in the interest of minimizing public health risk.

School-based control of soil-transmitted helminthiasis in western Visayas, Philippines.

PubMed

Belizario, V Y; Totañes, F I G; de Leon, W U; Matias, K M H

2014-05-01

We evaluated the effect of a local government unit-led, school-based, teacher-assisted mass drug administration (MDA) treatment of soil-transmitted helminthiasis (STH) on the morbidity of school children in selected provinces of western Visayas, the Philippines. Parasitological assessment was done on stool samples using the Kato-Katz technique. Nutritional status and school performance were also evaluated using secondary data from the Department of Education. The overall prevalence of STH decreased from 71.1% to 44.3% (p < 0.0001) and the prevalence of heavy infection with STH decreased from 40.5% to 14.5% (p < 0.0001), after two years of biannual MDA. The prevalence of underweight children decreased from 26.2% to 17.8% (p < 0.0001) and the prevalence of stunted children decreased from 20.9% to 16.6% (p < 0.0001) after two years of biannual MDA. School performance improved on standardized testing from a mean percentage of 53.8% to 64.6%. Advocacy, social mobilization, strong local government support and intersectoral collaboration with other agencies probably contributed to the success of the program.

Bootstrapping disaster: The challenge of growing and maintaining a cross-sector collaborative network.

PubMed

Wachhaus, Aaron

This article examines the interaction of nonprofit and private actors with the traditional bureaucratic structures of government in central Pennsylvania&s recovery from hurricane Irene and tropical storm Lee. That effort relied heavily on private and nonprofit organizations as drivers of the response and recovery. The author maps the organizations involved in the recovery effort and explores the impact of the recovery effort on those organizations. A social network analysis was conducted and complemented with follow-up interviews with key actors. The network analysis reveals weak communication between sectors and a reliance on nonprofits to deliver services; interviews uncover the challenges of intersectoral collaboration. The author addresses the successes and limitations of the means by which a network of nonprofit efforts were coordinated with federal and state relief efforts and draw lessons for improving future practices. The author finds that this case deviates from theory in several ways that complicated community response and recovery. In particular, the challenges of developing and maintaining a recovery network while simultaneously delivering services placed great strain on several organizations, as well as on the fledgling network as a whole.

Preconditions for market solution to urban water scarcity: Empirical results from Hyderabad City, India

NASA Astrophysics Data System (ADS)

Saleth, R. Maria; Dinar, Ariel

2001-01-01

Utilizing both primary and secondary information pertaining to the water sector of Hyderabad City, India, this paper (1) evaluates the economics of various technically feasible supply augmentations options; (2) estimates the group-specific water demand and consumption response functions under alternative pricing behaviors; (3) calculates the net willingness to pay (NWTP, considered to be the value of raw water at source) of different user groups as derived from their respective price elasticities; (4) shows how inadequate the NWTP is to justify most supply augmentation options including intersectoral water transfers under the existing water rate structure; (5) argues that the economic and institutional conditions internal to urban water sector cannot justify an externally imposed water transfers, whether market-based or otherwise, as long as the water rate structure is inefficient and regressive; and (6) concludes by underlining the central role that the pricing option, both the level and structure, plays not only in activating a number of nonprice options but also in generating incentives for the emergence of new and the consolidation of existing institutional conditions needed to support economically rooted water transfers and conservation initiatives.

The Jakarta Declaration on health promotion in the 21st century.

PubMed

1998-01-01

The Fourth International Conference on Health Promotion, held in Jakarta, Indonesia, in July 1997, focused on the theme: New Players for a New Era--Leading Health Promotion into the 21st Century. Health promotion strategies can change life-styles as well as the social, economic, and environmental conditions that determine health. Most effective are comprehensive approaches that combine public policy efforts, the creation of supportive environments, community action, the development of personal skills, and a reorientation of health services. Also required is the creation of new partnerships for health between different sectors at all levels of society and government. The conference identified five priorities for health promotion in the 21st century: 1) promote social responsibility for health; 2) increase investments for health development, especially for groups such as women, children, older persons, the indigenous, the poor, and marginalized populations; 3) consolidate and expand partnerships for health to enable the sharing of expertise, skills, and resources; 4) increase community capacity and empower the individual; and 5) secure an infrastructure for health promotion through new funding mechanisms, intersectoral collaboration, and training of local leadership.

Health seeking behaviour and health service utilization in Pakistan: challenging the policy makers.

PubMed

Shaikh, Babar T; Hatcher, Juanita

2005-03-01

There is a growing literature on health seeking behaviours and the determinants of health services utilization especially in the context of developing countries. However, very few focused studies have been seen in Pakistan in this regard. This paper presents an extensive literature review of the situation in developing countries and relates the similar factors responsible for shaping up of a health seeking behaviour and health service utilization in Pakistan. The factors determining the health behaviours may be seen in various contexts: physical, socio-economic, cultural and political. Therefore, the utilization of a health care system, public or private, formal or non-formal, may depend on socio-demographic factors, social structures, level of education, cultural beliefs and practices, gender discrimination, status of women, economic and political systems environmental conditions, and the disease pattern and health care system itself. Policy makers need to understand the drivers of health seeking behaviour of the population in an increasingly pluralistic health care system. Also a more concerted effort is required for designing behavioural health promotion campaigns through inter-sectoral collaboration focusing more on disadvantaged segments of the population.

[PAHO focuses on the problem of violence against women].

PubMed

Hartigan, P

1997-10-01

In Latin American and the Caribbean, a woman who is abused by her partner tends to deny the fact that she is the object of violence out of embarrassment, fear of revenge on the part of the assailant, or tacit consent on the part of the family and society at large. If she finally appeals to the justice or health care system, no one alleviates her circumstances, since both sectors operate independently and less efficiently than if intersectoral coordination existed. In June 1994 PAHO initiated a project in 16 countries involving the creation within the community of branches of the justice and health care systems, police, churches, non-government organizations, and community groups. These meet on a regular basis with the aim of launching a coordinated response to domestic violence. At the national level, the project fosters policies and legal norms that strengthen the institutional capacity to respond to the problem. Links with the media are also being promoted in order to combat social beliefs and attitudes that lead to women being abused in their own homes.

Infrastructure for Reaching Disadvantaged Consumers

PubMed Central

Hovenga, Evelyn J. S.; Hovel, Joe; Klotz, Jeanette; Robins, Patricia

1998-01-01

Both consumers and health service providers need access to up-to-date information, including patient and practice guidelines, that allows them to make decisions in partnership about individual and public health in line with the primary health care model of health service delivery. Only then is it possible for patient preferences to be considered while the health of the general population is improved. The Commonwealth Government of Australia has allocated $250 million over five years, starting July 1, 1997, to support activities and projects designed to meet a range of telecommunication needs in regional, rural, and remote Australia. This paper defines rural and remote communities, then reviews rural and remote health services, information, and telecommunication technology infrastructures and their use in Australia to establish the current state of access to information tools by rural and remote communities and rural health workers in Australia today. It is argued that a suitable telecommunication infrastructure is needed to reach disadvantaged persons in extremely remote areas and that intersectoral support is essential to build this infrastructure. In addition, education will make its utilization possible. PMID:9609497

[Evaluation of the inclusion of organic food from family-based agriculture in school food in municipalities of rural territories of the state of Rio Grande do Sul, Brazil].

PubMed

dos Santos, Fernanda; Fernandes, Patrícia Fogaça; Rockett, Fernanda Camboim; de Oliveira, Ana Beatriz Almeida

2014-05-01

Organic food enables the promotion of Food and Nutritional Safety (FNS) and sustainable regional development. In this context, the National School Food Program (NSFD) seeks to comply with the requirements of FNS. This study evaluated the inclusion of organic food in school food in the municipalities of rural territories of the state of Rio Grande do Sul by means of interviews with local managers. Eight territories were visited, albeit of its 153 municipalities only 102 comprised the sample for this study. Of these, 20.58% said they buy organic produce from family farms. The Center South Territory revealed the highest percentage of purchase, in which 40% of the municipalities visited purchased organic produce, followed by the Center Mountain Territory with 33.3%, while the lowest percentage was 7.1% in the Countryside Territory. The study identified the need for intersectoral action to develop organic production, as well as stimulate the consumption of these foods in the school environment, in order to meet the requirements of FNS.

Epidemiological profile of care for violence in public urgency and emergency services in Brazilian capital, Viva 2014.

PubMed

Souto, Rayone Moreira Costa Veloso; Barufaldi, Laura Augusta; Nico, Lucélia Silva; Freitas, Mariana Gonçalves de

2017-09-01

Injuries and deaths resulting from violence constitute a major public health problem in Brazil. The article aims to describe the profile of calls for violence in emergency departments and emergency Brazilian capitals. This is a descriptive study of Violence and Accident Surveillance System (VIVA), carried out in public emergencies Brazilian cities, from September to November 2014, a total of 4406 calls for aggression. We considered the following categories of analysis: 1) sociodemographic characteristics (gender, age, race / skin color, education, place of residence, vulnerability, alcohol intake); 2) Event feature (probable author, nature and means of aggression); and characteristics of care (getting to the hospital, prior service, evolution). Of the total calls for violence (n = 4406), the highest prevalence was among young people 20-39 years (50.2%), male, black and low education. As for the event characteristics it stands out that 87.8% were physical assaults; 46.3% cut/laceration and 13.7% involved a firearm. The results point to the need to strengthen intersectoral actions to expand the network of care and protection.

[Policy networks combating hunger and poverty: the Solidarity Community strategy in Brazil].

PubMed

Burlandy, Luciene; Labra, Maria Eliana

2007-01-01

This paper analyzes a strategy deployed by the Brazilian Government for combating hunger and poverty: the Solidarity Community (1995-2003), particularly institutional mechanisms used to fine-tune targeting processes and allocate resources to the Food Stocks Distribution Program (PRODEA) and the Undernourished Child and High-Risk Pregnancy Program (PCDMI). Primary data were obtained through interviews with policy network players, including segments of government and society: nine Federal; six State and 82 from eight Municipalities in Rio de Janeiro state. Moving towards its goal of converging programs for the poorest municipalities, the Solidarity Community made them more visible to executive civil servants. The introduction of different sectors into the Solidarity Community network varied, according to the political clout and institutional capacity of each sector. The Solidarity Community strategy was: to negotiate criteria with Ministries for setting priorities and provide technical support and information for local governments, improving their skills for obtaining federal funding. The role of the Solidarity Community was thus limited at the local level, due to poor intersectoral networking and difficulties in monitoring program implementation and beneficiary selection processes, blunting its advantages for more vulnerable groups.

Field warming experiments shed light on the wheat yield response to temperature in China

PubMed Central

Zhao, Chuang; Piao, Shilong; Huang, Yao; Wang, Xuhui; Ciais, Philippe; Huang, Mengtian; Zeng, Zhenzhong; Peng, Shushi

2016-01-01

Wheat growth is sensitive to temperature, but the effect of future warming on yield is uncertain. Here, focusing on China, we compiled 46 observations of the sensitivity of wheat yield to temperature change (SY,T, yield change per °C) from field warming experiments and 102 SY,T estimates from local process-based and statistical models. The average SY,T from field warming experiments, local process-based models and statistical models is −0.7±7.8(±s.d.)% per °C, −5.7±6.5% per °C and 0.4±4.4% per °C, respectively. Moreover, SY,T is different across regions and warming experiments indicate positive SY,T values in regions where growing-season mean temperature is low, and water supply is not limiting, and negative values elsewhere. Gridded crop model simulations from the Inter-Sectoral Impact Model Intercomparison Project appear to capture the spatial pattern of SY,T deduced from warming observations. These results from local manipulative experiments could be used to improve crop models in the future. PMID:27853151

A multiple case study of intersectoral public health networks: experiences and benefits of using research.

PubMed

Kothari, Anita; McPherson, Charmaine; Gore, Dana; Cohen, Benita; MacDonald, Marjorie; Sibbald, Shannon L

2016-02-11

Network partnerships between public health and third sector organisations are being used to address the complexities of population level social determinants of health and health equity. An understanding of how these networks use research and knowledge is crucial to effective network design and outcome evaluation. There is, however, a gap in the literature regarding how public health networks use research and knowledge. The purpose of this paper is to report on the qualitative findings from a larger study that explored (1) the experiences of public health networks with using research and knowledge, and (2) the perceived benefits of using research and knowledge. A multiple case study approach framed this study. Focus group data were collected from participants through a purposive sample of four public health networks. Data were analyzed using Framework Analysis and Nvivo software supported data management. Each network had the opportunity to participate in data interpretation. All networks used published research studies and other types of knowledge to accomplish their work, although in each network research and knowledge played different but complementary roles. Neither research nor other types of knowledge were privileged, and an approach that blended varied knowledge types was typically used. Network experiences with research and knowledge produced individual and collective benefits. A novel finding was that research and knowledge were both important in shaping network function. This study shifts the focus in the current literature from public health departments to the community setting where public health collaborates with a broader spectrum of actors to ameliorate health inequities. Both formal research and informal knowledge were found to be important for collaborative public health networks. Examining the benefits of research and knowledge use within public health networks may help us to better understand the relationships among process (the collaborative use of research and knowledge), structure (networks) and outcomes (benefits).

Disclosure experience in a convenience sample of Quebec-born women living with HIV: a phenomenological study.

PubMed

Rouleau, Geneviève; Côté, José; Cara, Chantal

2012-10-18

In Canada, there has been a considerable increase in the number of women infected with the human immunodeficiency virus (HIV). Within a stigmatized social context, disclosure of HIV positivity is still a prevailing concern among women. Little is known about the global understanding of how French-speaking, Quebec-born women living with HIV, live their serostatus disclosure experience. The aim of this qualitative study is to describe and understand the disclosure experience of these women. We conducted semi-structured interviews with seven women. A convenience sample of French-speaking, Quebec-born women was chosen because they all responded to the criteria of wishing to share their disclosure experience. The mean age of the participants was 46 years old (SD±12). They lived with HIV for an average of 10 years; time since diagnosis varied from 8 months to 23 years. Two out of four mothers had given birth to HIV positive children. Data analysis proposed by van Manen was performed to discover the essential themes of the experience. Seven themes were identified to understand the experience of disclosure in women: 1) Respecting for self and confidants; 2) Feeling apprehension; 3) Exercising control to ensure protection; 4) Deliberately engaging in a process of disclosure/non-disclosure; 5) Exposing oneself to stigma and social exclusion; 6) Suffering internally; and 7) Benefitting from the positive effects of one's decision. For these women, disclosing their HIV status meant: Living the ambivalence of a paradoxical process of revealing/concealing, in a state of profound suffering, exacerbated by stigma, while also being enriched by the benefits attained. Understanding the experience of disclosure in WLHIV is important to guide actions in the practice to support and accompany these women in their unique reality. Health professionals have to broaden their role and work on individual, interpersonal, inter-organizational and intersectoral levels. Mobilization of actors from different sectors would facilitate the implementation of pertinent and opportune interventions.

HIV prevention among street-based sex workers (SSWs) in Chongqing, China: interviews with SSWs, clients and healthcare providers.

PubMed

Zeng, Huan; Zhang, Lei; Zhao, Yong; Liu, Hui; Guo, Hang; Wang, Yang; Zhang, Zhen; Mao, Limin

2016-11-01

Street-based female sex workers (SSWs) are subjected to a relatively high risk of HIV transmission, even higher than establishment-based female sex workers in China. However, very few HIV intervention programmes have targeted this particular group to date. Based in Southwest China, this study aims to identify perceived barriers, demands and suggestions on HIV prevention from the perspectives of SSWs, clients and healthcare providers in Chongqing. Face-to-face, in-depth interviews were conducted in July 2008 with 23 participants. They were recruited by purposive, convenience sampling and included 12 SSWs, 5 male clients, 4 government healthcare providers and 2 outreach workers from a community-based non-governmental organisation. Thematic analysis was used. SSWs were largely rural-to-urban migrants with a low socioeconomic status. Most of their clients shared a similar background. Both SSWs and their clients demonstrated a low awareness of HIV infection and a lack of understanding of effective preventive strategies. Financial hardships, lack of family support, fear of police arrest and stigma in relation to sex work were identified as SSWs' major barriers for accessing healthcare services. Both SSWs and their clients indicated an urgent demand for accessing adequate HIV prevention and care programmes. On the other hand, government organisations trying to provide services to this group have also encountered obstacles, specifically their limited ability to establish mutual trust. Programmes provided by community-based non-governmental organisation, however, were perceived to be more attractive. In conclusion, there remains a substantial gap between the need of adequate HIV prevention services for SSWs and their clients and what is currently available. Strengthening inter-sectoral collaboration, providing specifically tailored health services, actively involving SSW peers and their clients, and reducing stigma in the society are keys to meet this urgent demand by SSWs in China. © 2015 John Wiley & Sons Ltd.

Public health human resources: a comparative analysis of policy documents in two Canadian provinces.

PubMed

Regan, Sandra; MacDonald, Marjorie; Allan, Diane E; Martin, Cheryl; Peroff-Johnston, Nancy

2014-02-24

Amidst concerns regarding the capacity of the public health system to respond rapidly and appropriately to threats such as pandemics and terrorism, along with changing population health needs, governments have focused on strengthening public health systems. A key factor in a robust public health system is its workforce. As part of a nationally funded study of public health renewal in Canada, a policy analysis was conducted to compare public health human resources-relevant documents in two Canadian provinces, British Columbia (BC) and Ontario (ON), as they each implement public health renewal activities. A content analysis of policy and planning documents from government and public health-related organizations was conducted by a research team comprised of academics and government decision-makers. Documents published between 2003 and 2011 were accessed (BC = 27; ON = 20); documents were either publicly available or internal to government and excerpted with permission. Documentary texts were deductively coded using a coding template developed by the researchers based on key health human resources concepts derived from two national policy documents. Documents in both provinces highlighted the importance of public health human resources planning and policies; this was particularly evident in early post-SARS documents. Key thematic areas of public health human resources identified were: education, training, and competencies; capacity; supply; intersectoral collaboration; leadership; public health planning context; and priority populations. Policy documents in both provinces discussed the importance of an educated, competent public health workforce with the appropriate skills and competencies for the effective and efficient delivery of public health services. This policy analysis identified progressive work on public health human resources policy and planning with early documents providing an inventory of issues to be addressed and later documents providing evidence of beginning policy development and implementation. While many similarities exist between the provinces, the context distinctive to each province has influenced and shaped how they have focused their public health human resources policies.

Bullying and associated factors in adolescents in the Southeast region according to the National School-based Health Survey.

PubMed

Mello, Flávia Carvalho Malta; Malta, Deborah Carvalho; Prado, Rogério Ruscitto do; Farias, Marilurdes Silva; Alencastro, Lidiane Cristina da Silva; Silva, Marta Angélica Iossi

2016-01-01

To estimate the prevalence of bullying from the perspective of victims in students from the Southeast region of Brazil and analyze its association with individual variables and family context. Information on 19,660 adolescents from the National School-based Health Survey was analyzed, calculating the association between bullying and sociodemographic variables, risk behaviors, mental health, and family background. Multivariate analysis and the calculation of odds ratio and confidence intervals were performed. The prevalence of bullying was 7.8% (95%CI 6.5 - 9.2). After adjustment, the following associations were observed: students with less than 13 years of age (OR = 2.40; 1.4 - 3.93); protection for those aged 14, 15, and 16 years; male gender (OR = 1.47; 95%CI 1.35 - 1.59); black color (OR = 1.24; 95%CI 1.11 - 1.40); yellow color (OR = 1.38 95%CI 1.14 - 1.6); private school students (OR = 1.11; 95%CI 1.01 - 1.23); and students who work (OR = 1.30; 95%CI 1.16 - 1.45). Higher education of the mothers was a protective factor in all groups. Risk factors considered were feeling lonely (OR = 2.68; 95%CI 2.45 - 2.94), having insomnia (OR = 1.95; 95%CI 1.76 - 2.17), having no friends (OR = 1.47; 95%CI 1.24 - 1.75), suffering physical abuse from family members (OR = 1.83; 95%CI 1.66 - 2.03), missing classes without their parents' knowledge (OR = 1.23; 95%CI 1.12 - 1.34), as well as family supervision (OR = 1.14; 95%CI 1.05 - 1.23). To have drunk in the last 30 days (OR = 0.88 95%CI 0.8 - 0.97) was a protective factor. Bullying increases vulnerabilities among students, which suggests the need for an intersectoral approach in order to find measures to prevent them.

Transforming Regions into High-Performing Health Systems Toward the Triple Aim of Better Health, Better Care and Better Value for Canadians.

PubMed

Bergevin, Yves; Habib, Bettina; Elicksen-Jensen, Keesa; Samis, Stephen; Rochon, Jean; Denis, Jean-Louis; Roy, Denis

2016-01-01

A study on the impact of regionalization on the Triple Aim of Better Health, Better Care and Better Value across Canada in 2015 identified major findings including: (a) with regard to the Triple Aim, the Canadian situation is better than before but variable and partial, and Canada continues to underperform compared with other industrialized countries, especially in primary healthcare where it matters most; (b) provinces are converging toward a two-level health system (provincial/regional); (c) optimal size of regions is probably around 350,000-500,000 population; d) citizen and physician engagement remains weak. A realistic and attainable vision for high-performing regional health systems is presented together with a way forward, including seven areas for improvement: 1. Manage the integrated regionalized health systems as results-driven health programs; 2. Strengthen wellness promotion, public health and intersectoral action for health; 3. Ensure timely access to personalized primary healthcare/family health and to proximity services; 4. Involve physicians in clinical governance and leadership, and partner with them in accountability for results including the required changes in physician remuneration; 5. Engage citizens in shaping their own health destiny and their health system; 6. Strengthen health information systems, accelerate the deployment of electronic health records and ensure their interoperability with health information systems; 7. Foster a culture of excellence and continuous quality improvement. We propose a turning point for Canada, from Paradigm Freeze to Paradigm Shift: from hospital-centric episodic care toward evidence-informed population-based primary and community care with modern family health teams, ensuring integrated and coordinated care along the continuum, especially for high users. We suggest goals and targets for 2020 and time-bound federal/provincial/regional working groups toward reaching the identified goals and targets and placing Canada on a rapid path toward the Triple Aim.

NCD Prevention and Control in Latin America and the Caribbean: A Regional Approach to Policy and Program Development.

PubMed

Hospedales, C James; Barcelo, Alberto; Luciani, Silvana; Legetic, Branka; Ordunez, Pedro; Blanco, Adriana

2012-03-01

This article describes efforts from the Pan American Health Organization (PAHO) that have supported progress in country-driven planning and implementing of actions to address noncommunicable diseases (NCD), as well as mechanisms that PAHO has supported for countries in the Americas to share and build on each other's experiences. The Regional Strategy and Plan of Action for NCD, approved by all member states in 2006, is the major frame for this work. The strategy has 4 lines of action: policy and advocacy; surveillance; health promotion and disease prevention; and integrated management of NCD and risk factors. Cross-cutting strategies include resource mobilization, communication, training, and networks and partnerships. The strategy is operationalized through biannual work plans for which countries link and commit to achieving specific objectives. PAHO then provides technical support toward achieving these plans, and countries report progress annually. The CARMEN (Collaborative Action for Risk Factor Prevention and Effective Management of NCD [Conjunto de Acciones para la Reducción y el Manejo de las Enfermedades No transmisibles]) Network provides a major platform for sharing, and the multisector Pan American Forum for Action on NCD has been launched to extend the network to include business and civil society. PAHO also supported civil society capacity building. Almost all member states have made substantial progress in implementing their national chronic disease programs, in most instances reporting exceeding the indicators of the strategic plan related to chronic diseases. From the Caribbean countries, leadership has been provided to achieve the historic UN High-Level Meeting on NCD in September 2011. The region is on track to meet the mortality reduction target set for 2013, though much remains to be done to further increase awareness of and resources for scaling up NCD prevention and control programs, given the huge health and economic burden, increasing costs, and worrying increases of some conditions such as obesity. Major challenges include getting NCD into social protection packages, building the human resource capacity, strengthening surveillance, achieving true intersectoral and multipartner action, given that most determinants of the epidemic lie outside the health sector, and increasing investment in prevention. Copyright © 2012 World Heart Federation (Geneva). Published by Elsevier B.V. All rights reserved.

England: a healthier nation.

PubMed

McInnes, D; Barnes, R

2000-01-01

HINTS AND TIPS: Several difficult challenges have had to be tackled in developing a health policy for England. Although not all the answers have yet been found and the learning process continues, some lessons can be drawn from experience to date. CONSULTATION: Public consultation and the involvement of a wide range of individuals and groups at all levels and stages is crucial to implementing the policy. Without it, The health of the nation would have remained a paper exercise and the local ownership of the policy that has been achieved in some places could not have come about. This principle has been adopted for Our healthier nation, which will benefit from extensive consultation. Communication of the concepts underlying the policy and of ideas about its strategic implementation is also crucial. A wide variety of mechanisms have been used in England, and this has helped to maintain momentum and to keep health policy high on the agenda. Anecdotal evidence suggests that the Health of the Nation calendar and the Target publication have been especially popular. Target in particular has been and continues to be an effective medium for disseminating ideas and examples of successful implementation strategies. In addition, publication of The health of the nation material on the Internet widened its potential audience considerably. The publication of The health of the nation was especially timely, not only in terms of gaining support and commitment from the leadership of the Department of Health and other government departments, but also across the political spectrum. In addition, the then-recent NHS reforms gave new opportunities for health policy to be incorporated into health service practice. Our healthier nation is also being launched in tandem with a white paper on health services, and the links between them are being stated explicitly. COMMITMENT: As indicated above, commitment from the top is essential to the success of the strategy; this applies not only to the Department of Health but to all government departments, local authorities, voluntary organizations and others with a role in developing health policy. Such commitment, especially at the local level, has been achieved in part through the fervent efforts of enthusiastic individuals and in part through extensive consultation. CONTENT AND FOCUS OF THE POLICY: The scope of The health of the nation is very wide, but focusing on a limited number of priorities or key areas with challenging but achievable targets has been vital in ensuring progress. In addition, to avoid concentrating exclusively on a small number of challenges, overlying themes such as healthy settings and health alliances allow flexibility and encourage innovation in implementation programmes. INCORPORATION OF EXISTING PROGRAMMES: When the Health of the Nation initiative began, other activities were already taking place locally and within other government departments that could be described as health policy development: for example, at the national level, the Department of Transport's accident targets and, at a local level, the Healthy Cities programmes. One issue that had to be addressed was how to harness these programmes and to bring them under the Health of the Nation banner when there was already strong ownership in other sectors. This was done through communication, consultation and the promotion of intersectoral working. In many cases the pre-existing programmes continued as before but with stronger intersectoral links and with a wider health perspective. CONTINUITY: Maintaining continuity in the overall direction of the health policy despite changes in personalities, politically and across the board, has been a challenge and a problem. This has been particularly true at the Department of Health where, as staff tend to move between directorates, corporate knowledge of the process of developing health policy needs to be maintained. (ABSTRACT TRUNCATED)

Maternal, newborn and child health needs, opportunities and preferred futures in Arusha and Ngorongoro: hearing women's voices.

PubMed

Petrucka, Pammla; Bassendowski, Sandra; Dietrich-Leurer, Marie; Spence-Gress, Cara; Athuman, Zenath; Buza, Joram

2015-12-12

With the approaching sunset on the Millennium Development Goals (MDGs), Tanzania continues with its final national push towards achievement of MDG #4 and MDG #5. The Mama Kwanza Socio-economic Health Initiative (MKSHI) was introduced in the hope of contributing to improving maternal, newborn, and child health in Arusha and Ngorongoro. The MKSHI project is a holistic, inter-sectoral approach to maternal, newborn, and child health which aligns with the Government of Tanzania's Vision 2025. At the project onset, a baseline assessment was conducted to launch ongoing benchmarking, monitoring, and evaluation of the project's impacts and implications. The aim of this baseline assessment was twofold. First it was to determine the state of maternal, newborn, and child health in the two project sites. Second it was to ensure that a baseline of key indicators was established as well as identification of unique indicators relevant to the populations of interest. The baseline study was a mixed methods approach to identify maternal, newborn, and child risk factors and indicators in the two target sites. This paper focuses on the qualitative methods and findings. The qualitative component included a series of five community dialogue meetings and thirty-seven individual/dyad interviews with women, providers, and stakeholders. Initially, community meetings were held as open dialogues on maternal, newborn, and child health issues, opportunities, and preferred futures. Individual/dyad interviews were held with women, providers, and stakeholders who held unique information or experiences. Both community dialogue and interview data was analysed for themes and guiding or critical comments. Three over-arching findings emerged: What took you so long to come? How do we know what you know? and How will it change for our daughters? Participant voices are vital in ensuring the achievement of local and global efforts and preferred futures for maternal, newborn, and child health services. This study contributes to the inclusion of women in all aspects of the planning, implementation, and delivery of maternal, newborn, and child health services in the target areas and beyond.

Community participation for malaria elimination in Tafea Province, Vanuatu: Part I. Maintaining motivation for prevention practices in the context of disappearing disease

PubMed Central

2010-01-01

Background In the 1990s, the experience of eliminating malaria from Aneityum Island, Vanuatu is often given as evidence for the potential to eliminate malaria in the south-west Pacific. This experience, however, cannot provide a blueprint for larger islands that represent more complex social and environmental contexts. Community support was a key contributor to success in Aneityum. In the context of disappearing disease, obtaining and maintaining community participation in strategies to eliminate malaria in the rest of Tafea Province, Vanuatu will be significantly more challenging. Method Nine focus group discussions (FGDs), 12 key informant interviews (KIIs), three transect walks and seven participatory workshops were carried out in three villages across Tanna Island to investigate community perceptions and practices relating to malaria prevention (particularly relating to bed nets); influences on these practices including how malaria is contextualized within community health and disease priorities; and effective avenues for channelling health information. Results The primary protection method identified by participants was the use of bed nets, however, the frequency and motivation for their use differed between study villages on the basis of the perceived presence of malaria. Village, household and personal cleanliness were identified by participants as important for protection against malaria. Barriers and influences on bed net use included cultural beliefs and practices, travel, gender roles, seasonality of mosquito nuisance and risk perception. Health care workers and church leaders were reported to have greatest influence on malaria prevention practices. Participants preferred receiving health information through visiting community health promotion teams, health workers, church leaders and village chiefs. Conclusion In low malaria transmission settings, a package for augmenting social capital and sustaining community participation for elimination will be essential and includes: 'sentinel sites' for qualitative monitoring of evolving local socio-cultural, behavioural and practical issues that impact malaria prevention and treatment; mobilizing social networks; intersectoral collaboration; integration of malaria interventions with activities addressing other community health and disease priorities; and targeted implementation of locally appropriate, multi-level, media campaigns that sustain motivation for community participation in malaria elimination. PMID:20380748

Adopting and implementing nutrition guidelines in recreational facilities: Public and private sector roles. A multiple case study

PubMed Central

2012-01-01

Background Recreational facilities are an important community resource for health promotion because they provide access to affordable physical activities. However, despite their health mandate, many have unhealthy food environments that may paradoxically increase the risk of childhood obesity. The Alberta Nutrition Guidelines for Children and Youth (ANGCY) are government-initiated, voluntary guidelines intended to facilitate children’s access to healthy food and beverage choices in schools, childcare and recreational facilities, however few recreational facilities are using them. Methods We used mixed methods within an exploratory multiple case study to examine factors that influenced adoption and implementation of the ANGCY and the nature of the food environment within three cases: an adopter, a semi-adopter and a non-adopter of the ANGCY. Diffusion of Innovations theory provided the theoretical platform for the study. Qualitative data were generated through interviews, observations, and document reviews, and were analysed using directed content analysis. Set theoretic logic was used to identify factors that differentiated adopters from the non-adopter. Quantitative sales data were also collected, and the quality of the food environment was scored using four complementary tools. Results The keys to adoption and implementation of nutrition guidelines in recreational facilities related to the managers’ nutrition-related knowledge, beliefs and perceptions, as these shaped his decisions and actions. The manager, however, could not accomplish adoption and implementation alone. Intersectoral linkages with schools and formal, health promoting partnerships with industry were also important for adoption and implementation to occur. The food environment in facilities that had adopted the ANGCY did not appear to be superior to the food environment in facilities that had not adopted the ANGCY. Conclusions ANGCY uptake may continue to falter under the current voluntary approach, as the environmental supports for voluntary action are poor. Where ANGCY uptake does occur, changes to the food environment may be relatively minor. Stronger government measures may be needed to require recreational facilities to improve their food environments and to limit availability of unhealthy foods. PMID:22632384

Validation of public health competencies and impact variables for low- and middle-income countries

PubMed Central

2014-01-01

Background The number of Master of Public Health (MPH) programmes in low- and middle-income countries (LMICs) is increasing, but questions have been raised regarding the relevance of their outcomes and impacts on context. Although processes for validating public health competencies have taken place in recent years in many high-income countries, validation in LMICs is needed. Furthermore, impact variables of MPH programmes in the workplace and in society have not been developed. Method A set of public health competencies and impact variables in the workplace and in society was designed using the competencies and learning objectives of six participating institutions offering MPH programmes in or for LMICs, and the set of competencies of the Council on Linkages Between Academia and Public Health Practice as a reference. The resulting competencies and impact variables differ from those of the Council on Linkages in scope and emphasis on social determinants of health, context specificity and intersectoral competencies. A modified Delphi method was used in this study to validate the public health competencies and impact variables; experts and MPH alumni from China, Vietnam, South Africa, Sudan, Mexico and the Netherlands reviewed them and made recommendations. Results The competencies and variables were validated across two Delphi rounds, first with public health experts (N = 31) from the six countries, then with MPH alumni (N = 30). After the first expert round, competencies and impact variables were refined based on the quantitative results and qualitative comments. Both rounds showed high consensus, more so for the competencies than the impact variables. The response rate was 100%. Conclusion This is the first time that public health competencies have been validated in LMICs across continents. It is also the first time that impact variables of MPH programmes have been proposed and validated in LMICs across continents. The high degree of consensus between experts and alumni suggests that these public health competencies and impact variables can be used to design and evaluate MPH programmes, as well as for individual and team assessment and continuous professional development in LMICs. PMID:24438672

[Study on the effectiveness of implementation: the National Demonstration Areas for Comprehensive Prevention and Control of Non-communicable Diseases].

PubMed

Zhang, J; Jin, R R; Li, J J; Li, J L; Su, X W; Deng, G J; Ma, S; Zhao, J; Wang, Y P; Bian, F; Qu, Y M; Shen, Z Z; Jiang, Y; Liu, Y L

2018-04-10

Objective: To assess the implementation and impact of programs carried out by the National Demonstration Areas for Comprehensive Prevention and Control of Non-communicable Diseases. Methods: Both sociological and epidemiological methods were used to collect qualitative and quantitative data in November and December, 2016 in order to conduct on process and outcome evaluation of the above mentioned objective. In the meantime, case study was also conducted. Results: All the National Demonstration Areas for Comprehensive Prevention and Control of Non-communicable Diseases were found well implemented across the country, with health education and health promotion, surveillance and safeguard measures in particular. A government-led and inter-sector coordination and communication mechanism had been well established, with more than 16 non-health departments actively involved. 28.7% of the residents living in the National Demonstration Areas for Comprehensive Prevention and Control of Non-communicable Diseases were aware of the key messages related to chronic diseases. Among the residents, 72.1% of them consumed vegetables and 53.6% consumed fruits daily, with another 86.9% walked at least 10 minutes per day. Over 70% of the patients with hypertension or diabetes reported that they were taken care of by the Community Health Centers, and above 50% of them were under standardized management. Residents, living in the National Demonstration Areas under higher ranking of implementation scores, were more likely to be aware of relevant knowledge on chronic disease control and prevention ( OR =6.591, 95% CI : 5.188-8.373), salt reduction ( OR =1.352, 95% CI : 1.151-1.589), oil reduction ( OR =1.477, 95% CI : 1.249-1.746) and recommendation on physical activities ( OR =1.975, 95% CI : 1.623- 2.403). Conclusion: The implementation of programs carried out by the National Demonstration Areas for Comprehensive Prevention and Control of Non-communicable Diseases had served a local platform for the control and prevention of non-communicable diseases, and thus become an important 'carrier' for chronic disease prevention and control programs in China.

Determining Possible Professionals and Respective Roles and Responsibilities for a Model Comprehensive Elder Abuse Intervention: A Delphi Consensus Survey

PubMed Central

Du Mont, Janice; Kosa, Daisy; Macdonald, Sheila; Elliot, Shannon; Yaffe, Mark

2015-01-01

Objective We have undertaken a multi-phase, multi-method program of research to develop, implement, and evaluate a comprehensive hospital-based nurse examiner elder abuse intervention that addresses the complex functional, social, forensic, and medical needs of older women and men. In this study, we determined the importance of possible participating professionals and respective roles and responsibilities within the intervention. Methods Using a modified Delphi methodology, recommended professionals and their associated roles and responsibilities were generated from a systematic scoping review of relevant scholarly and grey literatures. These items were reviewed, new items added for review, and rated/re-rated for their importance to the intervention on a 5-point Likert scale by an expert panel during a one day in-person meeting. Items that did not achieve consensus were subsequently re-rated in an online survey. Analysis Those items that achieved a mean Likert rating of 4+ (rated important to very important), and an interquartile range<1 in the first or second round, and/or for which 80% of ratings were 4+ in the second round were retained for the model elder abuse intervention. Results Twenty-two of 31 recommended professionals and 192 of 229 recommended roles and responsibilities rated were retained for our model elder abuse intervention. Retained professionals were: public guardian and trustee (mean rating = 4.88), geriatrician (4.87), police officer (4.87), GEM (geriatric emergency management) nurse (4.80), GEM social worker (4.78), community health worker (4.76), social worker/counsellor (4.74), family physician in community (4.71), paramedic (4.65), financial worker (4.59), lawyer (4.59), pharmacist (4.59), emergency physician (4.57), geriatric psychiatrist (4.33), occupational therapist (4.29), family physician in hospital (4.28), Crown prosecutor (4.24), neuropsychologist (4.24), bioethicist (4.18), caregiver advocate (4.18), victim support worker (4.18), and respite care worker (4.12). Conclusion A large and diverse group of multidisciplinary, intersectoral collaborators was deemed necessary to address the complex needs of abused older adults, each having important roles and responsibilities to fulfill within a model comprehensive elder abuse intervention. PMID:26630030

Mechanism of cross-sectoral coordination between nature protection and forestry in the Natura 2000 formulation process in Slovakia.

PubMed

Sarvašová, Zuzana; Sálka, Jaroslav; Dobšinská, Zuzana

2013-09-01

Nature protection as a policy sector is not isolated and is directly or indirectly influenced by many other sectors (e.g. forestry, water management, rural development, energy, etc.). These policy sectors are neither completely segmented nor unaffected by the decisions taken in other policy sectors. Policy formulation in nature protection is therefore also influenced by different sectors. For that reason it is inevitable to stress the need for inter-sectoral coordination to assure their policy coherence. The aim of this article is to describe the mechanism and modes of cross-sectoral coordination and to analyze the relevant actors and their interaction, using the case of the Natura 2000 formulation process in Slovakia. The European Union (EU) set up an ecological network of special protected areas, known as Natura 2000 to ensure biodiversity by conserving natural habitats and wild fauna and flora in the territory of the Member States. An optimized nature protection must therefore carefully consider existing limits and crossdisciplinary relationships at the EU, national and regional levels. The relations between forestry and biodiversity protection are analyzed using the advocacy coalition framework (ACF). The ACF is used for analyzing how two coalitions, in this case ecological and forest owners' coalitions, advocate or pursue their beliefs from the nature protection and forestry policy field. The whole process is illustrated at the regional scale on the case study of Natura 2000 sites formulation in the Slovak Republic. For better reliability and validity of research, a combination of various empiric research methods was used, supported by existing theories. So called triangulation of sociological research or triangulation of methods consists of mutual results testing of individual methodological steps through identifying corresponding political-science theories, assessing their formal points using primary and secondary document analysis and assessing their informal points with standardized interviews with experts. We can conclude that adequate cross-sectoral coordination represented by new modes is missing and the formulation of the Natura 2000 network in Slovakia shows deficits resulting from different policy beliefs concerning nature protection and forestry coalition. Copyright © 2012 Elsevier Ltd. All rights reserved.

Vulnerability of eco-environmental health to climate change: the views of government stakeholders and other specialists in Queensland, Australia

PubMed Central

2010-01-01

Background There is overwhelming scientific evidence that human activities have changed and will continue to change the climate of the Earth. Eco-environmental health, which refers to the interdependencies between ecological systems and population health and well-being, is likely to be significantly influenced by climate change. The aim of this study was to examine perceptions from government stakeholders and other relevant specialists about the threat of climate change, their capacity to deal with it, and how to develop and implement a framework for assessing vulnerability of eco-environmental health to climate change. Methods Two focus groups were conducted in Brisbane, Australia with representatives from relevant government agencies, non-governmental organisations, and the industry sector (n = 15) involved in the discussions. The participants were specialists on climate change and public health from governmental agencies, industry, and non-governmental organisations in South-East Queensland. Results The specialists perceived climate change to be a threat to eco-environmental health and had substantial knowledge about possible implications and impacts. A range of different methods for assessing vulnerability were suggested by the participants and the complexity of assessment when dealing with multiple hazards was acknowledged. Identified factors influencing vulnerability were perceived to be of a social, physical and/or economic nature. They included population growth, the ageing population with associated declines in general health and changes in the vulnerability of particular geographical areas due to for example, increased coastal development, and financial stress. Education, inter-sectoral collaboration, emergency management (e.g. development of early warning systems), and social networks were all emphasised as a basis for adapting to climate change. To develop a framework, different approaches were discussed for assessing eco-environmental health vulnerability, including literature reviews to examine the components of vulnerability such as natural hazard risk and exposure and to investigate already existing frameworks for assessing vulnerability. Conclusion The study has addressed some important questions in regard to government stakeholders and other specialists' views on the threat of climate change and its potential impacts on eco-environmental health. These findings may have implications in climate change and public health decision-making. PMID:20663227

The pursuit of political will: politicians' motivation and health promotion.

PubMed

Zalmanovitch, Yair; Cohen, Nissim

2015-01-01

The health promotion literature points out a significant gap between declared health promotion policy and practice. The common assumption is that one of the main obstacles to progress is "political will" and the intersectoral action necessary to create healthy environments. The concept of political will is most frequently invoked to explain a lack of action usually rooted in politicians' lack of personal courage or good sense. While stressing the fact that health and its promotion are profoundly political, we claim that the lack of political will is usually not because politicians have shown insufficient personal courage or good sense. Rather, we suggest that one of the reasons for the gap between the need for health promotion policies and political will derives from politicians' lack of attraction to several aspects associated with this policy area. In many cases, politicians are not attracted to the issue of health promotion because of the unique structural conditions usually associated with this policy domain. Using tools related to public policy theory, we suggest a conceptual framework that explains what those conditions are and answers the question of why politicians seem to lack the political will to undertake the design of health promotion policies. Copyright © 2013 John Wiley & Sons, Ltd.

The Role of Nurse Leaders in Advancing Carer Communication Needs across Transitions of Care: A Call to Action.

PubMed

Udod, Sonia A; Lobchuk, Michelle

2017-01-01

This paper focuses on the central role of senior nurse leaders in advancing organizational resources and support for communication between healthcare providers and carers that influences patient and carer outcomes during the transition from hospital to the community. A Think Tank (Lobchuk 2012) funded by the Canadian Institutes of Health Research (CIHR) gathered interdisciplinary and intersectoral stakeholders from local, national and international levels to develop a Family Carer Communication Research Collaboration. Workshop stakeholders addressed critical challenges in meeting communication needs of carers as partners with clinicians in promoting safe care for the elderly, chronically or seriously ill or disabled individuals in the community. Key priority areas identified the need to uncover nurse leader perspectives at the system, nurse leader, healthcare provider and patient levels where communication with carers occurs. The overarching outcome from the workshop focuses on the need for nurse leaders to advocate for patients and their families in meeting carer communication needs. The authors' "call to action" requires commitment and investment from nurse leaders in the critical juncture of healthcare delivery to strengthen communication between healthcare providers and carers that influence patient and carer outcomes in seamless transitions of care.

Constraints and potentials of future irrigation water availability on agricultural production under climate change.

PubMed

Elliott, Joshua; Deryng, Delphine; Müller, Christoph; Frieler, Katja; Konzmann, Markus; Gerten, Dieter; Glotter, Michael; Flörke, Martina; Wada, Yoshihide; Best, Neil; Eisner, Stephanie; Fekete, Balázs M; Folberth, Christian; Foster, Ian; Gosling, Simon N; Haddeland, Ingjerd; Khabarov, Nikolay; Ludwig, Fulco; Masaki, Yoshimitsu; Olin, Stefan; Rosenzweig, Cynthia; Ruane, Alex C; Satoh, Yusuke; Schmid, Erwin; Stacke, Tobias; Tang, Qiuhong; Wisser, Dominik

2014-03-04

We compare ensembles of water supply and demand projections from 10 global hydrological models and six global gridded crop models. These are produced as part of the Inter-Sectoral Impacts Model Intercomparison Project, with coordination from the Agricultural Model Intercomparison and Improvement Project, and driven by outputs of general circulation models run under representative concentration pathway 8.5 as part of the Fifth Coupled Model Intercomparison Project. Models project that direct climate impacts to maize, soybean, wheat, and rice involve losses of 400-1,400 Pcal (8-24% of present-day total) when CO2 fertilization effects are accounted for or 1,400-2,600 Pcal (24-43%) otherwise. Freshwater limitations in some irrigated regions (western United States; China; and West, South, and Central Asia) could necessitate the reversion of 20-60 Mha of cropland from irrigated to rainfed management by end-of-century, and a further loss of 600-2,900 Pcal of food production. In other regions (northern/eastern United States, parts of South America, much of Europe, and South East Asia) surplus water supply could in principle support a net increase in irrigation, although substantial investments in irrigation infrastructure would be required.

Analysis of inter-country input-output table based on citation network: How to measure the competition and collaboration between industrial sectors on the global value chain

PubMed Central

2017-01-01

The input-output table is comprehensive and detailed in describing the national economic system with complex economic relationships, which embodies information of supply and demand among industrial sectors. This paper aims to scale the degree of competition/collaboration on the global value chain from the perspective of econophysics. Global Industrial Strongest Relevant Network models were established by extracting the strongest and most immediate industrial relevance in the global economic system with inter-country input-output tables and then transformed into Global Industrial Resource Competition Network/Global Industrial Production Collaboration Network models embodying the competitive/collaborative relationships based on bibliographic coupling/co-citation approach. Three indicators well suited for these two kinds of weighted and non-directed networks with self-loops were introduced, including unit weight for competitive/collaborative power, disparity in the weight for competitive/collaborative amplitude and weighted clustering coefficient for competitive/collaborative intensity. Finally, these models and indicators were further applied to empirically analyze the function of sectors in the latest World Input-Output Database, to reveal inter-sector competitive/collaborative status during the economic globalization. PMID:28873432

Control of cutaneous leishmaniasis caused by Leishmania major in south-eastern Morocco.

PubMed

Bennis, Issam; De Brouwere, Vincent; Ameur, Btissam; El Idrissi Laamrani, Abderrahmane; Chichaoui, Smaine; Hamid, Sahibi; Boelaert, Marleen

2015-10-01

The incidence of cutaneous leishmaniasis (CL) caused by Leishmania major has increased in Morocco over the last decade, prompting the Ministry of Health to take intersectoral response measures including vector and reservoir control. The aim of this article was to describe the CL outbreak response measures taken in the province of Errachidia, where the reservoir of L. major, a sand rat (Meriones shawi), was targeted using strychnine-poisoned wheat baits from 2010 to 2012. We analysed routine surveillance data and other information using the data of the CL control programme. We present data on the evolution and the extension of CL in this province as well as the epidemiological profile of the disease. Between 2004 and 2013, 7099 cases of CL were recorded in Errachidia Province, gradually affecting all districts. Our results demonstrate that more women were affected than men and that all age groups were represented. Errachidia Province was the epicentre of the recent CL outbreak in Morocco. A notable decline in incidence rates was observed after 2011. The outbreak control measures may have contributed to this decline, as well as climatic trends or progressing herd immunity. © 2015 John Wiley & Sons Ltd.

Chile Crece Contigo: Implementation, results, and scaling-up lessons.

PubMed

Torres, A; Lopez Boo, F; Parra, V; Vazquez, C; Segura-Pérez, S; Cetin, Z; Pérez-Escamilla, R

2018-01-01

Chile Crece Contigo (ChCC) is defined as a comprehensive, intersectoral, and multicomponent policy that aims to help all children reach their full potential for development, regardless of their socio-economic status. This case study was developed on the basis of grey literature review and key informants' interviews. ChCC behaves as a complex adaptive system that combines universal and targeted benefits for the more vulnerable starting since gestation and until the children are 4 years old. Three key ministries are involved in ChCC management: health, education, and social development. Studies show adequate programme implementation and positive effects of ChCC on child development. In addition, it was found that the more families use ChCC benefits and the longer the subsystem has been operating in the commune, the greater the positive effects. Strong political support based on principles of equity and child rights combined with strong evidence and funding commitment from government has been central to emergence, scaling up, and sustainability of ChCC. Further sustainability of ChCC will rely on firmly establishing a well-trained and compensated cadre of early child development professionals and paraprofessionals as well as an improved management and evaluation decentralized system. © 2017 John Wiley & Sons Ltd.

Participatory construction of the State Health Promotion Policy: a case from Minas Gerais, Brazil.

PubMed

Campos, Daniela Souzalima; Turci, Maria Aparecida; Melo, Elza Machado de; Guerra, Vanessa de Almeida; Nascimento, Carolina Guimarães Marra; Moreira, Conceição Aparecida; Paschoal, Ellen Mendes; Beltrão, Nathalia Ribeiro Mota; Silva, Kleber Rangel

2017-12-01

Minas Gerais started the development of the Minas Gerais Health Promotion Policy (POEPS-MG) based on the review of the National Health Promotion Policy (PNPS). This is a case report based on the documentary analysis of the material produced in the 38 workshops with a participation of 1.157 members across the State. The first workshop was intrasectoral and took place at the State Health Secretariat (SDH-MG). The second was an intersectoral workshop with the participation of several State Health Secretariats of Minas Gerais. The final workshop counted on the participation of State Regional Technical References. Another 35 workshops were developed in the 28 State Regional Administrations. Results were systematized and consolidated from the Analytical Matrix used in the PNPS, generating the base document of the POEPS-MG. It is important to highlight that, the specific regional requirements identified during the Policy's construction process reinforce the enriching moments of developing in an innovative, democratic and participative way actions that may provide some meanings to Health Promotion in the State of Minas Gerais. The State Policy seeks to bring life to the PNPS, adapting it to the reality of the territory and strengthening it - with the assurance of budgetary resources.

Engaging policy makers in road safety research in Malaysia: a theoretical and contextual analysis.

PubMed

Tran, Nhan T; Hyder, Adnan A; Kulanthayan, Subramaniam; Singh, Suret; Umar, R S Radin

2009-04-01

Road traffic injuries (RTIs) are a growing public health problem that must be addressed through evidence-based interventions including policy-level changes such as the enactment of legislation to mandate specific behaviors and practices. Policy makers need to be engaged in road safety research to ensure that road safety policies are grounded in scientific evidence. This paper examines the strategies used to engage policy makers and other stakeholder groups and discusses the challenges that result from a multi-disciplinary, inter-sectoral collaboration. A framework for engaging policy makers in research was developed and applied to describe an example of collective road safety research in Malaysia. Key components of this framework include readiness, assessment, planning, implementation/evaluation, and policy development/sustainability. The case study of a collaborative intervention trial for the prevention of motorcycle crashes and deaths in Malaysia serves as a model for policy engagement by road safety and injury researchers. The analytic description of this research process in Malaysia demonstrates that the framework, through its five stages, can be used as a tool to guide the integration of needed research evidence into policy for road safety and injury prevention.

Towards environment and health promoting South African schools.

PubMed

Mathee, A; Byrne, J

1996-03-01

This article describes the activities of the Greater Johannesburg Healthy Schools Program of the World Health Organization's (WHO) Healthy Cities Project in South Africa. Healthy Cities projects emphasize community participation, intersectoral action, supportive environments for health, and a settings approach. Children in South Africa, are exposed to environmental and health hazards in the school setting including poor building design, poor equipment, and understaffing. The Healthy Schools initiative in Greater Johannesburg, is a pilot for enhancing environmental quality, health, and well-being among students. Schools include those in an informal settlement in an industrial area, an inner city district, and in a suburban area. The initiative includes research, establishment of environmental and health committees, development of an action plan, and evaluation and feedback. The plan aims to promote environmental and health sustainability, to empower children to become full participants in the community, and to support teachers and parents in the promotion of health-enhancing school environments. The program builds upon the lessons learned from several local school initiatives. Initiatives include an anti-smoking poster competition involving over 10,000 students, special environmental and health awareness days, consciousness raising among high school students about air pollution, and local efforts to engage students in environmental clean-up days.

Organizational responses to a changing aid environment: the German Agency for Technical Cooperation (GTZ).

PubMed

Hill, Peter S

2002-01-01

As a major European donor, German government development assistance faces a series of challenges. Recent political changes have raised expectations for demonstrable health outcomes as a result of German development assistance; there has been a deepened commitment to collaboration with other bilateral and multilateral donors; and partner countries are increasingly open to new approaches to development. German development assistance also reflects a new ethos of partnership and the shift to programmatic and sector based development approaches. At the same time, its particular organizational structure and administrative framework highlight the extent of structural and systems reforms required of donors by changing development relationships, and the tensions created in responding to these. This paper examines organizational changes within the German Agency for Technical Cooperation (Deutsche Gesellschaft für Technische, Zusammenarbeit) (GTZ), aimed at increasing its Regional, Sectoral, Managerial and Process competence as they affect health and related sectors. These include the decentralization of GTZ, the trend to integration of projects, the increasing focus on policy and health systems reform, increased inter-sectoral collaboration, changes in recruitment and training, new perspectives in planning and evaluation and the introduction of a quality management programme.

Analysis of inter-country input-output table based on citation network: How to measure the competition and collaboration between industrial sectors on the global value chain.

PubMed

Xing, Lizhi

2017-01-01

The input-output table is comprehensive and detailed in describing the national economic system with complex economic relationships, which embodies information of supply and demand among industrial sectors. This paper aims to scale the degree of competition/collaboration on the global value chain from the perspective of econophysics. Global Industrial Strongest Relevant Network models were established by extracting the strongest and most immediate industrial relevance in the global economic system with inter-country input-output tables and then transformed into Global Industrial Resource Competition Network/Global Industrial Production Collaboration Network models embodying the competitive/collaborative relationships based on bibliographic coupling/co-citation approach. Three indicators well suited for these two kinds of weighted and non-directed networks with self-loops were introduced, including unit weight for competitive/collaborative power, disparity in the weight for competitive/collaborative amplitude and weighted clustering coefficient for competitive/collaborative intensity. Finally, these models and indicators were further applied to empirically analyze the function of sectors in the latest World Input-Output Database, to reveal inter-sector competitive/collaborative status during the economic globalization.

[Recommendations for a multisectorial national policy to promote breastfeeding in Mexico: position of the National Academy of Medicine].

PubMed

Cosío-Martínez, Teresita González de; Hernández-Cordero, Sonia; Rivera-Dommarco, Juan; Hernández-Ávila, Mauricio

2017-01-01

Evidence strongly supports that to improve breastfeeding practices it is needed to strengthen actions of promotion, protection and support. To achieve this goal, it is necessary to establish a multisectoral national policy that includes elements such as design, implementation, monitoring and evaluation of programs and policies, funding research, advocacy to develop political willingness, and the promotion of breastfeeding from the national to municipal level, all coordinated by a central level. It is until now that Mexico has initiated a reform process to the establish a National Strategy for Breastfeeding Action. This strategy, is the result not only of the consistent scientific evidence on clear and strong benefits of breastfeeding on population health and the development of human capital, but also for the alarming data of deterioration of breastfeeding practices in the country. The comprehensive implementation of the National Strategy for Breastfeeding Action that includes the establishment of a national committee, intra- and inter-sectoral coordination of actions, setting clear goals and monitoring the International Code of Marketing of Breast-Milk Substitutes, is the awaiting responsibility of the public health agenda of the country.

Public-private sector interactions and the demand for supplementary health insurance in the United Kingdom.

PubMed

Bíró, Anikó; Hellowell, Mark

2016-07-01

We examine the demand for private health insurance (PHI) in the United Kingdom and relate this to changes in the supply of public and private healthcare. Using a novel collection of administrative, private sector and survey data, we re-assess the relationships between the quality and availability of public and private sector inpatient care, and the demand for PHI. We find that PHI coverage in the United Kingdom is positively related to the median of the region- and year-specific public sector waiting times. We find that PHI prevalence ceteris paribus increases with being self-employed and employed, while it decreases with having financial difficulties. In addition, we highlight the complexities of inter-sectoral relations and their impact on PHI demand. Within a region, we find that an increase in private healthcare supply is associated with a decrease in public sector waiting times, implying lower PHI demand. This may be explained by the usage of private facilities by NHS commissioners. These results have important implications for policymakers interested in the role of private healthcare supply in enhancing the availability of and equitable access to acute inpatient care. Copyright © 2016 Elsevier Ireland Ltd. All rights reserved.

Developing a composite index of spatial accessibility across different health care sectors: A German example.

PubMed

Siegel, Martin; Koller, Daniela; Vogt, Verena; Sundmacher, Leonie

2016-02-01

The evolving lack of ambulatory care providers especially in rural areas increasingly challenges the strict separation between ambulatory and inpatient care in Germany. Some consider allowing hospitals to treat ambulatory patients to tackle potential shortages of ambulatory care in underserved areas. In this paper, we develop an integrated index of spatial accessibility covering multiple dimensions of health care. This index may contribute to the empirical evidence concerning potential risks and benefits of integrating the currently separated health care sectors. Accessibility is measured separately for each type of care based on official data at the district level. Applying an Improved Gravity Model allows us to factor in potential cross-border utilization. We combine the accessibilities for each type of care into a univariate index by adapting the concept of regional multiple deprivation measurement to allow for a limited substitutability between health care sectors. The results suggest that better health care accessibility in urban areas persists when taking a holistic view. We believe that this new index may provide an empirical basis for an inter-sectoral capacity planning. Copyright © 2016 Elsevier Ireland Ltd. All rights reserved.

Evidence-based clinical policy: case report of a reproducible process to encourage understanding and evaluation of evidence.

PubMed

Rikard-Bell, G; Waters, E; Ward, J

2006-07-01

We report within a case study a reproducible process to facilitate the explicit incorporation of evidence by a multidisciplinary group into clinical policy development. To support the decision-making of a multidisciplinary Intersectoral Advisory Group (IAG) convened by the Royal Australasian College of Physicians Health Policy Unit, a systematic review of randomized controlled trials about environmental tobacco smoke and smoking cessation interventions in paediatric settings was first undertaken. As reported in detail here, IAG members were then formally engaged in a transparent and replicable process to understand and interpret the synthesized evidence and to proffer their independent reactions regarding policy, practice and research. Our intention was to ensure that all IAG members were democratically engaged and made aware of the available evidence. As clinical policy must engage stakeholder representatives from diverse backgrounds, a process to equalize understanding of the evidence and 'democratize' judgment about its implications is needed. Future research must then examine the benefits of such explicit steps when guidelines, in turn, are implemented. We hypothesize that changes to future practice will be more likely if processes undertaken to develop guidelines are transparent to clinicians and other target groups.

Planowanie strategiczne kluczowym czynnikiem rozwoju turystyki w regionie

NASA Astrophysics Data System (ADS)

Majewska, Iwona

2009-01-01

Elaborating strategic documents is being perceived as a basis for different initiatives and projects which on the other side stimulate regional and local development in various spheres. Tourism economy is one of the most efficient factor of the local and regional development thanks to its intersector links. It must be also stressed that the tourism economy will have the biggest influence on regional development the less nowadays the tourism potential is being explored. In such situation elaborating professional strategic documents like businessplans, tourism development strategies, tourism product development programmers, feasibility studies plays a key role. Documents containing clear action plans, being a scenario for the next years allow to avoid "ad hoc" actions and at the same time making mistakes that are sometimes very costly. Precisely identified and selected set of objectives and aims allows to concentrate resources on the most important, and, what is crucial, socially accepted actions. In tourism acceptance plays a key role because the whole community participates in tourism development and in image creation that influences directly on attractiveness, number of visitors and economic and social benefits. This is why the strategic planning plays a crucial role in the context of regional and local development.

Challenges in Achieving Food Security in India

PubMed Central

Upadhyay, R Prakash; Palanivel, C

2011-01-01

First Millennium Development Goal states the target of “Halving hunger by 2015”. Sadly, the recent statistics for India present a very gloomy picture. India currently has the largest number of undernourished people in the world and this is in spite of the fact that it has made substantial progress in health determinants over the past decades and ranks second worldwide in farm output. The causes of existing food insecurity can be better viewed under three concepts namely the: ‘traditional concept’ which includes factors such as unavailability of food and poor purchasing capacity; ‘socio-demographic concept’ which includes illiteracy, unemployment, overcrowding, poor environmental conditions and gender bias; ‘politico-developmental concept’ comprising of factors such as lack of intersectoral coordination and political will, poorly monitored nutritional programmes and inadequate public food distribution system. If the Millennium Development Goal is to be achieved by 2015, efforts to improve food and nutrition security have to increase considerably. Priority has to be assigned to agriculture and rural development along with promoting women empowerment, ensuring sustainable employment and improving environmental conditions (water, sanitation and hygiene). As the problem is multi-factorial, so the solution needs to be multi-sectoral. PMID:23113100

Large-scale fortification of condiments and seasonings as a public health strategy: equity considerations for implementation.

PubMed

Zamora, Gerardo; Flores-Urrutia, Mónica Crissel; Mayén, Ana-Lucia

2016-09-01

Fortification of staple foods with vitamins and minerals is an effective approach to increase micronutrient intake and improve nutritional status. The specific use of condiments and seasonings as vehicles in large-scale fortification programs is a relatively new public health strategy. This paper underscores equity considerations for the implementation of large-scale fortification of condiments and seasonings as a public health strategy by examining nonexhaustive examples of programmatic experiences and pilot projects in various settings. An overview of conceptual elements in implementation research and equity is presented, followed by an examination of equity considerations for five implementation strategies: (1) enhancing the capabilities of the public sector, (2) improving the performance of implementing agencies, (3) strengthening the capabilities and performance of frontline workers, (3) empowering communities and individuals, and (4) supporting multiple stakeholders engaged in improving health. Finally, specific considerations related to intersectoral action are considered. Large-scale fortification of condiments and seasonings cannot be a standalone strategy and needs to be implemented with concurrent and coordinated public health strategies, which should be informed by a health equity lens. © 2016 New York Academy of Sciences.

Urban planning and health equity.

PubMed

Northridge, Mary Evelyn; Freeman, Lance

2011-06-01

Although the fields of urban planning and public health share a common origin in the efforts of reformers to tame the ravages of early industrialization in the 19th century, the 2 disciplines parted ways in the early 20th century as planners increasingly focused on the built environment while public health professionals narrowed in on biomedical causes of disease and disability. Among the unfortunate results of this divergence was a tendency to discount the public health implications of planning decisions. Given increasingly complex urban environments and grave health disparities in cities worldwide, urban planners and public health professionals have once again become convinced of the need for inclusive approaches to improve population health and achieve health equity. To make substantive progress, intersectoral collaboration utilizing ecological and systems science perspectives will be crucial as the solutions lie well beyond the control of any single authority. Grounded in the social determinants of health, and with a renewed sense of interconnectedness, dedicated and talented people in government agencies and communities who recognize that our future depends on cultivating local change and evaluating the results can come to grips with the enormous challenge that lies ahead to create more equitable, sustainable, and healthier cities worldwide.

Integrating tobacco control into health and development agendas.

PubMed

Reddy, K Srinath; Yadav, Amit; Arora, Monika; Nazar, Gaurang P

2012-03-01

Tobacco use is one of the major risk factors for non-communicable diseases, with a profound impact on resource-poor low-income and middle-income countries such as India, where tobacco use is high and where socioeconomic as well as health inequalities are rampant. Effective implementation of the Framework Convention on Tobacco Control requires multisectoral efforts that can fructify through integration of tobacco control into broader health and development agendas such as food and water security, environment, the right to education and human rights. The global tobacco control community will need to explore innovative partnerships beyond its traditional confines and build a global coalition that supports tobacco control by partnering with others having convergent concerns on common determinants. A firm political commitment and intersectoral coordination between government and non-government agencies is paramount in order to implement effective tobacco control programmes. Integration of tobacco control into other health and development agendas as described in this paper has the potential to contribute to the achievement of all the eight United Nations Millennium Development Goals. This paper explores why the whole of government should accord a high priority to tobacco control, and how this integration could be achieved.

Human Rabies in the WHO Southeast Asia Region: Forward Steps for Elimination

PubMed Central

Gongal, Gyanendra; Wright, Alice E.

2011-01-01

There are eleven Member States in the WHO southeast Asia region (Bangladesh, Bhutan, Democratic People's Republic of Korea, India, Indonesia, Maldives, Myanmar, Nepal, Sri Lanka, Thailand, Timor-Leste) of which eight are endemic for rabies. More than 1.4 billion people in the Region are at risk of rabies infection, and approximately 45% of worldwide rabies deaths occur in Asia. Dog bites account for 96% of human rabies cases. Progress in preventing human rabies through control of the disease in dogs has been slow due to various factors. Innovative control tools and techniques have been developed and standardized in recent years. The introduction of cost-effective intradermal rabies vaccination regimens in Asian countries has increased the availability and affordability of postexposure prophylaxis. Elimination of rabies is not possible without regional and intersectoral cooperation. Considering the importance of consolidating achievements in rabies control in Member countries, the WHO Regional Office for southeast Asia has developed a regional strategy for elimination of human rabies transmitted by dogs in the Region. They have committed to provide technical leadership, to advocate national health authorities to develop major stakeholder consensus for a comprehensive rabies elimination programme, and to implement national strategies for elimination of human rabies. PMID:21991437

[The evolution of mortality by homicide in the State of Bahia in the period from 1996 to 2010].

PubMed

Souza, Tiago Oliveira de; Souza, Edinilsa Ramos de; Pinto, Liana Wernersbach

2014-06-01

An ecological study was conducted, the objective of which was to describe the evolution of homicide rates for residents of the State of Bahia, Brazil, and its nine health macroregions (MRS) in the period from 1996 to 2010. Crude and adjusted data from the Mortality Information System (SIM) and X85-Y09 codes of the Tenth International Statistical Classification of Diseases and Related Health Problems (ICD-10) were analyzed. The number, proportion and homicide mortality rates (TMH) were analyzed. considering the characteristics of the victim and the event. The results revealed a profile of predominantly male mortality, Afro-Brazilian race/ethnicity with little education. The public highways were the main location of occurrence of deaths. There was an increase in TMH in all age groups, though the highest rates were observed in the population of 15 to 39 years of age. The TMH age-standardized rates were higher in the Far South, East, North and South. The conclusion reached was that the killings can be addressed from the loation/regional realities through strategic and planning of intersectoral actions that take into account the socioeconomic and cultural characteristics.

Inter-sectoral conflict and recreational fisheries of the developing world : opportunities and challenges for co-operation

USGS Publications Warehouse

Bower, Shannon D.; Nguyen, Vivian M.; Danylchuk, Andy J.; Beard, T. Douglas; Cooke, Steven J.

2014-01-01

The recreational fishing sector is growing rapidly in the developing world with the potential to realize economic benefits estimated at tens of billions of dollars annually. These opportunities are accompanied by numerous ecological risks such as overfishing and habitat disturbance. To date, there has been little focus on sociological issues surrounding the growth of recreational fisheries in these areas. This chapter examines sources of potential conflict among small-scale fishing sectors in the developing world with particular attention paid to identification of key issues constraining stewardship of recreational fisheries. We identified conflicts related to fisher competition for access to resources, socio-demographic change, cultural differences, and governance as areas of concern among small-scale fisheries, and offer examples of successful and failed attempts to reduce, mitigate or solve these conflicts. The reality of limited resource availability will require that communication, proactive management strategies and cooperation be encouraged among sectors to maximize resiliency of the social-ecological system and to promote sustainability of fishing practices. We recommend stewardship initiatives that include avenues for stakeholder participation and establishing adaptive management strategies, particularly for emerging recreational fisheries in the developing world.

Comparative federal health care policy: evidence of collaborative federalism in Pakistan and Venezuela.

PubMed

Baracskay, Daniel

2013-01-01

Collaborative federalism has provided an effective analytical foundation for understanding how complex public policies are implemented in federal systems through intergovernmental and intersectoral alignments. This has particularly been the case in issue areas like public health policy where diseases are detected and treated at the local level. While past studies on collaborative federalism and health care policy have focused on federal systems that are largely democratic, little research has been conducted to examine the extent of collaboration in authoritarian structures. This article applies the collaborative federalism approach to the Islamic Republic of Pakistan and the Bolivarian Republic of Venezuela. Evidence suggests that while both nations have exhibited authoritarian governing structures, there have been discernible policy areas where collaborative federalism is embraced to facilitate the implementation process. Further, while not an innate aspect of their federal structures, Pakistan and Venezuela can potentially expand their use of the collaborative approach to successfully implement health care policy and the epidemiological surveillance and intervention functions. Yet, as argued, this would necessitate further development of their structures on a sustained basis to create an environment conducive for collaborative federalism to flourish, and possibly expand to other policy areas as well.

Use of Internet Audience Measurement Data to Gauge Market Share for Online Health Information Services

PubMed Central

Benson, Dennis; LaCroix, Eve-Marie; Siegel, Elliot R; Fariss, Susan

2005-01-01

Background The transition to a largely Internet and Web-based environment for dissemination of health information has changed the health information landscape and the framework for evaluation of such activities. A multidimensional evaluative approach is needed. Objective This paper discusses one important dimension of Web evaluation—usage data. In particular, we discuss the collection and analysis of external data on website usage in order to develop a better understanding of the health information (and related US government information) market space, and to estimate the market share or relative levels of usage for National Library of Medicine (NLM) and National Institutes of Health (NIH) websites compared to other health information providers. Methods The primary method presented is Internet audience measurement based on Web usage by external panels of users and assembled by private vendors—in this case, comScore. A secondary method discussed is Web usage based on Web log software data. The principle metrics for both methods are unique visitors and total pages downloaded per month. Results NLM websites (primarily MedlinePlus and PubMed) account for 55% to 80% of total NIH website usage depending on the metric used. In turn, NIH.gov top-level domain usage (inclusive of NLM) ranks second only behind WebMD in the US domestic home health information market and ranks first on a global basis. NIH.gov consistently ranks among the top three or four US government top-level domains based on global Web usage. On a site-specific basis, the top health information websites in terms of global usage appear to be WebMD, MSN Health, PubMed, Yahoo! Health, AOL Health, and MedlinePlus. Based on MedlinePlus Web log data and external Internet audience measurement data, the three most heavily used cancer-centric websites appear to be www.cancer.gov (National Cancer Institute), www.cancer.org (American Cancer Society), and www.breastcancer.org (non-profit organization). Conclusions Internet audience measurement has proven useful to NLM, with significant advantages compared to sole reliance on usage data from Web log software. Internet audience data has helped NLM better understand the relative usage of NLM and NIH websites in the intersection of the health information and US government information market sectors, which is the primary market intersector for NLM and NIH. However important, Web usage is only one dimension of a complete Web evaluation framework, and other primary research methods, such as online user surveys, usability tests, and focus groups, are also important for comprehensive evaluation that includes qualitative elements, such as user satisfaction and user friendliness, as well as quantitative indicators of website usage. PMID:15998622

Promoting good policy for leadership and governance of health related rehabilitation: a realist synthesis.

PubMed

McVeigh, Joanne; MacLachlan, Malcolm; Gilmore, Brynne; McClean, Chiedza; Eide, Arne H; Mannan, Hasheem; Geiser, Priscille; Duttine, Antony; Mji, Gubela; McAuliffe, Eilish; Sprunt, Beth; Amin, Mutamad; Normand, Charles

2016-08-24

Good governance may result in strengthened performance of a health system. Coherent policies are essential for good health system governance. The overall aim of this research is to provide the best available scientific evidence on principles of good policy related leadership and governance of health related rehabilitation services in less resourced settings. This research was also conducted to support development of the World Health Organization's (WHO) Guidelines on health related rehabilitation. An innovative study design was used, comprising two methods: a systematic search and realist synthesis of literature, and a Delphi survey of expert stakeholders to refine and triangulate findings from the realist synthesis. In accordance with Pawson and Tilley's approach to realist synthesis, we identified context mechanism outcome pattern configurations (CMOCs) from the literature. Subsequently, these CMOCs were developed into statements for the Delphi survey, whereby 18 expert stakeholders refined these statements to achieve consensus on recommendations for policy related governance of health related rehabilitation. Several broad principles emerged throughout formulation of recommendations: participation of persons with disabilities in policy processes to improve programme responsiveness, efficiency, effectiveness, and sustainability, and to strengthen service-user self-determination and satisfaction; collection of disaggregated disability statistics to support political momentum, decision-making of policymakers, evaluation, accountability, and equitable allocation of resources; explicit promotion in policies of access to services for all subgroups of persons with disabilities and service-users to support equitable and accessible services; robust inter-sectoral coordination to cultivate coherent mandates across governmental departments regarding service provision; and 'institutionalizing' programmes by aligning them with preexisting Ministerial models of healthcare to support programme sustainability. Alongside national policymakers, our policy recommendations are relevant for several stakeholders, including service providers and service-users. This research aims to provide broad policy recommendations, rather than a strict formula, in acknowledgement of contextual diversity and complexity. Accordingly, our study proposes general principles regarding optimal policy related governance of health related rehabilitation in less resourced settings, which may be valuable across diverse health systems and contexts.

Developing a conceptual framework of urban health observatories toward integrating research and evidence into urban policy for health and health equity.

PubMed

Caiaffa, W T; Friche, A A L; Dias, M A S; Meireles, A L; Ignacio, C F; Prasad, A; Kano, M

2014-02-01

Detailed information on health linked to geographic, sociodemographic, and environmental data are required by city governments to monitor health and the determinants of health. These data are critical for guiding local interventions, resource allocation, and planning decisions, yet they are too often non-existent or scattered. This study aimed to develop a conceptual framework of Urban Health Observatories (UHOs) as an institutional mechanism which can help synthesize evidence and incorporate it into urban policy-making for health and health equity. A survey of a select group of existent UHOs was conducted using an instrument based on an a priori conceptual framework of key structural and functional characteristics of UHOs. A purposive sample of seven UHOs was surveyed, including four governmental, two non-governmental, and one university-based observatory, each from a different country. Descriptive and framework analysis methods were used to analyze the data and to refine the conceptual framework in light of the empirical data. The UHOs were often a product of unique historical circumstances. They were relatively autonomous and capable of developing their own locally sensitive agenda. They often had strong networks for accessing data and were able to synthesize them at the urban level as well as disaggregate them into smaller units. Some UHOs were identified as not only assessing but also responding to local needs. The findings from this study were integrated into a conceptual framework which illustrates how UHOs can play a vital role in monitoring trends in health determinants, outcomes, and equity; optimizing an intersectoral urban information system; incorporating research on health into urban policies and systems; and providing technical guidance on research and evidence-based policy making. In order to be most effective, UHOs should be an integral part of the urban governance system, where multiple sectors of government, the civil society, and businesses can participate in taking the right actions to promote health equity.

Does expanding fiscal space lead to improved funding of the health sector in developing countries?: lessons from Kenya, Lagos State (Nigeria) and South Africa.

PubMed

Doherty, Jane; Kirigia, Doris; Okoli, Chijioke; Chuma, Jane; Ezumah, N; Ichoku, Hyacinth; Hanson, Kara; McIntyre, Diane

2018-01-01

The global focus on promoting Universal Health Coverage has drawn attention to the need to increase public domestic funding for health care in low- and middle-income countries. This article examines whether increased tax revenue in the three territories of Kenya, Lagos State (Nigeria) and South Africa was accompanied by improved resource allocation to their public health sectors, and explores the reasons underlying the observed trends. Three case studies were conducted by different research teams using a common mixed methods approach. Quantitative data were extracted from official government financial reports and used to describe trends in general tax revenue, total government expenditure and government spending on the health sector and other sectors in the first decade of this century. Twenty-seven key informant interviews with officials in Ministries of Health and Finance were used to explore the contextual factors, actors and processes accounting for the observed trends. A thematic content analysis allowed this qualitative information to be compared and contrasted between territories. Increased tax revenue led to absolute increases in public health spending in all three territories, but not necessarily in real per capita terms. However, in each of the territories, the percentage of the government budget allocated to health declined for much of the period under review. Factors contributing to this trend include: inter-sectoral competition in priority setting; the extent of fiscal federalism; the Ministry of Finance's perception of the health sector's absorptive capacity; weak investment cases made by the Ministry of Health; and weak parliamentary and civil society involvement. Despite dramatic improvements in tax revenue collection, fiscal space for health in the three territories did not improve. Ministries of Health must strengthen their ability to motivate for larger allocations from government revenue through demonstrating improved performance and the relative benefits of health investments.

Consumers' Perspectives on National Health Insurance in South Africa: Using a Mobile Health Approach

PubMed Central

Stuttaford, Maria C

2014-01-01

Background Building an equitable health system is a cornerstone of the World Health Organization (WHO) health system building block framework. Public participation in any such reform process facilitates successful implementation. South Africa has embarked on a major reform in health policy that aims at redressing inequity and enabling all citizens to have equal access to efficient and quality health services. Objective This research is based on a survey using Mxit as a mobile phone–based social media network. It was intended to encourage comments on the proposed National Health Insurance (NHI) and to raise awareness among South Africans about their rights to free and quality health care. Methods Data were gathered by means of a public e-consultation, and following a qualitative approach, were then examined and grouped in a theme analysis. The WHO building blocks were used as the conceptual framework in analysis and discussion of the identified themes. Results Major themes are the improvement of service delivery and patient-centered health care, enhanced accessibility of health care providers, and better health service surveillance. Furthermore, health care users demand stronger outcome-based rather than rule-based indicators of the health system’s governance. Intersectoral solidarity and collaboration between private and public health care providers are suggested. Respondents also propose a code of ethical values for health care professionals to address corruption in the health care system. It is noteworthy that measures for dealing with corruption or implementing ethical values are neither described in the WHO building blocks nor in the NHI. Conclusions The policy makers of the new health system for South Africa should address the lack of trust in the health care system that this study has exposed. Furthermore, the study reveals discrepancies between the everyday lived reality of public health care consumers and the intended health policy reform. PMID:25351980

Using Win-Win Strategies to Implement Health in All Policies: A Cross-Case Analysis

PubMed Central

Molnar, Agnes; Renahy, Emilie; O’Campo, Patricia; Muntaner, Carles; Freiler, Alix; Shankardass, Ketan

2016-01-01

Background In spite of increasing research into intersections of public policy and health, little evidence shows how policy processes impact the implementation of Health in All Policies (HiAP) initiatives. Our research sought to understand how and why strategies for engaging partners from diverse policy sectors in the implementation of HiAP succeed or fail in order to uncover the underlying social mechanisms contributing to sustainable implementation of HiAP. Methods In this explanatory multiple case study, we analyzed grey and peer-review literature and key informant interviews to identify mechanisms leading to implementation successes and failures in relation to different strategies for engagement across three case studies (Sweden, Quebec and South Australia), after accounting for the role of different contextual conditions. Findings Our results yielded no support for the use of awareness-raising or directive strategies as standalone approaches for engaging partners to implement HiAP. However, we found strong evidence that mechanisms related to “win-win” strategies facilitated implementation by increasing perceived acceptability (or buy-in) and feasibility of HiAP implementation across sectors. Win-win strategies were facilitated by mechanisms related to several activities, including: the development of a shared language to facilitate communication between actors from different sectors; integrating health into other policy agendas (eg., sustainability) and use of dual outcomes to appeal to the interests of diverse policy sectors; use of scientific evidence to demonstrate the effectiveness of HiAP; and using health impact assessment to make policy coordination for public health outcomes more feasible and to give credibility to policies being developed by diverse policy sectors. Conclusion Our findings enrich theoretical understanding in an under-unexplored area of intersectoral action. They also provide policy makers with examples of HiAP across wealthy welfare regimes, and improve understanding of successful HiAP implementation practices, including the win-win approach. PMID:26845574

Promoting evidence informed policymaking for maternal and child health in Nigeria: lessons from a knowledge translation workshop

PubMed Central

Uneke, Chigozie Jesse; Sombie, Issiaka; Uro-Chukwu, Henry Chukwuemeka; Mohammed, Yagana Gidado; Johnson, Ermel

2018-01-01

Background: Knowledge translation (KT) is a process that ensures that research evidence gets translated into policy and practice. In Nigeria, reports indicate that research evidence rarely gets into policymaking process. A major factor responsible for this is lack of KT capacity enhancement mechanisms. The objective of this study was to improve KT competence of an implementation research team (IRT), policymakers and stakeholders in maternal and child health to enhance evidence-informed policymaking. Methods: This study employed a “before and after” design, modified as an intervention study. The study was conducted in Bauchi, north-eastern Nigeria. A three-day KT training workshop was organized and 15 modules were covered including integrated and end-of-grant KT; KT models, measures, tools and strategies; priority setting; managing political interference; advocacy and consensus building/negotiations; inter-sectoral collaboration; policy analysis, contextualization and legislation. A 4-point Likert scale pre-/post-workshop questionnaires were administerd to evaluate the impact of the training, it was designed in terms of extent of adequacy; with “grossly inadequate” representing 1 point, and “very adequate” representing 4 points. Results: A total of 45 participants attended the workshop. There was a noteworthy improvement in the participants’ understanding of KT processes and strategies. The range of the preworkshop mean of participants knowledge of modules taught was from 2.04-2.94, the range for the postworkshop mean was from 3.10–3.70 on the 4-point Likert scale. The range of percentage increase in mean for participants’ knowledge at the end of the workshop was from 13.3%–55.2%. Conclusion: The outcome of this study suggests that using a KT capacity building programme e.g., workshop, health researchers, policymakers and other stakeholders can acquire capacity and skill that will facilitate evidence-to-policy link. PMID:29423364

Review of Climate Change and Health in Ethiopia: Status and Gap Analysis

PubMed Central

Simane, Belay; Beyene, Hunachew; Deressa, Wakgari; Kumie, Abera; Berhane, Kiros; Samet, Jonathan

2017-01-01

Background This review assessed Ethiopia’s existing situation on issues related to the environment, climate change and health, and identifies gaps and needs that can be addressed through research, training, and capacity building. Methods The research was conducted through a comprehensive review of available secondary data and interviewing key informants in various national organizations involved in climate change adaptation and mitigation activities. Results Climate change-related health problems, such as mortality and morbidity due to floods and heat waves, vector-borne diseases, water-borne diseases, meningitis, and air pollution-related respiratory diseases are increasing in Ethiopia. Sensitive systems such as agriculture, health, and water have been affected, and the effects of climate change will continue to magnify without the right adaptation and mitigation measures. Currently, research on climate change and health is not adequately developed in Ethiopia. Research and other activities appear to be fragmented and uncoordinated. As a result, very few spatially detailed and methodologically consistent studies have been made to assess the impact of climate in the country. There has often been a lack of sufficient collaboration among organizations on the planning and execution of climate change and health activities, and the lack of trained professionals who can perform climate change and health-related research activities at various levels. Conclusion Firstly, there is a lack of organized structure in the various organizations. Secondly, there is inadequate level of inter-sectoral collaboration and poor coordination and communication among different stakeholders. Thirdly, there are no reliable policy guidelines and programs among organizations, agencies and offices that target climate change and health. Fourth, the existing policies fail to consider the gender and community-related dimensions of climate change. Fifth, the monitoring and evaluation efforts exerted on climate change and health activities are not strong enough to address the climate change and health issues in the country. PMID:28867919

How Health in All Policies are developed and implemented in a developing country? A case study of a HiAP initiative in Iran.

PubMed

Khayatzadeh-Mahani, Akram; Sedoghi, Zeynab; Mehrolhassani, Mohammad Hossein; Yazdi-Feyzabadi, Vahid

2016-12-01

Population health is influenced by many factors beyond the control of health system which should be addressed by other sectors through inter-sectoral collaboration (ISC). Countries have adopted diverse initiatives to operationalize ISC for health such as establishment of Councils of Health and Food Security (CHFSs) and development of provincial Health Master Plans (HMPs) in Iran. The literature, however, provides meager information on how these initiatives have been moved into the top policy agenda, how and by whom they have been formulated and what factors enable or inhibit their implementation. In addressing these knowledge gaps, we employed a qualitative case study approach, incorporating mixed methods: in-depth interviews and a textual analysis of policy documents. Iran founded the Supreme Council of Health and Food Security (SCHFS) at national level in 2006 followed by provincial and district CHFSs to ensure political commitment to ISC for health and Health in All Policies (HiAPs). In 2009, the SCHFS mandated all provincial CHFSs across the country to develop provincial HMP to operationalize the HiAP approach and Kerman was among the first provinces which responded to this call. We selected Kerman province HMP as a case study to investigate the research questions raised in this study. The study revealed two types of leverage, which played crucial role in agenda setting, policy formulation and implementation of HMP including politics (political commitment) and policy entrepreneurs. The multiple streams model was found to be informative for thinking about different stages of a policy cycle including agenda setting, policy formulation and policy implementation. It was also found to be a useful framework in analyzing HiAP initiatives as these policies do not smoothly and readily reach the policy agenda. © The Author 2015. Published by Oxford University Press. All rights reserved. For Permissions, please email: journals.permissions@oup.com.

Statement of the ICN on the World Health Assembly technical discussions on strategies for Health for All in the face of rapid urbanization (May 1991).

PubMed

1991-01-01

National associations of nurses are represented by the International Council of Nurses (ICN). This ICN statement reaffirms a commitment to primary health care (PHC) and the WHO "Health for All" goals. Support for environmental and health programs in urban areas is reaffirmed, and attention is paid to the needs of the poorest and most disadvantaged people. Specific directions of the ICN include: 1) overcoming economic and social barriers in order to improve primary health care in cities (rural approaches which by-pass first level care may be successful in cities), 2) holding health care workers responsible for promoting health and environmental consciousness, and 3) involving and educating women for work in community health and environmental projects. Family health can be improved by improving literacy among women. In some developing countries, efforts have been directed to community mobilization in PHC programs. The results of such efforts have been positive for enhancing health in cities. On May 12th of every year, nurses celebrate International Nurses Day. The focus this year is on mental health. Another area of activity is involvement in interdisciplinary and government programs. One such collaborative project with the WHO AIDS groups in Africa is training trainers in workshops. The outcome is a well-informed health care population which can train other health workers and the public about HIV transmission and patient care. A project which has been ongoing for 4 years is overcoming the legal barriers which inhibit nurses from full participation in PHC. ICN recommends that health care workers be educated better in PHC and in intersectoral cooperation, community participation, and disease prevention. Healthy lifestyles, proper nutrition, and disease prevention need to be promoted in school health programs. Children can be taught to be responsible for their own health. Health education can benefit from the use of media such as radio and television. Interdisciplinary health teams must be established in cities. Legal barriers to the participation of nurses in PHC must be eliminated.

The integrated care pathway for post stroke patients (iCaPPS): a shared care approach between stakeholders in areas with limited access to specialist stroke care services.

PubMed

Abdul Aziz, Aznida Firzah; Mohd Nordin, Nor Azlin; Ali, Mohd Fairuz; Abd Aziz, Noor Azah; Sulong, Saperi; Aljunid, Syed Mohamed

2017-01-13

Lack of intersectoral collaboration within public health sectors compound efforts to promote effective multidisciplinary post stroke care after discharge following acute phase. A coordinated, primary care-led care pathway to manage post stroke patients residing at home in the community was designed by an expert panel of specialist stroke care providers to help overcome fragmented post stroke care in areas where access is limited or lacking. Expert panel discussions comprising Family Medicine Specialists, Neurologists, Rehabilitation Physicians and Therapists, and Nurse Managers from Ministry of Health and acadaemia were conducted. In Phase One, experts chartered current care processes in public healthcare facilities, from acute stroke till discharge and also patients who presented late with stroke symptoms to public primary care health centres. In Phase Two, modified Delphi technique was employed to obtain consensus on recommendations, based on current evidence and best care practices. Care algorithms were designed around existing work schedules at public health centres. Indication for patients eligible for monitoring by primary care at public health centres were identified. Gaps in transfer of care occurred either at post discharge from acute care or primary care patients diagnosed at or beyond subacute phase at health centres. Essential information required during transfer of care from tertiary care to primary care providers was identified. Care algorithms including appropriate tools were summarised to guide primary care teams to identify patients requiring further multidisciplinary interventions. Shared care approaches with Specialist Stroke care team were outlined. Components of the iCaPPS were developed simultaneously: (i) iCaPPS-Rehab© for rehabilitation of stroke patients at community level (ii) iCaPPS-Swallow© guided the primary care team to screen and manage stroke related swallowing problems. Coordinated post stroke care monitoring service for patients at community level is achievable using the iCaPPS and its components as a guide. The iCaPPS may be used for post stroke care monitoring of patients in similar fragmented healthcare delivery systems or areas with limited access to specialist stroke care services. No.: ACTRN12616001322426 (Registration Date: 21st September 2016).

Multisectoral Actions for Health: Challenges and Opportunities in Complex Policy Environments.

PubMed

Tangcharoensathien, Viroj; Srisookwatana, Orapan; Pinprateep, Poldej; Posayanonda, Tipicha; Patcharanarumol, Walaiporn

2017-05-16

Multisectoral actions for health, defined as actions undertaken by non-health sectors to protect the health of the population, are essential in the context of inter-linkages between three dimensions of sustainable development: economic, social, and environmental. These multisectoral actions can address the social and economic factors that influence the health of a population at the local, national, and global levels. This editorial identifies the challenges, opportunities and capacity development for effective multisectoral actions for health in a complex policy environment. The root causes of the challenges lie in poor governance such as entrenched political and administrative corruption, widespread clientelism, lack of citizen voice, weak social capital, lack of trust and lack of respect for human rights. This is further complicated by the lack of government effectiveness caused by poor capacity for strong public financial management and low levels of transparency and accountability which leads to corruption. The absence of or rapid changes in government policies, and low salary in relation to living standards result in migration out of qualified staff. Tobacco, alcohol and sugary drink industries are major risk factors for non-communicable diseases (NCDs) and had interfered with health policy through regulatory capture and potential law suits against the government. Opportunities still exist. Some World Health Assembly (WHA) and United Nations General Assembly (UNGA) resolutions are both considered as external driving forces for intersectoral actions for health. In addition, Thailand National Health Assembly under the National Health Act is another tool providing opportunity to form trust among stakeholders from different sectors. Capacity development at individual, institutional and system level to generate evidence and ensure it is used by multisectoral agencies is as critical as strengthening the health literacy of people and the overall good governance of a country. © 2017 The Author(s); Published by Kerman University of Medical Sciences. This is an open-access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/4.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

How to improve collaboration between the public health sector and other policy sectors to reduce health inequalities? - A study in sixteen municipalities in the Netherlands.

PubMed

Storm, Ilse; den Hertog, Frank; van Oers, Hans; Schuit, Albertine J

2016-06-22

The causes of health inequalities are complex. For the reduction of health inequalities, intersectoral collaboration between the public health sector and both social policy sectors (e.g. youth affairs, education) and physical policy sectors (e.g. housing, spatial planning) is essential, but in local practice difficult to realize. The aim of this study was to examine the collaboration between the sectors in question more closely and to identify opportunities for improvement. A qualitative descriptive analysis of five aspects of collaboration within sixteen Dutch municipalities was performed to examine the collaboration between the public health sector and other policy sectors: 1) involvement of the sectors in the public health policy network, 2) harmonisation of objectives, 3) use of policies by the relevant sectors, 4) formalised collaboration, and 5) previous experience. Empirical data on these collaboration aspects were collected based on document analysis, questionnaires and interviews. The study found that the policy workers of social sectors were more involved in the public health network and more frequently supported the objectives in the field of health inequality reduction. Both social policy sectors and physical policy sectors used policies and activities to reduce health inequalities. More is done to influence the determinants of health inequality through policies aimed at lifestyle and social setting than through policies aimed at socioeconomic factors and the physical environment. Where the physical policy sectors are involved in the public health network, the collaboration follows a very similar pattern as with the social policy sectors. All sectors recognise the importance of good relationships, positive experiences, a common interest in working together and coordinated mechanisms. This study shows that there is scope for improving collaboration in the field of health inequality reduction between the public health sector and both social policy sectors and physical policy sectors. Ways in which improvement could be realised include involving physical policy sectors in the network, pursuing widely supported policy goals, making balanced efforts to influence determinants of health inequalities, and increasing the emphasis on a programmatic approach.

Strengthening the research to policy and practice interface: exploring strategies used by research organisations working on sexual and reproductive health and HIV/AIDS

PubMed Central

2011-01-01

This commentary introduces the HARPS supplement on getting research into policy and practice in sexual and reproductive health (SRH). The papers in this supplement have been produced by the Sexual Health and HIV Evidence into Practice (SHHEP) collaboration of international research, practitioner and advocacy organizations based in research programmes funded by the UK Department for International Development. The commentary describes the increasing interest from research and communication practitioners, policy makers and funders in expanding the impact of research on policy and practice. It notes the need for contextually embedded understanding of ways to engage multiple stakeholders in the politicized, sensitive and often contested arenas of sexual and reproductive health. The commentary then introduces the papers under their respective themes: (1) The theory and practice of research engagement (two global papers); (2) Applying policy analysis to explore the role of research evidence in SRH and HIV/AIDS policy (two papers with examples from Ghana, Malawi, Uganda and Zambia); (3) Strategies and methodologies for engagement (five papers on Kenya, South Africa, Ghana, Tanzania and Swaziland respectively); (4) Advocacy and engagement to influence attitudes on controversial elements of sexual health (two papers, Bangladesh and global); and (5) Institutional approaches to inter-sectoral engagement for action and strengthening research communications (two papers, Ghana and global). The papers illustrate the many forms research impact can take in the field of sexual and reproductive health. This includes discursive changes through carving out legitimate spaces for public debate; content changes such as contributing to changing laws and practices, procedural changes such as influencing how data on SRH are collected, and behavioural changes through partnerships with civil society actors such as advocacy groups and journalists. The contributions to this supplement provide a body of critical analysis of communication and engagement strategies across the spectrum of SRH and HIV/AIDS research through the testing of different models for the research-to-policy interface. They provide new insights on how researchers and communication specialists can respond to changing policy climates to create windows of opportunity for influence. PMID:21679383

The Gateway Paper--stewardship and governance in the health sector in Pakistan.

PubMed

Nishtar, Sania

2006-12-01

As an opening for a dialogue on health reforms in the country, the Gateway Paper places emphasis on strengthening the stewardship function of mandated State agencies in Pakistan with particular attention to two key areas. Firstly, greater emphasis on a stewardship role for the Ministry and departments of health in the context of inter-sectoral scope of health and secondly, a stronger role for the State agencies as regulators of healthcare within the country. The Gateway Paper envisages that the role of State agencies will become more critical as new models of financing health and delivering services are structured given that these entail regulation of private sector providers, providing oversight for ensuring a system for ongoing education and implementation of frameworks for public-private partnerships. The Gateway Paper refers to stewardship with reference to analysis and overview of health policies within the country, their relationship with evidence, their follow-up into planning and finally their implementation. The Paper also provides an insight into policies from a process-related as well as content and program related perspectives. In doing so a number of questions relating to the evidence and policy disconnect; issues at strategic and operational levels of planning, and governance-related impediments to program implementation have been discussed and a viewpoint articulated on an approach to addressing these challenges.

Constraints and potentials of future irrigation water availability on agricultural production under climate change

PubMed Central

Elliott, Joshua; Deryng, Delphine; Müller, Christoph; Frieler, Katja; Konzmann, Markus; Gerten, Dieter; Glotter, Michael; Flörke, Martina; Wada, Yoshihide; Best, Neil; Eisner, Stephanie; Fekete, Balázs M.; Folberth, Christian; Foster, Ian; Gosling, Simon N.; Haddeland, Ingjerd; Khabarov, Nikolay; Ludwig, Fulco; Masaki, Yoshimitsu; Olin, Stefan; Rosenzweig, Cynthia; Ruane, Alex C.; Satoh, Yusuke; Schmid, Erwin; Stacke, Tobias; Tang, Qiuhong; Wisser, Dominik

2014-01-01

We compare ensembles of water supply and demand projections from 10 global hydrological models and six global gridded crop models. These are produced as part of the Inter-Sectoral Impacts Model Intercomparison Project, with coordination from the Agricultural Model Intercomparison and Improvement Project, and driven by outputs of general circulation models run under representative concentration pathway 8.5 as part of the Fifth Coupled Model Intercomparison Project. Models project that direct climate impacts to maize, soybean, wheat, and rice involve losses of 400–1,400 Pcal (8–24% of present-day total) when CO2 fertilization effects are accounted for or 1,400–2,600 Pcal (24–43%) otherwise. Freshwater limitations in some irrigated regions (western United States; China; and West, South, and Central Asia) could necessitate the reversion of 20–60 Mha of cropland from irrigated to rainfed management by end-of-century, and a further loss of 600–2,900 Pcal of food production. In other regions (northern/eastern United States, parts of South America, much of Europe, and South East Asia) surplus water supply could in principle support a net increase in irrigation, although substantial investments in irrigation infrastructure would be required. PMID:24344283

Implementing national strategies on antimicrobial resistance in Thailand: potential challenges and solutions.

PubMed

Sommanustweechai, A; Tangcharoensathien, V; Malathum, K; Sumpradit, N; Kiatying-Angsulee, N; Janejai, N; Jaroenpoj, S

2018-04-01

Thailand has developed a national strategic plan on antimicrobial resistance (NSP-AMR) and endorsed by the Cabinet in August 2016. This study reviewed the main contents of the NSP-AMR and the mandates of relevant implementing agencies and identified challenges and recommends actions to mitigate implementation gaps. This study analysed the contents of NSP-AMR, reviewed institutional mandates and assessed the implementation gaps among agencies responsible for NSP-AMR. Two of six strategies are related to monitoring and surveillance of AMR and antimicrobial consumption in human and animal. Two other strategies aim to improve antibiotic stewardship and control the spread of AMR in both clinical and farm settings. The remaining two strategies aim to increase knowledge and public awareness on AMR and establish national governance for inter-sectoral actions. Strategies to overcome implementation challenges are sustaining cross-sectoral policy commitments, effective cross-sectoral coordination using One Health approach, generating evidence which guides policy implementation, and improving enforcement capacities in regulatory authorities. To address AMR, Thailand requires significant improvements in implementation capacities in two dimensions. First, technical capacities among implementing agencies are needed to translate policies into practice. Second, governance and organizational capacities enable effective multi-sectoral actions across human, animal, and environmental sectors. Copyright © 2018 The Royal Society for Public Health. Published by Elsevier Ltd. All rights reserved.

Approaches to Climate Change & Health in Cuba: Guillermo Mesa MD MPhil, Director, Disasters & Health, National School of Public Health. Paulo Ortiz MS PhD, Senior Researcher, Climate Center, Cuban Meteorology Institute.

PubMed

Mesa, Guillermo; Ortiz, Paulo; Gorry, Conner

2015-04-01

The US National Institutes of Health predict climate change will cause an additional 250,000 deaths between 2030 and 2050, with damages to health costing US$2-$4 billion by 2030. Although much debate still surrounds climate change, island ecosystems-such as Cuba's-in the developing world are arguably among the most vulnerable contexts in which to confront climate variability. Beginning in the 1990s, Cuba launched research to develop the evidence base, set policy priorities, and design mitigation and adaptation actions specifically to address climate change and its effects on health. Two researchers at the forefront of this interdisciplinary, intersectoral effort are epidemiologist Dr Guillermo Mesa, who directed design and implementation of the nationwide strategy for disaster risk reduction in the Cuban public health system as founding director of the Latin American Center for Disaster Medicine (CLAMED) and now heads the Disasters and Health department at the National School of Public Health; and Dr Paulo Ortiz, a biostatistician and economist at the Cuban Meteorology Institute's Climate Center (CENCLIM), who leads the research on Cuba's Climate and Health project and is advisor on climate change and health for the UN Economic Commission for Latin America and the Caribbean (ECLAC).

Past Fame, Present Frames and Future Flagship? An Exploration of How Health is Positioned in Canadian Foreign Policy

PubMed Central

Labonté, Ronald; Runnels, Vivien; Gagnon, Michelle

2014-01-01

Canada has been regarded as a model global citizen with firm commitments to multilateralism. It has also played important roles in several international health treaties and conventions in recent years. There are now concerns that its interests in health as a foreign policy goal may be diminishing. This article reports on a thematic analysis of key Canadian foreign policy statements issued over the past decade, and interviews with key informants knowledgeable of, or experienced in the interstices of Canadian health and foreign policy. It finds that health is primarily and increasingly framed in relation to national security and economic interests. Little attention has been given to human rights obligations relevant to health as a foreign policy issue, and global health is not seen as a priority of the present government. Global health is nonetheless regarded as something with which Canadian foreign policy must engage, if only because of Canada’s membership in many United Nations and other multilateral fora. Development of a single global health strategy or framework is seen as important to improve intersectoral cooperation on health issues, and foreign policy coherence. There remains a cautious optimism that health could become the base from which Canada reasserts its internationalist status. PMID:24977037

Factors influencing perceived sustainability of Dutch community health programs.

PubMed

Vermeer, A J M; Van Assema, P; Hesdahl, B; Harting, J; De Vries, N K

2015-09-01

We assessed the perceived sustainability of community health programs organized by local intersectoral coalitions, as well as the factors that collaborating partners think might influence sustainability. Semi-structured interviews were conducted among 31 collaborating partners of 5 community health programs in deprived neighborhoods in the southern part of the Netherlands. The interview guide was based on a conceptual framework that includes factors related to the context, the leading organization, leadership, the coalition, collaborating partners, interventions and outcomes. Interviews were recorded, transcribed and content analyzed using NVivo 8.0. Participants in each of the programs varied in their perceptions of the sustainability of the program, but those people collaborating in pre-existing neighborhood structures expressed relatively high faith in their continuation. The participating citizens in particular believed that these structures would continue to address the health of the community in the future. We found factors from all categories of the conceptual framework that were perceived to influence sustainability. The program leaders appeared to be crucial to the programs, as they were frequently mentioned in close interaction with other factors. Program leaders should use a motivating and supportive leadership style and should act as 'program champions'. © The Author (2013). Published by Oxford University Press. All rights reserved. For Permissions, please email: journals.permissions@oup.com.

Leadership, governance and partnerships are essential One Health competencies.

PubMed

Stephen, Craig; Stemshorn, Barry

2016-12-01

One Health is held as an approach to solve health problems in this era of complexity and globalization, but inadequate attention has been paid to the competencies required to build successful teams and programs. Most of the discussion on developing One Health teams focuses on creating cross-disciplinary awareness and technical skills. There is, however, evidence that collaborative, multi-disciplinary teams need skills, processes and institutions that enable policy and operations to be co-managed and co-delivered across jurisdictions. We propose that competencies in leadership and human resources; governance and infrastructure; and partnership and stakeholder engagement are essential, but often overlooked One Health attributes. Competencies in these staple attributes of leadership and management need to be more prominent in training and One Health capacity development. Although One Health has been in existence for over a decade, there has been no systematic evaluation of the essential attributes of successful and sustainable One Health programs. As such, much of this paper borrows from experience in other sectors dealing with complex, cross and inter-sectoral problems. Our objective is to advocate for increased investment in One Health leadership, governance and partnership skills to balance the focus on creating cross-disciplinary awareness and technical proficiency in order to maintain One Health as a viable approach to health issues at the human-animal-environment interface.

The Bright Elusive Butterfly of Value in Health Technology Development

PubMed Central

Greenhalgh, Trisha; Fahy, Nick; Shaw, Sara

2018-01-01

The current system of health technology development is characterised by multiple misalignments. The "supply" side (innovation policy-makers, entrepreneurs, investors) and the "demand" side (health policy-makers, regulators, health technology assessment, purchasers) operate under different – and conflicting – logics. The system is less a "pathway" than an unstable ecosystem of multiple interacting sub-systems. "Value" means different things to each of the numerous actors involved. Supply-side dynamics are built on fictions; regulatory checks and balances are designed to assure quality, safety and efficacy, not to ensure that technologies entering the market are either desirable or cost-effective. Assessment of comparative and cost-effectiveness usually comes too late in the process to shape an innovation’s development. We offer no simple solutions to these problems, but in the spirit of commencing a much-needed public debate, we suggest some tentative ways forward. First, universities and public research funders should play a more proactive role in shaping the system. Second, the role of industry in forging long-term strategic partnerships for public benefit should be acknowledged (though not uncritically). Third, models of "responsible innovation" and public input to research priority-setting should be explored. Finally, the evidence base on how best to govern inter-sectoral health research partnerships should be developed and applied. PMID:29325407

Management of clandestine drug laboratories: need for evidence-based environmental health policies.

PubMed

Al-Obaidi, Tamara A; Fletcher, Stephanie M

2014-01-01

Clandestine drug laboratories (CDLs) have been emerging and increasing as a public health problem in Australia, with methamphetamine being the dominant illegally manufactured drug. However, management and remediation of contaminated properties are still limited in terms of regulation and direction, especially in relation to public and environmental health practice. Therefore, this review provides an update on the hazards and health effects associated with CDLs, with a specific look at the management of these labs from an Australian perspective. Particularly, the paper attempts to describe the policy landscape for management of CDLs, and identifies current gaps and how further research may be utilised to advance understanding and management of CDLs and inform public health policies. The paper highlights a significant lack of evidence-based policies and guidelines to guide regulatory authority including environmental health officers in Australia. Only recently, the national Clandestine Drug Laboratory Guidelines were developed to assist relevant authority and specialists manage and carry out investigations and remediation of contaminated sites. However, only three states have developed state-based guidelines, some of which are inadequate to meet environmental health requirements. The review recommends well-needed inter-sectoral collaborations and further research to provide an evidence base for the development of robust policies and standard operating procedures for safe and effective environmental health management and remediation of CDLs.